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19-198.03DavidEvansAssociatesPinesMissionIntersectionImprovements ANL 1171 Washington State �I/ Department of Transportation Supplemental Agreement Organization and Address Number 3 David Evans and Associates,Inc. Original Agreement Number 908 North Howard St, Suite 300 Spokane,WA 99201 19-198 Phone: (509) 232-8669 Project Number Execution Date Completion Date 0300 December 31, 2024 Project Title New Maximum Amount Payable Pines/Mission Intersection Improvements $227,084.57 Description of Work Traffic Engineering Design and PS&E per revised proposal dated 6/24/21. 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 12/19/2019 and identified as Agreement No. 19-198 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: No change. 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: Completion date is amended to December 31, 2024. III Section V, PAYMENT, shall be amended as follows: No change. 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: Ken Geibel, sociate By: John Hohman, City Manager Consultant Signature Approving Authority Signature /2 — 2. 1 2? Date DOT Form 140-063 Revised 09/2005 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YVYY) 12/1/2024 11/28/2023 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 Lockton Companies CONTACT 444 W.47th Street,Suite 900 PHONE FAX (A/C.No.Extl: (A/C,No): Kansas City MO 64 1 1 2-1 906 E-MAIL (816)960-9000 ADDRESS: kcasu@lockton.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Zurich American Insurance Company 16535 INSURED DAVID EVANS AND ASSOCIATES,INC. INSURER B:The Continental Casualty Company 20443 1456304 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: 16455937 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 I TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMBS LTR /Y INSD WVD POLICY NUMBER (MM/DDYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y N GL09830389 12/1/2023 12/1/2024 EACH OCCURRENCE $ 1,000,000 DAMAGE RENTED 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 X PE f LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ C AUTOMOBILE LIABILITY Y N BAP9830390 12/1/2023 12/1/2024 COMBINED SINGLE LIMIT $ (Ea accident) 1,000,000 x ANY AUTO BODILY INJURY(Per person) $ XXXXXXX OWNED SCHEDULED BODILY INJURY(Per accident) $ XXXXXXX H ONLY AUTOS $ XXX�O�XX HIREDIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ XXXXX�x UMBRELLA UAB OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX EXCESS LIAB CLAIMS-MADE AGGREGATE $ XXXXXXX DED RETENTION$ $ XXXXXXX D WORKERS COMPENSATION Y/N N WC9336626 12/1/2023 12/1/2024 X PER E STATUTE ERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N (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 B PROFESSIONAL N N AEH591924704 12/1/2023 12/1/2024 PER CLAIM$1,000,000 LIABILITY ANNUAL AGGREGATE$1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: 19-198-PINES/MISSION INTERSECTION IMPROVEMENTS(CIP#300).THE STATE AND AGENCY,THEIR OFFICERS,EMPLOYEES,AND AGENTS ARE ADDITIONAL INSUREDS AS RESPECTS GENERAL LIABILITY AND AUTO LIABILITY,AND THESE COVERAGES ARE PRIMARY,IF REQUIRED BY WRITTEN CONTRACT.THE ADDITIONAL INSUREDS'OWN COVERAGE 1S EXCESS OF AND NON-CONTRIBUTORY WITH THE GENERAL LIABILITY,AND ON THE AUTO LIABILITY AS RESPECTS THE USE OF VEHICLES OWNED BY DAVID EVANS AND ASSOCIATES,INC.IF REQUIRED BY WRITTEN CONTRACT. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 16455937 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF SPOKANE VALLEY ACCORDANCE WITH THE POLICY PROVISIONS. ATTN: CHRISTINE BAINBRIDGE,CITY CLERK AUTHORIZED REPRESENTATN 10210 EAST SPRAGUE AVENUE SPOKANE VALLEY WA 99206 4/ 47,B ©1988 015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD