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20-146.01 Horrocks Engineering: Wilbur Sidewalk Project Mission to Boone WiWashington State r Department of Transportation Supplemental Agreement Organization and Address Number 20-146.01 Horrocks Engineers,Inc. Original Agreement Number 1325 W. 1st Ave.,Ste.204,Spokane,WA 99201 20-146 Phone: (509)747-6790 Project Number Execution Date Completion Date TAP-1223(006) 12/31/2022 Project Title New Maximum Amount Payable Wilbur Sidewalk Project(Boone to Mission) $9,700 Description of Work Perform surveying within the project limits and legal descriptions for two temporary construction easements. The Local Agency of Spokane Valley desires to supplement the agreement entered in to with Horrocks Engineers,Inc. and executed on 8/21/2020 and identified as Agreement No. 20-146 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: Supplement the existing scope of work to include legal descriptions for temporary construction easements within parcels identified on the right of way map provided by the city of Spokane Valley I I Section IV, TIME FOR BEGINNING AND COMPLETION, is amended to change the number of calendar days for completion of the work to read: The completion date for this contract has been extended to 12/31/2022 III Section V, PAYMENT, shall be amended as follows: Maximum amount payable has been increased to$9,700 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. ArkBy: By:tA� GL58Y (11,pwCa, b Consultant /1/(4provi Signature . .u i'. 5i nature 9 b 9 g 3( zfat?I DOT Form 140-063 Revised 09/2005 Exhibit "A" Summary of Payments HOR Project City of Spokane € S ' a* .OS Valley ENGINEERING E N G II �N� E R S Wilbur Roar] hem Boone to Mission • . BE trio-: Dale: August 5,21i20 BUDGET ESTIMATE-SCOPE OF SERVICES . .Wee -4• I(Igfi'l: `�fi0 lllllleetorie_; :Nv.€y: y z, , _ l3e�bfiptbn Of WOrlc� n.: Vsll�a 1 Wilbur Road•Topographic Mapping end Survey 95.5% $8,40D Survey and map existing_site features as shown on the attached map. Prepare a one foot contour topographic map shovwing curbing and sldwalks,asphalt,parking,fences,buildings, stuctures,trees, bushes, mailboxes and other features that may be benef1cal fordesign-fvurflases. 'Survey control and morwumerltalion will be located as necessary for {determination of right of way. Review assessor records end adjoining property deeds as needed. Deliverable to be provided to the City is a Civil 3d cadd drawing with xml surface file,full size stamped bond copy and a point text file. Utility Locate Services A 00 2 "One Call Locate'service Mill be called for locateswithin public right of ��° $' way. Marks provided by that servlae.wNl be included in he topographic mapping. Other above ground featues(consisting of valve boons, hydrants, poles, riser boxes, manholes and other such observed features) have'been included In the topographic mapping above . BUDGET EVIIMATE-SURVEY SWIM OF SERVICES stem Project Milestone Project Scheduled (Description of Work) 96 Value mmolowwwwwwwworminmel 1 Legal Des4riptions for Parcels 45L61,9649 and 451614417 City of Spokane Valley, An average east With exhibit maps provided b y p cy,prepare 2 separate legal of S4501 per legal descriptions for the above parcels for use In temporary easement acquisition. Cuirreet 'warranty deeds will be researched and used as the basis for the descriptions. DOT Form 140-063 Revised 09/2005 �.....41 HORRENG-01 AGALLAHER ACORO DATE(MM/DD/YYYY) `,...--- CERTIFICATE OF LIABILITY INSURANCE 6/26/2021 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 Ashley Gallaher NAME: American Insurance&Investment Corp. PHONE 448 South 400 East (A/C,No,Ext):(801)364-3434 645 jjc,No►:(801)355-5234 Salt Lake City, UT 84111 ADDRE SS:Ashley.Gallaher@american ins.com INSURER(S)AFFORDING COVERAGE NAIC S INSURER A:Hartford Fire Insurance Co. 19682 INSURED INSURER B:Hartford Casualty Insurance Co 29424 Horrocks Engineers,Inc. INSURER C:Hartford Ins Co of The Midwest 37478 2162 W Grove Pkwy,Ste 400 INSURER D:XL Specialty Insurance Company 37885 Pleasant Grove,UT 84062 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 IMM/DD/YYYY) IMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 34UUNOZ0016 7/1/2021 7/1/2022 DAMAGETORENTED 1,000,000 X PREMISES IEa occurtence) $ 5,000 MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X ST& LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER. $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X 1 ANY AUTO 34UENOZ0015 7/1/2021 7/1/2022 BODILY INJURY(Per person) $ _. OWNED SCHEDULED AUTOS ONLY AUTOS BODILY pBOODILY INJURYp (Per accident) $ AUTOS ONLY AUTO ONLY (Per acEciRdent)AMAGE $ $ B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE 34XHUOZ0017 7/1/2021 7/1/2022 AGGREGATE $ 10,000,000 I DED X RETENTION$ 0 $ C WORKERS COMPENSATION Xy PER STATUTE0TH AND EMPLOYERS'LIABILITY - 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE ER Y/N 34WEOK8HOL 7/1/2021 7/1/2022 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ D Prof Liab Claim Made DPR9978619 7/1/2021 7/1/2022 Per Claim 10,000,000 D Retro Date 1/1/1965 DPR9978619 7/1/2021 7/1/2022 Aggregate 10,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Re: Contract Number:20-146/Wilbur Sidewalks Mission to Boone City of Spokane Valley is named as additional insured,per written contract,with regards to the General Liability,coverage is primary.30 days'notice of cancellation is provided. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Spokane ValleyTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN p ACCORDANCE WITH THE POLICY PROVISIONS. 10210 East Sprague Ave Spokane,WA 99206 AUTHORIZED REPRESENTATIVE�NT" i e2Wf-'.4. __ ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD