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05-06-2013-Packet
Joe Lockwood, Mayor CITY COUNCIL Karen Thurman Matt Kunz Bill Lusk Burt Hewitt Joe Longoria Lance Large CITY COUNCIL CHAMBERS City Hall, Suite 107E Monday, May 6, 2013 Regular Council Meeting Agenda 6:00 PM INVOCATION - Father Rob Wood, St. Aidan’s Episcopal Church, Milton, Georgia. CALL TO ORDER 1) ROLL CALL 2) PLEDGE OF ALLEGIANCE (Led by the Mayor) 3) APPROVAL OF MEETING AGENDA (Add or remove items from the agenda) (Agenda Item No. 13-106) 4) PUBLIC COMMENT 5) CONSENT AGENDA 1. Approval of the April 22, 2013 Regular City Council Meeting Minutes. (Agenda Item No. 13-107) (Sudie Gordon, City Clerk) MILTON CITY COUNCIL REGULAR COUNCIL MEETING MAY 6, 2013 Page 2 of 4 Persons needing special accommodations in order to participate in any City meeting should call 678-242-2500. 2. Consideration of the Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Core Physique, LLC for Fitness Classes and Boot Camps. (Agenda Item No. 13-108) (Jim Cregge, Parks & Recreation Director) 3. Consideration of the Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Eagle Stix Lacrosse, Inc. for Girls Lacrosse Programming. (Agenda Item No. 13-109) (Jim Cregge, Parks & Recreation Director) 4. Consideration of the Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and All Tournament Players Park, LLC for Summer Basketball Camps. (Agenda Item No. 13-110) (Jim Cregge, Parks & Recreation Director) 5. Consideration of the Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Kim Saunders Yoga, LLC for Yoga Classes. (Agenda Item No. 13-111) (Jim Cregge, Parks & Recreation Director) 6. Consideration of the Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Newtown Recreation, Inc. for Athletic Programming for Boys and Girls in Multiple Sports. (Agenda Item No. 13-112) (Jim Cregge, Parks & Recreation Director) 7. Consideration of the Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Sperber Music for Children’s Music Classes. (Agenda Item No. 13-113) (Jim Cregge, Parks & Recreation Director) 8. Consideration of the Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Young Men’s Christian Association of Metro Atlanta, Inc. for Soccer Programming. (Agenda Item No. 13-114) (Jim Cregge, Parks & Recreation Director) 9. Consideration of the Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Young Men’s Christian Association of Metro Atlanta, Inc. for Recreation Classes and Summer Camps. (Agenda Item No. 13-115) (Jim Cregge, Parks & Recreation Director) MILTON CITY COUNCIL REGULAR COUNCIL MEETING MAY 6, 2013 Page 3 of 4 Persons needing special accommodations in order to participate in any City meeting should call 678-242-2500. 10. Approval of a Construction Services Agreement between the City of Milton and A.L.S. Septic Systems to Provide Field Line Relocation at Fire Station 41. (Agenda Item No. 13-116) (Carter Lucas, Public Works Director) 11. Approval of a Construction Services Agreement between the City of Milton and Baldwin Paving Company, Inc. for Intersection Improvements at Deerfield Parkway and Morris Road. (Agenda Item No. 13-117) (Carter Lucas, Public Works Director) 6) REPORTS AND PRESENTATIONS 1. Proclamation Recognizing Peace Officers’ Memorial Day and Its Origin in Georgia. (Presented by Councilmember Bill Lusk) 7) FIRST PRESENTATION 1. Consideration of RZ13-10 – Batesville Road (North side approximately 1250 feet west of Birmingham Highway) Section 2/2, Land Lots 777, 736, 737, Cornerstone Bank, To rezone from AG-1 (Agricultural) to CUP (Community Unit Plan) to develop 15 single family residences (minimum 1 acre lots) on 19.9 acres. (Agenda Item No. 13-118) (Kathleen Field, Community Development Director) 8) PUBLIC HEARING (None) 9) ZONING AGENDA (None) 10) UNFINISHED BUSINESS (None) 11) NEW BUSINESS 1. Consideration of a Letter of Intent for Legal Representation of the City of Milton by Jarrard & Davis, LLP. (Agenda Item No. 13-119) (Ken Jarrard, City Attorney) MILTON CITY COUNCIL REGULAR COUNCIL MEETING MAY 6, 2013 Page 4 of 4 Persons needing special accommodations in order to participate in any City meeting should call 678-242-2500. 2. Consideration of a Resolution Appointing Members to the City of Milton Construction Board of Adjustment and Appeals by Appointing Board Members for Districts 1, 2, 3, 4, 5 and 6. (Agenda Item No. 13-120) (Mayor Joe Lockwood) 12) MAYOR AND COUNCIL REPORTS 13) STAFF REPORTS 14) EXECUTIVE SESSION (if needed) 15) ADJOURNMENT (Agenda Item No. 13-121) The minutes will be Provided electronically 24 HOME OF `THE BEST QUALITY OF LIFE 1N GEORGIA' .MILTON* TO: City Council ESTABLlSF1ED 2006 CITY COUNCIL AGENDA ITEM DATE: April 29, 2013 FROM: City Manager AGENDA ITEM: Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Core Physique, LLC for Fitness Classes and Boot Camps. MEETING DATE: Monday, May 6, 2013 Regular City Council Meeting. BACKGROUND INFORMATION: (Attach additional pages if necessary) See attached memorandum APPROVAL BY CITY MANAGER: XAPPROVED CITY A TTORNEY APPROVAL REQUIRED: t1) YES CITY A TTORNEY REVIEW REQUIRED: A YES APPROVAL BY CITY ATTORNEY KAPPROVED PLACED ON AGENDA FOR: 6 5U � REMARKS: {) NOT APPROVED {jNO (j NO (j NOT APPROVED 9120: YOUJM PHONE: 678.242.2500 I FAX: 578.242.2449 +uMAnn �.Green *�.Clii{tCi1* unity �:;r,°r info@cityofmiltonga.us www.c3tYafmiltan9a.us Comm7 dries 13000 Deerfield Parkway, Suite 107 1 Milton GA 30004 - CERTIHEa BRONZE To: Honorable Mayor and City Council Members From: Jim Cregge, Parks & Recreation Director Date: Submitted on April 25 for the May 6 Regular Council Meeting Agenda Item: Consideration of the Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Core Physique, LLC for Fitness Classes and Boot Camps. Department Recommendation: Staff is recommending the approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Core Physique, LLC for Fitness Classes and Boot Camps. Executive Summary: This is a renewal of the agreement reached last year. The Core Physique program has grown in popularity among our residents. It has expanded to the point that they have moved out of our Bethwell Community Center and are now operating in a local studio, along with programs offered after hours in several local schools. Core Physique leaving the Bethwell Community Center opens up the facility for other programming. Funding and Fiscal Impact: In recognition that Core Physique is no longer using City of Milton facilities for programming, the commission has been reduced from 20% to 10%. The commission will be paid to the City of Milton two weeks following the end of registration. The Parks and Recreation Advisory Board agreed that this is appropriate and voted unanimously to support this commission change. Non- resident fees will be collected by the provider and paid to the City at a rate of an additional 50% of the standard registration fee. Alternatives: If we do not renew with Core Physique, we would have to locate a new service provider. Document Legal Review: Contract Template – Paul Higbee, Jarrard & Davis on March 5, 2013 Concurrent Review: Chris Lagerbloom Attachment(s): 1) Parks and Recreation Agreement for Outside Providers Contract and SAVE Affidavit (2 copies) HOME OF ' QUALITY OF Llf- ESTABLISH ED 2006 CITY OF MILTON PARIS & RECREATION DEPARTMENT AGREEMENT FOR OUTSIDE PROVIDERS THIS IS AN AGREEMENT, made this day of , 2013, between: THE CITY OF MILTON, a municipal corporation organized and operating under the laws of the State of Georgia, with a business address of 13000 Deerfield Parkway, Suite 107 A, MILTON, Georgia 30004, hereinafter referred to as the "CITY." and CURE PHYSIQUE, LLC hereinafter referred to as "PROVIDER". CITY and PROVIDER may hereinafter collectively be referred to as "the Parties". In consideration of the mutual obligations of the Parties and for good and valuable consideration, the adequacy and receipt of which are hereby acknowledged, the Parties agree as follows: ARTICLE 1.0 PROVIDER's Services and Responsibilities 1.1 PROVIDER shall conduct services generally described as Fitness Classes & Boot Camps at the following locations: Core Physique, 6225 Atlanta Highway, Suite 111,Alpharetta GA 30004; Hopewell Middle School, 13060 Cogburn Road, Milton, GA 30004; Northwestern Middle School, 12805 Birmingham Hwy, Milton GA 30004; Cogburn Woods Elementary School, 13080 Cogburn Road, Milton GA 30004; Birmingham Falls Elementary School, 14865 Birmingham Hwy, Milton GA 30004; Bethwell Community Center, 2695 Hopewell Road, Milton GA 30004; Bell Memorial Park, 15245 Bell Road, Milton GA 30004. 1.2 The PROVIDER's services shall be performed during the days and hours described in Exhibit "A," attached hereto and incorporated herein by reference. 1.3 The PROVIDER and The Director of the Parks & Recreation Department or his designee, hereinafter referred to as the "DEPARTMENT", will agree upon program schedules. PROVIDER agrees to submit a Program Request Form to the Coordinator for each program being proposed eight (8) weeks prior to the beginning of each session. 1.4 The fees charged to each participant will be as described in Exhibit "A" for residents of MILTON & ALPHARETTA and a surcharge of 50% more for non-residents © Your,: � - �`- znp Green *certified PHONE: 67$.242.2500 FAX: 678.242.2499 WINNIN Community icy of i Infofcityofmiltonga.us www.cltyofmlltonga.us Y Ethics Lm 61Fg the AfAY lF St4f0WbAr UVOg 13000 Deerfield Parkway, Suite 107 1 Milton GA 30004 CERTIFIED BRONZE A; Document of MILTON & ALPHARETTA. The entire balance of this surcharge for non-residents shall be paid to the CITY. 1.5 The PROVIDER warrants to CITY that it is not insolvent, it is not in bankruptcy proceedings or receivership, nor is it engaged in or threatened with any litigation or other legal or administrative proceedings or investigations of any kind which would have an adverse effect on its ability to perform its obligations under this Agreement. 1.6 The PROVIDER agrees that it shall be solely responsible for all costs and/or expenses associated with, or as a result of its operation under this Agreement. The PROVIDER stipulates and certifies that it is qualified to provide the programs it is hired to provide, maintains the education and required licenses or permits necessary to provide the programs, and shall continue to maintain such licenses or permits during the term of this Agreement. 1.7 This Agreement is considered a non-exclusive Agreement between the Parties. The CITY shall have the right to purchase the same kind of services to be provided by the PROVIDER from other sources during the ternn of this Agreement. The PROVIDER is not precluded from providing the same or similar services for other parties so long as such other engagements do not interfere with the PROVIDER'S provision of services to the CITY. 1.8 The DEPARTMENT must approve any promotional material, flyers, and posters advertising the programs prior to its release. The following content and topics shall specifically be prohibited.• sexually explicit materials, profanity, child pornography, alcoholic beverages, tobacco products, adult movies, adult booklvideo stores, adult entertainment establishments, massage parlors, pawn shops, and tattoo parlors or shops. 1.9 The PROVIDER shall not promote any privately owned business in a CITY park/facility or solicit any participant in a CITY park/facility activity for any privately owned business. The PROVIDER may not use said facilities to conduct personal business including workshops, clinics, seminars, camps, or any other activities that are outside the scope of service described in (Exhibit "A"). It is further understood that such action(s) may result in immediate termination of the Agreement and the forfeiture of all compensation due to the PROVIDER. 1.10 The PROVIDER shall abide by the policies, procedures, rules and regulations of the DEPARTMENT, the CITY, and the FULTON COUNTY BOARD OF EDUCATION as promulgated from time to time. PROVIDER understands and agrees that the DEPARTMENT shall have Lirstdvriority for use of CTTYfaeilities, notwithstanding any other provisions of this Agreement 1.11 All assistants, substitutes, and subcontractors utilized by the PROVIDER must have prior written approval of the DEPARTMENT. Document 1.12 PROVIDER shall provide necessary supervisory personnel to ensure that the participants of the programs obey all applicable policies, procedures, Rules and Regulations. 1.13 The DEPARTMENT or CITY may require that the PROVIDER not be permitted to utilize specific assistants, substitutes, or subcontractors of PROVIDER who have failed to follow any policies, procedures, rules or regulations applicable to the use of the facility. 1.14 Although the CITY shall not control the PROVIDER's techniques, methods, procedures, or sequence of instruction, the PROVIDER will comply with the CITY's and DEPARTMENT's policies, rules, regulations and procedures, as well as those of the FULTON COUNTY BOARD OF EDUCATION, and shall not interfere with their operation, nor harm or damage the equipment or facilities afforded to PROVIDER for his/her programs, nor otherwise disrupt the other on-site activities being offered at such public facilities. 1.15 The PROVIDER also acknowledges that he or she is primarily responsible for the conduct of the participants in all programs under the PROVIDER's charge. 1.16 If the PROVIDER will be providing services directly with minor children without parental supervision, the PROVIDER shall, prior to commencing services under this Agreement, comply with the CITY's policy regarding criminal background screening. The CITY will furnish the PROVIDER with a background release form (Exhibit "B") for all the provider's counselors, coaches, volunteers, subcontractors, employees or any other individuals that will come in contact with a child, at the PROVIDER's sole expense. A Consent and Release Form to conduct a criminal background must be executed by any of PROVIDER's employees or any individual who will come in contact with a child at the CITY through PROVIDER or at PROVIDER's direction, such form authorizing the CITY to conduct a search of each such individual's criminal background. The result of such inquiry may be deemed acceptable by the CITY in its sole and complete discretion, and the CITY may reject any individual from participating in any program based upon such results. If the .PROVIDER has recently had a background screening conducted by another agency, the CITY, at its sole discretion, may accept that background screening and waive the requirement of a new background screening. PROVIDER and its employees must also execute a Waiver and Release of Liability holding the CITY and FULTON COUNTY BOARD OF EDUCATION harmless. 1.17 The CITY shall require all participants in all programs to sign a Waiver and Release of Liability. Document ARTICLE 2.4 Equipment & Materials 2.1 All program materials and equipment needed or pertaining to the above stated programs will be provided by the PROVIDER at his/her own cost and expense. However, PROVIDER may require participants to obtain certain materials required in the programs by providing a list of such materials (with approximate costs) to the participants. If PROVIDER makes such materials available to participants, they must be sold at PROVIDER's cost. All equipment provided by the PROVIDER shall be used in strict accordance with equipment manufacturer's instructions and in accordance with all applicable laws. PROVIDER shall coordinate storage of goal posts with the principal of the school located at the facility. 2.2 The sale of merchandise is restricted to those materials utilized in and for the programs. Fundraising activities conducted by the PROVIDER will not be permitted. The PROVIDER shall obtain the CITY's approval of any merchandise to be sold prior to its distribution or sale. 2.3 The CITY will provide no storage space to the PROVIDER, unless otherwise mutually agreed upon in a separate written agreement. 2.4 Any supplies or equipment left at the facility will be the responsibility of the PROVIDER. The CITY will not be responsible for any lost, stolen, or broken equipment or supplies. 2.5 The PROVIDER shall inspect the premises and equipment offered to him/her for his/her proposed activity and if he or she finds anything wrong with the premises or equipment before each program commences that cannot be corrected immediately by the DEPARTMENT, the program shall be canceled and the matter reported to the DEPARTMENT for correction. If the PROVIDER elects to hold his/her programs in the facility provided, it will be presumed that the PROVIDER has inspected the premises and facilities and equipment provided for such programs and has accepted same as being safe and suitable for the use intended. ARTICLE 3.0 Program Size Minimums: 3.1 ACTIVE: Program sizes shall meet the minimum numbers of participants for each program as designated in Exhibit "A." ARTICLE 4.0 Compensation and Method of Payment 4.1 In consideration of the releases and indemnities contained herein and of the PROVIDER's services in connection with the programs and activities described herein, Document the CITY shall be entitled to 10% of the registration fees paid by all program participants to the PROVIDER, and the PROVIDER shall be entitled to 90% of such fees paid, exclusive of the 50% non-resident surcharge. The 50% non-resident surcharge is fully payable to the CITY and shall not be included in PROVIDER's gross income calculation. PROVIDER shall be entitled to retain all non -registration fees paid by participants to PROVIDER, i.e. PROVIDER membership fees and costs for uniforms and pictures to participants. 4.2 The PROVIDER agrees to collect all fees from participants, and the PROVIDER agrees to provide CITY with schedules of fees to be charged to participants in conformance with Exhibit "A". It is agreed that the PROVIDER's sole obligation shall be to collect the fees from the participants and to remit the 10% of the fees collected as well as all 50% non-resident surcharge amounts to the CITY with a pay -out report of all monies collected. Payment will be made to the CITY within fourteen ( 14) business days of the end of each month or session or program, whichever occurs first. 4.3 It is the responsibility of the PROVIDER to pay all applicable local, state, and federal taxes associated with this Agreement, and to acquire and pay for all necessary permits, licenses, and insurance required for the execution of this Agreement. ARTICLE 5.0 Independent „PROVIDER 5.1 This Agreement does not create an employee/employer relationship between the Parties. It is the intent of the Parties that the PROVIDER is an independent contractor under this Agreement and not a CITY employee for all purposes, including but not limited to, the application of the Fair Labor Standards Act minimum wage and overtime payments, Federal Insurance Contribution Act, the Social Security Act, the Federal Unemployment Tax Act, the provisions of the Internal Revenue Code, The State Workers Compensation Act, and the State unemployment insurance law. The PROVIDER shall retain sole and absolute discretion in the judgment of the manner and means of carrying out PROVIDER's activities and responsibilities hereunder. The PROVIDER agrees that it is a separate and independent enterprise from the CITY, that it had full opportunity to find other business, that it has made its own investment in its business, and that it will utilize a high level of skill necessary to perform the work required hereunder. This Agreement shall not be construed as creating any joint employment relationship between the PROVIDER and the CITY and the CITY will not be liable for any obligation incurred by PROVIDER, including but not limited to unpaid minimum wages or overtime premiums. 5.2 PROVIDER warrants that it has not employed or retained any company or person, other than a bona fide employee working solely for the PROVIDER to solicit or secure this Agreement, and that it has not paid or agreed to pay any person, company, corporation, individual or firm any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of this provision, the CITY shall have the right to terminate Document the Agreement without liability at its discretion, to deduct from the contract price, or otherwise recover the full amount of such fee, commission, percentage, gift or consideration. ARTICLE 6.0 Insurance 6.1 PROVIDER shall not provide any service until all insurance required under this paragraph has been obtained and approved by the CITY. 6.2 Certificates of Insurance. Certificates of Insurance reflecting evidence of the required insurance shall be filed with the CITY prior to the commencement of this Agreement. These Certificates shall contain a provision that coverages afforded under these policies will not be cancelled until at least forty-five days (45) prior written notice has been given to the CITY. Policies shall be issued by companies authorized to do business under the laws of the State of Georgia. Financial Ratings must be not less than "A -VI" in the latest edition of "Best Key Rating Guide", published by A.M. Best Guide. 6.3 Insurance shall be in force until the obligations required to be fulfilled under the terms of the Agreement are satisfied. In the event the insurance certificate provided indicated that the insurance shall terminate and lapse during the period of this Agreement, then in that event, the PROVIDER shall furnish, at least thirty (30) days prior to the expiration of the date of such insurance, a renewed Certificate of Insurance as proof that equal and like coverage for the balance of the period of the Agreement and extension thereunder is in effect. The PROVIDER shall not provide any service pursuant to this Agreement unless all required insurance remains in full force and effect. 6.4 Commercial General Liabilit insurance to cover liability bodily injury and property damage. Exposures to be covered are: premises, operations, products/completed operations, and certain contracts. Coverage must be written on an occurrence basis, with the following limits of liability: $1,000,000 Combined Single Limit — each occurrence $2,000,000 Combined Single Limit — general aggregate $1,000,004 Personal Injury $1,040,000 Products/Completed Operations Aggregate PROVIDER shall have its insurer name the City of MILTON as an additional insured on its General Liability policy. 6.5 Worker's Compensation insurance shall be maintained during the life of this Agreement to comply with the statutory limits for all employees, and in the case any work is sublet, the PROVIDER shall require the subcontractor(s) similarly provide Workers Compensation Insurance for all the latter's employees unless and until such employees are covered by the protection afforded by the PROVIDER. The PROVIDER and his Document subcontractors shall maintain during the life of this Agreement Employers Liability Insurance. The following limits must be maintained: A. Workers Compensation Statutory B. Employer's Liability $100,000 each accident $500,000 Disease -policy limit $100,000 Disease -each employee If PROVIDER or its subcontractor claims to be exempt from this requirement, PROVIDER shall provide CITY proof of such exemption along with a written request for CITY to exempt PROVIDER, written on PROVIDER or subcontractor's letterhead. 6.6 PROVIDER shall also maintain Auto Liability and Directors and Officers insurance with limits reasonably acceptable to CITY during the term of this Agreement. 6.7 The CITY and the Fulton County Board of Education shall each be named as an additional insured and loss payee on all policies required by this Agreement. ARTICLE 7.0 Term and Termination 7.1 After a two (2) month trial period, the programs will be evaluated by the DEPARTMENT, and the remainder of this Agreement will either be terminated or continue in full force and effect. If at any time after the two (2) month evaluation, program enrollment should fall below the required minimum, the PROVIDER will be allotted four (4) weeks to bring enrollment up to the required minimum. The programs will be reevaluated and execution or termination of the contract will be determined by the DEPARTMENT. 7.2 The term of this Agreement shall commence upon the date of execution hereof and shall remain in effect for a period of one (1) year from the date of execution of this Agreement by the CITY, unless terminated sooner as provided in this Article. Renewal of this Agreement beyond the one (1) year term shall require the mutual written agreement of the CITY and PROVIDER. 7.3 This Agreement may be terminated by the CITY for convenience upon giving of at least thirty (30) days prior written notice of termination to the PROVIDER at the PROVIDER's address set forth herein at the sole and exclusive discretion of the CITY. This Agreement may be terminated by the City immediately by written notice to PROVIDER upon any willful, reckless, or grossly negligent act or omission by PROVIDER or any of its officers, agents, employees, or volunteers. 7.4 This Agreement may be terminated by PROVIDER upon giving at least thirty (30) days written notice of termination to the CITY. 7.5 PROVIDER must notify the DEPARTMENT in writing of any program cancellations at least ten (10) business days prior to the scheduled cancellation. Document 7.6 CITY reserves the right to cancel or reschedule any of the PROVIDER's programs, in the case of scheduling conflicts or other emergencies, as determined by the DEPARTMENT. ARTICLE 8.0 Indemnification 8.1 PROVIDER agrees to indemnify and hold harmless the CITY and the FULTON COUNTY BOARD OF EDUCATION, their trustees, elected and appointed officers, agents, servants and employees, from and against any and all claims, demands, or causes of action of whatsoever kind of nature, and the resulting losses, costs, expenses, reasonable attorneys' fees, including paralegal fees, liabilities, damages, orders, judgments, or decrees, sustained by the CITY, the FULTON COUNTY BOARD OF EDUCATION, or any third party arising out of, or by reason of, or resulting from the will full or negligent acts, errors, or omissions of the PROVIDER or its agents, officers, volunteers or employees_ 8.2 The Parties understand and agree that the covenants and representations relating to this indemnification provision shall survive the term of this Agreement and continue in full force and effect as to the PROVIDER's responsibility to indemnify. ARTICLE 9.0 Americans With Disabilities Act 9.1 PROVIDER shall not discriminate against any person in its operation and activities in its use or expenditure of the funds or any portion of the funds provided by this Agreement and shall affirmatively comply with all applicable provisions of the Americans With Disabilities Act ("ADA"), in the programs while providing any services funded in whole or in part by the CITY, including Titles I and 11 of the ADA and all applicable regulations, guidelines, and standards. 9.2 PROVIDER's decisions regarding the delivery of services under this Agreement shall be made without regard to or consideration of race, age, religion, color, gender, sexual orientation, national origin, marital status, physical or mental disability, political affiliation, or any other factor which cannot be lawfully or appropriately used as a basis for delivery of service. 9.3 PROVIDER in accordance with Title VI of the Civil Rights Act, as amended, 42 U.S.C. § 2000d, section 303 of the Age Discrimination Act of 1975, as amended, 42 U.S.C. § 6102, section 202 of the Americans with Disabilities Act of 1990, 42 U.S.C. § 12132, and all other provisions of Federal law, the Provider agrees that, during performance of this Agreement, Provider, for itself, its assignees and successors in interest, will not discriminate against any employee or applicant for employment, any subcontractor, or any supplier because of race, color, creed, national origin, gender, age or disability. In addition, Provider agrees to comply with all applicable implementing Document regulations and shall include the provisions of this Section IV(R) in every subcontract for services contemplated under this Agreement. ARTICLE 10.0 Miscellaneous 10.1 No modification, amendment, or alteration of the terms and conditions contained shall be effective unless contained in a written document executed with the same formality and equal dignity herewith. 10.2 This Agreement is non -transferable or assignable, and PROVIDER agrees not to transfer or assign the performance of services called for in the Agreement. 10.3 This Agreement sets forth the full and complete understanding of the Parties as of the effective date, and supersedes any and all negotiations, agreements, and representations made or dated prior to this Agreement. 10.4 The PROVIDER shall pay reasonable attorney's fees to the City should the City be required to incur attorney's fees in enforcing the provisions of this Agreement. 10.5 Time is of the essence of this Agreement. 10.5 Each of the individuals who executes this Agreement agrees and represents that he is authorized to execute this Agreement on behalf of the respective entity. Accordingly, the City and PROVIDER both waive and release any right to contest the enforceability of this Agreement based upon the execution and/or approval thereof. 10.7 It is the policy of City that unauthorized aliens shall not be employed to perform work on City contracts involving the physical performance of services. Therefore, the City shall not enter into a contract for the physical performance of services within the State of Georgia, unless the PROVIDER shall provide evidence on City -provided forms, attached hereto as Exhibits "C" and "D" that it and its subcontractors have within the previous twelve (12) month period conducted a verification of the social security numbers of all employees who will perform work on the City contract to ensure that no unauthorized aliens will be employed. The City Manager or his/her designee shall be authorized to conduct an inspection of the PROVIDER's and its subcontractors' verification process to determine that the verification was correct and complete. The PROVIDER and its subcontractors shall retain all documents and records of its verification process for a period of three (3) years following completion of the contract. This requirement shall apply to all contracts for the physical performance of services where more than three (3) persons are employed on the City contract. Compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300-10-1-.02 is mandatory. Document PROVIDER's compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300- 10-1-.02 shall be attested by the execution of the contractor's affidavit attached as Exhibit «C » Pursuant to O.C.G.A. § 50-36-1, the City must obtain a SAVE Affidavit and a secure and verifiable document evidencing the Contractor's legal status in the Country each time that Contractor obtains a public benefit, including any contract, from the City. Contractor hereby verifies that it has, prior to executing this Agreement, executed a SAVE Affidavit (to be sworn under oath under criminal penalty of false swearing pursuant to O.C.G.A. § 16-10-71), a form of which is attached hereto as Exhibit "E", and submitted such affidavit to the City in person, electronically, or by mail. Further, Contractor verifies that it has, prior to executing this Agreement, submitted a secure and verifiable document, evidencing the Contractor's legal status, to the City either in person or electronically (in compliance with the Uniform Electronic Transactions Act). Contractor verifies that it is in compliance with the Residency Status of an Applicant for Public Benefit, as required by the Georgia Security and Immigration Compliance Act (O.C.G.A. § 50-36-1). Document IN WITNESS OF THE FOREGOING, the Parties have set their hands and seal the day and year first written above. ATTEST: SLUDIE GORDON, CITY CLERK WITNESS: CITY: FMV JOE LOCKWOOD, MAYOR PROVIDER: 4�20EN RIDDICK, P SIDENT [AFFIX CORPORATE SEAL] EXHIBIT "A" Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. Thrs information will be used for consideration of program proposals. Use one form per p!!2gram. Name of Program Participant Ages: r] Dayls of the week program is offered: Time of Program: Z-0 CL" - �� t to Program Dates: to - L Program Fee: Program Enrollment: Minimum l f� Maximum S. Materials to be supplied by participants: Materials to be supplied by PRMDER: Materials to be supplied by the City of MILTON: 'Y'NC3 Y1 Additional Program Requirements: PROVIDER (s)Name: _ Address: -4 (_Q0 City/State/Zip Code: Phone Number: (Day (E-mail): (Evening) ,_ (Fax) _ ice Use Only: rogram Rate:$ ti of programs in Session: FeelProgram: Subsidy/Progrnm: $ New Fee/Program: $ New Program Rate` $ Notes: EXHIBIT "A" PROGRAM REQ Vii) ESTE'DRM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. phis inforncaiion will be used far consideration of program proposals. Use one form per iprogirarn. Name of Program: ■ Participant A ges: Dayls of the week program is offered: %; t+ Time of Proaram: t9.[7_ -��� m _to Program Dates: LAfL a lrW r,ri sto— Program Fee: 1QCYtL) ,rim h Chi / ,�)Y Q 1,t �Y Program Enrollment: Minimum lQ Maximum Materials to be supplied bypartici ants: t,t. 7c.t. 2 Materials to be supplied by PROVIDER: Materials to be supplied by the City of MILTON: Additional Program Requirements: PROVIDER (s)Name: Address: - (00 t — ,ti V�-� fir. CitylStatelZip Code: ilO un 2unq Phone Number: (Day) IDLI -4 •(Jgga _ (Evening) (E-mail): (Fax) _ Use Only: Rate:$ # of prograrns in Session: Fee/Program: Subsidy/Progra in: New Fee,'Progmw $ New Program Rats $ Notes: EXHIBIT "A" PRQGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this faun attached to the Letter of Interest. This information will be used for consideration of program proposals. Name of Pri Participant Ages: (ACI t i l'CS Day1s of the week program is offered: IW Time of Program: S'• 16 - IV,: �O G�.� _ to Program Dates: Lear iQ(,L n,4 to Program Fee: G Program Enrollment Minimum Maximum►. Materials to be supplied by participants: DNA, Materials to be supplied by PROVIDER: Materials to be supplied by the City of MILTON: Additional Program Requirements: PROVIDER (`s)Narne: Address: CityiState/Zip Code: Phone Nurpbe�: (Day) (Frmail): (Evening) _ (Fax) )ffiee Use only: Rate:$ # of programs in Session: Fee/Program: Subsidy/Program: $_ Notes: New Fee/?rograrn: $ New Program Rate: $ EXH[BIT "A" PROGILAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This inforniation will be used far consideration of program proposaIs. Use one form 13er prop -ram. ' Name of Program: i Participant Ages:Gd(k-VZS Dayls of the week program is offered: M ,.W Time of Pro gm ra: TS1.45 G -1'1 h tom [7•_ i Ct.� Program Dates:�Qa to Program Fee. a V - Program Enrollment: Minimum � Maximum Materials to be supplied by participants: '- Q_ -a- lrl-- vm--f - Materials to be supplied by Materials to be supplied by the City of MILTON: K)QY f Additional Program Requirements. PROVIDER Cs)Name: Address: Loo) l City/State/Zip Code: Phone Number: (Day) �i • _ (Evening) (E --mail): (Fax) Use Only: Rata $ # of programs in Session: FeelProgram: Subsidy/Program $ New Fee Program: $ New Program Rate: $ Notes-- EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used far consideration of program proposals. Use of Name of Program: Participant Ages: _ Dayls of the week pro ram is offered: _ Time of Program: I ' -So a"-4 Program Dates: Uea-r rou.vid Program Fee: I I a b I -,-;X � Program Enrollment: Minimum Materials to be supplied by participants Materials to be supplied by PROVIDER: Materials to be supplied by the City of MILTON: k Additional Program Requirements: PROVIDER (s)Name: Address:. 4tao Cyv"" p r� �+ C City/State/Zip Code: _ YYl LA C-, �- Phone Number: (Day) SO4 �&S 9f:�15; (Evening) (E-mail): (Fax) Use Only: Rate:$ ff of programs in Sessiocr: FeelProgram: Subsidy/Program: $� New Fee/Prograu: $ New Progiam Rate: $ Notes: EXHIBIT "A" PRQGRAM REQ(JEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter ofInterest. Interest. This information will be used, for consideration of program proposals. Use one form er pro m. Name of Program: Participant Ages: Dayls of the week program is offered: Time of Program: CO*v% to Program Dates: ` MLr- ►rou..r& to Program Fee: ___ 1Q0 / ?nX CL_l rL _� '� Sc 4, Program Enrollrmeni: M411mum Maximum Materials to be supplied by participants: \AJOAr.1r' bG" Lk, Ymt,k Materials to be supplied by PROVIDER: 1!_QS,_ WVv:S , Aywe� Materials to be supplied by the City of MILTON: r6wtg— Additional Program Requirements: PROVIDER (`s)Nam( Address: z- UCD CitylStatelZip Code: _ Phone Number: (Day) (E-mail): kna InC (Evening) — (Fax) - Use Only: Ram $__ ff of pogruns is Session: FedProgram: ,Notes: Subsidy/Program: $ New Fe&Prograna: $_ New Pro am Rate: $ EXHTI rr "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. U§e one form per program. Name of Program:i Participant Ages: (f ' I)Y , &(-v L . t. ) �I L{ I f Day/s of the week program is offered: Time of Program: • ? _ to Program Dates L E. LSC ; Ll to —14{-. �I11 jj Program Fee: l Program Enrollment: Minimum Maximum T7 Materials to be supplied by participants: i Materials to be supplied by PROVIDER: Materials to be supplied by the City of MILTON: Additional Program Requirements: PROVIDER (`s)Name: _1T C Address: Pk( �, .)l City/State/Zip Code: I T -t 1 Phone Number: (Day) i (Evening) � (E-mail): 1 L tc f Cc:,V �� �, t` (Fax) Minimum Requirements: 1,000,000 General Liability insurance Office Use Only, Program Rate:$ # of programs in 5essiorn: Fee/Program: i S i EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: ~ Participant Ages: _ (�� 1_� Day/s of the week program is offered: -T Time of Program Program Dates: ��� i �IL� C'� to Program Fee: to Program Enrollment: MinimumMaximum Materials to be supplied by participants: %Aocci��,'— Materials to be supplied by PROVIDER: UA -I 1 �L L` l r L •L► Materials to be supplied by the City of MILTON: Additional Program Requirements: PROVIDER Cs)Name: ,1. r Address: 4C�c LIN-.�-J�\0 V \ --e City/State/Zip Code: 0116A Phone Number: (Day) (Evening) (E-mail).- Minimum E-mail): Minimum Requirements: 1,000,000 General Liability Insurance (Fax) Office Use Only: Prograrn Rate:$ # of programs In Session: Fee/Program: Document EXHIBIT "C" STATE OF GEORGIA CITY OF MILTON CONTRACTOR AFFIDAVIT AND AGREEMENT By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm, or corporation which is contracting with the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13 -10 -91 - The undersigned further agrees that, should it employ or contract with any subcontractor(s) in connection with the physical performance of services pursuant to this contract with the City of Milton, contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. § 13-10-91 on the Subcontractor Affidavit provided in Rule 300-10-01-.08 in the form attached hereto as Exhibit "D." Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the City of Milton at the time the subcontractor(s) is retained to perform such service. EEV 1 asic Pilot Program User Identification Number BY: Authorized Offs r or Agent Date Core Physique, LLC Title of Authorized Officer or Agent of Contractor W2 L-C'JE1 Printed Name of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE 1-5- DAY OF ,�,r; t_ 7201 3 Notary Public �.•`� .• �''% My Commission Expires: - t1OTAq ice, ';Zm' _ Document STATE OF GEORGIA CITY OF MILTON EXHIBIT "D" SUBCONTRACTOR AFFIDAVIT By executing this affidavit, the undersigned subcontractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services under a contract with Core Physique on behalf of the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. E"Baicogram User Identification Number Bcer or Agent Date [INSERT SUBCONTRACTOR NAME] Title of Authorized Officer or Agent of Subcontractor 6L L4-r�?tdd'caL Printed Name of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF Z4ao ri t— Nota6 Public Y :� My Commission Expires: !4C .. 5� ACORD CERTIFICATE OF LIABILITY INSURANCE ATE (MMIDDIYYYY] H04/2b/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 pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certaln 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 NAME: The Insurance Store wC° No Ext: 770.422.4511 1eC No _ 770.423. 1417 1634 White Circle, Suite 103 E-MAIL ADDRESS' INSURER(S) AFFORDING COVERAGE NAIC# Marietta, CA 30066 PERSONAL & AOV INJURY $ 11000,000 INSURER A : Savi ers Prop & Ca5 INSURERS: Miscellaneous Companies INSURED Core Physique, LLC c/o Kol l een Riddick INSURER C : 460 Champions View Drive INSURER D: Milton, CA 30004 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 1Z-13 Master 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, R LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY EFF MMiDDIYYYY POLICY EXP MMIDDIYYYY L31AfT5 A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE T OCCUR Suite 107 A CP069634 08/2112012 08/21/2013 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 300,000 MED EXP tAny one person) $ 5,000 PERSONAL & AOV INJURY $ 11000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- JECT LOC PRODUCTS- COM PIOP AGG $ 3,000,000 $ AUTOMOBILE LIABILITY ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS Ea accident S BODILY INJURY (Per person) $ BODILY INJURY (Per accident) S AMAGE Peracodenl UMBRELLA LIAR EXCESS LIAR OCCUR CLAiMS-MADE I EACH OCCURRENCE $ AGGREGATE $ DEO I I RETENTION $ S B WORKERS COMPENSATION AND EMP LAYERS' LIABILITY N ANY PROPRIETORIPARTNERIEXECUTIV YIN 0FFICERIMEMBER EXCLUDED? MY (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A WC076608 10101/2012 10/01/2013 X I 7,RSTATU-T LIMITS ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISFIISE - POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Milton ACCORDANCE WITH THE POLICY PROVISIONS. tom. gil 1 i am@ci tyofmi 1 tonga . us AUTHORIZED REPRESENTATIVE 13000 Deerfield Parkway^-. Suite 107 A Milton, CA 30004 C. Dennis Collis/JACKIE O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD ACORD CERTIFICATE OF LIABILITY INSURANCE DATE IMM7DDIYYYY} a4/Z512013 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 The Insurance Store 1634 white Circle, Suite 103 Marietta, CA 30066 UQNIAQI -NAME: PHONE 770.423.1417 a No : 770.423.1417 o Ex fA1C No. €ADDRESS: INSURER(S) AFFORDING COVERAOE NAIC Al INSURERA: Saviers Prop & Cas INSURED Core Physique, LLC c/o Kol l een Riddick 460 Champions View Drive Milton, GA 30004 INSURER e : Miscellaneous Companies INSURERC : INSURER 13! INSURER E INSURER F! COVERAGES CERTIFICATE NUMBER: 12-13 Master 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. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE AUUL/LTR TYPE OF INSURANCE /NSR WVD POLICY NUMBER MMIDDIYYYY MMIDD P LIMITS A GENERAL LIABILITY X COMMERCIAL GENERA. LIABILITY OLAIMS-MADE 1 7X OCCUR 786 Cleveland Avenue 5W CP0696343 081211201210812112013 EACH OCCURRENCE $ 1,000,000 PREMISES JEa oocunenca S 300 , g0 MED EXP (Any one person) $ 5,0()( PERSONAL &ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 3,000,00C �EN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC )ECT PRODUCTS - COMPIOP AGG S 3,000,00 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED ALTOSAUTOS COMBINED SIROrE= Es accident $ BODILY INJURY (Per person) S BODILY I NJU RY (Per aoddent) $ 1 PROPERTY DAMAGE $ Per accident UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEQ I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIV OFFICE R+MEM BER EXCLUDED? (Mandatary in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N 1 A WC076608 10/01/2012 10/01/2013 X W ATU TORY LIMITS ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION Of OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) CERTIFICATE HOLDER CANCELLATION © 1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Fulton County Schools tom.gilliam@cityofmiltonga.us AUTHORIZED REPRESENTATIVE 786 Cleveland Avenue 5W Atlanta, GA 30315 C. Dennis Collis/]ACKIE © 1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Home Edit Account I Log Out CORE PHYSIQUE, LLC Control Number: 08060647 Main II Reports I Officers 11 Filing History Entity Info Entity Id 2695242 Key Indicators Model Type Limited Liability Company Locale Domestic Qualifier None Business Name CORE PHYSIQUE, LLC Registration Date 8/0312008 Entity Status Active/Compliance Foreign Name Date of Organization State Georgia Country Principal Office Address PRINCIPAL Linel 460 Champions View Drive Line2 City Milton State Georgia Zip 30004 Agent Is non-commercial Registered Agent? Yes Name Riddick, Kalleen Add ress Linea 460 Champions View Drive Line2 City Alpharetta State Georgia Zip 30004 Email Previous Names tUIN tnatvtctuat xequest - unline i�ppttcation EIN Assistant Your Progress: 1. Identity Z. Authenticate 3. Addresses Congratulations! Your EIN has been successfully assigned. EIN Assigned: 26-3378373 Legal Name: CORE PHYSIQUE LLC IMPORTANT: Save and/or print this page and the confirmation letter below for your permanent records. 4. Details The confirmation letter below is your official IRS notice and contains important information regarding your EIN. -Ot ' Help with saving and. CLICK HERE for Your EIN Confirmation Letter printing your letter Once you have saved or printed your letter, click "Continue" to get additional information about using your new EIN. Continue »> Fage t of t 5. EIN Help Topics What if I c access to time? Can I acc later date' l -.+x,.....11.,..1 ..n.,...�.......�..I..,...a:,.....1....,1:..:,7,...i�...._r.__.�a:...._ ..... n�i ���nnn ! LO N E" z V n° Ln v uy-�� .CQ �J•AJ o cu o r— o o CL D N -P O � U D uQ� L 1-1 o� F:.2w Ln LL �0 z�LU �u .•/ uo I tx LLJ 0 0 G1. ui ui 1-1 z w z 0 W }— CO w 0 oU) w� J z J w LL Lu LL M J w LL z C/)0 U� w L) c_) U = M ❑ cn w �n ❑ Z M z LU U) N CL ■ 0 PEE1 HERE Heartsaver'!J' American CPR A E D AsSOCt ssociatinrl� Kolk,, rn Riddick .... ... ... I. ......... ... .......... _ [,a5 su. -[Uw MM;A" ftsC � II ivG ..ri%4 m k;o Aim IN L'drr.tn4* & its$E Y. ., M AED UR AEU MW CPR U0 3 c te,gt�al+r,ie� ��ir Ndli „�sr�Cd 13sri C]a[r Anco[ranona®d Ra,lowitl Lite -sfrike 91rougf) thm :Modules NO'f completed. This card conlains un-ique stt; dty featurts to protect against tvrgery. TrafnIng TC ID O COMW Name- _Ct�I1e _s�£Aic�tital Txairsin� -•- X��QM3k5 iC lnf9 LAkw d, WA 99499 253-566.8292` Cwrse CPR Training School, Alpharetta, Cath Locafltn or Chrisf ne Neely 770-365-39W 1© e H40de1's Signaium - .._._.........._.... M....... .... ... ......... __I--,"........... 90-1913 1M n HCME OF `THE BEST QUALITY OF LIFE IN GEORGIA' MILTON* ESTABLISHED 2006 CITY COUNCIL AGENDA ITEM TO: City Council DATE: April 29, 2013 FROM: City Manager AGENDA ITEM: Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Eagle Stix Lacrosse, Inc. for Girls Lacrosse Programming. MEETING DATE: Monday, May 6, 2013 Regular City Council Meeting. BACKGROUND INFORMATION: (Attach additional pages if necessary) See attached memorandum APPROVAL BY CITY MANAGER: APPROVED (} NOTAPPROVED CITY ATTORNEY APPROVAL REQUIRED: YES (} NO CITY A TTORNEY REVIEW REQUIRED: ( YES (} NO APPROVAL BY CITY ATTORNEY Y�APPRO VED (} NOT APPRO VED PLACED ON AGENDA FOR: REMARKS: 91 YOM - PHONE: 678.242.25001 FAX: 578.242.2499 TIIIB Green ■� *44 Certifi ww� c©mmun!ty F th �s , info@cityofmiffinnga.us1www.ci#yofmiltangc�.us 1 : �.tg&'*W,,I,s,,: ;,.:,.:; 4V-$chics4�y 13000 Deerfield Parkway, Suite 107 1 Milton GA 30004 -- CERTIFIED 8RQNZi: Z To: Honorable Mayor and City Council Members From: Jim Cregge, Parks & Recreation Director Date: Submitted on April 25 for the May 6 Regular Council Meeting Agenda Item: Consideration of the Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Eagle Stix Lacrosse, Inc. for Girls Lacrosse Programming. Department Recommendation: Staff is recommending the approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Eagle Stix Lacrosse, Inc. for girls lacrosse programming. Executive Summary: This is a renewal of the agreement reached last year. The Eagle Stix Lacrosse program for girls is the 2nd largest youth program in the City of Milton and the largest program aimed at girls. Eagle Stix is working with us now on two IGA’s with the Fulton County Board of Education to solidify their usage of Northwestern Middle School as their base of operations. Funding and Fiscal Impact: A commission of 10% will be paid to the City of Milton two weeks following the end of registration. Non-resident fees will be collected by the provider and paid to the City at a rate of an additional 50% of the standard registration fee. Alternatives: If we do not renew with Eagle Stix, we would have to locate a new service provider. Legal Review: Contract Template – Paul Higbee, Jarrard & Davis on March 5, 2013 Document Concurrent Review: Chris Lagerbloom Attachment(s): 1) Parks and Recreation Agreement for Outside Providers Contract and SAVE Affidavit (2 copies) HOME of MI L I (,)N' ESTABLISHEf'} 20UG CITY OF MILTON PARKS & RECREATION DEPARTMENT AGREEMENT FOR OUTSIDE PROVIDERS THIS IS AN AGREEMENT, made this day of , 2013, between: THE CITY OF MILTON, a municipal corporation organized and operating under the laws of the State of Georgia, with a business address of 13000 Deerfield Parkway, Suite 107 A, MILTON, Georgia 30004, hereinafter referred to as the "CITY." and EAGLE STIR LACROSSE INC. hereinafter referred to as "PROVIDER". CITY and PROVIDER may hereinafter collectively be referred to as "the Parties". In consideration of the mutual obligations of the Parties and for good and valuable consideration, the adequacy and receipt of which are hereby acknowledged, the Parties agree as follows: ARTICLE 1.0 PROVIDER's Services and Responsibilities 1.1 PROVIDER shall conduct services generally described as Girls LaCrosse at the fallowing locations: Northwestern Middle School, 12805 Birmingham Hwy, Milton GA 30004; and Birmingham Falls Elementary School, 14865 Birmingham Highway, Milton, GA 30004. 1.2 The PROVIDER"s services shall be performed during the days and hours described in Exhibit "A," attached hereto and incorporated herein by reference. 1.3 The PROVIDER and The Director of the Parks & Recreation Department or his designee, hereinafter referred to as the "DEPARTMENT", will agree upon program schedules. PROVIDER agrees to submit a Program Request Form to the Coordinator for each program being proposed eight (8) weeks prior to the beginning of each session. 1.4 The fees charged to each participant will be as described in Exhibit "A" for residents of MILTON & ALPHARETTA and a surcharge of 50% more for non-residents of MILTON & ALPHARETTA. The entire balance of this surchar a for non-residents shall be paid to the CITY. PHONE: 678.242.25001 FAX: 678.242.2499 PC AINAao �'V ree n ; � * CerriF�ed WINNER City of info4cifyofmiltonga.us I www.cityofmiltonga.us �� ommunity Echics n �; n� t� f� w.r a SWvWar, L, 13000 Qeerfleid Parkway, Suiten 107 1 Milton GA 30004 - CERTIFIED BRONZE ?e 40, Document 1.5 The PROVIDER warrants to CITY that it is not insolvent, it is not in bankruptcy proceedings or receivership, nor is it engaged in or threatened with any litigation or other legal or administrative proceedings or investigations of any kind which would have an adverse effect on its ability to perform its obligations under this Agreement. 1.6 The PROVIDER agrees that it shall be solely responsible for all costs and/or expenses associated with, or as a result of its operation under this Agreement. The PROVIDER stipulates and certifies that it is qualified to provide the programs it is hired to provide, maintains the education and required licenses or permits necessary to provide the programs, and shall continue to maintain such licenses or permits during the term of this Agreement. 1.7 This Agreement is considered a non-exclusive Agreement between the Parties. The CITY shall have the right to purchase the same kind of services to be provided by the PROVIDER from other sources during the term of this Agreement. The PROVIDER is not precluded from providing the same or similar services for other parties so long as such other engagements do not interfere with the PROVIDER'S provision of services to the CITY. 1.8 The DEPARTMENT must approve any promotional material, flyers, and posters advertising the programs prior to its release. The following content and topics shall specifically be prohibited. sexually explicit materials, profanity, child pornography, alcoholic beverages, tobacco products, adult movies, adult boollvideo stores, adult entertainment establishments, massage parlors, pawn shops, and tattoo parlors or shops 1.9 The PROVIDER shall not promote any privately owned business in a CITY park/facility or solicit any participant in a CITY park/facility activity for any privately owned business. The PROVIDER may not use said facilities to conduct personal business including workshops, clinics, seminars, camps, or any other activities that are outside the scope of service described in (Exhibit "A"). It is further understood that such action(s) may result in immediate termination of the Agreement and the forfeiture of all compensation due to the PROVIDER. 1.14 The PROVIDER shall abide by the policies, procedures, rules and regulations of the DEPARTMENT, the CITY, and the FULTON COUNTY BOARD OF EDUCATION as promulgated from time to time. PROVIDER understands and agrees that the DEPARTMENT shall have first priarity�or use of CITYfacilides notwithstanding env other provisions of this Agreemrent 1.11 All assistants, substitutes, and subcontractors utilized by the PROVIDER must have prior written approval of the DEPARTMENT. 1.12 PROVIDER shall provide necessary supervisory personnel to ensure that the participants of the programs obey all applicable policies, procedures, Rules and Regulations. Document 1.13 The DEPARTMENT or CITY may require that the PROVIDER not be permitted to utilize specific assistants, substitutes, or subcontractors of PROVIDER who have failed to follow any policies, procedures, rules or regulations applicable to the use of the facility. 1.14 Although the CITY shall not control the PROVIDER's techniques, methods, procedures, or sequence of instruction, the PROVIDER will comply with the CITY's and DEPARTMENT's policies, rules, regulations and procedures, as well as those of the FULTON COUNTY BOARD OF EDUCATION, and shall not interfere with their operation, nor harm or damage the equipment or facilities afforded to PROVIDER for his/her programs, nor otherwise disrupt the other on-site activities being offered at such public facilities. 1.15 The PROVIDER also acknowledges that he or she is primarily responsible for the conduct of the participants in all programs under the PROVIDER's charge. 1.16 If the PROVIDER will be providing services directly with minor children without parental supervision, the PROVIDER shall, prior to commencing services under this Agreement, comply with the CITY's policy regarding criminal background screening. The CITY will furnish the PROVIDER with a background release form (Exhibit "B") for all the provider's counselors, coaches, volunteers, subcontractors, employees or any other individuals that will come in contact with a child, at the PROVIDER's sole expense. A Consent and Release Form to conduct a criminal background must be executed by any of PROVIDER's employees or any individual who will come in contact with a child at the CITY through PROVIDER or at PROVIDER's direction, such form authorizing the CITY to conduct a search of each such individual's criminal background. The result of such inquiry may be deemed acceptable by the CITY in its sole and complete discretion, and the CITY may reject any individual from participating in any program based upon such results. If the PROVIDER has recently had a background screening conducted by another agency, the CITY, at its sole discretion, may accept that background screening and waive the requirement of a new background screening. PROVIDER and its employees must also execute a Waiver and Release of Liability holding the CITY and FULTON COUNTY BOARD OF EDUCATION harmless. 1.17 The CITY shall require all participants in all programs to sign a Waiver and Release of Liability. ARTICLE 2.0 Equipment & Materials 2.1 All program materials and equipment needed or pertaining to the above stated programs will be provided by the PROVIDER at his/her own cost and expense. However, PROVIDER may require participants to obtain certain materials required in the programs by providing a list of such materials (with approximate costs) to the participants. If PROVIDER makes such materials available to participants, they must be sold at Document PROVIDER's cost. All equipment provided by the PROVIDER shall be used in strict accordance with equipment manufacturer's instructions and in accordance with all applicable laws. PROVIDER shall coordinate storage of goal posts with the principal of the school located at the facility. 2.2 The sale of merchandise is restricted to those materials utilized in and for the programs. Fundraising activities conducted by the PROVIDER will not be permitted. The PROVIDER shall obtain the CITY's approval of any merchandise to be sold prior to its distribution or sale. 2.3 The CITY will provide no storage space to the PROVIDER, unless otherwise mutually agreed upon in a separate written agreement. 2.4 Any supplies or equipment left at the facility will be the responsibility of the PROVIDER. The CITY will not be responsible for any lost, stolen, or broken equipment or supplies. 2.5 The PROVIDER shall inspect the premises and equipment offered to him/her for his/her proposed activity and if he or she finds anything wrong with the premises or equipment before each program commences that cannot be corrected immediately by the DEPARTMENT, the program shall be canceled and the matter reported to the DEPARTMENT for correction. If the PROVIDER elects to hold his/her programs in the facility provided, it will be presumed that the PROVIDER has inspected the premises and facilities and equipment provided for such programs and has accepted same as being safe and suitable for the use intended. ARTICLE 3.0 Program Size Minimums: 3.1 ACTIVE: Program sizes shall meet the minimum numbers of participants for each program as designated in Exhibit "A." ARTICLE 4.0 Compensation and Method of Payment 4.1 In consideration of the releases and indemnities contained herein and of the PROVIDER's services in connection with the programs and activities described herein, the CITY shall be entitled to 10% of the registration fees paid by all program participants to the PROVIDER, and the PROVIDER shall be entitled to 90% of such fees paid, exclusive of the 50% non-resident surcharge. The 50% non-resident surcharge is fully payable to the CITY and shall not be included in PROVIDER's gross income calculation. PROVIDER shall be entitled to retain all non -registration fees paid by participants to PROVIDER, i.e. PROVIDER membership fees and costs for uniforms and pictures to participants. Document 4.2 The PROVIDER agrees to collect all fees from participants, and the PROVIDER agrees to provide CITY with schedules of fees to be charged to participants in conformance with Exhibit "A", It is agreed that the PROVIDER's sole obligation shall be to collect the fees from the participants and to remit the 10% of the fees collected as well as all 50% non-resident surcharge amounts to the CITY with a pay -out report of all monies collected. Payment will be made to the CITY within fourteen (14) business days of the end of each month or session or program, whichever occurs first. 4.3 It is the responsibility of the PROVIDER to pay all applicable local, state, and federal taxes associated with this Agreement, and to acquire and pay for all necessary permits, licenses, and insurance required for the execution of this Agreement. ARTICLE 5.0 Independent PROVIDER 5.1 This Agreement does not create an employee/employer relationship between the Parties. It is the intent of the Parties that the PROVIDER is an independent contractor under this Agreement and not a CITY employee for all purposes, including but not limited to, the application of the Fair Labor Standards Act minimum wage and overtime payments, Federal Insurance Contribution Act, the Social Security Act, the Federal Unemployment Tax Act, the provisions of the Internal Revenue Code, The State Workers Compensation Act, and the State unemployment insurance law. The PROVIDER shall retain sole and absolute discretion in the judgment of the manner and means of carrying out PROVIDER's activities and responsibilities hereunder. The PROVIDER agrees that it is a separate and independent enterprise from the CITY, that it had full opportunity to find other business, that it has made its own investment in its business, and that it will utilize a high level of skill necessary to perform the work required hereunder. This Agreement shall not be construed as creating any joint employment relationship between the PROVIDER and the CITY and the CITY will not be liable for any obligation incurred by PROVIDER, including but not limited to unpaid minimum wages or overtime premiums. 5.2 PROVIDER warrants that it has not employed or retained any company or person, other than a bona fide employee working solely for the PROVIDER to solicit or secure this Agreement, and that it has not paid or agreed to pay any person, company, corporation, individual or firm any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of this provision, the CITY shall have the right to terminate the Agreement without liability at its discretion, to deduct from the contract price, or otherwise recover the full amount of such fee, commission, percentage, gift or consideration. Document ARTICLE 6.0 Insurance 6.1 PROVIDER shall not provide any service until all insurance required under this paragraph has been obtained and approved by the CITY. 6.2 Certificates of Insurance. Certificates of Insurance reflecting evidence of the required insurance shall be filed with the CITY prior to the commencement of this Agreement. These Certificates shall contain a provision that coverages afforded under these policies will not be cancelled until at least forty-five days (45) prior written notice has been given to the CITY, Policies shall be issued by companies authorized to do business under the laws of the State of Georgia. Financial Ratings must be not less than "A -VI" in the latest edition of "Best Key Rating Guide", published by A.M. Best Guide. 6.3 Insurance shall be in force until the obligations required to be fulfilled under the terms of the Agreement are satisfied. In the event the insurance certificate provided indicated that the insurance shall terminate and lapse during the period of this Agreement, then in that event, the PROVIDER shall furnish, at least thirty (30) days prior to the expiration of the date of such insurance, a renewed Certificate of Insurance as proof that equal and like coverage for the balance of the period of the Agreement and extension thereunder is in effect. The PROVIDER shall not provide any service pursuant to this Agreement unless all required insurance remains in full force and effect. 6.4 Commercial General Liability insurance to cover liability bodily injury and property damage. Exposures to be covered are: premises, operations, products/completed operations, and certain contracts. Coverage must be written on an occurrence basis, with the following Emits of liability: $1,000,004 Combined Single Limit — each occurrence $2,000,400 Combined Single Limit — general aggregate $1,000,000 Personal Injury $1,000,000 Products/Completed Operations Aggregate PROVIDER shall have its insurer name the City of MILTON as an additional insured on its General Liability policy. 6.5 Worker's Compensation insurance shall be maintained during the life of this Agreement to comply with the statutory limits for all employees, and in the case any work is sublet, the PROVIDER shall require the subcontractor(s) similarly provide Workers Compensation Insurance for all the latter's employees unless and until such employees are covered by the protection afforded by the PROVIDER. The PROVIDER and his subcontractors shall maintain during the life of this Agreement Employers Liability Insurance. The following limits must be maintained: A. Workers Compensation Statutory B. Employer's Liability $100,000 each accident $500,000 Disease -policy limit $100,000 Disease -each employee Document If PROVIDER or its subcontractor claims to be exempt from this requirement, PROVIDER shall provide CITY proof of such exemption along with a written request for CITY to exempt PROVIDER, written on PROVIDER or subcontractor's letterhead. 6.6 PROVIDER shall also maintain Auto Liability and Directors and Officers insurance with limits reasonably acceptable to CITY during the term of this Agreement. 6.7 The CITY and the Fulton County Board of Education shall each be named as an additional insured and loss payee on all policies required by this Agreement. ARTICLE 7.0 Term and Termination 7.1 After a two (2) month trial period, the programs will be evaluated by the DEPARTMENT, and the remainder of this Agreement will either be terminated or continue in full force and effect. If at any time after the two (2) month evaluation, program enrollment should fall below the required minimum, the PROVIDER will be allotted four (4) weeks to bring enrollment up to the required minimum. The programs will be reevaluated and execution or termination of the contract will be determined by the DEPARTMENT. 7.2 The term of this Agreement shall commence upon the date of execution hereof and shall remain in effect for a period of one (1) year from the date of execution of this Agreement by the CITY, unless terminated sooner as provided in this Article. Renewal of this Agreement beyond the one (1) year term shall require the mutual written agreement of the CITY and PROVIDER. 7.3 This Agreement may be terminated by the CITY for convenience upon giving of at least thirty (30) days prior written notice of termination to the PROVIDER at the PROVIDER's address set forth herein at the sole and exclusive discretion of the CITY. This Agreement may be terminated by the City immediately by written notice to PROVIDER upon any willful, reckless, or grossly negligent act or omission by PROVIDER or any of its officers, agents, employees, or volunteers. 7.4 This Agreement may be terminated by PROVIDER upon giving at least thirty (30) days written notice of termination to the CITY. 7.5 PROVIDER must notify the DEPARTMENT in writing of any program cancellations at least ten (10) business days prior to the scheduled cancellation. 7.6 CITY reserves the right to cancel or reschedule any of the PROVIDER's programs, in the case of scheduling conflicts or other emergencies, as determined by the DEPARTMENT. Document ARTICLE 8.0 Indemnification 8.1 PROVIDER agrees to indemnify and hold harmless the CITY and the FULTON COUNTY BOARD OF EDUCATION, their trustees, elected and appointed officers, agents, servants and employees, from and against any and all claims, demands, or causes of action of whatsoever kind of nature, and the resulting losses, costs, expenses, reasonable attorneys' fees, including paralegal fees, liabilities, damages, orders, judgments, or decrees, sustained by the CITY, the FULTON COUNTY BOARD OF EDUCATION, or any third party arising out of, or by reason of, or resulting from the will full or negligent acts, errors, or omissions of the PROVIDER or its agents, officers, volunteers or employees. 8.2 The Parties understand and agree that the covenants and representations relating to this indemnification provision shall survive the term of this Agreement and continue in full force and effect as to the PROVIDER's responsibility to indemnify. ARTICLE 9.4 Americans With Disabilities Act 9.1 PROVIDER shalt not discriminate against any person in its operation and activities in its use or expenditure of the funds or any portion of the funds provided by this Agreement and shall affirmatively comply with all applicable provisions of the Americans With Disabilities Act ("ADA"), in the programs while providing any services funded in whole or in part by the CITY, including Titles I and II of the ADA and all applicable regulations, guidelines, and standards. 9.2 PROVIDER's decisions regarding the delivery of services under this Agreement shall be made without regard to or consideration of race, age, religion, color, gender, sexual orientation, national origin, marital status, physical or mental disability, political affiliation, or any other factor which cannot be lawfully or appropriately used as a basis for delivery of service. 9.3 PROVIDER in accordance with Title VI of the Civil Rights Act, as amended, 42 U.S.C. § 2000d, section 303 of the Age Discrimination Act of 1975, as amended, 42. U.S.C. § 6102, section 202 of the Americans with Disabilities Act of 1990, 42 U.S.C. § 12132, and all other provisions of Federal law, the Provider agrees that, during performance of this Agreement, Provider, for itself, its assignees and successors in interest, will not discriminate against any employee or applicant for employment, any subcontractor, or any supplier because of race, color, creed, national origin, gender, age or disability. In addition, Provider agrees to comply with all applicable implementing regulations and shall include the provisions of this Section IV(R) in every subcontract for services contemplated under this Agreement. Document ARTICLE 10.0 Miscellaneous 10.1 No modification, amendment, or alteration of the terms and conditions contained shall be effective unless contained in a written document executed with the same formality and equal dignity herewith. 10.2 This Agreement is non -transferable or assignable, and PROVIDER agrees not to transfer or assign the performance of services called for in the Agreement. 10.3 This Agreement sets forth the full and complete understanding of the Parties as of the effective date, and supersedes any and all negotiations, agreements, and representations made or dated prior to this Agreement. 10.4 The PROVIDER shall pay reasonable attorney's fees to the City should the City be required to incur attorney's fees in enforcing the provisions of this Agreement. 10.5 Time is of the essence of this Agreement. 10.6 Each of the individuals who executes this Agreement agrees and represents that he is authorized to execute this Agreement on behalf of the respective entity. Accordingly, the City and. PROVIDER both waive and release any right to contest the enforceability of this Agreement based upon the execution and/or approval thereof. 10.7 It is the policy of City that unauthorized aliens shall not be employed to perform work on City contracts involving the physical performance of services. Therefore, the City shall not enter into a contract for the physical performance of services within the State of Georgia, unless the PROVIDER shall provide evidence on City -provided forms, attached hereto as Exhibits "C" and 44D" that it and its subcontractors have within the previous twelve (12) month period conducted a verification of the social security numbers of all employees who will perform work on the City contract to ensure that no unauthorized aliens will be employed. The City Manager or his/her designee shall be authorized to conduct an inspection of the PROVIDER's and its subcontractors' verification process to determine that the verification was correct and complete. The PROVIDER and its subcontractors shall retain all documents and records of its verification process for a period of three (3) years following completion of the contract. This requirement shall apply to all contracts for the physical performance of services where more than three (3) persons are employed on the City contract. Compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 340-10-1-.02 is mandatory. PROVIDER's compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300- 10-1-.02 shall be attested by the execution of the contractor's affidavit attached as Exhibit 44C: Document Pursuant to G.C.G.A. § 50-36-1, the City must obtain a SAVE Affidavit and a secure and verifiable document evidencing the Contractor's legal status in the Country each time that Contractor obtains a public benefit, including any contract, from the City. Contractor hereby verifies that it has, prior to executing this Agreement, executed a SAVE Affidavit (to be sworn under oath under criminal penalty of false swearing pursuant to Q.C.G.A. § 16-14-71), a form of which is attached hereto as Exhibit "E", and submitted such affidavit to the City in person, electronically, or by mail. Further, Contractor verifies that it has, prior to executing this Agreement, submitted a secure and verifiable document, evidencing the Contractor's legal status, to the City either in person or electronically (in compliance with the Uniform Electronic Transactions Act). Contractor verifies that it is in compliance with the Residency Status of an Applicant for Public Benefit, as required by the Georgia Security and immigration Compliance Act (a.C.G.A. § 50-36-1). Document IN WITNESS OF THE FOREGOING, the Parties have set their hands and seal the day and year first written abase. ATTEST: SUDIE GORDON, CITY CLERK CITY: BY: .TOE LOCKWOOD, MAYOR PROVIDER: BY: D4V115 WINSNESS, PRESIDENT [AFFIX CORPORATE SEAL] Document EXHIBIT "A" — FEE SCHEDULE FEE SCHEDULE — Fall 2013, Spring 2014, Summer 2014 Milton and Alpharetta Residents The Fees for Fall 2013 and Fall 2014 Girls Recreational Lacrosse will be $225. The Fees for Summer 2014 Lacrosse are: Camp Session: Summer Practices Non -Residents $125 per single session $200 for hath summer sessions $125 for 10 summer practices The Fees for Fall 2013 and Fall 2014 Girls Recreational Lacrosse will be $337.50. The bees for Summer 2014 Lacrosse are: Camp Session: $187.50 per single session $300 for both summer sessions Summer Practices: $187.50 for 10 summer practices Document EXHIBIT "S" 40miaw* City of Milton Georgia Criminal History Record Information Request and Consent f=orm 1) This Request Is For: (Check Only ane) Employment _., Military rj Licensing _i Personal Use u Other Use Not Listed (E) I✓ International Travel ❑ Firefi9hlefs Employment (E) _., Prospective Adoptive/Foster Parents (E . Note & 2 copies) Employment Working With The Elderly (N) _j Employment At A Child Care Facility (w) X Volunteer working with Children (W) Li Employment Working With The Mentally III (M) Police Ride Along Request (Cy . I Police Department Vendor/Contractor (C) 2) A History Is Requested On The Following Person: Name: Las! F 3 Social Security Number: - Sex - Mack Race: u White a Black -j Asian ii American Indian -j Unknown/Other Date Of Birth Phone Number: Mwil, aay Year Check If Request Is For Yourself And Proceed To Section 5 Al The Bottom of This Page_ 3) Person Requesting Criminal History: Name- City of MiltonlCompany Name {TBDj Address: 13000 Deerfield Parkway Suite 107 Phone: 678 242 2500 City[State/Zip: IIllilton, GA 30004 4) Consent: This portion is to be used if the person requesting the criminal history is different than wham the criminal history is being inquired on {sections I I & III above are not the same person}_ Third party notary is required. I hereby give my consent for my criminal history to be run and for the above named person in seciion III to have access to it. Seal: retry VLva Dae 5) In making this request. I agree that the City of Milton Police Department, its employees, heirs, trustees, etc., snail in no way be held at fault for the use or misuse of this record A photocopy of this release will be placed on rile and is valid as an original hereon, even though the photocopy does not contain an original signature. Incomplete requests MV be denied. This report is considered accurate at time of inquiry and may change at anytime. 1g.aose or- n R@%n ig c+*iia rltvrt ore Official Use Only — Do Not Mark Below Th IS Lore Operator ARN Date Submitted 1 051200856 Inquiry Date J 1_ Document EXHIBIT °�C" STATE OF GEORGIA CITY OF MILTON CONTRACTOR AFFIDAVIT AND AGREEMENT By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm, or corporation which is contracting with the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. The undersigned further agrees that, should it employ or contract with any subcontractor(s) in connection with the physical performance of services pursuant to this contract with the City of Milton, contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. § 13-10-91 on the Subcontractor Affidavit provided in Rule 300-10-01-.08 in the form attached hereto as Exhibit "D." Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the City of Milton at the time the subcontractor(s) is retained to perform such service. EEV 1 Basic Pilot Program User Identification Number h BY: Au orized Officer Agent Date Eagle Stix Lacrosse, Inc. Title of Authorized Officer or Agent of Contractor Printed Name of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF , 201 Notary Public My Commission Expires: Document STATE OF GEORGIA CITY OF MILTON EXHIBIT "D" SUBCONTRACTOR AFFIDAVIT By executing this affidavit, the undersigned subcontractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services under a contract with Newtown Recreation, Inc. on behalf of the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-14-91. EEV 1 Basic ogram User Identification Number BY: kuthorized O cer or Agent Date [INSERT SUBCONTRACTOR NAME] 7r-esi-jP 1 Title of Authorized Officer or Agent of Subcontractor Printed Name of Authorized Officer or Agent �Y�J:3►Y4.0111 0.1 a 1XIMto] &y► H 'i' BEFORE ME ON THIS THE DAY OF , 201 Notary Public My Commission Expires: Control No. 11044154 STATE OF GEORGIA Secretary of State Corporations Division 315 West Tower #2 Martin Luther King, Jr. Dr. Atlanta, Georgia 30334-1530 CERTIFICATE OF INCORPORATION 1, Brian P. Kemp, the Secretary of State and the Corporations Commissioner of the State of Georgia, hereby certify under the seal of my office that EAGLE STIR LACROSSE INCORPORATED a Domestic Profit Corporation has been duly incorporated under the laws of the State of Georgia on 06/07/2011 by the filing of articles of incorporation in the Office of the Secretary of State and by the paying of fees as provided by Title 14 of the Oficial Code of Georgia Annotated_ WITNESS my hand and official seal in the City of Atlanta and the State of Georgia on June 7, 2011 ■ Brian P. Kemp Secretary of State Control No: iio441s4 Date Filed: 06/07/2011 12:00 AM Brian P. Kemp Secretary of State Articles of Incorporation Of - Eagle Stix Lacrosse Incorporated Article 1. The name of the corporation is Eagle Stix Lacrosse Incorporated Article 2. The corporation is organized pursuant to the Georgia Nonprofit Corporation Code. Article 3. The street address of the registered office is 1201 Peachtree Street, N.E., Atlanta, Georgia 30361. County. of Fulton. The registered agent at such address is Business Filings Incorporated Article 4. The name and address of each incorporator is Business Filings Incorporated, 8040 Excelsior Dr, Suite 200, Madison, WI 53717 The corporation will not have members. Article 5. Article 6. The principal mailing address of the corporation is 1735 Windsor Cove, Milton, Georgia 30004. County of Fulton. Article 7. The principal business activity of the corporation shall be. an athlete youth organization focused on specifically youth lacrosse where boys and girls between the ages of 4 and 19 enroll to practice and play lacrosse. Fees are collected to cover the costs of uniforms, field rental, equipment purchase, applicable taxes, and professional services fees to operate the organization that can include minimal wages to the coaching staff' and organizers. The organization is formed as a not for profit, This corporation is organized exclusively for charitable, religious, educational, and scientific purposes, including, for such purposes, the making of distributions to organizations that qualify as exempt organizations under section 501(c)(3) of the Internal Revenue Code, or the corresponding section of any future federal tax code. State of Georgia Creation - Dornestic Emily 3 page(s) IB�IIVI�V�I�A-111I58N�VIVB�IIIIVI�IIII Notwithstanding any other provisions of these articles, this organization shall not carry on any activities not permitted, to be carried on by an organization exempt from Federal income tax under section 501(c)(3) of the Internal Revenue Code of 1985 or the corresponding provision of any future United States Internal Revenue law. No part of the net earnings of the organization shall inure to the benefit of, or be distributable to its members, trustees, officers, or other private persons, except that the organization shall be authorized and empowered to pay reasonable compensation for services rendered and to make payments and distributions in furtherance of the purpose set forth in the purpose clause hereof. No substantial part of the activities of the organization shall be the carrying on of propaganda, or otherwise attempting to influence legislation, and the organization shall not participate in, or intervene in (including the publishing or distribution of statements) any political campaign on behalf of any candidate for public office. Upon the dissolution of the organization, assets shall be distributed for one or more exempt purposes within the meaning of section 501(c)(3) of the Internal Revenue Code of 1986, or corresponding section of any future Federal tax code, or shall be distributed to the Federal, state, or local government for a public purpose. Any such assets not so disposed of shall be disposed of by a court of competent jurisdiction of the county in which the principal office of the organization is then located, exclusively for such purposes. IN WITNESS WHEREOF, the undersigned has executed these Articles of Incorporation. This June G, 2011. Business Filings Incorporated, Incorporator Mark Williams, A.V.P. Y OFFICE OF SECRETARY OF STATE CORPORATIONS DIVISION E- 315 West Tower, #2 Martin Wher (Sing, Jr. Drive ENRICO M. ROBINSON Atlanta, Georgia 30334-1530 Director 7 (444) 656-2827 Registered agent, officer, entity status information via the Internet SUSAN GOLDEN CATHY COX http:ltwww.georgtacorporations.org Assistant Director Secretary of State TRANSMITTAL INFORMATION GEORGIA PROFIT OR NONPROFIT CORPORATIONS IMPORTANT Remember to include your e-mail address when completing this transmittal farm. Providing your e-mail address allows us to notify you via e-mail when we receive your filing and when we take action on your filing. Please enter your e-mail address on the line below. Thank you. E -Mail: fulfillment(u bizfilings.com NOTICE TO APPLICANT: PRINT PLAINLY OR TYPE REMAWDER OF THIS FORM i_ Corporate Name Reservation Number (if one has been obtained; If articles are being filed without prior reservation, leave this line blank) Eagle Stix Lacrosse Inenr orated Corporate Name (List exactly as it appears in art des) 2, Mark Williams Name of person 0ling articles (certillcate wilt be mra#ed to this person, at address below) Telephone Number 8040 Excelsior Dr Ste 240 Address Madison Wisconsin 53717 City State Zip Code 3. Mail or deliver the following items to the Secretary of State, at the above address: t ) This transmittal form 2) Original and one copy of the Artlefes of Incorporation 3) Firing ice or$• $100, Do payable to Secretary of State, f=iling fees are NON -refundable. I certify that a Notice of Incorporation or Notice of Intent to Incorporate with a publication fee of $40.00 has been or will be mailed or delivered to the official organ of the county where the initial registered office of the corporation is to be located. (List of legal organs is posted at web site; or, the Clerk of Superior Court can advise you of the official organ in a particular county,) June 6, 2011 Authorized signature of person filing documents Date Request certificates and obtain entity information via the Internet: http://www.georgiacorporations.org I certify that the team, league, or event on whose behalf I am requesting this certificate mandates `I00% membership in US Lacrosse. In addition, I have verified our team's or league's events roster and all participants are currently registered members of US Lacrosse. I certify that this is true and l understand that liability coverage is only extended to our team, league, or event if all participants are current members of US Lacrosse. Further, I acknowledge by clicking on this box that event liability claims may be denied for coverage if our teamlleaguefevent is not 100% registered with US Lacrosse. )Name; David Winsness Organization: Eagle Stix Lacrosse Inc. Date: 1210412012 CERTIFICATE OF LIABILITY INSURANCE DATE12W2 �'�''�' THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMAMN ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES HOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(SL AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER - IMPORTANT: if the certificate holder is an ADDITIONAL INSURE D, the poficyfiesy must be endorsed- If SURROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this cer3ficate does not confer rights to the certificate holder in fieu of such endorsement(s). PRODUCER CONTACT Wft: BOLLINGER. Irrc, 101 JFK PARKWAY SHORT HILLS, NJ 07078(Ar-N€ PHONE:1-S00-521379 FAX: 973-921-2878 PtIONE J=,No,E[t): a0U-62&i379 FAX yS73-92i-2876 A=te. AODMIS, VNO INSURERLS) AFFORDING COVERAGE NAIL E MtUMRA.Markel Insurance Company 38S70 PAW0DNYW I1MStURED INIL WRB7 IISLzc asse,Inc_ 113 Rest University Pwkway BaWmor�e NO 21210 xlst"UMC- atsllrt�r n Re: Eagle Stix Lassos se iic- WSORER e: F ryt3cca x =rE $11OW 006 COVERAGES CERTIFICATE NUMBER: REVISION HUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSLIRED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTW ITHSTANDING ANY REOUIRFWNT, TF R71 OR CONDITION OF ANY CONTRACT OR OTHER DOCU WENT W ITH RESFECT TO WHICH TEAS CERTI FICATE kfAY HE ISSUED OR MAY PERTAIN:, THE INSURANCE AFFOROED BY TRE POLICIE DESCRIBED HEREIN IS SUBJECT TO ALL THE TERVS, EXCLUS€ONSAND CON DIT IONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID C1AIUS- 1HSR TYPE OF INSURANCE AUIL susn POLICY NUMBER PDUCY ETF PoLlcYr-" LIMITS LTH MR VNO 11 WDDfYYYY PAW0DNYW A GENERAL LIABILITY LIABILITY x F ryt3cca x =rE $11OW 006 � TO �S10opm 7CR�C"AL'GELIIERAL a502AHT21W9 (}1 DIJ2013 01101)2014iab wry y 51,0001000 GENT AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO- ® LOC JECT�+cTs-C[u,�siOPIF3G qpL AGI TC 35,(Y{{1p,000 53;900;O0m S AUTOMOBILE LIA33LITY ANY AUTO CdLA9e Del � T s 80IILY LH.fi.44Y � S r &41 iF%Y HLY'Jtl r S ALL OWNED SCHEDULED AUTOS 6lL1TC'S ,- _ AUTOS HIREDALTOS NON-Uffl €EDr. S x LJMSRELLA LM I x OC UR x EACTtOCCiN?1 1JCf Si,i}t30,1Y30 A EXCESS LFAB 4602AH221370 01f01f2013 017DV2014 a�r,�sxTE SI,0EI0S}D[S S LED R1 NTIQN $ VIKWKERSCOMPENSATKIX YIN AND EMPLOYERS' LiABIUTY N f A 5TAT4} ORrL ucrs Y nnr€raRa�aRrs�aT oFF�gxa�xa�a exemia EL EACH ACCIDENT T ELS-EAEkFLOYEE S (Mandatory in NHl E.L.i-PgLIC'/A}iA1T S $rye&. aMoet =RVT1nNMJF oft"T oe�vw A cmdent Medical 4102AM02522U 011011201.3 01101!2014 "de et Limit: 5100,000 atastrophicAce 4102ALH3D5882 011DIaO 3 01101f2D14 iss6aghicLimit: 51.000.000 DESCRIPTION OF OPFRATIONS I LOCATIONS f VEHICLFS (Attach ACORO 101, A[irl dorkal Remarks Schedute if more space es 3'Kluiredi Coverage applies only to teamsfleagues comprised of 7 OD% US Lacrosse member participants during scheduled a supervised lacrosse activites_ Certificate Hodder is named "Additional Insured " with respect to Eagle Stix lacrosse Inc - CERTIFICATE HOLDER CANCELLATIDU -9 1988-2010 ACORD CORPORATION. All rights reserved. ACDRD 25 1201OM5) Ttra ACORD nsme and lrin are ragister d ma*5 of ACC=RD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Ciry of X4i ton BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IH ACCORDARCE VffH THE POLICY PROVISION 5. 1300 Di-, s eld Parkway M2tor4 GA 3 AUTHORIZED REPRESENTATIVE -9 1988-2010 ACORD CORPORATION. All rights reserved. ACDRD 25 1201OM5) Ttra ACORD nsme and lrin are ragister d ma*5 of ACC=RD CERTIFICATE OF LIABILITY INSURANCE' ,{6,°;y- "' THIS CERTIFICATE IS ISSUED ASA FATTER OF INFORLIATION ONLY AND CONFERS NO RIGHTS UPON THE CERTNICATE 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 CONSTITIfTE A CONTRACT BETWEEN THE ISSUIW INSURERM, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDM IMPORTANT: If the certiTcate holder is an ADDITIONAL INSURE D, the policy(iesy must to endorsed. If SUBROGATM I5 WAIVED, subject to the terms and conditims of the policy, certain policies may require an endorsement A statement on this certifmate does not confer rights to the certificate holder in lieu of such endorsementts). PRODUCER 1C:0"TACT NAM E; BOLLINGER. Inc 191 JFK PARKWAY SHORT HILLS. NJ,07078 PHONE: 1-800 1.379 FAX 973521-2878 Prom" {wC li0.Eitj W0,526 -13T9 FAX (AIC,t1o)-97'3-971-2876 E-MQL AnnAERs: GENERAL LIABILITY x £O1.1IA£RCIAL GEN��RRL LIABILITY INSURE S AFFORDING COVERAGE NAC i WSURER A: Markel lnwrance Compamr 3N70 INSURED �Nsvlt" a: [7S i.across e, IrmC 113 West University Parknay Baltimore XW 21214 DAAh4C Tv ri�C'uTEES T144,404 MSOREfi C: aur R a. Re: Eagle Stix. Lacrosse Inc- wsulREfR E. L— RisUREft F: COVERAGES CERTIFEATE RLIMBLIC REVISION NUMBER - This IS TO CERTIFY THAT THE POLICFES OF INSU RANCE LISTED SaO W HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. AiOMITHSTANDING ANY RECUIREMFNT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WH ICH THIS CERTIFICATF MAY BE ISSUED OR MAY PERTAIN, THE INSURANGE AFFORDED BY THE P£LICIE DESCRIBED HEREIN I S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSK LTR TYPE OF INSURANCE ADOL INSR ILMR VSnlD POLICYNUMBER P-00CYEFF 'iS YY FICAXYEEP iYA.WDIYYYY LIMITS A GENERAL LIABILITY x £O1.1IA£RCIAL GEN��RRL LIABILITY x ERCH+.bCC;rR. € S1;OOO;t�O DAAh4C Tv ri�C'uTEES T144,404 GL411.fS-IAADE �bCCL1R 85€i2AR221MB alffilF2{i13 01M112014 P.c�,a 5T oomrav WEDE�P Aman SS,OOQ PFrtiicipantsLiatfR4awcsAO+e.axy X PE S1.Of50,#10si GENL AGSREGATE LIMIT APPLIES PER: POLICY i'RO LOC .QCT Yc�p1 A�[Tg SS,OD4,f%30 �aODscTs-caltnGG R�:: S AUTOMOBILE LRBIL€TY ANY AUTO win-LEcokffloam I- T a=doKv' Y BAY �Y Mw ALL OWJ ED SC{EDUtED ALTOS A{sTOS HrREDAUTCG I,*i{yWNED AUTOS l Y NARY a=11 re S sv nAamaoE y S x UMBRELLA LIA6x OCCCUR x }., •� Sl .a4a;0o4 A EXCESS LIAR � 4ED2AH221370 01101!2013 0114112D14 A BATE 51,400 (394 S DED FRETENTION 3 WO1fKERS COMPENSATION Y f AND FMPLOYER5' LIABILrTY Ah'1' �TOFL'AR?i7S�R °E�C:'ftsPs a *�eR.s�i,FteccErsxn� N rA NC S7ATiFT Qxr L t�xrs E.€.EaGiA��ENr T £L.itW.ASE-EAE VLOYEE S 1Mandatory in NR) $yw excly DE$CIFT7OU OF CPC%ATRQM i>� EL OtSEASE-POLICY VWT S A Accident Medical 4102AH02522G 01R71f2813 01101f2014 haident Limit: 3100,000 atastrolic Acc 4102AH3115a82 OV012013 01101!2014 tmsbrophicLimit: Sl AU,000 DESCRIPTION OF OPERATION 51 LOCATM51 VEHWLES (Attach ACORD 101, Additional Remrks Schedule, if mare space is required) Coverage apps on ly to teamslleagues comprised of 100% U 5 Lacrosse member participants during scheduled & supervised lacrosse activites. Certirwate Hotder is named 'Ad ditmdi Insu red " with respect to Eagle Stix Lacrosse Inc.. L LKI Jr ILA I C M;LUtH I-ANr'FI 1 ATRIN @ 1SH-2014 ACORD CORPORATION. All rights reed. ACORD 25 PCI0,D 5) The ACORD name arxd Ingo are registered made mf ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Fultm County Hoard ofEducation BEFORE THE EXPIRATION DATETIIEREOF, NOTICE WILL HE LII=LTVEIEB IN 13025 Birmingham Hwy ACCORDANCE MT•H THE POLICY PROVISIONS. Aipharrtta, Gel 380M a �e AUTHORIZED REPIZESENTATIVE @ 1SH-2014 ACORD CORPORATION. All rights reed. ACORD 25 PCI0,D 5) The ACORD name arxd Ingo are registered made mf ACORD I certify that the team, league, or event on whose behalf I am requesting this certificate mandates 100% membership in US Lacrosse. In addition, I have verified our team's or league's events roster and all participants are currently registered members of US Lacrosse. I certify that this is true and I understand that liability coverage is only extended to our team, league, or event if all participants are current members of US Lacrosse. Further, I acknowledge by clicking on this box that event liability claims may be denied for coverage if our teamlleaguelevent is not 100% registered with US Lacrosse. Mame: David Winsness Organization: Eagle Stix Lacrosse Inc. Date: 12/04/2012 1CMIR5 DEPARTMENT OF THE TREASURY INTERNAL REVENUE SERVICE CINCINNATI OH 45999-0023 EAGLE STIR LACROSSE INCORPORATED 1735 WINDSOR CV MILTON, GA 30404 Date of this notice: 06-15-201.1 Employer Identification Number: 45-2540122 Form: SS -4 Number of this notice: CP 575 B For assistance you may call us at: 1-800-829-4933 IF YOU WRITE, ATTACH THE STUB AT THE END OF THIS NOTICE. WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER Thank you for applying for an Employer Identification Number (EIN)_ We assigned you BIN 45-2540122. This EIN will identify you, your business accounts, tax returns, and documents, even if you have no employees. Please keep this notice in your permanent records. When filing tax documents, payments, and related correspondence, it is very important that you use your EIN and complete name and address exactly as shown above. Any variation may cause a delay in processing, result in incorrect information in your account, or even cause you to be assigned more than one EIN. if the information is not correct as shown above, please make the correction using the attached tear off stub and return it to us. Assigning an EIN does not grant tax-exempt status to non-profit organizations. Publication 557, Tax Exempt Status for Your Organization, has details on the application process, as well as information on returns you Tway need to file. To apply for formal recognition of tax-exempt status, most organizations will need to complete either Farre 1023, Application for Recognition of Exemption Under Section Sol (c)(3) of the Internal Revenue Code, or Form 1024, Application for Recognition of Exemption Under Section 501(a). Submit the completed form, all applicable attachments, and the required user fee to: Internal Revenue Service PO Box 12192 Covington, KY 41012-0192 The Pension Protection Act of 2006 contains numerous changes to the tax law provisions affecting tax-exempt organizations, including an annual electronic notification requirement (Form 990-N) for organizations not required to file an annual information return (Form 990 or Form 990 -EZ). Additionally, if you are required to file an annual information return, you may be required to file it electronically. Please refer to the Charities & Non -Profits page at www.irs.gov for the most current information on your filing requirements and on provisions of the Pension Protection Act of 2406 that may affect you. To obtain tax forms and publications, including those referenced in this notice, visit our Weh site at www.irs.gov. If you do not have access to the Internet, call 1-804-829-3676 (TI'y/TDI) 1-800-829-4059) or visit your local IRs office. (IRS USE ONLY) 575E IMPORTANT RE24IINDERS : 06-15-2011 BAGL Q 9999999999 SS -4 * Keep a copy of this notice in your permanent records. This notice is issued only one time and the IRS will not be able to generate a duplicate copy for you. * Use this EIN and your name exactly as they appear at the top of this notice on all your federal tax forms. * Refer to this EIN on your tax -related correspondence and documents. * Provide future officers of your organization with a copy of this notice. IIf you have questions about your EIN, you can call us at the phone number or write to us at the address shown at the top of this notice. If you write, please tear off the stub at the bottom of this notice and send it along with your letter. If you do not need to write us, do not complete and return the stub. Thank you for your cooperation. Keep this part for your records. CP 575 E (Rev. 7-2007) Return this part with any correspondence so we may identify your account. Please correct any errors in your name or address. CP 575 E 9999999999 Your Telephone Number Best Time to Call DATE OF THIS NOTICE: 06-1S-2011 ( - EMPLOYER IDENTIFICATION NUMBER: 45-2540122 FORM: SS -4 NOBOD INTERNAL REVENUE SERVICE EAGLE STIR LACROSSE INCOPPORATED CINCINNATI OH 45999-0023 1 1735 WINDSOR CV IIIIIIiIsI11ilIn1111111tnill1i111n1E1111lil sIII[ MILTON, GA 30004 HDME OF 'F HE t3ESf QUAIT'( OF LIFE IN GEORGIA' M I tTON* ESTABLISf IED 2006 CITY COUNCIL AGENDA ITEM TO: City Council DATE: April 29, 2013 FROM: City Manager AGENDA ITEM: Consideration of the Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and All Tournament Players Park, LLC for Summer Basketball Camps. MEETING DATE: Monday, May 6, 2013 Regular City Council Meeting. BACKGROUND INFORMA TION: (Attach additional pages if necessary) See attached memorandum y APPROVAL BY CITY MANAGER: PPPROVED (} NOTAPPROVED CITY ATTORNEY APPROVAL REQUIRED: x YES ()NO CITY A TTORNEY REVIEW REQUIRED: Ji YES ()NO APPROVAL BY CITY ATTORNEY V`(APPROVED (} NOT APPROVED PLACED ON AGENDA FOR: REMARKS: YOM - PHONE: 578.25001 FAX: 678.242.2499 �qreen * Certtfiei o info@city4fmiltonga.us 1 wwvtir.cftyvfmiltonga.us Community C, as p esyayroSi.sra�a iv 1 ��ty f hi[s �$ 13000 Deerfeld Parkway, Suite 107 1 Milton GA 30004 �— CERTIFIEO BRONZE .... .]"k a11L To: Honorable Mayor and City Council Members From: Jim Cregge, Parks & Recreation Director Date: Submitted on April 25 for the May 6 Regular Council Meeting Agenda Item: Consideration of the Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and All Tournament Players Park, LLC for Summer Basketball Camps. Department Recommendation: Staff is recommending the approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and All Tournament Players Park, LLC for summer basketball camps. Executive Summary: This is a renewal of the agreement reached last year. The All Tournament Players Park, LLC summer basketball camp program was successful last year and our participants let us know that they are looking forward to this program again this summer. Funding and Fiscal Impact: A commission of 30% will be paid to the City of Milton two weeks following the end of registration. Non-resident fees will be collected by the provider and paid to the City at a rate of an additional 50% of the standard registration fee. Alternatives: If we do not renew with All Tournament Players Park, LLC, we would have to locate a new service provider. Legal Review: Contract Template – Paul Higbee, Jarrard & Davis on March 5, 2013 Document Concurrent Review: Chris Lagerbloom Attachment(s): 1) Parks and Recreation Agreement for Outside Providers Contract and SAVE Affidavit (2 copies) HOME OF' it � I t wIJA1,1 1 �_ i1 l I: 11. L_i.Ci !A' M I LT 0 N, ESTABLISHED 2006 CITY OF MILTON PARKS & RECREATION DEPARTMENT AGREEMENT FOR OUTSIDE PROVIDERS THIS IS AN AGREEMENT, made this day of , 2013, between: THE CITY OF MILTON, a municipal corporation organized and operating under the laws of the State of Georgia, with a business address of 13000 Deerfield Parkway, Suite 107 A, MILTON, Georgia 30004, hereinafter referred to as the "CITY." and ALL TOURNAMENT PLAYERS PARK, LLC hereinafter referred to as "PROVIDER". CITY and PROVIDER may hereinafter collectively be referred to as "the Parties". In consideration of the mutual obligations of the Parties and for good and valuable consideration, the adequacy and receipt of which are hereby acknowledged, the Parties agree as follows: ARTICLE 1.0 PROVIDER's Services and Responsibilities 1.1 PROVIDER shall conduct services generally described as Basketball Summer Camp at the following location: Northwestern Middle School, 12805 Birmingham Hwy, Milton GA 30004. 1.2 The PROVIDER's services shall be performed during the days and hours described in Exhibit "A," attached hereto and incorporated herein by reference. 1.3 The PROVIDER and The Director of the Parks & Recreation Department or his designee, hereinafter referred to as the "DEPARTMENT", will agree upon program schedules. PROVIDER agrees to submit a Program Request Form to the Coordinator for each program being proposer! eight (8) weeks prior to the beginning of each session. 1.4 The fees charged to each participant will be as described in Exhibit "A" for residents of MILTON & ALPHARETTA and a surcharge of 50% more for non-residents of MILTON & ALPHARETTA. The entire balance of this surcharge for non-residents shall be paid to the CITY. 1.5 The PROVIDER warrants to CITY that it is not insolvent, it is not in bankruptcy proceedings or receivership, nor is it engaged in or threatened with any litigation or other Your �►w�� PHONY: 678.242.25001 FAX: 678.242.2499 MEAWARD ,Green IV * Cerrified * tY 9 9 wiNiieR Community C,hi. infoC�cio#milton a.us � www.cityafmilton a.us _ �y, Ethics 13000 Deerfield Parkway. Suite 107 1 Milton GA 30004 - GEATMEO BRONZE IhaA Document legal or administrative proceedings or investigations of any kind which would have an adverse effect on its ability to perform its obligations under this Agreement. 1.6 The PROVIDER agrees that it shall be solely responsible for all costs and/or expenses associated with, or as a result of its operation under this Agreement. The PROVIDER stipulates and certifies that it is qualified to provide the programs it is hired to provide, maintains the education and required licenses or permits necessary to provide the programs, and shall continue to maintain such licenses or permits during the term of this Agreement. 1.7 This Agreement is considered a non-exclusive Agreement between the Parties. The CITY shall have the right to purchase the same kind of services to be provided by the PROVIDER from other sources during the term of this Agreement. The PROVIDER is not precluded from providing the same or similar services for other parties so long as such other engagements do not interfere with the PROVIDER'S provision of services to the CITY. 1.8 The DEPARTMENT must approve any promotional material, flyers, and posters advertising the programs prior to its release. The following content and topics shall specifically be prohibited. sexually explicit materials, profanity, child pornography, alcoholic beverages, tobacco products, adult movies, adult book/video stores, adult entertainment establishments, massage parlors, pawn shops, and tattoo parlors or shop& 1.9 The PROVIDER shall not promote any privately owned business in a CITY park/facility or solicit any participant in a CITY park/facility activity for any privately owned business. The PROVIDER may not use said facilities to conduct personal business including workshops, clinics, seminars, camps, or any other activities that are outside the scope of service described in (Exhibit "A"). It is further understood that such action(s) may result in immediate termination of the Agreement and the forfeiture of all compensation due to the PROVIDER. 1.10 The PROVIDER shall abide by the policies, procedures, rules and regulations of the DEPARTMENT, the CITY, and the FULTON COUNTY BOARD OF EDUCATION as promulgated from time to time. PROVIDER understands and gees that the DEPARTMENT shall have first priority for use of CITY facilities, notwithstanding any other provisions of this Agreement 1.11 All assistants, substitutes, and subcontractors utilized by the PROVIDER must have prior written approval of the DEPARTMENT. 1.12 PROVIDER shall provide necessary supervisory personnel to ensure that the participants of the programs obey all applicable policies, procedures, Rules and Regulations. 1.13 The DEPARTMENT or CITY may require that the PROVIDER not be permitted to utilize specific assistants, substitutes, or subcontractors of PROVIDER who have Document failed to follow any policies, procedures, rules or regulations applicable to the use of the facility. 1.14 Although the CITY shall not control the PROVIDER's techniques, methods, procedures, or sequence of instruction, the PROVIDER will comply with the CITY's and DEPARTMENT's policies, rules, regulations and procedures, as well as those of the FULTON COUNTY BOARD OF EDUCATION, and shall not interfere with their operation, nor harm or damage the equipment or facilities afforded to PROVIDER for his/her programs, nor otherwise disrupt the other on-site activities being offered at such public facilities. 1.15 The PROVIDER also acknowledges that he or she is primarily responsible for the conduct of the participants in all programs under the PROVIDER's charge. 1.16 If the PROVIDER will be providing services directly with minor children without parental supervision, the PROVIDER shall, prior to commencing services under this Agreement, comply with the CITY's policy regarding criminal background screening. The CITY will furnish the PROVIDER with a background release form (Exhibit "B") for all the provider's counselors, coaches, volunteers, subcontractors, employees or any other individuals that will come in contact with a child, at the PROVIDER's sole expense. A Consent and Release Form to conduct a criminal background must be executed by any of PROVIDER's employees or any individual who will come in contact with a child at the CITY through PROVIDER or at PROVIDER's direction, such form authorizing the CITY to conduct a search of each such individual's criminal background. The result of such inquiry may be deemed acceptable by the CITY in its sole and complete discretion, and the CITY may reject any individual from participating in any program based upon such results. If the PROVIDER has recently had a background screening conducted by another agency, the CITY, at its sole discretion, may accept that background screening and waive the requirement o_f'a new background screening. PROVIDER and its employees must also execute a Waiver and Release of Liability holding the CITY and FULTON COUNTY BOARD OF EDUCATION harmless. 1.17 The CITY shall require all participants in all programs to sign a Waiver and Release of Liability. ARTICLE 2.0 Equipment & Materials 2.1 All program materials and equipment needed or pertaining to the above stated programs will be provided by the PROVIDER at his/her own cost and expense. However, PROVIDER may require participants to obtain certain materials required in the programs Document by providing a list of such materials (with approximate costs) to the participants. If PROVIDER makes such materials available to participants, they must be sold at PROVIDER's cost. All equipment provided by the PROVIDER shall be used in strict accordance with equipment manufacturer's instructions and in accordance with all applicable laws. PROVIDER shall coordinate storage of goal posts with the principal of the school located at the facility 2.2 The sale of merchandise is restricted to those materials utilized in and for the programs. Fundraising activities conducted by the PROVIDER will not be permitted. The PROVIDER shall obtain the CITY's approval of any merchandise to be sold prior to its distribution or sale 2.3 The CITY will provide no storage space to the PROVIDER, unless otherwise mutually agreed upon in a separate written agreement. 2.4 Any supplies or equipment left at the facility will be the responsibility of the PROVIDER. The CITY will not be responsible for any lost, stolen, or broken equipment or supplies. 2.5 The PROVIDER shall inspect the premises and equipment offered to him/her for his/her proposed activity and if he or she finds anything wrong with the premises or equipment before each program commences that cannot be corrected immediately by the DEPARTMENT, the program shall be canceled and the matter reported to the DEPARTMENT for correction. If the PROVIDER elects to hold his/her programs in the facility provided, it will be presumed that the PROVIDER has inspected the premises and facilities and equipment provided for such programs and has accepted same as being safe and suitable for the use intended. ARTICLE 3.0 Program Size Minimums: 3.1 ACTIVE: Program sizes shall meet the minimum numbers of participants for each program as designated in Exhibit "A." ARTICLE 4.0 Compensation and Method of Payment 4.1 In consideration of the releases and indemnities contained herein and of the PROVIDER's services in connection with the programs and activities described herein, the CITY shall be entitled to 30% of the registration fees paid by all program participants to the PROVIDER, and the PROVIDER shall be entitled to 70% of such fees paid, exclusive of the 50% non-resident surcharge. The 50% non-resident surcharge is fully payable to the CITY and shall not be included in PROVIDER's gross income calculation. PROVIDER shall be entitled to retain all non -registration fees paid by participants to Document PROVIDER, i.e. PROVIDER membership fees and costs for uniforms and pictures to participants. 4.2 The PROVIDER agrees to collect all fees from participants, and the PROVIDER agrees to provide CITY with schedules of fees to be charged to participants in conformance with Exhibit "A". It is agreed that the PROVIDER's sole obligation shall be to collect the fees from the participants and to remit the 30% of the fees collected as well as all 50% non-resident surcharge amounts to the CITY with a pay -out report of all monies collected. Payment will be made to the CITY within fourteen (14) business days of the end of each month or session or program, whichever occurs _first. 4.3 It is the responsibility of the PROVIDER to pay all applicable local, state, and federal taxes associated with this Agreement, and to acquire and pay for all necessary permits, licenses, and insurance required for the execution of this Agreement. ARTICLE 5.0 Independent PROVIDER 5.1 This Agreement does not create an employee/employer relationship between the Parties. It is the intent of the Parties that the PROVIDER is an independent contractor under this Agreement and not a CITY employee for all purposes, including but not limited to, the application of the Fair Labor Standards Act minimum wage and overtime payments, Federal Insurance Contribution Act, the Social Security Act, the Federal Unemployment Tax Act, the provisions of the Internal Revenue Code, The State Workers Compensation Act, and the State unemployment insurance law. The PROVIDER shall retain sole and absolute discretion in the judgment of the manner and means of carrying out PROVIDER's activities and responsibilities hereunder. The PROVIDER agrees that it is a separate and independent enterprise from the CITY, that it had full opportunity to find other business, that it has made its own investment in its business, and that it will utilize a high level of skill necessary to perform the work required hereunder. This Agreement shall not be construed as creating any joint employment relationship between the PROVIDER and the CITY and the CITY will not be liable for any obligation incurred by PROVIDER, including but not limited to unpaid minimum wages or overtime premiums. 5.2 PROVIDER warrants that it has not employed or retained any company or person, other than a bona fide employee working solely for the PROVIDER to solicit or secure this Agreement, and that it has not paid or agreed to pay any person, company, corporation, individual or firm any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of this provision, the CITY shall have the right to terminate the Agreement without liability at its discretion, to deduct from the contract price, or otherwise recover the full amount of such fee, commission, percentage, gift or consideration. Document ARTICLE 6.0 Insurance 6.1 PROVIDER shall not provide any service until all insurance required under this paragraph has been obtained and approved by the CITY. 6.2 Certificates of Insurance. Certificates of Insurance reflecting evidence of the required insurance shall be filed with the CITY prior to the commencement of this Agreement. These Certificates shall contain a provision that coverages afforded under these policies will not be cancelled until at least forty-five days (45) prior written notice has been given to the CITY. Policies shall be issued by companies authorized to do business under the laws of the State of Georgia. Financial Ratings must be not less than "A -VI" in the latest edition of "Best Key Rating Guide", published by A.M. Best Guide. 6.3 Insurance shall be in force until the obligations required to be fulfilled under the terms of the Agreement are satisfied. In the event the insurance certificate provided indicated that the insurance shall terminate and lapse during the period of this Agreement, then in that event, the PROVIDER shall furnish, at least thirty (3 0) days prior to the expiration of the date of such insurance, a renewed Certificate of Insurance as proof that equal and like coverage for the balance of the period of the Agreement and extension thereunder is in effect. The PROVIDER shall not provide any service pursuant to this Agreement unless all required insurance remains in full force and effect. 6.4 Commercial General Liability insurance to cover liability bodily injury and property damage. Exposures to be covered are: premises, operations, products/completed operations, and certain contracts. Coverage must be written on an occurrence basis, with the following limits of liability: $1,000,000 Combined Single Limit — each occurrence $2,000,000 Combined Single Limit — general aggregate $1,000,000 Personal Injury $1,000,000 Products/Completed Operations Aggregate PROVIDER shall have its insurer name the City of MILTON as an additional insured on its General Liability policy. 6.5 Worker's Cam nsation insurance shall be maintained during the life of this Agreement to comply with the statutory limits for all employees, and in the case any work is sublet, the PROVIDER shall require the subcontractor(s) similarly provide Workers Compensation Insurance for all the latter's employees unless and until such employees are covered by the protection afforded by the PROVIDER. The PROVIDER and his subcontractors shall maintain during the life of this Agreement Employers Liability Insurance. The following limits must be maintained: A. Workers Compensation Statutory B. Employer's Liability $100,000 each accident $500,000 Disease -policy limit $100,000 Disease -each employee Document If PROVIDER or its subcontractor claims to be exempt from this requirement, PROVIDER shall provide CITY proof of such exemption along with a written request for CITY to exempt PROVIDER, written on PROVIDER or subcontractor's letterhead. 6.6 PROVIDER shall also maintain Auto Liability and Directors and Officers insurance with limits reasonably acceptable to CITY during the term of this Agreement. 6.7 The CITY and the Fulton County Board of Education shall each be named as an additional insured and loss payee on all policies required by this Agreement. ARTICLE 7.4 Term and Termination 7.1 After a two (2) month trial period, the programs will be evaluated by the DEPARTMENT, and the remainder of this Agreement will either be terminated or continue in full force and effect. If at any time after the two (2) month evaluation, program enrollment should fall below the required minimum, the PROVIDER will be allotted four (4) weeks to bring enrollment up to the required minimum. The programs will be reevaluated and execution or termination of the contract will be determined by the DEPARTMENT. 7.2 The term of this Agreement shall commence upon the date of execution hereof and shall remain in effect for a period of one (1) year from the date of execution of this Agreement by the CITY, unless terminated sooner as provided in this Article. Renewal of this Agreement beyond the one (1) year term shall require the mutual written agreement of the CITY and PROVIDER. 7.3 This Agreement may be terminated by the CITY for convenience upon giving of at least thirty (30) days prior written notice of termination to the PROVIDER at the PROVIDER's address set forth herein at the sole and exclusive discretion of the CITY. This Agreement may be terminated by the City immediately by written notice to PROVIDER upon any willful, reckless, or grossly negligent act or omission by PROVIDER or any of its officers, agents, employees, or volunteers. 7.4 This Agreement may be terminated by PROVIDER upon giving at least thirty (30) days written notice of termination to the CITY. 7.5 PROVIDER must notify the DEPARTMENT in writing of any program cancellations at least ten (1 d) business days prior to the scheduled cancellation. 7.6 CITY reserves the right to cancel or reschedule any of the PROVIDER's programs, in the case of scheduling conflicts or other emergencies, as determined by the DEPARTMENT. Document ARTICLE 8.0 Indemnification 8.1 PROVIDER agrees to indemnify and hold harmless the CITY and the FULTON COUNTY BOARD OF EDUCATION, their trustees, elected and appointed officers, agents, servants and employees, from and against any and all claims, demands, or causes of action of whatsoever kind of nature, and the resulting losses, costs, expenses, reasonable attorneys' fees, including paralegal fees, liabilities, damages, orders, judgments, or decrees, sustained by the CITY, the FULTON COUNTY BOARD OF EDUCATION, or any third party arising out of, or by reason of, or resulting from the will full or negligent acts, errors, or omissions of the PROVIDER or its agents, officers, volunteers or employees. 8.2 The Parties understand and agree that the covenants and representations relating to this indemnification provision shall survive the tern of this Agreement and continue in full force and effect as to the PROVIDER's responsibility to indemnify ARTICLE 9.0 Americans With Disabilities Act 9.1 PROVIDER shall not discriminate against any person in its operation and activities in its use or expenditure of the funds or any portion of the funds provided by this Agreement and shall affirmatively comply with all applicable provisions of the Americans With Disabilities Act C ADA"), in the programs while providing any services funded in whole or in part by the CITY, including Titles I and II of the ADA and all applicable regulations, guidelines, and standards. 9.2 PROVIDER's decisions regarding the delivery of services under this Agreement shall be made without regard to or consideration of race, age, religion, color, gender, sexual orientation, national origin, marital status, physical or mental disability, political affiliation, or any other factor which cannot be lawfully or appropriately used as a basis for delivery of service. 9.3 PROVIDER in accordance with Title VI of the Civil Rights Act, as amended, 42 U.S.C. § 2000d, section 303 of the Age Discrimination Act of 1975, as amended, 42 U.S.C. § 6102, section 202 of the Americans with Disabilities Act of 1990, 42 U.S.C. § 12132, and all other provisions of Federal law, the Provider agrees that, during performance of this Agreement, Provider, for itself, its assignees and successors in interest, will not discriminate against any employee or applicant for employment, any subcontractor, or any supplier because of race, color, creed, national origin, gender, age or disability. In addition, Provider agrees to comply with all applicable implementing regulations and shall include the provisions of this Section IV(R) in every subcontract for services contemplated under this Agreement. Document ARTICLE 10.0 Miscellaneous 10.1 No modification, amendment, or alteration of the terms and conditions contained shall be effective unless contained in a written document executed with the same formality and equal dignity herewith. 10.2 This Agreement is non -transferable or assignable, and PROVIDER agrees not to transfer or assign the performance of services called for in the Agreement. 10.3 This Agreement sets forth the full and complete understanding of the Parties as of the effective date, and supersedes any and all negotiations, agreements, and representations made or dated prior to this Agreement. 10.4 The PROVIDER shall pay reasonable attorney's fees to the City should the City be required to incur attorney's fees in enforcing the provisions of this Agreement. 10.5 Time is of the essence of this Agreement. 10.6 Each of the individuals who executes this Agreement agrees and represents that he is authorized to execute this Agreement on behalf of the respective entity. Accordingly, the City and PROVIDER both waive and release any right to contest the enforceability of this Agreement based upon the execution and/or approval thereof. 10.7 It is the policy of City that unauthorized aliens shall not be employed to perform work on City contracts involving the physical performance of services. Therefore, the City shall not enter into a contract for the physical performance of services within the State of Georgia, unless the PROVIDER shall provide evidence on City -provided forms, attached hereto as Exhibits "C" and "D" that it and its subcontractors have within the previous twelve (12) month period conducted a verification of the social security numbers of all employees who will perform work on the City contract to ensure that no unauthorized aliens will be employed. The City Manager or his/her designee shall be authorized to conduct an inspection of the PROVIDER's and its subcontractors' verification process to determine that the verification was correct and complete. The PROVIDER and its subcontractors shall retain all documents and records of its verification process for a period of three (3) years following completion of the contract. This requirement shall apply to all contracts for the physical performance of services where more than three (3) persons are employed on the City contract. Compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300-10-1-.02 is mandatory. PROVIDER"s compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300- 10-1-.02 shall be attested by the execution of the contractor's affidavit attached as Exhibit «C Document Pursuant to O.C.G.A. § 50-36-1, the City must obtain a SAVE Affidavit and a secure and verifiable document evidencing the Contractor's legal status in the Country each time that Contractor obtains a public benefit, including any contract, from the City. Contractor hereby verifies that it has, prior to executing this Agreement, executed a SAVE Affidavit (to be sworn under oath under criminal penalty of false swearing pursuant to O.C.G.A. § 16-10-71), a form of which is attached hereto as Exhibit "E", and submitted such affidavit to the City in person, electronically, or by mail. Further, Contractor verifies that it has, prior to executing this Agreement, submitted a secure and verifiable document, evidencing the Contractor's legal status, to the City either in person or electronically (in compliance with the Uniform Electronic Transactions Act). Contractor verifies that it is in compliance with the Residency Status of an Applicant for Public Benefit, as required by the Georgia Security and Immigration Compliance Act (O.C.G.A. § 50-36-1). Document IN WITNESS OF THE FOREGOING, the Parties have set their hands and seal the day and year first written above. ATTEST: SUDIE GORDON, CITY CLERK WITNESS: Notary f'ubli MY Commission Cherokeg �mY, is '�'�"� August 7, 2013 CITY• BY: JOE LOCKWOOD, MAYOR PROVIDER: BY: ;E � KIM COLEMAN, PRESIDENT [AFFIX CORPORATE SEAL] Document STATE OF GEORGIA CITY OF MILTON CONTRACTOR AFFIDAVIT AND AGREEMENT By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm, or corporation which is contracting with the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. The undersigned further agrees that, should it employ or contract with any subcontractor(s) in connection with the physical performance of services pursuant to this contract with the City of Milton, contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. § 13-10-91 on the Subcontractor Affidavit provided in Rule 300-10-01-.08 in the form attached hereto as Exhibit "D." Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the City of Milton at the time the subcontractor(s) is retained to perform such service. EEV 1 Basic Pilot Prasram User Identification Number BY: Authorized Offi er o,r Agent Date Title of Authorized Officer or Agent of Contractor Printed Name of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON TIMS THE DAY OF ,-. , 201 Notary Public My Commission Expires: Notary 14Y Com ��pu , ChMke. Ct ,r y, Georgia mission Expires August T. 2011 Document STATE OF GEORGIA CITY OF MILTON EXHIBIT "D" SUBCONTRACTOR AFFIDAVIT By executing this affidavit, the undersigned subcontractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services under a contract with Newtown Recreation, Inc. on behalf of the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. EEV { Basic ``Piilot Pro am User Identification Number ®�vL BY: Authorized Officer orAgent Date [INSERT SUBCONTRACTOR NAME] r Title of Authorized Officer or Agent of Subcontractor rn Co (6,Vt Aq-t) Printed Name of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF Ao r, , 201 13 r ` Notary Public My Commission Expires: Ejgtk4 ]y public, Eher&ee County, Georgia My m: Aupust T. 2011 Document EXHIBIT "E" SAVE Affidavit By executing this affidavit under oath, and as an applicant for a public benefit, as referenced in O.C.G.A. § 50-36-1, from the City of Milton, the undersigned applicant verifies one of the following with respect to my application for a public benefit: 1) LeI am a United States citizen. 2) _ lam a legal permanent resident of the United States. 3) 1 am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an alien number issued by the Department of Homeland Security or other federal immigration agency. My alien number issued by the Department of Homeland Security or other federal immigration agency is: The undersigned applicant also hereby verifies that he or she is IS years of age or older and has provided at least one secure and verifiable document, as required by O.C.G.A. § 50-36-1(e)(1), with this affidavit. The secure and veriTA le document provided with this affidavit can best be classified as: tri Y L i.�-�•�- - In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A. § 16-10-200, and face criminal penalties as allowed by such criminal statute. Executed in Mf 'L f�r/ (city), (state). Signature of Applicant Printed Name of Applicant SUBSCRIBED AND SWORN FOREME N THIS THE AY OF 'L 241 b�� j6 f't NOTARY PUBLIC My Commission Expires: Control No. 08006777 STATE OF GEORGIA Secretary of State Corporations Division 315 West Tower ##2 Martin Luther Icing, Jr. Dr. Atlanta, Georgia 34334-1530 CERTIFICATE OF ORGANIZATION 1, Karen C Handel, the Secretary of State and the Corporations Commissioner of the State of Georg a, hereby certify under the seal of my office that ALL -TOURNAMENT PLAYERS PARK, LLC a Domestic Limited Liability Company has been duly organized under the laws of the State of Georgia on 01/24/2008 by the filing of articles of organization in the Office of the Secretary of State and by the paying of fees as provided by Title 14 of the Official Cade of Georgia Annotated. W1T,NESS my hand and official sea] in the City of Atlanta and the State of Georgia on January 24, 2008 Krarcn C Handzl Secr-�-tan• of State V Control No: 06777 I Date Filed: 01124I2fio8 04:28 PM Karen C Handel Secretary of State Jammry 24, 2£108 ARTICLES OF ORGANIZATION FOR GEORGIA LIMITED LIABILITY COMPANT The name of the Limited Liability Company is; Ail -Tournament Players Park, LLC The principal mailing address of the Limited Liability Company is: 3910 Canton Highway Marietta, GA 30065 The Registered Agent is: Kelley Knox 3810 Canton Highway Marietta, GA 30066 County: Colo The name and address of each organizerfs) are: Kelley Knox David Deman 3208 Golf Crest Lane 2621 Gladstone Terrace Woodstock, GA 30189 Woodstock, GA 30189 The optional provisions are: No optional provisions. IN VvTTNFSS LVHEREOF, the undersigned has executed those Article of Organization on the date set f0m below- Signature( s): bate: Memberf danager, Kelley Knox January 24, 20og Lneniw: "I'iu4U59 UtSALL I UU ACORD_ CERTIFICATE OF LIABILITY INSURANCE DATE IMMMDIYYYY] 104/04/2013 TYPE OF INSURANCE ADDLSUEIR NSR 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 NAME BB&T Insurance Services, Inc. PHONE 770 429-0482 FAX 8669257122 AJC, Ext AIG, Ho 1825 Barrett Lakes Blvd #320 Lo Kennesaw, GA 30144 ADORE$S PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 kNSURER{S] AFFORDING COVERAGE NAIC if 770 4290482 INSURER A: New Hampshire Insurance Company INSURED 1NSURERB: National Council of Compensatio All Tournament Players Park LLC - 3910 Canton Road INSURER C: COMBINED SINGLE LIMIT Ea aocidenl D , Marietta, GA 30066 PROPERTY DAMAGE $ Per accident INSURER E: INSURER F : UMeRruLALlns EXCESS LIA8 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDiTIONOF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY SE 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. LTR TYPE OF INSURANCE ADDLSUEIR NSR WVD POLICY NUMBER MMIDDY✓YYVY POLICY EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx-] OCCUR 9VAIP0000544705200 5107!2012 0510712013 EACH OCCURRENCE $1,000,000 E PREMISESOEaENTTr ,r, $ 300,000 MED EXP (Any one person) $ 0 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC PROD UC T5 - COM P1OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANYAUTO ALLOWNED SCHEDULED AUTOS AUTOS NOWMNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea aocidenl BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident A X UMeRruLALlns EXCESS LIA8 x OCCUR CLAIMS -MADE 9VAIX0000544747302 5/0712012 0510712D1 EACH OCCURRENCE 51,000,000 AGGREGATE 51,000,000 DED I X1 RETENTION $0 $ WORKERS COMPEN SATION28465190 AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNEWEXECUTIVE OF FICERIMEM8ER EXCLUDED? (MandatoryinNH) If yes, describe under ❑ESC RIPTI ON Or OPERATIONS below NIA 4101!2013 04101/201 )( WC STATU- OTH- E.L. EACH ACCIDENT $100,000 -— E.L. DISEASE - EA EMPLOYEE $100000 E.L. DISEASE - POLICY LIMIT $5500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) CERTIFICATE HOLDER CANCELLATION Northwestern Middle School SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 12805 Birmingham Hwy ACCORDANCE WITH THE POLICY PROVISIONS. Milton, GA 30004 AUTHORIZED REPRESENTATIVE D 1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD COBB COUNTY OCCUPATION TAX CERTIFICATE Ro. sox 64 AFQfJF,/-QEQRGIA 34461-0649 BUSINESS LOCATION T!� � F E CERTIFICATE NUMBER 3910 CANTON RD � '',!W �^ 797669 DATE ISSUED ,^m 01-01-2012 - FOR YEAR 2012 D/B1A ALL TOURNAMENT PLAYERS ` j CERTIFICATE EXPIRES CANTON PROMENADE E] LLC 12-31-2012 3910 CANTON RD ,_; MARIETTA, GA 3006fi TYPE GENERAL CERTIFICATE MUST BE DISPLAYFo THIS CERTIFICATE IS NOT VALID IF OWNERSHIP OR BUSINESS LOCATION CHANGES PROFESSIONALS & ATTORNEYS AT LAW ARE NOT REQUIRED TO DISPLAY BUSINESS DESCRIPTION CLASSIPICATIQN CODE CLASSIFICATION NAME AMOUNT 794102 SPORTS PROMOTION 1O&D4 PAYMENT DATE 03-05-2012 4332 108.00 4312 0.00 4314 0,00 4318 0.00 4318 0.00 SUB TOTAL $ 108,00 PENALTY $ 4.00 INTEREST $ 0.00 TOTAL $ 148,00 00.8u5 LicenseC"AIMW.I17861,2012,AI.LTOURNAMENT PLAYERS PARK aM? 4 BUSINESS LIGENSE DIVISION MANAI;I=R HOME OF' i HE B ST QUALITY OF LIFE IN Gi;OR. , M I tTON TO: City Council ESTAB Ll S 1-1 E D 2006 CITY COUNCIL AGENDA ITEM DATE: April 29, 2013 FROM: City Manager AGENDA ITEM: Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Kim Saunders Yoga, LLC for Yoga Classes. MEETING DATE: Monday, May 5, 2013 Regular City Council Meeting. BACKGROUND INFORMATION: {Attach additional pages if necessary] See attached memorandum APPROVAL BY CITY MANAGER: APPROVED { } NOT APPROVED CITY A TTORNEY APPROVAL REQUIRED: {KES () NO CITY ATTORNEY REVIEW REQUIRED: OYES (} NO APPROVAL BY CITY ATTORNEY APPROVED {} NOTAPPROVED PLACED ON AGENDA FOR: b , REMARKS: 91 You ' � � �Green -� *C:ertificd� PHONE: 678.242.2500 1 FAX: 67$.242.2499 ��'�"' Community * c.it, ,r info@cityofmiitonga.us I www.cityofmiltonga.us .,-.�g,n� Community le�,�,� i 1-14 ry �ch«5 13000 Deerfield Parkway, Suite 107 1 Milton GA 30004 — CERTIFrE❑ BRONZE 1447 �� To: Honorable Mayor and City Council Members From: Jim Cregge, Parks & Recreation Director Date: Submitted on April 25 for the May 6 Regular Council Meeting Agenda Item: Consideration of the Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Kim Saunders Yoga, LLC for Yoga Classes. Department Recommendation: Staff is recommending the approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Kim Saunders Yoga, LLC for yoga classes. Executive Summary: This is a renewal of the agreement reached last year. The Kim Saunders Yoga, LLC yoga class programming is the fastest growing adult programming in the City of Milton. Funding and Fiscal Impact: A commission of 30% will be paid to the City of Milton two weeks following the end of registration. Non-resident fees will be collected by the provider and paid to the City at a rate of an additional 50% of the standard registration fee. Alternatives: If we do not renew with Kim Saunders Yoga, LLC, we would have to locate a new service provider. Legal Review: Contract Template – Paul Higbee, Jarrard & Davis on March 5, 2013 Document Concurrent Review: Chris Lagerbloom Attachment(s): 1) Parks and Recreation Agreement for Outside Providers Contract and SAVE Affidavit (2 copies) HOME OF' E f 'd GEC7i2L;IA' M1 L I -ON' ESTABLISHED 2006 CITY OF MILTON PARKS & RECREATION DEPARTMENT AGREEMENT FOR OUTSIDE PROVIDERS THIS IS AN AGREEMENT, made this day of , 2013, between: THE CITY OF MILTON, a municipal corporation organized and operating under the laws of the State of Georgia, with a business address of 13000 Deerfield Parkway, Suite 107 A, MILTON, Georgia 30004, hereinafter referred to as the "CITY." and KIM SAUNDERS YOGA, LLC hereinafter referred to as "PROVIDER". CITY and PROVIDER may hereinafter collectively be referred to as "the Parties". In consideration of the mutual obligations of the Parties and for good and valuable consideration, the adequacy and receipt of which are hereby acknowledged, the Parties agree as follows: ARTICLE 1.0 PROVIDER's Services and Responsibilities 1.1 PROVIDER shall conduct services generally described as Yoga Classes at the following location: Bethwell Community Center, 2595 Hopewell Road, Milton GA 30004. 1.2 The PROVIDER's services shall be performed during the days and hours described in Exhibit "A," attached hereto and incorporated herein by reference. 1.3 The PROVIDER and The Director of the Parks & Recreation Department or his designee, hereinafter referred to as the "DEPARTMENT", will agree upon program schedules. PROVIDER agrees to submit a Program Request Farm to the Coordinator for each program being proposer! eight (8) weeks prior to the beginning of each session. 1.4 The fees charged to each participant will be as described in Exhibit "A" for residents of MILTON & ALPHARETTA and a surcharge of 50% more for non-residents of MILTON & ALPHARETTA. The entire balance of this surcharge for non-residents shall be paid to the CITY. 1.5 The PROVIDER warrants to CITY that it is not insolvent, it is not in bankruptcy proceedings or receivership, nor is it engaged in or threatened with any litigation or other © _# Your 2012 _ * yk e e r * PHONE: 678.242.2500 PACE RWAND IG rn Cen f d FAX: 678.242,2449 WINM ;, City of infoOcityofmilfonga.us I www.cityofmiltonga.us Community gLti; Lda"g" wnrro sa:rwaen ump 13000 Deerfield Parkway. Suite 107 [ Milton GA 30004 G E R i 1 f IE 6 OR Document legal or administrative proceedings or investigations of any kind which would have an adverse effect on its ability to perform its obligations under this Agreement. 1.6 The PROVIDER agrees that it shall be solely responsible for all costs and/or expenses associated with, or as a result of its operation under this Agreement. The PROVIDER stipulates and certifies that it is qualified to provide the programs it is hired to provide, maintains the education and required licenses or permits necessary to provide the programs, and shall continue to maintain such licenses or permits during the term of this Agreement, 1.7 This Agreement is considered a non-exclusive Agreement between the Parties. The CITY shall have the right to purchase the same kind of services to be provided by the PROVIDER from other sources during the term of this Agreement. The PROVIDER is not precluded from providing the same or similar services for other parties so long as such other engagements do not interfere with the PROVIDER'S provision of services to the CITY. 1.8 The DEPARTAfENT must approve any promotional material, flyers, and posters advertising the programs prior to its release. The following content and topics shall specifically be prohibited: sexually explicit materials, profanity, child pornography, alcoholic beverages, tobacco products, adult movies, adult bookfvideo stores, adult entertainment establishments, massage parlors, pawn shops, and tattoo parlors or shops. 1.9 The PROVIDER shall not promote any privately owned business in a CITY park/facility or solicit any participant in a CITY park/facility activity for any privately owned business. The PROVIDER may not use said facilities to conduct personal business including workshops, clinics, seminars, camps, or any other activities that are outside the scope of service described in (Exhibit "A"). It is further understood that such action(s) may result in immediate termination of the Agreement and the forfeiture of all compensation due to the PROVIDER. —' 1.10 The PROVIDER shall abide by the policies, procedures, rules and regulations of the DEPARTMENT, the CITY, and the FULTON COUNTY BOARD OF EDUCATION as promulgated from time to time. PROVIDER understands and agrees that the DEPARTMENT shall have rtrst Priority for use of CITYfacilities, notwithstanding an other Provisions of this Agreement 1.11 All assistants, substitutes, and subcontractors utilized by the PROVIDER must have prior written approval of the DEPARTMENT. 1.12 PROVIDER shall provide necessary supervisory personnel to ensure that the participants of the programs Obey all applicable policies, procedures, Rules and Regulations. 1.13 The DEPARTMENT or CITY may require that the PROVIDER not be permitted to utilize specific assistants, substitutes, or subcontractors of PROVIDER who have Document failed to follow any policies, procedures, rules or regulations applicable to the use of the facility. 1.14 Although the CITY shall not control the PROVIDER's techniques, methods, procedures, or sequence of instruction, the PROVIDER will comply with the CITY's and DEPARTMENT's policies, rules, regulations and procedures, as well as those of the FULTON COUNTY BOARD OF EDUCATION, and shall not interfere with their operation, nor harm or damage the equipment or facilities afforded to PROVIDER for his/her programs, nor otherwise disrupt the other on-site activities being offered at such public facilities. 1.15 The PROVIDER also acknowledges that he or she is primarily responsible for the conduct of the participants in all programs under the PROVIDER's charge. �s 1.16 If the PROVIDER will be providing services directly with minor children without parental supervision, the PROVIDER shall, prior to commencing services under this Agreement, comply with the CITY's policy regarding criminal background screening. The CITY will furnish the PROVIDER with a background release form (Exhibit "B") for all the provider's counselors, coaches, volunteers, subcontractors, employees or any other individuals that will come in contact with a child, at the PROVIDER's sole expense. A Consent and Release Form to conduct a criminal background must be executed by any of PROVIDER's employees or any individual who will come in contact with a child at the CITY through PROVIDER or at PROVIDER's direction, such form authorizing the CITY to conduct a search of each such individual's criminal background. The result of such inquiry may be deemed acceptable by the CITY in its sole and complete discretion, and the CITY may reject any individual from participating in any program based upon such results. If the PROVIDER has recently had a background screening conducted by another agency, the CITY, at its sale discretion, may accept that background screening and waive the requirement of'a new background screening. PROVIDER and its employees must also execute a Waiver and Release of Liability holding the CITY and FULTON COUNTY BOARD OF EDUCATION harmless. 1.17 The CITY shall require all participants in all programs to sign a Waiver and Release of Liability. ARTICLE 2.0 Equipment & Materials 2.1 All program materials and equipment needed or pertaining to the above stated programs will be provided by the PROVIDER at his/her own cost and expense. However, PROVIDER may require participants to obtain certain materials required in the programs by providing a list of such materials (with approximate costs) to the participants. If PROVIDER makes such materials available to participants, they must be sold at Document PROVIDER's cost. All equipment provided by the PROVIDER shall be used in strict accordance with equipment manufacturer's instructions and in accordance with all applicable laws. PROVIDER shall coordinate storage of goal posts with the principal of the school located at the facility. 2.2 The sale of merchandise is restricted to those materials utilized in and for the programs. Fundraising activities conducted by the PROVIDER will not be permitted. The PROVIDER shall obtain the CITY's approval of any merchandise to be sold prior to its distribution or sale. 2.3 The CITY will provide no storage space to the PROVIDER, unless otherwise mutually agreed upon in a separate written agreement. 2.4 Any supplies or equipment left at the facility will be the responsibility of the PROVIDER. The CITY will not be responsible for any lost, stolen, or broken equipment or supplies. 2.5 The PROVIDER shall inspect the premises and equipment offered to him/her for his/her proposed activity and if he or she finds anything wrong with the premises or equipment before each program commences that cannot be corrected immediately by the DEPARTMENT, the program shall be canceled and the matter reported to the DEPARTMENT for correction. If the PROVIDER elects to hold his/her programs in the facility provided, it will be presumed that the PROVIDER has inspected the premises and facilities and equipment provided for such programs and has accepted same as being safe and suitable for the use intended. ARTICLE 3.0 Program Size Minimums: 3.1 ACTIVE: Program sizes shall meet the minimum numbers of participants for each program as designated in Exhibit "A." ARTICLE 4.0 Compensation and Method of Payment 4.1 In consideration of the releases and indemnities contained herein and of the PROVIDER's services in connection with the programs and activities described herein, the CITY shall be entitled to 30% of the registration fees paid by all program participants to the PROVIDER, and the PROVIDER shall be entitled to 70% of such fees paid, exclusive of the 50% non-resident surcharge. The 50% non-resident surcharge is fully payable to the CITY and shall not be included in PROVIDER's gross income calculation. PROVIDER shall be entitled to retain all non -registration fees paid by participants to PROVIDER, i.e. PROVIDER membership fees and costs for uniforms and pictures to participants. Document — 4.2 The PROVIDER agrees to collect all fees from participants, and the PROVIDER agrees to provide CITY with schedules of fees to be charged to participants in conformance with Exhibit "A". It is agreed that the PROVIDER's sole obligation shall be to collect the fees from the participants and to remit the 30% of the fees collected as well as all 50% non-resident surcharge amounts to the CITY with a pay -out report of all monies collected. Payment will be made to the CITY within fourteen ( 14) business days of the end of each month or session or ro ram whichever occurs first. 4.3 It is the responsibility of the PROVIDER to pay all applicable local, state, and federal taxes associated with this Agreement, and to acquire and pay for all necessary permits, licenses, and insurance required for the execution of this Agreement. ARTICLE 5.0 Independent PROVIDER 5.1 This Agreement does not create an employee/employer relationship between the Parties. It is the intent of the Parties that the PROVIDER is an independent contractor under this Agreement and not a CITY employee for all purposes, including but not limited to, the application of the Fair Labor Standards Act minimum wage and overtime payments, Federal Insurance Contribution Act, the Social Security Act, the Federal Unemployment Tax Act, the provisions of the Internal Revenue Code, The State Workers Compensation Act, and the State unemployment insurance law. The PROVIDER shall retain sole and absolute discretion in the judgment of the manner and means of carrying out PROVIDER's activities and responsibilities hereunder. The PROVIDER agrees that it is a separate and independent enterprise from the CITY, that it had full opportunity to find other business, that it has made its own investment in its business, and that it will utilize a high level of skill necessary to perforin the work required hereunder. This Agreement shall not be construed as creating any joint employment relationship between the PROVIDER and the CITY and the CITY will not be liable for any obligation incurred by PROVIDER, including but not limited to unpaid minimum wages or overtime premiums. 5.2 PROVIDER warrants that it has not employed or retained any company or person, other than a bona fide employee working solely for the PROVIDER to solicit or secure this Agreement, and that it has not paid or agreed to pay any person, company. corporation, individual or firm any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of this provision, the CITY shall have the right to terminate the Agreement without liability at its discretion, to deduct from the contract price, or otherwise recover the full amount of such fee, commission, percentage, gift or consideration. Document ARTICLE 6.0 Insurance 6.1 PROVIDER shall not provide any service until all insurance required under this paragraph has been obtained and approved by the CITY. 5.2 Certificates of Insurance. Certificates of Insurance reflecting evidence of the required insurance shall be filed with the CITY prior to the commencement of this Agreement. These Certificates shall contain a provision that coverages afforded under these policies will not be cancelled until at least forty-five days (45) prior written notice has been given to the CITY. Policies shall be issued by companies authorized to do business under the laws of the State of Georgia. Financial Ratings must be not less than "A -VI" in the latest edition of "Best Key Rating Guide", published by A.M. Best Guide. 6.3 Insurance shall be in force until the obligations required to be fulfilled under the terms of the Agreement are satisfied. In the event the insurance certificate provided indicated that the insurance shall terminate and lapse during the period of this Agreement, then in that event, the PROVIDER shall furnish, at least thirty (30) days prior to the expiration of the date of such insurance, a renewed Certificate of Insurance as proof that equal and like coverage for the balance of the period of the Agreement and extension thereunder is in effect. The PROVIDER shall not provide any service pursuant to this Agreement unless all required insurance remains in full force and effect. 6.4 _Commercial General Liability insurance to cover liability bodily injury and property damage. Exposures to be covered are: premises, operations, products/completed operations, and certain contracts. Coverage must be written on an occurrence basis, with the following limits of liability: $1,000,000 Combined Single Limit — each occurrence $2,000,000 Combined Single Limit — general aggregate $1,000,000 Personal Injury $1,000,040 Products/Completed Operations Aggregate PROVIDER shall have its insurer name the City of MILTON as an additional insured on its General Liability policy. 5.5 Worker's Compensation insurance shall be maintained during the life of this Agreement to comply with the statutory limits for all employees, and in the case any work is sublet, the PROVIDER shall require the subcontractor(s) similarly provide Workers Compensation hisurance for all the latter's employees unless and until such employees are covered by the protection afforded by the PROVIDER. The PROVIDER and his subcontractors shall maintain during the life of this Agreement Employers Liability Insurance. The following limits must be maintained: A. Workers Compensation Statutory B. Employer's Liability $100,040 each accident $500,000 Disease -policy limit $100,000 Disease -each employee Document If PROVIDER or its subcontractor claims to be exempt from this requirement, PROVIDER shall provide CITY proof of such exemption along with a written request for CITY to exempt PROVIDER, written on PROVIDER or subcontractor's letterhead. 6.6 PROVIDER shall also maintain Auto Liability and Directors and Officers insurance with limits reasonably acceptable to CITY during the term of this Agreement. 6.7 The CITY and the Fulton County Board of Education shall each be named as an additional insured and loss payee on all policies required by this Agreement. ARTICLE 7.0 Term and Termination 7.1 After a two (2) month trial period, the programs will be evaluated by the DEPARTMENT, and the remainder of this Agreement will either be terminated or continue in full force and effect. If at any time after the two (2) month evaluation, program enrollment should fall below the required minimum, the PROVIDER will be allotted four (4) weeks to bring enrollment up to the required minimum. The programs will be reevaluated and execution or termination of the contract will be determined by the DEPARTMENT. 7.2 The term of this Agreement shall commence upon the date of execution hereof and shall remain in effect for a period of one (1) year from the date of execution of this Agreement by the CITY, unless terminated sooner as provided in this Article. Renewal of this Agreement beyond the one (1) year term shall require the mutual written agreement of the CITY and PROVIDER. 7.3 This Agreement may be terminated by the CITY for convenience upon giving of at least thirty (30) days prior written notice of termination to the PROVIDER at the PROVIDER's address set forth herein at the sole and exclusive discretion of the CITY. This Agreement may be terminated by the City immediately by written notice to PROVIDER upon any willful, reckless, or grossly negligent act or omission by PROVIDER or any of its officers, agents, employees, or volunteers. 7.4 This Agreement may be terminated by PROVIDER upon giving at least thirty (30) days written notice of termination to the CITY. 7.5 PROVIDER must notify the DEPARTMENT in writing of any program cancellations at least ten (1 d) business days prior to the scheduled cancellation. 7.6 CITY reserves the right to cancel or reschedule any of the PROVIDER's programs, in the case of scheduling conflicts or other emergencies, as determined by the DEPARTMENT. Document ARTICLE 8.0 Indemnification 8.1 PROVIDER agrees to indemnify and hold harmless the CITY and the FULTON COUNTY BOARD OF EDUCATION, their trustees, elected and appointed officers, agents, servants and employees, from and against any and all claims, demands, or causes of action of whatsoever kind of nature, and the resulting losses, costs, expenses, reasonable attorneys' fees, including paralegal fees, liabilities, damages, orders, judgments, or decrees, sustained by the CITY, the FULTON COUNTY BOARD OF EDUCATION, or any third party arising out of, or by reason of, or resulting from the will full or negligent acts, errors, or omissions of the PROVIDER or its agents, officers, volunteers or employees. 8.2 The Parties understand and agree that the covenants and representations relating to this indemnification provision shall survive the term of this Agreement and continue in full force and effect as to the PROVIDER's responsibility to indemnify. ARTICLE 9.0 Americans With Disabilities Act 9.1 PROVIDER shall not discriminate against any person in its operation and activities in its use or expenditure of the funds or any portion of the funds provided by this Agreement and shall affirmatively comply with all applicable provisions of the Americans With Disabilities Act ("ADA"), in the programs while providing any services funded in whole or in part by the CITY, including Titles I and I1 of the ADA and all applicable regulations, guidelines, and standards. 9.2 PROVIDER's decisions regarding the delivery of services under this Agreement shall be made without regard to or consideration of race, age, religion, color, gender, sexual orientation, national origin, marital status, physical or mental disability, political affiliation, or any other factor which cannot be lawfully or appropriately used as a basis for delivery of service. 9.3 PROVIDER in accordance with Title VI of the Civil Rights Act, as amended, 42 U.S.C. § 2000d, section 303 of the Age Discrimination Act of 1975, as amended, 42 U.S.C. § 6102, section 202 of the Americans with Disabilities Act of 1990, 42 U.S.C. § 12132, and all other provisions of Federal law, the Provider agrees that, during performance of this Agreement, Provider, for itself, its assignees and successors in interest, will not discriminate against any employee or applicant for employment, any subcontractor, or any supplier because of race, color, creed, national origin, gender, age or disability. In addition, Provider agrees to comply with all applicable implementing regulations and shall include the provisions of this Section IV(R) in every subcontract for services contemplated under this Agreement. Document ARTICLE 10.0 Miscellaneous 10.1 No modification, amendment, or alteration of the terms and conditions contained shall be effective unless contained in a written document executed with the same formality and equal dignity herewith. 10.2 This Agreement is non -transferable or assignable, and PROVIDER agrees not to transfer or assign the performance of services called for in the Agreement. 10.3 This Agreement sets forth the full and complete understanding of the Parties as of the effective date, and supersedes any and all negotiations, agreements, and representations made or dated prior to this Agreement. 10.4 The PROVIDER shall pay reasonable attorney's fees to the City should the City be required to incur attorney's fees in enforcing the provisions of this Agreement. 10.5 Time is of the essence of this Agreement. 10.6 Each of the individuals who executes this Agreement agrees and represents that he is authorized to execute this Agreement on behalf of the respective entity. Accordingly, the City and PROVIDER both waive and release any right to contest the enforceability of this Agreement based upon the execution and/or approval thereof. 10.7 It is the policy of City that unauthorized aliens shall not be employed to perform work on City contracts involving the physical performance of services. Therefore, the City shall not enter into a contract for the physical performance of services within the State of Georgia, unless the PROVIDER shall provide evidence on City -provided forms, attached hereto as Exhibits "C" and "D" that it and its subcontractors have within the previous twelve (12) month period conducted a verification of the social security numbers of all employees who will perform work on the City contract to ensure that no unauthorized aliens will be employed. The City Manager or his/her designee shall be authorized to conduct an inspection of the PROVIDER's and its subcontractors' verification process to determine that the verification was correct and complete. The PROVIDER and its subcontractors shall retain all documents and records of its verification process for a period of three (3) years following completion of the contract. This requirement shall apply to all contracts for the physical performance of services where more than three (3) persons are employed on the City contract. Compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300-10-1-.02 is mandatory. PROVIDER's compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300- 10-1-.02 shall be attested by the execution of the contractor's affidavit attached as Exhibit «C ,l Document Pursuant to O.C.G.A. § 50-36-1, the City must obtain a SAVE Affidavit and a secure and verifiable document evidencing the Contractor's legal status in the Country each time that Contractor obtains a public benefit, including any contract, from the City. Contractor hereby verifies that it has, prior to executing this Agreement, executed a SAVE Affidavit (to be sworn under oath under criminal penalty of false swearing pursuant to O.C.G.A_ § 16-10-71), a form of which is attached hereto as Exhibit "E", and submitted such affidavit to the City in person, electronically, or by mail. Further, Contractor verifies that it has, prior to executing this Agreement, submitted a secure and verifiable document, evidencing the Contractor's legal status, to the City either in person or electronically (in compliance with the Uniform Electronic Transactions Act). Contractor verifies that it is in compliance with the Residency Status of an Applicant for Public Benefit, as required by the Georgia Security and immigration Compliance Act (o.C.G.A. § 50-36-1). Document IN WITNESS OF THE FOREGOING, the Parties have set their hands and seal the day and year first written above. ATTEST: SUDIE GORDON, CITY CLERK WITNESS: U CITY: BY: JOE LOCKWOOD, MAYOR PROVIDER: BY: 'o— u Y� KIM SAUND R , PRESIDENT [AFFIX CORPORATE SEAL] EXHIBIT "A" PROGRAM REQUEST FORM IndividLials interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Usq one formep rprogram. Name of Program: i bq�— Participant Ages: Day/s of the week program is offered: V�" f r � Time of Program: Program Dates: n1 .. v to �n rj�j,' L, N I �'i r f i � { fr jf y� �•-� i' " Program Fee: � r ? - t r---- car Program Enrollment: Minimum G) Materials to be supplied by participants r Maximum C' Materials to be supplied by PROVIDER: —ant c)(-1c:� Materials to be supplied by the City of MILTON: Additional Program Requirements: ��) e r �.� j I � � � � � �� i r � � �-��. i � � �. �. �, � � PROVIDER (`s}Name: Address- City/State/Zip Code: 61 i Phone Number: (Day) .�L'� k ti J(Evening) rtl ) : ] Minimum Requirements: 1,000,000 General Liability insurance Office Use Only. Program Rate:$ # of programs in Session: Fee/Program: Document EXHIBIT °'C" STATE OF GEORGIA CITY OF MILTON CONTRACTOR AFFIDAVIT AND AGREEMENT By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm, or corporation which is contracting with the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. The undersigned further agrees that, should it employ or contract with any subcontractor(s) in connection with the physical performance of services pursuant to this contract with the City of Milton, contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. § 13-10-91 on the Subcontractor Affidavit provided in Rule 300-10-01-.08 in the form attached hereto as Exhibit "D." Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the City of Milton at the time the subcontractor(s) is retained to perform such service. EEV 1 Basic Hot Pr m User Identification Number BY. Au orized Officer or Agent Date Kim Saunders Yoga, LLC Title of Authorized Officer or Agent of Contractor Printed Name of Authorized Officer or Agent SUBSCRIBED AND SWORN BE ORE ME ON T IS T E I I_,_,7AY OF r, , 201 NoP blit �. . i tommissior� P ' ssidyIN o�~ r2••I+. SER5■' 4 Document STATE OF GEORGIA CITY OF MILTON EXHIBIT "D" SUBCONTRACTOR AFFIDAVIT By executing this affidavit, the undersigned subcontractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services under a contract with Newtown Recreation, Inc. on behalf of the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. EEV 1 Basic Pilot Program User Identification Number BY: Authorized Officer or Agent Date [INSERT UBCONTRACTOR NAME] Title ❑ Authorized Officer or Agent of Subcontractor Printed Name of Authorized Officer or Agent SUBSCRIBED AND SWORN 2013 �J U N Document EXHIBIT "E" SAVE Affidavit By executing this affidavit under oath, and as an applicant for a public benefit, as referenced in O.C.G.A. § 50-36-t, from the City of Milton, the undersigned applicant verifies one of the following with respect to my application for a public benefit: 1) I am a United States citizen. 2) I am a legal permanent resident of the United States. 3) I am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an alien number issued by the Department of Homeland Security or other federal immigration agency. My alien number issued by the Department of Homeland Security or other federal immigration agency is: The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at least one secure and verifiable document, as required by O.C.G.A. § 54-36-1(e)(1), with this affidavit. The secure and verifiable document provided with this affidavit can hest be classified as: In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A. § 16-14-24, and face criminal penalties as allowed by such criminal statute. Executed in SUBSCRIBED AND SWORN rF)AY ORE ME O T IS THE OF ( (city), (state}. Signa e 6f Applica r Printed Name of Applicant .�acp d PRODUCER Maguire Insurance Agency, Inc. 27101 Puerta Real Suite 200 Mission Viejo, CA 92691- (877).43-8.7459 CERTIFICATE OF LIABILITY INSURANCE DATE (M M/DDI) 04/10/2913 THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSUREDINSUR€RA: ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERIFICATION MAY BE ISSUED OR Philadelphia lndemn.ty insurance Company 18058 Kim Saunders INSR I NSU RER B: LIR Yoga Therapy INSURER C: 830 Freema nw cl Ln Miltpn, GA 30004- INSURER D: INSRD TYPE OF iNSDRANCE INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAM ED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERIFICATION MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF iNSDRANCE POLICY NUMBER DATE IMMIDDIYYYYI DATE(MM/ODIYYYY) LIMITS A % GENERALUABILITY PHPK935924-000 10/11/2012 10/17/7D13 EACH OCCURENCE $2,000,000 PREMiS ES Ea occurce nce $100,000 X COMMERCIAL GENERAL LIABILITY CLW MS MADE �x OCCUR MED EXP {Any one person) $2,500 PIE RSONAL&ADV INJURY $2,000,000 R PRDFES1011ALUABILITY GEN E RAL AGG RE GATE $4,000,0170 PRODUCTS—COMP/OP AGG $4,000,000 GEN'L AGG REGATE LI M IT APPLI ES PE R: X POLICY F1 PROJECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (EA accident) BOUT LY INJ U RY ALL O W N E D AUTOS SCHEOULED AUTOS (Per person) BO DI LY l NRJ RY H I REO AUTOS TION -OWNED AUTOS IPer acodeA[j PROPERTY DAMAGE (per accident) GARAGE LIABILITY AUTO ONLY — EA ACCIDENT OTHER THAN EA ACC ANY AUTO AUTO ONLY: AGG EXCESS I UMBRELLA LIABILITY EACH OCCURENCE OCCUR F-1 CLAIMS MADE AGGREGATE DEDUCTIBLE RETENTION N EMPLOYERS' LIABILITY Y N TORY LIMITS ER ANY PROPPL1To PARTNER/ERECUT1Vf OFFICER/MEMSEFI EXCLUDED? E. L. EACH ACCIDENT E. L. DISEASE — EA AMPLOYEE (Mandatory in NH) IF yes, describe under SPECAL PROVIS ION S below E. L. DISEASE — POLICY LIMIT OTHER DESCRIPTION OF OPE RATIO NSI LO CA71ONSI VEH I CLES I E% CLUSI ONS ADDE D BY ENDORSEMENT I SP ECIAL PR OVI Si ONS It is understood and agreed t9at the iol lowi ng entity is added as an additional insured but a9ly wish respe t(s) to the operations DF the named insured except that liability resulting from the additional insured's sole negligence. CERTIFICATE HOLDER CANCELLATION Crty of Milton 2695 Hopewell Road Milton, GA 30004- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL LD DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY DF ANY WIND UPON THE INSURER, ITS AGENTS OR REPRE5E NTATI VE S. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/01) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DATEIMM/DD/YYYYt v CERTIFICATE OF LIABILITY INSURANCE PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION Maguire Insurance Agency, Inc, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 27101 Puerta Real Suite 201 HOLDER. THIS CERTIFICATE DOES NOT AMMEND, EXTEND OR Mission Vieja•CA926SI ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. I877j438.7459 INSURED INSURER A: Fhitaseiphca Incemnity msurance company Kim Saunders INSURER B: Lift Yoga Therapy INSURER C: 630 F-Zanwood Ln INSURER D: Milton, GA 30004- 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 CERIFICATICIN 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 ADD'LPOLICY EFFECTIVE POLICY EXPIRATION LTR IN5RD TYPE OF IN5URANCE POLICYNUMBER DATE IMM/DD/YYYY DATE (MM/DDIYYYY UMITS A X G ENERAL LIABILITY PHPK935924-000 10/17/2012 10/17/2013 EACH OCCURENCE 52,000,090 PREMISES I Ea Attu rren{e 5100,000 X COMMERCIAL GENERAL LIABILITY MED EXP IAny dna Person) $2,500 CLAIMS MADE 71 OCCUR PERSONAL &ADV INJURY S2,000,000 X P ROPCSSIONAL LIABILITY G E NERAL AGGAEGAT'E $4,000,000 PRODUCTS–COMP/OP AGG $4,000,000 G E N'L AGG REGATE LI M IT APPLIES PER: X POLICY PROJECT LOC AUTOMOBILE LIABI LrTY COM BIN EU SINGLE. LIMIT (EA accident) ANY AUTO BODILY INIU BY ALL OWNED AUTOS 5CHEDU LEU AUTOS (Per person) BODILY INJ URY HIRED A VTOS {Per accidenI NON -OW NCD AUTOS PROPERTY DAMAGE (Pe r accident) GARAGE UASILITY AUTO ON LY – EA ACCIOMT OTHER THAN EA ACC ANY AUTO AUTO ON LY: AGG EXCESS / UM8RELIA LIABILITY EACH OCCURENCE AGGREGATE OCCUR F-1 CLAIMS MADE DEDUCTIBLE RETENTION WORJ(E RS COMPENSATION AND EMPLOYERS' LIABi[1TY Y N TORY UMITS CR ft C.1- EACH ACCIDENT ANY PROPRIETORIPARTNEIpR�EXECUTIVE OFFICER/M EM8E R FXCLU DE p7 E -L- DISEASE – EA AM PLOY E E (Mandatory in NH) ti L O ISEASE –POLICY UM I'F If yes, describe under SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES /EXCLUSIONS ADDED BY ENDOR5EMENT /SPECIAL PROVISIONS It is understood and agreed that the Fallowing entity is added as an additional insured but only with mspectNI to the operatinn5 of the named insured except that liability resulting from the additional insured'% sole negligence. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE Bethwell communitycenter THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL In DAYS WRITTEN NOTICE TO THE 2695 hopewell road CERTIFICATE HOLDER NAMED TO THE LEF•i', BUT FAILURE TO DO 50 SHALL IMPOSE NO OBLIGATION OR milte n, GA 30004- LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES, AUTHORIZED REPRFSENTA71VE ACORD 2S (2009/01) © 19$$-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Philadelphia Indemnity Insurance Company R1 One Bala Plaza, Suite 100, Baia Cynwyd, Pennsylvania 19004 COMMON POLICY DECLARATIONS Policy Number: PHPK935924-000 Named Insured and Mailing Address: Kim Saunders Lift Yoga Therapy 830 Freemanwood Ln Milton, GA 30004 - Producer: 6039 Maguire Insurance Agency, Inc. 27101 Puerta Real Suite 200 Mission Viejo, CA 92691 - CPD -PUC (01107) Policy Period From: 10117/2012 i'n: 10/1712013 at 12:01 AM. Standard Time at your mailing address shown above Business Description: Yoga Trainer IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED. THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. PREMIUM Commercial Property Coverage Part Commercial General Liability Coverage Part $135.00 Commercial Crime Coverage Part Commercial inland Marine Coverage Part Commercial Auto Coverage Part Commercial Stop Gap Part Businessowners Workers Compensation Taxes/FeeslSurcharges $701.00 Total $205.00 FORM (S) AND ENDORSEMENT (S) MADE A PART OF THIS POLICY AT THE TIME OF ISSUE Refer To Forms Schedule 'Omits applicable Forms and Endorsements if shown in specific Coverage Part/Coverage Form Declarations Countersignature Date Authorized Representative Philadelphia Indemnify Insurance Company COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS Policy Number-PHPK935924-000 See Supplemental Schedule Agent #:6039 LIMITS OF INSURANCE G $4,000,000 General Aggregate Limit (Other Than Products — Completed Operation) $4,000,000 ProductslCompleted Operations Aggregate Limit (Any One Person Or Organization) $2,000,000 Personal and Advertising Injury Limit $2,000,000 Each Occurrence Limit $140,000 Rented To You Limit $2,500 Medical Expense Limit (Any One Person) FORM OF BUSINESS: Individual Business Description: Yoga Trainer Location of All Premises You Own, Rent or Occupy: SEE SCHEDULE ATTACHED AUDIT PERIOD, ANNUAL, UNLESS OTHERWISE STATED: Rates Advance Premiums Premium Prodd Prod.] Classifications Basis Prem.lOps. Comp.O s. Prem./Ops. Comp. Ops. SEE SCHEDULE ATTACHED TOTAL PREMIUM FOR THIS COVERAGE PART: $13b.UU Included Retroactive DatetCG 00 02 Only) This insurance does not apply to "Bodily Injury", "Property Damage", or "Personal and Advertising Injury" which occurs before the retroactive date, if any, shown below. Retroactive ]late: _ FORM(S) AND ENDORSEMENT (S) APPLICABLE TO THIS COVERAGE PART: Refer To Forms Schedule Countersignature Date Authorized Representative Page 1 of 1 Page 1 of 1 Kira Saunders From: NoRepiy@dor.ga.gov Sent: Monday, May 14, 2012 8:43 PM To: kimsaunders@mindspring.com Subject: Official Georgia Department of Revenue Notification Atlanta Regional Office 1800 Century Blvd, N.E. Suite: 12000 Atlanta, GA 30345-3205 [404}417-6605 KIMBERLY S. SAUNDERS 830 FRI EMANWOOD LN MILTON GA 30004 You have been identified by KIM SAUDERS YOGA LLC as a person who may be held personally liable for unpaid sales tax, incorne tax withholding, or 911 charges on prepaid wireless services assessed against such business entity under sk ction 45-2-52 of the Official Code of Georgia Annotated. Section 48-2-52 states that "[a]ny officer or employee of any corporation, any member, manager, or employee of any limited liability company., or any partner or employee of any limited liability partnership who has control or supervision of collecting from purchasers or others amounts required under this title or of collecting frorn employees any taxes required under this title, and of accounting for and paying over the amounts or taxes to the commissioner, and who willfully fails to collect the amounts or taxes or truthfully to account i'or and pay over the amounts or taxes to the commissioner, or who willfully attempts to evade or defeat any obligation imposed under this title, shall be personally liable for an amount equal to the amount evaded, not collected, not accounted for, or not paid over." if KIM SAUDERS YOGA LLC has accurately identified you as a person who may he personally liable for the aforementioned taxes and charges, it is your responsibility to ensure that such taxes and charges are collected and timely remitted to the Department. Failure: to do so may result in the issuance of an assessment and state tax execution against you for any outstanding tax Iiabilities owed by KIM SAUDERS YOGA LLC_ If you do not control or supervise the collection of taxes or account for and pay over such amounts on behalf of KIM SAUDERS YOGA LLC please notify the Department regional office listed above so that we may amend our records. 5/15/2012 Yoga Alliance t FiN YogaAfflance Page 1 of) - —Teachers Schools Directory Education Member Benefits MWOMW Search returried t matches Page I of I Name Contact Address Regisiratinn [ ..... I ........ To Specialties: l2p ne: S $au33der5, itlmt]B rlj7 .. .. ... .. p style! HxAha Email: Miiinrl GA MOu04- Languaguas; English k 12,nde $( 1 Tidspring.Com Designation : E-F?Y'r 200, RYT RXI . I USIA W e bs 1f9;,An ric h.c...a..f e.co m Youa A114mn .e `: 2013 1 1701 ClaM-0F ,n Boulevard. Suite 110 1 Arlington, VA 22200 1 t-88840?'. -YOGA (9642) Yoga Alliance. Y& RYS, RCYS. RPYS, RYT, E-RYT. RGY7, and RiSYi' are registered tradernarks of Yoga NWan3c All rigins rose -veil Sit r e d http://www.yogaalliance.org/Registration/Teachers/TeacherDirectory.aspx 4/10/2013 t'U313tl u Directory Teacher Registry Seeking qualified yoga instruction? Search for a Reg 1stared Yoga Teacher [RYT} using any of the search criteria below. Please, no solicitations, spamml ng or telemarketing. Country: USA ........................ ...........� .................. LastlFirst Name, saunders ......................... —....._....._. ..... 1 kim CitylZip: 1 30Wa Style: Designation: State/Province:I Specialty�_. _....._ v... Website: Languages: v ResultslFage. 25 v Order By: Last Name v s MWOMW Search returried t matches Page I of I Name Contact Address Regisiratinn [ ..... I ........ To Specialties: l2p ne: S $au33der5, itlmt]B rlj7 .. .. ... .. p style! HxAha Email: Miiinrl GA MOu04- Languaguas; English k 12,nde $( 1 Tidspring.Com Designation : E-F?Y'r 200, RYT RXI . I USIA W e bs 1f9;,An ric h.c...a..f e.co m Youa A114mn .e `: 2013 1 1701 ClaM-0F ,n Boulevard. Suite 110 1 Arlington, VA 22200 1 t-88840?'. -YOGA (9642) Yoga Alliance. Y& RYS, RCYS. RPYS, RYT, E-RYT. RGY7, and RiSYi' are registered tradernarks of Yoga NWan3c All rigins rose -veil Sit r e d http://www.yogaalliance.org/Registration/Teachers/TeacherDirectory.aspx 4/10/2013 YT HOME OF'THE BEST QUALITY OF LIFE IN GEORGIA' M1tT0N*k4 ESTABLISHED 2005 TO: City Council CITY COUNCIL AGENDA ITEM DATE: April 29, 2013 FROM: City Manager AGENDA ITEM: Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Newtown Recreation, Inc_ for Athletic Programming for Boys and Girls in Multiple Sports. MEETING DATE: Monday, May 6, 2013 Regular City Council Meeting. BACKGROUND INFORMATION: (Attach additional pages if necessary) See attached memorandum APPROVAL BY CITY MANAGER: O_APPROVED CI TY A TTORNEY APPRO VAL REQUIRED YES CI TY A TTORNEY REVIEW REQ UIRED: h1] YES APPROVAL BY CITY ATTORNEY &APPROVED PLACED ON AGENDA FOR: O 3 REMARKS: () NOT APPROVED () NO () NO NOTAPPROVED V You(- PHONE: 678.242.25001 FAX: 678.242.2499 r Green -or * c;!.,ifiec * info@cEtyofmilfonga.us I www.cityofmiltonga.us WON Community 3 lii°5 13000 Deerfield Parkway, Suite 107 1 Milton GA 30004 -CERTIFIED BRONZE -- To: Honorable Mayor and City Council Members From: Jim Cregge, Parks & Recreation Director Date: Submitted on April 25 for the May 6 Regular Council Meeting Agenda Item: Consideration of the Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Newtown Recreation, Inc. for Athletic Programming for Boys and Girls in Multiple Sports. Department Recommendation: Staff is recommending the approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Newtown Recreation, Inc. for athletic programming for boys and girls in multiple sports. Executive Summary: This is a renewal of the agreement reached last year. Newtown Recreation, Inc. partnership has been extremely successful. Their ability to move quickly allows us to try new and different programming as the need is identified. In addition to continuing successful programs introduced last year, Newtown recreation will help us introduce Rugby and up to 4 teenage co-ed programs. Funding and Fiscal Impact: A commission of 30% will be paid to the City of Milton two weeks following the end of registration. Non-resident fees will be collected by the provider and paid to the City at a rate of an additional 50% of the standard registration fee. Alternatives: If we do not renew with Newtown Recreation, Inc. we would have to locate a new service provider. Legal Review: Contract Template – Paul Higbee, Jarrard & Davis on March 5, 2013 Document Concurrent Review: Chris Lagerbloom Attachment(s): 1) Parks and Recreation Agreement for Outside Providers Contract and SAVE Affidavit (2 copies) HOMEOF'oL ST QUALIT ' M1 LTO N' ESTABLISHED 2006 CITY OF MILTON PARKS & RECREATION DEPARTMENT AGREEMENT FOR OUTSIDE PROVIDERS THIS IS AN AGREEMENT, made this day of , 2013, between: THE CITY OF MILTON, a municipal corporation organized and operating under the laws of the State of Georgia, with a business address of 13000 Deerfield Parkway, Suite 107 A, MILTON, Georgia 34004, hereinafter referred to as the "CITY." and NEWTOWN RECREATION INC. hereinafter referred to as "PROVIDER". CITY and PROVIDER may hereinafter collectively be referred to as "the Parties". In consideration of the mutual obligations of the Parties and for good and valuable consideration, the adequacy and receipt of which are hereby acknowledged, the Parties agree as follows: ARTICLE 1.0 PROVIDER's Services and Responsibilities 1.1 PROVIDER shall conduct services generally described as Basketball, Boys Lacrosse, Flag Football, Tennis, Rugby, Volleyball, Slow Pitch Softball, Dodgeball, Kickball, Ultimate Frisbee & Summer Sports Camps at the following location: Hopewell Middle School, 13050 Cogburn Road, Milton, GA 30004; Northwestern Middle School, 12805 Birmingham Hwy, Milton GA 30004; Cogburn Woods Elementary School, 13080 Cogburn Road, Milton GA 30004; Birmingham Falls Elementary School, 14865 Birmingham Hwy, Milton GA 30004; Bethwell Community Center, 2695 Hopewell Road, Milton GA 30004; Bell Memorial Park, 15245 Bell Road, Milton GA 30004. 1.2 The PROVIDER's services shall be performed during the days and hours described in Exhibit "A," attached hereto and incorporated herein by reference. 1.3 The PROVIDER and The Director of the Parks & Recreation Department or his designee, hereinafter referred to as the "DEPARTMENT", will agree upon program schedules. PROVIDER agrees to submit a Program Request Form to the Coordinator for each program being proposed eight {S} weeks prior to the beginning of each NeSSiOn. 1.4 The fees charged to each participant will be as described in Exhibit "A" for residents of MILTON & ALPHARETTA and a surcharge of 50% more for non-residents © 30 you( r �� ''V teen � * PHONE: 678.242.25001 FAX: 678.242.2499 P1C2012 WINNER Community Y * ceirtifiwd ; c;ty,,fEthi,, infoftifyofmiltongci.ua I www.cityafmN Y oS� 13000 Deerfield Parkway, Suite 107 1 Milton GA 30004 CERTIFIED BRONZE `7 Document of MILTON & ALPHARETTA. The entire balance of this surchary-e for non-residents shall be paid to the CITY. 1.5 The PROVIDER warrants to CITY that it is not insolvent, it is not in bankruptcy proceedings or receivership, nor is it engaged in or threatened with any litigation or other legal or administrative proceedings or investigations of any kind which would have an adverse effect on its ability to perform its obligations under this Agreement. 1.6 The PROVIDER agrees that it shall be solely responsible for all costs and/or expenses associated with, or as a result of its operation under this Agreement. The PROVIDER stipulates and certifies that it is qualified to provide the programs it is hired to provide, maintains the education and required licenses or permits necessary to provide the programs, and shall continue to maintain such licenses or permits during the term of this Agreement. 1.7 This Agreement is considered a non-exclusive Agreement between the Parties. The CITY shall have the right to purchase the same kind of services to be provided by the PROVIDER from other sources during the term of this Agreement. The PROVIDER is not precluded from providing the same or similar services for other parties so long as such other engagements do not interfere with the PROVIDER'S provision of services to the CITY. J 1.8 The DEPARTMENT must approve any promotional material, flyers, and posters advertising the programs prior to its release. The, following content and topics shall specifically be prohihited: sexually explicit materials, profanity, child pornography, alcoholic beverages, tobacco products, adult movies, adult hook/video stores, adult entertainment establishments, massage parlors, pawn shops, and tattoo parlors or shops. 1.9 The PROVIDER shall not promote any privately owned business in a CITY park/facility or solicit any participant in a CITY park/facility activity for any privately owned business. The PROVIDER may not use said facilities to conduct personal business including workshops, clinics, seminars, camps, or any other activities that are outside the scope of service described in (Exhibit "A"). It is further understood that such action(s) may result in immediate termination of the Agreement and the forfeiture of all compensation due to the PROVIDER. 1.10 The PROVIDER shall abide by the policies, procedures, rales and regulations of the DEPARTMENT, the CITY, and the FULTON COUNTY BOARD OF EDUCATION as promulgated from time to time. PROVIDER understands and agrees Haat the DEPARTMENT shall have first priority. for use of CITY facilities. notwithstanding any other Provisions of this Agreement 1.11 All assistants, substitutes, and subcontractors utilized by the PROVIDER must have prior written approval of the DEPARTMENT. Document 1.12 PROVIDER shall provide necessary supervisory personnel to ensure that the participants of the programs obey all applicable policies, procedures, Rules and Regulations. 1.13 The DEPARTMENT or CITY may require that the PROVIDER not be permitted to utilize specific assistants, substitutes, or subcontractors of PROVIDER who have failed to follow any policies, procedures, rules or regulations applicable to the use of the facility. 1.14 Although the CITY shall not control the PROVIDER's techniques, methods, procedures, or sequence of instruction, the PROVIDER will comply with the CITY's and DEPARTMENT's policies, rules, regulations and procedures, as well as those of the FULTON COUNTY BOARD OF EDUCATION, and shall not interfere with their operation, nor harm or damage the equipment or facilities afforded to PROVIDER for his/her programs, nor otherwise disrupt the other on-site activities being offered at such public facilities. 1.15 The PROVIDER also acknowledges that he or she is primarily responsible for the ` conduct of the participants in all programs under the PROVIDER's charge. 1.16 If the PROVIDER will be providing services directly with minor children without parental supervision, the PROVIDER shall, prior to commencing services under this Agreement, comply with the CITY's policy regarding criminal background screening. The CITY will furnish the PROVIDER with a background release form (Exhibit "B") for all the provider's counselors, coaches, volunteers, subcontractors, employees or any other individuals that will come in contact with a child, at the PROVIDER's sole expense. A Consent and Release Form to conduct a criminal background must be executed by any of PROVIDER's employees or any individual who will come in contact with a child at the CITY through PROVIDER or at PROVIDER's direction, such form authorizing the CITY to conduct a search of each such individual's criminal background. The result of such inquiry may be deemed acceptable by the CITY in its sole and complete discretion, and the CITY may reject any individual from participating in any program based upon such results. If the PROVIDER has recently had a background screening conducted by another agency, the CITY, at its sole discretion, may accept that background screening and waive the requirement of a new background screening. PROVIDER and its employees must also execute a Waiver and Release of Liability holding the CITY and FULTON COUNTY BOARD OF EDUCATION harmless. 1.17 The CITY shall require all participants in all programs to sign a Waiver and Release of Liability. Document ARTICLE 2.4 Equipment & Materials 2.1 All program materials and equipment needed or pertaining to the above stated programs will be provided by the PROVIDER at his/her own cost and expense. However, PROVIDER may require participants to obtain certain materials required in the programs by providing a list of such materials (with approximate costs) to the participants. If PROVIDER makes such materials available to participants, they must be sold at PROVIDER's cost. All equipment provided by the PROVIDER shall be used in strict accordance with equipment manufacturer's instructions and in accordance with all applicable laws. PROVIDER shall coordinate storage of goal posts with the principal of the school located at the facility. 2.2 The sale of merchandise is restricted to those materials utilized in and for the programs. Fundraising activities conducted by the PROVIDER will not be permitted. The PROVIDER shall obtain the CITY's approval of any merchandise to be sold prior to its distribution or sale. 2.3 The CITY will provide no storage space to the PROVIDER, unless otherwise mutually agreed upon in a separate written agreement. 2.4 Any supplies or equipment left at the facility will be the responsibility of the PROVIDER. The CITY will not be responsible for any lost, stolen, or broken equipment or supplies. 2.5 The PROVIDER shall inspect the premises and equipment offered to him/her for his/her proposed activity and if he or she finds anything wrong with the premises or equipment before each program commences that cannot be corrected immediately by the DEPARTMENT, the program shall be canceled and the matter reported to the DEPARTMENT for correction. If the PROVIDER elects to hold his/her programs in the facility provided, it will be presumed that the PROVIDER has inspected the premises and facilities and equipment provided for such programs and has accepted same as being safe and suitable for the use intended. ARTICLE 3.4 Program Size Minimums: 3.1 ACTIVE: Program sizes shall meet the minimum numbers of participants for each program as designated in Exhibit "A." ARTICLE 4.4 Compensation and Method of Payment 4.1 In consideration of the releases and indemnities contained herein and of the PROVIDER's services in connection with the programs and activities described herein, Document the CITY shall be entitled to 30% of the registration fees paid by all program participants to the PROVIDER, and the PROVIDER shall be entitled to 70% of such fees paid, exclusive of the 50% non-resident surcharge. The 50% non-resident surcharge is fully payable to the CITY and shall not be included in PROVIDER's gross income calculation. PROVIDER shall be entitled to retain all non -registration fees paid by participants to PROVIDER, i.e. PROVIDER membership fees and costs for uniforms and pictures to participants. 4.2 The PROVIDER agrees to collect all fees from participants, and the PROVIDER agrees to provide CITY with schedules of fees to be charged to participants in conformance with Exhibit "A". It is agreed that the PROVIDER's sole obligation shall be to collect the fees from the participants and to remit the 30% of the fees collected as well as all 50% non-resident surcharge amounts to the CITY with a pay -out report of all monies collected. Payment will be made to the CITY within fourteen (14) business days of the end of each month or session or program, whichever occurs first. 4.3 It is the responsibility of the PROVIDER to pay all applicable local, state, and federal taxes associated with this Agreement, and to acquire and pay for all necessary permits, licenses, and insurance required for the execution of this Agreement. ARTICLE 5.0 Independent PROVIDER 5.1 This Agreement does not create an employee/employer relationship between the Parties. It is the intent of the Parties that the PROVIDER is an independent contractor under this Agreement and not a CITY employee for all purposes, including but not limited to, the application of the Fair Labor Standards Act minimum wage and overtime payments, Federal Insurance Contribution Act, the Social Security Act, the Federal Unemployment Tax Act, the provisions of the Internal Revenue Code, The State Workers Compensation Act, and the State unemployment insurance law. The PROVIDER shall retain sole and absolute discretion in the judgment of the manner and means of carrying out PROVIDER's activities and responsibilities hereunder. The PROVIDER agrees that it is a separate and independent enterprise from the CITY, that it had full opportunity to find other business, that it has made its own investment in its business, and that it will utilize a high level of skill necessary to perform the work required hereunder. This Agreement shall not be construed as creating any joint employment relationship between the PROVIDER and the CITY and the CITY will not be liable for any obligation incurred by PROVIDER, including but not limited to unpaid minimum wages or overtime premiums. 5.2 PROVIDER warrants that it has not employed or retained any company or person, other than a bona fide employee working solely for the PROVIDER to solicit or secure this Agreement, and that it has not paid or agreed to pay any person, company, corporation, individual or firm any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of this provision, the CITY shall have the right to terminate Document the Agreement without liability at its discretion, to deduct from the contract price, or otherwise recover the full amount of such fee, commission, percentage, gift or consideration. ARTICLE 6.4 Insurance 6.1 PROVIDER shall not provide any service until all insurance required under this paragraph has been obtained and approved by the CITY. 6.2 Certificates of Insurance. Certificates of Insurance reflecting evidence of the required insurance shall be filed with the CITY prior to the commencement of this Agreement. These Certificates shall contain a provision that coverages afforded under these policies will not be cancelled until at least forty-five days (45) prior written notice has been given to the CITY. Policies shall be issued by companies authorized to do business under the laws of the State of Georgia. Financial Ratings must be not less than "A -VI" in the latest edition of "Best Key Rating Guide', published by A.M. Best Guide. 6.3 Insurance shall be in force until the obligations required to be fulfilled under the terms of the Agreement are satisfied. In the event the insurance certificate provided indicated that the insurance shall terminate and lapse during the period of this Agreement, then in that event, the PROVIDER shall furnish, at least thirty (30) days prior to the expiration of the date of such insurance, a renewed Certificate of Insurance as proof that equal and like coverage for the balance of the period of the Agreement and extension thereunder is in effect. The PROVIDER shall not provide any service pursuant to this Agreement unless all required insurance remains in full force and effect. 6.4 Commercial General Liability insurance to cover liability bodily injury and property damage. Exposures to be covered are: premises, operations, products/completed operations, anal certain contracts. Coverage must be written on an occurrence basis, with the following limits of liability: $1,000,000 Combined Single Limit — each occurrence $2,000,000 Combined Single Limit — general aggregate $1,000,000 Personal injury $1,000,000 Products/Completed Operations Aggregate PROVIDER shall have its insurer name the City of MILTON as an additional insured on its General Liability policy. 6.5 Worker's Compensation insurance shall be maintained during the life of this Agreement to comply with the statutory limits for all employees, and in the case any work is sublet, the PROVIDER shall require the subcontractor(s) similarly provide Workers Compensation Insurance for all the latter's employees unless and until such employees are covered by the protection afforded by the PROVIDER. The PROVIDER and his Document subcontractors shall maintain during the life of this Agreement Employers Liability Insurance. The following limits must be maintained: A. Workers Compensation Statutory B. Employer's Liability $100,000 each accident $500,000 Disease -policy limit $100,000 Disease -each employee If PROVIDER or its subcontractor claims to be exempt from this requirement, PROVIDER shall provide CITY proof of such exemption along with a written request for CITY to exempt PROVIDER, written on PROVIDER or subcontractor's letterhead. 6.6 PROVIDER shall also maintain Auto Liability and Directors and Officers insurance with limits reasonably acceptable to CITY during the term of this Agreement. 6.7 The CITY and the Fulton County Board of Education shall each be named as an additional insured and loss payee on all policies required by this Agreement. ARTICLE 7.0 Term and Termination 7.1 After a two (2) month trial period, the programs will be evaluated by the DEPARTMENT, and the remainder of this Agreement will either be terminated or continue in full force and effect. If at any time after the two (2) month evaluation, program enrollment should fall below the required minimum, the PROVIDER will be allotted four (4) weeks to bring enrollment up to the required minimum. The programs will be reevaluated and execution or termination of the contract will be determined by the DEPARTMENT. 7.2 The term of this Agreement shall commence upon the date of execution hereof and shall remain in effect for a period of one (1) year from the date of execution of this Agreement by the CITY, unless terminated sooner as provided in this Article. Renewal of this Agreement beyond the one (1) year term shall require the mutual written agreement of the CITY and PROVIDER. 7.3 This Agreement may be terminated by the CITY for convenience upon giving of at least thirty (30) days prior written notice of termination to the PROVIDER at the PROVIDER's address set forth herein at the sole and exclusive discretion of the CITY. This Agreement may be terminated by the City immediately by written notice to PROVIDER upon any willful, reckless, or grossly negligent act or omission by PROVIDER or any of its officers, agents, employees, or volunteers. 7.4 This Agreement may be terminated by PROVIDER upon giving at least thirty (30) days written notice of termination to the CITY. 7.5 PROVIDER must notify the DEPARTMENT in writing of any program cancellations at least ten (10) business days prior to the scheduled cancellation. Document 7.6 CITY reserves the right to cancel or reschedule any of the PROVIDER's programs, in the case of scheduling conflicts or other emergencies, as determined by the DEPARTMENT. ARTICLE 8.0 Indemnification 8.1 PROVIDER agrees to indemnify and hold harmless the CITY and the FULTON COUNTY BOARD OF EDUCATION, their trustees, elected and appointed officers, agents, servants and employees, from and against any and all claims, demands, or causes of action of whatsoever kind of nature, and the resulting losses, costs, expenses, reasonable attorneys' fees, including paralegal fees, liabilities, damages, orders, judgments, or decrees, sustained by the CITY, the FULTON COUNTY BOARD OF EDUCATION, or any third party arising out of, or by reason of, or resulting from the will full or negligent acts, errors, or omissions of the PROVIDER or its agents, officers, volunteers or employees. 8.2 The Parties understand and agree that the covenants and representations relating to this indemnification provision shall survive the term of this Agreement and continue in full force and effect as to the PROVIDER's responsibility to indemnify. ARTICLE 9.0 Americans With Disabilities Act 9.1 PROVIDER shall not discriminate against any person in its operation and activities in its use or expenditure of the funds or any portion of the funds provided by this Agreement and shall affirmatively comply with all applicable provisions of the Americans With Disabilities Act ("ADA"), in the programs while providing any services funded in whale or in part by the CITY, including Titles I and II of the ADA and all applicable regulations, guidelines, and standards. 9.2 PROVIDER's decisions regarding the delivery of services under this Agreement shall be made without regard to or consideration of race, age, religion, color, gender, sexual orientation, national origin, marital status, physical or mental disability, political affiliation, or any other factor which cannot be lawfully or appropriately used as a basis for delivery of service. 9.3 PROVIDER in accordance with Title VI of the Civil Rights Act, as amended, 42 U.S.C. § 2000d, section 303 of the Age Discrimination Act of 1975, as amended, 42 U.S.C. § 6102, section 202 of the Americans with Disabilities Act of 1990, 42 U.S.C. § 12132, and all other provisions of Federal law, the Provider agrees that, during performance of this Agreement, Provider, for itself, its assignees and successors in interest, will not discriminate against any employee or applicant for employment, any subcontractor, or any supplier because of race, color, creed, national origin, gender, age or disability. In addition, Provider agrees to comply with all applicable implementing Document regulations and shall include the provisions of this Section IV(R) in every subcontract for services contemplated under this Agreement. ARTICLE 10.0 Miscellaneous 10.1 No modification, amendment, or alteration of the terms and conditions contained shall be effective unless contained in a written document executed with the same formality and equal dignity herewith. 10.2 This Agreement is non -transferable or assignable, and PROVIDER agrees not to transfer or assign the performance of services called for in the Agreement. 10.3 This Agreement sets forth the full and complete understanding of the Parties as of the effective date, and supersedes any and all negotiations, agreements, and representations made or dated prior to this Agreement. 10.4 The PROVIDER shall pay reasonable attorney's fees to the City should the City be required to incur attorney's fees in enforcing the provisions of this Agreement. 10.5 Time is of the essence of this Agreement. 10.6 Each of the individuals who executes this Agreement agrees and represents that he is authorized to execute this Agreement on behalf of the respective entity. Accordingly, the City and PROVIDER both waive and release any right to contest the enforceability of this Agreement based upon the execution and/or approval thereof. 10.7 It is the policy of City that unauthorized aliens shall not be employed to perform work on City contracts involving the physical performance of services. Therefore, the City shall not enter into a contract for the physical performance of services within the State of Georgia, unless the PROVIDER shall provide evidence on City -provided forms, attached hereto as Exhibits "C" and "D" that it and its subcontractors have within the previous twelve (12) month period conducted a verification of the social security numbers of all employees who will perform work on the City contract to ensure that no unauthorized aliens will be employed. The City Manager or his/her designee shall be authorized to conduct an inspection of the PROVIDER's and its subcontractors' verification process to determine that the verification was correct and complete. The PROVIDER and its subcontractors shall retain all documents and records of its verification process for a period of three (3) years following completion of the contract. This requirement shall apply to all contracts for the physical performance of services where more than three (3) persons are employed on the City contract. Compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300-10-1-.02 is mandatory. Document PROVIDER's compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300- 10-1-.02 shall be attested by the execution of the contractor's affidavit attached as Exhibit a�C Pursuant to O.C.G.A. § 50-36-1, the City must obtain a SAVE Affidavit and a secure and verifiable document evidencing the Contractor's legal status in the Country each time that Contractor obtains a public benefit, including any contract, from the City. Contractor hereby verifies that it has, prior to executing this Agreement, executed a SAVE Affidavit (to be sworn under oath under criminal penalty of false swearing pursuant to O.C.G.A. § 16-10-71), a form of which is attached hereto as Exhibit "E", and submitted such affidavit to the City in person, electronically, or by mail. Further, Contractor verifies that it has, prior to executing this Agreement, submitted a secure and verifiable document, evidencing the Contractor's legal status, to the City either in person or electronically (in compliance with the Uniform Electronic Transactions Act). Contractor verifies that it is in compliance with the Residency Status of an Applicant for Public Benefit, as required by the Georgia Security and Immigration Compliance Act (O.C.G.A. § 50-36-1). Document IN WITNESS OF THE FOREGOING, the Parties have set their hands and seal the day and year first written above. CITY: ATTEST: BY: SUDiE GORDON, CITY CLERK JOE LOCKWOOD, MAYOR PROVIDER: BY: B DON ALLEN, PRESIDENT [AFFIX CORPORATE SEAL] EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: BOYS YOUTH LACROSSE Participant Ages: 7-13yrs. old boys Day/s of the week program is offered: 1 practice a week and 1-2 games on the weekend Time of Program: Practices are 1 hour (4:30-5:30pm, 5:30-6:30pm, 6:30-7:30pm), games are scheduled 1 hour and 15 minutes apart on Saturdays (3:OOam-3:30pm) or on Sundays (1:00pm- 4:45pm) Program Dates: Practice begins February 17th, First game March 8" Last Game May 17th (all weather permitting). Program Fee: U9 Boys- $155, U11 Boys- $155, U13 Boys- $175 Program Enrollment: Minimum: 45 per age group Maximum: 150 per age group Materials to be supplied by participants: cleats/tennis shoes. Materials to be supplied by PROVIDER: Jersey, balls, cones, goals. Field will be lined by provider. Materials to be supplied by the City of MILTON: Field to participate on, Additional Program Requirements: PROVIDER COName: North Georgia Recreation (Brandon Allen) Address: 3000 Old Alabama Rd. Suite 104. Johns Greek, GA 30022 Phone Number: (Day) 678 297-2662 (Evening) 678 860-3102 (E-mail): brandon@newtownrec.com (Fax) 678 297-3920 Office Use Only - Program Rate:$ # of programs in 5essian: Fee/Program: I 5 I EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: YOUTH BASKETBALL Participant Ages: 6-14yrs. old (boys and girls separate leagues) Dayls of the week program is offered: 1 practice a week and 1 game on Saturdays Time of Program: Practices are 1 hour (5:30pm-7:45pm), games are scheduled 1 hour minutes apart on Saturdays (9:00am-5:00pm). Program Dates: Practice begins November 18th, First game December 7th, Last Game February 8" (all weather permitting). Program Fee: $155 for youth basketball, $115 for 6 shooters instructional class. Program Enrollment: Minimum: 28 per age group Maximum: 104 per age group Materials to be supplied by participants: Tennis shoes and shorts, hall for practice Materials to be supplied by PROVIDER: Uniform top (replica), equipment (basketballs, cones, and scorekeeping equipment). Materials to be supplied by the City of MILTON: Gym space to participate in. Additional Program Requirements: PROVIDER Cs)Name: North Georgia Recreation (Brandon Allen) Address: 3000 Old Alabama Rd. Suite 104. Johns Creek, GA 30022 Phone Number: (Day) G78 297-2662 (Evening) 678 860-3102 (E-mail): brandon@newtownrec.com (Fax) 678 297-3920 Office Use Only Program Rate:$ 4 of programs in Session- ession: Fee/Program.- Fee/Program: 1 i 5 i EXIIiBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: YOUTH RUGBY Participant Ages: 6-14yrs. old (boys and girls together) Day/s of the week program is offered: 1 practice a week and 1-2 games on the weekend Time of Program: Practices are 1 hour (4:30-5:30pm, 5:30-6:30pm, 6:30-7:30pm), games are scheduled 1 hour and 15 minutes apart on Saturdays (9:00am-3:30pm) or on Sundays (1:00pm- 4:45pm) Program Dates: Practice begins August 26th, First game September 14th, Last Game Nov. 9" (all weather permitting). Program Fee: $160 Program Enrollment: Minimum: 35 per age group Maximum: 140 per age group Materials to be supplied by participants: Mouth -guard, cleats/tennis shoes. Materials to be supplied by PROVIDER: Uniform top, equipment (rugby balls, cones, and flags). Field will be lined by provider. Materials to be supplied by the City of MILTON: Field to participate on_ Additional Program Requirements: PROVIDER (`s)Name: North Georgia Recreation (Brandon Allen) Address: 3000 Old Alabama Rd. Suite 104_ Johns Creek, GA 30022 Phone Number: (Day) 678 297-2662 (Evening) 678 860-3102 (E-mail). bra ndon�?a newtownrec.com (Fax) 678 297-3920 Office Use Only Program Rate:$ # of programs in Session: Fee/Progra m: EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will he used for consideration of program proposals. Use one form per program. Name of Program: YOUTH FLAG FOOTBALL Participant Ages: 6-18yrs. old (boys and girls together) Day/s of the week program is offered: 1 practice a week and 1-2 games on the weekend Time of Program: Practices are 1 hour (4:00-5:00pm or 5:00-6:00pm), games are scheduled 1 hour and 15 minutes apart on Saturdays (9:00am-3:30pm) or on Sundays (1:00pm- 4:45pm) Program Dates: Practice begins November 18th, First game December 7th, Last Game February 9th (all weather permitting). Program Fee: $150 Program Enrollment: Minimum: 35 per age group Maximum: 140 per age group Materials to be supplied by participants: Mouth -guard, cleats/tennis shoes. Materials to be supplied by PROVIDER: Uniform top (replica), equipment (footballs, cones, and flags). Field will be lined by provider. Materials to be supplied by the City of MILTON: Field to participate on. Additional Program Requirements: PROVIDER (`s)Name: North Georgia Recreation (Brandon Allen) Address: 3000 Old Alabama Rd. Suite 104. Johns Creek, GA 30022 Phone Number: (Day) 678 297-2662 (Evening) 678 860-3102 (E-mail): brandon@newtownrec.com (Fax) 678 297-3920 Office Use Only. Program Rate:$ # of programs in Session: Fee/Program: EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: YOUTH FLAG FOOTBALL Participant Ages: 6-11yrs. old (boys and girls together) Day/s of the week program is offered: 1 practice a week and 1-2 games on the weekend Time of Program: Practices are 1 hour (4:30-5.30pm, 5:30-6:30pm, 6:30-7:30pm), games are scheduled 1 hour and 15 minutes apart on Saturdays (9:00am-3:30pm) or on Sundays (1:00pm- 4:45pm) Program Dates: Practice begins August 26`', First game September 14"', Last Game Nov. 9`h (all weather permitting). Program Fee: $150 Program Enrollment: Minimum: 35 per age group Maximum: 140 per age group Materials to be supplied by participants: Mouth -guard, cleats/tennis shoes. Materials to be supplied by PROVIDER: Uniform top (replica), equipment (footballs, cones, and flags). Field will be lined by provider. Materials to be supplied by the City of MILTON: Field to participate on. Additional Program Requirements: PROVIDER Cs}Name: North Georgia Recreation (Brandon Allen) Address: 3000 Ofd Alabama Rd. Suite 104. Johns Creek, GA 30022 Phone Number: (Day) 678 297-2662 (Evening) 678 860-3102 (E-mail): Brandon@newtownrec.com (Fax) 678 297-3920 Office Use Only. - Program Rate:$ # of programs in Session: Fee/Prograrn: I EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: YOUTH VOLLEYBALL Participant Ages: 8-13yrs. old (girls) Day/s of the week program is offered: 1 practice a week and 1 game on the weekend Time of Program: Practices are 1 hour (4:30-5:30pm, 5:30-6:30pm, 6:30-7:30pm), games are scheduled 1 hour and 15 minutes apart on Saturdays (9.00am-3:30pm) or on Sundays (1:00pm- 4:45pm) Program Dates: Practice begins August 26', First game September 14°', Last Game Nov. 91h (all weather permitting). Program Fee: $165 Program Enrollment: Minimum: 28 per age group Maximum: 140 per age group Materials to be supplied by participants: Mouth -guard, tennis shoes Materials to be supplied by PROVIDER: Uniform top (jersey/pinnie), balls, cones Materials to be supplied by the City of MILTON: Gym and volleyball net Additional Program Requirements: PROVIDER (`s)Name: North Georgia Recreation (Brandon Allen) Address: 3000 Old Alabama Rd. Suite 104_ Johns Creek, GA 30022 Phone Number: (Day) 678 297-2662 (Evening) 678 860-3102 (E-mail): brandon@rewtownrec.com (Fax) 678 237-3920 Office use Only. Program Rate:$ # of programs in Session: Fee/Program: S I EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest This information will be used for consideration of program proposals_ Use one form per program. Name of Program: YOUTH VOLLEYBALL Participant Ages: 8-18yrs. old girls Day/s of the week program is offered: 1 practice a week and 1-2 games on the weekend Time of Program: Practices are 1 hour (4:30-5:30pm, 5:30-6:30pm, 6:30-7:30pm), games are scheduled 1 hour and 15 minutes apart on Saturdays (9:00am-3:30pm) or on Sundays (1:00pm- 4:45pm) Program Dates: Practice begins February 17th, First game March 8th Last Game May 17`h (all weather permitting). Program Fee: U9 Boys- $165 Program Enrollment: Minimum: 26 per age group Maximum: 130 per age group Materials to be supplied by participants: mouth -guard and tennis shoes Materials to be supplied by PROVIDER: Mersey, balls, cones. Materials to be supplied by the City of MILTON: Gym to participate in and a volleyball net. Additional Program Requirements: PROVIDER (`s)Name: North Georgia Recreation (Brandon Allen) Address: 3000 Old Alabama Rd_ Suite 104. Johns Creek, GA 30022 Phone Number: (Day) 678 297-2662 (Evening) 678 860-3102 (E-mail): brandon@newtownrec.com (Fax) 678 297-392❑ Office Use Only: Program Rate:$ # of programs in Session: Fee/Program: S EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest This information will be used for consideration of program proposals. Use one form per program. Name of Program: YOUTH FLAG FOOTBALL CAMP Participant Ages: 6-12yrs. old (boys and girls together) Day/s of the week program is offered: Monday -Thursday Time of Program: 8:30am-12:30pm Program Dates: June 24'h -27th Program Fee: $150 Program Enrollment: Minimum: 15 per age group Maximum: 100 per age group Materials to be supplied by participants: Mouth -guard, cleats/tennis shoes. Materials to be supplied by PROVIDER: Camp T-shirt, equipment (footballs, cones, and flags). Materials to be supplied by the City of MILTON: Field to participate on. Additional Program Requirements: PROVIDER (`s)Name: North Georgia Recreation (Brandon Allen) Address: 3000 Old Alabama Rd. Suite 104. Johns Creek, GA 30022 Phone Number: (Day) 678 297-2662 (Evening) 678 860-3102 (E-mail): brandon@newtownrec.com (Fax) 678 297-3920 Office Use only_ Program Rate:$ # of programs in Session: Fee/Program: S EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this farm attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: YOUTH FLAG FOOTBALL CAMP Participant Ages: 6-12yrs. old (boys and girls together) Day/s of the week program is offered: Monday -Thursday Time of Program: 8:30am-12:30pm Program Dates: June 24`h-27"' Program Fee: $150 Program Enrollment: Minimum: 15 per age group Maximum: 100 per age group Materials to be supplied by participants: Mouth -guard, cleats/tennis shoes. Materials to be supplied by PROVIDER: Camp T-shirt, equipment (footballs, cones, and flags). Materials to be supplied by the City of MILTON: Field to participate on. Additional Program Requirements: PROVIDER (`s)Name: North Georgia Recreation (Brandon Allen) Address: 3000 Old Alabama Rd. Suite 104. Johns Creek, GA 30022 Phone Number. (Day) 678 297-2662 (Evening) 678 860-3102 (E-mail): brandon@newtownrec.com (Fax) 678 297-3920 Office Use Only. Program Rate:$ # of programs in Session: Fee/Program: EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: YOUTH VOLLEYBALL CAMP Participant Ages: 9-18yrs. old girls Day/s of the week program is offered: Monday -Thursday Time of Program: 8:30am-12:30pm Program Dates: June 17`h-20", July 15°h -18th Program Fee: $170 Program Enrollment: Minimum: 12 per age group Maximum: 100 per age group Materials to be supplied by participants: Mouth -guard, tennis shoes. Materials to be supplied by PROVIDER: Camp T-shirt, equipment (balls, cones, training aids). Materials to be supplied by the City of MILTON: Gym space and a volleyball net Additional Program Requirements: PROVIDER ('s)Name: North Georgia Recreation (Brandon Allen) Address: 3000 Old Alabama Rd. Suite 104. Johns Creek, GA 30022 Phone Number: (Day) 678 297-2662 (Evening) 678 860--3102 (E-mail): brandan@newtownrec.com (Fax) 678 297-3920 Minimum Reauirements: 1,000,000 General Liability Insurance Office Use Only. Program Rate:$ # of programs in Session: Fee/Program: EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: YOUTH RUGBY CAMP Participant Ages: 6-13yrs. old (boys and girls together) Day/s of the week program is offered: Monday -Thursday Time of Program: 8:30am-12:00pm Program Dates: ,lune 10`h -13`h and July 8"-11`h Program Fee: $150 Program Enrollment: Minimum: 15 per age group Maximum: 100 per age group Materials to be supplied by participants: Mouth -guard, cleats/tennis shoes. Materials to be supplied by PROVIDER: Camp T-shirt, equipment (rugby galls, cones, and flags). Materials to be supplied by the City of MILTON: Field to participate on. Additional Program Requirements: PROVIDER ('s)Name: North Georgia Recreation (Brandon Allen) Address: 3000 Old Alabama Rd. Suite 104. Johns Creek, CA 30022 Phone Number: (Day) 678 297-2662 (Evening) 678 860-3102 (E-mail): brandon@newtownrec.com (Fax) 678 297-3920 Office use Only: Program Rate:$ # of programs to Session: Fee/Program: 1 8 EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: YOUTH BOYS LACROSSE CAMP Participant Ages. 7-15yrs. old boys Day/s of the week program is offered: Monday -Thursday Time of Program: 8:30am-12:30pm Program Dates: June 17th -20th, July 151h_18th Program Fee: $150 Program Enrollment: Minimum- 15 per age group Maximum: 100 per age group Materials to be supplied by participants: Mouth -guard, cleats/tennis shoes, lacrosse stick, helmet, pads and water bottle Materials to be supplied by PROVIDER: Camp T-shirt, equipment (balls, cones, goals, training aids). Materials to be supplied by the City of MILTON: Field to participate on. Additional Program Requirements: PROVIDER (`s)Name: North Georgia Recreation (Brandon Allen) Address: 3000 Old Alabama Rd. Suite 104. Johns Creek, GA 30022 Phone Number: (Day) 678 297-2662 (Evening) 678 860-3102 (E-mail): brandon@newtownrec.com (Fax) 678 297-3920 Minimum Requirements: 1,000,000 General Liability Insurance Office Use Only. Program Rate:$ # of programs in Session: �_ $ Pee/Program: EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: YOUTH GIRLS LACROSSE CAMP Participant Ages: 6-16yrs. old girls Day/s of the week program is Offered: Monday -Thursday Time of Program: 8:30am-12:30pm Program Dates: June 17th -20`h, July 15`h -18th Program Fee: $150 Program Enrollment: Minimum: 15 per age group Maximum: 100 per age group Materials to be supplied by participants: Mouth -guard, cleats/tennis shoes, lacrosse stick, goggles, water bottle. Materials to be supplied by PROVIDER: Camp T-shirt, equipment (balls, cones, goals, training aids). Materials to be supplied by the City of MILTON: Field to participate on. Additional Program Requirements: PROVIDER (`s)Name: North Georgia Recreation (Brandon Allen) Address: 3000 Old Alabama Rd. Suite 104. Johns Creek, GA 30022 Phone Number: (Day) 578 297-2652 (Evening) 578 850-3102 (E-mail): brandon@newtownrec.com (Fax) 578 297-3920 Minimum Requirements: 1,000,000 General Liability Insurance Office Use Only: Program Rate:$ # of programs in Session: 7 r ree/Program: EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: TEEN DODGEBALL Participant Ages: 14-18yr. old (boys and girls separate leagues) Day/s of the week program is offered: 1 practice a week and 1 game on Saturdays Time of Program: Practices are 1 hour (5:30pm-7:45pm), games are scheduled i hour minutes apart on Saturdays (9:00am-5:00pm). Program Dates: Practice begins November 18th, First game December 7th, Last Game February 8th (all weather permitting). Program Fee: Not sure if we want to do individual registration or team registration. Program Enrollment. Minimum: 4 teams per league Maximum: 10 teams per league Materials to be supplied by participants: Tennis shoes shorts, and mouth -guard Materials to be supplied by PROVIDER: T-shirt/Pinnie and equipment (balls, cones, and scorekeeping equipment). Materials to be supplied by the City of MILTON: Gym space to participate in. Additional Program Requirements: PROVIDER (`s)Name: North Georgia Recreation (Brandon Allen) Address: 3000 Old Alabama Rd. Suite 104. Johns Creek, GA 30022 Phone Number: (Day) 678 297-2662 (Evening) 678 860-3102 (E-mail): brandon@newtownrec.com (Fax) 678 297-3920 Office Use Only Program Rate:$ # of programs in Session - 5 Fee/Program: EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals_ Use one form per program. Name of Program: TEEN COED SLOW PITCH SOFTBALL LEAGUE Participant Ages: 14-18yrs. old (boys and girls together) Day/s of the week program is offered: 1 practice a week and 1-2 games on the weekend Time of Program: Practices are 1 hour (4:30-5:30pm, 5:30-6:30pm, 6:30-7:30pm), games are scheduled 1 Your and 15 minutes apart on Saturdays (9:00am-3:30pm) or on Sundays (1:00pm- 4:45pm) Program Dates: Practice begins February 17th, First game March 8`h Last Game May 17" (all weather permitting), Program Fee: not sure if we want to make this an individual registration or tears registration Program Enrollment: Minimum. 35 per age group Maximum: 200 per age group Materials to be supplied by participants: cleats/tennis shoes. Materials to be supplied by PROVIDER: Jersey/Pinnie, bats, softballs. Field will be lined by provider. Materials to be supplied by the City of MILTON: Field to participate on, bases on each field. Additional Program Requirements: PROVIDER (`s)Name: North Georgia Recreation (Brandon Alien) Address: 3000 Old Alabama Rd. Suite 104. Johns Creek, GA 30022 Phone Number: (Day) 678 297-2662 (Evening) 678 860-3102 (E-mail): Brandon@newtownrec.com (Fax) 678 297-3920 Minimum Requirements: 1,000,000 General Liability Insurance Office Use Only: Program Rate. -S_# of programs in Session: 5 Fee/Program- EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest_ This information will be used for consideration of program proposals. Use one form per program. Name of Program: TEEN ULTIMATE FRISBEE LEAGUE Participant Ages: 14-18yrs. old (boys and girls together) Day/s of the week program is offered: 1 practice a week and 1-2 games on the weekend Time of Program: Practices are 1 hour (4:30-5:30pm, 5:30-6:30pm, 6:30-7:30pm ), games are scheduled 1 hour and 15 minutes apart on Saturdays (9:00am-3:30pm) or on Sundays (1:OOpm- 4:45pm) Program Dates: Practice begins August 26`h, First game September 14`h, Last Game Nov. 9" (all weather permitting). Program Fee: not sure if we want to make this an individual registration or team registration Program Enrollment: Minimum: 35 per age group Maximum: 200 per age group Materials to be supplied by participants: Mouth -guard, cleats/tennis shoes. Materials to be supplied by PROVIDER: Jersey/Pinnie, cones and frisbees. Field will be lined by provider. Materials to be supplied by the City of MILTON: Field to participate on. Additional Program Requirements: PROVIDER (`s)Name: North Georgia Recreation (Brandon Allen) Address: 3000 Old Alabama Rd. Suite 104_ Johns Creek, GA 30022 Phone Number: (Day) 678 297-2662 (Evening) 678 860-3102 (E-mail): brandon@newtownrec.com (Fax) 678 297-3920 Minimum Requirements: 1,000,000 General Liability Insurance Office Use Only. - Program Rate:$ # of programs in Session: Fee/Program: Additional Program Requirements: PROVIDER (`s)Name: North Georgia Recreation (Brandon Allen) Address: 3000 Old Alabama Rd. Suite 104. ,Johns Creek, GA 30022 Phone Number: (Day) 678 297-2662 (Evening) 678 860-3302 (E-mail): brandon@newtownrec.com (Fax) 678 297-3920 Minimum Requirements: 1,000,000 General Liability Insurance Office use Only.- Program nly: Program Rate:$ # of programs in Session: Fee/Program : i 5 i Document EXHIBIT "C" STATE OF GEORGIA CITY OF MILTON CONTRACTOR AFFIDAVIT AND AGREEMENT By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm, or corporation which is contracting with the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. The undersigned further agrees that, should it employ or contract with any subcontractor(s) in connection with the physical performance of services pursuant to this contract with the City of Milton, contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. § 13-10-91 on the Subcontractor Affidavit provided in Rule 300-10-01-.08 in the form attached hereto as Exhibit "D." Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the City of Milton at the time the subcontractor(s) is retained to perform such service. EEV 1 B ' ilot Prog s Identification Number BY: Authorized Officer or Agent Date Newtown Recreation, Inc. Titlee of Authorized Officer or Agent of Contractor Printed Name of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON T IS THE 1 C DAY OF r- , 201 %M:9 Notary Public ►�����tiEf�t►���i� My fission Expires: �� % e 21.��b ��� Document STATE OF GEORGIA CITY OF MILTON EXHIBIT "D" SUBCONTRACTOR AFFIDAVIT By executing this affidavit, the undersigned subcontractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services under a contract with Newtown Recreation, Inc. on behalf of the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. EEV 1 Basic Pilot Progfakikse> IdWification Number BY: Authorized [INSERT SUB( Title of Authorized Officer or Agent of Subcontractor Printed Name of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE [ kf DAY OF i�;� , 201) Notary Fu - is My Co i sion Expires: G) '``��� c''IAare =m. _ r A ;, R , IA ��1N1lIH► Z oy!�ti'E ��i C •..�::. � tom.` Docurnent EXHIBIT "E" SAVE Affidavit By executing this affidavit under oath, and as an applicant for a public benefit, as referenced in O.C.G.A. § 50-35-1, from the City of Milton, the undersigned applicant verifies one of the following with respect to my application for a public benefit: I ) I am a United States citizen. 2) I am a legal permanent resident of the United States. 3) I am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an alien number issued by the Department of Homeland Security or other federal immigration agency. My alien number issued by the Department of Homeland Security or other federal immigration agency is: The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at least one secure and verifiable document, as required by O.C.G.A. § 50-3&-1(e)(1), with this affidavit. The secure and verifiable document provided with this affidavit can best be classified as: In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A. § 16-10-20, and face criminal penalties as allowed by such criminal statute. Executed (city), GEY IE� rf �°f / 1 21, SUBSCRIBED AND SWORN BEFORE ME ON THIS THE _[S DAY OF � , 20 �3 NOTA PUBLIC My Co mi sion Expires: (state). ignature of Applicant i Cti n Printed Name of Applicant NrEVVTORr OP ID: SS Ai �� CERTIFICATE OF LIABILITY INSURANCE �' 04,2`"`23112 '� 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), PRODUCER86&298-1Insurance Agcy 8fi6-P98-1668 Customer Service Center 888-739-1233 401 East Antietam St., Suite B TYPE OF INSURANCE P4oNr. FAx a-MAM ADUP&W Hagerstown, MD 21740 INSURER(S) AFF ORMMG COVERAGE NAIC 0 Kenneth All Bird INSURERA:Brotherhood Mutual Insurance 13528 INSURED New Town Recreation, Inc 3000 Old Alabama Road 9104 Johns Creek, GA 30022 INSURER B: INSURER C - INSURER D VMRER E: DAMAGE TO RE(Ea NTED ce S 300,TYM INSURER F : ?X�77ERCIAI GENERAL t1A81LIFY WMS MADE OCCUR COVERAGES CERTIFICATE NUMBER_ RFVLSICIN NI IMRFR- THIS iS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD IND=TED- NOTWITHSTANDING ANY RFQLJIRFMFNT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VVrFH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIE=S DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. t7R TYPE OF INSURANCE Milton, GA 30004 AUTHOMZED REPRESENTATME POLICY HUMBER MWD Y EFF POLICY FXP MM10 UNITSGENERALLIABLITY EACH OCCURRENCE $ 1,000,0 00 DAMAGE TO RE(Ea NTED ce S 300,TYM A ?X�77ERCIAI GENERAL t1A81LIFY WMS MADE OCCUR X 10INEA0321804 07114!77 07/14/14 MFA EXP {Arty one person] $ 5,00 PERSONAL & ADV INJURY $ 1,000,0 01( GENERAL AGGREGATE $ 3,000,00 ML AGGREGATE LIMIT APPLIES PER: PRODUCTS - COIHPIOP AGG S 3,000, POLICY PRa LOC $ OMOGILE LIA04n`r C�OM81T1EBfl�594GLE LIM[r s BODILY B4JURY [Per person] S NAUT131 ANY AUTO ALL DYd &D SCHEDULED AUTOS AUTOS SONLY KJURY (Per a=dent) S HIRE6AUFQ$ AUTOS ED NON-QWNPer PROPERTY DAMAGE aodaera s i UMBRELLA UAS OCCUR HCLAIMS-WDE EACH OCCURRENCE S AGGREGATE S EXCESS LI g DEC) I I RETENTIONS S WORKERS COMPENSATION WC STATU ❑TW - AND EMPLOYERS' UABLITY Y 1 N ANY PROPRIETOWPARTNER1EXECUTNV❑ E.LEACHACCIDENT S OFFICERIMEME RFa(CLUDEO? NrA (Mendar In NH] E -L- nrSEASE - EA EMPLOYE $ II, . deserba under DESCRIPTION OF OPERATIONS CeloW E.L DISEASE - POLIGY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS 7 VEHICLES [Attach ACORD 101. AddkWml Re=ft SdreduK It more apace Ia requWW) City of Milton is named as additional insured for use of city facilities. Coverage for additional insureds is strictly subject to all the teams of the policy. e+eorreer-ATe LJnI nco CANCFLLATink t? 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE MCRIBED POLICIES OE CANCELLED BEFORE City of Milton EXPIRATIONTHE DATE THEREOF, ACCORDANCE WITH THE PWGYY PROVISIONS.NOTICE WILL Be DELIVERED IN 13000 Deerfield Pkwy STE 107A Milton, GA 30004 AUTHOMZED REPRESENTATME Kenneth M Bird t? 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD NEWTORE OP ID: SS A`� �' CERTIFICATE OF LIABILITY INSURANCE °"`��' 04123/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATWELY OR NEGA71VELY 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, terrain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s . PRODUCER 86B-298-16 Bitner-Henry Insurance Agcy, Customer Service Center 88$-739-1 Z33 N�nY�ACT F D - N91 ADDRESS: 401 East Antietam St, Suite B 401 Hagerstown, MD 21740 Kenneth M Bird INSURER(S) APFORDINGCOVERAGE NAICN INSURER A : Brotherhood Mutual Insurance 113528 INSURED New Town Recreation, Inc 3000 Old Alabama Road #104 Johns Creels, GA 30022 INSURER 8: : I X COMMERCIAL GENERAL LrASILrrY I -CLAIMS -MADE �X OCCUR WSURERC INSURER A : WSUR--R li - 10MEA0321804 IILML"MR F 07/14114pREPRISE COVERAGES CERTIFICATE NUMBER: REVISION NUMBER - THIS IS TOCERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE: MEN ISSUED TO THE INSURED NAMED ABOVE FOR Till -POLICY PERIOD f�C19TLC1I�ATC INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDiTION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERT3FICATE MAY BE ISSUER] OR MAY PERTAIN, THE INSURANCE AFFORDED OY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. SB ILTH TYPE OF INSURANCE Atlanta, GA 30354 PDUCY NUMBER MW EFF M POLICY EXP LLNwrs GENERAL LIAB7lM EACH OCCURRENCE S 1,000.00( KLNWTF- Ea cocumaly e - MED DIP (My one person) S 6, A X COMMERCIAL GENERAL LrASILrrY I -CLAIMS -MADE �X OCCUR X 10MEA0321804 07/14111 07/14114pREPRISE PERSONAL& ADV INJURY $ 11000.0 GENERAL AGGRECA-fE $ 3,000,134 L AGGREGATE LIMITAPPLIES PER: HGFWPOL,cy PRODUCTS - COMPIOP AGG S 3,000,000 PR's LOG $ AUTOMOHILE LIAORiTY W.!F ED SINGLE LIMIT BODILY INJURY (Per person) $ ANY AUTO AL L OVMED SC44EDULED AUTOS AU708 i BODILY INJURY (Per aaidern) S (� arm s HIRED euros AUT S"`"E° a UMBRELLA L IAB DCCUR EACH OCCURRENCE S AGGREGATE S EXCESS L1AB CLAIlNS� ❑EP RETENTION $ $ WORKERS COMPENSATION WC STATLI- oTi'I^ EEL AND EMPLOYERS' LIAOMM Y 1 H ANY PROPRIETORIPAPTNERAE)CCC[TTlVE E.L EACH ACCIDENT S CFFTCERI►IE1d8ER EXCLUD�ED7 F-1 NIA IMandalory In NH) E.L. DISUSE -EA, EMPLOYEE ; E.L DISEASE -POLICY LIMIT S RyB s, de T10N "OF"" F]ESCRIPTIQN OF OPERA71bN5 6elOw DESCRWTION OF OPERATIORS I LOCATK)P4S / VEHICLES IAnach ACORD 101, Addltf Taal Roma" Sche"ls, N mm splice is regLaredj Fulton County Schools is named as additional insured for use of their facilities_ Cov,arage for additional insureds is strictly subioct: to all the terms of the policy. 2AA1 neo r.Aklt r-1 I ATlnu Q 1988-3010 ACQRD CORPORATION. Ali rights reserved. ACORD 25 (201 OM) The ACORD name and logo are registered marks of ACORD S14OULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Fulton County Schools THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WMI THE: POLICY PROVISIONS, 786 Cleveland Ave SE Atlanta, GA 30354 AUT D REPMEHTATIVE Kenneth M Bird Q 1988-3010 ACQRD CORPORATION. Ali rights reserved. ACORD 25 (201 OM) The ACORD name and logo are registered marks of ACORD -nrm W-9 Request for Taxpayer Give Form to the Rev. January 2011) Identification Number and Certification requester. Do not ]epatt Trent of the Treasury - send to the IRS. ntemal Revenue Service entities, it is your employer identification number (El N). If you do not have a number, see How to get a Name (as shown on your income tax return) Ci Business name/disregarded entity name, if different from above 11 Newtown Recreation M a Check appropriate box for federal tax c o classification (required): ❑ Individual/solero rietor J C Corporation p p S Corporation El Partnership ❑ Trust/estate d � ao ❑ Limited liability company. Enter the tax classification (C --C corporation, 5-S corporation, P --partnership) ■ ❑ Exempt payee o--------------•----------------- c - c l [a ❑ Other (see Instructions) I -- Address Address (number, street, and apt, or suite no.) Requester's name and address (optional) U CIL 3000 Old Alabama Road Suite 104 UJ City, state, and ZIP code m m Johns Creek, GA 30022 List account number(s) here (optional) ff IMM Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on the "Name" line I Social security number J avoid backup withholding, For individuals, this is year social security number However, for a re resident alien, sole proprietor, or disregarded entity, see the Part 1 instructions onn page 3. For other - m entities, it is your employer identification number (El N). 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 I Employer identification number 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 tome), and 2, 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) 1 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. l 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 secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 4. 0E9nSignature of I Here U.S. person ■ Date ■ General Instructions Section references are to the Intemal Revenue Code unless otherwise noted. Purpose of Form A person who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. 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 requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, a 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income. 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 to this Form W-9. Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: • An individual who is a U.S. citizen or U.S. resident alien, • A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, • An estate (other than a foreign estate), or • A domestic trust (as defined in Regulations section 301.7701-7). Special rules for partnerships_ Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on any foreign partners' share of income from such business. Further, in certain cases where a Form W-9 has not been received, a partnership is required to presume that a partner is a foreign person, and pay the withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid withholding on your share of partnership income. Gat. No. 10231X Form vii -9 (Rev. 1-2x11) Form W-9 (Rev. 1-2x11) page 2 The person who gives Form W-9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States is in the following cases: • The U.S. owner of a disregarded entity and not the entity, • The U.S. grantor or other owner of a grantor trust and not the trust, and • The U.S. trust (other than a grantor trust) and not the beneficiaries of the trust. Foreign person. If you are a foreign person, do not use Form W-9. Instead, use the appropriate Form W-8 (see Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entities). Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a "saving clause." Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes. If you are a U.S. resident alien who is retying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement to Form W-9 that specifies the following five items: 1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien. 2. The treaty article addressing the income. 3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions. 4. The type and amount of income that qualifies for the exemption from tax. 5. Sufficient facts to justify the exemption from tax under the terms of the treaty article. Example. Article 20 of the U.S.-China income tax treaty allows an exemption from tax for scholarship income received by a Chinese student temporarily present in the United States. Under U.S. law, this student will became a resident alien for tax purposes if his or her stay in the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30, 19 84) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who clualifles for this exception {under paragraph 2 of the first protocol} and is relying on this exception to claim an exemption from tax on his or her scholarship or fellowship income would attach to Form W-9 a statement that includes the information described above to support that exemption. If you are a nonresident alien or a foreign entity not subject to backup withholding, give the requester the appropriate completed Form W -8 - what is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS a percentage of such payments. This is called "backup withholding." Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding. You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return. Payments you receive will be subject to backup withholding if: 1. You do not furnish your TIN to the requester, 2. You do not certify your TIN when required (see the Part II instructions on page 3 for details), 3. The IRS tells the requester that you furnished an incorrect TIN, 4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or 5. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only). Certain payees and payments are exempt from backup withholding. See the instructions below and the separate Instructions for the Requester of Farm W-9. Also see Special ivies for partnerships on page 1. Updating Your Information You must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you no longer are tax exempt. In addition, you must furnish a new Form W-9 if the name or TIN changes for the account, for example, if the grantor of a grantor trust dies. Penalties Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect. CMI penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty. Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment. Misuse of TINS. If the requester discloses or uses TINS in violation of federal law, the requester may be subject to civil and criminal penalties. Specific Instructions Name If you are an individual, you must generally enter the name shown on your income tax return. However, if you have changed your last name, for instance, due to marriage without informing the Social Security Administration of the name change, enter your first name, the fast name shown on your social security card, and your new last name. If the account is in joint names, list first, and then circle, the name of the person or entity whose number you entered in fart I of the form. Sole proprietor. Enter your individual name as shown on your income tax return on the "Name" line. You may enter your business, trade, or "doing business as (UgA)" name on the "Business name/disregarded entity name" line, Partnership, C Corporation, or 5 Corporation. Enter the entity's name on the "Name" line and any business, trade, or "doing business as (IDEA) name" on the "Business name/disregarded entity name" line. Disregarded entity. Enter the owner's name on the "Name" line. The name of the entity entered an the "Name" line should never be a disregarded entity. The name on the "Name" line must be the name shown on the income tax return on which the income will be reported. For example, if a foreign LLC that is treated as a disregarded entity for U.S. federal tax purposes has a domestic owner, the domestic owner's name is required to be provided on the "Name" line. If the direct owner of the entity is also a disregarded entity, enter the first owner that is not disregarded for federal tax purposes. Enter the disregarded entity's name on the "Business name/disregarded entity name" line_ If the owner of the disregarded entity is a foreign person, you must complete an appropriate Form W-8. Note. Check the appropriate box for the federal tax classification of the person whose name is entered on the "Name" line (Individual/sole proprietor, Partnership, C Corporation, S Corporation, Trustiestate). Limited Liability Company (LLC). If the person identified on the "Name" line is an LLC, check the "Limited liability company" box only and enter the appropriate code for the tax classification in the space provided. if you are an LLC that is treated as a partnership for federal tax purposes, enter "P" for partnership. If you are an LLC that has filed a Form 8832 or a Form 2553 to be taxed as a corporation, enter "C" for C corporation or "S" for S corporation. if you are an LLC that is disregarded as an entity separate from its owner under Regulation section 301.7701-3 (except for employment and excise tax), do not check the LLC box unless the owner of the LLC (required to be identified on the "Name" line) is another LLC that is not disregarded for federal tax purposes. if the LLC is disregarded as an entity separate from its owner, enter the appropriate tax classification of the owner identified on the "Name" line. Form W-9 (Rev. 1-2011) Other entities. Enter your business name as shown on required federal tax documents on the "Name" line. This name should match the name shown on the charter or other legal document creating the entity. You may enter any business, trade, or DBA name on the "Business name/ disregarded entity name" line. Exempt Payee If you are exempt from backup withholding, enter your name as described above and check the appropriate box for your status, then check the "Exempt payee" box in the line following the "Business name/ disregarded entity name," sign and date the form. Generally, individuals (including sale proprietors) are not exempt from backup withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends, Note. If you are exempt from backup withholding, you should still complete this form to avoid possible erroneous backup withholding. The following payees are exempt from backup withholding: 1. An organization exempt from tax under section 501(a), any IRA, or a custodial account under section 403(b)(7) if the account satisfies the requirements of section 401(f)(2), 2. The United States or any of its agencies or instrumentalities, 3. A state, the District of Columbia, a possession of the United States, or any of their political subdivisions or instrumentalities, 4. A foreign government or any of its political subdivisions, agencies, or instrumentalities, or 5. An international organization or any of its agencies or instrumentalities. Other payees that may be exempt from backup withholding include: 6. A corporation, 7. A foreign central bank of issue, 8. A dealer in securities or commodities required to register in the United States, the District of Columbia, or a possession of the United States, 9. A futures commission merchant registered with the Commodity Futures Trading Commission, 10. A real estate investment trust, 11. An entity registered at all times during the tax year under the Investment Cornpany Act of 1340, 12. A common trust fund operated by a bank under section 584(a), 13. A financial institution, 14, A middleman known in the investment community as a nominee or custodian, or 15. A trust exempt from tax under section 664 or described in section 4947. The following chart shows types of payments that may be exempt from backup withholding. The chart applies to the exempt payees listed above, 1 through 15. IF the payment is for ... THEN the payment is exempt for... Interest and dividend payments All exempt payees except for 9 Broker transactions Exempt payees 1 through 5 and 7 through 13. Also, C corporations. Barter exchange transactions and Exempt payees 1 through 5 patronage dividends Payments over $500 required to be Generally, exempt payees reported and direct sales over 1 through 7 2 $5,000 k See Form 1099-MISC, Miscellaneous Income, and its instructions. 'However. the following payments made to a corporation and reportable on Form 1099-MISC are not exempt from backup withholding: medical and health care payments, attorneys' fees, gross proceeds paid to an attorney, and payments for services paid by a federal executive agency. page 3 Part I. Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. If you are a resident alien and you do not have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer identification number (ITIN). Enter it in the social security number box. if you do not have an ITIN, see How to get a TIN below. If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN. However, the IRS prefers that you use your SSN. If you are a single -member LLC that is disregarded as an entity separate from its owner (see Limited Liability Company (LLC) on page 2), enter the owner's SSN (or EIN, if the owner has one). Do not enter the disregarded entity's EIN. If the LLC is classified as a corporation or partnership, enter the entity's EIN. Note. See the chart on page 4 for further clarification of name and TIN combinations. How to get a TIN. if you do not have a TIN, apply for one immediately. To apply for an SSN, get Form SS -5, Application for a Social Security Card, from your local Social Security Administration office or get this form online at www.ssa.gov. You may also get this form by calling 1-500-772-1213. Use Form W-7, Application for IRS Individual Taxpayer Identification Number, to apply for an ITIN, or Form SS -4, Application for Employer Identification Number, to apply for an EIN. You can apply for an EIN online by accessing the IRS website at www.im.gov/businesses and clicking on Employer Identification Number (EIN) under Starting a Business. You can get Forms W-7 and SS -4 from the IRS by visiting IRS, gov or by calling 1 -800 -TAX -FORM (1-800-829-3676). If you are asked to complete Form W-9 but do not have a TIN, write "Applied For" in the space for the TIN, sign and date the form, and give it to the requester. For interest and dividend payments, and certain payments made with respect to readily tradable instruments, generally you will have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments. The 60 -day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester. Note. Entering "Applied For' means that you have already applied for a TIN 0 that you intend to apply for one soon. Caution. A disregarded domestic entity that has a foreign owner must use the appropriate Form W-8. Part II. Certification To establish to the withholding agent that you are a U.S. person, or resident alien, sign Form W-9. You may be requested to sign by the withholding agent even if item 1, below, and items 4 and 5 on page 4 indicate otherwise. For a joint account, only the person whose TIN is shown in Part I should sign (when required). In the case of a disregarded entity, the person identified on the "Name" line must sign. Exempt payees, see Exempt Payee on page 3. Signature requirements. Complete the certification as indicated in items 1 through 3, below, and items 4 and 5 on page 4. 1. Interest, dividend, and barter exchange accounts opened before 1984 and broker accounts considered active during 1983. You must give your correct TIN, but you do not have to sign the certification. 2. Interest, dividend, broker, and barter exchange accounts opened after 1983 and broker accounts considered inactive during 1983. You must sign the certification or backup withholding will apply. If you are subject to backup withholding and you are merely providing your correct TIN to the requester, you must cross out item 2 in the certification before signing the form. 3. Real estate transactions. You must sign the certification. You may cross out item 2 of the certification. Form W-9 (Rev . 1-2011) Page 4 4. Other payments. You must give your correct TIN, but you do not have to sign the certification unless you have been notified that you have previously given an incorrect TIN. "Other payments" include payments made in the course of the requester's trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services (including payments to corporations), payments to a nonemployee for services, payments to certain fishing boat crew members and fishermen, and gross proceeds paid to attomeys (including payments to corporations). 5. Mortgage interest paid by you, acquisition or abandonment of secured property, cancellation of debt, qualified tuition program payments (under section 529), IRA, Coverdell ESA, Archer MSA or HSA contributions or distributions, and pension distributions. You must give your correct TIN, but you do not have to sign the certification. What Name and Number To Give the Requester For this type of account: Give name and SSN of: 1. Individual The individual 2. Two or more individuals {joint The actual owner of the account or, account] If combined funds, the first individual on the account ' 3. Custodian account of a minor The minor' (Uniform Gift to Minors Act) 4. a. The usual revocable savings The grantor -trustee' trust (grantor is also trustee) b. So-called trust account that is The actual owner' not a legal or valid trust under state law 5. Sole proprietorship or disregarded The owner' entity owned by an individual 6_ Grantor trust filing under Optional The grantor' Form 1099 Filing Method 1 (see Regulation section 1.871-4(bX2)@(A)) For this type of account: Give name and EIN of: 7. Disregarded entity not owned by an The owner individual 8. A valid trust, estate, or pension trust Legal entity' 9_ Corporation or LLC electing The corporation corporate status on Form 8832 or Form 2553 10. Association, club, religious, The organization charitable, educational, or other tax-exempt organization 11. Partnership or multi -member LLC The partnership 12. A broker or registered nominee The broker or nominee 13. Account with the Department of The public entity Agricufture in the name of a public entity (such as a state or local government, school district, or prison) that receives agricultural program payments 14. Grantor trust filing under the Form The trust 1041 Filing Method or the Optional Form 1099 Filing Method 2 (see Regulation section 1-671-41(b)(2)(i)(8)) List fl rst and circle the name of the person whose number you fumish. If only one person on a joint account has an SSN, that person's number must be furnished. a Circle the minor's name and furnish the minor's SSN. ' You must show your individual name and you may also enter your business or 'DBA" name on the "Business narna/disregard ed entity" name line, You may use either your SSN or EIN Of you have one). but the IRS encourages you to use your SSN. { List first and circle the name of the tout, estate, or pension trust. (Do not furnish the TIN of the personal representative or trustee unless the legal eMrty itself u not designated in the account title.) Also see Special rules forparfners4ps on page 1. 'Note. Grantor also must provide a Form W-9 to trustee of trust. Note. If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed. Secure Your Tax Records from Identity Theft Identity theft occurs when someone uses your personal information such as your name, social security number (SSN), or other identifying information, without your permission, to commit fraud or other crimes. An identity thief may use your SSN to get a job or may file a tax return using your SSN to receive a refund. To reduce your risk: • Protect your SSN, • Ensure your employer is protecting your SSN, and • Be careful when choosing a tax preparer. If your tax records are affected by identity theft and you receive a notice from the IRS, respond right away to the name and phone number printed on the IRS notice or letter. If your tax records are not currently affected by identity theft but you think you are at risk due to a lost or stolen purse or wallet, questionable credit card activity or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit Form 14039. For more information, see Publication 4535, Identity Theft Prevention and Victim Assistance. Victims of identity theft who are experiencing economic harm or a system problem, or are seeking help in resolving tax problems that have not been resolved through normal channels, may be eligible for Taxpayer Advocate Service (TAS) assistance. You can reach TAS by calling the TAS toil -free case intake line at 1-877-777-4778 or TTYIMD 1-800-829-4059. Protect yourself from suspicious emails or phishing schemes. Phishing is the creation and use of email and websites designed to mimic legitimate business emails and websites. The most common act is sending an email to a user falsely claiming to be an established legitimate enterprise in an attempt to scam the user into surrendering private information that will be used for identity theft. The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does not request personal detailed information through email or ask taxpayers for the PIN numbers, passwords, or similar secret access information for their credit card, bank, or other financial accounts. If you receive an unsolicited email claiming to be from the IRS, forward this message to phrshing@irs.gov. You may also report misuse of the IRS name, logo, or other IRS property to the Treasury Inspector General for Tax Administration at 1-800-366-4484. You can forward suspicious emails to the Federal Trade Commission at. spam@uce.gov or contact them at www.ft'c.gov/idtheff or 1-877-IDTHEF F (1-877-438-4338). Visit IRS.gov to learn more about identity theft and how to reduce your risk. Privacy Act Notice Section 6109 of the ]ntemal Revenue Code requires you to provide your correct TIN to persons including federal agencies) who are required to file information returns with the IRS to report interest, dividends, or certain other income paid to you; mortgage interest you paid; the acquisition or abandonment of secured property; the cancellation of debt; or contributions you made to an IRA, Archer MSA, or HSA. The person collecting this form uses the information on the form to file information returns with the IRS, reporting the above information. Routine uses of this information include giving it to the Department of Justlee for civil and criminal litigation and to cities, states, the District of Columbia, and U.S. possessions for use in administering their laws. The information also may be disclosed to other countries under a treaty, to federal and state agencies to enforce civil and criminal laws, or to federal law enforcement and Intelligence agencies to combat terrorism. You must provide your TIN whether or not you are required to file a tax return. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent information. Brian P. Kemp Secretary of State Entity Control No. K838180 NEWTOWN RECREATION, INC. 3000 OLD ALABAMA RD Suite 104 Johns Creek, Georgia 30022 STATE OF GEORGIA 2013 Corporation Annual Registration OFFICE OF THE SECRETARY OF STATE Annual Registration Filing P.O. Box 23038 Columbus, Georgia 31902-3038 Information on record as of: 11:24:11 AM Amount Due: $30.00 Amount Due AFTER Aprit 1,'2013: $55.00 Each business entity registered or filed with the Office of Secretary of State is required to file an annual registration. Amount due for this entity is indicated above and below on the remittance form. Annual fee is S30. If amount is more thanS30 , the total reflects amounts) due from previous ycar(s) and any applicable late fee(s). Renew by April 1,20 11 Your Annual Registration must be postmarked by April 1,2013. 1f your registration and payment are not postmarked by April 1,2013, you will he assessed a 525.00 late filing penalty fee. For faster processing, we invite you to file your Annual Registration online with a credit card at i-Ittpllwww.sos.ga,yovlcomorationsl The Corporations Division accepts Visa, MC, Discover, American Express and ATMIDebit Cards with the Visa or MC logo far online filings only. Annual Registrations not processed online require payment with a check, certified bank chock or money order. We Cannot accept cash for payment. You may mail your registration in by submitting the bottom portion of this remittance with a check or money order payable to "Secretary of S t a t c " . All checks must be pre- printed with a complete address in order to be accepted by our offices for your filing, Absulutety, me counter or starter checks will be accepted. Failure to adhere to these guideliaes will delay or possibly reject your Filing. Checks that are dishonored by your bank arc subject to a $30.04 NSF charge. Failure to honor your payment could result in a civil suit filed against you andlor your entity may be Administratively Dissolved by the Secretary of State, [See O.C.G.A. § 13-6-15 and Title 14, respectively.] Officer, address and Agent information currently of record is listed below. Please verify "county of registered office." If correct and complete, detach bottom portion, sign, and return with payment_ Or, enter changes as needed and submit Complete eseh tine, even if the same individual serves as Chief Executive Officer, Chief Financial Officer, and Secretary of the corporation. Note: Registered Agent address must be a street address in Georgia where the agent may be served personally. A mail drop or P.O. Sox does not comply with Georgia law for registered office. P.O. Boxcs may be used for principal *free and orficers'sddresscs. Any person authorized by the entity to do so may sign and file registration (including online filing). Additionally, a person who signs a document submits an electronic filing he or she knows is false in any material respect with the intent that the document be delivered to the Secretary of State for filing shall be guilty of a misdemeanor and, upon conviction thereof, shall be punished to the highest degree permissible by law. [O .0 G A_ § 14-2.129.1 Please return ONLY the original fors below and applicable feels). For more information on Annual Registrations Or to file online, visit Htto:l(www.sos.ea.gavlcorporacionslOr, ca11404-656-2817. CORPORATION NAME ADDRESS CITY STATE ZIP Charlie Brown 3000 Old Alabama Road Johns Creek Georgia 30022 BJ Hebert 3000 Old Alabama Road Johns Creek Georgia 30022 BRANDON ALLEN 3000 Old Alabama Rd, Johns Creek Georgia 30022 THE ABOVE INFORMATION HAS BEEN UPDATED TO: CORPORATION NAME ADDRESS CITY STATE ZIP NEWTOWN RECREATION, INC. 3000 OLD ALABAMA RD, Suite 104 Johns Creek Georgia 30022 CEO: BRANDON ALLEN 3000 Old Alabama Rd. Johns Creek Georgia 30022 CFO: Joe Hohlian 3000 Old Alabama Road Johns Creek Georgia 30022 SEC: Charlie Brown 3000 Old Alabama Road Johns Creek Georgia 30022 AGT: Brandon Allen 3000 Old Alabama RD Johns Creek Georgia 30022 I CERTIFY THAT I AM AUTHORIZED TO 51GN THIS FORM AND THAT THE INFORMATION IS TRUE AND CORRECT. P.O. BOX NOT ACCEPTABLE FOR REGISTERED AGENTS ADDRESS COUNTY OF REGISTERED OFFICE: Fulton County AUTHORIZED SIGNATURE: Date:3122J2013 11:23:50 AM Total Due: Title:CEO Email: brandon®newtownrec.com $30.00 BR201 2013 Corporation Annual Registration 135 K838180%9 00311004 NEWT01>1NRECREATIONINC7 20130401k 0055004 HOME OF 'THE BEST QUALITY OF L;FE IN GEORGIA.' MitTo—eNi% TO: City Council ES I-A13LISI I ED 2006 CITY COUNCIL AGENDA ITEM DATE: April 29, 2013 FROM: City Manager AGENDA ITEM: Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Sperber Music for Children's Music Classes. MEETING DATE: Monday, May 6, 2013 Regular City Council Meeting. BACKGROUND INFORMATION: (Attach additionalpages ifnecessary) See attached memorandum APPROVAL BY CITY MANAGER: XAPPROVED (} NOT APPROVED CITY A TTORNEY APPRO VAL REQUIRED: YES ()NO CI TY A TTORNEY REVIEW REQUIRED: YES ()NO APPROVAL BY CITY ATTORNEY (APPROVED { } NOT APPRO VED PLACED ON AGENDA FOR- b REMARKS: YOM - PHONE: 678.242.2504 i FAX: 678.242.2449 1nfo@cityofmiftongp.us i www.eityofmiitonga_us 13000 Deerfield Parkwoy, Suite 107 1 Milton GA 30004 -Green WlYRER Communityh° f ^ r-- CETMFIER59RiONZE - %� ,U {� UP To: Honorable Mayor and City Council Members From: Jim Cregge, Parks & Recreation Director Date: Submitted on April 25 for the May 6 Regular Council Meeting Agenda Item: Consideration of the Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Sperber Music for Children’s Music Classes. Department Recommendation: Staff is recommending the approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Sperber Music for children’s music classes. Executive Summary: This is a renewal of the agreement reached last year. The Sperber Music program is still small but enjoys a loyal following among the participants. It is a unique arts program that is not available anywhere else. Funding and Fiscal Impact: A commission of 25% will be paid to the City of Milton two weeks following the end of registration. Non-resident fees will be collected by the provider and paid to the City at a rate of an additional 50% of the standard registration fee. Alternatives: If we do not renew with Sperber Music for Children, we would have to locate a new service provider. Legal Review: Contract Template – Paul Higbee, Jarrard & Davis on March 5, 2013 Document Concurrent Review: Chris Lagerbloom Attachment(s): 1) Parks and Recreation Agreement for Outside Providers Contract and SAVE Affidavit (2 copies) HOME OF' :-1E BEST QUALITY OF LIFE IN GEORGIA' MILTON*k ESTABLISHED 2006 CITY OF MILTON PARKS & RECREATION DEPARTMENT AGREEMENT FOR OUTSIDE PROVIDERS THIS IS AN AGREEMENT, made this day of 2013, between: THE CITY OF MILTON, a municipal corporation organized and operating under the laws of the State of Georgia, with a business address of 13000 Deerfield Parkway, Suite 107 A, MILTON, Georgia 30004, hereinafter referred to as the "CITY." and SPERBER MUSIC hereinafter referred to as "PROVIDER". CITY and PROVIDER may hereinafter collectively be referred to as "the Parties". In consideration of the mutual obligations of the Parties and for good and valuable consideration, the adequacy and receipt of which are hereby acknowledged, the Parties agree as follows: ARTICLE 1.0 PROVIDER's Services and Responsibilities 1.1 PROVIDER shall conduct services generally described as Music Camp & Music Classes at the following location: Bethwell Community Center, 2695 Hopewell Road, Milton GA 30004. 1.2 The PROVIDER's services shall be performed during the days and hours described in Exhibit "A," attached hereto and incorporated herein by reference. 1.3 The PROVIDER and The Director of the Parks & Recreation Department or his designee, hereinafter referred to as the "DEPARTMENT", will agree upon program schedules. PROVIDER agrees to submit a Program Request Form to the Coordinator for each program being proposed eight (S) weeks prior to the beginning of each session. 1.4 The fees charged to each participant will be as described in Exhibit "A" for residents of MILTON & ALPHARETTA and a surcharge of 50% more for non-residents of MILTON & ALPHARETTA. The entire balance of this surcharge for non-residents shall be paid to the CITY. 1.5 The PROVIDER warrants to CITY that it is not insolvent, it is not in bankruptcy proceedings or receivership, nor is it engaged in or threatened with any litigation or other cPrt�� PHONE: 678.242.2500 1 FAX: 678.242.2499 PAWiMMfA � �Green '' [ryof info0cityofmii#anga.us i www.ciiya#milfonga.us Community C , Erhlcs ieedny!He Way w 5�514+�APN 1 13000 Deerfield Parkway, Suite 107 1 Milton GA 30004 eEHr1F1E0 BRONik Document legal or administrative proceedings or investigations of any kind which would have an adverse effect on its ability to perform its obligations under this Agreement. 1.5 The PROVIDER agrees that it shall be solely responsible for all costs and/or expenses associated with, or as a result of its operation under this Agreement. The PROVIDER stipulates and certifies that it is qualified to provide the programs it is hired to provide, maintains the education and required licenses or permits necessary to provide the programs, and shall continue to maintain such licenses or permits during the term of this Agreement. 1.7 This Agreement is considered a non-exclusive Agreement between the Parties. The CITY shall have the right to purchase the same kind of services to be provided by the PROVIDER from other sources during the term of this Agreement. The PROVIDER is not precluded from providing the same or similar services for other parties so long as such other engagements do not interfere with the PROVIDER'S provision of services to the CITY. 1.8 The DEPARTMENT must approve any promotional material, flyers, and posters advertising the programs prior to its release. The following content and topics shall specifically be prohibited: sexually explicit materials, profanity, child pornography, alcoholic beverages, tobacco products, adult movies, adult booklvideo stores, adult entertainment establishments, massage parlors, pawn shops, and tattoo parlors or shops. 1.9 The PROVIDER shall not promote any privately owned business in a CITY park/facility or solicit any participant in a CITY park/facility activity for any privately owned business. The PROVIDER may not use said facilities to conduct personal business including workshops, clinics, seminars, camps, or any other activities that are outside the scope of service described in (Exhibit "A"). It is further understood that such action(s) may result in immediate termination of the Agreement and the forfeiture of all compensation due to the PROVIDER. 1.10 The PROVIDER shall abide by the policies, procedures, rules and regulations of the DEPARTMENT, the CITY, and the FULTON COUNTY HOARD OF EDUCATION as promulgated from time to time. PROVIDER understands and agrees that the DEPARTMENT shall have rirst priority for use of CITY facilities, notwithstanAm any other provisions of this Agreement 1.11 All assistants, substitutes, and subcontractors utilized by the PROVIDER must have prior written approval of the DEPARTMENT. 1.12 PROVIDER shall provide necessary supervisory personnel to ensure that the participants of the programs obey all applicable policies, procedures, Rules and Regulations. 1.13 The DEPARTMENT or CITY may require that the PROVIDER not be permitted to utilize specific assistants, substitutes, or subcontractors of PROVIDER who have Document failed to follow any policies, procedures, rules or regulations applicable to the use of the facility. 1.14 Although the CITY shall not control the PROVIDER's techniques, methods, procedures, or sequence of instruction, the PROVIDER will comply with the CITY's and DEPARTMENT's policies, rules, regulations and procedures, as well as those of the FULTON COUNTY BOARD OF EDUCATION, and shall not interfere with their operation, nor harm or damage the equipment or facilities afforded to PROVIDER for his/her programs, nor otherwise disrupt the other on-site activities being offered at such public facilities. 1.15 The PROVIDER also acknowledges that he or she is primarily responsible for the conduct of the participants in all programs under the PROVIDER's charge. 1.15 If the PROVIDER will be providing services directly with minor children without parental supervision, the PROVIDER shall, prior to commencing services under this Agreement, comply with the CITY's policy regarding criminal background screening. The CITY will furnish the PROVIDER with a background release form (Exhibit "B") for all the provider's counselors, coaches, volunteers, subcontractors, employees or any other individuals that will come in contact with a child, at the PROVIDER's sole expense. A Consent and Release Form to conduct a criminal background must be executed by any of PROVIDER's employees or any individual who will come in contact with a child at the CITY through PROVIDER or at PROVIDER's direction, such form authorizing the CITY to conduct a search of each such individual's criminal background. The result of such inquiry may be deemed acceptable by the CITY in its sole and complete discretion, and the CITY may reject any individual from participating in any program based upon such results. If the PROVIDER has recently had a background screening conducted by another agency, the CITY, at its sole discretion, may accept that background screening and waive the requirement of a new background screening. PROVIDER and its employees must also execute a Waiver and Release of Liability holding the CITY and FULTON COUNTY BOARD OF EDUCATION harmless. 1.17 The CITY shall require all participants in all programs to sign a Waiver and Release of Liability. ARTICLE 2.0 Equipment & Materials 2.1 All program materials and equipment needed or pertaining to the above stated programs will be provided by the PROVIDER at his/her own cost and expense. However, PROVIDER may require participants to obtain certain materials required in the programs by providing a list of such materials (with approximate costs) to the participants. if PROVIDER makes such materials available to participants, they must be sold at Document PROVIDER's cost. All equipment provided by the PROVIDER shall be used in strict accordance with equipment manufacturer's instructions and in accordance with all applicable laws. PROVIDER shall coordinate storage of goal posts with the principal of the school located at the facility. 2.2 The sale of merchandise is restricted to those materials utilized in and for the programs. Fundraising activities conducted by the PROVIDER will not be permitted. The PROVIDER shall obtain the CITY's approval of any merchandise to be sold prior to its distribution or sale. 2.3 The CITY will provide no storage space to the PROVIDER, unless otherwise mutually agreed upon in a separate written agreement. 2.4 Any supplies or equipment left at the facility will be the responsibility of the PROVIDER. The CITY will not be responsible for any lost, stolen, or broken equipment or supplies. 2.5 The PROVIDER shall inspect the premises and equipment offered to him/her for his/her proposed activity and if he or she finds anything wrong with the premises or equipment before each program commences that cannot be corrected immediately by the DEPARTMENT, the program shall be canceled and the matter reported to the DEPARTMENT for correction. If the PROVIDER elects to hold his/her programs in the facility provided, it will be presumed that the PROVIDER has inspected the premises and facilities and equipment provided for such programs and has accepted same as being safe and suitable for the use intended. ARTICLE 3.0 Program Size Minimums: 3.1 ACTIVE: Program sizes shall meet the minimum numbers of participants for each program as designated in Exhibit "A." ARTICLE 4.0 Compensation and Method of Payment 4.1 In consideration of the releases and indemnities contained herein and of the PROVIDER"s services in connection with the programs and activities described herein, the CITY shall be entitled to 25% of the registration fees paid by all program participants to the PROVIDER, and the PROVIDER shall be entitled to 75% of such fees paid, exclusive of the 50% non-resident surcharge. The 50% non-resident surcharge is fully payable to the CITY and shall not be included in PROVIDER's gross income calculation. PROVIDER shall be entitled to retain all non -registration fees paid by participants to PROVIDER, i.e. PROVIDER membership fees and costs for uniforms and pictures to participants. Document 4.2 The PROVIDER agrees to collect all fees from participants, and the PROVIDER agrees to provide CITY with schedules of fees to be charged to participants in conformance with Exhibit "A". It is agreed that the PROVIDER's sole obligation shall be to collect the fees from the participants and to remit the 25% of the fees collected as well as all 50% non-resident surcharge amounts to the CITY with a pay -out report of all monies collected. Payment will be made to the CITY within fourteen ( 14) business days of the end of each month or session or program, whichever occurs_ first. 4.3 It is the responsibility of the PROVIDER to pay all applicable local, state, and federal taxes associated with this Agreement, and to acquire and pay for all necessary permits, licenses, and insurance required for the execution of this Agreement. ARTICLE 5.0 Independent PROVIDER 5.1 This Agreement does not create an employee/employer relationship between the Parties. It is the intent of the Parties that the PROVIDER is an independent contractor under this Agreement and not a CITY employee for all purposes, including but not limited to, the application of the Fair Labor Standards Act minimum wage and overtime payments, Federal Insurance Contribution Act, the Social Security Act, the Federal Unemployment Tax Act, the provisions of the Internal Revenue Code, The State Workers Compensation Act, and the State unemployment insurance law. The PROVIDER shall retain sole and absolute discretion in the judgment of the manner and means of carrying out PROVIDER's activities and responsibilities hereunder. The PROVIDER agrees that it is a separate and independent enterprise from the CITY, that it had full opportunity to fmd other business, that it has made its own investment in its business, and that it will utilize a high level of skill necessary to perform the work required hereunder. This Agreement shall not be construed as creating any joint employment relationship between the PROVIDER and the CITY and the CITY will not be liable for any obligation incurred by PROVIDER, including but not limited to unpaid minimum wages or overtime premiums. 5.2 PROVIDER warrants that it has not employed or retained any company or person, other than a bona fide employee working solely for the PROVIDER to solicit or secure this Agreement, and that it has not paid or agreed to pay any person, company, corporation, individual or firm any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of this provision, the CITY shall have the right to terminate the Agreement without liability at its discretion, to deduct from the contract price, or otherwise recover the full amount of such fee, commission, percentage, gift or consideration. Document ARTICLE 6.0 Insurance 6.1 PROVIDER shall not provide any service until all insurance required under this paragraph has been obtained and approved by the CITY. 6.2 Certificates of Insurance. Certificates of Insurance reflecting evidence of the required insurance shall be filed with the CITY prior to the commencement of this Agreement. These Certificates shall contain a provision that coverages afforded under these policies will not be cancelled until at least forty-five days (45) prior written notice has been given to the CITY. Policies shall be issued by companies authorized to do business under the laws of the State of Georgia. Financial Ratings must be not less than "A -VI" in the latest edition of "Best Key bating Guide", published by A.M. Best Guide. 6.3 Insurance shall be in force until the obligations required to be fulfilled under the terms of the Agreement are satisfied. In the event the insurance certificate provided indicated that the insurance shall terminate and lapse during the period of this Agreement, then in that event, the PROVIDER shall furnish, at least thirty (30) days prior to the expiration of the date of such insurance, a renewed Certificate of Insurance as proof that equal and like coverage for the balance of the period of the Agreement and extension thereunder is in effect. The PROVIDER shall not provide any service pursuant to this Agreement unless all required insurance remains in full force and effect. 6.4 Commercial General Liability insurance to cover liability bodily injury and property damage. Exposures to be covered are: premises, operations, products/completed operations, and certain contracts. Coverage must be written on an occurrence basis, with the following limits of liability: $1,000,000 Combined Single Limit — each occurrence $2,000,000 Combined Single Limit — general aggregate $1,000,000 Personal Injury $1,000,000 Products/Completed Operations Aggregate PROVIDER shall have its insurer name the City of MILTON as an additional insured on its General Liability policy. 6.5 Worker's Compensation insurance shall be maintained during the life of this Agreement to comply with the statutory limits for all employees, and in the case any work is sublet, the PROVIDER shall require the subcontractor(s) similarly provide Workers Compensation Insurance for all the latter's employees unless and until such employees are covered by the protection afforded by the PROVIDER. The PROVIDER and his subcontractors shall maintain during the life of this Agreement Employers Liability Insurance. The following limits must be maintained: A. Workers Compensation Statutory B. Employer's Liability $100,000 each accident $500,000 Disease -policy limit $100,000 Disease -each employee Document If PROVIDER or its subcontractor claims to be exempt from this requirement, PROVIDER shall provide CITY proof of such exemption along with a written request for CITY to exempt PROVIDER, written on PROVIDER or subcontractor's letterhead. 6.6 PROVIDER shall also maintain Auto Liability and Directors and Officers insurance with limits reasonably acceptable to CITY during the term of this Agreement. 6.7 The CITY and the Fulton County Board of Education shall each be named as an additional insured and loss payee on all policies required by this Agreement. ARTICLE 7.4 Term and Termination 7.1 After a two (2) month trial period, the programs will be evaluated by the DEPARTMENT, and the remainder of this Agreement will either be terminated or continue in full force and effect. If at any time after the two (2) month evaluation, program enrollment should fall below the required minimum, the PROVIDER will be allotted four (4) weeks to bring enrollment up to the required minimum. The programs will be reevaluated and execution or termination of the contract will be determined by the DEPARTMENT. 7.2 The term of this Agreement shall commence upon the date of execution hereof and shall remain in effect for a period of one (1) year from the date of execution of this Agreement by the CITY, unless terminated sooner as provided in this Article. Renewal of this Agreement beyond the one (1) year term shall require the mutual written agreement of the CITY and PROVIDER. 7.3 This Agreement may be terminated by the CITY for convenience upon giving of at least thirty (30) days prior written notice of termination to the PROVIDER at the PROVIDER's address set forth herein at the sole and exclusive discretion of the CITY. This Agreement may be terminated by the City immediately by written notice to PROVIDER upon any willful, reckless, or grossly negligent act or omission by PROVIDER or any of its officers, agents, employees, or volunteers. 7.4 This Agreement may be terminated by PROVIDER upon giving at least thirty (30) days written notice of termination to the CITY. 7.5 PROVIDER must notify the DEPARTMENT in writing of any program cancellations at least ten (10) business days prior to the scheduled cancellation. 7.6 CITY reserves the right to cancel or reschedule any of the PROVIDER's programs, in the case of scheduling conflicts or other emergencies, as determined by the DEPARTMENT. Document ARTICLE 8.0 Indemnification 8.1 PROVIDER agrees to indemnify and hold harmless the CITY and the FULTON COUNTY BOARD OF EDUCATION, their trustees, elected and appointed officers, agents, servants and employees, from and against any and all claims, demands, or causes of action of whatsoever kind of nature, and the resulting losses, costs, expenses, reasonable attorneys' fees, including paralegal fees, liabilities, damages, orders, judgments, or decrees, sustained by the CITY, the FULTON COUNTY BOARD OF EDUCATION, or any third party arising out of, or by reason of, or resulting from the will full or negligent acts, errors, or omissions of the PROVIDER or its agents, officers, volunteers or employees. 8.2 The Parties understand and agree that the covenants and representations relating to this indemnification provision shall survive the term of this Agreement and continue in full force and effect as to the PROVIDER's responsibility to indemnify. ARTICLE 9.0 Americans With Disabilities Act 9.1 PROVIDER shall not discriminate against any person in its operation and activities in its use or expenditure of the funds or any portion of the funds provided by this Agreement and shall affirmatively comply with all applicable provisions of the Americans With Disabilities Act ("ADA"), in the programs while providing any services funded in whole or in part by the CITY, including Titles I and II of the ADA and all applicable regulations, guidelines, and standards. 9.2 PROVIDER's decisions regarding the delivery of services under this Agreement shall be made without regard to or consideration of race, age, religion, color, gender, sexual orientation, national origin, marital status, physical or mental disability, political affiliation, or any other factor which cannot be lawfully or appropriately used as a basis for delivery of service. 9.3 PROVIDER in accordance with Title VI of the Civil Rights Act, as amended, 42 U.S.C. § 2004d, section 303 of the Age Discrimination Act of 1975, as amended, 42 U.S.C. § 6102, section 202 of the Americans with Disabilities Act of 1990, 42 U.S.C. § 12132, and all other provisions of Federal law, the Provider agrees that, during performance of this Agreement, Provider, for itself, Its assignees and successors in interest, will not discriminate against any employee or applicant for employment, any subcontractor, or any supplier because of race, color, creed, national origin, gender, age or disability. In addition, Provider agrees to comply with all applicable implementing regulations and shall include the provisions of this Section IV(R) in every subcontract for services contemplated under this Agreement. Document ARTICLE 10.0 Miscellaneous 10.1 No modification, amendment, or alteration of the terms and conditions contained shall be effective unless contained in a written document executed with the same formality and equal dignity herewith. 10.2 This Agreement is non -transferable or assignable, and PROVIDER agrees not to transfer or assign the performance of services called for in the Agreement. 10.3 This Agreement sets forth the full and complete understanding of the Parties as of the effective date, and supersedes any and all negotiations, agreements, and representations made or dated prior to this Agreement. 10.4 The PROVIDER shall pay reasonable attorney's fees to the City should the City be required to incur attorney's fees in enforcing the provisions of this Agreement. 10.5 Time is of the essence of this Agreement. 10.6 Each of the individuals who executes this Agreement agrees and represents that he is authorized to execute this Agreement on behalf of the respective entity. Accordingly, the City and PROVIDER both waive and release any right to contest the enforceability of this Agreement based upon the execution and/or approval thereof. 10.7 It is the policy of City that unauthorized aliens shall not be employed to perform work on City contracts involving the physical performance of services. Therefore, the City shall not enter into a contract for the physical performance of services within the State of Georgia, unless the PROVIDER shall provide evidence on City -provided forms, attached hereto as Exhibits "C" and "D" that it and its subcontractors have within the previous twelve (12) month period conducted a verification of the social security numbers of all employees who will perform work on the City contract to ensure that no unauthorized aliens will be employed. The City Manager or his/her designee shall be authorized to conduct an inspection of the PROVIDER's and its subcontractors' verification process to determine that the verification was correct and complete. The PROVIDER and its subcontractors shall retain all documents and records of its verification process for a period of three (3) years following completion of the contract. This requirement shall apply to all contracts for the physical performance of services where more than three (3) persons are employed on the City contract. Compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 340-10-1-.02 is mandatory. PROVIDER's compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300- 10-1-.02 shall be attested by the execution of the contractor's affidavit attached as Exhibit "C.11 Document Pursuant to O.C.G.A. § 50-36-1, the City must obtain a SAVE Affidavit and a secure and verifiable document evidencing the Contractor's legal status in the Country each time that Contractor obtains a public benefit, including any contract, from the City. Contractor hereby verifies that it has, prior to executing this Agreement, executed a SAVE Affidavit (to be sworn under oath under criminal penalty of false swearing pursuant to a.C.G.A. § 16-10-71), a form of which is attached hereto as Exhibit "E", and submitted such affidavit to the City in person, electronically, or by mail. Further, Contractor verifies that it has, prior to executing this Agreement, submitted a secure and verifiable document, evidencing the Contractor's legal status, to the City either in person or electronically (in compliance with the Uniform Electronic Transactions Act). Contractor verifies that it is in compliance with the Residency Status of an Applicant for Public Benefit, as required by the Georgia Security and Immigration Compliance Act (D.C.G.A. § 50-36-1). Document IN WITNESS OF THE FOREGOING, the Parties have set their hands and seal the clay and year first written above. CITY• ATTEST: BY: SUDIE GORDON, CITY CLERIC JOE LOCKWOOD, MAYOR PROVIDER: ITNESS: BY: KAR9N DAWN CORNELL, PRESIDENT AFFIX CORPORATE SEAL] EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program:. M:A e-- s, Manu M � j s C L ,&� Participant Ages: -.1a,r f -k — Ur -S Day/s of the week program is offered: M OA I U J 0 u-»'1 r J' 3 i v_rn Time of Program: iJ 3oa.,., to i J. uz! (n s :,4,Ln Scss'4 I �:ns gyp) req i t�+ 3 fv C)�o Z j `� 7-01 5 C 4 weeks ) oCFm vfacr Z g, 1 a vd ptLZe 64, a, o. 3 C(o .p lcs) Program Dates:. 5a n .� dr,�. 6 , z UA to_ F r.+a,-L, z�, "1:2 ( R was )_ Program Fee: - tt70 vereL"t.-s `7v (o wea_ks 45' �-� .� �� e� add'{ ��►;�d] Program Enrollment: Minimum Maximum 10 Materials to be supplied by participants: c�n� Materials to be supplied by PROVIDER: _L ,j,r.L4,Lt <, Materials to be supplied by the wm Additional Program RPnuiremPnts- City of MILTON: ,k_ r 6 las-ILS PROVIDER Cs )Name: Address: 12- 7 7 Z- P-> orvA etJ City/State/Zip Cade: M + 40fl , (SA 30041 Phone Number: (Day) 6 78112-7-, -A& S 3 (Evening) (E-mail]: K,faa OD a—Atr NiUs:c-. cc1r+::� (Fax) Minimum Requirements: 1,000,000 General Liability Insurance Office Use Only Program Rate:$ # of programs in Session: S Fee/Program: EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: H ;n Ups , C,: s Participant Ages: Dayls of the week program is offered:1r� 424 5„ 5e1 -SAI: I : Time of Program VZ`� to p° C oPans yhan Suess : �l s vp� Sq rem Iir- 1�- Wo 7j k fJc ho txQr 2 4 ($ 3 oC Fxr 3 y of 3 4-u bR.c G -t tan r It (& .VCA k s) i01-3 Program Dates: to�Qa,���_ 7-7 HOrc.l-r 13 02-0,1-0 NLo�..� 8►'1 t gwea fc.$) Program Fee: _ Qo s 475- [a -.mak s (SS Jk5<lCi7.-,} 4cr Aef'Ltk LZ`I Program Enrollment: Minimum Materials to be supplied by participants: ONL Maximum ID Materials to be supplied by PROVIDER: Materials to be supplied by the city of MILTON: v+I Cm V : 7 J ra ' d o � Q,1] 5, er- s e►na, �ii0.5 F S Additional Program Requirements: PROVIDER (`s)Name: Address: 122 7 Z D on-o-gcd Lar - City/State/Zip Code: _ _ K, I pori ,_ (::, A 3 000.4 Phone Number: (Day) 1-Z-3-3653 (Evening) (E-mail): 9 .rer, �p 6"6,rl�ys ;c. c_c elg (Fax) Minimum Requirements: 1,000,0]0 General Liability Insurance Office use Only. - Program Rate:$ # of programs in Session: S Fee/Program: EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: Muni C, 4- Mover-jj G j0SSe S Participant Ages: Day/s of the week program is offered: rs � S Time of Program: 3 M ,Fern b4—,6-, "13 do 0bzr 3 l , ]-0 03 tjX[*,-A &r 1 Z (Ca vieeks) 12-oo 3 Program Dates: 1 ZA14Fez w cq _2-2 (_2IV Y. 4, 2-00 m rc-1 t 1 7. 19 to Zoiq Program Fee: J 100 1 'g..,eaAcs ` wz(, nr. �s � S d � s�w..f f -v- eack e -Cull ck (d ) Program Enrollment: Minimum Maximum 1 Materials to be supplied by participants: Aloew Materials to be supplied by PROVIDER: rods Materials to be supplied by the Additional Program Requirements: City of MILTON: R-� 1-e. / f if lA'rs IV -11-1 I b IAs47�' PROVIDER Cs)Name: Address: City/State/Zip Code: Phone Number: (Day) _611-2-3- 1 1�3 (Evening) (E-mail):�c. (Fax) Minimum Requirements: 1,000,000 General Liability Insurance Office Use Only Program Rate:$ # of programs in Session: Fee/Program: EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use ones form per program. Name of Program: _�,1'; MOIJArna 5L),'Yjm.W- Ca. -.JP -- Participant Ages: Day/s of the week program is offered: 0fl — i�fi d Time of Program: _ �0, D D cinn to 1 -00 AY -1 Program Dates: to Program Fee: 413 5�- fore -ark o..dd'f CLA [ j) Program Enrollment: Minimum 6�,- Maximum _ Q Materials to be supplied by participants: jeu, c L ! l un c. A Materials to be supplied by PROVIDER:_ �fv.nQ.r�F��,,)vg-S, evwU "C - I _. — Materials to be supplied by the lufrY► rn Un G Additional Program Requirements: city of MILTON: PROVIDER (`s)Name: Address: 12-777— City/State/Zip 2777— City/State/Zip Code: ' t L2,,a $ 6 A -3DDd Phone Number: (Day) 2-2-3-366 3 (Evening) (E-mail). t �4Jer Hus:G(Fax) Minimum Requirements: 1,000,000 General Liability Insurance Dice Use Only. - Program Rate:$ ## of programs in Session: Fee/Program: EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Leiter of Interest. This information will be used for consideration of program proposals. Use one form per program_ Name of Program: M;r� L kj-s5.6aYL5 -5o, rvLar Lk -k x92 Participant Ages: An es 3 - Day/s of the week program is offered: Moncla,.- f ri do -4 Time of Program: i0-CUC7cL-n to l �c rim Program Dates: to Program Fee: r3� L � � �5c��r Q�,r Ji a) Program Enrollment: Minimum Maximum 2— 0 Materials to be supplied by participants: /U/ICA Materials to be supplied by PROVIDER: IIIs rLJA1 L^1-s� pdpp40-SI it a rVIOS I c-, D �� Jrf ❑p f_�rS �or• LL05jC-rf +s Materials to be supplied by the city of MILTON: nor.n�on ays�pj 0, o-�,, ��on u��bs► ��1�rs;� b�as�s Additional Program Requirements: PROVIDER (`s)Name: Address: City/State/Zip Code: M,'14 -o4- C, A 34+0 Phone Number: (Day) (a 7.8 .27-3 -366 3 (Evening) (E-mail): fgaLeti tO 5�Lr M as, c. (Fax) Minimum Requirements: 1,000,000 General Liability Insurance office use only. - Program Rate:$ # of programs in Session: Fee/ P rogra m: Document STATE OF GEORGIA CITY OF MILTON CONTRACTOR AFFIDAVIT AND AGREEMENT By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm, or corporation which is contracting with the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. The undersigned further agrees that, should it employ or contract with any subcontractor(s) in connection with the physical performance of services pursuant to this contract with the City of Milton, contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. § 13-10-91 on the Subcontractor Affidavit provided in Rule 300-10-01-.0$ in the form attached hereto as Exhibit "D." Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the City of Milton at the time the subcontractor(s) is retained to perform such service. EEV 1 Basic Pilot Program User Identification Number BY. Authorized Officer or Agent Date �r pt as i c Title of Authorized Officer or Agent of Contractor X co"ter Printed Name of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE Ste' DAY OF 201,3 No ublic 040604f44 i M Commission Expires: `���,����►�i, luZ �'r����LiM ►GO►�r' Document STATE OF GEORGIA CITY OF MILTON EXHIBIT "D" SUBCONTRACTOR AFFIDAVIT By executing this affidavit, the undersigned subcontractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services under a contract with Newtown Recreation, Inc. on behalf of the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. EEV 1 Basic Pilot Program User Identification Number BY• uthorized officer or Agent Date Spar r Nlus i QNIn1f Title of Authorized Officer or Agent of Subcontractor Printed Name of Authorized Officer or Agent ►;,1 N Q SUBSCRIBED AND SWORN+`��, �w d.''�. BEFORE ME ON THIS THE Y DAY OF , 2013 Rp W. My Commis ion Expires: ,Notar&ublic'"In i66 2 --ID '7 Document EXHIBIT "E SAVE Affidavit By executing this affidavit under oath, and as an applicant for a public benefit, as referenced in O.C.G.A. § 50-36-1, from the City of Milton, the undersigned applicant verifies one of the following with respect to my application for a public benefit: 1) �� I am a United States citizen. 2) I am a legal permanent resident of the United States. 3) 1 am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an alien number issued by the Department of Homeland Security or other federal immigration agency. My alien number issued by the Department of Homeland Security or other federal immigration agency is: The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at least one secure and verifiable document, as required by O.C.G.A. § 50-36-1 (e)(1), with this affidavit. The secure and verifiable document provided with this affidavit can best be classified as: In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O_C_G.A. § 16-10-20, and face criminal penalties as allowed by such criminal statute. Executed in TO kA S Crte*, (city), P,2, ' &N state). 13 SUBSCRIBED AND SWORN BEFORE ME ON THIS THE AY O di�n,l _212QJ� NOTARY PUW_IC U My Commission Expires: --2-112-1-1 4&�tuire of Applicant 14ai-ex, b , � >� Printed Name of Applicant riOMF QF 'THF B :ST C�LALITY 0 UFE 1Ny �E, W N/UtTON* ESTABLISHES] 20 Business License (Horne Based Business) IN ACCORDANCE WITH THE PROVISIONS OF THE CITY OF MILTON CODE OF ORDINANCES, LICENSE IS HEREBY GRANTED TO OPERATE THE BUSINESS REFERENCED BELOW LICENSE #: BUSINESS: Sperber Music DBA: LOCATED AT'. 127722 Donegal Lane BUS002019-04-2012 DATE ISSUED: March 07, 2013 DATE EXPIRES: December 31, 2013 Given under my hand this date of March 07, 2013 Chris J. Lagerbioorn City Manager POST IN A CONSPICUOUS PLACE DATE tMBar❑D11CMI CERTIFICATE OF LIABILITY INSURANCE 03128/2012 NFETE HOLDER. T141S THIS CERTIFICATE CERTIFICATEDOESHDT Ai 1 iRMAT{VC AFFIRMATIVELYOURANCERNEGATIVELY AMEND,R OF INFORMATION EXTEND OR ALTER TAND CO Hl= COVERAGE AFFORDED NO RIGHTS UPON THE ASY -THE POLICIES CERT[F i.ate BELOW. 5E� ]ATIVi= ORS Cep .TIFPRODUCER, t]CER, AND HE CEDOES NOT RT FkCATE HOLDER.an DD A CONTRACT BETWEEN THE ISSUING ]N5L]lZEit{S), AUTHORIZED REPR IMrms and T. If thous off the pofii. ey. rcertain pof'Iciis an ADDIii es may requNAL �a3is ��an endthe orsement nt A statement on this cerEilseateldoes aAc❑n er rights to the erticertificate holder in lieu of such endorsementts]. C❑xracr : ScottRalston Scott Ralston, Agent PHONE � 10 FAX No: NAME c State Farm Insurance & Financial Services F- oli ss: sc❑n scottraist❑n.c❑m 415 Marietta Hwy INSURER s AFFORDME9 Roswell, GA 30075 INSURER A : State Farm Fila and C,as INS U Ftro INSURER B Karen Cornell INSURER C 12772 Donegal Ln INSURER -V: Milton, GA 34004-8146 Fm_. rz. OVERAGES. _-- _ CERTIFICATE NUMBER:LIMTED BELOW HAVE BEE IJ S$ DEE TO NSUF -""- - HIS IS TO. NORTWITHSTANTHE POLICIES ANY REQUIREMENT, Nr-ETERM ❑R CONDITION OF ANY CONTRAGT OR DTHE ITHER DOCUMENT VVVM RESPECT TOf"PERIOD CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN iS SU8lECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES_ LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLASEfi . LIMITS SR FGLSCY N4,11cSR ':1Dw L'. aO 1,000,000 EACH OCCURRENCE 5 ,��_-• PREMISES occurrence S i,s�_o Eb(P (AM wvs Payson) S PERSONAL &AOV INJURY S CERTIFICATE HOLDER City of Milton 130000eerfield Pkwy Suite 107 Milton, GA 30004 ACORD 25 (2010105) G:ILLRALAGGREGATE S pRQ36Crs _cc : PiGP AGG S S w Y :CRY iper w-1) 5 r z� $ 5 1,000,00[ S if i:.=Pe Spa- is Mquiredj CANCELLATION SHOULD POLICIES EXPIRA ON DATE THEREOF, NOTICE WILL BE CANCELLED EAEL THEIEVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED C -� i= 1=✓ v v u -� Q 1988-2010 ACORD CORPORATION. All rights reserved. =a a:-.3 logo are registered marks of ACORD 1003835 141464 11-11-2010 y I}EPANiE�TT OF THE TREASURY I RSD' 'ERTNA'(, Rv_vENUE SERVICE cT,NCINNATI ❑H 45999-0023 KAREN DAWN CORNELL SPERBER MUSIC 2025 COBBLESTONE CIR NE ATLANTA, GA 30319 Date of this notice: 02-25--2011 Employer Identification Number. 27-5149458 Form: SS -4 Number of this notice: CP 575 G For assistance you may call us at: 1-800-829-4933 IF YOU WRITE, ATTACH THE STUB AT THE ENL OF THIS NOTICE. WE ASSIGNED YOT] AN r-24PLOYER IDENTIFICATION NUNBER Thank you for applyizig for an Employer Identification Number (ETN) . We assigned you EIN 27-5149458. This EIN will identify you, your business accounts, tax returns, and documents, even if you have no employees. please keep this notice In your permanent records. Whcn filing tax documents, payments, and related correspondence, it is vary impo=t.ant that you use your EIN and complete name and address exactly as shown above. Any variation may cause a delay in processing, result in incorrect information in your account, or even cause you to be assigned more than one ETN. if the information is not correct as shown above, please rake the Correction using the attached tear off stub and return it to us. A limited liability company (LLC) may file Foam 8832, Ent'by C]ass'ficstion Election, and elect to be classified as an association taxable as a corporation- If the LLC is eligible to be treated as a corporation that meets certain tests and it will be electing S cpr�xsx'dLicsri sLaLus, iL must timely file Form 2553, Election by a Small Business Corporation. The LLC will be treated as a corporation as of the effective date of the S corporation election and does not need to file Form 8832. To obtain tax forms and publications, including those referenced in this notice, visit our Web site at www.irs.gcv. if you do not have access to the Internet, call 1-800-829-3676 (TTY%TDD 1-500-829-4059) or visit your local IRE office_ IMPORTANT R MI1MER3: * steep a copy of this notice in your pern-anent records. This notice is issued only one time and the IRS will not be able to generate a duplicate copy for you. * Use this BIN and your name exactly as they appear at the top of this notice on all your federal tax forms. Refer to this EIN on your tax -related correspondence and documents. If you have questions about your EIN, you can call us at the phone number or write to us at the address shown at the top of this notice. If you write, please tear off the stub at the bottom of this notice and send it along with your letter. If you do not need to write us, do not complete and return the stub. 'Thank you for your cooperation. (IRS USE ONLY) 575G a2-25-2011 CORN o 9999999999 SS -4 Y,eep this part for your records. CP 575 G (Rev. 7-2007) Return this part with any correspondence so we may identify your account. Please correct any errors in your name or address. CP 575 G 9999999999 Your Telephone Number Best Time to Call DATE OF THTS NOTICE: 02-25-2011 ( ) _ FMPT,nYRP TDYNTIF'ICATION NUMBER: 27-51494.58 FORM: SS -4 NOBOD INTERNAL REVEN7JE SERVICES CINCINNATI OR 45999-0023 II{Ilf11111191911111411l 1111111111111111«111111111 KARIW DAWN COR76T;IZ SPERBER MUSIC 2025 COBBLESTONE CIR NE ATLANTA, GA 30319 WE HOME OF ';tHE BEST QUALII Y OF Lire IN ;IA' MILTON, TO: City Council ES-FABLISHEU 2006 CITY COUNCIL AGENDA ITEM DATE: April 29, 2013 FROM: City Manager AGENDA ITEM: Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Young Men's Christian Association of Metro Atlanta, Inc. for Soccer Programming. MEETING DATE: Monday, May 6, 2013 Regular City Council Meeting. BACKGROUND INFORMATION: (Attach additional pages if necessary) See attached memorandum APPROVAL BY CITY MANAGER: XAPPROVED CITY ATTORNEY APPROVAL REQUIRED: 0 YES CITY ATTORNEY REVIEW REQUIRED: YES APPROVAL BY CITY ATTORNEY (APPROVED PLACED ON AGENDA FOR REMARKS. () NOT APPROVED () NO () NO () NOTAPPROVED ® Youcm- PHONE: 678.242.2500 1 FAX: 678.242.2499 rnei°n�x�iAxo -Green �� * C�eatfied Community th s' in#o@ci#ya#mil#onga.us www.cityafmfltonga.us . Echis !.fie i�Y.n� 'i- 5..5!¢.�i3c:e :.:.✓•� 13000 Deerfield Parkway, Suite 107 1 Milton GA 30004 — CERTIFIED 6ROMZE — a'3"'4- To: Honorable Mayor and City Council Members From: Jim Cregge, Parks & Recreation Director Date: Submitted on April 25 for the May 6 Regular Council Meeting Agenda Item: Consideration of the Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Young Men’s Christian Association of Metro Atlanta, Inc. for Soccer Programming Department Recommendation: Staff is recommending the approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Young Men’s Christian Association (“YMCA”) of Metro Atlanta, Inc. for soccer programming. Executive Summary: This is a renewal of the agreement reached last year. The YMCA soccer program is growing in popularity and our residents have been very pleased with the experience. We wish to continue this program and expect that there will be an even larger increase this year. Funding and Fiscal Impact: A commission of 30% will be paid to the City of Milton two weeks following the end of registration. Non-resident fees will be collected by the provider and paid to the City at a rate of an additional 50% of the standard registration fee. Alternatives: If we do not renew with YMCA of Metro Atlanta, Inc., we would have to locate a new service provider. Legal Review: Contract Template – Paul Higbee, Jarrard & Davis on March 5, 2013 Document Concurrent Review: Chris Lagerbloom Attachment(s): 1) Parks and Recreation Agreement for Outside Providers Contract and SAVE Affidavit (2 copies) HOME OF ' F LIFE IN GE( ' M-tLfO ESTABLISHED 2000 CITY OF MILTON PARIS & RECREATION DEPARTMENT AGREEMENT FOR OUTSIDE PROVIDERS THIS IS AN AGREEMENT, made this day of , 2013, between: THE CITY OF MILTON, a municipal corporation organized and operating under the laws of the State of Georgia, with a business address of 13000 Deerfield Parkway, Suite 107 A, MILTON, Georgia 30004, hereinafter referred to as the "CITY." and YOUNG MEN'S CHRISTIAN ASSOCIATION OF METROPOLITAN ATLANTA, INC'., hereinafter referred to as "PROVIDER". CITY and PROVIDER may hereinafter collectively be referred to as "the Parties". In consideration of the mutual obligations of the Parties and for good and valuable consideration, the adequacy and receipt of which are hereby acknowledged, the Parties agree as follows: ARTICLE 1.0 PROVIDER's Services and Responsibilities 1.1 PROVIDER shall conduct services generally described as Soccer Leagues at the following locations. Hopewell Middle School, 13060 Cogburn Road, Milton, GA 30004; Cogburn Woods Elementary School, 13080 Cogburn Road, Milton, GA 30004; and Birmingham Falls Elementary School, 14865 Birmingham Highway, Milton, GA 30004. 1.2 The PROVIDER's services shall be performed during the days and hours described in Exhibit "A," attached hereto and incorporated herein by reference. 1.3 The PROVIDER and The Director of the Parks & Recreation Department or his designee, hereinafter referred to as the "DEPARTMENT", will agree upon program schedules. PROVIDER agrees to submit a Program Request Farm to the Coordinator for each program being proposed eight (8) weeks prior to the beginning of each session. 1.4 The fees charged to each participant will be as described in Exhibit "A" for residents of MILTON & ALPHARETTA and a surcharge of 50% more for non-residents of MILTON & ALPHARETTA. The entire balance of this surcharge for non-residents shall be paid to the CITY. Youln- PHONE: 678.242.25001 FAX: 678.242.2499 PACE= wens /�Green WINUR Community * Cl,yof Infafcffyofmiltonga.us I www.eityofmlltcnga.us y Ethics 13000 Deerfield Porkway, Suite 107 1 Milton GA 31)004 ' 1aL�- Document 1.5 The PROVIDER warrants to CITY that it is not insolvent, it is not in bankruptcy proceedings or receivership, nor is it engaged in or threatened with any litigation or other legal or administrative proceedings or investigations of any kind which would have an adverse effect on its ability to perform its obligations under this Agreement. 1.6 The PROVIDER agrees that it shall be solely responsible for all costs and/or expenses associated with, or as a result of its operation under this Agreement. The PROVIDER stipulates and certifies that it is qualified to provide the programs it is hired to provide, maintains the education and required licenses or permits necessary to provide the programs, and shall continue to maintain such licenses or permits during the term of this Agreement. 1.7 This Agreement is considered a non-exclusive Agreement between the Parties. The CITY shall have the right to purchase the same kind of services to be provided by the PROVIDER from other sources during the term of this Agreement. The PROVIDER is not precluded from providing the same or similar services for other parties so long as such other engagements do not interfere with the PROVIDER'S provision of services to the CITY. ` 1.8 The DEPARTMENT must approve any promotional material, flyers, and posters advertising the programs prior to its release. The following content and topics shall specifically be prohibited. sexually explicit materials, profanity, child pornography, alcoholic beverages, tobacco products, adult movies, adult booklvideo stores, adult entertainment establishments, massage parlors, pawn shops, and tattoo parlors or shops 1.9 The PROVIDER shall not promote any privately owned business in a CITY park/facility or solicit any participant in a CITY park/facility activity for any privately owned business. The PROVIDER may not use said facilities to conduct personal business including workshops, clinics, seminars, camps, or any other activities that are outside the scope of service described in (Exhibit "A"). It is further understood that such action(s) may result in immediate termination of the Agreement and the forfeiture of all compensation due to the PROVIDER. 1.14 The PROVIDER shall abide by the policies, procedures, rules and regulations of the DEPARTMENT, the CITY, and the FULTON COUNTY BOARD OF EDUCATION as promulgated from time to time. PROVIDER understands and agrees that the DEPARTMENT shall have first Priority for use of CITY facilities, notwithstanding any other provisions of this Ajereement 1.11 All assistants, substitutes, and subcontractors utilized by the PROVIDER must have prior written approval of the DEPARTMENT_ 1.12 PROVIDER shall provide necessary supervisory personnel to ensure that the participants of the programs obey all applicable policies, procedures, Rules and Regulations. Document 1.13 The DEPARTMENT or CITY may require that the PROVIDER not be permitted to utilize specific assistants, substitutes, or subcontractors of PROVIDER who have failed to follow any policies, procedures, rules or regulations applicable to the use of the facility. 1.14 Although the CITY shall not control the PROVIDER's techniques, methods, procedures, or sequence of instruction, the PROVIDER will comply with the CITY's and DEPARTMENT's policies, rules, regulations and procedures, as well as those of the FULTON COUNTY BOARD OF EDUCATION, and shall not interfere with their operation, nor harm or damage the equipment or facilities afforded to PROVIDER for his/her programs, nor otherwise disrupt the other on-site activities being offered at such public facilities. 1.15 The PROVIDER also acknowledges that he or she is primarily responsible for the conduct of the participants in all programs under the PROVIDER's charge. I C 1.16 If the PROVIDER will be providing services directly with minor children without parental supervision, the PROVIDER shall, prior to commencing services under this Agreement, comply with the CITY's policy regarding criminal background screening. The CITY will furnish the PROVIDER with a background release form (Exhibit "B") for all the provider's counselors, coaches, volunteers, subcontractors, employees or any other individuals that will come in contact with a child, at the PROVIDER's sole expense. A Consent and Release Form to conduct a criminal background must be executed by any of PROVIDER's employees or any individual who will come in contact with a child at the CITY through PROVIDER or at PROVIDER's direction, such form authorizing the CITY to conduct a search of each such individual's criminal background. The result of such inquiry may be deemed acceptable by the CITY in its sole and complete discretion, and the CITY may reject any individual from participating in any program based upon such results. If the PROVIDER has recently had a background screening conducted by another agency, the CITY, at its sole discretion, may accept that background screening and waive the requirement of a new background screening. PROVIDER and its employees must also execute a Waiver and Release of Liability holding the CITY and FULTON COUNTY BOARD OF EDUCATION harmless. 1.17 The CITY shall require all participants in all programs to sign a Waiver and Release of Liability. ARTICLE 2.0 Equipment & Materials 2.1 All program materials and equipment needed or pertaining to the above stated programs will be provided by the PROVIDER at his/her own cost and expense. However, PROVIDER may require participants to obtain certain materials required in the programs by providing a list of such materials (with approximate costs) to the participants. If PROVIDER makes such materials available to participants, they must be sold at Document PROVIDER's cost. All equipment provided by the PROVIDER shall be used in strict accordance with equipment manufacturer's instructions and in accordance with all applicable laws. PROVIDER shall coordinate storage of goal posts with the principal of the school located at the facility. 2.2 The sale of merchandise is restricted to those materials utilized in and for the programs. Fundraising activities conducted by the PROVIDER will not be permitted. The PROVIDER shall obtain the CITY's approval of any merchandise to be sold prior to its distribution or sale. 2.3 The CITY will provide no storage space to the PROVIDER, unless otherwise mutually agreed upon in a separate written agreement. 2.4 Any supplies or equipment left at the facility will be the responsibility of the PROVIDER. The CITY will not be responsible for any lost, stolen, or broken equipment or supplies. 2.5 The PROVIDER shall inspect the premises and equipment offered to him/her for his/her proposed activity and if he or she finds anything wrong with the premises or equipment before each program commences that cannot be corrected immediately by the DEPARTMENT, the program shall be canceled and the matter reported to the DEPARTMENT for correction. If the PROVIDER elects to hold his/her programs in the facility provided, it will be presumed that the PROVIDER has inspected the premises and facilities and equipment provided for such programs and has accepted same as being safe and suitable for the use intended.. ARTICLE 3.0 Program Size Minimums: 3.1 ACTIVE; Program sizes shall meet the minimum numbers of participants for each program as designated in Exhibit "A." ARTICLE 4.0 Compensation and Method of Payment 4.1 In consideration of the releases and indemnities contained herein and of the PROVIDER's services in connection with the programs and activities described herein, the CITY shall be entitled to 30% of the registration fees paid by all program participants to the PROVIDER, and the PROVIDER shall be entitled to 70% of such fees paid, exclusive of the 50% non-resident surcharge. The 50% non-resident surcharge is fully payable to the CITY and shall not be included in PROVIDER's gross income calculation. PROVIDER shall be entitled to retain all non -registration fees paid by participants to PROVIDER, i.e. PROVIDER membership fees and costs for uniforms and pictures to participants. Document 4.2 The PROVIDER agrees to collect all fees from participants, and the PROVIDER agrees to provide CITY with schedules of fees to be charged to participants in conformance with Exhibit "A". It is agreed that the PROVIDER's sole obligation shall be to collect the fees from the participants and to remit the 30% of the fees collected as well as all 50% non-resident surcharge amounts to the CITY with a pay -out report of all monies collected. Payment will be made to the CITY within fourteen (14) business days of the end of each month or session or program, whichever occurs first. 4.3 It is the responsibility of the PROVIDER to pay all applicable local, state, and federal taxes associated with this Agreement, and to acquire and pay for all necessary permits, licenses, and insurance required for the execution of this Agreement. ARTICLE 5.0 Independent PROVIDER 5.1 This Agreement does not create an ernployeefemployer relationship between the Parties. It is the intent of the Parties that the PROVIDER is an independent contractor under this Agreement and not a CITY employee for all purposes, including but not limited to, the application of the Fair Labor Standards Act minimum wage and overtime payments, Federal Insurance Contribution Act, the Social Security Act, the Federal Unemployment Tax Act, the provisions of the internal Revenue Code, The State Workers Compensation Act, and the State unemployment insurance law. The PROVIDER shall retain sole and absolute discretion in the judgment of the manner and means of carrying out PROVIDER's activities and responsibilities hereunder. The PROVIDER agrees that it is a separate and independent enterprise from the CITY, that it had full opportunity to find other business, that it has made its own investment in its business, and that it will utilize a high level of skill necessary to perform the work required hereunder. This Agreement shall not be construed as creating any joint employment relationship between the PROVIDER and the CITY and the CITY will not be liable for any obligation incurred by PROVIDER, including but not limited to unpaid minimum wages or overtime premiums. 5.2 PROVIDER warrants that it has not employed or retained any company or person, other than a bona fide employee working solely for the PROVIDER to solicit or secure this Agreement, and that it has not paid or agreed to pay any person, company, corporation, individual or firm any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of this provision, the CITY shall have the right to terminate the Agreement without liability at its discretion, to deduct from the contract price, or otherwise recover the full amount of such fee, commission, percentage, gift or consideration. Document ARTICLE 6.0 Insurance 6.1 PROVIDER shall not provide any service until all insurance required under this paragraph has been obtained and approved by the CITY. 6.2 Certificates of Insurance. Certificates of Insurance reflecting evidence of the required insurance shall be filed with the CITY prior to the commencement of this Agreement. These Certificates shall contain a provision that coverages afforded under these policies will not be cancelled until at least forty-five days (45) prior written notice has been given to the CITY. Policies shall be issued by companies authorized to do business under the laws of the State of Georgia. Financial Ratings must be not less than "A -VP' in the latest edition of "Best Key Rating Guide", published by A.M. Best Guide. 6.3 Insurance shall be in force until the obligations required to be fulfilled under the terms of the Agreement are satisfied. In the event the insurance certificate provided indicated that the insurance shall terminate and lapse during the period of this Agreement, then in that event, the PROVIDER shall furnish, at least thirty (30) days prior to the expiration of the date of such insurance, a renewed Certificate of Insurance as proof that equal and like coverage for the balance of the period of the Agreement and extension thereunder is in effect. The PROVIDER shall not provide any service pursuant to this Agreement unless all required insurance remains in full force and effect. 6.4 Commercial General Liability insurance to cover liability bodily injury and property damage. Exposures to be covered are: premises, operations, products/completed operations, and certain contracts. Coverage must be written on an occurrence basis, with the following limits of liability: $1,000,000 Combined Single Limit — each occurrence $2,000,000 Combined Single Limit — general aggregate $1,000,000 Personal Injury $1,000,000 Products/Completed Operations Aggregate PROVIDER shall have its insurer name the City of MILTON as an additional insured on its General Liability policy. 6.5 Worker's Compensation insurance shall be maintained during the life of this Agreement to comply with the statutory limits for all employees, and in the case any work is sublet, the PROVIDER shall require the subcontractor(s) similarly provide Workers Compensation Insurance for all the latter's employees unless and until such employees are covered by the protection afforded by the PROVIDER. The PROVIDER and his subcontractors shall maintain during the life of this Agreement Employers Liability Insurance. The following limits must be maintained: A. Workers Compensation Statutory B. Employer's Liability $100,000 each accident $ 500,000 Disease -policy limit $100,000 Disease -each employee Document If PROVIDER or its subcontractor claims to be exempt from this requirement, PROVIDER shall provide CITY proof of such exemption along with a written request for CITY to exempt PROVIDER, written on PROVIDER or subcontractor's letterhead. 6.6 PROVIDER shall also maintain Auto Liability and Directors and Officers insurance with limits reasonably acceptable to CITY during the term of this Agreement. 6.7 The CITY and the Fulton County Board of Education shall each be named as an additional insured and loss payee on all policies required by this Agreement. ARTICLE 7.0 Term and Termination 7.1 After a two (2) month trial period, the programs will be evaluated by the DEPARTMENT, and the remainder of this Agreement will either be terminated or continue in full force and effect. If at any time after the two (2) month evaluation, program enrollment should fall below the required minimum, the PROVIDER will be allotted four (4) weeks to bring enrollment up to the required minimum. The programs will be reevaluated and execution or termination of the contract will be determined by the DEPARTMENT. 7.2 The term of this Agreement shall commence upon the date of execution hereof and shall remain in effect for a period of one (1) year from the date of execution of this Agreement by the CITY, unless terminated sooner as provided in this Article. Renewal of this Agreement beyond the one (1) year term shall require the mutual written agreement of the CITY and PROVIDER. 7.3 This Agreement may be terminated by the CITY for convenience upon giving of at least thirty (30) days prior written notice of termination to the PROVIDER at the PROVIDER's address set forth herein at the sole and exclusive discretion of the CITY. This Agreement may be terminated by the City immediately by written notice to PROVIDER upon any willful, reckless, or grossly negligent act or omission by PROVIDER or any of its officers, agents, employees, or volunteers. 7.4 This Agreement may be terminated by PROVIDER upon giving at least thirty (30) days written notice of termination to the CITY. 7.5 PROVIDER must notify the DEPARTMENT in writing of any program cancellations at least ten (10) business days prior to the scheduled cancellation. 7.6 CITY reserves the right to cancel or reschedule any of the PROVIDER's programs, in the case of scheduling conflicts or other emergencies, as determined by the DEPARTMENT. Document ARTICLE 8.0 Indemnification 8.1 PROVIDER agrees to indemnify and hold harmless the CITY and the FULTON COUNTY BOARD OF EDUCATION, their trustees, elected and appointed officers, agents, servants and employees, from and against any and all claims, demands, or causes of action of whatsoever kind of nature, and the resulting losses, costs, expenses, reasonable attorneys' fees, including paralegal fees, liabilities, damages, orders, judgments, or decrees, sustained by the CITY, the FULTDN COUNTY BOARD OF EDUCATION, or any third party arising out of, or by reason of, or resulting from the will full or negligent acts, errors, or omissions of the PROVIDER or its agents, officers, volunteers or employees. 8.2 The Parties understand and agree that the covenants and representations relating to this indemnification provision shall survive the term of this Agreement and continue in full force and effect as to the PROVIDER's responsibility to indemnify. ARTICLE 9.0 Americans With Disabilities Act 9.1 PROVIDER shall not discriminate against any person in its operation and activities in its use or expenditure of the funds or any portion of the funds provided by this Agreement and shall affirmatively comply with all applicable provisions of the Americans With Disabilities Act ("ADA"), in the programs while providing any services funded in whole or in part by the CITY, including Titles I and II of the ADA and all applicable regulations, guidelines, and standards. 9.2 PROVIDER's decisions regarding the delivery of services under this Agreement shall be made without regard to or consideration of race, age, religion, color, gender, sexual orientation, national origin, marital status, physical or mental disability, political affiliation, or any other factor which cannot be lawfully or appropriately used as a basis for delivery of service. 9.3 PROVIDER in accordance with Title VI of the Civil Rights Act, as amended, 42 U.S.C. § 2000d, section 303 of the Age Discrimination Act of 1975, as amended, 42 U.S.C. § 6102, section 202 of the Americans with Disabilities Act of 1990, 42 U.S.C. § 12132, and all other provisions of Federal law, the Provider agrees that, during performance of this Agreement, Provider, for itself, its assignees and successors in interest, will not discriminate against any employee or applicant for employment, any subcontractor, or any supplier because of race, color, creed, national origin, gender, age or disability. In addition, Provider agrees to comply with all applicable implementing regulations and shall include the provisions of this Section IV(R) in every subcontract for services contemplated under this Agreement. Document ARTICLE 10.0 Miscellaneous 10.1 No modification, amendment, or alteration of the terms and conditions contained shall be effective unless contained in a written document executed with the same formality and equal dignity herewith. 10.2 This Agreement is non -transferable or assignable, and PROVIDER agrees not to transfer or assign the performance of services called for in the Agreement. 10.3 This Agreement sets forth the full and complete understanding of the Parties as of the effective date, and supersedes any and all negotiations, agreements, and representations made or dated prior to this Agreement. 10.4 The PROVIDER shall pay reasonable attorney's fees to the City should the City be required to incur attorney's fees in enforcing the provisions of this Agreement. 10.5 Time is of the essence of this Agreement. 10.6 Each of the individuals who executes this Agreement agrees and represents that he is authorized to execute this Agreement on behalf of the respective entity. Accordingly, the City and PROVIDER both waive and release any right to contest the enforceability of this Agreement based upon the execution and/or approval thereof. 10.7 It is the policy of City that unauthorized aliens shall not be employed to perform work on City contracts involving the physical performance of services. Therefore, the City shall not enter into a contract for the physical performance of services within the State of Georgia, unless the PROVIDER shall provide evidence on City -provided forms, attached hereto as Exhibits "C" and "D" that it and its subcontractors have within the previous twelve (12) month period conducted a verification of the social security numbers of all employees who will perform work on the City contract to ensure that no unauthorized aliens will be employed. The City Manager or his/her designee shall be authorized to conduct an inspection of the PROVIDER's and its subcontractors' verification process to determine that the verification was correct and complete. The PROVIDER and its subcontractors shall retain all documents and records of its verification process for a period of three (3) years following completion of the contract. This requirement shall apply to all contracts for the physical performance of services where more than three (3) persons are employed on the City contract. Compliance with the requirements of O.C.G.A_ § 13-10-91 and Rule 300-10-1-.02 is mandatory. PROVIDER's compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300- 10-1-.02 shall be attested by the execution of the contractor's affidavit attached as Exhibit «C „ Document Pursuant to O.C.G.A. § 50-36-1, the City must obtain a SAVE Affidavit and a secure and verifiable document evidencing the Contractor's legal status in the Country each time that Contractor obtains a public benefit, including any contract, from the City. Contractor hereby verifies that it has, prior to executing this Agreement, executed a SAVE Affidavit (to be sworn under oath under criminal penalty of false swearing pursuant to O.C.G.A. § 16-10-71), a form of which is attached hereto as Exhibit "E", and submitted such affidavit to the City in person, electronically, or by mail. Further, Contractor verifies that it has, prior to executing this Agreement, submitted a secure and verifiable document, evidencing the Contractor's legal status, to the City either in person or electronically (in compliance with the Uniform Electronic Transactions Act). Contractor verifies that it is in compliance with the Residency Status of an Applicant for Public Benefit, as required by the Georgia Security and Immigration Compliance Act (O.C.G.A. § 50-36-1). Document IN WITNESS OF THE FOREGOING, the Parties have set their hands and seal the day and year first written above. ATTEST: SUDIE GORDON, CITY CLERK WITNESS: CITY: JOE LOCKWOOD, MAYOR PROVIDER: BY: EDWARD M R, PRES ENT [AFFIX CORPORATE SEAL] EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: A-11Ij Participant Ages: 3 • V Day/s of the week program is offered: 10Axt Time of Program: to l o Program Dates: 5 7t� Z-0 13 —to—,Pe--1- ?-�-,Ir- zo Program Fee: .1 7S Program Enrollment: Minimum S Maximum G4► G F� Materials to be supplied by participants: 5A -c-;, ,a,4aeo Materials to be supplied by PROVIDER: ,!5�066d"" Materials to be supplied by the City of MILTON: Additional Program Requirements: PROVIDER (`s)Name: id Address: 3&5'5 P►�s- �*-de,� r��' City/State/Zip Code: A 3o o 5 Phone Number: (Day) 7-70 _(Evening) 7-7o �coq -izz& (E-mail): � c_ y.����at a g2,-, (Fax) 7-io tn[,,I- o-63-7 Minimum Requirements: 1,000,000 General Liability insurance Letter(s) of Recommendation Office Use Only: Program Rate:$ # of programs in Session: Fee/Program: EYMBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: Fall So_cc-e-K .-0►3 Participant Ages ?/ 15, Dayls of the week program is offered: _114 Time of Program: (/Q .Sp ) �5�A 94-) to rM - F?p Program Dates: -,1� 64- 2-0125, to Program Fee: It o Program Enrollment: Minimum 1 Maximum a ml -e, -n �elid Materials to be supplied by participants: s � , s kc",, � �r Materials to be supplied by PROVIDER - a -41 Materials to be supplied by the City of MILTON: Additional Program Requirements: PROVIDER (`s)Name: Address: 355'r� fry. 2d City/StatelZip Code: Phone Number: (Day) 710 &6 1/ /;;7-," (Evening) -7-7o ��,y ►a -a n (E-mail) 6 D Minimum Requirements: 1,000,000 General Liability Insurance Letter(s) of Recommendation (Fax) -7-70- &&Y- 0337 Office Use only. Program Rate:$ # of programs in Session: Fee/Program, EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: 201 y Participant Ages: 3- Dayls of the week program is offered:-•-� Time of Program: yam- _ to h Program Dates: 1}7,z,4J"'- Z,0141 to Ln '—d z -,o H Program Fee: 7y Program Enrollment: Minimum 5 Maximum Materials to be supplied by participants: et d-;, Materials to be supplied by d'pCGca' 5�-c--moi, �Gc! �jt/15-5�-•res Materials to be supplied by the City Additional Program Requirements: PROVIDER Address: 5i,!5s ,. e City/State/Zip Code: rte- 476L .s,0 ooS- of PROVIDER: MILTON: (`s)Name: Phone Number: (Day) 7-7o &Zy 1? --,,,n (Evening) 77o &&-Y � (E-mail): A±s,4a dym �f1ce._p,S (Fax) -77o Minimum Reguirements: 1,000,000 General Liability Insurance Letter(s) of Recommendation Office use Only.- 1,000,000 nly: Program Rate:$ # of programs in Session; Fee/Program: EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the ,Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: c �,- Participant Ages: SIS Dayls of the week program is offered: Time of Program: 5,-f 9a) to ( Program Dates: 6 17 L'i 2,1 to m Iv Program Fee: 1l/o Program Enrollment: Minimum z Maximum Materials to be supplied by participants: 5k"— Materials to be supplied by PROVIDER: Materials to be supplied Additional Program Requirements: PROVIDER by the City of MILTON: (`s)Name: Address: 3I S5 fpr d City/State/Zip Code: Phone Number: (Day) -77a (Evening) -r-7a ��y rzzo (E-mail): (Fax) -770 &&y- x.337 Minimum Requirements: 1,000,000 General Liability insurance Letter(s) of Recommendation Office Use Only., Program Rate:$ # of programs in Session: Fee/Program: Document EXHIBIT "C" STATE OF GEORGIA CITY OF MILTON CONTRACTOR AFFIDAVIT AND AGREEMENT By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm, or corporation which is contracting with the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-1D-91. The undersigned further agrees that, should it employ or contract with any subcontractor(s) in connection with the physical performance of services pursuant to this contract with the City of Milton, contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. § 13-10-91 on the Subcontractor Affidavit provided in Rule 300-10-01-.08 in the form attached hereto as Exhibit "D_" Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the City of Milton at the time the subcontractor(s) is retained to perform such service. EEV 1 Basic Pilot Program User Mentification Number 110 BY: Authorize Officer or Agent Date Young Men's Christian Association of Metropolitan Atlanta, Inc. Title of Authorized Officer or Agent of Contractor _S�U-1ce_ F s tA� kcr- SLAUQ Printed Name of Authorized Offiedr or Agent ��• �s� .• 1 SUBSCRIBED AND SWORN �� r��YA9n��-� BEFORE ME ON THIS TIJ J L9 DAY OF 1 Yl , 2D 13 _ At \\ I n� * •, .....� a.,. COU0,'��, Notary ub is My Commission Expires: b-V(1K Document STATE OF GEORGIA CITY OF MILTON EXHIBIT "D" SUBCONTRACTOR AFFIDAVIT By executing this affidavit, the undersigned subcontractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services under a contract with Newtown Recreation, Inc. on behalf of the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-1Q-91. FEV 1 Basic Pilot Program User Identification Number 3 BY: Authoriz Officer or Agent Date [INSERT SUBCONTRACTOR NAME] cc d 1�� i oe11 Title of Authorized Officer or Agent of Subcontractor 5S Ed Mvrls�r- Printed Name of Authorized dfFcer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE 10 DAY 0 n , 241_3 Notary blit My Commission Expires: tAUP �! Document EXHIBIT "E" SAVE Affidavit By executing this affidavit under oath, and as an applicant for a public benefit, as referenced in O.C.G.A. § 50-36-1, from the City of Milton, the undersigned applicant verifies one of the following with respect to my application for a public benefit: 1) '� I am a United States citizen. 2) I am a legal permanent resident of the United States. 3) I am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an alien number issued by the Department of Homeland Security or other federal immigration agency. My alien number issued by the Department of Homeland Security or other federal immigration agency is: The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at least one secure and verifiable document, as required by O.C.G.A. § 50-36-1(e)(1), with this affidavit. The secure and verifiable document provided with this affidavit can best be classified as: In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A. § 16-10-20, and face criminal penalties as allowed by such criminal statute. Executed in 4.n+0.- (city), cC- (state). SUBSCRIBED AND SWORN BEFORE ME ON TW THE DAY OF , 2013 JLO�_ NOTARY PUBLIC My Commission Expires: &C Signature of A licant Printed Name of Applicant OP ID: BC CERTIFICATE OF LIABILITY INSURANCE DAT04/03D(YYYYJ 1 44/03/13 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 770-934-3248 Nilliams, Turner & Mathis Inc. P. O. Box 450289 770-723-8081 Atlanta, GA 31146 Williams, Turner & Mathis NTACT -NAME; PIFAx No Ex[ ; AIc Nn A1C e E-MAIL ADDRESS: PRODUCER CUSTOMER ID I!: YMCAO-1 INSURERISI AFFORDING COVERAGE NAIC tl EACH OCCURRENCE $ 1,000,00 INSURED YMCA Of Metro Atl Inc INSURER A : Great American Attn: Mitch Mouchabeck 100 Edgewood Ar► #1100 Atlanta, GA 30303 INSURER B: Zenith Insurance Co. INSURER C GEN'LAGGREGATE LIMIT APPLIES PER: POLICY PROL�l LOC PRODUCTS - COMPIOP AGG $ 3,()00,00 INSURER 0: INSURER E: AUTOMOBILE X INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF IN POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMI°DIYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE rx-1 OCCUR PAC2131878 65107112 0$107113 EACH OCCURRENCE $ 1,000,00 DAMAGE 10 REIN rE D PREMISES Ea occurrence $ 100,00 MED EXF' (Any one person) $ 15,06 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 3,000,00 GEN'LAGGREGATE LIMIT APPLIES PER: POLICY PROL�l LOC PRODUCTS - COMPIOP AGG $ 3,()00,00 $ A AUTOMOBILE X LUASILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNEDAUTOS CAP2131879 05/07112 05107113 COMBINED SINGLE LIMIT $ 1,000,00( {Ea accident) BODILY INJURY (Per Person) $ BODILY INJURY (Per acddent) S PROPERTY DAMAGE $ (Per accident) X X $ $ A UMBRELLA DAB EXCESS UAB X OCCUR CLAIMS -MADE UMB2131880 65167112 05107173 EACH OCCURRENCE $ 10,600,06 AGGREGATE $ 10,000,00 X DEDUCTIBLE RETENTION $ 10000 $ S B WORKERS COMPENSATION AND EMPLOYERS' LIABILrrY YIN ANY PROPRIETORPARTNEREXECUTiVE ❑ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 2069890305 07101/12 07101/13 X I WC STATU- I OT{H- LIMITSTORY E E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 EEL. DISEASE -POLICY LIMIT $ 1,000,06 DESCRIPTION OF OP ERATIONSI LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Program: YMCA youth soccer program CITYMIL City of Milton 13400 Deerfield Parkway Ste 14 Milton, GA 30004 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION, All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD OP ID'. BC ACC]R J5' �� CERTIFICATE OF LIABILITY INSURANCE DATE {NIM+Damm 05109112 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 CQNSTIIUI A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the cartlficate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certaln policies may require an endarsemerrL A statement on this certificate does not confer rights to the certificate holder in lieu of such andorsemen s . PRODUCER 770-934-3248 Williams, Turner 8r Mathis Inc. P. O. Box 450289 770-723-BGS1 Atlanta, GA 31145 Williams, Turner & Mathis CONT NAR1E ,vHowPHONV>x lR �]x...... — (AM, Nul: ApnRes� rRo G RC ER 10 . YMCAO-1 Ri$URE AFFOROWRCOVBRAGE NAIL/ INSURED YMCA Of Metra Atl Inc INSURER A: Great American Attn: Mitch Mouchabeck INauRRa.Zenith Insurance Co. 1 DO Edgewood Av #1100 Atlanta, GA 30303 -f-- SURM1) . RHSURE�t A : ... . INSURER E, ... IN9 05107112 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUtREMENT, 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. NOR LTRTYPE DF INSURANCE .__m.. xw ACCORDANCE WITH THE POLICY PROVISIONS. POtJGY UM R - POLICY LiMrfB GENERAL LIABILITY EACH OCCURRENCE S 1,000,00 A X coMME+Rr-mLGFNFRALLIABIUTY !PAC2131878 05107112 05/07113 Is S 100,00 CLAIM&MADE 0 OCCUR _MED EXP {Arty one-paraan S 15,00 PERSONAL R ADV INJURY S 1,000,060 GEN AL AGGREGATE S 3,000, GEN'. AGGREGATE LIMIT APPLIES PER. PRODUOTS - COMPIOP A3G S 3,000,000 • ,y PRO- LOC $ AUTOMOSILLr 1.10111TY COMBINED SINGLE LIMIT $ 1,400,00 A X ANY AUTO CAP2131879 05107112 07110 (Ea aeeldard) BODILY INJURY (Per person) $ ALL OWNED AUTOS B.'" BODILY INJURY (Par acck7eltt) S SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accfdent) _...........................................-..............-......................................................................_ X NON -OWNED AUTOS ......... $ UMBRELLA LIAR X OCCUR .-._-..........._..__-- EACH OCCURRENCE S 10,000,0 AGGREGATE -W $ 10,000,00 A EXCESS WAS CLAIMS -MADE UAAB213188Q 05107112 45/07/13 DEDUCTIBLE --- — ----- - S S X RETENTION S 10,000 WORKERS COMPENSATIONX WC TAT � DTH - AND EMPLOYERS' LVIeMJ7YTORY Y E.L.EACHACCIOFNT Is 1,000,00 S ANY PROPRIETORIPARTNERfEXECUTNE 069894304 07/01111 07/01112 OFFICEWMEMBER EXCLUDED? fMandatorglnNK) NIA E.LDfSEASE-EAEMPLO $ `1,000,00 Has , duerlbe under DCRIPTION OF OPERATIONS below E.L. DISEASE - Poucne4md S 1,000,00 DESCRIPTION OF OPFRATIONS I LOCATIONS I VEHICLES (Attar, ACORD 101, Additional Romsrka $OodLila. It more spur is raqulrod) Fulton County Board of Education is additional Insured for general liability. Period - Policy year CERTIFICATE HOLDER CANCELLATK]N FULT009 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Fulton County Board of THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Education ACCORDANCE WITH THE POLICY PROVISIONS. 5270 Northfield Boulevard AUTHORIZED REPRESENTATIVE College Park, GA 39349 5 1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25 [2009109] The ACORD name and logo are registered marks of ACORD ER HOME OF'HE BF QUALITY OF LIFE 1N GEORGIA'TO-N% ------------------------------------------------ ES I-ABLIS IED 2000 CITY COUNCIL AGENDA ITEM TO: City Council DATE: April 29, 2013 FROM: City Manager AGENDA ITEM: Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Young Men's Christian Association of Metro Atlanta, Inc. for Recreation Classes and Summer Camps. MEETING DATE: Monday, May 6, 2013 Regular City Council Meeting. BACKGROUND INFORMATION: (Attach additional pages if necessary) See attached memorandum APPROVAL BY CITY MANAGER: y APPROVED { } NOT APPROVED CITY ATTORNEY APPROVAL REQUIRED: YES () NO CITY A TTORNEY REVIEW REQUIRED: YES () NO APPROVAL BYCITYATTORNEY {APPROVED () NOTAPPROVED PLACED ON AGENDA FOR: 05-0 to 13 REMARKS: . . .. . ......... --- ----- - -------- ® youlm _ rd -e n * Certified * ==_= A�IY PHONE: 678.242.2500 r G FAX: 678.242.2499+x+ _ * « wlxYEll try of info@eit ofmilton ams I www.ci ofmilfon a.us Community CEthic ,i 13000 Deerfield Parkway, Suite 107 1 Milton GA 30004 - CEnTIF;en eflONZE - t��BL,- To: Honorable Mayor and City Council Members From: Jim Cregge, Parks & Recreation Director Date: Submitted on April 25 for the May 6 Regular Council Meeting Agenda Item: Consideration of the Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Young Men’s Christian Association of Metro Atlanta, Inc. for Recreation Classes and Summer Camps. Department Recommendation: Staff is recommending the approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Young Men’s Christian Association (“YMCA”) of Metro Atlanta, Inc. for recreation classes and summer camps. Executive Summary: This is a renewal of the agreement reached last year. The YMCA recreation classes and summer camps were very popular last year and our residents have been very pleased with the experience. Funding and Fiscal Impact: A commission of 10% will be paid to the City of Milton two weeks following the end of registration. The commission is lower for this program to keep the summer camps more affordable for the participants. Non-resident fees will be collected by the provider and paid to the City at a rate of an additional 50% of the standard registration fee. Alternatives: If we do not renew with YMCA of Metro Atlanta, Inc., we would have to locate a new service provider. Legal Review: Contract Template – Paul Higbee, Jarrard & Davis on March 5, 2013 Document Concurrent Review: Chris Lagerbloom Attachment(s): 1) Parks and Recreation Agreement for Outside Providers Contract and SAVE Affidavit (2 copies) HOME OF ' t'.iv' it•.: i;t::' ' MILtON'k ESTABLISHED X006 CITY OF MILTON PARKS & RECREATION DEPARTMENT AGREEMENT FOR OUTSIDE PROVIDERS THIS IS AN AGREEMENT, made this day of , 2013, between: THE CITY OF MILTON, a municipal corporation organized and operating under the laws of the State of Georgia, with a business address of 13000 Deerfield Parkway, Suite 107 A, MILTON, Georgia 30004, hereinafter referred to as the "CITY." and YOUNG MEN'S CHRISTIAN ASSOCIATION OF METROPOLITAN ATLANTA, INC., hereinafter referred to as "PROVIDER". CITY and PROVIDER may hereinafter collectively be referred to as "the Parties". In consideration of the mutual obligations of the Parties and for good and valuable consideration, the adequacy and receipt of which are hereby acknowledged, the Parties agree as follows: ARTICLE 1.0 PROVIDER's Services and Responsibilities 1.1 PROVIDER shall conduct services generally described as Summer Day Camp & Recreation Classes at the following location: Hopewell Middle School, 13060 Cogburn Road, Milton GA 30004. Bethwell Community Center, 2695 Hopewell Road, Milton GA 30004. 1.2 The PROVIDER's services shall be performed during the days and hours described in Exhibit "A," attached hereto and incorporated herein by reference. 1.3 The PROVIDER and The Director of the Parks & Recreation Department or his designee, hereinafter referred to as the "DEPARTMENT", will agree upon program schedules. PROVIDER agrees to submit a Program Request Form to the Coordinator for each program being proposed eight (8) weeks prior to the beginning of each session. 1.4 The fees charged to each participant will be as described in Exhibit "A" for residents of MILTON & ALPHARETTA and a surcharge of 50% more for non-residents of MILTON & ALPHARETTA. The entire balance_ of this surcharge for non-residents shall be paid to the CITY. E v Your 'f"* *' * RHONE: 678.242.2500 j FAX: 678.242.2499 ��■ Green ;W * Cen[fiied info@cityofmil#onga.us I www.cityofmiltonga.us Community i�, E,hi. t1 7r1r1tt uni ' ��f 13000 Deerfield Parkway, Suite 107 1 Milton GA 3WO4 - CERTIFIED BRONZE O Document 1.5 The PROVIDER warrants to CITY that it is not insolvent, it is not in bankruptcy proceedings or receivership, nor is it engaged in or threatened with any litigation or other legal or administrative proceedings or investigations of any kind which would have an adverse effect on its ability to perform its obligations under this Agreement. 1.6 The PROVIDER agrees that it shall be solely responsible for all costs and/or expenses associated with, or as a result of its operation under this Agreement. The PROVIDER stipulates and certifies that it is qualified to provide the programs it is hired to provide, maintains the education and required licenses or permits necessary to provide the programs, and shall continue to maintain such licenses or permits during the term of this Agreement. 1.7 This Agreement is considered a non-exclusive Agreement between the Parties. The CITY shall have the right to purchase the same kind of services to be provided by the PROVIDER from other sources during the term of this Agreement. The PROVIDER is not precluded from providing the same or similar services for other parties so long as such other engagements do not interfere with the PROVIDER'S provision of services to the CITY. Oyu 1.8 The DEPARTMENT must approve any promotional material, flyers, and posters advertising the programs prior to its release. The following content and topics shall specifically be prohibited: sexually explicit materials, profanity, child pornography, alcoholic beverages, tobacco products, adult movies, adult bookivideo stores, adult entertainment establishments, massage parlors, pawn shops, and tattoo parlors or shops. 1.9 The PROVIDER shall not promote any privately owned business in a CITY park/facility or solicit any participant in a CITY park/facility activity for any privately owned. business. The PROVIDER may not use said facilities to conduct personal business including workshops, clinics, seminars, camps, or any other activities that are outside the scope of service described in (Exhibit "A"). It is further understood that such action(s) may result in immediate termination of the Agreement and the forfeiture of all compensation due to the PROVIDER. ■�� 1.10 The PROVIDER shall abide by the policies, procedures, rules and regulations of the DEPARTMENT, the CITY, and the FULTON COUNTY BOARD OF EDUCATION as promulgated from time to time. PROVIDER understands and agrees that the DEPARTMENT shall have rtrst priority for use of CITY facilities, notwithstanding any other provisions of this A-creement 1.11 All assistants, substitutes, and subcontractors utilized by the PROVIDER must have prior written approval of the DEPARTMENT. 1.12 PROVIDER shall provide necessary supervisory personnel to ensure that the participants of the programs obey all applicable policies, procedures, Rules and Regulations. Document 1. 13 The DEPARTMENT or CITY may require that the PROVIDER not be permitted to utilize specific assistants, substitutes, or subcontractors of PROVIDER who have failed to follow any policies, procedures, rules or regulations applicable to the use of the facility. 1.14 Although the CITY shall not control the PROVIDER's techniques, methods, procedures, or sequence of instruction, the PROVIDER will comply with the CITY's and DEPARTMENT's policies, rules, regulations and procedures, as well as those of the FULTON COUNTY BOARD OF EDUCATION, and shall not interfere with their operation, nor harm or damage the equipment or facilities afforded to PROVIDER for his/her programs, nor otherwise disrupt the other on-site activities being offered at such public facilities. 1.15 The PROVIDER also acknowledges that he or she is primarily responsible for the conduct of the participants in all programs under the PROVIDER's charge. 1.16 If the PROVIDER will be providing services directly with minor children without parental supervision, the PROVIDER shall, prior to commencing services under this Agreement, comply with the CITY's policy regarding criminal background screening. The CITY will furnish the PROVIDER with a background release form (Exhibit "B") for all the provider's counselors, coaches, volunteers, subcontractors, employees or any other individuals that will come in contact with a child, at the PROVIDER's sole expense. A Consent and Release Form to conduct a criminal background must be executed by any of PROVIDER's employees or any individual who will come in contact with a child at the CITY through PROVIDER or at PROVIDER's direction, such form authorizing the CITY to conduct a search of each such individual's criminal background. The result of such inquiry may be deemed acceptable by the CITY in its sole and complete discretion, and the CITY may reject any individual from participating in any program based upon such results. If the PROVIDER has recently had a background screening conducted by another agency, the CITY, at its sole discretion, may accept that background screening and waive the requirement of a new background screening. PROVIDER and its employees must also execute a Waiver and Release of Liability holding the CITY and FULTON COUNTY BOARD OF EDUCATION harmless. 1.17 The CITY shall require all participants in all programs to sign a Waiver and Release of Liability. ARTICLE 2.4 Equipment & Materials 2.1 All program materials and equipment needed or pertaining to the above stated programs will be provided by the PROVIDER at his/her own cost and expense. However, PROVIDER may require participants to obtain certain materials required in the programs by providing a list of such materials (with approximate costs) to the participants. If PROVIDER makes such materials available to participants, they must be sold at Document PROVIDER's cost. All equipment provided by the PROVIDER shall be used in strict accordance with equipment manufacturer's instructions and in accordance with all applicable laws. PROVIDER shall coordinate storage of goal posts with the principal of the school located at the facility. 2.2 The sale of merchandise is restricted to those materials utilized in and for the programs. Fundraising activities conducted by the PROVIDER will not be permitted. The PROVIDER shall obtain the CITY's approval of any merchandise to be sold prior to its distribution or sale. 2.3 The CITY will provide no storage space to the PROVIDER, unless otherwise mutually agreed upon in a separate written agreement. 2.4 Any supplies or equipment left at the facility will be the responsibility of the PROVIDER. The CITY will not be responsible for any lost, stolen, or broken equipment or supplies. 2.5 The PROVIDER shall inspect the premises and equipment offered to him/her for his/her proposed activity and if he or she finds anything wrong with the premises or equipment before each program commences that cannot be corrected immediately by the DEPARTMENT, the program shall be canceled and the matter reported to the DEPARTMENT for correction. If the PROVIDER elects to hold his/her programs in the facility provided, it will be presumed that the PROVIDER has inspected the premises and facilities and equipment provided for such programs and has accepted same as being safe and suitable for the use intended. ARTICLE 3.0 Program Size Minimums: 3.1 ACTIVE: Program sizes shall meet the minimum numbers of participants for each program as designated in Exhibit "A." ARTICLE 4.0 Compensation and Method of Payment 4.1 In consideration of the releases and indemnities contained herein and of the PROVIDER's services in connection with the programs and activities described herein, the CITY shall be entitled to 10% of the registration fees paid by all program participants to the PROVIDER, and the PROVIDER shall be entitled to 90% of such fees paid, exclusive of the 50% non-resident surcharge. The 50% non-resident surcharge is fully payable to the CITY and shall not be included in PROVIDER's gross income calculation. PROVIDER shall be entitled to retain all non -registration fees paid by participants to PROVIDER, i.e. PROVIDER membership fees and costs for uniforms and pictures to participants. Document 4.2 The PROVIDER agrees to collect all fees from participants, and the PROVIDER agrees to provide CITY with schedules of fees to be charged to participants in conformance with Exhibit "A". It is agreed that the PROVIDER's sole obligation shall be to collect the fees from the participants and to remit the 10% of the fees collected as well as all 50% non-resident surcharge amounts to the CITY with a pay -out report of all monies collected. Payment will be made to the CITY within fourteen (14) business days of the end of each month or session or program, whichever occurs first. 4.3 It is the responsibility of the PROVIDER to pay all applicable local, state, and federal taxes associated with this Agreement, and to acquire and pay for all necessary permits, licenses, and insurance required for the execution of this Agreement_ ARTICLE 5.0 Independent PROVIDER 5.1 This Agreement does not create an employee/employer relationship between the Parties. It is the intent of the Parties that the PROVIDER is an independent contractor under this Agreement and not a CITY employee for all purposes, including but not limited to, the application of the Fair Labor Standards Act minimum wage and overtime payments, Federal Insurance Contribution Act, the Social Security Act, the Federal Unemployment Tax Act, the provisions of the Internal Revenue Code, The State Workers Compensation Act, and the State unemployment insurance law. The PROVIDER shall retain sole and absolute discretion in the judgment of the manner and means of carrying out PROVIDER's activities and responsibilities hereunder. The PROVIDER agrees that it is a separate and independent enterprise from the CITY, that it had full opportunity to find other business, that it has made its own investment in its business, and that it will utilize a high level of skill necessary to perform the work required hereunder. This Agreement shall not be construed as creating any joint employment relationship between the PROVIDER and the CITY and the CITY will not be liable for any Obligation incurred by PROVIDER, including but not limited to unpaid minimum wages or overtime premiums. 5.2 PROVIDER warrants that it has not employed or retained any company or person, other than a bona fide employee working solely for the PROVIDER to solicit or secure this Agreement, and that it has not paid or agreed to pay any person, company, corporation, individual or firm any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of this provision, the CITY shall have the right to terminate the Agreement without liability at its discretion, to deduct from the contract price, or otherwise recover the full amount of such fee, commission, percentage, gift or consideration. Document ARTICLE 6.0 Insurance 6.1 PROVIDER shall not provide any service until all insurance required under this paragraph has been obtained and approved by the CITY. 6.2 Certificates of Insurance. Certificates of Insurance reflecting evidence of the required insurance shall be filed with the CITY prior to the commencement of this Agreement. These Certificates shall contain a provision that coverages afforded under these policies will not be cancelled until at least forty-five days (45) prior written notice has been given to the CITY. Policies shall be issued by companies authorized to do business under the laws of the State of Georgia. Financial Ratings must be not less than "A -VI" in the latest edition of "Best Key Rating Guide", published by A.M. Best Guide. 6.3 Insurance shall be in force until the obligations requircd to be fulfilled under the terms of the Agreement are satisfied. In the event the insurance certificate provided indicated that the insurance shall terminate and lapse during the period of this Agreement, then in that event, the PROVIDER shall furnish, at least thirty (30) days prior to the expiration of the date of such insurance, a renewed Certificate of Insurance as proof that equal and like coverage for the balance of the period of the Agreement and extension thereunder is in effect. The PROVIDER shall not provide any service pursuant to this Agreement unless all required insurance remains in full force and effect. 6.4 Commercial General Liability insurance to cover liability bodily injury and property damage. Exposures to be covered are: premises, operations, products/completed operations, and certain contracts. Coverage must be written on an occurrence basis, with the following limits of liability: $1,000,000 Combined Single Limit — each occurrence $2,000,000 Combined Single Limit — general aggregate $1,000,000 Personal Injury $1,000,000 ProductslCompleted Operations Aggregate PROVIDER shall have its insurer name the City of MILTON as an additional insured on its General Liability policy. 6.5 Worker's Compensation insurance shall be maintained during the life of this Agreement to comply with the statutory limits for all employees, and in the case any work is sublet, the PROVIDER shall require the subcontractor(s) similarly provide Workers Compensation Insurance for all the latter's employees unless and until such employees are covered by the protection afforded by the PROVIDER. The PROVIDER and his subcontractors shall maintain during the life of this Agreement Employers Liability Insurance. The following limits must be maintained: A. Workers Compensation Statutory B. Employer's Liability $100,000 each accident $500,000 Disease -policy limit $100,000 Disease -each employee Document If PROVIDER or its subcontractor claims to be exempt from this requirement, PROVIDER shall provide CITY proof of such exemption along with a written request for CITY to exempt PROVIDER, written on PROVIDER or subcontractor's letterhead. 6.6 PROVIDER shall also maintain Auto Liability and Directors and Officers insurance with limits reasonably acceptable to CITY during the term of this Agreement. 6.7 The CITY and the Fulton County Board of Education shall each be named as an additional insured and loss payee on all policies required by this Agreement. ARTICLE 7.0 Term and Termination 7.1 After a two (2) month trial period, the programs will be evaluated by the DEPARTMENT, and the remainder of this Agreement will either be terminated or continue in full force and effect. If at any time after the two (2) month evaluation, program enrollment should fall below the required minimum, the PROVIDER will be allotted four (4) weeks to bring enrollment up to the required minimum. The programs will be reevaluated and execution or termination of the contract will be determined by the DEPARTMENT. 7.2 The term of this Agreement shall commence upon the date of execution hereof and shall remain in effect for a period of one (1) year from the date of execution of this Agreement by the CITY, unless terminated sooner as provided in this Article. Renewal of this Agreement beyond the one (1) year term shall require the mutual written agreement of the CITY and PROVIDER_ 7.3 This Agreement may be terminated by the CITY for convenience upon giving of at least thirty (30) days prior written notice of termination to the PROVIDER at the PROVIDER's address set forth herein at the sole and exclusive discretion of the CITY, This Agreement may be terminated by the City immediately by written notice to PROVIDER upon any willful, reckless, or grossly negligent act or omission by PROVIDER or any of its officers, agents, employees, or volunteers. 7.4 This Agreement may be terminated by PROVIDER upon giving at least thirty (30) days written notice of termination to the CITY. 7.5 PROVIDER must notify the DEPARTMENT in writing of any program cancellations at least ten (10) business days prior to the scheduled cancellation. 7.6 CITY reserves the right to cancel or reschedule any of the PROVIDER's programs, in the case of scheduling conflicts or other emergencies, as determined by the DEPARTMENT, Document ARTICLE 8.4 Indemnification 8.1 PROVIDER agrees to indemnify and hold harmless the CITY and the FULTON COUNTY BOARD OF EDUCATION, their trustees, elected and appointed officers, agents, servants and employees, from and against any and all claims, demands, or causes of action of whatsoever kind of nature, and the resulting losses, costs, expenses, reasonable attorneys' fees, including paralegal fees, liabilities, damages, orders, judgments, or decrees, sustained by the CITY, the FULTON COUNTY BOARD OF EDUCATION, or any third party arising out of, or by reason of, or resulting from the will full or negligent acts, errors, or omissions of the PROVIDER or its agents, officers, volunteers or employees. 8.2 The Parties understand and agree that the covenants and representations relating to this indemnification provision shall survive the term of this Agreement and continue in full force and effect as to the PROVIDER's responsibility to indemnify. ARTICLE 9.0 Americans With Disabilities Act 9.1 PROVIDER shall not discriminate against any person in its operation and activities in its use or expenditure of the funds or any portion of the funds provided by this Agreement and shall affirmatively comply with all applicable provisions of the Americans With Disabilities Act ("ADA"), in the programs while providing any services funded in whole or in pari by the CITY, including Titles I and II of the ADA and all applicable regulations, guidelines, and standards. 9.2 PROVIDER's decisions regarding the delivery of services under this Agreement shall be made without regard to or consideration of race, age, religion, color, gender, sexual orientation, national origin, marital status, physical or mental disability, political affiliation, or any other factor which cannot be lawfully or appropriately used as a basis for delivery of service. 9.3 PROVIDER in accordance with Title VI of the Civil Rights Act, as amended, 42 U.S.C. § 2000d, section 303 of the Age Discrimination Act of 1975, as amended, 42 U.S.C. § 6102, section 202 of the Americans with Disabilities Act of 1990, 42 U.S.C. § 12132, and all other provisions of Federal law, the Provider agrees that, during performance of this Agreement, Provider, for itself, its assignees and successors in interest, will not discriminate against any employee or applicant for employment, any subcontractor, or any supplier because of race, color, creed, national origin, gender, age or disability. In addition, Provider agrees to comply with all applicable implementing regulations and shall include the provisions of this Section IV(R) in every subcontract for services contemplated under this Agreement. Document ARTICLE 10.0 Miscellaneous 10.1 No modification, amendment, or alteration of the terms and conditions contained shall be effective unless contained in a written document executed with the same formality and equal dignity herewith. 10.2 This Agreement is non -transferable or assignable, and PROVIDER agrees not to transfer or assign the performance of services called for in the Agreement. 10.3 This Agreement sets forth the full and complete understanding of the Parties as of the effective date, and supersedes any and all negotiations, agreements, and representations made or dated prior to this Agreement. 10.4 The PROVIDER shall pay reasonable attorney's fees to the City should the City be required to incur attorney's fees in enforcing the provisions of this Agreement. 10.5 Time is of the essence of this Agreement. 10.6 Each of the individuals who executes this Agreement agrees and represents that he is authorized to execute this Agreement on behalf of the respective entity. Accordingly, the City and PROVIDER both waive and release any right to contest the enforceability of this Agreement based upon the execution and/or approval thereof. 10.7 It is the policy of City that unauthorized aliens shall not be employed to perform work on City contracts involving the physical performance of services. Therefore, the City shall not enter into a contract for the physical performance of services within the State of Georgia, unless the PROVIDER shall provide evidence on City -provided forms, attached hereto as Exhibits "C" and "D" that it and its subcontractors have within the previous twelve (12) month period conducted a verification of the social security numbers of all employees who will perform work on the City contract to ensure that no unauthorized aliens will be employed. The City Manager or his/her designee shall be authorized to conduct an inspection of the PROVIDER's and its subcontractors' verification process to determine that the verification was correct and complete. The PROVIDER and its subcontractors shall retain all documents and records of its verification process for a period of three (3) years following completion of the contract. This requirement shall apply to all contracts for the physical performance of services where more than three (3) persons are employed on the City contract. Compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300-10-1-.02 is mandatory. Document PROVIDER's compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300- 10-1-.02 shall be attested by the execution of the contractor's affidavit attached as Exhibit «C Pursuant to O.C.G.A. § 50-36-1, the City must obtain a SAVE Affidavit and a secure and verifiable document evidencing the Contractor's legal status in the Country each time that Contractor obtains a public benefit, including any contract, from the City. Contractor hereby verifies that it has, prior to executing this Agreement, executed a SAVE Affidavit (to be sworn under oath under criminal penalty of false swearing pursuant to O.C.G.A. § 16-10-71), a form of which is attached hereto as Exhibit "E", and submitted such affidavit to the City in person, electronically, or by mail. Further, Contractor verifies that it has, prior to executing this Agreement, submitted a secure and verifiable document, evidencing the Contractor's legal status, to the City either in person or electronically tin compliance with the Uniform Electronic Transactions Act). Contractor verifies that it is in compliance with the Residency Status of an Applicant for Public Benefit, as required by the Georgia Security and Immigration Compliance Act (O.C.G.A. § 50-36-1). Document IN WITNESS OF THE FOREGOING, the Parties have set their hands and seal the day and year first written above. CITY: ATTEST: IM SUDIE GORDON, CITY CLERK JOE LOCKWOOD, MAYOR PRnVTDF.R WITNE BY: dd Y�7v"�W� EDWARD M ER, PRESIDENT [AFFIX CORPORATE SEAL] EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: Participant Ages: Dayls of the week program is offered: Irrh - tri Time of Program: 7`34a to 1'664 Program Dates: 3rd to Program Fee: A, A/r� - Program Enrollment: Minimum I Maximum 5l� Materials to be supplied by participants:; Materials to be supplied by PROVIDER: Materials to be supplied by the City of MILTON: Additional Program Requirements: PROVIDER (`s)Name: Address: je,S.S Pr.� d ! _ City/State/Zip Code: 62,!�PkAe, 3,900S;- Phone ,9005Phone Number: (Day)17e 11,3 •355Y7 (Evening) 77d &1,,/ 122-n (E-mail): 1��x-,?-00 Minimum Requirements: 1,000,000 General Liability Insurance Letter(s) of Recommendation ( Fax) Office use Only.- Program nly. ?7o IPGY- X337 Program Rate:$ # of programs in Session: Fee/Program: Document EXHIBIT "C" STATE OF GEORGIA CITY OF MILTON CONTRACTOR AFFIDAVIT AND AGREEMENT By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm, or corporation which is contracting with the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. The undersigned further agrees that, should it employ or contract with any subcontractor(s) in connection with the physical performance of services pursuant to this contract with the City of Milton, contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. § 13-10-91 on the Subcontractor Affidavit provided in Rule 300-10-01-.08 in the form attached hereto as Exhibit "D." Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the City of Milton at the time the subcontractor(s) is retained to perform such service. EEVV I Basic Pilot Program User Identification Number Wj &,t � �-Ii v,r --:Zl BY: Authori-ed Officer or Agent Date Young Men's Christian Association of Metropolitan Atlanta., Inc. Cf 0 IP 'q6,4 Title of Authorized Officer or Agent of Contractor S�f Printed Name of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE _ 0_ DAY�OF .A,D►r] t , 2413 Notary ublic My Commission Expires: Document STATE OF GEORGIA CITY OF MILTON EXHIBIT "D" SUBCONTRACTOR AFFIDAVIT By executing this affidavit, the undersigned subcontractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services under a contract with Young Men's Christian Association of Metropolitan Atlanta, Inc, on behalf of the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. EEV / Basic Pilot Program User Identification Number Chit � a r 3 BY: Authoriz Officer or Agent Date [INSERT SUBCONTRACTOR NAME] CEO I Title of Authorized Officer or Agent of Subcontractor M M({n * r Printed Name of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF T , 2013. Notary Public My Commission Expires: r� 'Jf L����►s«+rrr�'r� F S .Atic �4 %26. pUBL� tl ` to Q � Document EXHIBIT "E" SAVE Affidavit By executing this affidavit under oath, and as an applicant for a public benefit, as referenced in O.C.G.A. § 50-36-1, from the City of Milton, the undersigned applicant verifies one of the following with respect to my application for a public benefit: 1) I am a United States citizen. 2} I am a legal permanent resident of the United States. 3} I am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an alien number issued by the Department of Homeland Security or other federal immigration agency. My alien number issued by the Department of Homeland Security or other federal immigration agency is: The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at least one secure and verifiable document, as required by O.C.G-A. § 50-36-1(e)(1), with this affidavit. The secure and verifiable document provided with this affidavit can best be classified as: G-etir q l'6 7Pn Vct, s b ce n S -e In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A. § 16-10-20, and face criminal penalties as allowed by such criminal statute. Executed in (city), �--e Ora (state). SUBSCRIBED AND SWORN BEFORE ME ON T IS THE 1Q DAY OF , 20/-� N ARV PUBLIC My Corgmission Expires: JI ,� (( . - r, .z r71 q Jd- ZA012ft Signature of AppKafit Erb & 64 ns -e e -- Printed Name of Applicant F S1 �,yf � �FTJA i %BLIG 3 �[ 1 � % j 1 '�.' 01 MV. �,'MiltO OP ID: BC A4C"R" CERTIFICATE OF LIABILITY INSURANCE DAT04103DIYYYYj 04103/13 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 770-934-3248 Milliams, Turner R Mathis Inc. 770-723-8481 O. Box 450289 ktianta, GA 31145 IVilliams, Turner & Mathis CONTACT NAME: PHONE FAX A!C No Ext : A1C No): EMAIL ADDRESS: PRODUCER YMCAO-1 CUSTOMER ID #: INSURER $ AFFORDING COVERAGE NAIL # INSURED YMCA Of Metro Atl Inc Attn: Mitch Mouchabeck 100 Edgewood AV #1100 Atlanta, GA 30303 INSURER A: Great American INSURER B: Zenith Insurance Co. INSURER c : INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS iS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED !NAMED ABOVE FOR THE POLICYPERIOD 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. NSR LTR TV PE OF INSURANCE POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAWS -MADE Fx7 OCCUR PAC2131878 05107112 05107/13 EACH OCCURRENCE S 1,000,00 PREMISES Ea occurrence $ 100,00 MED EXP [Any one Person] $ 15,00 PERSONAL & ADV INJURY $ 1,000,08 GENERAL AGGREGATE 3,000,00 GEML AGGREGATE LIMIT APPLIES PER' POLICY F PRC LOC PRODUCTS - COMPIOP AGG $ 3,000,00 S A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 1 CAP2131879 05107/12 05/07/13 COMBINED SINGLE LIMIT $ 7,000,00 (Ea accident] BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (P or accident) X X $ A UMBRELLA LIAR EXCESS UAB X OCCUR CLAIMS -MADE UMB2131880 05107172 05107/13 EACH OCCURRENCE S 10,000,00 AGGREGATE $ 10,000,00 X DEDUCTIBLE RETENTION $ 10000 S $ B WORKERS COMPENSATIONWC AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTiVE YIN F7 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS NIA 069890305 07/01117 07/01/13 STATU- OTH- X T RY OK41TS E.L. EACH ACCIDENT $ 1,000,00 E. L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L DISEASE - POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If mora space is required) Program: YMCA youth soccer program CITYMIL City of Milton 13000 Deerfield Parkway Ste 10 Milton, GA 30004 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD DP la}- 6C '44CC712O' DATE (MMFDDfrfYY) �. CERTIFICATE OF LIABILITY INSURANCE 05109/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONIFERS 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 PRO37L(CER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the polleypes) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an andorsernent. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsemen s . PRODUCER 770-934-3248 Willlams, Turner & Mathis Inc. P. O. Bax 450289 770.723-8089 Atlanta, GA 31145 Williams, Turner $ Mathis OONTA NAMF-CT A Ha E �" x.. .YMCAOA �t3UI1 S.AFFOIWRIO.COVEIiAGE NM# INSURED YMCA Of Metro Afl Inc Attn: Mitch Mouchabeck 100 Edgewood AV #1100 Atlanta, GA 30303 INSURER A. Great American INaunExe:Zenith Insurance Co. INSURER c; INSURER -10: INSURER E :. INSURER F. r_nVFW1knF-q rFW'"FI C ATF lift IrJFURR•:. IiFVICInki JTSI JURWR, THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ASO.VE 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. INISR to TPP! OF INSURANCE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BR POLICY NUMBER Education ACCORDANCE YYITH THE POLICY PROVISIONS. UNITS A GEUPPAL X LABILITY COMM ERCIALGOERALLIABILITY CLAI VrUADE OCCUR PAC2131878 03107/12 05/07-113 EACH OCCURRENCE S 1,000.00 KknN1ImU„ S 100,0Q MED EXP (Evry. one per"J S 13,00 PERSONAL & ADV INJURY $ 1,000,00 GENERALAGGREGATE S 3,000,00 GEN'L AGGREGATE LIMIT APPLIES PER 17 p(jj,(Cr Fir LOCI PRODUCTS - COIAPfOP AGO S 3,000,00 $ A AUTOMOBILE LIABILITY X ANY AUTO ALL DME D AUTOS SCHEDLLED AUTOS X HIRED AUTOS X NON-ow"EO AUTOS CAP2131879 05/07112 05/07/13 COMBINED SINGLE LIMIT (EaacaldaMj $ 1,000,00 BODILY INJURY (Par persan) $ ���-- BODILY INJURY (Par aockda[rt} $ PROPERTY DAMAGE (Per acddaq $ $ A UMBRELLA LIAR L 49 EXCESSLF x I OCCUR CLAIMS -MADE M@213188t3 05107112 05/07113 EACH OCCURRENCE S 16,000,004 AGGREGATE 11 10,000,00 HDEDucTIBLE: xRETWIGN S 10,00 �--------- s S Q WORKERS COMPENSATION AN1D EMPLOYERS' LIABIUrY ANYPROPRIETORIPARTNERMXECUTIVE YIN OFFICERFMEMBER EXCLUDED? (MandstaryIn NH) Py 6deacrl"under DESC ON OF OPERA NS halew NFA Z069890304 07101111 07/01/12 WCSTA'rU- OTIi- x. E,L, EACH ACCIDENT $ 1,000,00.. E.L. DISEASE - EA EMPLOYEE S 1,000,00 E.L.DfSEASE-POLIGYLIMIT S 1,000,08 DESCii1PTIOk OF OPERATIONS 1 LOCATIONS f VEHICLES (Attach ACORD 101, Additional Ramarka Schodule, l7 inon apace is requlrtad) Fulton County Board of Education is additional insured for general liability. Period - Policy[purpose - year i�E;laTll�Ie*art! rtnl nWft r_erarFt I Alrtrbw FULT069 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Fulton County Board of THE EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN Education ACCORDANCE YYITH THE POLICY PROVISIONS. 5270 Northfiteid Boulevard AUTHORIZED PERPMEENTATIVE Ca&Ux-6- Gallego Park, GA 30349 ® 1988-2009 ACORD CORPORATION, All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD HOME OF `I. sE BEST Qt!ALITY OF I..IFi= IN GEORGIA' M I LTO -N* ESTABLISHED 2006 TO: City Council CITY COUNCIL AGENDA ITEM DATE: April 29, 2013 FROM: City Manager AGENDA ITEM: Approval of a Construction Services Agreement between the City of Milton and A.L.S. Septic Systems to Provide Field Line Relocation at Fire Station 41. MEETING DATE: Monday, May 6, 2013 Regular City Council Meeting. BACKGROUND tNFORMA TION: (Attach additional pages if necessary) See attached memorandum APPROVAL BY CITY MANAGER: XAPPROVED CITY ATTORNEY APPROVAL REQUIRED: YES CITY ATTORNEY REVIEW REQUIRED: � YES APPROVAL BY CITY A TTORNEY PLACED ON AGENDA FOR: REMARKS: (KAPPROVED {) NOT APPROVED (} NO { } NO () NOTAPPROVED ❑ TC) 6 13 *Plf ;= rp��i •.��x � �� PHONE: 678.242.25001 FAX: 678.242.2499 reen Community info@cityofmiltonga.us I www.cityofmiitonga.us =4•:. irxm tRe :Y'ay '0 5� sioiraCi9 f �v:n7 13000 Deerfield Parkway, Suite 107 1 Miitan GA 30004 - GEfirIFi E6 ORQNZE - 'FCertifi�� ` City of � ��a�3,hi 4�y� 2 To: Honorable Mayor and City Council Members From: Roddy Motes, Public Works Manager Date: Submitted on April 18, 2013 for the May 6, 2013 Regular Council Meeting Agenda Item: Approval of a Construction Services Agreement between the City of Milton and A.L.S. Septic Systems to Provide Field Line Relocation at Fire Station 41 ______________________________________________________________________________ Department Recommendation: Approval. Executive Summary: The current septic field line system encroaches into the construction area for the Arnold Mill Rd. @ New Providence Rd. intersection improvement project. Staff is recommending approval of the Construction Services Agreement with A.L.S. Septic System in an amount not to exceed $4,975. Funding and Fiscal Impact: Funding for this project is available in the Infrastructure/Arnold Mill@New Providence capital grant account. Alternatives: None Legal Review: Paul Higbee – Jarrard & Davis (3/22/2013) Concurrent Review: Chris Lagerbloom, City Manager Attachment(s): Construction Services Agreement -pNAF CF ' , *t CONSTRUCTION SERVICES AGREEMENT — SHORT FORM Fire Station # 41 Septic Line Relocation 5� k This Services Agreement (the "Agreement") is made and entered into this day of ; � 1 2013, by and between the CITY OF MILTON, GEORGIA (hereinafter referred to as the "City"), and Adam L. Shelquist d/b/a A.L.S. Septic Systems, "a sole proprietorship" hereinafter referred to as the "Contractor") having its principal place of business at 200 Heard Rd, Canton, Georgia 30114 WITNESSETH THAT: WHEREAS, the City desires to employ a contractor to perform the services described herein (the "Work"); and WHEREAS, Contractor has familiarized itself with the Contract Documents, as defined below, the Work, and with all local conditions and applicable federal, state and local laws, ordinances, rules and regulations. NOW THEREFORE, the City and Contractor, in consideration of the mutual promises contained herein and other good and valuable consideration, the sufficiency of which is hereby acknowledged, agree as follows: Section 1. Contract Documents: This Agreement and the following named Exhibits, attached hereto and incorporated herein by reference, constitute the "Contract Documents": EXHIBIT A -SCOPE OF WORK; EXHIBIT B -INSURANCE CERTFICATE; EXHIBIT C -CONTRACTOR AFFIDAVIT AND AGREEMENT; EXHIBIT D -SUBCONTRACTOR AFFIDAVIT (IF NECESSARY); EXHIBIT E -SAVE AFFIDAVIT To the extent that there may be any conflict among the Contract Documents, the provision operating most to the benefit of the City shall govern. Section 2. The Work: Contractor shall provide all Work described in the Contract Documents. In the event of any discrepancy among the Contract Documents, the provision operating most to the benefit of the City, as determined by the City in its sole discretion, shall govern. Unless otherwise stated in the Contract Documents, the Work shall include Contractor's provision of materials, labor, expenses, and any other cost or item necessary to complete the Work, which is generally described as relocation of septic system lines. Section 3. Contract Time: Contractor understands that time is of the essence of this Agreement and warrants that it will perform the Work in a prompt manner, which shall not impose delays on the progress of the Work. It shall commence Work pursuant to this Agreement on or before a date to be specified on a written "Notice to Proceed" from the City, and shall fully complete the Work within 10 business days of the "Notice to Proceed". Section 4_ Work Changes: Any changes to the Work requiring an increase in the Contract Price, as defined below, shall require a written change order executed by the City in accordance with its purchasing regulations. Section 5. Compensation and Method of Payment: City agrees to pay Contractor for the services performed and costs incurred by Contractor upon the City's certification that the services were actually performed and costs actually incurred in accordance with this Agreement. Compensation for services performed and, if applicable, reimbursement for costs incurred shall be paid to Contractor upon the City's receipt and approval of an invoice, submitted upon completion of the Work, setting forth in detail the services performed and costs incurred. Invoices shall reflect charges incurred versus charges budgeted. The total amount paid under this Agreement for the Work shall not, in any case, exceed $4 975.00 (the "Contract Price"), except as outlined in Section 4 above. Contractor shall take no calculated risk in the performance of the Work. Specifically, Contractor agrees that in the event it cannot perform the Work within the budgetary limitations established without disregarding sound principles of Contractor's industry, Contractor will give written notice thereof immediately to the City. Section 6. Covenants of Contractor A. Assignment of Agreement: Contractor covenants and agrees not to assign or transfer any interest in, nor delegate any duties of this Agreement, without the prior express written consent of the City. B. Responsibility of Contractor and Indemnification of City: Contractor covenants and agrees to take and assume all responsibility for the services rendered in connection with the Work. Contractor shall bear all losses and damages directly or indirectly resulting to it on account of the performance or character of the services rendered pursuant to this Agreement. Contractor shall defend, indemnify and hold harmless the City, its officers, boards, commissions, elected and appointed officials, employees and agents from and against any and all claims, suits, actions, liability, judgments, damages, losses, and expenses, including but not limited to, attorney's fees, which may be the result of willful, negligent or tortious conduct arising out of the Work, performance of contracted services, or operations by Contractor, any subcontractor, anyone directly or indirectly employed by Contractor or subcontractor or anyone for whose acts Contractor or subcontractor may be liable, regardless of whether or not the negligent act is caused in part by a party indemnified hereunder. Contractor shall not be required to indemnify the City or its officers, boards, commissions, elected or appointed officials, employees or agents against liability or claims for damages, losses, or expenses, including attorney fees, arising out of bodily injury to persons, death, or damage to property caused by or resulting from the sole negligence of the City or its officers, boards, commissions, elected or appointed officials, employees or agents. C. Independent Contractor: Contractor hereby covenants and declares that it is engaged in an independent business and agrees to perform the Work as an independent contractor, not as agent or employee of City. Inasmuch as City and Contractor are contractors independent of one another, neither has the authority to bind the other to any third person or otherwise to act in any way as the representative of the other, unless otherwise expressly agreed to in writing by both parties. Contractor agrees not to represent itself as City's agent for any purpose to any party or to allow any employee to do so, unless specifically authorized, in advance and in writing, and then only for the limited purpose stated in such authorization. Contractor shall assume full liability for any contracts or agreements Contractor enters into on behalf of City without the express knowledge and prior written consent of City. D. Insurance: Contractor shall have and maintain in full force and effect for the duration of this Agreement, insurance approved by the City as shown on Exhibit "B". E. Licenses, Certifications and Permits: Contractor covenants and declares that it has obtained and will maintain all diplomas, certificates, licenses, permits or the like required by any national, state, regional, City, and local boards, agencies, commissions, committees or other regulatory bodies to perform the Work. Contractor shall comply with applicable legal requirements and meet the standard of quality ordinarily expected of its industry. F. Ownership of Work: All reports, drawings, specifications, and other items prepared or in the process of being prepared for the Work by Contractor ("materials") shall be the property of the City and the City shall be entitled to full access and copies of all materials. All copyrightable subject matter in all materials is hereby assigned to the City and Contractor agrees to execute any additional documents necessary to evidence such assignment. G. Contractor's Representative: Adam L Shelquist shall be authorized to act on Contractor's behalf with respect to the Work as Contractor's designated representative. H. Confidentiality: Contractor acknowledges that it may receive confidential information of the City and that it will protect the confidentiality of any such confidential information and will require any of its subcontractors, consultants, and/or staff to likewise protect such confidential information. 1. Meetings: Contractor shall meet with City's personnel or designated representatives to resolve technical or contractual problems that may occur during the term of the contract, at no additional cost to City. 2 Section 7. Warranty: Contractor shall repair all defects in materials, equipment, or workmanship appearing within one year from the date of completion of the Work at no additional cost to the City. Section S. Termination: The City may terminate this Agreement for convenience at any time upon written notice to Contractor. Provided that no damages are due to the City for Contractor's breach of this Agreement, the City shall pay Contractor for Work performed to date in accordance with Section 5 herein. Section 9. Miscellaneous A. Governing Law. This Agreement shall be governed by the laws of the State of Georgia. B. Counterparts. This Agreement may be executed in any number of counterparts, each of which shall be deemed to be an original, but all of which together shall constitute one and the same instrument. C. Sovereign Immunity. Nothing contained in this Agreement shall be construed to be a waiver of the City's sovereign immunity or any individual's qualified good faith or official immunities. D. Employment of Unauthorized Aliens Prohibited: (1) E -Verify Affidavit It is the policy of City that unauthorized aliens shall not be employed to perform work on City contracts involving the physical performance of services. Therefore, the City shall not enter into a contract for the physical performance of services within the State of Georgia unless the Contractor shall provide evidence on City -provided forms, attached hereto as Exhibits "C" and "D" (affidavits regarding compliance with the E -Verify program to be sworn under oath under criminal penalty of false swearing pursuant to O.C.G.A. § 16-10-71), that it and Contractor's subcontractors have within the previous twelve (12) month period conducted a verification, under the federal Employment Eligibility Verification ("EEV" or "E -Verify") program, of the social security numbers, or other identifying information now or hereafter accepted by the E -Verify program, of all employees who will perforin work on the City contract to ensure that no unauthorized aliens will be employed. The Contractor hereby verifies that it has, prior to executing this Agreement, executed a notarized affidavit, the form of which is provided in Exhibit "C", and submitted such affidavit to City. In the event the Contractor employs or contracts with any subcontractor(s) in connection with the covered contract, the Contractor agrees to secure from such subcontractor(s) attestation of the subcontractor's compliance with G.C.G.A. § 13-10-91 and Rule 300-10-1-.02 by the subcontractor's execution of the subcontractor affidavit, the form of which is attached hereto as Exhibit "D", and such subcontractor affidavit shall become part of the contractor/subcontractor agreement. Further, Contractor agrees to provide completed copies of Exhibit "D" to the City within five (5) business days of receipt from any subcontractor. The City Manager or his/her designee shall be authorized to conduct an inspection of the Contractor's and Contractor's subcontractors' verification process at any time to determine that the verification was correct and complete. The Contractor and Contractor's subcontractors shall retain all documents and records of their respective verification process for a period of three (3) years following completion of the contract. The City Manager or his/her designee shall further be authorized to conduct periodic inspections to ensure that no City Contractor or Contractor's subcontractors employ unauthorized aliens on City contracts. By entering into a contract with the City, the Contractor and Contractor's subcontractors agree to cooperate with any such investigation by making their records and personnel available upon reasonable notice for inspection and questioning. Where a Contractor or Contractor's subcontractors are found to have employed an unauthorized alien, the City Manager or his/her designee may report same to the Department of Homeland Security. The Contractor's failure to cooperate with the investigation may be sanctioned by termination of the contract, and the Contractor shall be liable for all damages and delays occasioned by the City thereby. 3 Contractor hereby agrees to comply with the requirements of the federal Immigration Reform and Control Act of 1986 (IRCA), P.L. 99-603, O.C.G.A. § 13-10-91 and Rule 300-10-1-.02. Contractor's compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300-10-1-.02 shall be attested by the execution of the contractor's affidavit, attached hereto as Exhibit "C" and incorporated herein by this reference. The above requirements shall be in addition to the requirements of State and federal law, and shall be construed to be in conformity with those laws. (2) SAVE Affidavit and Secure Verifiable Document Pursuant to O.C.G.A. § 50-36-1, the City must obtain a SAVE Affidavit and a secure and verifiable document evidencing the Contractor's legal status in the Country each time that Contractor obtains a public benefit, including any contract, from the City. Contractor hereby verifies that it has, prior to executing this Agreement, executed a SAVE Affidavit (to be sworn under oath under criminal penalty of false swearing pursuant to O.C.G.A. § 16-10- 71), a form of which is attached hereto as Exhibit "E", and submitted such affidavit to the City in person, electronically, or by mail. Further, Contractor verifies that it has, prior to executing this Agreement, submitted a secure and verifiable document, evidencing the Contractor's legal status, to the City either in person or electronically (in compliance with the Uniform Electronic Transactions Act). Contractor verifies that it is in compliance with the Residency Status of an Applicant for Public Benefit, as required by the Georgia Security and Immigration Compliance Act (O.C.G.A. § 50-36-1). E. Nondiscrimination. In accordance with Title VI of the Civil Rights Act, as amended, 42 U.S.C. § 2000d, section 303 of the Age Discrimination Act of 1975, as amended, 42 U.S.C. § 6102, section 202 of the Americans with Disabilities Act of 1990, 42 U.S.C. § 12132, and all other provisions of Federal law, the Consultant agrees that, during performance of this Agreement, Consultant, for itself, its assignees and successors in interest, will not discriminate against any employee or applicant for employment, any subcontractor, or any supplier because of race, color, creed, national origin, gender, age or disability. In addition, Consultant agrees to comply with all applicable implementing regulations and shall include the provisions of this Section IV(R) in every subcontract for services contemplated under this Agreement_ IN WITNESS WHEREOF, the parties have caused this Agreement to be executed under seal as of the date first above written. Adam L Shelquist Signature: U�l ' +� Title: [AFM CORPORATE SEAL] CITY OF MILTON, GEORGIA Joe Lockwood, Mayor Printed Name: cltC6'+^ Fj EXHIBIT "A" Scope of Work Scope of Work and Schedule The irn dersi9 nod as v:9d;-, dvulj r�� arty: reprG sail,=: `1:+G oxa m:"GC.I Vsi'.E o` Ina v;o'c and .r itorrllk Cd mseltiherself fcliy 1n rngard'e al corrdnion= pe1L:: c-.. L ;vn2re t 2 work a to :e netfnr R=d nrludinc dr.usc col -d slurs !rle to dr:lvC..•ry 'iani::i' 1 L c;lltl sIt; agL-! nt n,:�IloiAiti i I'•i ,=q:1G7rne!rt I he ka 1P.r Iza r;amne :a„ - .- : 1 r -.- 't d 61 j„ rtlmient a".r! ha-.. s,aj 41nd hr , If. �1etself'r:it thr Bidding Darilrian- .s an adequate and -: _ t 1611oli al -tie work which is rpq.I rr?d tri ne pet('. rm e d ann ttt: t the bidder Is irk Ing Fn � 1;*^ h-, parurnl ao1 .:' 'hark n .BSSnI Y. I fie G1oc e, !urfrler r,uri111cs :h6: no additio•ia ;nforrnatlor. i5 eouim l to r,:m:',!cte the . u -k ellcoriasutd I)y H 4 JJJJ within Ile c rs' and srCAedule estat311shea and agreed . pc, w111• r +.kur• h.4dc3.r' ,,, d():,i:,r•eI t 15 e Udder ural.ns,2s and Gc'ees :ra-. :- t -1s Lr_ , ... €&d Ip conTract wiri tnr, C*. Ty ,r Milton m pn" !d,: all' cor.strudion 12kxir n•aterlak. trrgt.lprr::1 '. r -L pc!tabon. and other fac:l.-.ies ac serulr:es :ss ]1L-LC]sc y ab)dkif req to rd!• lr,,_;<eeuEe S511d Col-Ipkc:,,:, A. L. 1 rl witrl -hu s:]onG ,z: w, :, Y I,r,t4 tr'a fIIii satisfaction of the city THE BASE BID IS THE AMOUNT UPON %VIfII_ I THE BIDDER WII 1 BI_ I OR 1t14I u EV!,,LUA I F1-1 AND WHIQH WI LI, FSI ll.�F`) TQ r)�: 11=Rk1INF THF I OWES RESUUNSIBLF RIM?Lk rrv, n;se 1.:1c ,i,arof il, :., (l: c!,:, w•• nlod:fie�i. i•xc.+p' at the regk tt�.r ,,f r.I,F ci-v. 'or 2 pc ri od et suety 1 •12 y6- { hts 13 a II)mp sum PaJ II) -:!r � �rr,!i- ;€ 'lased up:m The descnhccl supe of wgrr� BIDS DUE January 17, 2013 BY 5:01) PM Base BEd Amount iL {Company Name, ISignalure, - — I.Qol a - All lntl it In N ,n cj iDNIa1 Arttntr111n'VLIIj i; Scope of Work Georgi De:=rrt=ii& I o; Tra!-sp r:=t.:;:: wi:! hegm roadway irnp•c::. :•.: lie intersctflan of 3R '4O?'Ars,n+d !,fi! RJ arts ^les. I'rUv,dr ce i;d spy .-q 2013 The exist[ 1g s;" -::r •11 11: i:1 fae'nlpactod by tho project :ls shown on the drammjL. of exisL.ng sopiL,c systcnn, proposed co`, :: i .ri;:,5 so(,bon, In Se'r Jn B 0. . part at rlajht of way-acquis.lsa;rt :I,e City of Milton corrrmtted to i-1::: - .r- ir. spsten' ❑ tt.e fire stat.,)n so tria' th(, syslem wIII be oat of if e ecn51FUC1F J -I area pnrf TO tY!e *nad-W. nxlnn,ng" 011 May 21. 23`2 Ron Wtlkimson ;.A the rulton County Haalth 7tp-,; -:I;;;C.: Ierhal okay of a s,upt.'c solution far t -e Fire Staiv it l;zJrre; :i•.at he n$a recently seer, and appiuv[_u Tl- is a:ternative- is a la*c� yraval pit that wculd serve as the drain f1 --:c for the Parcel due to ti -8 tigntriess of the area r maismg In tree fiar'o yard TRis scope of .vork wlil nclu:le the de -sign of the alterrlativ-� sec,!7-,7 �,sLc m f,- l .{ilii r ....SIC-. r:_ I,!, :al of tyle Axis;InL�- `,i)'St-�IT' i.85 rlt:ccssarry instaiWIon o'. the flew 5aptic systc-- cn'r pr0vtr{ r--r_�i•.; ': c ;DCII r?ecri uu!Itruk :.flail L= o=t {put15,L:e lul kA,Lt :ill.lrg :1 I'.. I:, :!1 1"0 General Conditions aj Cuiiwixtirrn ic,-ivity w:ttur'C49G feet Cal' an,, s ;,:'.1plr"i Ii ti ir.l ;.r rr li bta yours Of ::317 AM And r 3U Pm and Sai hetween 8'30 AM and 5,00 FIM Lonstru-.tion ar_riviiy mnr(,. than 1300 feel f orii ail ❑CCUDItd residence will he alk -wed Mor? Fli bYLvmerl the hocir5 n` ; 00 AM zvid 10 00 1 -IM ::if rd Sat hotween thu Ituurs tsf 8.30 ARA and i;:00 P.M. bi C;ilfltractor mUS11 I1JIity the city air Mi torr (6 19,, 247-2:i1;f3. hven fou s24 yours prior to beginniuy �C11Slru�tioll iii }3u6d 4f 60nELLbljCti011,, fl) ntc!iL)I? i"^.. 11nt permlttcd .m,thin t: -,n, City of NAiItur AI! r'onsircict:0IF rr,atrrgals ai„I debris within tlip work area shall be properly disposed of by thy: conuac:o: n'. C-:)I,,t3ciz!r �zt,a1: p:cvIde all nemssaIli lo No. •?q] prrrcdl-t u.Lror:c^o m:aterrr_I- Ir, pe,f!,rn1 all wofk as Jefiilerl :t ,hr.-cllc:kirig scope dtiV sc:hr:luie el Hoad'uay blial rernan acc:sssible fpr local traffic &&roil COI1Strt:M100. 2.0 Erosion and Sedirrlertt Calltrol a; Ail erosioi) IarKi t,Od r'tiellt cunt(ol work shall Oc', !)erforrruu l In accordaixe Kitl? 1.A3 sl -,.j r -L:jf d,- pe -civ :--d rn Phe Gemara Mart;al'Or Lias,on and Sedimeilt.:oridol Ir Ueo!-ria 1xtm,S[ F-dit:st� r,l Ilri-�vikwL dcwbie rov: t+f I gl 1. salt tenrr- .ttlonq ti?A drnan •;.,,,r.;= Ide n' ail disfiirhFi: are as rill himar Ii -i sliasf be In placia puix to ary iand cistui oing activities Gfl`_ frnr;ES aI'd fell na C' ii8l7"It;15 shall be CIOaf Pf] i}rrh•jliir:i r1 i•iriii 111:�17idillt:f� in fiJrl�:il:lliil. l:Vl'rClitrUll fl I�F.n 7a `C rt Gr63,C]r1 ,.tirIII U: rT1E375UlCa 0,( ti;*Ia ;sheu, A:! tilt It I'r:L7 arld Vti Lr tvn-,,*r )t j I'll r3+I �5llr�^S will. CSC mmovrn f bythE wtlet: tits s!",�- '6 5tal le 'tali reIILC robrIL sIla; i bo comprised of Gia OepaIt*n c-, tit r'` ! van spo[isl.tx 1:aI-riP,d ')M1 L! C.1 ; Suction 1 r IvpF._C Iul siIL le! Ice faf.i!ii type "A srt teneCl *�atn IC; arrci cOrlsiruc'tlVri T I i a y be a!'c:well With pr iw wl i ttc i - ,I P Pm W".I from the !j: 16 Je VAI up I 31i it ispecto;. c'1 Ir.:rtIwIa:y vt,yt:ta.ion 61'rd'0 1, e av / n'IUicIr. s.rI:l Lsr: u_i:d IIizr r3;t c 11; r,e::rJyr> sflc-il; G rte bc; Ic:ll care for m1! k [1,611 c',jI LCCr' i E ,3,y1, I No cit-.i!f1143 re,lorld the Il'"111,5 01 OlSt1"iTbarii;:0 l„}rJvfl »' '_f,t? Ar1lr6'JPi-i If -IA] :7i:- :li'r7iVOU VPEIVAil .�Ilfl3nva" r':I .i li PiovI{IP a rr'!:liinI.IT: of ii inch O`-'.ruk: Iing. Ier7 oura"i acid ver llaner1t Seer:itlij a? Ak cther.1Islu1bO,' _area= 10 utilities Tt,,e co;:[r3i [ci sitalk be reCtudred to eoare!natL ar i ;7; 3f}r7L'e ally and al::tr.ity +I Cates :31 :d c : rekcicat!nrty Vvr:hin file Scope ai his, ;�Fcjklci 4.0 Performance tai All work peifarrricu shod bca ro accordancc- wal': Fulton CouMY 11Laklls Department• c5eorrusu Depart ertt :.n ira-is1 Q.TItItrror! j11l i; fy C:I NLltr�ri L:nrYsluit. Iiori S',:;rrIi-r:l5 i i i i c.ui.[riaCl:;r •hell AdIIt--lu 1 r F]il f:uI r r I I 5[at e ar,d I edea LDnSt�:rclton Safetv requ:ati0ns. i t'.e I ud m g 051 1A iequlabortS. -Tile LjoliaetOf vvlil cm ulrll trr MIM I rl:J eid lrtE, Sii[e 0 c,evtgi;i Llvpirirlrer'r[ cil r rai 2SWrtdl•url sictiicl ii LA fur trdil i• WiW A I he i;ontrxto° vii st m wtrtn i ;arr wnrk�r:3r� inr their virnpiiiyc o -c• �Irtrr VMlir it:Ai to e41T if 11 lgal r,mr. At' %vk irlk tilli::l !'+F! kr1S fh-- I"1'i nPIL-I Npri •:)vpri F:y flip i:liy n, tc4dlirri IjPf-,?itrlFr�t of I':rh':C-- WO A E;{MIarAl in I hC CQnl!aC:l1J1 Uiil0111 tri; itoquirt td pc rllltt- It reokivect. r{Ive .;I1 noticrs anm rornpfL, ldltri rill I�1VJS 0raIna11tiL•:i, uogku::ulu6 and fcgt ulali0Iis bealiIig OlI Ii1L ::oI)duct of tI'-e wofk andel this coriLract. If Pite co:rlraclt+r ubNs 4 •ah rtvai Fhr: rar:rv.rnc: an.i arc at varancc thcrc•with- hu• shAl i-.-rrytly l!.11ily 1:1-i P. City i Cl %Arrlb11 If thL' Corluucto[ pu'-'fJwii' any work k!:S7lNrrli.] ;I 10 i PP..1,f a f fit "Ii II I LW`ti crltl anc,'-s cnrirs nice~ a?ld tcouFr)liCifltL. -010 wit+lout such notice to tha t:: -?y• rtn ;mhclil hear afi co -,-t arising t17CrC 5.0 Safely Ret{a+lt•6t1ALnt5 ,1 t he L:ontractor shall tae resrinr.EICAP far thii ent,r, Silt;- ,artia the Lft-[1011 cri ILL ! WFK: aPPJ Pluviue 011 lilt rIk�f'-r'fiti`iIY llr[itri:.t11-In`i 1IegIAire'd by law -1 o iirrl ;iiIc :� qt ) vel n111 q S"ctl Cc'IF:tltiCallS ails, as IeiliAII�rd by '_tie City i;;ilir:u,:rn !':ilarl bo rr-spoliSibio for J: mage caused of-iher dn—t:lly tir ilidii oc l-ly by h imse!i- his ocr$[:'if;ul ui''iiE $�-:f1- cow, ral=:rr!S- :3!^.d s',` = I •sake qaod such. d.qm--vjo_: Fr} T he colntiar;_tar snaU c,•u viv vwt•.:, All ("wl t nt $tam and F 7E -rat CGr75tt „i:t lil(l ScIIE y fBc]ula*Inns rr cltldinu OSI -It, r:gulclti". 41 E -i r.Z S;i,rlir l�:tiar must I)i Dinah a salF: w•'•rk cc;ne fr-•i- tt:err cl7,pi�y+_�:;. Fir_+'JC: yFriUn ar-d voh:C.riai iransp!.11ati+3n Al --murk Shall by inspected and approied ;?y the G Ity of Milton Departmoni of Pulllir• d'7 rlrC (.ontrr7r;ttiJr,rtdlE t)rovuie. 311 nec*$Sarr+ fill. Pcr�pns or: ihLa •:�urk. [:nntraulnr sha:I. c -leanly mark or post E;IgPs wa;nitay r 1,,aE- cxrgIli r•rl, and Shp 1 barrl,---=idr, cxc:r3v i.icrri� -41 id $V Hilo! Il..r.:ir:t;. l' ie chalk prole::t •3g4i'+7st Jarrlac{�: lar Int;.l:y lissaktl{7q tn�n'. Fslklrty iri:3tirlr;i:: tirlr! IIH Shall rriamlaln of p, a_ecti t c7r:v ir:rti .l'i:i tsutns ti7rout ltaut the lir.l!Irr-- is crl lfit, :vu:n 6.0 Clean-up 'Ii 4 7e C antr�r.tri sltA'l s ell tf�e 5':CeS arsl s�rrruurt :ir c; :sii::a 11.1&:ctr aWv free frn;u r:. F: l4h at all shall nt TTICM.- debris from !tie site, from lin,i: to limc, a: vllen dire -ted lr, do so Inv thr nify r3rr[t!1r: fill 2I rrrrprcholl and 31:%f r+t7nf.0 of the PfcleQt. the f-ontrar.tornhatl lhl lou ih+v uti•ari the sites and cornp42tEly repmfe ,he I„riir:[:h �i7i1 S!ttr kir utt ty tl:e City TO 5ChL''dule G, f rc,lPC. t shrirl ;:1r1 mIinn 1 c.jlrwrl;irir [icy;5 v ilio' ric,irr.:r.• Ir l I : J! v lcu!I :71anTif r a4 df�ierned hV 14 DPW, lnrithin 30 c;slendar rd-ayt� i'. -I; I.,,I. C;_ to t;rn] ecic EXHIBIT `B" Insurance Certificate ALSSE-1 OP ID: AC ,�caR►� CERTIFICATE OF LIABILITY INSURANCE 7TE04/12/1(MM/DDMYYYJ 3 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 INSURERS), 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 770479-9823 Insurance Agency Kim Fowler 770-479-2060 Kim F PO Box 886 Canton, GA 30169 NTACT CNAME:OME: PHONE FAX A1C No E><t : Aic No): E-MAIL ADDRESS: INSURE S AFFORDING COVERAGE NAIC 0 Lynn Smith INSURER A: Selective Insurance Company 12572 MAGE TO RENTEO PREMISES Ea occurrence $ 100,00 INSURED A L S Septic Systems Adam Shelquis# Elba 200 Heard Road INSURER B INSURER c Canton, GA 30114 INSURER D: INSURER E $ INSURER F: AUTOMOBILE X COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IL7R TYPE OF INSURANCE DDL SUER POLICY NUMBER POVCY EFF POLICY EXP 04/28113 LIMITS A GENERAL LIABILITY X. COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FxI OCCUR Milton, GA 30004 L# � yX X_ 1977242 04128/12 EACH OCCURRENCE $ 1,000,00 MAGE TO RENTEO PREMISES Ea occurrence $ 100,00 MED EXP (Anfone person) $ 10,08 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 3,000,00 GE"L AGGREGATE LIMIT APPLIES PER- POLICY PRO- JE TLPC PRODUCTS - COMPIOP AGG $ 3,000,80 $ A AUTOMOBILE X LIABILITY ANY AUTO SCHEDULED AUTOS AUTOS ALLOWNED Ix HIRED AUTOS NON -OWNED AUTOS 51977242 0412W12 04!28113 CCO MBIN dEeD SINGLE LIMIT $ 500,00 BODILY INJURY [Per person] $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE S Per acddent S UMBRELLA LIA13 EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE S DEC) I I RETENTION$ $ WORKERS COMPENSATIONWC AN DEMPLOYERS'LIABILnY YIN ANY PROPRIETORIPARTNERIEXECUTIVE QFFICERIMEMBER EXCLUDED? [Mandatory in NHI If yes, describe under DESCRIPTION OF OPERATIONS below N 1 A STATU- OTH- T11 FR E.L EACH ACCIDENT $ E, I. DS EASE- EA E M PLOYEE $ E. I. DISEASE- POLICY LIMIT $ I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, i! mare space Is required} CERTIFICATE HOLDER CANCELLATION C ITYM-2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci of Milton - Georgia ty g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Fax: 678-242-2499 ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Matt FailstrDm AUTHORIZED REPRESENTATIVE 13000 Deerfield Pkwy Ste. 107A Milton, GA 30004 L# � yX X_ ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD A.L.S, Septic Systems Adam Shelquist 200 Heard izd. Canton. GA 30114 I Name 1 Address i City o r.MiI[on Fire 57vtion 1267[1 Arnold Mill Rd. Estimate Date Estimate # 1/17/2013343 Description Phone # Fax # 073-8524471 678-193-9159 Project Description Riy Rafe Total Silt fence irw3lled 125 4.11[1 500.00 200 1; ol'draw field or equiti•alcnt pit gine As d'sscussod with Ronald 200 17.00 340000 Wilkinson P%'c pipe 75 5.11[1 375.00 .;"(I ,nod Straw disturbed arra 1 350.00 350,00 Permit 1 350.00 350.00 Total $4.975.00 Phone # Fax # 073-8524471 678-193-9159 CITY OF MILTON EXHIBIT"C" I'1.F-.ASF Itis; I-I.ItIV I'IIIS FORM NN I II BID Itfr.SPONSE CONTRACTOR .AF'FIDAVT1 By cv.ctaina 06,, allidatil. Ihk• ulyda• ignt.•J contraoor %oifim its conyliurwe with 0-( -C.-A. ; 13-10-9L st nk:t_ :11141l:I Ndy [hat [he tndi[iduaL 11rntor �%hlch i� cnguurd rls Ilse p klikrad pull-CoIntmlcr of ur%I:.:< under a :,�I'Ifacl s' it II (u:lrn, of ComrICI00 i+n hc11:i1! Of 11h: {_'iI: mf Milkon hu:; ri!i>lcrcd %lith am I1duII[114ai1I1�; M a iWOL11 ur1k 111V llppll"tbnilty lintcllinrs ��lahh�llc[E in [?-C'.CI t. ti l.i-11)-+11. I_I-A' 13usi, Pil0l i'rt,wl,u11 l .C•, liirllli!7c0641 hi+wl:rr 131 : Au[horizcd 01liuci c+l Avwol Dobk Iitl� „t':Autktini�.�:cl [7Ylitrr �sr •lecllr ��i [ +�niract�+[ 1'rimixi Nil knc of Awhori�,cd [ ]f[icvr[lr Agc 111 St l3tii-'KMLD ANL) ti11'0RN 11t.1 ORF MF. ON 11IN I}If_ UAY of '_[II STATE OF GEORGIA CITY OF MILTON EXHIBIT "U' SUBCONTRACTOR AFFIDAVIT By executing this affidavit, the undersigned subcontractor verifies its compliance with O.C.G.A. § 13-10- 91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services under a contract with ALS Septic Systems on behalf of the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. EEV 1 Basic Pilot Program User Identification Number BY: Authorized Officer or Agent Date (Subcontractor Name) Title of Authorized Officer or Agent of Subcontractor Printed Name of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF , 241 Notary Public My Commission Expires: STATE OF GEORGIA CITY OF MILTON EXHIBIT "E" SAVE AFFIDAVIT By executing this affidavit under oath, and as an applicant for a public benefit, as referenced in O.C.G.A. § 50-36-1, from the City of Milton, the undersigned applicant verifies one of the following with respect to my application for a public benefit: I ) �4 I am a United States citizen. 2) I am a legal permanent resident of the United States. 3) I am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an alien number issued by the Department of Homeland Security or other federal immigration agency. My alien number issued by the Department of Homeland Security or other federal immigration agency is: The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at least one secure and verifiable document, as required by O.C.G.A. § 50-36-1(e)(1), with this affidavit. The secure and verifiable document provided with this affidavit can best be classified as: In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A. § 16-10-20, and face criminal penalties as allowed by such criminal statute. Executed in (-o+n �0"-) (city), c-4 (state). Signature of Applicark AAte 4� Printed Name of Applica t SUBSCRIBED AND SWORN BEFORE ME ON THIS THE A DAYOFAIpril 1201 ll �� `<<titiiINryrr iTARY PUBLIC 4p,�ES My Commission Expires: �j b g 'V OF HOME OF `THE BE3 F QUALITY OF LIFE IN GEORGIA' M I LTONI ES-TABUSHED'1606 TO: City Council CITY COUNCIL AGENDA ITEM DATE: April 29, 2013 FROM: City Manager AGENDA ITEM: Approval of a Construction Services Agreement between the City of Milton and Baldwin Paving Company, Inc. for Intersection Improvements at Deerfield Parkway and Morris Road. MEETING DATE: Monday, May 6, 2013 Regular City Council Meeting. BACKGROUND INFORMATION: (Attach additional pages if necessary) See attached memorandum APPROVAL BY CITY MANAGER: {APPROVED CI TY A TTORNEY APPRO VAL REQUIRED. ( YES CITY A TTORNEY REVIEW REQUIRED: YES APPROVAL B Y CITY A TTORNEY (XAPPRO VED PLACED ON AGENDA FOR: () 7 0(o 13 REMARKS: () NOT APPROVED () NO .'/Mei ..../ i M a' i s PHONE; 57$.242.2500 I FAX: 678.242.2494 G 1 Commun�t e�[ Or *Ce rifi,d Ctry of � � infaQcityafmiltonga.us I www.e€tyofm€ltonga.us W sasne+na lgey l ro sustanac7e +v:.:g Y 13000 Deerfield Parkway, Suite 107 1 Milton GA 30004 — CERTIFIED BRONZE — To: Honorable Mayor and City Council Members From: Carter Lucas, PE – Public Works Director Date: Submitted on April 25, 2013 for the May 6, 2013 Regular Council Meeting Agenda Item: Approval of a Construction Services Agreement between the City of Milton and Baldwin Paving Company, Inc. for Intersection Improvements at Deerfield Parkway and Morris Road ______________________________________________________________________________ Department Recommendation: Approval. Executive Summary: The primary need for the project is to provide intersection improvements at the intersection of Deerfield Parkway and Morris Road as a result of recent and proposed roadway improvements in the area. The current intersection warrants a signal due to the volume of the left turns from westbound Morris Road to southbound Deerfield Parkway. Increasing traffic volumes are anticipated with the completi on of Westside Parkway which provides a parallel route to both GA400 and State Route 9. The proposed additional northbound through lane to be added on Westside Parkway/Deerfield Parkway at Windward Parkway will increase the northbound capacity at that inte rsection allowing additional traffic at the Deerfield Parkway-Morris Road intersection. In accordance with the city procurement procedures an invitation to bid was issued to secure a qualified contractor to complete this project. The city received five bids on the project and Baldwin Paving Company, Inc. was determined to be the lowest reliable bidder. Staff is recommending approval of a Construction Services Agreement with Baldwin Paving Company, Inc. in the amount of $339,955.52. Table 1. Bid Tabulation. Firm Bid Baldwin Paving Company $339,955.52 Blount Construction $349,000.00 Scott and Sons Holding $356,500.00 CMC Inc. $384,927.00 Johnson Landscapes $385,775.00 Page 2 of 2 Funding and Fiscal Impact: Funding for this project is available in the capital grant fund Infrastructure/Deerfield@Morris fund. Alternatives: None. Legal Review: Paul Higbee – Jarrard & Davis (4-25-2013) Concurrent Review: Chris Lagerbloom, City Manager Attachment(s): Construction Services Agreement HOME OF 'Ti IE BEST QUALITY OF LIFE IN GEORGIA' MILTON ESTABLISHED 2006 CONSTRUCTION SERVICES AGREEMENT FOR DEERFIELD PARKWAY -MORRIS ROAD INTERSECTION IMPROVEMENTS This Agreement (the "Agreement") to provide intersection improvements is made and entered into this _ day of , 2013, by and between the CITY OF MILTON, a municipal corporation of the State of Georgia, acting by and through its governing authority, the Milton City Council (hereinafter referred to as the "City"), Baldwin Paving Company, Inc., a Georgia corporation with its principal place of business located at 1014 Kenmill Dr NW, Marietta, Georgia 30060-7911 (hereinafter referred to as the "Contractor"). WITNESSETH: WHEREAS, the City issued an Invitation to Bid for the Deerfield Parkway at Morris Road Intersection Improvements; and WHEREAS, based upon Contractor's bid to construct the intersection improvements as required by the bid documents, the City has selected Contractor as the winning bidder, and WHEREAS, Contractor has agreed to perform such work as set forth in this Agreement, according to the terms and conditions provided in this Agreement; and WHEREAS, Contractor has familiarized itself with the nature and extent of the Contract Documents, the Project, and the Work, with all local conditions and federal, state and local laws, ordinances, rules and regulations in any manner that may affect cost, progress or performance of work, and Contractor is aware that he must be licensed to do business in the State of Georgia. NOW THEREFORE, the City and Contractor, in consideration of the mutual promises contained herein and other good and valuable consideration, the sufficiency of which is hereby acknowledged, agree as follows: Section 1 Contract Documents The following documents are incorporated herein by reference and constitute the Contract Documents: A. This Agreement (18 Pages); B. Invitation to Bid ITB (54 Pages), attached hereto as Exhibit "A"; Project within 180 calendar days from the date of Notice to Proceed. Every effort will be made by Contractor to shorten this period. Section 5 Contractor's Compensation; Time and Method of Payment A. The total amount paid under this Agreement shall not, in any case, exceed $339,955.52, except as outlined in Section 6 below. City agrees to pay the Contractor for the work upon certification by the City that the Work was actually performed and costs actually incurred in accordance with the Agreement. This amount shall include all use, lease, or other taxes, and all expenses for personnel and equipment (including fuel) that Contractor will incur to provide the Work. Unless otherwise agreed in writing signed by both Parties, the compensation payable by the City to Contractor is limited to the price amount set forth in the Bid Submittal Form, and City will not pay any other sum attributable to taxes, costs or expenses that Contractor may incur in providing the Work. B. Compensation for Work performed shall be paid to the Contractor upon receipt and approval by the City of invoices setting forth in detail the Work performed. Invoices shall be submitted on a monthly basis, and such invoices shall reflect charges incurred versus charges budgeted. Each invoice shall be accompanied by an Interim Waiver and Release upon Payment (or a Waiver and Release upon Final Payment in the case of the invoice for final payment) procured by the Contractor from all subcontractors in accordance with O.C.G.A. § 44-14-366. C. As long as the gross value of the completed work is less than 50% of the total contract amount and/or when satisfactory progress has not been achieved by the Contractor during any period for which payment is to be made, the City may retain a percentage of said payment, not to exceed ten percent (10%) of the maximum Contract Price to ensure performance of the Agreement. Said cause and progress shall be determined by the City, in its sole discretion, based on its assessment of any past performance of the Contractor and likelihood that such performance will continue. Upon completion of all contract requirements, retained amounts shall be paid promptly less any offsets or deductions authorized hereunder or by law. D. Any material deviations in tests or inspections performed, times or locations required to complete such tests or inspections and like deviations from the Work described in this Agreement shall be clearly communicated to the City before charges are incurred and shall be handled through change orders or construction change directives as described in Section 6 below. All invoices should be submitted to Rick Pearce (Budget and Procurement Coordinator), for approval. The City shall pay the Contractor within thirty (30) days after approval of the invoice by the City. No payments will be made for unauthorized work. Payment will be sent to the designated address by U.S. Mail only; payment will not be hand -delivered. E. The City may withhold payment or final payment for reasons including, but not limited to, the following: unsatisfactory job performance or progress, defective work, disputed work, failure to comply with material provisions of the Agreement, third party claims filed or reasonable evidence that a claim will be filed or other reasonable cause. Section 6 Work Changes A. The City reserves the right to order changes in the Work to be performed under this Agreement by altering, adding to, or deducting from the Work. All such changes shall be incorporated in written change orders executed by the Contractor and the City. Such change orders shall specify the changes ordered and any necessary adjustment of compensation and completion time. If the Parties cannot reach an agreement on the terms for performing the changed work within a reasonable time to avoid delay or other unfavorable impacts as determined by the City in its sole discretion, the City shall have the right to determine reasonable terms and the Contractor shall proceed with the changed work. B. Any work added to the scope of this Agreement by a change order shall be executed under all the applicable conditions of this Agreement. No claim for additional compensation or extension of time shall be recognized, unless contained in a written change order duly executed on behalf of the City and the Contractor. C. The City Manager has authority to execute without further action of the Milton City Council, any number of change orders so long as their total effect does not materially alter the terms of this Agreement or materially increase the total amount to be paid under this Agreement. Any such change orders materially altering the terms of this Agreement or increasing the total amount to be paid under this Agreement in excess of $50,000, must be approved by resolution of the Milton City Council. Section 7 Covenants of Contractor. A. Ethics Code Contractor agrees that it shall not engage in any activity or conduct that would be in violation of the City of Milton Code of Ethics. B. Time is of the Essence Contractor specifically acknowledges that TIME IS OF THE ESSENCE for completion of the Project. 4 C. Expertise of Contractor Contractor accepts the relationship of trust and confidence established between it and the City, recognizing that the City's intention and purpose in entering into this Agreement is to engage an entity with the requisite capacity, experience, and professional skill and judgment to provide the services in pursuit of the timely and competent completion of the Work undertaken by Contractor under this Agreement. D. Buddy Limitations Contractor agrees and acknowledges that budgetary limitations are not a justification for breach of sound principals of Contractor's profession and industry. Contractor shall take no calculated risk in the performance of the Work. Specifically, Contractor agrees that, in the event it cannot perform the Work within the budgetary limitations established without disregarding sound principals of Contractor's profession and industry, Contractor will give written notice immediately to the City. E. CiV's Reliance on the Work The Contractor acknowledges and agrees that the City does not undertake to approve or pass upon matters of expertise of the Contractor and that; therefore, the City bears no responsibility for Contractor's services performed under this Agreement. The Contractor acknowledges and agrees that the acceptance of Work by the City is limited to the function of determining whether there has been compliance with what is required to be produced under this Agreement. The City will not, and need not, inquire into adequacy, fitness, suitability or correctness of Contractor's performance. Contractor further agrees that no approval of designs, plans, specifications, or work by any person, body or agency shall relieve Contractor of the responsibility for adequacy, fitness, suitability, and correctness of Contractor's professional and industry standards or for performing services under this Agreement in accordance with sound and accepted professional and industry principals. F. Contractor's Reliance of Submissions by the City Contractor must have timely information and input from the City in order to perform the services required under this Agreement. Contractor is entitled to rely upon information provided by the City, but Contractor shall be required to provide immediate written notice to the City if Contractor knows or reasonably should know that any information provided by the City is erroneous, inconsistent, or otherwise problematic. G. Contractor's Representative shall be authorized to act on Contractor's behalf with respect to the Work as Contractor's designated representative. H. Assignment of Agreement The Contractor covenants and agrees not to assign or transfer any interest in, nor delegate any duties of this Agreement, without the prior express written consent of the City. Responsibility of Contractor and Indemnification of City The Contractor covenants and agrees to take and assume all responsibility for the services rendered in connection with this Agreement. The Contractor shall bear all losses and damages directly or indirectly resulting to it on account of the performance or character of the services rendered pursuant to this Agreement. Contractor shall defend, indemnify and hold harmless the City, its officers, boards, commissions, elected and appointed officials, employees and agents from and against any and all claims, suits, actions, liability, judgments, damages, losses, and expenses, including but not limited to, attorney's fees, which may be the result of willful, negligent or tortuous conduct arising out of the Work, performance of contracted services, or operations by the Contractor, any subcontractor, anyone directly or indirectly employed by the Contractor or subcontractor or anyone for whose acts the Contractor or subcontractor may be liable, regardless of whether or not the negligent act is caused in part by a party indemnified hereunder. Such obligation shall not be construed to negate, abridge, or otherwise reduce any other right or obligation of indemnity which would otherwise exist as to any party or person described in this provision. In any and all claims against the City or any of its agents or employees, by any employee of the Contractor, any subcontractor, anyone directly or indirectly employed by the Contractor or subcontractor or anyone for whose acts the Contractor or subcontractor may be liable, the indemnification obligation set forth in this provision shall not be limited in any way by any limitation on the amount or type of damages, compensation or benefits payable by or for the Contractor or any subcontractor under workers' or workmen's compensation acts, disability benefit acts or other employee benefit acts. This obligation to indemnify and defend the City, its members, officers, agents, employees and volunteers shall survive termination of this Agreement. Contractor shall not be required to indemnify the City or its officers, boards, commissions, elected or appointed officials, employees or agents against liability or claims for damages, losses, or expenses, 0 including attorney fees, arising out of bodily injury to persons, death, or damage to property caused by or resulting from the sole negligence of the City or its officers, boards, commissions, elected or appointed officials, employees or agents. J. Independent Contractor Contractor hereby covenants and declares that it is engaged in an independent business and agrees to perform the services as an independent contractor and not as the agent or employee of the City. The Contractor agrees to be solely responsible for its own matters relating to the time and place the services are performed; the instrumentalities, tools, supplies and/or materials necessary to complete the services; hiring of Contractors, agents or employees to complete the services; and the payment of employees, including compliance with Social Security, withholding and all other regulations governing such matters. The Contractor agrees to be solely responsible for its own acts and those of its subordinates, employees, and subcontractors during the life of this Agreement. Any provisions of this Agreement that may appear to give the City the right to direct Contractor as to the details of the services to be performed by Contractor or to exercise a measure of control over such services will be deemed to mean that Contractor shall follow the directions of the City with regard to the results of such services only. The Contractor shall obtain and maintain, at the Contractor's expense, all permits, licenses, or approvals that may be necessary for the performance of the services. The Contractor shall furnish copies of all such permits, licenses, or approvals to the City of Milton Representative within ten (10) days after issuance. Inasmuch as the City of Milton and the Contractor are contractors independent of one another neither has the authority to bind the other to any third person or otherwise to act in any way as the representative of the other, unless otherwise expressly agreed to in writing signed by both parties hereto. The Contractor agrees not to represent itself as the City's agent for any purpose to any party or to allow any employee of the Contractor to do so, unless specifically authorized, in advance and in writing, to do so, and then only for the limited purpose stated in such authorization. The Contractor shall assume full liability for any contracts or agreements the Contract enters into on behalf of the City of Milton without the express knowledge and prior written consent of the City. K. Insurance (1) Requirements: The Contractor shall have and maintain in full force and effect for the duration of this Agreement, insurance insuring against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the Work by the Contractor, its agents, representatives, employees or subcontractors. All policies shall be subject to approval by the City Attorney to form and 7 content. These requirements are subject to amendment or waiver if so approved in writing by the City Manager. (2) Minimum Limits of Insurance: Contractor shall maintain limits no less than: (a) Comprehensive General Liability of $1,000,000 combined single limit per occurrence for bodily and personal injury, sickness, disease or death, injury to or destruction of property, including loss of use resulting there from. (b) Comprehensive Automobile Liability (owned, non -owned, hired) of $1,000,000 combined single limit per occurrence for bodily and personal injury, sickness, disease or death, injury to or destruction of property, including loss of use resulting there from. (c) Professional Liability of $1,000,000 limit for claims arising out of professional services caused by the Contractor's errors, omissions, or negligent acts. (d) Workers' Compensation limits as required by the State of Georgia and employers Liability limits of $1,000,000 per accident. (3) Deductibles and Self -Insured Retentions: Any deductibles or self-insured retentions must be declared to and approved by the City. (4) Other Insurance Provisions: The policy is to contain, or be endorsed to contain, the following provisions: (a) General Liability and Automobile Liability Coverage. (i) The City, its officials, employees, agents and volunteers are to be covered as insured as respects: liability arising out of activities performed by or on behalf of the Contractor; products and completed operations of the Contractor; premises owned, leased, or used by the Contractor; automobiles owned, leased, hired, or borrowed by the Contractor. The coverage shall contain no special limitations on the scope of protection afforded to the City, its officials, employees, agents or volunteers. (ii) The Contractor's insurance coverage shall be primary noncontributing insurance as respects to any other insurance or self-insurance available to the City, its officials, employees, agents or volunteers. Any insurance or self-insurance maintained by the City, its officials, 8 employees or volunteers shall be excess of the Contractor's insurance and shall not contribute with it. (iii) Any failure to comply with reporting provisions of the policies shall not affect coverage provided to the City, its officials, employees, agents or volunteers. (iv) Coverage shall state that the Contractor's insurance shall apply separately to each insured against whom claim is made or suit is brought, except with respect to the limits of the insurer's liability. (v) Coverage shall be provided on a "pay on behalf' basis, with defense costs payable in addition to policy limits. There shall be no cross liability exclusion. (vi) The insurer agrees to waive all rights of subrogation against the City, its officials, employees, agents and volunteers for losses arising from work performed by the Contractor for the City. (vii) All endorsements to policies shall be executed by an authorized representative of the insurer. (b) Workers' Compensation Coverage: The insurer will agree to waive all rights of subrogation against the City, its officials, employees, agents and volunteers for losses arising from work performed by the Contractor for the City. (c) All Coverages: (i) Each insurance policy required by this clause shall be endorsed to state that coverage shall not be suspended, voided, canceled, reduced in coverage or in limits except after thirty (30) days prior written notice by certified mail, return receipt requested, has been given to the City. (ii) Policies shall have concurrent starting and ending dates. (iii) Policies shall include an endorsement incorporating the Indemnification obligations assumed by the Contractor under the terms of this Agreement, including but not limited to Section 7(I) of this Agreement. (iv) Policies shall include an endorsement incorporating the Indemnification obligations assumed by the Contractor E under the terms of this Agreement, including but not limited to Section 7(I) of this Agreement. (5) Acceptability of Insurers: Insurance is to be placed with insurers with an A.M. Bests' rating of no less than A: VII. (6) Verification of Coverage: Contractor shall furnish the City with certificates of insurance and endorsements to the policies evidencing coverage required by this clause prior to the start of work. The certificates of insurance and endorsements for each insurance policy are to be signed by a person authorized by that insurer to bind coverage on its behalf. The certificate of insurance and endorsements shall be on a form utilized by Contractor's insurer in its normal course of business and shall be received and approved by the City prior to execution of this Agreement by the City. The City reserves the right to require complete, certified copies of all required insurance policies, at any time. The Contractor shall provide proof that any expiring coverage has been renewed or replaced at least two (2) weeks prior to the expiration of the coverage. (7) Subcontractors: Contractor shall include all subcontractors as insured under its policies or shall furnish separate certificates and endorsements for each subcontractor. All coverage for subcontractors shall be subject to all of the requirements stated in this Agreement, including but not limited to naming the parties as additional insured. (8) Claims -Made Policies: Contractor shall extend any claims -made insurance policy for at least six (6) years after termination or final payment under the Agreement, whichever is later. (9) City as Additional Insured and Loss Patiee: The City shall be named as an additional insured and loss payee on all policies required by this Agreement. L. Employment of Unauthorized Aliens Prohibited (1) E -Verify Affidavits It is the policy of the City of Milton that unauthorized aliens shall not be employed to perform work on City contracts involving the physical performance of services. Therefore, the City shall not enter into a contract for the physical performance of services within the State of Georgia, unless the Contractor shall provide evidence on City -provided forms, attached hereto as Exhibits "E" and "F" that it and Contractor's subcontractors have within the previous twelve (12) month period conducted a verification of the social security numbers of all employees who will perform work on the City contract to ensure that no 10 unauthorized aliens will be employed. The City Manager or his/her designee shall be authorized to conduct an inspection of the Contractor's and Contractor's subcontractors' verification process to determine that the verification was correct and complete. The Contractor and Contractor's subcontractors shall retain all documents and records of its verification process for a period of three (3) years following completion of the contract. This requirement shall apply to all contracts for the physical performance of services where more than three (3) persons are employed on the City contract. The City Manager or his/her designee shall further be authorized to conduct periodic inspections to ensure that no City Contractor or Contractor's subcontractors employ unauthorized aliens on City contracts. By entering into a contract with the City, the Contractor and Contractor's subcontractors agree to cooperate with any such investigation by making its records and personnel available upon reasonable notice for inspection and questioning. Where a Contractor or Contractor's subcontractors are found to have employed an unauthorized alien, the City Manager or his/her designee may order the Contractor to terminate or require its subcontractor to terminate that person's employment immediately and to report same to the Department of Homeland Security. The Contractor's failure to terminate the employee, or otherwise cooperate with the investigation may be sanctioned by termination of the contract, and the Contractor shall be liable for all damages and delays occasioned by the City thereby. Compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300-10-1-.02 is mandatory. Contractor agrees that, in the event the Contractor employs or contracts with any subcontractor(s) in connection with this Agreement, the Contractor will secure from the subcontractor(s) such subcontractor(s') indication of the above employee -number category that is applicable to the subcontractor. Contractor's compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300-10-1-.02 shall be attested by the execution of the contractor's affidavit attached as Exhibit "E." The above requirements shall be in addition to the requirements of State and federal law, and shall be construed to be in conformity with those laws. (2) SAVE Affidavit and Secure Verifiable Document Pursuant to O.C.G.A. § 50-36-1, the City must obtain a SAVE Affidavit and a secure and verifiable document evidencing the Contractor's legal status in the Country each time that Contractor obtains a public benefit, including any contract, from the City. Contractor hereby verifies that it has, prior to executing this Agreement, executed a SAVE Affidavit (to be sworn under oath under 11 criminal penalty of false swearing pursuant to O.C.G.A. § 16-10-71), a form of which is attached hereto as Exhibit "G", and submitted such affidavit to the City in person, electronically, or by mail. Further, Contractor verifies that it has, prior to executing this Agreement, submitted a secure and verifiable document, evidencing the Contractor's legal status, to the City either in person or electronically (in compliance with the Uniform Electronic Transactions Act). Contractor verifies that it is in compliance with the Residency Status of an Applicant for Public Benefit, as required by the Georgia Security and Immigration Compliance Act (O.C.G.A. § 50-36-1). M. Records, Reports and Audits (1) Records: (a) Records shall be established and maintained by the Contractor in accordance with requirements prescribed by the City with respect to all matters covered by this Agreement. Except as otherwise authorized, such records shall be maintained for a period of three years from the date that final payment is made under this Agreement. Furthermore, records that are the subject of audit findings shall be retained for three years or until such audit findings have been resolved, whichever is later. (b) All costs shall be supported by properly executed payrolls, time records, invoices, contracts, or vouchers, or other official documentation evidencing in proper detail the nature and propriety of the charges. All checks, payrolls, invoices, contracts, vouchers, orders or other accounting documents pertaining in whole or in part to this Agreement shall be clearly identified and readily accessible. (2) Reports and Information: Upon request, the Contractor shall furnish to the City any and all statements, records, reports, data and information related to matters covered by this Agreement in the form requested by the City. (3) Audits and Inspections: At any time during normal business hours and as often as the City may deem necessary, there shall be made available to the City for examination all records with respect to all matters covered by this Agreement. The Contractor will permit the City to audit, examine, and make excerpts or transcripts from such records, and to audit all contracts, invoices, materials, payrolls, records of personnel, conditions of employment and or data relating to all matters covered by this Agreement. N. Conflicts of Interest Contractor agrees that it shall not engage in any activity or conduct that would 12 result in a violation of the City of Milton Code of Ethics. O. Confidentiality Contractor acknowledges that it may receive confidential information of the City and that it will protect the confidentiality of any such confidential information and will require any of its subcontractors, consultants, and/or staff to likewise protect such confidential information. The Contractor agrees that confidential information it receives or such reports, information, opinions or conclusions that Contractor creates under this Agreement shall not be made available to, or discussed with, any individual or organization, including the news media, without prior written approval of the City. The Contractor shall exercise reasonable precautions to prevent the unauthorized disclosure and use of City information whether specifically deemed confidential or not. P. Licenses. Certifications and Permits The Contractor covenants and declares that it has obtained all diplomas, certificates, licenses, permits or the like required of the Contractor by any and all national, state, regional, county, local boards, agencies, commissions, committees or other regulatory bodies in order to perform the services contracted for under this Agreement. All work performed by Contractor under this Agreement shall be in accordance with applicable legal requirements and shall meet the standard of quality ordinarily expected of competent professionals. Q. jRESERVEDI R. Authority to Contract The Contractor covenants and declares that it has obtained all necessary approvals of its board of directors, stockholders, general partners, limited partners or similar authorities to simultaneously execute and bind Contractor to the terms of this Agreement, if applicable. S. Ownership of Work All reports, designs, drawings, plans, specifications, schedules, work product and other materials prepared or in the process of being prepared for the services to be performed by the Contractor ("materials") shall be the property of the City and the City shall be entitled to full access and copies of all such materials. Any such materials remaining in the hands of the Contractor or subcontractor upon completion or termination of the work shall be delivered immediately to the City. The Contractor assumes all risk of loss, damage or destruction of or to such materials. If any materials are lost, damaged or destroyed before final delivery to the City, the Contractor shall replace them at its own expense. Any and all 13 copyrightable subject matter in all materials is hereby assigned to the City and the Contractor agrees to execute any additional documents that may be necessary to evidence such assignment. T. Meetings The Contractor is required to meet with the City's personnel, or designated representatives, to resolve technical or contractual problems that may occur during the term of the contract, at no additional cost to the City. Meetings will occur as problems arise and will be coordinated by the City. The Contractor will be given a minimum of three full working days notice of meeting date, time, and location. Face-to-face meetings are desired. However, at the Contractor's option and expense, a conference call meeting may be substituted. Consistent failure to participate in problem resolution meetings, two consecutive missed or rescheduled meetings, or to make a good faith effort to resolve problems, may result in termination of the contract. Section 8 Covenants of the City A. Right of Entry The City shall provide for right of entry for Contractor and all necessary equipment along the Bethany Bend Road right-of-way, in order for Contractor to complete the Work. B. City's Representative Matt Fallstrom shall be authorized to act on the City's behalf with respect to the Work as the City's designated representative Section 9 Warranty Except as may be otherwise specified or agreed, the Contractor shall repair all defects in materials, equipment, or workmanship appearing within one year from the date of Final Completion of the Project at no additional cost to the City. An inspection shall be conducted by the City or its representative(s) near the completion of the one-year general warranty period to identify any issues that must be resolved by the Contractor. Section 10 Termination A. The City may terminate this Agreement for convenience at any time upon written notice to Contractor. In the event of a termination for convenience, Contractor shall take immediate steps to terminate work as quickly and effectively as possible and shall terminate all commitments to third -parties unless otherwise instructed by the City. Provided that no damages are due to the City for Contractor's failure to perform in accordance with this Agreement, the City shall 14 pay Contractor for work performed to date in accordance with Section 5 herein. The City shall have no further liability to Contractor for such termination. B. The City may terminate this Agreement for cause if Contractor breaches any material provision of this Agreement. The City shall give Contractor seven (7) days written notice of its intent to terminate the Agreement and the reasons therefore, and, if Contractor, or its Surety, fails to cure the default within that period, the termination shall take place without further notice. The City shall then make alternative arrangements for completion of the Project and deduct the cost of completion from the unpaid Contract Price. The City will make no payment to the Contractor or its Surety until all costs of completing the Project are paid. If the unpaid balance of the amount due the Contractor, according to this agreement, exceeds the cost of finishing the Project, the Contractor or its Surety will receive the applicable funds due. If the costs of completing the Project exceed the unpaid balance, the Contractor or its Surety will pay the difference to the City. C. If the City terminates this Agreement for cause, and it is later determined that the City did not have grounds to do so, the termination will be treated as a termination for convenience under the terms of this Section (A) above. D. Upon termination, the Contractor shall: (1) promptly discontinue all services affected, unless the notice directs otherwise; and (2) promptly deliver to the City all data, drawings, reports, summaries, and such other information and materials as may have been generated or used by the Contractor in performing this Agreement, whether completed or in process, in the form specified by the City. E. The rights and remedies of the City and the Contractor provided in this Section are in addition to any other rights and remedies provided under this Agreement or at law or in equity. Section 11 Miscellaneous A. Complete Agreement. This Agreement contains all of the understandings and agreements of whatsoever kind and nature existing between the parties hereto with respect to the subject matter contained herein. B. Governing Law. This Agreement shall be governed by and construed under the laws of the State of Georgia. C. Counterparts. This Agreement may be executed in any number of counterparts, each of which shall be deemed to be an original, but all of which together shall constitute one and the same instrument. D. Invalidity of Provisions. Should any part of this Agreement for any reason be declared by any court of competent jurisdiction to be invalid, such decision shall not affect the validity of any remaining portion, which remaining portion shall 15 continue in full force and effect as if this Agreement had been executed with the invalid portion hereof eliminated, it being the intention of the parties that they would have executed the remaining portion of this Agreement without including any such part, parts or portions which may for any reason be hereafter declared invalid. E. Notice. All notices requests, demands and other communications hereunder shall be in writing and shall be deemed received, and shall be effective when personally delivered or on the third day after the postmark date when mailed by certified mail, postage prepaid, return receipt requested or upon actual delivery when sent via national overnight commercial carrier to the parties at the addresses given below, unless a substitute address shall first be furnished to the other parties by written notice in accordance herewith: NOTICE TO CITY shall be sent to: City of Milton Attn: City Manager 13000 Deerfield Parkway, Suite 107F Milton, Georgia 30004 NOTICE TO CONTRACTOR shall be sent to: Baldwin Paving Company, Inc. Attn: Mike Demery 1014 Kenmill Drive NW Marietta, Georgia, 30060 F. Sovereign Immunity. Nothing contained in this Agreement shall be construed to be a waiver of the City's sovereign immunity or any individual's qualified good faith or official immunities. G. Force Majeure. Neither the City nor Contractor shall be liable for their respective non -negligent or non -willful failure to perform or shall be deemed in default with respect to the failure to perform (or cure a failure to perform) any of their respective duties or obligations under this Agreement or for any delay in such performance due to: (i) any cause beyond their respective reasonable control; (ii) any act of God; (iii) any change in applicable governmental rules or regulations rendering the performance of any portion of this Agreement legally impossible; (iv) earthquake, fire, explosion or flood; (v) strike or labor dispute, excluding strikes or labor disputes by employees and/or agents of Contractor; (vi) delay or failure to act by any governmental or military authority; or (vii) any war, hostility, embargo, sabotage, civil disturbance, riot, insurrection or invasion. In such event, the time for performance shall be extended by an amount of time equal to the 16 period of delay caused by such acts and all other obligations shall remain intact. H. Headings. All headings herein are inserted only for convenience and ease of reference and are not to be considered in the construction or interpretation of any provision of this Agreement. I. Nondiscrimination. In accordance with Title VI of the Civil Rights Act, as amended, 42 U.S.C. § 2000d, section 303 of the Age Discrimination Act of 1975, as amended, 42 U.S.C. § 6102, section 202 of the Americans with Disabilities Act of 1990, 42 U.S.C. § 12132, and all other provisions of Federal law, the Consultant agrees that, during performance of this Agreement, Consultant, for itself, its assignees and successors in interest, will not discriminate against any employee or applicant for employment, any subcontractor, or any supplier because of race, color, creed, national origin, gender, age or disability. In addition, Consultant agrees to comply with all applicable implementing regulations and shall include the provisions of this Section IV(R) in every subcontract for services contemplated under this Agreement. IN WITNESS WHEREOF, the parties have caused this Agreement to be executed under seal as of the date first above written. [SIGNATURES ON FOLLOWING PAGE] 17 SIGNED, SEALED, AND DELIVERED In the presence of: `Witness\ (Corporate Secretary should attest) Print Name Notary P lic [NOTARY SEAL] My Commission Expires: Baldwin Paving�Cmpany, Inc. Sigrre / Print Name Title [AFFIX CORPORATE SEAL] %%t 11tlIj" i %%% W H Eq T� �'•. Qom.pT A,g..;dp EXPIRES GEORGIA►' "s :. AUG. 2, 2014 i s ' �''•1'UB1.1C''�.� CC'' - • "Of Z K C0\3 .•` MILTON CITY COUNCIL: Joe Lockwood, Mayor SIGNED, SEALED, AND DELIVERED In the presence of: Witness Notary Public [NOTARY SEAL] My Commission Expires: 18 [CITY SEAL] EXHIBIT "A" REQUEST FOR BID HOME OF 'THE BEST QUALITY OF LIFE IN GEORGIA' MILTON* ESTABLISHED 2006 CITY OF MILTON INVITATION TO BID (THIS IS NOT AN ORDER) Bid Number: Project Name: 13-PW5 f Deerfield Parkway at Morris Road Intersection Improvements Due Date and Time: April 2, 2013 Number of Pages: 54 Local Time: 2:00 m ISSUING DEPARTMENT INFORMATION Issue Date: March 4, 2013 City of Milton Phone: 678-242-2500 Public Works Department Fax: 678-242-2499 13000 Deerfield Pkwy, Suite 107G Website: www.citvofmiltonga.us Milton, Ga. 30004 _ INSTRUCTIONS TO BIDDERS Return Submittal to: Mark Face of Envelope/Package: Bidder Phone Number: Bid Number: 13-PW5 City of Milton Name of Company or Firm Special Instructions• Attn: Rick Pearce, Purchasing Office Deadline for Written Questions 13000 Deerfield Pkwy March 15, 2013 Suite 107G Email questions to Rick Pearce at Milton, Ga. 30004 rick.nearce(a,cityofmiltonga.us IMPORTANT: SEE STANDARD TERMS AND CONDITIONS BIDDERS MUST COMPLETE THE FOLLOWING Bidder Name/Address: Authorized Bidder Signatory: Please print name and sign in in Bidder Phone Number: Bidder FAX Number: Bidder Federal I.D. Number: Bidder E-mail Address: BIDDERS MUST RETURN THIS COVER SHEET WITH BID RESPONSE ©, Vous' '� ,� �- -Green .v * C.en,fie ; PHONE: 678.242.2500 FAX: 678.242.2499 GOIIYtlll11t1�ty City of in1o@cltyofm1Itong0.us www.cflyofmiltonga.us �,, a „� �g„ns�,� - 7 Ethics 13000 Deerfield Parkway, Suite 107 1 Milton GA 30004 - CERTIFIED BfIONZE -- �B�L 2 1 ITB 13-PW5 Table of Contents Topic Page Invitation to Bid 3 Introduction 5 Bidding Instructions 6 Insurance Requirements 6 Bonding Requirements 6 Bid Submittal Form 8 Addenda Acknowledgement 9 Bid Bond 10 Qualifications Signature and Certification 13 List of Subcontractors 14 Bid Price Certification 15 Disclosure Form 16 Contractor Affidavit Exhibit' F" (everify) 17 Schedule of Events 18 Project Specifications 19 Sample Construction Agreement 28 3 1 ITB 13-PW5 CITY OF MILTON Purchasing Division Invitation to Bid Number: 13-PW5 Deerfield Parkway at Morris Road Intersection Improvements The City of Milton is accepting sealed bids from qualified firms for an Intersection Improvement Project for the Public Works Department in conformance with Title 32, Chapter 4, Article 4, Part 2 of the Official Code of Georgia Annotated. All work will be done in accordance with Georgia Department of Transportation's (GDOT) Standard Drawings, Standard Specifications, and Pay Items Index as standards and specifications for the construction and completion of the work required. All bidders must comply with all general and special requirements of the bid information and instructions enclosed herein. Sealed bids will be received no later than 2:00 PM Local Time on April 2, 2013. Sealed bids shall be submitted to: City of Milton Attn: Rick Pearce, Purchasing Office 13000 Deerfield Pkwy Suite 107G Milton, Ga. 30004. At approximately 2:05 PM Local Time on April 2, 2013 bids will be publicly opened and the bidder's name and total bid amount will be read aloud at: City of Milton Courthouse 13000 Deerfield Parkway Suite 107E Milton, GA 30004. Bids received after the above time or in any other location will not be accepted. Bids shall be presented in a sealed envelope with the bid number (13-PW5) and the name of the company or firm submitting clearly marked on the outside of the envelope. ONE (1) ORIGINAL (PAPER) AND TWO (2) COPIES (PAPER) AND A PDP COPY OF THE BID ON CD MUST BE SUBMITTED. Bids will not be accepted verbally or email. Questions must be in writing. For questions, please email Rick Pearce at rick. pearce(i cityofmiltonga.us. Deadline for questions is March 15, 2013 at 5:00pm. Official answers to questions and potential changes to the ITB (Addendums) will be posted at the same web locations as the ITB on or about March 19, 2013. Any other form of interpretation, correction, or change to this ITB will not be binding upon the City. It is the bidder's responsibility to check the websites for potential updates. Please refer to Bid (I3-PW5) and bid name Deerfield Parkway at Morris Road Intersection Improvements when requesting information. The selected contractor must be able to start work within ten (10) calendar days after the "Notice to Proceed" is issued. The time of completion for the project is one hundred eighty days (180) calendar days from the date of the "Notice to Proceed." If weather affects the required completion schedule, The City and selected contractor will negotiate a new completion date. Section 108.08 of the State of Georgia Department of Transportation Standard Specifications Construction of Transportation Systems (current edition) shall be applied. To bid on this project the construction firm must be a GDOT qualified contractor and provide (on separate qualifications sheet) a list of at least three similar projects for a local government, county or state agency (with references) upon which the contractor has served in a lead or prominent role. At a minimum, the qualifications list should include the name of the jurisdiction 4 1 ITB 13-PW5 for which the work was performed, a brief description of the work, reference name and contact information. The City of Milton reserves the right to reject any or all bids and to waive technicalities and informalities, and to make award in the best interest of the City of Milton. 5 1 ITB 13-PW5 TO: PURCHASING OFFICE CITY OF MILTON MILTON, GEORGIA 30004 Ladies and Gentlemen: In compliance with your Invitation To Bid, the undersigned, hereinafter termed the Bidder, proposes to enter into a Contract with the City of Milton, Georgia, to provide the necessary machinery, tools, apparatus, other means of construction, and all materials and labor specified in the Contract Documents or as necessary to complete the Work in the manner therein specified within the time specified, as therein set forth, for: Bid Number 13-PW5 DEERFIELD PARKWAY AT MORRIS ROAD INTERSECTION IMPROVEMENTS The Bidder has carefully examined and fully understands the Contract, Specifications, and other documents hereto attached, has made a personal examination of the Site of the proposed Work, has satisfied himself as to the actual conditions and requirements of the Work, and hereby proposes and agrees that if his bid is accepted, he will contract with the City of Milton in full conformance with the Contract Documents. Unless otherwise directed, all work performed shall be in accordance with the Georgia Department of Transportation Standard Specifications, Construction of Transportation Systems (current edition). All materials used in the process of completion of the work included in the Contract will be furnished from Georgia Department of Transportation certified suppliers only. It is the intent of this Bid to include all items of construction and all Work called for in the Specifications, or otherwise a part of the Contract Documents. In accordance with the foregoing, the undersigned proposes to furnish and construct the items listed in the attached Bid schedule for the lump sum price stated. The Bidder agrees that the cost of any work performed, materials furnished, services provided or expenses incurred, which are not specifically delineated in the Contract Documents but which are incidental to the scope, intent, and completion of the Contract, shall be deemed to have been included in the prices bid for the various items scheduled. 6 1 ITB 13-PW5 BIDDING INSTRUCTIONS FAILURE TO RETURN THE FOLLOWING BID DOCUMENTS COULD RESULT IN THE BID BEING DEEMED NON-RESPONSIVE AND BEING REJECTED: 1. Filled out and signed Invitation to Bid (Page 1) 2. City Bid Submittal Form, and City Bid Bond 3. Applicable Addenda Acknowledgement 4. Qualification Signature and Certification 5. List of Subcontractors 6. Bid Price Certification 7. Disclosure Form 8. Contractor Affidavit and Agreement (eVerify) (Listed as Exhibit F in this document) 9. Qualification sheet listing projects that meet the experience requirement along with references. Use your own form. INFORMATION AND INSTRUCTIONS The purpose of this solicitation is to enter into a lump sum price contract with one firm to be the primary supplier of the Deerfield Parkway at Morris Road Intersection Improvements (13-PW5). No specification expressed or implied shall be construed as any type of restrictive specification that would limit competition. The City reserves the right to cancel the contract at any time with 30 days written notice. Title to any supplies, materials, equipment or other personal property shall remain the Contractors' until fully paid for by the City. Any damage to any building or traffic control device, or equipment incurred during the course of work shall be repaired at the contractor's expense to the complete satisfaction of the City of Milton with no additional expense to the City. EVALUATION The City intends to evaluate the ITB on the lowest, best, responsible, and responsive vendor. INSURANCE REQUIREMENTS Within 10 days of Notice of Award, and at all times that this Contract is in force, the Contractor shall obtain, maintain and furnish the City Certificates of Insurance from licensed companies doing business in the State of Georgia with an A.M. Best Rating A-6 or higher and acceptable to the City. Insurance requirements are included in the SAMPLE CONTRACT AGREEMENT below. BONDING REQUIREMENTS Each bid must be accompanied with a BID BOND (bond only: certified checks or other forms are not acceptable) in an amount equal to five percent (5%) of the base bid (not including the bid 7 1 ITB 13-PW5 alternate), payable to the City of Milton. Said bid bond guarantees the bidder will enter into a contract to construct the project strictly within the terms and conditions stated in this bid and in the bidding and contract documents, should the construction contract be awarded. The Successful Bidder shall be required to furnish a PERFORMANCE BOND for the faithful performance on the contract and a PAYMENT BOND to secure payment of all claims for materials furnished and/or labor performed in performance of the project, both in amounts equal to one hundred percent (100%) of the contract price. The Successful Bidder shall also be required to furnish a MAINTENANCE BOND, in the amount of one-third (1/3) of the contract price, guaranteeing the repair or replacement caused by defective workmanship or materials for a period of two (2) years from the completion of construction. Bonds shall be issued by a corporate surety appearing on the Treasury Department's most current list (Circular 570 as amended) and be authorized to do business in the State of Georgia. Bonds shall be on the forms provided by the City and subject to the review and approval of the City Attorney. Date of Bond must not be prior to date of Contract. If Contractor is a Partnership, all partners shall execute Bond. OATH Prior to commencing the Work, the successful bidder shall execute a written oath as required by O.C.G.A. §§ 32-4-122 and 36-91-21(e). COST OF PREPARING A PROPOSAL The costs for developing and delivering responses to this ITB and any subsequent presentations of the proposal as requested by the City are entirely the responsibility of the bidder. The City is not liable for any expense incurred by the bidder in the preparation and presentation of their proposal. All materials submitted in response to this ITB become the property of the City of Milton. 8 1 ITB i 3 -PWS Bid Submittal Form Deerfield Parkway at Morris Road Intersection Improvements [BIDDERS MUST RETURN THIS SHEET WITH BID RESPONSE] The undersigned, as bidder, declares and represents that it has examined the site of the work and informed himself/herself fully in regard to all conditions pertaining to the place where the work is to be performed, including those conditions affecting the cost of the work and the delivery, handling and storage of materials and equipment. The bidder has examined and read the Bidding Document and has satisfied himself/herself that the Bidding Document is an adequate and acceptable reflection of the work which is required to be performed and that the bidder is willing and able to perform all of the work necessary. The bidder further certifies that no additional information is required to complete the work encompassed by this bid within the cost and schedule established and agreed upon within this bidding document. Hereby proposes and agrees, if this bid for the above named project is accepted to enter into a contract to perform all work necessary to the successful completion of the contract; and to supply all required submittals as indicated or specified in the ITB and the bid documents to be performed or furnished by bidder for the for the total contract price of Total Base Bid Price (Lump Sum) $ Print Dollar Amounti he e-� � � . r� y-r�(!�e- N?N,4- kVr-,k-?-4 arc BALDWIN PAVING COMPANY A. COMPANY ADDRESS 1 0 1 q �--' rv., � I D AUTHORIZED SIGNATURE PRINT / TYPE NAME POSITION W t' J� Q 3004 9 1 I -FB 13-PW5 ADDENDA ACKNOWLEDGEMENT [BIDDERS MUST RETURN THIS SHEET WITH BID RESPONSE] Bidder acknowledges receipt of the following addenda: Addendum No. Date viewed Bidder further declares that the full name and resident address of Bidder's Principal is as follows: Signed, sealed, and dated this day of Bidder Mailing Address: By: Title: By: Title: Bidder Company Name (Seal) 10 1 ITB 13-PW5 BID BOND CITY OF MILTON, GEORGIA [BIDDERS MUST RETURN THIS SHEET WITH BID RESPONSE] Attached hereto is an executed Bid Bond in the amount of Bid). Dollars ($ (Five Percent of Amount If this bid shall be accepted by the City of Milton and the undersigned shall fail to execute a satisfactory contract in the form of said proposed Contract, and give satisfactory Performance and Payment Bonds, or furnish satisfactory proof of carriage of the insurance required within tcn days from the date of Notice of Award of the Contract, then the City of Milton may, at its option, determine that the undersigned abandoned the Contract and there upon this bid shall be null and void, and the sum stipulated in the attached Bid Bond shall be forfeited to the City of Milton as liquidated damages. BIDDER (Name and Address): SURETY (Name and Address of Principal Place of Business): OWNER (hereinafter referred to as the "City" (Name and Address): City of Milton, Georgia ATTN: Purchasing Office 13000 Deerfield Parkway, Suite 107G Milton, Georgia 30004 BID BID DUE DATE: PROJECT (Brief Description Including Location): BOND BOND NUMBER: DATE (Not later that Bid due date): PENAL SUM: (Words) (Figures) IN WITNESS WHEREOF, Surety and Bidder, intending to be legally bound hereby to the City, subject to the terms printed below or on the reverse side hereof, do each cause this Bid Bond to be duly executed on its behalf by its authorized officer, agent or representative. BIDDER (Seal) Bidder's Name and Corporate Seal SURETY (Seal) Surety's Name and Corporate Seal 11 1 ITB 13-PW5 By: Signature and Title: Attest: Signature and Title: By: Signature and Title: (Attach Power of Attorney) Attest: Signature and Title: Note: (1) Above addresses are to be used for giving any notice required by the terms of this Bid Bond. (2) Any singular reference to Bidder, Surety, the City or any other party shall be considered plural where applicable. 1. Bidder and Surety, jointly and severally, bind themselves, their heirs, executors, administrators, successors and assigns to pay to the City upon Default of Bidder the penal sum set forth on the face of this Bond. 2. Default of Bidder shall occur upon the failure of Bidder to deliver within the time required by the Bidding Documents (or any extension of that time agreed to in writing by the City) the executed Agreement required by the Bidding Documents and any performance and payment Bonds required by the Bidding Documents. This obligation shall be null and void if: 3.1The City accepts Bidder's Bid and Bidder delivers within the time required by the Bidding Documents (or any extension of that time agreed to in writing by the City) the executed Agreement required by the Bidding Documents and any performance and payment Bonds required by the Bidding Documents; or 3.2A11 Bids are rejected by the City; or 3.3The City fails to issue a Notice of Award to Bidder within the time specified in the Bidding Documents (or any extension of that time agreed to in writing by Bidder and, if applicable, consented to by Surety when required by paragraph 5 hereof). 4. Payment under this Bond will be due and payable upon Default by Bidder within 30 calendar days after receipt by Bidder and Surety of a written Notice of Default from the City, which Notice will be given with reasonable promptness and will identify this Bond and the Project and include a statement of the amount due. 5. Surety waives notice of, as well as any and all defenses based on or arising out of, any time extension to issue a Notice of Award agreed to in writing by the City and Bidder, provided that the total time, including extensions, for issuing a Notice of Award shall not in the aggregate exceed 120 days from Bid due date without Surety's written consent. 6. No suit or action shall be commenced under this Bond either prior to 30 calendar days after the Notice of Default required in paragraph 4 above is received by Bidder and Surety or later than one year after Bid due date. 7. Any suit or action under this Bond shall be commenced only in a court of competent jurisdiction located in the State of Georgia. 8. Notices required hereunder shall be in writing and sent to Bidder and Surety at their respective addresses shown on the face of this Bond. Such notices may be sent by personal delivery, commercial 12 1 ITB 13 -PWS courier or by United States Registered or Certified Mail, return receipt requested, postage pre -paid, and shall be deemed to be effective upon receipt by the party concerned. 9. Surety shall cause to be attached to this Bond a current and effective Power of Attorney evidencing the authority of the officer, agent or representative who executed this Bond on behalf of Surety to execute, seal and deliver such Bond and bind the Surety thereby. 10. This Bond is intended to conform to all applicable statutory requirements. Any applicable requirement of any applicable statute that has been omitted from this Bond shall be deemed to be included herein as if set forth at length. If any provision of this Bond conflicts with any applicable statute, then the provision of said statute shall govern and the remainder of this Bond that is not in conflict therewith shall continue in full force and effect. 11. The term "Bid" as used herein includes a Bid, offer or proposal, as applicable under the particular circumstances. 12. The terms of this Bid Bond shall be governed by the laws of the State of Georgia. 13 1 ITB 13-PW5 QUALIFICATIONS SIGNATURE AND CERTIFICATION [BIDDERS MUST RETURN THIS SHEET WITH BID RESPONSE] I certify that this offer is made without prior understanding, agreement, or connection with any corporation, firm, or person submitting a proposal for the same materials, supplies, equipment, or services and is in all respects fair and without collusion or fraud. I understand collusive bidding is a violation of State and Federal Law and can result in fines, prison sentences, and civil damage awards. I agree to abide by all conditions of the proposal and certify that I am authorized to sign this proposal for the proposer. I further certify that the provisions of the Official Code of Georgia Annotated, Sections 45-10-20 et. Seq. have not been violated and will not be violated in any respect. Authorized Signature Print/Type Name Print/Type Company Name Here Date 2013 CORPORATE CERTIFICATE I, , certify that I am the Secretary of the Corporation named as Contractor in the foregoing bid; that who signed said bid in behalf of the Contractor, was then (title) of said Corporation; that said bid was duly signed for and in behalf of said Corporation by authority of its Board of Directors, and is within the scope of its corporate powers; that said Corporation is organized under the laws of the State of This (Signature) day of , 2013 (Seal) 14 1 ITB 13 -PWS LIST OF SUBCONTRACTORS [BIDDERS MUST RETURN THIS SHEET WITH BID RESPONSE] I do , do not , propose to subcontract some of the work on this project. I propose to Subcontract work to the following subcontractors: Company Name: 15 1 ITB 13 -PWS BID PRICE CERTIFICATION [BIDDERS MUST RETURN THIS SHEET WITH BID RESPONSE] In compliance with the attached Specification, the undersigned offers and agrees that if this Bid is accepted, by the City Council within One Hundred and Twenty (120) days of the date of Bid opening, that he will furnish any or all of the Items upon which Prices are quoted, at the Price set opposite each Item, delivered to the designated point(s) within the time specified in the Bid Schedule. COMPANY ADDRESS AUTHORIZED SIGNATURE PRINT / TYPE NAME 16 1 ITS 13-PW5 DISCLOSURE FORM BIDDERS MUST RETURN THIS SHEET WITH BID RESPONSE This form is for disclosure of campaign contributions and family member relations with City of Milton officials/employees. Please complete this form and return as part of your Bid package when it is submitted. Name of Bidder Name and the official position of the Milton Official to whom the campaign contribution was made (Please use a separate form for each official to whom a contribution has been made in the past two (2) years.) List the dollar amount/value and description of each campaign contribution made over the past two (2) years by the Applicant/Opponent to the named Milton Official. Amount/Value Description Please list any family member that is currently (or has been employed within the last 9 months) by the City of Milton and your relation: 17 1 ITB 13-PW5 EXHIBIT "F" [BIDDERS MUST RETURN THIS SHEET WITH BID RESPONSE] STATE OF GEORGIA CITY OF MILTON CONTRACTOR AFFIDAVIT AND AGREEMENT By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm, or corporation which is contracting with the City has registered with and is participating in a federal work authorization program, in accordance with the applicable provisions and deadlines established in O.C.G.A. § 13-10-91. The undersigned further agrees that, should it employ or contract with any subcontractor(s) in connection with the physical performance of services pursuant to this contract with the City, contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. § 13-10-91 on the Subcontractor Affidavit provided in Rule 300-10-01-.08 in the form attached hereto as Exhibit "G." Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the City at the time the subcontractor(s) is retained to perform such service. EEV I Basic Pilot Program User Identification Number BY: Authorized Officer or Agent Date(Contractor name) Title of Authorized Officer or Agent of Contractor Printed Name of Authorized Officer or Agent SIGNED, SEALED, AND DELIVERED in the presence of: Witness Notary Public [NOTARY SEAL] My Commission Expires: 18 1 ITB 13 -PWS SCHEDULE OF EVENTS FOR REFERENCE ONLY - DO NOT SUBMIT WITH BID RESPONSE Event: Release of ITB Deadline for Written Questions Date: 3/4/2013 3/15/2013 @ 5:00 PM *Submit via E -Mail to Rick Pearce of Purchasing Office City of Milton Addendum (on or about) 3/19/2013 (Official answers to questions and potential changes to ITB. Addendum will be posted at the same web locations as the ITB) Bids due 4/2/2013 @ 2:OOPM Bids are due to: City of Milton Attn: Rick Pearce, Purchasing Office 13000 Deerfield Pkwy Suite -107G Milton, Ga. 30004 Tentative Contract Award (On/about) 4/22/2013 Notice to Proceed Issued (On/about) 4/23/2013 19 1 ITB 13-PW5 Project Specifications Deerfield Parkway at Morris Road Intersection Improvements SCOPE OF WORK The City of Milton Public Works Department, (City), requests that interested parties submit formal sealed bids/proposals for the DEERFIELD PARKWAY AT MORRIS ROAD INTERSECTION IMPROVEMENTS. The scope of this project generally consists of the addition of a new traffic signal with other associated roadway, drainage, and shoulder work. The project location is at the intersection of Deerfield Parkway and Morris Road approximately 1/5 mile north of Windward Parkway and as depicted on the provided location map. Q� rvro v�ao° Project Location �fr tans Rd W, o n`Iw'ard FkY Qi 9K �l Cun'rtin9 St 0`0 s p`13 `. GENERAL CONDITIONS 1. The contractor shall comply with the plans and specifications for the "DEERFIELD PARKWAY AT MORRIS ROAD INTERSECTION IMPROVEMENT PLANS" as prepared by A&R Engineering (Design Engineer), dated February 15, 2013. The plans (Bid Package) may be downloaded at: http://miltonintersectionprojects.com/wp-content/uploads/2013/02/DM FinalPlans.pdf In addition to other standard specifications referenced herein, the bid package includes: a. Construction Drawings; b. Special Provision 163 — Miscellaneous Erosion Control Items; 20 1 ITB 13-PW5 c. Special Provision 165 - Maintenance of Temporary Erosion and Sedimentation Control Devices; d. Special Provision 171 — Silt Fence; e. Special Provision 700 — Grassing. 2. Where contract documents reference "The Department" or "GA Department of Transportation" or "The Engineer", it shall also mean "City of Milton." 3. Perform all work in accordance with Georgia Standard Specifications, Current Edition, and any supplemental specifications as modified by contract documents. 4. All traffic control measures and detour signage are the responsibility of the contractor. Contractor shall coordinate all work with the City of Milton. 5. Replace, in kind, any vegetation or landscaping damaged during construction. Include cost in the price bid. 6. Unless otherwise directed, all work performed under this contract shall be in accordance with the Georgia Department of Transportation Standard Specifications, Construction of Transportation Systems (current edition), and Special Provisions modifying them, except as noted below. SECTION 101 DEFINITION AND TERMS Section 101.14 COMMISSIONER Section 101.22 DEPARTMENT Section 101.24 ENGINEER Section 101.84 Delete as written and substitute the following: DIRECTOR OF PUBLIC WORKS, CITY OF MILTON Delete as written and substitute the following: PUBLIC WORKS DEPARTMENT CITY OF MILTON Delete as written and substitute the following: DIRECTOR OF PUBLIC WORKS, CITY OF MILTON, ACTING DIRECTLY OR THROUGH A DULY AUTHORIZED REPRESENTATIVE OF THE DIRECTOR Add: DIRECTOR OF PUBLIC WORKS CITY OF MILTON SECTION 102 BIDDING REQUIREMENTS AND CONDITIONS Section 102.05 EXAMINATION OF PLANS, Add the following paragraph: SPECIFICATIONS, SPECIAL PROVISIONS, 21 1 ITB 13-PW5 AND SITE OF THE WORK Section 102.07 REJECTION OF PROPOSALS Section 102.08 PROPOSAL GUARANTY Add Section 102.15 ADDENDA AND INTERPRETATION Section 102.09 DELIVERY OF PROPOSALS: "The City will not be responsible for Bidders' errors or misjudgment, nor for any information on local conditions or general laws and regulations." Add the following subparagraphs "I. The City reserves the right to reject any and all bids, to waive technicalities, and to make an award as deemed in its best interest. It is understood that all bids are made subject to this Agreement, that the City reserves the right to award the bid to the lowest, responsible Bidder, and in arriving at this decision, full consideration will be given to the reputation of the Bidder, his financial responsibility, and work of this type successfully completed. "J. The City also reserves the right to reject any and all bids from any person, firm, or corporation who is in arrears in any debt or obligation to The City of Milton, Georgia." Substitute the following for the first sentence "No bid will be considered unless it is accompanied by an acceptable bid bond an amount not less than five percent (5%) of the amount bid and made payable to City of Milton, Georgia. Such Bid Bond shall be on the forms provided by the City." Delete in its entirety and substitute the following: Bids shall be submitted on the Bid Form provided by the City. The bid package as described in Notice to Contractors, Page 1 must be submitted with the bid. Failure to do so could result in the omission of pertinent documents and the rejection of the apparent low bid." Add the following as 102.15: 22 1 1T8 13-PW5 "No interpretation of the meaning of the Contract Documents will be made orally to any Bidder. Any request for such interpretation should be in writing addressed to the Purchasing Department, The City of Milton 13000 Deerfield Pkwy., Suite 107G Milton, Ga. 30004. TEL. 678/242-2500, FAX 678/242-2499.Each such interpretation shall be given in writing, separately numbered and dated, and furnished to each interested Bidder. Any request not received in time to accomplish such interpretation and distribution will not be accepted. SECTION 103 AWARD OF AND EXECUTION OF CONTRACT Section 103.02 AWARD OF CONTRACT Section 103.05 REQUIREMENTS OF CONTRACT BONDS Section 103.07 FAILURE TO EXECUTE CONTRACT Delete in its entirety and substitute the following: "The contract, if awarded, shall be awarded to the lowest responsible bidder. The City of Milton reserves the right to exercise exclusive discretion as to the responsibility of any bidder. The contract shall be executed on the forms attached, will be subject to all requirements of the Contract Document, and shall form a binding Contract between the contracting parties." Delete in its entirety and substitute the following: "At the time of the execution of the contract, and as a part thereof, the successful bidder shall furnish Contract Bond Below: Performance Bond in the full amount of the contract. Payment Bond in the full amount of the contract. Maintenance bond in the amount of one-third (1/3) of the contract." Delete in its entirety and substitute the following: 23 1 ITB 13 -PWS "Failure to execute the Contract Performance, Payment or Maintenance Bonds, or furnish satisfactory proof of carriage of the insurance required within ten days after the date of Notice of Award of the Contract, may be just cause for the annulment of the award and for the forfeiture of the proposal guaranty to the City of Milton, not as a penalty, but as liquidation of damages sustained. At the discretion of the City, the award may then be made to the next lowest bidder, may be re -advertised, or may be constructed by City forces. The Contract and Contract bonds shall be executed in quadruplicate." SECTION 107 LEGAL REGULATIONS AND RESPONSIBILITY TO THE PUBLIC Section 107.18 ACQUISITION OF RIGHT OF WAY Add the following paragraph: "The Contractor shall inspect all easements and rights-of-way to ensure that the City has obtained all land and rights-of-way necessary for completion of the Work to be performed pursuant to the Contract Documents. The Contractor shall comply with all stipulations contained in easements acquired by the Department." Section 107.21 CONTRACTORS Add the following sentence to RESPONSIBILITY FOR UTILITY PROPERTY AND SERVICE Paragraph A: "The Contractor is responsible for the location of above and below ground Utilities and structures which may be affected by the Work." SECTION 109 MEASUREMENT AND PAYMENT Section 109.07 PARTIAL PAYMENTS Delete the first sentence of the Second Paragraph under `A. General" As long as the gross value of completed work is less than 50% of the total Contract amount, or if the Contractor is not maintaining his construction schedule to the satisfaction of the Engineer, the Department 24 1 ITB 13-PW5 shall retain 10% of the gross value of the work that has been completed as indicated by the current estimate certified by the Engineer for payment. Section 109.08 FINAL PAYMENT Delete in its entirety and substitute the following: "Final Payment: Upon completion by the Contractor of the work, including the receipt of any final written submission of the Contractor and the approval thereof by the Department, the CITY will pay the Contractor a sum equal to 100 percent (100%) of the compensation set forth herein, less the total of all previous partial payments, paid or in the process of payment. The Contractor agrees that acceptance of this final payment shall be in full and final settlement of all claims arising against the CITY for work done, materials furnished, costs incurred, or otherwise arising out of this Agreement and shall release the CITY from any and all further claims of whatever nature, whether known or unknown for and on account of said Agreement, and for any and all work done, and labor and materials furnished, in connection with same." PROSECUTION AND PROGRESS Construction shall begin no later than TEN (10) calendar days past the issuance of Notice to Proceed. The intent is to issue the Notice to proceed April 23, 2013. The Contractor will coordinate mobilization with timing of signal equipment delivery. The time of completion for the project is one hundred eighty days (180) calendar days from the date of the Notice to Proceed. If weather affects the required completion schedule, The City and selected contractor will negotiate a new completion date. Normal workday for this project shall be 7:30 am to 7:30 pm and the normal workweek shall be Monday through Friday. Construction will be allowed on Saturday from 9:00 am to 6:00 pm. The City will consider extended workdays or workweeks upon written request by the Contractor on a case by case basis. No work will be allowed on Sunday or national holidays (i.e. Memorial Day, July 4`h, Labor Day, etc.) The work will require bidder to provide all labor, administrative forces, equipment, materials and other incidental items to complete all required work. The City shall perform a Final Inspection 25 1 ITB 13-PW5 upon completion of all work. The contractor will be allowed to participate in the Final Inspection. All repairs shall be completed by the contractor at his expense prior to issuance of Final Acceptance. 10% retainage will be held from the total amount due the contractor until Final Acceptance of work is issued by the City. PERMITS AND LICENSES The contractor shall procure all permits and licenses, pay all charges, taxes and fees, and give all notices necessary and incidental to the due and lawful prosecution of the work. MATERIALS Contractor will be responsible for replacing any work performed with material from rejected sample lot at no cost to the City. DEVIATION OF QUANTITIES The quantities given are estimates only and will vary from those indicated. This project shall be bid as a lump sum contract and it is the responsibility of the contractor to inspect the project site prior to submitting their bid to ensure final quantities. Contractor will notify the City in writing if additional items are identified or quantities of contract items will exceed plan. At no time will contractor proceed with work outside the prescribed scope of services for which additional payment will be requested without the written authorization of the City. EROSION CONTROL It is the responsibility of the contractor to follow all Federal, State and Local erosion and sediment control laws and specifications. This includes meeting all NPDES guidelines. Erosion/Sediment Control measures shall be installed and maintained by the contractor throughout the duration of the project. The contractor is responsible for the removal and disposal, off project site, of all installed temporary erosion/sediment control measures when affected areas have been restored to a level where vegetative coverings will minimize erosion. The cost for this will be considered incidental to the project and included in the overall bid unless otherwise shown in the Bid Schedule. UTILITIES There are utilities in the project area. Contractor shall be responsible for locating and coordinating any utility relocation necessary for completion of the work. Call "811 Know what's below Call before you dig." Locate, maintain and protect existing utilities at all times during construction. TEMPORARY TRAFFIC CONTROL The contractor shall, at all times, conduct his work in accordance with the traffic control plan and so as to assure the least possible obstruction of traffic. The safety and convenience of the general public and the residents along the roadway and the protection of persons and property shall be provided for by the contractor as specified in the State of Georgia, Department of Transportation Standard Specifications Sections 104.05, 107.09 and 150. Traffic whose origin and destination is within the limits of the project shall be provided ingress 26 1 ITB 13-PW5 and egress at all times unless otherwise specified by the City. The ingress and egress includes entrances and exits VIA driveways at various properties, and access to the intersecting roads and streets. The contractor shall maintain sufficient personnel and equipment (including flaggers and traffic control signing) on the project at all times, particularly during inclement weather, to insure that ingress and egress are safely provided when and where needed. The contractor shall furnish, install and maintain all necessary and required barricades, signs and other traffic control devices in accordance with the MUTCD and DOT specifications, and take all necessary precautions for the protection of the workers and safety of the public. This shall include variable message boards to be placed near the intersection location, prior to beginning construction activities, to notify the traveling public of the upcoming lane closurc(s). These variable message boards shall remain in place from to the beginning construction until substantial completion of each bridge project site. There shall be three (3) variable message boards, (one in each direction). All existing signs, markers and other traffic control devices removed or damaged during construction operations will be reinstalled or replaced at the contractor's expense. At no time will contractor remove regulatory signing which may cause a hazard to the public. The Contractor shall, within 24 hours place temporary pavement markings (paint or removable tape) matching existing pavement markings on milled or patched pavements. All personnel and equipment required for maintaining temporary traffic control, public convenience and safety will be included in the contract price. PROTECTION AND RESTORATION OF PROPERTY AND LANDSCAPE The contractor shall be responsible for the preservation of all public and private property, crops, fish ponds, trees, monuments, highway signs and markers, fences, grassed and sodded areas, etc. along and adjacent to the highway, road or street, and shall use every precaution necessary to prevent damage or injury thereto, unless the removal, alteration, or destruction of such property is provided for under the contract. When or where any direct or indirect damage or injury is done to public or private property by or on account of any act, omission, neglect or misconduct in the execution of the work, or in consequence of the non -execution thereof by the contractor, he shall restore, at his/her own expense, such property to a condition similar or equal to that existing before such damage or injury was done, by repairing, rebuilding or otherwise restoring as may be directed, or she/he shall make good such damage or injury in an acceptable manner. The contractor shall correct all disturbed areas before retainage will be released. CLEANUP All restoration and clean-up work shall be performed daily. Operations shall be suspended if the contractor fails to accomplish restoration and clean-up within an acceptable period of time. Asphalt and other debris shall be removed from gutters, sidewalks, yards, driveways, etc. Failure to perform clean-up activities may result in suspension of the work. Milling operation shall be followed immediately by clean-up at which the contractor is to provide power brooms, vacuum sweepers, power blowers, or other means to remove loose debris or dust. Do not allow dust control to restrict visibility of passing traffic or to disrupt adjacent property owners. All 27 1 ITB 13-PW5 pavement areas shall be clean and dry prior to placing tack coat, asphaltic concrete or other materials. SAFETY Beginning with mobilization and ending with acceptance of work, the contractor shall be responsible for providing a clean and safe work environment at the project site. The contractor shall comply with all OSHA regulations as they pertain to this project. SPECIAL PROVISIONS All work associated with this contract shall meet the Georgia DOT standard specifications for construction materials, methods and procedures not specifically listed in this solicitation. The special provisions provided above were prepared specifically for this contract and may be in conflict with parts of the standard specifications. If conflicts are evident, the special provisions shall take precedence over the standard specifications. 28 1 ITB 13-PW5 Reference Only Subject to Change SAMPLE CONSTRUCTIONAGREEMENT This Construction Agreement (the 'Agreement') is made and entered into this day of 20 by and between the City of Milton (hereinafter referred to as the "City'), and XXU=,, a Georgia corporation with its principal place of business located at XXXXXXX (hereinafter referred to as the "Contractor'). WITNESSETH: WHEREAS, the City issued a Request for Bid, dated XXXXXXXXXXXX; and WHEREAS, based upon Contractor's bid in response to the Request for Bid for XXXXXXXXXXXXX, the City has selected Contractor as the successful bidder; and WHEREAS, Contractor has agreed to perform such work as set forth in this Agreement, according to the terms and conditions provided in this Agreement, and WHEREAS, Contractor has familiarized itself with the nature and extent of the Contract Documents, the Project, and the Work, with all local conditions and federal, state and local laws, ordinances, rules and regulations in any manner that may affect cost, progress or performance of the Work, and Contractor is aware that it must be licensed to do business in the State of Georgia. NOW THEREFORE, the City and Contractor, in consideration of the mutual promises contained herein and other good and valuable consideration, the sufficiency of which is hereby acknowledged, agree as follows: Section 1. Contract Documents The following documents are incorporated herein by reference and constitute the Contract Documents: A. This Agreement; B. Request for Bid (and other bid related documents) attached hereto as Exhibit "A C. Bid Documents from Contractor dated January 25'",2013 attached hereto as Exhibit 'T D. Performance Bond, Payment Bond and Maintenance Bond, attached hereto collectively as Exhibit "C'" E. Non -collusion Affidavit of Prime Bidder, attached hereto as Exhibit "D F. Final Affidavit, attached hereto as Exhibit "E "; G. Alien Employment affidavits attached hereto as Exhibits "F" and "G H. SAVE affidavit attached hereto as Exhibit "H"; 1. Plans and specifications, attached hereto collectively as Exhibit "I"; J. Key Personnel, attached hereto as Exhibit "J"; K The following which may be delivered or issued after the Effective Date of the Agreement and are not attached hereto: All Written Amendments and other documents amending, modifying, or supplementing the Contract Documents if properly adopted in writing and executed by the Parties, and all Architect's plans. 29 1 ITB 13-PW5 Section 2. Proiect Description The Project is defined generally as follows: Y_VXXXUCKXXUCXX Section 3. The Work The Work is specified and indicated in the Contract Documents (the "Work'). The Work previously described includes all material, labor, insurance, tools, equipment, and any other miscellaneous items necessary to complete the Work as described. Contractor shall complete the Work in strict accordance with the Contract Documents. In the event of any discrepancy among the terms of the various Contract Documents, the provision most beneficial to the City, as determined by the City in its sole discretion, shall govern. Section 4. Contract Time Contractor agrees to complete the Project within XXX days from the date of the City's issuance of a written Notice To Proceed. Every effort will be made by Contractor to shorten this period. The Project shall only be considered complete upon the Architect's issuance of a final Certificate for Payment ("Final Completion'). The Contractor agrees to pay an amount of $XXXX per day, not as a penalty, but as liquidated damages because actual damages would be difficult or impossible to determine, for each day beyond XXXX days without completion of the Project. Section 5. Contractor's Compensation; Time and Method of Payment City agrees to pay the Contractor $X XXM for work performed by Contractor upon certification by the City that the work was actually performed and costs actually incurred in accordance with the Agreement. Compensation for work performed and reimbursement.for costs incurred shall be paid to the Contractor upon receipt and approval by the City of, and the issuance by the Architect of a Certificate for Payment regarding, invoices setting forth in detail the work performed and costs incurred. Invoices shall be submitted on a monthly basis, and such invoices shall reflect charges incurred versus charges budgeted. Each invoice shall be accompanied by an Interim Waiver and Release upon Payment (or a Waiver and Release upon Final Payment in the case of the invoice for final payment) procured by the Contractor from all subcontractors in accordance with O. C. G.A. § 44-14-366. The Contractor through each invoice may request payment for no more than ninety percent (90916) of that portion of the Work completed during the term covered by each invoice as agreed upon by the Architect, with the remaining ten percent (10%) to be retained by the City until Final Completion of the Project. The final Certificate for Payment issued by the Architect shall include all amounts retained by the City under this paragraph. Any material deviations in tests or inspections performed times or locations required to complete such tests or inspections and like deviations from the Work described in this Agreement shall be clearly communicated to the City before charges are incurred and shall be handled through change orders or construction change directives as described in Section 6 below. The City shall pay the Contractor within thirty (30) days after approval of the invoice by the City subsequent to the issuance of a Certificate for Payment by the Architect. No payments will be made for unauthorized work. Payment will be sent to the designated address by U.S. Mail only; payment will not be hand -delivered, though the Contractor may arrange to pick up payments directly from the City or may make written requests for the City to deliver payments to the Contractor 1nj Federal Express delivenj at the Contractor's expense. Section 6. Work Chanes A. 77w City reserves the right to order changes in the Work to be performed under this Agreement by altering, adding to, or deducting from the Work. All such changes shall be incorporated in written change orders. Such change orders or construction change directives shall speeifij the changes ordered and any necessary adjustment of compensation and completion time. If the 30 1 ITB 13-PW5 Parties cannot reach an agreement on the terms for performing the changed work within a reasonable time to avoid delay or other unfavorable impacts as determined by the City in its sole discretion, the City shall have the right to determine reasonable terms and the Contractor shall proceed with the changed work. B. Any work added to the scope of this Agreement by a change order or construction change directive shall be executed under all the applicable conditions of this Agreement. No claim for additional compensation or extension of time shall be recognized, unless contained in a written change order or construction change directive duly executed on behalf of the City and the Contractor. C. The City Manager has authority to execute any number of change orders or construction change directives so long as their total effect does not materially alter the terms of this Agreement or materially increase the total amount to be paid tinder this Agreement. Any such change orders or construction change directives materially altering the terms of this Agreement or increasing the total amount to be paid under this Agreement in excess of $10,000.00, must be approved by the City of Milton Mayor and Council. Section Z Covenants of Contractor. A. Ethics Code Contractor agrees that it shall not engage in any activity or conduct that would be in violation of the City of Milton Code of Ethics or any other similar law or regulation. B. Time is of the Essence Contractor specifically acknowledges that TIME IS OF THE ESSENCE for completion of the Project. C. Expertise of Contractor Contractor accepts the relationship of trust and confidence established between it and the City, recognizing that the City's intention and purpose in entering into this Agreement is to engage an entihj with the requisite capacity, experience, and professional skill and judgment to provide the services in pursuit of the timely and competent completion of the Work undertaken by Contractor under this Agreement. D. Budgetariy Limitations Contractor agrees and acknowledges that budgetary limitations are not a justification for breach of sound principals of Contractor's profession and industry. Contractor shall take no calculated risk in the performance of the Work. Specifically, Contractor agrees that, in the event it cannot perform the Work within the budgetary limitations established without disregarding sound principals of Contractor's profession and industry, Contractor will give written notice immediately to the City. CiW's Reliance on the Work The Contractor acknowledges and agrees that the City does not undertake to approve or pass upon matters of expertise of the Contractor and that therefore, the City bears no responsibility for Contractor's services performed under this Agreement. The Contractor acknowledges and agrees that the acceptance of Work lnj the City is limited to the function of determining whether there has been compliance with what is required to be produced under this Agreement. The City will not, and need not, inquire into adequacy, fitness, suitabilihj or correctness of Contractor's 31 1 ITB 13-PW5 performance. Contractor further agrees that no approval of designs, plans, specifications, or work lnj any person, body or agency shall relieve Contractor of the responsibility for adequacy, fitness, suitability, and correctness of Contractor's professional and industry standards or for performing services under this Agreement in accordance with sound and accepted professional and industry principals. Contractor's Reliance of Submissions by the City Contractor must have timely information and input from the City in order to perform the services required under this Agreement. Contractor is entitled to rely upon information provided by the City, but Contractor shall be required to provide immediate written notice to the City if Contractor knows or reasonably should know that any information provided by the City is erroneous, inconsistent, or otherwise problematic. G. Contractor's Representative shall be authorized to act on Contractor's behalf with respect to the Work as Contractor's designated representative. H. Assignment of Agreement The Contractor covenants and agrees not to assign or transfer any interest in, nor delegate any duties of this Agreement, without the prior express written consent of the City. Resvonsibilitv of Contractor and Indemnification of Citu The Contractor covenants and agrees to take and assume all responsibility for the services rendered in connection with this Agreement. The Contractor shall bear all losses and damages directly or indirectly resulting to it on account of the performance or character of the services rendered pursuant to this Agreement. Contractor shall defend, indemnify and hold harmless the City, its officers, boards, commissions, elected and appointed officials, employees and agents from and against any and all claims, suits, actions, liability, judgments, damages, losses, and expenses, including but not limited to, attorney's fees, which may be the result of willful, negligent or tortious conduct arising out of the Work, performance of contracted services, or operations by the Contractor, any subcontractor, anyone directly or indirectly employed by the Contractor or subcontractor or anyone for whose acts the Contractor or subcontractor may be liable, regardless of whether or not the negligent act is caused in part by a party indemnified hereunder. Such obligation shall not be construed to negate, abridge, or otherwise reduce any other right or obligation of indemnihj which would otherwise exist as to any party or person described in this provision. In any and all claims against the City or any of its agents or employees, by any employee of the Contractor, any subcontractor, anyone directly or indirectly employed by the Contractor or subcontractor or anyone for whose acts the Contractor or subcontractor may be liable, the indemnification obligation set forth in this provision shall not be limited in any way lnj any limitation on the amount or type of damages, compensation or benefits payable by or for the Contractor or any subcontractor under workers' or workmen's compensation acts, disability benefit acts or other employee benefit acts. This obligation to indemnifij and defend the City, its members, officers, agents, employees and volunteers shall survive termination of this Agreement. Indevendent Contractor Contractor hereby covenants and declares that it is engaged in an independent business and agrees to perform the services as an independent contractor and not as the agent or employee of the. City. The Contractor agrees to be solely responsible for its own matters relating to the time and place the services are performed; the instrumentalities, tools, supplies and/or materials necessary to 32 1 ITB 13-PW5 complete the services; hiring of Contractors, agents or employees to complete the services; and the payment of employees, including compliance with Social Security, withholding and all other regulations governing such matters. 771e Contractor agrees to be solely responsible for its own acts and those of its subordinates, employees, and subcontractors during the life of this Agreement. Any provisions of this Agreement that may appear to give the City the right to direct Contractor as to the details of the services to be performed Inj Contractor or to exercise a measure of control over such services will be deemed to mean that Contractor shall follow the directions of the City with regard to the results of such services only. The Contractor shall obtain and maintain, at the Contractor's expense, all permits, licenses, or approvals that may be necessary for the performance of the services. The Contractor shall furnish copies of all such permits, licenses, or approvals to the City's Representative within ten (10) days after issuance. Inasmuch as the City and the Contractor are contractors independent of each other neither has the authority to bind the other to any third person or otherwise to act in any way as the representative of the other, unless otherwise expressly agreed to in writing signed by both parties hereto. The Contractor agrees not to represent itself as the City's agent for any purpose to any party or to allow any employee of the Contractor to do so, unless specifically authorized, in advance and in writing, to do so, and then only for the limited purpose stated in such authorization. The Contractor shall assume full liability for any contracts or agreements the Contractor enters into on behalf of the City without the express knowledge and prior written consent of the City. K. Insurance (1) Requirements: The Contractor shall have and maintain in full force and effect for the duration of this Agreement, insurance insuring against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the Work by the Contractor, its agents, representatives, employees or subcontractors. All policies shall be subject to approval by the City Attorney as to form and content. These requirements are subject to amendment or waiver if so approved in writing lnj the City. (2) Minimum Limits of Insurance: Contractor shall maintain limits no less than: (a) Comprehensive General Liability of $1,000,000 combined single limit per occurrence for bodily and personal injury, sickness, disease or death, injury to or destruction of property, including loss of use resulting therefrom. (b) Comprehensive Automobile Liability (owned, non -owned, hired) of $1,000,000 combined single limit per occurrence for bodily and personal injury, sickness, disease or death, injury to or destruction of property, including loss of use resulting therefrom. (c) Workers' Compensation limits as required by the State of Georgia and employers Liability limits of $1,000,000 per accident. (3) Deductibles and Self -Insured Retentions: Any deductibles or self-insured retentions must be declared to and approved by the City. (4) Other Insurance Provisions: The policy is to contain, or be endorsed to contain, the following provisions: (a) General Liability and Automobile Liability Coverage. 33 1 ITB 13-PW5 (i) The City, its officials, employees, agents and volunteers are to be covered as insured as respects: liability arising out of activities performed by or on behalf of the Contractor; products and completed operations of the Contractor; premises owned, leased, or used by the Contractor; automobiles owned, leased, hired, or borrowed Inj the Contractor. 77w coverage shall contain no special limitations on the scope of protection afforded to the City, its officials, employees, agents or volunteers. (ii) The Contractor's insurance coverage shall be primary noncontributing insurance as respects to any other insurance or self-insurance available to the City, its officials, employees, agents or volunteers. Any insurance or self-insurance maintained by the City, its officials, employees or volunteers shall be excess of the Contractor's insurance and shall not contribute with it. (iii) Any failure to comply with reporting provisions of the policies shall not affect coverage provided to the City, its officials, employees, agents or volunteers. (iv) Coverage shall state that the Contractor's insurance shall apply separately to each insured against whom claim is made or suit is brought, except with respect to the limits of the insurer's liability. (v) Coverage shall be provided on a "pay on behalf' basis, with defense costs payable in addition to policy limits. There shall be no cross liability exclusion. (vi) The insurer agrees to waive all rights of subrogation against the City, its officials, employees, agents and volunteers for losses arising from work performed by the Contractor for the City for General Liability coverage only. (vii) All endorsements to policies shall be executed by an authorized representative of the insurer. (b) Workers' Compensation Coverage: The insurer will agree to waive all rights of subrogation against the City, its officials, employees, agents and volunteers for losses arising from work performed by the Contractor for the City. (c) All Coverages: (i) Each insurance policy required by this clause shall be endorsed to state that coverage shall not be suspended, voided, canceled, reduced in coverage or in limits except after thirty (30) days prior written notice Inj certified mail, return receipt requested, has been given to the City. (ii) Policies shall have concurrent starting and ending dates. (d) Builder's Risk Insurance. Contractor shall provide a Builder's Risk to be made payable to the City and Contractor, as their interests may appear. The policy amount shall be equal to 100% of the Contract price, written on a Builder's Risk "All Risk," or its equivalent. The policy shall be endorsed as follows: "The following may occur without diminishing, changing, altering or otherraise 34 1 ITB 13-PW5 affecting the coverage and protection afforded the insured under this policy: i) Furniture and equipment may be delivered to the insured premises and installed in place ready for use; and ii) Partial or complete occupancy by Owner, and iii) Performance of Work in connection with construction operations insured lnj the Owner, by agents or lessees or other Contractors of the Owner or Using Agency." (5) Acceptabiliyj of Insurers: Insurance is to be placed with insurers with an A.M. Bests' rating of no less than A:VII. (6) Verification of Coverage: Contractor shall furnish the City with certificates of insurance and endorsements to the policies evidencing coverage required by this clause prior to the start of work. The certificates of insurance and endorsements for each insurance policy are to be signed lnj a person authorized by that insurer to bind coverage on its behalf. The certificate of insurance and endorsements shall be on a form utilized by Contractor's insurer in its normal course of business and shall be received and approved by the City prior to execution of this Agreement by the City. The City reserves the right to require complete, certified copies of all required insurance policies, at any time. The Contractor shall provide proof that any expiring coverage has been renewed or replaced at least two (2) weeks prior to the expiration of the coverage. (7) Subcontractors: Contractor shall include all subcontractors as insured under its policies or shall furnish separate certificates and endorsements for each subcontractor. All coverage for subcontractors shall be subject to all of the requirements stated in this Agreement, including but not limited to naming the parties as additional insured. (8) Claims -Made Policies: Contractor shall extend any claims -made insurance policy for at least six (6) years after termination or final payment under the Agreement, whichever is later. (9) City as Additional Insured and Loss Pail: The City shall be named as an additional insured and loss payee on all policies required by this Agreement. L. Employment of unauthorized Aliens Prohibited (1) E -Verify Affidavit It is the policy of City that unauthorized aliens shall not be employed to perform work on City contracts involving the physical performance of services. Therefore, the City shall not enter into a contract for the physical performance of services within the State of Georgia unless the Contractor shall provide evidence on City -provided forms, attached hereto as Exhibits "F" and "G" (affidavits regarding compliance with the E -Verify program to be sworn under oath under criminal penalty of false swearing pursuant to O.C.G.A. § 16-10-71), that it and Contractor's subcontractors have within the previous twelve (12) month period conducted a verification, under the federal Employment Eligibility Verification ("EEV" or "E -Verify") program, of the social security numbers, or other identifijing information now or hereafter accepted by the E -Verify program, of all employees who will perform work on the City contract to ensure that no unauthorized aliens zvill be employed. The Contractor hereby verifies that it has, prior to executing this Agreement, executed a notarized affidavit, the form of which is provided in Exhibit "F", and submitted such affidavit to City. In the event the Contractor employs or contracts with any subcontractor(s) in connection with the covered contract, the Contractor agrees to secure from such subcontractor(s) attestation of the subcontractor's compliance with O.C.G.A. § 13-10-91 and Rule 300-10-1-.02 by the subcontractor's execution of the subcontractor affidavit, the form of which is attached hereto as Exhibit "G", and such subcontractor affidavit shall become part of the contractor/subcontractor agreement. Further, Contractor 35 1 ITB 13 PW5 agrees to provide completed copies of Exhibit "G" to the City within five (5) business days of receipt from any subcontractor. The City Manager or his/her designee shall be authorized to conduct an inspection of the Contractor's and Contractor's subcontractors' verification process at any time to determine that the verification was correct and complete. The Contractor and Contractor's subcontractors shall retain all documents and records of their respective verification process for a period of three (3) years following completion of the contract. The City Manager or his/her designee shall further be authorized to conduct periodic inspections to ensure that no City Contractor or Contractor's subcontractors employ unauthorized aliens on City contracts. By entering into a contract with the City, the Contractor and Contractor's subcontractors agree to cooperate with any such investigation by making their records and personnel available upon reasonable notice for inspection and questioning. Where a Contractor or Contractor's subcontractors are found to have employed an unauthorized alien, the City Manager or his/her designee may report same to the Department of Homeland Security. The Contractor's failure to cooperate with the investigation may be sanctioned by termination of the contract, and the Contractor shall be liable for all damages and delays occasioned by the City thereby. Contractor herelnj agrees to comply with the requirements of the federal Immigration Reform and Control Act of 1986 (IRCA), P.L. 99-603, O.C.G.A. § 13-10-91 and Rule 300-10-1-.02. Contractor's compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300-10-1-.02 shall be attested by the execution of the contractor's affidavit, attached hereto as Exhibit "F" and incorporated herein by this reference. The above requirements shall be in addition to the requirements of State and federal larv, and shall be construed to be in conformity with those laws. (2) SA VE Affidavit and Secure Verifiable Document Pursuant to O.C.G.A. § 50-36-1, the City must obtain a SAVE Affidavit and a secure and verifiable document evidencing the Contractor's legal status in the Country each time that Contractor obtains a public benefit, including any contract, from the City. Contractor herelnj verifies that it has, prior to executing this Agreement, executed a SAVE Affidavit (to be sworn under oath under criminal penalty of false swearing pursuant to O. C.G.A. § 16-10-71), a form of which is attached hereto as Exhibit "H", and submitted such affidavit to the City in person, electronically, or by mail. Further, Contractor verifies that it has, prior to executing this Agreement, submitted a secure and verifiable document, evidencing the Contractor's legal status, to the City either in person or electronically (in compliance with the Uniform Electronic Transactions Act). Contractor verifies that it is in compliance with the Residency Status of an Applicant for Public Benefit, as required by the Georgia Security and Immigration Compliance Act (O.C.G.A. § 50-36-1. M. Records, Reports and Audits (1) Records: (a) Records shall be established and maintained by the Contractor in accordance with requirements prescribed by the City with respect to all matters covered by this Agreement. Except as otherwise authorized, such records shall be maintained for a period of three years from the date that final payment is made under this Agreement. Furthermore, records that are the subject of audit findings shall be retained for three years or until such audit findings have been resolved, whichever is later. 36 1 ITB 13 PWS (b) All costs shall be supported by properly executed payrolls, time records, invoices, contracts, or vouchers, or other official documentation evidencing in proper detail the nature and propriety of the charges. All checks, payrolls, invoices, contracts, vouchers, orders or other accounting documents pertaining in whole or in part to this Agreement shall be clearly identified and readily accessible. (2) Reports and Information: Upon request, the Contractor shall furnish to the City any and all statements, records, reports, data and information related to matters covered by this Agreement in the form requested by the City. (3) Audits and Inspections: At any time during normal business hours and as often as the City may deem necessary, there shall be made available to the City for examination all records with respect to all matters covered by this Agreement. The Contractor will permit the City to audit, examine, and make excerpts or transcripts from such records, and to audit all contracts, invoices, materials, payrolls, records of personnel, conditions of employment and or data relating to all matters covered by this Agreement. N. Conflicts of Interest Contractor agrees that it shall not engage in any activity or conduct that would result in a violation of the City of Milton Code of Ethics or any other similar law or regulation. O. Confidentiality Contractor acknowledges that it may receive confidential information of the City and that it will protect the confidentiality of any such confidential information and will require any of its subcontractors, consultants, and/or staff to likewise protect such confidential information. The Contractor agrees that confidential information it receives or such reports, information, opinions or conclusions that Contractor creates under this Agreement shall not be made available to, or discussed with, any individual or organization, including the news media, without prior written approval of the City. The Contractor shall exercise reasonable precautions to prevent the unauthorized disclosure and use of City information whether specifically deemed confidential or not. P. Licenses, Certifications and Permits The Contractor covenants and declares that it has obtained all diplomas, certificates, licenses, permits or the like required of the Contractor lnj any and all national, state, regional, City, local boards, agencies, commissions, committees or other regulatory bodies in order to perform the services contracted for under this Agreement. All work performed lnj Contractor under this Agreement shall be in accordance with applicable legal requirements and shall meet the standard of quality ordinarily expected of competent professionals. Q. Key Personnel All of the individuals identified in Exhibit "J" are necessary for the successful prosecution of the Work due to their unique expertise and depth and breadth of experience. There shall be no change in Contractor's Project Manager or members of the project team, as listed in Exhibit "J", without written approval of the City. Contractor recognizes that the composition of this team was instrumental in the City's decision to award the work to Contractor and that compelling reasons for substituting these individuals must be demonstrated for the City's consent to be granted. Any substitutes shall be persons of comparable or superior expertise and experience. Failure to comply with the provisions of this section shall constitute a material breach of Contractor's obligations 37 1 11-B 13-PW5 under this Agreement and shall be grounds for termination. Contractor shall not subcontract with any third party for the performance of any portion of the Work without the prior written consent of the City. Contractor shall be solely responsible for any such subcontractors in terms of performance and compensation. R. City to Contract The Contractor covenants and declares that it has obtained all necessary approvals of its board of directors, stockholders, general partners, limited partners or similar authorities to simultaneously execute and bind Contractor to the terms of this Agreement, if applicable. S. Ownership of Work All reports, designs, drawings, plans, specifications, schedules, work product and other materials prepared or in the process of being prepared for the services to be performed by the Contractor ("materials") shall be the property of the City and the City shall be entitled to full access and copies of all such materials. Any such materials remaining in the hands of the Contractor or subcontractor upon completion or termination of the work shall be delivered immediately to the City. The Contractor assumes all risk of loss, damage or destruction of or to such materials. If any materials are lost, damaged or destroyed before final delivery to the City, the Contractor shall replace them at its own expense. Any and all copyrightable subject matter in all materials is hereby assigned to the City and the Contractor agrees to execute any additional documents that may be necessary to evidence such assignment. T. Meetings The Contractor is required to meet with the City's personnel, or designated representatives, to resolve technical or contractual problems that may occur during the term of the contract, at no additional cost to the City. Meetings will occur as problems arise and will be coordinated by the City. The Contractor will be given a minimum of three full working days notice of meeting date, time, and location. Face-to-face meetings are desired. However, at the Contractor's option and expense, a conference call meeting may be substituted. Consistent failure to participate in problem resolution meetings, two consecutive missed or rescheduled meetings, or to make a good faith effort to resolve problems, may result in termination of the contract. Section 8. Covenants of the City A. Right of Entry The City shall provide for right of entry for Contractor and all necessary equipment in order for Contractor to complete the Work. B. Cihfs Representative XXXXXX shall be authorized to act on the City's behalf with respect to the Work as the City's designated representative Section 9. Warran Except as may be otherwise specified or agreed, the Contractor shall repair all defects in materials, equipment, or workmanship appearing within one year from the date of Final Completion of the Project at no additional cost to the City. An inspection shall be conducted by the City or its representative(s) near the completion of the one-year general warranty period to identify any issues that must be resolved by the Contractor. 38 1 ITB 13 PW5 Section 10. Termination A. The City may terminate this Agreement for convenience at any time upon written notice to Contractor. In the event of a termination for convenience, Contractor shall take immediate steps to terminate work as quickly and effectively as possible and shall terminate all commitments to third -parties unless otherwise instructed by the City. Provided that no damages are due to the City for Contractor's failure to perform in accordance with this Agreement, the City shall pay Contractor for work performed to date in accordance with Section 5 herein. The City shall have no further liability to Contractor for such termination. Further, and at its sole discretion, the City may pay Contractor for additional value received as a result of Contractor's efforts, but in no case shall said payment exceed the total profit and overhead remaining in Contractor's budget at that time. B. The City may terminate this Agreement for cause if Contractor breaches any material provision of this Agreement. The City shall give Contractor seven (7) days written notice of its intent to terminate the Agreement and the reasons therefore, and, if Contractor, or its Surety, fails to cure the default within that period, the termination shall take place without further notice. The City shall then make alternative arrangements for completion of the Project and deduct the cost of completion from the unpaid Contract Price. The City will make no payment to the Contractor or its Surety until all costs of completing the Project are paid. If the unpaid balance of the amount due the Contractor, according to this agreement, exceeds the cost of finishing the Project, the Contractor or its Surety will receive the applicable funds due. If the costs of completing the Project exceed the unpaid balance, the Contractor or its Surety will pay the difference to the City. C. If the City terminates this Agreement for cause, and it is later determined that the City did not have grounds to do so, the termination will be treated as a termination for convenience under the terms of this Section (A) above. D. Upon termination, the Contractor shall: (1) promptly discontinue all services affected, unless the notice directs otherwise; and (2) promptly deliver to the City all data, drawings, reports, summaries, and such other information and materials as may have been generated or used by the Contractor in performing this Agreement, whether completed or in process, in the form specified by the City. E. The rights and remedies of the City and the Contractor provided in this Section are in addition to any other rights and remedies provided under this Agreement or at law or in equity. Section 11. Construction Administration A. The City and the Contractor will communicate with each other in the first instance through John Rebar or designee. B. The Architect's decisions in matters relating to aesthetic effect shall be final if consistent with the intent of this Agreement. C. THE DUTIES, OBLIGATIONS AND RESPONSIBILITIES OF THE CONTRACTOR UNDER THIS AGREEMENT SHALL IN NO MANNER WHATSOEVER BE CHANGED, ALTERED, DISCHARGED, RELEASED, OR SATISFIED BY ANY DUTY, OBLIGATION OR RESPONSIBILITY OF THE ARCHITF,CT. THE CONTRACTOR IS NOT A THIRD -PARTY BENEFICIARY OF ANY AGREEMENT BY AND BETWEEN THE OWNER AND THE ARCHITECT. IT IS EXPRESSLY ACKNOWLEDGED AND AGREED THAT THE DUTIES OF THE CONTRACTOR TO THE CITYARE INDEPENDENT OF, AND ARE NOT DIMINISHED BY, ANY DUTIES OF THE ARCHITECT TO THE CITY. 39 1 ITB 13-PW5 Section 12. Miscellaneous A. Complete Agreement. This Agreement contains all of the understandings and agreements of Whatsoever kind and nature existing between the parties hereto with respect to the subject matter contained herein. B. Governing Law. This Agreement shall be governed by and construed under the laws of the State of Georgia. C. Counterparts. This Agreement may be executed in any number of counterparts, each of which shall be deemed to be an original, but all of which together shall constitute one and the same instrument. D. Invalidity of Provisions. Should any part of this Agreement for any reason be declared by any court of competent jurisdiction to be invalid, such decision shall not affect the validity of any remaining portion, which remaining portion shall continue in full force and effect as if this Agreement had been executed with the invalid portion hereof eliminated, it being the intention of the parties that they would have executed the remaining portion of this Agreement without including any such part, parts or portions which may for any reason be hereafter declared invalid. E. Notice. All notices requests, demands and other communications hereunder shall be in writing and shall be deemed received, and shall be effective when personally delivered or on the third day after the postmark date when mailed by certified mail, postage prepaid, return receipt requested or upon actual delivery when sent via national overnight commercial carrier to the parties at the addresses given below, unless a substitute address shall first be furnished to the other parties by written notice in accordance herewith: NOTTCE TO CITY shall be sent to: City of Milton 13000 Deerfield Parkway Suite 107 City Manager Milton, GA 30004 NOTICE TO CONTRACTOR shall be sent to: F. Sovereign Immunitii. Nothing contained in this Agreement shall be construed to be a waiver of the City's sovereign immunihj or any individual's qualified good faith or official immunities. G. Force Majeure. Neither the City nor Contractor shall be liable for their respective non -negligent or non -willful failure to perform or shall be deemed in default with respect to the failure to perform (or cure a failure to perform) any of their respective duties or obligations under this Agreement or for any delay in such performance due to: (i) any cause beyond their respective reasonable control; (ii) any act of God; (iii) any change in applicable governmental rules or regulations rendering the performance of any portion of this Agreement legally impossible; (iv) earthquake, fire, explosion or flood; (v) strike or labor dispute, excluding strikes or labor disputes by employees and/or agents of Contractor; (vi) delay or failure to act by any governmental or military authority; or (vii) any war, hostility, embargo, sabotage, civil disturbance, riot, insurrection or invasion. In such event, the time for performance shall be extended by an amount of time equal to the period of delay caused by such acts. Any additional reasonable costs incurred by Contractor as a result of such extension 40 1 ITB 13-PW5 may be added to the Contract price subject to the terms of Section 6 and approval of a Change Order relating to same. All other obligations shall remain intact. H. Hems. All headings herein are inserted only for convenience and ease of reference and are not to be considered in the construction or interpretation of any provision of this Agreement. IN WITNESS WHEREOF, the parties have caused this Agreement to be executed under seal as of the date first above zoritten. (Contractor name) By: XXXXXX Attest: XXXXXXXX [AFFIX CORPORATE SEAL] SIGNED, SEALED, AND DELIVERED in the presence of, Witness Notary Public [NOTARY SEAL] My Commission Expires: [SIGNATURES CONTINUED ON THE FOLLOWING PAGE] 41 1 rrB 13-Pw5 Approved as to form: Cihj Attorney CITY OF MILTON [CITYSEAL] SIGNED, SEALED, AND DELIVERED in the presence of Witness Notary Public [NOTARY SEAL] My Commission Expires: 42 1 FrB 13-PW5 EXHIBIT 'A" EXHIBIT 'B" 43 1 ITS 13-PW5 EXHIBIT "C" PERFORMANCE BOND KNOW ALL MEN BY THESE PRESENTS THAT Firm Name (as CONTRACTOR, hereinafter referred to as the "Principal"), and (as SURETY COMPANY, hereinafter referred to as the "CONTRACTOR'S SURETY"), are held and firmly bound unto the City of Milton, Georgia (as OWNER, hereinafter referred to as the "City"), for the use and benefit of any "Claimant," as hereinafter defined, in the sum of Dollars ($ ), lawful money of the United States of America, for the payment of which the Principal and the Contractor's Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the Principal has entered, or is about to enter, into a certain written agreement with the City, dated the of , 20_ which is incorporated herein by reference in its entirety (Hereinafter referred to as the "CONTRACT"), for the construction of a project known as FY12 Project Name (hereinafter referred to as "the PROJECT"). NOW THEREFORE, the conditions of this obligation are as follows: 1. That if the Principal shall fully and completely perform each and all of the terms, provisions and requirements of the Contract, including and during the period of any warranties or guarantees required thereunder, and all modifications, amendments, changes, deletions, additions, and alterations thereto that may hereafter be made, and if the Principal and the Contractor's Surety shall indemnify and hold harmless the Cityfrom any and all losses, liability and damages, claims, judgments, liens, costs and fees of every description, including but not limited to, any damages for delay, which the City may incur, sustain or suffer by reason of the failure or default on the part of the Principal in the performance of any and all of the terms, provisions and requirements of the Contract, including all modifications, amendments, changes, deletions, additions, and alterations thereto and any warranties or guarantees required thereunder, then this obligation shall be void; otherwise to remain in full force and effect; 2. In the event of a failure of performance of the Contract by the Principal, which shall include, but not be limited to, any breach of default of the Contract: a. The Contractor's Surety shall commence performance of its obligations and undertakings 44 1 ITB 13-PW5 under this Bond no later than thirty (30) days after written notice from the City to the Contractor's Surety; and b. The means, method or procedure by which the Contractor's Surety undertakes to perform its obligations under this Bond shall be subject to the advance written approval of the City. The Contractor's Surety hereby waives notice of any and all modifications, omissions, additions, changes and advance payments or deferred payments in or about the Contract, and agrees that the obligations undertaken by this Bond shall not be impaired in any manner Inj reason of any such modifications, omissions, additions, changes, and advance payments or deferred payments. The Parties further expressly agree that any action on this Bond may be brought within the time allowed Inj Georgia lam for suit on contracts under seal. IN WITNESS WHEREOF, the principal and Contractor's Surety have hereunto affixed their corporate seals and caused this obligation to be signed by their duly authorized officers or attorneys -in -fact, this day of ,20 Firm Name By:, Attest: [AFFIX CORPORATE SEALI Date: Attest: Date: (Insert Name of Contractor's Surety) By: Title: (SEAL) (ATTACH SURETY'S POWER OF ATTORNEY) 45 1 ITB 13-FW5 PAYMENTBOND CITY OF MILTON, GEORGIA KNOW ALL MEN BY THESE PRESENTS THAT Firm Name. (as CONTRACTOR, hereinafter referred to as the "Principal"), and (as SURETY COMPANY, hereinafter referred to as the "CONTRACTOR'S SURETY"), are held and firmly bound unto the City of Milton, Georgia (as OWNER, hereinafter referred to as the "City"), for the use and benefit of any "Claimant," as hereinafter defined, in the sum of Dollars ($ ), lawfid money of the United States of America, for the payment of which the Principal and the Contractor's Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the Principal has entered, or is about to enter, into a certain written agreement with the City, dated , which is incorporated herein Inj reference in its entirety (hereinafter referred to as the "CONTRACT"), for the construction of a project known as Project Name, (hereinafter referred to as "the PROJECT") NOW THEREFORE, the condition of this obligation is such that if the Principal shall promptly make payment to any Claimant, as hereinafter defined, for all labor, services and materials used or reasonably required for use in the performance of the Contract, then this obligation shall be void; otherwise to remain in full force and effect. A "Claimant" shall be defined herein as any Subcontractor, person, Party, partnership, corporation or other entity furnishing labor, services or materials used or reasonably required for use in the performance of the Contract, without regard to whether such labor, services or materials were sold, leased or rented, and without regard to whether such Claimant is or is not in privity of the Contract with the Principal or any Subcontractor performing Work on the Project. In the event of any claim made by the Claimant against the City, or the filing of a Lien against the property of the City affected by the Contract, the Contractor's Surety shall either settle or resolve the Claim and shall remove any such Lien lnj bond or otherwise as provided in the Contract. 46 1 ITB 13-PW5 The Parties further expressly agree that any action on this Bond may be brought within the time allozoed by Georgia law for suit on contracts under seal. IN WITNESS WHEREOF, the Principal and Contractor's Surety have hereunto affixed their corporate seals and caused this obligation to be signed by their duly authorized officers on this day of ,20 Attest: Date: Attest. Firm name By: (Signatures Continued on Next Page) (Insert Name of Contractor's Surety) By: Title: (SEAL) (ATTACH SURETY'S POWER OF ATTORNEY) 47 1 ITB 13-PW5 MAINTENANCE BOND CITY OF MILTON, GEORGIA KNOW ALL MEN BY THESE PRESENTS THAT [FIRM NAME] (as CONTRACTOR, hereinafter referred to as the "Principal" located at [FIRM ADDRESS], and (as SURETY COMPANY, hereinafter referred to as the "Contractor's Surety"), are held and firmly bound unto the City of Milton, Georgia (as OWNER, hereinafter referred to as the "City"), for the use and benefit of the City for maintenance of Improvements as described below in the sum of Dollars ($ ), lawful money of the United States of America, for the payment of which the Principal and the Contractor's Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the Principal has entered, or is about to enter, into a certain written Agreement with the City, dated which is incorporated herein by reference in its entirety (hereinafter referred to as the "Agreement"), for the construction of certain Improvements as contemplated by that Project for [PROJECT NAME] (hereinafter referred to as the "Project"); and WHEREAS, said Project is to be approved by the City of Milton, under the terms that a maintenance bond is required of said Principal and good and sufficient surety payable to the City, and conditioned that the Principal shall, for a period of two (2) years beginning on , maintain all improvements ("Improvements") involved in said Project in accordance with all applicable federal and state laws, with the Agreement, and with all applicable City regulations, including but not limited to the Code of Ordinances for the City of Milton, Georgia, in force as of the date of said approval. NOW THEREFORE, the conditions of this obligation are as follows: I. That if the Principal shall maintain the Improvements as described above, and if the Principal and the Contractor's Surety shall indemnify and hold harmless the City from any and all Iosses, liability and damages, claims, judgments, liens, costs and fees of every description, including but not limited to, any damages for costs of maintenance of Improvements, which the City may incur, sustain or suffer by reason of the failure or default 48 1 ITB 13-PW5 on the part of the Principal in the performance of any and all of the terms, provisions and requirements described herein, then this obligation shall be void; otherwise to remain in full force and effect; 2. In the event of a failure of performance by the Principal; a. The Contractor's Surety shall commence performance of its obligations and undertakings under this Bond no later than thirty (30) days after written notice from the City to the Contractor's Surehj; b. The means, method or procedure by which the Contractor's Surety undertakes to perform its obligations under this Bond shall be subject to the advance written approval of the City. The Parties further expressly agree that any action on this Bond may be brought within the time allowed by Georgia lazy for suit on contracts under seal. IN WITNESS WHEREOF, the Principal and Contractor's Surety have hereunto affixed their corporate seals and caused this obligation to be signed by their duly authorized officers on this day of 20 [SIGNATURES ON THE FOLLOWING PAGE] (Contractor Name) By: Name, Title: (SEAL) Attest: By: Name, Title: Date: (Name of Contractor's Surety) By: Name, Title: (SEAL) Attest: By: Name, Title: Date: (ATTACH SURETY'S POWER OFATTORNEY 49 1 ITB 13-PW5 STATE OF GEORGIA City of Milton EXHIBIT 'D" NONCOLL USION AFFIDAVIT OF PRIME BIDDER J being first duly sworn, deposes and says that: (1) He is (Owner, Partner, Officer, Representative, or Agent) of XXXXXXXXXX (the "Bidder") that has submitted the attached Bid, (2) He is fully informed respecting their preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid; (3) Such Bid is genuine and is not a collusive of sham Bid; (4) Neither the said Bidder nor any of its officers, partners, owners, agents, representatives, employees, or parties in interest, including this affidavit, has in any way colluded, conspired, connived, or agreed, directly or indirectly, with any other Bidder, firm or person to submit a collusive or sham Bid in connection with the Contract for which the attached Bid has been submitted to or refrain from bidding in connection with such Contract, or has in any collusion or communication or conference with any other Bidder, firm or person to fix the price or prices in the attached Bid or of any other Bidder, or to secure through any collusion, conspiracy, connivance or unlawful agreement any advantage against the City or any person interested in the proposed Contract; and, (5) The price or prices quoted in the attached Bid are fair an proper and are not tainted by any collusion, conspiracy, connivance, or unlawful agreement on the part of the Bidder or any of its agents, representatives, owners, employees, or parties in interest., including this affidavit. (6) Bidder has not directly or indirectly violated O.C.G.A. § 36-91-21(d). (Signed) Subscribed and Sworn to before me (Name) this day of .20 Title My Commission Expires Date (SEAL) 50 1 ITB 13-PW5 EXHIBIT E" FINAL AFFIDAVIT TO CITY OF MILTON, GEORGIA I, 'hereby certifij that all suppliers of materials, equipment and service, subcontractors, mechanics, and laborers employed by XXXXXXX. or any of its subcontractors in connection with the construction of the XXXXXXXXX for the City have been paid and satisfied in full as of 20 , and that there are no outstanding obligations or claims of any kind for the payment of which the City on the above named project might be liable, or subject to, in any lawful proceeding at laza or in equity. Signature Title Personally appeared before me this day of , 20 Who under oath deposes and says that he is of the firm of XXXXXXXXX. that lie has read the above statement and that to the best of his kttowledge and belief sante is an exact true statement. Notary Public My Commission Expires 51 1 ITB 13-PW5 STATE OF GEORGIA CITY OF MILTON EXHIBIT "F" CONTRACTOR AFFIDAVITAND AGREEMENT By executing this affidavit, the undersigned contractor verifies its compliance with O.C. G.A. § 13-10-91, stating affirmatively that the individual, firm, or corporation which is contracting with the City has registered with and is participating in a federal work authorization program, in accordance with the applicable provisions and deadlines established in O.CG.A. § 13-10-91. The undersigned further agrees that, should it employ or contract with any subcontructor(s) in connection with the physical performance of services pursuant to this contract with the City, contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. § 13-10-91 on the Subcontractor Affidavit provided in Rule 300-10-01-.08 in the forth attached hereto as Exhibit "1." Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the City at the time the subcontractor(s) is retained to perform such service. EEV/Basic Pilot Program User Identification Number BY. Authorized Officer or Agent Date (Contractor name) Title of Authorized Officer or Agent of Contractor Printed Name of Authorized Officer or Agent SIGNED, SEALED, AND DELIVERED in the presence of. Witness Notary Public [NOTARY SEAL] My Commission Expires: 52 1 ITB 13-PW5 STATE OF GEORGIA CITY OF MILTON EXHIBIT "G" SUBCONTRACTOR AFFIDAVIT By executing this affidavit, the undersigned subcontractor verifies its compliance with O.C. G.A. § 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services under a contract with Firm Name on behalf of the City has registered with and is participating in a federal work authorization program, in accordance with the applicable provisions and deadlines established in O. C. G.A. § 13- 10-91. EEV/Basic Pilot Program User Identification Number BY: Authorized Officer or Agent Date (Insert Subcontractor Name) Title of Authorized Officer or Agent of Subcontractor Printed Nanie of Authorized Officer or Agent SIGNED, SEALED, AND DELIVERED in the presence of. Witness Notary Public [NOTARY SEAL] My Commission Expires: 53 1 ITB 13-PW5 EXHIBIT "H" SAVEAffidavit By executing this affidavit under oath, and as an applicant for a public benefit, as referenced in O.C.G.A. § 50-36-1, from the City of Milton, the undersigned applicant verifies one of the following with respect to my application for a public benefit: 1) 1 am a United States citizen. 2) lam a legal permanent resident of the United States. 3) 1 am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an alien number issued by the Department of Homeland Security or other federal immigration agency. My alien number issued by the Department of Homeland Security or other federal immigration agency is: The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at least one secure and verifiable document as required by O.C.G.A. § 50-36-1(e)(1), with this affidavit. The secure and verifiable document provided with this affidavit can best be classified as: In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A. § 16-10-20, and face criminal penalties as allowed by such criminal statute. Executed in SUBSCRIBED AND SWORN BEFORE ME ON THIS THE _ DAY OF 20_ NOTARY PUBLIC My Commission Expires: (city), (state). Signature of Applicant Printed Name of Applicant 54 1 ITB 13-PW5 EXHIBIT "I" Site/Civil Drawings EXHIBIT " J" KEY PERSONNEL END SAMPLE CONTRA CT EXHIBIT "B" BID FROM CONTRACTOR HOME OF' iVl i I I ON�l` ISFA811S11ED 2006 CITY OF MILTON INVITATION TO BID (THIS IS NOT AN ORDER) Bid Number: 13-PW5 Due Date and Time: April 2, 2013 Local Time: 2:9Upm Project Name: Deerfield Parkway at Morris Road Intersection Improvements Number of Pages: 54 ISSUING DEPARTMENT INFORMATION Issue Date: March 4, 2013 City of Milton Public Works Department 13000 Deerfield Pkwy, Suite 1070 Milton, Ga. 30004 Phone: 678-242-2500 Fax: 678-242-2499 Website: wwrr.cityotmiltonaa.us INSTRUCTIONS TO BIDDERS Return Submittal to: Mark Face of Envelope/Package: Bid Number: 13-PW5 City of Milton Name of Company or Firm Attn: hick Pearce, Purchasing Special Instructions: Office Deadline for Written Questions 13000 Deerfield Pkwy March 15, 2013 Suite 107G Email questions to Rick Pearce at Milton, Ga. 30004 rick.aearce(a.citvofmiltoneams IMPORTANT: SEE STANDARD TERMS AND CONDITIONS BIDDERS MUST COMPLETE THE FOLLOWING Bidder Name/Address: Authorized Bidder Signatory: m lk{ Oor+et,/�l mar' 300io Please print name and gn in ink Bidder Pho a Number: 1P�a^yLS-"lit Bidder FAX Number: 0 -y - 07 0 Bidder Federal I.D. Number: Bidder E-mail Address: 5 1- 13 b _ BIDDERS MUST RETURN THIS COVER SHEET WITH 1§113 RESPONS , Youn *** PHONE: 678.242.25001 FAX: 678.242.2499 .„' info@cityafmiltonga.us j www.cityotrnflCommunit� i tonga.us 4 till;, ,ti 13000 Deerfield Parkway, Suite 107 1 Milton GA 30004 ''meg tt` ACKNOWLEDGEMENT RECEIPT OF ADDENDUM #1 ITB 13-PW5 Upon receipt of documents, please email, fax or mail this page to: City of Milton Attn: Rick Pearce, Purchasing Office 13000 Deerfield Pkwy Suite 107G Milton, GA 30004 Phone: 678-242-2511 Fax: 678-242-2499 Email: rick.nrarcc(n`,cit� ofwt�ittu�i�*u.us I hereby acknowledge receipt of documents pertaining to the above referenced ITB. COMPANY NAME: Soldovii4 evi i; CONTACT PERSON: Mjkc &du ADDRESS: 10 M Knn al ail of. CITY: _Mr t Q r} y STATE: G 4- ZIP: 2 nQ G D PHONE:.770-44t- 4t 4l -FAX: - qZ�',-o 7qp EMAIL ADDRSS:1dw✓1dT fr�,lrlftlJ ri�r� Si ature Date DDENDUM #1 M Topic Table of Contents Page Invitation to Bid 3 Introduction 5 Bidding Instructions 6 Insurance Requirements 6 Bonding Requirements 6 Bid Submittal Form 8 Addenda Acknowledgement 9 Bid Bond 10 Qualifications Signature and Certification 13 List of Subcontractors 14 Bid Price Certification 15 Disclosure Form 16 Contractor Affidavit Exhibit "F" (everify) 17 Schedule of Events 18 Project Specifications 19 Sample Construction Agreement 28 3111 B11`�I CITY OF MILTON Purchasing Division Invitation to Bid Number: 13-PW5 Deerfield Parkway at Morris Road Intersection Improvements The City of Milton is accepting sealed bids from qualified firms for an Intersection Improvement Project for the Public Works Department in conformance with Title 32, Chapter 4, Article 4, Part 2 of the Official Code of Georgia Annotated. All work will be done in accordance with Georgia Department of Transportation's (GDOT) Standard Drawings, Standard Specifications, and Pay Items Index as standards and specifications for the construction and completion of the work required. All bidders must comply with all general and special requirements of the bid information and instructions enclosed herein. Sealed bids will be received no later than 2:00 PM Local Time on April 2, 2013. Sealed bids shall be submitted to: City of Milton Attn: Rick .Pearce, Purchasing Office 13000 Deerfield Pkwy Suite 107G Milton, Ga. 30004. At approximately 2:05 PM Local Time on April 2, 2013 bids will be publicly opened and the bidder's name and total bid amount will be read aloud at: City of Milton Courthouse 13000 Deerfield Parkway Suite 107E Milton, GA 30004. Bids received after the above time or in any other location will not be accepted. Bids shall be presented in a sealed envelope with the bid number (13 -PWS) and the name of the company or firm submitting clearly marked on the outside of the envelope. ONE (1) ORIGINAL (PAPER) AND TWO (2) COPIES (PAPER) AND A PDF COPY OF THE BID ON CD MUST BE SUBMITTED. Bids will not be accepted verbally or email. Questions must be in writing. For questions, please email Rick Pearce at rick.taexrcc{riscityofntiiltonga.0 �. Deadline for questions is March 15, 2013 at 5:00pm. Official answers to questions and potential changes to the ITB (Addendums) will be posted at the same web locations as the ITB on or about March 19, 2013. Any other form of interpretation, correction, or change to this ITB will not be binding upon the City. It is the bidder's responsibility to check the websites for potential updates. Please reter to Bid (13-PW5) and bid name Deerfield Parkway at Morris Road Intersection Improvements when requesting information. The selected contractor must be able to start work within ten (10) calendar days after the "Notice to Proceed" is issued. The time of completion for the project is one hundred eighty days (180) calendar days from the date of the "Notice to Proceed." If weather affects the required completion schedule, The City and selected contractor will negotiate a new completion date. Section 108.08 of the State of Georgia Department of Transportation Standard Specifications Construction of'Transportation Systems (current edition) shall be applied. To bid on this project the construction firm must be a GDOT qualified contractor and provide (on separate qualifications sheet) a list of at least three similar projects for a local government, county or state agency (with references) upon which the contractor has served in a lead or prominent role. At a minimum, the qualifications list should include the name of the jurisdiction 4 for which the work was performed, a brief description of the work, reference name and contact information. The City of Milton reserves the right to reject any or all bids and to waive technicalities and informalities, and to make award in the best interest of the City of Milton. TO: PURCHASING OFFICE CITY OF MILTON MILTON, GEORGIA 30004 Ladies and Gentlemen: In compliance with your Invitation To Bid, the undersigned, hereinafter termed the Bidder, proposes to enter into a Contract with the City of Milton, Georgia, to provide the necessary machinery, tools, apparatus, other means of construction, and all materials and labor specified in the Contract Documents or as necessary to complete the Work in the manner therein specified within the time specified, as therein set forth, for: Bid Number 13-PW5 DEERFIELD PARKWAY AT MORRIS ROAD INTERSECTION IMPROVEMENTS The Bidder has carefully examined and fully understands the Contract, Specifications, and other documents hereto attached, has made a personal examination of the Site of the proposed Work, has satisfied himself as to the actual conditions and requirements of the Work, and hereby proposes and agrees that if his bid is accepted, he will contract with the City of Milton if] full conformance with the Contract Documents. Unless otherwise directed, all work performed shall be in accordance with the Georgia Department of Transportation Standard Specifications, Construction of Transportation Systems (current edition). All materials used in the process of completion of the work included in the Contract will be furnished from Georgia Department of Transportation certified suppliers only. It is the intent of this Bid to include all items of construction and all Work called for in the Specifications, or otherwise a part of the Contract Documents. In accordance with the foregoing, the undersigned proposes to furnish and construct the items listed in the attached Bid schedule for the lump sum price stated. The Bidder agrees that the cost of any work performed, materials furnished, services provided or expenses incurred, which are not specifically delineated in the Contract Documents but which are incidental to the scope, intent, and completion of the Contract, shall be deemed to have been included in the prices bid for the various items scheduled. BIDDING INSTRUCTIONS FAILURE TO RETURN THE FOLLOWING BID DOCUMENTS COULD RESULT IN THE BID BEING DEEMED NON-RESPONSIVE AND BEING REJECTED: 1. Filled out and signed Invitation to Bid (Page 1) 2. City Bid Submittal Form, and City Bid Bond 3. Applicable Addenda Acknowledgement 4. Qualification Signature and Certification 5. List of Subcontractors 6. laid Price Certification 7. Disclosure Form 8. Contractor Affidavit and Agreement (eVerify) (Listed as Exhibit F in this document) 9. Qualification sheet listing projects that meet the experience requirement along with references. Use your own form. INFORMATION AND INSTRUCTIONS The purpose of this solicitation is to enter into a lump sum price contract with one firm to be the primary supplier of the Deerfield Parkway at Moms Road Intersection Improvements (l 3-PW5). No specification expressed or implied shall be construed as any type of restrictive specification that would limit competition. The City reserves the right to cancel the contract at any time with 30 days written notice. Title to any supplies, materials, equipment or other personal property shall remain the Contractors' until fully paid for by the City. Any damage to any building or traffic control device, or equipment incurred during the course of work shall be repaired at the contractor's expense to the complete satisfaction of the City of Milton with no additional expense to the City. EVALUATION The City intends to evaluate the ITB on the lowest, best, responsible, and responsive vendor. INSURANCE REQUIREMENTS Within 10 days of Notice of Award, and at all times that this Contract is in force, the Contractor shall obtain, maintain and furnish the City Certificates of Insurance from licensed companies doing business in the State of Georgia with an A.M. Best Rating A-6 or higher and acceptable to the City. Insurance requirements are included in the SAMPLE CONTRACT AGREEMENT below. BONDING REQUIREMENTS Each bid must be accompanied with a BID BOND (bond only: certified checks or other forms are not acceptable) in an amount equal to five percent (5%) of the base bid (not including the bid alternate), payable to the City of Milton. Said bid bond guarantees the bidder will enter into a contract to construct the project strictly within the terms and conditions stated in this bid and in the bidding and contract documents, should the construction contract be awarded. The Successful Bidder shall be required to furnish a PERFORMANCE BOND for the faithful performance on the contract and a PAYMENT BOND to secure payment of all claims for materials furnished and/or labor performed in performance of the protect, both in amounts equal to one hundred percent (100%) of the contract price. The Successful Bidder shall also be required to furnish a MAINTENANCE BOND, in the amount of one-third (1/3) of the contract price, guaranteeing the repair or replacement caused by defective workmanship or materials for a period of two (2) years from the completion of construction. Bonds shall be issued by a corporate surety appearing on the Treasury Department's most current list (Circular 570 as amended) and be authorized to do business in the State of Georgia. Bonds shall be on the forms provided by the City and subject to the review and approval of the City Attorney. Date of Bond must not be prior to date of Contract. If Contractor is a Partnership, all partners shall execute Bond. OATH Prior to conimencing the Work, the successful bidder shall execute a written oath as required by O.C.G.A. §§ 32-4-122 and 36-91-21(e). COST OF PREPARING A PROPOSAL The costs for developing and delivering responses to this ITB and any subsequent presentations of the proposal as requested by the City are entirely the responsibility of the bidder. The City is not liable for any expense incurred by the bidder in the preparation and presentation of their proposal. All materials submitted in response to this ITB become the property of the City of Milton. 6 1 ; iz ,,%. Bid Submittal Form Deerfield Parkway at Morris Road Intersection Improvements [BIDDERS MUST RETURN THIS SHEET WITH BID RESPONSE] The undersigned, as bidder, declares and represents that it has examined the site of the work and informed himself/herself fully in regard to all conditions pertaining to the place where the work is to be performed, including those conditions affecting the cost of the work and the delivery, handling and storage of materials and equipment. The bidder has examined and read the Bidding Document and has satisfied himself/herself that the Bidding Document is an adequate and acceptable reflection of the work which is required to be performed and that the bidder is willing and able to perform all of the work necessary. The bidder further certifies that no additional information is required to complete the work encompassed by this bid within the cost and schedule established and agreed upon within this bidding document. Hereby proposes and agrees, if this bid for the above named project is accepted to enter into a contract to perfonn all work necessary to the successful completion of the contract; and to supply all required submittals as indicated or specified in the ITB and the bid documents to be performed or furnished by bidder for the for the total contract price of- Total f Total Base Bid Price (Lump Sum) $ 3 3 9 15-F- s z Print Dollar Amount b&4&,►fd d-h1r�14C the4sidd nine hgdeed 4 JC La COMPANYDg/ci.mtl P�:; n� ADDRESS 1O ll Kadm,Il A% 14,q j, e fe 1,,. 3 oo ,�o AUTHORIZED SIGNATURE PRINT / TYPE NAME Mike. ke. De'lig e'r x POSITION V j"� e Prdsl o &/VL 9 1 11 [3 13 PMS, G, ADDENDA ACKNOWLEDGEMENT [BIDDERS MUST RETURN THIS SHEET WITH BID RESPONSE] Bidder acknowledges receipt of the following addenda: Addendum No. Date viewed I 3 - Z 5--j3 Bidder further declares that the full name and resident address of Bidder's Principal is as follows: Signed, sealed, and dated this Z day of Bidder I'g e l % (Seal) Company Name Bidder Mailing Address: JJhn rf�rrisbn —' s�T By: Titl : m;1+C pdmar Title:l?�e�e,� Mwny9Cr IIs BID BOND CITY OF MILTON, GEORGIA JBIDDERS MUST RETURN THIS S}IEi.'l- WITH BID 1ZESPONSE1 Attached hereto is an executed Bid Bond in Clic amount of _ _ Dollars ($ (Dive Percent of Amount Bid). II*this bid shall be accepted by the City of Milton and the undersigned shall fail to execute a satisfactory contract in the form of said proposed Contract. and give satisfactory Perlbrtnance and Payment Bonds. or furnish satisfactory prool'ofcarriage ol'the insurance required within ten days from the date of Notice of Award oi'the Contract, then the City of Milton may, at its option. determine that the undersigned abandoned the Contract and there upon this bid shall be null and void. and the sum stipulated in the attached Bid Bond shall be forfeited to the City of Milton as liquidated damages. BIDDER (]name. and Address): .Baldwin Paving Co., Inc., 1014_ Kenmill Dr., Marietta.,-CiA_ 30060 SURETY (Marne and Address of Principal Place of Buainess): Hartford Fire lttsuranee Company, One Hanford Plaza,Hari1'orcl,_CT 06155 OWNER (hereinafter referred to as the "City" (`lame and Address): City of `Tilton, Georgia A F[ N: Purchasing Office 13000 Deerfield Parkin ay. Suite 107G Milton, Georgia 30004 BID BID DUE DATE: 4/2/13 PROJECT (Brief Description Including Ltvatiun): Deerfield Parkway @ Morris Road Intersection Improvements BOND BOND til IMBER: N/A DATE (Not later that laid due date): 4/2/13 PENAL SUM: Five Percent 5% of Principal's Bid (Words) (Figures) IN W11NESS WHI RFOF, Surcty and Bidder, intending to be legally bound I)crcby to the City. subject to the terms printed below or on the reverse side hereof, do each cause this laid Bond to be duly executed on its behalf by its authorized officer. agent or representalkc. BIDDER B-41.dwin,PAying C0..,.1nC. _(Seal) Bidder's Nanic and Corporate Seal St IRL.TY Hartford Fire Insurance ComnanySeal) Surety's Name and Corporate Seal Bv: V `oC te3"Jtq Sign. !re anti 1 hl . Attest:. Signature and 'l itle: Signature and '�"itle Carolyn F Smith (Attach howar of Attorney) Attorney -In -Fact Attest:— Signature ttet:_Signature and l itic: Note: (1) Above addrebscs me t0 be uscd fior giving any notice required by the tenets of this Bid Hojid. (2) Any singular reference to Bidder, Surety, the City or any other party shall be considered plural where applicable. 1. bidder anti Surety-, jointly and wverally, bind themselves, their heirs. executors. administrators. successors and assigns to pay to the City upon Default of Bidder the penal sum set forth on the face of this Bond. 2. Default of Bidder shall occur upon the failure of Bidder to deliNer within the time required by the Bidding Documents (or any extension of that time agreed to in writing by the City) the executed Agreement required by the Bidding, Documents and an), petformance anti payment Bonds required by the Bidding Documents. This obligation shall be null and void if. 3.1 Tlie City accepts Bidder's Bid anti Bidder dt^livers within the time required by the I3idding Documents (or any extension of that time agreed to in writing by the City) the executed Agreement required by the Bidding Documcnts and any perturrttattce anti payment 13011th required by the Bidding Documents; or 3.2AIl Bids arc rejected by the City: or +.3Tlte City fails to issue a Notice of Award to Bidder within the time specified in the Bidding Documents (or any extension of that time agreed to in writing by Bidder and, it' applicable, cunsentcd to by Surety 'when required by paragraph 5 hercol). Payment under this Bond will be due and pa}able upon Default by Bidder within 30 calendar days after receipt by Bidder and Surety of written Notice of Default from the City, which Notice will be given with reasonable promptness and will identify. this Bond and the Project and include a statement of the amount due. 5. Surety waives notice of, as well as any and all deicroscs based on or arising out ol: an)- tine extension to issue a Notice of Award agreed to in writing by the Cit) and Bidder, provided that the total time, including extensions. ti. -yr issuing a Notice oi'Amkird shall not in the aggregate exceed 120 days from 11 id due date without Surety's written consent. 6. No snit or action shall be commenced under this Bond either prior to 30 calendar days after the Nonce of Default required in paragraph •1 above is received by Bidder and Surety or later than one year after laid due date. 7. Any suit or action under this Bond shall be commenced only in a court of competent jurisdiction located in the State of Georgia. 8. Noti"-s required hereunder shall be in writing and sent to Bidder and Surety at their respective addresses shown on the face of this Bond. Such notice,, may be sent by personal delivery, commercial 12 courier or by United States Registered or Certified Mail. return receipt requested. postage pre -paid, and shall he deemed to he cf bclitie upon receipt by the party concerned. tt. Surety shall caww to be attached to this Bond a current And effective Power of Attorney evidencing the authority ol'the off icer. agent or representative w•ho executed this Bond on behalf of Surety to execute, seal and deliv-er such Bond and bind the Surety thereby. 10. This Bond is intended tc-, con1brnl to all applicable �,tatutory requirements. Any applicable requirement ofaly applicable atalute that has been omitted from this Bond shall be deemed to be included herein as if set forth at length. If any provision of this Bond conflicts with any applicable statute. then the provision of said statute shall go,, ern and the remainder of this Bond that is not in conflict therewith shall comillne ill full Jbrce and effect. H. 1'he term "Bid" as used herein includes a Bid. offer or proposal, as applicable under the particular c:ircunlstances. 1 '1 he terms of this Bid Bond shall be governed by the laws of the State of Georgia. Direct inquiries/Claims to. 1HE HARTFORD POWER OFATTOR-NEY One Hartford rttfordPlaza Hartford, Connecticut 06155 call: 888-266-3488 or fax: 860-757-5835 KNOW ALL PERSONS BY THESE PRESENTS THAT: Agency Code: 20-262197 L^J Hartford Fire Insurance Company, a corporation duly organized under the laws of the State of Connecticut OHartford Casualty Insurance Company, a corporation duly organized under the laws of the State of Indiana FX --j Hartford Accident and Indemnity Company, a c:urpurdtion duly urganizml under Clic laws urthe State orcutmccticut 0r Hartford Underwriters Insurance Company, a corporation duly organized under the laws of the State of Connecticut lJ Twin City Fire insurance Company, a corporation duly organized under the laws of the Statc of Indiana O Hartford Insurance Company of Illinois, a corporation duly organized under the laws of the State of Illinois Hartford Insurance Company of the Midwest, a corporation duly organized under the laws of the State of Indiana Hartford insurance Company of the Southeast, a corporation duly organized under the laws of the State of Florida having their home office in Hartford, Connecticut, (hereinafter collectively referred to as the "Companies") do hereby make, constitute and appoint, up to the amount of unlimited. William H. Skeeles, John Langsfeld, Marilyn Brown, Rita L. Smith, Robert J. Ryan, Carolyn F. Smith, Madalyn H. Seiffert Of Atlanta, GA their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above, to sign its name as surety(ies) only as delineated above by ®, and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. In Witness Whereof, and as authorized by a Resolution of the Board of Directors of the Companies on August 1, 2009 the Companies have caused these presents to be signed by its Vice President and its corporate seals to be hereto affixed, duly attested by its Assistant Secretary. Further, pursuant to Resolution of the Board of Directors of the Companies, the Companies hereby unambiguously affirm that they are and will be bound by any mechanically applied signatures applied to this Power of Attorney. lrt ► ! (f- ��rWt y •+�''4�?t:.^ � rio#> * ,�t�� _fy^»•r...��;: �`7 •nooro•. I � �1 '+nnr�r �a��f�M� Int r9t9 � �, loin =�. ' • Wesley W. Cowling, Assistant Secretary STATE OF CONNECTICUT Hartford COUNTY OF HARTFORD M Ross Fisher, Vice President On this 12th day of July, 2012, before me personally came M. Ross Fisher, to me known, who being by me duly sworn, did depose and say: that he resides in the County of Hartford, State of Connecticut; that he is the Vice President of the Companies, the corporations described in and which executed the above instrument; that he knows the seals of the said corporations; that the seals affixed to the said instrument are such corporate seals; that they were so affixed by authority of the Boards of Directors of said corporations and that he signed his name thereto by like authority. I, the undersigned, Vice President of the Companies, DO HEREBY CERTIFY that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies, which is still in full force effective as of April 2, 2013. Signed and sealed at the City of Hartford. ®rr/ TP Qp 1979.rFt 11117S . 79t♦ All Gary W. Stumper, Vice President ' •��. Kathleen 7. Maynard Ci14o• Noary Public My Commission Expires July 31, 2016 CERTIFICATE I, the undersigned, Vice President of the Companies, DO HEREBY CERTIFY that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies, which is still in full force effective as of April 2, 2013. Signed and sealed at the City of Hartford. ®rr/ TP Qp 1979.rFt 11117S . 79t♦ All Gary W. Stumper, Vice President QUALIFICATIONS SIGNATURE AND CERTIFICATION [BIDDERS MUST RETURN THIS SHEET WITH BID RESPONSE] 1 certify that this offer is made without prior understanding, agreement, or connection with any corporation, firm, or person submitting a proposal for the same materials, supplies, equipment, or services and is in all respects fair and without collusion or fraud. I understand collusive bidding is a violation of State and Federal Law and can result in fines, prison sentences, and civil damage awards. I agree to abide by all conditions of the proposal and certify that I am authorized to sign this proposal for the proposer. I further certify that the provisions of the Official Code of Georgia Annotated, Sections 45-10-20 et. Seq. have not been violated and will not be violated in any respect. /f Authorized Signature Print/Type Name Date Jf- 2,--2013 Print/Type Company Name Here a7jj4o P,166 T� CORPORATE CERTIFICATE r 4SS IS rNA./; 1, MIc.'"A E(- U-- tomer I #,-Z O , certify that I aln the Secretary of the Corporation named as Contractor in the foregoing bid; that IVAC ie -y _ who signed said bid in behalf of the Contractor, was then (title) ✓l a ecepildlO, of said Corporation; that said bid was duly signed for and in behalf of said Corporation by authority of its Board of Directors, and is within the scope of its corporate bowers; that said Corporation is organized under the laws of the State of This - _ day of 2013 T ~ ' (Seal) (Signature) 14 1 ist1 1 '1-� 1=A -c, LIST OF SUBCONTRACTORS [BIDDERS MUST RETURN THIS SHEET WITH BID RESPONSE] I do V 'do not , propose to subcontract some of the work on this project. 1 propose to Subcontract work to the following subcontractors: Company Name: 5Vvj4eS_I►_3_ BID PRICE CERTIFICATION (BIDDERS MUST RETURN THIS SHEET WITH BID RESPONSE) In compliance with the attached Specification, the undersigned offers and agrees that if this Bid is accepted, by the City Council within One Hundred and Twenty (l 20) days of the date of Bid opening, that he will furnish any or all of the Items upon which Prices are quoted, at the Price set opposite each Item, delivered to the designated point(s) within the time specified in the Bid Schedule. COMPANY 4jgId.v.:2--- ADDRESS jpA 4e4LtdI Ar, i 4170ji C4 ,loo AUTHORIZED SIGNATURE 1 ' PRIN"1' /TYPE NAME M Jfit is I p 3 DISCLOSURE FORM BIDDERS MUST RETURN THIS SHEET WITH BID RESPONSE This form is for disclosure of campaign contributions and family member relations with City of Milton officials/employees. Please complete this form and return as part of your Bid package when it is submitted. Name of Bidder _ Bglaw l,n Name and the official position of the Milton Official to whom the campaign contribution was made (Please use a separate form for each official to whom a contribution has been made in the past two (2) years.) List the dollar aniount/value and description of each campaign contribution made over the past two (2) years by the Applicant/Opponent to the named Milton Official. Amount/Value Description Please list any family member that is currently (or has been employed within the last 9 months) by the City of Milton and your relation: 17 1 1;1� is EXHIBIT "F" (BIDDERS MUST RETURN THIS SHEET WITH BID RESPONSE] STATE OF GEORGIA CITY OF MILTON CONTRACTOR AFFIDAVIT AND AGREEMENT By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm, or corporation which is contracting with the City has registered with and is participating in a federal work authorization program, in accordance with the applicable provisions and deadlines established in O.C.G.A. § 13-10-91. The undersigned further agrees that, should it employ or contract with any subcontractor(s) in connection with the physical performance of services pursuant to this contract with the City, contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. § 13-10-91 on the Subcontractor Affidavit provided in Rule 300-10-01-.08 in the form attached hereto as Exhibit "(i." Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the City at the time the subcontractor(s) is retained to perform such service. EEV 1 Basic Pilot Program User Identification Number W111/1 ,may' BY: thorized Offi or Agent Date(Contractor name) J j re �rC514CAi' Title of Authon edz Officer or Agent of Contractor P+^ Printed Name of Authorized Officer or Agent SIGNED, SEALED, AND DELIVERED in the presence of: Witness l� --lr ���� e I Notary blie ANGIF l't'.. (NOTARY SEAL) My Commission Expires: EXHIBIT "C" BONDS Bond #20BCSGD0543 .PAYMENT BOND CITY OF MH:rON, GEORGIA KNOW ALL MEN BY THESE PRESENTS THAT Baldwin Paving Company, Inc. (as CONTRACTOR, hereinafter referred to as the "Principal"), and Hartford Fire Insurance Company _TY COMPANY, hereinafter as SURF referred to as the "CONTRACTOR'S SURETY"), are held and firmly bound unto the City of Milton, Georgia (as OWNER, hereinafter referred to as the "City"), for the use and benefit of any "Claimant," as hereinafter defined, in the sum of three hundred thirty nine thousand nine hundred fifty five dollars and fifty two cents ($339,955.52), lawful money of the United States of America, for the payment of which the Principal and the Contractor's Surely bind themselves, their heirs, executors, administrators, successors and assigns, j ointly and severally, firmly by these presents. WHEREAS, the Principal has entered, or is about to enter, into a certain written agreement with the City, dated . which is incorporated herein by reference in its entirety (hereinafter referred to as the "CONTRACT"), for the construction of a project known as Deerfield Parkway -Morris Road Intersection Improvements (hereinafter referred to as "the PROJECT"). NOW THEREFORE, the condition of this obligation is such that if the Principal shall promptly make payment to any Claimant, as hereinafter defined, for all. labor, services and materials used or reasonably required for use in the performance of the Contract, then this obligation shall be void; otherwise to remain in full force and effect. A "Claimant" shall be defined herein as any Subcontractor, person., Party, partnership, corporation or other entity furnishing labor, services or materials used or reasonably required for use in the performance of the Contract, without regard to whether such labor, services or materials were sold, leased or rented, and without regard to whether such Claimant is or is not in privity of the Contract with the Principal or any Subcontractor perfom-ling Work on the Project. In the event of any claim made by the Claimant against the City, or the filing of a Lien against the property of the City affected by the Contract, the Contractor's Surety shall either settle or resolve the Claim and shall remove any such Lien by bond or otherwise as provided in the Contract. The Parties ffirther expressly agree that any action on this Bond may be brought within the time allowed by Georgia law for suit on contracts under seal. IN WITNESS WHEREOF, the Principal and Contractor's Surety have hereunto of fixed their corporate seals and caused this obligation to be signed by their duly authorized officers on this day of 2013. Baldwin Paving Company, Inc. By:-It,-J-1,61�L Title: Q ') U— PC-e—SI '"—(SEAL) (Signatures Continued on Next Page) Attest: Title: Date: Attest: Date: Hartford Fire Insurance Company (Marne of Contractor's Surety) By:dv._JIIVZll-h Carol . Smith Title: -Attorney -In -Fact --(SEAL) (ATTACH SURETY'S POWER OF ATTORNEY) Direct Inquiries/Claims to: T POWER OF ATTORNEY one HartforBOND,HARTORD dTPlaza Hartford, Connecticut 06155 call: 888-266-3488 or fax: 860-757-5835 KNOW ALL PERSONS BY THESE PRESENTS THAT: Agency Code: 20-262197 0 Hartford Fire Insurance Company, a corporation duly organized under the laws ofthe State of Connecticut 0 Hartford Casualty Insurance Company, a corporation duly organized under the laws of the State of hdiana OHartford Accident and Indemnity Company, a corporation duly organized under the laws of the State of Connecticut Hartford Underwriters Insurance Company, a corporation duly organized under the laws of the State of Connecticut Twin City Fire Insurance Company, a corporation duly organizedunder the laws of the State of Indiaia Hartford Insurance Company of Illinois, a corporation duly organized under the laws of the State of Illinois Hartford Insurance Company of the Midwest, a corporation duly organized under the laws of the State of Indiana Hartford Insurance Company of the Southeast, a corporation duly organized under the laws of the State of Florida having their home office in Hartford, Connecticut, (hereinafter collectively referred to as the "Companies") do hereby make, constitute and appoint, up to the amount of unlimited: William H. Skeeles, John Langsfeld, Marilyn Brown, Rita L. Smith, Robert J. Ryan, Carolyn F. Smith, Madalyn H. Seiffert of Atlanta, GA their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above, to sign its name as surety(ies) only as delineated above by ®, and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. In Witness Whereof, and as authorized by a Resolution of the Board of Directors of the Companies on August 1, 2009 the Companies have caused these presents to be signed by its Vice President and its corporate seals to be hereto affixed, duly attested by its Assistant Secretary. Further, pursuant to Resolution of the Board of Directors of the Companies, the Companies hereby unambiguously affirm that they are and will be bound by any mechanically applied signatures applied to this Power of Attorney. �r l� (T Lim 1 �9f �,r�Y�p e`��' •y�e' t�s ��� u��"A r°'.sr'v'�t js�%����. > �yn1 tf t � t�'eb t ♦,NtR i'i titv110 ��+�alitA►'�' >w�1y76ie S� t �4r .ryU �a��rt� b+N '. lr�� � � �•• ci•a�i �c•r.t+. '+Z�/i�i�.�`• Wesley W. Cowling, Assistant Secretary STATE OF CONNECTICUT S& Hartford COUNTY OF HARTFORD y �= M. Ross Fisher, Vice President On this 12th day of July, 2012, before me personally came M. Ross Fisher, to me known, who being by me duly sworn, did depose and say: that he resides in the County of Hartford, State of Connecticut; that he is the Vice President of the Companies, the corporations described in and which executed the above instrument; that he knows the seals of the said corporations; that the seals affixed to the said instrument are such corporate seals; that they were so affixed by authority of the Boards of Directors of said corporations and that he signed his name thereto by like authority. I, the undersigned, Vice President of the Companies, DO HEREBY CERTIFY that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies, which is still in full force effective as of Signed and sealed at the City of Hartford. #97b1 » 'ry C, H �..,n• 11 ifs: f. a iP'+s r' F 4+'"+c. i > .� lv�t'� �+�rnYM► L }? �e 19 9 1.»' 1 ➢ j, x s' 's � v� ✓m �� i" �.�, ' �i���h" r� t xkY;�.:�:-.:pi �yrti '� x+`� J • �4r ht nrtir h•.•N• ` ,,�y�`�� ` Sig tf Gary W. Stumper, Vice President ����� L �'*"/ r Kathleen T. Maynard A�rr� Notary Public CERTIFICATE My Commission Expires July 31, 2016 I, the undersigned, Vice President of the Companies, DO HEREBY CERTIFY that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies, which is still in full force effective as of Signed and sealed at the City of Hartford. #97b1 » 'ry C, H �..,n• 11 ifs: f. a iP'+s r' F 4+'"+c. i > .� lv�t'� �+�rnYM► L }? �e 19 9 1.»' 1 ➢ j, x s' 's � v� ✓m �� i" �.�, ' �i���h" r� t xkY;�.:�:-.:pi �yrti '� x+`� J • �4r ht nrtir h•.•N• ` ,,�y�`�� ` Sig tf Gary W. Stumper, Vice President Bond #20BCSGD0543 PERFORMANCE BOND CITY OF MILTON, GEORGIA KNOW ALL MEN BY THESE PRESENTS THAT Baldwin Paving Company, Inc. (as CONTRACTOR, hereinafter referred to as the "Principal"), and Hartford Fire Insurance Company (as SURETY COMPANY, hereinafter referred to as the "CONTRACTOR'S SURETY"), are held and firmly bound unto the City of Milton, Georgia (as OWNER, hereinafter referred to as the "City"), for the use and benefit of any "Claimant," as hereinafter defined, in the sum of three hundred thirty nine thousand nine hundred fifty five dollars and fifty two cents ($339,955.52), lawful money of the United States of America, for the payment of which the Principal and the Contractor's Surety bind themselves, their heirs, executors, administrators; successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the Principal has entered, or is about to enter, into a certain written agreement with the City, dated the of , 2013 which is incorporated herein by reference in its entirety (hereinafter referred to as the "CONTRACT"); for the construction of a project known as Deerfield Parkway -Morris Road Intersection Improvements, (hereinafter referred to as "the PROJECT"). NOW THEREFORE, the conditions of this obligation are as follows: 1. That if the Principal shall fully and completely perform each and all of the terms, provisions and requirements of the Contract, including and during the period of any warranties or guarantees required thereunder, and all modifications, amendments, changes, deletions, additions, and alterations thereto that may hereafter be made, and if'the Principal and the Contractor's Surety shall indemnify and hold harmless the City from any and all losses, liability and damages, claims, judgments, liens, costs and fees of every description, including but not limited to, any damages for delay, which the City may incur, sustain or suffer by reason of the failure or default on the part of the Principal in the performance of any and all of the terms, provisions and requirements of the Contract, including all modifications, amendments, changes, deletions, additions, and alterations thereto and any warranties or guarantees required thereunder, then this obligation shall be void; otherwise to remain in full force and effect; 2. In the event of a failure of performance of the Contract by the Principal, which shall include, but not be limited to, any breach of default of the Contract: a. The Contractor's Surety shall commence performance of its obligations and undertakings under this Bond no later than thirty (30) days after written notice from the City to the Contractor's Surety; and b. The means, method or procedure by which the Contractor's Surety undertakes to perform its obligations under this Bond shall be subject to the advance written approval of the City. The Contractor's Surety hereby waives notice of any and all modifications, omissions, additions, changes and advance payments or deferred payments in or about the Contract, and agrees that the obligations undertaken by this Bond shall not be impaired in any manner by reason of any such modifications, omissions, additions, changes, and advance payments or deferred payments. The Parties further expressly agree that any action on this Bond may be brought within the time allowed by Georgia law for suit on contracts under seal. IN WITNESS NMEREOF, the principal and Contractor's Surety have hereunto affixed their corporate seals and caused this obligation to be signed by their duly authorized officers or attorneys -in -fact, this day of 12013. Attest: Title: "o, Date: Attest: Date: Baldwin Paving Company, Inc. By: Al Title: (SEAL) Hartford Fire Insurance Company (Name of Contractor's Surety) By:6,�W&2)zlm�_� Carol F. Smith Title; Attorney -In -Fact (SEAL) (ATTACH SURETY'S POWER OF ATTORNEY) Direct Inquiries/Claims to: POWER OF ATTORNEY THE HARTFORD BOND, T-4 One Hartford Plaza Hartford, Connecticut 06155 call: 888-266-3488 or fax: 860-757-5835 KNOW ALL PERSONS BY THESE PRESENTS THAT: Agency Code: 20-262197 Hartford Fire Insurance Company, a corporation duly organized under the laws of the State of Connecticut Hartford Casualty Insurance Company, a corporation duly organized under the laws of the State of hdiana 0 Hartford Accident and Indemnity Company, a corporation duly organized under the laws of the State of Connecticut Hartford Underwriters Insurance Company, a corporation duly organized under the laws ofthe State of Connecticut Twin City Fire Insurance Company, a corporation duly organizedunder the laws of the State of Indiana Hartford Insurance Company of Illinois, a corporation duly organized under the laws of the State of Illinois Hartford Insurance Company of the Midwest, a corporation duly organized under the laws of the State of Indiana Hartford Insurance Company of the Southeast, a corporation duly organized under the laws of the State of Florida having their home office in Hartford, Connecticut, (hereinafter collectively referred to as the "Companies") do hereby make, constitute and appoint, up to the amount of unlimited: William H. Skee/es, John Langsfeld, Marilyn Brown, Rita L. Smith, Robert J. Ryan, Carolyn F. Smith, Madalyn H. Seiffert of Atlanta, GA their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above, to sign its name as surety(ies) only as delineated above by ®, and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. In Witness Whereof, and as authorized by a Resolution of the Board of Directors of the Companies on August 1, 2009 the Companies have caused these presents to be signed by its Vice President and its corporate seals to be hereto affixed, duly attested by its Assistant Secretary. Further, pursuant to Resolution of the Board of Directors of the Companies, the Companies hereby unambiguously affirm that they are and will be bound by any mechanically applied signatures applied to this Power of Attorney. �"7yl,Ynu�,4.i ,yN�4F�' ti x ���tt t ,� �/y,'��✓t'c"l cs� � ,u," a v l �+ � 2���' `.:��' ...,+� �� arra tvf+�� �•4;�r`IAfI► .� � t f9 7 a teat •,.�k+�, \-f____,a.`fs'/ Wesley W. Cowling, Assistant Secretary STATE OF CONNECTICUT ss, Hartford COUNTY OF HARTFORD M. Ross Fisher, Vice President On this 12th day of July, 2012, before me personally came M. Ross Fisher, to me known, who being by me duly sworn, did depose and say: that he resides in the County of Hartford, State of Connecticut; that he is the Vice President of the Companies, the corporations described in and which executed the above instrument; that he knows the seals of the said corporations; that the seals affixed to the said instrument are such corporate seals; that they were so affixed by authority of the Boards of Directors of said corporations and that he signed his name thereto by like authority. I, the undersigned, Vice President of the Companies, DO HEREBY CERTIFY that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies, which is still in full force effective as of Signed and sealed at the City of Hartford. Tt:yV� �6!wIry t�y�` C�) b �Mraa►>_ fw, `at Z YH a �;��.Pri�►r>► t` `:�i *2u9W7i�,a.4:' �t:'r lIt97w.,•a,�y' k �' 4�eT�tN 4ysK b f i/ Gary W. Stumper, Vice President •x Kathleen T. Maynard �*ae� Notary Public CERTIFICATE My Commission Expires July 31, 2016 I, the undersigned, Vice President of the Companies, DO HEREBY CERTIFY that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies, which is still in full force effective as of Signed and sealed at the City of Hartford. Tt:yV� �6!wIry t�y�` C�) b �Mraa►>_ fw, `at Z YH a �;��.Pri�►r>► t` `:�i *2u9W7i�,a.4:' �t:'r lIt97w.,•a,�y' k �' 4�eT�tN 4ysK b f i/ Gary W. Stumper, Vice President MAINTENANCE BOND CITY OF MILTON, GEORGIA KNOW ALL MEN BY THESE PRESENTS THAT Baldwin Paving Company, Inc. (as CONTRACTOR, hereinafter referred to as the "Principal" located at 1014 Kenmill Drive NW, Marietta, Georgia 30060, and (as SURETY COMPANY, hereinafter referred to as the "Contractor's Surety"), are held and firmly bound unto the City of Milton, Georgia (as OWNER, hereinafter referred to as the "City"), for the use and benefit of the City for maintenance of Improvements as described below in the sum of one hundred thirteen thousand three hundred eighteen Dollars ($113,318), lawful money of the United States of America, for the payment of which the Principal and the Contractor's Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the Principal has entered, or is about to enter, into a certain written Agreement with the City, dated which is incorporated herein by reference in its entirety (hereinafter referred to as the "Agreement"), for the construction of certain Improvements as contemplated by that Project for Deerfield Parkway -Morris Road Intersection Improvements (hereinafter referred to as the "Project"); and WHEREAS, said Project is to be approved by the City of Milton, under the terms that a maintenance bond is required of said Principal and good and sufficient surety payable to the City, and conditioned that the Principal shall, for a period of two (2) years beginning on maintain all improvements ("Improvements") involved in said Project in accordance with all applicable federal and state laws, with the Agreement, and with all applicable City regulations, including but not limited to the Code of Ordinances for the City of Milton, Georgia, in force as of the date of said approval. NOW THEREFORE, the conditions of this obligation are as follows: 1. That if the Principal shall maintain the Improvements as described above; and if the Principal and the Contractor's Surety shall indemnify and hold harmless the City from any and all losses, liability and damages, claims, judgments, liens, costs and fees of every description, including but not limited to, any damages for costs of maintenance of Improvements, which the City may incur, sustain or suffer by reason of the failure or default on the part of the Principal in the performance of any and all of the terms, provisions and requirements described herein, then this obligation shall be void; otherwise to remain in full force and effect; 2. In the event of a failure of performance by the Principal; a. The Contractor's Surety shall commence performance of its obligations and undertakings under this Bond no later than thirty (30) days after written notice from the City to the Contractor's Surety; b. The means, method or procedure by which the Contractor's Surety undertakes to perform its obligations under this Bond shall be subject to the advance written approval of the City. The Parties further expressly agree that any action on this Bond may be brought within the time allowed by Georgia law for suit on contracts under seal. IN WITNESS WHEREOF, the Principal and Contractor's Surety have hereunto affixed their corporate seals and caused this obligation to be signed by their duly authorized officers on this day of , 20_ [SIGNATURES ON THE FOLLOWING PAGE] Attest: By: Name, Title: Date: Attest: By: Name, Title: Date: Baldwin Paving Company, Inc. By: Name, Title: (SEAL) (Name of Contractor's Surety) By: Name, Title: (SEAL) (ATTACH SURETY'S POWER OF ATTORNEY) EXHIBIT "D" NONCOLLUSION AFFIDAVIT OF PRIME PROPOSER STATE OF GEORGIA CITY OF MILTON being first duly sworn, deposes and says that: (1) He is (C: w;.e--Perfty►, Officer, Represenwive, or-4gent) of Baldwin Paving Company, Inc. (the "Proposer") that has submitted the attached Proposal; (2) He is fully informed respecting their preparation and contents of the attached Proposal and of all pertinent circumstances respecting such Proposal; (3) Such Proposal is genuine and is not a collusive of sham Proposal; (4) Neither the said Proposer nor any of its officers, partners, owners, agents, representatives, employees, or parties in interest, including this affidavit, has in any way colluded, conspired, connived, or agreed, directly or indirectly, with any other Proposer, firm or person to submit a collusive or sham Proposal in connection with the Contract for which the attached Proposal has been submitted to or refrain from proposing in connection with such Contract, or has in any collusion or communication or conference with any other Proposer, firm or person to fix the price or prices in the attached Proposal or of any other Proposer, or to secure through any collusion, conspiracy, connivance or unlawful agreement any advantage against the City or any person interested in the proposed Contract; and, (5) The price or prices quoted in the attached Proposal are fair an proper and are not tainted by any collusion, conspiracy, connivance, or unlawful agreement on the part of the Proposer or any of its agents, representatives, owners, employees, or parties in interest, including this affidavit. (6) Proposer h of directly or indirectly violated O.C.G.A. § 36-91-21(d). Signa e of Authori d Officer or Agent 1, C,- P� Printed Name and Title of Aukhorized Officer or Agent SUBSCRIBED AND SWORN TO BEFORE ME THIS c;Z-2QDAY OF _ 20N3 Notary Publ My Com ' sion Expires Date EXHIBIT "E" CONTRACTOR AFFIDAVIT AND AGREEMENT STATE OF GEORGIA CITY OF MILTON By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm, or corporation which is contracting with the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. The undersigned further agrees that, should it employ or contract with any subcontractor(s) in connection with the physical performance of services pursuant to this contract with the City of Milton, contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. § 13-10-91 on the Subcontractor Affidavit provided in Rule 300-10-01-.08 in the form attached hereto as Exhibit "F" Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the City of Milton at the time the subcontractor(s) is retained to perform such service. ICa,)(,* 5- EEV / Basic Pilot Pr am User identification Number BY Authorize ff er or Agent Date Baldwin Paving G6mpany Qfd K� , C'�— Title of Authorized Officer or Agent of Contractor % V -,z— D:LL�� Printed Name of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF r , , 2013 VV ' Notary Publ m+ Q ••ri o 1. y.•c� M Commission Expires: EXHIBIT "G" SAVE Affidavit STATE OF GEORGIA CITY OF MILTON By executing this affidavit under oath, and as an applicant for a public benefit, as referenced in O.C.G.A. § 50-36-1, from the City of Milton, the undersigned applicant verifies one of the following with respect to my application for a public benefit: 1) ✓ I am a United States citizen. 2) I am a legal permanent resident of the United States. 3) I am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an alien number issued by the Department of Homeland Security or other federal immigration agency. My alien number issued by the Department of Homeland Security or other federal immigration agency is: The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at least one secure and verifiable document, as required by O.C.G.A. § 50-36-1(e)(1), with this affidavit. The secure and erifiable document provided with this affidavit can best be classified as: v— In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A. § 16-10-20, and face criminal penalties as allowed by such criminal statute. Executed in N. c a (city), (state). 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(�! 9 ( 1!j IJIM ili . 1 I a3i {f; 115 i n i I _ ,! 1 a tNpY G 1 is P 'r 11SGg1I!?'9!{, c} a• 3 _,. � � I�� '�i€1-+�i (iiil��� ��� l,l �s g�. Gi G` i� :i0f1j1� W- 1 ! a �I rg G i ftJl t 111., 3 t�ir a, W. . t S ; � �J IJ' t ! 3 7l! E+ .s i a T 4-1 i l t 'g`• `S.. il�ti iy ,V NOIS30 IVNDIS -coulf5ut.jeaU115ug 8vv (1131:IU330 IV SMIJON SIIV130 i to if l it 41. IN rn is � if C� �+ � r- it is .No I pigi u SIQUAMYO FENGE M IBELTON*4 fI ESIABEISHED 30506 ACKNOWLEDGEMENT RECEIPT OF ADDENDUM #1 ITB 13-PW5 Upon receipt of documents, please email, fax or mail this page to: City of Milton Attn: Rick Pearce, Purchasing Office 13000 Deerfield Pkwy Suite 107G Milton, GA 30004 Phone: 678-242-2511 Fax: 678-242-2499 Email: rick.nearce(i,cityofmiltonsa.us I hereby acknowledge receipt of documents pertaining to the above referenced ITB. COMPANY NAME: CONTACT PERSON: ADDRESS: CITY: STATE: ZIP: PHONE: FAX: EMAIL ADDRESS: Signature ADDENDUM M Date 1IPage ITB 1 3 -PW i ADDENDUM 41 ITB 13-PW5 Item #1 By this addendum, the plan is amended to include 2 additional black luminaires and black powder coated galvanized steel luminaire arms. Each mast arm assembly (4 total) should be supplied with a luminaire arm and luminaire. See the answers to questions below for additional information. Questions and Answers 1. The list of materials mentions what I think is a luminaire arm for a lighting fixture. What length of arm do you need? 2. Which two poles is the luminaire arm mounted to? This iter? has been attended to inchide all 4 most arm assemblies. See hem 1 of the adelendum listed ahare. 3. What mounting height do you want the lighting fixture to be at? 30 feet 4. Would you have the spec for the light fixture? Fixtures should match, or be the current equivalent to, the existing fixtures on Deerfield Parkway North of Webb Road. The fixture provided by Sawnee Electric for that project was a Cooper Streetworks OVF flat glass OVF40SWW3D. 2 a g c i t l3 1 11 EXHIBIT "I" FINAL AFFIDAVIT TO CITY OF MILTON, GEORGIA I, , hereby certify that all suppliers of materials, equipment and service, subcontractors, mechanics, and laborers employed by Baldwin Paving Company, Inc. or any of its subcontractors in connection with the construction of the Deerfield Parkway - Morris Road Intersection Improvements for the City have been paid and satisfied in full as of ,20 , and that there are no outstanding obligations or claims of any kind for the payment of which the City on the above named project might be liable, or subject to, in any lawful proceeding at law or in equity. Signature Title Personally appeared before me this day of , 20 , who under oath deposes and says that he is of the firm of Baldwin Paving Company, Inc. that he has read the above statement and that to the best of his knowledge and belief same is an exact true statement. Notary Public [NOTARY SEAL] My Commission Expires NOME OF -E BEST QUALITY OF 11FEIN GEORGIA' MILTON*k ESTABLISHED 2006 CITY COUNCIL AGENDA ITEM TO: City Council DATE: April 29, 2013 FROM: City Manager AGENDA ITEM: Proclamation Recognizing Peace Officers' Memorial Day and Its Origin in Georgia. MEETING DATE: Monday, May 6, 2013 Regular City Council Meeting. BACKGROUND INFORMATION: (Attach additional pages if necessary) See attached memorandum APPROVAL BY CITY MANAGER: (APPROVED () NOTAPPROVED CITY ATTORNEY APPROVAL REQUIRED: () YES (k NO CITY ATTORNEY REVIEW REQUIRED: () YES kNO APPROVAL BY CITY ATTORNEY () APPROVED { j NOT APPRO VED PLACED ON AGENDA FOR: 11-5 REMARKS: you;,>; m� -Green � PHONE: 678.242.25001 FAX: 678.242,2499 �N ° * �;ty info@cityofmiltonga,us I www.cityofmiltonga.us Community $ Hrhies 103:s�.naB:e Lv.ny `3 L 13000 Deerfield Parkwey, Suite 107 1 Milton GA 30004 — cenTIFIED anaHae — �jZ744 Peace Officers’ Memorial Day and its origin in Georgia WHEREAS, the Congress and President of the United States have designated May 15 as Peace Officers’ Memorial Day, and the week in which May 15 falls as National Police week; and WHEREAS, Robert Forsyth of Augusta, Georgia, an American patriot who served as a captain in Lee's Legion under Henry "Light Horse Harry" Lee, was selected by President George Washington to be the first United States Marshal for the state of Georgia and became the first U.S. Marshal and first of more than 200 U.S. Marshals and Deputies killed in the line of duty; and WHEREAS, from that first tragedy to the present day, the members of the law enforcement agency of the City of Milton play an essential role in safeguarding the rights and freedoms of the City of Milton; and WHEREAS, it is important that all citizens know and understand the duties, responsibilities, hazards, and sacrifices of the law enforcement agency, and that members of our law enforcement agency recognize their duty to serve the people by safeguarding life and property, by protecting them against violence and disorder, and by protecting the innocent against deception and the weak against oppression; and WHEREAS, the men and women of the law enforcement agency of the City of Milton unceasingly provide a vital public service; Now, therefore, I, Mayor of the City of Milton, call upon all citizens of the City of Milton and upon all patriotic, civic and educational organizations to observe the week o f May 12, 2013, as Police Week and appropriate ceremonies and observances in which all of our people may join in commemorating law enforcement officers, past and present, who, by their faithful and loyal devotion to their responsibilities, have rendered a dedicated service to their communities and, in so doing, have established for themselves an enviable and enduring reputation for preserving the rights and security of all citizens. I further call upon all citizens of the City of Milton to observe May 15 as Peace Officers’ Memorial Day in honor of those law enforcement officers who, through their courageous deeds, have made the ultimate sacrifice in service to their community or have become disabled in the performance of duty, and let us recognize and pay respect to the survivors of our fallen heroes. Given under my hand and seal of the City of Milton, Georgia on this 6th Day of May, 2013. (Seal) ______________________ Joe Lockwood Mayor m HOME OF `i HE BEST QUALITY OF LIFE IN GEORGIA' .M ILTON* ESTABL151-1 ED 2006 TO: City Council CITY COUNCIL AGENDA ITEM DATE: April 29, 2013 FROM: City Manager AGENDA ITEM: Consideration of RZ13-10 — Batesville Road (North side approximately 1250 feet west of Birmingham Highway) Section 212, Land Lots 777, 736, 737, Cornerstone Bank, To rezone from AG -1 (Agricultural) to CUP (Community Unit Plan) to develop 15 single family residences (minimum I acre lots) on 19.9 acres. MEETING DATE: Monday, May 6, 2013 Regular City Council Meeting. BACKGROUND INFORMATION: (Attach additional pages if necessary) See attached memorandum APPROVAL BY CITY MANAGER: APPROVED CITY ATTORNEY APPROVAL REQUIRED: {} YES CITY ATTORNEY REVIEW REQUIRED: () YES { } NOT APPROVED XNO KNO APPROVAL BY CITY ATTORNEY ()APPROVED (} NOT APPROVED PLACED ON AGENDA FOR: 49S-010(3 REMARKS: *44� ..... ..... ... ® . YOUR xen PHONE: x,78.242.25001 FAX: 678.242.2494 Gme * errtfied Community: '%iry cf info@cityofmiltonga.us I www.cityofmiltonga.us+rhi�s `•�.� �:n� !Ae li;:n' Ev S:.ra•,a�cre r i.:n� Vj �� 13000 Deerfield Parkway, Suite 107 1 Milton GA 30004 — cE6l' mEO BRONZE ''�`` Prepared by the Community Development Department for the City of Milton Mayor and City Council Meeting on May 20, 2013 5/1/2013 Page 1 of 19 RZ13-10 RZ13-10 PROPERTY INFORMATION ADDRESS Batesville Road (North side, approximately 1250 feet west of Birmingham Hwy) DISTRICT, LAND LOT 2/2 776, 777, 736 OVERLAY DISTRICT Northwest Fulton EXISTING ZONING AG-1 (Agricultural) PROPOSED ZONING CUP (Community Unit Plan) ACRES 19.9 EXISTING USE Single family residential, one existing, one under construction PROPOSED USE 15 Single Family Residential Units PETITIONER Ridge Planning and Engineering – John Loyd ADDRESS 1785 White Circle, Suite 202 Marietta, GA 30066 770-868-7591 OWNER Brightwater Homes ADDRESS 230 Hammond Drive, City Walk Suite 520 Sandy Springs, GA 30068 404-585-5990 INTENT To rezone from AG-1 (Agricultural) to CUP (Community Unit Plan) to develop 15 single family residences (minimum 1 acre lots) on 19.9 acres. Prepared by the Community Development Department for the City of Milton Mayor and City Council Meeting on May 20, 2013 5/1/2013 Page 2 of 19 RZ13-10 COMMUNITY DEVELOPMENT RECOMMENDATION – APRIL 23, 2013 RZ13-10 – APPROVAL CONDITIONAL PLANNING COMMISSION RECOMMENDATION – APRIL 23, 2013 RZ13-10- APPROVAL CONDITIONAL 5-0 Prepared by the Community Development Department for the City of Milton Mayor and City Council Meeting on May 20, 2013 5/1/2013 Page 3 of 19 RZ13-10 LOCATION MAP Prepared by the Community Development Department for the City of Milton Mayor and City Council Meeting on May 20, 2013 5/1/2013 Page 4 of 19 RZ13-10 CURRENT ZONING MAP Prepared by the Community Development Department for the City of Milton Mayor and City Council Meeting on May 20, 2013 5/1/2013 Page 5 of 19 RZ13-10 2030 FUTURE LAND USE MAP Prepared by the Community Development Department for the City of Milton Mayor and City Council Meeting on May 20, 2013 5/1/2013 Page 6 of 19 RZ13-10 Revised Site Plan submitted on April 22, 2013 Prepared by the Community Development Department for the City of Milton Mayor and City Council Meeting on May 20, 2013 5/1/2013 Page 7 of 19 RZ13-10 Entrance looking toward Batesville Road Home under construction in subdivision Prepared by the Community Development Department for the City of Milton Mayor and City Council Meeting on May 20, 2013 5/1/2013 Page 8 of 19 RZ13-10 Existing home (requires proposed building setbacks) Cell Tower to the northwest Prepared by the Community Development Department for the City of Milton Mayor and City Council Meeting on May 20, 2013 5/1/2013 Page 9 of 19 RZ13-10 View of constructed street View of detention pond adjacent to Batesville Road Prepared by the Community Development Department for the City of Milton Mayor and City Council Meeting on May 20, 2013 5/1/2013 Page 10 of 19 RZ13-10 SUBJECT SITE AND BACKGROUND: The subject site contains 19.9 acres. It has been platted as a 15 lot, single family subdivision zoned AG-1 (Agricultural) with one single family residence that is already constructed. The subdivision was formally known as the Milton Registry. The proposed name for the subdivision is Highgrove. The site is located within the “Low Density Residential” designation of the 2030 City of Milton Comprehensive Plan. The applicant is requesting a rezoning to CUP (Community Unit Plan) to build 14 additional single family residences at an overall density of .753 units per acre. SITE PLAN ANALYSIS Based on the applicant’s revised site plan submitted to the Community Development Department on April 22, 2013, Staff offers the following considerations: DEVELOPMENT STANDARDS – SEC. 64-897 - CUP (Community Unit Plan) Development Standards Proposed Development No building shall exceed 40 feet in height 35 feet Minimum lot area as specified in conditions The minimum lot size shown is one (1) acre Minimum CUP development size shall be ten acres The CUP development size is 19.9 acres Maximum density allowed is 5 units per gross acre The density of the subject site is .753 units per acre Minimum lot width (at building line) per conditions 100 feet Minimum CUP development frontage shall be 35 feet Exceeds the minimum Minimum lot frontage shall be 20 feet adjoining a street 35 feet minimum Minimum heated floor area as specified in conditions 3,500 square feet Minimum perimeter setback as specified Varies; per site plan Prepared by the Community Development Department for the City of Milton Mayor and City Council Meeting on May 20, 2013 5/1/2013 Page 11 of 19 RZ13-10 The following are proposed building setbacks for individual lots (CUP allows for applicant to specify building setbacks): a) Front yard setback – 20 feet b) Side yard setback – 10 feet except for lot #4 which shall have a 25 foot side yard setback along the exterior property line c) Side yard setback adjacent to a street – 20 feet d) Rear yard- 50 feet LANDSCAPE STRIPS AND BUFFERS The proposed development shall comply with Article III, Tree Preservation and Administrative Guidelines within the Zoning Ordinance, Sec. 64-237 (g) of the Zoning Ordinance which states “Unless otherwise specified, lots developed with single-family detached dwelling units are not required to provide landscape areas or zoning buffers”. Staff notes that a 20-foot landscape strip and fencing are required around all detention ponds. The site plan does not indicate the required landscape strip and fencing for the facility adjacent to Batesville Road. The fencing shall be a 6- foot high, five-board equestrian style fence with two inch by four inch welded wire constructed around it. The existing fencing around the detention pond does not meet this requirement nor does the 20 foot landscape strip around it. Although the subject site was permitted under Fulton County prior to the City’s incorporation, Staff will condition the six-foot high, five board equestrian style fence with two inch by four inch welded wire constructed around it. This requirement will be reflected in the Recommended Conditions. Staff notes that there is an additional storm water facility located in the rear of the project and is not visible based on topography of the site. Staff is not requesting any additional plantings or fencing for the facility in the rear. OTHER SITE PLAN CONSIDERATIONS Pursuant to Sec 64-2392, the Zoning Ordinance requires sidewalks which shall be constructed in accordance with the Department of Public Works standard plan which requires sidewalks on both sides of the street. Within the City Code, Chapter 50, Subdivisions, it is required that sidewalks within residential subdivisions be a minimum of 5 feet in width with a minimum 2 foot beauty strip Prepared by the Community Development Department for the City of Milton Mayor and City Council Meeting on May 20, 2013 5/1/2013 Page 12 of 19 RZ13-10 between the sidewalk and the curb. Although the site plan does not indicate the required sidewalks, the applicant has stated that they will be constructed as required by the code and are included in the Recommended Conditions. ENVIRONMENTAL SITE ANALYSIS The Environmental Site Analysis (ESA) report is sufficient and satisfies the requirement of Section 64.2126. A field survey of the site was conducted by Staff to verify areas addressed in the ESA report. The proposed site does not contain wetlands, historical sites or sensitive plant and animal species. The site does contain a stream that has been delineated with the appropriate buffers and setbacks. In addition, floodplain exists on the site adjacent to Sandy Copper Creek but is outside the building limits of the existing lots in the subdivision. The site also contains slopes exceeding 25% and up to 39% in areas. These aggressive slopes are the reason for the requested rezoning to reduce environmental impact due to the steep slopes in the rear of the site. FULTON COUNTY BOARD OF EDUCATION Prepared by the Community Development Department for the City of Milton Mayor and City Council Meeting on May 20, 2013 5/1/2013 Page 13 of 19 RZ13-10 FINANCIAL MODELING RESULTS Prepared by the Community Development Department for the City of Milton Mayor and City Council Meeting on May 20, 2013 5/1/2013 Page 14 of 19 RZ13-10 PUBLIC INVOLVEMENT On March 27, 2013 the applicant was present at the Community Zoning Information Meeting (CZIM) held at the Milton City Hall. There was no one from the community in attendance. Public Comments – Staff has not received any comments from the public regarding this petition. PUBLIC PARTICIPATION REPORT The applicant held their Public Participation meeting on Wednesday, April 17, 2013. Staff received the Participation Report which reported that two neighbors came to the meeting and had general questions regarding the development. They were not opposed to the applicant’s request for a CUP (Community Unit Plan). CITY OF MILTON DESIGN REVIEW BOARD COURTESY REVIEW – APRIL 2, 2013 Comments: Incorporate the topography into your house placement. Provide a “streetscape” that promotes walking within the subdivision. Standards of Review (Section 64-2104) Planning Staff shall, with respect to each zoning application, investigate and make a recommendation with respect to factors 1 through 7, below, as well as any other factors it may find relevant. 1. Whether or not the proposal will permit a use that is suitable in view of the use and development of adjacent and nearby Property? The proposed 15 lot single family residential subdivision developed at a density of .753 units per acre is consistent with adjacent and nearby properties zoned CUP (Community Units Plan) to the southwest and AG-1 (Agricultural) to the north, east, south, and northeast which are also developed at less than one units per acre. It is Staff’s opinion that the proposed use is suitable with adjacent and nearby developments and zonings if approved with Staff’s recommended conditions. Prepared by the Community Development Department for the City of Milton Mayor and City Council Meeting on May 20, 2013 5/1/2013 Page 15 of 19 RZ13-10 Existing uses and zoning of nearby property Location Zoning Petition Zoning / Name Approved Density/Min. Heated Floor Area North AG-1 (Agricultural) Enniskerry Subdivision 1 units per acre East & Southeast AG-1 (Agricultural) Scattered Single Family 1 units per acre South & West RZ85-181 CUP (Community Unit Plan) Estates at Atlanta National Subdivision .37 units per acre/minimum 2 acre lots/3,000 sq.ft. HFA Northwest AG-1 (Agricultural) 140 ft monopole cell tower None given Further Northwest AG-1 (Agricultural) Valmont Subdivision 1 units per acre 2. Whether or not the proposal will adversely affect the existing use or usability of adjacent or nearby property? It is Staff’s opinion that the proposal will not adversely affect existing use or usability of the adjacent properties as described above. The proposed development is consistent with the adjacent and nearby properties. 3. Whether the property to be affected by the proposal has a reasonable economic use as currently zoned? The subject site may have a reasonable use currently zoned AG-1 (Agricultural). 4. Whether the proposal will result in a use which will or could cause an excessive or burdensome use of existing streets, transportation facilities, utilities or schools? Staff does not anticipate a significant impact on public services or utilities. The estimated number of new students for the proposed rezoning which Prepared by the Community Development Department for the City of Milton Mayor and City Council Meeting on May 20, 2013 5/1/2013 Page 16 of 19 RZ13-10 will have an impact on the Birmingham Falls Elementary, Northwestern Middle School, and Milton High School is minimal. The subdivision is already developed and will not have a negative impact on exciting streets, transportation facilities, or utilities. 5. Whether the proposal is in conformity with the policies and intent of the land use plan? 2030 City of Milton Comprehensive Plan: Low Density Residential Proposed use/density: Single Family Residential at .753 units per acre The proposed CUP (Community Unit Plan) development conforms to the suggested policies and intent of the 2030 City of Milton Comprehensive Plan if developed with the recommended conditions. 6. Whether there are other existing or changed conditions affecting the use and development of the property which gives supporting grounds for either approval or disapproval of the proposal? The majority of the lots in the rear of the development have substantial slopes going down from the streets. This will allow for the fronts of the homes to be closer to the streets and therefore reduce the amount of clearing of trees for septic systems behind the homes. The request for the proposed CUP allows for additional flexibility to better site these homes within the subdivision. These facts are grounds to recommend approval of the proposed CUP (Community Unit Pan) if developed with the recommended conditions. 7. Whether the zoning proposal will permit a use which can be considered environmentally adverse to the natural resources, environment and citizens of the City of Milton? The proposed use will not be environmentally adverse to the natural resources, environment and citizens of the City if developed with the recommended conditions. Prepared by the Community Development Department for the City of Milton Mayor and City Council Meeting on May 20, 2013 5/1/2013 Page 17 of 19 RZ13-10 CONCLUSION If developed as a CUP (Community Unit Plan) with the recommended conditions, the 15 lot single family subdivision would be consistent with the 2030 City of Milton Comprehensive Plan and will provide for a better development with the proposed CUP (Community Unit Plan) development standards. Therefore, Staff recommends APPROVAL CONDITIONAL of RZ13-10 to rezone from AG-1(Agricultural) to CUP (Community Unit Plan). Prepared by the Community Development Department for the City of Milton Mayor and City Council Meeting on May 20, 2013 5/1/2013 Page 18 of 19 RZ13-10 RECOMMENDED CONDITIONS If this petition is approved by the Mayor and City Council, the rezoning of property located on Batesville Road with a frontage of 1,170 feet should be approved for CUP (Community Unit Plan) CONDITIONAL subject to the owner’s agreement to the following enumerated conditions. Where these conditions conflict with the stipulations and offerings contained in the Letter of Intent, these conditions shall supersede unless specifically stipulated by the Mayor and City Council. 1) To the owner’s agreement to restrict the use of the subject property as follows: a) Single family detached dwellings and accessory uses and structures. b) No more than 15 total dwelling units at a maximum density of .753 units per acre, whichever is less, based on the total acreage zoned. Approved lot/units totals are not guaranteed. The developer is responsible through site engineering (at the time of application for a Land Disturbance Permit) to demonstrate that all lots/units within the approved development meet or exceed all the development standards of the City of Milton. The total lot/units yield of the subject site shall be determined by this final engineering. 2) To the owner’s agreement to abide by the following: a) To the revised site plan received by the Community Development Department on April 22, 2013. Said site plan is conceptual only and must meet or exceed the requirements of the Zoning Ordinance, all other applicable City ordinances and these conditions prior to the approval of a Land Disturbance Permit. Unless otherwise noted herein, compliance with all conditions shall be in place prior to the issuance of the first Certificate of Occupancy. b) All areas which are not part of an individual lot and held in common shall be maintained by a mandatory homeowners association, whose proposed documents of incorporation shall be submitted to the Director of Community Development for review and approval prior to the recording of the first final plat. Prepared by the Community Development Department for the City of Milton Mayor and City Council Meeting on May 20, 2013 5/1/2013 Page 19 of 19 RZ13-10 3) To the owner’s agreement to the following site development considerations: a) Minimum lot size – 43,560 square feet (1 acre) b) Maximum Height – 35 feet c) Minimum lot width (at building line) – 100 feet d) Minimum lot frontage – 35 feet e) Minimum heated floor area per unit – 3,500 square feet f) Minimum front yard setback – 20 feet g) Minimum side yard setback – 10 feet h) Minimum side yard setback adjacent to a street – 20 feet i) Minimum rear yard- 50 feet j) Construct sidewalks on both sides of streets for the entire development per City Code Chapter 50, Subdivisions k) Minimum side yard setback for Lot #4 – 25 feet along the exterior property line. 4) To the owner’s agreement to abide by the following: a. The stormwater management facility in the front of the subdivision adjacent to Batesville Road shall utilize earthen embankments, where possible. Walled structures are not encouraged. If walled structures are proposed, they must meet the acceptable design standards of the City of Milton Department of Community Development and the Department of Public Works. i. Where side slopes for stormwater management facility are steeper than 4:1 the facility shall have a six foot high, five- board equestrian style fence with two inch by four inch welded wire constructed around it, or equivalent as may be approved by the City of Milton Public Works Department. ii. Provide a 20 foot landscape strip on the exterior side of the required fencing for the stormwater management facility adjacent to Batesville Road with selection of plantings approved by the City Arborist. Page is too large to OCR. ORDINANCE NO._______ PETITION NO. RZ13-10 STATE OF GEORGIA COUNTY OF FULTON AN ORDINANCE TO REZONE FROM AG-1 (AGRICULTURAL) TO CUP (COMMUNITY UNIT PLAN) FOR A 15 LOT SINGLE FAMILY SUBDIVISION PROPERTY LOCATED ON BATESVILLE ROAD HAVING A FRONTAGE OF APPROXIMATELY 1,170 FEET CONTAINING 19.90 ACRES BE IT ORDAINED by the City Council for the City of Milton, Georgia while in regular session on May 20, 2013 at 6:00 p.m. as follows: SECTION 1. That the Zoning Ordinance of the City of Milton be amended, and the official maps established in connection therewith be changed so that the following property located on Batesville Road with frontage of approximately 1,170 feet, consisting of a total of approximately 19.90 acres as described in the attached legal description, be rezoned to the CUP (Community Unit Plan) District with conditions, attached hereto and made a part herein; ALL THAT TRACT or parcel of land lying and being Land Lot 736, 777, and 776 of the 2nd District 2nd Section, City of Milton, Fulton County, Georgia; and SECTION 2. That the CUP (Community Unit Plan) zoning listed in the attached conditions of approval, be approved under the provisions Chapter 64, Article VI, Division 23 of the Zoning Ordinance of the City of Milton; and SECTION 3. That the property shall be developed in compliance with the conditions of approval as attached to this ordinance. Any conditions hereby approved (including any site plan) do not authorize the violation of any district regulations; and SECTION 4. That the official maps referred to, on file in the Office of the City Clerk, be changed to conform with the terms of this ordinance; and SECTION 5. That all ordinances or part of ordinances in conflict with the terms of this ordinance are hereby repealed; and SECTION 6. This Ordinance shall become effective upon adoption by the Mayor and City Council and the signature of approval of the Mayor. ORDAINED this 20th day of May, 2013. Approved: ______________________ Joe Lockwood, Mayor Attest: ________________________________ Sudie Gordon, City Clerk (Seal) RECOMMENDED CONDITIONS If this petition is approved by the Mayor and City Council, the rezoning of property located on Batesville Road with a frontage of 1,170 feet should be approved for CUP (Community Unit Plan) CONDITIONAL subject to the owner’s agreement to the following enumerated conditions. Where these conditions conflict with the stipulations and offerings contained in the Letter of Intent, these conditions shall supersede unless specifically stipulated by the Mayor and City Council. 1) To the owner’s agreement to restrict the use of the subject property as follows: a) Single family detached dwellings and accessory uses and structures. b) No more than 15 total dwelling units at a maximum density of .753 units per acre, whichever is less, based on the total acreage zoned. Approved lot/units totals are not guaranteed. The developer is responsible through site engineering (at the time of application for a Land Disturbance Permit) to demonstrate that all lots/units within the approved development meet or exceed all the development standards of the City of Milton. The total lot/units yield of the subject site shall be determined by this final engineering. 2) To the owner’s agreement to abide by the following: a) To the revised site plan received by the Community Development Department on April 22, 2013. Said site plan is conceptual only and must meet or exceed the requirements of the Zoning Ordinance, all other applicable City ordinances and these conditions prior to the approval of a Land Disturbance Permit. Unless otherwise noted herein, compliance with all conditions shall be in place prior to the issuance of the first Certificate of Occupancy. b) All areas which are not part of an individual lot and held in common shall be maintained by a mandatory homeowners association, whose proposed documents of incorporation shall be submitted to the Director of Community Development for review and approval prior to the recording of the first final plat. 3) To the owner’s agreement to the following site development considerations: a) Minimum lot size – 43,560 square feet (1 acre) b) Maximum Height – 35 feet c) Minimum lot width (at building line) – 100 feet d) Minimum lot frontage – 35 feet e) Minimum heated floor area per unit – 3,500 square feet f) Minimum front yard setback – 20 feet g) Minimum side yard setback – 10 feet h) Minimum side yard setback adjacent to a street – 20 feet i) Minimum rear yard- 50 feet j) Construct sidewalks on both sides of streets for the entire development per City Code Chapter 50, Subdivisions k) Minimum side yard setback for Lot #4 – 25 feet along the exterior property line. 4) To the owner’s agreement to abide by the following: a. The stormwater management facility in the front of the subdivision adjacent to Batesville Road shall utilize earthen embankments, where possible. Walled structures are not encouraged. If walled structures are proposed, they must meet the acceptable design standards of the City of Milton Department of Community Development and the Department of Public Works. i. Where side slopes for stormwater management facility are steeper than 4:1 the facility shall have a six foot high, five-board equestrian style fence with two inch by four inch welded wire constructed around it, or equivalent as may be approved by the City of Milton Public Works Department. ii. Provide a 20 foot landscape strip on the exterior side of the required fencing for the stormwater management facility adjacent to Batesville Road with selection of plantings approved by the City Arborist. REVISED SITE PLAN SUBMITTED ON APRIL 22, 2013 WA HOME OF `THE BEST QUALITY OF FIFE IN GEORGIA' M ILTON*k TO: City Council EST-Ai3L1SHE❑ 2006 CITY COUNCIL AGENDA ITEM DATE: April 29, 2013 FROM: City Manager AGENDA ITEM: Consideration of a Letter of Intent for Legal Representation of the City of Milton by Jarrard & Davis, LLP. MEETING DATE: Monday, May 6, 2013 Regular City Council Meeting. BACKGROUND INFORMA TION- (Attach additional pages if necessary) See attached memorandum APPROVAL BY CITY MANAGER: APPROVED () NOTAPPROVED CITY ATTORNEY APPROVAL REQUIRED: YES (} NO CI TY ATTORNEY REVIEW REQUIRED: YES { } NO APPROVAL BY CITY ATTORNEY {APPROVED (} NOT APPROVED PLACED ON AGENDA FOR: 0 5Z (9 13 REMARKS: *P1 ® Youm-rQ HItE �O �.CCf I{i2� PRONE: 678.242.2500 j FAX: 578.242.2499 V ■ e6r � c}, o info@cityofmiltonga.us I www.cityofmlltonga.us CD * Cif Community *A �thic 13000 Deerfield Parkway, Suite 107 J Milton GA 30004 - CERTIFIED BRONZE - �3g44 JARRARD ~DAVIS,LLP A Limited Liability Partnership KEN E. JARRARD \05 Pilgrim Village Drive, Suite 200 PAUL B. FRICKEY ANGELA E. DAVIS Cumming, Georgia 30040 KENNETH P. ROBIN CHRISTOPHER J. HAMIL TON TELEPHONE: 678.455.7150 ELIZABETH M. WHITWORTH FACSIMILE: 678.455.7149 SEANP.KANE PAUL N. HIGBEE, JR. MEGANN. MARTIN KJARRARD@JARRARP-DAVIS.COM April 25, 2013 Mr. Joe Lockwood Mayor, City of Milton 13000 Deerfield Parkway, Suite 107 Milton, GA 30004 Dear Mayor Lockwood: This correspondence is intended to memorialize the relationship between Jarrard & Davis, LLP and the City of Milton that has been ongoing and productive since 2007. It has been and remains a pleasure serving Milton and its residents. Jarrard & Davis, LLP (the "Firm") shall bill Milton for services going forward, which are rendered by the Firm based upon the amount of time spent working on your matters and the hourly billing rates charged by the individual ~ttomeys and employees who perform services on your behalf. We periodically review our hourly rates. I, or a partner or associate assigned by me, will be performing services on your behalf. My current individual billing rate is $150.00 per hour, and our paralegal rates are $75.00 per hour. I will delegate work to paralegals and associates when more efficient in providing service to you. We shall send you a statement each month itemizing all services performed on your behalf and the value of those services based upon the Firm's current billing rates. Our monthly invoices will also include an itemization of all out-of-pocket expenses we have advanced. You will be responsible for the bills as they become due. Finance charges may be assessed if any invoice is not paid within thirty (30) days from the date of the invoice. Any disputes about the bill must be communicated to me within fifteen (15) days of the billing date or be deemed waived. Scope of Services: 1. Designated Areas of Responsibility J&D shall be responsible for the general legal representation of the City of Milton and all of its agencies, employees, elected officials, and departments, boards, committees, and authorities irrespective of the nature or type of legal matter involved, and specifically including but not limited to matters of litigation, property acquisition, Mr. Joe Lockwood, Mayor City of Milton April 23,2013 Page 2 zoning, contract review and negotiation, and general counsel and advice. (The "Representation"). 2. Rate of Fees The Representation as defined above shall be provided at a billable rate of $150.00 per hour for attorney services and $75.00 per hour for paralegal services. 3. Conflict Counsel In the event that J&D is presented with a legal conflict on a certain matter for which J&D has responsibility, the Council upon becoming apprised of such conflict by J&D shall appoint different counsel to handle the matter in resolution of the conflict. 5. Expenses Expenses incurred such as computerized research, postage, copying, transcripts, court reporters, expert witness fees, and other out-of-pocket expenses shall be billed directly to the City. 6. Termination This appointment may be terminated at any time, with or without cause, upon formal vote of the City Council. If the foregoing terms and conditions are satisfactory, please sign below and return one original to me in the self-addressed stamped envelope. I have enclosed an additional copy of this correspondence for your files. Kindest regards, Sincerely, JARRARD & DAVIS, LLP Mr. Joe Lockwood. Mayor City of Milton April 23.2013 Page 2 KEJ Enclosures AGREED TO AND ACCEPTED BY: Joe Lockwood. Mayor City of Milton W. HOME OF 'THE BEST QUALITY OF LIFE IN GFORG2IA' MILTON* ES-TABLISHED 2Q0G CITY COUNCIL AGENDA ITEM TO: City Council DATE: April 29, 2013 FROM: City Manager AGENDA ITEM: Consideration of a Resolution Appointing Members to the City of Milton Construction Board of Adjustment and Appeals by Appointing Board Members for Districts 1, 2, 3, 4, 5 and 6. MEETING DATE: Monday, May 6, 2013 Regular City Council Meeting. BACKGROUND INFORMATION: (Attach additional pages if necessary) See attached memorandum APPROVAL BY CITY MANAGER: APPROVED (} NOTAPPROVED Cl TY A TTORNEY APPRO VAL REQUIRED: { } YES KNO CITY ATTORNEY REVIEW REQUIRED: () YES KNO APPROVAL BY CITY ATTORNEY () APPROVED { j NOT APPROVED PLACED ON AGENDA FOR: ❑ �b i2 REMARKS: ' You I ' �k * �k � PHONE: 678.242.2500 I FAX: 678.242.249"Green * 7,,ofy* r� Cit t info@cifyofmiltongo.us I www.c1tyofmiltongo.us :. Community �� �� ;��, 1* 13000 Deerfield Parkway, Suite 107 1 Milton GA 30004 - CERTIFIED BRONZE STATE OF GEORGIA COUNTY OF FULTON RESOLUTION NO. A RESOLUTION APPOINTING MEMBERS TO THE CITY OF MILTON CONSTRUCTION BOARD OF ADJUSTMENT AND APPEALS BY APPOINTING BOARD MEMBERS FOR DISTRICTS 1, 2, 3, 4, 5 AND 6 BE IT RESOLVED by the City Council of the City of Milton, GA while in regular session on May 6, 2013 at 6:00 p.m. as follows: SECTION 1. That __________ __________ (District 1) is hereby appointed for a term commencing May 6, 2013 and ending December 31, 2013; and, SECTION 2. That __________ __________ (District 2) is hereby appointed for a term commencing May 6, 2013 and ending December 31, 2015; and, SECTION 3. That __________ __________ (District 3) is hereby appointed for a term commencing May 6, 2013 and ending December 31, 2013; and, SECTION 4. That __________ __________ (District 4) is hereby appointed for a term commencing May 6, 2013 and ending December 31, 2015; and, SECTION 5. That __________ __________ (District 5) is hereby appointed for a term commencing May 6, 2013 and ending December 31, 2013; and, SECTION 6. That __________ __________ (District 6) is hereby appointed for a term commencing May 6, 2013 and ending December 31, 2015; and, SECTION 7. That this Resolution shall become effective upon its adoption. RESOLVED this 6th day of May, 2013. Approved: ____________________________ Joe Lockwood, Mayor Attest: ______________________________ Sudie AM Gordon, City Clerk (Seal)