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15-039.01 Simpson Engineers: Surveying Services 15- 71.1 Washington State Department of Transportation Supplemental Agreement Organization and Address Number 1 Clarence E.Simpson Engineers,Inc. 909 N.Argonne Rd. Original Agreement Number Spokane Valley,WA 15-039 Phone: 509-926-1322 Project Number Execution Date Completion Date 3/25/15 12/31/16 Project Title New Maximum Amount Payable On Call Professional Surveying Services for Various Projects $ 90,000.00 Description of Work On call surveying services as defined in Exhibit A of the original contract and per the City of Spokane Valley Standards. Work will be awarded per task order assignments. The Local Agency of City of Spokane Valley desires to supplement the agreement entered in to with Clarence E. Simpson Engineers,Inc. and executed on 3/25/15 and identified as Agreement No. 15-039 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: No Change I I Section IV, TIME FOR BEGINNING AND COMPLETION, is amended to change the number of calendar days for completion of the work to read: No Change III Section V, PAYMENT, shall be amended as follows: The original contract amount of$60,000.00 is amended$30,000.00 to a new maximum amount payable of $90,000.00 as set forth int eh attached Exhibit A, and by this reference made a part of this supplement. If you concur with this supplement and agree to the changes as stated above, please sign in the Appropriate spaces below and return to this office for final action. By; Ed +prod. SVI .. By: i\e Jackson, City Manager 2onsultant Signature Approving Authority Signature /a/61n Date DOT Form 140-063 Revised 09/2005 Exhibit "A" Summary of Payments Basic Supplement#1 Total Agreement Direct Salary Cost 27324.89 13662.45 40987.34 Overhead 28576.38 14288.19 42864.57 (Including Payroll Additives) Direct Non-Salary Costs 0 Fixed Fee 4098.73 2049.36 6148.09 Total 60000 30000 90000 *Each item of work under this SUPPLEMENT will be provided by task assignment. Each assignment will be individually negotiated with the COSULTANT. The amount established for each assignment will be the maximum amount payable for that assignment unless modified in writing by the AGENCY DOT Form 140-063 Revised 09/2005 A OC RO® SAD DATEIMMIDDPITYY) CERTIFICATE OF LIABILITY INSURANCE R045 3/4/2015 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: ALLIANT INSURANCE SERVICES INC/PHS il"ue°Nro Mlr. (866) 967-8730 FAX smc,pl (888) 943-6112 802465 P: (866) 467-8730 F: (888) 443-6112 :42m PO BOX 33015 INSURER(S)AFFORDING COVERAGE MICR SAN ANTONIO TX 78265 INSImERA:Hartford Casualty Ins Co INSURED INSURERB: INSURER C• CLARENCE E SIMPSON ENGINEERS INC INSURER 13• 909 N ARGONNE RD INSURER E: SPOKANE WA 99212 INsuRERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES 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. /ASR TYPE Of INSURANCE ADDL SUDR POLICTAW,UDER POUCE EFF POLICY EYP Wills LTR :ACR I17T INAUDLPRRI? /Aupsn PTIt COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 • CLAIMS-MADE ElOCCURDAMAGE TO RENTED s3 0 0,0 0 0 PREMISES(Ea occurrence) A X General Liab X 52 SBA PJ6656 04/01/2015 04/01/2016 MEDExp(Any one person) s10,000 PERSONALS ACV INJURY S1,000,000 GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE s2,000,000 RPOLICYn PRO'❑LAC PRODUCTS-COMP/OP AGG 52,000,000 'SECT OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE UNIT 51,000,000 IEEEEtED X ANY AUTO BODILY INJURY(Per person) s A ALLOWNED SCHEDULED 52 UEC UR0799 09/01/2015 04/01/2016 BOOILYINJURY(PeraaldeM) $ AUTOS AUTOS NON-OWNED PROPERTY OAMAGE X HIRED AUTOS X AUTOS (Per $ — (PeraWdenl) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $1,000,000 A EXCESS LIAB ^ CLAIMS-MADE 52 SBA PJ6656 04/01/2015 04/01/2016 AGGREGATE $1,000,000 s 0E0 X RETENTIONS 10,000 R UODSEN.TLOAIPENSATIDN (SpTEATUTE I AEROTIL AA EMPLOTERSUWMMII ANY PROPRIETORIPARTNER/EXECUTNE YIN El EACH ACCIDENT OFFICERIMEMBER EXCLUDED? ❑ — •• (Mandatory In NH) NIA EL DISEASE-EA EMPLOYEE S II yes,describe under El DISEASE-POUCY UNIT S DESCRIPTION OF OPERATIONS below A EMP STOP GAP 52 SBA P.16656 04/01/2015 04/01/2016 $1,000,000/1,000,000/1,000,000 DESCRIPTION OF OPERATIONS/LOCADONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may he attached It 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. Coverage is primary & non-contributory 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 DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Spokane Valley AUTHORIZED REPRESENTATIVE 11707 E SPRAGUE AVE STE 106 74-z_ SPOKANE VALLEY, WA 99206 ©1988-2014 ACORD CORPORATION.All rights reserved. - ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD