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HomeMy WebLinkAboutPW11-081 - Amendment - #1 - Shannon & Wilson, Inc. - Green River Levee Certification Project - 12/02/2011 M = ps� n - �rr eRecords R. WA' �i. - Document CONTRACT COVER SHEET This is to be completed by the Contract Manager prior to submission I to City Clerks Office. All portions are to be completed. I If you have questions, please contact City Clerk's Office. Vendor Name: Shannon & Wilson, Inc. Vendor Number: JD Edwards Number Contract Number: This is assigned by City Clerk's Office Project Name: Green River Levee Certification Description: ❑ Interlocal Agreement ❑ Change Order ® Amendment ❑ Contract ❑ Other: Contract Effective Date: Date of the Mayor's Signature Termination Date: 12/31/12 Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: Joe Fielding Department: Engineering Detail: (i.e. address, location, parcel number, tax id, etc.): Extend the time of_ completion to December 31, 2012 so the Consultant can continue to conduct a wetland reconnaissance and biological assessment for the project. S•Publlc\RecordsManagement\Forms\ContractCover\adcc7832 1 11/08 1 KENT W AS NINGTON AMENDMENT NO. 1 NAME OF CONSULTANT OR VENDOR: Shannon & Wilson, Inc. CONTRACT NAME & PROJECT NUMBER: Green River Levees ORIGINAL AGREEMENT DATE: January 11, 2011 This Amendment is made between the City and the above-referenced Consultant or Vendor and amends the original Agreement and all prior Amendments. All other provisions of the original Agreement or prior Amendments not inconsistent with this Amendment shall remain in full force and effect. For valuable consideration and by mutual consent of the parties, Consultant or Vendor's work is modified as follows: 1. Section I of the Agreement, entitled "Description of Work," is hereby modified to add additional work or revise existing work as follows: In addition to work required under the original Agreement and any prior Amendments, the Consultant or Vendor shall: No change is necessary to the scope of work, however an amendment is needed to extend the time of completion to December 31, 2012 so the Consultant can continue to conduct a wetland reconnaissance and biological assessment for the project. 2. The contract amount and time for performance provisions of Section II "Time of Completion," and Section III, "Compensation," are modified as follows: Original Contract Sum, $50,870.00 including applicable WSST 3 Net Change by Previous Amendments $0 including applicable WSST i Current Contract Amount $50,870.00 including all previous amendments ! Current Amendment Sum $0 Applicable WSST Tax on this $0 Amendment Revised Contract Sum $50,870.00 AMENDMENT - 1 OF 2 c Original Time for Completion 12/31/11 (insert date) Revised Time for Completion under 0 prior Amendments (insert date) Add'I Days Required (t) for this 366 calendar days Amendment Revised Time for Completion 12/31/12 (insert date) The Consultant or Vendor accepts all requirements of this Amendment by signing below, by its signature waives any protest or claim it may have regarding this Amendment, and acknowledges and accepts that this Amendment constitutes full payment and final settlement of all claims of any kind or nature arising from or connected with any work either covered or affected by this Amendment, including, without limitation, claims related to contract time, contract acceleration, onsite or home office overhead, or lost profits. This Amendment, unless otherwise provided, does not relieve the Consultant or Vendor from strict compliance with the guarantee and warranty provisions of the original Agreement. All acts consistent with the authority of the Agreement, previous Amendments (if any), and this Amendment, prior to the effective date of this Amendment, are hereby ratified and affirmed, and the terms of the Agreement, previous Amendments (if any), and this Amendment shall be deemed to have applied. The parties whose names appear below swear under penalty of perjury that they are authorized to enter into this Amendment, which is binding on the parties of this contract. IN WITNESS, the parties below have executed this Amendment, which will become effective on the last date written below. CONSULTANT/VENDOR: CITY OF KENT: By: j0r� : (signature) r (signature) Print Name: f �tr-r- nt m uzette Cooke Its V i CQ /r5, cf 4, t Mayor te,(ti le) (title) DATE: 17J1 DATE: APPROVED AS TO FORM: (applicable/f Mayor's signature required) -A"A- I!m 0 � Kenj Law Department Shannon&Wdson-GR Levees Amd 1/Feldinq i AMENDMENT - 2 OF 2 k Client#:330606 SHANNWIL11 ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 1/05/2011 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(les)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 CONTACT NAME Kibble&Prentice,a USI CO. PHONE 206 441-6300 IC,No 610-362-8528 P 0.Box 370 E M IN Ext ADDRESS PL Certrequest@kpcom.com Seattle,WA 98111 206 441-6300 CUSTOMER ID# INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A XL Specialty Insurance Company 37885 Shannon&Wilson,Inc. INSURER B P.O.Box 300303 INSURER C Seattle,WA 98103 INSURER D INSURER E f 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 DDL UBR POLICY EFF POLICY EXP LIMBS LTR N D POLICY NUMBER MIDDM'W M MM/DDlYYYY GENERAL LIABILITY EACH OCCURRENCETO $ COMMERCIAL GENERAL LIABILITY DAMAGES) RENTED PREMISES EaNTED occurrence) $ CLAIMS-MADE OCCUR ME EXP(Any one person) $ j PERSONAL$ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMITAPPLIES PER PRODUCTS-COMMOP AGG S i POLICY F7 PRCT O- LOD S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ' ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS $ $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ CESS EX LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN - ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ OFFICER,MEMBER EXCLUDED? ❑ NIA (Mandatory in NH) EL DISEASE EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ , A Professional DPR9688922 1/01/2011 01/011201 $2,000,000 per claim $ ,Liability $2,000,000 annl aggr. DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) RE:S&W Job No:21-2-60314/Location: Green River,Kent,WA Project Name:Green River Levee Improvements between River Mile 14,25 to River Mile 22 00, Kent,WA (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE { THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN { City of Kent ACCORDANCE WITH THE POLICY PROVISIONS Attn. Nancy Yoshitake 220 Fourth Avenue South AUTHORIZED REPRESENTATIVE 3 Kent,WA 98032 011988.2009 ACORD CORPORATION All rights reserved ACORD 25(2009/09) 1 of 2 The ACORD name and logo are registered marks of ACORD #S5186690/M5169333 SXFJU d DESCRIPTIONS (Continued from Page 1) Description of Work:Wetland reconnaissance and biological assessment for five levee improvement locations Along the Green River , i e 9 r i i s a 7 2 AMS 25 3(2009109) 2 of 2 #S5186690/M5169333 DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 1/7,2011 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 It the certificate holder is an ADDITIONAL INSURED,the policy(les) 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). CONTACT PRODUCER NAME Aou Private Risk Management - Seattle PHONE FAX 1420 5th Ave. #1200 Ic No (206) 749-4800 (FAY No (206) 749-4860 E-MAIL ADDRESS Seattle WA 98101 PRODUCER CUSTOMER o it 15264 INSURE S AFFORDING COVERAGE NAIC# INSURED INSURERA Hartford Underwriters Insurance 30104 Shannon & Wilson, Inc. INSURERS St Paul Fire and Marine Insuran 24767 P.O. Box 300303 INSURERC Travelers Property Casualty Comp 25674 Seattle W-A 98203 INSURERD Travelers Property Casualty Comp 25674 (206) 632-8020 INSURERE INSURER F COVERAGES CERTIFICATE NUMBER'Cert ID 22159 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 COND17IONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR ADDL SUBR POLICY EFF POUCY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUNBER MM/DDNYYY MMfDDNYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,ODO C X COMMERCIAL GENERAL LIABILITY Y y P630226DO611TIL11 1/1/2011 1/1/2012 PREMISES Ea occurrence 5 1,000,000 CLAIMS MADE F 7xOCCUR MED EXP(Any one persoi) S 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO El LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea acadent) D X ANY AUTO y y P810226DO611TIL11 1/1/2011 1/1/2012 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per acadent) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per acadent) NON-0VJNED AUTOS B X UMBRELLA LIAR X OCCUR N Qg09401127 1/i/2011 1/1/2012 EACH OCCURRENCE $ 1,000,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,000 DEDUCTIBLE $ X RETENTION $ 10,000 $ WORKERS COMPENSATION X VrC STATUMIT- OTH AND EMPLOYERS'UABIUTY 52WETL5148 l/l/2011 1/1/2012 Y A YIN y ANYPROPRIETOR/PARTNEPoEXECUTIVE❑ NIA EL EAC4ACCIDENT S 1,000,000 OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) EL DISEASE-EA EMPLOYE $ 1,000,00 If Yes,descnbe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space,s required) If, and as required under written contract, Additional Insured and Waiver of Subrogation shall apply under those policies designated above with "Y". Umbrella/Excess Policy follows form as respects Additional Insured status. Workers' Compensation coverage is not provided under the above policy for Monopolistic States. However, Stop-Gap Employers' Liability for Washington is provided with limits as stated above. Professional Liability and Pollution Liability are excluded If 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 Rant Atta: Nancy Yoshitake AUTHORIZED REPRESENTATIVE 220 Fourth Avenue South !f"<"r�areatc 2u"s 7�awaycme<r Kent WA 96032 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD Page 1 of 2 1 F DESCRIPTION OF OPERATIONS SECTION CONTINUED DATE 1/7/2011 CERTIFICATE HOLDER INSURED City of Kent Shannon & Wilson, Inc. Attn: Nancy Yoshitake P.O. Sox 300303 220 Fourth Avenue South Seattle WA 981D3 Kent WA 98032 DESCRIPTION OF OPERATIONS CONTINUED' C required by written contract, and only as instructed by the Named Insured, a minimum of 30 days notice of cancellation will given to the Certificate Holder an the event the General Liability ` policy as cancelled. Project: Green River Levee Improvements between River Mile 14.25 to River Mile 22.00, Kent, WA (S&W Job #21-2-60314) Separation of Insureds is afforded under the General Liability policy. If required by written contract, primary/non-contributory coverage applies under the General Liability policy. ' a 1 i k p d 3 t a DOC(1012003) I Page 2 of 2 ,, J COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE DEAD IT CAREFULLY 9 BLANKET ADDITIONAL INSURED (CONTRACTORS) a This endorsement modifies insurance provided under the following- COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED— (Section 11) is amended c) The insurance provided to the additional in- to include any person or organization that you sured does not apply to "bodily injury" or agree in a "written contract requiring insurance" "property damage" caused by "your work" y to include as an additional insured on this Cover- and included in the "products-completed op- age Pad, but erations hazard" unless the "written contract a) Only with respect to lability for"bodily injury", reauiring insurance" specifically requires you "property damage"or"persona€injury';and to provide such coverage for that addtional insured, and then the insurance provided to b) If, and only to the extent that, the injury or the additional insured applies only to such , damage 3s caused by acts or omissions of "bodily injury" or "property damage" that oc- you or your subcontractor in the performance curs before the and of the oenod of time for of "your work" to which the "written contract which the "written contract requiring insur- requiring insurance" applies The person or ante" requires you to provide such coverage oreanization does not qualify as an additional or the end of the policy penod, whichever is insured with respect to the independent acts earlier I or omissions of such person or organization 3. The insurance provided to the additional insured 2. The insurance provided to the additional insured by this endorsement is excess over any valid and ' by this endorsement is limited as follows collectible "ocher insurance", whether primary, a) In the event that the Limits of Insurance of excess, contingent or on any other basis, that is this Coverage Part shown In the Declarations available to the additional insured for a loss we exceed the limits of liability required by the cover under this endorsement However, if the 'Written contract requiring insurance", the in- "written contract requiring insurance" specifically surance provided to the additional insured requires that this insurance apply on a primary shall be limited to the limits of liability re- basis or a primary and non-contributory basis, quired by that "written contract requiring in- this insurance is primary to "other insurance" surance" This endorsement shall not in- available to the additional insured v✓hich covers crease the limits of insurance described in that person or organization as a named insured Section III—Limits Of Insurance for such loss, and we will not share with that b The insurance provided to the additional m- "other insurance" But the insurance provided to p the additional insured by this endorsement still is sured does not apply to "bodily injury", "prop- excess over any valid and collectible "other in- erty damage" or "personal injury" arising out surance", whether primary, excess, contingent or of the rendering of, or failure to render, any on any other basis, that is available to the addi- professional architectural, engineering or sur- tional insured when that person or organization is vexing services, including an additional insured under such "other insur- I. The preparing, approving, or failing to ante". prepare or approve, maps, shop draw- 4. As a condition of coverage provided to the ings, opinions, reports, surveys, field or- additional insured by this endorsement ders or change orders, or the preparing, approving, or failing to prepare or ap- a) The additional insured must give us written prove, drawings and specifications,and notice as soon as practicable of an "occur- ii. Supervisory, inspection, architectural or rence" or an offense which may result in a claim To the extent possible, such notice engineering activities should include CG D2 46 08 05 ®2005 The St Paul Travelers Companies, Inc. Page 1 of 2 t i I S COMMERCIAL GENERAL LIABILITY I. How, when and where the "occurrence" any provider of"other insurance"which would or offense took place, cover the additional insured for a loss we ri. The names and addresses of any injured cover under this endorsement. However, this persons and witnesses, and condition does not affect whether the insur- ance provided to the additional insured by tit. The nature and location of any injury or this endorsement is primary to "other incur- j damage arising out of the"occurrence"or ante" available to the additional insured offense which --avers that person or organization as a b) If a claim is made or"suit"is brought against named insured as described in paragraph 3. the additional insured, the additional insured above must 5. The following definition is added to SECTION V. i. Immediately record the specifics of the —DEFINITIONS. claim or"suit"and the date received,and "Written contract requiring insurance" means ii. Notify us as soon as practicable. that part of any written contract or agreement under which you are required to include a The additional insured must see to it that we person or organization as an additional in- receive written notice of the claim or"suit" as soon as practicable sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- c) The additional insured must immediately curs and the "personal injury" is caused by an send us copies of all legal papers received in offense committed- i connection with the claim or"suit", cooperate a. After the signing and execution of the j with us in the investigation or settlement of contract or agreement by you, the claim defense against the "suit", and b While that art of the contract or otherwise comply with all policy conditions agreement is in effect, and d) The additional insured must tender the de- fense and indemnity of any claim or "suit" to c. Before the end of the policy period. , j " si j , I j t Page 2 of 2 0 2005 The St Paul Travelers Companies, Inc. CG D2 46 08 05 COMMERCIAL AUTO TH18 ENDORSEMENT CHANGES THE POLICYr PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT � i i This endorsement modifies Insurances provided underthe fol!oWing- SUSINEsS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless inodi- fled by the endorsement J GENERAL DESCRIPTION OF COVERAGE—This endorsement broadens coverage However,coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement tD the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or umrfed by such an endorsement, The following I;sting is a general cover- age description only Limitations and exclusions may apply to these coverages Read all the provisions of this en- dorsement and the rest of your policy carefully to deterrt ine rights, duties, and what is and is not covered, A. BROAD FORM NAMED INSURED H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE—INCREASED LIMIT B. BLANKET ADDITIONAL INSURED I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES—INCREASED LIMIT 9 C. EMPLOYEE HIRED AUTO J. PERSONAL EFFECTS D EMPLOYEES AS INSURED K AIRBAGS E. SUPPLEMENTARY PAYMENTS — INCREASED L. NOTICE AND KNOWLEDGE OF ACCIDENT LIMITS OR LOSS F. HIRED AUTO — LIMITED WORLDWIDE M. BLANKET WAIVER OF SUBROGATION COVERAGE=INDEMNITY BASIS G. WAIVER OF DEDUCTIBLE—GLASS N. UNINTENTIONAL ERRORS OR OMISSIONS PROVISIONS A. BROAD FORM NAMED INSURED executed by you before the "bodily Injury" or The following is added to Paragraph A.1., Who Is "property damage" occurs and that is in effect An Insured of SECTION tl — LIABILITY COV- during the policy period, to be named as an addi- ERAGE tonal insured is an "insured" for L`abdity Cover age, but only for damages to which this insurance Any organization you newly acquire or form dui- applies and only to the extent that person or or- ng the pDhcy period over which you maintain ganrzatlon qualifles as an "Insured" under the 60% or more ownership Interest and that is not Who Is An Insured provision contained in Sectlorf separately insured for Business Auto Coverage, II Coverage under this provision is afforded only un- til the 180tn day after you acquire or form the or- ganization or the end of the policy period, which- 1. The fo,lbmng is added to Paragraph A.1., 1 ever is earlier. Who Is An Insured, of SECTION 11 — LI- B. BLANKET ADDITIONAL INSURED ABILITY COVERAGE The following is added to Paragraph d. In A.1:, An "employee" of yours iS an "insured" while Who Is An Insured, of SECTION 11 —LIABILITY operating an "auto" hired of rented under a COVERAGE contract or agreement in that "employee's' name, v✓Ith your permissori, while performing Any person or organization who is required under duties felated to the conduct of yo:ir busi- a written contract or agreement is you and ness fhaf person or organization, that is signed and CA T3 53 06 09 6266§The lia'velers(56firtafifes',Inc page 'I of 4 1 Includes the copyrighted material of Insurance Services Office,Inc adh its permission. n 7 ACORD. CERTIFICATE OF LIABILITY INSUARANCE DATE(MWDWYYY`) 3 uosrzoll 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 I 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 1 certificate holder In lieu of such endorsements) PRODUCER CONTACT NAME Kibble&Prentice,a LISI Co. PHONE FAX lU Na Ext 206 441-6300 AC,No) 610-362-8528 P.O. Box 370 ADDRESS PL.Certrequest@kpcom.com Seattle,WA 98111 PRODU ER 206 441-6300 CUSTOMER ID# INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA XL Specialty Insurance Company 37885 Shannon&Wilson,Inc. INSURER B P.O.Box 300303 Seattle,WA 98103 INSURER 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 INSIR 4DDI_511BR� POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR VVD POLICY NUMBER MM/DD/Y1'YV MMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ s COMMERCIAL GENERAL LIABILITY DAMAGE RENTED ' PREMISES Ea occurrence $ CLAIMS-MADE F7 OCCUR IdED EXP(Any one parson) E PERSONAL&Al INJURY $ k GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ ( POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS $ 9 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER_ ANY PROPRIETORIPARTNER1EXECUTVE E L EACH ACCIDENT $ Y OFFICERWEMBER EXCLUDED? ❑ N/A (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ 9 If yes describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT I$ a A Professional DPR9688922 1101/2011 01/011201 $2,000,000 per claim Liability $2,000 000 annl a r. DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) J RE: S&W Job No:21-2-60314/Location' Green River,Kent,WA Project Name. Green River Levee Improvements between River Mile 14 25 to River Mile 22.00, Kent,WA d (See Attached Descriptions) I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Kent ACCORDANCE WITH THE POLICY PROVISIONS , Attn. Nancy Yoshitake 220 Fourth Avenue South AUTHORIZED REPRESENTATIVE Kent,WA 98032 ®1988-2009 ACORD CORPORATION All rights reserved. ACORD 25(2009/09) 1 of 2 The ACORD name and logo are registered marks of ACORD #S5186690/M5169333 SXFJU DESCRIPTIONS (Continued from Page 1) Description of Work:Wetland reconnaissance and biological assessment for five levee improvement locations along the Green River I! 's i a a ,i { i i k u Y d AMS 25 3(2009109) 2 of 2 #S51666901M5169333 REQUEST FOR MAYOR'S SIGNATURE 40 Please Fill in All Applicable Boxes \-1147KENO WASHINGTGN This form must be printed on cherry paper i Routing Information (ALL REQUESTS MUST FIRST BE ROUTED THROUGH THE LAW DEPARTMENT) Originator Joe Fielding Phone (Originator). 5518 Date Sent I VQ511I Date Required t'k3c/l J Return Signed Document to Nancy Yoshitake CONTRACT TERMINATION DATE: 12/31/12 VENDOR NAME: Shannon &Wilson, Inc DATE OF COUNCIL APPROVAL: 12/14/10 I Brief Explanation of Document: l The attached Amendment No 1 to the Green River Levees agreement is necessary to extend the time of completion to December 31, 2012 so Shannon &Wilson can continue to conduct a wetland reconnaissance and biological assessment for the project I i i All Contracts Must Be Routed Through the Law Department (This Area to be Completed By the Law Department) ' f Val the Received: 01VE Approval of Law Dept.. L A Law Dept. Comments: KOY 2 S 2011 KENT LAiPV f)EPY. Date Forwarded to Mayor: ( � t Shaded Areas to Be Completed by Administration Staff Received: Recommendations & Comments: 7 TT- ' 1 Disposition: /Af //J Date Returned: Iage5870_templatebase • 2/07