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HomeMy WebLinkAboutRaftelis Financial Consultants, Inc. - 2018-07-25 PROFESSIONAL SERVICES CONTRACT BETWEEN THE CITY OF HUNTINGTON BEACH AND RAFTELIS FINANCIAL CONSULTANTS, INC. FOR WATER RATE STUDY—ADDITIONAL SERVICES THIS AGREEMENT ("Agreement") is made and entered into by and between the City of Huntington Beach, a municipal corporation of the State of California, hereinafter referred to as "CITY," and RAFTELIS FINANCIAL CONSULTANTS, INC., a North Carolina corporation, hereinafter referred to as "CONSULTANT." WHEREAS, CITY desires to engage the services of a consultant to perform a water rate study; 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 Sanjay Gaur, who shall represent it and be its sole contact and agent in all consultations with CITY during the performance of this Agreement. 2. CITY STAFF ASSISTANCE CITY shall assign a staff coordinator to work directly with CONSULTANT in the performance of this Agreement. agree/surfnet/professional svcs to$49 10115 18-6593/182747/mv 1 of I I 3. TERM, TIME OF PERFORMANCE Time is of the essence of this Agreement. The services of CONSULTANT are to commence on c , 20 I$ (the "Commencement Date"). This Agreement shall automatically terminate three (3) years from the Commencement Date, unless extended or sooner terminated as provided herein. All tasks specified in Exhibit "A" shall be completed no later than three (3) years from the Commencement Date. 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. In the event the Commencement Date precedes the Effective Date,CONSULTANT shall be bound by all terms and conditions as provided herein. 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 Twenty-Nine Thousand Eight Hundred Fifty-Five Dollars ($29,855.00). 5. EXTRA WORK In the event CITY requires additional services not included in Exhibit "A" or changes in the scope of services described in Exhibit "A," CONSULTANT will undertake such work only after receiving written authorization from CITY. Additional compensation for such extra work shall be allowed only if the prior written approval of CITY is obtained. 6. METHOD OF PAYMENT CONSULTANT shall be paid pursuant to the terms of Exhibit "B." u f v 4 agreels rfnet/pro essional s cs to$ 9 10115 18-6593/182747/mv 2 of 11 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(or alleged 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 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 agree/surfnet/professional svcs to$49 10115 18-6593/182747/mv 3 of 11 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 without the express written consent of CITY;however an insurance policy "deductible" of Ten Thousand Dollars ($10,000.00) or less is permitted. 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. If CONSULTANT fails or refuses to produce or maintain the insurance required by this section or fails or refuses to furnish the CITY with required proof that insurance has been procured and is in force and paid for, the CITY shall have the right, at the CITY's election, to forthwith terminate this Agreement. Such termination shall not affect Consultant's right to be paid for its time and materials expended prior to notification of termination. CONSULTANT waives the right to receive compensation and agrees to indemnify the CITY for any work performed prior to approval of insurance by the CITY. agree/surfnet/professional svcs to$49 10115 18-6593/182747/mv 4 of 11 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. 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 all payment of all taxes, social security, state disability insurance compensation, unemployment compensation and other agree/surfnet/professional svcs to$49 10115 18-6593/182747/mv 5 of 11 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. 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 agree/surfnet/professional svcs to S49 10/15 18-6593/182747/mv 6 of 11 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 1 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 party via personal delivery, a reputable overnight carrier or U. S. certified mail-return receipt requested: TO CITY: TO CONSULTANT: City of Huntington Beach Raftelis Financial Consultants, Inc. ATTN: Chris Davis ATTN: Sanjay Gaur 2000 Main Street 445 S. Figueroa Street, Suite 2270 Huntington Beach, CA 92648 Los Angeles, CA 90071 Tel: (212) 327-4405 Fax: (213) 262-9303 17. CONSENT 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. 18. MODIFICATION No waiver or modification of any language in this Agreement shall be valid unless in writing and duly executed by both parties. agree/surfnet/professional svcs to$49 10115 18-6593/182747/mv 7 of 11 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. INTERPRETATION OF THIS AGREEMENT The language of all parts of this Agreement shall in all cases be construed as a whole, according 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 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 agree/surfnet/professional svcs to S49 10115 18-6593/182747/mv 8 of 11 the date of its execution and delivery, be deemed an original. Each duplicate original shall be deemed an original instrument as against any party who has signed it. 22. IMMIGRATION 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, each party shall bear its own attorney's fees, such that the prevailing party shall not be entitled to recover its attorney's fees from the nonprevailing 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. agree/surfnet/professional svcs to$49 10115 18-6593/182747/mv 9 of II 26. GOVERNING LAW This Agreement shall be governed and construed in accordance with the laws of the State of California. 27. SIGNATORIES Each undersigned represents and warrants that its signature hereinbelow has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify CITY fully for any injuries or damages to CITY in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. 28. 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 party'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 supersede all prior understandings and agreements whether oral or in writing between the parties respecting the subject matter hereof. 29. EFFECTIVE DATE This Agreement shall be effective on the date of its approval by the City Attorney. This Agreement shall expire when terminated as provided herein. agree/surfnet/professional svcs to$49 10115 18-6593/182747/mv 10 of 11 IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by and through their authorized officers. CONSULTANT, CITY OF HUNTINGTON BEACH, a municipal corporation of the State of RAFTELIS FINANCIAL CONSULTANTS, California INC. COMPANY NAME —/ Director/Chief (Pursuant To HBMC§3.03.100) By. APPROVED AS TO FORM: print name _- --� ITS: (circle one)Chairman/Preside ice President 1 AND —'e4z City Attorney AW By: DaIeK /l/lam rZ Son RECEIVE AND FILE: print name ITS: (circle one)Secretary Chief Financial Officer Asst. Secretary—Treasurer Ci y Cler Date 8�afl/az( agree/surfnet/professional svcs to$49 10115 18-6593/182747/mv I I of I I EXHIBIT "A" A. STATEMENT OF WORK: (Narrative of work to be performed) Consultant will follow up work on water rate study, specifically to ensure compliance with Proposition 218 regarding assessment of equivalent dwelling unit(EDU) assessment for Multifamily Residential customers. B. CONSULTANT'S DUTIES AND RESPONSIBILITIES: 1. Review City Policy and planning documents related to water service rates 2. Prepare a memorandum related to water service matters, as defined by City Staff 3. Participate in or lead conference calls of in-person meetings, as required to address water service matters defined by staff. 4. Perform any other tasks related to the topics defined by staff and related to City water service and rates. C. CITY'S DUTIES AND RESPONSIBILITIES: 1. Provide any and all documents as requested by consultant Surfuet Exhibit A 2. Provide direction on memorandum and any other tasks 3. Make payments on a regular basis D. WORK PROGRAM/PROJECT SCHEDULE: Work is to begin as soon as contract is executed Surfnet Exhibit A 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: Project Manager: $290 Financial Consultant: $180 Administrative Staff: $75 B. Travel. Charges for time during travel are not reimbursable C. Billin 1. All billing shall be done monthl in fifteen (15) minute increments and matched to an appropriate breakdown of the time that was taken to perform that work and who performed it. 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 project. 3. A copy of memoranda, letters, reports, calculations and other documentation prepared by CONSULTANT may be required to 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. 4. 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 Surfnet Exhibit B hourly 1 the 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. 5. 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. Surfnet Exhibit B hourly 2 RAFTE IS April 24,2018 Mr.Kenneth Dills Public Works Project Manager City of Huntington Beach 2000 Main Street Huntington Beach,CA 92648 Subject:2017 Water Rate Study-Additional Services Dear Mr.Dills: Raftelis Financial Consultants, Inc. (Raftelis) is pleased to submit this scope of services to provide additional services related to the 2017 Water Rate Study to the City of Huntington Beach(City).The following sections outline the additional services to be provided to the City on an as-needed basis. Specifically,Raftelis will perform the following tasks: 1. Review City policy and planning documents related to water service and rates 2. Prepare a memorandum related to water service matters,as defined by City staff 3. Participate in or lead conference calls or in-person meetings, as required to address water service matters defined by staff 4. Perform any other tasks related to the topics defined by staff and related to City water service and rates We look forward to working with you. Sincerely, RAFTELIS FINANCIAL CONSULTANTS,INC. G'd" Sanjay Gaur Vice-President 445 S.Figueroa St.,Suite 2270 Los Angeles,CA 90071 1 213 262 9300 www.raftelis.com City of Huntington Beach 2017 Water Rate Study - Additional Services Scope of Service Task 1: Water Service and Rate Document Review Raftelis will conduct a comprehensive review of the City's published documentation as it relates to its water service and its rates. Such documents include the urban water management plan, master plan studies, drought ordinances and policies, mandates or other action related to the 2015 drought, and any other documentation as identified by the City or Raftelis as pertinent to topics identified and prioritized by the City. Meetings:See Task Deliverables:None Task 2: Memorandum Raftelis will prepare a draft memorandum summarizing the findings and conclusions derived from the"published documentation review. After receiving comments and revisions from staff, we will provide the City a final memorandum. Meetings:See Task 3 Deliverables:Memorandum Task 3: Conference Calls and In-Person Meetings Raftelis will participate in or lead conference calls or in-person meetings as requested by the City to discuss the findings and conclusions of the memorandum. We will prepare and provide staff any presentation materials as deemed necessary for the purpose of discussion. Raftelis has allocated 20 hours for this task. Meetings:Webinars and In-Person Meetings as needed Deliverables:Presentation materials Task 4: Additional Tasks Raftelis will perform any additional tasks later identified by City staff as they relate to the City's water service and rates.Raftelis has allocated 60 hours for this task Meetings:Webinars and In-Person Meetings as needed in excess of the allocation for Task 3 Deliverables:To be determined 2 City of Huntington Beach 2017 Water Rate Study - Additional Services Fee Schedule Raftelis proposes to complete the scope of work outlined above on a time-and-materials basis with a not-to-exceed cost of$29,8SS. The following work plan provides a breakdown of the estimated level of effort required for completing each task described and the hourly billing rates for the personnel scheduled to complete the project. City of Huntington Beach 2017 Water Rate Study—Additional Services TotalFees Task eExpenses ®11ir0 F � � }IO L jiATES $29Q $1$0 S75 " ' l #d` 1 'Water Service and Rate Document Review 4 24 2 30 $5,430 % 2 Memorandum 4 16 0 20 $4,240 3 Conference Calls and In-Person Meetings 10 10 0 20 $4,900 4 Additional Tasks 30 30 1 61 $14,785 o : 3 a '�J +: ProjectManager(PM):Sanjay Gaur Financial Consultants(FC) Administrative Staff(Admin) 3 PROFESSIONAL SERVICES CONTRACT BETWEEN THE CITY OF HUNTINGTON BEACH AND FOR Table of Contents 1 Scope of Services................................................................................................................ 1 2 City Staff Assistance...........................................................................................................2 3 Term; Time of Performance................................................................................................2 4 Compensation......................................................................................................................2 5 Extra Work..........................................................................................................................2 6 Method of Payment.............................................................................................................3 7 Disposition of Plans,Estimates and Other Documents.......................................................3 8 Hold Harmless.....................................................................................................................3 9 Professional Liability Insurance ..............................................................................4 10 Certificate of Insurance.......................................................................................................5 11 Independent Contractor.......................................................................................................6 12 Termination of Agreement..................................................................................................6 13 Assignment and Delegation..................................................................................................6 14 Copyrights/Patents ..............................................................................................................7 15 City Employees and Officials..............................................................................................7 16 Notices... .................................................................................................................7 17 Consent................................................................................................................................8 18 Modification........................................................................................................................8 19 Section Headings.................................................................................................................8 20 Interpretation of this Agreement.........................................................................................8 21 Duplicate Original...............................................................................................................9 22 Immigration..........................................................................................................................9 23 Legal Services Subcontracting Prohibited ...........................................................................9 24 Attorney's Fees..................................................................................................................... 10 25 Survival................................................................................................................................ 10 26 Governing Law..................................................................................................................... 10 27 Signatories............................................................................................................................ 10 28 Entirety................................................................................................................................. 10 29 Effective Date.................................................................................I I INSURANCE REQUIREMENTS FOR PROFESSIONAL SERVICE CONTRACTORS PLEASE GIVE THESE INSURANCE REQUIREMENTS TO YOUR INSURANCE AGENT Huntington Beach City Council Resolution No. 2007-3 requires submittal of certificates of insurance evidencing the following minimum limits with a California admitted carrier with a current A.M. Best's Rating of no less than A:VII Minimum Limits of Insurance Professional Liability/Errors and Omissions Liability Insurance: Minimum of $1,000,000 per occurrence and in the aggregate. Claims made policies are acceptable if the policy further provides that: 1. The policy retroactive date coincides with or precedes the professional services contractor's start of work (including subsequent policies purchased as renewals or replacements). 2. The professional services contractor will make every effort to maintain similar insurance during the required extended period of coverage following project completion, including the requirement of adding all additional insureds. 3. If insurance is terminated for any reason, professional services contractor 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 or permit. 4. The reporting of circumstances or incidents that might give rise to future claims. Deductibles, Self-Insured Retentions, or Similar Forms of Coverage Limitations or Modifications Any deductibles, self-insured retentions or similar forms of coverage limitations or modifications, must be approved by the Risk Manager and City Attorney of the City of Huntington Beach. NOTE: Waivers and / or modifications are discouraged and will be considered only under extraordinary circumstances. Description of Work to be Performed The staff contact and purpose of the evidence of coverage must be identified. g/attymisc/insurance requirements �k II suilciiy INSURANCE AND INDEMNIFICATION WAIVER MODIFICATION REQUEST 1. Requested by: Ken Dills 2. Date: 7/24/18 3. Name of contractor/permittee: Raftelis Financial Consultants 4. Description of work to be performed: Water Rate Study Additional Service 5. Value and length of contract: $29,855, 3-years 6. Waiver/modification request: $25,000 deductible 7. Reason for request and why it should be granted: consultant work performed primarily off site 8. Identify the risks to the City in approving this waiver/modification: none noted Department Head Signature Date: i 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 ministrator's Office is only required if Risk Management and the City A rney's Office d agree- 1. Ri Management Approved ❑ Denied Signature D 2. City Attorney's Office P�lpproved ❑ Denied Signa re 'Date/ 3. City Manager's Office ❑ Approved ❑ Denie Signature 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 Human Resources 7/25/2018 6:56:00 AM � t DATE(MMIDDIYYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 07/06/2018 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 have ADDITIONAL INSURED provisions or 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 Pamela Morton NAME: Bear Insurance Service PHONE (704)982-1156 (704)982-7012 A1C No Ext: A/C,No 173 North Second Street E-MAIL morton bearinsurance.com ADDRESS. p @ INSURER(S)AFFORDING COVERAGE NAIC S Albemarle NC 28001 INSURERA: The Cincinnati Insurance Company 10677 INSURED INSURER B: Old Republic Ins CO 24147 Raftelis Financial Consultants,Inc. INSURER C: 227 W Trade St INSURER O: Suite 1400 INSURER E: Charlotte NC 28202 INSURER F: COVERAGES CERTIFICATE NUMBER: 2018-CA/FL 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. 1�7A P TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD MMIDO LIMITS COMMERCIAL GENERAL LIABILITY 2,000,000 EACH OCCURRENCE S CLAIMS-MADE �OCCUR PREMISES Ea occurrence S DAMAGE TO RENTED 50,000 IM X Includes XCU MED EXP fAny one person) S 10.000 A X Contractual Liability CAP5124411 01/21/2018 01/21/2019 PERSONAL BADV INJURY S 2.000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 4,000,000 POLICY X PRO- 4,000,000 JECT L. PRODUCTS-COMPIOP AGG S OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000.000 Ea accident ANY AUTO BODILY INJURY(Per person) 5 A OWNED SCHEDULED CAP5124411 01/21/2018 01/21/2019 BODILY INJURY(Pw accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY IX AUTOS ONLY Per accident S X UMBRELLA LIAB 1 X OCCUR EACH OCCURRENCE S 5,000,000 A EXCESS LIAB CLAIMS-MADE CAP5124411 01/21/2018 OV21/2019 AGGREGATE S 5,000,000 DED 11 RETENTION S Follows Form 5 WORKERS COMPENSATION X STA UTE ERH _ AND EMPLOYERS'LIABILITY YIN " ANYPROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT S 1,000,000 A OFFICER/MEMBEREXCLu0Eo7 N NIA EWC0472640 01/21/2018 01/21/2019 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,OD0,000 It yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S Professional Liability B Claims Made Policy/Retro Date 7/1/17 ALT74641 01/21/2018 01/21/2019 $5,000,000 occurrence $25,000 Ded $5,000,000 aggregate DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Thirty(30)days notice of cancellation,except ten(10)days for non pay,wil be provided. +lA T FN P��Ov�p 5 6`I: M1G CC0 0 O�PGH CERTIFICATE HOLDER CANCELLATION F SHOULD ANY OF THE ABOVE DESCRIBED PO IES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Huntington Beach ACCORDANCE WITH THE POLICY PROVISIONS. 2000 Main Street AUTHORIZED REPRESENTATIVE Huntington Beach CA 92648 QL �. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2316103) The ACORD name and logo are registered marks of ACORD