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HomeMy WebLinkAbout042213_ra01Department of Public Works O Regular Agenda Page 1 of 1 Jefferson County Board of Commissioners Agenda Request To: Board of Commissioners Philip Morley, County Administrator From: Frank Gifford, Public Works Director ~~Y Agenda Date: April 22, 2013 Subject: Chimacum Safe Routes to School, Education and Encouragement Agreement with the ReCyclery Statement of Issue: Jefferson County Public Works has received a grant for improvements to pedestrian and bicycle transportation infrastructure through the Safe Routes to School Program for Chimacum School District. In addition to building transportation improvements this Safe Routes to Schools grant has an education and encouragement component. Using the professional services roster the ReCyclery has been chosen to educate and encourage the students and staff to walk or bicycle to school. Analysis/Strategic Goals/Pro's & Con's: The ReCyclery is an established non-profit organization whose mission is to promote bicycling and walking in Jefferson County. Forming apublic/private partnership with the ReCyclery is a powerful way to leverage resources to meet the goals of this grant. The combination of simultaneously improving infrastructure and providing education and encouragement is an example of systems thinking and is a productive and proactive approach. Fiscal Impact/Cost Benefit Analysis: The Safe Routes to Schools grant program is providing 100% of the funding for this grant. The ReCyclery is contributing additional resources, funding, and volunteers for the project. Project leadership is being provided by the Parks and Recreation division. The Parks and Recreation Division has expertise in benefits based programming and will also facilitate use of the County Parks near Chimacum Schools as part of the program. Recommendation: Sign three originals of the agreement and return to Public Works Department Contact: Matt Tyler, 385-9129 f;e ie edB ~'/ ? ' Philip r y, County Adm' istrator Y13~~~ Date Local Jefferson County Standard Consultant Agreement Agreement ^Architectural/Engineering Agreement ® Personal Services Agreement 1917-EDUCATION-1 Agreement Number Federal Aid Number Agreement Type (Choose one) ^ Lump Sum Lump Sum Amount $ ^ Cost Plus Fixed Fee Overhead Progress Payment Rate Overhead Cost Method ^ Actual Cost ^ Actual Cost Not to Exceed ^ Fixed Rate Fixed Fee $ ^ Specific Rates Of Pay ® Negotiated Hourly Rate ^ Provisional Hourly Rate ^ Cost Per Unit Do you require a 1099 for IRS? Completion Date ® Yes ^No December 31, 2015 Total Amount Authorized $21,975 Management Reserve Fund $0 Maximum Amount Payable $21,975 Index of Exhibits (Check all that apply): ® Exhibit A-1 Sco e of Work ^ Exhibit G-2 Fee-Sub S ecific Rates ^ Exhibit A-2 Task Order A eement ^ Exhibit G-3 Sub Overhead Cost ^ Exhibit B-1 DBE Utilization Certification ® Exhibit H Title VI Assurances ® Exhibit C Electronic Exchan a of Data ® Exhibit I Pa ent U on Termination of A eement ^ Exhibit D-1 Pa ent - Lum Sum ^ Exhibit J Alle ed Consultant Desi Error Procedures ^ Exhibit D-2 Pa ent -Cost Plus ® Exhibit K Consultant Claim Procedures ® Exhibit D-3 Pa ent - Hourl Rate ^ Exhibit L Liabili Insurance Increase ^ Exhibit D-4 Pa ent -Provisional ® Exhibit M-la Consultant Certification ^ Exhibit E-1 Fee - Lum /Fixed/CJnit ® Exhibit M-lb Jefferson Coun Official Certification ® Exhibit E-2 Fee - S ecific Rates ® Exhibit M-2 Certification -Prima ® Exhibit F Overhead Cost ^ Exhibit M-3 Lobb in Certification ^Exhibit G Subcontracted Work ^ Exhibit M-4 Pricing Data Certification ^Exhibit G-1 Subconsultant Fee ^A .31.910 Su lemental Si nature Pa e THIS AGREEMENT, made and entered into this day of , between the Local Agency of Jefferson County , Washington, hereinafter called the "AGENCY", and the above organization hereinafter called the "CONSULTANT" DOT Form 140-089 EF Revised 3/2008 ConsultantlAddress/Telephone The ReCyclery 1925 Blaine St. Port Townsend, WA 98368 360-643-1755 Project Title And Work Description Chimacum School Safe Route to School Education and Encouragement Component. To provide education and encouragement to the teachers and staff of Chimacum School District for the purpose of increasing bicycling and walking to and from school, and increasing utilization of the corresponding infrastructure improvements being made with this grant. DBE Participation ^ Yes ®No Federal ID Number or Social Security Number 27-4063279 PW_Forms/Standard Consultant Agreement 3.20.13 with exhibits Page 1 of 27 WITNESSETH THAT: WHEREAS, the AGENCY desires to accomplish the above referenced project, and WHEREAS, the AGENCY does not have sufficient staff to meet the required commitment and therefore deems it advisable and desirable to engage the assistance of a CONSULTANT to provide the necessary services for the PROJECT; and WHEREAS, the CONSULTANT represents that he/she is in compliance with the Washington State Statutes relating to professional registration, if applicable, and has signified a willingness to furnish Consulting services to the AGENCY, NOW THEREFORE, in consideration of the terms, conditions, covenants and performance contained herein, or attached and incorporated and made a part hereof, the parties hereto agree as follows: I General Description of Work The work under this AGREEMENT shall consist of the above described work and services as herein defined and necessary to accomplish the completed work for this PROJECT. The CONSULTANT shall furnish all services, labor, and related equipment necessary to conduct and complete the work as designated elsewhere in this AGREEMENT. H Scope of Work The Scope of Work and projected level of effort required for this PROJECT is detailed in Exhibit "A" attached hereto and by this reference made a part of this AGREEMENT. III General Requirements All aspects of coordination of the work of this AGREEMENT with outside agencies, groups, or individuals shall receive advance approval by the AGENCY. Necessary contacts and meetings with agencies, groups, and/or individuals shall be coordinated through the AGENCY. The CONSULTANT shall attend coordination, progress and presentation meetings with the AGENCY and/or such Federal, State, Community, City or County officials, groups or individuals as may be requested by the AGENCY. The AGENCY will provide the CONSULTANT sufficient notice prior to meetings requiring CONSULTANT participation. The minimum required hours or days notice shall be agreed to between the AGENCY and the CONSULTANT and shown in Exhibit "A." The CONSULTANT shall prepare a monthly progress report, in a form approved by the AGENCY, which will outline in written and graphical form the various phases and the order of performance of the work in sufficient detail so that the progress of the work can easily be evaluated. The CONSULTANT, and each SUBCONSULTANT, shall not discriminate on the basis of race, color, national origin, or sex in the performance of this contract. The CONSULTANT, and each SUBCONSULTANT, shall carry out applicable requirements of 49 CFR Part 26 in the award and administration of USDOT-assisted contracts. Failure by the CONSULTANT to carry out these requirements is a material breach of this AGREEMENT that may result in the termination of this AGREEMENT. Participation for Disadvantaged Business Enterprises (DBE), if required, per 49 CFR Part 26, or participation of Minority Business Enterprises (MBE), and Women Business Enterprises (WBE), shall be shown on the heading of this AGREEMENT. If D/M/WBE firms are utilized, the amounts authorized to each firm and their certification number will be shown on Exhibit "B" attached hereto and by this reference made a part of this AGREEMENT. If the Prime CONSULTANT is a DBE firm they must comply with the Commercial Useful Function (CUF) regulation outlined in the AGENCY'S "DBE Program Participation Plan". The mandatory DBE participation goals of the AGREEMENT are those established by the WSDOT'S Highway and Local Programs Project Development Engineer in consultation with the AGENCY. All Reports, PS&E materials, and other data furnished to the CONSULTANT by the AGENCY shall be PW_Forms/Standard Consultant Agreement 3.20.13 with exhibits Page 2 of 27 returned. All electronic files, prepared by the CONSULTANT, must meet the requirements as outlined in Exhibit "C." All designs, drawings, specifications, documents, and other work products, including all electronic files, prepared by the CONSULTANT prior to completion or termination of this AGREEMENT are instruments of service for this PROJECT, and are the property of the AGENCY. Reuse by the AGENCY or by others, acting through or on behalf of the AGENCY of any such instruments of service, not occurring as a part of this PROJECT, shall be without liability or legal exposure to the CONSULTANT. IV Time for Beginning and Completion The CONSULTANT shall not begin any work under the terms of this AGREEMENT until authorized in writing by the AGENCY. All work under this AGREEMENT shall be completed by the date shown in the heading of this AGREEMENT under completion date. The established completion time shall not be extended because of any delays attributable to the CONSULTANT, but may be extended by the AGENCY in the event of a delay attributable to the AGENCY, or because of unavoidable delays caused by an act of GOD or governmental actions or other conditions beyond the control of the CONSULTANT. A prior supplemental agreement issued by the AGENCY is required to extend the established completion time. V Payment Provisions The CONSULTANT shall be paid by the AGENCY for completed work and services rendered under this AGREEMENT as provided in Exhibit "D" attached hereto, and by reference made part of this AGREEMENT. Such payment shall be full compensation for work performed or services rendered and for all labor, materials, supplies, equipment, and incidentals necessary to complete the work. The CONSULTANT shall conform to all applicable portions of 48 CFR Part 31. A post audit may be performed on this AGREEMENT. The need for a post audit will be determined by the State Auditor, WSDOT External Audit Office and/or at the request of the AGENCY' S PROJECT Manager. VI Sub-Contracting The AGENCY does not permit sub-contracts for any portion of this agreement. VII Employment The CONSULTANT warrants that they have not employed or retained any company or person, other than a bona fide employee working solely for the CONSULTANT, to solicit or secure this contract, and that it has not paid or agreed to pay any company or person, other than a bona fide employee working solely for the CONSULTANT, any fee, commission, percentage, brokerage fee, gift, or any other consideration, contingent upon or resulting from the award or making of this contract. For breach or violation of this warrant, the AGENCY shall have the right to annul this AGREEMENT without liability or, in its discretion, to deduct from the AGREEMENT price or consideration or otherwise recover the full amount of such fee, commission, percentage, brokerage fee, gift, or contingent fee. Any and all employees of the CONSULTANT or other persons while engaged in the performance of any work or services required of the CONSULTANT under this AGREEMENT, shall be considered employees of the CONSULTANT only and not of the AGENCY, and any and all claims that may arise under any Workmen's Compensation Act on behalf of said employees or other persons while so engaged, and any and all claims made by a third party as a consequence of any act or omission on the part of the CONSULTANT' S employees or other persons while so engaged on any of the work or services provided to be rendered herein, shall be the sole obligation and responsibility of the CONSULTANT. The CONSULTANT shall not engage, on a full- or part-time basis, or other basis, during the period of the contract, any professional or technical personnel who are, or have been, at any time during the period of the Pw Forms/Standard Consultant Agreement 3.20.13 with exhibits Page 3 of 27 contract, in the employ of the United States Department of Transportation, or the STATE, or the AGENCY, except regularly retired employees, without written consent of the public employer of such person. VIII Nondiscrimination During the performance of this contract, the CONSULTANT, for itself, its assignees, and successors in interest agrees to comply with the following laws and regulations: Title VI of the Civil Rights Act of 1964 (42 USC Chapter 21 Subchapter V Section 2000d through 2000d-4a) Federal-aid Highway Act of 1973 (23 USC Chapter 3 Section 324) Rehabilitation Act of 1973 (29 USC Chapter 16 Subchapter V Section 794) Age Discrimination Act of 1975 (42 USC Chapter 76 Section 6101 et seq.) Civil Rights Restoration Act of 1987 (Public Law 100-259) American with Disabilities Act of 1990 (42 USC Chapter 126 Section 12101 et. seq.) 49 CFR Part 21 23 CFR Part 200 RCW 49.60.180 In relation to Title VI of the Civil Rights Act of 1964, the CONSULTANT is bound by the provisions of Exhibit "H" attached hereto and by this reference made part of this AGREEMENT, and shall include the attached Exhibit "H" in every sub-contract, including procurement of materials and leases of equipment, unless exempt by the Regulations or directives issued pursuant thereto. IX Termination of Agreement The right is reserved by the AGENCY to terminate this AGREEMENT at any time upon ten (10) days written notice to the CONSULTANT. In the event this AGREEMENT is terminated by the AGENCY other than for default on the part of the CONSULTANT, a fmal payment shall be made to the CONSULTANT as shown in Exhibit "I" for the type of AGREEMENT used. No payment shall be made for any work completed after ten (10) days following receipt by the CONSULTANT of the Notice to Terminate. If the accumulated payment made to the CONSULTANT prior to Notice of Termination exceeds the total amount that would be due when computed as set forth herein above, then no final payment shall be due and the CONSULTANT shall immediately reimburse the AGENCY for any excess paid. If the services of the CONSULTANT are terminated by the AGENCY for default on the part of the CONSULTANT, the above formula for payment shall not apply. In such an event, the amount to be paid shall be determined by the AGENCY with consideration given to the actual costs incurred by the CONSULTANT in performing the work to the date of termination, the amount of PW_Forms/Standard Consultant Agreement 3.20.13 with exhibits Page 4 of 27 work originally required which was satisfactorily completed to date of termination, whether that work is in a form or a type which is usable to the AGENCY at the time of termination, the cost to the AGENCY of employing another film to complete the work required and the time which may be required to do so, and other factors which affect the value to the AGENCY of the work performed at the time of termination, Under no circumstances shall payment made under this subsection exceed the amount, which would have been made using the formula set forth above. If it is determined for any reason that the CONSULTANT was not in default or that the CONSULTANT'S failure to perform is without the CONSULTANT'S or its employee's default or negligence, the termination shall be deemed to be a termination for the convenience of the AGENCY. In such an event, the CONSULTANT would be reimbursed for actual costs in accordance with the termination for other than default clauses listed previously. In the event of the death of any member, partner or officer of the CONSULTANT or any of its supervisory personnel assigned to the PROJECT, or dissolution of the partnership, termination of the corporation, or disaffiliation of the principally involved employee, the surviving members of the CONSULTANT hereby agree to complete the work under the terms of this AGREEMENT, if requested to do so by the AGENCY. This subsection shall not be a bar to renegotiation of the AGREEMENT between the surviving members of the CONSULTANT and the AGENCY, if the AGENCY so chooses. In the event of the death of any of the parties listed in the previous paragraph, should the surviving members of the CONSULTANT, with the AGENCY' S concurrence, desire to terminate this AGREEMENT, payment shall be made as set forth in the second paragraph of this section. Payment for any part of the work by the AGENCY shall not constitute a waiver by the AGENCY of any remedies of any type it may have against the CONSULTANT for any breach of this AGREEMENT by the CONSULTANT, or for failure of the CONSULTANT to perform work required of it by the AGENCY. Forbearance of any rights under the AGREEMENT will not constitute waiver of entitlement to exercise those rights with respect to any future act or omission by the CONSULTANT. X Changes of Work The CONSULTANT shall make such changes and revisions in the complete work of this AGREEMENT as necessary to correct errors appearing therein, when required to do so by the AGENCY, without additional compensation thereof. Should the AGENCY find it desirable for its own purposes to have previously satisfactorily completed work or parts thereof changed or revised, the CONSULTANT shall make such revisions as directed by the AGENCY. This work shall be considered as Extra Work and will be paid for as herein provided under Section XIV. XI Disputes Any dispute concerning questions of fact in connection with the work not disposed of by AGREEMENT between the CONSULTANT and the AGENCY shall be referred for determination to the Director of Public Works or AGENCY Engineer, whose decision in the matter shall be fmal and binding on the parties of this AGREEMENT; provided, however, that if an action is brought challenging the Director of Public Works or AGENCY Engineer's decision, that decision shall be subject to de novo judicial review. If the parties to this AGREEMENT mutually agree, disputes concerning alleged design errors will be conducted under the procedures found in Exhibit "J", and disputes concerning claims will be conducted under the procedures found in Exhibit "K". XII Venue, Applicable Law, and Personal Jurisdiction In the event that either party deems it necessary to institute legal action or proceedings to enforce any right or obligation under this AGREEMENT, the parties hereto agree that any such action shall be initiated in the Superior court of the State of Washington, situated in the county in which the AGENCY is located. The parties hereto agree that all questions shall be resolved by application of Washington law and that the parties to such PW_Forms/Standard Consultant Agreement 3.20.13 with exhibits Page 5 of 27 action shall have the right of appeal from such decisions of the Superior court in accordance with the laws of the State of Washington. The CONSULTANT hereby consents to the personal jurisdiction of the Superior court of the State of Washington, situated in the county in which the AGENCY is located. XIII Legal Relations The CONSULTANT shall comply with all Federal, State, and local laws and ordinances applicable to the work to be done under this AGREEMENT. This contract shall be interpreted and construed in accordance with the laws of the State of Washington. The CONSULTANT shall indemnify and hold the AGENCY and the STATE and its officers and employees harmless from and shall process and defend at its own expense all claims, demands, or suits at law or equity arising in whole or in part from the CONSULTANT'S negligence or breach of any of its obligations under this AGREEMENT; provided that nothing herein shall require a CONSULTANT to indemnify the AGENCY or the STATE against and hold harmless the AGENCY or the STATE from claims, demands or suits based solely upon the conduct of the AGENCY or the STATE, their agents, officers and employees; and provided further that if the claims or suits are caused by or result from the concurrent negligence of (a) the CONSULTANT' S agents or employees, and (b) the AGENCY or the STATE, their agents, officers and employees, this indemnity provision with respect to (1) claims or suits based upon such negligence (2) the costs to the AGENCY or the STATE of defending such claims and suits shall be valid and enforceable only to the extent of the CONSULTANT' S negligence or the negligence of the CONSULTANT S agents or employees. The CONSULTANT' S relation to the AGENCY shall be at all times as an independent contractor. The CONSULTANT shall comply with all applicable sections of the applicable Ethics laws, including RCW 42.23, which is the Code of Ethics for regulating contract interest by municipal officers. The CONSULTANT specifically assumes potential liability for actions brought by the CONSULTANT'S own employees against the AGENCY and, solely for the purpose of this indemnification and defense, the CONSULTANT specifically waives any immunity under the state industrial insurance law, Title 51 RCW. Unless otherwise specified in the AGREEMENT, the AGENCY shall be responsible for administration of construction contracts, if any, on the PROJECT. Subject to the processing of a new sole source, or an acceptable supplemental agreement, the CONSULTANT shall provide On-Call assistance to the AGENCY during contract administration. By providing such assistance, the CONSULTANT shall assume no responsibility for: proper construction techniques, job site safety, or any construction contractor's failure to perform its work in accordance with the contract documents. The CONSULTANT shall obtain and keep in force during the terms of the AGREEMENT, or as otherwise required, the following insurance with companies or through sources approved by the State Insurance Commissioner pursuant to Title 48 RCW. Insurance Coverage A. Worker's compensation and employer's liability insurance as required by the STATE. B. Commercial general liability and property damage insurance in an aggregate amount not less than two million dollars ($2,000,000) for bodily injury, including death and property damage. The per occurrence amount shall not exceed one million dollars ($1,000,000). C. Vehicle liability insurance for any automobile used in an amount not less than a one million dollar ($1,000,000) combined single limit. D. Professional liability (Errors and Omissions) policy in an amount of not less than one million dollars ($1,000,000.00) combined single limit if any employee, agent or representative of the CONSULTANT undertaking work in furtherance of or pursuant to this Agreement holds or is required to hold a professional license issued by the State of Washington or any other state. The Consultant shall include all subcontractors as insured under its insurance policies or shall furnish separate certificates and endorsements for each subcontractor. All insurance policies provided by or on behalf of any PW Forms/Standard Consultant Agreement 3.20.13 with exhibits Page 6 of 27 subcontractor of the Consultant shall comply with all terms and conditions of this "Legal Relations" section. All contracts between the Consultant and their subcontractors for work to be performed in furtherance or implementation of this contract shall contain the insurance provisions found herein. Failure of the Consultant to take out and/or maintain any required insurance shall not relieve The Consultant from any liability under the Agreement, nor shall the insurance requirements be construed to conflict with or otherwise limit the obligations concerning indemnification. It is agreed by the parties that insurers shall have no right of recovery or subrogation against the County, including its employees and other agents and agencies. It is further agreed by the parties that insurance companies issuing the policy or policies required by this Agreement shall have no recourse against the County (including its employees and other agents and agencies) for payment of any premiums or for assessments under any form of policy. It is further agreed by the parties that any and all deductibles in the above described insurance policies shall be assumed by and be at the sole risk of the Consultant. Excepting the Worker's Compensation Insurance and any Professional Liability Insurance secured by the CONSULTANT, the AGENCY will be named on all policies as an additional insured. The CONSULTANT'S insurance required by this Section shall be in all circumstances primary to any insurance available to the AGENCY. The CONSULTANT shall furnish the AGENCY with verification of insurance and endorsements required by the AGREEMENT. The AGENCY reserves the right to require complete, certified copies of all required insurance policies at any time. All insurance shall be obtained from an insurance company authorized to do business in the State of Washington. The CONSULTANT shall submit a verification of insurance as outlined above within fourteen (14) days of the execution of this AGREEMENT to the AGENCY. No cancellation of the foregoing policies shall be effective without thirty (30) days prior notice to the AGENCY. The CONSULTANT'S professional liability to the AGENCY shall be limited to the amount payable under this AGREEMENT or one million ($1,000,000) dollars, whichever is the greater, unless modified by Exhibit "L". In no case shall the CONSULTANT'S professional liability to third parties be limited in any way. The AGENCY will pay no progress payments under Section V until the CONSULTANT has fully complied with this section. This remedy is not exclusive; and the AGENCY and the STATE may take such other action as is available to it under other provisions of this AGREEMENT, or otherwise in law. XIV Extra Work A. The AGENCY may at any time, by written order, make changes within the general scope of the AGREEMENT in the services to be performed. B. If any such change causes an increase or decrease in the estimated cost of, or the time required for, performance of any part of the work under this AGREEMENT, whether or not changed by the order, or otherwise affects any other terms and conditions of the AGREEMENT, the AGENCY shall make an equitable adjustment in the (1) maximum amount payable; (2) delivery or completion schedule, or both; and (3) other affected terms and shall modify the AGREEMENT accordingly. C. The CONSULTANT must submit any "request for equitable adjustment", hereafter referred to as "CLAIM", under this clause within thirty (30) days from the date of receipt of the written order. However, if the AGENCY decides that the facts justify it, the AGENCY may receive and act upon a CLAIM submitted before fmal payment of the AGREEMENT. D. Failure to agree to any adjustment shall be a dispute under the Disputes clause. However, nothing in this clause shall excuse the CONSULTANT from proceeding with the AGREEMENT as changed. PW_Forms/Standard Consultant Agreement 3.20.13 with exhibits Page 7 of 27 E. Notwithstanding the terms and conditions of paragraphs (A) and (B) above, the maximum amount payable for this AGREEMENT, shall not be increased or considered to be increased except by specific written supplement to this AGREEMENT. XV Endorsement of Plans If applicable, the CONSULTANT shall place their endorsement on all plans, estimates, or any other engineering data furnished by them. XVI Federal and State Review The Federal Highway Administration and the Washington State Department of Transportation shall have the right to participate in the review or examination of the work in progress. XVII Certification of the Consultant and the Agency Attached hereto as Exhibit "M- 1 (a and b)" are the Certifications of the CONSULTANT and the AGENCY, Exhibit "M-2" Certification Regarding Debarment, Suspension and Other Responsibility Matters -Primary Covered Transactions, Exhibit "M-3" Certification Regarding the Restrictions of the Use of Federal Funds for Lobbying and Exhibit "M-4" Certificate of Current Cost or Pricing Data. Exhibit "M-3" is required only in AGREEMENTS over $100,000 and Exhibit "M-4" is required only in AGREEMENTS over $500,000. XVIII Complete Agreement This document and referenced attachments contain all covenants, stipulations, and provisions agreed upon by the parties. No agent, or representative of either party has authority to make, and the parties shall not be bound by or be liable for, any statement, representation, promise or "agreement not set forth herein. No changes, amendments, or modifications of the terms hereof shall be valid unless reduced to writing and signed by the parties as an amendment to this AGREEMENT. XIX Execution and Acceptance This AGREEMENT may be simultaneously executed in several counterparts, each of which shall be deemed to be an original having identical legal effect. The CONSULTANT does hereby ratify and adopt all statements, representations, warranties, covenants, and agreements contained in the proposal, and the supporting material submitted by the CONSULTANT, and does hereby accept the AGREEMENT and agrees to all of the terms and conditions thereof. PW_Forms/Standard Consultant Agreement 3.20.13 with exhibits Page 8 of 27 In witness whereof, the parties hereto have executed this AGREEMENT as of the day and year shown in the "Execution Date" box on page one (1) of this AGREEMENT. "'r'te ~~ ~ CI_~y Consultant (Please print) CAP--s~.~t s ~ z~ , ~ , Consultant's me (Please print) 4e Consultant's Signatur ~/~/3 Date COUNTY OF JEFFERSON BOARD OF COMMISSIONERS John Austin, Chair Phil Johnson, Member David W. Sullivan, Member A oved as to form ly: ,~ ~ ~~ David Alvarez Date Deputy Prosecuting Attorney Frank Gifford Date Public Works Director PW_Forms/Standard Consultant Agreement 3.20.13 with exhibits Page 9 of 27 Exhibit A-1 Scope of Work Objective The objective of this Agreement is to provide professional services necessary to promote bicycling and walking to and from school at the Chimacum School District. This education and encouragement campaign will occur alongside a program to improve the transportation infrastructure as part of a Safe Routes to School grant program. Project Sites The project will occur at the Chimacum School Main Campus and the Chimacum Primary School, in the associated transportation corridors, as well local parks such as H.J. Carroll Park and Chimacum Park. Goals 1. Improve air quality, create quieter more open roadways, and reduce emissions from internal combustion engines. 2. Increase bicycling and walking to and from school by staff and students. 3. Increase the safety and wellness of the students and staff of Chimacum School District. 4. Educate the students and staff of the Chimacum School District about the Safe Routes to Schools infrastructure improvements taking place as part of this grant. Schedule, Benchmarks and Reporting The following tasks are expected to take approximately three years, beginning in the summer of 2013 and ending in the fall of 2015. Many of the tasks are ongoing. Benchmarks for each task are included in the task description. The consultant will provide a monthly report and invoice based on each task. Information about reporting criteria are included with each task description Services The consultant will perform all services and furnish all materials necessary on behalf of Jefferson County to accomplish the following tasks: 1. Work with the Chimacum School District to set goals, adopt and market a plan for increasing safe, student bike ridership. The plan will be dynamic and meaningful to the participants in the program and to the Chimacum School District staff and administration. The planning process will occur during the school year of 2013/2014 and will be completed by June of 2014. A copy of the plan will be included in the June 2014 report. Due to the nature of this program, the planning process is seen as part of the program, and flexibility in the plan is a given. STAFF LIVE IIRS PREP HRS ALL HRS COST/IiR TOTAL $ Director 30 30 60 30 1,800 Su ort 30 30 20 600 Material 200 2. Recruit, train and motivate partners and volunteers willing to contribute to the goals and objectives of this agreement. Document volunteer activities and include in monthly report. This is an ongoing effort that will last the duration of the agreement. A current list of partners and PW_Forms/Standard Consultant Agreement 3.20.13 with exhibits Page 10 of 27 volunteers as well as a report of how many hours are donated will be provided each month as part of the monthly progress report and invoice. STAFF LIVE HRS PREP HRS ALL HRS COST/HR TOTAL $ Director 20 10 30 30 900 Su ort 5 10 15 20 300 Material 20 3. Include Jefferson County Sheriff deputies for 76 hours of activities in which the deputies participate on their official Sheriff bicycles. At least 50% of the hours should be completed by June of 2014, 75% by December of 2014, and 100% by June of 2015. The names, program participated in, and the hours of the deputies will be included in the monthly report. STAFF LIVE HRS PREP HRS ALL HRS COST/HR TOTAL $ Director 4 4 8 30 240 Material 25 4. Hold 5 meetings with parents to encourage bicycling and educate parents about the program. Use a facilitated meeting approach in order to gain buy in and support of families. Three meetings will be held in the school year of 2013/2014, and two meetings will be held in the school year of 2014/2015. Dates, locations, list of attendees, and a meeting summary will be included in the monthly report. STAFF LIVE HRS PREP HRS ALL HRS COST/HR TOTAL $ Director 8 2 10 30 300 Su ort 8 2 10 20 200 Material 25 5. Train Chimacum School Teachers to help teach bicycle safety and empowerment. The training program will be meaningful to the teachers and will lead to inclusion of bicycle safety and empowerment in the teacher's curricula. This training will occur during the first school year of the program. Dates, locations, list of participants, and program description will be included in the monthly report. STAFF LIVE HRS PREP HRS ALL HRS COST/HR TOTAL $ Director 6 4 10 30 300 Material 25 PW_Forms/Standazd Consultant Agreement 3.20.13 with exhibits Page 11 of 27 6. Provide safety and empowerment classes, events, and/or activities for students. The classes, events and activities will be designed to reach a wide variety of students. These programs will be evenly distributed throughout the length of the program. Dates, locations, list of participants, and description of the class, event or activity will be included in the monthly report. STAFF LIVE HRS PREP I3RS ALL HRS COST/HR TOTAL $ Director 100 100 200 30 6,000 Su ort 70 30 100 20 2,000 Material 500 7. Provide properly fitting helmets, gloves and safety lights to youth who might use them. It is more important to provide equipment that is used of a long period of time than to provide a large amount of equipment. The equipment will be distributed slowly, over the entire length of the Agreement. Names, a list of what was provided, and a short explanation will be submitted with the monthly report. STAFF LIVE I3RS PREP HRS ALL HRS COST/HR TOTAL $ Director 2 2 30 60 Su ort 2 3 5 20 100 Material 700 8. Provide and install covered bike racks for at least 30 bikes in a safe and appropriate place. The design, location and installation of the bike rakes can be an important program component in and of itself. The bike racks should be installed before June of 2014. STAFF LIVE HRS PREP HRS ALL HRS COST/HR TOTAL $ Director 2 2 4 30 120 Su ort 2 2 4 20 80 Material 1,000 PW Forms/Standard Consultant Agreement 3.20.13 with exhibits Page 12 of 27 9. Hold at least 4 events to celebrate success and recognize participants. The recognition program will help promote the goals of the students, and the school. Two events will occur in the school year of 2013/2014, and two events in the school year of 2014/2015. STAFF LIVE HRS PREP HRS ALL HRS COST/HR TOTAL $ Director 10 10 20 30 600 Su ort 10 10 20 20 400 Material 500 10. Develop and administer surveys for baselines, program modifications and monitoring progress. The initial baseline of bicycle use will be taken in the spring of 2013 with annual follow up assessment in 2014 and 2015. Each program will include an evaluation survey of the participants. Results will be reported in the monthly report. STAFF LIVE HRS PREP HRS ALL HRS COST/HR TOTAL $ Director 4 4 8 30 240 Support 4 4 8 20 160 Material 200 11. Develop and implement summer bike camps in 2013, 2014 and 2015. The camps will occur in the Chimacum area. Dates, locations, a list of participants, and. a description will be included in the monthly report. STAFF LIVE HRS PREP HRS ALL HRS COST/IIR TOTAL $ Director 10 10 20 30 600 Su ort 10 10 20 20 400 Material 200 12. Develop a space for bike maintenance and repair and train supervisors for the space. Knowledge of and participation in bicycle maintenance naturally promotes the goals of this program. The maintenance space will be completed by November of 2013 and will operate for the duration of the program. A description of the approximate numbers of students and staff using the maintenance and repair area will be provided in the monthly report. STAFF LIVE HRS PREP HRS ALL HRS COST/HR TOTAL $ Director 2 2 4 30 120 Su ort 5 5 10 20 200 Material 2,860 GRAND TOTAL STAFF LIVE HRS PREP HRS ALL HRS COST/HR TOTAL $ Director 198 178 376 30 11,280 Su ort 116 106 222 20 4,440 Material 6,255 TOTAL 21,975 PW_Forms/Standard Consultant Agreement 3.20.13 with exhibits Page 13 of 27 Exhibit C Electronic Exchange of Data This exhibit describes the reporting requirement of this Agreement. 1. Monthly Reports. A monthly report will be provided on or before the 5`" day of each month of the agreement. The monthly report will include the following components: a. General statement of progress. b. Running sum total and remainder of each items hours and dollar amounts. c. Activity data report as detailed in each item. The monthly reports will be submitted electronically in .pdf format tom ler(a~co jefferson.wa.us. PW Forms/Standard Consultant Agreement 3.20.13 with exhibits Page 14 of 27 Exhibit D-3 Payment (Negotiated Hourly Rate) The ReCyclery shall be paid by Jefferson County for completed work and services rendered under this AGREEMENT as provided hereinafter. Such payment shall be full compensation for work performed or services rendered and for all labor, materials, supplies, equipment, and incidentals necessary to complete the work. The ReCyclery shall conform to all applicable portions of 48 CFR 31. 1. Hourly Rates: The ReCyclery shall be paid by Jefferson County for work done, based upon the negotiated hourly rates shown in Exhibits "E" and "F" attached hereto and by this reference made part of this AGREEMENT. The rates listed shall be applicable for the first twelve (12) month period and shall be subject to negotiation for the following twelve (12) month period upon request of the ReCyclery or Jefferson County. If negotiations are not conducted for the second or subsequent twelve (12) month periods within ninety (90) days after completion of the previous period, the rates listed in this AGREEMENT, or subsequent written authorization(s) from Jefferson County shall be utilized. The rates are inclusive of direct salaries, payroll additives, overhead, and fee. The ReCyclery shall maintain support data to verify the hours billed on the AGREEMENT. 2. Direct Non-Salary Costs: Direct Non-Salary Costs will be reimbursed at the Actual Cost to the ReCyclery. These charges may include, but are not limited to the following items: travel, printing, long distance telephone, supplies, computer charges, and sub-consultant costs. a. Air or train travel will be reimbursed only to economy class levels unless otherwise approved by Jefferson County. The ReCyclery shall comply with the rules and regulations regarding travel costs (excluding air, train, and rental car costs) in accordance with Jefferson County'S Travel Rules and Procedures. However, air, train, and rental car costs shall be reimbursed in accordance with 48CFR Part 31.205-46 "Travel Costs." b. The billing for Direct Non-Salary Costs shall include an itemized listing of the charges directly identifiable with the PROJECT. c. The ReCyclery shall maintain the original supporting documents in their office. Copies of the original supporting documents shall be supplied to Jefferson County upon request. d. All above charges must be necessary for the services provided under this AGREEMENT. Management Reserve Fund: Jefferson County may desire to establish a Management Reserve Fund to provide the Agreement Administrator with the flexibility to authorize additional funds to the AGREEMENT for allowable unforeseen costs, or reimbursing the ReCyclery for additional work beyond that already defined in this AGREEMENT. Such authorization(s) shall be in writing and shall not exceed the lesser of $100,000 or 10% of the Total Amount Authorized as shown in the heading of this AGREEMENT. The amount included for the Management Reserve Fund is shown in-the heading of this AGREEMENT. This fund may not be replenished. Any changes requiring additional costs in excess of the Management Reserve Fund shall be made in accordance with Section XIV, "Extra Work." 4. Maximum Total Amount Payable: The Maximum Total Amount Payable by Jefferson County to the ReCyclery under this AGREEMENT shall not exceed the amount shown in the heading of this AGREEMENT. The Maximum Total Amount Payable is comprised of the Total Amount Authorized, and the Management Reserve Fund. The Maximum Total Amount Payable does not include payment for Extra Work as stipulated in Section XIV, "Extra Work." No minimum amount payable is guaranteed under this AGREEMENT. PW_Forms/Standard Consultant Agreement 3.20.13 with exhibits Page I S of 27 Monthly Progress Payments: Progress payments may be claimed on a monthly basis for all costs authorized in 1 and 2 above. The monthly billings shall be supported by detailed statements for hours expended at the rates established in Exhibit "E", including names and classifications of all employees, and billings for all direct non-salary expenses. To provide a means of verifying the billed salary costs for the ReCyclery's employees, Jefferson County may conduct employee interviews. These interviews may consist of recording the names, titles, salary rates, and present duties of those employees performing work on the PROJECT at the time of the interview. Final Payment: Final Payment of any balance due the ReCyclery of the gross amount earned will be made promptly upon its verification by Jefferson County after the completion of the work under this AGREEMENT, contingent upon receipt of all PS&E, plans, maps, notes, reports, electronic data and other related documents which are required to be furnished under this AGREEMENT. Acceptance of such Final Payment by the ReCyclery shall constitute a release of all claims for payment, which the ReCyclery may have against Jefferson County unless such claims are specifically reserved in writing and transmitted to Jefferson County by the ReCyclery prior to its acceptance. Said Final Payment shall not, however, be a bar to any claims that Jefferson County may have against the ReCyclery or to any remedies Jefferson County may pursue with respect to such claims. The payment of any billing will not constitute agreement as to the appropriateness of any item and at the time of fmal audit, all required adjustments will be made and reflected in a fmal payment. In the event that such fmal audit reveals an overpayment to the ReCyclery, the ReCyclery will refund such overpayment to Jefferson County within thirty (30) days of notice of the overpayment. Such refund shall not constitute a waiver by the ReCyclery for any claims relating to the validity of a fmding by Jefferson County of overpayment. The ReCyclery has twenty (20) days after receipt of the fmal POST AUDIT to begin the appeal process to Jefferson County for audit findings. 7. Inspection of Cost Records: The ReCyclery and their sub-consultants shall keep available for inspection by representatives of Jefferson County, STATE, and the United States, for a period of three (3) years after receipt of final payment, the cost records and accounts pertaining to this AGREEMENT and all items related to or bearing upon these records with the following exception: if any litigation, claim or audit arising out of, in connection with, or related to this contract is initiated before the expiration of the three (3) year period, the cost records and accounts shall be retained until such litigation, claim, or audit involving the records is completed. PW_Forms/Standard Consultant Agreement 3.20.13 with exhibits Page 16 of 27 Exhibit E-2 Consultant Fee Determination -Summary Sheet (Specific Rates of Pay) Fee Schedule STAFF LIVE HRS PREP HRS ALL HRS COST/HR TOTAL $ Task 1 Director 30 30 60 $ 30 $ 1,800 Support 30 30 $ 20 $ 600 Material $ 200 Task 2 Director 20 10 30 $ 30 $ 900 Support 5 10 15 $ 20 $ 300 Material $ 20 Task 3 Director 4 4 8 $ 30 $ 240 Material $ 25 Task 4 Director 8 2 10 $ 30 $ 300 Support 8 2 10 $ 20 $ 200 Material $ 25 Task 5 Director 6 4 10 $ 30 $ 300 Material $ 25 Task 6 Director 100 100 200 $ 30 $ 6,000 Support 70 30 100 $ 20 $ 2,000 Material $ 500 Task 7 Director 2 2 $ 30 $ 60 Support 2 3 5 $ 20 $ 100 Material $ 700 Task 8 Director 2 2 4 $ 30 $ 120 Support 2 2 4 $ 20 $ 80 Material $ 1,000 Task 9 Director 10 10 20 $ 30 $ 600 Support 10 10 20 $ 20 $ 400 Material $ 500 PW Forms/Standard Consultant Agreement 3.20.13 with exhibits Page 17 of 27 Exhibit E-2 Consultant Fee Determination -Summary Sheet (Specific Rates of Pay) Fee Schedule Task 10 Director 4 4 8 $ 30 $ 240 Support 4 4 8 $ 20 $ 160 Material $ 200 Task 11 Director 10 10 20 $ 30 $ 600 Support 10 10 20 $ 20 $ 400 Material $ 200 Task 12 Director 2 2 4 $ 30 $ 120 Support 5 5 10 $ 20 $ 200 Material $ 2,860 Totals 314 284 598 $ 21,975 PW_Forms/Standard Consultant Agreement 3.20.13 with exhibits Page 18 of 27 Exhibit F -Overhead Cost Jefferson County ReCyclery 1925 Blaine St #500. Port Townsend, WA 98368 March 29, 2013 . Jefferson County Public Works 623 Sheridan St . Port Townsend, WA 98368 Please consider this letter to be a statement of rates for Jefferson County ReCyclery, It covers consulting services to be provided to support the Jefferson County Department of Public Works. The ReCyclery.is a newly-formulated non-profit company with no calculated overhead rate. We charge a flat hourly fee for services that isall-inclusive of direct salary, overhead,-and fee. The hourly fees offered for the agreement to provide services associated with the Safe Roates to School project in;Chimacum (SR 19 Crossing Improvement) are the lowest fees we offer for preferred clients. Through this letter I affirm that all non-salary costs will be invoiced without mark-up. The following rates will be charged for service performed (refer to Exhibit E-2 Fee -Specific Rates): Director - $30 per hour; Support Staff - $20 per hour. c The ReCyclery will comply with the rules and regulations regarding travel costs in accordance with - Washington State Department of Transportation Accounting Manual M13-82, Chapter 10 Travel Rules and Procedures, and revisions thereto. Sincerely Yours, .. ~~ ~, Kees Kolf, President Jefferson County ReCyclery Exhibit H Title VI Assurances During the performance of this AGREEMENT, the ReCyclery, for itself, its assignees, and successors in interest agrees as follows: Compliance with Regulations: The ReCyclery shall comply with the Regulations relative to non- discrimination in federally assisted programs of Jefferson County, Title 49, Code of Federal Regulations, Part 21, as they may be amended from time to time (hereinafter referred to as the "REGULATIONS"), which are herein incorporated by reference and made a part of this AGREEMENT. 2. Non-discrimination: The ReCyclery, with regard to the work performed during the AGREEMENT, shall not discriminate on the grounds of race, color, sex, or national origin in the selection and retention of sub-consultants, including procurement of materials and leases of equipment. The ReCyclery shall not participate either directly or indirectly in the discrimination prohibited by Section 21.5 of the REGULATIONS, including employment practices when the AGREEMENT covers a program set forth in Appendix B of the REGULATIONS. 3. Solicitations for Sub-consultants, Including Procurement of Materials and Equipment: In all solicitations either by competitive bidding or negotiations made by the ReCyclery for work to be performed under asub-contract, including procurement of materials or leases of equipment, each potential sub-consultant or supplier shall be notified by the ReCyclery of the ReCyclery's obligations under this AGREEMENT and the REGULATIONS relative to non-discrimination on the grounds of race, color, sex, or national origin. 4. Information and Reports: The ReCyclery shall provide all information and reports required by the REGULATIONS or directives issued pursuant thereto, and shall permit access to its books, records, accounts, other sources of information, and its facilities as may be determined by JEFFERSON COUNTY, STATE or the Federal Highway Administration (FHWA) to be pertinent to ascertain compliance with such REGULATIONS, orders and instructions. Where any information required of a CONSULTANT is in the exclusive possession of another who fails or refuses to furnish this information, the ReCyclery shall so certify to Jefferson County, STATE or the FHWA as appropriate, and shall set forth what efforts it has made to obtain the information. Sanctions for Non-compliance: In the event of the ReCyclery's non-compliance with the non- discrimination provisions of this AGREEMENT, Jefferson County shall impose such AGREEMENT sanctions as it, the STATE or the FHWA may determine to be appropriate, including, but not limited to: • Withholding of payments to the ReCyclery under the AGREEMENT until the ReCyclery complies, and/or; • Cancellation, termination, or suspension of the AGREEMENT, in whole or in part 6. Incorporation of Provisions: The ReCyclery shall include the provisions of paragraphs (1) through (5) in every sub-contract, including procurement of materials and leases of equipment, unless exempt by the REGULATIONS, or directives issued pursuant thereto. The ReCyclery shall take such action with respect to any sub-consultant or procurement as Jefferson County, STATE or FHWA may direct as a means of enforcing such provisions including sanctions for non-compliance. Provided, however, that in the event a CONSULTANT becomes involved in, or is threatened with, litigation with asub-consultant or supplier as a result of such direction, the ReCyclery may request Jefferson County and the STATE enter into such litigation to protect the interests of Jefferson County and the STATE and, in addition, the ReCyclery may request the United States enter into such litigation PW_Forms/Standazd Consultant Agreement 3.20.13 with exhibits Page 20 of27 to protect the interests of the United States. PW_Forms/Standazd Consultant Agreement 3.20.13 with exhibits Page 21 of 27 Exhibit I Payment Upon Termination of Agreement By the Agency Other Than for Fault of the Consultant (Refer to Agreement, Section lX) Lump Sum Contracts A final payment shall be made to the CONSULTANT which when added to any payments previously made shall total the same percentage of the Lump Sum Amount as the work completed at the time of termination is to the total work required for the PROJECT. In addition, the CONSULTANT shall be paid for any authorized extra work completed. Cost Plus Fixed Fee Contracts A final payment shall be made to the CONSULTANT which when added to any payments previously made, shall total the actual costs plus the same percentage of the fixed fee as the work completed at the time of termination is to the total work required for the Project. In addition, the CONSULTANT shall be paid for any authorized extra work completed. Specific Rates of Pay Contracts A final payment shall be made to the CONSULTANT for actual hours charged at the time of termination of this AGREEMENT plus any direct non salary costs incurred at the time of termination of this AGREEMENT. Cost Per Unit of Work Contracts A final payment shall be made to the CONSULTANT for actual units of work completed at the time of termination of this AGREEMENT. PW Forms/Standard Consultant Agreement 3.20.13 with exhibits Page 22 of 27 Exhibit K Consultant Claim Procedures The purpose of this exhibit is to describe a procedure regarding claim(s) on a consultant agreement. The following procedures should only be utilized on consultant claims greater than $1,000. If the consultant's claim(s) are a total of $1,000 or less, it would not be cost effective to proceed through the outlined steps. It is suggested that the Director of Public Works or Agency Engineer negotiate a fair and reasonable price for the consultant's claim(s) that total $1,000 or less. This exhibit will outline the procedures to be followed by the consultant and the agency to consider a potential claim by the consultant. Step 1 -Consultant Files a Claim with the Agency Project Manager If the consultant determines that they were requested to perform additional services that were outside of the agreement's scope of work, they may be entitled to a claim. The first step that must be completed is the request for consideration of the claim to the Agency's project manager. The consultant's claim must outline the following: • Summation of hours by classification for each firm that is included in the claim; • Any correspondence that directed the consultant to perform the additional work; • Timeframe of the additional work that was outside of the project scope; • Summary of direct labor dollars, overhead costs, profit and reimbursable costs associated with the additional work; and • Explanation as to why the consultant believes the additional work was outside of the agreement scope of work. Step 2 -Review by Agency Personnel Regarding the Consultant's Clairn for Additional Compensation After the consultant has completed step 1, the next step in the process is to forward the request to the Agency's project manager. The project manager will review the consultant's claim and will meet with the Director of Public Works or Agency Engineer to determine if the Agency agrees with the claim. If the FHWA is participating in the project's funding, forward a copy of the consultant's claim and the Agency's recommendation for federal participation in the claim to the WSDOT Highways and Local Programs through the Region Local Programs Engineer, if the claim is not eligible for federal participation, payment will need to be from agency funds. If the Agency project manager, Director of Public Works or Agency Engineer, WSDOT Highways and Local Programs (if applicable), and FHWA (if applicable) agree with the consultant's claim, send a request memo, including backup documentation to the consultant to either supplement the agreement, or create a new agreement for the claim. After the request has been approved, the Agency shall write the supplement and/or new agreement and pay the consultant the amount of the claim. Inform the consultant that the fmal payment for the agreement is subject to audit. No further action in needed regarding the claim procedures. If the Agency does not agree with the consultant's claim, proceed to step 3 of the PW_Forms/Standard Consultant Agreement 3.20.13 with exhibits Page 23 of 27 procedures. Step 3 -Preparation of Support Documentation Regarding Consultant's Claim(s) If the Agency does not agree with the consultant's claim, the project manager shall prepare a summary for the Director of Public Works or Agency Engineer that included the following: • Copy of information supplied by the consultant regarding the claim; • Agency's summation of hours by classification for each firm that should be included in the claim; • Any correspondence that directed the consultant to perform the additional work; • Agency's summary of direct labor dollars, overhead costs, profit and reimbursable costs associated with the additional work; • Explanation regarding those areas in which the Agency does/does not agree with the consultant's claim(s); • Explanation to describe what has been instituted to preclude future consultant claim(s); and • Recommendations to resolve the claim. Step 4 -Director of Public Works or Agency Engineer Reviews Consultant Claim and Agency Documentation The Director of Public Works or Agency Engineer shall review and administratively approve or disapprove the claim, or portions thereof, which may include getting Agency Council or Commission approval (as appropriate to agency dispute resolution procedures). If the project involves federal participation, obtain concurrence from WSDOT Highways and Local Programs and FHWA regarding final settlement of the claim. If the claim is not eligible for federal participation, payment will need to be from agency funds. Step 5 -Informing Consultant of Decision Regarding the Claim The Director of Public Works or Agency Engineer shall notify (in writing) the consultant of their final decision regarding the consultant's claim(s). Include the final dollar amount of the accepted claim(s) and rationale utilized for the decision. Step 6 -Preparation of Supplement or New Agreement for the Consultant's Claim(s) The agency shall write the supplement and/or new agreement and pay the consultant the amount of the claim. Inform the consultant that the final payment for the agreement is subject to audit. PW_Forms/Standard Consultant Agreement 3.20.13 with exhibits Page 24 of 27 Exhibit M 1- A Certification Of Consultant Project No. CK tgl7 Local Jefferson County I hereby certify that I am ~ ~95~ C-(s (G~ ~~ and duly authorized representative of the firm of ~~ P--~e1j ~-~~~ whose address is ~ q Z ~ B~~e~ ~~jr ~ _ ~`~, 195 and that neither I nor the above firm I here represent has: (a) Employed or retained for a commission, percentage, brokerage, contingent fee, or other consideration, any firm or person (other than a bona fide employee working solely for me or the above CONSULTANT) to solicit or secure the AGREEMENT; (b) Agreed, as an express or implied condition for obtaining this contract, to employ or retain the services of any firm or person in connection with carrying out this AGREEMENT; or (c) Paid, or agreed to pay, to any firm, organization or person (other than a bona fide employee working solely for me or the above CONSULTANT) any fee, contribution, donation, or consideration of any kind for, or in connection with, procuring or carrying out this AGREEMENT; except as hereby expressly stated (if any); I acknowledge that this certificate is to be available to the Washington State Department of Transportation and the Federal Highway Administration, U.S. Department of Transportation in connection with this AGREEMENT involving participation of Federal-aid highway funds, and is subject to applicable State and Federal laws, both criminal and civil. Date Si re PW Forms/Standard Consultant Agreement 3.20.13 with exhibits Page 25 of27 Exhibit M 1- B Certification Of Jefferson County Official I hereby certify that I am Jefferson County Official of the Local Jefferson County of ,Washington, and that the consulting firm or its representative has not been required, directly or indirectly as an express or implied condition in connection with obtaining or carrying out this AGREEMENT to: (a) Employ or retain, or agree to employ to retain, any firm or person; or (b) Pay, or agree to pay, to any firm, person, or organization, any fee, contribution, donation, or consideration of any kind; except as hereby expressly stated (if any): I acknowledge that this certificate is to be available to the Washington State Department of Transportation and the Federal Highway Administration, U.S. Department of Transportation, in connection with this AGREEMENT involving participation of Federal-aid highway funds, and is subject to applicable State and Federal laws, both criminal and civil. Name Frank Gifford, Public Works Director (please print) ~/ / Signature ~[- ~ Date '~` ~~ 3 PW Forms/Standard Consultant Agreement 3.20.13 with exhibits Page 26 of27 Exhibit M - 2 Certification Regarding Debarment, Suspension, and Other Responsibility Matters-Primary Covered Transactions I. The prospective primary participant certifies to the best of its knowledge and belief, that it and its principals: A. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or Jefferson County; B. Have not within athree-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission or fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; C. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph I( B) of this certification; and D. Have not within a three (3) year period preceding this application/proposal had one or more public transactions (federal, state, or local) terminated for cause or default. II. Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. Consultant (Firm): ~('~"~ ~~ ~~['~~~ Name lease print) Signature: President r Auth rized Official of Consultant D to PW_Forms/Standard Consultant Agreement 3.20.13 with exhibits Page 27 of 27