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13-085.00 Budinger & Associates: Pines North of I-90 & UPRR TracksFormal Task Assignment Document Task Number A The general provisions and clauses of Agreement On -Call shall be in full force and effect for this Task Assignment Location of Project: Pines Road (SR27) north of I -40 and UPRR Tracks Project Title: Pines/Mansfield Project #0005- UPRR Sidewalk Work Maximum Amount Payable Per Task Assignment: $855.86 Completion Date: December 31, 2013 Description of Work: (Note attachments and give brief description) Budinger, Inc. will provide compaction testing and concrete air and slump tests for the Pines/Mansfield UP Sidewalk work. (see attached Scope) Agency Project Manager Signature: Oral Authorization D, Consultant Signature: Agency Approving A Aoop — V //� , 0 �� DOS' Form 140.089 EF Formal Task Assignment Revised 6105 Dated: April 3, 2013 Date: .5— f5--1,5 Date: 5 9-1-3 C,ol3 -099 DOCUMENTS EXEMPT FROM PUBLIC DISCLOSURE The page entitled "Subconsultant Fee Determination — Summary Sheet / Exhibit E -2" 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. ' BUDIN-2 OP ID: KY AWREY CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 07/31/13 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 425-489-4500 CONTACT Hub International Northwest 425489 4501 PHONE FAX - - P.O.Box 3018 (A/C.No.Ext): (A/C,No): Bothell,WA 98041-3018 E-MAIL Chad Epple ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Mutual of Enumclaw Ins.Co. 14761 INSURED Budinger&Associates Inc INSURER B: 1101 N Fancher Rd Spokane,WA 99212 INSURER C: 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 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MM/DDYYY) (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CPP0011785 08/06/13 08/06/14 DAMAGE T O D 300 PREMISES(Ea RENTE occurrence) $ ,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 X WA STOP GAP GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 —1 POLICY X JECT LOC Emp Ben. $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) A X ANY AUTO CPP0011785 08/06/13 08/06/14 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- X OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N CPP0011785 08/06/13 08/06/14 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) WA STOP GAP E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) ADDITIONAL INSURED AS REQUIRED BY WRITTEN CONTRACT: CITY OF SPOKANE VALLEY, THEIR AGENTS, OFFICERS AND EMPLOYEES. COVERAGE IS PRIMARY AND NON- CONTRIBUTORY. SEE ATTACHED ENDORSEMENT. RE: ANY AND ALL OPERATIONS OF THE NAMED INSURED. CERTIFICATE HOLDER CANCELLATION CITYSPV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF SPOKANE VALLEY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 11707 EAST SPRAGUE AVENUE SUITE 106 AUTHORIZED REPRESENTATIVE SPOKANE VALLEY,WA 99206 L. ATt04 0� ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Imo COMMERCIAL GENERAL LIABILITY CG 20 33 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured any person or or- additional insureds, the following additional exclu- ganization for whom you are performing operations sions apply: when you and such person or organization have This insurance does not apply to: agreed in writing in a contract or agreement that such person or organization be added as an addi- 1. "Bodily injury", "property damage" or "personal tional insured on your policy. Such person or or- and advertising injury" arising out of the render- ganization is an additional insured only with re- ing of, or the failure to render, any professional spect to liability for "bodily injury", "property architectural, engineering or surveying ser- damage" or "personal and advertising injury" vices, including: caused, in whole or in part, by: a. The preparing, approving, or failing to pre- 1. Your acts or omissions; or pare or approve, maps, shop drawings, 2. The acts or omissions of those acting on your opinions, reports, surveys, field orders, change orders or drawings and specifica- behalf; tions; or in the performance of your ongoing operations for b. Supervisory, inspection, architectural or the additional insured. engineering activities. A person's or organization's status as an additional 2. "Bodily injury" or "property damage" occurring insured under this endorsement ends when your after: operations for that additional insured are com- pleted. a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than ser- BLANKET AND PRIMARY & NON-CONTRIBUTORY vice, maintenance or repairs) to be per- formed by or on behalf of the additional in- AS REQUIRED BY WRITTEN CONTRACT. sured(s) at the location of the covered operations has been completed; or b. That portion of"your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontrac- tor engaged in performing operations for a principal as a part of the same project. CG 20 33 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 ❑