HomeMy WebLinkAboutComPraise - 041717� or;
PERSONAL SERVICES AGREEMENT
Between
JEFFERSON COUNTY
And
ComPraise
THIS AGREEMENT is entered into between the County of Jefferson, a municipal corporation,
hereinafter referred to as "the County", and George A. Brooks of ComPraise, General Real Estate
Appraiser, hereinafter referred to as "the Consultant", in consideration of the mutual benefits,
terms, and conditions hereinafter specified.
1. Project Designation. The Consultant is retained by the County to provide appraisal
services to support property acquisitions for the purpose of floodplain restoration and
salmon recovery (RCO #12-1384, RCO #13-1189, RCO #15-1189, RCO #16-1480, RCO
#16-1494 and/or JC Department of Public Works Quilcene Floodplain Acquisition
Account 45533Q.61.000) consistent with Washington State Recreation and Conservation
Office Manual 3, Acquiring Land: Policies
http://www.rco.wa.gov/documents/Manuals&Forms/Manual 3 acq.pdf. The appraisal(s)
must be reported in a fully self-contained appraisal report format to exceed the
requirements outlined in the 2014-15 "Uniform Standards of Professional Appraisal
Practices" (USPAP). The report(s) must describe in detail the information analyzed and
the reasoning and methodology that supports any analyses, opinions, and conclusions.
The report(s) will be subject to review and the appraiser will be required to clarify any
issues in writing. Failure to do so may result in the report(s) being considered
unacceptable. The process used to develop the report(s) must also be consistent with the
RCO Appraisal Assignment Instructions for Grant Funded Projects, Exhibit D. The
report(s) must be essentially free of spelling and formatting errors.
2. Scope of Services. Consultant agrees to perform the services, identified on Exhibit "A"
attached hereto, including the provision of all labor.
3. Time for Performance. Work under this contract shall commence upon the giving of
written notice by the County to the Consultant to proceed. Consultant shall perform all
services and provide all work product requested pursuant to this Agreement no later than
30 days of the dates listed on Exhibit "A". This agreement terminates on August 31, 2018
unless amended by written instrument signed by both County and Consultant.
4. Payment. The Consultant shall be paid by the County for completed work and for
services rendered under this Agreement as follows:
a. Payment for the work provided by Consultant shall not exceed $20,000 at a rate
of not to exceed $3,000 per self-contained appraisal report or $1,000 per self-
contained appraisal update without express written modification of the Agreement
signed by the County. Additional appraisal needs may be identified through the
Page 1 of 13
Big Quilcene River Restoration Planning process lead by the Hood Canal Salmon
Enhancement Group or the HCCC Lead Entity Technical Advisory Group with
respect to the RCO grants identified in Section 1.
b. The consultant may submit invoices to the County once per month during the
progress of the work for partial payment for project completed to date, up to 80%
of total project costs. Such vouchers will be checked by the County, and upon
approval thereof, payment will be made to the Consultant in the amount approved.
Final payment of any balance due the Consultant of the total contract price earned
will be made promptly upon its ascertainment and verification by the County after
the completion of the work under this Agreement and its acceptance by the
County.
d. Payment as provided in this section shall be full compensation for work
performed, services rendered and for all materials, supplies, equipment and
incidentals necessary to complete the work.
e. The Consultant's records and accounts pertaining to this Agreement are to be kept
available for inspection by representatives of the County and state for a period of
three (3) years after final payments. Copies shall be made available upon request.
5. Ownership and Use of Documents. All documents, drawings, specifications and other
materials produced by the Consultant in connection with the services rendered under this
Agreement shall be the property of the County whether the project for which they are
made is executed or not. The Consultant shall be permitted to retain copies, including
reproducible copies, of drawings and specifications for information, reference and use in
connection with Consultant's endeavors.
6. Compliance with laws. Consultant shall, in performing the services contemplated by this
Agreement, faithfully observe and comply with all federal, state, and local laws,
ordinances and regulations, applicable to the services to be rendered under this
Agreement.
7. Indemnification. Consultant shall indemnify, defend and hold harmless the County, its
officers, agents and employees, from and against any and all claims, losses or liability, or
any portion thereof, including attorneys fees and costs, arising from injury or death to
persons, including injuries, sickness, disease or death to Consultant's own employees, or
damage to property occasioned by a negligent act, omission or failure of the Consultant.
Insurance.
The Consultant shall obtain and keep in force during the terms of the Agreement, policies
of insurance as follows:
If and only if the Consultant employs any person(s) in the status of employee or
employees separate from or in addition to any equity owners, sole proprietor, partners,
Page 2 of 13
owners or shareholders of the Consultant, Worker's Compensation Insurance in an
amount or amounts that are not less than the required statutory minimum(s) as established
by the State of Washington or the state or province where the Consultant is located.
Commercial Automobile Liability Insurance providing bodily injury and property
damage liability coverage for all owned and non -owned vehicles assigned to or used in
the performance of the work for a combined single limit of not less than $500,000 each
occurrence with the County named as an additional insured in connection with the
Consultant's performance of the contract.
General Commercial Liability Insurance in an amount not less than a single limit of one
million dollars ($1,000,000) per occurrence and a aggregate of not less than two (2) times
the occurrence amount ($2,000,000.00 minimum) for bodily injury, including death and
property damage, unless a greater amount is specified in the contract specifications. The
insurance coverage shall contain no limitations on the scope of the protection provided
and include the following minimum coverage:
a. Broad Form Property Damage, with no employee exclusion;
b. Personal Injury Liability, including extended bodily injury;
C. Broad Form Contractual/Commercial Liability — including completed operations;
d. Premises — Operations Liability (M&C);
e. Independent Contractors and subcontractors;
£ Blanket Contractual Liability.
Such insurance coverage shall be evidenced by one of the following methods:
* Certificate of Insurance;
* Self-insurance through an irrevocable Letter of Credit from a qualified financial
institution.
Certificates of coverage as required by this section shall be delivered to the County
within fifteen (15) days of execution of this Agreement.
Any deductibles or self-insured retention shall be declared to and approved by the County
prior to the approval of the contract by the County. At the option of the County, the
insurer shall reduce or eliminate deductibles or self-insured retention or the Consultant
shall procure a bond guaranteeing payment of losses and related investigations, claim
administration and defense expenses.
The Consultant shall include all subcontractors as insured under its insurance policies or
shall furnish separate certificates and endorsements for each subcontractor. All insurance
provisions for subcontractors shall be subject to all of the requirements stated 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.
Page 3 of 13
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 being the
intention of the parties that the insurance policies so affected shall protect both parties
and be primary coverage for any and all losses covered by the above described insurance.
It is further agreed by the parties that insurance companies issuing the policy or policies
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.
It is agreed by the parties that judgments for which the County may be liable, in excess of
insured amounts provided herein, or any portion thereof, may be withheld from payment
due, or to become due, to the Consultant until such time as the Consultant shall furnish
additional security covering such judgment as may be determined by the County.
The County reserves the right to request additional insurance on an individual basis for
extra hazardous contracts and specific service agreements.
Any coverage for third party liability claims provided to the County by a "Risk Pool"
created pursuant to Ch. 48.62 RCW shall be non-contributory with respect to any policy
of insurance the Consultant must provide in order to comply with this Agreement.
If the proof of insurance or certificate indicating the County is an "additional insured" to
a policy obtained by the Consultant refers to an endorsement (by number or name) but
does not provide the full text of that endorsement, then it shall be the obligation of the
Consultant to obtain the full text of that endorsement and forward that full text to the
County.
The County may, upon the Consultant's failure to comply with all provisions of this
contract relating to insurance, withhold payment or compensation that would otherwise
be due to the Consultant.
9. Independent Contractor. The Consultant and the County agree that the Consultant is an
independent contractor with respect to the services provided pursuant to this Agreement.
Nothing in this Agreement shall be considered to create the relationship of employer and
employee between the parties hereto. Neither Consultant nor any employee of Consultant
shall be entitled to any benefits accorded County employees by virtue of the services
provided under this Agreement. The County shall not be responsible for withholding or
otherwise deducting federal income tax or social security or for contributing to the state
industrial insurance program, otherwise assuming the duties of an employer with respect
to Consultant, or any employee of Consultant.
