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16-103.01 Northwest Roof Consultants: CenterPlace Roof Repair CONTRACT AMENDMENT TO THE AGREEMENT BETWEEN THE CITY OF SPOKANE VALLEY AND NW ROOF CONSULTANTS INC. Contract #16-103.01 For good and valuable consideration,the legal sufficiency of which is hereby acknowledged, City and the Consultant mutually agree as follows: 1. Purpose: This Amendment is for the Contract for providing roof consultant inspections, reports and services for the CenterPlace Roof Repair Project by and between the Parties, executed by the Parties on June 16,2016,and which terminates on August 30,2016. 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 $7,000.00. 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 is 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. Extend term of contract to December 31, 2016. 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 6/16/16 $ 7,000.00 Amendment#1 8/19/16 $ 0.00 Total Amended Compensation $7,000.00 1112 The parties have executed this Amendment to the Original Contract this 7t% day of A�2016. CITY OF SPO6NE VALLEY: CONSULTANT:7111 6.4 Utitoti... i,-, • Mark Calhoun,Acting City Manager By: �1 Its: law/ 1.o IS)A.? P✓,e41c(1tn-1 AT ,p/ APPROVE AS TO FORM: 0/ .) .. ,citt,t, dit.i , 1 7,' - Christine Bainbridge, City Clerk Offic `o g the Ci orney 1 ,„„-, ® DATE(MM/DD/YYYY) AE D CERTIFICATE OF LIABILITY INSURANCE 6/6/2016 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(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 NAME:CT Cheri Robbins ISII Insurance Service PHONE (208)664-9783 FAX (208)664-9870 IA/C.No.Extl: (AIC,No): Haddock & Associates E-MAIL :cherir@isu-haddock.com ADDRE1311 Northwood Center Court INSURER(S)AFFORDING COVERAGE NAIC# Coeur d'Alene ID 83814 INSURER A:Ohio Security INSURED INSURERS Mutual Of Enumclaw 14761 BC Engineers, Inc. INSURER C:Ohio Casualty DBA: Northwest Roof Consultants INsuRERD:State Insurance Fund 8680 N Wayne Drive, Suite A INSURER E:Travelers Hayden ID 83835 INSURERF: COVERAGES CERTIFICATE NUMBER:2015 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 ADDL SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) IMMIDD/YYYYI X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 1,000,000 A CLAIMS-MADE I X I OCCUR PREMISES(Ea occurrence) $ X PD Dedt/Claim $250 X BKS56588653 6/1/2016 6/1/2017 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICYX JECPROT LOC- PRODUCTS-COMP/OPAGG $ 2,000,000 WA-StopGap $ 1,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) BODILY INJURY(Per person) $ B ANY AUTO ALL OWNED X SCHEDULED BAP0002889 1/22/2016 1/22/2017 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS %AUTOS (Per accident) $ X UMBRELLALIAB X OCCUR _EACH OCCURRENCE $ 2,000,000 C EXCESSLIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED RETENTION$ ES056588653 6/1/2016 6/1/2017 $ D WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY YIN 624032 ANY PROPRIETOR/PARTNER/EXECUTIVE 1/1/2016 1/1/2017 EL EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 E Professional Liability 105551099 1/22/2016 1/22/2017 For Each Claim $1,000,000 Claims-made form Retro-date: 01/22/2011 For All Claims $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) The certificate holder is hereby named as additional insured with respect to all operations of the named insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Spokane Valley THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 2426 N. Discovery Place Spokane Valley, WA 99216 AUTHORIZED REPRESENTATIVE R Haddock (HA1)/CR '' �� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(2014011 Current Policy Period Detail -Idaho State Insurance Fund Page 1 of 2 r i. t y .} "q /fat_: Home Employer , injured Worker Insurance Agent . Medical Provider , Safety • Search By Policy#: Continue Haddock Company Inc-200 Quick Links My Profile Log Out Current Policy Period Detail BC Engineers Policy#:624032 Status:Active Anniversary:01/01/2016 Current EAP:$1,596 Underwriter: KGILL Inc Outstanding Payroll Reports There are no Outstanding Payroll Reports for this policy. Outstanding Amounts There are no Outstanding Amounts for this policy. —Policy Information Policy Status: Active Current Balance: $0.00 Mailing Address: 8680 N Wayne Dr Ste A Hayden,ID 83835 Telephone Number. 208-772-8424 Billing Address: SAME AS MAILING ADDRESS Policy Effective Date: 01/01/2016 Policy Expiration Date: 01/01/2017 Deposit Amount: Billing Plan: One Pay Payment Plan Experience Modification: 0.00 Coverage Endorsements: Limits of Employers Liability Insurance: Bodily Injury By Accident$1,000,000.00 EACH ACCIDENT Bodily Injury By Disease$1,000,000.00 POLICY LIMIT Bodily Injury By Disease$1,000,000.00 EACH EMPLOYEE Business Name:BC Engineers Inc Entity Type: CORPORATION Owners: Comelison,Brent,PRESIDENT,Not Covered Erickson,Jason,VICE PRESIDENT,Not Covered Business Location:I-ENG-A of The Inland Northwest Physical Address: 8680 N Wayne Dr Ste A Hayden,ID 83835 Telephone Number: 208-772-8424 Business Location:Northwest Roof Consultants Physical Address: 8680 N Wayne Dr Ste A Hayden,ID 83835 Telephone Number: 208-772-8424 SIF Service Team . Name Department Phone Number Email Address KATIE GILL UNDERWRITING 208/332-2316 katie.clilli idahosif.orq JOSEPH GUERRINHA CLIENT RELATIONS 208/666-5612 joseoh.ouerrinhaa(2idahosif.orq JACK KIRSCH RISK MANAGEMENT 208/666-5611 lack kirschC)a idahosif.oro hUps.//www.idahosif.org/agcnt/policy_details.aspx?policy=624032 6/6/2016 Current Policy Period Detail -Idaho State Insurance Fund Page 2 of 2 • CLAIMS 208/332-2160 CLAIMSIM(rDIDAHOSIF.ORG PREMIUM AUDITING 208/332-2150 AUDITIM(8 IDAHOSIF.ORG Idaho State Insurance Fund Business Hours:8 am.to S p.m.MT,weekdays except state holidays. 1215 West State Street P.O.Box 83720 Documents received after business hours are recorded as received the Boise,ID 83720-0044 next business day. 208-332-2100 800-334-2370 About Us I Contact Us I Employment I Privacy Policy I Website Support • • • httpsl/www irlahosiforg/agent/policy_details.aspx?policy=624032 6/6/2016