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CONTRACT
JEFFERSON COUNTY,WASHINGTON
THIS AGREEMENT,made and entered into this 2 day of October, 2021,between the COUNTY
OF JEFFERSON and Rocky Lang of Adna, WA,hereinafter called the Contractor.
WITNESSETH: 8"
That in consideration of the terms and conditions contained herein and attached and made a part of this
agreement,the parties hereto covenant and agree as follows:
1. The Contractor agrees to furnish all labor and equipment and do certain work,to-wit: That the
Contractor herein will undertake and complete the following described work:
Properly remove and properly dispose of all dilapidated and collapsed structures and solid waste from
the property known as Assessor's Parcel#702242012 including:
— Three small all-wood structures less than 100 ft2 each with dirt floors,wood siding and wood
roof.
— Collapsed and partially buried house.
— A dilapidated 40-foot metal travel trailer, including asbestos-containing roof coating.
— A vehicle frame and remains.
— All solid waste including household materials,appliances,vehicle remains, swing set,and
litter.
— Property decommission an on-site system believed to be located near the bathroom of the
collapsed home. Tank must be pumped by an approved 0&M specialist:
https://www jeffersoncountypublichealth.org/655/LicensedCertified-Septic-System-Professi
— Apply,pay for,and obtain all necessary notifications and permits including from ORCAA,
for on-site tank decommissioning(JCPH Certification of Tank Decommissioning From
https://www jeffersoncountypublichealth.org/653/Septic-System-Applications-Forms),and
approval from the Sherriff's Office to remove the trailer.
— -All work areas should be left clean and covered in weed-free straw to a depth of 3".
for the total sum of seventeen thousand,three-hundred eighty-two dollars($17,382)in accordance
with and as described in the attached plans and specifications and the Standard Specifications of the
Washington Department of Transportation which are by this reference incorporated herein and made
a part hereof. The Contractor shall perform any alteration in or addition to the work provided in this
contract and every part thereof.
The Contractor shall complete the described work as follows:
with a start date of Upon Signature and a completion date of November 31,2021.
The Contractor shall provide and bear the expense of all equipment,work and labor of any sort
whatsoever that may be required for the transfer of materials and for constructing and completing the
work provided for in this contract and every part thereof.
2. The County of Jefferson hereby promises and agrees with the Contractor to employ, and does employ
the Contractor to furnish the goods and equipment described and to furnish the same according to the
attached specifications and the terms and conditions herein contained,and hereby contracts to pay for
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EH-2 1-048
the same according to the attached specifications and the schedule of unit or itemized prices hereto
attached,at the time and in the manner and upon the condition provided for in this contract. The
County further agrees to employ the Contractor to perform any alterations in or additions to the work
provided for in this contract that may be ordered and to pay for the same under the terms of this
contract and the attached specifications at the time and in the manner and upon the conditions
provided for in this contract.
3. The Contractor for himself,and for his heirs,executor,administrators, successors,and assigns, does
hereby agree to the full performance of all the covenants herein contained upon the part of the
Contractor.
4. Prior to commencing work,the Contractor shall obtain at its own cost and expense the following
insurance from companies licensed in the State with a Best's rating of no less than A: VII. The
Contractor shall provide to the County Risk Manager certificates of insurance with original
endorsements affecting insurance required by this clause prior to the commencement of work to be
performed.
The insurance policies required shall provide that thirty(30)days prior to cancellation, suspension,
reduction or material change in the policy,notice of same shall be given to the County Risk Manager
by registered mail,return receipt requested, for all of the following stated insurance policies.
If any of the insurance requirements are not complied with at the renewal date of the insurance policy,
payments to the Contractor shall be withheld until all such requirements have been met, or at the
option of the County,the County may pay the renewal premium and withhold such payments from
the moneys due the Contractor.
All notices shall name the Contractor and identify the agreement by contract number or some other
form of identification necessary to inform the County of the particular contract affected.
A. Workers Compensation and Employers Liability Insurance. The Contractor shall procure and
maintain for the life of the contract, Workers Compensation Insurance, including Employers
Liability Coverage, in accordance with the laws of the State of Washington.
B. General Liability(1)-with a minimum limit per occurrence of one million dollars($1,000,000)
and an aggregate of not less than two million dollars($2,000,000)for bodily injury, death and
property damage unless otherwise specified in the contract specifications. This insurance
coverage shall contain no limitations on the scope of the protection provided and indicate on the
certificate of insurance the following coverage:
1. Broad Form Property Damage with no employee exclusion;
2. Personal Injury Liability, including extended bodily injury;
3. Broad Form Contractual/Commercial Liability including completed operations(contractors
only);
4. Premises-Operations Liability(M&C);
5. Independent Contractors and Subcontractors; and
6. Blanket Contractual Liability.
(1)Note: The County shall be named as an additional insured party under this policy.
