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16-185.01 Eller Corp: On Call Road Graders for Snow Removal • • CONTRACT AMENDMENT TO THE AGREEMENT BETWEEN THE CITY OF SPOKANE VALLEY AND ELLER CORPORATION Spokane Valley Contract# 16-185.01 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 On-Call Road Graders for Snow Removal Project by and between the Parties,executed by the Patties on December 8,2016,and which terminates on April 30, 2017. 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$40,000.00. • 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 are either 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. Additional compensation for hours wonted. 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 December 8,2016 $40,000.00 Amendment#1 January 26,2017 $30,000.00 Total Amended Compensation $70,000.00 The parties have executed this Amendment to the Original Contract this cAa+day of January,2017. CIT I OF SPO VALLEY: ELLER CORPORATION: . ZA)7( Mark Calhoun By: K A.Wilson City Manager Its: Pres ent A s •APP OVED TO FORM: Christine Bainbridge,City Clerk " Office the City ey • 1 �---"1 ELLECOR-01 SSIMPSON ACORN" DATE IMMEILYTTYi 44......---- CERTIFICATE OF LIABILITY INSURANCE 12113/2016 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 have ADDITIONAL INSURED provisions or 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 !CT Stacie Simpson 99999 REGrorouupp'�verside roup, Suite 510 tArc, ,EA;(509)319-2912 Ira,Nol:(509)319-2920 Spokane,WA 99201 lass;ssimpson@bkjet.com INSURERISI AFFORDING COVERAGE NAIC Y INSURER A;Continental Western Insurance Company _10804 INSURED INSURER a: Eller Corporation INSURER C: PO Box 117 INSURER D: Newman Lake,WA 99025 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 AU.THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAiD CLAIMS. INSR UCY EFF POUCY EXP LTR iYPE OF INSURANCE AINm wvo POLICY NUMBER ilieRb Cpiyy I DATYYi LIMITS A X OOLMIERCUIL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 I CLAIMS-MADE n OCCUR CPA 6026641 12/31/2016 12/31/2017 R nnes,rr race: S 300,000 MED EXP(Any aro person) $ 10,000_ `_ PERSONAL d ADV INJURY 5 1,000,000 .0.N1•rc- c TE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 _ POLICY © ga LOC PRODUCTS-COMP/OP AGG $ 2,000,000 ETHER. WA STOP GAP $ 1,000,000 A Autonomi man), Ic.Eea,+el SINGLE LIMIT 1,000,000 1,000,000 X ANNYNAUTO g�EpU CPA 6026641 12/31/2016 12/31/2017 BODILY INJURY(Per person} S _ }AOUTEOpS ONLY ^_ AUTOS LEEpp BODILY INJURY M(Per sedasnp $ X AUTOS ONLY X �NLY XH�ef� q E S $ A X UMBRELLA LJAB X OCCUR EACH OCCURRENCE S 2,000,000 EXCESS UAB CLAIMS-MADE CPA 6026641 12131/2018 12/31/2017 AGGREGATE s 2,000,000 DED RETENTION$ -1 WORKERS COMPENSATION LI aWTY �� p YIN STATUTE ER ANY PRCPRIETORIP CUTNE liEMIA ESL,EACH ACCIDENT S under El E.L.DISEASE-EA EMPLOYES S �IONs OF OPERATIONS below EL.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS i LOCATIONS 1 VEHICLES(ACORD 181 Ad SIIosal Restarts Scissbil., be sllfdrd I'mots space Is AS RESPECTS: OPERATIONS OF INSURED AS RELATES ON-CALL GRADER SNOW REMOVAL 2016-2017 SNOW EASON-CONTRACT#16--185 CONFIRMATION OF COVERAGE 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 AITN:DEVEN ANE VALLEYSON ACCORDANCE WITH THE POLICY PROVISIONS. 11701 E SPRAGUE,STE 106 SPOKANE VALLEY,WA 99206 JUITNORaaD REPRESENTATIVE cuiin E›,i,pui..."--. I ACORD 25(2016/03) ®1988-2015 ACORD CORPORATION. An rights reserved. The ACORD name and logo are registered marks of ACORD f�1 ELLECOR-01 SSIMPSON ACORO' DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12H5/2016 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 have ADDITIONAL INSURED provisions or 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 suchooendorsement(s). PRODUCER NAME:4CT Stacia Simpson BK-JET Group LLC 999 W Riverside Avenue,Suite 510 ((a/H"Co,Nr o,Est):(509)319-2912 FAX No):(509)319-2920 Spokane,WA 99201 ADDRESS:ssimpson©bkjet.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Continental Western Insurance Company 10804 INSURED INSURER B: Eller Corporation INSURER C: PO Box 117 INSURER D: Newman Lake,WA 99025 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYYI (MM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X CPA 6026641 12/31/2016 12/31/2017 PREMISES(Ea occurrence) $ 300,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JEC LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: WA STOP GAP $ 1,000,000 A AUTOMOBILE LIABIUTY (Ea COMBINED SINGLE LIMIT $ 1,000,000 X ANY AUTO X CPA 6026641 12/31/2016 12/31/2017 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOSNVyNEp BODILY INJURY(Per accident) $ X AU S AUT ONLY X NOM (I-err accident)AMAGE A X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAR CLAIMS-MADE X CPA 6026641 12/31/2016 12/31/2017 AGGREGATE $ 2,000,000 DED RETENTIONS $ WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY Y/N STATUTE ERH ANY YIPROP IIMTgOER EXCLUDED ECUTIVE N/A E.L EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101 Additional Remarks Schedule may be attached If more space Is required) AS RESPECTS: OPERATIONS OF INSURED AS RELATES ON-CALL GRADER SLOW REMOVAL 2016-2017 SNOW SEASON-CONTRACT#16-185 PRIMARY/NONCONTRIBUTORY ADDITIONAL INSURED STATUS AND WAIVER OF SUBROGATION AS IT RELATES TO GENERAL LIABILITY IS GIVEN TO THE CITY OF SPOKANE VALLEY,ITS OFFICERS,AGENTS AND EMPLOYEES PER ENDORSEMENTS ATTACHED. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ANE VALLEY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF SPOK ATTN:DEVEN ANE VALLEY ACCORDANCE WITH THE POLICY PROVISIONS. 11701 E SPRAGUE,STE 106 SPOKANE VALLEY,WA 99206 AUTHORIZED REPRESENTATIVE 60111 ir )90)444" .' ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ELLER CORPORATION https://secure.lni.wa.gov/verify/Details/liabilityCertificate.aspx?UBI... STATE OF WASHMTON Department of Labor& Industries Certificate of Workers' Compensation Coverage February 6, 2017 WA UBI No. 600 184 764 L&I Account ID 363,277-00 Legal Business Name ELLER CORPORATION Doing Business As ELLER CORP Workers'Comp Premium Status: Account is current. Estimated Workers Reported Pending current quarter filing (See Description Below) Account Representative Employer Services Help Line, (360) 902-4817 Licensed Contractor? Yes License No. ELLERC*242C3 License Expiration €09/30/2018 What does "Estimated Workers Reported" mean? Estimated workers reported represents the number of full time position requiring at least 480 hours of work per calendar quarter. A single 480 hour position may be filled by one person, or several part time workers. Industrial Insurance Information Employers report and pay premiums each quarter based on hours of employee work already performed, and are liable for premiums found later to be due. Industrial insurance accounts have no policy periods, cancellation dates, limitations of coverage or waiver of subrogation (See RCW 51.12.050 and 51.16.190). 1 of 1 2/6/2017 8:58 AM