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20-085.02 Commonstreet Consulting: Sprague/Barker Intersection Improvements 2a• ©g5-02- 4111 . 1,71 Washington State �I/ Department of Transportation Supplemental Agreement Organization and Address Number 2 Commonstreet Consulting,LLC. Original Agreement Number 100 S.King St.,Ste. 100 Seattle,WA 98104 20-085 Phone: Project Number Execution Date Completion Date 0205 04/29/2020 12/31/2023 Project Title New Maximum Amount Payable Sprague/Barker Intersection Improvement Project $74,092.25 Description of Work Right-of-way services for the 0205 Sprague/Barker Intersection Improvement Project. The Local Agency of City of fi kaae V41]cy desires to supplement the agreement entered in to with Commonstreet Consulting.LLC. and executed on 04/29/2020 and identified as Agreement No. 20-085 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: Additional funds added to the contract to account for new property appraisals performed by Commonstreet Consulting due to the redesign of two properties. The redesign was requested by the property owners during row negotiations. 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: N/A III Section V, PAYMENT, shall be amended as follows: This supplement adds$5,525.00 is added to the original agreement of$ 68,657.25 to account for the added scope of work as described in Section 1. 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: Morgan B'sho ,PM By: J oNits.r y dvuel,1 Consultant Signature Approving Aut tority ignature 3'zy_ Z2 Date DOT Form 140-063 Revised 09/2005 �...41 COMMCON-01 TMCKNIGHT ACORD DATE(MWDD/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE 7/27/2021 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). CONTACT PRODUCER NAME: WAFD Insurance Group,Inc. FAX PO BOX 327 (A/C,o,Eat):(503)357-7111 (A/c,No): 1909 Cedar St ADMDRESS:tedm@wafdinsurance.com Forest Grove,OR 97116 INSURER(S)AFFORDING COVERAGE NAIC# •'%? INSURER A:Liberty Mutual Insurance INSURED INSURER B:SAIF Commonstr Multi INSURER C:Hiscox Insurance Company 100 S Kin 100 '.! INSURER D: Seattle, 04 INSURER E: ;1 :- INSURER F: COVERAGES C I es ' MBER: REVISION NUMBER: THIS IS TO CERTIFY THAT'1`HE POLO; - • %'• -TED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING AN'.ti' ;,: ENT 'i'" CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR 'jF AIN, T ` .;'Ii. AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF S yiekLICIES.LI HOW' HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DADDL '-- • OLI , BER POLICY EFF POLICY EXP LIMITS LTR INSD - (MM/DD/YYYYI (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY - EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR :LS58 1 . ,': 8/1/2021 8/1/2022 DAMAGETORENTED 1,000,000 X PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LI*APP IES PER: �•`.• GENERAL AGGREGATE $ 2,000,000 X POLICY .1 • LOC .F PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: 'I',''�' $ '"•`"- ' COMBINED SINGLE LIMIT AUTOMOBILE LtA�ILITY (Ea accident) $ ANY AUTO _ BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY-. ,'• S BODILY INJURY(Per accident) $ HIRED WNE� ( + ;�. PROPERTY DAMAGE AUTOS ONLY ON r (Per accident) w"•I- - $ A UMBRELLA LIAB X occ CURRENCE $ 5,000,000 X EXCESS LIAR CLAIy1{� •DE E 59671 8/1 8/1/21 G $ '=° 5,000,000 DED RETENTION$ 'R�., .,:, - - .: $ B WORKERS COMPENSATION PER I OTH- AND EMPLOYERS'LIABILITY '. t _e'^‘+4c - • STATU - ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y �- t;•,��"i' OOO 1/1/2O21 O21 "' H ACCIDE,' 1'000'000 OFFICER/MEMBER NH EXCLUDED? 1,000,000 (Mandatory ) E.L.:SEASE-' $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below4 E.L.DISE•` C Professional Liabili ' '•L2022 7/28/2021 7/2: DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be!ittached if more space is required) Professional Liability Aggregate Limit$2,000,000 Project#20-085. City of Spokane Valley is an additional insured to the ext ;coverage per form CG8810 0413. Profession . ity aggregate limit is $2,000,000. I : 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,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 COMMONSTREET CONSULTING LLC Page 1 of 2 STATE OF WASHINGTON Department of Labor& Industries Certificate of Workers' Compensation Coverage March 17, 2022 WA UBI No. 604 107 152 L&I Account ID 652,018-00 Legal Business Name COMMONSTREET CONSULTING LLC Doing Business As COMMONSTREET CONSULTING Workers' Comp Premium Status: Account is current. Estimated Workers Reported Quarter 4 of Year 2021 "11 to 20 (See Description Below) Workers" Account Representative Employer Services Help Line, (360) 902-4817 Licensed Contractor? No What does "Estimated Workers Reported" mean? Estimated workers reported represents the number of full time position requiring at least 480 hours of work per calendar quarter. A single 480 hour position may be filled by one person, or several part time workers. Industrial Insurance Information Employers report and pay premiums each quarter based on hours of employee work already performed, and are liable for premiums found later to be due. Industrial insurance accounts have no policy periods, cancellation dates, limitations of coverage or waiver of subrogation (See RCW 51.12.050 and 51.16.190). https://secure.lni.wa.gov/verify/Detail s/liabilityCertificate.aspx?UBI=604107152&LIC=&... 3/17/2022 COMMONSTREET CONSULTING LLC Page 2 of 2 https://secure.lni.wa.gov/verify/Details/liabilityCertificate.aspx?UBI=604107152&LIC=&... 3/17/2022