C. Automobile(2)-with a minimum limit per occurrence of$1,000,000 for bodily injury,death and
property damage unless otherwise specified in the contract specifications. This insurance shall
indicate on the certificate of insurance the following coverage:
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1. Owned automobiles;
2. Hired automobiles; and,
3. Non-owned automobiles.
(2)Note: The County shall be named as an additional insured party under this policy.
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 Contractor shall procure a bond
guaranteeing payment of losses and related investigations,claim administration and defense
expenses.
The Contractor 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 Contractor to take out and/or maintain any required insurance shall not relieve the
Contractor 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 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 Contractor.
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 Contractor until such time as the Contractor 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
Contractor must provide in order to comply with this Agreement.
If the proof of insurance or certificate of coverage indicating the County is an"additional
insured"to a policy obtained by the Contractor 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 Contractor
to obtain the full text of that endorsement and forward that full text to the County within 30 days
of the execution of this Agreement.
The County may,upon the Contractor's failure to comply with all provisions of this contract
relating to insurance,withhold payment or compensation that would otherwise be due to the
Contractor.
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5. The Contractor shall comply with all Federal, State, and local laws and ordinances applicable to the
work to be done under this Agreement. This Agreement shall be interpreted and construed in accord
with the laws of the State of Washington and venue shall be in Jefferson County, WA.
The Contractor shall defend, indemnify and hold the County, its officers, officials,employees, agents
and volunteers(and their marital communities)harmless from any and all claims, injuries, damages,
losses or suits including attorney fees, arising out of or resulting from the acts, errors or omissions of
the Contractor in performance of this Agreement, except for injuries and damages caused by the sole
negligence of the County. Should a court of competent jurisdiction determine that this Agreement is
subject to RCW 4.24.115,then, in the event of liability for damages arising out of bodily injury to
persons or damages to property caused by or resulting from the concurrent negligence of the
Contractor and the County, its officers, officials,employees, agents and volunteers(and their marital
communities)the Contractor's liability, including the duty and cost to defend,hereunder shall be only
to the extent of the Contractor's negligence.
Claims against the County shall include,but not be limited to assertions that the use and transfer of
any software,book, document,report,film,tape,or sound reproduction of material of any kind,
delivered hereunder, constitutes an infringement of any copyright,patent,trademark,trade name, or
otherwise results in an unfair trade practice or an unlawful restraint of competition.
The Contractor specifically assumes potential liability for actions brought against the County by the
Contractor's employees, including all other persons engaged in the performance of any work or
service required of the Contractor under this Agreement and, solely for the purpose of this
indemnification and defense,the Contractor specifically waives any immunity under the state
industrial insurance law,Title 51 R.C.W. The Contractor recognizes that this waiver was specifically
entered into pursuant to provisions of R.C.W. 4.24.115 and was subject of mutual negotiation.
The provisions of this section shall survive the expiration or termination of this Agreement.
6. The Contractor's relation to the County shall be at all times as an independent Contractor, and
nothing herein contained shall be construed to create a relationship of employer-employee or master-
servant,and any and all employees of the Contractor or other persons engaged in the performance of
any work or service required of the Contractor under this Agreement shall be considered employees
of the Contractor only and any claims that may arise on behalf of or against said employees shall be
the sole obligation and responsibility of the Contractor.
7. The Contractor shall not sublet or assign any of the services covered by this contract without the
express written consent of the County or its authorized representative. Assignment does not include
printing or other customary reimbursable expenses that may be provided in an agreement.
8. Nothing in the foregoing clause shall prevent the County, at its option,from additionally requesting
that the Contractor deliver to the County an executed bond as security for the faithful performance of
this contract and for payment of all obligations of the Contractor.
For contracts of$150,000 or less,the County and the Contractor may agree that in-lieu of the
Contract Bond;the County will withhold 10%of the Contract amount in accordance with R.C.W
39.08.010. If applicable,the Contractor will indicate this option on Exhibit D.
9. The Contractor will declare a management option of the statutory retained percentage on Exhibit E.
Limited Small Works Project per RCW 39.04.155(3): Performance Bond and Retainage
Waived
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INDEX OF EXHIBITS
• Exhibit A: Certification Regarding Debarment, Suspension,Ineligibility,and Voluntary
Exclusion
11 Exhibit B: Certification of Compliance with Wage Payment Statues
❑ Exhibit C: Contract Bond,Jefferson County, Washington
11 Exhibit D: Contractor's Declaration of Option for Contracts for Less Than$150,000
• Exhibit E: Contractor's Declaration of Option for Management of Statutory Retained Percentage
it
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IN WITNESS WHEREOF,the Contractor has executed this instrument on the day and year first below
written,and the Board of County Commissioners has caused this instrument to be executed by and in the
name of said County of Jefferson the day and year first above written.
Executed by the Contractor /0 /C7 ,20 7,-I
Contractor:
RC
(Please print)
By: �G/( Lv10
(Please print)
(Signature)
State of Washington,ABCN00001593 Exp.08/01/2024
COUNTY OF JEFFERSON
BOARD OF COMMISSIONERS
Kate can District 1
eidi Ei nhour,District 2
re ro e , istrict 3
Approved as to form only:
September 30, 2021
Philip C.Hunsucker Date
Chief Civil Deputy Prosecutor
II'
Version JCPH Risk LegalReview Date 06/17/2020 Page 6 of 11
Construction Contract Contract G g
EXHIBIT A
CERTIFICATION REGARDING
DEBARMENT,SUSPENSION,INELIGIBILITY,AND VOLUNTARY EXCLUSION
The Contractor 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 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 antitrust 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 3-year period preceding this contract had one or more public transactions(Federal,
State, or local)terminated for cause or default.
Where the Contractor is unable to certify to any of the statements in this certification, such Contractor
shall attach an explanation.
(//k 1(7 colj
Name of Contractor(Please print)
RacicY Lcv
Name and Title of Authorized Re entative (Please print)
Signature of thorize Represents ' e
I am unable to certify to the above statement. An explanation is attached.
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EXHIBIT B
CERTIFICATION OF COMPLIANCE WITH WAGE PAYMENT STATUTES
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and
correct.
The undersigned bidd r hereby ce�ifies that,within the three-year period immediately preceding the bid
solicitation date IO-(O 7�z ,the bidder is not a"willful"violator,as defined in RCW 49.48.082,
or any of the provisions of chapters 49.46,49.48,or 49.52 RCW as determined by a final and binding
citation and notice of assessment issued by the Department of Labor and Industries or through a civil
judgment entered by a court of limited or general jurisdiction.
Rook )" L�-fl
Bidder's Business Name
Signature of Authorized Offi ' 1*
\o tli
Printed Name
ouvra
Title
ta—i0-7)77/i 0 ill e"h 11$
1444
Date City State
Check One:
Sole Proprietorship Partnership Joint Venture Corporation I I
State of Incorporation,or if not a corporation, State where business entity was formed:
\IVA
If a co-partnership, give firm name under which business is transacted:
*If a corporation,proposal must be executed in the corporate name by the president or vice-president
(or any other corporate officer accompanied by evidence of authority to sign). If a co-partnership,
proposal must be executed by a partner.
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EXHIBIT C
CONTRACT BOND
JEFFERSON COUNTY,WASHINGTON
KNOW ALL MEN BY THESE PRESENTS:
That , of ,as Principal, and
,as Surety, are jointly and severally held and bound unto the
COUNTY OF JEFFERSON,the penal sum of Dollars
($ ), for the payment of which we jointly and severally bind ourselves,or heirs,executors,
administrators,and assigns,and successors and assigns, firmly by these presents.
The condition of this bond is such that WHEREAS, on the day of ,A.D., 20 ,the
said ,Principal herein, executed a certain contract with the
County of Jefferson,by the terms, conditions and provisions of which contract the said
, Principal herewith,agrees to furnish all materials and do certain
work,to-wit: That the said Principal herein will undertake and complete the following described work:
in Jefferson County, Washington,as per maps,plans and specifications made a part of said contract,
which contract as so executed, is hereunto attached, and is now referred to and by this reference is
incorporated herein and made a part hereof as full for all purposes as if here set forth at length.
NOW THEREFORE, if the Principal herein shall faithfully and truly observe and comply with the
terms,conditions and provisions of said contract, in all respects and shall well and truly and fully do and
perform all matters and things by the said Principal undertaken to be performed under said contract,upon
the terms proposed therein,and within the time prescribed therein,and until the same is accepted, and
shall pay all laborers,mechanics, subcontractors and materialmen,and all persons who shall supply such
contractor or subcontractor with provisions and supplies for the carrying on of such work, and shall in all
respects faithfully perform said contract according to law,then this obligation to be void, otherwise to
remain in full force and effect.
WITNESS our hands this day of ,20
PRINCIPAL SURETY COMPANY
By: By:
By:
Attorney in fact
Address of local office and agent of surety company:
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EXHIBIT D
CONTRACTOR'S DECLARATION OF OPTION FOR
CONTRACTS FOR LESS THAN$150,000
A. A Contract Bond will be provided as required.
Date Signed
B. In lieu of providing a Contract Bond,the County will withhold 10%of the ontract amount.
Date Signed
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EXHIBIT E
CONTRACTOR'S DECLARATION OF OPTION FOR MANAGEMENT
OF STATUTORY RETAINED PERCENTAGE
A. I hereby elect to have the retained percentage of this contract held in a fund by the Owner until(30)
days following final acceptance of the work.
Date I �( w� l Signed
B. I hereby elect to have the Owner deposit the retained percentage of this contract in an interest bearing
account,not subject to withdrawal until after final acceptance of the work.
Date Signed
C. I hereby elect to have the Owner invest the retained percentage of this contract from time to time as
such retained percentage accrues.
I hereby designate as the repository for the escrow of
said funds.
I hereby further agree to be fully responsible for payment of all costs or fees incurred as a result of
placing said retained percentage in escrow and investing it as authorized by statute. The Owner shall not
be liable in any way for any costs or fees in connection therewith.
Date Signed
D. I hereby elect to provide a Retainage Bond in accordance with R.C.W 60.28.011.
Date Signed
Construction Contract Contract G Version JCPH Risk Legal Review Date 06/17/2020 Page 11 of 11
615 Sheridan Street
Port Townsend, WA 98368
Allason www.JeffersonCountyPublicHealth.org
Consent Agenda
Public HealthSeptember 21, 2021
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Mark McCauley, Interim County Administrator
FROM: Pinky Mingo, Environmental Public Health and Water Quality Director
Tami Pokorny, Natural Resources Program Coordinator
DATE: V cikr ao at
SUBJECT: Agenda Item — Project Agreement with Rocky Lang; Upon Signature —
November 31, 2021; for $15,932 + tax of $1,450 for a total of $17,382
STATEMENT OF ISSUE:
Jefferson County Public Health requests approval of Project Agreement with Advanced Environmental; Upon
Signature — November 31, 2021; for $15,932 + tax of $1,450 for a total of$17,382.
ANALYSIS/STRATEGIC GOALS/PRO'S and CON'S:
Rocky Lang is retained by the County to remove and properly dispose of all improvements, solid waste, vehicle
remains and asbestos-containing materials (ACM) previously identified by NWA Northwest Environmental from
the property known as APN#702242012 in Quilcene, WA, and to leave it clean and ready for replanting.
FISCAL IMPACT/COST BENEFIT ANALYSIS:
Funding for the Project Agreement is provided by RCO #18-1227, Lower Big Quilcene Floodplain Acquisitions
project matched by the Public Works Big Quilcene Flood Account ($2,671). There is no impact to the Jefferson
County General Fund for this agreement.
RECOMMENDATION:
Jefferson County Public Health requests approval of Project Agreement with Advanced Environmental; Upon
Signature — November 31, 2021; for $15,932 + tax of $1,450 for a total of$17,382.
REVIEWED BY:
0/0411t�� /o L, LI
Mark McCauley, rim County Administrator Date
Community Health
Developmental Disabilities Environmental Public Health
360-385-9400 360-385-9444
360-385-9401 (f) (f) 360-379-4487
Always working for a safer and healthier community
EH-21-048
CONTRACT REVIEW FORM
(INSTRUCTIONS ARE ON THE NEXT PAGE)
CONTRACT WITH: Rocky Lang EH-21-048
(Name of Contractor/Consultant) Contract No.
COUNTY DEPARTMENT: Jefferson County Public Health
Contact Person: Tami Pokorny
Contact Phone: x498
Contact email: TPokomvCa)_co.iefferson.wa.us
AMOUNT: $17,382.00 PROCESS: — Exempt from Bid Process
Revenue: _ Cooperative Purchase
Expenditure: $17,382.00 _ Competitive Sealed Bid
Matching Funds Required: _ Small Works Roster
Sources(s)of Matching Funds _ Vendor List Bid
x RFP or RFQ
Other:
APPROVAL STEPS:
STEP 1:DEPARTMENT CERTIFIES COMPLIANCE WITH JCC 3.55.080 AND CHAPTER 42.23 RCW.
CERTIFIED: _ N/A:❑ Glenn Gilbert ;�4r
Signature Date
STEP 2: DEPARTMENT CERTIFIES THE PERSON PROPOSED FOR CONTRACTING WITH THE
COUNTY (CONTRACTOR) HAS NOT BEEN DEBARRED BY ANY FEDERAL, STATE, OR LOCAL
AGENCY.
o �,.�w erc�.n,c�n.,�
CERTIFIED: N/A: ❑
Glenn Gilbert :a�,maoow.�,Lo.wva
Signature Date
STEP 3:RISK MANAGEMENT REVIEW(will be added electronically through Laserfiche):
Electronically approved by Risk Management on 9/20/2021.
STEP 4:PROSECUTING ATTORNEY REVIEW(will be added electronically through Laserfiche):
Electronically approved as to form by PAO on 9/30/2021.
STEP 5: DEPARTMENT MAKES REVISIONS & RESUBMITS TO RISK MANAGEMENT AND
PROSECUTING ATTORNEY(IF REQUIRED).
STEP 6: CONTRACTOR SIGNS
STEP 7: SUBMIT TO BOCC FOR APPROVAL
1