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18-068.02 TDH: On Call Construction Engineering & Inspection Svcs � Washington State �I/ Department of Transportation Supplemental Agreement Organization and Address Number 18-068.2 Thomas,Dean&Hoskins,Inc. Original Agreement Number 303 E.2nd Avenue Spokane,WA 99202 18-068 Phone: 509-622-2888 • Project Number Execution Date Completion Date, NA 4/30/2018 12/31/2019 • Project Title New Maximum Amount Payable CN Management and Inspection Services $120,000 Description of Work Provide construction inspection services for selected federal or state funded projects. • The Local Agency of City of Spokane Valley desires to supplement the agreement entered in to with Thomas.Dean&Hoskins,inc. and executed on 4/30/2018 and identified as Agreement No. 18-068 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: Section 1, SCOPE OF WORK, is hereby changed to read: No change II Section IV,TIME FOR BEGINNING AND COMPLETION, is amended to change the number of calendar days for completion of the work to read: No Change • Ill Section V, PAYMENT, shall be amended as follows: The maximum compensation shall be increased to$120,000.00 • , and by this reference made a part of this supplement. If you concurwith 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: Steven N. Marsh.Vice President By: r' ark Catkotio fiif" a c>c '52A 41 6 44- Consultant Signature Approv ng Authonty Signature ZA2/161 Date DOT Form 140-063 • Revised 09/2005 • Client#:54916 THOMDEAN ACORDXM CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)2/01/2019 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Nicole Larsen Greyling Ins.Brokerage/EPIC PHONE 770-552-4225 FAX 866-550-4082 (A/C,No,Ext): (A/C,No): 3780 Mansell Rd.Suite 370 E-MAIL enr L l coe. asre Iln ADDRESS: Ni@g Y g•com Alpharetta,GA 30022. INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Sentinel Insurance Company 11000 INSURED INSURER B:Hartford Casualty Ins.Co. 29424 Thomas,Dean&Hoskins, Inc. INSURER C: 1800 River Drive North INSURER D: Great Falls, MT 59401 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 18-19 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 EFF POLICY EXP WD/ LIMITS LTR INSR VD POLICY NUMBER (MM/DYYYY) (MMIDD/YYYY) A X COMMERCIAL GENERAL LIABILITY 20SBWP16386 09/01/2018 09/01/2019 EACHOCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) $1,000,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X JEC PROT- LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY 20UEGAU8256 09/01/2018 09/01/2019 COMBINEacc(dent)D SINGLE LIMIT _$1,000,000 (Ea X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ — $ HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY (Per accident) B X UMBRELLA LIAB X OCCUR 20XHGYH2417 09/01/2018 09/01/2019 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTION$10000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYIPROPRIE ER PROPRIETOR/PARTNER/EXECUTIVE 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) Project:Spokane Valley On Call.City of Spokane Valley,its officers and employees are included as additional insureds on the above policies when required by written contract. CERTIFICATE HOLDER CANCELLATION Cityof Spokane ValleySHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE p THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10210 E.Sprague Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Spokane,WA 99206 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1412414/M1168169 NLAR1 ...---"1 THOMDEA-01 RTYLINSKI ACC,RJv" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) • `1 01/31/2019 • 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 License#0696870 CONE:TACT NA Rhodna Tyllnski HUB International Mountain States Limited PHONE Fax 100 Park Drive S (Aro,No,Ext):(406)453-1464 I(A1C,Ne);(866)801-0495—_ • Great Falls,MT 69401 • ADDRESS :rhonda.tylinskl@hubinternational.com AFFORDING COVERAGE NAIC N__ INSURER A:Continental Casualty Company 20443 - I INSURED INSURER B: Thomas Dean&Hoskins Inc INSURER C: 1800 River Dr No INSURER D: Great Falls,MT 59401 _ 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 ADD_SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IN WVD POLICY NUMBER CHINVDD DDPCIVO LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS•MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurtpncel $ MED EXP(Any one parson) $ PERSONAL 8 ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY j n LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY CO aBINNEen SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AURTEO�S ONLY _ AUTOSND BODILY INJURY(Per accident) $ — AUTOS ONLY ,_ AUTOS ONLY � �e 0denli GE —$ w •$ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE ,.3 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY(,� �PR@OPREIETgO�Rg/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ QEsF'ICEERRIMMEMBER EXCLUDED? N I A IM Ml EL DISEASE-EA EMPLOYEE $ Eyes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ A Professional Liab AEH113826009 09/01/2018 09/01/2019 Per Claims 2,000,000 A Professional Liab AEH113826009 09/01/2018 09/01/2019 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Project: Spokane Valley On Call . . j CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CI of Spokane ValleyTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City P ACCORDANCE WITH THE POLICY PROVISIONS. 10210 E Sprague Valley Spokane,WA 99206 AUTHORIZED REPRESENTATIVE IVwi��C ACORD 25(2016/03) ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD