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BLD2009-0101 DOCS05/06/2010 05:02 FAX 4258220372 BCIB/RHIS INSURANCE 002 DATE (MWDDNYYY) CERTIOLTE OF LIABILITY INSURANCE 051060010 PRODUCER Best Contractors Insurance & Bonds Rose K11 Insurance Services 733 Severtth Avenue, Suite 112 Kiddand, WA 98033 Doucette Enterprises LLC 6053 38th Avenue NE Seattle, WA 98115 rf%V9=DAr_Fz4Z ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 13Y THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC 9 INSURER,k- Bankers insurance Company INSURER & INSURER C7 INSURER 0: INSURER E; THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAJN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAJM& 74i;k'- 5-'. - - I - - .- '' ... .. .. POLICY EFFECTIVE POLJTCYt%(P=N LTIII 11M9 TYPE OF INSURANCE POLICY NUM13ER DATE IMWDDIM- DA JE D LIMITS A X CENIERAL LIABILITY CONIMSACIALGENSRALLLABILMY 46 OU0000908 8 01 09/09f2009 09109r2ol 0 EACH OCCURRENCE $ 1,000,000 U__ rence).- $ 100,000 MEO EXP (Any ons pem&V $ 5.000 CLAWS MADE IK OCCUR INJURY 3 1,000,000 GENEPALAGGACGATE 9 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOPAGG S 2,000.000 S 7 -7 PRO- LOC x POLICY � JECT AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT acdoent) $ ALL OMEO AUTO$ SCHEDULED AUTOS BODILY INJURY T_ P—) 3 BODILY INJURY (per accill.) H IRED AUTO$ NON -OWNED AUMS PROPERTY DAMAGE (PW accident) GARAcr LLAjNuTy AUTO ONLY - FA ACCIDENT S OYHERT�-" EA ACC S ANY AUTO -6 AUTO ONLY! AGG FXCESSIUMBRELIA LABILITY EACH OCCURRENCE $ AGGREGATE S 7 OCCUR CLAAMS MADE S -1 DEDUCTIBLE WC STATU-OETRH wORKM COMPEMSATION AND TORY LIMn"S E.L. EACH ACCIDENT S EMPLOYERS7 LIABILITY ANY PROPRIETOFLIPARTNEKIEXECLMVE OFFICERIMEMBER EXCLUDED? E L DISEASE - EA EMPLOYEE 3 E.L. 0 ISEASE -POLICY LTMrr S N yas. dawrba under SPECIAL PROVISIONS below OTHER DEscPjPn0N OF oPERA-noNs i LacATIONS f VEHICLES I EXCLUSIONS ADDED By ENDORSEMENT1 SPECIAL PROMMONS Cortificate holder is named 2S additonal insured under the above general liability insurance for all work performed by or on behaff of the named insuried for the certificate holder. 914OULD ANY Or WE AflOVV DMIRIBED POLJCJES BE CANCELLED GLIFORE THE EXPIRATION City af Edmonds Building Division DATE THERrLOF, TUE ISSUING INSURER WtLL ENDEAVOR TO MAIL 30 DAYS WRITTEm 121 5th Avenue N NOMCETOTMECOMFICATE HOLDER NAMEOMTHELEFT. BUT FAILURIETO DO SO SMALL City Hall Second Floor IMPOSE NO OBLIGATION OR LJARIUTY OF ANY 1UND UPON THE INSURER. ITS AGENTS OR Edmonds, WA 98020 REPRIESENTATIVE& AUTHORLZED Ak;VKIL) Zb (ZUUIIUUI W %'Wff%vw� a 1-1m . U0. FCity of Edmonds Development Services De,artmen, Build ing-Engineeri ng-Pla n n i ng 121 5th Avenue North -2 nd Floor A Edmonds, WA 98020 o C Phone: 425.771.0220 Fax: 425.771.0221 COVER PAGE n: Date Transmitte Recipient's Fax No: d: 501W-45?2c� No. of Pages: kInGluaing cover page.) If there are any problems during transmission or documents are received incomplete, please call 425. 771.0220 and ask for: LTemp/jana/forms/DS FAX 5. SITE RESTORATION BONDING A surety bond, frozen fund account, or instrument of credit shall be posted by the applicant in an amount to assure the restoration of any area on the site or in the surrounding area --disturbed or damaged by slides during construction, and to ensure completion of the work authorized by the permit. Or, if the work is not completed, to assure that the site will be restored -to a safe and stable condition at least equal to the safety and stability of the site prior to commencement of work under the permit. (Dollar amount. established by the City Engineer). This surety bond or cash deposit shall be posted prior to issuance of the permit and held in place until occupancy of the structure is granted and a formal letter of release is issued. Other forms of financial responsibility may be submitted to the City for review in order to fulfill this requirement. 6* GENERAL COI'*ITRACTOR PUBLIC LIABILITY INSURANCE The owner's general contractor shall carry general public liability insurance, effective through final occupancy approval, which shall name the City as an additional _nam�_d insured against the injury, death, property damage, and/or loss, an7sing_7�om or out of, the City's involvement in the 'pennitting process for the project and the loss due to earth movement. The amount shall be a miniftium. of one million dollars per incident which represents the potential loss to both public and private property which could be attributable to the development. The insurance policy shall state that the City be notified 30 days in advance of policy cancellation. The Building Official is authorized to stop work during insurance lapses until such time as the policy is reinstated. A copy of the policy shall be provided to the City prior to permit issuance. 7. SEASONAL CONSTRUCTION PERIOD, SITE ACCESS & PHASED APPROVA-L The Building Official may impose conditions that address site work issues that includes: Limiting all excavation and drainage installation to the drier season (normally between May I" and the end'of September) and, securing City approval before entering a site with excavating, grading or clearing C) equipment to grade or to clear for any purpose, including the creation of access to the site. The Building Official may also require sequencing of construction phases or activities such as the installation of shon-ng or temporary erosion control remedies and/or drainage systems, well in advance of grading or foundation construction on a time frame consistent with geotechnical recommendations and peer review. When permit conditions such as groundwork are limited by the Building Official the project geotechnical engineer may request in writing that portions of work progress, such request shall include a detailed work schedule from the general contractor specifying work to be done, a timeline, and provisions for geotechnical monitoring and use of equipment is specified. Any such recommendation shall be based upon best available science and be consistent with standard geotechnical engineering practice. The Building Official may require peer review concurrence prior to a decision on the type and duration of work, the type of equipment to be used, additional temporary erosion and sediment control provisions required, and applicability of special inspections, and similar issues. V:\FU,ES\MEADOW\ESLHA2007.DOC4/2/07 Page 12 05/05/2010 23:10 FAX 4258220372 BCIB/RHIS INSURANCE 16002 r__19 F_ I ACCPRa CERTIPFCATE OF LIABILITY INSMANCE DATE (UMMDffYYY) 09J11t2009 PRODUCER Best Contractors Insurance & Bonds Rose Hill Insurance & Bonds 733 7th Ave, Su Re 112 Kirkland, WA 98033 THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER- THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Doucette Enterprises LLG 6053 38th Ave NE Seattle, WA 98115 INSURER A: Bankers insurance Company INSURER 8: INSURER C� INSURER-01, INSURER E: ^^%flMn Al"_00 THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWTHSTANDING ANY RECIUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADWL IC rFFEc'nvE PoucY E)MRAT)ON1 LIMITS LTHINSRO TYPE OF IKSURARCE POUCYNUMBER Poo-LTEIMMIDDlYN) _DATF(MM/DDrCn I A GENERAL UASILITY x CONWERCIAL GENERAL LIA81LrTY 46 OW000908 9 01 09/0912009 09109/2010 EACH OCCURRENCE 1,000,000 r11k IT ES F Rr,ff 100,000 MED W tmv an* pamon) 5,000 CLXMSMADE 7X OCCUR PERSONAL& ADV IKJURY 1 1,000,000 1 GENERAL AGGREGATE " S 2,000,000 GE WL AGGREGATE VMIT APPLIES PER* PRODUCTS -CC M PIOP AGG S 2,000,000 :�i POLICY 77 JE"COT F7 LOC AUTOMOBILE LIA.DIUrY ANY AUTO COMBINED, SINGLE LIMIT 3 ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per Per3w) S HIRED AUTOS NON -OWNED AUTOS DODNYINJURY (Pe-r eoclaenO S PROPERTY DAMAGE (Per wxjdcrvt) S GARAGE LABILITY AUTO ONLY -EAACCFDENT S OTW ER THAN EA A -CC S ANYAUTO $ AUTO ONLY: AGG EXCESS(UMARELLA LIABIUTY EACH OCCURRENCE 3 AGGREGATE OCCUR 71 CLAWS MADE — DEDUCTIBLE RETENTION 3 WORKCRS COMPENSATION AND 7vZ SYA ru- I OTH. I TORY UMnS ER E,L EACH ACCIDENT CMpLOYE;tS'UARILrrY ANY PROPRIETORMARTNERJEXECUTIVE OFFICERIMEMBER E)�CLUDED7 E.L. DISEASE - EA EMPLOYEE S E.L. DISEASE - POLICY LIMIT if yes. dws=ba �dw SPECIAL PROVISIONS Wow OTRER ,,ESCRI�F_ I LOCATIONS I 111-:1,11CLES I "CLUSIONS ADDED BY ENDORSEMENT I SPSCLAL PROVISIONS ��Ml F'-- — I -- Slate of washington Department of Labor & Industries Gontractors Registratlon Section PO Box 44450 Olympia, WA 9a504 SHOULD ANY OF THE ABOVE DESCRIIBED eou= BE CAWCPLL20 BEFORE TIfE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL EMOC-AVORTO MAJIL 30 DAYS WPATT6N NOTICE To THE CERTIMCATF 14OLDER kAMED TO TME LEFT. BUT FAILURE TO DO 30 SHALL IMPOSE NO OBLIGATION OR LLAALITY OF ANY KIND UPON THE INSURER. 