HomeMy WebLinkAboutContracts & Agreements_105-2019PS 1 1 {I 24 19)
AGREEMENT TO PERFORM PROFESSIONAL SERVICES
This agreement for the provision of professional environmental consulting services
("Agreement") is made and entered in this 4t11 day of June, 2019 ("Effective Date"), by and
between the City of Redlands, a municipal corporation ("City)" and PlaceWorks, Inc ,
("Consultant") City and Consultant are sometimes individually referred to herein as a "Party"
and, together, as the "Parties " In consideration of the mutual promises contained herein, City
and Consultant agree as follows
ARTICLE I — ENGAGEMENT OF CONSULTANT
1 1 City hereby engages Consultant to provide professional environmental consulting
services for the environmental analysis and envu-oninental document preparation related
to a proposed ballot measure to amend three voter -approved initiatives `Measure U,'
`Measure N,' and `Proposition R' for City (the "Services")
1 2 The Services shall be performed by Consultant in a professional manner, and Consultant
represents that it has the skill and the professional expertise necessary to provide the
Services to City at a level of competency presently maintained by other practicing
professional consultants in the industry providing like and similar types of Services
ARTICLE 2 — SERVICES OF CONSULTANT
2 1 The Services that Consultant shall perform are more particularly described in Exhibit
"A," entitled "Scope of Services," which is attached hereto and incorporated herein by
reference
2 2 Consultant shall comply with applicable federal, state and local laws and regulations in
the performance of this Agreement including, but not limited to, State prevailing wage
laws
ARTICLE 3 — RESPONSIBILITIES OF CITY
3 1 City shall make available to Consultant information in its possession that may assist
Consultant in perfonnmg the Services
3 2 City designates Brian Desatmk, Director, Development Services Department, as City's
representative with respect to performance of the Services, and such person shall have the
authority to transmit instructions, receive information, interpret and define City's policies
and decisions with respect to performance of the Services
ARTICLE 4 — PERFORMANCE OF SERVICES
4 1 Consultant shall perform and complete the Services in a prompt and diligent manner in
accordance with the schedule set forth in Exhibit "13," entitled "Project Schedule," which
is attached hereto and incorporated herein by reference
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4 2 If Consultant's Services include deliverable electronic visual presentation materials, such
materials shall be delivered m a form, and made available to the City, consistent with
City Council adopted policy for the same It shall be the obligation of Consultant to
obtain a copy of such policy from City staff
ARTICLE 5 — PAYMENTS TO CONSULTANT
5 1 Total compensation for Consultant's performance of the Services shall not exceed the
amount of one hundred thirty one thousand seventy two dollars ($131,072) City shall
pay Consultant on a time and materials basis up to the not to exceed amount in
accordance with Exhibit "C" entitled "Fee Schedule" attached hereto and incorporated
herein by reference
5 2 Consultant shall submit monthly invoices to City describing the Services performed
during the preceding month Consultant's invoices shall include a brief description of the
Services performed, the dates the Services were performed, the number of hours spent
and by whom, and a description of reimbursable expenses related to the Services City
shall pay Consultant no later than thirty (30) days after receipt and approval by City of
Consultant's invoice
5 3 Any notice or other communication required, or which may be given, pursuant to this
Agreement, shall be in writing Any such notice shall be deemed delivered (i) on the date
of delivery in person, (n) five (5) days after deposit in first class registered snail, with
return receipt requested, (m) on the actual delivery date if deposited with an overnight
courier, or (iv) on the date sent by facsinnle, if confirmed with a copy sent
contemporaneously by first class, certified, registered 01 express mail, in each case
propeily posted and fully prepaid to the appropriate address set forth below, or such other
address as a Party may provide notice in accordance with this section
City
City Clerk
City of Redlands
35 Cajon Street
P 0 Box 3005 (mailing)
Redlands, CA 92373
Consultant
Kara Kosel
PlaceWorks, Inc
3 MacArthur Place, Suite 1100
Santa Ana, CA 92707
Email lckosel@placeworks com
Telephone (714) 966 - 9220
ARTICLE 6 — INSURANCE AND INDEMNIFICATION
6 1 The following insurance coverage required by this Agreement shall be maintained by
Consultant for the duration of its performance of the Services Consultant shall not
perform any Services unless and until the required insurance listed below is obtained by
Consultant Consultant shall provide City with certificates of insurance and endorsements
evidencing such insurance pnor to commencement of the Services Insurance policies
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shall include a provision prohibiting cancellation or modification of the policy except
upon thirty (30) days pnor written notice to City
A Workers' Compensation and Employer's Liability )Insurance in the amount that meets
statutory requirements with an insurance carrier acceptable to City, of certification to
City that Consultant is self-insured or exempt from the workers' compensation laws
of the State of California Consultant shall execute and provide City with Exhibit "D"
entitled "Workers' Compensation Insurance Certification," which is attached hereto
and incorporated herein by this reference prior to performance of the Services
B Comprehensive General Liability insurance with carriers acceptable to City in the
minnnum amount of One Million Dollars ($1,000,000) per occurrence and Two
Million Dollars ($2,000,000) aggregate, for public liability, property damage and
personal injury is required City shall be named as an additional insured and such
insurance shall be primary and non-contnbuting to any insurance or self-insurance
maintained by City
C Business Auto Liability coverage, with minimum limits of One Million Dollars
($1,000,000) per occurrence, combined single limit bodily injury liability and
property damage liability This coverage shall include all Consultant owned vehicles
used in connection with Consultant's provision of the Services, hired and non -owned
vehicles, and employee non -ownership vehicles City shall be named as an additional
insured and such insurance shall be primly and non-contributing to any insurance or
self-insurance maintained by City
D Consultant is expressly prohibited from assigning or subcontracting any of the
Services without the prior written consent of City In the event of mutual agreement
by the Parties to assign or subcontract a portion of the Services, Consultant shall add
such assignee or subcontractoi as an additional insured to the insurance policies
required hereby and provide City with the insurance endorsements prior to any
Services being performed by the assignee or subcontractor
6 2 Consultant shall defend, indemnify and hold harmless City and its elected officials,
employees and agents from and against any and all claims, losses or liability, including
attorneys' fees, arising from injury or death to persons or damage to property occasioned
by any negligent act or omission by, or the willful misconduct of, Consultant, or its
officers, employees and agents in performing the Services
ARTICLE 7 — CONFLICTS OF INTEREST
7 1 Consultant covenants and represents that it does not have any investment or interest in
any real property that may be the subject of this Agreement or any other source of
income, interest in real property or investment that would be affected in any mariner or
degree by the performance of Consultant's Services Consultant further covenants and
represents that in the performance of its duties hereunder, no person having any such
interest shall perform any Services under this Agreement
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7 2 Consultant agrees it is not a designated employee within the meaning of the Political
Reform Act because Consultant
A Does not make a governmental decision whether to
(i) approve a rate, rule or regulation, or adopt or enforce a City law,
(ii) issue, deny, suspend or revoke any City pennit, license, application,
certification, approval, order or similar authorization or entitlement,
(in) authonze City to enter into, modify or renew a contract,
(iv) grant City approval to a contract that requires City approval and to which
City is a party, or to the specifications for such a contract,
(v) grant City approval to a plan, design, report, study or similar item,
(vi) adopt, or grant City approval of, policies, standards or guidelines for City
or for any subdivision thereof
B Does not serve in a staff capacity with City and in that capacity, participate in
making a governmental decision or otherwise perforin the same or substantially
the same duties for City that would otherwise be performed by an individual
holding a position specified in City's Conflict of Interest Code undei Government
Code section 87302
7 3 In the event City determines that Consultant must disclose its financial interests,
Consultant shall complete and file a Fair Political Practices Commission Form 700,
Statement of Economic Interests, with the City Clerk's office pursuant to the wntten
instructions provided by the City Clerk
ARTICLE 8 — GENERAL CONSIDERATIONS
8 1 In the event any action is commenced to enforce or interpret any of the terms or
conditions of this Agreement the prevailing Party shall, in addition to any costs and other
relief, be entitled to the recovery of its reasonable attorneys' fees, including fees for the
use of in-house counsel by a Party
8 2 Consultant shall not assign any of the Services, except with the pnor wntten approval of
City and in strict compliance with the terms and conditions of this Agreement Any
assignment or attempted assignment without such prior written consent may, in the sole
discretion of City, results in City's immediate termination of this Agreement
8 3 Consultant is for all purposes under this Agreement an independent contractor and shall
perform the Services as an independent contractor Neither City nor its agents shall have
control over the conduct of Consultant or Consultant's employees, except as herein set
forth Consultant shall supply all necessary tools and instrumentalities required to
perform the Services Assigned personnel employed by Consultant are for its account
only, and in no event shall Consultant or personnel retained by it be deemed to have been
employed by City or engaged by City for the account of, or on behalf of City Consultant
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shall have no authority, express or implied, to act on behalf of City in any capacity
whatsoever as an agent, not shall Consultant have any authonty, express or implied, to
bind City to any obligation
8 4 This Agreement may be terminated by City, in its sole discretion, by providing not less
than five (5) days prior written notice to Consultant of City's intent to terminate If this
Agreement is terminated by City, an adjustment to Consultant's compensation shall be
made, but (1) no amount shall be allowed for anticipated profit or unperformed Services,
and (2) any payment due Consultant at the time of termination may be adjusted to the
extent of any additional costs to City occasioned by any default by Consultant Upon
receipt of a termination notice, Consultant shall immediately discontinue its provision of
the Services and, within five (5) days of the date of the termination notice, deliver or
otherwise make available to City, copies (in both hard copy and electronic form, where
applicable) of project related data, design calculations, drawings, specifications, reports,
estimates, sumrnanes and such other information and materials as may have been
accumulated by Consultant in performing the Services Consultant shall be compensated
on a pro -rata basis foi Services completed up to the date of termination
8 5 Consultant shall maintain books, ledgers, invoices, accounts and other records and
documents evidencing costs and expenses related to the Services for a penod of three (3)
years, or foi any longer period required by law, from the date of final payment to
Consultant pursuant to this Agreement Such books shall be available at reasonable times
foi examination by City at the office of Consultant
8 6 This Agreement, including the Exhibits incorporated herein by reference, represents the
entire agreement and understanding between the Parties as to the matters contained
herein, and any prior negotiations, written proposals or verbal agreements relating to such
matters are superseded by this Agreement Except as otherwise provided for herein, any
amendment to this Agreement shall be in writing, approved by City and signed by City
and Consultant
8 7 This Agreement shall be governed by and construed in accordance with the laws of the
State of California
8 8 If one or more of the sentences, clauses, paragraphs or sections contained in this
Agreement is declared invalid, void or unenforceable by a court of competent
jurisdiction, the same shall be deemed severable from the remainder of this Agreement
and shall not affect, impair or invalidate the remaining sentences, clauses, paragraphs or
sections contained herein, unless to do so would depnve a Party of a material benefit of
its bargain under this Agreement
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IN WITNESS WHEREOF, duly authorized representatives of City and Consultant have signed
m confirmation of this Agreement
CITY OF REDLANDS
By
Attest
e Donaldson, City Clerk
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PLACEWORKS, INC
By
wayneears, P cipal
EXHIBIT "A"
SCOPE OF SERVICES
May 24, 2019
Bnan Foote, AICP
Planning Manager/City Planner
City of Redlands
Development Services Dept , Planning Division
35 Cajon Street, Suite 20 1 Mailing P 0 Box 3005
Redlands, CA 92373
PS 1 1 (I 24 19)
P ACEWORKS
Subject Scope and Budget Supplemental EIR on the Proposed Ballot Initiative
Dear Mr Foote
Thank you for the opportunity to continue to be of service to the City of Redlands This scope, budget,
and timeline reflect the work we prepared earhei on the Initial Study/Notice of Preparation and the need
for an efficient completion of tasks We are committed to meeting the schedule and working with the
City of Redlands on this important project
PROJECT UNDERSTANDING
The proposed project would result in a ballot initiative to remove the building permit limitation and
density cap currently placed on the Transit Village Planning Area (TVPA) by Measure U No land use
changes will result from the ballot initiative, and the provisions of the initiative will only be accessible
with the adoption of a specific plan and accompanying environmental analysis
APPROACH
This scope assumes that a supplement (SEIR) to the 2017 Certified City of Redlands General Plan
Update and Climate Action Plan EIR (General Plan EIR) will be prepared, relying on the existing
analysis to the maximum extent practicable The proposed ballot initiative will affect the tuning of future
development but would not change any of the existing land use designations or circulation element
provisions As proposed, the provisions of the ballot initiative cannot be implemented without adoption
of a specific plan and its associated CEQA document The SEIR will rely upon this bright line in its
analysis and will avoid speculating as to the location of later land uses, or charactenstics of
transportation associated with subsequent development
The table below shows our assumptions on the contents of the SEIR Issues with minimal change are
those that might be impacted by the ballot initiative or might need to be refreshed with new information,
but the conclusions would remain unchanged As can be seen, we believe many of the EIR sections will
remain adequate for the project with no substantive changes This table is based on our current
knowledge of the project and would be refined after the details of the project have been finalized
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Environmental Issue Disposition
ENVIRONMENTAL ISSUE
NO CHANGE
MINIMAL CHANGE
Air Quality
X
Biological Resources
X
Cultural Resources
X
Energy
X
Geology and Soils
X
Greenhouse Gas Emissions
X
Hazards and Hazardous Materials
X
Hydrology and Water Quality
X
Land Use and Planning
X
Mineral Resources
X
Noise
X
Population and Housing
X
Public Services
X
Recreation
X
Transportation
X
Tribal Cultural Resources
X
Utilities and Service Systems
X
Wildfire
X
Alternatives
X
Cumulative
X
SCOPE OF WORK
Task 1 Notice of Preparation and Scoping Meeting
The administrative draft of the Notice of Preparation will need to be amended to reflect the Council
action anticipated on June 4th PlaceWorks will make the modifications and submit the NOP to the City
for final review and approval before circulation PlaceWorks will prepare drafts of all requisite filing
font's and submit copies to the State Clearinghouse This scope assumes the City will file the Notice of
Preparation with the County Clerk and will publish the notice in the focal paper, starting the 30 day
public comment penod for the NOP
A public scoping meeting should be held approximately two weeks into the 30 -day public comment
penod to allow public agencies and the public to provide input on the scope of the EIR analysis This is
also the appropriate time to initiate SB -18 and AB -52 tribal consultation PlaceWorks will provide a
PoweiPoint and comment cards in support of the meeting and will attend to explain the CEQA process
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and the scope of the SEIR The format of the meeting is not set by CEQA and can range from an open
house to a standard presentation The format for the scoping meeting will be determined with the City as
part of the kick-off meeting
Task 2 Technical Appendices
Without a physical project to evaluate, the technical analysis will rely on assumptions and compansons
to the analysis in the General Plan EIR The following technical memos will be included as appendices to
the SEIR to support the discussion in the document The memos will include a bnef narrative explaining
the rationale for model assumptions but will not be lengthy technical studies
Transportation
PlaceWorks will rely on the City's transportation consultant EPD Solutions to provide basic trip
generation information within the TVPA related to the ballot initiative This information will be used to
estimate relative changes in traffic within and around the TVPA, which will inform the subsequent air
quality, greenhouse gas, and noise analysis The assumptions used in the analysis will be drafted into a
technical memorandum to accompany the SEIR No additional traffic analysis is proposed as part of this
scope
Air Quality and Greenhouse Gas Emissions Analysis
PlaceWorks will evaluate potential an quality and greenhouse gas (GI -IG) emissions impacts associated
with the proposed project compared to what was previously analyzed in the 2017 Certified City of
Redlands General Plan Update and Climate Action Plan EIR (Certified EIR) The analysis will be based
on the current methodology of the South Coast Air Quality Management Distnct (SCAQMD) for
projects within the South Coast An Basin (SoCAB) Modeling will be conducted using the California
Emissions Estimator Model (Ca1EEMod) and will be included as an appendix to the SEIR Overall, it is
not anticipated that the proposed project would result in greater or new types of air quality impacts that
what was identified in the General Plan EIR
The air quality analysis will include a consistency evaluation of the project's regional emissions to the air
quality management plan prepared by SCAQMD and provide qualitative assessments of potential CO
hotspots and odor impacts In addition, the GbIG emissions impact analysis will evaluate project
consistency with the statewide, regional, and local GIIG emissions reduction strategies and plans such as
the California Air Resources Board 2017 Scoping Plan, the Southern California Association of
Governments' 2016 2040 Regional Transportation Plan/Sustainable Communities Strategy, and the City
of Redlands Action Plan Overall, it is not anticipated that the proposed project would result in greater
impacts regarding these areas than what was identified in the General Plan EIR
Noise and Vibration
PlaceWorks will qualitatively evaluate potential noise and vibration impacts for the construction and
operational phases of the proposed project in relation to the analysis previously prepared for the General
Plan EIR The impact assessment will discuss relevant cnteria for noise exposure based on applicable
federal, state, and local standards The findings of the analyses will be provided in a noise and vibration
section of the EIR
Cultural Analysis
The scope assumes that PlaceWorks can include the results of the SB 18 and AB -52 tribal consultation
process initiated by the City without the need for additional study A summary of all materials received
during the consultation process will be provided as an attachment to the SEIR
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Task 3 Administrative Draft SEIR
Preparation of the SEIR will follow the CEQA Guidelines and the process agreed upon by the City at the
kick-off meeting PlaceWorks will prepare administrative drafts of all environmental documents as
electronic submittals The scope assumes a single set of consolidated electronic comments from the City
Public review drafts of all documents will be provided in both electronic and hard copy as requested in
the final scope of work PlaceWorks will also provide electronic draft versions of all notices and
transmittals for review by the City
PlaceWorks will prepare the document for review in separate chapters with graphics The document will
be concise and formatted like the existing General Plan EIR To the maximum extent practicable, the
analysis will rely upon the General Plan EIR and supplement only when the proposed project would
change the analysis or the conclusion At the end of staff review we will meet with staff to discuss the
comments and outline changes to the document
The Public Draft SEIR will be provided in both electronic format for posting on the website and in hard
copy with appendices on CD or thumb drive The number of copies will be deteriiuned at the kick off
meeting PlaceWorks will deliver the 15 copies of the electronic document to the state clearinghouse
using their e -submittal process and forms
Task 4 Final SEIR, Findings, and Mitigation Monitoring and Reporting Program
The Final EIR will include response to comments, any edits needed to the Draft EIR, and errata if
necessary PlaceWorks will meet with the City to evaluate the comments received on the Draft EIR and
collaborate on responses PlaceWorks will code each comment to allow efficient review of responses If
there are numerous comments on snnilai topics, we may recommend master response(s) to ensure a
thorough and reasoned response The response to comments will also differentiate between
environmental issues and those that do not affect the adequacy of the SEIR This scope and budget
provides an estimate of the time needed to prepare the Final SEIR, we may need to revaluate the scope
and budget if significantly more comments are received
PlaceWorks will prepare Draft Findings for review by the City based on the set of findings used for the
General Plan EIR or in another format approved by the City Attorney PlaceWorks will prepare a
Mitigation Monitoring and Reporting Program (MMRP) based on the MMRP from the General Plan EIR
and resulting from any changes discussed in the SEIR PlaceWorks will provide electronic copies of the
Final SEIR, Findings, and MMRP for use in the staff report PlaceWorks will assist in prepanng the staff
report and PowerPoint presentation for the project and will attend the certification hearing(s) for the EIR
to answer questions PlaceWorks will prepare the Notice of Determination for filing by the City
Deliverables
• Revised Notice of Preparation
• Scoping Meeting Matenals (PPT, Comment Cards) • Technical Memorandums summarizing
assumptions for
— Transportation (Based on EPD Solutions Information)
— Air Quality and GHG
— Noise
— Cultural Resources (from City)
• Administrative Draft Supplemental EIR (SEIR)
• Public Draft SEIR
• Administrative Draft Final SEIR, Findings, and MMRP
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• Public Draft Final SEIR, Findings, and MMRP
• Draft Public Notices including availability, SCH e filing forms, Notice of Determination Meetings
• Presentation matenals for certification heanngs
The scope includes the following meetings While we have scoped and budgeted for in-person meetings,
the City may change any meeting into a conference call Because tuning is of the essence, we will
schedule regular check-in calls to review information, answer questions, and ensure that oui assumptions
are correct
1 Kick Off
2 Scoping Meeting
3 Technical Report
4 Administrative Draft EIR
5 Administrative Final SEIR
6 Planning Commission
7 City Council
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EXHIBIT "B"
PROJECT SCHEDULE
BUDGET AND TIMELINE
PlaceWorks has assigned the necessary staff to meet the anticipated, efficient timeline shown
below Note the bold italic text that represents City review periods To meet the timeline, we will
provide information in electronic format and communicate regularly The timeline is shown in
reverse chronological order
SEIR Timeline
DATE
Tuesday, November 5, 2019
- Friday, October 25, 2019
Tuesday, October 8, 2019
Monday, September 23, 2019
Friday, September 13, 2019
Thursday, September 12, 2019
Tuesday, September 3, 2019
Friday, July 19, 2019
Thursday, July 18, 2019
Friday, July 12, 2019
Thursday, July 11, 2019
Wednesday, July 3, 2019
Tuesday, June 26, 2019
Wednesday, June 12, 2019
Monday, June 10, 2019
Thursday, June 6, 2019
Tuesday, June 4, 2019
MILESTONE
City Council Meeting to Certify SEIR
Agenda to Council
Alternative Commission Date
Planning Commission Meeting
Responses Mailed to Public Agency
Preparation of Responses — Collaborative
End of SEIR Comment Period
Public Review of SEIR Begins
PlaceWorks Prepares Public Review Draft SEIR
End of NOP Comment Period
City Review of SEIR
Admin Draft SEIR
Scoping Meeting for NOP
NOP issued for Public Review
City Review of NOP
PlaceWorks Amended IS/NOP To City
Council proposed Language for Ballot
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EXHIBIT "C"
FEE SCHEDULE
Redlands Supplemental EIR Budget
TASK
TASK 1. Notice of Preparation
Revision of NOP
PLACEWORKS
HOURS
PS 1 1 (1 24 19)
PLACEWORKS
LABOR TOTAL
120
$15,180
Public Scoping Meeting
12
$1,980
Task 1 Subtotal -
Transportation
132
4
$17,160
$780
Cultural
2
$230
Air Quality & GHG
16
$2,795
Noise
9
$1 620
TASK 3. Administrative Draft EIR
Task 2 Subtotal
31
$5,425
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Air Quality
20
$3,780
Biological Resources
0
$0
Cultural Resources
2
$230
Energy
24
$3,280
Geology and Soils
o
$0
Greenhouse Gas Emissions
20
$3,780
Hazards and Hazardous Materials
0
$0
Hydrology and Water Quality
0
$0
Land Use and Planning
40
$4,680
Mineral Resources
0
$0
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TASK`4 Final SEIR.,:
Administrative Final SEIR
180
$27,040
Draft Findings & MMRP
48
$6,080
TASK
PLACEWORKS
HOURS
32
Public Final SEIR, Findings & MMRP
PLACEWORKS
LABOR TOTAL
$3,520
Task 4 Subtotal
260
36,640
Reimbursable Expenses
$7,585
2% of Labor for Office Expenses
$ 2,421
GRAND TOTAL
$131,072.
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Noise
24
$3,280
Population and Housing
6
$910
Public Services
4
$460
Recreation
20
$2,180
Transportation
28
$3 580
Tribal Cultural Resources
12
$1,300
Utilities and Service Systems
20
$2 140
Wildfire
0
$0
Alternatives
0
$0
Cumulative
24
$3080
Review, Oversight & Coordination
112
$20,240
Public Draft SEIR
64
$8,920
Task 3 Subtotal
420
$61,840
TASK`4 Final SEIR.,:
Administrative Final SEIR
180
$27,040
Draft Findings & MMRP
48
$6,080
TASK
PLACEWORKS
HOURS
32
Public Final SEIR, Findings & MMRP
PLACEWORKS
LABOR TOTAL
$3,520
Task 4 Subtotal
260
36,640
Reimbursable Expenses
$7,585
2% of Labor for Office Expenses
$ 2,421
GRAND TOTAL
$131,072.
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PS 1 1 (1 24 19)
ACKNOWLEDGMENT
This proposal shall remain valid for a period of 90 days from the time of submittal As Associate
Principal, I am authorized to bind PlaceWorks and the project team to the contents of this
proposal We look forward to working with you to bang about the successful completion of this
project If you have any questions regarding the contents of this proposal, please feel free to
contact the undersigned at (916) 932-2130 or mteague@placeworks com Respectfully
submitted,
PLACEWORKS
Mark Teague
Associate Principal
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EXHIBIT "D"
WORKERS' COMPENSATION INSURANCE CERTIFICATION
Every employer, except the State, shall secure the payment of compensation in one or more of
the following ways
(a) By being insured against liability to pay compensation by one or more insurers
duly authorized to write compensation insurance in this State
(b) By securing from the Director of Industrial Relations, a certificate of consent to
self -insure, either as an individual employer, or as one employer in a group of
employers, which may be given upon furnishing proof satisfactory to the Director
of Industrial Relations of ability to self -insure and to pay any compensation that
may become due to his or her employees
CHECK ONE
X I am aware of the provisions of Section 3700 of the Labor Code which requires every
employer to be insured against liability for Workers' Compensation or to undertake self-
insurance in accordance with the provisions of that Code, and I will comply with such provisions
before commencing the performance of the work and activities required or pennitted under this
Agreement (Labor Code §1861)
I affirm that at all times, in performing the work and activities required or permitted under
this Agreement, I shall not employ any person in any manner such that I become subject to the
workers' compensation laws of California However, at any time, if I employ any person such
that I become subject to the workers' compensation laws of California, immediately I shall
provide the City with a certificate of consent to self -insure, or a certification of workers'
compensation insurance
I certify under penalty of perjury under the laws of the State of California that the information
and representations made in this certificate are true and correct
PLACEWORKS, INC Date
hal --;77€'?----
By
Dwayne Mears, Principal
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