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HomeMy WebLinkAboutContract No. 2013 2507 0 AGREEMENT FOR SERVICES PERFORMED BY INDEPENDENT CONTRACTOR THIS AGREEMENT is made on the _16th_ _ day of A ri� n 1___, 2013, between the CITY OF COLUMBIA HEIGHTS ("City"), whose business address is 825 41St Avenue NE. NE, Columbia Heights, MN 55421, and Johnson's Outdoor Services ("Contractor"), whose business address is PO 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. 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. INSURANCE COMPANY NAME: (NOT the insurance agent) POLICY NO. OR SELF-INSURANCE PERMIT NO.: DATES OF COVERAGE: -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 C RTIFY THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT. Contractor( `ignat re) 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 under 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 Insurance. 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 Private. 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 COLUMBIA HE GHTS CON RACrR: Ma r.:._..,...,... � fib✓ �C� s City Administrato r ra Attest: City Clerk f Form W-9 Request for Taxpayer Give Form to the (Rev.December Trea I Treasury Identification Number and Certification requester. not Department of the Trea send to the RS. Internal Revenue Service Name(as shown on your income tax return) N Business name/disregarded entity name,if different from above rn Johnson's Outdoor Services, LLC °- Check appropriate box for federal tax classification: c ❑ Individual/sole proprietor ❑ C Corporation ❑ S Corporation ❑ Partnership ❑Trust/estate m c CL o 3 0 Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=partnership)10- $ El Exempt payee o ---- - - ----- C N M E] Other(see instructions)► u Address(number,street,and apt.or suite no.) Requester's name and address(optional) a PO Box 32947 rn City,state,and ZIP code (D rn Fridley,MN.55432 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 the"Name"line Social security number to avoid backup withholding.For individuals,this is your social security number However,for a -m -F resident alien,sole proprietor,or disregarded entity,see the Part I instructions on n 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. 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. M45 - 2 5 1 5 1 0 0 9 5 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. 1 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. 1 am a U.S.citizen or other U.S.person(defined below). 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 secureq property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other than interest and divide s,you are not required to sign the certification,but you must provide your correct TIN.See the instructions on page 4. Sign Signature of Here U.S.person No Date► General Instructions Note.If a requester gives you a form other than Form W-9 to request your TIN,you must use the requester's form if it is substantially similar Section references are to the Internal Revenue Code unless otherwise to this Form W-9. noted. Definition of a U.S.person.For federal tax purposes,you are Purpose of Form considered a U.S.person if you are: A person who is required to file an information return with the IRS must •An individual who is a U.S.citizen or U.S.resident alien, obtain your correct taxpayer identification number(TIN)to report,for •A partnership,corporation,company,or association created or example,income paid to you,real estate transactions,mortgage interest organized in the United States or under the laws of the United States, you paid,acquisition or abandonment of secured property,cancellation •An estate(other than a foreign estate),or of debt,or contributions you made to an IRA. •A domestic trust(as defined in Regulations section 301.7701-7). Use Form W-9 only if you are a U.S.person(including a resident alien),to provide your correct TIN to the person requesting it(the Special rules for partnerships.Partnerships that conduct a trade or requester)and,when applicable,to: business in the United States are generally required to pay a withholding tax on any foreign partners'share of income from such business. 1.Certify that the TIN you are giving is correct(or you are waiting for a Further,in certain cases where a Form W-9 has not been received,a number to be issued), partnership is required to presume that a partner is a foreign person, 2.Certify that you are not subject to backup withholding,or and pay the withholding tax.Therefore,if you are a U.S.person that is a 3.Claim exemption from backup withholding if you are a U.S.exempt partner in a partnership conducting a trade or business in the United payee. If applicable,you are also certifying that as a U.S.person,your States,provide Form W-9 to the partnership to establish your U.S. allocable share of any partnership income from a U.S.trade or business status and avoid withholding on your share of partnership income. is not subject to the withholding tax on foreign partners'share of effectively connected income. Cat.No.10231X Form W-9(Rev.12-2011) ACO CERTIFICATE OF LIABILITY INSURANCE F DATE Y) 4/24/2013 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 CONTACT Sandi Bucheger Blakestad/Phenow, Inc. P"C.N o t• A/C No (763)574-7447 FAx (713)574-7504 C N 6875 Highway 65 NE E-MAIL sbucheger @blakestad.com INSURERS AFFORDING COVERAGE NAIC# Fridley NIN 55432 INSURERA:Owners Insurance 32700 INSURED INSURER B:Auto—Owners Insurance 18988 Johnson Outdoor Services LLC INSURERC: P 0 BOX 32947 INSURER D: INSURER E: Fridley NIN 55432 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1342401299 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. ILTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/D/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES E a occurrence $ 50,000 A CLAIMS-MADE ❑X OCCUR 08460254 12/10/201212/10/2013 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO- AUTOMOBILE $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 500,000 ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED 4746025401 11/30/2012 11/30/2013 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident PIP-Basic $ 20,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ �DECD ESS LIAB HCLAIMS-MADE AGGREGATE $ RETENTION$ $ B WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) 08111319 12/10/2012 12/10/2013 E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Columbia Heights ACCORDANCE WITH THE POLICY PROVISIONS. 590 40th Avenue NE Columbia Heights, MN 55421 AUTHORIZED REPRESENTATIVE Joseph Washleski/SANB ^ ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD 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 Charge Per Hour (quote shall be for time spent on property and can not include travel time) City will pay minimum of one hour and quarter hour increments there �' �YQ��� J�,�� rle f. after. �.1 O� 1 U 6D Company Name Address j f City/State/Zip Code Contact E-mail �1 A u3 L Business Phone Number -7(o Numbers APR 20113 C}j HT5 FIRE DEPT City of Columbia Heights Fire Department 825 - 41St Ave. NE Columbia Heights, MN 55421 Telephone Number (763) 706-8150 SNOW REMOVAL QUOTE FORM Charge Per Hour � � (quote shall be for time spent on property and can not include travel time) U City will pay minimum of one hour and uarter hour increments there �^ after. }'D , j wt/,P_g7 Company Name Address City/State/Zip Code 6411 Contact Name �i U Contact E-mail Business Phone Number 7,16 7�7-17� 7 Cell/Pager/Fax Numbers RECEIVED APR _L 2 J Cot Hrs