10. Covenant Against Contingent Fees. The Consultant warrants that he has not employed or
retained any company or person, other than a bonafide employee working solely for the
Consultant, to solicit or secure this contract, and that he has not paid or agreed to pay any
Page 4 of 13
company or person, other than a bonafide employee working solely for the Consultant,
any fee, commission, percentage, brokerage fee, gifts, or any other consideration
contingent upon or resulting from the award or making of this contract. For breach or
violation of this warranty, the County shall have the right to annul this contract without
liability or, in its discretion to deduct from the contract price or consideration, or
otherwise recover, the full amount of such fee, commission, percentage, brokerage fee,
gift, or contingent fee.
11. Discrimination Prohibited. The Consultant, with regard to the work performed by it under
this Agreement, will not discriminate on the grounds of race, color, national origin,
religion, creed, age, sex or the presence of any physical or sensory handicap in the
selection and retention of employees or procurement of materials or supplies.
12. Assignment. The Consultant shall not sublet or assign any of the services covered by this
Agreement without the express written consent of the County.
13. Non -Waiver. Waiver by the County of any provision of this Agreement or any time
limitation provided for in this Agreement shall not constitute a waiver of any other
provision.
14. Termination.
a. The County reserves the right to terminate this Agreement at any time by giving
ten (10) days written notice to the Consultant.
b. In the event of the death of a member, partner or officer of the Consultant, or any
of its supervisory personnel assigned to the project, 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 County. This section shall not be a bar to
renegotiations of this Agreement between surviving members of the Consultant
and the County, if the County so chooses.
15. Notices. Notices to the County of Jefferson shall be sent to the following address:
Jefferson County Environmental Health
615 Sheridan Street
Port Townsend, WA 98368
Ph: 360/379-4498
Notices to Consultant shall be sent to the following address:
George A. Brooks
ComPraise
425 Ericksen Avenue NE, Suite 215
Bainbridge Island, WA 98110
Ph: (206) 201-3557
Page 5 of 13
16. Integrated Agreement. This Agreement together with exhibits or addenda, represents the
entire and integrated Agreement between the County and the Consultant and supersedes
all prior negotiations, representations, or agreements written or oral. This Agreement may
be amended only by written instrument signed by both County and Consultant.
DATED this /� day of A20 � 20 .
George A. Brooks
Name of Consultant
(Signature)
State Certification Number — General
#1102323 Expiration: 10/10/2018
Date
JEFFERSON COUNTY
BOARD OF COMMISSIONERS
Kathleen K Char
David . Sullivan, Member
Ka4 Dean, ember
Approved as to form only:
t,V C. ate
Prose ting Atto ey
Page 6 of 13
Exhibit A
Scope of Work
Big Quilcene River Floodplain Appraisal Reports
George A. Brooks, certified General Real Estate Appraiser, will perform self-contained
appraisals and, as needed, appraisal updates for fee -simple property acquisitions located on the
floodplains of the Big Quilcene and Dosewallips Rivers as part of a coordinated effort to recover
salmon and prevent flood impacts.
Properties to be appraised include the following parcels.
RCO #12-1384:
APN 991 700 001: March 1, 2017
APN 702 243 019: April 1, 2017
RCO #13-1221:
APN 602 342 006: March 1, 2017
Quilcene Floodplain Acquisition Account:
APN 991200305: August 1, 2017
APN 991200304: August 1, 2017
APN 991200407: August 1, 2017
Deliverables: One signed hard copy and an electronic copy (PDF) of each self-contained
appraisal or appraisal update.
Due Dates: 30 Days from Notice to Proceed dates listed above.
Page 7 of 13
Exhibit B
CERTIFICATION OF CONSULTANT
Jefferson County
I her abcertify at I am e r�� a ak S ,and duly authorized representative of the firm
Of � �a r° S e 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 Contractor) to solicit or secure this contract.
(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 the contract.
(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 Contractor) any fee, contribution, donation or consideration of
any kind for, or in connection with procuring or carrying out the contract; except as here
expressly stated (if any):
I further certify that the firm I hereby represent is authorized to do business in the State of Washington
and that the firm is in full compliance with the requirements of the Board of Professional Registration.
