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12-138.00 Taylor Engineering: Sprague Ave Evergreen to SullivanAdW MVWington State bepart rtment of Transportation Supplemental Agreement r p g Organization and Address Taylor Engineering, Inc. Number 2 106 W. Mission Ave. Spokane, WA 99201 Original Agreement Number Phone: (509) 328 -3371 , Project Number Execution Date Completion Date 0115 Project Title New Maximum Amount Payable Sprague Ave. Reconstruction- Ever. to Sull. $ 85,384.80 Description of Work Re- establisli destroyed survey monuments and property comers. The Local Agency of City Of Valley desires to supplement the agreement entered into with Taylor Engineering, Inc. and executed on 09/18/2012 and Identified as Agreement No, 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 t, SCOPE 0F WORK, Is hereby changed to read, ,,gr.P attarhed Sea= e, of Wnrk. 11 Section IV, TIME FOR BEGINNING AND COMPLETION, is amended to change the number of calendar days for completion of the work to read: Px*nt in ht, enmpleted hl ead nfthe year, 2n12_ 111 Section V, PAYMENT, shall be amended as follows: ,SEp Rxhihit A. This supplement increases the fee_hc� !t3�006 fnr a taint contract mmmnnt of USAR4.80. 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 below and return to this office for final action. By: Ina rk i7rOi?SO�7 — /�'irtC�n4� Consultant Signature DOT Form 140 -063 U Revised 912005 l� sign in the appropriate spaces Authority Signature �- Date (,o 2 - -13,9 EXHIBIT A Taylor Engineering Scope of Work: dated September 4, 2012 (via email) Sprague Avenue Reconstruction Re- establish Destroyed Survey Monuments It is our understanding that the centerline monuments at Adams and Progress in Sprague Avenue have been destroyed and need to be re- established. We will set crossfire mag nails for the setting of monument cases at these two intersections. After the monument cases are set, we will return to the site to set rebar with cap inside the monument cases. Additionally, we will set new reference points at the intersection corners, as required. We will then prepare and submit to the Department of Natural Resources a "Completion Report for Monument Removal or Destruction." Additionally, we are aware that two property corner monuments have been destroyed at the southeast corner of Progress and Sprague. We will reset these two corners by setting rebar with plastic cap and will prepare and record a Land Corner Record for each monument. A written declaration will be submitted to the Engineer stating that all survey monuments within the project limits have been perpetuated. Total Amount: $3,000.00 David M. Seese, PLS Survey Manager, Associate Taylor Engineering, Inc. Civil Engineering, Surveying, Planning 106 W. Mission Avenue Spokane, WA 99201 Ph 509.328.3371 Fx 509.328.8224 www.tgyloreno-T.com Services throughout Washington, Oregon, Idaho & Montana Client#: 335033 TAYLOENG ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 1 02/09/2012 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 Kibble & Prentice, a USI Co PR CONTACT NAME: PHONE 206 441 -6300 610 -362 -8528 A/C No EM : A/C, No 601 Union Street, Suite 1000 E -MAIL I certre t k com.com ADDRESS: p ues ' q P Seattle, WA 98101 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Travelers Indemnity Company of 25682 $1,000,000 INSURED INSURER B: Travelers Indemnity Company 25658 Taylor Engineering, Inc. INSURER C: Certain Underwriters at Lloyds A85202 106 W. Mission Avenue $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO J. — LOC Spokane, WA 99201 INSURER D: INSURER E • INSURER F: COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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 ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM / DD POLICY EXP MM /DD LIMITS • GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE lFwl Al OCCUR 68082581_286 02/24/2012 02/24/2013 OCCURENTED RENCE $1,000,000 ppEACCMH PRE�ISES Ea nce $1,000,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO J. — LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ • AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED X HIREDAUTOS X AUTOS BA8254L171 02/24/2012 02/24/2013 aBcidentSINGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Peraccident $ B X UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE CUP8452Y816 02/24/2012 02/24/2013 EACH OCCURRENCE s4,0001000 AGGREGATE s4,000,000 DED I X RETENTION $10000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 68082581_286 (WA Stop Gap) 02/24/2012 02/24/201 WC STL TU- X I ERH E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 C Professional Liability PGIARK0172800 03124/2012 03/24/2013 $2,000,000 per claim $2,000,000 annl aggr. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Sprague Avenue Survey. City of Spokane Valley is included as an additional insured on the General Liability policy where required by written contract. City of Spokane Valley THE SHOULD EXPIRATTIIONH DATE V THEREOF, E NOTTICEIEWILL CBE CDELIVERED NE Attn: Steve M. Worley, P.E. ACCORDANCE WITH THE POLICY PROVISIONS. 11707 E. Sprague Ave., Suite 106 Spokane, WA 99216 AUTHORIZED REPRESENTATIVE ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S6919807/M6919804 MXTJU