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AGREEMENT FOR ENGINEERING DESIGN, BID AND CONSTRUCTION SUPPORT SERVICES WATER AND WAS TEW ATER CONVEYANCE SCAD A PROJECT BETWEEN CITY OF MOSCOW, IDAHO AND Z ENGINEERS, PLLC THIS AGREEMENT FOR ENGINEERING DESIGN, BID AND CONSTRUCTION SUPPORT SERVICES, BETWEEN CITY OF MOSCOW, IDAHO AND Z ENGINEERS, PLLC (hereinafter Agreement shall become effective the "Z-8 day of IJ O u € "1 0 2016, between the City of Moscow, a municipal corporation of the State of Idaho, (hereinafter "CITY"), 206 East Third Street, Moscow, Idaho, 83843, and Z Engineers, PLLC (hereinafter "ENGINEER"), One Fifth Street, Suite 150, Wenatchee, Washington, 98801. INTRODUCTION WHEREAS, CITY has a need for Engineering Design, Bid and Construction Support Services for the Water and Wastewater Conveyance Supervisory Control And Data Acquisition (SCADA) project (hereinafter "Project"); and WHEREAS, ENGINEER is specially trained, experienced and competent to perform and has agreed to provide such Services; NOW, THEREFORE, in consideration of the mutual promises, covenants, terms and conditions hereinafter contained, the parties agree as follows: A. Scope of Services Design Phase Services: TERMS AND CONDITIONS 1. One initial site visit to tour the existing stations with CITY staff, document existing conditions, and obtain as-built information; 2. Communications alternative coordination, including fiber optic and radio system evaluation and equipment selection; 3. Coordination with other design professionals and contractors at sites under construction, for equipment and communications requirements; 4. Coordination with CITY during design to obtain additional site-specific information, photos, etc., needed for design; 5. Design drawing development is estimated to include: a. Cover Sheet; b. SCADA and Telemetry System Overview; c. Communications System Overview; d. Typical Remote Panel Elevation; e. Typical Remote Panel I/O Diagrams; PROFESSIONAL ENGINEERING SERVICES Z ENGINEERS, PLLC AND CITY PAGE 1OF11 ---PAGE BREAK--- f. Panel Elevation; g. Panel I/O Diagrams; h. Site Specific Details - Booster sites (two sheets); i. Site Specific Details - Well sites (two sheets); J. Site Specific Details - Lift Station sites (two sheets); k. Site Specific Details - Projects with PLC by others (two sheets). 6. Develop technical specifications for the remote site hardware, communications equipment, and SCADA system hardware, software, and programming requirements. Specifications will be in standard CSI format. 7. Prepare estimate for probable construction cost starting at sixty percent (60%) design, and update at each design milestone; 8. Attend one on-site meeting with CITY following sixty percent (60%) design submittal for design document review, evaluation of SCADA alternatives, and additional data gathering; 9. Ninety percent (90%) design submittal and teleconference review meeting, incorporate CITY review comments; 10. One hundred percent (100%) design submittal and review meeting, on site, incorporate final review comments; 11. Prepare and deliver stamped and signed plans, specifications and cost estimate; and 12. Project Management, QA, QC. Bid Support Services: 1. Attend pre-bid meeting at CITY; 2. Answer telephone calls and respond to technical questions from contractors; 3. Prepare addenda as required; 4. Review bid price and contractor qualifications with CITY; Construction Support Services: 1. Attend pre-construction meeting at CITY; 2. Written responses to RFI's, change order requests, and contractor support during construction; 3. Review of contractor submittals and written review comments; 4. Two site visits during the construction to verify installation progress; 5. One site visit at substantial completion to witness system testing and overall system functionality (two days). 6. Review contractor O&M, system testing and verification documentation, and as-built drawings for completeness and accuracy; and 7. Project management and closeout. Deliverables: All deliverables will be provided in electronic pdf format. 1. Design drawings, specifications and cost estimate at each milestone; 2. Stamped and signed plans, specifications and cost estimate (PS&E); 3. Addenda; and 4. Written responses to RFI's and submittal reviews. PROFESSIONAL ENGINEERING SERVICES Z ENGINEERS, PLLC AND CITY PAGE20F 11 ---PAGE BREAK--- Exclusions: Not included in this Agreement are programming and commissioning of SCADA and telemetry system. B. Terms 1. Upon execution of this Agreement AND any associated Task Order(s) and receipt of CITY' s written notice to proceed, ENGINEER shall comply in all respects and perform and furnish to CITY, all Services listed in any corresponding task order(s) incorporated herein by this reference, together with any amendments that may be agreed to in writing by the parties. 2. All documents or materials acquired or produced by the ENGINEER in conjunction with the Project shall become the property of, and be delivered to, CITY without any restrictions or limitations with respect to their further use thereof. All documents or materials prepared for CITY shall not be distributed by ENGINEER, sub-engineers, their agents, representatives or employees to any third party without the express written consent of CITY. Use of these documents by CITY on any other project, without written verification or adaptation by ENGINEER for the specific purpose intended, will be at CITY's sole risk and shall be without liability or legal exposure to ENGINEER. 3. ENGINEER shall provide Services and work under this Agreement consistent with the requirements and standards established by applicable Federal, State and local laws, ordinances, regulations, and resolutions. ENGINEER represents and warrants that ENGINEER will perform work in accordance with generally accepted industry standards and practices for the profession or professions that are used in performance of this Agreement, and resulting task order(s) in effect at the time of performance of this Agreement, and associated task order(s). Except for that representation and any representations made or contained in any proposal submitted by ENGINEER and any reports or opinions prepared or issued as part of the work performed by ENGINEER under this Agreement, ENGINEER makes no other warranties, either express or implied, as part of this Agreement. 4. Services and work provided by ENGINEER at CITY's request under this Agreement will be performed in a timely manner in accordance with a Schedule of Work, which the parties hereto shall agree to. The Schedule of Work may be revised from time to time upon mutual written consent of the parties. C. Consideration 1. ENGINEER shall perform the Services on a time and materials basis for a Not-To Exceed total fee of forty eight thousand five hundred thirty dollars ($48,530) as outlined in Exhibit Compensation Estimate. Design phase services are estimated at current 2016 hourly rates, with bid and construction phase services estimated at 2017 hourly rates. Billing will be based on PROFESSIONAL ENGINEERING SERVICES Z ENGINEERS, PLLC AND CITY PAGE3OF11 ---PAGE BREAK--- the standard rates at the time of service. Payment terms will be Net Thirty (30) days from invoice date. 2. ENGINEER shall provide CITY with incurred invoices, as Services warrant, of fees earned and costs incurred for Services provided during the billing period, which CITY will pay within thirty (30) days of receipt of a correct invoice and approval by CITY. CITY will not withhold any Federal or State income taxes or Social Security Tax from any payment made by CITY to ENGINEER under the terms and conditions of this Agreement. Payment of all taxes and other assessments on such sums is the sole responsibility of ENGINEER. D. Time of Performance Schedule: ENGINEER will provide the design phase deliverables within one hundred twenty (120) days of receipt of an approved Agreement and formal notice to proceed. Bid phase services are expected to be provided in early 2017, with construction during the spring and summer of 2017. E. Independent Contractor 1. In all matters pertaining to this Agreement, ENGINEER shall be acting as an independent contractor, and neither ENGINEER nor any officer, employee or agent of ENGINEER will be deemed an employee of CITY. 2. ENGINEER shall determine the method, details and means of performing the work and Services to be provided by ENGINEER under this Agreement. ENGINEER shall be responsible to CITY only for the requirements and results specified in this Agreement and, except as expressly provided in this Agreement, shall not be subjected to CITY's control with respect to the physical action or activities of ENGINEER in fulfillment of this Agreement. F. Indemnification and Insurance ENGINEER shall indemnify and save and hold harmless CITY from and for any and all losses, claims, actions, judgments for damages, or injury to persons or property and losses and expenses and other costs including litigation costs and attorney's fees, arising out of, resulting from, or in connection with the negligent acts and/or errors or omissions by ENGINEER, its servants, agents, officers, employees, guests, and business invitees, and not caused by or arising out of the negligent conduct of CITY or its employees. ENGINEER shall maintain, and specifically agrees that it will maintain, throughout the term of this Agreement, liability insurance in the minimum amounts as follow: General Liability One Million Dollars ($1,000,000) per incident or occurrence, Professional Liability I Professional errors and omissions One, Million Dollars ($1,000,000) aggregate, Automobile Liability Insurance One Million Dollars ($1,000,000) per incident or occurrence, and Workers' Compensation Insurance, in the statutory limits as required by law. CITY shall be named as PROFESSIONAL ENGINEERING SERVICES Z ENGINEERS, PLLC AND CITY PAGE4 OF I I ---PAGE BREAK--- an additional insured on both General Liability and Automotive policies. The limits of insurance shall not be deemed a limitation of the covenants to indemnify and save and hold harmless CITY; and if CITY becomes liable for an amount in excess of the insurance limits, herein provided, ENGINEER covenants and agrees to indemnify and save and hold harmless CITY from and for all such losses, claims, actions, or judgments for damages or injury to persons or property and other costs, including litigation costs and attorneys' fees, arising out of, resulting from, or in connection with the negligent performance of this Agreement by ENGINEER or ENGINEER's officers, employees, agents, representatives or subcontractors and resulting in or attributable to personal injury, death, or damage or destruction to tangible or intangible property. ENGINEER shall provide CITY with a Certificate of Insurance, or other proof of insurance evidencing ENGINEER's compliance with the requirements of this paragraph and file such proof of insurance with CITY at least ten (10) days prior to the date ENGINEER begins performance of its obligations under this Agreement. In the event the insurance minimums are changed, ENGINEER shall immediately submit proof of compliance with the changed limits. Evidence of all insurance shall be submitted to CITY Engineer with a copy to CITY's Finance office, and to the City Clerk, 206 East Third Street, P 0 Box 9203, Moscow, Idaho, 83843. G. Notices Any and all notices required to be given by either of the parties hereto, unless otherwise stated in this Agreement, shall be in writing and be deemed communicated when mailed in the United States mail, certified, return receipt requested, addressed as follows: ENGINEER Z Engineers, PLLC Brian Ziesmer, P One Fifth Street, Suite 150 Wenatchee, WA 98801 (509) 888-9364 CITY City of Moscow, Idaho Les MacDonald 206 East Third Street P 0 Box 9203 Moscow, ID 83843 (208) 883-7028 Either party may change their address for the purpose of this paragraph by giving written notice of such change to the other in the manner herein provided. H. Assignment It is expressly agreed and understood by the parties hereto, that ENGINEER shall not have the right to assign, transfer, hypothecate or sell any of its rights under this Agreement except upon the prior express written consent of CITY. I. Discrimination Prohibited In performing the Services required herein, ENGINEER shall not unlawfully discriminate in violation of any Federal, State or local law, rule or regulation against any person on the basis of race, color, religion, gender, pregnancy, national origin, ancestry, age, marital status, PROFESSIONAL ENGINEERING SERVICES Z ENGINEERS, PLLC AND CITY PAGES OF 11 ---PAGE BREAK--- veteran status, disability, sexual orientation, genetic information, or any other basis prohibited by Federal, State, or local law. J. Reports and Information 1. At such times and in such forms as CITY may require, there shall be furnished to CITY such statements, records, reports, data and information as CITY may request pertaining to matters covered by this Agreement. 2. ENGINEER shall maintain all writings, documents and records prepared or compiled in connection with the performance of this Agreement for a minimum of five years from the termination or completion of this Agreement. This includes any handwriting, typewriting, printing, photo static, photographic and every other means of recording upon any tangible thing, any form of communication or representation including letters, words, pictures, sounds or symbols or any combination thereof. K. Audits and Inspections At any time during normal business hours and as often as CITY may deem necessary, there shall be made available to CITY for examination, all of ENGINEER's records with respect to all matters covered by this Agreement. ENGINEER shall permit CITY to audit, examine, and make excerpts or transcripts from such records, and to make audits of all contracts, invoices, materials, payrolls, records of personnel, conditions of employment and other data relating to all matters covered by this Agreement. L. Publication, Reproduction and Use of Material No material produced in whole or in part under this Agreement shall be subject to copyright in the United States or in any other country. CITY shall have unrestricted authority to publish, disclose and otherwise use, in whole or in part, any reports, data or other materials prepared under this Agreement. M. Compliance with Laws In performing the scope of Services required hereunder, ENGINEER shall comply with all applicable laws, ordinances, and codes of Federal, State, and local governments. N. Public Information Pursuant to Idaho Code Section 74-124, et seq., information or documents received from ENGINEER may be open to public inspection and copying unless exempt from disclosure. ENGINEER shall clearly designate individual documents as "exempt" on each page of such documents and shall indicate the basis for such exemption. CITY will not accept the marking of an entire document as exempt. In addition, CITY will not accept a legend or statement on one page that all, or substantially all, of the document is exempt from disclosure. ENGINEER shall indemnify and defend the CITY against all liability, claims, damages, losses, expenses, actions, attorney fees and suits whatsoever for honoring such a designation PROFESSIONAL ENGINEERING SERVICES Z ENGINEERS, PLLC AND CITY PAGE 6OF11 ---PAGE BREAK--- or for ENGINEER's failure to designate individual documents as exempt. ENGINEER's failure to designate as exempt any document or portion of a document that is released by CITY, shall constitute a complete waiver of any and all claims for damages caused by any such release. 0. Changes CITY may, from time to time, request changes in the Scope of Services to be performed hereunder. Such changes, including any increase or decrease in the amount of ENGINEER's compensation, which are mutually agreed upon by and between CITY and ENGINEER, shall be incorporated in written amendments to this Agreement. P. Termination 1. If, through any cause, ENGINEER, its officers, employees, or agents fails to fulfill in a timely and proper manner its obligations under this Agreement, violates any of the covenants, agreements, or stipulations of this Agreement, falsifies any record or document required to be prepared under this Agreement, engages in fraud, dishonesty, or any other act of misconduct in the performance of this Agreement, or if the City Council determines that termination of this Agreement is in the best interest of CITY, CITY shall thereupon have the right to terminate this Agreement by giving written notice to ENGINEER of such termination and specifying the effective date thereof, at least fifteen (15) days before the effective date of such termination. ENGINEER may terminate this Agreement at any time by giving at least sixty (60) days' notice to CITY. 2. In the event of any termination of this Agreement, all finished or unfinished documents, data, and reports prepared by ENGINEER under this Agreement shall, at the option of CITY, become CITY's property, and ENGINEER shall be entitled to receive just and equitable compensation for any work satisfactorily completed hereunder. 3. Notwithstanding the above, ENGINEER shall not be relieved of liability to CITY for damages sustained by CITY by virtue of any breach of this Agreement by ENGINEER, and CITY may withhold any payments to ENGINEER for the purposes of set-off until such time as the exact amount of damages due CITY from ENGINEER is determined. This provision shall survive the termination of this Agreement and shall not relieve ENGINEER of its liability to CITY for damages. Q. Construction and Severability If any part of this Agreement is held to be invalid or unenforceable, such holding will not affect the validity or enforceability of any other part of this Agreement so long as the remainder of the Agreement is reasonably capable of completion. R. Advice of Attorney Each party warrants and represents that in executing this Agreement, it has received independent legal advice from its attorneys or the opportunity to seek such advice. PROFESSIONAL ENGINEERING SERVICES Z ENGINEERS, PLLC AND CITY PAGE 7OF11 ---PAGE BREAK--- S. Entire Agreement This Agreement contains the entire agreement of the parties and supersedes any and all other agreements or understandings, oral of written, whether previous to the execution hereof or contemporaneous herewith. T. Appropriations and Approval Any and all obligations of CITY under this Agreement may be subject to annual approval and/or budgeting and appropriation by CITY. U. Applicable Law It is agreed that this AGREEMENT shall be construed under and governed by the laws of the State of ldaho. In the event of litigation concerning it, it is agreed that proper venue shall be the District Court of the Second Judicial District of the State of Idaho, in and for the County of Latah. Should any litigation be commenced between the parties hereto concerning this Agreement, the prevailing party shall be entitled, in addition to any other relief as may be granted, to court costs and reasonable attorneys' fees as determined by a Court. V. Approval Required This Agreement shall not become effective or binding until approved by the Mayor and Council of the City of Moscow. ENGINEER Z Engineers, PLLC PROFESSIONAL ENGINEERING SERVICES Z ENGINEERS, PLLC AND CITY CITY City of Moscow, Idaho Approved as to Form Roderick Hall, City Attorney PAGE 8OF11 ---PAGE BREAK--- STATE OF Q -HJ Nu:. I c ' COUNTY OF G· 11- NJ ACKNOWLEDGMENT ) ) SS. ) On this - day of tJ U tA1\ , 2016, before me, a Notary Public in and for said State, appeared 1 LJ 'l \ QL. known to me to be the person named above and acknowledged that he/she executed the foregoing document as the duly authorized representative for Z Engineers, PLLC. PROFESSIONAL ENGINEERING SERVICES Z ENGINEERS, PLLC AND CITY PAGE9OF11 ---PAGE BREAK--- EXHIBIT Z Engineers, PLLC Engineering Fee Estimate October 27, 2016 City of Mosccw Water and Wastewater Conveyance SCADA Project Design Phase Services (2016 rates) Task Description A Oeslgn servtces 1 lntitial site visit and meeting with City 2 Communications alternatives evaluation 3 Coordination for sites under construction 4 City design coordination 5 Design Drawings: (estimated) Cover Sheet SCADA and Telemetry System Overview Communications System Overview Typical Remote Panel Elevation Typical Remote Panel 110 Diagrams Master Panel Elevation Master Panel 110 Diagrams Site Specific Details - Booster sites (2 sheets) Site Specific Details - Well sites (2 sheets) Site Specific Details - Lift Station sites (2 sheets) Site Specific Details - Projects by others (2 sheets) 6 Technical specification development 7 Develop estimate of probable construction costs 8 Site visit for 60% review, SCADA meeting, data gathering 9 Design submittal at 90% and review meeting at City 10 Design submittal at 100% and telecon review meeting 11 Bid document submittal 12 Project Management, QA, QC, scheduling, misc 13 Mileage and Expenses - Wenatchee to Moscow - 3 trips Total - Oesian Total Estimated Hours: PROFESSIONAL ENGINEERING SERVICES Z ENGINEERS, PLLC AND CITY EXHIBIT Principal Engineer Brian Ziesmer P.E. $140 8 4 4 6 1 1 1 1 1 1 2 2 2 2 12 8 8 8 2 6 24 104 Engineer II Wesley Tech Ill Tech Ill Ward Adam Greg EIT Bluher Henn $120 $115 $115 Total 120 16 $2,400 8 $1,480 12 $2,220 1 $115 8 $1,060 8 $1,060 6 $830 6 $830 6 $830 6 $830 16 $2,120 16 $2,120 16 $2,120 16 $2,120 8 $2,600 6 $1,810 4 $1,580 4 $1,580 4 $740 2 $1,070 $3,360 $350 $34,345 169 273 PAGE lOOF 11 ---PAGE BREAK--- Z Engineers, PLLC Engineering Fee Estimate October 27, 2016 City of Moscow Water and Wastewater Conveyance SCADA Project Bid and Construction Support Services (2017 rates) Task Description ti 1c1u:upponserv1ces 1 Attend pre.bid meeting at City 2 Telephone support for technical questions 3 A<:ldenda preparation 4 Ski and qualification review with City 5 Mileage - Wenatchee to Mosoow - 1 trips Total - Bid SUDDOrt 1construct1on support services 1 Attend pre-construction meeting at City 2 Written responses to RF l's and contractor requests 3 Review of contractor submittals 4 Two site visits during construction 5 One site visit for witness testing (2 days) 6 Review contractor O&M and final docs 7 Project Management and closeout 8 Mileage - Wenatchee to Moscow - 4 trips Total - Construction Suooort l ota1 i::,st1matea Hours: PROFESSIONAL ENGINEERING SERVICES Z ENGINEERS, PLLC AND CITY EXHIBIT Principal Engineer Brian Ziesmer P.E. $145 8 8 4 2 8 1 2 4 16 1 6 4 2 84 Engineer II Wesley Tech Ill Tech Ill Ward Adam Greg EIT Bluher Henn $125 $120 $120 Total 160 $1,160 $580 $290 $115 $3,305 $1,160 $1,740 12 $2,020 $2,320 $2,320 $580 $290 $450 $10,880 1 2 96 PAGE 11 OF11 ---PAGE BREAK--- Form W-9 Request for Taxpayer Give Form to the (Rev. December 2014) Identification Number and Certification requester. Do not Department of the Treasury send to the IRS. Internal Revenue Service 1 Nama (as shown on your Income tax retum). Name is required on this lino; do not leave this line blank. Z Engineers PLLC C\i 2 Business name/disregarded entity name, If different from above Q) gi Q. 3 Check appropriate box for federal tax classification; check only one of the following seven boxes: 4 Exemptions (codes apply only to c: 0 0 proprietor or 0 C Corporation lZJ S Corporation 0 Partnership 0 TrusVestate certain entities, not individuals; see iJ instructions on page single-member LLC Exempt payee code (if any) 0 Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) Note. For a single-member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for Exemption from FATCA reporting the tax classification of the single-member owner. code (if any) ;f . 0 Other (see Instructions) (Appllas lo accounts malntaln9d ouls/de lhe U.S.) l 5 AddreJIS (number. street, and apt. or suite no.) Requester's name and address (optlonaQ 1 Fifth Street, Suite 150 II) 6 City, state, and ZIP code a! en Wenatchee, WA 98801 7 List account number(s) here (optional) · Taxpayer Identification Number (TIN} Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid I Social security number I . . . . backup withholding. For individuals, this Is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. DJ] -I I I I I or Note. If the account Is In more than one name, see the instructions for line 1 and the chart on page 4 for guidelines on whose number to enter. I Employer Identification number 2 0 - 4 5 6 5 7 7 7 Certification Under penalties of perjury, I certify that: 1. The number shown on this form Is my correct taxpayer identification number (or I am waiting for a number to be Issued to me); and 2. I am not subject to backup withholding because: I am exempt from backup withholding, or I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or the IRS has notified me that I am no longer subject to backup withholding; and 3. I am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (If any) Indicating that I am exempt from FATCA reporting Is correct. Certification Instructions. You must cross out item 2 above If you have been notified by the IRS that you are currently subject to backup withholding because you have failed 'to report all Interest and d!victends on your tax return. For real estate transactions, Item 2 does not apply. For mortgage Interest patd, acquisition or abandonment of secured property, cancellation of debt, contributions to an Individual retirement arrangement (IRA), and generally, payments other than Interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the Instructions on page S. Sign Signature ol Here u.s. person General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. Information about developments affecting Form W-9 (such as legislation enacted after we release II) is at www.irs.gov/fw9. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (!TIN), adoption taxpayer identification number (ATIN), or employer Identification number (EIN), to report on an Information return the amount paid to you, or other amount reportable on an Information return. Examples of Information returns Include, but are not limited to, the following: • Form 1099-INT (interest earned or paid) • Form 1099-DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) Date r -2-S: - 2oL / •Form 1098 (home mortgage Interest), 1098-E (student loan interest), 1098·T tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandon men I of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding? on page 2. By signing the filled-out form, you: 1. Certify that the TIN you are giving Is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business Is not subject to the withholding tax on foreign partners' share of effectively connected income, and 4. Certify that FATCA code(s) entered on this form (If any) indicating that you are exempt from the FATCA reporting, is correct. See What is FATCA reporting? on page 2 for further information. Cat. No. 10231X Form W-9 (Rev. 12-2014) ---PAGE BREAK--- ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) 7/13/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 1,,VNll'<,.I NAME: Mitchell Reed & Schmitten Insurance, Inc r g,QN,_\=n Exll • (509)665-0500 I r.e- Nol: (509) 664-4004 124 E. Penny Road, Suite 101 E-MAIL ADDRESS: Wenatchee, WA 98801 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A :American Economv Insurance Co 19690 INSURED INSURER B :Beazl.ev Insurance Co. Z Engineers, PLLC INSURERC: 1 5th St Ste 150 INSURERD; Wenatchee, WA 98801 INSURER E: INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR A A A B TYPE OF INSURANCE x COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: DPRO- POLICY JECT OTHER: AUTOMOBILE LIABILITY - ANY AUTO Owe - ALL OWNED - SCHEDULED - AUTOS - AUTOS x x NON-OWNED HIRED AUTOS AUTOS - - UMBRELLA LIAB H OCCUR - EXCESS LIAB CLAIMS-MADE OED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE D OFFICER/MEMBER EXCLUDED? (Mandatory in NH) kl;mnfoirgp ()'f'i)PERA TIONS below PROFESSIONAL LIABILITY CLAIMS MADE FORM AODLISUt>I< POLICY EFF 1hi&'6j1 LIMITS POLICY NUMBER fMM/DD/YYYYI EACH OCCURRENCE $ DAMAGE TO 1<1:1' 1 t:u PREMISES fEa occurrencel $ 02BP88504570 4/21/2016 4/21/2017 MED EXP {Any one person) $ PERSONAL & ADV INJURY $ GENERALAGGREGATE $ PRODUCTS ·COMP/OP AGG $ $ LIMll $ BODILY INJURY {Per person) $ 02BP88504570 4/21/2016 4/21/2017 BODILY INJURY {Per accidenl) $ PROPERTY DAMAGE f Par acddenll $ NON-OWNED & HIRED LIAS. $ EACH OCCURRENCE $ AGGREGATE $ $ WA State - Employers I 3fTUTE I I +kH· N / A Contingent Liab-Stop Gap E.L. EACH ACCIDENT $ 02BP88504570 4/21/2016 4/21/2017 E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ Vl5SlU160801 4/21/2016 4/21/2017 PER CLAIM AGGREGATE DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Evidence of Insurance CERTIFICATE HOLDER CANCELLATION 2,000,000 2,000,000 10,000 2,000,000 4,000,000 4,000,000 2,000,000 1,000 000 1,000 000 1 000 000 2,000,000 2,000,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TO BE USED FOR INFORMATION ONLY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CALL [PHONE REDACTED] or [PHONE REDACTED] ACCORDANCE WITH THE POLICY PROVISIONS. MITCHELL, REED & SCHMITTEN INS TO ADD ANY CERTIFICATE HOLDERS AUTHORIZED REPRESENTATIVE Lori Reed/JS -c;;t;.e.clll£ ti!. © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) INS0251?014011 The ACORD name and logo are registered marks of ACORD