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12-189.00 David N Randall: Bettman/Dickey - 14th to 11th Storm Conveyance CONTRACT AMENDMENT# 1 FOR THE AGREEMENT BETWEEN THE CITY OF SPOKANE VALLEY AND DAVID N. RANDALL, CIVIL ENGINEER Contract# SVPW#12-015 For good and valuable consideration, the legal sufficiency of which is hereby acknowledged, City and the David N.Randall mutually agree as follows: 1. Purpose: This Amendment is for the Contract for design and preparation of bid documents for the Bettman/Dickey stormwater conveyance by and between the Parties, executed by the Parties on June 5th, 2012, and which terminated on September 5th, 2012. Total compensation under the Original Contract is not to exceed $8360.00. Said contract shall be referred to as the "Original Contract"and its terms are hereby incorporated by reference. 2. Original Contract Provisions: The Parties agree to continue to abide by those terms and conditions of the Original Contract, dated June 5t'= 2012, and any amendments thereto, which are not specifically modified by this Amendment. 3. Amendment Provisions: This Amendment is subject to the following amended provisions,which are afollows:T� o��c The Parties agree to extend the contract expiration date to April,2013. All such amendment provisions are hereby incorporated by reference herein and shall control over any conflicting provisions of the Original Contract, including any previous amendments thereto. 1 Amendment#1 to Contract#12-015 4. Compensation Amendment History: This is Amendment# 1 of the Original Contract and the history of amendments to the Consultant's compensation is as follows: Date Compensation Original Contract Amount June 5th,2012 $8,360.00 Amendment#1 December 5t,2.012 $0,000.00 Total Amended Compensation $0,000.00 The parties have executed this Amendment to the Original Contract this 5th day of December, 2012. CITY OF SPOKANE VALLEY: DAVID N.RANDALL 72%al Mike J& .n By: David Randall City Manager Its: Consultant ATTEST: APPROVED AS TO FORM: / 'pristine Bainbri+ge,City Cl 9 Offiif the Ci Attorney 2 Amendment#1 to Contract#12-015 Aco v' VEHICLE OR EQUIPMENT CERTIFICATE OF INSURANCE DATEmeg°D"' December 11,20101 2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. This form is used to report coverages provided to a single specific vehicle or equipment Do not use this form to report liability coverage provided to multiple vehicles under a single policy.Use ACORD 25 for that purpose. PRODUCER CONTACT DARREN YOUNG,AGENT nary�s.. DARREN YOUNG INSURANCE AGENCY INC �No. 509-624-7890 I oi. 509 4624-7717 al 2308 E 57TH2 E S: DARRENCPDARRENYOUNG.ORG SPOKANE,WA 99223 c TYAilstmt: 47-94AC INSURERS)AFFORDING COVERAGE NAIC$ INSURED INSuRERA: State Farm Mutual Automobile Insurance Company 25178 DAVID RANDALL INSURERS: LISA RANDALL INSURER C: 521 W CAMERON RD INSURER D SPANGLE,WA 99031 INSURER E: DESCRIPTION OF VEHICLE OR EQUIPMENT YEAR MAKE 1 MANUFACTURER MODEL BODY TYPE VEHICLE mEN1IFICATIDN NUMBER 2013 TOYOTA TACOMA PICKUP 3TMMU4FN3DM050670 DESCRIPTION SERIAL NUMBER COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICY(IES)OF INSURANCE LISTED BELOW HAS/HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD(S)INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT'Mm RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICY(IES}DESCRIBED HEREIN IS/ARE SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICY(IES). INSR ADOI POUCY EFFECTIVE POLICY EXPIRATION LTR Nl$RD 1 TYPE OF INSURANCE POLICY NUMBER DATE GUINDI IyyyY) DATE(MMIBOIYYYY) UNITS X 1 VEHICLE UABUJTY COMBINED SINGLE LIMIT $ • BODILY INJURY(Par pares,) $ 1,000,000 070 3154-B22-47F 10116/2012 02/2212013 BODILY INJURY(Per ambient) $ 1,000,000 PROPERTY DAMAGE $ 1,000,000 GENERAL LIABILITY EACHOCCURENCE $ OCCURRENCE GENERAL AGGREGATE _ $ CLAIMS MADE $ INER LOn POLICY EFFECTIVE POLICY EXPIRATION LTR PAYEE TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDIYYYY) DATE(AMIDDIYYYY) LIMITS 1 DEDUCTIBLE VEH COLLISION LOSS ❑ACV ❑AGREED AMT $ LIMIT ❑ ❑STATED AMT $ DED VEH COMP u VEH orc []ACV ❑AGREED AMT $ UNIT ❑ ❑STATED AMT $ DIED PROPERTY ❑ACV ❑AGREED ANT $ LBBT BASIC BROAD 0 RC ❑STATED ANT SPECIAL ❑ DEO REMARKS(INCLUDING SPECIAL CONDITIONS/OTHER COVERAGES)(ABaeh ACORD 1d1,Addlemel Ramtts Schedule,Emma specs Is rogWrod) ADDITIONAL INTEREST CANCELLATION Select one of the following: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED X The ed6Eonsl Interest described below has been added to me pdky(les)Mod heroin by policy number(s). BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL.BE A request has been submitted to add the addleonel Interest deserisad below to Ow p0Ngr(ee) DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. listed hereto by poem rumber(st. VEHICLE I EpJ1PMBIT INTEREST: 1 1 LEASED I 1 FINANCED DESCRP110N OP THE ADDITIONAL INTEREST NAME AND ADDRESS OF*DornONAL INTEREST X ADDn1ONAL IISU RED LOSS PAYEE CITY OF SPOKANE VALLEY LENDER'S LOSS PAYEE C/O CHRISTINE BAINBRIDGE LOAN/LEASE IONISER 11707 E SPRAGUE AVE STE 106 SPOKANE VALLEY,WA 99206 AunRORIaD REP�FATIyQ'/�� 191997-2010 ACORD CORPORATION.All rights reserved. ACORD 23(2010105) The ACORD name and logo are registered marks of ACORD 1004361 142987 09-30-2011 �..4 RANDDAI OP ID:CR .ACORE)' DATE(MM/DDNYYY) 40.........---- CERTIFICATE OF LIABILITY INSURANCE 12/11/12 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 509-928-2121 CNAME Starr&Brown --PHONE .... ..... .. FAX Insureco,Inc 509-928-8379 , N, E ms,: =A O: 219 N Pines Rd E-MAIL Spokane,WA 99206 ADDRESS: Kirby D Brown INSURERS)AFFORDING COVERAGE NAIC If INSURER A:QBE INSURED David Randall,Civil Engineer iINSURER B:Travelers Insurance Cos 521 W Cameron Rd Spangle,WA 99031 INsuRERC; 9INSURER D: INSURERE ......... ...... . 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 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 —. .. .... lacro SUbN POLICY EFF POLICY EXP t ....LIMITS LTA TYPE OF INSURANCE MR WVD POLICY NUMBER IMM/DOIYYVY) (MM/DD/YYYYI I . GENERAL LIABILITY I EACH OCCURRENCE I$ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X CFB1088312 10/15/12 10/15/13 CE�O-R� Eo _ 100,000 PREMISES LE,occurcence�P..,$ X CLAIMS-MADE I 1 OCCUR MED EXP(Any one person) $ 5,000 B PROFESSIONAL LIAB 105240386 03(12/12 03/12/13 PERSONAL&ADV INJURY 1$ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 —1 POLICY I Ii' r LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT JEa accident) I$ __ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED —.SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS - . HIRED AUTOS AUTOS PROPERTY DAMAGE $ Per accident) • UMBRELLA LIAB - OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE. AGGREGATE $ DED I RETENTIONS . $ WORKERS COMPENSATION - ( WC STATU- 0TH AND EMPLOYERS'LIABILITY .,_,,,�:.TORY.LIMIT$„� �.E,R,,.,V._..-.. — ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N _ ? EL EACH ACCIDENT _ $ OFFICER/MEMBER EXCLUDED', I N/A I(Mandatory in NH) E L DISEASE-EA EMPLOYEE)$ If yes,describe under- DESCRIPTION OF OPERATIONS below I I E DISEASE-POLICY LIMIT I$ !Commercial Applica 1 X PROPERTY 5,463 1 , DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED IN REGARDS TO THE OPERATIONS OF THE NAMED INSURED. 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 SUITE 106 AUTHORIZED REPRESENTATIVE SPOKANE VALLEY,WA 99206 AcoL............5zz_. r ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD ■ STATE FARM INSURANCE COMPANIES® guio DATE OF NOTICE: NOV 062012 PO Box 5000 Dupont WA 98327-5000 CODE: 150A AT1 15 A 00074e 0093 CITY OF SPOKANE VALLEY NOTE: PLEASE NOTIFY STATE FARM AT THE T C/O CHRISTINE BAINBRIDGE ADDRESS LISTED AT THE TOP, LEFT CORNER s 11707 E SPRAGUE AVE STE 106 OF THIS PAGE REGARDING ANY CHANGE OF SPOKANE VLY WA 99206-6124 ADDRESS INFORMATION. 4 co 0 0 s ADDITIONAL`INSURED'S NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 94AC-F489W NAMED INSURED: POLICY NO: 070 3154-B22-47F COVERAGE: o RANDALL,DAVID&LISA YR/MAKE/MODEL: 2013 TOYOTA PICKUP BI AND PD LIABILITY N 521 W CAMERON RD VIN/CAMPER: 3TMMU4FN3DM050670 $1 MIL I$1 MIL/$1 MIL $500 DED COMP. SPANGLE WA 99031-9732 AGENT NAME: DARREN YOUNG INS AGCY INC . $500 DED.COLL. AGENT PHONE: (509)624-7890 ENDORSEMENT NO: 6028BL POLICY EFFECTIVE OCT 16 2012 UNTIL TERMINATED &"• POLICY MESSAGES: The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance provided and subject to all policy provisions.The additional insured will be given 10 days notice if the policy is terminated. Until such notice ,ei is provided,it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of Fany change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. e FRT