HomeMy WebLinkAboutContracts & Agreements_41A-2022AGREEMENT FOR THE PROVISION OF PROFESSIONAL
ENVIRONMENTAL CONSULTING SERVICES FOR A PRIVATE PROJECT
This agreement for the provision of professional environmental consulting services
("Agreement") is made and entered into this 1st day of April, 2022 ( "Effective Date"), by and
between the City of Redlands, a municipal corporation ("City") and Lilburn Corporation, a
California corporation ("Consultant"), who 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 1 — ENGAGEMENT OF CONSULTANT
1 1 City hereby engages Consultant to provide professional environmental consulting 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,"
titled "Scope of Services," including a project schedule, 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 Brian Desatnik, City's Development Services Director, or his designee, 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 accordance with the project schedule
The Services shall commence on the Effective Date of this Agreement and be completed on
or before January 31, 2023
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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 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 The total compensation for Consultant's performance of the Services shall not exceed the
amount of fifty two thousand nine hundred eighty-five dollars ($52,985). City shall pay
Consultant on a time and materials basis, up to the not to exceed amount, in accordance with
Exhibit "B," titled "Project Costs and Hourly Rates," which is attached hereto and
incorporated herein by this reference
5.2 Consultant shall submit an invoice to City describing the Services performed, the dates the
Services were performed, and the number of hours spent and by whom, upon completion of
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 certified, registered or express
mail, with return receipt requested, (iii) on the actual delivery date if deposited with an
overnight courier, or (iv) on the date sent by facsimile or electronic mail transmission
(including PDF), 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.
Brian Desatnik, Director
Development Service Department
35 Cajon Street, Ste 20
P 0 Box 3005 (mailing)
Redlands, CA 92373
bdesatnik@cityofredlands org
(909) 798-7555
CONSULTANT.
Cheryl A. Tubbs, Vice President
Lilburn Corporation
1905 Business Center Drive
San Bernardino, CA 92408
cheryl@lilburncorp corn
(909) 890-1818
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
provision prohibiting cancellation or modification of the policy except upon thirty (30) days
prior written notice to City
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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 "C,"
titled "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
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.
7.2 Consultant agrees it is not a designated employee within the meaning of the Political
Reform Act because Consultant.
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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
agent, nor shall Consultant have any authority, express or implied, to bind City to any
obligation.
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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
Charles M Duggan, Jr , Canag
ATTEST
Donaldson, City Clerk
LILBURN CORPORATION
Cheryl At ubbs, Vice President
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EXHIBIT "A"
SCOPE OF SERVICES
PROPOSAL FOR CEQA DOCUMENTS
SAN BERNARDINO & WABASH AVENUES PRD
The City of Redlands is requesting the services of an environmental consulting firm to prepare and
process a California Environmental Quality Act (CEQA) document for a proposed Planned
Residential Development with 98 single-family lots and 5 lettered lots to be located on a vacant
parcel at the southwest corner of San Bernardino Avenue and Wabash Avenue The Project Site has
residential development to the east, west, and south and is directly across from the Redlands Sports
Park. Our methodology for preparation of the CEQA Initial Study, public review noticing, and
presence at public hearings, as requested in the City's Scope Request is described herein. Our scope
of work will lead to the completion of CEQA compliance for the City's consideration of adopting a
Mitigated Negative Declaration and approval of the project.
Our overall approach is summarized below Following this summary, the tasks required are
described in detail
❑ Meet with City and Applicant to Review Proposed Project
❑ Prepare a Comprehensive Project Description for use in the Initial Study
❑ Peer Review Applicant's Technical Studies (up to five) for CEQA adequacy
❑ Prepare a Noise Study
❑ Air Quality/Greenhouse Gas and Energy Model Assessments and OPTIONALLY a
Land Evaluation and Site Assessment (LESA) Model for inclusion in the Initial Study
❑ Prepare Draft Initial Study and Mitigation Monitoring and Reporting Program (MMRP)
Cl Finalize Initial Study and MMRP
❑ Prepare required CEQA notices including Notice of Intent (NOI), Notice of
Completion (NOC) and SCH Summary Form
❑ Submit Notices to State Clearinghouse electronically and produce and Circulate
Initial Study as directed by City
❑ Review and Discuss Comments Received on Document; prepare or assist City staff
with Responses
❑ Prepare Mitigated Negative Declaration for City adoption
❑ Meet with City staff prior to public hearing(s)
❑ Attend up to three public hearings to support City staff
❑ File Notice of Determination (NOD) with the San Bernardino County Clerk of the Board
❑ Provide monthly progress reports and invoices
TASK 1 MEET WITH PROJECT APPLICANT AND CITY, REVIEW PROPOSED
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PROJECT AND OBJECTIVES
The purpose of this task is to collect and review all pertinent background data necessary to
conduct the environmental analysis. It will be necessary to obtain sufficient design detail and site
disturbance information to conduct an adequate environmental evaluation. We will review the
Site Plan, Grading Plan, and Landscape Plan, as well as the project objectives. Any focused
technical studies provided to the City by the Applicant will be obtained during the meeting for
peer review and incorporation into the Initial Study
TASK 2 DEVELOP PROJECT DESCRIPTION
In this task we will prepare a CEQA Project Description for use in the Initial Study and for
reviewing and preparing the technical reports The Project Description will be developed in
cooperation with City staff and the Applicant. The Project Description will include a summary of
the project as proposed, a discussion of the existing conditions of the site and vicinity, a
discussion of the site plans, and graphics The graphics prepared for use in the Initial Study will
be based in part on exhibits prepared to date by the project designers and engineers Lilburn
Corporation will review the Applicant's architectural renderings for adequacy in portraying
changes in the visual character of the site We will photograph the site to document surrounding
land uses and current site conditions Final approval of the Project Description will be provided
by the City
TASK 3 PEER REVIEW APPLICANT -SUBMITTED STUDIES
The City of Redlands will provide Lilburn Corporation with technical studies (as listed in City's
February 24, 2022 request for a scope and cost) that will be prepared by the Applicant. Most
studies will be reviewed in-house with the exception of the biological assessment/SBKR trapping
results, cultural/paleontology report, and traffic study which will be reviewed by others
1 Biological Study - Karen Kirtland, President NRAI, USFWS Permit #TE831-
207-6, CDFW MOU Reissued March 3, 2020
2. Cultural/Paleontological Study - Brian Smith, President BFSA, B.A. History and
Anthropology 1975, M.A. History 1982, Meets Secretary of the Interior's
Professional Qualification Standards
3 VMT Assessment - Giancarlo Ganddini, President Ganddini Group, Professional
Engineer (Traffic) TR 2663, Professional Transportation Planner No 597
Lilburn Corporation will provide the City with peer review memos summarizing results of the
reviews and documenting any need to revise the studies for accuracy or CEQA adequacy
TASK 4 NOISE STUDY
The following scope of work will be conducted by Ganddini following completion of the Traffic
Analysis. They will initially review applicable, Federal, State and Local Noise criteria including the
City's Noise Element and Municipal Code to determine appropriate noise standards and significance
criteria. They will review the Project study area to identify noise -sensitive uses as well as the source
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and location of potential noise generators. This information will be used to select the noise
monitoring locations.
Ganddini will visit the project area and take up to four 15-minute ambient noise measurements and
one long-term 24-hour ambient noise measurement to document existing conditions They will
calculate construction noise impacts from the project and determine if project construction noise
would exceed applicable City standards at nearby sensitive receptors. Ground borne vibration
associated with proposed construction activities will be estimated to determine if vibration
associated with the project would exceed any applicable City standards or disturb nearby sensitive
receptors Ganddini will recommend mitigation measures to help reduce noise and vibration
impacts to sensitive receptors, as necessary
They will model future traffic noise levels at the project site and discuss project's consistency with
the City's Noise/Land Use Compatibility Criteria and the State's interior noise standards Using
project -specific traffic data, they will determine if noise associated with the addition of project
traffic on area road segments will create an impact at any existing sensitive receptors in light of
applicable standards. Mitigation measures will be recommended to reduce traffic noise impacts to
sensitive receptors, if necessary
In addition to project -generated traffic noise, they will utilize the SoundPLAN noise model to
estimate operational noise associated with the proposed project (i.e., loading and unloading, slow
moving on -site trucks, truck idling, parking lot activities, etc) would exceed applicable noise
standards at nearby sensitive receptors. They will recommend mitigation measures to reduce
operational noise impacts to existing sensitive receptors, if necessary Ganddini will prepare a
technical report that incorporates the methodology, findings, and all supporting calculations and
assumptions. They will review one compiled set of City comments and make minor revisions, if
necessary
TASK 5 AQ/GHG/ENERGY MODEL ASESSMENTS
Lilburn Corporation will run South Coast Air Quality Management District's (SCAQMD
CalEEModf v 2020 4 to complete the Initial Study sections for Air Quality Emissions, Energy Use,
and Greenhouse Gas Emissions associated with the Proposed Project. The estimated air emissions
calculated using project information and the traffic study input to Ca1EEMod and will be totaled on
a daily and annual basis and compared to significance thresholds recommended by the SCAQMD
Depending on the significance level of the potential impacts, mitigation measures may be
recommended for implementation. These measures would serve to reduce the level of emissions
and reduce to the extent feasible the level of significance. Construction -related mitigation measures
are typically limited to compliance with standard requirements of the SCAQMD and may also
require modifications to the anticipated construction schedule
The potential project and cumulative emissions will also be analyzed for consistency with the Air
Quality Management Plan and the City's General Plan. The General Plan has allotted or allowed for
a specific increase in air quality emissions based on acceptable land uses and future development.
The Ca1EEMod model also generates greenhouse gas emissions from construction activities,
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vehicular usage, and from operational activities Electrical generation and natural gas combustion
emissions are included in the operational emissions. The analysis will incorporate any Title 24
measures proposed by the Applicant that would reduce emissions If necessary, we will use the
most applicable State and local guidance currently available to develop mitigation measures as
appropriate
Lilburn Corporation will also utilize the proposed construction equipment, materials, and schedule
(if not available we will use the default values from the Air Quality Analysis) to determine the
project's energy requirements from both construction and operations Lilburn Corporation will then
identify all applicable local, State and federal energy regulations and programs. We will determine
the project's construction activities' energy use to quantify fuel consumption from the proposed
project. Any energy -efficient measures (Title 24) proposed by the Applicant for project design will
also be incorporated. Mitigation measures to reduce impacts to the maximum extent possible will
be provided.
TASK 6 LESA MODEL REVIEW
California's Land Evaluation and Site Assessment (LESA) Model is a point -based approach for
rating the relative importance of agricultural land resources based upon specific measurable
features The model was developed to provide lead agencies with an optional methodology to
ensure that potentially significant effects on the environment of agricultural land conversions are
quantitatively and consistently considered in the environmental review process (Public Resources
Code Section 21095), including in CEQA reviews
The entire Project Site is designated by the California Department of Conservation (DOC) as
Grazing Land and the City has requested an overview of the LESA Model which is primarily run
for significance determinations for impacts to Prime Farmland. However due to Redlands' citrus
heritage and potential public concern, an overview of the land classifications and modeled data used
for determining significance, we will provide a detailed discussion in the Initial Study
Lilburn Corporation will evaluate the Project Site and adjacent properties in light of LESA model
parameters for use in completing the CEQA Initial Study We will conduct the model required
background research for completion of Initial Study Section II.
TASK 7 PREPARE INITIAL STUDY, MMRP & NOTICES
Based on the findings of the technical studies prepared and reviewed, and the information contained
in the Project Description, we will prepare an Administrative Draft Initial Study to evaluate all
potential environmental impacts associated with the proposed project. We will utilize the City's
current format for an Initial Study The Initial Study will include mitigation measures for any
identified significant or potentially significant impacts, and supporting documentation as required.
We will incorporate relevant and available information from the site visit and the technical studies.
Lilburn Corporation will address all CEQA and City -required environmental resource areas We
will summarize and incorporate the findings of all technical studies provided to us. We will assist
Planning staff with identifying and/or refining any necessary mitigation measures that would result
from the City's consultation with local Native American Tribal Governments Mitigation measures
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would be incorporated as necessary into the Initial Study to address potential impacts during the
Project's construction phase.
Lilburn Corporation will submit the Administrative Initial Study electronically for the City's
review The City will then provide comments/revisions to Lilburn Corporation. Following
completion of the review by staff, we will revise the document as necessary and prepare a final draft
Initial Study We will also prepare a Mitigation Monitoring and Reporting Program (MMRP) to
include mitigation measures identified. The MMRP will be circulated as part of the Initial Study
The City may conduct a final review before determining the document is ready to release for public
review
Notices and Circulation. Upon approval of the Initial Study, Lilburn Corporation will prepare
notices for the City to conduct a 30-day public review Our cost estimate includes the preparation of
the Notice of Intent (NOI) and circulating to local agencies and interested parties including Native
American tribes We will be responsible for circulating the document electronically to the State
Clearinghouse along with the Notice of Completion and Summary Form for Electronic Submittal.
The City will use the NOI to prepare and publish the legal notice in the Redlands Daily Facts (or
other newspaper of general circulation) and we will post the NOI with the County Clerk.
TASK 8 FINAL DOCUMENTS
Upon completion of the public review process, we will discuss any comments received with City
staff and determine appropriate responses and prepare letters for the City to submit to the
commenters. Our cost assumes no more than five letters will be received and none from attorney's
offices. Lilburn Corporation would discuss with the City any substantive changes that should be
made to the project or the Initial Study as a result of the comments received. We will also update
the MMRP as necessary in consideration of any public input that results in City changes to
mitigation measures
Lilburn Corporation will prepare the Notice of Determination (NOD) and upon City approval, we
will file the notice with the County Clerk of the Board The Applicant will provide a check for the
applicable NOD and any other notice filing fees that are required.
TASK 9 PROJECT MANAGEMENT & MEETINGS
Throughout the project, coordination with the City will be regularly initiated to discuss results of
analyses, obtain additional information as necessary, resolve any contract administration issues, and
provide schedule updates. We will attend a kick-off meeting and will participate in regular conference
calls if directed.
Lilburn Corporation will attend a staff meeting to discuss the final CEQA document and findings
prior to public hearings that will be scheduled with the Planning Commission (PC) and City
Council Our Fee Proposal includes attendance at up to three public hearings.
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EXHIBIT "B"
PROJECT COSTS AND HOURLY RATES
Cost Estimate for Environmental Consulting Services
Initial Study for San Bernardino & Wabash Avenues PRD
City of Redlands
COST CATEGORY
LABOR
TASKS
Pdndpal/Projed
Director $225/hr
Project
M nager
$180/hr.
Sr
Environ.
Analyst
$180/hr.
Environ.
Analyst
$98/hr
Docum nt
Manager
$123/hr
Luber Subtotal
Subconsultants/Oth
er Direct Casts
TOTAL
ESTIMATED
COSTS
Hou
Costs
Task 1- Site Visit, Kick-off Mtg with City & Applicant
1
3
3
7
$1,059
$1,059
Task 2 CEQA Project Description
1
2
1
4
$708
$708
Task 3 Peer Review Applicant Studies
6
4
10
$2,070
$7 400
$9,470
Task 4' Noise Study
1
1
$225
$5,900
$6,125
Task 5. AQ/GHG/Energy Model Assessments
1
28
29
$5,265
$5,265
Task 6 LESA Modeling and Reporting (Optional)
1
20
21
$3,825
$3,825
Task 7 Initial Study MMRP & Public Review Notices
2
10
160
4
176
$18,422
$18,422
Task 8. Final Documents/NOD
1
6
2
8
2
19
$2,695
$2,695
Task 9: Project Mgmt. Stag Mtg (3) & Up l0 3 Public
Hearings
4
24
2
30
$5,416
$5,416
TOTAL TASKS
18
97
2
173
7
297
$39,685
$13,30
0
$52,985
Estimated cost per hearing $720
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Lilbum Corporation
EXHIBIT "C"
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
CyECK ONE
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
LILBURN CORPORATION
By
Cheryl Al/Tubbs, Vice President
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Date - ZbZ Z_