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11-016.00 CLC Associates: Indiana Ave ExtensionX : . AMENDMENT No. 5 TO AGREEMENT FOR PROFESSIONAL SERVICES Easement Legal Descriptions, Exhibits and Additional Topo Survey CLC Associates, Inc COSY Contract # 09 -048 Indiana Avenue Extension Project, CIP 0112 THIS AMENDMENT No. 5 is made to the Agreement for Professional Services dated October 20, 2009 by and between the City of Spokane Valley, a code City of the State of Washington, hereinafter "City" and CLC Associates, Inc., hereinafter "Consultant" and jointly referred to as "parties" Pursuant to Section 1.0 Modifications of the Agreement for Professional Services, the parties hereby agree to amend the Agreement as set forth in the attached 1/12/11 COSV request for Construction Surveying Services and the 1/27111 Amendment 5 Task Spreadsheet. These services will be tracked and billed on time and materials basis, and are subject to all of the conditions set forth in the original Agreement. The City agrees to pay Consultant up to $7,150.00 for the additional services provided for in this Amendment to the Agreement. Exhibits to this Amendment are as follows: 1. Professional Services Agreement dated October 20, 2009, 2. Request for additional Construction Surveying Services'dated January 12, 2011, 3. Amendment 5 Task Spreadsheet dated January 27, 2011 4. CLC 2011 Hourly fee Schedule Original Contract Amount $24,024.00 Prior amendments $ 7,723.00 Current Amendment Amount $ 7.150.00 Amended Contract Amount $38,897.00 The remainder of the Agreement will remain unchanged by this Amendment. IN WITNESS WHEREOF, the parties have executed this Agreement this L2 . day o _2� 2011 CITY Of SP? VALLEY: Constant:LC Associates, c. ATTES pristine Bainbridge, City Cle Tax N4AS .� APP OV TO FORM: Office the City orney This document contains confidential tax information and has been redacted pursuant to RCW 82.32.330. You may petition for a review of our findings pertaining to any redacted or withheld documents pursuant to Spokane Valley Municipal Code (SVMC) 2.75.080; and obtain judicial review pursuant to RCW 42.56.550. January 12, 2011 Mr. Zack Lennon, PLS Survey Project Manager CLC Associates 12730 E. Mirabeau Parkway, Ste 100 Spokane Valley, WA 99216 RE: Request for Construction Surveying Services COSY Contract 09 -048 Indiana Avenue Extension City of Spokane Valley Capital Improvement Project No. 0112 The City of Spokane Valley requires additional services on the Indiana Avenue Extension proj ect. The scope of services consists of providing staff, equipment and office calculations for the following tasks: Task 1- Revised ROW Legal Descriptions and Exhibits Provide legal descriptions and exhibit for a revised ROW take for Tax Parcel 45124.0203. Task 2 — Section Corner Restoration The Consultant will survey the existing section corner monument located in the Mission Avenue / Flora Road intersection, install reference marks, prepare and file the Report for Monument Removal or Destruction with the Washington Department of Natural Resources; coordinate with the road construction contractor so that a monument case is set in the proper location during intersection reconstruction; reset the original monument or fbinish, install, label and mark a new monument cap inside the case and file the replacement paperwork with the Washington State Department of Natural Resources, as required by WAC- 120 -070. After project completion, a Land Corner Record shall be filed with the Spokane County Auditor depicting monuments replaced, and their relationships to the road Indiana Ave Extension #0112 Request for Additional Surveying Services right of way lines, and in conformance with the requirements of RCW 58.09.040 and WAC 332 - 130 -050. Task 3 — On Call Construction Staking Services • Perform Topographic Data Collection and Mapping. • Perform Construction Staking for Utility construction or as directed with specified documentation. • Perform Quality Control Checking and prepare Reports of Results for projects as directed. • Perform As -Built Data Acquisition and Prepare Mapping or Reports. • Perform Boundary Surveys related to Land Acquisition and Prepare Mapping. • Prepare and or Review Legal Descriptions for Right of Way Acquisition, Easements or other activities requiring Parcel or Use descriptions. • Provide Principal Professional Land Surveyor Review as needed. • Invoicing for services will be done monthly or as needed using the CLC & Associates 2011 Hourly Fee Schedule. Please call me to discuss or if you need additional information. Sincerely, �� � 2 Cral Aldworth, P. E Senior Engineer City of Spokane Valley 11707 E. Sprague Ave., Suite 106 Spokane Valley, WA 99206 PH: (509) 720 -5001 FX: (509) 921 -1008 encl: Indiana Avenue Extension — Preliminary Utility Plan Indiana Ave Extension #0112 2 Request for Additional Surveying Services COSV Contract 09 -048 Agreement for Professional Services with CLC Associates Inc. Amendment 5 Task Spreadsheet Task Description Budget 5.1 Revised ROW Legals & Exhibits $550.00 5.2 Section Corner Restoration $1,600.00 5.3 On -Call Construction Surveying $5,000.00 Amendment Total $7,150.00 DOCUMENTS EXEMPT FROM PUBLIC DISCLOSURE The page entitled " Schedule of Fees and Charges contains confidential cost and rate data and is withheld from public disclosure pursuant to 23 USC 112(2)(F). Prenotification; confidentiality of data A recipient of funds requesting or using the cost and rate data shall notify any affected firm before such request or use. Such data shall be confidential and shall not be accessible or provided, in whole or in part, to another firm or to any government agency which is not part of the group of agencies sharing cost data under this paragraph, except by written permission of the audited firm. If prohibited by law, such cost and rate data shall not be disclosed under any circumstances. You may petition for a review of our findings pertaining to any redacted or withheld documents pursuant to Spokane Valley Municipal Code (SVMC) 2.75.080; and obtain judicial review pursuant to RCW 42.56.550. ,4 ° CERTIFICATE OF LIABILITY INSURANCE Fi/31/2011 ) 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 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 Van Gilder Insurance Corp. 1515 Wynkoop, Suite 200 Denver CO 80202 NAME: Mable Griest PHONE I FAX A/C No Ext: -8 7 -8 A/c No: -8 1 -52 5 ADDR M riest @V ic.com 680676OL987 PRODUCER CUSTOMER ID #: CLC INSURER(S) AFFORDING COVERAGE NAIC # $1,000,000 INSURED INSURER A: Travelers Insurance 0 CLC Associates, Inc. 12730 E. Mirbeau Parkway, #210 INSURER B: National Union Fire Ins Co of 0 INSURER C: Hudson Insurance Compan Spokane WA 99216 INSURER D : GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X I PRO- LOC PRODUCTS- COMP/OP AGG INSURER E : $ INSURER F: AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULEDAUTOS HIREDAUTOS NON -OWNED AUTOS COVERAGES CERTIFICATE NUMBER: 1574189951 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 POLICY NUMBER MM/ //YYW EXP MMIDD /YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F-_1 OCCUR Y y 680676OL987 12/21/2010 12/21/2011 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $1,000,000 MED EXP (Any one person) $10,000 PERSONAL BADVINJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X I PRO- LOC PRODUCTS- COMP/OP AGG $2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULEDAUTOS HIREDAUTOS NON -OWNED AUTOS y y BA6757L252 12/21/2010 12/21/2011 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE y y EBUO34248281 12/21/2010 12/21/2011 EACH OCCURRENCE $8,000,000 AGGREGATE $8,000,000 DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR /PARTNER/EXECUTIVE F—] OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA y WC STATU- OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ C Professional Liability Claims Made Y Y A 12/21/2010 12/21/2011 Per Claim $2,000,000 Annual Aggregate $4,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach ACORD 101, Addltlonal Remarks Schedule, If more space Is required) If required by written contract or written agreement, the following provisions apply subject to the policy terms, conditions, limitations and exclusions: The Certificate Holder and Owner are included as Additional Insureds for ongoing and completed operations under General Liability; Designated Insured under See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Spokane Valley 11707 E. Sprague Avenue Suite 106 Spokane Valley WA 99206 AUTHORIZED REPRESENTATIVE @ 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD AC a� AGENCY CUSTOMER ID: CLC LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Van Gilder Insurance Corp. NAMED INSURED CLC Associates, Inc. 12730 E. Mirbeau Parkway, #210 Spokane WA 99216 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: I THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE:CERTIFICATE OF LIABILITY INSURANCE Automobile Liability; and Additional Insured under Umbrella / Excess Liability but only with respect to liability arising out of the Named Insured's work performed on behalf of the certificate holder and owner. This insurance will apply on a primary, non - contributory basis. A Blanket Waiver of Subrogation applies for General Liability, Automobile Liability and Umbrella /Excess Liability. Limited Contractual Liability is included. The Umbrella / Excess Liability policy provides excess coverage over the General Liability, Automobile Liability and Employers Liability. Workers Compensation coverage does not apply to employees who are hired or reside in the States of North Dakota, Ohio, Washington, and Wyoming. Employers Liability Stop Gap coverage applies to the States of North Dakota, Ohio, Washington, and Wyoming. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Verify Workers' Comp Premium Status - Account Information in Washington State Department of Labor & Industries Verify Workers' Comp Premium Status: Account Information Did you know ... .. that workers' compensation that under Washington State law *, you may be liable for the unpaid � (industrial insurance) premiums of any business you hire or contract with? ( *See RCW 51.12.070) In the construction industry, you can protect yourself from liability for your subcontractor's unp aid premiums. Click here to see what you have to do. Contact Us Printer - Friendly Version ® New Search ® Contractor Tracking Search _1 L&I will track a contractor for you and tell you if their status changes. If this is a contractor whose premiums and license are current, a "Submit Contractor Tracking Request" link will appear in the certificate below. Click it to fill out a Tracking Request. If the contractor fails to pay workers' comp premiums or renew their contractor registration or if their electrical contractor license is suspended or revoked within one year of the start-date on your tracking request, L&I will send you a notification letter. Results for account. "977,410 -00" shown Account#: UBIM Business: Search below. Department of Labor and Industries Employer Liability Certificate Date: 01/31/2011 UBI #: 601 638 565 - Check for active Department of Revenue tax account. Legal Business Name: COLORADO LAND CONSULTANTS INC Account #: ', 977,410 -00 .............................. ......_ ... 'Doing Business As' Name: CLC ASSOCIATES Estimated Workers Reported: Quarter 4 of Year 2010 "11 to 20 Workers" (See Description Below) Workers' Comp Premium Status: Account is current. Firm has voluntarily reported and paid their premiums. Licensed Contractor? No Risk Classification: Get risk classification information. Experience Factor: ! Get experience factor history. Account Representative: T5 / CHUCK MYDLAR (360)902 -5596 - Email: MYDL235 @lni.wa.gov What does "Estimated Workers Reported" mean? Estimated workers reported represents the number of full time position requiring at least 48o hours of work per calendar quarter. A single 48o hour position may be filled by one person, or several part time workers. https://fortress.wa.gov/lni/crpsi/Acctlnfo.aspx?Accountld=9774 1000... 1 oft 1/31/2011 2:14 PM