' ' W r q -
Date
CERTIFICATION OF AGENCY OFFICIAL
Sign re
I hereby certify that I am the AGENCY Official of the County of Jefferson, Washington State and that the
above 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 contract to:
(a) Employ or retain, or agree to employ or retain, any firm or person, or
(b) Pay or agree to pay to any firm, person or org lation, any fee, contribution, donation or
consideration of any kind, except as here expressly ted (if y
/7/
Date Si ature
Page 8 of 13
Exhibit C
CERTIFICATION REGARDING DEBARMENT, SUSPENSION AND OTHER
RESPONSIBILITY MATTERS - PRIMARY COVERED TRANSACTIONS
The prospective primary participant certifies to the best of its knowledge and belief that it and its
principals:
1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from covered transactions by any Federal department or agency;
2. Have not within a three (3) year period preceding this proposal been convicted of or had a
civil judgment rendered against them for commission of 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 anti-
trust statutes or commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, or receiving stolen property;
3. 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 (2) of this certification; and
4. Have not within a three (3) year period preceding this proposal had one or more public
transactions (Federal, State and local) terminated for cause or default.
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.
C; 4'�' & red P
Consultant (Firm Name)
Signature (AMiorized Official or Consultant)
DATE
Page 9 of 13
Exhibit D
RCO Appraisal Assignment Instructions for Grant Funded Projects
This is a list of appraisal assignment instructions for use by RCO project sponsors when hiring
an appraiser to conduct a real property valuation for an RCO funded acquisition project. These
are minimum conditions and instructions that the RCO project sponsor should include in the
solicitation for hiring an appraiser to ensure that the appraisal document meets RCO
requirements. This list is not meant to be a comprehensive list, but includes pertinent information
to assist the contractor in his preparation of an appropriate scope of work for the appraisal
assignment. The project sponsor should feel free to add additional information and instructions
as deemed necessary to ensure the development of a credible appraisal.
RCO project sponsors should include the following instructions in any appraisal solicitation:
1) Assignment Description
Provide a description of the appraisal assignment and the property to be valued. State whether the
appraisal is for fee simple interest in the property or for less than fee simple rights, such as a
conservation easement, and describe all reservations.
2) Property Information
a) Legal Description — Include the legal description from the preliminary title report. If
only a portion of the ownership listed on the preliminary title report is to be appraised,
clearly identify the area to be acquired in the property description.
b) Property Description — Include the parcel number(s), acreage to be acquired and a map. If
the acreage is different from the county assessment records, state source for the acreage
estimate.
c) Property Access — Describe the existing physical access to the property and the location
of legal access to the public roadway, if known.
d) Ownership and Occupant Information — Include any information you have about the
current ownership of the property and any tenants. Note other adjacent property under the
same ownership if the acquisition is for less than the entire ownership.
e) Preliminary Title Report — Provide a copy of the preliminary title report with existing
easements and encumbrances.
f) Special Property Characteristics — Identify or describe any special attributes or conditions
affecting the property (i.e. threatened or endangered species, geologic hazards, etc.)
3) Appraisal Criteria and Instructions
a) Client — The client must be the recipient of RCO grant funds. It cannot include the
landowner or other third party unless approved by RCO.
Page 10 of 13
b) Intended Users — The intended users must always include the client (i.e., the recipient of
RCO grant funds) and RCO.
c) Intended Use — The intended use must include a statement regarding the voluntary
acquisition of the identified property.
d) Appraisal Standards — Instruct the appraiser that the appraisal is required to comply, at a
minimum, with the Uniform Standards of Professional Appraisal Practice (USPAP) and
applicable requirements specified in RCO's Manual 3, Acquisition Projects (December
2010).
UASFLA — If the acquisition is to be funded with an RCO administered federal
program grants, the appraiser also must comply with the performance and
reporting requirements of the Uniform Appraisal Standards for Federal Land
Acquisitions (UASFLA).
ii. Land and Water Conservation Fund (LWCF) projects only — If the project is to
be funded in the LWCF program, include a copy of Chapter 4, Section of the
Land and Water Conservation Fund Assistance Program Manual (October 2008)
and instruct the appraiser to follow any applicable requirements.
e) Definition of Market Value — The appraiser must employ the definition of market value
in the UASFLA if conducting an appraisal to the federal standards. For USPAP
compliant appraisals, RCO recommends the use of the UASFLA definition of market
value. The market value must be a expressed as a point value.
fl Date of Value — This typically should be the same as the date of the last property
inspection unless otherwise instructed or justified.
g) Encumbrances — Include encumbrances from the preliminary title report and instruct the
appraiser to address whether any of the encumbrances would impact the market value of
the property. If the appraiser becomes aware of unrecorded encumbrances through the
course of their work, those should also be addressed as to whether they would impact the
market value of the property.
h) Property Owner Contact — The appraiser must contact the landowner or landowner's
representative and invite them to accompany the appraiser on the property inspection.
The appraisal must include a description of the efforts to contact the landowner including
dates, methods of contact, whether the landowner accompanied the appraiser during the
inspection and any other general communication between the appraiser and landowner.
i) Report Format — The report format must be a self-contained appraisal report, unless the
acquisition is non-complex and acquisition on the entire property, in which case the
report format may be a summary appraisal report. Restricted use reports are not
acceptable.
Page I I of 13
j) Report copies — Specify the number of printed copies of the appraisal report that the
appraiser will be required to submit. Provide an electronic copy of the final report to
RCO at the conclusion of the appraisal review process.
k) Participation in the Appraisal Review Process — The appraiser should be informed that
the appraisal report will be reviewed by an independent review appraiser. The appraisal
contract should require that the appraiser respond to the review appraiser's inquiries and
questions, and provide clarifications and corrections as necessary to enhance the
credibility of the appraisal report.
4) Special Conditions
a) Extraordinary Assumptions — The appraiser may not assume any extraordinary
assumptions without the client's written pre -approval. RCO strongly recommends that
the project sponsor seek pre -approval of any atypical assignment conditions under which
the appraisal is conducted to ensure compliance with RCO policies and the grant project
agreement. This recommendation does not extend to extraordinary assumptions regarding
commonly occurring circumstances (such as final terms and conditions of a conservation
easement if the appraisal is made before recording).
b) Hypothetical Conditions — The appraiser may not use any hypothetical conditions without
the client's written pre -approval. RCO strongly recommends that the project sponsor seek
pre -approval of any special assignment conditions under which the appraisal is conducted
to ensure compliance with RCO policies and the grant project agreement. This
recommendation does not extend to hypothetical conditions regarding commonly
occurring circumstances (such as the conditions of a property in the "before" or "after"
premise).
c) Any other interest, such as a life estate or leases must be provided. If the appraisal is for
less than fee simple rights, such as an easement, provide the appraiser with an outline of
the easement terms at a minimum. It is preferable to provide the appraiser with a
complete negotiated easement (with language approved by RCO) to ensure all terms of
the easement are addressed in the appraisal.
5) Appraiser Qualifications
a) Level of Licensure — The appraiser must have the appropriate level of state licensure
based upon the appraisal assignment in order to conduct the appraisal. RCO strongly
recommends that the principal appraiser be a State Certified General Real Estate
Appraiser for all complex property types and partial acquisitions (i.e., license number
begins with 270-11).
b) Competency — The appraiser should indicate to the project sponsor as part of his fee
quote proposal his competency in appraising properties of the type and geographic
location of the subject property. Demonstration of competency must also be included in
the appraisal report.
Page 12 of 13
c) UASFLA training — If conducting an appraisal to UASFLA standards, the appraiser must
identify his experience and qualifications for conducting an appraisal to meet these
standards. The RCO recommends the appraiser provide evidence of recent training
(within the past 5 years) in the UASFLA standards.
Page 13 of 13
615 Sheridan Street
Port Townsend, WA 98368
$ffoson www.JeffersonCountyPublicHealth.org
is Hea
Consent Agenda
January 31, 2017
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Philip Morley, County Administrator
FROM: Tami Pokorny, Environmental Health Specialist II
Will Butterfield, Public Works Right -of -Way Representative
DATE: ql (T Joh.. n --
SUBJECT: Consent Agenda Item — Personal Services Agreement with George A.
Brooks of ComPraise, General Real Estate Appraiser; Upon signature -
August 31, 2018; $20,000
STATEMENT OF ISSUE:
Jefferson County Public Health, Water Quality Division, is requesting Board approval of a Personal Services
Agreement — George A. Brooks of ComPraise, General Real Estate Appraiser; Upon signature - August 31,
2018; $20,000
ANALYSIS/ STRATEGIC GOALS/PRO'S and CON'S:
Environmental Health requests Board approval of a personal services agreement with George A. Brooks,
certified General Real Estate Appraiser, to perform self-contained appraisals and, as needed, appraisal
updates for fee -simple property acquisitions located on the floodplains of the Big Quilcene and Dosewallips
Rivers as part of a coordinated effort to recover salmon and prevent flood impacts.
Properties to be appraised include the following parcels RCO #12-1384 (APN 991 700 001, APN 702 243
019), RCO #13-1221 (APN 602 342 006), Quilcene Floodplain Acquisition Account (APN 991200305, APN
991200304, APN 991200407). Additional appraisal needs may be identified through the Big Quilcene River
Restoration Planning process lead by the Hood Canal Salmon Enhancement Group or the HCCC Lead Entity
Technical Advisory Group with respect to the RCO grants indentified in the agreement.
George A. Brooks of ComPraise, General Real Estate Appraiser will provide one signed hard copy and an
electronic copy (PDF) of each self-contained appraisal or appraisal update. The due dates will be 30 days
from Notice to Proceed of the reports.
Community Health
Developmental Disabilities
360-385-9400
360-385-9401 (f)
Always working for a safer and healthier community
Environmental Health
Water Quality
360-385-9444
(f) 360-379-4487
615 Sheridan Street
Port Townsend, WA 98368
�eihson www.JeffersonCountyPublicHealth.org
Public Heallt
FISCAL IMPACT/COST BENEFIT ANALYSIS:
The appraisals listed are funded by a Salmon Recovery Funding Board grant (RCO #12-1384 and 13-1221)
or funded by the Public Works Quilcene Floodplain Acquisition Account (##5533Q.61.000). Matching funds
have been provided through the value of parcels previously acquired on the Dosewallips River floodplain.
RECOMMENDATION:
JCPH management requests approval of the Personal Services Agreement — George A. Brooks of ComPraise,
General Real Estate Appraiser; Upon Signature — August 31, 2018; $20,000
REVIEWED BY:
4Mp4",Cunty A ' ator !! ff
Community Health
Developmental Disabilities
360-385-9400
360-385-9401 (t)
Date
Always working for a safer and healthier community
Environmental Health
Water Quality
360-385-9444
(t) 360-379-4487
Public Hea
615 Sheridan Street
Port Townsend, WA 98368
www.JeffersonCountyPublicHealth.org
FEB 0 2 20 17
WQ-17-5
CONTRACT REVIEW FORM
CONTRACT WITH: George A. Brooks of ComPraise, General Real Estate Appraiser
CONTRACT FOR: Appraisal Services TERM: Upon Signature - August 31, 2018
COUNTY DEPARTMENT: Jefferson County Public Health
For More Information Contact: Tami Pokorny
Contact Phone #: X498
RETURN TO
I1►fi[*111111►>1141
Jenny Matter RETURN BY
Revenue:
Expenditure: $20,000
Matching Funds Required:
Source(s) of Matching Funds:
Step 1: REVIEW BY RISK
Review by:
Date Reviewed/
APPROVED FORM
Comments:
RIMEOW/
MAR 2 0 2017
ASAP r. JEFFERSON COUNTY
PROCESS:
Step 2: REVIEW BY PROSE"TIN
Review by: C.
Date Reviewed:
APPROVED AS TO FORM
Comments: +� ) dh pvc
❑ Exempt from Bid Process
✓ Consultant Selection Process
❑ Cooperative Purchase
❑ Competitive Sealed Bid
❑ Small Work Roster
❑ Vendor List Bid
❑ RFP or RFQ
❑ Other:
for revision (See Comments)
RNEY
Returned for revision (See Comments)
(This form to stay with contract throughout the contract review process)
Community Health Environmental Health
Developmental Disabilities Water Quality
360-385-9400 360-385-9444
360-385-9401 (f) Always working for a safer and healthier community (f) 360-379-4487