10-031.00 Strata: Broadway Sullivan PCCP IntersectionAdMIL
Washington State
®® Department of Transportation
Supplemental Agreement
Organization and Address
Number 09- 054(1)
STRATA, Inc.
10020 E. Knox Avenue, Ste 200
Spokane Valley, WA 99206 -4748
Original Agreement Number
09 -054
Phone: (509) 891 -1904
Project Number
Execution Date
Completion Date
12/31/2010
Project Title
New Maximum Amount Payable
Broadway Sullivan PCCP hntersection Project
$ 25,685.92
Description of Work
Material Testing Services for the Broadway Sullivan PCCP Intersection Project per attached C Aldworth RFP
2/19/2010 and the March 3, 2010 STRATA Proposal File no SP 10026.
The Local Agency of City of Spokane Valley
desires to supplement the agreement entered into with STRATA Inc.
and executed on 10/21/2009 and identified as Agreement No. 09 -054
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:
Material Testing Services for the Rrandm= Sullivan PCCP Intersection Project per ttached C AldwnrTh RFP
2/19/2010 and the March 3, 2010 STR ATA Proposal File no SP100 6
11
Section IV, TIME FOR BEGINNING AND COMPLETION, is amended to change the number of calendar days for
completion of the work to read: December- 31, 2010
Section V, PAYMENT, shall be amended as follows:
0
maxim um_ad(iitinnaI nave ent of X14 115 9) Masrin,,,m an, A—A r„ Vac 4 04 ni :--I A,f2]r.
as set forth in the attached Exhibit A, and by this reference made a part of this supplement.
If you concur with this supplement a9d agree tort changes as stated above, please sign in the appropriate spaces
below and return to this office for,ffnal action'
By: rl 5 Lo V sy: _lJ�(( , �L lit elf w
l
Consultant Signature Approving Author i Signature
DOT Form 140 -063 EF Date
Revised 9/2005
Cc (C' C:.(
03- 04 -'10 12;23 FROM -Terra Insurance 1- 415 - 927 -3204
Terra Insurance Company
(A Risk Retention Group)
Two Fifer Avenue, Suite 100
Corte Madera CA 94925
CERTIFICATE OF INSURANCE
DATE
03/04/10
NAME AND ADDRESS OF INSURED
Strata, Inc.
10020 E. Knox Ave., Ste. 200
Spokane, WA 99206
T -049 P002/002 F -751
�RRA
�c�: .
This certifies that the "claims made" insurance policy (described below by policy number) written on forms in
use by the Company has been issued. This certificate is not a policy or a binder of insurance and is issued as
a matter of information only, and confers no rights upon the certificate holder. This certificate does not alter,
amend or extend the coverage afforded by this policy.
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. Aggregate limits
shown may have been reduced by paid claims.
TYPE OF INSURANCE
POLICY NUMBER
210082
LIMITS OF LIABILITY
Professional 'Liability
EFFECTIVE DATE
01 /01 /10
EXPIRATION DATE
12/31/10
$1,000,000 EACH CLAIM
$1,000,000 ANNUAL AGGREGATE
PROJECT DESCRIPTION
Broadway /Sullivan PCCP Intersection Project
ML aterial Testing Services
CANCELLATION If the described policy is cancelled by the Company before its
expiration date, the Company will mail written notice to the certificate holder thirty (30)
days in advance, or ten (10) days in advance for non - payment of premium. Company will
described policy I's cancelled by the insured before its expiration date, the
mail written notice to the certificate holder within thirty (30) days of the notice to the
Company from the insured.
CERTIFICATE HOLDER
City of Spokane Valley, Public Works Dept.
Attn: Craig Aldworth, P.F.
11707 E_ Sprague Avenue, Suite 106
Spokane 'Valley, WA 99206
ISSUING COMPANY:
TERRA INSURANCE COMPANY
(A Risk Retention Group)
President
CERTIFICATE OF LIABILITY INSURANCE OP ID JE DATE)rVIMIDDNYYY)
STRAT -1 1 03/05/10
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Higgins 6 Rutledge Insurance, HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1661 Shoreline Drive, Ste 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BE LOW
Boise ID 83702
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
Phone: 208- 343 -7741 Fax:208- 343 -9371
INSURERS AFFORDING COVERAGE NAIC #
.. .......... - - .._ ....
INSURED Strata Inc- Intermountain
Materials Westin , Inc.;
- . . . .
