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HomeMy WebLinkAbout24-191.01ComonstreetConsultingSSullivanRdPreservationDocusign Envelope ID: 89079481-988D-41A5-894F-732C41B94260 Adw � Washington State TWO Department of Transportation Supplemental Agreement Organization and Address Number 24-191.1 Commonstreet Consulting, LLC 92 Lenora Street, PMB 125; Seattle, WA 98121 Original Agreement Number 24-191 Phone: Project Number Execution Date Completion Date 366 1 /23/25 12/31 /2025 Project Title New Maximum Amount Payable S. Sullivan Rd Preservation $ 1 69,042.56 Description of Work ROW Services for the S Sullivan Rd Preservation project The Local Agency of City of Spokane Valley desires to supplement the agreement entered in to with Commonstreet Consulting. LLC and executed on 1/23/2025 and identified as Agreement No. 24-191 _. 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: N/A 11 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: 12/31/2026 III Section V, PAYMENT, shall be amended as follows: N/A 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. Chris LaBonte Signed by: C6nst4R9iF re DOT Form 140-063 Revised 09/2005 ,..�i 0 ►1,� �i kMll Approving Authority Signature Date Exhibit "A" Summary of Payments Basic Agreement Supplement #1 Total Direct Salary Cost $ 57,357.75 $ 0 $ 57,357.75 Overhead (Including Payroll Additives) $ 71,269.16 $ 0 $ 71,269.16 Direct Non -Salary Costs $ 24,352.3 $ 0 $ 24,352.3 €�ee $ 16,063.15 $ 0 $ 16,063.15 Total $ 169,042.56 $ 0 $ 169,042.56 DOT Form 140-063 Revised 09/2005 A`OR" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/27/2025 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 Jill Harper NAME: Huggins Insurance Services, Inc. (503) 585-2211 aC, (503) 399-4658 CNo I EXt : No): E-MAIL U r15.COm ADDRESS: )illh@ ggI P.O. BOX 270 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Hartford Underwriters 30104 Salem OR 97308 INSURED INSURER B : Salf Corporation 36196 Commonstreet Consulting, LLC INSURER C : HISCOX Insurance CO Inc 10200 92 Lenora St INSURER D INSURER E : Seattle WA 98121-2108 INSURER F : COVERAGES CERTIFICATE NUMBER: 25-26 GL UMC WC PL 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE ❑X OCCUR DAMA NTED PREMISES Ea occurrence) 1,000,000 $ MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 A Y Y 52SBAAW7B5G 03/10/2025 03/10/2026 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 PRO - POLICY � JECT PRO ❑ LOC PRODUCTS - COMP/OP AGG $ 4,000,000 BASEP $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 2,000,000 BODILY INJURY (Per person) $ ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS Y Y 52SBAAW7B5G 03/10/2025 03/10/2026 BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 A EXCESS LAB CLAIMS -MADE Y 52SBAAW7B5G 03/10/2025 03/10/2026 DED I X1 RETENTION $ 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N/A Y 100020541 01/01/2025 01/01/2026 PER /� STATUTE EORH E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 $ C Professional Liability/Claims Made MPL533800225 07/28/2025 03/10/2026 Professional Liability $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: COSV.1008. Right of Way Services — S. Sullivan Rd. Preservation. City of Spokane Valley is included as additional insured as respects to general liability and auto liability as required by written contract or agreement per form SL 30 32 06 21 attached. Primary and noncontributory, and waiver of subrogation applies as required by written contract or agreement per BUSINESS LIABILITY COVERAGE Form SL 00 00 10 18, and HIRED & NON -OWNED AUTO Form SL 02 30 10 18. City of Spokane Valley 10210 E Sprague Ave Spokane WA 99206 L;ANL;tLLAI IUN 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 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD