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17-102.01 Fehr & Peers: Pines BNSF Grade Separationj7) Washington State Department of Transportation Supplemental Agreement Number 01 Organization and Address City of Spokane Valley 10210 E. Sprague Avenue Spokane Valley, WA 99206 Phone: 509-720-5000 Original Agreement Number 17-102 Project Number 0223 Execution Date 08/16/17 Completion Date 12/31/19 Project Title Pines Road/BNSF Grade Separation Project #0223 New Maximum Amount Payable $36,190.00 Description of Work Perforin travel demand forecasting and traffic analysis in support of the Pines Road/BNSF Grade Separation Project #0223. The Local Agency of City of Spokane Valley desires to supplement the agreement entered in to with Fehr & Peers and executed on 08/16/17 and identified as Agreement No 17-102 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: 1 Section 1, SCOPE OF WORK, is hereby changed to read: No change. 11 Section IV, TIME FOR BEGINNING AND COMPLETION, is amended to change the number of calendar days for completion of the work to read: Contract completion date is revised to 12/31/19 111 Section V, PAYMENT, shall be amended as follows: No change. 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: Chris Breiland, Principal DOT Form 140-063 Revised 09/2005 By• 7Y C, r7- &i9 15-4:/) Consultant Signature Approving Authority Signature 2. —2- ?—i Date FEHR&PE-01 JACKSONNA 7 ACORO CERTIFICATE OF LIABILITY INSURANCE 41.----- DATE (MMIDD/YYYY) 12/05/2018 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(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 License # 0E67768 IOA Insurance Services 3875 Hopyard Road Suite 200 Pleasanton, CA 94588 CONTACT Naomi Jackson NAME: PHONE Ext): (925) 660 3998 FAX No): EA/�ANo, ADDREss: Naomi.Jackson@ioausa.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : RLI Insurance Company 13056 INSURED Fehr & Peers 100 Pringle Avenue, Suite 600 Walnut Creek, CA 94596 INSURER B : Hartford Insurance Company of the Midwest 37478 INSURER c:Liberty Insurance Underwriters, Inc 19917 INSURER D: $ 1,000,000 INSURER E : $ 1,000,000 INSURER F : • VISION 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. 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 LTRINSD TYPE OF INSURANCE ADDL SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP IMM/DD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY PSB0006683 12/06/2018 12/06/2019 EACH OCCURRENCE $ 1,000,000 DAMAGETORENTED PREMISES (Ea occurrence) $ 1,000,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGCREGATE POLICY OTHER: X LIMIT APPLIES PRO -T JEC PER: LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO OWNED AUTOS ONLY A R OS ONLY X SCHEDULED AUTOS AUTOS yON Y PSA0002276 12/06/2018 12/06/2019 (EOa acccdentDnt)INGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) BODILY $ (verr acEcldentDAMAGE $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE PSE0002889 12/06/2018 12/06/2019 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 $ DED RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/ N N /A 57WEGZJ1989 05/01/2018 05/01/2019 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE 1,000,000 $ E.L. DISEASE - POLICY LIMIT 1,000,000 $ C C Professional Liab. Professional Liab. AEXNYABEFJ2003 AEXNYABEFJ2003 12/06/2018 12/06/2018 12/06/2019 12/06/2019 Per Claim Aggregate 3,000,000 3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is requi ed) RE: Project Number/Name: SE17-0556.00 / Pines Road/BNSF Grade Separation All Operations of the Named Insured, including the aforementioned project, if any. General Liability: Please see blanket Additional Insured endorsement attached; such coverage is Primary and Non -Contributory with Waiver of Subrogation included, as required per written contract. Auto Liability: Please see blanket Additional Insured endorsement with Waiver of Subrogation included, as required per written contract. Workers' Compensation: Waiver of Subrogation is in favor of the aforementioned Additional Insured as per attached blanket Waiver of Subrogation endorsement, as required per written contract. SEE ATTACHED ACORD 101 City of Spokane Valley ATT11707ECandice. paue PowvHenderson, Chris Bainbridge 11707 Sprague Avenue, Suite 106 'Spokane. 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. AUTHORIZED REPRESENTATIVE CJ/ L �libc-(��.4�' ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD / 1 ACORD AGENCY CUSTOMER ID: FEHR&PE-01 JACKSONNA LOC #: 1 ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY License # 0E67768 IOA Insurance Services NAMED INSURED 10 r Peers 1000 Pringle Avenue, Suite 600 Walnut Creek, CA 94596 POLICY NUMBER SEE PAGE 1 CARRIER SEE PAGE 1 NAIC CODE SEE P 1 EFFECTIVE DATE: SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Description of Operations/LocationsNehicles: GENERAL LIABILITY & AUTO LIABILITY INCLUDE THE FOLLOWING PERSON(S) OR ORGANIZATION(S): City of Spokane Valley, their officers, employees, and agents, As required per written contract ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD