HomeMy WebLinkAboutContracts & Agreements_236-2018AGREEMENT TO PERFORM PROFESSIONAL SERVICES
PS 1 I (9/1 ifrs)
This agreement for the provision of engineering design and environmental services
( `Agreement") for the East Valley Corridoi Bike Route Interconnect Project is made and entered in
this 18th day of Deceinbei, 2018 ("Effective Date") by and between the City of Redlands, a municipal
corporation ('`City)" and KOA Corporation ("Consultant") City and Consultant are sometimes
individually ieferred to herein as a "Party" and, together, as the "Parties" In consideration of the
mutual promtses contained herein, City and Consultant agree as follows
ARTICLE 1 — ENGAGEMENT OF CONSULTANT
City hereby engages Consultant to provide engineering design and environmental services for
City (the "Services")
12 The Services shall be peiforrned 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 to 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 Paul Toot, Municipal Utilities and Engineering Director, 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 pet formance of the Services
ARTICLE 4 — PERFORMANCE OF SERVICES
4 1 Consultant shall complete the Services by December 31 2022, unless the Services are
terminated eatller as provided foi herein
4 2 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 foi the same It shall be the obligation of Consultant to obtain a copy of
such policy from City staff
L 1caldimlAgreementslkOA Agreement 12 13 1 s doe
1
PS 1 1 (9/11/18)
ARTICLE 5 — PAYMENTS TO CONSULTANT
5 1 Total compensation foi Consultant's performance of the Services shall not exceed the amount
of two hundred seventy eight thousand, nine hundred thirty nine dollars and twenty six cents
($278,939 26) City shall pay Consultant on a time and materials basis up to the not to exceed
amount in accordance with Exhibit "B" entitled `Proposed Fee" attached hereto and
incorporated herein by reference
5 2 Consultant shall submit monthly invoices to City describing the Services performed dun mg the
preceding month Consultant's invoices shall include a brief description of the Services
pei formed, the dates the Services were performed, the numbei 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, of which may be given pursuant to this
Agreement, shall be in writing Any such notice shall be deemed delivered (i) on the date of
deliveiy in person, (ii) five (5) days after deposit in first class registered mail, with return
receipt requested, (iii) on the actual delivery date if deposited with an overnight coot iei, or (iv)
on the date sent by facsimile, if confirmed with a copy sent contemporaneously by first class
certified, registered of express mail, in each case properly posted and fully prepaid to the
appropi late address set forth below, or such other address as a Party may provide notice in
accordance with this section
City
City Cleik
City of Redlands
35 Cajon Street
P 0 Box 3005 (mailing)
Redlands, CA 92373
Consultant
Ming Guan
KOA, Corporation
3190 C Shelby Street
Ontai io, CA 9 1764
mwuan,c koacorp corn,
909 890 9693
ARTICLE 6 — INSURANCE AND INDEMNIFICATION
6 1 The following insurance coverage required by this Agreement shall be maintained by
Consultant foi 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 prioi to commencement of the Services Insurance policies shall include a provision
prohibiting cancellation of modification of the policy except upon thirty (30) days prioi written
notice to City
A WorkersCompensation and Employei s Liability insurance in the amount that meets
statutory requirements with an insurance carnet acceptable to City or certification to City
that Consultant is self -insured of exempt from the workers' compensation laws of the State
of California Consultant shall execute and provide City with Exhibit `C' entitled
'Workers' Compensation Insurance Certification," which is attached hereto and
incorporated herein by this reference prioi to performance of the Services
I \ea\djm\Agreements\KOA Agreement 12 13 18 doe.
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PS 1 1 (9111118)
B Comprehensive General Liability insurance with carriers acceptable to City in the
minimum amount of One Million Dollars ($1,000.000) pet occurrence and Two Million
Dollars ($2,000,000) aggregate fot 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-conti ibuting to any insurance of self-insurance maintained by City
C Business Auto Liability coverage, with minimum limits of One Million Dollars
($1,000,000) pei 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 01 self-insurance
maintained by City
6 2 Consultant shall defend, indemnity and hold harmless City and its elected officials, employees
and agents from and against any and all claims, losses or liability, including attorneys' fees,
al ising from injury 01 death to persons oi damage to property occasioned by any negligent act
or omission by, of 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 of interest in any real
property that may be the subject of this Agreement o1 any othei source of income, interest in
real property of investment that would be affected in any manner o1 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 undei
this Agreement
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,
(it) issue, deny, suspend o1 revoke any City permit, license, application,
certification, approval, order or similai authorization o1 entitlement,
(iti) authorize City to enter into, modify o1 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 oi similai item,
(vi) adopt, 01 grant City approval of, policies standaids o1 guidelines foi City o1 For
any subdivision thereat
B Does not serve in a staff capacity with City and in that capacity, participate in making a
governmental decision o1 otherwise perform the same of 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
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I S 1 1 (9111/18)
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 I In the event any action is commenced to enforce of interpret any of the terms of 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 sti ict compliance with the terms and conditions of this Agreement Any assignment or
attempted assignment without such prior wi ttten consent may, in the sole discretion of City,
results in City's immediate termination of this Agreement
8 3 Consultant is foi all purposes undei this Agreement an independent contractoi and shall
peifoim the Services as an independent contractoi Neithei City noi its agents shall have
control ovei the conduct of Consultant of 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 foi 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 foi the account of, or on behalf of City Consultant shall have no authority,
express o1 implied, to act on behalf of City in any capacity whatsoevei as an agent, noi shall
Consultant have any authoi ity, express of 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 wiitten 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 (I) no
amount shall be allowed fot anticipated profit of 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 othei
infoimation and materials as may have been accumulated by Consultant in petfoiming the
Services Consultant shall be compensated on a pro-rata basis fot Services completed up to the
date of termination
8 5 Consultant shall maintain books, ledgers, invoices accounts and othei records and documents
evidencing costs and expenses related to the Services for a period of three (3) years, of for any
longei 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
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PS 1 1 (9/11/18)
8 6 Fhis Agreement, fncludtng 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 of verbal agreements relating to such matters are
superseded by this Agreement Except as otherwise provided foi 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
Calitornia
8 8 if one of more of the sentences clauses paragraphs or sections contained in this Agreement is
declared invalid, void or unenforceable by a court of competent jui tsdiction, the same shall be
deemed severable from the remaindet of this Agreement and shall not affect, impair of
invalidate the remaining sentences, clauses, paragraphs of sections contained herein, unless to
do so would deprive a Party of a material benefit of its bargain under this Agreement
IN WITNESS WHEREOF, duly authorized representatives of City and Consultant have signed in
confirmation of this Agreement
CITY OF REDLANDS
ByC
Paul W Fostei Mayo'
Attest
eDonaldson, City Cleik
1 \ca\dim\Agreemuns\KOA Agreement 12 13 18 doe,
KOA Corporation
13y
Ming Guan
J
EXHIBIT "A"
SCOPE OF SERVICES
PS 1 1 (9/11/18)
Task 1 - Project Management and Administration
The Consultant team will meet with the City to establish the design parameters for this project Under
the project management task, Consultant will be responsible for maintaining contact with the City's
Project Manages to keep him/hei informed of the developments on the project It is anticipated that
monthly PDT meetings will be held until the final completion of the project Consultant will also meet
with the City and identify all applicable agencies with authority over any particular aspects of the
project We will develop a list and contact information Consultant will coordinate with each agency
and determine permits or project specifications that are required Consultant will serve as the main
coordinator and liaison between the City and agencies Consultant will include Project Invoicing in
accordance with funding program requirements specified in the ATP Grant Applications Invoice will
be submitted with charges segregated by work performed within City of San Bernardino, County of
San Bernal dino and City of Redlands of each month
The following specific subtasks will be performed
I) Management of project team including sub -consultant
2) Attend Project Start-up Meeting, Development and Agreement on Design Standards which
may be per AASHTO Greenbook when on National Highway System (NHS) or locally
adopted standards when off NHS
3) Conduct PDT Meetings including Prepai ing Agenda and Meeting Minutes
4) Submitting of Monthly Progress Reports and Invoices including Updating Schedules
5) Provide a presentation to City Council and additional committees as requested by City staff
6) Coordinate design and construction schedule with Robertsons Ready Mix, CUP No 964,
located just south of the City boundaiy on Alabama Street
Deliverables Meeting agendas, attendance rosters, minutes / Detailed project schedule / Monthly
project reports / QAP
Task 2 - Utility Reseal ch and Coordination
Consultant will provide preliminary notification/request letter and relocation/removal notices to all
utility companies that have facilities within the limits of the project The City shall provide Consultant
with the required format foi the utility notice in Microsoft Word format
I) Contact and Obtain Utility Information
2) Prepare notices and follow up requests with plans to utility companies
Deliverables Utility Log, Spreadsheet log of notices sent to utility companies and responses received
Task 3 - Data Review, Field Surveying and Base Mapping
Project Controls will be established foi aei ial mapping Field surveys will be conducted foi mapping
elevations against National Mapping Accuracy Standards This work will include sending field crews
to the project area and surveying topographic information to develop one -foot contour base maps of
the project area AutoCAD plans will be prepared foi the purpose of engineering design Survey will
include street centei line and light of way information, and survey monuments Survey shall be tied
L ILa\djm\Agreements\KOA Agreement 12 13 18 doc.
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PS 1 1 (9/1I/RS)
into state plane coordinate system and City benchmarks The coverage for the aerial mapping will
include the Class II and IV bike lanes and the proposed Class I bike route along Alabama Street 40-
scale planiinetric aerial mapping with I -foot contours will be obtained Supplemental topographic
field surveys will be performed to collect cross sectional information every 50' along Alabama Street
from Santa Ana Rivet trail to the Robertson's Ready Mix Specific tasks will Include
I) Obtain and Review Existing Documents and Reports
2) Conduct Field Surveys for Control and Mapping
3) Preparation of Base Map
4) Perform pre -construction survey monument preservation within flood control corridoi with
required cornet records submitted to the County of San Bernardino
Deliverables Report of potential conflicts / Electronic copy of all field surveys in AutoCAD, latest
format
Task 4 -- Conceptual Alignment ancl Estimate
Immediately upon receipt of the Survey, Consultant will develop a preliminary concept alignment. and
hold a workshop with all applicable agencies to review and modify as needed The preliminary
alignment will be developed based on a full field review, review of right of way limits, and
consultation with stakeholders
l) Prepare Conceptual Alignment Plan and Cost Estimates
2) Conduct Design Review Field Meetings
3) Conceptual alignment plan workshop
Deliverables Conceptual Alignment and Cost Estimates
Task 5 - Right -of -Way Engineering (Optional)
It is important that exact property lines on the parcel are indicated on the base reap Once the design
footprint has been finalized, Consultant will identify the needs for new rights -of -way, permanent
easements, temporary construction easements, and rights -of -entry The Consultant team will prepare
right-of-way maps showing existing tights -of -way and easements, areas requiring acquisition,
assessor s parcel number, zoning, owner's name, addresses, and type of business, street centerlines,
property lines, building footpi ints, setback distances from right-of-way to building, existing and
proposed improvements within the taking areas, including potential acquisition and easements
required fat maintenance access, utilities, and construction work area, as necessary
Consultant will provide the following right-of-way services should they be required Consultant will
coordinate and/ot negotiate to obtain i ights-of way or easements for properties as necessary and
identify Right -of -Way Requirements
I) Obtain Right of Entry
2) Prepare Legal Document
3) Prepare R/W Data Sheet Report
4) Appraisal and Negotiation Services
Deliverable If applicable, Rtght of Way Impact Map, Legal and Plats / Appraisal report / Prepare
Acquisition Offer Packages / Owner -Executed Acquisition Documents
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PS 1 1 (9/11/1S)
Task 6 - Geotechnical Design Report
Geotechnical field investigation will consist of drilling exploratory borings to obtain material samples
pavement design The results of field exploration and geotechnical laboratory tests will be evaluated
and engineeiing analyses will be performed rn order to provide geotechnical recommendations fot the
design and construction of the proposed project A professional report will be prepared to summarize
the data collected and present ow findings, conclusions, and geotechnical recommendations foi design
and construction of the proposed project Specific tasks will include
1) Perform Laboratory Testing
2) Design pavement structural thickness
3) Prepare pavement evaluation / over lay thickness recommendations report
Deliverable Geotechnical Design Report
Task 7 - Envii onrnental Document
The CEQA Lead Agency will be the City of Redlands The following specific subtasks will be
performed as identified in the Preliminary Environmental Analysis Report
1) Initial Study pursuant to CEQA
2) CEQA documents as required to comply with law
3) Coordination with Wash Plan and SBVWCD
*If additional Technical Studies are requested by Caltrans, supplemental request will be requested
Deliverable Environmental Documents and Technical Reports
Task 8 - Prepare Interim and Final Plans, Specifications and Estimate
Consultant will prepare and assemble a set of plans, specifications and estimate foi this project in a bid
package format foi City review, in accordance with the City of San Bernardino, County of San
Bernardino, and City of Redlands Standards These plans will be prepared in 60%, 90%, and 100%
The plan will be assembled after individual tasks are completed as defined in the tasks above Other
plans not noted in the tasks will be completed under this task These plans include, Vicinity Map civil
design plans, traffic signal plans and signing and striping plans
All approved plans will be provided to the City on compact disk in AutoCAD, as well as on "D ' size
Mylat Specifications documents, including technical specifications, will be provided on digital
medium disks in Microsoft Word format and as a combined PDF document in preparation to advertise
foi construction The Engineers Estimate will be provided in Excel format Specific sub -tasks include
1) Specifications and Special Provisions and Engineers Estimate
2) 2" d Review 60% Submittal
3) 3rd Review 90% Submittal
4) Final 100% Submittal
Deliverables
Three (3) full-size copies of plan submittals at 60%, 90% completion milestones
One full-size signed Mylat of approved 100% plan set
Cost estimates and Project Specification at 60%, 90% and 100% completion milestones
L 1ca\djmlAgrecments1kO 1 Agreement 12 13 18 doe
PS 1 1 (9/11/18)
One CD containing final signed plans (PDF and Autocad format), specifications, and estimate
Task 9 - Engineei ing Support during Bidding, Award & Construction Phase
KOA will assist the City of Redlands in advertising for bids, and providing plans and specifications
Tasks may include answering questions from prospective bidders, providing responses to requests for
information (RFI's), preparing addenda to the PS&E during the advertisement period, and providing
consultation and interpretation of construction documents KOA will attend the project pre -
construction meeting During construction, we will be available to answei requests for information,
requests for elaiification, and address interpretation needing comment All responses to requests for
information addenda, interpretations and any other communication shall be delivered only to City
staff foi disti ibution We will be available to review and comment on project submittals KOA will
woik closely with the City's appointed construction inspector Subtasks will be as follows
1) Bidding Services
2) Preconstruction meeting
3) Review Inquiries, submittals and change orders during construction
4) Prepare As Built Drawings
Deliverables RFI Responses / As Built Drawing
L 1caldj ntA(zrec mcntsliN.OA Agreement 12 13 18 doc
9
Proposal Fee
ENGINEERING AND DESIGN SERVICES
EAST VALLEY CORRIDOR BIKE ROUTE INTERCONNECT PROJECT
CITY PROJECT NO 47029
TASKS
'
Principal
In Charge
$219
Project
Clanger
3142
Senior
Engineer
$219
Senor
Engineer
$182
Senior
Eng'araer
$144
Design
Ergilwe
3B6
Design
Engi .or
398
Admin
Assist
392
Environmental
ECORP
ISA
EnSafa
Right al Wry
Epic Land
Surveying
WerstLand
Group
Gsolech
Tsiring
TOTAL
COST
esk1 Project Management end Mosnrslrallon
leak
I) Meragcmrl of protect teem auiuCmg yi.L.rbrsyryanl
2
1.
4
4
4
34.301 41
.)Attend Proed Swap Meeks; DeMopmmt and A7eemcnt on Orson Slandads
4
2
a
4
.
$10 26
3) Conduct POT kleenas Incucrp Kneen A;alde and F4eetrp Matures
4
-4
24
36,588 C•
4) Submt'alg d Mowry Prepress Reports and I nvoces ardudnd Upcatng Schedules
4
40
4
4
4
20
4
40
S14 247 79
5) Provides presereataan to Qrryy Court end committees os req,w.sled by Cry sa'I
3
a
St.90135
b) Coa9rme design and rms9r1i9n S0leodemin R00essons Reedy Aix
4
8
$1,335 24
Subtotal
10
92
8
10
12
64
6
40
50
30
30
10
30
331,03877
2 4114i1y Research and Coordination
T»N
1) Contact and Otttm USIdy krloma6ar
4
20
$2484 47
21 Prepare nukes end follow yo rousts with darts to u01M amp8nes
8
20
$3.053 5:
uhtota
12
40
S0
30
3O
$0
30
S5,537.95
3-0eta Review, Field Surveying and Lase Mapping
n) Oman end Renee, Eustaq Occunonts and Repsls
4
e
33532
35.86724
2; Conduct Field Sums kr Coro and 3dnpir1
4
A
536.71
S33,10624
3i Preparetm of base M p
4
20
2C
57 101
$11503 71
Subtotal
12
38
20
50
30
30
552407
30
339.477.19
Task./ Conceptual Akgrao.nt and Eo8mata
1; Prepare Conceptual Mearna0 Ran any Cost Esametes
40
8
8
6
80
80
S544610
2; Conduct Desgn Raven Field Mee;ngs
6
e
$1y04.11
3, Conceptual elmmanl den 4M(shop
4
4
S152 18
Suboal;.
_.
52
B
8
• a
92
BO
36
S0
So
S6
S
Task 5. Rghlol-Way Engiawnrq (Optional)
1) Men Right ofrlr5y
4
4
518.300
S19,216
59000
$9952.16
3h Prepay RAN [oL191044 Report
2
2
9
8
S2B.'17
S31,221 CO
4) Apprws9 693 N89469tdn Se 4ces (6 farces',
0
B
531.700
533601
Subaoal
18
2
24
a
50
SO
379,117
39,000
$0
394,02380
Task 6 Geotachnlcal Net n Rayon
1) PMenn Laboratory Testnl
2
63.560
53.764 5E
2; Design pavement structural 3atlmess
2
4
4
66.(00
57.0.906E
3; Prepare parercrtmt evteua9a+ l crcAat Slickness remmmeMa' ens reoa^,
2
8
9
55374
3' 190 58
Subtotal
6
12
12
So
SO
SO
30
iT4,97A
$I9.8 0.74
Task 7 Ertleonrnareai Docranert
11 Frelimerv&ear mark& Analysis Recce' !REAM'
2
8
16
S20.737
$11.312
335,15749
210ECACalegurcal Exrrrpton
2
4
8
52.261
54,13402
3)Coma-miensit Wert hen and 551,ANCD
2
16
16
512775
517.02149
00449751
6
28
40
235873
$11,312
30
30
30
$56,31299
Task B Prepare Intern and Final Rant Speenicalbm and Estimate
7) Spay+c0200s and Special Prwisals and Engrloas Es3m4'e
•Z,
4
20
40
$7.351 75
2nd Rytia,4 6036 &emu
8
40
123
120
530.45 66
3) 3rd Ren. 90.4 aorndal
a
20
80
a2
57391910
LF,nal 100%344n:114
4
12
40
23
38,124 61
Subtotal
21
92
280
220
30
30
30
SO
30
$86,225.33
Task a Ealkwenng Support MAIN Bidding, Award 6, Corelruclion Phau
1)043vSereCes
2
4
4
$1.8i1721 74
21Preconstucten mee:no
4
4
4
CMe 3!Rv hearts. wbrmnxs and chasm yealmro s drg cs3ctm
u33.49679
'
4
4
20
$3.496
4)Pre9xe As MI Den.vngs
4
2
10
16
$3,920 &-
311.01844
Subtotal
8
16
6
48
18
SO
SO
30
30
30
Reimbursable*
I) Rt-J5 �. Penang and Myra
52,000.00
2) 60leage
$1,000.00
TOTAL HOURS
48
328
16
18
28
636
362
40
TOTAL COST
S10,507
S46,668
$3,502
53,418
S4,022
S60,906
S34,667
53,666
S35,873
S11,312
579 117
S61407
S14,874
$372,969.06
pm KOA sin;: CO�RPuORATION
,.
Without Optional Right of Way Englneenng Task $278,939.26
PS 1 I (9/11/€S)
EXHIBIT "C"
WORKERS' COMPENSATION INSURANCE CERTIFICATION
Every employe', 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 oI more insurers duly
authorized to write compensation Insurance in this State
(b) By securing from the Directoi of Indust! tat Relations, a certificate of consent to self -
Insure, either as an individual employer, of as one employer in a group of employers,
which may be given upon furnishing proof satisfactory to the Directoi of Industrial
Relations of ability to self -insure and to pay any compensation that may become due to
his of 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 foi 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 of permitted under this Agreement (Labor Code
§1861)
I affirm that at all times, in performing the woik and activities required or permitted undei 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, of a certification of workers' compensation insurance
I certify under penalty of perjury undei the laws of the State of Calitornia that the mforrnation and
representations made in this certificate are true and correct
KOA Corporation Date 12/20/18
By..
Ming Guan
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