175 AUENTS Olt REPRCSENTATr,%& 25 (2001108) 05/05/2010 23:10 FAX 4258220372 UAKER M�..KAWE anoup 9 01 46 0440000908 M 5000 00000 CONT BLCK BCIB/RHIS INSURANCE Z 003 BANKERS INSURANCE COMPAN CL 150 0406 0707 PO Box 33060 46-0100510 St. Petersburg, Florida 33733 9/11/09 900-627-0000 COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS PAGE Date of Issue. 9/11/09 RENEWAL DECLARATIONS Fro= 9/09/09 To: 9/09/10 12-01 a.m., Standard Time General Aggregate Limit (Other Than Products -Completed Operations) $2,000,000 Products -Completed Operations Aggregate Limit $2,000,000 Personal and Advertising Injury Limit $1,000,000 Each Occurrence Limit $1,000,000 Damage to Prem- Rented to You $ 100,000 Medical Expense Limit (Any One Person) S 5,000 Property Damage Liability Deductible Per Claim $ 1,000 Coverage A of this Insurance does not apply to "bodily injury" Or "Property damage" which occurs before the Retroactive Date, if any, shown here: �, ;,� M, - , . 'a, Form of Business: 0 Individual [3 Partnership 0 Organization (Other than Individual or Partnership) [Z LLC Business Description*: Framing of new houses and remodel of single family dwellings Location of All Premises You Own, Rent, or Occupy. 6053 38TH AVE NE SEATTLE WA 98115-7409 Premium Rate Advance Premium Classification Code No. Basis Prem/Ops Prod/CO Prem/Ops Prod/CO Contractors — subcontracted work 91585 20000 .672 13.693 13 274 Carpentry —residential 91340 37800 17.056 12.345 645 467 Carpentry — residential framing c91344 If Any .000 .000 0 0 Subtotal Premium $ 2, 05 7 Stop Gap Premium 128 Amount To Equal Minimum Premium $ 658— Additional Insured Premium $ 0 Total Advance Premium S 1,527 Forms and Endorsements applying to this Coverage Part and made part of this policy at time of issue: CG 21 46 0798 CG 20 10 0704 BGL 99.333 0107 BGL 99.337 0406 CG 03 00 0196 BGL 99.178 0308 CG 01 97 1207 BGL 46.300 0308 BGL 99.168 0208 CG 26 77 1204 CG 00 01 1207 BGL 46.301 0607 BGL 99.306 0308 BGL 99.339 0308 IL 01 98 0908 BGL 99.336 0798 BGL 99.334 0107 BGL 99.304 0406 BXXX99.206 1207 BGL99-GOB 0406 CL 175WA607 CG 04 42 1103 BXXX99.207 0407 BGL99.200 0405 Forms and Endorsements applicable to this Coverage Part omitted if shown elsewhere in the policy. TERSE DECLARATIONS AND THE COMMON POLICY DECLARATIONS, IF APPLICABU. TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE FORMS AND FORMS AND ENDORSEMENTS. IF ANY, ISSUED TO FORM A PART THEREOF. COMPLETE THE ABOVE NUMBERED POLICY. Agent Frnm- FAXm:ikpr To-14257710221 Paae: 2/3 Date: 9/2312009 2:02:29 PIV AUUMP. ULK I .. i . 1� I K; . A j1L Ul� LIAUILI I Y MbUKANUL 09/23/20109 ROqUCER C425)827-7400 FAX (W)827-7402 Mcdonald Insurance Group Inc. 416 6th St S. P.O. Box 3089 Kirkland, WA 98083-3089 THIS CERTIFICATE I ED AS A MATTER OF INFORMATION ONLYANDCONFER RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED John NicholTs— DBA: Nicholls Construction 15619 OK Mill RD Snohomish, WA 98290-4595 INSURER A: Lexington Insurance Company INSURER 6 INSURER C: INSURER D: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR LTR �DD NS�N TYPE OF INSURANCE POLICY NUMBER POLICYEIFECW Wa — DATE N _ POLICY EXPIRATICN DATE IMMIDOMI LIMITS GENERAL LIABILITY 41-LX-8995532-3 10/30/2008 10/30/2009 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurenrp) $ 100,000 COMMERCIAL GENERALUABILFY MED EXP (Any one person) $ 5,000 CLAIMSMADE 1XI OCCUR PERSONAL & ADV INJURY $ 1,000,000 A X GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 1,000,000 —1 POLICY F—] J'ECT F-] LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT Ea accident) $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ PANY AUTO $ EXCESSIUMBRELLA LIABILITY 7 OCCUR CLAIMSMADE MOVED EACH OCCURRENCE $ AGGREGATE $ $ $ ' 3EP 2 3 20V —TwocR—ys—LT $ PDEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DEVELOPMENT (.,Ily SERVICES OF EDMONDS CTR- ) A.TLsT 177 E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNEPJEXECUTIVE OFFICERWEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ ff Cde5obe under SPE5 IAL PROVISIONS below A OTHER ourse of onstruction Bl anket Coverage 41-LX-899SS32-3 10/3072008 10/30/ZO09 Max per building $600,000 Max per loss - $1,500,000 $10,000 Property in Transit DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES; I EXCLUSIONS ADDED B ENDORSEMENT I SPECIAL PROVISIONS Certificate holder is named as AdditionalyInsured under the above General Liability insurance for all work performed by or on behalf of the Named Insured for the Certificate Holder. City of Edmonds Building Division 121 Sth Avenue N, City Hall Second Floor Edmond, WA 98020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRAT10N DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLICA71ON OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Robert Bush/MONICA ACORD25(2001/08) FAX: (425)771-0221 @ACORD CORPORATION 1999 From: FAXmaker To:14257710221 Page: 3/3 Date: 9123/2009 2:02:29 PM IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001108) 0 11'jr� 40 "TURN ADDRESS: City of Edmonds, City Clerk 121 5th Avenue North Edmonds,, WA 98020 COVENANT OF NOTIFICATION AND INDEMNIFICATION/HOLD HARMLESS Reference #: 1?a jWqlo It*) I Grantor(s): (I)CI-HP,15 jjfiM4M))(2 RIJA aAMfWA b Additional on pg., Grantee(s): City of Edmonds Legal Description (abbreviated): Sec 67 Twn Z7 _Rng JJ,5 Q t r,5 &J OR Lot Block Z4 PiatNwkwdale, Assessor's Tax Parcel ED#(s): (1) (2) Assessor's Tax Parcel IDH not yet assigned -CITY OF EDMONDS APPROVED FOR RECORDING BY:. M& DATE84�k PAGEL OF Under the review procedures established pursuant to the State Building Code, incorporating amendments promulgated by the City of Edmonds, and as a prerequisite to the issuance of a building permit for the construction of a residential structure and attendant facilities, the undersigned OWNERS of property do hereby covenant, stipulate and promise as fol . lows: ft 1. Description of Subject Property. JAPP V DFORR 7 B DATE-P: Y-� 0 PA� V F This covenant of notification and indemnification/hold harmless relates to a tract of land at the street address of J.S7A 0 .5' 71r *A PldlA- (insert street address), Edmonds Snohomisi County, Washington and legally described as: (PER STATUTORY WARRANTY DEED RECORDING NO. 200102230189) ALL THAT PORTION OF TRACT 24, PLAT OF MEADOWDALE BEACH, ACCORDING TO THE PLAT THEREOF RECORDED IN VOLUME 5 OF PLATS, PAGE 38, IN SNOHOMISH COUNTY, WASHINGTON, DESCRIBED AS FOLLOWS. BEGINNING AT THE SOUTHWEST CORNER OF THAT PORTION OF TRACT 24 LYING EAST OF COUNTY ROAD, THENCE IN A NORTHERLY DIRECTION ALONG THE EASTERLY MARGIN OF SAID ROAD 142 FEET TO THE POINT OF BEGINNING, THENCE CONTINUING NORTHERLY ALONG EAST MARGIN OF COUNTY ROAD 122 FEET, THENCE EASTERLY PARALLEL TO SOUTH BOUNDARY OF TRACT 24 120 FEET; THENCE SOUTHERLY PARALLEL TO THE COUNTY ROAD 122 FEET, THENCE WESTERLY PARALLEL TO SOUTH BOUNDARY OF TRACT 24 120 FEET TO THE POINT OF BEGINNING 2. Notification and Covenant of Notification. The above referenced site (hereinafter "subj ect site") Ub§ within an area which has been identified by the City of Edmonds as having a potential for earth subsidence or landslide hazard. The risks associated with development of the site have been evaluated by technical consultants and engineers engaged by the applicant as a part of the process to obtain a building permit for the subject site. The results of the consultant's reports and evaluations of the risks associated with development are contained in building permit file number (insert number) on file with the City of Edmonds Building Department. Conditions, limitations, or prohibitions on development may have been imposed in accordance with the recommendations of 40 EAV E ID FOR RE 0 0 P�4 C DAT P pp By- Y P P AGA OF the consultants in the course of permit issuance. The conditions, limitations, or prohibitions may require ongoing maintenance on the part of any owner or lessee or may require modifications to the structures and earth stabilization matters in order to address future or anticipated changes in soil or other site conditions. The statements and conditions proposed by the OWNERS' geotechnical engineer, geologist, architect and/or structural engineer are hereby incorporated by reference from the contents of the rile as fully as if herein set forth. Any future purchaser, lessee, lender or any other person acquiring or seeking to acquire an interest in the property is put on notice of the existence of the content of the file and the City urges review of its contents. The file may be reviewed during normal business hou rs or copies obtained at the Building Department, City of Edmonds, 121 5th Avenue North, Edmonds, Washington 98020. 3. Indemnification. and Hold Harmless. The undersigned OWNERS hereby waive any and all liability associated with development, stating that they have fully informed themselves of all risks associated with development of the property and do therefore waive and relinquish any and all causes of action against the City of Edmonds, its officers, agents and employees arising from and out of such development. In addition, the OWNERS on behalf of themselves, their successors in interest, heirs, and assignees, do hereby promise to indemnify and hold harmless the City of Edmonds, its officers, agents and employees from any loss, claim, liability or damage of any kind or nature to persons or property either on or off the site resulting from or out of earth subsidence or landslide hazard, arising from or out of the issuance of any permit(s) authorizing development of the site, or occurring or L-7 JA V*D F R ': I PP 0 0 0 C B DAT OF PA6F- 7 arising out of any false, misleading, or inaccurate information provided by the OWNERS, their employees, or professional consultants in the course of issuance of the building permit. 4. Insurance Requirement. In addition to any bonding which may be required during the course of development, the Community Services Director has/has not (strike one) specifically required the maintenance of an insurance policy for public liability coverage in the amount and for the time set forth below in order to provide for the financial responsibilities established through the indemnification and hold harmless agreement above: 5. Covenant to Touch and Concern the Land. This Covenant of notification and indemnification/hold harmless touches and concerns the subject tract and shall run with the landi binding, obligating and/or inuring to the benefit of future owners, heirs, successors and intere sts or any other person or entity acquiring an interest in property, as their interest may appear. This provision shall not be interpreted to require a mortgagor or lender to indemnify the City except to the extent of their loss nor to obligate such persons to maintain the insurance above required. L7 [ A -PP 0 BY-W PAGE DONE this day of 199. OWNER(S) By: By: By STATE OF WASHINGTON ss: COUNTY OF KIM& I certify that I know or have satisfactory evidence that W�Olj H MArAGKO signed this instrument and acknowledged it to be (his/her) free and voluntary act for the purposes mentioned in this instrument. DATED this day of j, 61 11,jal '199 4WVC AP Z7 Z!:� NOTA�k)rRdff rC My coi"ission expires:o"4-0-9 (P -1 6 09- 'N I 1 0 F w P- L.-\TEMP\BUILDING\iMEADOW\COVENANT EAPPRQVED.FOR RECORDM�: I BY: DAT�E�� -4o, PAG OF 6;?,- STATE OF WASHINGTON ) ss: COUNTYOF V-JK& I certify that I know or have satisfactory evidence that "- "IS H W A0 tA-D signed this instrument and acknowledged it to be (his/her) free and voluntary act for the purposes mentioned in this instrument. DATED this day of NOTARY/PUBLIC My con"ission expires: B 6 Q��j 0 9 - ;-Z-- WA, AMV- L-VrEMMUELD1NG\MEAD0W\C0VENANT 1-983 JUN 23 PP, 3- ;C, �rl-Lr-rY PAS1-MFNT Pee,. DEAh Shoff of benefits to accrue to the gra'rtors -re- in, IWPLyhde-rsi�W-�Ld_, Stanley Andahl and Alice Andahl hereby grant to the CITY OF EDMONDS a Municipal Corporation, a permanent easement for the installation, oDeration and ma4ntenance ot� C> a Storm sewer over, across, through, and below the follow:�jn property; and the further right to remove trees, bushes. and other obstructions interfering with the location, i, a n maintenance of said utility or utilities, together wlitJ) th�� access to the easement at any time for the stated purpfi�se�- The easement and right-of-way hereby granted 4,,.s a!: County of Snohomish, State of Washington, and is more described as follows: A ten toot strip of land that is 5.00 feet an each sioc.