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HomeMy WebLinkAboutCC-08-05-13-04 CRC Contract with American Structurepoint, Inc - $40,000 SPONSOR: Councilor Snyder RESOLUTION CC-08-05=43-04 A RESOLUTION OF THE COMMON COUNCIL OF THE CITY OF CARMEL, INDIANA, APPROVING CARMEL REDEVELOPMENT COMMISSION PROFESSIONAL SERVICES CONTRACT WITH AMERICAN STRUCTUREPOINT, INC. WHEREAS, the City of Carmel Common Council ("Council") created by ordinance the Carmel Redevelopment Commission ("CRC"); and WHEREAS, by subsequent ordinance, the Council now requires the CRC to seek its approval, by simple majority vote, of all professional services contracts that exceed Twenty-Five Thousand Dollars ($25,000.00) in a calendar year (the "Threshold Amount"); and WHEREAS, the CRC now desires to enter into the professional services contract with American Structurepoint, Inc., the same being attached hereto as Exhibit A, which contract (the "Professional Services Contract") is in an amount that exceeds the Threshold Amount; and WHEREAS, the CRC has therefore presented the Professional Services Contract to the Council and has requested its approval of the same. NOW, THEREFORE, BE IT RESOLVED by the Common Council of the City of Carmel, Indiana, as follows: Section 1. The foregoing Recitals are incorporated herein by this reference. • Section 2. The Professional Services Contract should be and the same is hereby APPROVED by the Common Council of the City of Carmel, Indiana. SO RESOLVED by the Common Council of the City of Carmel, Indiana, this 5 day of .._ -4 , 2013, by a vote of '7 ayes and Zj nays. Page One of Two Pages This Resolution was prepared by Douglas C. Haney, Carmel City Attorney, on 07/23/13 at 2:29 p.m. No subsequent revision to this Resolution has been reviewed by Mr. Haney for legal sufficiency or otherwise. Z:1E Bass1My Documents1Resolutions-CCCICRC resolutions-approving contracts120131CC-0 8-0513-04-AMERICAN STRUCTUREPOINT Contract 7-23-13.docx7/26/2013 11:41 AM SPONSOR: Councilor Snyder COMMON COUNCIL FOR THE CITY OF CARMEL . ' /4-7 PrOf r Kevin D. Rider (Wi II: pt., Richard L. Sharp, President Pro Tempore Carol Schleif / H -Z ' • " .,,,,A (g7,—,."---- / /.' Ronald E Carter W. Eric Seidensticker - 4 , / 4 S % am LL ci Sn er ATTE , < . / . ./ , Diana L. Cordray, IAMC, Clerk- 'r-asurer Presented by me to the Mayor of the City of Carmel, Indiana this5 day of , 2013, at 9. oy P Al Diana L. Cordray, IAMC, CaUtA-4--+-ler: reasurer Approved by me, the Mayor of the City of Carmel, Indiana, thisV5 day of , 2013, at Q•loci P .M. L 071. flames Brainard, Mayor ATTES . i Diana L. Cordray, IAMC, Clerk-Try surer Resolution No. CC-08-05-13-04 Page Two of Two Pages This Resolution was prepared by Douglas C. Haney, Carmel City Attorney, on 07/23/13 at 2:29 p.m.No subsequent revision to this Resolution has been reviewed by Mr. Haney for legal sufficiency or otherwise. Z:1E BasstMy Documents\Resclutions-CCCICRC resolutions-approving contracts120131CC-08-05-13-04-AMERICAN STRUCTUREPOINT Contract 7-23-13.docx7/26/2013 11:41 AM American Structurepoint,Inc. Carmel Redevelopment Commission and Carmel Redevelopment Depaitnient-2013 Appropriation#4460807; P.O.#25335 Contract Not To Exceed$40,000.00 AGREEMENT FOR PROFESSIONAL SERVICES THIS AGREEMENT FOR PROFESSIONAL SERVICES ("Agreement") is hereby made and entered into by and between the City of Carmel, Indiana, Redevelopment Commission (hereinafter "City"), and American Structurepoint, Inc. (hereinafter"Professional"). RECITALS WHEREAS CRC owns and is responsible for the operation and maintenance of its property, personnel, public works and infrastructure; and WHEREAS, from time to time, CRC needs professional assistance in fulfilling its foregoing responsibilities; and WHEREAS, Professional is experienced in providing and desires to provide to CRC the professional services ("Services") referenced herein; and WHEREAS, CRC desires to engage Professional as an independent contractor for the purpose of providing to CRC the Services referenced herein; NOW, THEREFORE, in consideration of the foregoing recitals and the covenants and conditions set forth herein, CRC 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 CRC 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 CRC may, from time to time, request Professional to provide additional or modified Services to CRC. When CRC desires additional Services from Professional, the CRC shall notify Professional of such additional Services desired, as well as the time frame in which same are to be provided. Only after CRC 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 CRC. A copy of the CRC's authorization documents for the purchase of additional Services shall be numbered and attached hereto in the order in which they are approved by CRC. 2.3 Time is of the essence of this Agreement. /Z\shared\Prof.Svcs&Goods Svcs\CRC\2013\AMERICAN STRUCTUREPONT-CRC Professional Son vIces.doc7/26/2013,11:37 AM] American Structurepoint, Inc. Carmel Redevelopment Commission and Carmel Redevelopment Department-2013 Appropriation#4460807;P.O.#25335 Contract Not To Exceed$40,000.00 SECTION 3. CRC 'S RESPONSIBILITIES 3.1 CRC shall provide such information as is reasonably necessary for Professional to understand the Services requested. 3.2 CRC shall provide all data required for provision of Services. Professional may assume that all data so provided is correct and complete. 3.3. CRC shall arrange for Professional to enter upon public and private property as reasonably required for Professional to perform the Services. 3.4 CRC shall designate payment of the Services from appropriate CRC budget appropriation number funds. 3.5 CRC shall designate its Executive Director or his duly authorized representative to act on CRC'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 CRC 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 CRC hereunder shall be no more than Forty Thousand Dollars ($40,000.00) (the "Estimate"). Professional shall submit an invoice to CRC no more than once every thirty (30) days for Services provided CRC 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. CRC shall pay Professional for all undisputed Services rendered and stated on such invoice within sixty (60) days from the date of CRC's receipt of same. 5.2 Professional agrees not to provide any Services to CRC that would cause the total cost of same to exceed the Estimate, without CRC's prior written consent. 1Z:lshared\Prof cs&Goods S.cs1CRC12013\AMERICAN STRUCTUREPONT-CRC Professional Sell ices.do.7/26/20132 I 37 AMI American Structurepoint,Inc. Carmel Redevelopment Commission and Carmel Redevelopment Department-2013 Appropriation#4460807; P.O. #25335 Contract Not To Exceed$40,000.00 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, 2013, 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 CRC 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 CRC, for cause, immediately upon Professional's receipt of CRC'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. CRC 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 CRC 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 CRC for and from any and all costs, fees, expenses and/or damages incurred by CRC 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. ]Z:�shared\Prof.Svcs&Goods Svcs\CRC\2013\AMERICAN STRUCTUREPONT-CRC Professional Sell ices I:37 AM] American Structurepoint, Inc. Carmel Redevelopment Commission and Carmel Redevelopment Department-2013 Appropriation#4460807; P.O.#25335 Contract Not To Exceed$40,000.00 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 CRC 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 CRC. 7.6 Liens. Professional shall not cause or permit the filing of any lien on any of CRC'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, CRC 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 CRC 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, CRC 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 CRC 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, to the fullest extent allowed by law, indemnify and hold harmless CRC and its officers, officials, and employees from all liabilities, damages and costs, including, but not limited to, court costs and reasonable attorney fees, to the extent caused by any failure to perform its services in accordance with the applicable standards of reasonable professional care, including intentional or negligent acts or omissions, of Professional and/or any of its employees or subconsultants in the performance of this Agreement. This indemnification obligation shall survive the termination of this Agreement. However, Professional shall not be obligated to indemnify CRC or its officers, officials and employees for any portion of such liabilities, damages and costs that is attributable to its or their own negligence or actionable fault. �Z:\shared\Prof S‘cs&Goods Svcs\CRC\2013\AMERICAN STRUCTUREPONT-CRC Professional Serc tees.doc7/26/2014 I:37 AMA American Structurepoint, Inc. Carmel Redevelopment Commission and Carmel Redevelopment Department-2013 Appropriation#4460807;P.O. #25335 Contract Not To Exceed$40,000.00 7.10 Discrimination Prohibition. Consistent with Indiana Code 5-16-6-1, Professional 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 CRC 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 CRC'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 CRC 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 CRC 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. [Z\shared\Prof.Svcs&Goods Svcs1CRC2OI31AMERICAN STRUCTUREPONT-CRC Professional Sery ices.doc7/2 6/2 0 1 35 1:37 AM[ American Structurepoint, Inc. Carmel Redevelopment Commission and Carmel Redevelopment Department-2013 Appropriation#4460807;P.O. #25335 Contract Not To Exceed$40,000.00 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: CRC: Carmel Redevelopment Commission Douglas C. Haney 30 West Main Street, Suite 220 Carmel City Attorney Carmel, Indiana 46032 One Civic Square ATTENTION: Les Olds Carmel, Indiana 46032 PROFESSIONAL: American Structurepoint, Inc. 7260 Shadeland Station Indianapolis, Indiana 46256-3957 ATTENTION: Robert R. Olson Notwithstanding the above, CRC 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 CRC's prior written consent. ,Z\shared\Prof.S,cs&Goods Svcs\CR020I3\AMERICAN STRUCTUREPONT-CRC Professional Services.doc7/26/201151:37 AMA American Structurepoint, Inc. Carmel Redevelopment Commission and Carmel Redevelopment Department-2013 Appropriation#4460807; P.O. #25335 Contract Not To Exceed$40,000.00 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. CRC 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. CRC agrees that all ownership rights and copyrights thereto lie with Professional, and CRC will use them solely for and on behalf of its own operations. CRC 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 CRC. 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. IZ:\shared\P`of Svcs&Goods Svcs\CRC\2013AMERICAN STRUCTUREPONT-CRC Professional Sery Ices.doe-7/26/201371 37 AMA American Structurepoint,Inc. Carmel Redevelopment Commission and Carmel Redevelopment Department-2013 Appropriation#4460807; P.O.#25335 Contract Not To Exceed$40,000.00 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. CRC shall have free 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, and in accordance with standards of reasonable professional care for similar projects, including compliance with applicable laws. In accomplishing the project, Professional shall take such steps as are appropriate to ensure that the services involved are properly coordinated with related work being carried on within CRC's organization. 7.26 Iran Certification, Pursuant to I.C. § 5-22-16.5, the Consultant shall certify that, in signing this document, it does not engage in investment activities within the Country of Iran. 7.27 Job Site Safety. Neither the professional activities or the Professional, nor the presence of the Professional or its employees and subconsultants at a construction/project site, shall relieve the general contractor of its obligations, duties and responsibilities including, but not limited to, construction means, methods, sequence, techniques or procedures necessary for performing, superintending and coordinating the work in accordance with the contract documents and any health or safety precautions required by any regulatory agencies. The Professional and its personnel have no authority to exercise any control over any construction contractor or its employees in connection with their work or any health or safety programs or procedures. 7.28 Mediation In an effort to resolve any conflicts that arise during the design and construction of the Project or following the completion of the Project, the CRC and the Professional agree that all disputes between them arising out of or relating to the Agreement or the Project shall be submitted to nonbinding mediation unless the parties agree otherwise. Such nonbinding mediation shall be conducted in accordance with the Indiana Rules of Alternative Dispute Resolution. (remainder of page intentionally left blank) ,Z:\shared\Prof.Sscs&Goods Slcs1 CRC 120I3 AMERICAN S7RUCTUREPONT-CRC Professional Senv ices.doc7/2 6/20 1 38 1:37 AMA American Structurepoint, Inc. Carmel Redevelopment Commission and Carmel Redevelopment Department-2013 Appropriation#4460807;P.O.#25335 Contract Not To Exceed$40,000.00 IN WITNESS WHEREOF, the parties hereto have made and executed this Agreement as follows: CARMEL REDEVELOPMENT COMMISSION AMERICAN STRUCTUREPOINT, INC. BY: BY: William Hammer, President Authorized Signature Date: Printed Name: Title: David C. Bowers, Vice President Date: FID/TIN: Last Four of SSN if Sole Proprietor: Bradley F. Meyer, Secretary Date: Date: Thomas Crowley, Member Date: Jeff Worrell, Member Date: lZashared\ProfSves&Goods Svcs\CRC\2013\AMERICAN STRUCTUREPONT-CRC Professional Sercices.doc7/26/201191:37 AM] 0 AMERICAN STRUCTUREPOINT INC. EXHIBIT A AMERICAN STRUCTUREPOINT, INC. 7/24/13 — SCOPE OF SERVICES Site design and engineering services for Parcel #5 —City Center, Parcel #7C—The Mezz not to exceed $40,000 per attached hourly rate schedule 1. Evaluate existing field survey engineering for sufficiency and order any additional survey required to complete engineering. 2. Analyze existing grade information and confirm any existing foundation to be used for the two new structures. 3. Provide drainage calculations for stormwater run-off to include proposed work by City Engineer on south side of property. 4. Coordinate with City utilities department on sanitary and water needs for projects and develop connection points per City direction. 5. Coordinate with City Engineering on stormwater issues and anticipated construction near existing stormwater lines. 6. Provide biddable construction document and bid specifications for all site work to include interface of all utility companies. 7. Provide designs for streetscapes and park areas adjacent to the Monon Trail, including walks, landscaping, lighting, and street furniture. 8. Provide construction pay requests review and shop drawing review during the construction process. Exhibit 7260 Shadeland-Statron Indianapolis;Indiana 46256, TEL 317 547 5580 FAX.3.17.543',0270 www structu?epoint corn Ersi QL_i AMERICAN STRUCTUREPOINT INC. t AMERICAN STRUCTUREPOINT, INC. HOURLY RATE SCHEDULE EMPLOYEE CLASSIFICATION HOURLY RATE Principal Architect or Engineer $160/hr Project Manager $135/hr Senior Architect,Engineer, Scientist, Planner $125/hr Project Architect, Engineer, Scientist, Planner $105/hr Staff Architect, Engineer, Scientist,Planner $90/hr Design Engineer $90/hr Landscape Architect $90/hr Registered Land Surveyor $110/hr Senior Tech/Senior CAD Tech/Senior GIS Tech/ $95/hr Traffic Counting Tech Tech/CAD Tech/Drafter $85/hr Senior Inspector $85/hr Inspector $80/hr Survey Crew $165/hr GPS Crew $225/hr Researcher $80/hr Environmental Researcher $65/hr Permit Coordinator $75/hr 203 7260 Shadeland-Station Indianapolis Indiana 46,256 TEL3I7.547:5580, M317.543 0270, www strutturep`oint`com" EXHIBIT B Invoice Date: Name of Company: Address &Zip: Telephone No.: Fax No.: Project Name: Invoice No. Purchase Order No: _ Goods Services Person Providing Date Goods/Services Provided Cost Per Hourly Total Goods/Services Goods/ (Describe each good/service Item Rate/ Service separately and in detail) Hours Provided Worked GRAND TOTAL Signature Printed Name EXHIBIT C INSURANCE COVERAGES Worker's Compensation& Disability Statutory Limits Employer's Liability: Bodily Injury by Accident/Disease: $100,000 each employee Bodily Injury by Accident/Disease: $250,000 each accident Bodily Injury by Accident/Disease: $500,000 policy limit Property damage, contractual liability, products-completed operations: General Aggregate Limit (other than Products/Completed Operations): $500,000 Products/Completed Operations: $500,000 Personal & Advertising Injury Policy Limit: $500,000 Each Occurrence Limit: $250,000 Fire Damage (any one fire): $250,000 Medical Expense Limit (any one person): $ 50,000 Comprehensive Auto Liability (owned, hired and non-owned) Bodily Single Limit: $500,000 each accident Injury and property damage: $500,000 each accident Policy Limit: $500,000 Umbrella Excess Liability Each occurrence and aggregate: $500,000 Maximum deductible: $ 10,000 EXHIBIT D AFFIDAVIT Benjamin A. Braun ,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: 1. I am over eighteen(18)years of age and am competent to testify to the facts contained herein. 2. I am now and at all times relevant herein have been employed by American Structurepoint, Inc. (the"Employer") in the position of Manager of Corporate Affairs • 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, S. The Company does not knowingly employ any unauthorized aliens. FURTHER AFFIANT SAYETH NOT. EXECUTED on the GK / day of ,)V C ,20/3 . 42g/ .1111. Printed:Benjamin A. Braun 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. " Tim„"' J 4,NN2N"" --� ' NOTARY 11 Printed: Margaret E. Karrtz iccgi* PUBLIC SEAL oI -5 i • k'F 11 ` �i M{tl4'liOWl`00 .. CO3 ;f: ME9 4ig ;;, -P p.I.■ Fk E-VF I F EP -OF Company ID Number: 254011 Information Required for the E-Verify Program Information relating to your Company: Company Name: American Structurepoint,Inc. Company Facility Address: 7260 Shadeland Station Indianapolis,IN 46256 Company Alternate Address: County or Parish: MARION Employer Identification Number: 351127317 North American Industry Classification Systems Code: 541 Parent Company: Number of Employees: 100 to 499 Number of Sites Verified for: 2 Are you verifying for more than 1 site?If yes, please provide the number of sites verified for in each State: • OHIO 1 site(s) Page 12 of 131E-Verify MOU for EmployerlRevision Date 10/29/08 www.dhs.gov/E-Verify , y^ bF 1,5 }5y _ 3 ''Td' wa Company ID Number: 254011 o INDIANA 1 site(s) Information relating to the Program Administrator(s)for your Company on policy questions or operational problems: Name: Chelsea Shumaker Telephone Number: (317)547-5580 Fax Number: (317)543-0270 E-mail Address: cshumaker @structurepoint.com Page 13 of 131E-Verify MOU for EmployeriRevision Date 10/29/08 vvvvw.dhs.gov/E-Verify