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12-171.00 Skillings Connolly: On Call ROW Acquistion & AppraisalSUPPLEMENTAL AGREEMENT ORGANIZATION AND ADDRESS N0. 2 Skillings Connolly, Inc. PO Box 5080 AGREEMENT NUMBER Lacey, WA 98509 -5080 10 -008 PROJECT NUMBER PHONE 360 491 -3399 PROJECT TITLE NEW MAXIMUM AMOUNT PAYABLE On -Call Right of Way Acquisition and Appraisal Services DESCRIPTION OF WORK Time Extension Only The Local Agency of City of Spokane Valley desires to supplement the agreement entered into with Skillings Connolly, Inc. executed on January 20, 2010 and identified as Agreement No. 10 -008. 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: Remains unchanged. SECTION IV, TIME FOR BEGINNING AND COMPLETION, is amended to change the completion date from December 31, 2012 to December 31, 2013. SECTION V, PAYMENT, shall be amended as follows: Remains unchanged. 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. Signed this C - day of 12012. By: Skillings Connolly, Inc„ Principal By: City of Spok Valley signing Auth- ity Skillings Connolly, Inc. Page 1 of 1 Project No. 10016 City of Spokane Valley On -Call Right of Way Acquisition and Appraisal Services October 22, 2012 Client#: 324969 SKILLCON ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 1 12/20/2011 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 Kibble & Prentice, a USI Co PR 601 Union Street, Suite 1000 Seattle, WA 98101 NAME: ' PHONE 206 441 -6300 610 - 362 -8528 A/C N. Ext : A/C, No E -MAIL ADDRESS: p I certre uest k com.com • q p INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Travelers Indemnity Co. of Amer 25666 INSURED Skillings Connolly, Inc. 5016 Lacey Blvd. SE Lacey, WA 98503 INSURER B: XL Specialty Insurance Company 37885 INSURER C: Charter Oak Fire Insurance Comp 25615 INSURER D INSURER E EEAACCH�OCCURRENCE PREMISES Ea o.. ",ance 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. LTRR TYPE OF INSURANCE NSRL SSUB POLICY NUMBER POLICY EFF MM/DDY EXP LIMITS A GENERAL LIABILITY 680676OL011 12/18/2011 12/18/201 $1,000,000 EEAACCH�OCCURRENCE PREMISES Ea o.. ",ance $1,000,000 X COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) $10,000 CLAIMS -MADE Fx] OCCUR PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $2,000,000 $ POLICY EX i a LOC I C AUTOMOBILE LIABILITY BA6752L594 12118/2011 12/18/201 MBINED Ea accident) SINGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS P OaccidenOAMAGE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? F_N] (Mandatory in NH) N/A 6806760L011 (WA Stop Gap) 12/18/2011 12/18/201 WC STATU- X OTH- FIR E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below B Professional DPR9692241 03/02/2011 03/02/2012 $1,000,000 per claim Liability $1,000,000 anni aggr. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Re: Project No. 10016, City of Spokane Valley On -Call Right -of -Way Acquisition and Appraisal Services. The Certificate Holder is named as an Additional Insured on the General Liability Policy, with respects to operations of the Named Insured. SHOULD TI H ABOVE DESCRIBED POLICIES CANCELLED City of Spokane Valley THE EXPIRATION DATE THEREOF, NOTICE WILL BE BEFORE DELIVERED N 11707 East Sprague Avenue, Suite 106 ACCORDANCE WITH THE POLICY PROVISIONS. Spokane, WA 99206 AUTHORIZED REPRESENTATIVE © 1988 -2010 ACORD cORPORAI ION. Au ngnts reservea. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S6747877/M6747876 MXTJU e