Forma Construction Company 9/20/2017 Amendment 1

• PAYMENT BOND Bond No. 023039344 The City of Everett has awarded to Forma Construction Company (Principal), a contract for the construction of the project designated as City of Everett* Project No.[Project#1, in Everett , Washington (Contract), and said Principal is required under the terms of that Contract to furnish a payment bond in accord with Title 39.08 Revised Code of Washington (RCW) and (where applicable) 60.28 RCW. *Job Order Contract,Year 3 The Principal, and Liberty Mutual Insurance Company (Surety), a corporation organized under the laws of the State of Massachusetts and licensed to do business in the State of Washington as surety and named in the current list of"Surety Companies Acceptable in Federal Bonds" as published in the Federal Register by the Audit Staff Bureau of Accounts, U.S. Treasury Dept., are jointly and severally held and firmly bound to the City of Everett, in the sum of Two Million and 00/100ths--------- US Dollars ($ 2,000,000.00 ) Total Contract Amount, subject to the provisions herein. This statutory payment bond shall become null and void, if and when the Principal, its heirs, executors, administrators, successors, or assigns shall pay all persons in accordance with RCW Titles 39.08 and 39.12 including all workers, laborers, mechanics, subcontractors, and material suppliers, and all persons who shall supply such contractor or subcontractor with provisions and supplies for the carrying on of such work; and if such payment obligations have not been fulfilled, this bond shall remain in full force and effect. The Surety for value received agrees that no change, extension of time, alteration or addition to the terms of the Contract, the specifications accompanying the Contract, or to the work to be performed under the Contract shall in any way affect its obligation on this bond, except as provided herein, and waives notice of any change, extension of time, alteration or addition to the terms of the Contract or the work performed. The Surety agrees that modifications and changes to the terms and conditions of the Contract that increase the total amount to be paid the Principal shall automatically increase the obligation of the Surety on this bond and notice to Surety is not required for such increased obligation. This bond may be executed in two (2) original counterparts, and shall be signed by the parties' duly authorized officers. This bond will only be accepted if it is accompanied by a fully executed and original power of attorney for the officer executing on behalf of the surety. SIGNED and SEALED this 11th day of July, 2017. PRINCIPAL rma tstrucCompany SURETY Liberty Mutual Insurance—Company ithis. .))) 111.1.l..A- 21 Printed Name: Jace Munson Printed Name: Julie R.Truitt Title: Principal/COO Title: Attorney-in-Fact Name, address, and telephone number of local office/agent of Surety is: Propel Insurance 1201 Pacific Avenue, Suite 1000 Tacoma,WA 98402 (253)759-2200 PAYMENT BOND APPROVED BY CITY OF EVERETT,WASHINGTON ATi1AIJ : APPROVED AS TO FORM: 1 / it A. Ra I. - n-', Mayor Sharon 011 OCU y I amen D.1ef d J ney Date: Date: