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13-012.04 Skillings Connolly: Mansfield Connection ROW Acquisition i13- Dl?..61 SUPPLEMENTAL AGREEMENT ORGANIZATION AND ADDRESS No. 4 Skillings Connolly, Inc. AGREEMENT NUMBER PO Box 5080 13-008 Lacey, WA 98509-5080 FEDERAL AID NUMBER PHONE CM-1223(002) (360)491-3399 PROJECT TITLE NEW MAXIMUM AMOUNT PAYABLE Mansfield Avenue Connection Project $87,293.55 Right of Way Acquisition Services DESCRIPTION OF WORK Additional Negotiations Services The Local Agency of the City of Spokane Valley,WA desires to supplement the agreement entered into with Skillings Connolly, Inc. executed on January 24,2013 and identified as Agreement No.13-008. All provisions in the basic agreement remain in effect except as expressly modified by this supplement. The changes to the agreement are described as follows: SECTION 1, SCOPE OF WORK, is hereby changed to read: See Exhibit A,Scope Variance Directive Attached. SECTION IV,TIME FOR BEGINNING AND COMPLETION, is amended to change the completion date from December 31,2014 to December 31,2015. SECTION V, PAYMENT,shall be amended as follows: Original Agreement—Amount Authorized $74,384.14 Supplemental Agreement No. 1—Time Extension -- Supplemental Agreement No. 2—Time Extension -- Supplemental Agreement No. 3—Additional Appraisal Services From MRF 7,438.41 Supplemental Agreement No.4—Additional Negotiations 5,471.00 New Authorized Amount $87,293.55 Original Agreement—Management Serve Fund $ 7,438.41 Supplemental Agreement No. 3—from MRF (7,438.41) $ -- If you concur with this supplement and agree to the changes as stated above, please sign in the appropriate spaces below. Signed this74, day of 44,1 , 201/C By: Skillings Connolly, Inc By: Ci of .ok- e Valley , 4S-(-01 /Al //, ,, Principal / Signing Aut,•rity EXHIBIT A g S K I L L I N G S Project Name: Mansfield Avenue Connection Project Right of Way Acquisition Services C O N N O L LY Project Number: 13-008(13019) 5016 Lacey Boulevard SE,Lacey,Washington 98503 (360)491-3399 (800)454-7545 Fax(360)491-3857 www.skillings.com Agreement Date: January 24, 2013 Variance Number: 2 SCOPE OF WORK VARIANCE Client: City of Spokane Valley The following scope of work is not included in the Agreement Scope of Work or approved supplements: • Additional acquisition services Client Representative: Ken Knutson Effect on Schedule: None Effect on Budget: $ 5,471.00 Submitted by: Thomas E.Skillings, PE Date: December 18,2014 Client Direction: (Please check box) ❑ Per your conversation with of my staff,you are authorized to proceed with the additional scope of work described above. • Proceed with the additional scope of work described above only upon my written authorization. ❑ Ken Knutson of my staff has directed you to proceed with the additional scope of work described above. ❑ Other: Client Endorsement: Date: Signature of Authorizing Official Upon receipt of the Client's endorsement,a supplemental scope of work and budget will be developed and forwarded for Client approval. Skillings Connolly,Inc. Page 2 of 3 Project No.13019 City of Spokane Valley Mansfield Avenue Connection DOCUMENTS EXEMPT FROM PUBLIC DISCLOSURE The page entitled "Exhibit B / Consultant Fee Determination - Summary" contains confidential cost and rate data and is withheld from public disclosure pursuant to 23 USC 112(2)(F). Prenotification; confidentiality of data. A recipient of funds requesting or using the cost and rate data shall notify any affected firm before such request or use. Such data shall be confidential and shall not be accessible or provided, in whole or in part, to another firm or to any government agency which is not part of the group of agencies sharing cost data under this paragraph, except by written permission of the audited firm. If prohibited by law, such cost and rate data shall not be disclosed under any circumstances. You may petition for a review of our findings pertaining to any redacted or withheld documents pursuant to Spokane Valley Municipal Code (SVMC) 2.75.080; and obtain judicial review pursuant to RCW 42.56.550. • Client#:324969 SKILLCON ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYY1)12/31/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.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). PRODUCER CONTACT NAME: Kibble&Prentice,a USI Co PR ja"°,No,Ext):206 4414300 FAX 601 Union Street,Suite 1000 E-MAIL (ac,No): 610-3624530 ADDREss: pl.certrequest@kpcom.com Seattle,WA 98101 INSURER(S)AFFORDING COVERAGE NAIC INSURERA:Travelers Indemnity Co.of Amer 25666 INSURED INSURER B:XL Specialty Insurance Company 37885 Skillings Connolly,Inc. 5016 Lacey Blvd.SE INSURER C:Travelers Indemnity Company of 25682 Lacey,WA 98503 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A GENERAL LIABILITY 6806760L011 12/18/2014 12/18/2015 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea ocaurtence) $1,000,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 —1 POLICY n JE T n LOC $ c AUTOMOBILE LIABILITY BA6752L594 12/18/2014 12/18/2015(ECOMBINEDaaccident)SI $NGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION 6806760L011 12/18/2014 12/18/2015 TORY LIMITS X 24" - AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N (WA Stop Gap) E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 B Professional DPR9713571 03/02/2014 03/02/2015 $1,000,000 per claim Liability $1,000,000 annl aggr. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) RE: Project#13-008(13019),Mansfield Avenue Connection Project Right of Way Acquisition Services. The General Liability policy includes an automatic Additional Insured endorsement that provides Additional Insured status to the Certificate Holder,only when there is a written contract that requires such status, and only with regard to work performed on behalf of the named insured. CERTIFICATE HOLDER CANCELLATION Cityof Spokane ValleySHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Ken Knutson ACCORDANCE WITH THE POLICY PROVISIONS. 11707 East Sprague Avenue,Suite 106 Spokane Valley,WA 99206 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #514045474/M14030158 GXJZP COMMERICAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following is added to WHO IS AN INSURED INSURANCE (Section III) for this Coverage (Section II): Part. Any person or organization that you agree in a B. The following is added to Paragraph a. of 4. "contract or agreement requiring insurance" to in- Other Insurance in COMMERCIAL GENERAL dude as an additional insured on this Coverage LIABILITY CONDITIONS (Section IV): Part, but only with respect to liability for"bodily in- However, if you specifically agree in a"contract or jury", "property damage" or "personal injury" agreement requiring insurance"that the insurance caused, in whole or in part, by your acts or omis- provided to an additional insured under this Coy- sions or the acts or omissions of those acting on erage Part must apply on a primary basis, or a your behalf: primary and non-contributory basis,this insurance a. In the performance of your ongoing opera- is primary to other insurance that is available to tions; such additional insured which covers such addi- b. In connection with premises owned by or tional insured as a named insured, and we will not rented to you;or share with the other insurance, provided that: c. In connection with "your work" and included (1) The "bodily injury" or "property damage" for within the "products-completed operations which coverage is sought occurs; and hazard". (2) The "personal injury" for which coverage is Such person or organization does not qualify as sought arises out of an offense committed; an additional insured for "bodily injury", "property after you have entered into that "contract or damage" or "personal injury" for which that per- agreement requiring insurance". But this insur- son or organization has assumed liability in a con- ance still is excess over valid and collectible other tract or agreement. insurance, whether primary, excess, contingent or The insurance provided to such additional insured on any other basis, that is available to the insured is limited as follows: when the insured is an additional insured under d. This insurance does not apply on any basis to any other insurance. any person or organization for which cover- C. The following is added to Paragraph 8. Transfer age as an additional insured specifically is Of Rights Of Recovery Against Others To Us added by another endorsement to this Cover- in COMMERCIAL GENERAL LIABILITY CON- age Part. DITIONS(Section IV): e. This insurance does not apply to the render- We waive any rights of recovery we may have ing of or failure to render any "professional against any person or organization because of services". payments we make for "bodily injury", "property f. The limits of insurance afforded to the addi- damage" or "personal injury" arising out of "your tional insured shall be the limits which you work" performed by you, or on your behalf, under agreed in that "contract or agreement requir- a "contract or agreement requiring insurance"with ing insurance" to provide for that additional that person or organization. We waive these insured, or the limits shown in the Declare- rights only where you have agreed to do so as tions for this Coverage Part, whichever are part of the "contract or agreement requiring insur- less. This endorsement does not increase the ance" with such person or organization entered limits of insurance stated in the LIMITS OF into by you before, and in effect when, the "bodily CG D3 81 09 07 ©2007 The Travelers Companies,Inc. Page 1 of 2 Includes the copyrighted material of Insurance Services Office, Inc.,with its permission. COMMERICAL GENERAL LIABILITY injury" or "property damage" occurs, or the "per- erage Part, provided that the_"bodily injury" and sonal injury"offense is committed. "property damage" occurs, and the "personal in- D. The following definition is added to DEFINITIONS jury"is caused by an offense committed: (Section V): a. After you have entered into that contract or "Contract or agreement requiring insurance" agreement; means that part of any contract or agreement un- b. While that part of the contract or agreement is der which you are required to include a person or in effect; and organization as an additional insured on this Cov- c. Before the end of the policy period. Page 2 of 2 ©2007 The Travelers Companies,Inc. CG D3 81 09 07 Includes the copyrighted material of Insurance Services Office, Inc.,with its permission.