16-048.01 Moore Iacofano Goltsman (SVR): Appleway Path Pines to Evergreen ((0-01-Ig.0k
V7;11
Washington State
VI/ Department of'Transportation
Supplemental Agreement Organization and Address
Number 1 MIG/SvR
Original Agreement Number 615 Second Ave, Ste 280, Seattle,WA 98104
16-048 Phone: (206)223-326
Project Number Execution Date Completion Date
Public Works CIP No. 0227 7/13/2016 12/31/2017
Project Title New Maximum Amount Payable
Appleway Shared Use Path $107,323.07
Description of Work
Prepare WSDOT Intersection Plan for Approval for trail crossing at SR-27/Pines Road. Develop and refine
City provided schematic design for Evergreen Plaza into final bid set documents.
The Local Agency of City of Spokane Valley
desires to supplement the agreement entered in to with Moore Iacofano Goltsman,Inc.
and executed on July 13,2016 and identified as Agreement No. 16-048
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:
Develop and submit Intersection Plan for Approval. Refine Evergreen Plaza concept for Bid Set
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:
Maximum amount payable increased from$99,983.00 to$107,323.07; an addition of$7,340.07.
as set forth in the 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.
Byj..oriasvon Schrader, ' By: friarK04OLfr1 Ar-117 CKd
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Consultant Signature Approving Authority Signature
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Date
DOT Form 140-063
Revised 09/2005
Exhibit"A"
Summary of Payments.
Basic Supplement#1 Total
Agreement
Direct Salary Cost $31,682.14 $2,398.70 $34,080.84
Overhead $56,750.61 $3,921.76 $60,672.37
(Including Payroll Additives)
Direct Non-Salary Costs $2,000.00 $300.00 $2,300.00
Fixed Fee $9,504.64 $719.61 $10,224.25
Total $99,937.39 $7,340.07 $107,277.46
DOT Form 140-063
Revised 09/2005
Supplement#1-Consultant Fee Determination 7/132016
I I
Appleway Trail-Pines/SR-27 to Evergreen -
Civil Engineering Design Fee Estimate
M V R
for City of Spokane Valley
Date TonyPee Dave Kathy Nathan Lolly Jeff Annie Jesska
Sr
Principal Technician
Engr l/ 11/Sr
Senior Engr V/Senior Engr ill/IV; Project Office
Scope of Work Total Principal Principal II Engr IV LA ll Senior LA I Assistant Engr I Assistant
$ 88.46 $ 73.55 5 55.00 $ 44.99 $ 41.27 $ 33.53 $ 28.00 $ 19.15
Project Management
Scope/contract adjustment 1.0 2.0
Coordinate with Owner 3.0
Subtotal hours 6.0 1.0 - - 5.0 - - - -
Direct Salary Cost $ 312.76 $ 88.46 $ - $ - $ 224.30 $ - $ - $ - $ -
WSDOT Intersection Plan for Approval
Identify plan requirements and complete checklist 4.0
PFA Plan Sheet-draft 10.0 10.0
PFA Plan Sheet-final 3.0 2.0
QA/QC 1.0
Subtotal hours 30.0 1.0 - - 17.0 - 12.0 - -
Direct Salary Cost $ 1,25344 $ 88.46 $ - $ - $ 762.62 $ - $ 402.36 $ - $ -
Direct Salary Cost= $ 1,566.20
Overhead Cost(191.93%)= $ 3,006.01 (%of DLC/DSC)
- Fixed Fee(30%)= $ 469.86 (%of DLC/DSC)
Subtotal= $ 5,042.07
Total Consultant Direct Salary Cost= $ 5,050.00 (Round up to nearest$10)
1 of 1
Supplement#1
Consultant Fee Determination-Summary Sheet
(Lump Sum,Cost Plus Fixed Fee,Cost Per Unit of Work)
Project: Appleway Trail-Pines Rd to Evergreen Rd
Direct Salary Cost(DSC):
Classification Man Hours = Rate = Cost
Principal 2 X $88.46 $176.92
Principal X $73.55 $0.00
Principal Engineer I X $55.00 $0.00
Senior Engineer IV X $55.19 $0.00
Senior Engineer IV X $53.86 $0.00
Senior Engineer III X $49.72 $0.00
Senior Landscape Architect III X $47.50 $0.00
Senior Landscape Architect II X $45.00 $0.00
Senior Engineer II X $44.98 $0.00
Engineer V 22 X $44.86 $986.92
Engineer IV X $42.45 $0.00
Engineer IV X $41.30 $0.00
