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HomeMy WebLinkAboutPW16-410 - Supplement - #2 - KBA, Inc. - 108th Ave SE & SE 208th St Intersection Improvements - 12/21/2017 F� �r u Document W g9MINGiON 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: KBA, Inc. Vendor Number: JD Edwards Number ContractContract INumber: ? This is assigned by City Clerk's Office a Project Name: 108" AVe. SE & SE 208`" St. Intersection Improvement::____ Description: ❑ Interlocal Agreement ❑ Change Order Z Amendment ❑ Contract ❑ Other: Contract Effective Date: 12/21J17 Termination Date: 6/30/18 Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: Eric Connor Department: Engineering Contract Amount: $0.00 Approval Authority: (CIRCLE ONE) Department Dire t r Mayor City Council Detail: (i.e. address, location, parcel number, tax id, etc.): Extend the time of completion to June 30, 2018. As of: 08/27/14 tl Adft Washington State Department of Transportation Supplemental Agreement Organization and Address Number 2 KBA,Inc. Original Agreement Number 11201 SE 8th St„Suite 160 Bellevue,WA 98004-6455 LA 7963 Phone: (425)455-9720 Project Number Execution Date Completion Date 11/22/16 6/30/18 Project Title New Maximum Amount Payable I08th Ave.SE(SR 515)& SE 208th St,Intersection Improv $160,136 Description of Work Continue services as in the original Scope of Work. This is a zero dollar Supplement to extend the Completion Date from December 31,2017 to June 30,201 S. There is no increase to the Maximum Amount Payable. The Local Agency of City of Kent desires to supplement the agreement entered in to with KBA.Joe. and executed on 11/22/16 and identified as Agreement No. LA 7963 All provisions in the basic agreement remain in effect except as expressly modified by this supplement. The changes to the agreement are described as follows: I Section 1, SCOPE OF WORK, is hereby changed to read: No change. II Section IV, TIME FOR BEGINNING AND COMPLETION, is amended to change completion of work to read: 6130118. III Section V, PAYMENT, shall be amended as follows: No change. If you concur with this supplement and agree to the changes as stated above, please sign in the Appropriate spaces below and return to this office for final action. By: K, Wendell Admus Vice-Pr'esldem. ��a;�'" r flI v J.LaPorte,P.E..I'ubBic NA'r/tektiDirector I Consultant Sig afore pr mg Atdhon9y Sig`°nature -2�112— Date DOT Form 140-063 Revised 09/2005 Client#: 322877 KBAINC ACORD- CERTIFICATE OF LIABILITY INSURANCE TE DA/1012DDJYYYY) 5/1 012 01 7 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIr-"ICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),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[o the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate dogs not confer rights to the certificate holder in lieu of such elldorsement(s). CNTACT PRODUCER N. ME: USI Kibble&Prentice PR IAHONkE,E 11 206 441-6300 �ynJc,Naf. 610-362-8528 601 Union Street,Suite 1000 e,kIL ' ' ' rt -- ADDaess: PL,CertRegv,Ilastr�'ilusl.com Seattle,WA 98101 _,,.--_ ...... . . .. .... _.. .. __. ..-..., INSURER(S)AFFORDING COVERAGE NAICq INSURER A.Travelers Indemnity Company of 25682 ..._ ......_. ...._.._. ____._.......... ............ --- ..... INSURED INSURER e:XL Specialty Insurance Company 37885 KBA, Inc. .._......--- ...._ ._-_.._...,.,....._.._._—_.�. .....-_..------._.. INSURER C 11201 SE 8th Street,Suite 160 ...NSURER D _...w__._._...._.-..-..—.. .... ........_ ._. _.... I Bellevue,WA 98004 .- .. ...._..._—.w._ ........ ........_ _.____.. INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: PHIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,. TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUUJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Oy _- ....... .._. — IN$R - ADD L SUER ___.._ POLIOYEFF Pg LICY EXP LIMITS LTR TYPE OF INSURANCE NSR pn/n POLICY NUMBER lMMIDDIVVVYI M IDDfYYYY) A X COMMERCIAL GENERAL LIABILITY 6800JB02318 5/10/2017 051101201E EACH OCCUif. nCE $1000000 CI-AIMS-MADE MADE occuR P E h f ED 00.000 $1 D MED ESP An persm) ...- $10 .-.. ...- I Y-'�� .ODD PERSONALS ADV INJURY S1.000.000 GEN L AGGREGATE LIMIT APPLIES PER GENERAL A60F ATF 000.000 .�yyy ..... PRO �..... $2 .�._:—.w... ..... POucv�._X JEcr ,�Loc PR----- -LwPJOPACG $2 000.000 OTHER'. $ C.OMatlNL.D^,iIN II tUMl7f p AUTOMOBILE LIABILITY BA8570X17A 5/10/2017 05/1D1201f P,a�nldanp:.... $1 000,000 X ANY AUTO BODILY INJURY(Pef person) $ LL ALL OWNED SCHEDULED BODILY INJURY(F r cmdenl) $ AUTOS AUTOS -- - NON OWNED PROn ERTY LJhMAtl E $ X HIRED AUTOS X AUTOS 11 er uLeiElmvt),,, UMBRELLA JABrIpIII-O�^CCUR EACH 0C000RENCE I$ EXCESSLIAR E CI4IMS MADE AGGREGATE. S DED RFTENTInN.f _ -..�....__...... __.......... ............_ ........... ..-...-_-...... ._ ........... ....._— ._. ....- A WORKERS COMPENSATION G80OJ802318 5/1012017 05110/201f rPTA 7E X�°a" AND EMPLOYERS'LIABILITY f """""'--- P NY PROLIFIC fORIPARTNER/EXECUTIVE rY—IN (WA Stop Gap) EL EACH ACCIDENT $1000000 OFFICER/MEMBER EXCLUDED? LhJ� NIA (Mandatory In NH) E L DISEASE EA FMPLOYEE'.. $1 ODD 000 If Yes,desenhe under _ 00 nPSCRIPTION OF OPERATIONS below EL DISEASE POLICY LIMIT $1 ODD ODD ..__..... ._,.,.._s _ .___ ,.-.... ....----.. ...-...,. _.. ,.110/_....1E _, ....... ' B Professional DPR9913953 5/10l2017 05110/2018 $1,000,OOD per claim Liability $1,000,000 annl eggs. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACERB 101,Additional Remarks Schedule,may be attached If more space Is required) RE: Project#016032-01, City of Kent Project#12-3006, LAG#LA 7963, Federal Aid#HSIP-0515(014), 1080 Ave. SE(SR 515)and SE 208th St. Intersection Improvements. The General Liability and Automobile Liability policies include an automatic Additional Insured endorsement that provides Additional Insured status to The State of Washington,the City of Kent, and their officers, employees, and agents, only when there is a written contract that requires such status, and only with (See Attached Descriptions) ` CERTIFICATE HOLDER CANCELLATION City of Kent SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Eric Connor ACCORDANCE WITH THE POLICY PROVISIONS. 220 4th Avenue, S. Kent,WA 98032 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) 1 of 2 The ACORD name and logo are registered marks of ACORD #S20479094/M20477001. AKGZP DESCRIPTIONS (Continued from Page 1) regard to work performed on behalf of the named insured.The General Liability policy contains a special endorsement with Primary and Noncontributory wording,when required by written contract.The General Liability and Automobile Liability policies include a Waiver of Subrogation endorsement in favor of Additional Insured as referenced above. SAGITTA 25.3(2014/01) 2 of 2 #520479094/M20477001 Policy ff6800J802318 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION II — WHO IS It. This insurance does not apply to "bodily AN INSURED: injury" or"property damage" caused by "your Any person or organization that you agree in a work" and included in the "products- "written contract requiring insurance" to include as completed operations hazard" unless the an additional insured on this Coverage Part, but: "written contract requiring insurance" specifically requires you to provide such a. Only with respect to liability for "bodily injury", coverage for that additional insured, and then "property damage" or"personal injury and the insurance provided to the additional b. If, and only to the extent that, the injury or insured applies only to such "bodily injury" or damage is caused by acts or omissions of "property damage" that occurs before the end you or your subcontractor In the performance of the period of time for which the "written of "your work" to which the "written contract contract requiring insurance" requires you to requiring insurance" applies, or in connection provide such coverage or the end of the with premises owned by or rented to you. policy period, whichever is earlier. The person or organization does net qualify as an 2. The following is added to Paragraph 4.a. of additional insured: SECTION IV — COMMERCIAL GENERAL c. With respect to the independent acts or LIABILITY CONDITIONS: omissions of such person or organization; or The insurance provided to the additional insured d. For "bodily injury", "property damage" or is excess over any valid and .collectible other "personal injury" for which such person or insurance, whether primary, excess, contingent or organization has assumed liability in a on any other basis, that is available to the additional insured for a loss we cover. However, if contract or agreement. you specifically agree in the "written contract The insurance provided to such additional insured requiring insurance" that this insurance provided is limited as follows: to the additional insured under this Coverage Part must apply on a primary basis or a primary and e. This insurance does not apply on any basis to non-contributory basis, this insurance is primary any person or organization for which to other insurance available to the additional coverage as an additional insured specifically insured which covers that person or organizations is added by another endorsement to this as a named insured for such loss, and we will not Coverage Part. share with the other insurance, provided that: f. This insurance does not apply to the (1) The "bodily injury" or "property damage" for rendering of or failure to render any which coverage is sought occurs; and "professional services". In the event that the Limits of Insurance of the (2) The "personal injury" for which coverage is 9• sought arises out of an offense committed; Coverage Part shown in the Declarations exceed the limits of liability required by the after you have signed that "written contract "written contract requiring insurance", the requiring insurance". But this insurance provided insurance provided to the additional insured to the additional insured still is excess over valid shall be limited to the limits of liability required and collectible other insurance, whether primary. by that "written contract requiring insurance"_ excess, contingent or on any other basis, that is This endorsement does not increase the available to the additional insured when that limits of insurance described in Section III — person or organization is an LJditional insured Limits Of Insurance. under any other insurance. CG D3 81 09 15 ©2015 The Travelers Indemnity Company.All rights reserved. Page 1 of 2 Includes the copyrighted material of Insurance Services Office, Inc.,with its permission COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph B., Transfer 4. The following definition is added to the Of Rights Of Recovery Against Others To Us, DEFINITIONS Section: of SECTION IV — COMMERCIAL GENERAL "Written contract requiring insurance" means that LIABILITY CONDITIONS: part of any written contract under which you are We waive any right of recovery we may have required to include a person oI organization as an against any person or organization because of additional insured on this Coverage Part, payments we make for "bodily injury", "property provided that the "bodily injury' and "property damage" or "personal injury" arising out of "your damage" occurs and the "personal injury" is work" performed by you, or on your behalf, done caused by an offense committed: under a "written contract requiring insurance" with that person or organization. We waive this right a. After you have signed that written contract; only where you have agreed to do so as part of b. While that part of the written contract is in the "written contract requiring insurance" with effect; and such person or organization signed by you before, and in effect when, the "bodily injury" or c. Before the end of the policy period. "property damage" occurs, or the"personal injury" offense is committed. Page 2 of 2 2015 The Treuelers Indemnity Company.Al rights reserved. CG D3 81 09 15 ndLJde5 the copyrighted material of Insurance Services Office,Inc.,with its permission Policy #BA8570X17A COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO COVERAGE PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE—This endorsement broadens coverage. However,-overage for any Injury, damage or medical expenses described In any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part,and these coverage broadening provisions de not apply to the extent that coverage is excluded or limited by such an endorsement. The fallowing listing 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 determine rights, duties, and what is and Is not covered. A. BLANKET ADDITIONAL INSURED H. AUDIO, VISUAL AND DATA ELECTRONIC B. EMPLOYEE HIRED AUTO EQUIPMENT—INCREASED LIMIT C. EMPLOYEES AS INSURED I. WAIVER OF DEDUCTIBLE—GLASS D. SUPPLEMENTARY PAYMENTS — INCREASED J. PERSONAL PROPERTY LIMITS K. AIRBAGS E. TRAILERS—INCREASED LOAD CAPACITY L. AUTO LOAN LEASE GAP F. HIRED AUTO PHYSICAL DAMAGE M. BLANKET WAIVER OF SUBROGATION G. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES—INCREASED LIMIT A. BLANKET ADDITIONAL INSURED performing duties related to the conduct of The following is added to Paragraph A.1 Who Is your business. An Insured,of SECTION 11—COVERED AUTOS 2. The following replaces Paragraph b, in B.5„ LIABILITY COVERAGE: Other Insurance, of SECTION IV — BUSI- Any person or organization who is required under NESS AUTO CONDITIONS; a written contract or agreement between you and b. For Hired Auto Physical Damage Cover- that person or organization, that Is slgned and age, the following are denmed to be cov- executed by you before the "bodily injury" or ered "autos"you own: "property damage" occurs and that is in effect (1) Any covered "auto' you lease, hire, during the policy period, to be named as an addi- rent or borrow; and tlonal insured is an "Insured" for Covered Autos Liability Coverage, but only for damages to which (2) Any covered"auto" hired or rented by this insurance applies and only to the extent that your "employee" undai a contract In person or organization qualifies as an "Insured" an "employee's" name, with your under the Who Is An Insured provision contained permission, while performing duties In Section 11. related to the conduct of your busl- B. EMPLOYEE HIRED AUTO ness. 1. The following Is added to Paragraph A.1., However, any"auto"that is leased, hired, rented or borrowed with a driver is not a Who Is An Insured, of SECTION II — COV- covered"auto". ERED AUTOS LIABILITY COVERAGE: C. EMPLOYEES AS INSURED An "employee" of yours is an "insured" while operating a covered "auto" hired or rented The following Is added to Paragraph A.1.,Who Is under a contract or agreement in an "em- An Insured, of SECTION II—COVERED AUTOS ployee's" name, with your permission, while LIABILITY COVERAGE: CA T4 20 02 15 02015 Tha Travelers Indemnity Company.All rights reserved, Page 1 Of 3 Includes copyrighted material of Insurance services Office,Inc.with Its permission. COMMERCIAL AUTO Any "employee" of yours is an "insured"while us- (2) An adjustment for depreciation and physical Ing a covered"auto"you don't own, hire or borrow condition will be made in determining actual in your business or your personal affairs. cash value in the event of a total"loss". D. SUPPLEMENTARY PAYMENTS — INCREASED (3) If a repair or replacement rosults in better LIMITS than like kind or quality,we will not pay for the 1. The following replaces Paragraph A,2.a.(2) of amount of betterment. SECTION II—COVERED AUTOS LIABILITY (4) A deductible equal to the highest Physical COVERAGE: Damage deductible applicable to any owned (2) Up to $3,000 for cost of bail bonds (in- covered "auto dueling bonds for related traffic law viola- (5) This Coverage Extension does not apply to: dons) required because of an "accident" (a) Any "auto" that Is hired, rented or bor- we cover. We do not have to furnish rowed with a driver; or these bonds, 2. The followingreplaces Paragraph A.2.a. 4 of (b) Any "auto" that Is hired, rented or bor- PO rowed from your"employee". SECTION II—COVERED AUTOS LIABILITY COVERAGE: G. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES—INCREASED LIMIT (4) All reasonable expenses incurred by the "insured" at our request, including actual The following replaces the first sentence In Para- loss of earnings up to $500 a day be- graph AA.a., Transportation Expenses, of cause of time off from work. SECTION III — PHYSICAL DAMAGE COVER- AGE: E. TRAILERS—INCREASED LOAD CAPACITY T We will pay up to $50 per day to a maximum of The following replaces Paragraph CA. of SEC- TION I—COVERED AUTOS: curred for temporary transportation expense in- curred by you because of the total theft of a cov- 1. "Trailers" with a load capacity of 3,000 ered"auto" of the