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17-108.11 David Evans & Associates: Barker/BNSF GSP 17- Io$, Il Washington State �� Department of Tr ansportation Supplemental Agreement Organization and Address Number 11 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 December 31,2023 Project Title New Maximum Amount Payable Barker Rd/BNSF Grade Separation $3,146,274.69 Description of Work This supplement requests authorization to transfer funds from the Management Reserve Fund(MRF)budget on the above project for extra work related to completing the Record of Survey and monumentation work. 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: Provide additional budget to place new right of way monumentation,and replace one DNR monument and finalize the Record of Survey. 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 December 31.2023. III Section V, PAYMENT, shall be amended as follows: This supplement requests the City authorize release of$9,732.17 of the MRF for extra work associated with monumentation work, as detailed in the attached Exhibit A-2.The total authorized contract amount will remain$3,146,274.69. 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. 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E o - m E E IQ 01 o E Z _ i2 a Q p E to C y N in z ti ' m E Q o a,a m 9 Tii -o �o c aU 6 2 O i.Q LL t e j J w DATE(MM/DDIYYYY) ACCORD AC� 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). PRODUCER Lockton Companies CONTACT 444 W.47th Street,Suite 900 PHONE FAX (A/C.No,Ext(: (A/C,No): Kansas City MO 64 1 1 2-1 906 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS B X COMMERCIAL GENERAL LIABILITY N N GL09830389 12/1/2022 12/1/2023 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ 1,000,000 MED EXP(Any one person) $ 10,000 PERSONAL 8,ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JERC LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ C AUTOMOBILE LIABILITY N N BAP9830390 12/1/2022 12/1/2023 COMBINED SINGLE LIMIT $ (Ea accident) 1,000,000 x ANY AUTO BODILY INJURY(Per person) $ XXXXXXX _ OOUTOS ONLY SCHEDWNED SCHEDULED BODILY INJURY(Per accident) $ XXXXXXX HIRED NON-OWNED PROPERTY DAMAGE $ XXX� GCSC AUTOS ONLY AUTOS ONLY (Per accident) $ XXXXXXX UMBRELLA LIAB OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX EXCESS LIAB CLAIMS-MADE AGGREGATE $ XXXXXXX DED RETENTION$ $ XXXXXXX D WORKERS COMPENSATION N PER OTH- AND EMPLOYERS'LIABILITY �,/N WC9336626 12/1/2022 12/1/2023 X STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE 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 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 I 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 7 SPOKANE VALLEY WA 99206 .4112-1/‘ ©1988 015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD