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Lindenschmidt, Inc/Util/3,078/Professional Safety ServicesLindenschmidt, Inc. Utilities Department - 2018 Appropriation #01-7042-05; P.O.#S03084 Contract Not To Exceed $3,078.00 AGREEMENT FOR PROFESSIONAL SERVICES acs 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 Lindenschmidt, Inc. (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. ISX .".c T,4 S— d Gads S—%U,d.t-\2018Wnd—hmd4 1— Prdun 1 S—d-2/27R018 12 58 PMI Lindenschmidt, Inc. Utilities Department - 2018 Appropriation #01-7042-05; P.O.#S03084 Contract Not To Exceed $3,078.00 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 01-7042-05 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 Three Thousand Seventy Eight Dollars ($3,078.00) (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:�Cont�slPtdSvrs&C-.h SmWhlm.VG18tl....k—h..dL bc. Pt4-1 Sang d -W 201117.58 PM1 2 Lindenschmidt, Inc. Utilities Department - 2018 Appropriation #01-7042-05; P.O.#S03084 Contract Not To Exceed $3,078.00 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. Is:�Caova vwas�n k G-6 SmUjlindVO131Joamcfim.X low Prat.." servion.dw 2/271201912 59 PK Lindenschmidt, Inc. Utilities Department - 2018 Appropriation #01-7042-05; P.O.#S03084 Contract Not To Exceed $3,078.00 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. (SX -t,. \PWS—&Ga,dUS—\Utait-\2o1e'LudmL b idt[—P.(—w.1Schan.d-2/27!201812 58 PMI Lindenschmidt, Inc. Utilities Department - 2018 Appropriation #01-7042-05; P.O.#S03084 Contract Not To Exceed $3,078.00 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. IS:,CMma 4 d.S.o kCniab Sva1UU1wie1201tlWWm�rLmwlt. Inc Ptoks .l Sa J.-212712018 12-M PMI Lindenschmidt, Inc. Utilities Department - 2018 Appropriation #01-7042-05; P.O.#S03084 Contract Not To Exceed $3,078.00 7.13 Notice Any notice, invoice, order or other correspondence required or allowed to be sent pursuant to this Agreement shall be written and either hand -delivered or sent by prepaid U.S. certified mail, return receipt requested, addressed to the parties as follows: CITY: City of Carmel Department of Utilities 30 W. Main St, Ste 220 Carmel, Indiana 46032 ATTENTION: John Duffy PROFESSIONAL: Lindenschmidt, Inc. 8227 Northwest Blvd Suite 230 Indianapolis, IN 46278 Douglas C. Haney Corporation Counsel One Civic Square Carmel, Indiana 46032 Notwithstanding the above, City may orally provide to Professional any notice required or permitted by this Agreement, provided that such notice shall also then be sent as required by this paragraph within ten (10) business days from the date of such oral notice. 7.14 Effective Date The effective date ("Effective Date") of this Agreement shall be the date on which the last of the parties hereto executes same. 7.15 Governing Law: Lawsuits This Agreement shall be governed by and construed in accordance with the laws of the State of Indiana, except for its conflict of laws provisions, as well as by all ordinances and codes of the City of Carmel, Indiana. The parties agree that, in the event a lawsuit is filed hereunder, they waive any right to a jury trial they may have, agree to file such lawsuit in an appropriate court in Hamilton County, Indiana only, and agree that such court is the appropriate venue for and has jurisdiction over same. 7.16 Waiver Any delay or inaction on the part of either parry in exercising or pursuing its rights and/or remedies hereunder or under law shall not operate to waive any such rights and/or remedies nor in any way affect the rights of such party to require such performance at any time thereafter. 7.17 Non -Assignment Professional shall not assign or pledge this Agreement nor delegate its obligations hereunder without City's prior written consent. IS.'Caouscu�Praf$vo A C-xh 181Lad.—_ha idL lac P, lk_ 1 Scv --227,2018 12 M PMI 6 Lindenschmidt, Inc. Utilities Department - 2018 Appropriation #01-7042-05; P.O.#503084 Contract Not To Exceed $3,078.00 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 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 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. 151C= \Prof Seo k Go h S.cAl tdi0n%201$LLL—k s hi & lac P,ofe al Sanoce Jo. -2/27/2016 12 59 PMO Lindenschmidt, Inc. Utilities Department - 2018 Appropriation #01-7042-05; P.O.#S03084 Contract Not To Exceed $3,078.00 7.25 Accomplishment of Prosect 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) ISAC.a \hf.S—a Coad. 1acPrk.—.lScv,aa.d.2/t7/201812.58PATI Lindenschmidt, Inc. Utilities Department - 2018 Appropriation #01-7042-05; P.O.#S03084 Contract Not To Exceed $3,078.00 IN WITNESS WHEREOF, the parties hereto have made and executed this Agreement as follows: CITY OF CARMEL, INDIANA by and through its Board of Public Works and Safety BY: James Brainard, Presiding Officer Date: Lori S. Wats , Me ber Date: 3 61 ATTEST: C ristine S. Pauley, Q& -Treasurer Date: // DD Lindenschmidt, Inc. M Authorized Signature Printed Name: Am"j- Title: FID/TIN: Last Four of SSN if Sole Proprietor: Date: 3 /b 17-1)1 g jSXwv v\Anf.SmkGo,&S. %Lihdc,\20181A­� aWLIo emf­1Scrsi=d :Zniao1112:51rnn 9 PJAS PARTNERS IN WORKPLACE SAFETY City of Carmel Utilities PROPOSAL & AUTHORIZATION Please Sign and Return This proposal is in response to a discussion with Jason Stewart, Inspections Supervisor, City of Carmel Utilities and Mr. Michael Mariner with RMS -Safety on November 22, 2017. At a meeting on December 06, 2017, Mr. Stewart and members of the Safety Committee Meeting had requested the professional services of RMS -Safety to provide City of Carmel Utilities with professional safety services which are outlined in our 2 -Phase approach that identifies the intended scope discussed : Phase I: Conduct a baseline Risk Management Assessment (RMA) specific to the operations of the `Utilities' division: RMS -Safety feels it is uniquely qualified to meet or exceed your expectations. We utilize a team approach and have extensive experience in conducting Risk Management Assessments within industrial clients. Phase II: Create and/or modify written safety & health program; customizing to meet current state of business and Indiana regulatory agencies & to provide direction for implementation. Work with the City of Carmel's Process Safety Management ( PSM ) Champion to provide a PSM program overview. Act as the City of Carmel Utilities' Safety Director on an as needed basis. For Future Consideration Only: Phase III: Evaluate the current safety orientation and training process and implement a recommended matrix that delivers site-specific training programs to improve customer, asset, property, and people safety. The revised processes for new hire orientation and recurring training, will meet or exceed existing OSHA regulations. Establish a safety meeting and "Tool Box Talk" program that can be managed and sustained by department supervisors. Increasing employee awareness of safety and health issues affecting them within the `Utilities' department through training and daily coaching is one main ingredients in sustaining an excellent safety culture. Phase IV: As the P/T Safety Director and Workers' Comp Liaison - RMS -Safety will work closely with the management and safety committee team to continually improve and/or sustain the Safety & Health Management System with a budget minded approach, including, but not limited to: developing supervisory personnel to better deliver safety & health information through training and coaching; develop internal resources to conduct meaningful monthly site inspections to reduce or eliminate unsafe conditions or observe and correct unsafe behaviors; and guide the Safety Committee to improve internal effectiveness in areas such as communicating safety and health issues to management and Exhibit rbF� employees, improve accident investigations to prevent reoccurrences and provide cost- effective implementation strategies, where appropriate. Delivery / Execution: PHASE I: RMS -Safety proposes to conduct a Risk Management Assessment (RMA) for City of Carmel at their "Utilities' location. The intent of conducting this RMA will be to identify any gaps as compared to interpreted OSHA General Industry regulations (29 CFR OSHA 1910 and 29 CFR OSHA 1926) , as well as opportunities to adopt better management practices for continuous improvement regarding workplace safety. The RMA will focus on gaps from OSHA regulations and common industry practices, assess corporate safety culture, and provide and discuss recommendations and implementation strategies with City of Carmel Utilities Management. The RMA will be performed by walking through the health and safety management process in its entirety, from written policies and record keeping practices to facilities, grounds, & everyday tasks within the Utilities' department. The RMA will be comprised of the following steps: a. On -Site Assessment Activities with two (2) primary auditors; Michael Mariner & Steve Boester b. During this process the auditors may interview key employees and managers; photograph specific situations where improvements can be realized (gaps), and also record where standards and guidelines are currently being implemented; c. Conduct a Closing Meeting with discussion of preliminary fmdings and observations; d. Analyze the findings through Post Assessment Evaluation of risks and/or compliance issues, industry best practices and opportunities for improvement providing a positive return on investment. RMS professionals with unique expertise in technical areas covered will be involved in this step; e. Report Generation: RMS will prepare the report taking into account potential verbal comments. Written recommendations will also be provided to assist in meeting your goal of continuous improvement. Phase H: RMS -Safety consultants will create or modify any written safety & health programs/policies and customize to meet current state of business and to allow for easy implementation. Will also assist PSM Champion with reviewing written Process Safety Management program, revising and/or establishing roles and responsibilities that focus on PSM, and assist in creating a usable checklist or guidelines toward minimum standard requirements. Phase III: FUTURE CONSIDERATION ONLY - RMS -Safety professionals will develop and deliver site-specific training programs at City of Carmel Utilities. The specific topics of these training programs will be determined during Phases I and R of this important project; and will include, but not limited to topics such as: Respiratory Protection and PPB, Hazard Communication 2012, Lockout/Tagout, Exposure Control for Blood Borne Pathogens, Emergency Planning and Fire Prevention, Fall Protection and equipment training on aerial lifts, powered industrial trucks and powered working platforms. Phase TV: FUTURE CONSIDERATION ONLY - RMS -Safety will work closely with the City of Carmel Utilities Safety Committee Members and Supervisors to help implement, manage, and sustain the occupational health & safety program. Exhibit 2f3 Your investment in the professional services of RMS -Safety within Phase I .... to conduct this Risk Management Assessment (RMA) will not to exceed $1520 ( i.e. 16 hrs. X $95.00). The estimate is based on prior experience completing similar audits. This initial assessment will serve as the baseline and help write and customize the written program and help prioritize the path forward plan. The initial or bulk portion of the RMA will be scheduled in IQ of 2018 with members of Carmel Utilities' Safety Committee. The additional Phase(s)s and on-going support will be delivered once the MGA baseline report is reviewed. RMS -Safety Service Deliverables (-32 Hours Phase I and Phase 11) ........... $95.00 per hour less applicable discounts *Time spent traveling to provide consulting services will be billed at the standard hourly rate, plus the prevailing IRS mileage reimbursement rate per mile as a fixed coast. Any other required travel accommodations (i.e. air fare, hotel, meals, equipment rental, etc) will be billed at cost. All invoices will be billed with "Net 30" terms. I authorize RMS -Safety to perform Phase I as indicated above and agree to all associated costs and terms with the remaining phases & payment schedule. Signature Date Exhibit 3cf3 • RMA — Baseline Audit (< or= 16 Hrs. ) • Written Policy (< or = 16 hrs.) • PSM Overview < or = 4 Hrs.) Est. HRS of Service •- 36 hrs Standard Pricing $95 / Hr Discount Rate -10% Total Cost $3078.00 10% Down Payment n/a Not to Exceed - Amount Deferred $3078.00 Monthly Payments nla *Time spent traveling to provide consulting services will be billed at the standard hourly rate, plus the prevailing IRS mileage reimbursement rate per mile as a fixed coast. Any other required travel accommodations (i.e. air fare, hotel, meals, equipment rental, etc) will be billed at cost. All invoices will be billed with "Net 30" terms. I authorize RMS -Safety to perform Phase I as indicated above and agree to all associated costs and terms with the remaining phases & payment schedule. Signature Date Exhibit 3cf3 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 Statutory Limits $100,000 each employee $250,000 each accident $500,000 policy limit $500,000 $500,000 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 FVAEAF 111/1Q1A6-L- AlkAl t✓i!54�- , 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 4N 3c«Mi I> T /N4' di -t RMO-5i e (the "Employer") in the position of i�P �, �/���5 y �? Jed i✓��+'� t S 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. 5. The Company does not knowingly employ any unauthorized aliens. FURTHER AFFIANT SAYETH NOT. EXECUTED on the day of /v/,"/e eAl , 20 lb 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 rep sentations are true and correct. i PLA T"I it 101.5 �r 1 Notary sHendricks Public, state of Indiana Hendri Nouy� ; + ,t. ♦- cks County Printed: . tEA� ,: Commission M 627228 •�MCIAM� • MY Commission Expires Juno 16, 2019 City of Carmel ONE CIVIC SQUARE CARMEL, INDIANA 46032 INDIANA RETAIL TAX EXEM CERTIFICATE NO. 003120155 002 0 FEDERAL EXCISE TAX EXEMPT 35-6000972 FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL - 1997 PAGE 'I PURCHASE ORDER NUMBER S03084 THIS NUMBER MUST APPEAR ON INVOICES, A/P VOUCHER, DELIVERY MEMO, PACKING SLIPS, SHIPPING LABELS AND ANY CORRESPONDENCE. PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. , DESCRIPTION 2/27/2018 365289 RMS Safety VENDOR Northwest Blvd Ste 230 Indianapolis IN Carmel Utilities SHIP 30 West Main St Ste 220 TO Carmel, IN 46032 CONFIRMATION I BLANKET I CONTRACT PAYMENTTERMS I FREIGHT QUANTITY I UNIT OF MEASURE I DESCRIPTION UNIT PRICE I EXTENSION 1.00 Each Baseline Risk Management 3,078.00 3,078.00 Assessment 01-7042-05 PLEASE INVOICE IN DUPLICATE Credit 0.00 Department Account Project Project Account AMOUNT PAYMENT 3,078.00 SHIPPING INSTRUCTIONS ' A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. SHIP PREPAID NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND ' C.O.D. SHIPMENTS CANNOT BE ACCEPTED VOUCHER HAS THE PROPER SWORN AFFADAVIT ATTACHED. PURCHASE ORDER NUMBER MUST APPEAR ON ALL ` I HEREBY CERTIFY THAT THERE IS AN OBLIGATED BALANCE IN SHIPPING LABELS THIS APPROPRIATION SUFFICIENT T PAY F T E ABOVE ORDER. THIS ORDER ISSUED IN COMPLIANCE WITH•CHAPTER 99, ACTS 1945 AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY TITLE DOCUMENT CONTROL NO. S03084 CLERK -TREASURER