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11-192.00 Michael Terrell: West Entry Sign Design1 AMENDMENT TO AGREEMENT FOR WEST ENTRY SIGN PROJECT Adding additional scope of services to contract with Michael Terrell, Landscape Architect 5312 South Chapman Road, Greenacres, Washington 99016 THIS AMENDMENT is made to the Agreement for City of Spokane Valley West Entry Sign Design Project contract dated November 17, 2011 (the Agreement) by and between the City of Spokane Valley, a code City of the State of Washington, hereinafter "City" and Michael Terrell, Landscape Architect, hereinafter "Contracting Entity" and jointly referred to as "Parties." Sections 1 and 3 of the Agreement are amended by adding additional services to be performed, with additional fees authorized by the City, as set forth below. Attached to this Amendment is a Scope of Services for additional design work for incorporating sculpture into the project to be added to the existing contract. The City agrees to pay the Contractor an amount not to exceed $2,200.00 for this additional work. O riginal Contract Amount ......... ............................... $3,300 Amendment No. 1 .................. ............................... $2.200 Amended Contract Amount ....... ............................... $5,500 The remainder of the Agreement will remain unchanged by this Amendment. IN WITNESS WHEREOF, the Parties have executed this Agreement thisv — th day of December, 2011. CITY OF SPOKANE VALLEY: Mike J95ys on City N Contracting Entity: y- �4 Its: Authorized Representative aATTES Christine Bainbridge, City Cle APPROVED AS TO FORM: Cary skell, Ci orney EOH - I (,'2- MEMO To: City of Spokane Valley, Parks and Recreation Attention: Mike Stone From: Mike Terrell, ASLA Date: 12/A 0-1: / 12 1 Project: West Entry Sign Design Project NO IR_O AG Re: Additional Services for Art CC. File Our original scope of work for the City of Spokane Valley West Entry Sign Design included preliminary and final design for the city's west entry sign on the site between Appleway Blvd and South David Street, west of Thierman Street. We have received direction to develop options to incorporate the installation of a piece of scultpture into the site. These options include changing locations and configurations of site designs with the sign locations and landscaping that were previously completed. As we have discussed, the work associated with design to incorporate the sculpture is considered additional services. We propose the following modification to our contract: 1. Develop revised concepts based on direction received from staff and create preliminary and final design drawings. Concepts to include location of sign and sculpture on city property at west entry. 2. Deliverables: a. Presentation level preliminary and final design drawings of selected concept as a power point slide. b. Revised estimate of sign and site development. c. The installation of the sculpture and associated improvements will be difficult to estimate without selection of the sculpture by the city. These additional services should not exceed: $2,200.00 M i c h a e l T e r r e I I a L a n d s c a p e A r c h i t e c t 1421 N . M e a d o w w o o d Lane, Suite 1 50 L i b e r t y L a k e, W a s h i n g t o n 9 9 0 1 9 (509) 922 -7449 w w w. m t- I a. c o m M e m b e r A m e r i c a n S o c i e t y o f L a n d s c a p e A r c h 1 t e c t s ,­ 10 ACCW ° CERTIFIC TE OF LIABILITY INSUR. NICE DATE (MM /DDiYYYY) 11 - -30 -2011 THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE MOLDER. 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 SUBROGATIONIS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does no, ;ton er rights to the certificate holder in lieu of such endorsenlent(s). __— CONTACT PRODUCER NAME• — USAA INSURANCE AGENCY INC /PHS NNo EXt): (888)242 -1430 (' No ).: (87 -C457 — 812846 P:(888)242 -1430 F:(877)905 -0457 A IL r ADMD RESS: PO BOX 3 3 015 DUCER SAN ANTONIO TX 7 8 2 6 5 TOMER ID H: —. �! INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A : Hart Casualty Ins Co INSURER B : s — MICHAEL TERRELL DBA MICHAEL TERRELL LANDSCAPE ARCHITECT I NSURER C � POLICY _I PRCT O- L X l LOC JE AUTOMOBILE LIABILITY n ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 5312 S CHAPMAN RD INSURER D — t . Ec, F =. pAR1:S & RECRE GREENACRES WA 99016 INSURER E INSURER F : CERTIFICATE NUMBER: HtViSiON Nulvintn: COVERAGES THIS INDICATED. CERTIFICATE EXCLUSIONS IS TO CERTIFY THAT THE POLICIES NO WITHSTANDING ANY REQUIREMENT, MAY BE ISSUED OR MAY AND CONDITIONS OF SUCH OF PERTAIN, POLICIES. INSURANCE LISTED BELOW HAVE TERM OR CONDITION OF THE INSURANCE AFFORDED LIMITS SHOWN MAY HAVE BEEN BEEN ISSUED ANY CONTRACT BY THE POLICIES REDUCED BY TO THE INSURED NAMED ABOVE FOR THE t POLICYPERIOD + SPECT ' T'::S I Uivi ` OR OTHER DOCENT WITH " ' ` DESCRIBED HEREIN IS SUBJECT TO ALL THE TEAS, 1 PAID CLAIMS. INSRI LTR A TYPE OF INSURANCE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I OCCUR X General Liab INSR X WVD j POLICY NUMBER 65 SBA PU5843 POLICY EFF (MM /DD /YYYY) i 01/13/2012 POLIC EXP j LIMITS (MM /DD/YYYY) .— EACH OCCURRENCE I$ 1, 0 0 0, 0 0 0 DAMAGE NTELI — PREMISES (Ea oc ! $300,000 I MED EY.P ;Any one person j $ 1 0, 000 01/13/2013 PERSONALS ADV INJUR $ 1, 00 000 GENERAL AGGREGATE ; S 2,000,000 PRODUCTS - COMP;OP AG G I S 2 , 0 0 , 0 0 0 GEWL AGGREGATE LIMIT APPLIES PER: � POLICY _I PRCT O- L X l LOC JE AUTOMOBILE LIABILITY n ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS — t . Ec, F =. pAR1:S & RECRE __ t('f `1 T10N DEPT. 1 g - - -- - - -- COMBINED SINGLE L;%17 (Ea accident) BODILY INJURY (Par person) $ —� � BODILY INJURY (Per accident) ! $ PROPERTY DAMAGE ( Per accident) $ - - - -- $ -- UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ _ 1 N / A ! ( I I $ DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y . / ri ANY PROPRIETORrPARTNERiEXECUTiVEj OFFICERIMEMBEREXCLUDED? u (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below i $ WC STATU• I 'OTH- TORY LIMITS I ER - � 'T , E.L. cA.Ci -i fi;::ID'u "i E.L. DISEASE - EA EMPLO $ E.L. DISEASE - POLICY 'LIM $ — DESCRIPTION OF OPERATIONS f LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Those usual to the Insured's Operations. Re: West Entry Sign. Certific-ate Holder is an Additional Insured per the Business Liability Coverage Form SS0008. I CERTIFICATE HOLDER UANL;ELLA I i0N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED City of Spokane valley BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE Attn Parks & Recreation Dept DELIVERED IN ACCORDANCE WITH THE P OLICY PRO SIONS. AUTHORIZE R PRESENTATIVE 2426 N DISCOVERY PL SPOKANE VALLEY, WA 99216�"� 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD GERTIFIGATE VI- LIAbIL1 I Y MUKANUt ` " 01 V 11!23/2011 (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 LeatzoW Insurance 300 S . Riverside Plaza, Suite 2100 Chicago, IL 60606 CONTACT NAME RICH PIVARCYK PHONE (312) 930 -5556 FAX (866) 741 -2778 EMAIL ADDRESS rich@ leatzotvinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A New Hampshire Insurance Company 23841 INSURED Michael Terrell- Landscape Architect 5312 South Chapman Road Greenacres, WA 99016 INSURER B: POLICY EFF (MMIDDIYYYYI INSURER C: iJrdRS INSURER D: GENERAL LIABILITY INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED T07HE 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. UNUTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADD INSR SUB WVD POLICY NUMBER POLICY EFF (MMIDDIYYYYI POLICY EXP (MMIDDNMI iJrdRS GENERAL LIABILITY EACH OCCURRENCE S DAMAGE TO RENTED PREMISES (Ea occurrence) $ COMMERCIAL GENERAL LIABILITY ❑ EI CLAIMS MADE FI OCCUR MED IXP (Anyone person) $ DOES NOT APPLY PERSONAL AND ADV INJURY S GENERALAGGREGATE $ GEHL AGGREGATE UMMAPPLIES PER:- PRODUCTS - COMPIOPAGG S POLICY PROJECT 7 LOC I $ AUTOMOBILE LIABILITY ❑ ANY AUTO Scheduled autos ALL OWNED �Non-owned ❑ ❑ DOES NOT APPLY COMBINED SINGLE LIMIT (Ea accident) S BODILY INJURY (Per pmcn) s BODILY INJURY (Per accident) i s AUTOS Autos F-1 Hired Autos PROPERTY DAMAGE tPer accident) $ : EDED A LIAB OCCUR LIAB CLAIMS -MADE ❑ ❑ DOES NOT APPLY EACH OCCURRENCE $ AGGREGATE $ ❑ RETENTION $ S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY P PRIE ERIMEM TORIPARTNERlrXECUTIVE❑ OFFICERTORIXCLUpED7 NIA 1 DOE=S NOT APPLY WC TORY tJMTr OTH ER EL EA CC IDE $ EASE- A EMPL EL DISEASE- EA imrr $ EL. DISEASE- POLICY LIr�iIT '> i each claim A PROFESSIONAL LIABILITY ❑ El 011104912 1/1612011 1/1012012 1,000,000 aggregate DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Re: West Entry Sign Design CERTIFICATE HOLDER CANCELLATION City of Spokane Valley SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Parks and Recreation Department EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH Attn: Mike Stone THE POLICY PROVISIONS. 