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19-162.06 Poe Asphalt Paving IncCONTRACT AMENDMENT TO THE AGREEMENT BETWEEN THE CITY OF SPOKANE VALLEY AND Poe Asphalt Paving Inc. Spokane Valley Contract 19-162.06 For good and valuable consideration, the legal sufficiency of which is hereby acknowledged, City and the Poe Asphalt Paving Inc. mutually agree as follows: 1. Purpose: This Amendment is for the Contract for additional street maintenance for local access roadway work by and between the Parties, executed by the Parties on March 13, 2020, and which terminates on December 31, 2023. Said contract is referred to as the "Original Contract" and its terms are hereby incorporated by reference. 2. Original Contract Provisions: The Parties agree to continue to abide by those terms and conditions of the Original Contract and any amendments thereto which are not specifically modified by this Amendment. 3. Amendment Provisions: This Amendment is subject to the following amended provisions, which are either as follows, or attached hereto as Appendix "A". All such amended provisions are hereby incorporated by reference herein and shall control over any conflicting provisions of the Original Contract, including any previous amendments thereto. The amount authorized to be expended for 2023 only is increased by an additional $317 208 89 to provide Rock Ridge Drive from 16`h Avenue to the South End 19t' Avenue east from Rock Ridge Drive to End 4. Compensation Amendment History: This is Amendment #3 of the Original Contract. The Original Contract incorporates annual renewals and the 2022 Contract Amount shown was executed on December 8, 2021. The history of amendments to the compensation on the Original Contract and all amendments is as follows: Date Contract Amount 2023 Contract Amount 01/01/2023 $ 1,566,980.77 Amendment #3 (This Amendment) To be executed $ 317,208.89 Total Amended 2023 Contract Amount $ 1,884,189.66 The parties have executed this Amendment to the Original Contract this day of July 2023. CITY OF SPOKANE VALLEY: ohn Hohman City Manager APPROVED AS TO FORM: o the City Attorney POE ASPHALT PAVING INC. Z.I By: Brooke lly Its: Project Manager �,�•'-� POEASPH-03 ACORU' �,- CERTIFICATE OF LIABILITY INSURANCE MNEIGHBORS DATE (MMroDnmY)10/28/2022 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 endorsements . PRODUCER Spokane Office PayneWest Insurance, a Marsh McLennan Agency LLC Company 501 N. Rive oint Blvd., Ste 403 Spokane, WA 99202 c TACT Jim Majeskey (aCTN , Et): (609) 789-7430 FAX No): ma'eske a newest.com INSURERS AFFORDING COVERAGE NAIC tl INSURER A: Cincinnati Insurance Company 10677 INSURED Poe Asphalt Paving Inc 2732 N. Beck Road Post Fails, ID 83854 INSURER 8 : INSURER C : INSURER D : INSURER E INSURER F : 1'AVFR2Ar_FC rFRTIFIr:ATF KIHMRFR• 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 LTRA TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR X X EPP 0633923 11/1/2022 11/1/2023 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED ence)MED $ 300,000 EXP oneperson) 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑X J Re LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 WA STOP GAP $ 1,000,000 A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOpSWN p AUTOS ONLY AUOTOS ONLY Ll X X EPP 0633923 11/1/2022 11/1/2023 COMBINED SINGLE LIMIT cident)X $ 1,000,000 BODILY INJURY Perperson) $ BODILY INJURY Per accident _ $ PeOra denDAMAGE $ $ A X UMBRELLA LIAB EXCESS UA9 X OCCUR CLAIMS -MADE EPP 0633923 11/1/2022 11/1/2023 EACH OCCURRENCE _$ 4,000,000 AGGREGATE $ 4,000,000 DED I X I RETENTION $ 0 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY CCPROPREIEETgO�RIPARTNER/EXE' UT"v : IFanda= in NH) EXCLUDED' If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER I OTH- A ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached N more space Is required) City of Spokane Valley Contracts City of Spokane Valley 10210 E Sprague Ave Spokane Valley, WA 99206 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PnFASPH_03 JSCHPFIRFR r ACORO' �� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 10/27/2023 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 S okane OfficeFAX Marsh McLennan Agency LLC 501 N. Riverpoint Blvd., Ste 403 Spokane, WA 99202 CONTACT NAME: PHONE (A/C, No, Ext): (509) 838-3501 (Alc, No):(866) 226-3738 ADDRE S: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Cincinnati Insurance Company 10677 INSURED INSURER B : INSURERC: Poe Asphalt Paving Inc INSURER D : 2732 N. Beck Road Post Falls, ID 83854 INSURER E INSURER F : rnvCnAr_Cc /`CDTICl1 ATC AIIIIURI=D• RFVISION NUMBER: v 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 NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE ❑X OCCUR X X EPP 0633923 11/1/2023 11/1/2024 DAMAGE TORENTED PREMISES E oc rren e 500,000 $ MED EXP An one person)$ 1 O,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PECOT- LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 21000,000 WA STOP GAP $ 1,000,000 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 $ BODILY INJURY Per person)$ X ANY AUTO X X EPP 0633923 1111/2023 11/1/2024 BODILY INJURY Per accident $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 AGGREGATE $ EXCESS LIAB CLAIMS -MADE EPP 0633923 11/1/2023 11/1/2024 DED RETENTION $ Aggregate 4,000,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N / A E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Spokane Valley Contracts City of Spokane Valley 10210 E Sprague Ave Spokane Valley, WA 99206 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE it4k " — ACORD 25 (2016/03) © 1988-2015 AGURD CORPORA I IUN. All rignts reserves. The ACORD name and logo are registered marks of ACORD 11/8/23, 8:22AM POE ASPHALT PAVING INC STATE OF WASHINGTON Department of Labor & Industries Certificate of Workers' Compensation Coverage WA UBI No. L&I Account ID Legal Business Name Doing Business As Workers' Comp Premium Status: Estimated Workers Reported (See Description Below) Account Representative Licensed Contractor? License No. License Expiration November 8, 2023 409 018 683 191, 377-00 POE ASPHALT PAVING INC POE ASPHALT PAVING INC Account is current. Quarter 3 of Year 2023 "51 to 75 Workers" Employer Services Help Line, (360) 902-4817 Yes POEASP"333NM 11 /29/2023 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). hftps:llsecure.ini.wa.govlverify/DetailslliabilityCertificate.aspx?UBI=409018683&LIC=POEASP`333NM&VIO=&SAW=false&ACCT=l 9137700 1 /1