17-091.01 Devries: City Hall Move CONTRACT AMENDMENT TO THE AGREEMENT BETWEEN THE CITY OF
SPOKANE VALLEY AND DEVRIES MOVING
Spokane Valley Contract#17-091.01
For good and valuable consideration,the legal sufficiency of which is hereby acknowledged, City and the
Devries mutually agree as follows:
1. Purpose: This Amendment is for the Contract for moving the City Hall by and between the Parties,
executed by the Parties on June 28, 2017, and which terminates on September 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$21,150.00.
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. j•
3. Amendment Provisions: This Amendment is subject to the following amended provisions, which are
either as follows, or attached hereto as Appendix "A". 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.
4. Compensation Amendment History: This is Amendment#01 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 June 28,2017 $21,150.00
Amendment#1 August 3,2017 $*2,400.00
Total Amended Compensation $23,550.00
The parties have executed this Amendment to the Original Contract this rot day of August,2017.
C r e F SP a KANE V LEY: CONSULTANT/CONTRACTOR:
ViLifk \777116
G;
ark Calhoun Ca i eco By:
City Manager Its: 71_44 dtad-
A,t,'if APP' •VED ` I O' ► :
itdr.A.i
*- /4/16/01
store Bainbri a ge,City Clerk Office •i the Cit VO
ey
APPENDIX"A" •
1. Paragraph 3 (Compensation) of the Original Contract is hereby amended to change the total
compensation paid from$21,150.00,to$23,550.00. Paragraph 3 of the Original Contract is amended to
read as follows: City agrees to pay Consultant$23550.00(which includes Washington State sales tax if any is
1 - •
applicable)as full compensation for everything done under this Agreement,as set forth in Exhibit A. Consultant
shall not perform any extra,further,or additional services for which it will request additional compensation from the
City without a prior written agreement for such services and payment therefore.The City agrees to pay up to
$23,550.00 as full compensation for everything furnished and done under this contract, in accordance
with the provisions outlined in the scope of work,as previously and/or presently amended. •
2. The Scope of Work, (Exhibit A) of the Original Contract, is hereby amended to include the following
additional tasks and/or services:
Consultant/Contractor shall Disassemble SpaceSaver racking, located in the current City Hall
building and in the warehouse and after the approval of the C of 0, install the racking in the basement of
the newly constructed City Hall.
2
Ai
Quotation
Moving •Packing •Storage
Local,Interstate and Worldwide
Quotation Date:
112 N. Haven,Suite B August 3,2017
Spokane,WA 99202
V-509-924-6000
F-509-924-6000
Commercial Services
Bill to: (City of Spokane Valley Job Site: (City of Spokane Valley
Name: Doug Powell Name: Deanna Horton
Address: 11707 E. Sprague Ave. Address: 11707 E. Sprague Ave.
Address: Spokane Valley,WA 99206 Address: Spokane Valley,WA 99206
Good Thru Payment Terms Sales Rep
31-Aug-17 Net 10 Ron Douglas
Quantity Description of Services Unit Price Total
1.00 Teardown,relocate and rebuild shelving $2,400.00 $2,400.00
$0.00 $0.00
$0.00 $0.00
$0.00 $0.00
$0.00 $0.00
$0.00
$0.00
$0.00
$0.00
$0.00
0.087 Wash St Sales Tax $0.00
(Total Estimate: $1,1103 I
Comments:
City of Spokane Valley will pack all files on shelving and place it back when rebuilt
3 11
SIGNATURE ATURE DATE
SIGNATURE DATE
..per.: .g
Client#:146291 JiMSTRAN
D/YYY1t7
E(MMID
ACORD. CERTIFICATE OF LIABILITY INSURANCE DAT4/E(MMID 7
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 NneL CT Amy Augustine
Propel insurance PHONE 800 499-0933 FAX 866 577-1326
Seattle Commercial insurance IE•A Lo.E■+i. tA/c.Nnl:
ADDRESS: amy.augustine@propelinsurance.com
925 4th Ave,Suite 3200 INSURER(S)AFFORDING COVERAGE ,NAIC II
Seattle,WA 98104 INSURER A:Transguard Insurance Company of 28886
INSURED INSURER 8:
DeVries Moving Packing Storage
112 N Haven Ste.B INSURER C
Spokane,WA 99202 INSURER D:
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.
WSR AOOLSUBR POUCYEF1p FPUCYEXP
LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (NMIDD(YYY17 (MM/DLATS
A X COMMERCIAL GENERAL UASIUTY X X TCP000041703 12/03/2016 12/03/2017 awl OCCURRENCE x1,000,000
IMAIMS MADE ❑X occuR F FINKS Mo NToePena) :100,000 •
X Medical Expenses for MED EXP(Any ono parson) s5,000
Temp WOrkers:$50K PERSONAL&ADVINJURY :1,000,000
GENt.AGGREOATEUMITAPPLIESPEt: GENERAL AGGREGATE 52,000,000 •
POLICY E JERC0.T [1 LOC PRODUCTS-COMP/OP AGO 52,000,000
OTHER $
A AUTOMOBILEUA NUTY X TCP000041703 12/03/2016 12/03/20171E,aNelr INGLE LIMIT :1,000,000 _
ANY AUTO BODILY INJURY(Per person)_$
ALL OWNED X SCHEDULED BODILY INJURY(Per accident) S
AUTOS AUTOS
X HIRED AUTOS X AUT14°NaVVNED (Psraad DAMAGE S _
X Tri?Intchy' 150,000 Lint S
A X UrdeREI"MB X OCCUR TCU000037103 12/03/2016 12/03/2017 EACH OCCURRENCE :5,000,000 '
EXCESS LIAR CLAGIS.MDE AGGREGATE $5,000,000
DED I X RETENnON:1O,000 x
A WOE
COMPENSATION TCP000041703 12/03/2016 12/03/2017 laity! I X
AND EMPLOYERS'LIABIL/rf ITF
ANY PROPRIETOR/PARTNEWEXECLRiVEY/N WA Stop Gap/ E.L.EACH ACCIDENT $11000,000
OFFICER/MEMBEREXCLUDED? a N/A
(Mandatory lnNII) Employer's Liab El.DISEASE•EAEMPLOYEE 51,000,000
If yes,describe under
DESCRIPTION OFOPERAflONS below EL DISEASE-POUCYmar :1,000,000
A Cargo Legal Liab TCP000041703 12/03/2016 12/03/2017 $250,000 Any One Loss
$5,000 Ded $500,000 Agg in Transit
Whse legal Liab'- - SEE WHRSEINFO-BEtOW
DESCRIPTIONOFOPERATIONS/LOCATIONS/VEHICLES(ACORD10i,Additional Remarks Seheduto,maybe attached If more space Is required)
"Warehouse'Locations&Limits:
112 N.Haven,Spokane,WA:$600,000 limit
25 N.Fisk,Spokane,WA:$600,000 limit •
City of Spokane Valley is included as additional insured per the attached.
CERTIFICATE HOLDER CANCELLATION
City of Spokane Valley SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE
THE EXPIRATION DATE THEREOI-, NOTICE WILL BE DELIVERED IN
11707 E.Sprague Ave.Suite 106 ACCORDANCE WITH THE POLICY PROVISIONS.
Spokane Valley,WA 99206
AUTHORIZED REPRESENTATIVE
I Fmr.tri•d..9aUd"""
ID 1988.2014 ACORD CORPORATION.All rights reserved.
ACORD 25(2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S2679464/M2528714 TMT00
JIMS TRANSFER INC Page 1 of 1
5.Th1EOFWMHICTGN
Department of Labor& Industries
Certificate of Workers' Compensation Coverage
April 24,2017
•
WA UBI No. 328 028 324
L&I Account ID 445,372-00
•
•
Legal Business Name JIMS TRANSFER INC
Doing Business As DEVRIES MOVING PACKING
STORAGE
. .. . . . . ... . . . . .. . .
Workers'Comp Premium Status: 'Account is current.
.Estimated Workers Reported .Quarter 4 of Year 2016"31 to 50
(See Description Below) :Workers"
Account Representative Employer Services Help Line, (360)
902-4817
Licensed Contractor? Yes
License No. DEVRIMP876BB
License Expiration :01/02/2019 •
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 r u ~
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).
https://securedni.wa.gov/verify/Details/IiabilityCertificate.aspx?UBI=328028324&LIC=D... 4/24/2017
DEVRIES MOVING PACKING STORAGE Page 1 of 2
i lulur l'pzdi.d I 1 i il.a I .Searchrr••• ti;•L&I
....... .....
A-%I nitre I I ell My!hi
Safety&Health Claims&Insurance Workplace Rights Trades S Licensing
oak
klWashington State Department of
Labor & Industries
DEVRIES MOVING PACKING STORAGE
Owner or tradesperson 112 N HAVEN STE B
Principals SPOKANE.WA 99202
509-924-6000
DEVRIES.MICHAEL B,PRESIDENT SPOKANE County
County
DEVRIES,REBECCA L.SECRETARY
Doing business as
DEVRIES MOVING PACKING STORAGE
WA UBI No. Business type
328 028 324 Corporation
Parent company Governing persons
JIM'S TRANSFER INC MICHAEL
B
DEVRIES
WILLIAM DEVRIES;
REBECCA L DEVRIES;
License
Verify the contractor's active registration/license/certification(depending on trade)and any past violations.
Construction CoVactor. Active.
Meets current requirements.
License specialties
Cabinets,Millwork and Finish Carpentry
License no.
DEVRIMP876BB
Effective—expiration
01/02/2013-01/02/2019
• Bond
Lexon Ins Co $6,000.00
. _ Bond acountno.
9814702
Received by L&I Effective date
01/02/2013 12128/2012
Expiration date
Until Canceled
insurance
TRANSGUARD INSURANCE COMPANY 0 31.000.000.00
Policy no.
TCP000041703 •
Received by LEI Effective date
11/28/2016 12/03/2016
Expiration date
12/03/2017
Insurance history
Savings
rJo savings accounts during the previous 6 year period. Help us Improve
httpsJ/secure.lni.wa.gov/verify/Detail.aspx?UBI 328028324&LIC=DEVRIMP876BB&SAW= 4/24/2017
DEVRIES MOVING PACKING STORAGE Page 2 of 2
Lawsuits a8alnst the bond or savings
No lawsuits against the tioiid or savings accounts during the previous 6 year period.
L&I Tax debts
No tArtildebts are recorded for this contractor license during the previous 6 year period,but some debts
may be recorded by other agencies.
License Violations
Ho Ifcense vfofations during the previous 6 year period.
Workers' comp
Do you know if the business has employees?If so.verify the business is up-to-date on workers'comp premiums.
L&I Account ID Account Is current.
446,372-00
Doing bustness as
DEVRIES MOVING PACKING STORAGE
Estimated workers reported
Quarter 4 of Year 2016"31 to 50 Workers"
L&I account representative
TO/KRISTINE HATHAWAY(360)902-4811-Email:HATK235@ini.wa.gov
Workplace safety and health
Check for any past safety and health violations found on Jobsites this business was responsible for.
ti?Washington Stale Dept of tabor it industries.use of this silo to subject to the laws of are state of Washapton.
Help us Improve
haps://secure.lni.wa.gov/verify/Detail.aspx?UBI=328028324&LIC=DEVRIMP876BB&SAW 4/24/2017