private passenger type. pounds or less designed primarily for travel H. AUDIO, VISUAL AND DATA ELECTRONIC on public roads. EQUIPMENT—INCREASED Lllv;!T F. HIRED AUTO PHYSICAL DAMAGE Paragraph C.1.b. of SECTION III — PHYSICAL The following Is added to Paragraph AA., Cover- DAMAGE COVERAGE Is deleted: age Extensions, of SECTION III — PHYSICAL L WAIVER OF DEDUCTIBLE—GLASS DAMAGE COVERAGE: The following is added to Paraglaph D., Deducti- Hired Auto Physical Damage Coverage ble, of SECTION III — PHYSICAL DAMAGE If hired "autos" are covered "autos" for Covered COVERAGE: Autos Liability Coverage but not covered "autos" No deductible for a covered "auto" will apply to for Physical Damage Coverage, and this policy glass damage If the glass Is repaired rather than also provides Physical Damage Coverage for an replaced. owned "auto", then the Physical Damage Cover- J. PERSONAL PROPERTY age Is extended to "autos" that you hire, rent or The following Is added to Paragraph AA., Cover- borrow subject to the following: age Extensions, of SECTION III — PHYSICAL (1) The most we will pay for "loss" to any one DAMAGE COVERAGE: "auto" that you hire, rent or borrow Is the Personal Property Coverage lesser of: We will pay up to $400 for "loss" to wearing ap- (a) $50,000; parel and other personal property which is: (b) The actual cash value of the damaged or (1) Owned by an"insured":and stolen property as of the time of the (2) In or on your covered"auto". "lass";or This coverage only applies In the event of a total (c) The cost of repairing or replacing the theft of your covered"auto". damaged or stolen property with other No deductibles apply to Personal Property cover- property of like kind and quality. age. Page 2 of 3 02015 The Travelers Indemnity Company.All rights reserved. CA T4 20 02 15 Includes copyrighted material of Insurance Sardeas Office,Inc.with its permission. COMMERCIAL AUTO K. AIRBAGS (2) Any: The following is added to Paragraph B.3., Exclu. (a) Overdue lease or loan payments at the slons, of SECTION III — PHYSICAL DAMAGE time of the "loss"; COVERAGE: (b) Financial penalties imposed under a Exclusion 3.a. does not apply to "loss" to one or lease for excessive use, abnormal wear more airbags in a covered "auto"you own that In- and tear or high mileage; flate due to a cause other than a cause of "loss" set forth in Paragraphs A.1.b. and A.1.c., but (c) Security deposits not returned by the les- only: sor; a. If that "auto" Is a covered "auto"for Compre- (d) Costs for extended warranties, Credit Life henslve Coverage under this policy; Insurance, Health, Accident or Disability b, The airbags are not covered under any war- Insurance purchased with the loan or lease; and panty; and c. The airbags were not Intentionally Inflated. (e) Carry-over balances from previous loans or leases. We will pay up to a maximum of $1,000 for any M. BLANKET WAIVER OF SUBROGATION one"loss". L, AUTO LOAN LEASE GAP The following replaces Paragrap;i A.5., Transfer Of Rights Of Recovery Against Others To Us, The following is added to Paragraph AA., Cover- of SECTION IV — BUSINESS AUTO CONDI- age Extensions, of SECTION III — PHYSICAL TIONS: DAMAGE COVERAGE: Auto Loan Lease Gap Coverage for Private 5. Transfer Of Rights Of Recovery Against Others To Us Passenger Type Vehicles In the event of a total "loss"to a covered"auto"of We waive any right of recovery we may have the private passenger type shown in the Schedule against any person or organization to the ex- or Declaratons for which Physical Damage Cov- tent required of you by a written contract exe- erage Is provided, we will pay any unpaid amount cuted prior to any "accident" or "loss", pro- due on the lease or loan for such covered "auto" vided that the "accident"or"lass"arises out of less the following: the operations contemplated by such con- (1) The amount paid under the Physical Damage tract. The waiver applies only to the person or Coverage Section of the policy for that"auto"; organization designated in such contract. and CA T4 20 02 15 ©2015 The TraveIors lndemnly Company. All rights to so Ned. Page 3 of 3 Includes copyrighted matnrial of Insurance Services Office,Inc.with Its permission.