2426 N. Discovery Place AUTHORIZED REPRESENTATIVE Spokane Valley, WA 99216 r�� r LEATZOW INSURANCE ©1988.20'UACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACCORD name and logo are registered marks of ACORD ADDL INFO ON NEXT PAGE PAGE 7 k 4 t,,. % , UNITED SERVICES AUTOMOBILE ASSOCIATION 1 �© (A RECIPROCAL INTERINSURANCE EXCHANGE) State 09 10 Ven POLICY NUMBER USAA 9800 Fredericksburg Road - San Antonio, Texas 78288 00358 99 36U 7104 8 A 25 25 Ter ' WASHINGTON AUTO POLICY POLICY PERIOD: (12:01 A.M. standard time) AMENDED DECLARATIONS EFFECTIVE NOV 22 2011 TO FEB 20 2012 _ ATTACH TO PREVIOUS POLICY Named Insured and Address MICHAEL D TERRELL CAPT USN I 5312 S CHAPMAN RD i GREENACRES WA 99016 -8832 I !'t'_ = 1 t= CHtf =?_; Description of Vehicle(s) VEH USE` WOMSCHOOL Miles Days VEH YEAR TRADE NAME MODEL BODY TYPE ANNUAL MILEAGE IDENTIFICATION NUMBER SYM one Way r P e Week 09 98 TOYOTA 4RUNNERSR5 UTIL 4X4 5000 JT3HN86R7W0155361 P 10 12 SUBARU OUTBK2.51AWL UTL4X44D 10000 4S4BRBKCXC3219368 B The Vehicles) described herein is princi g ara ed at the above address unless otherwise stated W /C= Wcrk/Schcol; B= Business; F= Farm;P= Pleasure VEH 09 GREENACRES WA 99016 -8832 VEH 10 GREENACRES WA 99016 -8832 This ppolicy provides NLY those coverages where a premium is shown below. The limits shown be the number of may be reduced by policy provisions and may vehicles for which a premium is listed unless specifically not combined regardless of authorized elsewhere in this policy. Vt:H VEH VI=H VEH COVERAGES LIMITS OF LIABILITY 09 6 -MONTH 10 6 -MONTH ACV" MEANS ACTUAL CASH VALUE ( " ACV" D =DED PREMIUM D =DED PREMIUM D =DED PREMIUM D =DED PREMIUM AIMOUNT $ AMOUNT $ AMOUNT $ $ BODILY INJURY EA PER $ 500,000 EA ACC $1,000,000 282.26 104.83 PROPERTY DAMAGE EA ACC $ 300,000 153.41 59.26 PART B - PERSONAL INJURY PROTECTIO MEDICAL BENEFITS - EA PER $ 10,000 INCOME CONTINUATION - $200 PER WEEK LOSS OF SERVICES BENEFITS - $40 /DAY MAX, $200 /WK MAX, $5,000 MAXIMUM TOTAL FUNERAL EXPENSE - $2,000 32.33 12.58 PART C - UNDERINSURED MOTORISTS BODILY INJURY EA PER $ 500,000 EA ACC $1,000,000 42.31 50.77 PROPERTY DAMAGE EA ACC $ 10,000 5.11 6.14 PART D - PHYSICAL DAMAGE COVERAGE COMPREHENSIVE LOSS ACV LESS D1000 42.84b1000 32.73 COLLISION LOSS ACV LESS D1000 188.33D1000 117.31 TOWING AND LABOR 4.00 4.00 TOTAL PREMIUM - SEE FOLLOWING PAGE(S) LOSS PAYEE VEH 10 SUBARU AUTO LEASING LIMITED, KENNESAW GA E H E . E E E 1 11 11 1 H ...1.. 1.. L.. ...J I.. III VVIIIVCJJ VVIICI�CVf, III", JUU0U1IVGI0 a4 VIYIIL vvu � I I . I --- . r ._ -_ _. J - _� their Attorney -in -Fact on this date NOVEMBER 27, 2011 1 Laura Bishop President, USAA Reciprocal Attorney -in -Fact, Inc. 5000 U 07 -11 53461 -07 -11 Verify Workers' Comp Premium r +atus - Employer Liability Certificate Washington State Department of Labor and Industries Department of Labor and Industries Employer Liability Certificate Date: 11/16/2011 UBI #: 601 382 389 Legal Business Name: TERRELL MICHAEL DAVID Account #: 072,594 -01 Page 1 of 1 Employer Liability Certificate 'Doing Business As' Name: MICHAEL TERRELL LANDSCAPE ARCH Estimated Workers Reported: Quarter 3 of Year 2011 "l to 3 Workers" (See Description Below) Workers' Comp Premium Status: Account is current. Firm has voluntarily reported and paid their premiums. Licensed Contractor? No Account Representative: Tl / KHANH TRAN (360)902 -4802 - Email: TRAK235 @lni.wa.gov 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 hone / / fnrtracc xx7A rtn1711ni 11rrxoi /A +T-- P -D,, -+ —_0 A i.n..— +TA -1) 77C(l At) 1 D. A