HomeMy WebLinkAboutChristopher Burke Engineering, LLC/Eng/4,300/Westfield Boulevard Bridge over Carmel Creek - DesignChristopher B. Burke Engineering, LLC
Engineering Department - 2018
Appropriation # 2016 Storm Water Bond Fund; P.O. #101865 �•
Contract Not To Exceed $4,300.00
AGREEMENT FOR PROFESSIONAL SERVICES
THIS AGREEMENT FOR PROFESSIONAL SERVICES ("Agreement") is hereby made and entered into by
and between the City of Carmel, Indiana, acting by and through its Board of Public Works and Safety (hereinafter
"City"), and Christopher B. Burke, LLC, (hereinafter "Professional").
RECITALS
WHEREAS City owns and is responsible for the operation and maintenance of its property, personnel, public
works and infrastructure; and
and
WHEREAS, from time to time, City needs professional assistance in fulfilling its foregoing responsibilities;
WHEREAS, Professional is experienced in providing and desires to provide to City the professional services
("Services") referenced herein; and
WHEREAS, City desires to engage Professional as an independent contractor for the purpose of providing to
City the Services referenced herein;
NOW, THEREFORE, in consideration of the foregoing recitals and the covenants and conditions set forth
herein, City and Professional mutually agree as follows:
SECTION 1 INCORPORATION OF RECITALS
The foregoing Recitals are hereby incorporated into this Agreement and made a part hereof.
SECTION 2 SCOPE OF SERVICES
2.1 City desires to engage Professional as an independent contractor for the Services set forth in attached
Exhibit A, incorporated herein by this reference.
2.2 Professional understands and agrees that City may, from time to time, request Professional to provide
additional or modified Services to City. When City desires additional Services from Professional, the City
shall notify Professional of such additional Services desired, as well as the time frame in which same are to
be provided. Only after City has approved Professional's time and cost estimate for the provision of such
additional Services, has encumbered sufficient monies to pay for same, and has authorized Professional, in
writing, to provide such additional Services, shall such Services be provided by Professional to City. A copy
of the City's authorization documents for the purchase of additional Services shall be numbered and attached
hereto in the order in which they are approved by City.
2.3 Time is of the essence of this Agreement.
[SXontrsaslProf.Svcs & Goods Svcs\Engineering120181Chris1opha B. Burke Engineving, LLC Prof—ionel Savi—doc:812112018 10:31 AMU
Christopher B. Burke Engineering, LLC
Engineering Department - 2018
Appropriation # 2016 Storm Water Bond Fund; P.O. #101865
Contract Not To Exceed $4,300.00
SECTION 3 CITY'S RESPONSIBILITIES
3.1 City shall provide such information as is reasonably necessary for Professional to understand the Services
requested.
3.2 City shall provide all data required for provision of Services. Professional may assume that all data so
provided is correct and complete.
3.3. City shall arrange for Professional to enter upon public and private property as reasonably required for
Professional to perform the Services.
3.4 City shall designate payment of the Services from City budget appropriation number 2016 Storm Water Bond
Fund funds.
3.5 City shall designate the Mayor or his duly authorized representative to act on City's behalf on all matters
regarding the Services.
SECTION 4 PROFESSIONAL'S RESPONSIBILITIES
4.1 Professional shall perform the Services pursuant to the terms of this Agreement and within any applicable
time and cost estimate.
4.2 Professional shall coordinate with City its performance of the Services.
4.3 Professional shall provide the Services by following and applying at all times reasonable and lawful
standards as accepted in the industry.
SECTION 5 COMPENSATION
5.1 Professional estimates that the total price for the Services to be provided to City hereunder shall be no more
than Four Thousand Three Hundred Dollars ($4,300.00) (the "Estimate"). Professional shall submit an
invoice to City no more than once every thirty (30) days for Services provided City during the time period
encompassed by such invoice. Invoices shall be submitted on a form containing the same information as that
contained on the Professional Services Invoice attached hereto as Exhibit B, incorporated herein by this
reference. City shall pay Professional for all undisputed Services rendered and stated on such invoice within
thirty five (35) days from the date of City's receipt of same.
5.2 Professional agrees not to provide any Services to City that would cause the total cost of same to exceed the
Estimate, without City's prior written consent.
[SXontraasTrof.Sv &C—ds S—Tngmeenng\201MCbristopher B. Burke Engineering, ILC Prof—ionil Services d-8212018 10:31 AK
2
Christopher B. Burke Engineering, LLC
Engineering Department - 2018
Appropriation # 2016 Storm Water Bond Fund; P.O. #101865
Contract Not To Exceed $4,300.00
SECTION 6 TERM
Unless otherwise terminated in accordance with the termination provisions set forth in Section 7.1
hereinbelow, this Agreement shall be in effect from the Effective Date through December 31, 2018, and shall,
on the first day of each January thereafter, automatically renew for a period of one (1) calendar year, unless
otherwise agreed by the parties hereto.
SECTION 7 MISCELLANEOUS
7.1 Termination
7.1.1 The obligation to provide all or any portion of the Services under this Agreement may be terminated
by City or Professional, without cause, upon thirty (30) days' notice.
7.1.2 The obligation to provide all or any portion of the Services under this Agreement may be terminated
by City, for cause, immediately upon Professional's receipt of City's "Notice To Cease Services."
7.1.3 In the event of full or partial Agreement termination, and as full and complete compensation
hereunder, Professional shall be paid for all such Services rendered and expenses incurred as of
the date of termination that are not in dispute, except that such payment amount shall not exceed
the Estimate. Disputed compensation amounts shall be resolved as allowed by law.
7.2 Binding Effect
City and Professional, and their respective officers, officials, agents, partners and successors in interest are
bound to the other as to all Agreement terms, conditions and obligations.
7.3 No Third Party Beneficiaries
Nothing contained herein shall be construed to give rights or benefits to anyone other than the parties
hereto.
7.4 Relationship
The relationship of the parties hereto shall be as provided for in this Agreement, and neither Professional nor
any of its agents, employees or contractors are City employees. Professional shall have the sole
responsibility to pay to or for its agents, employees and contractors all statutory, contractual and other
benefits and/or obligations as they become due. Professional hereby warrants and indemnifies City for and
from any and all costs, fees, expenses and/or damages incurred by City as a result of any claim for wages,
benefits or otherwise by any agent, employee or contractor of Professional regarding or related to the subject
matter of this Agreement. This indemnification obligation shall survive the termination of this Agreement.
(SACootr=U\Prof.Svo & Goods Svcs\P.ngin—g\2018`Christopha B. &¢Ice Pngmeaing. LLC Professional Servi—doc:8212018 10:31 AK
Christopher B. Burke Engineering, LLC
Engineering Department - 2018
Appropriation # 2016 Storm Water Bond Fund; P.O. #101865
Contract Not To Exceed $4,300.00
7.5 Insurance
Professional shall procure and maintain with an insurer licensed to do business in the State of Indiana such
insurance as is necessary for the protection of City and Professional from all claims under workers'
compensation, occupational disease and/or unemployment compensation acts, because of errors and
omissions, because of bodily injury, including, but not limited to, the personal injury, sickness, disease, or
death of any of Professional's employees, agents or contractors and/or because of any injury to or
destruction of property, including, but not limited to, any loss of use resulting therefrom. The coverage
amounts shall be no less than those amounts set forth on attached Exhibit C. Such insurance policies shall
not be canceled without thirty (30) days' prior written notice to City.
7.6 Liens
Professional shall not cause or permit the filing of any lien on any of City's property. In the event such a lien
is filed and Professional fails to remove it within ten (10) days after the date of filing, City shall have the right
to pay or bond over such lien at Professional's sole cost and expense.
7.7 Default
In the event Professional: (a) repudiates, breaches or defaults under any of the terms or conditions of this
Agreement, including Professional's warranties; (b) fails to perform the Services as specified; (c) fails to
make progress so as to endanger timely and proper completion of the Services and does not correct such
failure or breach within five (5) business days after receipt of notice from City specifying same; or (d)
becomes insolvent, files, or has filed against it, a petition for receivership, makes a general assignment for
the benefit of creditors or dissolves, each such event constituting an event of default hereunder, City shall
have the right to terminate all or any part of this Agreement, without liability to Professional and to exercise
any other rights or remedies available to it at law or in equity.
7.8 Government Compliance
Professional agrees to comply with all laws, executive orders, rules and regulations applicable to
Professional's performance of its obligations under this Agreement, all relevant provisions of which being
hereby incorporated herein by this reference, to keep all of Professionals' required professional licenses and
certifications valid and current, and to indemnify and hold harmless City from any and all losses, damages,
costs, liabilities, damages, costs and attorney fees resulting from any failure by Professional to do so. This
indemnification obligation shall survive the termination of this Agreement.
7.9 Indemnification
Professional shall indemnify and hold harmless City and its officers, officials, employees and agents from all
losses, liabilities, claims, judgments and liens, including, but not limited to, all damages, costs, reasonable
expenses and reasonable attorney fees arising out of any intentional or negligent act or omission of
Professional and/or any of its employees, agents or contractors in the performance of this Agreement. This
indemnification obligation shall survive the termination of this Agreement.
1S:: Coutrwts\Rof.S-s & Goods Sws\Engineamg\2018VChnstophc B. Burke Engin—g, LLC Professional Servio-d-8292018 9:08 AK
4
Christopher B. Burke Engineering, LLC
Engineering Department - 2018
Appropriation # 2016 Storm Water Bond Fund; P.O. #101865
Contract Not To Exceed $4,300.00
7.10 Discrimination Prohibition
Professional represents and warrants that it and each of its employees, agents and contractors shall comply
with all existing and future laws prohibiting discrimination against any employee, applicant for employment
and/or other person in the subcontracting of work and/or in the performance of any Services contemplated by
this Agreement with respect to hire, tenure, terms, conditions or privileges of employment or any matter
directly or indirectly related to employment, subcontracting or work performance hereunder because of race,
religion, color, sex, handicap, national origin, ancestry, age, disabled veteran status or Vietnam era veteran
status. This indemnification obligation shall survive the termination of this Agreement.
7.11 E -Verify
Pursuant to I.C. § 22-5-1.7 et seq., Professional shall enroll in and verify the work eligibility status of all of its
newly -hired employees using the E -Verify program, if it has not already done so as of the date of this
Agreement. Professional is further required to execute the attached Affidavit, herein referred to as Exhibit D,
which is an Affidavit affirming that: (i) Professional is enrolled and is participating in the E -verify program, and
(ii) Professional does not knowingly employ any unauthorized aliens. This Addendum incorporates by
reference, and in its entirety, attached Exhibit D. In support of the Affidavit, Professional shall provide the City
with documentation that it has enrolled and is participating in the E -Verify program. This Agreement shall not
take effect until said Affidavit is signed by Professional and delivered to the City's authorized representative.
Should Professional subcontract for the performance of any work under this Addendum, the
Professional shall require any subcontractor(s) to certify by affidavit that: (i) the subcontractor does not
knowingly employ or contract with any unauthorized aliens, and (ii) the subcontractor has enrolled and is
participating in the E -verify program. Professional shall maintain a copy of such certification for the duration
of the term of any subcontract. Professional shall also deliver a copy of the certification to the City within
seven (7) days of the effective date of the subcontract.
If Professional, or any subcontractor of Professional, knowingly employs or contracts with any
unauthorized aliens, or retains an employee or contract with a person that the Professional or subcontractor
subsequently learns is an unauthorized alien, Professional shall terminate the employment of or contract with
the unauthorized alien within thirty (30) days ("Cure Period"). Should the Professional or any subcontractor of
Professional fail to cure within the Cure Period, the City has the right to terminate this Agreement without
consequence.
The E -Verify requirements of this Agreement will not apply, should the E -Verify program cease to exist.
7.12 Severability
If any provision of this Agreement is held to be invalid, illegal or unenforceable by a court of competent
jurisdiction, that provision shall be stricken, and all other provisions of this Agreement that can operate
independently of same shall continue in full force and effect.
[SXoshraatstProf.Sm & Goad Sws\Engineermg12018\Christophc B. Burke Engineering, LLC Professional SCrvi—d-8212018 10:31 AK
Christopher B. Burke Engineering, LLC
Engineering Department - 2018
Appropriation # 2016 Storm Water Bond Fund; P.O. #101865
Contract Not To Exceed $4,300.00
7.13 Notice
Any notice, invoice, order or other correspondence required or allowed to be sent pursuant to this Agreement
shall be written and either hand -delivered or sent by prepaid U.S. certified mail, return receipt requested,
addressed to the parties as follows:
CITY:
City of Carmel
Department of Engineering
One Civic Square
Carmel, Indiana 46032
ATTENTION: Jeremy Kashman
PROFESSIONAL:
Christopher B. Burke Engineering, LLC
115 West Washington Street
Suite 1368 South
Indianapolis, IN 46204
ATTENTION: Jon Stolz, P.E.
Douglas C. Haney
Corporation Counsel
One Civic Square
Carmel, Indiana 46032
Notwithstanding the above, City may orally provide to Professional any notice required or permitted by this
Agreement, provided that such notice shall also then be sent as required by this paragraph within ten (10)
business days from the date of such oral notice.
7.14 Effective Date
The effective date ("Effective Date") of this Agreement shall be the date on which the last of the parties
hereto executes same.
7.15 Governing Law; Lawsuits
This Agreement shall be governed by and construed in accordance with the laws of the State of Indiana,
except for its conflict of laws provisions, as well as by all ordinances and codes of the City of Carmel,
Indiana. The parties agree that, in the event a lawsuit is filed hereunder, they waive any right to a jury trial
they may have, agree to file such lawsuit in an appropriate court in Hamilton County, Indiana only, and agree
that such court is the appropriate venue for and has jurisdiction over same.
7.16 Waiver
Any delay or inaction on the part of either party in exercising or pursuing its rights and/or remedies hereunder
or under law shall not operate to waive any such rights and/or remedies nor in any way affect the rights of
such party to require such performance at any time thereafter.
7.17 Non -Assignment
Professional shall not assign or pledge this Agreement nor delegate its obligations hereunder without City's
(SXont—AsTrof.Sv & Goods SvcsXFngineaingV0189Cbristopha B. Burke E gieamg. LLC Nof—i—I S—i—doc:8/212018 10:31 AMI
6
Christopher B. Burke Engineering, LLC
Engineering Department - 2018
Appropriation # 2016 Storm Water Bond Fund; P.O. #101865
Contract Not To Exceed $4,300.00
prior written consent.
7.18 Entire Agreement
This Agreement contains the entire agreement of and between the parties hereto with respect to the subject
matter hereof, and no prior agreement, understanding or representation pertaining to such subject matter,
written or oral, shall be effective for any purpose. No provision of this Agreement may be amended, added to
or subtracted from except by an agreement in writing signed by both parties hereto and/or their respective
successors in interest. To the extent any provision contained in this Agreement conflicts with any provision
contained in any exhibit attached hereto, the provision contained in this Agreement shall prevail.
7.19 Representation and Warranties
Each party hereto represents and warrants that it is authorized to enter into this Agreement and that any
person or entity executing this Agreement on behalf of such party has the authority to bind such party or the
party which they represent, as the case may be.
7.20 Headings
All headings and sections of this Agreement are inserted for convenience only and do not form a part of this
Agreement nor limit, expand or otherwise alter the meaning of any provision hereof.
7.21 Advice of Counsel
The parties warrant that they have read this Agreement and fully understand it, have had an opportunity to
obtain the advice and assistance of counsel throughout the negotiation of same, and enter into same freely,
voluntarily, and without any duress, undue influence or coercion.
7.22 Copyright
City acknowledges that various materials which may be used and/or generated by Professional in
performance of Services, including forms, job description formats, comprehensive position questionnaire,
compensation and classification plan and reports are copyrighted. City agrees that all ownership rights and
copyrights thereto lie with Professional, and City will use them solely for and on behalf of its own operations.
City agrees that it will take appropriate action with its employees to satisfy its obligations with respect to use,
copying, protection and security of Professional's property.
7.23 Personnel
Professional represents that it has, or will secure at its own expense, all personnel required in performing the
services under this agreement. Such personnel shall not be employees of or have any contractual
relationship with City. All of the services required hereunder will be performed by Professional or under his
supervision and all personnel engaged in the work shall be fully qualified to perform such services.
7.24 Records and Inspections
Professional shall maintain full and accurate records with respect to all matters covered under this
agreement for three (3) years after the expiration or early termination of this Agreement. City shall have free
(S:\ContreclstProf.S c & Goad SvcstEngtneeringt2018`,Cbristopb= B. Burke Fngmeming, LLC Professional Servi—doc:8R1/2018 10:31 AMI
Christopher B. Burke Engineering, LLC
Engineering Department - 2018
Appropriation # 2016 Storm Water Bond Fund; P.O. #101865
Contract Not To Exceed $4,300.00
access at all proper times to such records and the right to examine and audit the same and to make
transcripts there from, and to inspect all program data, documents, proceedings and activities.
7.25 Accomplishment of Project
Professional shall commence, carry on, and complete the project with all practicable dispatch, in a sound
economical and efficient manner, in accordance with the provisions thereof and all applicable laws. In
accomplishing the project, Professional shall take such steps as are appropriate to ensure that the work
involved is properly coordinated with related work being carried on within City's organization.
7.26 Iran Certification
Pursuant to I.C. § 5-22-16.5, the Professional shall certify that, in signing this Agreement, it does not engage
in investment activities within the Country of Iran.
7.27 Access to Public Records Act
Professional understands and agrees that any "public record", as that term is defined in Indiana Code 5-14-3-
2(m), as amended, that is related to the subject matter of this Agreement, whether the same is in the
possession or control of the Professional or the City, shall be subject to release under and pursuant to the
provisions of Indiana's Access to Public Records Act, as codified in Indiana Code 5-14-3-1, et sec., as
amended.
(remainder of page intentionally left blank)
[SACmtntsTmf.S— & Good SvcsEng—ring12018`Chfistopha B. Bwke Engineering, LLC Professional Servi—d-8/212018 10:31 AK
Christopher B. Burke Engineering, LLC
Engineering Department - 2018
Appropriation # 2016 Storm Water Bond Fund; P.O. #101865
Contract Not To Exceed $4,300.00
IN WITNESS WHEREOF, the parties hereto have made and executed this Agreement as follows:
CITY OF CARMEL, INDIANA Christopher B. Burke Engineering, LLC
by and through its Board of Public
Works and Safety
(-0
ATTEISPau:l�ey, hristine
Date:
AN
ALL
Authoriz gnature
Printed Name: ��� 54�I-z--
Title:
FIDITIN: q5--3gyQs25
Last Four of SSN if Sole Proprietor:
Dater ws� 25f , 2C)(s
IS.1eq+n I'T'oUS'.&G-1,Sao`f ,tinccnnpCUlS'CAmngh.7 B. H.AY F., --p. LLC R aslmial S—A-1,11101% M31 ANN
F
B -
April 17, 2018
Jeremy Kashman, PE
Carmel City Hall
One Civic Square
Carmel, IN 46032
1 10- — S W -- '—"Z-
Christopher
2
Christopher B. Burke Engineering, LLC
115 W. Washington St. Suite 1368 South Indianapolis, IN 46204 317.266.8000 cbbel-in.com
Subject: Westfield Boulevard Bridge over Carmel Creek
Professional Services Proposal
Dear Mr. Kashman:
Christopher B. Burke Engineering, LLC (CBBEL) is pleased to provide this proposal for professional
environmental services for the above-mentioned project located along Westfield Boulevard, just south of
116th Street in Carmel, Hamilton County, Indiana. The following is our understanding of the assignment,
scope of services and estimated fee in support of the project.
UNDERSTANDING OF THE ASSIGNMENT
During 2016, CBBEL assisted the City of Carmel and Kite Realty Group in obtaining permits and
authorizations from the Indiana Department of Natural Resources (IDNR), the Indiana Department of
Environmental Management (IDEM) and the U.S. Army Corps of Engineers (USACE) for the replacement
of the Westfield Boulevard crossing of Carmel Creek. Due to delays in the project initiation and utility
coordination, it is expected that the project will not be completed by the expiration date of the IDNR
approval. Additionally, the USACE authorization and the associated IDEM authorization expired in 2017. It
is our understanding that you would like CBBEL to perform the necessary tasks to extend the IDNR
approval for an additional year and renew the USACE and IDEM authorizations.
SCOPE OF SERVICES
CBBEL will provide the following services for this work:
Task 1 – Construction in a Floodway Permit Extension: CBBEL staff will prepare and submit the
necessary information to the IDNR to extend the expiration date of the previously issued approval for one
year. This would allow the project approval to remain valid until August 2019. CBBEL will submit the
information, periodically check with IDNR after the information is submitted regarding its status and
respond to questions as needed.
Task 2 – Section 401 and 404 Permit Applications: CBBEL will complete and submit a new Section 401
Water Quality Certification application to IDEM and a new Section 404 Department of the Army permit
application to USACE for approval of the proposed project impacts. The new applications will rely on the
previously submitted and approved project plans, application forms and related exhibits and documentation
for the Section 401 and 404 permit applications. CBBEL will coordinate the progress and review of the
project by the regulatory agencies.
Westfield Boulevard over Carmel Creek
19.RI80185.00000
April 17, 2018
Exhibit A page 1 00
ESTIMATED FEE
We have estimated the total cost of these services shall not exceed $4,300. If the value of work accomplished
exceeds this figure, CBBEL will assess the remaining work and notify you, in writing, of the revised
compensation and schedule before continuing with the services.
We will bill you monthly, on a time and material basis, for assigned tasks in accordance with our attached
standard charges for professional services. In addition, our contract will be established in accordance with the
attached general terms and conditions. These general terms and conditions are expressly incorporated into
and are an integral part of this contract for professional services.
If this proposal meets with your approval, please sign where indicated and return an executed original to us as
our notice to proceed. The executed proposal, along with the estimated fee, and the attached standard charges
for professional services and general terms and conditions constitute the whole of our agreement. Any
modification to any part of this agreement without prior acknowledgement and consent by CBBEL will make
null and void this agreement. Any time commitment made by CBBEL as part of the agreement does not
begin until CBBEL has received an executed original.
We appreciate the opportunity to submit this proposal and look forward to working with you on this project.
Please contact me or Kerry Daily at the number listed above if you have any questions.
Sincerely,
Jon Stolz, PE
Managing Vice President
THIS PROPOSAL, ESTIMATED FEE, STANDARD CHARGES FOR PROFESSIONAL
SERVICES, AND GENERAL TERMS AND CONDITIONS ARE ACCEPTED ON BEHALF OF
THE CITY OF CARMEL:
Signature:
Name (Printed):
Title:
Date:
Attachments: Standard Charges for Professional Services
General Terms and Conditions
Westfield Boulevard over Carmel Creek
19.R1 80185.00000
Exhibit _� April 1 Page 2 C1 3
Personnel
Christopher B. Burke Engineering, LLC
Standard Charges for Professional Services, January %010
Engineer»JI....................................................................................................................................................................
216
Engineerv.....................................................................................................................................................................
l07
Engineer/v....................................................................................................................................................................
172
EngineerIII ...................................................................................................................................................................
144
Engineer//u.................................................................................................................................................................
1l3
ResourcePlanner V......................................................................................................................................................
16O
ResourcePlanner IV .....................................................................................................................................................
16O
ResourcePlanner III ...................................................................................................................................................
13O
ResourcePlanner l/I..................................................................................................................................................
105
EngineeringTechnician IV.........................................................................................................................................
1SS
EngineeringTechnician III .........................................................................................................................................
130
EngineeringTechnician I/I.......................................................................................................................................
1OS
CAD[L--.--._'—_—_-------_--------'_. ---------_------.130
CADl.............................................................................................................................................................................
107
GISSpecialist III ...........................................................................................................................................................
13V
GISSpecialist I/l........................................................................................................................................................
1OU
Environmental Resource Specialist V.......................................................................................................................
1S1
Environmental Resource Specialist lv......................................................................................................................
l30
Environmental Resource Specialist III ......................................................................................................................
12S
Environmental Resource Specialist I/I...................................................................................................................
1OS
Environmental Resource Technician .------------.----------__----_------..OV
Administrative.................................................................................................................................................................
7G
EngineeringIntern ..........................................................................................................................................................
6O
Direct Costs
inclu6overbead andprqflit
Cbristopber B. Burke Engineering, LLC reserves the ngbtm6narase these rates and costs �y 5% if the contract is executed after
December 31, 2018.
Westfield Boulevard over c=elCreek April 17, Mm _P3
EXHIBIT B
Invoice
Name of Company:
Address & Zip:
Telephone No.:
Fax No.:
Project Name:
Invoice No.
Purchase Order No:
Date:
Signature
Printed Name
Goods
Services
Person Providing
Goods/Services
Date
Goods/
Service
Provided
Goods/Services Provided
(Describe each good/service
separately and in detail)
Cost Per
Item
Hourly
Rate/
Hours
Worked
Total
GRAND TOTAL
Signature
Printed Name
EXHIBIT C
INSURANCE COVERAGES
Worker's Compensation & Disability
Employer's Liability:
Bodily Injury by Accident/Disease:
Bodily Injury by Accident/Disease:
Bodily Injury by Accident/Disease:
Property damage, contractual liability,
products -completed operations:
General Aggregate Limit (other than
Products/Completed Operations):
Products/Completed Operations:
Personal & Advertising Injury
Policy Limit:
Each Occurrence Limit:
Fire Damage (any one fire):
Medical Expense Limit (any one person):
Statutory Limits
$100,000 each employee
$250,000 each accident
$500,000 policy limit
$500,000
$500,000
$500,000
$250,000
$250,000
$ 50,000
Comprehensive Auto Liability (owned, hired and non -owned)
Bodily Single Limit:
Injury and property damage:
Policy Limit:
Umbrella Excess Liability
Each occurrence and aggregate:
Maximum deductible:
$500,000 each accident
$500,000 each accident
$500,000
$500,000
$ 10,000
EXHIBIT D
AFFIDAVIT
being first duly sworn, deposes and says that
he/she is familiar with and has personal knowledge of the facts herein and, if called as a witness in this
matter, could testify as follows:
I am over eighteen (18) years of age and am competent to testify to the facts contained
herein.
2. 1 am now and at all times relevant herein have been employed by
C� ►, s ian �.�� Ig • ��-iC- �.-�, . L L (the "Employer")
in the position of 11G., 11: « Prosht-4-
X
3. I am familiar with the employment policies, practices, and procedures of the Employer and
have the authority to act on behalf of the Employer.
4. The Employer is enrolled and participates in the federal E -Verify program and has
provided documentation of such enrollment and participation to the City of Carmel,
Indiana.
The Company does not knowingly employ any unauthorized aliens.
FURTI IER AFFIANT SAYETH NOT.
EXECUTED on the P- !Ke ` clay of /��w , 20 1 r.
Printed:
I certify under the penalties for perjury under the laws of the United States of America and the State of
Indiana that the foregoing factual statements and representations are true and correct.
t�
Printed:
City
®fCareAINDIANA RETAIL TAX EXEMPT
JIII'1CERTIFICATE NO. 003120155 002 0
FEDERAL EXCISE TAX EXEMPT
ONE CIVIC SQUARE 35-6000972
CARMEL, INDIANA 46032-2584
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL - 1997
Page 1 of 1
PURCHASE ORDER NUMBER
101865
THIS NUMBER MUST APPEAR ON INVOICES, A/P
VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE
PURCHASE ORDER DATE I DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
8/14/2018 1 356865 Project 18 -SW -22; Contract Date 09.05.18
CHRISTOPHER BURKE ENGINEERING LLC
VENDOR DEPT 20-7045
PO BOX 5997
CAROL STREAM, IL 60197-5997
PURCHASEID BLANKET CONTRACT
28481
QUANTITY UNIT OF MEASURE
Department: 2200
Account: 44-628.71
1 Each
Send Invoice To:
Fund: 0
PAYMENT TERMS
DESCRIPTION
2016 Storm Water Bond
City Engineering's Office
SHIP 1 Civic Square
TO Carmel, IN 46032 -
Kate Lustig
FREIGHT
UNIT PRICE I EXTENSION
Westfield Boulevard Bridge over Carmel Creek - Design $4,300.00
Sub Total
R■ 6 � s � Z■�
L .�
$4,300.00
$4,300.00
Jill Newport
CrossRoad Engineers, P.C.
3417 Sherman Drive
Beech Grove, IN 46107
% AtA ,..
Email: jnewport@crossroadengineers.com
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT
PAYMENT $4,300.00
SHIPPING INSTRUCTIONS
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A
PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN
'SHIP PREPAID.
AFFIDAVIT ATTACHED. I HEREBY CERTIFY THAT THERE IS AN UNOBUGATED BALANCE IN
'C.O.D. SHIPMENT CANNOT BE ACCEPTED.
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
'PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABEL
'THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 �Z
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY
Jeremy Kashman
TITLE Director
CONTROLNO. 101865 CLERK -TREASURER