HomeMy WebLinkAboutContracts & Agreements_126-2019Ps 1 1 (1 24 19)
AGREEMENT TO PERFORM PROFESSIONAL SERVICES
This agreement for the provision of professional engineering services to complete
pavement condition evaluation and pavement management system upgrades ("Agreement") is
made and entered in this 2nd day of July, 2019 ("Effective Date"), by and between the City of
Redlands, a municipal corporation ("City") and Bucknam Infrastructure Group, 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
1.1
ARTICLE 1— ENGAGEMENT OF CONSULTANT
City hereby engages Consultant to provide professional engineering services to complete
pavement condition evaluation and pavement management system upgrades services 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 performing the Services
3 2 City designates Savat Khamphou, City's Municipal Utilities and Engineering Department
Engineering Manages, 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 "B," entitled "Project Schedule," which
is attached hereto and incorporated herein by reference
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4 2 The term of this Agreement shall commence on its Effective Date and shall terminate on
November 30, 2019, unless terminated earlier as provided herein
4 3 If Consultant's Services include deliverable electronic visual presentation materials, such
materials shall be delivered in 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 sixty five thousand eight hundred twenty one dollars ($65,821) City shall pay
Consultant on a time and materials based upon the hourly rates set forth in Exhibit "C"
entitled "Cost Proposal" 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, (ii) five (5) days after deposit in first class registered mail, with return
receipt requested, (in) on the actual delivery date if deposited with an overnight courier, or
(iv) on the date sent by facsimile, if confirmed with a copy sent contemporaneously by first
class, certified, registered or express mail, in each case properly 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
Peter Bucknam, President
Bucknam Infrastructure Group, Inc
3548 Seagate Way, Ste 230
Oceanside, CA 92056
Email peter@bucknam-inc com
Phone (760) 216-6529
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 prior to commencement of the Services Insurance policies shall include a
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provision prohibiting cancellation or modification of the policy except upon thirty (30)
days prior 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, or 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
minimum 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-contributing 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 primary and non-contributing to any insurance or self-
insurance
elfinsurance 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 subcontractor 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 manner 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 permit, license, application,
certification, approval, order or similar authorization or entitlement,
(iii) authorize 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 perform 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 under 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 written 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 prior written 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 shall have no
authority, express or implied, to act on behalf of City in any capacity whatsoever as an
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agent, nor shall Consultant have any authority, 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,
summaries 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
for 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 period of three (3)
years, or for 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 for
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 deprive 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
in confirmation of this Agreement
CITY OF REDLANDS BUCKNAM INFRASTRUCTURE
GROUP, INC
By \r
Paul W Foster, Mayor Peter '. ucknam, President
Attest
•/4
e Donaldson, City Clerk
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EXHIBIT "A"
SCOPE OF SERVICES
The scope of work includes pavement inspection, assessment, and rating, evaluation, selection,
and set-up of the pavement management database software platform, preparation and presentation
of a pavement management program report, development of street maintenance and street
improvement program strategy, and one year of as -needed support services to maintain and update
the pavement management program database
TASK 1 Project Implementation, Management & Administration
Task 1 1 Project Kickoff
The first step in implementing a successful pavement management system (PMS) truly resides
in frequent communication and timely scheduled data updates It will be essential to assist the
City in the continued, proactive management and application of PMS to maintain and protect
the street improvements that have been applied over the past several years To achieve this,
Consultant will assist the City by delivering on the following project tasks
• Cost effective Arterial, Collector, Local pavement inspections,
• Proactive Arterial, Local and Alley rehabilitation programs (PARIS enhancement),
• Common-sense, maintenance zone based Slurry Seal Program, and
• Annual, proactive stewardship of the PMS that will ensure its continued success
Project Kickoff meeting will set to further discuss and review in detail the expectations/goals
of the project, technical approach, PMS data assessment, CycloMedia imagery assessment,
zone maintenance, County compliance, current pavement applications/budgets, review of the
scope of work, budget and schedule This effort will continue to build upon the consensus
between the Municipal Utilities and Engineering Department as well as build stronger
ARTERIAL and LOCAL maintenance programs/schedules
Task 1 2 Project Status Meetings - Quality Control Program
Status Meetings and Progress Reports
1) Minimum of three meetings during the project
(Kickoff 60% and 100% completion meeting),
2) Field review meetings (if necessary),
3) Monthly progress status reports will be delivered to City project manager.
Quality Control (QC)
Consultant will use a statistical sampling approach for measuring the quality of field
technician's work In this manner, 10 percent of the original surveys will be re -surveyed by
an independent survey crew (30 of the 300 miles), supervised by a lead supervisor, and the
results will be compared to the original surveys QC process involves checking the field crews'
work in a "blind study" fashion Quality control checks will be performed at the end of each
survey week This will ensure that all field personnel are properly collecting distresses and
pavement quantities for all street segments
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PCI variance reporting will be performed where previous PCI data will be compared to 2019
data, if PCI's vary more than three (3) points per year Consultant will assess the potential
cause through unrecorded work history, accelerated pavement deterioration, etc. Consultant
will record/log any discrepancies between the previous and 2019 PMS databases (any
corrections/changes to the database shall not be made without prior City approval)
Since Consultant are collecting distress information on field Tablets, Consultant will perform
several quality control tests within the pavement management software using a sample set of
the City of Redland's street distress data This will ensure that all system and analysis settings
as well as City recommendations and standards are being appropriately followed, reviewed
for completeness/accuracy and data clarity
Consultant Surveys follow the accepted ASTM D6433-16 procedure requirements A copy
of the QA/QC plan utilized by Consultant during the project will be submitted along with the
PMS certification documents
TASK 2 Client Satisfaction
Task 2.1. Project Deliverables
Shown throughout Scope of Work, each Task is summarized with project deliverables Client
satisfaction will derive from frequent communication with the Project Manager and key staff
members from the Public Works / Maintenance department Project success is created by
delivering on three main factors,
1) Adherence to scope tasks and deliverables,
2) Performing to the standard set by the Project Schedule, and
3) Controlling costs
TASK 3 Project Schedule
Task 3.1 Work Flow / Committed Project Schedule
Project schedule shows each major task identified in scope of work, as well as quality control
milestones and meetings Consultant has ample staff to apply to this project in order to meet
an aggressive schedule (two/three field technicians will drive the proactive schedule) Critical
Path Method (CPM) project schedule shows each major task identified in the scope of work,
as well as quality control milestones and meetings
TASK 4 Scope of Services
Task 4 1 MicroPAVER Implementation / Update Work History
• Work history updates
• Pavement segmentation assessment / validation
• Upgrade/purchase of MicroPAVER
Task 4 2 Pavement Condition Surveys
Arterial, Collector and Local Street Survey
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First and foremost, the assessment of the City's pavement segmentation is the one of the key
priorities for this project With several years between major City inspections it will be essential
to verify that all Local / Arterial segmentation is up-to-date and that section SF quantities are
accurate and reliable Once the pavement segmentation has been assessed and verified, the
necessary inspections will be performed Survey methodology will include the following
approach based on ASTM D6433-16 and the City's cost/benefit analysis.
1 2019 PMS Survey -Walking - All sections are surveyed through walking
methodologies Distress types will be collected based upon actual surface conditions
and physical characteristics of the segment Surveying methods will be conducted by
remaining consistent with ASTM D6433-16 & the Army Corp of Engineers sampling
guidelines while being flexible to current City requirements
All sample locations are observed through walking surveys, additional street factors such as
unique distress areas found outside sample areas will be recorded According to the City's
RFP the following pavement sections are to be surveyed for the upcoming 2019 PMS update
• The inspection of approximately 110 miles of Arterial/Collector and 190 miles of
Local segments will be performed,
• Recent slurry seal and overlay maintenance will reduce total mileage of survey —
TBD, and no private streets will be surveyed under this effort
For all surveys, the use of PMS -Tablet units allows staff to collect pavement data with the
City of Redlands' MicroPAVER database in the field At the end of the day all electronic data
is accessible at office for quality control and management
Roadway Verification Survey - A listing of the field attribute data that is updated/verified
during the survey for the pavement management database is listed below
2 Field Attribute Data (updated and/or verified)
• From/to, indicating the assigned limits of the section, sample test areas, street
name,
• Street ranking indicating local, alley, arterial, collector, # of lanes, surface type
• Historical PCI tracking from previous inspections and 2019 PCI inspections
• Segment quantities, indicating the length, width, and total true area of the
section
3 Conditional data will be evaluated for all street segments and will include
• ASTM 20 AC & 19 PCC distresses by type, severity and sample area
• PCI ratings (0-100), taking into account the surface condition, level of
distress
Upon 60% and 100% completion of the required condition surveys, Consultant will prepare
draft PCI Reports and PCI GIS maps that document the conditions of all pavement segments
Consultant will produce a "PCI Variance Report" that will demonstrate PCI variances
comparing previous PCI's vs. 2019 PCI's This report will allow staff to identify large
variances caused by inspection issues, work history impacts and other field survey factors
Deliverable Citywide PCI reports, compliant County PCI reports, updated PMS database
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Task 4.3. Budgetary Analysis / Pavement Improvement Report
Consultant will assist the City in developing the most cost-effective preventative maintenance,
repair and rehabilitation (M & R) strategies possible Consultant will meet with the City to
discuss and strategize maintenance activities that are currently being used by the City
(PARIS) They will conduct an historical and prospective analysis on the conditional and
financial impact these practices have on the pavement network Based on fiscal and
deterioration analysis, Consultant will present the results and recommendations to City
Consultant will review the Redlands database deterioration curves that have been developed
based on historical pavement condition inspections, surface type, work histories and road
classification The curves will be updated based on 2019 pavement conditions. Maintenance
strategies that are typically reviewed are rehabilitation and reconstruction (R&R), grinding,
slurry seals, overlays, AC on PCC stop gap, the expected improvement in pavement condition,
the life -cycle extension that would result and the unit costs for maintenance
All maintenance practices/unit costs will be integrated into software and will be derived from
the most recent construction bids for pavement rehabilitation Consultant will account for
inflation rates when long-term revenues projections are made Consultant will also review
and recommend an update to the existing Area/Zone Local cycle, this will allow them to
proactively schedule localized maintenance efforts throughout the CIP
Consultant's Project Manager and Principal will work closely with City in defining repair and
rehabilitation strategies during each fiscal yeas (i e 2019-2024) Once the repair/rehabilitation
strategies have been defined, the identification of a five year Forecasted Maintenance schedule
will be generated The recommended budget scenarios will be identified on the basis of several
criteria.
The primary emphasis of this task is to maximize the scheduling of street maintenance using
the most cost-effective strategies available and taking into account a life -cycle cost analysis
Task 4.4. Final CIP Report/Compliance Reports
Consultant will deliver the Final Report to the City which will be essential for staff reference
and use as well as beneficial for elected officials/upper management This report will
complement and enhance the City's PARIS program by providing
• Current inventory and pavement conditions indices (PCI) for all road classes,
• Projected annual rehabilitation programs for street maintenance for a 5 -yr period that
show the largest return on investment and acceptable levels of service,
• Modeling and comparison of multiple budget scenarios that will include
• Gradual, Frontloaded, Constrained and Unlimited funding analysis
• Strategies and recommendations for the City's maintenance programs and procedures,
including a preventative maintenance schedule, and
• A detailed breakdown of deferred maintenance (backlog)
Consultant will attend/presentation of the results from the 2019 PMS update to City personal
and/or City Council if necessary
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Deliverable Three (3) bound copies of the Final Pavement PMS Report, one (1) DVD copy
that includes all final reporting documents, PMS database and GIS files
Task 4 5 Mapping and GIS
As an enhancement and proactive approach to this project, Consultant will update the existing
Pavement -GIS link between MicroPAVER and the City's GIS system Consultant will review,
with City, all ongoing upcoming capital projects that may impact the GIS mapping delivered
for this project The maps described below will be incorporated into the City's Final PMS
report
• PCI values for every section,
• Work History identifications,
• 5 -yr Arterial / Local Rehabilitation and Slurry Seal Programs,
• Maps demonstrating Fix All, Do Nothing, Steady State and Optimal budgets, and
• Functional classification maps
Once the City has approved the block -to -block pavement segmentation, Consultant will
update the necessary MicroPAVER-GIS Iinkages By using the unique ID's within the PMS
and the City's street shapefile ID's, Consultant will create a one-to-one match for each
pavement section in the GIS Consultant will coordinate all project deliveries with the
Municipal Utilities and Engineering, GIS division and CycloMedia staff to ensure that the
most current and accurate PMS -GIS maps are represented within the City's GIS Enterprise
Task 4 6• As -Needed PMS Support Services
Pavement Management System Support
With the City implementing a biennial PMS management schedule, Consultant will provide
annual PMS support that will cover data previously submitted by Consultant If additional
services outside the identified scope of work above are requested, Consultant will provide
timely and proactive services to the City As -Needed services typically include
• Additional budget scenarios, general reporting, deterioration studies,
• Additional visual inspections above the mileage amount indicated in Task 4 3,
• Additional pavement management - GIS mapping,
• Additional MicroPAVER training, operation use;
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EXHIBIT "B"
PROJECT SCHEDULE
lank riam: 1 -Aug
&Aug 15 -Fug
22-A4 29 -Aug
-Sep 12 -Sep
19 -Sep 26 -Sep
3-0c1 10-(kI 1l -Ott 24Ott 31 -Ott 1-1iot
SASE SCOPE OF WORK
t
1) Project Implementation
-I
Task 11 Project kickort X
Assess PMP data / Establish Survey
Task 1.1 _Project Status Meetings Quality Girard
PrajettStatus Meetings
X
X
:
ClientSanstat4on
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Task42 Pavement fondnaaSurvey il••
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X
1008 I
Survey Project Status Meting
X
Quality Control [becks
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Draft PCIReporting
Task 43 Budget dialysis / Pavement Itrgiotelnent Report--
City Rea tor of Oraft Final Report•
—_
CIP Project Status Meeting
X
Delivery oiFinal OP Report
Task 4A Final CIP Report/ Compliance Report
Task 45 Mappagawl GIS —_
Task 4.6 AsWeeded PRN Soppon knives
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EXHIBIT "C"
COST PROPOSAL
Drur.ption Principal Protect GIS Analyst Field Admin Total by Task
Manager Techmcianlsj
'Base Fee 1 $295/hr $185/hr1 $145/hr $91/hr1 $60/hr
Tasks 'Project Implementation i _
Task1,1 iPro&ectKickoff 1 2 2€ ? S66°
Task 1.2 ° Project Status Meetings_ Qua Iity.Control : 1{3_j_ 31 32 514,197
Task2 'client Satisfaction f •I•
i_
Task 2-1 1Pr ject0eliverables I - 4 41 2r 1 X1582
Task 3 ' Project Schedule
Task 3.1 'Work Flow Pro'ectSchedule ; 1i 31 11 ` 995
Task 4 'Scope of Work
1
1 -?- -1. -
Task 4 ~ -
1
MicroPAVER Im mentation / Update Work Histayµ l 4 11- 241 $2,705
r Work History Updates I ' 1 -1-
1 Pavement5g_mentatian AssessmentLValidation i __ .
_ Upgrade of MicroPAVER 157200
Task 4.2_jPavement Condition Survey (300 miles) Si 41 370; $35,730
Task 4.3 1Budletary Anallsisf Pavement Improvement R rt ?— 81 21 4 $2,134
Task 4,4 1Fina I CIF./ Compliance Reports _ 21 32! 41 21 l $7,352
Task 4.5_Mapping&GIS i ! 41 161 161 $4,516
Task 4.6 LAs Needed PMS SuupportServices 1 81 S $2,208
Reimbursables Imileapel,prirKing, materials ; _ _ 1 - $2,542
Ali deliverables will become roP_.e ythe Ci of Redlands 1 [ j 1
P
,!Total Hours per staff _41 761 371 454 2!_..
;Tota] Bas! Fee $ 1,1201$ 14,06o,$ 5,965 1 $ 41,314 ` $ 160 I $65,821
The above -referenced hours for the identified tasks are estimates only Consultant will conduct the
above scope on an hourly time and materials basis, and will be compensated up to the not to exceed
amount of sixty five thousand eight hundred twenty one dollars ($65,821)
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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
foliowmg 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
v# 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 permitted 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
BUCKNAM INFRASTRUCTURE GROUP, INC
By
Pet- Bucknam, President
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