Engineer IV X $41.27 $0.00
Engineer III X $41.01 $0.00
Senior Landscape Architect I X $40.46 $0.00
Senior Project Assistant X $35.78 $0.00
Landscape Architect II X $35.16 $0.00
Landscape Architect II X $34.23 $0.00
Senior Technician II 12 X $33.53 $402.36
Engineer II X $32.91 $0.00
Landscape Designer X $31.09 $0.00
CAD Technician X $29.00 $0.00
Tech Designer I X $28.00 $0.00
Planner I X $27.22 $0.00
Landscape Designer X $25.00 $0.00
Office Assistant X $19.15 $0.00
Total DSC = $1,566.20
Overhead(OH Cost--including Salary Additives):
OH Rate x DSC of 191.93 %x$ $1,566.20 $3,006.01
Fixed Fee(FF):
FF Rate x DSC of 30 %x$ $1,566.20 $469.86
Page 1 of 2
Reimbursable Estimate: units at Cost
Reproduction/Courier 1 $ 200 $200.00
Office supplies(paper,copier,etc) 1 $ 100 $100.00
Reimbursable Estimate Total $300.00
Subconsultant Costs(See Exhibit G)
MT-LA $1,998.00
Grand Total $7,340.07
Prepared By: MIGISvR Date: 7/13/20161
Page 2 of 2
•
Supplement#1
Subconsultant Fee Determination Summary Sheet
(mandatory when Subconsultants are utlized)
Project: Appleway Trail-Pines Rd to Evergreen Rd
Additional Services: Evergreen Plaza
Subconsultant: MT-LA
Direct Salary Cost(DSC)
Direct Labor
Classification Man Hours Rate Cost
Principal 11 X $ 49.00 $ 539.00
Landscape Architect 7 X $ 22.50 $ 157.50
Landscape Designer 8.5 X $ 16.00 $ 136.00
TOTA DSC $ 832.50
Overhead(OH Cost--including Salary Additives)
OH Rate X DSC of 110.0% X $ 832.50 = $ 915.75
Fixed Fee(FF)
FF Rate x DSC of 30.0% X $ 832.50 = $ 249.75
Reimbursable
$ -
Total Reimbursables = $ -
Subconsultant Total $ 1,998.00
Grand Total $ 1,998.00
Client#:2042 MOOREIACO ,.
ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM(DD/YY)fY)07/01/2016
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
II
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 NY,IPCT Jo Lusk
Dealey,Renton&Associates r,�o"a Ext):510 465.3090 FAX No): 510 4524193
P.O.Box 12675 DREss:jlusk@dealeyrenton.com
Oakland,CA 94604-2675 INSURERS)AFFORDING COVERAGE NAIL II
510 465-3090 INSURER A:Travelers Indemnity Co.of Conn 25682
INSURED INSURER B:Travelers Property Casualty Co 25674
Moore lacofano Goltsman,Inc. INSURER C:Twin City Fire Insurance Co. 29459
MIGISvR INSURER D:ACE American Insurance Company 22667
800 Hearst Avenue
INSURER E:
Berkeley,CA 94710
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 POUCY 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.
RLiTSRR ADLSUBR
TYPE OF INSURANCE 1 R WVD POLICY NUMBER (WDD/YYYY) (MMIDD/YY11Y) LIMITS
A X COMMERCIAL GENERAL UABILITY 6802G239267 08/31/2015 08/31/2016LEEACCMHAAGGOEECCpCURRRENCE S1 000 000
CLAIMS-MADE X OCCUR PRAAEhOSES(Ea o rtence) $1,000,000
MED EXP(My one person) S10,000
PERSONAL IL ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000
POLICY I X JECT LOC PRODUCTS-COMP/OP AGG ,s 2,000,000
S
OTHER COMBINED SINGLE UNIT
B AUTOMOBILEUABIUTY BA2G258325 08/31/2015 08/31/2016(Eaacddent) X1,000,000
X ANY AUTO BODILY INJURY(Per person) $
ALL OWNED ^ SCHEDULED BODILY INJURY(Per accident) S
_ AUTOS _ AUTOS PROPERTY DAMAGE S
X HIRED AUTOS
(Per aeX NON-OWNED AUTOS dden() S
B X UMBRELLA UAB X OCCUR CUP0H758762 03/22/2016 08/31/2016_EACH OCCURRENCE $10,000,000
EXCESS UAB CLAIMS-MADE AGGREGATE 610,000,000
DED I RETENTION S S
C WOR AND EMKERSCYERS'LLABLITOMPENSATION 57WEDD8525 04/01/2016 04/01/2017 X Dip'sum I 1
PLY
ANY PRROPRIE B PARTNEEEXCLUE ECUTYIN N N(A El.EACH ACCIDENT 51,000,000
OFF(Mandatory In NH) E.L.DISEASE•EA EMPLOYEE 61,000,000
D IPTIOe ander E.L.DISEASE-POLICY LIMIT s1,000,000
DESCRIPTION OF OPERATIONS below
D Professional 021656434013 b7/01/2016 07/01/2017 $2,000,000 per Claim
Liability $3,000,000 Annl Aggr.
