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15-108.01 Clearwater Summit Group: Valley Mission Dog Park Ph 1 CONTRACT AMENDMENT TO THE AGREEMENT BETWEEN THE CITY OF SPOKANE VALLEY AND CLEARWATER SUMMIT GROUP Contract #15-108.01 For good and valuable consideration, the legal sufficiency of which is hereby acknowledged, City and the Clearwater Summit Group mutually agree as follows: 1. Purpose: This Amendment is for the Contract for construction of the Valley Mission Dog Park Phase 1 Project by and between the Parties, executed by the Parties on October 16, 2015, and which terminates on December 31, 2015. Said contract shall be referred to as the "Original Contract"and its terms are hereby incorporated by reference. Total compensation under the Original Contract is not to exceed$76,633.50. 2.Original Contract Provisions: The Parties agree to continue to abide by those terms and conditions of the Original Contract 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 amended provisions are hereby incorporated by reference herein and shall control over any conflicting provisions of the Original Contract, including any previous amendments thereto. Add Additive Alternate Bid Item#1 to the contract. This alternate is the furnishing and installation of decomposed granite within fenced dog park boundaries beyond limits shown as base bid. Total contract increase is $22,827.00. This is made up of the alternate bid item of$21,000.00 plus$1,827.00 W.S.S.T. 4. Compensation Amendment History: This is Amendment #1 of the Original Contract. The history of amendments to the compensation on the Original Contract and all amendments is as follows: Date Compensation Original Contract Amount 10/16/15 $76,633.50 Amendment#1 11/09/15 $22,827.00 Total Amended Compensation $99,460.50 The parties have executed this Amendment to the Original Contract this /7 day of November, 2015. CITY O P'KANE VALLEY: CONT' • TO 1p Mike ackson By: City Manage Its: Owner A A_ F ATT T: APPROVED TO FORM: Christine Bainbridge, City Clerk Of ce of the ttorney 1 �-...4 eLLAK-4 UF'IU:SD '4�R�� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10108/2015 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: 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: Wheat&Associates Insurance PHONE FAX P.O.Box 3548 (A/C.No,Ext): (NC,No): Spokane,WA 99220-3548 E-MAIL Derek M Collett ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Ohio Security Ins Co 24082 INSURED Clearwater Summit Group Inc INSURER B:AM Best Rating-A XV Ruby Nee PO Box 6470 INSURER c Spokane,WA 99217 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 LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X X BKA56386308 12/22/2014 12/22/2015 PDAMAGE TOEa RENTEDoccurrence) $ 1,000�000 REMISES( CLAIMS-MADE X OCCUR MED EXP(My one person) _ $ 15,000 PERSONAL&ADV INJURY _ $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 7 POLICY X !Pa O LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) i$ A X ANY AUTO BKA56386308 12/22/2014 12/22/2015 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILYINJURY(Per $ AUTOS AUTOSaccident) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS APER ACCIDENT) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 A EXCESS LIAB CLAIMS-MADE BKA56386308 12/22/2014 12/22/2015 AGGREGATE $ 4,000,000 DED X RETENTION$ 0 $ WORKERS OTH- AND EMPLOYERS' I TORY LIWC MITS TS U- X I ER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N BKA56386308 12/22/2014 12/22/2015 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) WA STOP GAP E"L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Project: Valley Mission Dog Park Phase I City of Spokane Valley is Additional Insured pertaining to the General Liability as per form CG9044. Coverage is primary & non-contributory and includes completed operations and waiver of subrogation. CERTIFICATE HOLDER CANCELLATION CITSP-3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Spokane ValleyTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN p ACCORDANCE WITH THE POLICY PROVISIONS. 11707 E Sprague Ave Ste 106 Spokane Valley,WA.99206 AUT/H-O//./,,''//,R///IfJJZED REPRESENTATIVE/An�,t��+ • ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 10/6/2015 CLEARWATER SUMMIT GROUP INC Flame Inicioen Espeni of Contact Search L&I [4:0301 ='` '• A Z Index Help My Secure LACI Safety Claims&Insurance Workplace Rights Trades&Licensing CkWashington State Department of i Labor & Industries CLEARWATER SUMMIT GROUP INC Owner or tradesperson PO BOX 6470 SPOKANE,WA 99217-0908 Principals 509-482-2722 SWEET,TIM P, PRESIDENT SPOKANE County ULLMAN,TY ROBERT,VICE PRESIDENT ULLMAN,LAURA LOUISE,SECRETARY SWEET,ELAINE,TREASURER Doing business as CLEARWATER SUMMIT GROUP INC WA UBI No. Business type 601 450 995 Corporation Governing persons ELAINE SWEET LAURA ULLMAN; TIMOTHY P SWEET; TY R ULLMAN; License • Verify the contractor's active registration/license/certification(depending on trade)and any past violations. Construction Contractor Active. Meets current requirements. License specialties GENERAL License no. CLEARSG000KN Effective—expiration 05/15/2000—07/11/2016 Bond TRAVELERS CAS&SURETY CO $12,000.00 Bond account no. 055S103627339BCM Received by L&I Effective date 05/28/2002 07/01/2002 Expiration date Until Canceled Insurance Ohio Security Ins Co $1,000,000.00 Policy no. BKA56386308 Received by L&I Effective date 12/04/2014 12/22/2014 Expiration date 12/22/2015 1/3 ' 10/6/2015 CLEARWATER SUMMIT GROUP INC Insurance history Savings No savings accounts during the previous 6 year period. Lawsuits against the bond or savings No lawsuits against the bond or savings accounts during the previous 6 year period. L&I Tax debts ....a debts tax debts are recorded for this contractor license during the previous 6 year period,but some debts may be recorded by other agencies. License Violations Infraction no. ESODA00253 Satisfied Issue date RCW/WAC 06/25/2015 19.28.101 RCW Violation city Violation amount SPOKANE $250.00 Type of violation ELECTRICAL CITATION Description Covering or concealing installations prior to inspection. Infraction no. ESODA00252 Satisfied Issue date RCW/WAC 06/25/2015 19.28.041 RCW Violation city Violation amount SPOKANE $500.00 Type of violation ELECTRICAL CITATION Description Offering to perform,submitting a bid for, advertising,installing or maintaining cables, conductors or equipment that convey or utilize electrical current without having a valid electrical contractor license. Infraction no. Satisfied ESODA00254 ---•---~-- Issue date RCW/WAC 06/25/2015 19.28.271 RCW Violation amount Violation city $250.00 SPOKANE Type of violation ELECTRICAL CITATION Description Employing an individual for the purposes of chapter 19.28 RCW who does not possess a valid certificate of competency or training certificate to do electrical work. Workers' comp Do you know if the business has employees?If so,verify the business is up-to-date on workers'comp premiums. This company has multiple workers'comp accounts. Active accounts L&I Account ID Account is current. 472,384-01 Doing business as CLEARWATER SUMMIT GROUP INC 10/6/2015 CLEARWATER SUMMIT GROUP INC Estimated workers reported Quarter 2 of Year 2015"51 to 75 Workers" L&I account representative TO I GARY HONG(360)902-4823-Email:HONC235@Ini.wa.gov Track this contractor01 :. Workplace safety and health Check for any past safety and health violations found on jobsites this business was responsible for. Citation issue date 06/13/2014 Violations Inspection no. 317319408 Location 4228 E Wellesley Spokane,WA 99207-6780 Washington State Dept.of Labor&Industries.Use of this site is subject to the laws of the state of Washington. hi-inc./ie.,pro Ini%A,a nroduorifidflatail asnY91 IRI.8()1450995&LIC=CLEARSO000KN&SAW=False 3/3