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19-162.08PoeAsphaltPavingStreetStormwaterMaintenance CONTRACT AMENDMENT TO THE AGREEMENT BETWEEN THE CITY OF SPOKANE VALLEY AND Poe Asphalt Paving Inc. Spokane Valley Contract 19-162.08 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, 2024. 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: The amount authorized to be expended for 2024 only is increased by an additional $80,000 to provide for additional local street maintenance. 4. Compensation Amendment History: This is Amendment #4 of the Original Contract. The Original Contract incorporates annual renewals and the 2024 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 2024 Contract Amount 12/05/2023 $ 1,585,120.00 Amendment#4(This Amendment) To be executed $ 80,000.00 Total Amended 2024 Contract Amount $ 1,665,120.00 The parties have executed this Amendment to the Original Contract this 7 1 day of October 2024. CITY OF SPOKANE VALLEY: POE ASPHALT PAVING INC. -- ohn Hohman By: City Manager Its: Project Manager A OVED TO ORM: Off of e Ci Attorney 1 �...N POEASPH-03 JSCHREIBER ,4cORv CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `..� 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 CONTACT NAME: Spokane Office Marsh McLennan Agency LLC (A//C,No,Ext):(509)838 3501 I(Aic,No):(866)226-3738 501 N.Riverpoint Blvd.,Ste 403 D E-MAIL SS: Spokane,WA 99202 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Cincinnati Insurance Company 10677 INSURED INSURER B: Poe Asphalt Paving Inc INSURER C: 2732 N.Beck Road INSURER D: Post Falls,ID 83854 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYY1 (MM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X X EPP 0633923 11/1/2023 11/1/2024 PDREMISES EaoccurrenceI $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: WA STOP GAP $ 1,000,000 COMBINED A AUTOMOBILE LIABILITY Ea accidentSINGLE LIMIT $ 1,000,000 X ANY AUTO X X EPP 0633923 11/1/2023 11/1/2024 BODILY INJURY(Per person) $ - OWNED SCHEDULED AUTOSO ONLY _ AUTOS SSWN BODILY INJURY(Per accident) $ AU- TOS ONLY _ AUUTOS ONLY (Per PROPERTY tDAMAGE $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 EXCESS UAB CLAIMS-MADE EPP 0633923 11/1/2023 11/1/2024 AGGREGATE $ DED RETENTION$ Aggregate $ 4,000,000 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if mom space is required) City of Spokane Valley Contracts CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Spokane ValleyTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P ACCORDANCE WITH THE POLICY PROVISIONS. 10210 E Sprague Ave Spokane Valley,WA 99206 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD STATE OF WASHINCTON Department of Labor& Industries Certificate of Workers' Compensation Coverage October 1, 2024 WA UBI No. 409 018 683 L&I Account ID 191,377-00 Legal Business Name POE ASPHALT PAVING INC Doing Business As POE ASPHALT PAVING INC Workers'Comp Premium Status: Account is current. Estimated Workers Reported Quarter 2 of Year 2024"51 to 75 Workers" (See Description Below) Account Representative Employer Services Help Line, (360)902-4817 Licensed Contractor? Yes License No. POEASP*333NM License Expiration 11/29/2025 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).