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20-158.01 LaRiviere: Browns Park Playground & Shelter 21 I c-I Spokane Valley CHANGE ORDER NO: 1 ENGINEERING DIVISION CONSTRUCTION CONTRACT NO: 20-158 PROJECT: Browns Park Playground and Shelter CONTRACT DATE: 12/28/2020 PRIME CONTRACTOR: LaRiviere, Inc. CIP NO: 315 DESCRIPTION OF CHANGES Remove existing sod, lower rim of existing drywell, and regrade swale between competition volley-ball court and large picnic shelter to improve drainage. Replace sod. No irrigation modifications are included. Item No. Description Unit Quantity Unit Price Total ONSITE-SCHEDULE A CO-1.1 Regrade existing swale and replace sod $ 13,835.95 8.9% Sales Tax $ 1,231.40 Subtotal Schedule A $ 15,067.35 Total Amount of this Change Order(incl.Tax): $ 15,067.35 VERBAL APPROVAL AND JUSTIFICATION Independent Justification on File Yes Verbal Approval Yes Verbal Approval by Glenn Ritter PHYSICAL COMPLETION Original Contract Working Days: 50 Revision By This Change Order: 3 Revisions by Prior Change Orders: 6 Total Revised Contract Working Days: 59 CONTRACT AMOUNT THESE CHANGES RESULT IN THE FOLLOWING ADJUSTMENTS OF TOTAL CONTRACT AMOUNT: ORIGINAL TOTAL CONTRACT AMOUNT $ 375,577.59 TOTAL PRIOR CONTRACT CHANGE ORDER AMOUNT(through co#_) $ 0.00 TOTAL CONTRACT AMOUNT PRIOR TO THIS CHANGE ORDER $ 375,577.59 NET THIS CHANGE ORDER $ 15,067.35 TOTAL CONTRACT AMOUNT INCLUDING THIS CHANGE ORDER $ 390,644.94 Thomas CONTRACTOR ACCEPTANCE: / LaRiviere DATE: 7. /7 - Z The contractor hereby accepts this adjustment under the terms of Section 1-04.4 of the original contract. RECOMMENDED BY: DATE: 7-13-21 . Z Project Mange APPROVED BY: �� , DATE: /) 7'/9.ZUZ-/ ngin r APPROVED BY: it/ arti& � DATE: 7 16 2,I City Manager ATTACHMENTS: Proposed Change Order#010 Distribution: ORIGINAL TO: City of Spokane Valley Clerk's Office COPIES TO: Contractor, PW Project File, Project Inspector, Finance Department COSV Form 96/2014 1119 INCORPORATED Project Name: COSV Browns park Playground & Shelter PCO# 010 Owner/GC: City of Spokane Valley Date 6/21/21 Reference: Additional Swale Work Description of Work: LaRiviere Inc was asked to redo a swale to the east of the project outside of the original project boundaries. This swale needs to have the existing drywell lid lowered, sod removed, swale regraded, and new sod installed. The swale has no know irrigation in it and no allowance was made for any irrigation rework that is required. Description LABOR EQUIP MATERIAL SUB Qty UM Operator- Backhoe $49.11 24 HR $1,178.64 Operator- Skidsteer $40.44 24 HR $970.56 Landscape Labor $48.95 18 HR $881.10 Superintendent $75.00 17 HR $1,275.00 Cat 305.5 Hoe $125.00 24 HR $3,000.00 Skid Steer $115.00 24 HR $2,760.00 Mobilize Equip $350.00 1 LS $350.00 Demobilize Equip $350.00 1 LS $350.00 SOD 2,500 SF 0.45 2500 SF $1,125.00 Haul off old sod $325.00 1 LS $325.00 Labor $4,305.30 Mark Up 12% $ 516.64 Equipment $6,460.00 Mark Up 12% $ 775.20 Materials $1,125.00 Mark Up 12% $ 135.00 Subcontractor $325.00 Mark Up 5% $16.25 Sub Total $13,658.39 Insurance/Bond 1.3% $177.56 Sub Total $13,835.95 TAX 8.9% $1,231.40 TOTAL $15,067.35 LARIINC-01 CLONGINOTTI ACORLO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 7/15/2021 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 NAIMTEEACT Spokane Office PHONE PayneWest Insurance,Inc. (A/c,No,Ezt):(509)838-3501 �(A//C,No):(509)838-3511 501 N.Riverpoint Blvd.,Ste 403 ADDRESS: Spokane,WA 99202 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Alaska National Insurance Company 38733 INSURED INSURER B: LaRiviere,Inc. INSURER C: 17564 North Dylan Court INSURERD: Rathdrum,ID 83858 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DDIYYYYI (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X X 21D PS 08913 4/1/2021 4/1/2022 PREMISES(Ea o T ence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: WA STOP GAP $ 1,000,000 A AUTOMOBILE LIABILITY (CEOs accideDISINGLE LIMIT $ 1,000,000 ) X ANY AUTO X x 21D AS 08913 4/1/2021 4/1/2022 BODILY INJURY(Per person) $ OWNED SCHEDULED _ AUTOSRE� ONLY _ AUTOS BODILYO INJURYD (Per acodent) $ AUTOS ONLY _AUTOS ONLY (Peracadenl)AMAGE A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE 21D LU 08913 4/1/2021 4/1/2022 AGGREGATE $ 10,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY Y/N _STATUTE ERH ANYQp PROPRIETOR/PARTNER/EXECUTIVER/ E E.L.EACH ACCIDENT $ OFFICdEER/MEn BER EXCLUDED? N/A (Ma to I NIl) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Contract No.20-158,Browns Park Playground and Shelter,Spokane Valley Capital Improvement Project No.0315 City of Spokane Valley is additional insured,on a primary/non-contributory basis,including waiver of subrogation,as per attached forms. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, City of Spokane Valley ACCORDANCE WITH THE POLICY PROVISIONSCE WILL BE DELIVERED IN 10210 E Sprague Avenue Spokane Valley,WA 99206 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD