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22-189.01 Country View Landscape: On Call Winter Snow Operators CONTRACT AKEIVDMIENT TO THE AGREEMENT BETWEEN TUE CITY OF SPOKANE VALLEY AND COUNTRY VIEW LANDSCAPE Spokane VaBey Contract#22-189.01 For good astd valuable consideration,the icgat sufficiency of which is hereby acknowiedged,City and the Country View LigNiStApe mutually Agrere m,tonows: GPI> L puwoke:This Agocralmnat ki for the Contract for City Sim*snow minim1 by and between the Parties, eaocuted by the Patties on November 4,204cand which terminates on Ardi 30,204. Said contact is referred 10 as the"Original.Contract"and I *ins an hercby inecnnrated by Team= 2,Original Conuar..-t Provisions:The Patti=agree to continue to abide by those terms and conditions of tbe Original Contract nod any antendreenmtlacteto which are not specifically modified by this Aincrahnent. 3_Ajmerkimt,Iyoxisiom: This Arrandokent is 1512bieet to the following attended provisions,which are either as follows,or attached hereto as Appendix"A . All Mall an=ded provilinna are hereby incorporated by reference herein and shall control over any conflicting provisions or the Original Contract including any pigViQL13 amendinuns thereto_ Ihe amount tmtbATioetink_amgki for the remainder of the 2022-2023:num st'ILSOT3 is increased by giliddti51.(Lonal 001topotyjcleAtilinnrtt Wog:. .. , . 4.,Componsatitng)peattimthisiorv:This is AMMIWILItt#J of the Original Contract The histcri of amendments to the compensation on the Original Contractand ail.amendments is as follow Date Compensation Original.Contract Amount November 4,2023 $40,0011.00 Amendment 4.9 _ . To he orecuted $I 0„000.00 Total Amended Compensation $50,406,0111 (lit The parties have executed this Amendment to the Original Contract this day of Fcbmaiy zoa3. CITY OF SPOKANE VALLEY: CX)I.FNW V 7,w I ANDSCAPE: cito/ it Hohman By:Jo apatite City Mart APPROVED AS TO FORM: ‘ 7 office 0 111-, , City A wy 1 ACQ® DATE(MM/DD/YYYY) C - CERTIFICATE OF LIABILITY INSURANCE 11/01/2022 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). PRODUCER CONTACT NAME: Blake Jordan(793433P) PHONE FAX 915 E Hawthorne Rd Ste E (A/C,NO,EXT):509-483-4580 (A/C,No):509-466-0253 E-MAIL Spokane WA 99218-1482 ADDRESS: bjordan@farmersagent.com INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Truck Insurance Exchange 21709 INSURER B: Farmers Insurance Exchange 21652 COUNTRY VIEW LANDSCAPE LLC INSURER c: Mid Century Insurance Company 21687 7707 N EXCELL DR INSURER D: INSURER E: SPOKANE WA 99208 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME 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 SUBJECTTO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDTL SUER POLICY NUMBER POLICYEFF POLICYEXP LIMITS LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(EaOccurrence) $ 100,000 MEDEXP(Anyoneperson) $ 5,000 B Y 606994740 05/24/2022 05/24/2023 PERSONAL&ADVINJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 1X POLICY X PROJECT LOC PRODUCTS-COMP/OPAGG $ 4,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00C (Ea accident) ANY AUTO BODILYINJURY(Perperson) $ C OWNED AUTOS v SCHEDULED BODILY INJURY(Per accident)$ ONLY fN AUTOS Y 607005208 08/18/2022 08/18/2023 HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ - EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTHER $ AND EMPLOYERS'LIABILITY STATUTE ANY PROPRIETOR/PARTNER/ Y/N E.L.EACH ACCIDENT $ EXECUTIVE OFFICER/MEMBER N/A . EXCLUDED?(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 1 Ryes,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) Certificate Holder is Listed as additional insured CERTIFICATE HOLDER CANCELLATION City of Spokane Valley SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 10210 East Sprague Ave DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Spokane Valley,WA 99206 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION.All Rights Reserved 31-17r q 1 1-1 S The ACORD name and loan are reaistered marks of ACORD a•• 'it }! 4i 57AIE''OF WASHINGrON Department of Labor&Industries Certificate of Workers' Compensation Coverage November 1, 2022 WA UBI No. 604 924 846 L&I Account ID 318,121-00 Legal Business Name COUNTRY VIEW LANDSCAPE LLC Doing Business As COUNTRY VIEW LANDSCAPE LLC Workers'Comp Premium Status: Recently opened account,no premiums are due or owed at this time. Estimated Workers Reported N/A (See Description Below) Account Representative Employer Services Help Line,(360)902-4817 Licensed Contractor? Yes License No. COUNTVL782K6 License Expiration 05/26/2024 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 5l.1 2.050 and 51.16.190).