17-108.10 David Evans & Associates: Barker/BNSF GSP Dg.ID
Washington State
Department of Transportation
Supplemental Agreement Organization and Address
Number 10 City of Spokane Valley
Original Agreement Number 11707 E.Sprague Ave.,Suite 106
Spokane Valley,WA
17-108
Phone: 509-720-5102
Project Number Execution Date Completion Date
0143 August 24,2017 May 31,2023
Project Title New Maximum Amount Payable
Barker Rd/BNSF Grade Separation $3,146,274.69
Description of Work
Additional construction engineering support
The Local Agency of City of Spokane Valley
desires to supplement the agreement entered in to with David Evans and Associates,Inc.
and executed on August 24,2017 and identified as Agreement No. 17-108
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:
Task 19:Construction Support Services
Perform additional project administration,field support services,submittal reviews,and documentation support.
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: contract end date is revised to May 31,2023.
III
Section V, PAYMENT, shall be amended as follows:
See attached Exhibit A.This supplement adds$49,420.36 to the previous contract amount of$3,096,854.33 for a total amount
authorized of$3,146,274.69.The fixed fee amount is increased by$2611.35,for a total of$155,510.51.
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. Debra Seeman,Vice President By: .715m#,/
Dpiela
Consultant Signature Approving Authority Signature
Date
DOT Form 140-063
Revised 09/2005
® DATE(MM/DD/YYYY)
ACCORD CERTIFICATE OF LIABILITY INSURANCE
12/1/2023 11/29/2022
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).
p CONTACT
PRODUCER
Lockton Companies NAME:
444 W.47th Street,Suite 900 PHONE FAX
(A/C.No.EMI: (A/C,No):
Kansas City MO 64112-1906 E-MAIL
(816)960-9000 ADDRESS:
kctsu@lockton.com INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A:Continental Casualty Company 20443
INSURED DAVID EVANS AND ASSOCIATES,INC. INSURER B:Zurich American Insurance Company 16535
1401891 2100 S RIVER PARKWAY,SUITE 100 INSURER C:American Guarantee and Liab. Ins.Co. 26247
PORTLAND OR 97201 INSURER D:American Zurich Insurance Company 40142
INSURER E:
INSURER F:
COVERAGES MAIN CERTIFICATE NUMBER: 14894652 REVISION NUMBER: XXXXXXX
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 POUCPOLICY NUMBER (MM DDY
EFF POLICY EXP
TYPE OF INSURANCE
LTR INSD WVD /YYYY) (MMIDD//YYYY) LIMITS
B X COMMERCIAL GENERAL LIABILITY N N GL09830389 12/1/2022 12/1/2023 EACH OCCURRENCE $ 1,000,000
DAMAGE TED
CLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) $ 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
X POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER: $
C AUTOMOBILE LIABILITY N N BAP9830390 12/1/2022 12/1/2023 COMBIaccidNEDent)SINGLE LIMIT $
(Ea 1,000,000
x
ANY AUTO BODILY INJURY(Per person) $ XXXXXXX
OWNED SCHEDULED BODILY INJURY(Per accident) $ XXXXXXX
AUTOS ONLY AUTOS—
HIRED NON-OWNED PROPERTY DAMAGE $ XXXXXXX
AUTOS ONLY AUTOS ONLY (Per accident)
$
UMBRELLA UAB OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX
EXCESS LIAB CLAIMS-MADE AGGREGATE $ XXXXXXX
DED RETENTION$ $ XXXXXXX
WORKERS COMPENSATION PER OTH-
D AND EMPLOYERS'LIABILITY �,/N N WC9336626 12/1/2022 12/1/2023 X STATUTE ER
PROPRIETOR/PARTNER/EXANYIPROR D7 ECUTIVE N N/A E.L.EACH ACCIDENT $ 1,000,000
FF(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
A PROF.LIAB./ N N AEH591924704 12/1/2022 12/1/2023 PER CLAIM$1,000,000
CONTRACTORS ANNUAL AGGREGATE$1,000,000
POLLUTION LIAB.
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required)
RE:CONTRACT#17-108.BARKER ROAD/BNSF GRADE SEPARATION PHASE I—CONCEPT DEVELOPMENT DESIGN SERVICES.THE STATE OF WASHINGTON AND CITY OF
SPOKANE VALLEY,THEIR OFFICERS,EMPLOYEES AND AGENTS ARE ADDITIONAL INSUREDS AS RESPECTS GENERAL LIABILITY AND AUTO LIABILITY,AND THESE
COVERAGES ARE PRIMARY,AS REQUIRED BY WRITTEN CONTRACT.THE ADDITIONAL INSUREDS'OWN COVERAGE IS EXCESS OF AND NON-CONTRIBUTORY WITH THE
GENERAL LIABILITY,AND ON THE AUTO LIABILITY AS RESPECTS THE USE OF VEHICLES OWNED BY DAVID EVANS&ASSOCIATES,INC.WHERE REQUIRED BY WRITTEN
CONTRACT.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
14894652 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
CITY OF SPOKANE VALLEY ACCORDANCE WITH THE POLICY PROVISIONS.
ATTN:CANDANCE POWERS-HENDERSON
10210 E SPRAGUE AVE AUTHORIZED REPRESENTATIV-
SPOKANE VALLEY WA 99206
I ,,, 41
@ 1988,015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
DOCUMENTS REQUIRING THIRD-PARTY NOTIFICATION
PRIOR TO PUBLIC DISCLOSURE
This page has been inserted in place of the page(s) entitled "Exhibit A/Summary of Payments -
Supplement 10" of a contract document which sets forth the rates charged by the contracting
entity. Pursuant to the Washington Public Records Act (RCW 42.56), the City has determined
that this record may be available for disclosure upon request for review by a third party.
However, pursuant to RCW 42.56.520 and RCW 42.56.540, the City has determined it is
appropriate to provide the contracting entity notification of any request for this record to allow
them time to determine if they wish to seek to obtain a court order requiring the record to be
withheld.
Please contact the City Public Records Officer at (509) 720-5000 or visit our website at
www.spokanevalley.org to complete a Public Record Request to receive a copy of this record.