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HomeMy WebLinkAboutPW15-325 - Original - AECOM - Upper Mill Creek Dam Improvements - 09/11/2015 Records j e e a rit WASHiNOTON Document j CONTRACT COVER SHEET This is to be completed by the Contract Manager prior to submission to City Clerks Office. All portions are to be completed. If you have questions, please contact City Clerk's Office. Vendor Name: AECOM Vendor Number: JD Edwards Number Contract Number: P t d -- IL This is assigned by City Clerk's Office Project Name: Upper Mill Creek Dam Improvements Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment ® Contract ❑ Other: glJll ) IC3 Contract Effective Date: Date of the Mayor's signature Termination Date: 12/31/16 Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: Steve Lincoln Department: Engineering Contract Amount: $64,127.56 Approval Authority: (CIRCLE ONE) Department Director Mayor City Counci Detail: (i.e. address, location, parcel number, tax id, etc.): The Consultant shall provide design and permit support for the Upper Mill Creek Dam Improvements project. As of: 08/27/14 i • KENT CONSULTANT SERVICES AGPEEMENT between the City of Kent and AECOM THIS AGREEMENT is made between the City of Kent, o Washington municipal corporation (hereinafter the "City"), and AECOM organized under the laws of the State of Washington, located and doing business at 1501 41h Ave., Suite 1400, Seattle, WA 98101, Phcne: (206) 438-2125/Fax: (206) 438- 2699, Contact: Carla Talich (hereinafter the "Consultant"). I. DESCRIPTION OF WORK. Consultant shall perform the following services for the City in accordance with the following described plans and/or specifications: The Consultant shall provide design and permit support f,;r the Upper Mill Creek Dam Improvements project. For a description, see the Consultnt's Scope of Work which is attached as Exhibit A and incorporated by this reference. Consultant further represents that the services furnished under this Agreement will be performed in accordance with generally accepted professional practices within the Puget Sound region in effect at the time those services are performed. II. TIME OF COMPLETION. The parties agree that work will begin on the tasks described in Section I above immediately upon the effective date of this Agreement. Consultant shall complete:.the work described in Section I by December 31, 2016. III. COMPENSATION. A. The City shall pay the Consultant, based on time anc': materials, an amount not to exceed Sixty Four Thousand, One Hundred Twenty Seven Do:lars and fifty six cents ($64,127.56), for the services described in this Agreement. This is d,,e maximum amount to be paid under this Agreement for the work described in Section I above, and shall not be exceeded without the prior written authorization of the City in the Norm of a negotiated and executed amendment to this agreement. The Consultant agree s that the hourly or flat rate charged by it for its services contracted for herein shall remair,-focked at the negotiated rate(s) for a period of one (1) year from the effective date of thiaAgreement. The Consultant's billing rates shall be as delineated in Exhibit A, B. The Consultant shall submit monthly payment invoice:, to the City for work performed, and a final bill upon completion of all services described3 in this Agreement. The City shall provide payment within forty-five (45) days of receipt: of an invoice. If the City objects to all or any portion of an invoice, it shall notify the Cony ultant and reserves the option to only pay that portion of the invoice not in dispute. In that event, the parties will immediately make every effort to settle the disputed portion. IV. INDEPENDENT CONTRACTOR. The parties intend that an Independent Contractor- Employer Relationship will be created by this Agreement. By their execution of this Agreement, and in accordance with Ch. 51.08 RCW, the parties make the following representations: CONSULTANT SERVICES AGREEMENT - 1 (Over$20,000) A. The Consultant has the ability to control and direct the performance and details of its work, the City being interested only in the results obtained under this Agreement. B. The Consultant maintains and pays for its own place of business from which Consultant's services under this Agreement will be performed. C. The Consultant has an established and independent business that Is eligible for a business deduction for federal Income tax purposes that existed before the City retained Consultant's services, or the Consultant is engaged in an independently established trade, occupation, profession, or business of the same nature as that involved under this Agreement. D. The Consultant is responsible for filing as they become due all necessary tax documents with appropriate federal and state agencies, including the Internal Revenue Service and the state Department of Revenue, E. The Consultant has registered its business and established an account with the state Department of Revenue and other state agencies as may be required by Consultant's business, and has obtained a Unified Business Identifier (UBI) number from the State of Washington. F. The Consultant maintains a set of books dedicated to the expenses and earnings of its business. V. TERMINATION. Either party may terminate this Agreement, with or without cause, upon providing the other party thirty (30) days written notice at its address set forth on the signature block of this Agreement. After termination, the City may take possession of all records and data within the Consultant's possession pertaining to this project, which may be used by the City without restriction. If the City's use of Consultant's records or data is not related to this project, it shall be without liability or legal exposure to the Consultant. VI. DISCRIMINATION. In the hiring of employees for the performance of work under this Agreement or any subcontract, the Consultant, its subcontractors, or any person acting on behalf of the Consultant or subcontractor shall not, by reason of race, religion, color, sex, age, sexual orientation, national origin, or the presence of any sensory, mental, or physical disability, discriminate against any person who is qualified and available to perform the work to which the employment relates. Consultant shall execute the attached City of Kent Equal Employment Opportunity Policy Declaration, Comply with City Administrative Policy 1.2, and upon completion of the contract work, file the attached Compliance Statement. VII. INDEMNIFICATION. Consultant shall defend, indemnify and hold the City, its officers, officials, employees, agents and volunteers harmless from any and all claims, injuries, damages, losses or suits, including all legal costs and attorney fees, arising out of or in connection with the Consultant's performance of this Agreement, except for that portion of the injuries and damages caused by the City's negligence. The City's inspection or acceptance of any of Consultant's work when completed shall not be grounds to avoid any of these covenants of indemnification. Should a court of competent jurisdiction determine that this Agreement is subject to RCW 4.24,115, then, in the event of liability for damages arising out of bodily injury to persons or damages to property caused by or resulting from the concurrent negligence of the Consultant and the City, its officers, officials, employees, agents and volunteers, the Consultant's liability hereunder shall be only to the extent of the Consultant's negligence. IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE INDEMNIFICATION PROVIDED HEREIN CONSTITUTES THE CONSULTANT'S WAIVER OF IMMUNITY UNDER INDUSTRIAL CONSULTANT SERVICES AGREEMENT - 2 (Over$20,000) INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES OF THIS INDEMNIFICATION. THE PARTIES FURTHER ACKNOWLEDGE THAT THEY HAVE MUTUALLY NEGOTIATED THIS WAIVER. In the event Consultant refuses tender of defense in any suit or any claim, if that tender was made pursuant to this indemnification clause, and if that refusal is subsequently determined by a court having jurisdiction (or other agreed tribunal) to have been a wrongful refusal on the Consultant's part, then Consultant shall pay all the City's costs for defense, including all reasonable expert witness fees and reasonable attorneys' fees, plus the City's legal costs and fees incurred because there was a wrongful refusal on the Consultant's part. The provisions of this section shall survive the expiration or termination of this Agreement, VIII. INSURANCE. The Consultant shall procure and maintain for the duration of the Agreement, insurance of the types and in the amounts described in Exhibit B attached and incorporated by this reference. IX. EXCHANGE OF INFORMATION. The City will provide its best efforts to provide reasonable accuracy of any information supplied by it to Consultant for the purpose of completion of.the work under this Agreement. X. OWNERSHIP AND USE OF RECORDS AND DOCUMENTS. Original documents, drawings, designs, reports, or any other records developed or created under this Agreement shall belong to and become the property of the City. All records submitted by the City to the Consultant will be safeguarded by the Consultant. Consultant shall make such data, documents, and files available to the City upon the City's request, The Consultant acknowledges that the City is a public agency subject to the Public Records Act codified in Chapter 42.56 of the Revised Code of Washington. As such, the Consultant agrees to cooperate fully with the City in satisfying the City's duties and obligations under the Public Records Act. The City's use or reuse of any of the documents, data, and files created by Consultant for this project by anyone other than Consultant on any other project shall be without liability or legal exposure to Consultant. XI. CITY'S RIGHT OF INSPECTION. Even though Consultant is an independent contractor with the authority to control and direct the performance and details of the work authorized under this Agreement, the work must meet the approval of the City and shall be subject to the City's general right of inspection to secure satisfactory completion. XII. WORK PERFORMED AT CONSULTANT'S RISK. Consultant shall take all necessary precautions and shall be responsible for the safety of its employees, agents, and subcontractors in the performance of the contract work and shall utilize all protection necessary for that purpose. All work shall be done at Consultant's own risk, and Consultant shall be responsible for any loss of or damage to materials, tools, or other articles used or held for use in connection with the work. XIII. MISCELLANEOUS PROVISIONS. A. Recyclable Materials. Pursuant to Chapter 3.80 of the Kent City Code, the City requires its contractors and consultants to use recycled and recyclable products whenever practicable. A price preference may be available for any designated recycled product. B. Non-Waiver of Breach. The failure of the City to insist upon strict performance of any of the covenants and agreements contained in this Agreement, or to exercise any option conferred by this Agreement In one or more instances shall not be construed to be a waiver or relinquishment of those covenants, agreements or options, and the same shall be and remain in full force and effect. C. Resolution of Disputes and Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of Washington. If the parties are unable to settle any dispute, difference or claim arising from the parties' performance of this Agreement, the exclusive means of resolving that dispute, difference or claim, shall only be by filing suit exclusively under the venue, rules and jurisdiction of the King County Superior Court, King County, Washington, unless the parties agree in CONSULTANT SERVICES AGREEMENT - 3 (Over$20,000) - writing to an alternative dispute resolution process. In any claim or lawsuit for damages arising from the parties' performance of this Agreement, each party shall pay all its legal costs and attorney's fees incurred in defending or bringing such claim or lawsuit, including all appeals, in addition to any other recovery or award provided by law; provided, however, nothing In this paragraph shall be construed to limit the City's right to indemnification under Section VII of this Agreement. D. Written Notice. All communications regarding this Agreement shall be sent to the parties at the addresses listed on the signature page of the Agreement, unless notified to the contrary. Any written notice hereunder shall become effective three (3) business days after the date of mailing by registered or certified mail, and shall be deemed sufficiently given if sent to the addressee at the address stated in this Agreement or such other address as may be hereafter specified in writing. E. Assignment. Any assignment of this Agreement by either party without the written consent of the non-assigning party shall be void. If the non-assigning party gives its consent to any assignment, the terms of this Agreement shall continue in full force and effect and no further assignment shall be made without additional written consent. F. Modification. No waiver, alteration, or modification of any of the provisions of this Agreement shall be binding unless in writing and signed by a duly authorized representative of the City and Consultant. G. Entire Agreement. The written provisions and terms of this Agreement, together with any Exhibits attached hereto, shall supersede all prior verbal statements of any officer or other representative of the City, and such statements shall not be effective or be construed as entering into or forming a part of or altering in any manner this Agreement. All of the above documents are hereby made a part of this Agreement. However, should any language in any of the Exhibits to this Agreement conflict with any language contained in this Agreement, the terms of this Agreement shall prevail. H. Compliance with Laws. The Consultant agrees to comply with all federal, state, and municipal laws, rules, and regulations that are now effective or in the future become applicable to Consultant's business, equipment, and personnel engaged in operations covered by this Agreement or accruing out of the performance of those operations. I. Public Records Act. The Consultant acknowledges that the City is a public agency subject to the Public Records Act codified in Chapter 42,56 of the Revised Code of Washington and documents, notes, emails, and other records prepared or gathered by the Consultant in its performance of this Agreement may be subject to public review and disclosure, even if those records are not produced to or possessed by the City of Kent. As such, the Consultant agrees to cooperate fully with the City in satisfying the City's duties and obligations under the Public Records Act. i ]. City Business License Required. Prior to commencing the tasks described in Section I, Contractor agrees to provide proof of a current city of Kent business license pursuant to Chapter 5.01 of the Kent City Cade. CONSULTANT SERVICES AGREEMENT - 4 - (Over$20,000) '. K. Counterparts and Signatures by Fax or Email. This Agreement may be executed in any number of counterparts, each of which shall constitute an original, and all of which will together constitute this one Agreement. Further, upon executing this Agreement, either party may deliver the signature page to the other by fax or email and that signature shall have the same force and effect as if the Agreement bearing the original signature was received In person. IN WITNESS, the parties below execute this Agreement, which shall become effective on the last date entered below. CONSULTANT: CITY OF KEN f: By: gy g t.(fre) 5 (signature) Print Nam - > I p N) Print Nan�i;e: )Suzette Cooke _r Its_ i/Z— Its Mayor DATE: 1 f DATE: i NOTICES TO BE SENT TO: NOTICES TO BE SENT TO: CONSULTANT: CITY OF KENT: Carla Talich Timothy J. LaPorte, P.E. AECOM City of Kent 1501 41h Ave., Suite 1400 220 Fourth Avenue South Seattle, WA 98101 Kent, WA 98032 (206) 438-2125 (telephone) (253) 856-5500 (telephone) (206) 438-2699 (facsimile) (253) 856-6500 (facsimile) APPROyED AS TO FORM. � Kent Law Department Al-J,,l,,MITI Crk DIMA rmin s I I CONSULTANT SERVICES AGREEMENT - 5 (Over$20,000) DECLARATION CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY The City of Kent is committed to conform to Federal and State laws regarding equal opportunity. As such all contractors, subcontractors and suppliers who perform work with relation to this Agreement shall comply with the regulations of the City's equal employment opportunity policies. The following questions specifically identify the requirements the City deems necessary for any contractor, subcontractor or supplier on this specific Agreement to adhere to. An affirmative response is required on all of the following questions for this Agreement to be valid and binding. If any contractor, subcontractor or supplier willfully misrepresents themselves with regard to the directives outlines, it will be considered a breach of contract and it will be at the City's sole determination regarding suspension or termination for all or part of the Agreement; The questions are as follows: 1. I have read the attached City of Kent administrative policy number 1.2. 2. During the time of this Agreement I will not discriminate in employment on the basis of sex, race, color, national origin, age, or the presence of all sensory, mental or physical disability. 3. During the time of this Agreement the prime contractor will provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 4. During the time of the Agreement I, the prime contractor, will actively consider hiring and promotion of women and minorities. 5. Before acceptance of this Agreement, an adherence statement will be signed by me, the Prime Contractor, that the Prime Contractor complied with the requirements as set forth above. By signing below, I agree to fulfill the five requirements referenced above. By: For: (_f I t /w� JiCa Title: J Date: f EEO COMPLIANCE DOCUMENTS - 1 CITY OF KENT ADMINISTRATIVE POLICY NUMBER: 1.2 EFFECTIVE DATE: January 1, 1998 SUBJECT: MINORITY AND WOMEN SUPERSEDES: April 1, 1996 CONTRACTORS APPROVED BY Jim White, Mayor POLICY: Equal employment opportunity requirements for the City of Kent will conform to federal and state laws. All contractors, subcontractors, consultants and suppliers of the City must guarantee equal employment opportunity within their organization and, if holding Agreements with the City amounting to $10,000 or more within any given year, must take the following affirmative steps: I 1. Provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 2. Actively consider for promotion and advancement available minorities and women. Any contractor, subcontractor, consultant or supplier who willfully disregards the City's nondiscrimination and equal opportunity requirements shall be considered in breach of contract and subject to suspension or termination for all or part of the Agreement. Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and Public Works Departments to assume the following duties for their respective departments. 1. Ensuring that contractors, subcontractors, consultants, and suppliers subject to these regulations are familiar with the regulations and the City's equal employment opportunity policy. 2. Monitoring to assure adherence to federal, state and local laws, policies and guidelines. EEO COMPLIANCE DOCUMENTS - 2 CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE STATEMENT This form shall be filled out AFTER COMPLETION of this project by the Contractor awarded the Agreement. I, the undersigned, a duly represented agent of Company, hereby acknowledge and declare that the before-mentioned company was the prime contractor for the Agreement known as that was entered into on the (date), between the firm I represent and the City of Kent. I declare that I complied fully with all of the requirements and obligations as outlined in the City of Kent Administrative Policy 1.2 and the Declaration City of Kent Equal Employment Opportunity Policy that was part of the before-mentioned Agreement. i By: For: Title: Date: I EEO COMPLIANCE DOCUMENTS - 3 i n Ex iMit A PROFESSIONAL ENGINEERING SERVICES UPPER MILL CREEK DAM IMPROVEMENTS SCOPE OF WORK August 14, 2015 The City of Kent (City) prepared a Drainage Master Plan (DMP) in September 2008 and the flood capacity of Upper Mill Creek storage facilities was reviewed. "High" priority was assigned to these facilities because flooding of these structures may cause risks to public safety, major roadway transportation, emergency vehicle access, business community, and water quality. The City and URS Corporation (now AECOM) entered into a contract agreement in December 2011 to provide professional engineering services for the Upper Mill Creek Dam Improvements project (December 15, 2011). The project included upgrading the Upper Mill Creek Dam (dam) and replacing the upstream diversion structure to increase the flood storage and capacity of the Upper Mill Creek Pond. Work under the original contract included the period from December 2011 to December 2013. The original contract was amended two times: Amendment 1 extended the contract end date to December 2014 and Amendment 2 extended the end date to December 2015. Neither Amendment 1 nor Amendment 2 included budget increases, A new contract is needed to allow for additional scope and budget for design and permit support. Design is needed as a result of unknown site conditions at the existing dam, which became apparent once the design was underway, as well as a revised design approach (which changed from an earthen dam to a structural wall to aid in permit acquisition and to avoid conflicts with the adjacent roadway). Also a new contract is needed to provide permit support for the mitigation site, including delineation and archaeological resource review. The mitigation site was recently identified by the City and is located within the same watershed as the proposed project. This document includes three main sections that describe: • Status on the existing contract; • Project work elements on this new contract; and • Potential future contract amendment. STATUS ON THE EXISTING CONTRACT The following tasks were included in the original scope of work. Status on each task under the original contract is listed in bullet form below. • Task 1 —Project Management o Task is over budget due to a longer contract period (4 years actual versus 2 years planned). o Budget allocated in new contract is for the amount of the overage plus new work for the wetland mitigation site described under"Project work elements on new contract." 1 Exhibit A • Task 2 — Geotechnical Investigation & Report o Task is over budget due to the items listed below; further detail is provided under "Project work elements on new contract": • Geotechnical Investigation and Report required additional field and laboratory work (Budget modification request 3/13/2012). • Geotechnical/Mechanically Stabilized Earth (MSE) Wall Investigation (Budget modification request 212512 0 1 3) to determine existing materials within the dam and evaluate their strength and resulting dam stability. • Design calculations needed to strengthen the existing MSE wall. o Task will be complete, pending this contract agreement. No additional geotechnical investigation-related work is anticipated. • Task 3—Wetland Investigation & Reporting o Additional wetland investigation was needed at the dam outlet (Budget modification request dated 11/27/2012). This work is described under "Project work elements on new contract." o Task will be complete pending this contract agreement. • Task 4—Archaeological Investigation & Cultural Resources Report o Task is complete. • Task 5— Hydrology & Hydraulics Data/Model Review o Task is complete, • Task 6 —Survey Coordination & Base Map Review o Task is complete. • Task 7 — Dam Improvements Alternatives Analysis o Task is complete._, • Task 8— Dam Design and. Outlet Works o Task is at 90% design level, except for electrical and mechanical engineering, which will be initiated following permit review. o Additional structural analyses were needed related to the existing MSE wall. o Also, an earthen dam was assumed in scoping, which is less complex. The structural parapet wall design was selected by the City to limit wetland impacts, expedite the construction schedule, and avoid conflicts with the adjacent roadway. o Additional work needed for the 90% design is included under"Project work elements on new contract." o A future contract amendment may be necessary based on permit review, and structural, mechanical, and electrical design needs (see "Potential Future Contract Amendment'). • Task 9— Diversion Design o Task is at approximately 30% design level, awaiting permit review. o Work remaining includes structural, calculations and fish screen design (see 'Potential Future'Contract Amendment"). • Task 10 —Construction Plan Drawings o Construction plans for the Dam are at 90% design level with need for some additional details. Mechanical and electrical engineering will be initiated following permit review. o Diversion Structure Plans are at 30%, pending permit review. o See "Potential Future Contract Amendment" for drawing needs. • Task 11 —Specifications (task has not been started). • Task 12—Construction Cost Estimates (task has not been started) • Task 13—Construction Schedule (task has not been started). • Task 14 —Support for JARPA Permitting Permit Support Meetings were necessary (Budget modification request 2/5/2013). 2 I Exhibit A o Work associated with the wetland mitigation site includes wetland delineation, cultural resources and development of a mitigation plan. This work is described under"Project work elements on new contract." • Task 15— Support for Dam Safety Permitting o Draft report was submitted in January 2014, o AECOM recommends submitting the report and awaiting regulatory comments prior to negotiating additional scope for this task as it may not be necessary. • Task 16 — Bidding Support (task has not been started). PROJECT WORK ELEMENTS ON NEW CONTRACT The following tasks are included in the original scope of work. • Task 1 — Project Management • Task 2— Geotechnical Investigation & Report • Task 3—Wetland Investigation & Reporting • Task 4— Dam Design and Outlet Works • Task 5 —Support for JARPA Permitting The following scope of work describes the work needed for each project task. Task 1 — Project Management Project activities will be coordinated and directed with the goals of completing all work within budget, schedule and City objectives and expectations. Coordination and liaison with the City will be on a regular basis to ensure that these objectives are met. Progress, schedule and budget will be monitored weekly during intense periods of work. Invoices will be generated every four weeks. Monthly progress reports will be completed as cover letters for invoices. They will summarize work completed during the period of work and show used and available budgets. Potential out-of-scope items will be addressed after being reviewed for their viability and impact to the project. AECOM will be responsible for the quality of our work and will ensure that in-house quality control and technical reviews are conducted for all AECOM deliverables prior to submittal to the City for comment and review. The in-house review will be conducted and documented for all submittals. Work includes project management scope and budget for January 2014 to June 2015. Also included is project management support associated with the wetland mitigation site. It is assumed that the work on the mitigation plan will cover the period from August 2015 to October 2016. Deliverables: Y Monthly status reports/invoices. Task 2 — Geotechnical Investigation & Report In 2012, a geotechnical field program was conducted to evaluate the foundation soils for the dam and diversion structures. A gectechnical report was prepared in March 2012. Additional scope and budget for the geotechnical investigation and report is needed to plan and perform the !R i Exhibit A drilling for the geotechnical investigation. The contract budget was based on a contractor being able to drive to the boring locations; however, a drill rig had to be lifted over the dam in order to obtain the data necessary to evaluate fill within upstream of the dam. Additional items that were needed during the investigation included contacting a number of drilling firms when CPT was not feasible (firms: Boretec, Geologic Drill, Cascade, Boart-Longyear) as well as lifting company (NW Excavating); prepared a critical lift plan; conducted two site visits to coordinate drilling and lift (one was anticipated). During drilling we encountered soft, organic soils. The result was a need to run more tests than anticipated. The original contract assumed 6 sieve tests and 2 Atterberg Limit tests. The actual testing conducted included: 1. Moisture content: 16 tests; 2. Bulk density: 2 tests; 3. Particle size analysis (sieve analysis and percent passing the No. 200 sieve): 13 tests; 4. Atterberg Limits: 5 tests; and 5. Organic content: 3 tests In January 2013, an additional site investigation and evaluation was conducted for the existing mechanically stabilized earth (MSE) wall. This task provided follow up to the Technical Memorandum prepared by URS on January 28, 2013 regarding the existing strength of the dam related to the unknown characteristics of the geotextile material used in the construction of the MSE section of the dam in 1989. The type of stabilizing fabric used in the MSE wall construction is not speLll ed on the 1989 drawings and only one reference to the material is cited in the Periodic Dam Safety Inspection Memo prepared by the Department of Ecology Dam Safety Office in July 2009, which reported that Mirafi 60OX material was used. Geotechnical wall stability analyses were conducted by URS under the original scope of work for this contract based on published material properties for the Mirafi 60OX for the existing and proposed wail configuration. For both configurations, the resulting factors of safety suggest that there may be potential instability. In order to identify the material, evaluate the existing and proposed wall stability, and make recommendations for design, the City and URS agreed that collecting a sample of the material for inspection and testing was needed. Work included two sub-tasks: 1) Field and Laboratory Work, and 2) Evaluation and Recommendations. Field and Laboratory Work URS provided a senior geotechnical engineer on-site while the City provided equipment to isolate geotextile within the existing MSE wall, URS prepared a trip report to document the observations during the investigation. Work included identifying locations in the field for taking sample of the existing fabric. Three fabric samples of approximately 2 square meters each were collected. The following assumptions were included: • The City to provide equipment for the investigation. • One field trip (including mileage and expenses). • URS coordinated with a Mirafi representative to determine if the sample can be identified as a Mirafi 60OX or other Mirafi product. 4 Exhibit A I I • The City washed and shipped the samples to the laboratory to be tested in accordance with applicable ASTM specifications and lab recommendations. The following tests were performed: a. ASTM D 4595 Tensile Strength. b. ASTM D 6992 Reduction Factor Determination (creep-rupture). c. URS provided fabric data and loading data for the tests as specified by the lab. • Lab fees are not included in this scope of work. Evahaation and Recommendation Geotechnical wall stability analyses were revised and documented in a technical memorandum for review and coordination with the City. Results would be used to evaluate the existing structure and proposed dam modifications and determine if retrofits or other actions are needed. In 2013 and early 2014, additional design changes were needed to mitigate for concerns related to the existing dam and MSE wall. Additional geotechnical analyses were prepared to evaluate the existing and proposed dam. Calculations are provided as attachments to the Draft Dam Safety Report submitted on January 16, 2014. Deliverables: 2012 Geotechnical Report • January 28, 2013 Technical Memorandum regarding the existing strength of the dam related to the unknown characteristics of the geotextile material used in the construction of the MSE section of the dam in 1989. • Geotechnical calculations related to the MSE wall stability presented in the Draft Dam Safety Report submitted on January 16, 2014. Task 3 —Wetland Investigation +& Reporting In November 2012, additional Wetland Investigation & Reporting was completed and included a wetland delineation conducted at the dam structure outlet (west of 104th AVE SE) using the methods outlined in the currently accepted manuals: • Corps of Engineers Wetlands Delineation Manual (1987). • Regional Supplement to the Corps of Engineers Wetland Delineation Manual: Western Mountains, Valleys, and Coast Region (Version 2.0) (2010). Field Work Wetland boundaries at the dam structure outlet were located by assessing an area for wetland indicators (hydrophytic vegetation, hydric soils and wetland hydrology). Paired plots were described in at least two areas per wetland type to characterize the wetland and adjacent upland area. Plots were located in areas that are representative of the wetland type being delineated. All wetland boundaries and sample plots were marked in the field with labeled flags. The City of Kent surveyed the wetland boundary flags and sample plots. Each wetland type was classified using "Classification of Wetlands and Deepwater Habitats of the United States" (Cowardin et al, 1979). The wetlands were also classified according to their hydrogeomorphic (HGM) setting (Ecology 2004), Wetland and site conditions were documented 5 Exhibit A with photographs. All wetlands were rated using the Washington State Wetland Rating System for Western Washington. Report i The additional wetland delineation area was added to the draft wetland report prepared for the project. In addition, the figures were updated to include the additional delineation area. Assumptions • The City to obtain permission and facilitate access to the site. • One field trip is assumed. • Wetland investigation associated with the mitigation site is covered under Task 5. Deliverables • Revised Jurisdictional Waters/Wetland Delineation Report to include at the dam structure outlet (west of 104th AVE SE), 2012. Task 4— Dam Design l This task included the design of the dam improvements. The original budget included the design of an earth filled dam. The structural design was preferred for environmental and schedule related reasons. A structural design is more complex and in this case was made more challenging due to the stability of the existing dam. During design, it was found that the geotextile material in the MSE wall is not strong enough to support the dam raise and a facing wall was needed. Additional structural calculations were conducted for this purpose. These calculations are provided as attachments to the Draft Dam Safety Report submitted on January 16, 2014. Deliverables: e Structural calculations provided as attachments to the Draft Dam Safety Report submitted on January 16, 2014. Task 5 _ Support for JARPA Permitting This task will involve providing support to the City for obtaining the necessary Federal, State and local permits for proceeding with construction. The wetland report completed for Task 3 and the Cultural Resources Report completed under Task 4 of our original contract will be used as attachments to the JARPA application. An additional delineation and cultural resource inventory will be completed for the proposed mitigation site. In addition, a mitigation plan and no-effect letter update will be completed. Mitigation Site Wetland Delineation The wetland delineation of the proposed mitigation site will be conducted using the methods outlined in the 1987 Corps of Engineers Wetlands Delineation Manual and the 2010 Regional Supplement to the Corps of Engineers Wetland Delineation Manual: Western Mountains, Valleys, and Coast Region (Version 2.0). 6 Exhibit A Wetland boundaries will be located by assessing an area for wetland indicators (hydrophytic vegetation, hydric soils and wetland hydrology). Paired plots will be described in at least two areas per wetland type to characterize the wetland and adjacent upland area. Plots will be located in areas that are representative of the wetland type being delineated. One indicator for each parameter is normally required to consider an area to be jurisdictional wetland. As part of the delineation work, the area will be assessed as to whether or not "normal circumstances" exist on the site. This will include an assessment of antecedent rainfall. The area will also be assessed as to whether or not it can be considered a "problem area" as defined in the Regional Supplement. All wetland boundaries and sample plots will be clearly marked in the field with labeled flags. The City of Kent will survey the wetland boundary flags and sample plots. Each wetland type will be classified using "Classification of Wetlands and Deepwater Habitats of the United States" (Cowardin et al, 1979). The wetlands will also be classified according to their hydrogeomorphic (HGM) setting (Ecology 2004), Wetland and site conditions will be documented with photographs. All wetlands will be rated using the Washington State Wetland Rating System for Western Washington. The ordinary high water mark (OHWM) of the portion of Upper Mill Creek on the proposed mitigation site will be determined during the wetland delineation field work and recorded using a Trimble GPS unit. The OHWM will not be flagged. A separate wetland report will not be written for the proposed mitigation site, but instead included in the mitigation Nlan. Mitigation Site Cultural Resource Inventory To verify that historic and archaeological resources are not impacted by project activities, AECOM will complete a literature review and record search of the proposed mitigation area, focusing on a one-mile radius surrounding the site. This review will be designed to determine the presence or absence of known archaeological resources and will be conducted utilizing records on file with the Washington Department of Archaeology and Historic Preservation in Olympia, Washington. Following completion of the record search, a complete pedestrian inventory will be conducted of the proposed mitigation area. Fieldwork will be conducted by a crew of one archaeologist over a one-day period, inclusive of travel. During the survey, utilizing transect spacing of no more than 20 meters. As appropriate, shovel probing will be conducted during the course of inventory to better determine the presence or absence of buried cultural materials. In addition, any structures 45 years old or older, will be subject to documentation. A complete report documenting the results of the investigation will be prepared, providing recommendations for additional studies, if warranted. The report will also include specific recommendations for treatment of effects to any archaeological sites or historic structures located within the project area. A draft of the report will be submitted to the City for review before the report is finalized. The final report will be provided in hard copy (5 copies) and electronic form (one CD). ..: 7 I Exhibit A No Effect Letter Update It is assumed that a Biological Assessment will not be required to describe possible effects to threatened endangered species for the Corps of Engineers consultation. A no-effect letter has been prepared. The no-effect letter will be updated with the mitigation site information and updated to reflect current ESA listings. Mitigation Plan Two versions of the mitigation plan will be prepared: draft and final plans. No conceptual mitigation plan will be prepared. Now that the City has chosen a proposed mitigation site, a draft plan will be completed that can be included in the JARPA submittal. The draft plan will lay out the basic mitigation strategy, mitigation site description (including results of wetland delineation), and include an impacts analysis of the project site and discussion of functional lift on the proposed mitigation site. The City will provide the drawings for the mitigation design. The design is anticipated to consist of plantings, minor earthwork, and potentially the installation of large woody debris above the ordinary high water mark. Agency comments are anticipated and will be incorporated into a final version of the mitigation plan. For each submittal, AECOM will provide documents in hard copy (5 copies) and electronic form (one CD with PDF files). The report will include an impact analysis section. It is assumed there will be no more than twelve figures/maps. Assumptions This scope assumes that the City will obtain permission and facilitate access to the site. In addition, it assumes that the blackberries that currently cover the proposed mitigation site will be cleared before field site assessment (wetland and cultural). It is assumed that a nationwide Section 404 permit will be appropriate for this project and that a Corps 404(b)1 Alternatives Analysis will not be required. For the cultural resource inventory of the proposed mitigation site, it is assumed that no cultural resources requiring documentation will be found. It is assumed that the City will prepare the JARPA form and graphics needed for the permit application. It is also assumed that the City will prepare the Coastal Zone Consistency and SEPA documents and any other City permit forms. AECOM will provide information to support the applications. Meetings We will also support the City in meetings with regulatory agencies for the purpose of securing approvals and permits required for construction. AECOM attended a February 2013 site visit with the Washington State Department of Fish and Wildlife and the Muckleshoot Tribe to discuss the plans for the new diversion structure and fish ladder. A daily trip report was prepared following the meeting and transmitted to the City. .� •T �a1.y'cYrBa .... . . ... ..8�ro Exhibit A The following tasks are anticipated: I • Participation in two teleconferences, one with the Department of Ecology (Ecology) and one with the US Army Corps of Engineers (Corps). o Prior to the calls, AECOM will attend one pre-teleconference meeting at the City's office to coordinate on permit strategy. o Meeting minutes will be prepared for each call. o If agency schedules allow, we will combine these two calls/meetings into one call/meeting. • AECOM will attend a site visit with the Corps and Ecology to review and discuss the project, anticipated wetland impacts, and proposed mitigation strategy. A daily trip report will be prepared following the meeting and transmitted to the City. • It is also assumed that 8 hours of time will be needed to provide written comment responses to agency questions. Deliverables: • Memo related to the field work associated with the wetland mitigation site (email transmittal). • Draft and final Cultural Resources Report for the wetland mitigation site. The final report will be provided in hard copy (5 copies) and electronic form (one CD). • No Effect Letter Update (email transmittal). • Draft and final Mitigation Plan. The final report will be provided in hard copy (5 copies) and electronic form (one CD). • Meeting minutes for two phone calls with regulatory agencies, Ecology and US Army Corps of Engineers (email transmittal). • AECOM will attend a site visit with the Corps and Ecology to review and discuss the project, anticipated wetland impacts, and proposed mitigation strategy. A daily trip report will be prepared following the meeting and transmitted to the City (electronic submittal). POTENTIAL FUTURE CONTRACT AMENDMENT It is expected that remaining work will be completed under the original contract. Remaining work on the project is described as follows. Following regulatory review, the scope and budget will be revisited to determine if a contract amendment Is needed. • Task 1 —Project Management o Additional project management time will depend on the project duration and level of effort required by the City and what is needed to address regulatory review. • Task 8 —Dam Design and Outlet Works o Pending regulatory review. o Hydraulic Analyses: • Finalize emergency spillway and water over roadway considerations. • Finalize principal spillway pipes and gates. • Revise plunge pool at the principal spillway (west of 104th AVE) to omit rock riprap. • Design the trash rack system for principal spillway. o Structural Analysis ■ Principal spillway outlet pipe structural analysis. 9 Exhibit A Coordination with mechanical, electrical, civil design led by City. o Geotechnical Analysis • Principal spillway outlet pipe filter design. • Emergency spillway outlet channel stability analysis and filter design, • Stability analyses and consolidation settlement considering soft/organic soils under the main dam. • Task 9—Diversion Design o Pending regulatory review. o Hydraulic Analysis • Design the fish screen on the diversion channel. • Design the trash rack and gate on the fish way structure. • Task 10—Construction Plan Drawings (pending regulatory review) o Dam Improvements: • Finalize emergency spillway. • Finalize principal spillway pipes and outlet. • Add trash rack system for principal spillway. • Add principal spillway outlet pipe structural details, • Coordinate structural details with geotechnical, mechanical, electrical, civil. • Add mechanical plan and details for gates and actuators. ■ Add electrical plan and details for gates and actuators. o Diversion: • Add plan and details for the fish screen on the diversion channel. • Add plan and details for the trash rack and gate on the fish way structure. • Structural plans and details for the diversion structure, box culverts, retaining walls, wing walls, including details for securing gates, trash racks, and fish screens. • Mechanical and Electrical Engineering —the original contract for the diversion structure did not include mechanical or electrical engineering. • Task 14—Support for JARPA Permitting (pending regulatory review) • Task 15 —Support for Dam Safety Permitting (pending regulatory review) ESTIMATED SCHEDULE The project schedule will be prepared by the City. 10 i EXHIBITA UPPER MILL CREEK DAM IMPROVEMENTS FEE PROPOSAL For:Clly of Keet Public Works Depadmenl By:AECOM Iformer URS) m Job Number: 33763338 (URS)/60414418 (AECOM) ••"s $ a _ ig § y yC 11 so te Task Raw Hourly Rate N Vr a ry d ra rv� t7i �8 � 12 +";'1 Multiplier 2.78 2,88 2,06 2.06 2.85 2.65 2.85 2.66 2.86 Ratcmel `I 01000 Proect Management January 2014-June 2015 18 17 35 Is 4,395,61 Welland Miti atlon SIW(3 month duration) i 8 12 21 $ 2,533.77 Subtotal-Task 01000 66 $ 6,929.38 02000 Gootechnical Investigation&Report Geolechnleal lnvesi9allon&Report(Budget modification request WIS/2012), 2 2 8 2 1 15 $ 2,316.02 Goclech/MSE Wall lnvesllgalion Budget moditkafion request 2/25/2013. 2 8 16 0 62 P. 0 96 $ 12,505.62 Additional Geoleohnicol Design asscolated with MSE We 2 0 1B 8 20 66 $ 6,413,90 Subtotal-Task 02000 162 $ 23.315.64 '.. 03000 Waliends Investigation&Ra arting. Addlllbnol Welland Invooligattan&ReportIng _ 14 3 1 18 $ 2,129.98 Subtotal-Task 03000 16 $ 2129.98 04000 Dam Design and Outlet Works Stmctursl(change from earth tostructural Wall;u0grade exisling MSE wei6 2 4 10 8 2 60 8,786,68 Subtotal-Task 04000 1 1 1 60 $ 8,786.88 05000 JARPA Permll Support Additional JARPA Permll Su oR(8ud el Modiilcalion ReRucst 2l6/2013 14 2 2 22 40 $ 5,062.b8 Oran Mlligalbn Plan 4 60 1 20 1 B 62 $ 9,260.42 Final Mlllgolion Plan 2 20 6 1 B 1 36 $ 4,041.07 No Effect Letter Update 2 6 1 9 $ 1,16R37 Bellneaten of MlOgotlen Site(will be done under original contrail budget) 0 $ Cultural Resource Survey(will be done under original contract budget) 0 $ Meetings 8 6 16 $ 2,33E 54 Olracl Costs $ 500.00 Subtotal-Task 06000 183 $ 22,966.98 Total 7 75 54 ji 32 12 20 70 6 ]0 24 3g 469 $ 64,12].fi6 Page 1 of 1 i EXHIBIT B INSURANCE REQUIREMENTS FOR CONSULTANT SERVICES AGREEMENTS Insurance The Consultant shall procure and maintain for the duration of the Agreement, insurance against claims for injuries to persons or damage to property which may arise from or in connection with the performance of the work hereunder by the Consultant, their agents, representatives, employees or subcontractors. A. Minimum Scope of Insurance Consultant shall obtain insurance of the types described below: 1. Automobile Liability insurance covering all owned, non-owned, hired and leased vehicles. Coverage shall be written on Insurance Services Office (ISO) form CA 00 01 or a substitute form providing equivalent liability coverage. If necessary, the policy shall be endorsed to provide contractual liability coverage. 2. Commercial General Liability insurance shs,Jl be written on ISO occurrence form CG 00.01 and shall cover liability arising from premises, operations, independent contractors, products-completed operations, personal injury and advertising injury, and liability assumed under an insured contract. The City shall be named as an insured under the Consultant's Commercial General Liability insurance policy with respect to the work performed for the City using ISO additional insured endorsement;CG 20 10 11 85 or a substitute endorsement providing equivalent coverage. 3. Workers' Compensation coverage as required by the Industrial Insurance laws of the State of Washington. 4. Professional Liability insurance appropriate to the Consultant's profession. B. Minimum Amounts of Insurance Consultant shall maintain the following insurance limits: 1. Automobile Liability insurance with a minimum combined single limit for bodily injury and property damage; of $1,000,000 per accident. 2. Commercial General Liability insurance shall be written with limits no less than $2,000,000 each occurrence;$2,000,000 general aggregate and a $1,000,000 prod ucts-corripleted operations aggregate limit. EXHIBIT B (continued) 3. Professional Liability insurance shall be written with limits no less than $2,000,000 per claim and $2,000,000 policy aggregate limit. C. Other Insurance Provisions The insurance policies are to contain, or be endorsed to contain, the following provisions for Automobile Liability and Commercial General Liability insurance: 1. The Consultant's insurance coverage shall be primary insurance as respect the City. Any Insurance, self-insurance, or insurance pool coverage maintained by the City shall be excess of the Consultant's insurance and shall not contribute with it. 2. The Consultant's insurance shall be endorsed to state that coverage shall not be cancelled by either party, except after thirty (30) days prior written notice by certified mail, return receipt requested, has been given to the City. 3. The City of Kent shall be named as an additional insured on all policies (except Professional Liability) as respects work performed by or on behalf of the Consultant and a copy of the endorsement naming the City as additional insured shall be attached to the Certificate of Insurance. The City reserves the right to receive a certified copy of all required insurance policies. The Consultant's Commercial General Liability insurance shall also contain a clause stating that coverage shall apply separately to each insured against whom claim is made or suit is brought, except with respects to the limits of the insurer's liability. D. Acceptability of Insurers Insurance is to be placed with insurers with a current A.M. Best rating of not less than A:VII. E. Verification of Coverage Consultant shall furnish the City with original certificates and a copy of the amendatory endorsements, including but not necessarily limited to the additional insured endorsement, evidencing the insurance requirements of the Contractor before commencement of the work. F. Subcontractors Consultant shall include all subcontractors as insureds under its policies or shall furnish separate certificates and endorsements for each subcontractor. All coverages for subcontractors shall be subject to all of the same insurance requirements as stated herein for the Consultant. ---ealif ® DATE MMIDOYYYIY /ate® CERTIFICATE OF LIABILITY INSURANCE os!6v2o15 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 CONTACT Marsh Risk&Insurance Services PHON NAMEE; -_.. -- FAX CA License 110437153 tAIC No ExtP _.-... . .. ___ AIC No: '. 777 South Figueroa Street E-MAIL - ADDRess, Los Angeles,CA 90017 Attn:LosAngeles.Cergdeguest@Marsh,Com INSURER(S)AFFORDING COVERAGE_ NAIC H 06510-AECOM—15-16 Seattl GLALP 12 2016 INSURER A;Zurich American insurance Company 16535 INSURED INSURER B:NIA NIA AECOM -- -- 1501 4th Avenue,Suite 1400 INSURER c:Illinois Union Insurance Co_. 27960 Seattle,WA 98101 INSURER D: _ INSURER E: _ INSURER F: COVERAGES CERTIFICATE NUMBER: LOS-001972638-01 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. I,me TYPE OF INSURANCE AD EL SUBR POLICY NUMBER MMIOI�mVY MMIDD%YYXYY LIMITS LTR A X I COMMERCIAL GENERAL LIABILITY GLO 596589107 v 04f0112015 104101!2016 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED CLAIMS-MADE IX I OCCUR PREY SES(Es occurrence) $ 2,000,D00 MED PRE(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 8 2,000,000 X POLICY❑ PRO-JEST ❑ LOG PRODUCTS-COMPIOP ANA $ 2,000,000 OTHER: A AUTOMOBILE LIABILITY BAP 5965693W Ogf0172075 0410112016 COMBINED SINGLE LIMIT S 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) 8 AUTOS AUTOS NON-OWNED Pere iid.ntTY DAMAGE $ HIRED AUTOS ALTOS --- -- I 5 UMBRELLA LIAB _ OCCUR EACI I OCCURRENCE S EXCESS LIAB CIAIMG-MADE AGGREGATE S DED T RETENTION$ PER OTH- $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STAI'UfE ER ANY PROPRIETORIPARTNERIEXECUTIVE NIA E.LEACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? EL (Mandatory In NH) ELL DISEASE EAEMPLOYEES _.. If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C ARCHITECTS&ENG EON G21654693 ID!0812G14 04N112016 Per Claim,Agg 2,000,DOD PROFESSIONAL HAS ""`CLAIMS MADE""' Defense Included DESCRIPTION OF OPERATIONS I LOCATIONS)VEHICLES (ACORD Tat,Additional Remarks Schedule,may be attached if more space is required) Re,AECOM Project 60438962.00001 I Upper Mill Creek Dam Improvements City of Kent is named as additional Insured forGL&AI.coverages,but only as respects work performed by or on behalf of the named insured, Contractual Llablilry is moluded in the General Liablllty covorage. This Insurance Is primary and non-contributory over any existing insurance and limited to liability arising oil of the opemlions of the named Insured and where required by wrlhan contract wilh respect to the GL&AL coverages, Severeblity Of InleresifCmss Liability Is Included for General Liability coverage. CERTIFICATE HOLDER CANCELLATION III City of Kent Public Works Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 400 West Gowe THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Kent,WA 98032 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh Risk&Insurance Services David Dennean .�lsA��dwi/►Q�I @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD AEcoM"I naI r."rledee 01'lin yel--I '31V[Iuyfer,° C.WIIM1 I In aR4 tl 1 l se / F In der spell sons L' Ie Of atltllr-Il -brein= _�e .Dion ny IL Oa..e. to .eess In 11 ]lLrcns I't)JCi WM6E'+.14 SnfiE841.U! COM.4IEPGIAI 2ENE i,C 1Ill11 1I 1Y AmurI'n' ill-Ll'mru 011nsur ddfl: '!^II;A'eon.lbes[ C6 20 tI1 U9 13 Ir Il,redIby your 11 IL Ns ud t,al In Meru 19 - U eMtr I I I tee n rl tlb'la L Issue n a o"Ilg ell M1 Lets M M1cwnaln IM1e THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. Iv' l+nben IIM1 atonal' Ia lbs Drestredy bddbu. r eou I . f Requ'rc:by meconatl rcxu'ex'ne-p or ADDITIONAL INSURED-OWNERS, LESSEES OR CONTRACTORS-SCHEDULED PERSON OR ORGANIZATION Ill,enrmrseresnl front,ty Ins:rancaern ueL_-Uel IM1e rollori C MMR,l Nil.r3ENERAI.LlABlJT1.11=1A:I PART BCHEDJLE Heme CryOrd-Mal IIIIetlrse ls) Or or anlaa pribi Loeenonls ereerer.e0oord"15 .. mly these'mnerereynm=1'1.1 dry' roe -ifeldr sr a'.I to comniem ml4 Eenodule unn'.s o abore wm neronr nme eeo o'a'l"Is u, Se obby,II-Wia is M l rea Is amendsi to B.Wier'e al to be TLLIILItoo'Ifertlrd to Lnxce a>diun tl be P.irdle)or fore null sureds, tM1C folauing I101 ral Iorr re's IIbnlsl si In S'aie-di do,bw only s apply wllM1 respell to llLUli""Ton+l'16nVl hmn Fly oc dcce not nnPl'/tu"jnrylnNry er .g ' "pe L su'.—Ill, buy prop 1 9 srdi,q slierl d . 'IOIC o p by 1 AI ieC m: belerbIr p,I, 0 1.You r nnlon s oqupnl finished P netla".Rd'aon x:ls or mis5len5 ortnose a dire u-.11, yi Yre I 'other ell seMce, p 1 e.-_11 p (M"Cbyor 0 h +_ o IDing a b d ! Ue t _10e IM1 LdR n91e -d(1 1 Ih0 r T to I. MA, cmtl oalon=b,s.: ErS:;"aletl apme It a w.. Hwe�n L Tlrpl portion do : wnA 1 or 111 Ill 1. nnu msurnae '.1,i snn "It-dyby ended n Lnv person o orb drum on only aepa Ilea aN¢V eermelcp by 1 nIs eom of undbi 1"0 Nns Denote mr a zIP :e pro red to it ea:.nlmaurnrrnu la pl' Bnano'Co Pro.21 mq�e by omraa " ne e armmm to slim adul sole I_ren l l o border :be Inan teat x^.r1r . a n uIM by fire contract I .Ine'l le proNdeN eneb adtluenol insurers. CG 201D M'll Fr v..r 1,.aervionx Dullre I- 20'I: Page1LR2 does or2 ............5nv ves t)lubdr l n_.112 CG M Ill 1113 AEGOIA and Its Subsidiaries GLO 5965891-07 Eff 0410112015 I POLICY NUMBER: GLO 5965891-07 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURE m OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Only those where required by written contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III— Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused, in whole or in part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the "products-completed operations 1. Required by the contract or agreement; or hazard". 2. Available under the applicable Limits of However: Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted This endorsement shall not increase the applicable by law; and Limits of Insurance shown in the Declarations. 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 04 13 Q Insurance Services Office, Inc., 2012 Page 1 of 1 Wolters Kluwer Financial services I Uniform Forrn JM AECOM and Its Subsidiaries BAP 5965893 D7 Ef104/0112015 POLICY NUMBER: BAP 5965893-07 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM Wth respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies persori or organizations) who are "insureds"for Covered Autos Liability Coverage under the who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: AECOM and Its Subsidiaries Endorsement Effective Date: 04/01/2015 SCHEDULE Name Of Person(s) Or Organization(s): Only those where required by written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured"for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section It — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section i — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 C Insurance Services Office, Inc... 2011 Page 1 of 1 1Afolters Kiu,vei Financial Sew es I Uniform Forms"" A�ae CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 1/1/2016 9/3/2015 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 Lockton Insurance Brokers,LLC CONTACT - - 725 S.Figueroa Street,35th FI. PHONIAIC,N Q.e. - INC.rvm;.. '.. CA License 017]5767 EMAIL Los Angeles CA 90017 ADDRESS (213)689-0065 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA Insurance Company of the State of PA 19429 INSURED INSURER B. AECOM - 1389302 FIRS Corporation INSURERC:. _. 1501 Fourth Avenue, Slate 1400 INSURERS: _ Seattle WA 99101-3655 INSURER INSURER F: COVERAGES AECTE01 CERTIFICATE NUMBER: 13652848 REVISION NUMBER: XXXXXXX 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 SUER - _-- POLICY EFF POLICYEXP LIMITS LTR WVD POLICY NUMBER MMIDDIYYYY IY MMIODYYY ':. COMMERCIAL GENERAL LIABILITY NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX OAMAGET RENTED - - CLAIMS MADE L.._ OCCUR PREMISES Ica currence) $ XXXXXXX MED EXP(Any one person) $ XXXXXXX PERSONAL M ADV INJURY $ XXXXXXX GEN'L ACGREGAI E LIMIT APPLIES PER: GENERAL AGGRFGAI E _ $ XXXXXXX POtIGY PRO- LOC PRODUCT"S-COMPIOP AGO $ XXXXXXX OTHER: AUTOMOBILE LIABILITY NOT APPLICABLE, COMBINED SINGLE LIMIT $ E..uddaup XXXXXXX ANY AUTO BODILY INJURY(Per person) $ X'x'X'X'XX' At 1.OWNED SAUTOSX,� CHEDULED AUTOS BODILY INJURY(Per accidenQ $ X' 'X}y'XXXX __ - NON-OWNED PROPERTY DAMAGE $ XXrXr- HIREDAUTOS AUTOS I R".t,.Hd'c __.. _- I $ XXXXXXX UMBRELLA LIAR OCCUR NOT APPLICABLE 'i EACH OCCURRENCE $ XXXXXXX EXCESS LIAR CLAIMS-MADE AGGREGATE $ XXXXXXX DeD RETENuoNa $ XXXXXXX TR A WORKERS COMPENSATION N SEE ATTACHED ACORll 101 1/1/Z015 1/1/2016 X STATUTE _ ER I AND EMPLOYERS'LIABILITY yIN -1 ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH AGCIOENT $ 2,000,000 OFFICERIMEMBER E%CLUDED9 NIA E.L.DISEASE-EAFMPLOYEE'i$ 2000000 If(Mandatory in NH) Yes,describe under DESCRIPTION OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 2,000,000 D DESCRIPTION OF OPERATIONS)LOCATIONS I VEHICLES (ACORD 101,Additional Remark.Schedule,may be attached if more space i.required) Notice of Canecllation applies per attached endorsement,Re:Project No.60438962.00001,Upper Mill CI'bel<Dam Improvements. CERTIFICATE HOLDER CANCELLATION See Attachments 13652848 City Of Kent VE DESCRIBED PO THEUEXPIRATION LD ANY OF H DATED THEREOF, NOTIICECIES WILLE BE DELIVE CELLED ED IN Public Works Departincrtl ACCORDANCE WITH THE POLICY PROVISIONS. 400 West Gowe Izent WA 98032 - AUTHORIZED REPRE^JBNYAT @ 1688-2014`ACGfkD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Insurer A:The Insurance Company of the State of Pennsylvania The Workers'Compensation coverage shown does not apply in monopolistic states.In the State of ND,OH,WA,and WY Workers' Compensation coverage is provided by the State Fund. In those States,the above reference policies provide Stop-Gap Employers' Liability only.Workers'Compensation policies apply as indicated below: AECOM WC 028328280-CA WC 028328281-FL WC 028328282-MA,NO,Ol I,WA.WI;.A'Y WC 028328283-ME WC 028328284-AK,AZ,VA WC 028328286-IL,KY,NC,NH,UT,VT WC 028328286-NJ,PA WC 028328287-AL,AR,CO,CT,DC,DE,GA,HI,IA,ID,IN,KS,LA,MD,MI,MN,M0,MS,MT,NE,NM,NV,NY,OK,OR,RI,SC,SD,TN,TX,WV URS Corporation WC 028328288-CA WC 028328289-FL WC 028328290-MA.ND,OH,VJA,WIAVY WC 026328291-AL,AR,CO,CT,DC,DE.GA,HI,IA,ID,IN,KS,LA,MD,MI,MN,MO,MS,MT,NE,NM,NV,NY,OK,OR,RI,SC,SD,TN,TX,WV WC 028328292-IL.KY,NC,NH,UT,VT WC 028328293-NJ,PA WC 028328294-AK,AZ,VA WC 028328295-ME ACORD 101 Miscellaneotts Attachment:M503712 Master ID: 1389302, Certificate ID: 13652848 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 1/1/2015 forms a part of Policy SEE ATTACHED ACORD 101 No. Issued to AECOM URS Corporation - By The Insurance Company of the State of Pennsylvania LIMITED ADVICE OF CANCELLATION TO SCHEDULED ENTITIES (WORKERS' COMPENSATION ONLY) This policy is amended as follows: In the event that the Insurer cancels this policy for any reason other than non-payment of premium, and 1.the cancellation effective date is prior to this policy's expiration date; '.. 2.the Named Insured or, if applicable, any other employers named in Item 1 of the Information Page is under an existing contractual obligation to notify a certificate holder(s)when this policy is canceled (hereinafter, the"Certificate Holder(s)")and the Named Insured has provided the Insurer, either directly or through its broker of record, either: (a)the name of the entity shown on the certificate, a contact name at such entity and the U.S. Postal Service mailing address of each such entity; or (b)the email address of a contact at each such entity;and 3. prior to the effective date of cancellation,the Named Insured confirms to the Insurer, either directly or through its broker of record, that the persons or organizations set forth in the Schedule below, as well as their respective addresses listed, should continue to be a part of the Schedule and, if not,the names of the persons or organizations that should be deleted, the Insurer will provide advice of cancellation (the"Advice")to each such Certificate Holders)confirmed by the Named Insured in writing to be correctly a part of the Schedule within 30 days after the Named Insured confirms the accuracy of the Schedule below with the Insurer; provided, however, that if a specific number of days is not stated above, then the Advice will be provided to such Certificate Holder(s)as soon as reasonably practicable after the Named Insured confirms the accuracy of the Schedule below with the Insurer. Proof of the Insurer emailing the Advice, using the information provided and subsequently confirmed by the Named ' Insured in writing,will serve as proof that the Insurer has fully satisfied its obligations under this endorsement. This endorsement does not affect, in any way,coverage provided under this policy or the cancellation of this policy or the effective date thereof, nor shall this endorsement invest any rights in any entity not insured under this policy. The following definitions apply to this endorsement: _ 1. Named Insured means the first named employer in Item 1 of the Information Page of this policy. 2. Insurer means the insurance company shown in the header on the Information Page of this policy. WC 99 00 58 (Ed.04111) Attachment Code: D503695 Master ID: 1389302,Certificate ID: 13652948 [ ENT KE�1 �Q Agenda Item: Consent Calendar - 7F TO: City Council DATE: September 1, 2015 SUBJECT: Consultant Services Agreement with AECOM for Upper Mill Creek Dam Improvements - Authorize MOTION: Authorize the Mayor to sign a consultant services agreement with AECOM in an amount not to exceed $64,127.56 to provide additional design services related to the Upper Mill Creek Dam Project, subject to final terms and conditions acceptable to the City Attorney and Public Works Director. SUMMARY: The Upper Mill Creek Dam Improvement Project is a high priority project intended to provide flood risk reduction to downtown Kent. In 2011, the City entered into an agreement with the URS Corporation to design these improvements. The URS Corporation has since merged with the AECOM Technology Corporation, and now operates as part of AECOM under the AECOM brand. As work in the design with URS began, it was determined that the original concept for the dam improvements could not be accomplished without impacts to both 104t�' Avenue and the wetlands of the Upper Mill Creek Reservoir. This resulted in changes to the structural and geotechnical design of the wall, as well as work related to wetland buffer impacts and mitigation to meet our city codes. This contract will allow AECOM to continue working on the project, with focus on obtaining permits from the Department of Ecology and the Army Corps of Engineers. These permits are long lead time items required to construct the dam improvements. A future contract amendment will likely be required to fully design and construct the project improvements. EXHIBITS: Consultant Services Agreement with AECOM RECOMMENDED BY: Public Works Committee YEA: Ralph, Fincher, Higgins NAY: BUDGET IMPACTS: Funding for this contract will come from the drainage fund and grants from the King County Flood Control District. REQUEST FOR MAYOR'S SIGNATURE KENT rp Routing Information(ALL REQUESTS MUST FIRST BE ROUTED THROUGH THE LAW DEpJCRTMENYj I Appmyy d' by Di cCar 1 r1 Originator:Steve Lincoln Phone (Originator): 5552 Date Sent: j111-: Date Required: Return Sicined Document to:Nancy Yoshitake Contract Termination Date 12/31/16` VENDOR NAME- Date Finance Notified: AECOM (Only required on contracts 8/26/15 10 900 andbver or on art..Grant DATE OF COUNCIL APPROVAL: Date Risk Manager Notified N/A ` 9/1/15 (Required on Non-City Standard Contracts/A reenents Has this Document been Specific all Account Number: D20021 Authorized in the Bud et? ® YES NO Brief Explanation of Document: The attached agreement is for AECOM to provide design and permit support for the Upper Mill Creek Dam project. All Contracts Must Be pouted Through The Law Department at < & J (This area to be completed by the Law Departmentl_ Received Approval of Caw Dept.: i t Law Dept. Comments. a "=: Date Forwarded to Mayor: "v ; Shaded Areas To Be Completed By Administration Staff Received: � � � r 'air I Recommendations and Comments: 'TIC Zq Dlsp r osit on: W P' r ✓ < � ,t f Date Returned. Civ Faem10o411menXomss nglfteq rvsll aya s9N^=mrt:docv r m 1. ACCIliRfY CERTIFICATE CAE LIABILITY INSURANCE RANC:E DATE(MMlDDCYYYY) 1/112017 12/7/2015 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 Lockton Insurance Brokers,LLC NAME: 725 S.Figueroa Street,35th F, -PRUNE AdC Ext: xx No): CA License#0F15767 EMAIL Las An r�eles CA 90017 ADDRESS: (213)69MO65 INSURER AFFORDING COVERAGE NAI INSURER A: *SEC ATTACHMENT INSURED AECOM INSURER B: 1389302 URS Corporation INSURER C: 600 Montgomery Street,26th Floor San Francisco CA 94111 IN5URER D INSURER E: IN RER F: COVERAGES Al TEt11 CERTIFICATE NUMBER: 13238385 REVISION NUMBER: XXXXXXX 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 ADDL SUSR POLICY EFF POLICY'EXP LT TYPE OF INSURANCE INSD VWD POLICY NUMBER MMIDD YYY MM1DD Y LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE XXXXXXX CILAIMS MADE OCCUR NOT APPLICABLE DAMAGE TO 7CNTED XXXXXXX El PREMISES Ea c ccurrence MED EXP(Any oneperson) XXXXXXX PERSONAL&ADV INJURY S XXXXXXX GEN°L AGGREGATE LIMIT APPLIES PER; GENERAL AGGREGATE $ XXXXXXX POLICY EC ❑I.00 PRODUCTS-COMPIOP AGO $ XXXXXXX OTHER $ AUTOMOBILE LIABILITY COMMNED SINGLE LIMIT sXXXXXX i i�)7"Af'1'I..IC"ABl E Ea ar'.cidenll $ ANY AUTO BODILY INJURY(Per person) $ XXXXXXX ALL OWNEDSC HEDULED NED O BODILY INJURY(Per accident $XXXXXXX NON-OWNED PR PERTY DAMAGE $ XXXXXX.X, HIRED AUTOS AUTOS Par accident H $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 7CXXXXXX EXCESS LIA'B CLAIMS-MADE NOT APPLICABLE AGGREGATE $ XXXXXXX DED I I RETENTION$ $ A WORKERS COMPENSATION SEE AI�'1"ACI-IEDACtlt.l7lrll 1./kl2lYlG 1C@12ti17 X STATUTE OTH- AND(EMPLOYERS"LIABILITY Y J N ANY PROPMETOPOPARTNERlEXECUTIVE, � N t A E.L..EACH ACCiOENT $ 2,000.000 OFFICENM,tEMBEREXCLl9Ck ,(^"syl(yyrrl} l!11 fifi,,AAtt (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE 2 000J '000 DESCRIPTIION uOF�OPERATIONS'bolaw E:r.,DISEASE•oyaLlcY LIMIT 22000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,may be attached it more space is required) Notice a f Cancellation applies Per attached endorsement.Evidence Of lnSurance CERTIFICATE HOLDER CANCELLATION See Attachments SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 13238385 AUTHORIZED REPRESENTATIVE My of Kent Attn:Renee Cameron-Legal Dept. 220 4th Avenue South Kent WA 98032 USA ACORD 25(2014/01) @19(88-2014oAcAD C RPORATION.All rights reserved The ACORD name and logo are registered marks of ACORD — Policy# Issuing Company States)Covered 0910710 Nat'l Union Dire Ins Co OH 014268016 The Insurance Company of the State of Pennsylvania FL 014268017 The Insurance Company of the State of Pennsylvania ME 014268019 The Insurance Company of the State of Pennsylvania IL,KY 014268020 The Insurance Company of the State of Pennsylvania NV 014268021 The Insurance Company of the Statc of Pennsylvania CO 014268022 The Insurance Company of the State of Pennsylvania NJ,PA 014268023 The Insurance Company of the State of Pennsylvania MA,ND,OI I,WA,VA WY 014268024 The Insurance Company of the State of Pennsylvania CA 014268025 The Insurance Company of the State of Pennsylvania IL,KY,NC,NI-I,U"I',V'1' 014268026 The Insurance Company of the State of Pennsylvania AL,Alt,CO,C7',DC,DE,GA,HI,IA,ID,IN,KS,LA,MD,MI,MN,M0,MS, M'1',NE,NM,NV,NY,OK,OR,RI,SC,SD,TN;I'X,WV 014268027 The Insurance Company of the State of Pennsylvania AK,AZ,VA 014268028 The Insurance Company of the State of Pennsylvania NY 014268018 The Insurance Company of the State of Pennsylvania IL,WA 014268029 The Insurance Company of the State of Pennsylvania CO,ID,NM,SC,7N 014268030 '1'hc Insurance Company of the State of Pennsylvania TX Miscellaneous Attachment:M503712 Master ID: 1389302,Certificate ID: 13238385 • II THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following"attaching clause"need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement,effective 12:01 AM 1/1/2016 forma apart of Policy No. Sh,.1:A'I'1'ACHED ACORD 101 Issued to AI:COM UIIS Corporation By The Insurance Company of the State of Pennsylvania LIMITED ADVICE OF CANCELLATION TO SCHEDULED ENTITIES (WORKERS'COMPENSATION ONLY) This policy is amended as follows: In the event that the Insurer cancels this policy for any reason other than non-payment of premium,and 1.the cancellation effective date is prior to this policy's expiration date; 2.the Named Insured or,if applicable,any other employers named in Item 1 of the Information Page is under an existing contractual obligation to notify a certificate holder(,.)when this policy is canceled(hereinafter,the"Certificate I Iolder(s)')and the Named Insured has provided the Insurer,either directly or through its broker of record,either: (a)the name of the entity shown on the certificate,a contact name at such entity and the U.S.Postal Service mailing address of each such entity;or (b)the email address of a contact at each such entity;and 3.prior to the effective date of cancellation,the Named Insured confirms to the Insurer,either directly or through its broker of record,that the persons or organizations set forth in the Schedule below,as well as their respective addresses listed,should continue to be a part of the Schedule and,if not,the names of the persons or or&nnizations that should be deleted, the Insurer will provide advice of cancellation(the"Advice")to each such Certificate I Iolder(s)confirmed by the Named Insured in writing to be correctly a part of the Schedule within 30 days after the Named Insured confirms the accuracy of the Schedule below with the Insurer;provided,however,that if a specific number of days is not stated above,then the Advice will be provided to such Certificate 1-lolder(s)as soon as reasonably practicable after the Named Insured confirms the accuracy of the Schedule below with the Insurer. Proof of the Insurer emailing the Advice,using the information provided and subsequently confirmed by the Named Insured in writing,will serve as proof that the Insurer has fully satisfied its obligations under this endorsement. This endorsement does not affect,in any way,coverage provided under this policy or the cancellation of this policy or the effective date thereof,nor shall this endorsement invest any rights in any entity not insured under this policy. The following definitions apply to this endorsement. 1.Named Insured means the first named employer in Item 1 of the Information Page of this policy. 2.Insurer means the insurance company shown in the header on the Information Page of this policy. WC 99 00 58 (Ed.04/11) Attachment Code: D503695 Master ID: 1389302,Certificate ID: 13238385