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached N more space Is required)
General Liability Policy excludes claims arising out of the performance of professional services.
Note:30 days notice of cancellation will be given except 10 days for non-payment.
Project Name/Number:Appleway Trail Ph 2-Pines Rd to Evergreen Rd/#15066/#16-048
The State and City of Spokane Valley,their officers,employees,and agents are named as Additional Insured
as respects General Liability and Auto Liability coverages.Insurance is Primary/Non-Contributory per
(See Attached Descriptions)
CERTIFICATE HOLDER CANCELLATION
Of Spokane ValleySHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
City p THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Attn:Darla Arnold ACCORDANCE WITH THE POLICY PROVISIONS.
11707 E.Sprague A venue
Spokane,WA 99206 AUTHORIZED REPRESENTATIVE
I 6
0 1988 2014 ACORD CORPORATION.All rights reserved.
ACORD 25(2014/01) 1 of 2 The ACORD name and logo are registered marks of ACORD
#S1746074/M1746058 AZM
DESCRIPTIONS (Continued from Page 1)
policy form wording.Waiver of Subrogation applies.See attachments.Should any of the above described
policies be cancelled before the expiration date thereof,the issuing insurer will mail 30 days written
notice to the Certificate Holder.
SAGITTA 25.3(2014101) 2 of 2
#S1746074/M1746058
Moore lacofano Goltsman,Inc.
6802G239267 1
08/31/2015 COMMERCIAL 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 Ill) for this Coverage
(Section II): Part. 1
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 Cov-
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 03 81 09 07 O 2007 The Travelers Companies,Inc. Page 1 of 2
Includes the coovriohted material of Insurance Services Office.Inc..with Its permission
COMMERCIAL 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 indude a person or in effect and
organization as an additional insured on this Coy- c. Before the end of the policy period.
Page 2 of 2 0 2007 The Travelers Companies,Inc. CG 03 81 09 07
Includes the coovriohted material of Insurance Services Office.Inc..with its permission
POLICY NUMBER: BA2G258325 COMMERCIAL AUTO
CA 20 48 10 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED INSURED FOR
COVERED AUTOS LIABILITY COVERAGE
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless
modified by this endorsement.
This endorsement identifies person(s)or organization(s)who are"insureds"for Covered Autos Liability Coverage
under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage
provided in the Coverage Form.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated
below.
Named Insured: Moore lacofano Goltsman,Inc.
Endorsement Effective Date: 08/31/2015
SCHEDULE
Name Of Person(s)Or Organization(s): City of Spokane Valley
Attn:Darla Arnold
11707 E.Sprague A venue
Spokane,WA 99206
Information required to complete this Schedule, if not shown above,will be shown in the Declarations.
Each person or organization shown in the Schedule is
an"insured"for Covered Autos Liability Coverage, but
only to the extent that person or organization qualifies
as an "insured" under the Who Is An Insured
provision contained in Paragraph A.1. of Section II —
Covered Autos Liability Coverage in the Business
Auto and Motor Carrier Coverage Forms and
•
Paragraph D.2. of Section I — Covered Autos
Coverages of the Auto Dealers Coverage Form.
CA 20 48 10 13 ®Insurance Services Office, Inc.,2011 Page 1 of 1
Insured: Moore lacofano Goltsman,Inc.
Policy Number. 57WEDD8525
Effective Date: 04/01/2016
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF OUR RIGHT TO RECOVER FROM
OTHERS ENDORSEMENT - CALIFORNIA
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not
enforce our right against the person or organization named in the Schedule. (This agreement applies only to the
extent that you perform work under a written contract that requires you to obtain this agreement from us.)
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in
the work described in the Schedule.
The additional premium for this endorsement shall be % of the California workers' compensation premium
otherwise due on such remuneration.
SCHEDULE
Person or Organization Job Description
Project Name/Number:Appleway Trail Ph 2-Pines Rd to Evergreen Rd/#15066/#16-048.PERSON
S) agents ORGANIZATION(S)CONT.:The State and City of Spokane Valley,their officers,employees
City of Spokane Valley
Attn:Dada Arnold
11707 E.Sprague A venue
Spokane,WA 99206
Countersigned by 44."
Authorized Representative
Form WC 04 03 06 (1) Printed in U.SA.
Process Date: Policy Expiration Date: