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15-136.01 AM Landshaper: Discovery Playground Shade Structure CONTRACT AMENDMENT TO THE AGREEMENT BETWEEN THE CITY OF SPOKANE VALLEY AND AM LANDSHAPER, INC. Contract #15-136.01 For good and valuable consideration,the legal sufficiency of which is hereby acknowledged,City and the Contractor mutually agree as follows: 1. Purpose: This Amendment is for the Contract for the installation of a shade structure over the outdoor classroom area at Discovery Playground project by and between the Parties, executed by the Parties on December 3, 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. Totalcompensation under the Original Contract is not to exceed$13,587.50. 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 Alternate#1 to the project. Price is$1,700.00 plus$147.90 W.S.S.T for a total add of$1,847.90. This alternate provides for the installation of the cast-in-place concrete. 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 12/03/15 $13,587.50 Amendment#1 01/14/16 $ 1,847.90 Total Amended Compensation 515,435.40 The parties have executed this Amendment to the Original Contract.this rfi-4- day of January,2016. CI OF SPOKANE VALLEY: CONTRACTOR: Mike Jatfon Owner Mark C. Albin City Manager • President ATT ST• APPROVED A. TO FORM: /3_6:4 C A Christine ainbridge,City Clerk Office o the C ttorney 1 _____.......14) AMLANDS-01 WCHRISTESON ACORLYDATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/3/2015 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: Spokane Office PHONE509 838-3501 FAX 838-3511 PayneWest Insurance,Inc. (A/C,No,Est):( ) (A/c,No):(509) 501 N.Riverpoint Blvd.,Ste 403 ADDR1ESS: Spokane,WA 99202 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:The Cincinnati Insurance Co. 10677 INSURED INSURER B: A.M.Landshaper,Inc. INSURER c: Mark Albin 8004 North Market INSURER D: Spokane,WA 99217 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. ILICY EXP LTR TYPE OF INSURANCE R AINSD DDL SWVD POLICY NUMBER (UBR MM/DD/YYYY) (MMIDDIIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X EPP0128051 02/24/2015 02/24/2016 PREM SES(Ea occu Dnce) $ 500,000 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 X JECOT- LOC • PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: WA STOP GAP $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X ANY AUTO EPP0128051 02/24/2015 02/24/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-0WNED PROPERTY DAMAGE $ X X (Per HIRED AUTOS AUTOS accident) $ • X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE EPP0128051 02/24/2015 02/24/2016 AGGREGATE $ 1,000,000 DED X RETENTION$ 0 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT ,$ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Equipment Floater EPP0128051 02/24/2015 02/24/2016 Leased and Rented 225,000 A EPP0128051 02/24/2015 02/24/2016 Deductible 1,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Discovery Playground Shade Structure Project City of Spokane Valley is an additional insured on a primary/non-contributory basis per policy forms. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Spokane Valley ACCORDANCE WITH THE POLICY PROVISIONS. Parks and Recreation Department 2426 N Discovery PI Spokane Valley,WA 99216 AUTHORIZED REPRESENTATIVE I I .°11k 5A141191 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) • The ACORD name and logo are registered marks of ACORD 12/1/2015 A M LANDSHAPER INC Home blobo en Espanol Contact Search L&I a' ' A-Z Aiden Help My Secure L&I Safety Claims&Insurance Workplace Rights Trades&Licensing Washington State Department of Labor & Industries A M LANDSHAPER INC Owner or tradesperson 8004 N.MARKET Principals SPOKANE,WA 99217 p 509.468-4335 ALBIN,MARK C, PRESIDENT SPOKANE County MCGEE,TYE CYRIL,SECRETARY Doing business as A M LANDSHAPER INC WA UBI No. Business type 601 701 273 Corporation Governing persons MARK C ALBIN TYECMCGEE; 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. AMLANI"971 DO Effective—expiration 03/20/2003—02/24/2016 Bond North American Spec Ins Co $12,000.00 Bond account no. 2181927 Received by L&I Effective date 07/16/2014 09/24/2014 Expiration date Until Canceled RLI INS CO $12,000.00 Bond account no. SSB397618 Received by L&I Effective date 10/02/2009 09/24/2009 Expiration date Until Canceled Insurance Cincinnati Ins Co $1,000,000.00 https://secureini.wa.gov/verify/Detail.aspx?UBI=601701273&LIC=AM LAN I*971D O&SAW=False 1/2 12/'/2015' A M LANDSHAPER INC Policy no. EPP225013 Received by L&I Effective date 02/19/2015 02/24/2012 Expiration date 02/24/2016 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&l Tax debts No L&I 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 No license violations during the previous 6 year period. 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. 816,368-01 Doing business as A M LANDSHAPER INC Estimated workers reported Quarter 3 of Year 2015"11 to 20 Workers" L&I account representative TO!CAROLYN CRAWFORD(360)902-4715-Email:CRAI235@lni.wa.gov Workplace safety and health Check for any past safety and health violations found on jobsites this business was responsible for. ©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/Detai I.aspx?U BI=601701273&LIC=AM LAN I*971 DO&SAW=False 2/2 n '� O / A ::1 ,- 000 ods• . In 11 S i )� � .N y00p0 ONdM' � � O ` .--1 a J a c 69 b4 V) b9 b9 b9 69 &4 69 69 v` k. 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