. -_.. _ _ ...__._.. _ ---- ._.... _ ..... . ._ _._....._.... _.. - - - --
INSURER A: Cincinnati Insurance Campaay 10677
Howard Consultants , Inc. ;
Victoryy Enterprises LLC
INSURER B: State Insurance Fund
- ._..... .............._..._ _ .�_.._.-- _.._..__
StrataGeotechnical engineering
INSURER C:
8653 W Hackamore
A
I X : X COMMERCIAL GENERAL LIABILITY CPP0882591
INS ...................... - ._..-_....__._ ........ _ ........................................ _ ...... ....... ----- .... __ i__.......... ..._-
05/01/10
INSURER E: Spokane
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADD'L -- --- -- ... - --
j POLICY EFFECTIVE POLICY EXPIRATIONI
LTR INSR❑ TYPE OF INSURANCE POLICY NUMBER ;DATE MMIDD/YYYY DATE IMMIODN Y I LIMITS
j GENERAL LIABILITY
i
EACH OCCURRENCE
$ 1, 000, 000
A
I X : X COMMERCIAL GENERAL LIABILITY CPP0882591
05/01/09
05/01/10
- D:ANT. i�ET6RENTEiJ. _......__...__
PREMISES E aoccuren ee
. ................... .........__..___.............
'
$ 500 000
MED EXP (Any one person)
$ 10, 000
CLAIMS MADE F X 7 OCCUR
j
X Se verabil of
I--
_. ....... _ ... ...__.
PERSONAL 8 ADV INJURY
$1,000,000 .___....._ ._
I Interest . .
_ .......... . _
GENERAL AGGREGATE
$ 2, 000 , 000
GEN'L AGGREGATE LIMIT APP PER. -
PRODUCTS - COMPIOP AGG
$ 2 , 0 0 0 , O O 0
t PRO-
! POLICY �I
I
IX JECT LOC
j
t AUTOMOBILE LIABILITY
A X ANY AUTO CPP0882591
I 05/01/09
j 05/01/10
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
X ALL OWNED AUTOS
I
_.._..... .. .......... ............ _...._._�..._..._..
I
BODILY INJURY
$
X SCHEDULED AUTOS :
(Per person)
j
............ .................. . ....... _ ..... __ ......... _..__..
[ X ! HIRED AUTOS
—
BODILY INJURY
NON -OWNED AUTOS
(Per accident)
S
---------------- — ___...
PROPERTY DAMAGE
$
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCID
$
ANY AUTO _ I
- —
OTHER THAN EA ACC
- - - --
$
$
AUTO ONLY- AGG
EXCESS 1 UMBRELLA LIABILITY I
EACH O CCURRE NCE
$ 4,00 0,000
A X X � CLAIMS MADE CPP0882591
05/01/09
05/01/10
AGGREGATE
$Q
$ --
i
DEDUCTIBLE I
$
X RETENTION $ None
I
$
WORKERS COMPENSATION
AND I I
,. -
EMPLOYERS' LIABILITY
YrN
.. _X_ TORY LIMITS __.,,,.. _ER
B ANY PROPRIETOR/PARTNER/EXECUTIV 620608 05/02/09
05/01/10
E.L.EACHACCI DENT
$ 100000
OFRCER/MEMBER EXCLUDED? I
E.L. DISEASE - EA EMPLOYEE
$ 1
I
(Mandatory in NH) IDAHO
. _.._......,......._.
...................._....._........_..
. . . .._
SPECIAL PROVISIONS below
L.
E. DISEASE - POLICY LIMIT
$ 500000
OTHER
A !Pollution Liabilit CPP0882591 05/01/09
05/01/10
Pollution 1000000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Re: Broadway /Sullivan PCCP Intersection Project; Materials Testing Services.
City of Spokane Valley is an Additional Insured (except WC) as their
interest may appear regarding the above described project. Waiver of
Subrogation applies in favor of all Additional Insureds.
I IrII.H I C nvwtK GANGtLLA I ION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO
CITSPO4 DATE THEREOF, THE ISSUING INSURER WILL3CZ3K3Wm[XXVAIL 30 DAYS WRITTEN
City of Spokane NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT„ XWXXCt1Rdt]QC"XXJM
Public Works Dept. ] ogexe¢ x�t7tora>+ �axxoa�COt�vR� ¢�x�5staCax]eriea4ro¢t¢x�tA6cx
Attn: Craig Aldworth, P.E. XIMEARVEXXXXX
11707 E Sprague Ave; S-106 AUTHORIZED EPR ENTATIVE
Spokane Valley WA 99206
ACORD 25 (2009/01) -2009 ACORD GORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized
representative or producer, and the certificate holder, nor does it affirmatively or negatively amend,
extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 (2009/01)