HomeMy WebLinkAboutFALZON, PATRICIA - 2003-10-06�• Professional Services Contracts Checklist
' for Submittal to City Clerk's Office
(Please transmit this form when your contract is ready to be filed in the City Clerk's Office)
To: Connie Brockway, City Clerk
x5404
PLEASE PRINT
1. Name of Contractor: Patricia Falzon
2. Purpose of Contract: Grant writing services for the Huntington Beach Art Center.
3. Expiration Date: September 30, 2004
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4. Amount of Contract: $10,000.00
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A. Is the attached contract RELATED to a PREVIOUSLY SUBMITTED contract (Renewal/Amendment/Etc)?
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- 0 YES X NO
B. Did you attach the LIST OF CONSULTANTS from whom proposals were requested — pursuant to HBMC 3.03.100?
X YES 0 N/A
OR Is the attached contract a SOLE SOURCE?
0 YES 0 N/A
C. Did you attach a COPY of the insurance certificate and send the ORIGINAL TO RISK MANAGEMENT? XYES
PLEASE INCLUDE:
Janeen Laudenback X5496
Name/Extension
Community Services Dept.
Department
October 14, 2003
Date
CITY CLERK'S OFFICE U5E ONLY:
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PROFESSIONAL SERVICES CONTRACT BETWEEN
THE CITY OF HUNTINGTON BEACH AND
Pq.-�-r i �_ia �'alzovl
FOR
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Table of Contents
Scopeof Services..................................................................................................... I
CityStaff Assistance ........... ............................................. -......................................
2
Term; Time of Performance.....................................................................................2
Compensation..........................................................................................................2
ExtraWork...............................................................................................................2
Methodof Payment .......................................... ........................................................
3
Disposition of Plans, Estimates and Other Documents...........................................3
HoldHarmless.........................................................................................................3
Professional Liability Insurance.............................................................................4
Certificate of Insurance............................................................................................5
IndependentContractor............................................................................................6
Termination of Agreement.......................................................................................6
Assignmentand Delegation......................................................................................6
Copyfghts/Patents...................................................................................................7
CityEmployees and Officials..................................................................................7
Notices.........................................................................................
7
Consent............................................. —....................................................................
8
Modification.............................................................................................................
8
SectionHeadings.....................................................................................................8
Interpretation of this Agreement..............................................................................8
DuplicateOriginal....................................................................................................9
Immigration....................................................... .....................9
Legal Services Subcontracting Prohibited................................................................9
Attorney's Fees..........................................................................................................
10
Survival.....................................................................................................................
10
GoverningLaw.........................................................................................................10
Entirety......................................................................................................................10
PROFESSIONAL SERVICES CONTRACT BETWEEN
THE CITY OF HUNTINGTON BEACH AND
PAT' W C. ► A F p.L.Zor.l
FOR
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THIS AGREEMENT ("Agreement") is made and entered into this day of
w6be+r za o3, by and between the City of Huntington Beach, a municipal
corporation of the State of California, hereinafter referred to as "CITY, and
PAT R.I C► A: FA L.-Z-0r,1 , a So-E P P V PQ-L eF-M $Z.
hereinafter referred to as "CONSULTANT."
WHEREAS, CITY desires to engage the services of a consultant to
SR.ESEA-Qf- t AND PQEPAQ-E &eAN AT" APPLiLAnONL5,and
Pursuant to documentation on file in the office of the City Clerk, the provisions of
the Huntington Beach Municipal Code, Chapter 3.03, relating to procurement of
professional service contracts have been complied with; and
CONSULTANT has been selected to perform these services,
NOW, THEREFORE, it is agreed by CITY and CONSULTANT as follows:
1. SCOPE OF SERVICES
CONSULTANT shall provide all services as described in Exhibit "A,"
which is attached hereto and incorporated into this Agreement by this reference. These
services shall sometimes hereinafter be referred to as the "PROJECT."
CONSULTANT hereby designates Pere-kC t A tAL.2atit who shall
represent it and be its sole contact and agent in all consultations with CITY during the
performance of this Agreement.
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2. CITY STAFF ASSISTANCE
CITY shall assign a staff coordinator to work directly with CONSULTANT
in the performance of this Agreement.
3. TERM: TIME OF PERFORMANCE
Time is of the essence of this Agreement. The services of CONSULTANT
are to commence as soon as practicable after the execution of this Agreement by CITY (the
"Commencement Date"). This Agreement shall expire on unless
sooner terminated as provided herein. All tasks specified in Exhibit "A" shall be
completed no later than Sgnkmbe.r 30,E from the Commencement Date of this
Agreement. These times may be extended with the written permission of CITY. The time
for performance of the tasks identified in Exhibit "A" are generally to be shown in
Exhibit "A." This schedule may be amended to benefit the PROJECT if mutually agreed
to in writing by CITY and CONSULTANT.
4. COMPENSATION
In consideration of the performance of the services described herein, CITY
agrees to pay CONSULTANT on a time and materials basis at the rates specified in
Exhibit "B," which is attached hereto and incorporated by reference into this Agreement,
a fee, including all costs and expenses, not to exceed
Te-yi t�a.c Dollars ($10, 000. oo ).
5. EXTRA WORK
In the event CITY requires additional services not included in Exhibit "A"
or changes in the scope of services described in Exhibit "A," CONSULTANT will
undertake such work only after receiving written authorization from CITY. Additional
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compensation for such extra work shall be allowed only if the prior written approval of
CITY is obtained.
6. METHOD OF PAYMENT
CONSULTANT shall be paid pursuant to the terms of Exhibit "B."
7. DISPOSITION OF PLANS, ESTIMATES AND OTHER DOCUMENTS
CONSULTANT agrees that title to all materials prepared -hereunder,
including, without limitation, all original drawings, designs, reports, both field and office
notices, calculations, computer code, language, data or programs, maps, memoranda,
letters and other documents, shall belong to CITY, and CONSULTANT shall turn these
materials over to CITY upon expiration or termination of this Agreement or upon
PROJECT completion, whichever shall occur first. These materials may be used by CITY
as it sees fit.
8. HOLD HARMLESS
CONSULTANT hereby agrees to protect, defend, indemnify and hold
harmless CITY, its officers, elected or appointed officials, employees, agents and
volunteers from and against any and all claims, damages, losses, expenses, judgments,
demands and defense costs (including, without limitation, costs and fees of litigation of
every nature or liability of any kind or nature) arising out of or in connection with
CONSULTANT's (or CONSULTANT's subcontractors, if any) negligent performance of
this Agreement or its failure to comply with any of its obligations contained in this
Agreement by CONSULTANT, its officers, agents or employees except such loss or
damage which was caused by the sole negligence or willful misconduct of CITY.
CONSULTANT will conduct all defense at its sole cost and expense and CITY shall
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approve selection of CONSULTANT's counsel. This indemnity shall apply to all claims
and liability regardless of whether any insurance policies are applicable. The policy limits
do not act as limitation upon the amount of indemnification to be provided by
CONSULTANT.
9. PROFESSIONAL LIABILITY INSURANCE
CONSULTANT shall obtain and furnish to CITY a professional liability
insurance policy covering the work performed by it hereunder. This policy shall provide
coverage for CONSULTANT's professional liability in an amount not less than One
Million Dollars ($1,000,000.00) per occurrence and in the aggregate. The above -
mentioned insurance shall not contain a self -insured retention, "deductible" or any other
similar form of limitation on the required coverage except with the express written consent
of CITY. A claims -made policy shall be acceptable if the policy further provides that:
A. The policy retroactive date coincides with or precedes the initiation
of the scope of work (including subsequent policies purchased as
renewals or replacements).
B. CONSULTANT shall notify CITY of circumstances or incidents
that might give rise to future claims.
CONSULTANT will make every effort to maintain similar insurance during
the required extended period of coverage following PROJECT completion. If insurance is
terminated for any reason, CONSULTANT agrees to purchase an extended reporting
provision of at least two (2) years to report claims arising from work performed in
connection with this Agreement.
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10. CERTIFICATE OF INSURANCE
Prior to commencing performance of the work hereunder, CONSULTANT
shall furnish to CITY a certificate of insurance subject to approval of the City Attorney
evidencing the foregoing insurance coverage as required by this Agreement; the certificate
shall:
A. provide the name and policy number of each carrier and policy,
B. shall state that the policy is currently in force; and
C. shall promise that such policy shall not be suspended, voided or
canceled by either party, reduced in coverage or in limits except
after thirty (30) days' prior written notice; however, ten (10) days'
prior written notice in the event of cancellation for nonpayment of
premium.
CONSULTANT shall maintain the foregoing insurance coverage in force
until the work under this Agreement is fully completed and accepted by CITY.
The requirement for carrying the foregoing insurance coverage shall not
derogate from CONSULTANT's defense, hold harmless and indemnification obligations as
set forth in this Agreement. CITY or its representative shall at all times have the right to
demand the original or a copy of the policy of insurance. CONSULTANT shall pay, in a
prompt and timely manner, the premiums on the insurance hereinabove required.
11. INDEPENDENT CONTRACTOR
CONSULTANT is, and shall be, acting at all times in the performance of
this Agreement as an independent contractor herein and not as an employee of CITY.
CONSULTANT shall secure at its own cost and expense, and be responsible for any and
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all payment of all taxes, social security, state disability insurance compensation,
unemployment compensation and other payroll deductions for CONSULTANT and its
officers, agents and employees and all business licenses, if any, in connection with the
PROJECT and/or the services to be performed hereunder.
12. TERMINATION OF AGREEMENT
All work required hereunder shall be performed in a good and workmanlike
manner. CITY may terminate CONSULTANT's services hereunder at any time with or
without cause, and whether or not the PROJECT is fully complete. Any termination of this
Agreement by CITY shall be made in writing, notice of which shall be delivered to
CONSULTANT as provided herein. In the event of termination, all finished and
unfinished documents, exhibits, report, and evidence shall, at the option of CITY, become
its property and shall be promptly delivered to it by CONSULTANT.
13. ASSIGNMENT AND DELEGATION
This Agreement is a personal service contract and the work hereunder shall
not be assigned, delegated or subcontracted by CONSULTANT to any other person or
entity without the prior express written consent of CITY. If an assignment, delegation or
subcontract is approved, all approved assignees, delegates and subconsultants must satisfy
the insurance requirements as set forth in Sections 9 and 10 hereinabove.
14. COPYRIGHTS/PATENTS
CITY shall own all rights to any patent or copyright on any work, item or
material produced as a result of this Agreement.
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15. CITY EMPLOYEES AND OFFICIALS
CONSULTANT shall employ no CITY official nor any regular CITY
employee in the work performed pursuant to this Agreement. No officer or employee of
CITY shall have any financial interest in this Agreement in violation of the applicable
provisions of the California Government Code.
16. NOTICES
Any notices, certificates, or other communications hereunder shall be given
either by personal delivery to CONSULTANT's agent (as designated in Section I
hereinabove) or to CITY as the situation shall warrant, or by enclosing the same in a sealed
envelope, postage prepaid, and depositing the same in the United States Postal Service, to
the addresses specified below. CITY and CONSULTANT may designate different
addresses to which subsequent notices, certificates or other communications will be sent by
notifying the other parry via personal delivery, a reputable overnight carrier or U. S.
certified mail -return receipt requested:
TO CITY:
City of Huntington Beach
ATTN:}e
-
2000 Main Street
Huntington Beach, CA 92648
17. CONSENT
TO CONSULTANT:
IN
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When CITY's consent/approval is required under this Agreement, its
consent/approval for one transaction or event shall not be deemed to be a consent/approval
to any subsequent occurrence of the same or any other transaction or event.
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18. MODIFICATION
No waiver or modification of any language in this Agreement shall be valid
unless in writing and duly executed by both parties.
19. SECTION HEADINGS
The titles, captions, section, paragraph and subject headings, and descriptive
phrases at the beginning of the various sections in this Agreement are merely descriptive
and are included solely for convenience of reference only and are not representative of
matters included or excluded from such provisions, and do not interpret, define, limit or
describe, or construe the intent of the parties or affect the construction or interpretation of
any provision of this Agreement.
20. niURPRETATION OF THIS AGREEMENT
The language of all parts of this Agreement shall in all cases be construed
as a whole, accofding to its fair meaning, and not strictly for or against any of the parties.
If any provision of this Agreement is held by an arbitrator or court of competent
jurisdiction to be unenforceable, void, illegal or invalid, such holding shall not invalidate
or affect the remaining covenants and provisions of this Agreement. No covenant or
provision shall be deemed dependent upon any other unless so expressly provided here.
As used in this Agreement, the masculine or neuter gender and singular or plural number
shall be deemed to include the other whenever the context so indicates or requires.
Nothing contained herein shall be construed so as to require the commission of any act
contrary to law, and wherever there is any conflict between any provision contained herein
and any present or future statute, law, ordinance or regulation contrary to which the parties
have no right to contract, then the latter shall prevail, and the provision of this Agreement
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which is hereby affected shall be curtailed and limited only to the extent necessary to bring
it within the requirements of the law.
21. DUPLICATE ORIGINAL
The original of this Agreement and one or more copies hereto have been
prepared and signed in counterparts as duplicate originals, each of which so executed shall,
irrespective of the date of its execution and delivery, be deemed an original. Each
duplicate original shall be deemed an original instrument as against any parry who has
signed it.
22. INMIGRATION
CONSULTANT shall be responsible for full compliance with the
immigration and naturalization laws of the United States and shall, in particular, comply
with the provisions of the United States Code regarding employment verification.
23. LEGAL SERVICES SUBCONTRACTING PROHIBITED
CONSULTANT and CITY agree that CITY is not liable for payment of any
subcontractor work involving legal services, and that such legal services are expressly
outside the scope of services contemplated hereunder. CONSULTANT understands that
pursuant to Huntington Beach City Charter Section 309, the City Attorney is the exclusive
legal counsel for CITY; and CITY shall not be liable for payment of any legal services
expenses incurred by CONSULTANT.
24. ATTORNEY'S FEES
In the event suit is brought by either party to construe, interpret and/or
enforce the terms and/or provisions of this Agreement or to secure the performance hereof,
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each parry shall bear its own attorney's fees, such that the prevailing party shall not be
entitled to recover its attorney's fees from the non -prevailing party.
25. SURVIVAL
Terms and conditions of this Agreement, which by their sense and context
survive the expiration or termination of this Agreement, shall so survive.
26. GOVERNING LAW
This Agreement shall be governed and construed in accordance with the
laws of the State of California.
27. ENTIRETY
The parties acknowledge and agree that they are entering into this
Agreement freely and voluntarily following extensive arm's length negotiation, and that
each has had the opportunity to consult with legal counsel prior to executing this
Agreement. The parties also acknowledge and agree that no representations, inducements,
promises, agreements or warranties, oral or otherwise, have been made by that party or
anyone acting on that parry's behalf, which are not embodied in this Agreement, and that
that party has not executed this Agreement in reliance on any representation, inducement,
promise, agreement, warranty, fact or circumstance not expressly set forth in this
Agreement. This Agreement, and the attached exhibits, contain the entire agreement
between the parties respecting the subject matter of this Agreement, and supercede all prior
understandings and agreements whether oral or in writing between the parties respecting
the subject matter hereof
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PV WITNESS WHEREOF, the parties hereto have caused this Agreement to be
executed by and through their authorized offices the day, month and year first above
written.
CONSULTANT, SCE P9-099 .l E i ce.
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print name
ITS: (circle one) Chairman/president/Vice President APPROVED AS TO FORM:
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City ey
CITY OF HUNTINGTON BEACH,
a municipal corporation of the State of California
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print name
ITS: (circle one) Secretary:;Chief Financial OfficerAsst
Secretary — Treasurer
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REVIEWED AND APPROVED:
City Administrator
(only for contracts $50,000.00 and over)
INSURANCE AND INDEMNIFICATION WAIVER
�,, MODIFICATION REQUEST
1. Requested by: Janeen Laudenback
2. Date: September 23, 2003
3. Name of contra ctor/pe rm ittee: Patrcia Falzone
4. Description of work to be performed: Grant research and application preparation
5. Value and length of contract: 10 000 - one e r
6. Waiver/modification request: Please waive Professional Liability Insurance Requirement
7. Reason for request and why it should be granted: Little risk associated with grant -writing
8. Identify the risks to the City in approving this waiver/modification: None
9/23/03
epartment Head Wriature Date:
APPROVALS
Approvals must.be obtained in"the order listed on this form. Two approvals are required
for a request to.begranted Approyaifrom:the City Administrator's Office is only required if
Rlsk_Management and"the City Aft rney's Office disagree.
1. Risk Management ,
roved ❑ Denied
PP 3'
Signature Date
2. City Attorney's Office
Approved ❑ Denie
Signatureo Date
3. City Administrator's Office
❑ Approved ❑ Denied Q p- . pj
Si ature Date
-.' if approved, -the cgmpleted waiverfmoditicaUoh.request.is to'be submitted to the
City Attorney' s;Offidq along.*lth the contract for: approval:" Once the contract has been approved,
. -this"form is°.tabe;filed wiih"th, ;Oisk-Management Division of Administrative Services
Insurance & Indemnification Waiver 9/23/200310:02 AM
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Su, N PROFESSIONAL SERVICE CONTRACTS
B PURCHASING CERTIFICATION
1. Requested by: Janeen Laudenback
2. Date: September 23, 2003
3. Name of consultant: Patricia Falzone
4. Description of work to be performed: Grant research and application
prepartation.
5. Amount of the contract: $10,000.00
S. Are sufficient funds available to fund this contract?' ® Yes, ❑ No
7. Company number and object code where funds are budgeted: 50045551.69450
8. Is this contract generally described on the list of professional service contracts
approved by the City Council? ®Yes, ❑ No
9. Is this contract within $25,000 or 25% (whichever is less) of the amount stated on
the list of professional service contracts approved by the City Council?'
® Yes, ❑ No
10. Were (at least) informal written proposals requested of three consultants?
® Yes, ❑ No
11. Attach list of consultants from whom proposals were requested (including a
contact telephone number).
12. Attach proposed scope of work.
13. Attach proposed payment schedule.
RICtriARD AMADRIL, Manager
PurchasinglCentral Services
' If the answer to any these questions is "No," the contract will require approval from the City Council.
Purchasing Certification- Grant Writing 9/23/2003 11:08 AM
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Hj� CITY OF HUNTINGTON BEACH
a
INTER -DEPARTMENTAL COMMUNICATION
HUNTINGTON BEACH COMMUNITY SERVICES
To: Rick Amadril, Central Services Manager
From: Janeen Laudenback, Superintendent
Recreation, Human & Cultural Services
Date: September 29, 2003
Subject: Professional Services Contract — Grant Writer HBAC
Request for Proposals were sent to the following:
Patricia Falzon
18173 Santa Joanna
Fountain Valley, CA 92807
(714) 593-0157
Linda Jensen
12 Tribute Ct.
Newport Beach, CA 92663
(949) 722-1740
Laura Lux
18861 Lister Lane
Huntington Beach, CA 29646
(714) 968-7143
Cathy Michaels
Arts OC
3750 S. Susan St., Suite 200
Santa Ana, CA 92704
(714) 556-5160 x11
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EXHIBIT "A"
A. STATEMENT OF WORKS (Narrative of work to be performed)
Contractor shall provide consulting and writing services for the Huntington Beach Art
Center (HBAC). Contractor shall research funding sources and develop appropriate
grant requests and foundation and corporate proposals to fund programs and
operational costs of the Art Center.
B. CONSULTANT'S DUTIES AND RESPONSIBILITIES:
1. Research and develop a fist of possible funding sources.
2. Develop individual narratives describing the HBAC funding needs for
proposals and grants.
3. In consultation with HBAC staff, identify grants and develop strategies for
successful grant submissions.
4. Prepare grant proposals and letters of inquiry as required.
5. Develop grant reporting and tracking systems for current grantees to the
HBAC.
C. CITY'S DUTIES AND RESPONSIBILITIES:
1. HBAC will provide office support for phone, fax, e-mail, and copies, if
needed.
D. WORK PROGRAMIPROJECT SCHEDULE:
This contract position will be funded for one year and work will be reviewed
monthly to measure progress.
imp/contracts grouplexN9129103
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EXHIBIT "B"
Payment Schedule (Hourly Payment)
A. Hourly Rate
CONSULTANT'S fees for such services shall be based upon the following hourly rate and
cost schedule:
__. $20. per hour
B. Travel
10 hours per week
Charges for time during travel are normally not reimbursable and will only be paid
if such time is actually used in performing services for CITY or as otherwise
arranged with CITY.
2. As CITY sometimes uses consultants that are outside of the nearest metropolitan
area, CITY is very conscious of travel costs. Subject to agreement othenvise.
CONSULTANT will be held to charging no fees on travel time to or from
Huntington Beach.
3. Automobile expenses are limited to the IRS standard business mileage rate. All
other travel expenses must be approved in advance by CITY in writing. Requests
for approval shall be submitted at least fourteen (14) days in advance, to allow for
reduced transportation fares. Meals are not billable to CITY, without prior written
consent of CITY.
C. Billing
1. All billing shall be done monthly in one -tenth -hour (0.10) increments and matched
to an appropriate breakdown of the time that was taken to perform that work and
who performed it.
Minimum billing charges are unacceptable. CONSULTANT shall only charge for
actual time spent. For example, minimum of 0.2 hours for phone calls or 0.4 hours
for letters is unreasonable unless that is an accurate measure of time spent.
2. Each month's bill should include a total to date. That total should provide, at a
glance, the total fees and costs incurred to date for the case or matter.
3. Telephone, cellular phone and postage charges are billable at actual cost. A copy of
all service bills/costs should accompany the billing for each single item that exceeds
Seventy -Five Dollars ($75.00). The fee for the sending or receiving of facsimiles
shall not exceed Twenty-five Cents ($0.25) per page. CITY will not pay a fee or
agreedormslexH-hourly Fee/9/29/03 EXHIBIT B
Hourly Payment
EXHIBIT "B"
Payment Schedule (Hourly Payment)
charge for telephone calls or facsimiles to CITY. Photocopier costs should be no
more than the actual cost of duplication, or Ten Cents ($0.10) per page, whichever
is less.
4. CITY will not pay for secretarial time or secretarial overtime. CITY will not pay
for secretarial tasks or tasks that should be subsumed into CONSULTANT's
overhead. For example, time spent for faxing, mailing, arranging for messengers
and calendaring are not acceptable charges.
5. CITY will not pay for word processing charges. This includes per page or hourly
charges.
6. CITY will not pay for billing or discussion of bills. If CITY has questions about
billing or needs additional information on bills, that is not a chargeable event;
CONSULTANT should respond without charging CITY for the time required.
7. CITY appreciates when CONSULTANT has researched an issue previously and
uses that research on the present case. CITY has retained CONSULTANT because
of its past experience. CONSULTANT shall not charge CITY for work it has done
and billed another client for in the past.
8. Delivery of work product: A copy of every memorandum, letter, report, calculation
and other documentation prepared by CONSULTANT shall be submitted to CITY to
demonstrate progress toward completion of tasks. In the event CITY rejects or has
comments on any such product, CITY shall identify specific requirements for
satisfactory completion.
9. CONSULTANT shall submit to CITY an invoice for each monthly payment due. Such
invoice shall:
A) Reference this Agreement;
B) Describe the services performed;
C) Show the total amount of the payment due;
D) Include a certification by a principal member of CONSULTANT's firm that
the work has been performed in accordance with the provisions of this
Agreement; and
E) For all payments include an estimate of the percentage of work completed.
Upon submission of any such invoice, if CITY is satisfied that CONSULTANT is
making satisfactory progress toward completion of tasks in accordance with this
Agreement, CITY shall approve the invoice, in which event payment shall be made
within thirty (30) days of receipt of the invoice by CITY. Such approval shall not be
unreasonably withheld. If CITY does not approve an invoice, CITY shall notify
CONSULTANT in writing of the reasons for non -approval and the schedule of
performance set forth in Exhibit "A" may at the option of CITY be suspended until the
agree/formVexB-hourly fee/9/29/03 EXHIBIT B 2
Hourly Payment
0 EXHIBIT "B" 0
Payment Schedule (Hourly Payment)
parties agree that past performance by CONSULTANT is in, or has been brought into
compliance, or until this Agreement has expired or is terminated as provided herein.
10. Any billings for extra work or additional services authorized in advance and in writing
by CITY shall be invoiced separately to CITY. Such invoice shall contain all of the
information required above, and in addition shall list the hours expended and hourly
rate charged for such time. Such invoices shall be approved by CITY if the work
performed is in accordance with the extra work or additional services requested, and if
CITY is satisfied that the statement of hours worked and costs incurred is accurate.
Such approval shall not be unreasonably withheld. Any dispute between the parties
concerning payment of such an invoice shall be treated as separate and apart from the
ongoing performance of the remainder of this Agreement.
agreelformslexB-hourly fee/9/29/03 EXHIBIT B 3
Hourly Payment
S i INSURANCE AND INDEMNIFICATION WAIVER
HU. B. MODIFICATION REQUEST
1. Requested by: Janeen Laudenback
2. Date: September 23, 2003
3. Name of contra ctorlpermittee: Patrcia Falzone
4. Description of work to be performed: Grant research and application preparation
5. Value and length of contract: $10,000 - one year
6. Waiver/modification request: Please waive Professional Liability Insurance Requirement
7. Reason for request and why it should be granted: Little risk associated with grant -writing
8. Identify the risks to the City in approving this waiver/modification: None
,�--A 9/23/03
epartment ead I nature Date:
APPROVALS
Approvals must be obtained in the order listed on this form. Two approvals are required
for a request to be granted. Approval from the City Administrator's Office is only required if
Risk Management and the City Attorney's Office disagree.
1. Risk Management
roved ❑ Denied
pp
Signature Date
2. City Attorney's Office
'W; Approved ❑ Denie
Signature Date
3. City Administrator's Office
❑ Approved ❑ Denied Q� pr -
SigtTature T Date
If approved, the completed waiver/modification request is to be submitted to the
City Attorney's Office along with the contract for approval. Once the contract has been approved,
this form is to be filed with the Risk Management Division of Administrative Services
C.i -2 —
7ks 0 /Z ,6 1'��4 L
Insurance & Indemnification Waiver 9/23/200310:02 AM