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19-205.01 Inland Asphalt: Indiana Ave Preservation Evergreen to Sullivan Sjcars o ne 1eJ CHANGE ORDER NO: 1 ENGINEERING DIVISION CONSTRUCTION CONTRACT NO: 19-205 PROJECT: Indiana Avenue Preservation Project-Evergreen to Sullivan CONTRACT DATE: 4/2/2020 PRIME CONTRACTOR: Inland Asphalt Company CIP NO: 285 DESCRIPTION OF CHANGES This change order covers all costs related to delays, contractor time and personal protective equipment required because of or caused by the COVID-19 pandemic for the project. Item No. Description Unit Quantity Unit Price Total CO-1.1 COVID-19 Costs LS 1 $ 12,654.97 $ 12,654.97 Total Amount of this Change Order(incl.Tax): $ 12,654.97 VERBAL APPROVAL AND JUSTIFICATION Independent Justification on File Yes Verbal Approval 5/5/2020 1 Verbal Approval by EKA PHYSICAL COMPLETION Original Contract Working Days: 60 Revision By This Change Order: 0 Revisions by Prior Change Orders: 0 Total Revised Contract Working Days: 60 CONTRACT AMOUNT THESE CHANGES RESULT IN THE FOLLOWING ADJUSTMENTS OF TOTAL CONTRACT AMOUNT: ORIGINAL TOTAL CONTRACT AMOUNT(Plus Applicable Sales Tax) $ 1,611,000.00 TOTAL PRIOR CONTRACT CHANGE ORDER AMOUNT $ 0.00 TOTAL CONTRACT AMOUNT PRIOR TO THIS CHANGE ORDER $ 1,611,000.00 NET THIS CHANGE ORDER $ 12,654.97 TOTAL CONTRACT AMOUNT INCLUDING THIS CHANGE ORDER $ 1,623,654.97 0.Jared Boucher °��"�'°'�'pBow. CONTRACTOR ACCEPTANCE: �«�-�� ������-�wN•-� DATE: 9/28/2020 bt pl9�t1�aN dTO°' e�a.�c.A)S I he contractor hereb acce is ttns Sd ustrnent under the terms ot-Se tion 1-04:4of the on if?aicontract. RECOMMENDED BY: /f,( Cj Idri DATE: Ct fa) •roj y,"anager APPROVED BY: .�-!%`� / DATE: 09'2 •ZOO City 'n&JI.L. ' eer APPROVED BY: )1/(0/1 / DATE: IC-)/5/22 2 City Manager ATTACHMENTS: Distribution: ORIGINAL TO: City of Spokane Valley Clerk's Office COPIES TO: Contractor,PW Project File,Project Inspector,Finance Department COSV Form 9/5/2014 SCITY O�I.� ^ Community&Public Works Department LI C 10210 E Sprague Avenue ♦ Spokane Valley WA 99206 do•O Va11e Phone: (509)720 5000 • Fax: (509)720-5075 Ave • www.spokanevalley.orgWA Change Order Memo Date: 9/22/20 By: Erica K.Amsden,Project Manager Re: Change Order#1 for Indiana Avenue Preservation Project—Evergreen to Sullivan Project No.0285 1. Describe the Change Construction of the project began during the governor's phase 1 construction guidance/COVID-19 protocols. Additional staff time was required for cleaning equipment,taking temperatures,filling out COVID-19 questionnaires at the start of work each day,along with furnishing and using required personal protective equipment. 2. Evolution of the Change Construction of the project began during a pandemic. The contractor emailed me prior to the start of construction noting that additional equipment and time would be required to build the project safely and in accordance with the governor's protocols. I agreed that additional time and equipment would be necessary and discussed a plan to track the expenses and reach agreement at the end of the project. Time related to COVID-19 efforts was discussed daily and tracked on the COSV inspector daily reports (IDR). The contractor and all subcontractors have presented time and equipment costs that were compared to DR records and evaluated by the project manager. 3. Payment Please see the attached cost calculation. Costs were based on inspector field tracking of time related to COVID,receipts for personal protective equipment and contractor supplied rates for staff time. All claimed costs were evaluated by the project manager prior to being included on the final cost calculation. The file includes receipts and correspondence that supports the costs. 4. Time No additional time was granted as part of these costs. 5. Change Order Approval The change order was drafted by the project manager for signatures by the contractor and city manager. 6. Attachments See attached cost calculation sheet and justifications. .' CERTIFICATE OF LIABILITY INSURANCE I DATE(MMIDDEYYYY) 110/1/2020 THIS CERTIFICATE 18 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 poilcy(les)must have ADDITIONAL INSURED provisions or be endorsed. B 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 endorsemennt(s). PRODUCER Liberty Mutual Insurance Co.National Insurance East NAMME Valerie Reece 2000 Westwood Dr. MEM 613-867-3822 FAX INC.No.Extt INC.No): ADDRESS: Wausau,WI 54401Oldcaslle.oerts©ubertyMutual.com ADDRE INSURER(S)AFFORDING COVERAGE NAIC I www.LibertyMutual.com INSURER A: Liberty Mutual Fire Insurance Company 23035 INSURED inland Asphalt Company(120-SPO) INSURER a: Liberty Insurance Corporation 42404 CPM Development Corporation dba INSURER C: PO Box 3366 INSURER D: Spokane,WA 99220-3366 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:57008424 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. EXP m� EFF MO! 1TYPE OF INSURANCE _o POUCY NUMBER I POUCY I IMDD LIMITS A ✓ COMMERCIAL GENERAL UABIUTY TB2-C81-004095-110 9/1/2020 9/1/2021 EACHOCCuRRENCE 52,000,000 DAMAGE TO RENTED CLAlM3-MADE 7OCCUR PREMISES(Ea occurrence) $300,000 / Primary/Non-Contributory ✓ ✓ XCU Coverage Included MED EXP(Any one person) $50,000 _L Separation of Insured PERSONAL a ADV INJURY $2,000,000 GtN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY ✓ j LOC PRODUCTS-COMPOPAGO $2,000,000 OTHER: $ A AUTOMOBILEUAaLITY AS2-C81-004095-120 9/1/2020 9/1/2021 (Ea SINGLEUNIT $2,000,000 1 ANY AUTO BODILY INJURY(Per person) 5 A OWNED SCHEDULED ✓ / AS2-C81-054502-520 9/1/2020 9/1/2021 BODILY INJURY r accident $ —AUTOS ONLY —AUTOS Physical Damage only: ) HIRED NON-OWNED amg y' PROPERTY DAMAGE 5 — AUTOS ONLY AUTOS ONLY Comprehensive Dad$10,000 (Per accident) _ Collision Dpd$10,000 s _ UMBRELLAUAa —OCCUR EACH OCCURRENCE 5 EXCESS UAB CLAIMS-MADE AGGREGATE 5 DED RETENTIONS , S B WORKERS COMPENSATION WA7-C8D-004095-020 9/1/2020 9/1/2021 ' i gaATUTic ER AND EMPLOYERS'LIABILITY YIN AU except OH,ND,WA,WY ANYPROPRIETORPARTNER/EXECUTIVE EL.EACH ACCIDENT $1,000,000 OFFICERINEMBEREXCL.UDED? 1 N N/A ✓ B (Mandatory In NH) WC7-C81-004095-010 9/1/2020 9/1/2021 EL DISEASE-EA EMPLOYEE 51,000.000 rc yq describe undo DESCRIPTION OF OPERATIONS below WI,MN _ E.L DISEASE-POUCY LIMIT $1,000,000 A Washington Stop Gap TB2-C81-004095-110 9/1/2020 9/1/2021 BI Each Accident $1,000,000 Employers Liability Coverage BI Aggregate Limit $1,000,000 BI Each Employee $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be atlaahed If more space is required) RE: Indiana Ave. Street Preservation City of Spokane Valley is additional insured with respect to the above referenced project. Coverage is primary and non-contributory. Waiver of subrogation applies. CERTIFICATE HOLDER CANCELLATION City of Spokane Valley SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10210 E.Sprague THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Spokane Valley,WA 99206 AUTHORIZED REPRESENTATIVE Y • 1 Valerie Reece P 44a Xeed.4.. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 57000424 I IJi_44 19/20-9/21 - Standard 2/2 v/NA Stop Gap I Dona Sattale I e/12/2020 2,06,34 PH (CDT) I Page 1 of 2 POUCY NUMBER:TB2-C81-004095-110 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to 1. All work, induding materials, parts or include as an additional insured the person(s) or equipment furnished in connection with such organization(s) shown in the Schedule, but only with work, on the project (other than service, respect to liability for "bodily injury", "property maintenance or repairs) to be ed by or damage" or "personal and advertising injury" on behalf of the additional insured(s) at the t caused,in whole or in part,by: location of the covered operations has been 1. Your acts or omissions;or completed;or 2. The acts or omissions of those acting on your 2. That portion of "your work' out of which the half; injury or damage arises has been put to its in theperformance of intended use by any person or organization your ongoing operations for other than another contractor or subcontractor the additional insured(s) at the location(s) engaged in performing operations for a designated above. principal as a part of the same project. However C. With respect to the insurance afforded to these 1. The insurance afforded to such additional additional insureds, the following is added to insured only applies to the extent permitted by Section III—Limits Of Insurance: law;and If coverage provided to the additional insured is 2. If coverage provided to the additional insured is required by a contract or agreement, the most we required by a contract or agreement, the will pay on behalf of the additional insured is the insurance afforded to such additional insured will amount of insurance: not be broader than that which you are required by the contract or agreement to provide for such 1. Required by the contrail or agreement;or additional insured. 2. Available under the applicable Limits of B. With respect to the insurance afforded to these Insurance shown in the Declarations; additional insureds, the following additional whichever Is less. exclusions apply: This endorsement shall not increase the This insurance does not apply to "bodily injury' or applicable Limits of Insurance shown in the "property damage"occurring after Declarations. SCHEDULE Name Of Additional Insured Person(s) Location(s)Of Covered Operations Or Organization(s): Any owner,lessee,or contractor for whom you have Any location listed in such agreement agreed in writing prior to a loss to provide liability insurance Information required to complete this Schedule.if not shown above,will be shown in the Declarations. CG 2010 0413 ®Insurance Services Office,Inc.,2012 Page 1 of 1 Policy Number.AS2-C81-004095-120 Issued by:Liberty Mutual Fire Insurance Co. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED-NONCONTRIBUTING This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIERS COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is.An Insured Provision of the Coverage Form.This endorsement does not alter coverage provided in the Coverage form. Schedule Name of Person(s)or Organizations(s): Any person or organization where the Named Insured has agreed by written contract to include such person or organization Regarding Designated Contract or Project: Any Each person or organization shown in the Schedule of this endorsement is an"Insured"for Liability Coverage,but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. The following is added to the Other Insurance Condition: If you have agreed in a written agreement that this policy will be primary and without right of contribution from any insurance in force for an Additional Insured for liability arising out of your operations, and the agreement was executed prior to the "bodily injury" or"property damage", then this insurance will be primary and we will not seek contribution from such insurance. AC 84 23 08 11 ®2010, Liberty Mutual Group of Companies. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with Its permission. POLICY NUMBER:TB2-C81-004095-110 COMMERCIAL GENERAL LIABILITY CG24040509 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule below because of payments we make for injury or damage arising out of your ongoing operations or "your work"done under a contract with that person or organization and included in the"products- completed operations hazard'.This waiver applies only to the person or organization shown in the Schedule below. SCHEDULE Name Of Person Or Organization: As required by written contract or agreement entered into prior to loss. Infuination required to complete this Schedule,if not shown above,will be shown in the Declarations. CG 24 04 05 09 0 Insurance Services Office,Inc.,2008 . Page 1 of 1