CrossRoad Engineers/Eng/237,500/Hazel Dell Pkwy ImprovementsCrossRoad Engineers, P.C.
Engineering - 2016
Appropriation # 2016 COTT Bond; P.O. # 33693
Contract Not To Exceed $237,500.00 gq�FO
,JAO
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 CrossRoad Engineers, P.C. (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. Professional will not perform any of the Services detailed in
Exhibit A prior to obtaining a written Notice to Proceed from the City. Upon receiving a Notice to Proceed,
the Professional shall perform only those Services specifically detailed in the Notice. If the Professional
desires clarification of the scope of any Notice to Proceed, the Professional shall obtain such clarification
from the City in writing, prior to performing the service set forth in the Notice to Proceed. Any services
performed without the City's prior express written authorization will not be compensated.
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
{SAConnnclsTwf.Sv & Goads Sws\EnginccringN20161CromRond Enginccrs, P.C. Profcssionnl Smics.d-0/320169:31 AMJ
CrossRoad Engineers, P.C.
Engineering - 2016
Appropriation # 2016 COLT Bond; P.O. # 33693
Contract Not To Exceed $237,500.00
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.
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 COIT Bond 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 Two Hundred Thirty Seven Thousand Five Hundred Dollars ($237,500.00) (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.
]S:\Ca11—tAP,&S— & Goals S—S,gi—ring@016\CrossRond Engurccrs, P.C. Profcssionnl Scrvics.d-3/320169:31 AM]
IF)
CrossRoad Engineers, P.C.
Engineering - 2016
Appropriation # 2016 COIT Bond; P.O. # 33693
Contract Not To Exceed $237,500.00
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, 2016, 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.
1S:\Contrn1.%\Pmf.S— S Goods S-%\Enginccring@016\C—,Road Engin—P.C. Professional S—ics.d—:302016 9:31 ANTI
CrossRoad Engineers, P.C.
Engineering - 2016
Appropriation # 2016 COIT Bond; P.O. # 33693
Contract Not To Exceed $237,500.00
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, expenses and
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.
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CrossRoad Engineers, P.C.
Engineering - 2016
Appropriation # 2016 COPT Bond; P.O. # 33693
Contract Not To Exceed $237,500.00
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 heldto 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.
7.13 Notice.
[S:\Cnnlfacls\P.f.SYW &. Goals Svcs\Engm-6r g\2016\Cm Road Engine-, P.C. Pmf—ionnl Smics.d-3/320169:31 AM]
5
CrossRoad Engineers, P.C.
Engineering - 2016
Appropriation # 2016 COIT Bond; P.O. # 33693
Contract Not To Exceed $237,500.00
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:
CrossRoad Engineers, P.C.
3417 South Sherman Drive
Beech Grove, IN 46107
ATTENTION: Chip Charles
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.
[SACcnUncts\Prof.Svcs & Goods Svcs\Enginceriog\2016\Cma sRoid Enginccrs. P.C. Prof—imml Scrvi—d-31320169:31 AM]
CrossRoad Engineers, P.C.
Engineering - 2016
Appropriation # 2016 COTT Bond; P.O. # 33693
Contract Not To Exceed $237,500.00
7.17 Non -Assignment.
Professional shall not assign or pledge this Agreement nor delegate its obligations hereunder without City's
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.
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CrossRoad Engineers, P.C.
Engineering - 2016
Appropriation # 2016 COIT Bond; P.O. # 33693
Contract Not To Exceed $237,500.00
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. City 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, 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 seg., as
amended.
(remainder of page intentionally left blank)
JS:\Contrncls\Prof.Svcs & Goods Svc \Enginmring@016\Cr.,,Rond Engfi—, P.C. Prof—i—I Scrvi-d-3/320169:31 AM]
CrossRoad En_incers. P.C.
En-ineering - 2016
Appropriation # 2016 COIT Bond; P,O. # 3.3693
Contract Not To Exceed $237.600.00
IN WITNESS WHEREOF, the parties hereto have made and executed this Agreement as follows:
CITY OF CARMEL, INDIANA CrossRoad Engineers, P.C.
by and through its Board of. Public
Works and Safety
James Brainard, Presiding Officer
Date: 3
Mary AnnB rke, Mgtnbe�
Date: S 6 (�
Lori. W , M mber
Date. 3 � - (r._ t o .
Authorized Signaturf
Printed Name:
Title: G, D
FIDITIN:
Last Four of SSN if Sole Proprietor:
Date: 3 &��
s:•c4 r�, .•r „cs.., & G -1,s. Ifnp :P.C. »q
HAZEL DELL PARKWAY IMPROVEMENTS
CrossRoad Engineers, PC
I. PROJECT DESCRIPTION
This project involves the milling, resurfacing, and widening of Hazel Dell Parkway from
just north of the Cherry Creek Boulevard roundabout to 146th Street. The results will be
a 4 lane section as well as added left turn lanes at Canton Drive and Rippling Brook Way.
The existing roadway in this area has one lane in each direction with curbed roadsides.
Storm runoff currently is conveyed via inlets and storm sewers to creek crossings. The
project will construct asphalt widening for additional travel lanes as well as reconstruct
concrete curb and gutter where necessary, add center curb, widened asphalt pavement,
drainage structure modifications where necessary, and roadside asphalt multi -use path
and sidewalk modifications where necessary.
No bridges or large culverts are anticipated to be affected by the project.
II. SCOPE OF PROFESSIONAL SERVICES
1. Route Survey and Supplemental Topographic Survey
A Route Survey will be prepared for the project area since the project will involve
right of way parcels. We will utilize the previous topographic survey which was
performed by CrossRoad Engineers several years ago but the survey will be
supplemented for added turn lanes and checked for any changes in the area.
This effort will also include meeting with the HOA's in the area to determine
locations of any HOA improvements within the impacted areas (lighting, wiring,
irrigation, etc.). This work will generally follow INDOT procedures and will
include locating (horizontally & vertically) all necessary features in the field such
as edges of pavement, existing drainage structures and patterns, utilities,
buildings, signs, etc.
2. Road Design
Design and construction plans will be prepared in accordance with the City of
Carmel's standards, guidelines and directions, and using INDOT standards where
applicable. CrossRoad Engineers will submit plans to the City Engineer for review
at the following milestones:
• Preliminary Plans (Approximately 35% complete) EXHIBIT
• Field Check Plans (Approximately 70% complete)
It is expected that the project will require minimal right of way near the
intersection of Canton Drive and Rippling Brook Way due to the addition of the
left turn lanes in this location.
It is not expected that any lighting or landscaping design will be affected, so no
services are included in this proposal for those items.
3. Permit Applications
The project will likely require the disturbance of more than one acre of land.
Therefore, an IDEM Rule 5 permit will be required.
4. Bid Documents and Bidding Phase
Following the City Engineer's approval of Final Check Plans, final bid documents
will be prepared, including construction plans, project specifications and final
engineer's estimate.
Bidding documents will be prepared using "front end" information and
documents provided by the City. A CrossRoad Engineers representative will also
attend and prepare agendas and minutes for the pre-bid, bid opening and the
pre -construction meetings.
S. Right of Way Services
It is anticipated that the only right of way that would be required for this project
is in the area of the Canton Drive and Rippling Brook Way intersection due to the
addition of the left turn lanes. Therefore, the following services are intended to
provide all work that may be required for these right of way parcels:
EXHIBIT
z�y
Work Item
Est. Quantity
Fee
Total Fee
Preliminary T & E Report ill
4 each
$450.00
$1,800.00
R/W Plats
4 each
$400.00
$1,600.00
R/W Legal Descriptions
4 each
$450.00
$1,800.00
Short Form Appraisal (�)
2 each
$2,000.00
$4,000.00
Long Form Appraisal- Residential
2 each
$3,500.00
$7,000.00
2nd Appraisal (1)
4 each
Varies
$11,000.00
Negotiations
4 each
$1,500.00
$6,000.00
R/W Staking
4 each
$400.00
$1,600.00
Document Preparation & Title
Review
4 each
$150.00
$600.00
Payment Processing & Deed
Recordation
4 each
$100.00
$400.00
Recording Fees (2)
4 each
$50.00
$200.00
R/W Management
4 each
$1,000.00
$4,000.00
ESTIMATED TOTAL FEE
$40,000.00
NOTES: (1) This is a subcontracted item and the fee shown here is estimated. The
final cost will consist of the actual invoiced amounts from the subcontractor plus a 10% mark-up
for task coordination and administrative efforts.
(2) These are fees that will be incurred for partial mortgage releases,
recordations, etc., and the fee shown here is estimated. The final cost will consist of the actual
fees charged plus a 10% mark-up for task coordination and administrative efforts.
6. Construction Inspection
Prior to construction beginning, we anticipate that there will be some
communication needed with HOA contacts and other stakeholders. There will
also be some utility coordination necessary. Therefore, during this estimated 2
week period, we have budgeted 4 hours per week for the Director and 40 hours
per week for the RPR. During the construction season (estimated 9 weeks in
2016), we have budgeted 8 hours per week for the Director, 50 hours per week
for the RPR, and 50 hours per week for the Assistant Project Inspector. There
will also be preparation of the final construction record that will occur post -
construction. These budgeted hours, with the corresponding billing rates, yield
the estimated costs as shown on the attached spreadsheet.
EXHIBIT A-
3 'rFY
III. PROPOSED FEES
ACTIVITY IFPROPOSED
FEE
Route Survey and Supplemental Topographic Survey
$20,700
Road Design
$48,800
Permit Applications
$5,000
Bid Documents and Bidding Phase
$6,000
Right of Way Services (Estimated Total)
40,000
Construction Inspection (hourly with Not -to -Exceed)
$117,000
TOTAL ESTIMATED FEE
$237,500
EXHIBIT A
y ,fN
EXHIBIT B
Invoice
Name of Company:
Address & Zip:
Telephone No.:
Fax No.:
Project Name:
Invoice No.
Purchase Order No:
®ate:
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 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:
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
platter, could testify as follows:
I am over eighteen (1 S) years of age and am competent to testify to the facts contained
herein.
2. I and now and at dal ll hill rel ant herein have been employed by
G�`��✓`7Oct
(the "Employer")
in the position of �j Q
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. Documentation
of this enrollment and participation is attached and incorporated herein.
5, The Employer does not knowingly employ any unauthorized aliens.
G. To the best of my information and belief, the Employer does not currently employ any
unauthorized aliens.
7. FURTHER AFFIANT SAYETII NOT.
EXECUTED on the Ad -day of�L , 20&
Printed: �(iL �� r� (! �C'?
I certify under the penalties for perjury under the laws of
Indiana that the foregoing factual statements and represei
tate of
Printed:`' ^ `'�y� ILIL-1 D
�mf.� Lia Yom"
Company ID Number: 440231
To be accepted as a participant in E Verify, you should only sign the Employer's Section
of the signature page. If you have any questions, contact E -Verify at 888-464-4218.
;Employer CrossRoad Engineers, PC i
JillNewport ......... ......__........ ...._._.........._......,..._.....__.._ __.__....._._._
Name (Please Typo or Print) .}. ;Title ___..... ._..__.__._..
Electronically Signed '08115!2011 F
Signature Date
I
Department of Homeland Security – Verification Division
i
USCIS Verification Division
.. ..... ....... .....__.____...__........._....._...._.___. _-.---....__.__ ........_._._..................___.._....._.._..._._........_.....____......._.._..__._______....__.._._.._........_....._...
:Name (Please Type or Print):11612011
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(Electronically Signed _.. _....._....._._.___........._..._.._.._.._..-______-
ignalure _.......__..__-_.E-'iDale ...._...._.__.
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:........................... _......._.._._...._...._................-._._...._.._. ____......__._._..._........_.__-.__.._.-__..... _........ .............. ....... ... ..._.._._._.,................._.......___._............. .....-_•__...._
Information Required for the E -Verify Program
iformation relating to your Company:
_...Company Name:kCrossRoad Engineers, PC^ __....__.._._.........._.�. _
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Company Facility Address:;3417 Sherman Drive
IN 46107
Company Alternate '
__uAddress_ 13417,Sherman Drive _..._._.—..____...._...
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County or Parish: ;MARION
Employer Identification
Number: .351963331
Page 12 of 131 E -Verify MOU for Employer i Revision Date 09/01/09
www.dhs.gov/E-Verify
Company ID Number: 440231
North American Industry
uiessiTication Systems
Code'
Administrator:
. . ...... . ..
.,--N,.umb.qr of Emplovees: '20 to 99
Number of Sites Verified I
for:
- — ---------- 11 ....... ...... ---- ... .... ... ..... . . ...... ..................... .. .. . .... .. .....
Are you verifying for more than I site? If yes, please provide the number of Sites Verified for
;in each State:
INDIANA I site(s)
Information relating to the Program Administrator(s) for your Company on policy
questions or operational problems:
Nome: .till A Newport
Telephone Number: (317) 780 -1555 ext. 120
13 -mail Address: jnewport(iPcrossrundengincers.com
Nnme: Walter E Charles
Telephone Number: (317) 780 - 1555 ext. 115
E-mail Address: celiariesCa,)crossruaidengineers.cum
Page 13 of 131E Verify MOU for Employer I Revision Date 091011109
Fox Number: (317) 780 -6525
Fax Number: (317) 780 .6525
www.dhs.gov/E-Verify