- of. the storm sewer as it now exists, or as located in Lhe FuLtj--o� Within the following described property. All that portion of Tract 24, Plat of Meadowdale Reach, according to plat thereof recorded in Volume 5 of plar�-_ page 38, records of said county, described as foll�')19.111 Beginning at the Southwest corner of that portion of Trac- 24 lying East of county road; thence in a Northerly djr,��,-tiorj along the Easterly margin of said road 142 feet to the poit-it of beginning; thence continuing Northerly along rast marc' of county road 122 feet; thence Easterly parallel. to South boundary of 'rract 24 120 feet; thence Southerly p-11rallel Lc - the county road 122 feet; thence Westerly parallel to South boundary of Tract 24 120 feet to the point of beginning. TOGETHER WITH a temporary 10 foot construction easement ovc- the aforementioned property. Said construction easement wit! end upon the completion of the construction of the sewer, or January 1, 1985, whichever comes first. THE CITY agrees to restore to substantially the original condi.- tion such improvements as are disturbed during the constritetion, Main- tenance and repair of said utility or utilities; provided the their heirs, or assigns shall not construct any permanent struCt--1't',' over, upon, or within the permanent easement. DATED this 27th day of Apri 1 19 83 STATE OF WASHINGTON) ) Ss COUNTY OF SNOHOMISH) on this day personally appeared before me Stanley B. Andah.] and �ndndahl to me known to be the vidual (s) de- scriddliT� who executed the within and foregoing instrument, ond ackn,owlq that they signed the same as their 4:ree and pt&�Pfnact and deed, r the uses and purposes therein mentioned. 1AY OF Aprii, 1983. �&,��FIAND AND OFFICIAL SEAL THIS 27th r, OTA 3 N;�AnY PTJBLT(ra and for the State Washington residing at Edmonds OU0 6 23 0 25 Q UTILITY EASEMENT IN CONSIDERATION of benefits to accrue to the -grantf-)rs here- U%. in, the undersigned, David Shannon Ferris and Eva Irene Ferris I hereby grant to the C7ITY —op -icip EDMONDS, a Mun al —Corporation, > permanent easement for the installationt operation and iraintenanr:e �)i a storm &ewer over, across, through, and below the following. des�-.r. 1--)d property; and the further right to remove trees, bushes, under-grow"11, and other obstructions interfering with the location, cons!-niction maintenance of said utility or utilities, together with th., r1rib-t (,,1- C> access to the easement at any time for the stated purpose-,. The easement and right-of-way hereby granted is County of Snohomish, State of Washington, and is more parti:-u!;�r!!; described as follows; A ten foot strip of land that is 5.00 feet an each ;-Jas� c)" the storm sewer as it now exi-sts.. or as located in `1.he Within the.....following described propefty: Part of Tract 24, Meadowdale Beach, lying East of tj-ze County i6Wd, EXCEPT South 100 feet and EXCEPT the West 120 feet and-EXi�FPT the East 1,60 feet thereof, per Volume 5 of Plats, page 38, records of said County and State; TOGETHER 'WITH an easement for road and water line over the North 15 feet of the Fast 160 feet of Tract 24, Meadowdale Beach, per Volume 5 of Plats, page 38, records of Snohomish County, Washington. V TOGETHER WITH a temporary 10 foot construction easernan,,, ovt.— the aforementioned property. Said construction easement wii'l end upon the completion of the construction of the storm sewer, or January 1, 1985, whichever comes first. THE CITY agrees to restore to substantially the original cz,>ndi- tion such improvements as are disturbed during the construction, main- tenance and repair of said utility or utilities; provided th"e' grantors, their heirs, or assigns shall not construct any permanent st�:uctul:-e over, upon, or within the permanent easement. DATED this day of I ' � ,.. ( ; , .1.9 JJ Husband -4L Wife STATE OF WASHINGTON) ) ss COUNTY OF SNOHOMISH) and J�On this day personally appeared before me t, JI - - `�:� " �� ( ' / to me known to be the indiv idui-1--(-S) de --- scribed in and who executed the within and foregoing instrument, and acknowledged that I . < I /-I signed the same as "T �f l. - f ree and voluntary act and deed, for the uses and purp therein mentioned. UNDER MY HAND AND OFFICIAL SEAL THIS DAY op . ......... NOTARY PUBER in and f Fr--tFe- state Washington residing at A IA" e4t' MR, 23 3,:, 0,1 5 6 $0423 0 otpu) v*,� i7,�A 275-6 'PrCORDED i �vN t2f �T ITY EASEMENT S 0 'C kATION of benefits to accrue to the gra"tors �iere- in, t1K8UTL1ynder_s1gp_qd_,_ Stanley Andahl and Alice Andahl CV hereby grant to the CITY OF EDMONDS ' a Municipal Corporation, -.1 �0 permanent easement for the installation, ooeration and mainteriance or, C) a storm sewer over, across, through, arid below the follow'.,,q rj-.;sf ri�"*.d K\ property; and the further right to remove trees, bushes, cc and other obstructions interfering with the location, an-J, maintenance of said utility or utilities, together with 'r�e />f access to the easement at any time for the stated purposeq. The easement and right-of-way hereby granted is County of Snohomish, State of Washington, and is more described as follows: A ten foot strip of land that is 5.00 feet on each sid(� of the storm sewer as it now exists, or as located in Lhr� Nt-tiy'e. Within the following described property: All that portion of Tract 24, Plat of Meadowdale Reach, according to plat thereof recorded in Volume 5 of plats, page 38, records of said county, described as foll�)ws- Beginning at the Southwest corner of that portion of 'fract 24 lying East of county road; thence in a Northerly direction along the Easterly margin of said road 142 feet to the 3oint of beainning; thence continuing Northerly along Rast margin of county road 122 feet; thence Easterly parallel, to socz� ' h. boundary of Tract 24 120 feet; thence Southerly parallol (.() the county road 122 feet; thence Westerly parallel to South boundary of Tract 24 120 feet to the point of beginning. TOGETHER WITH a temporary 10 foot construction ea3ement the aforementioned property. said Construction easement w;tl end upon the completion of the construction of thc- !�tor:.A sewer, or January 1, 1985, whichever comes first. THE CITY agrees to restore to substant i ally the original cr)ndi- tion such improvements as are disturbed during the construction, nllin- tenance and repair of said utility or utilities; providec] the granwrs, their heirs, or assigns shall not construct any permanent struct.ure over, upon, or within the permanent easement. DATED this 27th day of Apri 1 19 83—. �_C4 AT— ec STATE OF WASHINGTON) ) ss COUNTY OF SNOHOMISH) on this day personally appeared before me Stanley B. Andah.1 and Alice H. Andahl to me known to be the individual (s) de- scribed in and who executed the within and foregoing instrument, arid acknowle that they signed the same as their f. ree �� I M"I and T>,act and deed, r the uses and purposes therein mentioned. AND OFFICIAL SEAL THIS 27th DAY OF Aprili., 1983. _� z- U00 N ARY PUBLI in and for the State ()f Washington residing at Edmonds P30623025'01 yc� i�94 274b UTILITY EASEMENT %01 . IN CONSIDERATION of benefits to accrue to the grantors h(—e- Lft , in, the undersigned, David Shannon Ferris and Eva Irene Ferris ';j hereby grant to the CITY OF EDMONDS, a MUn-icipaT-Corporation, a C:) permanent easement for the installation, operation and maintenance a storm sewer over, across, through, and below the following property; and the further right to remove trees, bushes, undergrowvi and other obstructions interfering with the location, cons'.ruction and. maintenance of said utility or utilities, together with thn rLght r)j, Q access to the easement at any time for the stated purposes. OD The easement and right-of-way hereby granted is loc*.-: �j at County of Snohomish, State of Washington, and is raore partt�-ulir!�y described as follows: A ten foot strip of land that is 5.00 feet on each the storm sewer as it now exists, or as located in the Wi.th,in the. following described prope'Fty: Part of Tract 24, Meadowdale Beach, lying East of the County ioa�a, EXCEPT South 100 feet and EXCEPT the West 120 feet and_gk*�PT the East 1,60 feet IchereoE, per Volume 5 of Plats, page 38, records of said County and State; TOGETHER WITH an easement for road and water line over the North 15 feet of the East 160 feet of Tract 24, meadowdale Beach, per Volume 5 of Plats, page 38, records of Snohomish County, Washington. TOGETHER WITH a temporary 10 foot construction easu:pent r)vt_ the aforementioned property. Said construction easement end upon the completion of the construction of the starm sewer, or January 1, 1985, whichever comes first. THE CITY agrees to restore to substantially the original condi- tion such improvements as are disturbed during the construc:ion, main- tenance and repair of said utility or utilities; provided the gr.antors, their heirs, or assigns shall not construct any permanent stcucturc, over, upon, or within the permanent easement. DATED this day of 19 Husband Wife STATE OF WASHINGTON) ) ss COUNTY OF SNOHOMISH) on this day personally appeared before me and to me known to be the individual (s) de- scribed in and who executed the within and foregoing instrument, and acknowledged that signed the same as free and voluntary act am r the uses and purpo7ses therein mentioned. UNDER MY HAND AND OFFICIAL SEAL THIS DAY OF -C in and for the Stat f NOTARY PUBLI f, of Wash�ington residing at 3". W Ll V 42 3 0 2 5 6 .':, i7`,,34i',,.a27,56 U(/U1/ZULj0 ".- IZZ) 10tJU-)411j4U I 1 1-1 — — I -- I ACORDL CERTIFICATE OF LIABILITY INSURANCE -T DATE IMMIDDrrM) 1/1/2008 PRODUCER (425) 357-1555 FAX IneuranceTek Inc CA Licence #0932789 13300 Bothell-Evrt Hwy #6129 Mill Creek WA 98012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC 9 INSURED Greenwalk Development, LLC 12733 39th Avenue NE ,Seattle WA 98125 INSURER A! underwriters at Lloyd's INSURER S; Amer i ran Contractors Ind Compan INSURER C! INSURER D: INSURER E; f� rN % I r- 0 A r-' r- Q THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. INSA LTR 11NSR0 III'Ll TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE CATE(MMIDDfYYI PQLJCY EXPIRATION DATEfMMIDDIYY) LIMITS OENERAL LIABILITY EACH OCCURRENCE 1, OOD, CDO DAMAGE TO RENTED PREMISES CEO occurmricn) 100,000 X COMMERCIAL GENERAL LIABILITY MEO EXP (Any one person) 5,000 A CLAIMS MADE Fx] OCCUR MCP 4 6 - 0 0 0 0 S 2 3/20/2007 9/20/2008 PERSONAL & ADV INJURY 1,000,000 GENFRALAGGREGA7E 2,000,000 GEN11, AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG 2,000,000 POLICY F7 JPER&. 7 LOC AUTOMOBILE LIABILITY ANY AUTO CON10INED SINGLE LIMIT (Ea scrident) 1,000,000 BODILY INJURY (Per pem0m) A ALL OWNED AUTOS SCHEDUILEDAUTOS • BODILY INJURY (Po3r occIdent) S HIRED AUTOS NON-OWNEDAUTOS mcp 49-000052 9/20/2007 9/20/2008 • PROPERTY DAMAGE (Per accicent) S AGE LIABILITY AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC ANY AUTO AUTO ONLY! AGG ExCESSiUmBRELLA LIABILITY �H EAC AGGREGATE OCCUR CLAIMS MADE DEDUCTIBLE —TT-cWLlmTYS RETENTION 3 A Waahinton Stop Gap JOTH. I — 1 ER E,L. EACH ACCIDENT $ 1,000,000 EMPLOYEPS'UASILITY ANY PPOPR1ETOR1PArTNeR1CXFCUTIVE OFFIGERIMEMBER EXCLUDED? MCP 46-000OS2 9/20/2007 9/20/2008 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 E.L. DISEASE - POLICY LIMIT S 1,000,000 if ycz, dnrcHbr under SOECIAL PROVISIONS below B OTHER WA Contractors Bond 100032509 7/27/2007 COntinUCIUB Vntil Cancelled $12,000 RECEIVED DESCRIPnON OF OPERATIONSILOCA-nONSfVEHICLES/EXCLIJSICNS ADDED BY ENDO RSEMEN TISPE-CiAL PROVISIONS rity of Edmonda is added as additional insured. J U L 2008 BUILDINCI DEPT -- � �A�= �nl M=0 CANCELLATION (425) 77 1- 0221 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Edmicinds EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 121 5th Ave X 30 DAYS wRirrEN Nana ToTKE CERTIFICATE HOLDER NAMED To T11F LEFT. BUT Edmonds, WA 98020 FAILURE TO DO 90 SMALL IMPOSP NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS A0ENT9 OR REPRESENTATIVES, 1AUTHORIZED RFPRESENTAnVE H. Eric Vennes/KANE ACORD 25 (2001100) 0 ACURO CORPORATION 1988 INS025 mionos AMS VMP i6ioKg9ge Solutions. Inc, (900)327-0,rdFa Page I of 2