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20-172.01 KPFF Consulting Engineers: Sullivan/SR 290 Interchange Reconstruction Adak Washington State 11 Department of Transportation Supplemental Agreement Organization and Address Number 1 KPFF, Inc. 1601 Fifth Avenue, Suite 1600 Original Agreement Number Seattle,WA 98101 20-172..0 ( Phone: 206-926-0548 Project Number Execution Date Completion Date 031 1 October 6, 2020 December 31, 2022 Project Title New Maximum Amount Payable Sullivan Road/State Route 290 Interchange Reconstruction $284,854.87 Description of Work Further develop and evaluate the recommendations from the Sullivan Road Corridor Study as they relate to the Sullivan Road/SR290 Interchange. This project is expected to take place in three phases, described in Exhibit A, Scope of Work. The Local Agency of City of Spokane Valley desires to supplement the agreement entered in to with KPFF.Inc. and executed on October 6, 2020 and identified as Agreement No. 20-172 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. 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 is revised to December 31. 2022 III Section V, PAYMENT, shall be amended as follows: No change. 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.By: a-(31Jr�+ �� " �n-& P By: Ark ( IItOul4 ift151-- ConsultantSignature `--r - pproving Authority Signature t4421 Date DOT rorm 140-0C3 Revised 09/2D05 Client#: 25326 KPFFINCO YYYY) ACORDT. CERTIFICATE OF LIABILITY INSURANCE 9/2 DATE(4/2021 MMIDDIMWDDI 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 ACT Sabrina Wynn Greyling Ins. Brokerage/EPIC PHONE 4707852254 FAX 3780 Mansell Road,Suite 370 a MAIo Ext): {A/C,No): ADDRESS: sabrina.wynn@greyling.com Alpharetta,GA 30022 INSURER(S)AFFORDING COVERAGE NAIC# INSURER National Union Fire Ins.Co. 19445 INSURED INSURER B:The Continental Insurance Company 35289 KPFF, Inc. New Hampshire Ins.Co. 23841 INSURER C: P 1601 5th Ave Allied World Surplus24319 Lines Ins Suite 1600 INSURERD: INSURER E: Seattle,WA 98101 INSURER F: COVERAGES CERTIFICATE NUMBER: 21-22 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 MI LIMITS LTR INSR WVD POLICY NUMBER (MMIDDIYYYY) (MDDIYYYY) A X COMMERCIAL GENERAL UABIUTY GL5268336 04/01/2021 04/01/2022 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR PREMISES(EaE rrence) $500,000 MED EXP(Any one person) $25,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X J CT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY CA9775930 04/01/2021 04/01/2022 COMaccidenUBINED SINGLE LIMIT $ r 2 000,000 (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 6050399824 04/01/2021 04/01/2022 EACH OCCURRENCE $10,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED X RETENTION$O $ C WORKERS COMPENSATION WCO22298245(AOS) 04/01/2021 04/01/2022 X STATUTE EORH AND EMPLOYERS'LIABILITY C ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WCO22298244(CA) E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (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 D Professional/ 03120067 10/10/2021 10/10/2022 Per Claim$10,000,000 Pollution Aggregate$10,000,000 Liability SIR: $250,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Sullivan Road/State Route 290.City of Spokane Valley is named as an Additional Insured on the above referenced liability policies with the exception of workers compensation&professional liability where required by written contract.The above referenced liability policies with the exception of workers compensation and professional liability are primary&non-contributory where required by written contract. CERTIFICATE HOLDER CANCELLATION City of Spokane Valley SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10210 East Sprague Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Spokane,WA 99206-0000 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 #52905881/M2900361 SWY01