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16-085.03 Clearwater Summit Group: Browns Park Championship Sand Volleyball Court • CONTRACT AMENDMENT TO THE AGREEMENT BETWEEN THE CITY OF SPOKANE VALLEY AND CLEARWATER SUMMIT GROUP INC. Spokane Valley Contract#16-085.03 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 Browns Park Championship Sand Volleyball Court Project by and between the Parties, executed by the Parties on May 4, 2016, and which terminates on June 10,2016. 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 $51,523.80 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. -Extend the contract time of performance to May 1, 2017.. This is to allow for the closing out of the project and the initial start-up in the spring. 4. Compensation Amendment History: This is Amendment #3 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 5/4/16 $ 51,523.80 Amendment#1 6/3/16 $108,359.04 Amendment#2 7/22/16 $ 0.00 Amendment#3 11/7/16 $ 0.00 Total Amended Compensation $159,882.84 The parties have executed this Amendment to the Original Contract this ''y day of November, 2016. CITY OF SPOKAN VALLEY: CO.,NTRA TOR: It r.lL _ _ 1` 2 � Mark Calhoun By: Ty llman City Manager Its: Vice resident ATTEST: APPROVED AS TO FORM: �r��-c-c�✓ n,�- 'amu -c Christine Bainbridge, City Clerk Of ice o he City rney 1 _ • C:LbAfl-4 UP lU:S dAC R DATE(MM/DDIYYYY) �..---- CERTIFICATE OF LIABILITY INSURANCE I 05/02/2016 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 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 ACT Derek M Collett Wheat&Associates Insurance PHONE,.Ext):509-922-2937 (A/ ,No):509-922-4103 P.O.Box 3548 Spokane,WA 99220-3548 E-MAIL E-MAILADDRESS:derek@wheatinsurance.com Derek M Collett INSURER(S)AFFORDING COVERAGE NAIL# . INSURER A:Cincinnati Insurance Co 10677 INSURED Clearwater Summit Group Inc INSURER a:AM Best Rating-A XV Ruby Nee INSURER C: PO Box 6470 INSURER D: Spokane,WA 99217 • INSURER E: INSURER F: • COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDINCE LISTED TION OF ANY CONTHAVE BEEN RACT OR OTHER DOCUMENT WITH D TO THE INSURED NAMED ABOVE ORESPECT TOR THE L INDICATED. ICY PERIOD 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. ADDL SUBR POLICY EFF POLICY EXP LIMITS /LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER ' (MM/DD/YYYY) (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,001 EPP 0366855 12/22/2015 12/22/2016 DAMAGETORENTED 500,001 A X COMMERCIAL GENERAL LIABILITY X X PREMISES(Ea occurrence) $ CLAIMS-MADE X OCCUR MED EXP(Anyone person) $ 10,001 • PERSONAL&ADV INJURY $ 1,000,001 GENERAL AGGREGATE $ 2,000,001 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,001 • n POLICY n PRO- n LOC $ JTYT COMBINED SINGLE LIMIT 1,000,001 AUTOMOBILE LIABILITY (Ea accident) $ A X ANY AUTO EPP 0366855 12/22/2015 12/22/2016 BODILYINJURY(Perperson) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS _ AUTOS PROPERTY DAMAGE HIRED AUTOS AUTOS $ NON-OWNED (PER ACCIDENT) 1 $ X UMBRELLA LIABX OCCUR EACH OCCURRENCE $• 4,000,001 A EXCESS LIAB CLAIMS-MADE EPP 0366855 12/22/2015 12/22/2016 AGGREGATE $ 4,000,001 DED X RETENTIONS 0 $ WORKERS COMPENSATION WC STATU- X OTH- TORY LIMITS ER AND EMPLOYERS'LIABILITY YIN 1,000,00( A ANY PROPRIETOR/PARTNER/EXECUTIVE EPP 0366855 12/22/2015 12/22/2016 E.L.EACH $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) WA STOP GAP E.LDISEASE-EAEMPLOYEE $ 1,000,00C If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 1,000,00L DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) - Project: Browns Park Championship Sand Volleyball Court City of Spokane Valley is Additional Insured pertaining to the General Liability as per form GA233. Coverage is primary and non-contributory and includes completed operations. Waiver of subrogation applies. Fax to: 509-688-0188 CERTIFICATE HOLDER CANCELLATION CITSP-3 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. 2426 N Discovery Place Spokane Valley,WA 99216 AUTHORIZED REPRESENTATIVE . XI dfr. I - -_-- --•- - arte.. Al!_...L.6.+.nenn,Grl • • 4127/2016 CLEARWATER SUMMIT GROUP INC Hone Espanol Contact !Search L&I A-Z Index Help My Ltd Safety&H.ealth Claims&Insurance Workplace Rights Trades&Licensing • .::.: f y Wagllingt0pSt?f€ :*• reA of- ab Lor & Industries 1 CLEARWATER SUMMIT GROUP INC PO BOX 6470 Owner or tradesperson 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; . I 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 Cincinnati Ins Co $1,000,000.00 Policy no. EPP0366855 Received by L&I Effective date 12/22/2015 12/22/2015 Expiration date 4/27/2016 CLEARWATER SUMMIT GROUP INC • Cincinnati Ins Co $1,000,000.00 Policy no. 847987 Received by L&I Effective date 12/22/2015 12/22/2015 Expiration date 12/22/2016 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&I Tax debts WO-0,1 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. Satisfied Issue date ROW/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. ESODA00254 Satisfied Issue date r RCW/WAC •- 06/25/2015 19.28.271 RCW Violation city Violation amount SPOKANE $250.00 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. Infraction no. Satisfied ESODA00253 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. , . 4/27/2016 CLEARWATER SUMMIT GROUP INC 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 Estimated workers reported Quarter 4 of Year 2015"51 to 75 Workers" L&I account representative TO/GARY HONC(360)902-4823-Email:HONC235@lni.wa.gov Track this contractor,4, • Workplace safety and health Check for any past safety and health violations found on jobsites this business was responsible for. Inspection results 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. •