BLD1998-0315 MISCFile No l 6-3/s~
App1 i cant v //rS44d
AFFIDAVIT OF MEADOWDALE LANDSLIDE PERMIT POSTING
STATE OF WASHINGTON )
) ss.
COUNTY OF SNOHOMISH )
u-t- C)((es+ CCT being first duly sworn, on oath, deposes
and says;
That on the day oflgqB_ the
site located at l5� }-�— 7'. �, was posted as
prescribed by Ordinance No. 2661 on the subject property. This posting
begins on the day the City accepts the permit application for review
and shall remain until building occupancy is granted.
Signed
Subscribed and sworn to before me this day of
19 9d!
13
�ae�ao®3
T A6
pb, L!G Notary Public in and for the State of
Washington.
"�0,r'••.'•�0+..'µ�`�� Residing at
.....................................................................................................................................................
ACLr 'f 'I1 ::I
ID B�i DATE (MM/DD/YY)
L �AB_I L I. I 1 Y: 4
.O
....................
:::I:N.S r
OLbBS..l:..... 09/26/98
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Gunning & Associates, Inc.
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
624 Yale Avenue North
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Seattle WA 98109
COMPANIES AFFORDING COVERAGE
Anne L Kelley
COMPANY
A valley Insurance Co
PnoneNo. 206-628-9029 Fax No.206-628-0644
INSURED
COMPANY
B
COMPANY
011estad Sheetmetal & Plumbing
C
15111 Smokey Point Blvd
COMPANY
Marysville WA 98270
D
OVER . GES::.:.:.:.::.:::.:::::::::.:.:.:::.:.::.::.:::::.:.:.::.:.:.:.::.:.::.:::.:.::.::::::.:::::.:::.::.:.:.:.:.:.::::::::::::::::::::::::.:.:::::
......................................................................................................................................................
. . . . . . . . .............................
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MM/DD/YY)
POLICY EXPIRATION
DATE (MM/DD/YY)
LIMITS
GENERAL
LIABILITY
GENERAL AGGREGATE
$ 2000000
A
COMMERCIAL GENERAL LIABILITY
4103CP002884
01/31/98
01/31/99
g
PRODUCTS - COMP/OP AGG
$ 2000000
CLAIMS MADE FX] OCCUR
PERSONAL BADVINJURY
$ 1000000
EACH OCCURRENCE
$ 1000000
OWNER'S& CONTRACTOR'SPROT
FIRE DAMAGE (Any one fire)
$ 50000
MED EXP (Any one person)
$ 5000
AUTOMOBILE
LIABILITY
A
ANY AUTO
4103CP002884
01/31/98
01/31/99
COMBINED SINGLE LIMIT
$ 500000
X
BODILY INJURY
$
ALL OWNED AUTOS
SCHEDULED AUTOS
(Per person)
X
HIREDAUTOS
BODILY INJURY
$
X
NON -OWNED AUTOS
(Per accident)
I
PROPERTY DAMAGE
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN AUTO ONLY:
ANY AUTO
EACHACCIDENT
$
AGGREGATE
$
EXCESS LIABILITY
EACH OCCURRENCE
$
AGGREGATE
$
]UMBRELLA FORM
$
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
WC STATU-
TORY H OT-
LIMITS PER
'
EMPLOYERS' LIABILITY
EL EACH ACCIDENT
$ 500000
A
THE PROPRIETOR/ INCL
PARTNERS/EXECUTIVE
REXCL
4103CP002884 WA STOP GAP
01/31/98
01/31/99
EL DISEASE -POLICY LIMIT
$ 500000
EL DISEASE - EA EMPLOYEE
1 $ 500000
OFFICERSARE:
OTHER
A
Biz Pers Prop #1
4103CP002884
01/31/98
01/31/99
Spec, RC 50,000.
A
Biz Pers Prop #2
4103CP002884
01/31/98
01/31/99
Spec, RC 10,000.
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
Certificate Holder is Additional Insured as respects work performed by the
named insured.
DEE:::::::..:...:..:.:.:..::::.::::::::::::::::.:...:..
...... FICATE ti . L...............................................................................................
.......................
CANCELLAT{ON:::::::::::::_::::::'::':':':'::'::'::::::::::::::::::'::::::::::::-: :
.............................................
C ITY02 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
City Of Edmonds
45 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
C/O Burt Ol les tad
P.O. Box 6424
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
Lynnwood WA 98036
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Anne L Kelle
...........................
ACiSftD:25 :1195::::::::::.:.::::::::::::::::::::::..................:::::::::::::
(.........................................................................................................AGORD
.............................y.... ,........ ..
:::'.:...
QRAORATON:1888::::
INSURED:
011estad Sheetmetal & Plumbing -
INSURANCE COMPANY:
POLICY NUMBER:
15111 Smokey Point Blvd
Marysville, WA 98270
Valley Insurance Co
4103CP002884
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 20 10 11 85
ADDITIONAL INSURED - OWNERS, LESSORS OR CONTRACTORS (FORM B)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
City of Edmonds
C/O Burt 011estad
P.O. Box 6424
Lynnwood, WA 98036
(If no entry appears above, information required to complete this endorsement will be shown in
the Declarations as applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or
organization shown in the Schedule, but only with respect to liability arising out of "your work"
for that Insured by or for you.
