Loading...
HomeMy WebLinkAbout22-139.02CommonstreetConsultingLLCPinesRD/BNSFGSPDocusign Envelope ID: CA341A7E-FA32-4CF5-BOB6-2712B92CF928 Alift � Washington State WI/ Department of Transportation Supplemental Agreement Organization and Address Number 2 Commonstreet Consulting, LLC. 92 Lenora St., PMB 125 Seattle, WA 98121 Original Agreement Number 22-139 Phone: Project Number Execution Date Completion Date 0223 8/15/22 12/31/25 Project Title New Maximum Amount Payable Pines Road/BNSF Railroad Grade Separation $256,251.03 Description of Work Right-of-way services for the Pines Rd./BNSF Railroad Grade Separation Project. The Local Agency of Ci y of Spokane Valley desires to supplement the agreement entered in to with Commonstreet Consulting. LLC, and executed on 08/15/22 and identified as Agreement No. 22-139 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 Section IV, TIME FOR BEGINNING AND COMPLETION, is amended to change the number of calendar days for completion of the work to read: 12/31/27 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 By: f4psed by: (t, s (, t&-tt, CohStliw6wWw... DOT Form 140-063 Revised 09/2005 By: Approving Authority Signature l z- ey- z_� / COI AV CERTIFICATE OF LIABILITY INSURANCE IY DATE (MMIDDYYY) 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. PHONE (503) 585-2211 FAX (503) 399-4658 0 No Ext : AIC No (AC. E-MAIL )�°gg III hU InS.Com ADDRESS: P.O. BOX 270 INSURER(S) AFFORDING COVERAGE NAIC R Salem OR 97308 INSURERA: Hartford Underwriters 30104 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 AUUL15UtSK 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 A Ea 1711 PMISES occurtence RE 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'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY JECT PRO ❑ LOC PRODUCTS - COMP/OPAGG $ 4,000,000 BASEP $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 2,000,000 BODILY INJURY (Per person) $ ANYAUTO A OWNED SCHEDULED AUTOS ONLY AUTOS Y Y 52SBAAW7B5G 03/10/2025 03/10/2026 BODILY INJURY (Per accident) $ X HIRED �/ NON -OWNED AUTOS ONLY /� AUTOS ONLY PROPERTY DAMAGE Per accident $ 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 SPER I TATUTE EORH X1 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 I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: COSY 1006. Agreement Number: 22-139. Right of way services for the Pines Rd/BNSF Railroad Grade Separation Project. 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. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Spokane Valley ACCORDANCE WITH THE POLICY PROVISIONS. 10210 E Sprague Ave AUTHORIZED REPRESENTATIVE Spokane WA 99206 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD