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16-190.00 CH2M Hill: Sullivan West Bridge Replacement MK Va7/ Waill".°11DePerhillealiti"Of ThinSPOltallan Supplemental Agreement Organization and Address p p J CH2M HILL,INC. Number 13 999 W.Riverside Avenue, Suite 500 Spokane,WA 99201 Original Agreement Number Sullivan Road W Bridge Replacement#0155 Phone: Project Number Execution Date Completion Date BRM 4103(007) 11/8/2011 7/31/2017 Project Title New Maximum Amount Payable SULLIVAN ROAD WEST BRIDGE $ 2,015,035.00 Description of Work Professional services to provide bridge and retaining wall structural and traffic signal and illumination-related construction management, office engineering,and construction inspection services. The Local Agency of City of Spokane Valley,Washington desires to supplement the agreement entered into with CH2M HILL,INC. and executed on 11/8/2011 and identified as Agreement No. 0155 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: I Section 1, SCOPE OF WORK, is hereby changed to read: N/A -Contract completion date amendment only II Section IV,TIME FOR BEGINNING AND COMPLETION, is amended to change the number of calendar days for completion of the work to read: The Completion Date is hereby revised to 7n1/9017 III Section V, PAYMENT, shall be amended as follows: N/A -Contract completion date amendment only 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. By: Roger W Flint By: Mark Calhoun, City Manager er° Al a/efat -- / l sultant Signature Approving Authority Signature 7 [2422(! DOT Form 140-063 EF Date Revised 9/2005 A Q® DATE( YYYY) CERTIFICATE OF LIABILITY INSURANCE oa/27/2016/2o1s 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 MARSH USA INC. PHPHONE: 1225 17TH STREET,SUITE 1300 (A/C.N .Ext) FAX No): DENVER,CO 80202-5534 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# , 15114-01245-SG2PL-16/17 022768 CA INSURER A:Greenwich Insurance Company 22322 INSURED INSURER B:XL Specialty Insurance Company 37885 CH2M HILL,INC. - 9191 SOUTH JAMAICA STREET INSURER C:N/A N/A ENGLEWOOD,CO 80112 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: SEA-002917279-23 REVISION NUMBER:2 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 LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY X EACH OCCURRENCE $ 1,500,000 A CLAIMS-MADE X OCCUR RGE500025505 05/01/2016 05/01/2017 PREM SESO(Ea occcu ence) $ 1,500,000 X $500,000 SIR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 1,500,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 X POLICY jeCOT- LOC PRODUCTS-COMP/OP AGG $ 5,000,000 OTHER: $ AUTOMOBILE LIABILITY X COMBINED SINGLE LIMIT $ 2000000 (Ea accident) , , A X ANY AUTO RAD500025405 05/01/2016 05/01/2017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE —$ HIRED AUTOS — AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE _ $ _ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITYSTATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE YNN N/A RWD500025205(AOS) 05/01/2016 05/01/2017 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? 'STOP GAP LIABILITY' (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 'ONLY 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) THE CERTIFICATE HOLDER IS INCLUDED AS AN ADDITIONAL INSURED ON THE GENERAL LIABILITY AND AUTOMOBILE LIABILITY POLICIES AS REQUIRED BY WRITTEN CONTRACT OR AGREEMENT. CERTIFICATE HOLDER • CANCELLATION CITY OF SPOKANE VALLEY,WA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 11707 E.SPRAGUE AVENUE,SUITE 106 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SPOKANE VALLEY,WA 99206-6124 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Sharon A.Hammer . -,,64,,..,_...._,...._, Q-.tiN� - IEv I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ENDORSEMENT#007 This endorsement, effective 12:01 a.m.,May 1,2016 forms a part of Policy No.RAD500025405 issued to CH2M HILL COMPANIES; LTD. by Greenwich Insurance Company' THIS EN[7ORSEMENT HANESCQTHE POLICY, PLEASE READ IT CAREFULLY CANCELLATION NOTIFICATION 7P OTH.ERS,ENDORS;EMENT In the event coverage is cancelled or non renewed for any statutorily permitted reason it if coverage is materially reduced,or a oirerage is cancelled for non-payment of prediium advanced writterfriotidewill be mailed to the person or entity according to the notification schedule shoWn below: Number of Days NUrnber of Advan Geed Days Notice of Advanced 'Cancellation or Notice of Name of Person or Entity ,Mailing Address: Statutorily for Non- Permitted Payment of Reasons or if Premium Coverage is Materially Reduced Any entity,person or TBA organization where required by any contract,permit or access, 60 days 10 days agreement For the purpose of this endorsement,non-renewal shall mean solely non-renewal of the Policy and shall not include expiration or Notice of Conditional Renewal. Material reduction in coverage shall mean,With the,Insured'aagreement: • policy limitsshownin the declarations page get amended;or • change in the deductibtebr se'If-insured retention, except where specific contract or project retentions.are requested and agreed-to by You and Us;or • the application of a new polipy xclgalon not contemplated at inception except as required per state rules and regulations. All other terms and conditions of the Policy remain unchanged. (;;;4,-- (Authorized Representative) MANUS ©2016`X.L.America,.Inc.All Rights Reserved, May not be copied without permission.