Loading...
HomeMy WebLinkAboutPW18-295 - Supplement - #3 - KBA, Inc. - East Valley Highway Pavement Preservation - 07/19/2018 Agreement Routing Form KEN T For Approvals,Signatures and Records Management WASHINGTON This form combines&replaces the Request for Mayor's Signature and Contract Cover Sheet forms. (Print on pink or cherry colored paper) Originator: Nancy for Eric Connor Department: Public Works Date Sent: 12/30/19 Date Required: 1/3/20 R o Authorized Director or Designee Date of / p, to Sign: Council N A QMayor Approval: Budget R90106 Grant? Yes No Account Number. Type: N/A Vendor Name: KBA, Inc. Category: Contract = Vendor 1089599 Sub-Category Amendment 0 Number: a Project E Name: East Valley Highway Pavement Preservation h. 161. Project +. Details: Extend completion date to complete the project. _ EAgreement 0 Basis for y Amount: Selection of ' Contractor. Q Start Date: 12/30/19 Termination Date: 6/30/20 Notice required prior to Yes No Contract Number: disclosure? Date Received by City Attorney. Comments: M 0 0 cC N a 3 a+ R C Date Routed to the Mayor's Office: in ar Date Routed to the City Clerk's Office: 'a a cc Date Sent to Originator: Visit Documents.KentWA.gov to obtain copies of all agreements adccW22373_6_19 Washington State A# Department of Tfransportation Supplemental Agreement Organization and Address Number 3 KBA,Inc. Original Agreement Number 11201 SE 8th St„Suite 160 LA 9212 Bellevue,WA 98004 Phone; (425)455-9720 Project Number Execution Date Completion Date STPUL-1073(005) 7/19/18 6/30/20 Project Title New Maximum Amount Payable East Valley Highway Pavement Preservation $226,119 Description of Work Extend the completion date to June 30,2020 due to additional time is necessary to complete the project. The Local Agency of City of Kent desires to supplement the agreement entered in to with KBA.Inc. and executed on 7/19/18 and identified as Agreement No. LA 9212 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 to the scope of work. I I Section IV, TIME FOR BEGINNING AND COMPLETION, is amended to change the number of calendar days for completion of the work to read: June 30 2020. III Section V, PAYMENT, shall be amended as follows: No change, as set forth in the attached Exhibit A, and by this reference made a part of this supplement. If you concur with this supplement and agree to the changes as stated above, please sign in the Appropriate spaces b I w and return Jo this office for final action. L'W By _ By: Timothy J..LaPorte P.E.,Public WorksDireclor Con sultant Signature Approving Authority Signature 2 30 �a DOT Form 140-063 ate Revised 09/2005 Exhibit "A" Summary of Payments Basic Supplement#1 Total Agreement Direct Salary Cost Overhead (Including Payroll Additives) Direct Non-Salary Costs Fixed Fee Total DOT Form 140-063 Revised 09/2005 . .. . &_ va L1P%LJ1f_1 I r troJUKAN(:t - , I 5/8/2019 CTHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LL'OW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED 2EPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or 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 ri hts to the certificate holder In lieu of such endorsernent(s). ,UUMER Dealey, Renton 8,Associates NA P. O. Box 12675 HONE . 510-465-3090 Oakland CA 946014-2675 „Ic No:510 452-2193 E-MAILAA E : Certificates deale renton.com INSURE S AFFORDING COVERAGE NAIC# INSURED INSURER A:Travelers Indemnity Company of America 25666 KBAINC KBA, Inc. INSURERB:XL S cial Insurance Co. 37885 11201 SE 8th Street, Ste 160 INSURER C: Phoenix Insurance Company25623 Bellevue WA 98004 INSURER D: INSURER E: COVERAGES INSURER F CERTIFICATE NUMBER:2077479282 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. IN SR TR TYPE OF INSURANCE POLICYNUM6ER POLICY F P Y EXP A X COMMERCIAL GENERAL LIABILITY Y Y LIMITS 6806N033449 5/10/2019 5/10/2020 CLAIMS-MADE a OCCUR EACH OCCURRENCE f 1,000,000 PR MI E a f 1,000,000 MEO EXP(Any one person) $10,000 , 0 GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL E ACV INJURY S 1,000 00 POLICY F_ECT1:1 LOC GENERAL AGGREGATE $2,000,000 OTHER: PRODUCTS-COMP/OP AGG f 2,000,000 AUTOMOBILE LIABILITY f Y Y BA6N034864 5/10/2019 5/10/2020 N D INGL LIMI X ANY AUTO a S 1,000,000 OVrNEO SCHEDULED BODILY INJURY(Per person) S AUTOS ONLY AUTOS X HIRED NON-OWNED BODILY INJURY(Per accident) S AUTOS ONLY X AUTOS ONLY PR R DAMA Per t S UMBRELLA LIAR S OCCUR EXCESS LIAB CW MS-MADE EACH OCCURRENCE $ DED RETENTIONS AGGREGATE $ A WORKERS COMPENSATION f AND EMPLOYERS'UAs1UTy Y 6806N033449 5/10/2019 5/10/2020 PER TH- ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N T R OFFlCE ory In NER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT (Mandatory in NH) $1,000,000 UIr yyes,describe under DESCRIPTION OF OPERATIONS Wow E.L DISEASE-EA EMPLOYE f 1,000,000 8 Prohsapnal Liabyh E.L.DISEASE-POLICY LIMIT S 1,000,000 DPR9941979 5/10/2019 5/10/2020 51,000,000 $1,000.000 DE3CR1PTk0N GF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Addltlonal Remarks Schedule,may be attached If more space Is required) RE Project 018014-01,Ag reement#LA-9212 Fed Aid#STPUL-1073(005),East Valley Highway Pavement Preservation-South 18)th Street to South I kth Street. The General Liability and Automobile Liability policies include an automatic Additional Insured endorsement that provides Additional Insured status to City of Kent, and the State of Washington,and their officers, employees, and agents, only when there is a written contract that requires such status,and only with 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 Automobile Liability policy contains a special endorsement with Prima words The Generai Liability and Automobile Liability Primary n9 when required by written Contract. favor of the Certificate Holder as referenced above s include a Waiver of Subrogation endorsement in CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CIty of Kent ACCORDANCE WITH THE POLICY PROVISIONS. 4U0 West Gowe St. W Kent WA 98032 AUTHORUXD REPRESENTATIVE ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ORD CORPORATION. All rights reserved. COMMERCIAL GENERAL LIABILITY POLICY NUMBER 6806NO33449 ISSUED DATE: 5/8/2019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Names of Additional Insured Person(s) or Organization(s): Any person or organization that you agree in a written contract, on this Coverage Part, provided that such written contract was signed and executed by you before, and is in effect when the "bodily injury"or"property damage" occurs or the "personal injury" or"advertising injury" offense is rnmmittcari Location of Covered Operations: Any project to which an applicable written contract with the described in the Name of Additional Insured Person(s)or Organization(s) section of this Schedule applies. (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 in- This insurance does not apply to "bodily injury" or clude as an additional insured the person(s) or "property damage" occurring, or "personal injury' ornani`ation/cl shown in the Schedules but only or "adverticinn inir int" aricinn nut of an offense with respect to liability for"bodily injury", "property committed, after: damage", "personal injury" or "advertising injury" 1. All work, including materials, parts or equip- caused, in whole or in part, by: ment furnished in connection with such work, 1. Your acts or omissions; or on the project (other than service, mainte- 2. The acts or omissions of those acting on your nance or repairs) to be performed by or on behalf; behalf of the additional insured(s) at the loca- tion of the covered operations has been com- in the performance of your ongoing operations for pleted; or the additional insured(s) at the location(s) desig- 2. That portion of "your work" out of which the nated above. injury or damage arises has been put to its in- B. With respect to the insurance afforded to these tended use by any person or organization additional insureds, the following additional exclu- other than another contractor or subcontrac- sions apply: for engaged in performing operations for a principal as a part of the same project. CG D3 61 03 05 Copyright 2005 The St. Paul Travelers Companies, Inc. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. POLICY NUMBER: 6806N033449 COMMERCIAL GENERAL LIABILITY ISSUED DATE• 5/8/2019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITION� AL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Any person or organization that you agree in a written contract to include as an additional insured on this Coverage Part for"bodily injury" or"property damage" included in the "products- completed operations hazard", provided that such contract was signed and executed by you before, and is in effect when, the bodily injury or property damage occurs. Location And Description Of Completed Operations Any project to which an applicable contract described in the Name of Additional Insured Person(s) or Organization(s) section of this Schedule applies. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- location designated and described in the schedule of clude as an additional insured the person(s) or or- this endorsement performed for that additional in- ganization(s) shown in the Schedule, but only with sured and included in the "products-completed opera- respect to liability for "bodily injury" or "property dam- tions hazard". age" caused, in whole or in part, by "your work" at the f 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 COMMERCIAL GENERAL LIABILITY COVERAGE NAMED INSURED: KBA, Inc. POLICY NUMBER: 6806NO33449 ADDITIONAL COVERAGES BY WRITTEN CONTRACT OR AGREEMENT This is a summary of the coverages provided under the following forms (complete forms available): Excerpt from COMMERCIAL GENERAL LIABILITY COVERAGE (FORM #CG T1 00 02 19) SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS 4. OTHER INSURANCE - d. PRIMARY AND NON-CONTRIBUTORY INSURANCE IF REQUIRED BY WRITTEN CONTRACT: if you specifically agree in a written contract or agreement that the insurance afforded to an insured under this Coverage Part must apply on a primary basis, or a primary and non-contributory basis, this insurance is primary to other insurance that is available to such insured which covers such insured as a named insured, and we will not share with that other insurance, provided that. (1) The"bodily injury" or"property damage" for which coverage is sought occurs-,.and i'rl 1 ne "nersonal and advertisma_ iniurV for which coverage is Suuyhi is caused y an offense that is committed; subsequent to the signing of that contract or agreement by you. Excerpt from XTEND ENDORSEMENT FOR ARCHITECTS, ENGINEERS AND SURVEYORS (FORM #CG D3 79 02 19) PROVISION M. - BLANKET WAIVER OF SUBROGATION - WHEN REQUIRED BY WRITTEN CONTRACT OR AGREEMENT: If the insured has agreed in a written contract or agreement to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of: a. "Bodily injury" or"property damage" that occurs; or b. "Personal and advertising injury" caused by an offense that is committed; subsequent to the signing of that contract or agreement. Page 1 I I Policy: BA6N034864 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM The following is added to Paragraph c. in A.1., Who between you and that person or organization, that is Is An Insured, of SECTION II — COVERED AUTOS signed by you before the "bodily injury" or "property LIABILITY COVERAGE in the BUSINESS AUTO damage" occurs and that is in effect during the policy COVERAGE FORM and Paragraph e. in A.1., Who Is period, to name as an additional insured for Covered An Insured, of SECTION II — COVERED AUTOS Autos Liability Coverage, but only for damages to LIABILITY COVERAGE in the MOTOR CARRIER which this insurance applies and only to the extent of COVERAGE FORM, whichever Coverage Form is that person's or organization's liability for the conduct part of your policy: of another"insured". This includes any person or organization who you are required under a written contract or agreement CA T4 37 02 16 ®2016 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc.with its permission Page 1 Of 1 . TRAVELERS -1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76(00) — 001 POLICY NUMBER: 6806NO33449 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT CALIFORNIA (BLANKET WAIVER) We have the riaht to recover our payments from anyone liable for an iniury covered by this policy. we will not entorce our right against the person or organizatiur, married ill the ou 1VUu1c. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 3.00 % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description ALL PERSONS OR ORGANIZATIONS THAT ARE PARTIE TO A CONTRACT THAT REQUIRES YOU TO OBTAIN THIS AGREEMENT, PROVIDED YOU EXECUTED THE CONTRACT BEFORE THE LOSS. DATE OF ISSUE: 5/8/2019 ST ASSIGN: CA 017106