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HomeMy WebLinkAboutContract 2011 2367 (;;oit :2367 AGREEMENT FOR SERVICES PERFORMED BY INDEPENDENT CONTRACTOR THIS AGREEMENT is made on the clay of , 2011, between the CITY OF COLUMBIA HEIGHTS ( "City"), whose business address is 590 - 40 Ave. NE, Columbia Heights, MN 55421, and Johnson's Outdoor Service ( "Contractor "), whose business address is _P.O. Box- 32947, Fridley; -MN -- 55432. THE CITY AND CONTRACTOR AGREE AS FOLLOWS: 1. Independent Contractor. The City hereby retains the Contractor as an independent contractor upon the terms and conditions set forth in this Agreement. The Contractor is not an employee of the City and is free to contract with other entities as provided herein. Contractor shall be responsible for selecting the means and methods of performing the work. Contractor shall furnish any and all supplies, equipment, and incidentals necessary for Contractor's performance under this Agreement. City and Contractor agree that Contractor shall not at any time or in any manner represent that Contractor or any of Contractor's agents or employees are in any manner agents or employees of the City. Contractor shall be exclusively responsible under this Agreement for Contractor's own FICA payments, workers compensation payments, unemployment compensation payments, withholding amounts, and /or self-employment taxes if any such payments, amounts, or taxes are required to be paid by law or regulation. 2. Contractor's Services. The Contractor agrees to provide services as described in Exhibit A, attached and made a part of this Agreement. The Contractor shall, in the execution of services, conform to all applicable federal, state, and local laws, codes, ordinances, and regulations. 3. Time for Performance of Services. The Contractor shall perform the services according to Exhibit A. 4. Compensation for Services. The City agrees to pay the Contractor for services as described in Exhibit A. Compensation shall be in accordance with Exhibit B, attached and made a part of this Agreement. 5. Method of Payment. The Contractor shall submit to the City, on a monthly basis, itemized bills for professional services performed under this Agreement. Bills submitted shall be paid in the same manner as other claims made to the City. 6. Termination. Either party, without cause, may terminate this Agreement by seven (7) days' written notice delivered to the other party at the address written above. After termination, the City shall have no further obligation to Contractor except to compensate Contractor for services performed before Contractor's receipt of notice of termination. 7. Subcontractor. The Contractor shall not enter into subcontracts for services provided under this Agreement, except as noted in Exhibit A, without the express written consent of the City. 8. Assignment. Neither party shall assign this Agreement, or any interest arising herein, without the written consent of the other party. 4 9. Indemnification. Contractor agrees to defend, indemnify and hold the City, its officers, and employees harmless from any liability, claims, damages, costs, judgments, or expenses, including reasonable attorney's fees, resulting directly or indirectly from an act or omission (including without limitation professional errors or omissions) of the Contractor, its agents, employees, or subcontractors in the performance of the services provided by this Agreement and against all losses by reason of the failure of said Contractor fully to perform, in any - respect all - obligations Mulder -this Agreement: 10. Workers Compensation Insurance. Worker's compensation coverage shall be furnished meeting minimum requirements of Minnesota law. The Contractor shall provide proof of workers' compensation coverage and shall execute the form attached hereto. 11. Records Access. The Contractor shall provide the City access to any books, documents, papers, and records which are directly pertinent to the Agreement, for the purpose of making audit, examination, excerpts, and transcriptions, for three years after final payments and all other pending matters related to this Agreement are closed. 12. General Liability Lisurance. The Contractor shall provide the City a Certificate of Insurance complying with the standard contractor's minimum coverage requirements of $1,000,000. combined single limit naming the City of Columbia Heights as an additional insured. Contractor's liability policy shall be so endorsed with a copy delivered to the City. 13. Data Privacy. The Contractor shall comply with Minnesota Statutes Chapter 13, The Minnesota Government Data Practices Act. The Contractor shall not disclose non- public information except as authorized by the Act. 14. Ownership of Documents. All plans, diagrams, analyses, reports, and information generated in connection with performance of the Agreement shall become the property of the City. The City may use the information as it sees fit. Such use by the City shall not relieve any liability on the part of the Contractor. 15. Governing Law. The laws of the State of Minnesota shall control this Agreement. Executed as of the day and year first written above. CITY OF COL /, ID IA HFI CO / TRA TOR: —141. Mayer. / TL By: f 1)1r1J0nr5, A ' ‘-1 (;,,id City Administrat r i Attest 11 _ ; I/_.a._r.� City :7-lerk / PROOF OF WORKERS' COMPENSATION INSURANCE COVERAGE Minnesota Statutes Section 176.182 requires every governmental subdivision entering into a contract for doing any public work to obtain acceptable evidence of compliance with the workers' compensation insurance coverage requirement of Section 176.181, subd. 2. The - information - required - -is. - the - name - -of -the insurance company,- the - policy- number, - and - dates -of coverage or the permit to self- insure. This information will be collected by the licensing agency and put in their company file. It will be furnished, upon request, to the Department of Labor and Industry to check for compliance with Minnesota Statutes Section 176.181, subd. 2. This information is required by law, and a contract for the doing of any public work may not be entered into if it is not provided and /or is falsely reported. Furthermore, if this information is not provided and /or is falsely reported, it may result in a penalty assessed against the applicant by the Commissioner of the Department of Labor and Industry payable to the Special Compensation Fund. Provide the information specified above in the spaces provided, or certify the precise reason your business is excluded from compliance with the insurance coverage requirement for workers' compensation. ,` A� ) l� \�� INSURANCE COMPANY NAME: VA U V (NOT the insurance agent) POLICY NO. OR SELF - INSURANCE PERMIT NO.: DATES OF COVERAGE: I 4/ Y 3-- + z_ - OR- I am not required to have workers' compensation liability coverage because: ❑ I have no employees covered by the law. ❑ Other (specify): I HAVE READ AND UNDERSTAND MY RIGHTS AND OBLIGATIONS WITH REGARD TO PUBLIC CONTRACTS AND WORKERS' COMPENSATION COVERAGE, AND I CERTIFY THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT. L, Contra for (Signet i City of Columbia Heights Fire Department 825 - 41 Ave. NE Columbia Heights, MN 55421 Telephone Number (763) 706 -8150 TALL GRASS AND WEED REMOVAL QUOTE FORM 7I1 wScirl(5 0)/(/' c-7/1 r Charge Per Hour (quote shall be for time spent on property and 1 4 , can not include travel time) City will pay minimum of one hour and quarter ho increments there /1 ( a, j 1- f; after. �! Company Name o � (78. Address City /State /Zip Code C Name d 'J , 3 1 A1LSO - r) Contact E -mail // )75A n .< D U f j6 6 r C o idv Business Phone Number `'f _ �s 7., j 777 Cell /Pager /Fax Numbers //-5- C J / RECENED MAR 4 2011 HTS tiRE LJE 0-6 e f.Q .SA G u.1 dJ P o 1 IALQ s)--;11 g-e P j h ove rni n i my a City of Columbia Heights Tall Grass and Weed Removal Program Exhibit A Description of Work Contractor will perform the foIIowing: (a) Contractor shall thoroughly familiarize themselves with City ordinances and State laws dealing with noxious weeds and long grass. (b) Contractor shall, within two business days, cut or remove weeds and long grass as instructed by the Fire Department or his representative. Removal of weeds and long grass includes trimming along all fences, walls and structures, trimming around all trees and permanent objects, and the mulching or removal of all clippings. (c) Digital photo's shall be taken on every property prior to cutting and after cutting and shall be retained by contractor. City of Columbia Heights Tall Grass and Weed Removal Program Exhibit B Contractor Information Johnson's Outdoor Service PO Box 32947 Fridley, MN 55432 (w) 763 - 757 -1797 j ohnsonsoutdoor.com Contacts: Chad Johnson Pricing $49 minimum for first hour. Time over the initial hour will be paid at $12.25 for quarter hour increments. Upon arrival if yard is already cut, there will be a one hour trip charge minimum of $49. Form W Request for Taxpayer Give form to the (Rev. November 2005) Identification Number and Certification requester. Do not Department of the Treasury send to the IRS. Internal Revenue Service N Name (as shown on your income tax return) e NrN 0) o- Business name, if different from abov 0 c �p� riS�1 S CA) -} �fiY ' Y 01 ( S IndividuaV ❑ Exempt from backup •� Check appropriate box: Sole proprietor 111 Corporation ❑ Partnership ❑ Other ■ withholding a C Address (number"'eet, an d apt. ` or suite no.) Requester's name and address (optional) City, state, and zl 4 ‘ � v a. List account number(s) here (optional) Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid Social security number backup withholding. For individuals, this is your social security number (SSN). However, for a resident I I I 1. I I I 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. or Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose Employer identification number !! number to enter. AEI (t // e�4 r�l oI '(1 t Part II 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: (a) I am exempt from backup withholding, or (b) 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 (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. I am a U.S. person (including a U.S. resident alien). 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 dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than inter t and dividends, you are not required to sign the Certification, but you must provide your correct TIN. (See the instr ctions page 4.) Sign Signature of •', f 1 Here U.S. person • V ' Date • • Purpose of Form • An individual who is a citizen or resident of the United A person who is required to file an information return with the States, IRS, must obtain your correct taxpayer identification number • A partnership, corporation, company, or association (TIN) to report, for example, income paid to you, real estate created or organized in the United States or under the laws transactions, mortgage interest you paid, acquisition or of the United States, or abandonment of secured property, cancellation of debt, or • Any estate (other than a foreign estate) or trust. See contributions you made to an IRA. Regulations sections 301.7701 -6(a) and 7(a) for additional U.S. person. Use Form W -9 only if you are a U.S. person information. (including a resident alien), to provide your correct TIN to the Special rules for partnerships. Partnerships that conduct a person requesting it (the requester) and, when applicable, to: trade or business in the United States are generally required 1. Certify that the TIN you are giving is correct (or you are to pay a withholding tax on any foreign partners' share of waiting for a number to be issued), income from such business. Further, in certain cases where a 2. Certify that you are not subject to backup withholding, or Form W -9 has not been received, a partnership is required to presume that a partner is a foreign person, and pay the 3. Claim exemption from backup withholding if you are a withholding tax. Therefore, if you are a U.S. person that is a U.S. exempt payee. partner in a partnership conducting a trade or business in the In 3 above, if applicable, you are also certifying that as a United States, provide Form W -9 to the partnership to U.S. person, your allocable share of any partnership income establish your U.S. status and avoid withholding on your from a U.S. trade or business is not subject to the share of partnership income. withholding tax on foreign partners' share of effectively connected income. The person who gives Form W -9 to the partnership for purposes of establishing its U.S. status and avoiding Note. If a requester gives you a form other than Form W -9 to withholding on its allocable share of net income from the request your TIN, you must use the requester's form if it is partnership conducting a trade or business in the United substantially similar to this Form W -9. States is in the following cases: For federal tax purposes, you are considered a person if you • The U.S. owner of a disregarded entity and not the entity, are: Cat. No. 10231X Form W -9 (Rev. 11 -2005) • Minnesota Workers' Compensation Assigned Risk Plan Standard Workers' Compensation and Employers' Liability Policy Contract Administrator: RTW Inc. C NCCI Carrier Code: 39579 P.O. Box 390901 Minneapolis, Minnesota 55439 -0901 1- 888 - 273 -9709 INFORMATION PAGE WCIP Renewal of No. MNAR - 0000016914 -3 Policy Number: MNAR- 0000016914 -4 Association File Number: 3223068 1. — The Insured Chad Johnson Tax ID #: 412020361 DBA: Johnson's Outdoor Services UIC #: Exempt PO Box 32947 Date of Mailing: 03/14/2011 Fridley, MN 55432 X Individual Partnership Other workplaces not shown above: SEE WC990601 Corporation Other 2. — The policy period is from 12:01 a.m. 03/13/2011 to 12:01 a.m. 03/13/2012 at the insured's mailing address. 3. A. Workers' Compensation Insurance: Part One of the policy applies to Workers' Compensation Law of the state(s) listed here: MN B. Employers' Liability Insurance: Part Two of the policy applies to work in each state listed in ITEM 3.A.: The limits of our liability under Part Two are: Bodily Injury by Accident $1,000,000 Each Accident Bodily Injury by Disease $1,000,000 Each Employee Bodily Injury by Disease $1,000,000 Policy Limit C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: D. This policy includes these endorsements and schedules: See POLICY FORM AND ENDORSEMENT SCHEDULE attached. 4. The premium for this policy will be determined by our Manual of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. PREMIUM BASIS RATES CODE ENTRIES IN THIS ITEM, EXCEPT AS SPECIFICALLY ESTIMATED ESTIMATED PER $100 OR NO. PROVIDED ELSEWHERE IN THIS CONTRACT; DO NOT ANNUAL TOTAL ANNUAL REMUNERATION MODIFY ANY OF THE OTHER PROVISIONS OF THIS POLICY. PREMIUM REMUNERATION Manual Premium $0 See Schedule Increased Employer Liability Limits 9812 5.00% $150 Standard Premium $150 Merit Rating Credit (.67) 9680 .67 ($50) Minimum Premium: $658 Minimum Premium Adjustment 0990 $378 Adjusted Standard Premium $478 Terrorism 9740 $0.02 $0 Estimated Annual Premium $478 Expense Constant 0900 $180 Agency Name and Address Special Compensation Fund Surcharge 0174 3.20% $21 WCRA Assessment 0988 0.60% $4 Policy Total Estimated Cost $683 Net Deposit Premium Required 100% $683 Premium Paid to Date $683 DATE: 3/14/2011 SIGNATURE: Includes copyright material of the National Council on Compensation Insurance used with its permission. @ 1983 @ 1991 National Council on Compensation Insurance WC 99-00 - Insured Copy Minnesota Department of Agriculture MINNESOTA DEPARTMENT OF AGRICULTURE FERTILIZER LICENSE 625 ROBERT STREET NORTH, ST. PAUL, MINNESOTA 55155 -2538 JOHNSON CHAD M DBA JOHNSONS OUTDOOR SERVICES FERTILIZER LICENSE 2516 SHERWOOD RD JOHNSON CHAD M DBA MOUNDS VIEW MN 55112 STORAGE/MIXING JOHNSONS OUTDOOR SERVICES 2516 SHERWOOD RD -OR- MOUNDS VIEW MN 55112 PLANT LOCATION: 20128332 2/3/2011 12/31/2011 License Number Effective Date Expiration Date MOUNDS VIEW License Categories JOHNSON CHAD M DBA APPLY NON -AG FERTILIZER • JOHNSONS OUTDOOR SERVICES PO BOX 32947 FRIDLEY MN 55432 20128332 100.00 2/3/2011 12/31/2011 20128332 116.50 12/31/2011 License Number License Fee Paid Effective Date Expiration Date License Number License Fee Paid Expiration Date This license must be posted in a conspicuous place and is not transferable. AG -00853 In accordance with the Americans With Disabilities Act, an alternative form of communication is available upon request. i4CORI TM CERTIFICATE OF LIABILITY INSURANCE 04/04/2011 PRODUCER 763, 574 , 7447 FAX 763.574.7504 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Insurance Mart ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6875 Highway 65 NE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR g y ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fridley, MN 55432 Karen Chartier INSURERS AFFORDING COVERAGE NAIC # INSURED Chad Johnson INSURER A: Owners Insurance 32700 OBA: Johnson Outdoor Services INSURER B: PO Box 32947 INSURER C: Fridley, MN 55432 INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADM TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS I TR NSW' tATF IMMIlN1IYYI IlATF (MMIIIfFVYI GENERAL LIABILITY 08460254 12/10/2010 12/10/2011 EACH OCCURRENCE $ 1,000,000 ! X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50 000 PRFMISFS (Fa nrcurancn) CLAIMS MADE U OCCUR MED EXP (Any one person) $ 5,000 a A PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENII AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 n POLICY n FECOT- n LOC AUTOMOBILE LIABILITY 4746025401 12/10/2010 12/10/2011 COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO 1,000, 000 ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) — HIRED AUTOS BODILY INJURY $ NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ — 1 ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ n OCCUR n CLAIMS MADE AGGREGATE $ $ _ H DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND I TORY IMITS I I ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ It yes, SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ SEAL PROIIO OTHER DESCRIPTION OF OPERATIONS / LOCATIONS l VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, C olumbia Heights Fire Department FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 825 41st Ave NE OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Columbia Heights, MN 55421 AUTHORIZED REPRESENTATIVE Karen Chartier ACORD 25 (2001/08) © ACORD CORPORATION 1988 •