17-064.02 Belsby Engineering: On Call Surveying SvcsSriokane"0"..3/4
.0.0Vailey
10210 E Sprague Avenue • Spokane Valley WA 99206
Phone: (509) 720-5000 • Fax: (509) 720-5075 ♦ www.spokanevalley.org
Email: cityhall@spokanevalley.org
December 6, 2018
Contract No. 17-064.02
Brian Belsby
Belsby Engineering
1325 W. 1s` Avenue, Suite 204
Spokane, WA 99201
Re: Implementation of 2019 option year, Agreement for On -Call Surveying for Capital
Improvement Projectsl7-064, executed June 1, 2017
Dear Mr. Belsby:
The City executed an Agreement for provision of On -Call Surveying for Capital
Improvement Projects on June 1, 2017, by and between the City of Spokane Valley,
hereinafter "City", and Belsby Engineering hereinafter "Contractor" and jointly referred
to as "Parties."
The original Agreement states that it was for one year, with three optional one-year terms
possible if the parties mutually agree to exercise the options each year. This is the second
of three possible option years that can be exercised and runs through December 31, 2019.
The City would like to exercise the 2019 option year of the Agreement. The
Compensation includes the labor and material cost negotiated and shall not exceed
$40,174.07. The history of the annual renewals, including dollar amounts, is set forth as
follows:
Original contract amount $50,000.00
2018 Renewal $49,500.00 (remaining funds)
2019 Renewal $40,174.07 (remaining funds)
All of the other contract provisions contained in the original Agreement shall remain in
place and remain unchanged in exercising this option year.
If you are in agreement with exercising the 2019 option year, please sign below to
acknowledge the receipt and concurrence to perform the 2019 option year. Please return
two copies to the City for execution, along with current insurance information. A fully
executed original copy will be mailed to you for your files.
CITY OF SPOKANE VALLEY BELSBY ENGINEERING
a 13.3
Mark Calhoun, City Manager Name 1
Ck
Title
ATTEST:
hristine Bainbridge, City Clerk
APPROVED AS TO FORM:
Offi of the City Attorney
s
RD CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDD/YYY11)
6!28/2018
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 such endorsement(s).
PRODUCER
Hall & CompanyPHONENo.
1966010th Ave N E
Poulsbo WA 98370
ACT
NAME: Julia Ardon
(A/C. Ext): 360-626-2956 uc.No):360-598-3703
ADDARESS: lardoniahailandcompany.com
INSURER(S) AFFORDING COVERAGE
NAIC S
INSURER A : Continental Casualty Company
20443
INSURED BELSENG-01
Belsby Engineering
1325 W. 1st Ave. #204
Spokane WA 99201
INSURER B : Transportation Insurance Company
20494
INSURER c : Argonaut Insurance Company
19801
INSURER D :
51,000,000
INSURER E :
5300,000
INSURER F :
CLAIMS -MADE
•
REVISION NUMBER:
v
THIS ,IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTAND073 ANY"REQUIREMENT,"TERM OR CONDI1'k N 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
LTR
TYPE OF INSURANCE
ADDL
INSD
SUBR
WVD
POUCY NUMBER
POLICY EFF
1MDDIVYYY)
POLICY EXP
(MMIDDNYYYf
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
6020063573
1/24/2018
1242019
EACH OCCURRENCE
51,000,000
PREM SES (EGE TO a occurrence)
5300,000
CLAIMS -MADE
X
OCCUR
MED EXP (Any one person)
S 10,000
PERSONAL & ADV INJURY
51,000,000
5 2,000,000
GENERAL AGGREGATE
GEM.
AGGREGATE
POLICYX
OTHER:
LIMIT APPLIES
jECa
PER:
1 LOC
PRODUCTS - COMP/OP AGG
S 2,000,000
S
B
AUTOMOBILE
X
v
X
LIABILITY
ANY AUTO
OWNED
AUTOS ONLY
HIRED
AUTOS ONLY
—
_X
SCHEDULED
AUTOS
NON NED
AUTOS ONLY
6020063668
1242018
1242019
COMBINED SINGLE LIMIT
(Ea accident)
51,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
5
PROPERTY
(Per accident)5
5
A
X
UMBRELLA UAB
EXCESS UAB
X
OCCUR
CLAIMS -MADE
6020083623
1242018
1242019
EACH OCCURRENCE
51,000,000
AGGREGATE
51,000,000
5
DED X RETENTION 5 10 000
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANYPROPRIETOR/PARTNER/EXECUTIVE I—'j
OFFICER/MEMBEREXCLUDED? I J
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
6020063573
1242018
1242019
PERX ERS
WA Stop Gap
E.L. EACH ACCIDENT
51,000,000
E.L. DISEASE- EA EMPLOYEE
S 1,000,000
E.L. DISEASE - POLICY LIMIT
51,000,000
C
Professlonal Liab; Claims Made
IAE4217033
6222018
822/2019
Per Claim
Aggregate
62,000,000
62,000,000
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
The certificate holder is an additional insured per the attached.
"For all operations with the City of Spokane Valley
Where required by written contract the City of Spokane Valley Is Included as additional insured (except on workers comp and Professional Liability)."
Project: On Cali Surveying
1
Cityof Spokane Valley
10210 East Sprague Avenue
Spokane Valley WA 99206
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL. BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZEDREPRESE ATNF
ACORD 25 (2016103)
1988-2015 ACORD CORPORATION. Ail rights reserved.
The ACORD name and logo are registered marks of ACORD
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Record Status: Active
ENTITY
Belsby Engineering, LLC Status: Active
DUNS: 179646562 +4: CAGE Code: 5A3U2 DoDAAC:
Expiration Date: 01/23/2019 Has Active Exclusion?: No Debt Subject to Offset?: No
Address: 1325 W 1st Avenue Ste 204
City: Spokane State/Province: WASHINGTON
ZIP Code: 99201-4136 Country: UNITED STATES
December 05, 2018 2:54 PM
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