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17-090.02 Welch Comer: Sullivan Wellesley Intersection Improvements 17-090.02 AIM Washington State �� Department of T1r'ansportation Supplemental Agreement Organization and Address Number 2 Welch Comer&Associates,Inc. Original Agreement Number 330 E.Lakeside Ave.,Ste 101 Coeur d'Alene,ID 83814 17-090 Phone: 208-664-9382 Project Number Execution Date Completion Date 0249 December 21,2017 December 31, 2022 Project Title New Maximum Amount Payable Sullivan&Wellesley Intersection Improvement Project-Ph.1 $121,450 Description of Work Public involvement,conceptual design,and traffic capacity&safety analysis at the intersection of Sullivan and Wellesley in the City of Spokane Valley. Concept options to be analyzed include a traffic signal,single lane roundabout,or a double lane roundabout. The Local Agency of City of Spokane Valley desires to supplement the agreement entered in to with Welch Corner&Associates,Inc. and executed on 12/21/2017 and identified as Agreement No. 17-090 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: 1 Section 1, SCOPE OF WORK, is hereby changed to read: No change. II 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 Ill 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. MarkCalkotoi By: irk)/q'�'j /r1�/[.�� By: " ►Ark 064_ on nt ignature Approving A rity Signature By: (4(7(26024 ate DOT Form 140-063 Revised 09/2005 Approving Authority Signature WELCCOM-01 WRAMOS AM E:1 DATE IMM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/18/2021 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 Wendy Ramos NAME: The Hartwell Corporation PHONE Ext): I FAx (A/C,No): PO Box 400 E-MAIL Caldwell,ID 83606 ADDRESS:wendy@thehartwellcorp.com INSURER(S)AFFORDING COVERAGE NAIC 0 INSURER A:Idaho State Insurance Fund 36129 INSURED INSURER :Berkley Insurance Company 32603 -_ Welch Corner&Associates Inc INSURER C: 330 E Lakeside Ave,Suite 101 INSURER D: Coeur D'Alene,ID 83814 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 ADDL SUBR POUCY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER IMMIDD/YYYYI IMM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ _ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POUCY jP& LOC PRODUCTS-COMP/OP AGG $ OTHER: $ A COMBINED SINGLE LIMIT AU LIABILITY (Ea ANY AUTO BODILY INJURY(per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ AUTOS ONLY NON-OWNEDUTS N veracER Yt?AMAGE UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ A WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATUTE ERH 651659 11/1/2021 11/1/2022 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE YNN NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (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 $ B Professional Liabili AEC-9042787-03 3/1/2021 3/1/2022 Each Claim Limit 1,000,000 B Retro Date 1/1/1977 AEC-9042787-03 3/1/2021 3/1/2022 Aggregate Limit 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Sullivan&Wellesley Improvement Proj-Phase 1 Design 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 E.Sprague Ave. Spokane Valley,WA 99206 AUTHORIZED REPRESENTATIVE 4444-.1 i ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Client#: 54546 WELCCOME YYYY) DDI MM/ ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE 12/( tMDD! 1 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 CONTACT Trudy Henry Greyling Ins. Brokerage/EPIC PHONE 770-552-4225 FAX 866-550-4082 (A/C,No,EA: (A/C,No): 3780 Mansell Rd.Suite 370 ADDRESS: Trudy.Henry@greyling.com Alpharetta,GA 30022 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Sentinel Insurance Company 11000 INSURED INSURER B: Welch Corner&Associates, Inc. INSURER C: 330 E.Lakeside Ave,Suite 101 INSURER D: Coeur D Alene, ID 83814 INSURER E: 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 W LIMITS LTR INSR VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIALGENERALUABIUTY 2OSBWPE75O6 06/01/2021 06/01/2022 EAAI-IISES( CCOECCCOURRRENCE $1,000,000 CLAIMS-MADE X OCCUR PEREMEaEocNaDence) $1,000,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- PRODUCTS-COMP/OP AGG $2 00O 000 POLICY X JECT LOC > > OTHER: $ A AUTOMOBILE LIABILITY 20UEGIB8620 06/01/2021 06/01/2022 COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ $ v AUTOS ONLY v AUTOS ONLY (Per amide accident) A X UMBRELLA LIAB X OCCUR 20SBWPE7506 06/01/2021 06/01/2022 EACH OCCURRENCE $3,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000 DED X RETENTION$10000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (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) RE:Sullivan&Wellesley Contract CIP#0249 The City of Spokane is named as an Additional Insured with respects to General&Automobile Liability where required by written contract.Should any of the above described policies be cancelled by the issuing insurer before the expiration date thereof,30 days'written notice(except 10 days for nonpayment of premium)will be provided to the Certificate Holder. CERTIFICATE HOLDER CANCELLATION Cityof Spokane ValleySHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE p THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10210 E.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 #53003639/M2740130 THEN2