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15-026.01 Michael Terrell: Edgecliff Park Shelter Ph 2 CONTRACT AMENDMENT FOR THE AGREEMENT BETWEEN THE CITY OF SPOKANE VALLEY AND MICHAEL TERRELL LANDSCAPE ARCHITECTURE, PLLC Contract #15-026.01 For good and valuable consideration, the legal sufficiency of which is hereby acknowledged, City and the Michael Terrell Landscape Architecture, PLLC mutually agree as follows: 1. Purpose: This Amendment is for the Contract for professional services for the Edgecliff Park Shelter Phase 2 project by and between the Parties, executed by the Parties on February 19, 2015, and which terminates on July 1, 2015. Total compensation under the Original Contract is not to exceed $3,153.00. Said contract shall be referred to as the "Original Contract" and its terms are hereby incorporated by reference. 2. Original Contract Provisions: The Parties agree to continue to abide by those terms and conditions of the Original Contract, dated February 19, 2015, and any amendments thereto, which are not specifically modified by this Amendment. 3. Amendment Provisions: This Amendment is subject to the following amended provisions, which are as follows. All such amendment provisions are hereby incorporated by reference herein and shall control over any conflicting provisions of the Original Contract, including any previous amendments thereto. Extend term of contract until August 15, 2015. 4. Compensation Amendment History: This is Amendment#1 of the Original Contract and the history of amendments to the Michael Terrell Landscape Architecture, PLLC compensation is as follows: Date Compensation Original Contract Amount 2/19/15 $3,153.00 Amendment#1 7/7/15 $0.00 Total Amended Compensation $3,153.00 1 The parties have executed this Amendment to the Original Contract this 168 day of July 2015. CITY OF SPOKANE VALLEY: CONSULTANT: )1itailk 8L/1AA--- ./100 Mark ('q,utolii4 Michael Te ell eity Ma .. .efttlyCify Mailer Its: Authorized Representative ATTEST: APPROVED AS TO FORM: A / ‘ 6 Christine Bainbri.ge, City C k Office f the City Attorney 2 A •^ ® RJB DATE(MM/DD/YW1) L CERTIFICATE OF LIABILITY INSURANCE R054 2/16/2015 THIS CERTIFICATEIS 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 SUBROGATIONIS 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: USAA INSURANCE AGENCY INC/PHS PHONE (NC,No,EA): (888) 242-1430 FAX (ac,No>: (888) 443-6112 812846 P: (888) 242-1430 F: (888) 443-6112 ADDRESS PO BOX 33015 INSURER(S)AFFORDING COVERAGE NAIL# SAN ANTONIO TX 78265 INSURERA: Hartford Casualty Ins Co 29424 INSURED INSURER B: MICHAEL TERRELL- LANDSCAPE INSURER C: ARCHITECTURE, PLLC INSURER D: 5312 S CHAPMAN RD INSURER E: GREENACRES WA 99016 INSURERF: 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 'IDOL SUDR POLICY NUMBER POLICY EFF POLICY EXP LIMITS TYPEOPINSURANCE LTR /MSR WYD (MM/DD/YYYY) !MM/DIVYYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED $300 000 PREMISES(Ea occurrence) _ A X General Liab X 65 SBA PU5843 01/13/2015 01/13/2016 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PRO- JECT X LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITY (Ea COMacciBINED SINGLE LIMIT $1,000,000 ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED 65 SBA PU5843 01/13/2015 01/13/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) HIRED AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ $ DED RETENTION S :YORKERSCOMPENSATION PER OTH - ANDEMPLOYERS'LIABILITY STATUTE ER $ ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT OFFICER/MEMBERNH)EXCLUDED? ^ WA - $ (Mandatory in NH) I I E.L.DISEASE-EA EMPLOYEE If yes,describe underE.L.DISEASE-POLICY LIMB $ DESCRIPTION OF OPERATIONS below ' DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Those usual to the Insured's Operations. Certificate Holder is an Additional Insured per the Business Liability Coverage Form SS0008 attached to this policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE City of Spokane Valley DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Mike Stoen AUTHORIZED REPRESENTATIVE 2426 N DISCOVERY PL 7Gz--,_. Gt.a e-v - SPOKANE VALLEY, WA 99216 ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD • .4CU/2D, -- -- ----------- - - -- - DATE(MM/DD/YYY`Q CERTIFICATE OF LIABILITY INSURANCE 02/17/2015 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:lithe certificate holder is an ADDITIONAL INSURED,the policy(les)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 Karen Bronson Leatzow Insurance PHONE (312)930-5556 FAX (866)741-2778 500 W. Madison St.-Suite 3000 EMAIL ADDRESS kareni ieatzowinsurance.com Chicago, IL 60661 INSURER(S)AFFORDING COVERAGE I NAIC# INSURER A: New Hampshire Insurance Company 23841 INSURED INSURER B: Michael Terrell-Land.Arch., PLLC INSURER C: 5312 South Chapman Road Greenacres, WA 99016 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 SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR MD (MM/DDIYYYYI (MM/DDIYYYYI GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY n DAMAGE TO RENTED $ PREMISES(Ea occurrence) _n CLAIMS MADE n OCCUR MED EXP(Any one person) is DOES NOT APPLY PERSONAL AND ADV INJURY $ GENERAL AGGREGATE S GEM.AGGREGATE LIMIT APPLIES PER: - PRODUCTS-COMP/OP AGG $ POLICY PROJECT LOC $ n n n AUTOMOBILE LIABILITY 'COMBINED SINGLE LIMIT $ nANY AUTO n Scheduled (Ea accident) Autos BODILY INJURY(Per person) $ ALL OWNED Non-owned DOES NOT APPLY • BODILY INJURY(Per accident) S AUTOS Autos Hired Autos PROPERTY DAMAGE S (Per accident) —UMBRELLA LIAB OCCUR I I I I EACH OCCURRENCE S — EXCESS LIAB CLAIMS-MADE LJ LJ DOES NOT APPLY AGGREGATE $ • DED n RETENTIONS $ OTH- WORKERS COMPENSATION nWC STATU-'TORY LIMITS ER AND EMPLOYERS'LIABILITY Y/N EL.EACH ACCIDENT �— la ANY PROPRIETORIPARTNER/EXECUTIVE N/A DOES NOT APPLY EL DISEASE-EA EMPLOYEE IS OFFICER/MEMBER EXCLUDED? EL DISEASE-POLICY LIMIT IS 1,000,000 each occurrence A PROFESSIONAL LIABILITY n n 015622393 1/16/2015 1/16/2016 1,000,000 aggregate DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Re: Edgecliff Park Shelter Phase II CERTIFICATE HOLDER CANCELLATION City of Spokane Valley Parks and SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Recreation EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH Attn: Mike Stone THE POLICY PROVISIONS. • 2426 N. Discovery Place Spokane Valley,WA 99216 AUTHORIZED REPRESENTATIVE f<Zr ,� -Y 3—'_ LEATZOW INSURANCE • ©19882010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACCORD name and logo are registered marks of ACORD 7/8/2015 MICHAEL TERRELL LANDSCAPE ARCHITECTURE PLLC Home Inicioe3Espafiol Contact Search L&I CM A-Z Index Help hMv Secure.L&I Safety Claims&Insurance Workplace Rights Trades&Licensing O.Washington State Department of Labor & Industries MICHAEL TERRELL LANDSCAPE ARCHITECTURE PLLC Owner or tradesperson 5312 S CHAPMAN RD KARA TERRELL GREENACRES,WA 99016-8832 Doing business as MICHAEL TERRELL LANDSCAPE WA UBI No. Governing persons 603 368 643 KARA L TERRELL MICHAEL D TERRELL; Workers' comp Do you know if the business has employees?If so,verify the business is up-to-date on workers'comp premiums. L&I Account ID Account is current. 072,594-02 Doing business as MICHAEL TERRELL LANDSCAPE Estimated workers reported Quarter 1 of Year 2015"1 to 3 Workers" L&I account representative T3/NATASHA DRAGOVICH(360)902.4679-Email:DRAG235@Ini.wa.gov Workplace safety and health . No inspections during the previous 6 year period. ©Washington State Dept.of Labor&Industries.Use of this site is subject to the laws of the state of Washington. https://secure.lni.wa.gov/verify/Detail.aspx?UBI=603368643&SAW=False 1/1