HomeMy WebLinkAboutPSA - Phil BacklundPersonal Services Agreement
THIS AGREEMENT is entered into between KITTITAS COUNTY (hereinafter "the County" or "Kittitas County"), a
political subdivision of the State of Washington, and
County's Address:
Kittitas County
205 W. 5th Avenue, Suite 108
Ellensburg, WA 98926
County Project Manager:
Name: Laura Osiadacz
Title: BOCC Chairman
Telephone #: 509-962-7508
Email : bocc@co.kittitas.wa. us
Name:
Address:
Project Contact
Telephone #:
Email:
Phil Backlund
2418 Wheaton Court
Ellensburg, WA 98926
Phil Backlund
(s09) 312-9317
Philip.Backlund @cwu.edu
(hereinafter "Contractor")
This Agreement is comprised of
Attachment A - Scope of Work
Attachment B - Compensation
Attachment C - General Conditions
Attachment D - lnsurance
Attachment E - Retirement Status Form (signature required)
Attachment F - Contractor W-9 (must be completed and returned to the County for payment)
Copies of which are attached hereto and incorporated herein bythis reference as if fully set forth.
The term of this Agreement shall commence on the 1st day of July,2O22, and shall be completed no later than
December 3t, 2022, unless terminated or modified as provided elsewhere in this Agreement.
Page 1 of 20
PERSONAL SERVICES AG REEM ENT
Contractor acknowledges and by signing this Agreement agrees that the lndemnification provisions set forth in
Paragraphs 7 (lndependent Contractor), 9 (Taxes), 15 (Defense and lndemnity Agreement), 21 (Patent/Copyright
lnfringement) and 24 (Confidentiality), are totally and fully part of this Agreement and have been mutually
negotiated by the parties.
lN wlTNESs WHEREOF, the parties have executed this Agreement *ris -&1rv of \ U lit ,2022.
APPROVED:
CONTRACTOR
KITTITAS , WASHINGTON
ature
Print Name:4_
Title 0n9 /,1 ,f
Date:U(
i t? "(- lt zoZT
CONTRACT HAS BEEN APPROVED AS TO FORM BY KITTITAS
COUNTY DEPUTY PROSECUTING ATTORNEY
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PERSONAL SERVICES AGREEM ENT
ATTACHMENT ''A''
SCOPE OF WORK
Contractor shall provide ongoing consultation services on BOCC strategic plan development, implementation
and refinement.
Contractor to provide the following:
One monthly l-hour meeting with BOCC after Management Team meeting to determine plan
component progress, identify additional needs and troubleshoot issues related to plan
implementation
One quarterly 2-hour strategic plan review workshop to refine plan elements, assess individual
progress towards plan elements and, if necessary, amend strategic plan elements
One monthly 1-hour meeting with Executive Committee to discuss and consider materials to present
to Management Team
One monthly 1-hour meeting with Management Team to develop goals, core values, and policy
discussion
Eight hours per month preparing materials, meeting with individual county employees, maintaining
location of meeting records, and occasional other work as needed
Develop one day long workshop for the Management Team, facilitating the event, and following up on
action items
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PERSONAL SERVICES AGREEM ENT
ATTACHMENT ''Btt
COMPENSATION
The County shall pay the Contractor the following compensation which shall be invoiced to the County on the
first day of each month after services are provided:
o |2,OOo/month for services provided
o $L,000 per quarterly workshop which will be payable upon submission of an invoice detailing the
expense
o $2,000 for one day Management Team workshop
lnvoices may be submitted to:
Julie Kjorsvik
205 West 5th Avenue, Suite 108
Ellensburg, WA 98926
J u lie. Kiorsvi k@co. kittitas.wa. us
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PERSONAL SERVICES AGREEMENT
ATTACHMENT ''C"
GENERAL CONDITIONS
Scope of Contractor's Services: Contractor agrees to provide to the County services and any materials
set forth in the project narrative identified in Attachment "A" during the Agreement period. No material,
labor, or facilities will be furnished by the County, unless otherwise provided for in the Agreement.
Performance of Work: Contractor shall perform work in accordance with, and shall comply with, all of
the provisions of this Agreement. All work shall comply with applicable codes and ordinances.
Schedule of Performance: Unless directed otherwise by the County, Contractor shall perform the work
in accordance with any schedules made a part of this Agreement.
4. Definitions
4.L "Additional lnsured's" means the County, its successors and assigns, and the respective directors,
officers, employees, agents and representatives of the County and its successors and assigns.
4.2 "Support" means the following: Contractor's directors, officers, employees, agents and
representatives; and sub-Contractors of any tier; the respective directors, officers, employees,
agents and representatives of these sub-Contractors of any tier; and any other person or entity
acting under the direction or control of, or on behalf of, Contractor or any Contractor's sub-
Contractors of any tier in connection with or incident to the performance of the Work or this
Agreement.
The "Work" means all of the duties listed in Attachment "A" and the performance of all other
obligations, under this Agreement by Contractor or its Support.
4.3
5 Accounting and Pavment for Contractor Services: Payment to the Contractor for services rendered under
this Agreement shall be as set forth in Attachment "8". Where Attachment "B" requires payments by
the County, payment shall be based upon billings, supported unless otherwise provided in Attachment
"B", bY documentation of units of work actually performed and amounts earned, including where
appropriate, the total number of hours for the month and the total dollar payment requested. Unless
specifically stated in Attachment "B" or approved in writing in advance by the Kittitas County Board of
Commissioners, the County will not reimburse the Contractor for any costs or expenses incurred by the
Contractor in performance of this Agreement.
THE COUNTY WItt NOT PROCESS PAYMENT FOR SERVICES RENDERED UNDER THIS AGREEMENT UNTIT THE CONTRACTOR
suBMtTs A coMptETED W-9 (SEE ATTACHMENT "F")
Where required, the County shall, upon receipt of appropriate documentation, compensate the
Contractor, no more often than monthly, through the County voucher system, for the Contractor's
service pursuant to the fee schedule set forth in Attachment "8".
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PERSONAL SERVICES AGREEM ENT
6 Assignment and Subcontracting: No portion of this Agreement may be assigned or subcontracted to any
other individual, firm or entity without the express and prior written approval of the County.
7. lndependent Contractor: The Contractor's services shall be furnished by the Contractor as an
independent Contractor and nothing herein contained shall be construed to create a relationship of
employer-employee or master-servant, but all payments made hereunder and all services performed
shall be made and performed pursuant to this Agreement by the Contractor as an independent
Contractor.
The Contractor acknowledges that the entire compensation for this Agreement is specified in
Attachment "B" and the Contractor is not entitled to any County benefits including, but not limited to:
vacation pay, holiday pay, sick leave pay, medical, dental, or other insurance benefits, or any other rights
or privileges afforded to Kittitas County employees.
Contractor will defend, indemnify and hold harmless the County, its Additional lnsured's, officers, agents
or employees from any loss or expense, including but not limited to settlements, judgments, setoffs,
attorneys'fees or costs incurred by reason of claims or demands because of breach of the provisions of
this paragraph.
arantee of Em ent: The performance of all or part of this Agreement by the Contractor shall
not operate to vest any employment rights whatsoever and shall not be deemed to guarantee any
employment of the Contractor or any employee of the Contractor or any sub-Contractor or any
employee of any sub-Contractor by the County at the present time or in the future.
Taxes: The Contractor understands and acknowledges that the County will not withhold Federal or State
income taxes. Where required by State or Federal law, the Contractor authorizes the County to make
withholding for any taxes other than income taxes (i.e. Medicare). All compensation received by the
Contractor will be reported to the lnternal Revenue Service at the end of the calendar year in accordance
with the applicable IRS regulations. lt is the responsibility of the Contractor to make the necessary
estimated tax payments throughout the year, if any, and the Contractor is solely liable for any tax
obligation arising from the Contractor's performance of this Agreement. The Contractor hereby agrees
to indemnify the County against any demand to pay taxes arising from the Contractor's failure to pay
taxes on compensation earned pursuant to this Agreement.
The County will pay sales and use taxes imposed on goods or services acquired hereunder as required
by law. The Contractor must pay all other taxes including, but not limited to: Business and Occupation
Tax, taxes based on the Contractor's gross or net income, or personal property to which the County does
not hold title. The County is exempt from Federal Excise Tax.
Resulations and Requirement: This Agreement shall be subject to all laws, rules and regulations of the
United States of America, and State of Washington, and politicalsubdivisions of the State of Washington,
and to any other provisions set forth herein or in the Attachments.
8.
9
L0.
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PERSONAL SERVICES AGREEMENT
!1,. Risht to R CVIEW This contract is subject to review by any Federal or State auditor. The County or its
designee shall have the right to review and monitor the financial and service components of this program
by whatever means are deemed expedient by the County. Such review may occur with or without notice,
and may include, but is not limited to, on-site inspection by County agents or employees, inspection of
all records or other materials which the County deems pertinent to the Agreement and its performance,
and any and all communications with or evaluation by service recipients under this Agreement. The
Contractor shall preserve and maintain all financial records and records relating to the performance of
work under this Agreement for 6 years after contract termination, and shall make them available for
such review, within Kittitas County, State of Washington, upon request.
12. Modifications:
!2.t Either party may request changes in the Agreement. Any and all agreed modifications shall be in
writing, signed by each of the parties.
12.2 The County may, at any time, by written notice thereof to Contractor ("Change Notice") make
changes in the Work within the general scope of this Agreement, including, but not limited to:
(a) changes in, revisions to, substitutions for, additions to or deletions of any Work; (b) changes
in schedule; and (c) acceleration, deceleration or suspension of performance of any Work.
L2.3 lf any change in the Work causes an increase or decrease on Contractor's cost of, or the time
required for, performance of the Work, an equitable adjustment in the compensation to
Contractor and in the schedule for the performance of the Work shall be made to reflect such an
increase or decrease.
!2.4 Notwithstanding any dispute or delay in arriving at a mutually acceptable equitable adjustment,
Contractor shall proceed in accordance with all Change Notices. Contractor must, within thirty
(30) days after receipt of any Change Notice that does not set forth any acceptable adjustment,
submit to the County a written statement setting forth any adjustment claimed.
L2.5 lf any change results in a decrease in the Work performed, Contractor shall be entitled to
compensation associated with changing the Work, such as revising design already completed,
revising calculations already performed, and revising documents.
13.Termination for Default: lf the Contractor defaults by failing to perform any of the obligations of the
Agreement or becomes insolvent or is declared bankrupt or commits any act of bankruptcy or insolvency
or makes an assignment for the benefit of creditors, the County may, by depositing written notice to the
Contractor in the U.S. mail, postage prepaid, terminate the Agreement, and at the County's option,
obtain performance of the work elsewhere. lf the Agreement is terminated for default, the Contractor
shall not be entitled to receive any further payments under the Agreement until all work called for has
been fully performed. Any extra cost or damage to the County resulting from such default(s) shall be
deducted from any money due or coming due to the Contractor. The Contractor shall bear any extra
expenses incurred by the County in completing the work, and all damage sustained, or which may be
sustained by the County by reason of such default.
Page 7 of 20
Termination for Public Convenience: The County may terminate the Agreement in whole or in part
whenever the County determines, in its sole discretion that such termination is in the best interests of
the County. Whenever the Agreement is terminated in accordance with this paragraph, the Contractor
shall be entitled to payment for actual work performed at unit contract prices for completed items of
work. ln the event of such termination, an equitable adjustment shall be made in the compensation
payable to Contractor.
An equitable adjustment in the contract price for partially completed items of work will be made, but
such adjustment shall not include provision for loss of anticipated profit on deleted or uncompleted
work. Termination of this Agreement by the County at any time during the term, whether for default or
convenience, shall not constitute a breach of contract by the County.
15.Defense & lndemnitv Agreement: The Contractor agrees to and shall defend, indemnify and hold
harmless the County, its Additional lnsured's, appointed and elective officers, agents and employees,
from and against all loss or expense, including but not limited to judgments, settlements, attorney's fees
and costs by reason of any and all claims and demands upon the County, its Additional lnsured's, its
elected or appointed officials, agents, or employees for damages because of personal or bodily injury,
including death at any time resulting therefrom, sustained by any person or persons and on account of
damage to property including loss of use thereof, when such injury to persons or damage to property is
due to the negligence of the Contractor, its sub-Contractors, its elected officers, employees or their
agents, except only such injury or damage as shall have been occasioned by the sole negligence of the
County, its Additional lnsured's, appointed or elected officials, agents, or employees. lt is further
provided that no liability shall attach to the County by reason of entering into this contract, except as
expressly provided herein.
1,6. lndustrial lns rance Waiver With respect to the performance of this Agreement and as to claims against
the County, its Additional lnsured's, officers, agents and employees, the Contractor expressly waives its
immunity under Title 51 of the Revised Code of Washington, the lndustrial lnsurance Act, for injuries to
its employees and agrees that the obligations to indemnify, defend and hold harmless provided in this
agreement extend to any claim brought by or on behalf of any employee of the Contractor. This waiver
is mutually negotiated by the parties to this Agreement.
PERSONAL SERVICES AGREEM ENT
lf a notice of termination for default has been issued and it is later determined for any reason that the
Contractor was not in default, the rights and obligations of the parties shall be the same as if the notice
of termination had been issued pursuant to the Termination for Public Convenience paragraph hereof.
Venue and Choice of Law: ln the event that any litigation should arise concerning the construction or
interpretation of any of the terms of this Agreement, the venue of such action of litigation shall be in the
Superior Court of the State of Washington in and for the County of Kittitas. This Agreement shall be
governed by the law of the State of Washington.
Withholding Pavment: ln the event the Contractor has failed to perform any obligation to be performed
by the Contractor under this Agreement within the time set forth in this Agreement, then the County
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18.
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PERSONAL SERVICES AGREEMENT
may, upon written notice, withhold all monies due and payable to Contractor, without penalty, until such
failure to perform is cured or otherwise adjudicated.
t9 Future Non-Allocation of Funds: lf sufficient funds are not appropriated or allocated for payment under
this Agreement for any future fiscal period, the County will not be obligated to make payments for
services or amounts incurred after the end of the current fiscal period. No penalty or expense shall
accrue to the County in the event this provision applies.
20. Contractor Commitments.rranties and Reoresentations:The Contractor represents and warrants to
the County as follows:
20.L The Contractor is duly incorporated, validly existing and in good standing under the laws of the
State of Washington, and has all requisite corporate power and authority to enter into and to
perform its obligations under this Agreement.
zo.2 The Contractor has the authority to execute this Agreement, to make the representations and
warranties set forth in it and to perform the obligations of the Contractor under this Agreement
in accordance with its terms.
20.3 This Agreement has been validly executed by an authorized representative of the Contractor
and constitutes a valid and legally binding and enforceable obligation of Contractor.
20.4 The Contractor has or will obtain prior to the commencement date such licenses, permits and
other authorizations from federal, state and other governmental authorities, as are necessary
for the performance of its obligations under this Agreement.
20.5 The Contractor is not in violation of any applicable law, ordinance or regulation the consequence
of which will or may materially affect Contractor's ability to perform its obligations under this
Agreement. The Contractor is not subject to any order or judgment of any court, tribunal or
governmental agency which materially and adversely affects its operations or assets in the State
of Washington, or its ability to perform its obligations under this Agreement.
20.6 The Contractor certifies that that it is not presently debarred, suspended, proposed for
debarment, declared ineligible or voluntarily excluded from covered transactions by any Federal
department or agency.
20.7 None of the representations or warranties in this Agreement, and none of the documents,
statements, certificates or schedules furnished or to be furnished by Contractor pursuant hereto
or in connection with the performance of the obligations contemplated under this Agreement,
contains or will contain any untrue statement of a material fact or omits or will omit to state a
material fact necessary to make the statements of fact contained therein not misleading.
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PERSONAL SERVICES AGREEMENT
2t Patent/Copvrieht lnfringement: Contractor will defend and indemnify the County from any claimed
action, cause or demand brought against the County; to the extent such action is based on the claim that
information supplied by the Contractor infringes any patent or copyright. The Contractor will pay those
costs and damages attributable to any such claims that are finally awarded against the County in any
action. Such defense and payments are conditioned upon the following:
zL.L Contractor shall be notified promptly in writing by County of any notice of such claim.
2L.2 Contractor shall have the right, hereunder, at its option and expense, to obtain for the County
the right to continue using the information, in the event such claim of infringement is made,
provided no reduction in performance or loss results to the County.
22. Disputes:
22.I General: Differences between the Contractor and the County, arising under and byvirtue of the
Agreement Documents shall be brought to the attention of the County at the earliest possible
time in order that such matters may be settled or other appropriate action promptly taken.
Except for such objections as are made of record in the manner hereinafter specified and within
the time limits stated, the records, orders, instructions, and decisions of the Kittitas County
Commissioners shall be final and conclusive.
22.2 Notice of Potential Claims: The Contractor shall not be entitled to additional compensation which
otherwise may be payable, or to extension of time for (1) any act or failure to act by the County,
or (2) the happening of any event or occurrence, unless the Contractor has given the County a
written Notice of Potential Claim within ten (10) days of the commencement of the act, failure,
or event giving rise to the claim, and before final payment by the County. The written Notice of
Potential Claim shall set forth the reasons for which the Contractor believes additional
compensation or extension of time is due, the nature of the cost involved, and insofar as possible,
the amount of the potential claim. Contractor shall keep full and complete daily records of the
work performed, labor and material used, and all costs and additional time claimed to be
additional.
22.3.Detailed Claim: The Contractor shall not be entitled to claim any such additional compensation,
or extension of time, unless within thirty (30) days of the completion of the portion of the work
from which the claim arose, and before final payment by the County, the Contractor has given
the County a detailed written statement of each element of cost or other compensation
requested and of all elements of additional time required, and copies of any supporting
documents evidencing the amount or extension of time claimed to be due.
Ownership of ltems Produced: All writings, programs, data, public records or other materials prepared
by the Contractor and/or its consultants or sub-Contractors, in connection with performance of this
Agreement shall be the sole and absolute property of the County.
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PERSONAL SERVICES AGREEMENT
24 Confidentialitv: The Contractor, its employees, sub-Contractors, and their employees shall maintain the
confidentiality of all information provided by the County or acquired by the Contractor in performance
of this Agreement, except upon the prior written consent of the Kittitas County Prosecuting Attorney or
an order entered by a court after having acquired jurisdiction over the County. Contractor shall
im mediately give to the Cou nty notice of any judicia I p roceedings seeking d isclosu re of such information.
Contractor shall indemnify and hold harmless the County, its Additional lnsured's, officials, agents or
employees from all loss or expense, including, but not limited to settlements, judgments, setoffs,
attorneys' fees and costs resulting from Contractor's breach of this provision.
25.Notice: Except as set forth elsewhere in the Agreement, for all purposes under this Agreement, except
service of process, notice shall be given by the Contractor to the department head of the department
for whom services are rendered, the County Project Manager (listed on page 1 of this Agreement) and
to the Kittitas County Board of County Commissioners, 205 W 5th Ave, Suite 108, Ellensburg, WA 98926.
Notice to the Contractor for all purposes under this Agreement shall be given to the address reflected
on the signature page. Notice may be given by delivery or by depositing in the U.S. Mail, first class,
postage prepaid.
26. Severabilitv: lf a ny term or condition of this Agreement or the application thereof to any person(s) or
circumstances is held invalid, such invalidity shall not affect other terms, conditions or applications which
can be given effect without the invalid term, condition or application. To this end, the terms and
conditions of this Agreement are declared severable.
27. Miscellaneous
27'I The County's failure or delay to insist upon strict performance of any of the provisions of this
Agreement or to exercise any rights or remedies under this Agreement shall not be construed as
a waiver or relinquishment to any extent of its right to assert or rely upon any such provisions,
rights or remedies in that or any other instance; rather the same shall be and remain in full force
and effect.
27.2 This Agreement embodies the entire Agreement between the County and Contractor, and
supersedes any and all prior agreements, regarding the Work. No change, amendment or
modification of any provisions of this Agreement shall be valid unless set forth in a written
instrument signed by the party to be bound thereby.
27.3 The rights and remedies of the County set forth in any provision of this Agreement are in addition
to and do not in any way limit any other rights of remedies afforded to the County by any other
provisions of this Agreement, by any of Contractor's Support or by law.
27 '4 The headings of sections and paragraphs of this Agreement are for convenience of reference only
and are not intended to restrict, affect or be of any weight in the interpretation or construction
of the provisions of such sections or paragraphs.
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PERSONAL SERVICES AGREEM ENT
Waiver: Waiver of any breach or condition of this Agreement shall not be deemed a waiver of any prior
or subsequent breach. No terms or conditions of this Agreement shall be held to be waived, modified
or deleted except by an instrument, in writing, signed by the parties hereto.
29 survival: The provisions of paragraphs 7,9, LL, !3, L4, rs, !6, L7, rg, Lg,20, z!,22,23,24,2g, 30, and
31, shall survive, notwithstanding the termination or invalidity of this Agreement for any reason.
30. Nondiscrimination:
30.1 The County is an equal opportunity employer.
3O.2 Nondiscrimination in Emplovment: ln the performance of this Agreement, the Contractor will
not discriminate against any employee or applicant for employment on the grounds of race,
creed, color, national origin, sex, sexual orientation, marital status, age or the presence of any
sensory/ mental or physical handicap; provided that the prohibition against discrimination in
employment because of handicap shall not apply if the particular disability prevents the proper
performance of the particular worker involved. The Contractor shall ensure that applicants are
employed, and that employees are treated during employment without discrimination because
of their race, creed, color, national origin, sex, sexual orientation, marital status, age or the
presence of any sensory, mental or physical handicap. Such action shall include, but not be
limited to: employment, upgrading, demotion or transfers, recruitment or recruitment
advertising, layoff or termination, rates of pay or other forms of compensation, and programs for
training including apprenticeships. The Contractor shall take such action with respect to this
Agreement as may be required to ensure full compliance with local, state and federal laws
prohibiting discrimination in employment.
30.3 Nondiscrimin ion in Services The Contractor will not discriminate against any recipient of any
services or benefits provided for in this Agreement on the grounds of race, creed, color, national
origin, sex, sexual orientation, marital status, age or the presence of any sensory, mental or
physical handicap.
30.4 lf any assignment and/or subcontracting has been authorized by the County, said assignment or
subcontract shall include appropriate safeguards against discrimination. The Contractor shall
take such action as may be required to ensure full compliance with the provisions in the
immediately preceding paragraphs herein.
Prevailing Wage: Contractor shall pay the prevailing rate of wages to all workers, laborers, or mechanics
employed in the performance of any part of the Work in accordance with RCW 39.12 and the rules and
regulations of the Department of Labor and lndustries. The schedule of prevailing wages rates for the
locality or localities of the Work is determined by the lndustrial Statistician of the Department of Labor
and lndustries. lt is the Contractor's responsibility to verify the applicable prevailing wage rate. lt is
understood that the Contractor is responsible for obtaining and completing all required government
forms and submitting same to the proper authorities.
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PERSONAL SERVICES AGREEMENT
Contractor verifies that it meets the requirements set forth in RCW 39.04.350 by certifying that either
the Contractor has received training on prevailing wage and public works requirements or that the
Contractor is exempt from this training because they have completed three or more public works
projects and have had a valid Washington business license for three or more years.
Disputes regarding prevailing wage rates shall be referred for arbitration to the Director of the
Department of Labor and lndustries. The arbitration decision shall be final and conclusive and binding
on all parties involved in the dispute as provided for by RCW 39.12.000.
Time is of Essence: Time is of the essence in the performance of this contract unless a more specific time
period is set forth elsewhere in this Agreement.
Construction: This Agreement has been mutually reviewed and negotiated bythe parties and should be
given a fair and reasonable interpretation and should not be construed less favorably against either
party.
34.Stand
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32.
33.
of Care : The Contractor shall perform its duties hereunder in a manner consistent with that
degree of care and skill ordinarily exercised by members of the same profession as Contract currently
practicing under similar circumstances. The Contractor shall, without additional compensation, correct
those services not meeting such a standard.
Agreement Not for Benefit of Third Parties: This Agreement is entered into solelyforthe benefit of the
parties hereto and vests no rights in, or is it enforceable by, anythird parties.
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PERSONAL SERVICES AGREEMENT
ATTACHMENT ''D''
INSURANCE
The Contractor shall secure and maintain in effect at all times during performance of the Work such insurance
as will protect Contractor, its Support and the Additional lnsured's from all claims, losses, harm, costs, liabilities,
damages and expenses arising out of personal injury (including death) or property damage that may result from
performance of the work or this Agreement, whether such performance is by Contractor or any of its Support.
All insurance shall be issued by companies admitted to do business in the State of Washington and have a rating
of A-, Class Vll or better in the most recently published edition of Best's Reports unless otherwise approved by
the County. lf an insurer is not admitted, all insurance policies and procedures for issuing the insurance policies
must comply with Chapter 48.15 RCW and 284-LS WAC.
The Contractor shall provide proof of insurance for:
X Commercial General Liabilitv lnsurance.''"":"l'ilililllltk=*iil"ra,
.ns asgrega,e
o $1,000,000 personal and advertising injury, each offense
. Certificate Holder - Kittitas County
' The Certificate must name the County as additional insured as defined in the Agreement
' Sixty (60) days written notice from Contractor to the County of cancellation of the
insurance policy.
Commercial Automo le Liabilitv lnsurance.
Automobile Liability for owned, non-owned, hired, and leased vehicles, with an MCS 90
endorsement and a CA 9946 endorsement attached if 'pollutants' are to be transported.
Coverage limits not less than:
o $L,000,000 combined single limit
Thirty (30) days written notice from Contractor to the County of cancellation of the
insurance policy.
I
n Excess or Umbrella Liabilitv.
' The Contractor shall provide Excess or Umbrella Liability coverage at limits of S1,000,000
per occurrence and annual aggregate. This Excess or Umbrella Liability coverage shall
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PERSONAL SERVICES AGREEMENT
apply, at a minimum, to both the Commercial General and Auto lnsurance policy
coverage.
This requirement may be satisfied instead through the Contractor's primary Commercial
General and Automobile Liability coverage, or any combination thereof.
X Workers' Compensation.
o Workers' Compensation in amounts required by law
Stop Gap/Emplovers Liabilitv.
r Coverage limits not less than:
. S1,000,000 each accident
o $L,000,000 disease - policy limit
. S1,000,000 disease - each employee
' Thirty (30) days written notice from Contractor to the County of cancellation of the
insurance policy.
Contractor shall furnish to the County a Certificate of lnsurance with Endorsement as evidence that policies
providing insurance required by this Agreement are in full force and effect, and name the County as additional
insured, excluding i) Workers Compensation and ii) Commercial Automobile Liability, where County will not be
named additional insured. Contractor hereby waives all rights of recourse against Kittitas County for personal
injury, including death, and property damage. Contractor's insurance policies required above shall be primary
insurance and shall be non-contributing with any other insurance maintained by Kittitas County.
The Contractor shall assume full responsibility for all loss or damage from any cause whatsoever to any tools,
Contractor's employee-owned tools, machinery, equipment, or motor vehicles owned or rented by the
Contractor, or the Contractor's agents, suppliers or contractors as well as to any temporary structures,
scaffold ing and protective fences.
The Contractor shall have sole responsibility for ensuring the insurance coverage and limits required are
obtained by subcontractors.
NOTE: No contract shallform until and unless a copy of the Certificate of lnsurance with Endorsement, properly
completed and in the amount required, is attached hereto.
Page 15 of20
ATTACHMENT ''E''
RETIREMENT STATUS FORM (STGNATURE REQUTREDI-COUNTy RETATNS THtS FORM
Att CONTRACTORS, SERVICES CONTRACTORS, AND INDEPENDENT CONTRACTORS MUST COMPTETE AND SIGN
SECTION 1: CONTRACTOR COMPLETES THIS SECTION:
Did you retire from one of the State of Washington Retirement Systems?
Did you retire before age 55 using the 2008 early retirement factors (ERF)?
Will you be receiving direct compensation for these services?
Will you be receiving indirect compensation for these services?
1. Contractor has been a member of a Washington State Retirement System?
lf yes, which system and plan?
2. ls the Contractor a retiree of a Washington State Retirement System?
3. Did the Contractor retire before age 65 using the 2008 ERF?
I have verified the information above using MRV or by contacting DRS.
COUNTY REPRESENTATIVE
/
Yes
Yes
-?*"
u/No
NoL4es
Yes D *o
CONTRACTOR (Full name of contractor as in DRS filings-Please Print) Philip M. Backlund
Signature Last Four Digits of Social Security No
1no=-LUL -Date b-
SECTION 1: COUNTY COMPLETES THIS SECTION:
[Use Member Reporting Verification (MRV] to verify the past retirement membership and document belowl
ves (No
Teacher's Retirement System (TRS) _ Plan L _ Plan 2 _ Plan 3
School Employees' Retirement System (SERS) _ Plan 2 _ Plan 3
Public Employees' Retirement Systems (PERS) _ Plan 1 _ Plan 2 _ Plan 3
Public Safety Employees' Retirement System (PSERS) _ Plan 2
Law Enforcement Officers' & Fire Fighters' Retirement System (LEOFF) _ Plan L _ Plan 2
Washington State Patrol Retirement System (WSPRS) _ Plan 1 _ Plan 2
Judicial Retirement System (JRS)
-Yes
X ruo
-
Yes {, *o
I DateSignature:
_>
e Print)
COUNTY RETAINS IS FORM
Page 15 of 20
PERSONAL SERVICES AGREEMENT
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ATTACHMENT ''F''
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Page 17 of 20
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Page 18 of 20
PERSONAL SERVICES AGREEMENT
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Page 19 of 20
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