THIS FORM IS VOID IF BACKGROUND! IS NOT BLUE.
REL .i= SURETY COMPANY 3 P:
0 Reliance RELIANCE INSURANCECOM ANYPANY (215) 864-4000 A 19102
RELIANCE NATIONAL INDEMNITY COMPANY
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, That the RELIANCE SURETY COMPANY is a corporation organized under the laws of the State of Delaware, and that RELIANCE
INSURANCE COMPANY and UNITED PACIFIC INSURANCE COMPANY, are corporations duty organized under the laws of the Commonwealth of Pennsylvania and that RELIANCE
NATIONAL INDEMNITY COMPANY is a corporation duly organized under the laws of the State of Wisconsin (herein collectively called "the Companiesl and that the Companies by virtue
of signature and seals do hereby make, constitute and appoint N. B. Fix, Myung S. Fix, Richard A Fix, and Christine V. Bator individually of Seattle, Washington their true and
lawful Attomey(s)4n-Fact, to make, execute, seal and deliver for and on their behalf, and as its act and deed, one of the following bonds:
ADMINISTRATOR, EXECUTOR, PERSONAL REPRESENTATIVE, COMMISSIONER, SALE OF REAL ESTATE, CONSERVATOR, COMMITTEE, GUARDIAN,
TRUSTEE UNDER WILL, TRUSTEE OR RECEIVER IN BANKRUPTCY or RECEIVER IN STATE COURT in an amount not to exceed $1,000,000.00.
ANY OTHER BOND OR UNDERTAKING OF SURETYSHIP in an amount not to exceed $100,000.00.
ANY BOND OR INDEMNITY PROVIDED THAT WRITTEN AUTHORITY FROM AN OFFICER OF RELIANCE INSURANCE COMPANY, UNITED PACIFIC
INSURANCE COMPANY, RELIANCE NATIONAL INDEMNITY COMPANY AND/OR RELIANCE SURETY COMPANY SPECIFICALLY AUTHORIZING ITS
EXECUTION ACCOMPANIES THIS POWER OF ATTORNEY.
and to bind the Companies thereby as full and to the same extent as if such bonds and undertakings and other writings obligatory in the nature thereof were signed by an Executive Officer
of the Companies and sealed and attested by one other of such officers, and hereby rates and confirms all that their said Attomey(s)-intact may do in pursuance hereof.
This Power of Attorney is granted under and by authority of Article VII of the By-L As of RELIANCE SURETY COMPANY, RELIANCE INSURANCE COMPANY, UNITED
PACIFIC INSURANCE COMPANY, and RELIANCE NATIONAL INDEMNITY COMPANY which provisions are in full force and effect, reading as follows:
ARTICLE VII - EXECUTION OF BONDS AND UNDERTAKING
1. The Board of Directors, the President, the Chairman of the Board, any Senior Vice President, any Vice President or Assistant Vice President or other officer designated by the
Board of Directors shall have power and authority to (a) appoint Attomey(s)-in-Fact and to authorize them to execute on behalf of the Company, bonds and undertakings, recognizances,
contracts of indemnity and other writings obligatory in the nature thereof, and (b) to remove any such Attomey(s)-in-Fact at any time and revoke the power and authority given to them.
2. Attomey(s)-in-Fact shall have power and authority, subject to the terms and limitations of the Power of Attorney issued to them, to execute and deliver on behalf of the Company,
bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof. The corporate seal is not necessary for the validity of any bonds and
undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof.
3. Attomey(s)-in-Fact shall have power and authority to execute affidavits required to be attached to bonds, recognizances, contracts of indemnity or other conditional or obligatory
undertakings and they shall also have power and authority to certify the financial statement of the Company and to copies of the By -Laws of the Company or any article or section thereof.
This Power of Attorney is signed and sealed by facsimile under and by authority of the following resolution adopted by the Executive and Finance Committees of the Boards of Directors of
Reliance Insurance Company, United Pack Insurance Company and Reliance National Indemnity Company by Unanimous Consent dated as of February 28, 1994 and by the Executive
and Financial Committee of the Board of Directors of Reliance Surety Company by Unanimous Consent dated as of March 31,1994.
"Resolved that the signatures of such directors and officers and the seal of the Company may be affixed to any such Power of Attorney or any certificates relating
thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be valid and binding upon the Company and any
such Power so executed and certified by facsimile signatures and facsimile seal shall be valid and binding upon the Company, in the future with respect to any bond or
undertaking to which It is attached."
IN WITNESS WHEREOF, the Companies have caused these presents to be signed and by their corporate seals to be hereto affixed, this Sth day of May, 1994.
A,yuMj F MN.�
STATE OF Pennsylvania
Y �
COUNTY OF Philadelphia gg. G OEx�V 1p�� °a . A<' ' ,,,, ,.�'••'�f Vice President
On this May 6, 1994, before me, Rita M. Sambrick, personally appeared Charles B. Schmalz, who acknoWledged himself to be the Executive Vice President of the
RELIANCE SURETY COMPANY, and the Vice President of RELIANCE INSURANCE COMPANY, UNITED PACIFIC INSURANCE COMPANY, and RELIANCE
NATIONAL INDEMNITY COMPANY and that as such, being authorized to do so, executed the foregoing instrument for the purpose therein contained by signing the
name of the corporation by himself as its duly authorized officer.
My Commission Expires: NOTORIAL SEAL ID
Rffa M. Sam. Del Notary PublicMay 22, 1399 RadnorTwp. Delaware County My Commission Expires May 22.1999 Notarg Public in andiffir the State of Pennsylvania
I, Anita Zippert, Secretary of the RELIANCE INSURANCE COMPANY, UNITED PACIFIC INSURANCE COMPANY, RELIANCE NATIONAL INDEMNITY
COMPANY and/or RELIANCE SURETY COMPANY, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney executed by
RELIANCE INSURANCE COMPANY, UNITED PACIFIC INSURANCE COMPANY, RELIANCE NATIONAL INDEMNITY COMPANY and/or RELIANCE
SURETY COMPANY, which is still in full force and effect.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed the seal of said Company this day of
OSecretary PIV
Copy
RETURN ADDRESS:
City of Edmonds, City Clerk COPY
121 5th Avenue North ^' "' 01 FILE IN THE
Edmonds, WA 98020 S OFFICE
I (IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII
199909280162
09/28/1999 10:14 AM Snohomish
P.0006 RECORDED County
COVENANT OF NOTIFICATION
AND INDEMNIFICATION/HOLD HARMLESS
Reference #:_ 9
Grantor(s): (I) u r-t (2) Additional on pg.
Grantee(s): City of Edmonds
Legal Description (abbreviated): Sec Twn X_Rng4_Qtr
OR Lot Block 2-?� Plat mpndi- w delle tBeACI%
Assessor's Tax Parcel ID#(s): (1(2)
Assessor's Tax Parcel ID# not yet assigned
CITY OF EDMONDS
APPROVED FOR RECORDING BY:LDATE: iI G PAGE I OF G
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 follows:
FAPPRQVED FOR RECODDATE: ��, OF
1. Description of Subject Property. This covenant of notification and
indemnification/hold harmless relates to a tract of land at the street address of
15 922- `l S 1:6 P (ace u Jrt (insert street
address), Edmonds Snohomish County, Washington and legally described as:
PARCEL A:
The South 30 feet of Lot 6 and the North 15 feet of Lot 7, Block 28,
MEADOWDALE BEACH, according to the Plat thereof recorded in Volume 5 of
Plats, Page 38, records of Snohomish County, Washington;
TOGM10 WITH that portion of vacated street adjoining, which, upon
vacation, attached to said property by operation of law.
Situate In the County of Snohomish, State of Washington.
PARCEL B:
A portion of Lot 7, Block 28, MEADOWALE BEACH, according to the Plat
thereof recorded in Volume 5 of Plats, Page 38, records of Snohomish
County, Washington, as quieted to Walter J. Pisco in Snohomish County
Superior Court Cause Number 96-2-02004-2, described.as follows:
Beginning at the Southeast corner of the North 15.00 feet of said Lot 7;
THENCE South 2°48'17" West along the East line of said Lot 4.85 feet;
THENCE North 88'29'23" West 28.40 feet;
THENCE North 86"09'43" West parallel with the North line of said Lot 7 a
distance of 77.68 feet;
THENCE North 1°50'17" East 5.01 feet to the South line of the North
15.00 feet of said Lot 7;
THENCE South 88°09'43" East along said North line 106.16 feet to the
point of beginning.
Situate in the County of Snohomish, State of Washington.
2. Notification and Covenant of Notification The above referenced site
(hereinafter "subject site") lies 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 "64 0 % U--' (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
APPROVED FOR RECO ING:
BY: DATE: �t
PAGE 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 file 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 hours 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
JAPP
R \ZED FOR RECOeN,L:
BY: DATEi
PAGE OF
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
.fi6S/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 land, binding, obligating and/or inuring to the benefit of
future owners, heirs, successors and interests 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.
DONE this 23
STATE OF WASHINGTON
COUNTY OF
APPROVED FOR RECORD G
BY: DATE � I
PAGE OF
day ofPO .199
ss:
By:
I certify that I know or have satisfactory evidence that
3 s e r- 0 / f19S &a signed this instrument and
acknowledged it to be (his/her) free and voluntary act for the purposes mentioned in
this instrument.
DATED this"''+
� ae SLSej`.jYti e���
{ A
NOTARY -PUBLIC
My commission expires:
L:\TEMP\BUILDING\MEADOW\COVENANT
h
APPROVED FOR RECORDING:
BY. DATE: C���
PA OF
STATE OF WASHINGTON )
ss:
COUNTY OF )
I certify that I know or have satisfactory evidence that
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 ,199_
L:\TEMP\BUILDING\MEADOW\COVENANT
NOTARY PUBLIC
My commission expires: