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21-030.01 Avidex Industries: CenterPlace Great Room Video Wall Repair DocuSign Envelope ID:7B86DD68-52AA-42FA-99ED-D71F8593D514 CONTRACT AMENDMENT TO THE AGREEMENT BETWEEN THE CITY OF SPOKANE VALLEY AND AVIDEX INDUSTRIES,LLC Spokane Valley Contract#21-030.01 For good and valuable consideration,the legal sufficiency of which is hereby acknowledged,City and the Contractor mutually agree as follows: 1. Purpose: This Amendment is for the Contract for services fr the CenterPlace Great Room Video Wall Repair by and between the Parties, executed by the Parties oil April 13, 2021, and which terminates on May 31,2021. Said contract is referred to as the"Original Contract"and its terms are hereby incorporated by reference. 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. 3.Amendment Provisions: This Amendment is subject to the following amended provisions, which are as follows. 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. Extend the term of contract to June 30,2021. 4. Compensation Amendment History: This is Amendment #1 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 04/13/21 $7,083.95 Amendment#1 05/20/21 =0- Total Amended Compensation - $7,083.95 The parties have executed this Amendment to the Original Contract this 27 day of May,2021. CITY OF SPOKANE VALLEY: AVIDEX INDUSTRIES,LLC: (1.4451../jv (--ewmaismwbr Mark Calhoun y 032688,acaead oose Adams City Manager Its: General Manager • 5/20/2021 i . APPROVED AS TO FORM: • Office o t e City/ ney 1 AccoRD DATE(MM/oD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 03/23/2021 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 CONTACT Marsh USA,Inc. PHONE ONE FAX 1166 Avenue of the Americas (A/C.No.Ext): (A/C.No): New York,NY 10036 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL# CN102238245-Avide-GAUP-20-21 INSURER A:Tokio Marine America Insurance Company 10945 INSURED INSURER B:Travelers Indemnity Company 25658 Avidex Industries,LLC 13555 Bel-Red Road,Suite 226 INSURER C:N/A N/A Bellevue,WA 98005 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: NYC-011066841-01 REVISION NUMBER: 2 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 W /Y LIMITS LTRINSD VD POLICY NUMBER (MM/DDYYY) (MMIDD/YYYY) A X COMMERCIAL GENERAL LIABILITY X X CLL6403455-10 06/30/2020 06/30/2021 EACH OCCURRENCE $ 1,000,000 DAMAGE TO CLAIMS-MADE X OCCUR PREMISES(EaENTED occurrence) $ 1,000,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JECT PRO- LOC PRODUCTS-COMP/OPAGG $ 1,000,000 OTHER: $ B AUTOMOBILE LIABILITY X X 810-3N540859-43-20-G 06/30/2020 06/30/2021 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED x NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident) A x UMBRELLA LIAB X OCCUR X X CU6406757-07 06/30/2020 06/30/2021 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETORIPARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (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) The City of Spokane Valley is included as Additional Insured where required by written contract or agreement, CERTIFICATE HOLDER CANCELLATION The City of Spokane Valley SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10210 East Sprague Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Spokane Valley,WA 99206 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Mina Cho ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD C DATE(MMIDD/YYYY) A CC CERTIFICATE OF LIABILITY INSURANCE 3/23/2021 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 CONTACT NAME: Lori E.Staples Arthur J. Gallagher Risk Management Services, Inc. INC.°NNo.Eat): 336-217-5767 FAX No):336-275-1776 4700 Homewood Court, Suite 260 E-MAIL Raleigh NC 27609-5732 ADDRESS: lori_staples@ajg.com - INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Twin City Fire Insurance Company 29459 INSURED INSURER B: Avidex Industries, LLC 13555 Bellevue-Redmond Road INSURER C: Bellevue,WA 98005 INSURER D: _ INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1911656972 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 NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE TO RENTED $ CLAIMS-MADE OCCUR PREMISES Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JE T LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION 22WBAA3GT9 6/30/2020 6/30/2021 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y ANYPROPRIETOR/PARTNER/EXECUTIVE N N N/A E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED7 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) RE:CenterPlace Video Wall Repair CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. The City of Spokane Valley 10210 East Sprague Avenue AUTHOR ED REPRESENTATIVE Spokane Valley WA 99206 G!o ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • Washg an State Depum,emd Labor&Industries(https://Ini.wa.,gov AVIDEX INDUSTRIES LLC Owner or tradesperson 13555 BEL RED RD STE 226 Principals BELLEVUE,WA 98005 RICHARDSON,MICHAEL,PARTNER/MEMBER KING 3-0330 KING County CLARK,MICHAEL,PARTNER/MEMBER HARRIS,JOEL,PARTNER/MEMBER LANGEL,JEFFREY C,PARTNER/MEMBER PECK,PAUL D,PARTNER/MEMBER BALLJO,JOEL A,PARTNER/MEMBER (End:12/19/2012) Doing business as AVIDEX INDUSTRIES LLC WA UBI No. Business type 602 347 574 Limited Liability Company Governing persons PAUL D PECK MICHAEL C RICHARDSON; JOEL AMOS BALLEJO; MICHAEL A CLARK; License Verify the contractor's active registration/license/certification(depending on trade)and any past violations. Electrical Contractor Active Meets current requirements. License specialties LIMITED ENERGY License no. AVIDEIL963CZ Effective—expiration 02/09/2004—02/11/2022 Designated administrator Active Douglas,Andrew J Meets current requirements. License type License no. Electrical Administrator DOUGLAJ925P1 Bond Great American Ins Co $4,000.00 Bond account no. 0470535 Received by L&I Effective date 11/07/2014 11/01/2014 Expiration date Until Canceled WESTERN SURETY CO $4,000.00 Bond account no. 929413469 Received by L&I Effective date 02/06/2007 02/09/2007 Expiration date Until Canceled Savings " No savings accounts during the previous 6 year period. License Violations No license violations during the previous 6 year period. Certifications & Endorsements OMWBE Certifications No active certifications exist for this business. Apprentice Training Agent No active Washington registered apprentices exist for this business.Washington allows the use of apprentices registered with Oregon or Montana.Contact the Oregon Bureau of Labor&Industries or Montana Department of Labor &Industry to verify if this business has apprentices. Workers' Comp Do you know if the business has employees?If so,verify the business is up-to-date on workers'comp premiums. This company has multiple workers'comp accounts. Active accounts L&I Account ID Account is current. 110,231-00 Doing business as AVIDEX Estimated workers reported Quarter 4 of Year 2020"51 to 75 Workers" L&I account contact T4/RAECHEL WRIGHT(360)902-4579-Email:WRIV235@lni.wa.gov Track this contractor 0 Public Works Requirements Verify the contractor is eligible to perform work on public works projects. Required Training—Effective July 1,2019 Exempt from this requirement. Contractor Strikes No strikes have been issued against this contractor. Contractors not allowed to bid No debarments have been issued against this contractor. Workplace Safety & Health Check for any past safety and health violations found on jobsites this business was responsible for. No inspections during the previous 6 year period.