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2018/11/19 - Briefing Packet
November 19.1 BOARD OF MASON COUNTY COMMISSIONERS DRAFT BRIEFING MEETING AGENDA 411 North Fifth Street, Shelton WA 98584 Week of November 19, 2018 Monday, November 19, 2018 Commission Chambers 9:00 A.M. Closed Session — RCW 42.30.140 (4) Labor Discussion 9:30 A.M. Support Services — Frank Pinter 10:00 A.M. Recess 10:15 A.M. Treasurer/Support Services — Lisa Frazier/Melissa Drewry 10:30 A.M. Public Works — Jerry Hauth Utilities & Waste Management 11:00 A.M. Community Services — Dave Windom 11:30 A.M. Audit Committee — Leo Kim 11:45 A.M. Proposed 2019 Budget Review— Jennifer Beierle Commissioner Discussion — as needed Briefing Agendas are subject to change,please contact the Commissioners'office for the most recent version. Last printed 11/15/18 at 4:42 PM If special accommodations are needed,contact the Commissioners'office at ext.419,Shelton#360-427-9670;Belfair #275-4467,Elma#482-5269. MASON COUNTY COMMISSIONER BRIEFING INFORMATION FOR WEEK OF November 19, 2018 In the spirit of public information and inclusion, the attached is a draft of information for Commissioner consideration and discussion at the above briefing. This information is subject to change, additions and/or deletion and is not all inclusive of what will be presented to the Commissioners. We have changed the packet format so that it is an interactive document. Please click on the agenda item which then takes you to the cover sheet of that section in the document. To get back to the agenda, hit your "home" key on the keyboard. Please see draft briefing agenda for schedule. CO 185" Mason County Support Services Department Budget Management x Cptr n" 411 North 5 th Street Commissioner Administration �, �•,,�; Emergency Management Shelton, WA 98584 Facilities, Parks&Trails 360.427.9670 ext. 419 Human Resources Information Services Labor Relations IOU Risk Management MASON COUNTY COMMISSIONER BRIEFING ITEMS FROM SUPPORT SERVICES November 19, 2018 • Specific Items for Review o Consolidation of funds; delete certain funds—Jennifer o Final review of the 2018 Budget Hearing that will be held December 11 -Jennifer o Civil Service Commission position expires 12/31/18. Request to circulate news release—Dawn o Elected Official/Department Head meeting on Monday, Dec 3—agenda items?— Frank • Commissioner Discussion o Behavioral Health Organization (BHO) Governing Board Commissioner Assignment—Cmmr. Drexler J:\DLZ\Briefing Items\2018\2018-11-19.docx V MASON COUNTY BRIEFING ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS FROM: Dawn Twiddy DEPARTMENT: Human Resources / Civil Service EXT: 422 BRIEFING DATE: 11/19/2018 PREVIOUS BRIEFING DATES: n/a If this is a follow-up briefing, please provide only new information ITEM: Approval of placing a News Release — Civil Service Commission Vacancy on the County Commissioners November 27, 2018 Agenda. EXECUTIVE SUMMARY: (If applicable, please include available options and potential solutions): Civil Service Commissioner B. Dean Byrd's term ends on December 31, 2018. Requesting applicants to fill a six-year term which will end on December 31, 2024. BUDGET IMPACTS: None —This is a volunteer position on a 3 member commission. RECOMMENDED OR REQUESTED ACTION: Approval of placing a News Release— Civil Service Commission Vacancy on the County Commissioners November 27, 2018 agenda. ATTACHMENT: News Release — Civil Service Commission Vacancy Briefing Summary— 11/19/2018 ee PRESS RELEASE November 27, 2018 MASON COUNTY COMMISSIONERS 411 NORTH 5T" ST SHELTON, WA 98584 (360) 427-9670 EXT. 419 TO: KMAS, KRXY, SHELTON-MASON COUNTY JOURNAL, THE OLYMPIAN, SHELTON CHAMBER OF COMMERCE, NORTH MASON CHAMBER OF COMMERCE, CITY OF SHELTON, ECONOMIC DEVELOPMENT COUNCIL, THE SUN RE: Mason County Civil Service Commission Vacancy The Board of Mason County Commissioners is seeking applications to fill a position on the Mason County Civil Service Commission. This is for a six year term that will end on December 31, 2024. To qualify, the individual must be a United States citizen, a resident of Mason County for at least the past two years and an elector in Mason County. This person cannot be employed by Mason County and shall serve without compensation. At the time of appointment not more than two commissioners shall be adherents of the same political party. The general purpose of the Civil Service Commission is to establish a merit system of employment for county deputy sheriffs and other employees of the office of county sheriff. The Mason County Civil Service Commission meets on the 311 Thursday of each month at 5:00 p.m. in Mason County Building 1, 411 North 5th Street, Shelton. Interested parties may obtain an application at the Mason County Commissioners Office, 411 North 5th Street, Shelton, or call 427-9670, ext. 419 or visit the Mason County website at www.co.mason.wa.us. Applications will be accepted until Friday, December 14, 2018. BOARD OF MASON COUNTY COMMISSIONERS Randy Neatherlin Kevin Schutty Terri Drexler Chair Commissioner Commissioner MASON COUNTY BRIEFING ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS FROM: Lisa Frazier/Melissa Drewry DEPARTMENT: Treasurer/Support Services EXT: 589 BRIEFING DATE: Nov. 19, 2018 PREVIOUS BRIEFING DATES: If this is a follow-up briefing, please provide only new information ITEM: Recap of Tax Title Auction held October 12-15, 2018 EXECUTIVE SUMMARY: 44 Tax Title parcels were put up for auction on Bid4assets.com; 29 of those parcels sold. BUDGET IMPACTS: Total sales from the auction are $93,040- see attached spreadsheet for breakdown of disbursements. RECOMMENDED OR REQUESTED ACTION: Per RCW 36.35.150- when no acceptable bids are received at public auction, private sale can be made within twelve months of the date of the attempted public auction. If none of the remaining 15 parcels can be used for County purposes, they will be sent to Richard Beckman Realty, LLC. ATTACHMENTS: Spreadsheet showing sold and unsold parcels with a breakdown of disbursements. Briefing Summary 11/14/2018 PUBLIC WORKS MONDAY NOVEMBER 19.2018— BRIEFING ITEMS FROM PUBLIC WORKS (For Commissioners Meeting November 20& 27,2018) Items for this meeting are due to Diane Zoren on Wednesday, November 21,2018 5.0 CORRESPONDENCE AND ORGANIZATIONAL BUSINESS (None) 8.0 APPROVAL OF ACTION ITEM • Contract with Insta-Pipe,Inc. in the amount of$229,008.78 for completing the Rustlewood Sewer Main Lining Project Bid. • Road Closure on Old Belfair Highway, Sunday, December 2, 2018 from 3:30pm to 5:00pm for the Belfair Christmas Parade. (Requesting approval at the November 20,2018 Commission Meeting) • Private Line Occupancy Permit for Joel and Angie Kramer to install underground lines for power,water and septic transport under and across North Shore Road for address 4730 North Shore Road. • Surplus list of equipment and vehicles • Grinder pump contract with Correct Equipment • Call for Bids: Asphalt Emulsion for 2019 • Call for Bids: 2019 Paint Line • Call for Bids: Manufacturing and Stockpiling Chipseal Aggregate for 2019 • Call for Bids: Asphaltic Materials for 2019. • Call for Bids: Culvert pipes and culvert linings for 2019. • Vendor Roster solicitation for road surfacing materials for 2019. • Vendor Roster solicitation for vehicle and equipment tire repair and towing services for 2019. 9.0 OTHER BUSINESS (None) 10.0 PUBLIC HEARINGS AND ITEMS SET FOR A CERTAIN TIME (None) DISCUSSION ITEMS: • Public Works Org Chart—Equipment Maintenance box (6.5 FTE) Attendees: Commissioners: Public Works: Other Dept.: Press: Public: _Randy Neatherlin _Jerry Hauth List below: List below List Below: _Kevin Shutty _Bart Stepp Terri Drexler Others-List below: MASON COUNTY BRIEFING ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS FROM: Bart Stepp, Deputy Director/ Utilities and Waste Management DEPARTMENT: Public Works EXT: 652 BRIEFING DATE: November 19, 2018 PREVIOUS BRIEFING DATE: March 5, 2018 ITEM: Rustlewood Sewer Main Lining Project Bid EXECUTIVE SUMMARY: The County budgeted for 2019 to complete a cured in place piping (CIPP) project for the Rustlewood Sewer System. This process consists of sticking a polyethylene tube inside an existing sewer main, heating the tube until it hardens and sticks to the existing main, and then cutting the existing services via a remote operated unit inside the pipe. This creates a new sewer pipe inside the existing sewer pipe, which has better flow characteristics, without any excavation. The proposed project for Rustlewood would line all the existing old concrete sewer mains that were installed as part of Phase 1 of that subdivision. Installation of the CIPP should reduce the amount of infiltration and inflow the Rustlewood Wastewater Plant receives in the winter, hopefully so it does not exceed the permitted amount of 57,000 gallons per day. The County previously went out to bid for this project in March but received only one bid for $591,303.30, more than double the original cost estimate. I asked a CIPP Contractor who did not bid and he said the project schedule was for summer 2018 and they were already booked through summer. He also said some bid items were tough to bid because of a lack of system information. So this summer the County hired a contractor to clean and videotape the lines. The County then re- bid the project this fall, included the line videotapes, and allowed the contractor until September 2019 to complete the work. This time the County received five bids, all lower than last spring. The low bidder was Insta-Pipe, Inc. Their bid amount was $229,008.78. They meet all state contractor requirements and I received acceptable references from two public projects that they completed. Cost Impact to the County The preliminary 2019 budget for Rustlewood include a REET 2 contribution of $400,000 that was to be used for paying for this capital project. The Rustlewood Fund should be able to reduce that contribution by over $100,000. The amount of REET needed will depend on the final contract amount, which may include some change orders. RECOMMENDATION: Recommend the Board authorize the Deputy Director/Utilities & Waste Management to sign the contract with Insta-Pipe, Inc. for completing the Rustlewood Sewer Main Lining Project in the amount of$229,008.78 which includes sales tax. Attachment 1. Rustlewood Sewer Main Lining Project Bid Tab 2. Insta-Pipe, Inc. Bid Proposal 3. Insta-Pipe, Inc. Contractor Information Briefing Summary PROJECT:Mason County,WA Rustlewood CIPP Bid Tab Date: 11/1/2018 Prepared by: Bart Stepp Page 1 Mason County Rustlewood Sewer Main Lining Project Bid Results Engineer's Estimate Insta-Pipe,Inc. Insituform Technologies,LLC Tumwater,WA 98512 Chesterfield,MO 63005 Item No. Item Description Material Quantity Eng.Unit Cost Eng.Estimate Unit Cost Price Unit Cost Price 1 General Spill Prevention 1 $1,000 $1,000 1 500.00 $1,500.00 500.00 S500.00 2 General Mobilization 1 $25,000 $25,000 19 544.00 $19,544.00 5 187.00 $5,187.00 3 General Traffic Control Supervisor 1 $20,000 $20,0001 $3,000.00 $3,000.00 811.00 $811.00 4 General Other Temporary Traffic Control 1 $15,000 $15,0001 $2,500-00 $2,500.00 $8,105.00 $8,105.00 5 General Roadside Cleanup 1 $5,000 $5,000 $500.00 $500.00 $2,250.00 $2,250.00 6 Special CCN Inspection 4482 10 $44,820 $3.00 $13,446.00 4.00 $17,928.00 7 Special 8"Concrete Pipe-8"x 4-mm CIPP 4482 48 $215,136 $29.00 $129,978.00 39.00 $174,798.00 8 Special Service Reconnections 37 325 $12,025 $400.00 $14,800.00 125.00 54,625.00 9 Special Manhole Wall Interface Sealing 42 100 $4,200 $400.00 $16,800.00 $145.00 $6,090,00 10 Special Sewage Bypass for Project 1 $25,000 $25,000 9 000.00 $9,000.00 $2,500-00 $2,500.00 Subtotal $367,181 Subtotal $211,068.00 Subtotal $222,794.00 Sales Tax 8.5% 31 210 Sales Tax 8.5Y $17,940.78 Sales Tax 8.5% 18 937.49 Grand Total $398,391 Grand Total 1 $229,008.78 Grand Total $241,731.49 ADDITIVE BID ITEMS LOW BIDDER 2nd AD1 Special Grouting of service line connections 1 350.00 $350.001 $3,800.001 $3,800.00 AD2 Special Point Excavation for service line $9,000.001 $9,000.001 $16,211.001 16 211.00 AD3 Special Point Repair of 10'of 8"pipe 8'deep $12,500.0ol $12 01 532.421.00132 421.00 Meson County Rustlewood Sewer Main Lining Project Bid Results Michels Corporation Iron Horse,LLC Rognlin's,Inc. Salem,OR 97302 Fairview,OR 97024 Aberdeen,WA 98520 Item No. Item Description Material Quantity Unit Cost Price Unit Cost Price Unit Cost Price 1 General Spill Prevention 1 $1,241.00 $1,241.00 2 000.00 $2,000.00 500.00 $500.00 2 General Mobilization 1 $35,004.00 $35,004.00 $28,000-00 $28,000.00 50 000.00 50 000.00 3 General Traffic Control Supervisor 1 $8,000.00 $8,000.001 $14,500.00 $14,500.00 S20,000.00 $20,000.00 4 General Other Temporary Traffic Control 1 $26,000.00 $26,000.00 $17,000.00 $17,000.00 20 000.00 20 000.00 5 General Roadside Cleanup 1 $2,160.00 $2,160.00 $2,500.00 $2,500.00 $5,000.00 5 000.00 6 Special CCN Inspection 4482 $6.25 $28,012.50 $3.50 $15,687.00 10.00 $44,820.00 7 Special 8"Concrete Pipe-8"x 4-mm CIPP 4482 $43.00 $192,726.00 63.00 $282,366.00 $60.00 $268,920.00 8 Special Service Reconnections 37 $295.00 $10,915.00 $400.00 $14,800.00 $275.00 $10,175.00 9 Special Manhole Wall Interface Sealing 42 $177.00 $7,434.00 $250.00 $10,500.00 $10.00 $420.00 10 Special Sewage Bypass for Project 1 $4,899.00 $4,899.00 $16,000.00 16 000.00 40 000.00 40 000.00 Subtotal $316,391.50 Subtotal $403,353.00 Subtotal $459,835.00 Sales Tax 8.5% $26,893.28 Sales Tax 8.5% $34,285.01 Sales Tax 8.5Y $39,085-98 Grand Total $343,284.78 Grand Total $437,638.01 Grand Total $498,920.98 ADDITIVE BID ITEMS 3rd 4th 5th AD1 Special Grouting of service line connections I 1 $6,394.001 $6,394.0012 800.00 2 800.001 $5,0 o.`DoT $5000.00 AD2 Special Point Excavation for service line 1 $20,000.001 $20,000.001 $6,700.001 $6,700.001 00.00 $22,000.00 AD3 Special Point Repair of 10'of 8"pipe 8'dee 1 $20,000.001 $20,000.001 $9,800.001 9 800.00 $22,000.00 22 000.00 n 3 j l BID PROPOSAL FORM TO: Mason County Public Works 100 W. Public Works Drive Shelton,Washington 98584 FROM: Bidder Insta-pipe, Inc. Address 2520 50th Ave Tumwater, WA 98512 Telephone 360-943-5840 E-Mail dennis@insta-pipe.com The undersigned, as bidder, declares that we have examined all of the contract documents and that we will contract with Mason County to do everything necessary to complete the work as outlined on the plans and specifications for the Rustlewood Sewer Main Linin,. We acknowledge that addenda numbers 1 to 1 have been delivered to us and have been examined as part of the contract documents. We agree that the Bidder Qualifications form shall be a part of this proposal. If our BID is accepted, we agree to sign the contract form and the required evidences of insurance within ten (10)calendar days after receiving written notice of the award of contract. We further agree, if our BID is accepted and a contract for performance of work is entered into with. Mason County, to so plan the work and to prosecute it with such diligence that all of the work shall be completed within the time period stated in the contract. We understand that Mason County reserves the right to reject any or all bids and to determine which proposal is, in the judgment of Mason County, the lowest responsible bid, and which proposal, if any, should be accepted in the best interests of Mason County and that Mason County also reserves the right to waive any informalities in any proposal or bid. We further state that we have not, either directly or indirectly, entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free competitive bidding in connection with such contract. Bidder agrees that the work will be completed within forty (40) working days after the date when the bidder commences work. Notes: (1) See Special Provisions and the Standard Specifications for State sales tax requirements. (2) The County reserves the right to adjust the scope of this work to match available funds. (3) The County reserves the right to reject any or all bids. (4) The table on the next page provides a list of items required to complete the project. It is the contractor's responsibility to complete the project scope to all required standards and specifications. (5) The low bidder will be based on the base bid, additive item costs will not be used to determine the low bid. 10 We propose to perform the work at the prices listed in the following bid schedules) BID SCHEDULE—RUSTLEWOOD SEWER MAIN LINING Item Section Material Description Quantity Units Unit Cost Bid Price 1. 1-07 Spill Prevention,Control and 1 LS $1,500.00 $1,500.00 Countermeasure Plan 2. 1-09 Mobilization 1 LS $19,544.00 $19,544.00 3. 1-10 Traffic Control Supervisor 1 LS $3,000.00 $3,000.00 4. 1-10 Other Temporary Traffic Control 1 LS $2,500.00 $2,500.00 5. 2-01 Roadside Cleanup 1 LS $500.00 $500.00 6. SPEC. CCTV Inspection 4,482 LF $3.00 $13,446.00 7. SPEC. 8"Concrete Pipe—8"x 4-mm CIPP 4,482 LF $29.00 $129,978.00 8. SPEC. Service Reconnections 37 EA $400.00 $14,800.00 9. SPEC. Manhole/Wall Interface Sealing 42 EA $400.00 $16,800.00 10. SPEC. Sewage Bypass for Project 1 LS $9,000.00 $9,000.00 Base Bid Subtotal of Work $211,068.00 Sales Tax @ 8.5% $17,940.78 Rustlewood Sewer Main Lining Base Bid Total (Subtotal+Sales Tax) $299 008jf! :Za jf AD1* SPEC. Grouting of service line connections 1 EA $350.00 $12,950.00 Point Excavation for reinstatement of AD2* SPEC. service lines per 3.61)of the Technical 1 EA $9,000.00 $9,000.00 Specifications Point Repair:Replace 10'section of 8" AD3* SPEC., sewer main that is 8'deep,including 1 EA $12,500.00 $12,500.00 backfill and repaving of trench The Rustlewood Sewer Main Lining Base Bid Total written out in words is: Two hundred ninty nine thousand, eight Dollars and 78 Cents. *Additive items 1—3 may be utilized during the project if the need for that work is found. BIDDER acknowledges receipt of the following ADDENDUM: Addendum No. Addendum Receipt Date Si kno led ment 1 October 24, 2018 2 11 WASHINGTON STATE AND LOCAL SALES TAX.Sales Tax(8.5%) shall be added to full contract price. BIDDER'S ADDRESS. Notice of Acceptance of this bid or requests for additional information should be addressed to the undersigned at the address stated below. NON-COLLUSION DECLARATION I, by signing the proposal, hereby declare, under penalty of perjury under the laws of the United States that the following statements are true and correct: 1. That the undersigned person(s), firm, association or corporation has (have) not, either directly or indirectly,entered into any agreement, participated in any collusion,or otherwise taken any action in restraint of free competitive bidding in connection with the project or which this proposal is submitted. 2 That by signing the signature page of this proposal, I am deemed to have signed and have agreed to the provisions of this declaration. CERTIFICATION OF COMPLIANCE WITH WAGE PAYMENT STATUTES The bidder hereby certifies that,within the three-year period immediately preceding the bid solicitation date 10/12/18,the bidder is not a"willful"violator, as defined in RCW 49.48.082,of any provision of chapters 49.46,49.48, or 49.52 RCW,as determined by final and binding citation and notice of assessment issued by the Department of Labor and Industries or through a civil judgment entered by a court of limited or general jurisdiction. I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. NOTES: 1. This proposal form is not transferable and any alteration of the firm's name entered hereon without prior permission from the Deputy Director will be cause for considering the proposal irregular and subsequent rejection of the bid. Insta-pipe, Inc. Bidder's Busin s Name Signature of thori ed Official* �1et�is'�mith Printed Name Owner Title 1 November 2018 Olympia WA Date City State 12 Check One: Sole Proprietorship ❑ Partnership ❑ Joint Venture ❑ Corporation EX State of Incorporation, or if not a corporation, State where business entity was formed: Washington If a co-partnership, give firm name under which business is transacted: *If a corporation,proposal must be executed in the corporate name by the president or vice-president(or any other corporate officer accompanied by evidence of authority to sign). if a co-partnership,proposal must be executed by a partner. Contractor's License No.: WA#INSTAI*914P6 By: Insta-pipe, Inc. 2520 50th Ave. Address Tumwater WA 98512 City State Zip 13 r Bond No. SCP3158 BID BOND KNOW ALL MEN BY THESE PRESENTS,that we, Insta-Pipe, Inc. of Tumwater,Washington as Principal,and the Lexon Insurance Company a corporation duly organized under the laws of the State of Texas and authorized to do business in the State of Washington, as surety, are held and firmly bound unto Mason County, Washington in the full and penal sum of five (5) percent of the total amount of the bid proposal of said principal for the work hereinafter described, for the payment of which, well and truly to be made, we bind our heirs, executors, administrators and assigns, and successors and assigns,firmly by these presents.. The condition of this bond is such, that whereas the principal herein is herewith submitting his or its sealed proposal for the following public work,to wit: Rustlewood Sewer Main Lining to include: Lining existing concrete sewer mains with cured-in-place- pipe (CIPP). Concrete sewer mains to be lined or replaced were installed as partof Phase I of the Rustlewood Subdivision in Grapeview,WA. This phase includes 4,482 feet of 8"concrete mains between 23 manholes. 7 manholes are located outside ROW along property lines with access easements. Sewer main sections that cannot be lined due to defects or bends will be replaced with 8" PVC Sewer Main to match.the existing sewer main on either side of the defect and the rest of the main will be lined. Said bid and proposal, by reference thereto, being made a part hereof. NOW, THEREFORE, If the said proposal bid by said principal be accepted, and the contract be awarded to said principal, and if said principal shall duly make and enter into and execute said contract and shall furnish bond as required by Mason.County within a period of twenty(20) days from and after said award, exclusive of the day of such award, then this obligation shall be null and void,otherwise it shall remain and be in full force and effect. IN TESTIMONY WHEREOF,The principal and surety have caused these presents to be signed and sealed this 30th day of October 2018, Insta-Pipe, Inc. ci I Lexon Insurance Company Surety Attorney-in-fact istopher Kinyon 14 POWER OF ATTORNEY Lx 3479 Lexon Insurance Company KNOW ALL MEN BY THESE PRESENTS,that LEXON INSURANCE COMPANY,a Texas Corporation,with its statutory home office in Austin, Texas, does hereby constitute and appoint Aliceon A. Keltner, Cynthia L. Jay, Eric A. Zimmerman, James B. Binder, Brandon K. Bush, Jacob T. Haddock,Diane M.Harding,Karen C.Swanson,Jamie L.Marques,Carley Espiritu,Christopher Kinyon;Brent E.Heilesen,Peter J.Comfort,Annelies M. Richie, Kyle Joseph Howat,Heather L.Allen, Holli Albers, Michael S. Mansfield, Sara Sophie Sellin, Donald Percell Shanklin Jr., Misti M.Webb, Kari Michelle Motley,Bryan Richard Ludwick,Tamara A. Ringeisen,Dana Marie Brinkley, Linda Diane Shaddon its true and lawful Attomey(s)-In-Fact to make,execute,seal and deliver for,and on its behalf as surety,any and all bonds,undertakings or other writings obligatory in nature of a bond. This authority is made under and by the authority of a resolution which was passed by the Board of Directors of LEXON INSURANCE COMPANY on the 1 st day of July,2003 as follows: Resolved,that the President of the Company is hereby authorized to appoint and empower any representative of the Company or other person or persons as Attorney-In-Fact to execute on behalf of the Company any bonds, undertakings, policies, contracts of indemnity or other writings obligatory in nature of a bond not to exceed$5,000,000.00, Five Million Dollars;which the Company might execute through its duly elected officers, and affix the seal of the Company thereto.Any said execution of such documents by an Attorney-In-Fact shall be as binding upon the Company as if they had been duly executed and acknowledged by the regularly elected officers of the Company. Any Attomey-In-Fact, so appointed, may be removed for good cause and the authority so granted may be revoked as specified in the Power of Attorney. Resolved, that the signature of the President and the seal of the Company may be affixed by facsimile on any power of attorney granted,and the signature of the Assistant Secretary,and the seal of the Company may be affixed by facsimile to any certificate of any such power and any such power or certificate bearing such facsimile signature and seal shall be valid and binding on the Company.Any such power so executed and sealed and certificate so executed and sealed shall, with respect to any bond of undertaking to which it is attached, continue to be valid and binding on the Company. IN WITNESS THEREOF, LEXON INSURANCE COMPANY has caused this instrument to be signed by its President,and its Corporate Seal to be affixed this 22nd day of June,2018. LEXON INSURANCE COMPANY �A "NeF c kpr ap`PO'4r0�0 S E A L BY r;y9�h wBrian Beggs f President ACKNOWLEDGEMENT On this 22nd day of June,2018,before me, personally came Brian Beggs to me known,who be duly sworn,did depose and say that he is the President of LEXON INSURANCE COMPANY,the corporation described in and which executed the above instrument;that he executed said instrument on behalf of the corporation by authority of his office under the By-laws of said corporation. y T�nO AMY TAYLOR340qol.�� Notary Public-State of TennesseeBY Davidson County My Commission Expires OT-08-19 AmylPsylor Notary Public CERTIFICATE I, the undersigned, Assistant Secretary of LEXON INSURANCE COMPANY, A Texas Insurance Company, DO HEREBY CERTIFY that the original Power of Attorney of which the forgoing is a true and correct copy, is in full force and effect and has not been revoked and the resolutions as set forth are now in force. Signed and Seal at Mount Juliet,Tennessee this 30th Day of October ,2018 SEAL BY a e Andrew Smith Assistant Secretary rg of t e 'WARNING:Any person who knowingly and with intent to defraud any insurance company or other person,files and application for insurance of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act,which is a crime and subjects such person to criminal and civil penalties." BIDDER QUALIFICATIONS Project: RUSTLEWOOD SEWER MAINLINING If the above contract is awarded to our company,the following persons will be authorized to sign change orders, progress payments,and similar documents for the company:(names and positions) Dennis Smith -Owner/Bob Jeralds-Project Mgr. /Mike Shepp-Project Lead The contractor's superintendent at the job site per Article 1-05.13 of the Standard Specifications will be(give full name): Mike Sheep The last three projects completed or substantially completed by our company involving similar construction work are as follows: 1. Project Name: Poulsbo-CIPP Dollar amount of Contract:$ —989,000.00 Owner: City of Poulsbo Owner's Representative: Joe Smith Phone No.: 360-620-8661 Contractor's Superintendent on this Project: Mike Shepp Brief Description of Project Scope: 2,500 ft of 18" UV CIPP- clean.TV and line main interceptor. Traffic control and bypass was part of this project. 2. Project Name: Manchester Pump Station-45,46,47 Beach sewer Rehab Dollar amount of Contract:$ —$203,000.00 Owner: Kitsap County PUD .Owner's Representative: Floyd Bayless Phone No.: 360.509.1209 Contractor's Superintendent on this Project: Mike Shepp Brief Description of Project Scope: Install—3,300 ft of 8" UV CIPP on the beach working off of barges following the tide schedules. 15 Y 3. Project Name: IMCO- Boeing UV CIPP @ Renton Dollar amount of Contract:$ $120,000.00 Owner: IMCO General Construction Owner's Representative: Nick Rawlins Phone No.: 253-226-9932 Contractor's Superintendent on this Project: Mike Shepp Brief Description of Project Scope: 740 ft of 8" UV CIPP, Bypass Traffic Control Includes pre&post video, Grout&gravel removal Name/Title Completing Form: Dennis Smith Signature• Date: October 30, 2018 Phone No.. 36 - - 40, 16 Roster & Business Type Roster Type(s): Small Works Business Type: Corporation Number Of Employees: 1 - 30 Does your business qualify as a Small Business? No Is your business's gross revenue under two hundred fifty thousand dollars annually as reported on your federal tax return? No Is your business's gross revenue under one million dollars annually as reported on your federal tax return? Yes Contact Information Business Name: Insta-Pipe,inc Parent Company/Legal Business Name: Website URL: www.insta-pipe.com Accept emergency work: Yes Primary Contact Name: J Dennis Smith Title: Owner Branch Location: Address: 855 Trosper Rd SW 108-204 Tumwater, WA 98512 Phone: 360-943-5840 Fax: 360-943-5865 Email: dennis@insta-pipe.com Notify this contact about project new opportunities Emergency Work Contact Additional Contact #1 Name: Brenda Wright Title: Office Manager Address: 855 Trosper Rd SW 108-204 Tumwater, WA 98512 Phone: 360-943-5840 Fax: 360-943-5865 Email: brenda@insta-pipe.com Notify this contact about project new opportunities Emergency Work Contact Classifications & Licenses UBI #: 602895266 Number of WA Employees: 1 - 30 Employment Security #: 575828000 Federal Tax ID #: 264207769 L&I: https://fortress.wa.gov/1ni/crpsi/Experienc eFactorHistory.aspx?Accountld=97652301 &Businessld=602895266&BusinessName =1NSTA+PIPE+INC&Selflnsured=&Busines sLegalName=INSTA+PIPE+INC Experience Factor: Contractor's License Number #: INSTAI*914P6 Expiration Date: 11/01/2019 Professional/Specialty License License Name: Number: Expiration Date: v Certifications Federally Disadvantaged Business Enterprise Certification number: Small Business Enterprise Certification number: WA Disadvantaged Business Enterprise (DBE) Certification number: WA Minority Business Enterprise (MBE) Certification number: WA Minority Woman Business Enterprise (WMBE) Certification number: WA Woman Business Enterprise (WBE) Certification number: WA Combination Business Enterprise (CBE) Certification number: Veteran Owned Certification number: OAAB33F2 Service Disabled Veteran Owned Small Business (SDVOSB): Certification number: HUBZone (Historically Underutilized Business Zone) No 8(a) Certified Firm by SBA No Insurance Insurance Company Name Propel Insurance Contact Name Michelle Newberg Contact Phone Number : 253-761-3203 Policy #: BAS56110659 Expiration Date: 05/17/2018 Bonding Bonding Company: Propel Ins. Contact Name: Michelle Newberg Contact Phone Number: 253-310-4040 Upload a Statement of Qualifications Insta-Pipe Statement of Qualification with Mike resume.pdf Project Summaries Project #1 Name: UV Point Repair in Sewer Main J Public Agency: Seattle Public Utilities Agency Point of Contact Name: John Marchitto Phone Number: 253-778-2343 Email: john.marchitto@seattle.gov Project Detail Were you the prime contractor?: Yes Specify the prime contractor?: Contract Amount: $ 13,000.00 When was the project completed?: 07/2016 Provide a brief description of the project: CIPP Point Repair in Sewer Main &AV-100 Grouting Project #2 Name: Lift Station No. 7 Force Main Primus Liner Public Agency: Southwest Suburban Sewer Dist. Agency Point of Contact Name: Phone Number: Email: Project Detail Were you the prime contractor?: Yes Specify the prime contractor?: Contract Amount: $ 80,000.00 When was the project completed?: 05/2016 Provide a brief description of the project: The decision was to install a Primus Line@ DN 200 ND with a nominal diameter of 8 inch and a nominal design pressure of 290 psi. Since the technology works with an annular space to achieve long insertion lengths and negotiate bends, the liner provides an actual outer diameter of 7.165 inch and inner diameter of 6.693 inch. Jobreport_Seattle_USA, ....pdf ... Selected Services Small Works Sanitary Sewer Construction, Repair, and Maintenance - All • Grouting and Sealing • Manhole Rehabilitation • Pipeline Repair (Dig Up/Spot Repairs) • Pipeline Video Inspection • Residential Side Sewer Service Installation • Sanitary Sewer Cleaning • Sanitary Sewer Construction • Sanitary Sewer Hot Tapping • Sanitary Sewer Internal Repairs • Sewage Backup Response and Cleaning • Sewer Lift Station Construction and Maintenance • Side Service Construction and Repair • Temporary Bypass Pumping Site Improvement, Repair, and Maintenance • Trenchless Pipe Installation and Repair Storm Drainage Facility Construction, Repair, and Maintenance • Catch Basin Cleaning/Vactoring/Jet Rodding • Catch basin/Manhole Rehabilitation and Repair • Culverts - Large Diameter • Pipeline Bursting and Jacking • Pipeline Cleaning • Pipeline Rehabilitation (Internal) • Pipeline Repair (Dig Up/Spot Repairs) • Pipeline Testing • Pipeline Video Inspection • Storm Drainage Construction Water Facility Construction, Repair, and Maintenance • Leak Detection • Underwater Video Inspection • Water Main Construction, Repair and Maintenance • Water/Wastewater Treatment Selected Public Agency Rosters Statewide Home RsNfiol Contact Search L&I l A-Z Index Help 3fy f&T Safety&Health Claims&Insurance Workplace Rights Trades&Licensing Washington State Department of Labor & Industries Insta-Pipe Inc Owner or tradesperson 855 Trosper Rd SW 108-204 TUMWATER,WA 98512-8108 Principals 360-943.5840 Smith,Dennis John,PRESIDENT THURSTON County Doing business as Insta-Pipe Inc WA UBI No. Business type 602 895 266 Corporation License Verify the contractor's active registration!license/certification(depending on trade)and any past violations. Construction Contractor Active. Meets current requirements. License specialties GENERAL License no. INSTAI'914P6 Effective—expiration 10126/2009-11/01/2019 B__ond Ironshore Indemnity Inc $12,000.00 Bond account no. SUR40001836 Received by L&I Effective date 08!14/2014 09/02/2014 Expiration date Until Canceled Bond history Insurance Ohio Security Ins Co $1,000,000.00 Policy no. BKS56110659 Received by L&I Effective date 05/14/2018 05/1712017 Expiration date 05/17/2019 Insurance history Savings No savings accounts during the previous 6 year period. Lawsuits against,the bond or savings Cause no. 15-2-04820-1 SEA Dismissed Complaint filed by Complaint against bond(s)or savings STATE OF WASHINGTON SI4197 Help 4s improve V Complaint date Complaint amount 03/03/2015 $6,000.00 L&I Tax_debts No L&I tax debts are recorded for this contractor license during the previous 6 year period,but some debts may be recorded by other agencies_ License Violations No license violations during the previous 6 year period. Workers' comp Do you know if the business has employees?If so,verify the business is up-to-date on workers'comp premiums. L&I Account ID Account Is current. 976,523-01 Doing business as INSTA PIPE INC Estimated workers reported Quarter 3 of Year 2018"21 to 30 Workers" L&I account contact T2/SUSAN BETTS(360)902.4828-Email:BETT235@lni.wa.gov Public Works Strikes and Debarments Verify the contractor is eligible to perform work on public works projects. Contractor Strikes No strikes have been issued against this contractor. Contractors not allowed to bid No debarments have been issued against this contractor. Workplace safety and health No inspections during the previous 6 year period. ®Washington State Dept.of Labor&Industries.Use of this site is subject to the laws of the state of Washington. Help us improve MDOF-1 My DOR Unauthenticated Business Lookup MICHIGAN STREET SHELL License Information: New search Back to results Entity name: INSTA-PIPE,INC. Business name: MICHIGAN STREET SHELL Entity type: Profit Corporation UBI#: 602-895-266 Business ID:001 Location ID:0001 Location: Open Location address: 2520 50TH AVE SW TUMWATER WA 98512-6701 USA Mailing address: 855 TROSPER RD SW#108-204 TUMWATER WA 98512-8108 USA Excise tax account and reseller Open(Miew) permit status: Secretary of State status: Click here Endorsements Endorsements held at this location License# Count Details Status Expiration date First issuance del Bellingham General Business Active Nov-17-2016 Olympia General Business 19554 Active Jan-31-2019 Jan-01-2010 Poulsbo General Business Active Jan-31-2019 Aug-25-2017 ---..............._......---.......... ---- Tumwater General Business R-009433 Active Jan-31-2019 Apr-29-2009 4 Rows Governing Peopler r •w••�+wwow•��•wse..s.nnS--r-Wrdsm. Governing people SMITH,DENNIS The Business Lookup information is updated nightly. Search date and time:11/1/2018 2:58:23 PM Working together to fund Washington's future fA STATE OF WASHINGTON Department of Labor&Industries Certificate of Workers' Compensation Coverage November 1, 2018 WA UBI No. 602 895 266 L&I Account ID 1976,523-01 _.............. ...._--.........._......._._ . ......d..._..... _._.....__.........—__ ................... .......... Legal Business Name INSTA PIPE INC Doing Business As INSTA PIPE INC Workers'Comp Premium Status: Account is current. j .—�.—_.._.._._.._.............._._....—_—_...___.•____,_—-_..—..___ ..._.._ __._ __...._....._.. ......... ...E Estimated Workers Reported Quarter 3 of Year 2018"21 to 30 Workers" (See Description Below) Account Representative Employer Services Help Line,(360)902817, Licensed Contractor? ;Yes ;License No. — INSTAI'914P6 License Expiration 11/01/2019 What does "Estimated Workers Reported" mean? Estimated workers reported represents the number of full time position requiring at least 480 hours of work per calendar quarter.A single 480 hour position may be filled by one person,or several part time workers. Industrial Insurance Information Employers report and pay premiums each quarter based on hours of employee work already performed, and are liable for premiums found later to be due. Industrial insurance accounts have no policy periods, cancellation dates, limitations of coverage or waiver of subrogation(See RCW 51.12.050 and 51.16.190). J 'lnsfa-Pipe; Inc POD . �?er t§ I Ins to-Pipe, Ind 855 TrosperRd SW 106-204 f Tumwater, WA 9851.2 MikeS.hepp 360.507.1815 mikes@insta-pipe.com General Manager/Superintendent Experience v Mike has over 3 years industry experience Key Projects r Mike has managed-rr►asi}:prcijects including but not r Iimited td;- 0 1tiataa`Indian fsSand—P} hurstailitan r +, ti nes:P rol�ci:requ rel. reptng 10W f+7acecietiertines:fi�nt tifrstaticrnts setrer NBK Bangor—Pipeliurst saniiary sesv er lines,Wort nuns"isted.til teplsef,i .aiapritx. 1300 If of8"sanitary sever i eaintirteineludiitgins taliiae a fu{I,bypa4s sysit:n�_during�?nsn•uGtin:tc5chedute: - • Clq!.of"Biaistir 5ztver Iine,I'riiject requirYd sI i�sliting Q�-3(N){1 II`t�I`I-t't'iberglass ppe nth f(I'"lii]Pt•U{2 I;1 p1pt:t4cingaIpng length..highstrepetbwutchings-steri. Tekeland!,Souit ern Puget.Sound oxer trilFiai, r • l3otisitt ;��thontt°—Sl plrne}�otahiy«at�r ire Project crmsi ted of Ain Iining al+proa,:1.3ZOOif0i' 10"Arid 8 ca_inas Wilb i and 2"HDPE pressuty Professional . Licenses P'P�i°using long tcn�tl-L�nett sirengtlt tt+inching StSt�tii. SCO Gape T)tsaplxzintmem- Ptpeburst 4 tiirced main and&"graviiy sewer u;aitts.Replaced agin r anis tailing Po ed malas gnd gravity mains. • Tongue-Pt.Joh Cbrps'Cetiim Amim OR R COITIPCIeW E. Pip bursi.entire potable avatrr sygorn.P.ruiect requiredreplac+ng appmN. U.0041fof tiYater ntaii>$ and sin ices•V is Pipe.bur,-.i j»eihncl: •. h urii,i rtaus Oflati SpCciviszed 7'ip i tir5tin� l i cc r P`bm 19%6,ihru 21}16 to Aaae. . Nisit� NNdicai Training and CPR DOT Drug and Alcohol TraininIg Pro€essir>n•References: Lee Millen:King bounty Washington Cam McCrary.City of Kaiama.Washington Bqb Buci"iey;.Pierce County.Washington 1'nsta-Pipe Trenchless Pipe Repair Services Offered Sewer LIJ A R Ir Trenchless Repan* Cl PP Lining(Cured'Jn Place) Primus Liner Pipe Bursting,;&HDPE Fusing CIPP Point RepAlt (1Aan io.le Repair;Re,[aabilitatiprl k M�oum Testing' CCTV(camera) Inspections,Small and Large Pipe ReWential+Commercial Industrial and_-Munici.01 Ripjeds "SE'V4 WITHOUT DIGV*. WITH`SEWER PIPE IMN Wo pyer�5 years of expetiezrce Insta-Pipe'T'rend o' ss Pipe Repa f"'�i repair-5eWer lines and ot :; t-iiain pipesvi►iSefer pipe lining,services in Olympia,Tacoma arteSeattle arm DtjrX't l your piisyou can ta .advantage of bur pipe lining evaluation and seoiices. See our`Website www.insta-pipe.com Phone:360-943-5840 Toll Fre�"866-463-9747 Insta-Pipe,Inc.-Trench Iess'Pipe Repair 955TrosperRd SW,108204 €3lym.pia,wash nIon 9$ 11 111�'EJ1t�S1d�6 :, MASON COUNTY BRIEFING ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS FROM: Jerry W. Hauth, Director/County Engineer DEPARTMENT: Public Works EXT: 450 BRIEFING DATE: November 19, 2018 PREVIOUS BRIEFING DATES: (If this is a follow-up briefing,please provide only new information,) ITEM: Road Closure — Portion of Old Belfair Highway "Belfair Christmas Parade"— December 21 2018 EXECUTIVE SUMMARY: The North Mason Music Booster Club is sponsoring a Belfair Christmas Parade to be held on Sunday, December 2, 2018. They have requested a road closure on a portion of Old Belfair Highway, county maintained portion from State Route 300 to Faith in Action HUB Senior Center, approximately milepost 0.000 to milepost 0.100 from 3:30pm to 5:00pm. The parade will start at Faith in Action HUB Senior Center and the adjacent lot on Old Belfair Hwy and continue through the intersection of Old Belfair Hwy and Old Clifton Road to the DairyQueen/McLendon's parking lot. The Road Use Application was received on Tuesday, November 6, 2018. With no Briefing's last week, approval of this closure would need to be requested at the November 20th Commission meeting to meet public notice requirements. RECOMMENDED OR REQUESTED ACTION• Recommend the Board 1. Authorize Public Works to move this item to the November 20, 2018 Commission Meeting Agenda. 2. Approve and execute the resolution to close Old Belfair Highway at approximately milepost 0.000 to milepost 0.100 on Sunday, December 2, 2018 from 3:30pm to 5:00pm Attachment: Resolution Map 0 RESOLUTION NUMBER COUNTY ROAD CLOSURE OLD BELFAIR HWY#98250 NOTICE IS HEREBY GIVEN that pursuant to RCW 47.48.020, a portion of Old Belfair Hwy, County Road No. 98250, shall be closed to all through traffic on Sunday,December 2,2018 from 3:30pm to 5:00 pm(milepost 0.000 to milepost 0.100). NOW THEREFORE,BE IT RESOLVED,the Board of County Commissioners has declared the above described road closure a necessity for public safety during the North Mason Community Celebration Committee Belfair Christmas Parade event. THEREFORE, the County Engineer is hereby ordered and authorized to proceed as prescribed by law. ADOPTED this day of , 2018. BOARD OF COUNTY COMMISSIONERS MASON COUNTY,WASHINGTON Randy Neatherlin, Chair ATTEST: Terri Jeffreys, Vice Chair Melissa Drewry, Clerk of the Board APPROVED AS TO FORM: Kevin Shutty, Commissioner Tim Whitehead, Chief Deputy Prosecuting Attorney cc: Commissioners Engineer JOURNAL: Publ. It.: 11/29/18 (Bill Road Dept.) POST: At Least three(3)days nrior to closure. •IC LJr' • ' .• "r.1 a/r 1 I ' i I+ ♦ r. r f 0 ALP 74 • i ;' lap)\ Asa `fr"►��r-•� f� � - - ..-_� � +300. � I' t• r �� i' ,, Belfair Christmas Parade MASON COUNTY BRIEFING ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS FROM: Jerry W. Hauth, RE, Director/County Engineer Loretta Swanson, Technical Services Manager DEPARTMENT: Public Works EXT: 450 BRIEFING DATE: November 19, 2018 PREVIOUS BRIEFING DATES: (If this is a follow-up briefing, please provide only new information,) ITEM: Private Line Occupancy Permit for Joel &Angie Kramer EXECUTIVE SUMMARY: Mr. & Mrs. Kramer have applied for a Private Line Occupancy Permit to install underground lines for power, water, and septic transport under and across North Shore Road. The current septic system located at 4730 North Shore Road (parcel #22202-52-00010) is inadequate for future improvements. The newly approved septic designed re-locates the new system to the upland side of the North Shore Road on parcel# 22202-52-00900 also owned by the Kramers. The application fee has been paid to process the proposed Private Line Occupancy Permit granting permission to run power, water, and septic transport line under and across the North Shore Road for the benefitting tax parcel number 22202-52-00010. Recommended Action: Recommend the Board approve the Private Line Occupancy Permit granting permission to run a power,water, and septic transport line under and across North Shore Road for parcel number 22202-52-00010. Attachments: PLO Exhibit 1 Briefing Summary IN THE MATTER OF THE APPLICATION OF jo FL � Rq m E FOR A PRIVATE LINE UTILITY OCCUPANCY PERMIT TO CONSTRUCT, OPERATE, AND MAINTAIN IJ67ER L 2 SEfvc L wePowu ALONG AND UNDER 14E Ho 0 ,A C UNTY MAINTAINED ROAD LOCATED IN MASON COUNTY,WASHINGTON MictCm,cK)WA q3617— Application 3OiZApplication of J E L k f , with principal residence located at Aiam R 455 by and-through - ve-L&R�r , for a private line utility occupancy permit to construct,operate and maintain a private waterline under county roads and highways in Mason County,Washington,as set forth in attached Exhibit`B",having come before the County Commissioners of Mason County,Washington during a regularly scheduled public meeting,on the day of ,2018,and that it is in the public interest to allow the private line utility occupancy permit herein granted; NOW THEREFORE,IT IS ORDERED that a non-exclusive private line utility occupancy permit be, and the same is hereby given and granted to operator, and its successors and assigns, hereinafter referred to as the"Permittee",for a period commencing from and after the date of the entry of this order for the purposes,at the location(s),and upon the express terms and conditions as described herein, and terminating as provided herein. I. DEFINITIONS For the purposes of this private line utility occupancy permit, terms,phrases, words, and their derivations not defined herein that are defined in Title 12 of the Mason County Code or the Manual on Accommodating Utilities in the Mason County Right-of-Way published by the County Engineer(the"Manual"),shall have the same meaning or be interpreted as provided in Title 12 of the Mason County Code or the Manual. Words not defined here,in Title 12 of the Mason County Code or the Manual shall have their ordinary meaning. A reference to Title 12 of the Mason County Code or the Manual refers to the same as may be amended,revised,updated,re-enacted or re-codified from time to time. H. GRANT The County of Mason(hereafter the"County")hereby grants to the Permittee a non-exclusive private line utility occupancy permit(hereinafter"Permit")which, once it becomes effective shall authorize-the Permittee to enter upon the road rights-of-way located within the Permit Area for the purpose of maintaining,repairing,replacing, which grant shall be limited to the following described purpose(s): F&Ot i nE "-re(— A>sT Aigv7iwJ FDr q Z P/. -rr/ tje_t( 6e_raru) Thy, cc) 2Z2 ©z - °-moo Ib *rjD Z.2Z02 -s-z-0090 j � Pl�c `(' Pow ER, L1NS_-ZjTr- 1 Such grant is subject to and must be exercised in strict accordance with and subject to this Permit, Title 12 of the Mason County Code, the Manual and all applicable laws,rules,regulations and ordinances. Permittee's exercise of any rights granted pursuant to the Permit is subject to the exercise of the County's police powers, and other regulatory powers as it may have or obtain in the future. No rights shall pass to the Permittee by implication. This Permit does not include permission to enter into or upon the road rights-of-way for any purposes others than the purposes expressly described herein. Permittee has a duty to notify the County of any change in use or condition of the utility facilities that may affect the status of the utility facilities as (a) private line(s)or the impact of the utility facilities upon the road rights-of-way. III. UTILITY PERMIT REQUIRED Permittee shall not commence or perform work to install, construct, maintain repair, replace adjust,connect,disconnect,rebuild,or relocate its utility facilities within the road rights-of-way (hereafter collectively or individually the "Work"), without first applying for, paying all associated fees, and obtaining a utility permit as required pursuant to Title 12 of the Mason County Code. In any utility permit so issued, the County may impose, as a condition of the granting the utility permit,such conditions and regulations as may be necessary for the protection, preservation and management of the road rights-of-way, including,by way of example and not limitation, for the purpose of protecting any structures in the road rights-of-way, maintaining proper distance from other utilities,ensuring the proper restoration of such road rights-of-way and structures,and for the protection of the County and the public and the continuity of pedestrian and vehicular traffic. Permittee shall first file with the County Engineer its application for a utility permit to do such Work together with plans and specifications showing at a minimum: A. The position, depth and location of all such utility facilities sought to be constructed, laid, installed or erected at that time, showing their relative position to existing county roads, rights-of-way or other county property upon plans drawn to scale,hereinafter collectively referred to as the"map of definite location; B. The class and type of material and equipment to be used, manner of excavation, construction, installation, backfill, erection of temporary structures, erection of permanent structures, traffic control,traffic turnouts and road obstructions; C. The manner in which the utility facility is to be installed; D. Measures to be taken to preserve safe and free flow of traffic; E. Structural integrity of the roadway,bridge, or other structure; F. Specifications for the restoration of the county road, right-of-way or other county property in the event that the road right of way will be disturbed by the Work; and 2 G. Provision for ease of future road maintenance and appearance of the roadway. Provision shall be made for known or planned expansion of the utility facilities,particularly those located underground or attached to bridges or other structures within the road right-of-way. The location, alignment and depth of the utility facilities shall conform with said map of definite location, except in instances in which deviation may be allowed thereafter in writing by the County Engineer pursuant to application by Permittee. All such Work shall be subject to the approval of and shall pass the inspection of the County Engineer. The Permittee shall pay all costs of and expenses incurred in the examination, inspection and approval of such work on account of granting the said utility permits. IV. RESTORATION OF ROAD RIGHT OF WAY In any Work which disturbs or causes damage to the road rights-of-way subject to this Permit, public or private property, the Permittee shall at its own expense and with all convenient speed, complete the work to repair and restore the county road right-of-way, or the public or private property so disturbed or damaged,and leave the same in as good or better condition as before the Work was commenced, to the reasonable satisfaction of the County Engineer. The Permittee shall pay all costs of and expenses incurred in the examination, inspection and approval of such restoration or repair. The County Commissioners and/or County Engineer may at any time do,order or have done any and all work that they consider necessary to restore to a safe condition such County road right-of- way or other County property left by the Permittee or its agents in a condition dangerous to life or property, and the Permittee, upon demand, shall pay to the County all costs of such work. V. PERMITTEE WORK IN RIGHT OF WAY Permittee expressly agrees and understands that, with regard to Work within the road rights-of- way: A. All of Permittee's utility facilities and Work within the road rights-of-way or other County property shall be performed in compliance with the provisions of Title 12 MCC, the Manual,the administrative regulations adopted by the County Engineer,other County-established requirements for placement of utility facilities in road rights-of-way, including the specific location of utility facilities in the road rights-of-way, and all applicable laws,rules, regulations and ordinances; B. In preparing plans and specifications for the Work the Permittee shall use the Manual. Prior to commencement of any Work,Permittee shall submit such plans and specifications to the County Engineer for review and approval together with the adequate exhibit depicting the existing or proposed location of the utility facility in relation to the road, including right-of-way or 3 easement lines; relationship to currently planned road revisions, if applicable; and all locations and situations for which deviations in depth of cover (including the proposed method of protection) or other locational standards that are anticipated; C. All Work subject to this Permit shall be done in such a manner as not to interfere, other than in ways approved by the County,with the construction,operation and maintenance of other utilities, public or private, drains, drainage ditches and structures, irrigation ditches and structures,located therein,nor with the grading or improvements of such County roads,rights-of- way or other County property; D. The owners and operators of all utility facilities (public or private) installed in the Permit Area or other county property prior in time to the utility facilities of the Permittee, shall have preference as to the alignment and location of such utilities so installed with respect to the Permittee. Such preference shall continue in the event of the necessity of relocating or changing -the grade of any such county road or right-of-way; E. Permittee shall perform the Work and operate its utility facilities in a manner that minimizes interference with the use of the road rights-of-way by others,including others that may be installing utility facilities; and F. The County may require that Permittee's utility facilities be installed at a particular time, at a specific place,or in a particular manner as a condition of access to a particular road or road right-of-way; may deny access if a Permittee is not willing to comply with the County's requirements; and may remove, or require removal of, any utility facility that is not installed in compliance with the requirements established by the County,or which is installed without prior County approval of the time,place,or manner of installation and charge the Permittee for all the costs associated with removal; and may require Permittee to cooperate with others to minimize adverse impacts on the road and road rights-of-way through joint trenching and other arrangements. G. The County may inspect the utility facilities at any time reasonable under the circumstances to ensure compliance with this Permit and applicable law,including to ensure that the private line utility facilities are constructed and maintained in a safe condition. If an unsafe condition is found to exist, the County, in addition to taking any other action permitted under applicable law,may order the Permittee,in writing,to make the necessary repairs and alterations specified therein forthwith to correct the unsafe condition on a time-table established by the County which is reasonable in light of the unsafe condition. The County has the right to correct, inspect,administer,and repair the unsafe condition if the Licensee fails to do so,and to charge the Permittee therefor. The right of the County to conduct such inspections and order or make repairs shall not be construed to create an obligation therefore, and such obligation to construct and maintain its utility facilities in a safe condition shall at all times remain the sole obligation of the Permittee. 4 H. When required by the County,Permittee shall make information available to the public regarding any Work involving the ongoing installation, construction, adjustment, relocation, repair or maintenance of its utility facilities sufficient to show(1)the nature of the work being performed;(2)where it is being performed;(3)its estimated completion date;and(4)progress to completion. I. PERMITTEE IS PLACED ON NOTICE THAT FIBER OPTIC COMMUNICATIONS, POWER, CONTROL SYSTEMS, OTHER TYPES OF CABLES AND PIPELINES MAY BE BURIED ON THE RIGHT OF WAY. Before beginning any underground work,Permittee will contact the appropriate personnel to have such facilities located and make arrangements as to protective measures that must be adhered to prior to the commencement of any work within the road and road rights-of-way. In addition to the liability terms elsewhere in this Agreement, Permittee shall indemnify and hold the County and its elected and appointed officers,employees and agents harmless against and from all cost, liability, and expense whatsoever (including, without limitation, attorney's fees and court costs and expenses) arising out of or in any way contributed to by any act or omission of Permittee,its contractor, agents and/or employees,that cause or in any way or degree contribute to(1) any damage to or destruction of any such facilities by Permittee, and/or its contractor, agents and/or employees, on the County's property, (2) any injury to or death of any person employed by or on behalf of any entity, and/or its contractor, agents and/or employees, on the road rights-of-way, and/or(3) any claim or cause of action for alleged loss of profits or revenue,or loss of service,by a customer or user of services or products of such company(ies). J. Permittee shall continuously be a member of the State of Washington one number locator service under RCW 19.122, or an approved equivalent, and shall comply with all such applicable rules and regulations. K. Except in the event of emergency as described below,Permittee and its agents may not enter upon the permit area to perform work for which a utility permit is required, unless and except upon two-business days notice to the County Engineer. L. In the event of an emergency involving the threat of imminent harm to persons or property, and for purposes of taking immediate corrective action, Permittee and its agents may enter the Permit Area without advance notice to the County as long as such entry is for the sole purpose of addressing the emergency; provided however, that if any entry for such purposes would require issuance of a utility permit, Permittee shall give the County verbal or telephonic notice of the places where and the manner in which entry is required prior to such entry,promptly followed by written notice. In all cases,notice to the County shall be given as far in advance as practical prior to entry or as soon as practicable after entry upon the road right-of-way. M. Permittee shall promptly reimburse the County for its reasonable and direct costs incurred in responding to an emergency that is caused,created by or attributable to the presence, construction,maintenance,repair,or operation of Permittee's utility facilities in the road rights- of-way. 5 N. If, during any Work, Permittee or its agents discover scientific or historic artifacts, Permittee or its agents shall immediately notify the County of said discovery and shall protect such artifacts in a manner as specified by the County. Any such artifact shall be the property of the County if the County wishes to own it. VI. PROTECTION OF PUBLIC All Work done under this Permit shall be done in a thorough and workman-like manner. In the performance of any Work,including without limitation,the opening of trenches and the tunneling under county roads,right-of way or other county property,the Permittee shall leave such trenches, ditches and tunnels in such a way as to interfere as little as possible with public travel and shall take all due and necessary precautions to guard the same,so that damage or injury shall not occur or arise by reason of such Work;and where any of such trenches,ditches and tunnels are left open at night, the Permittee shall place warning lights, barricades and other appropriate protective devices at such a position as to give adequate warning of such Work. The Permittee shall be liable for any injury to person or persons or damage to property sustained arising out of its carelessness or neglect,or through any failure or neglect to properly guard or give warning of any trenches, ditches or tunnels dug or maintained by the Permittee. VII. POLICE POWERS The County,in granting this Permit,does not waive any rights which it now has or may hereafter acquire with respect to county roads,rights-of-way or other county property and this Permit shall not be construed to deprive the county of any powers,rights or privileges which it now has or may hereafter acquire to regulate the use of and to control the county roads, right-of-way and other county property covered by this Permit. The County retains the right to administer and regulate activities of the Permittee up to the fullest extent of the law. The failure to reserve a particular right to regulate, or reference a particular regulation, shall not be interpreted by negative implication or otherwise to prevent the application of a regulation to the Permittee. VIII. RELOCATION Permittee shall, in the course of any Work, comply with the following requirements: A. The Permittee shall,by a time specified by the County,protect, support,temporarily disconnect,relocate,or remove any of its utility facilities when required by the County by reason of traffic conditions; public safety; road right-of-way construction; road right-of-way repair (including resurfacing or widening);change of road right-of-way grade;construction,installation, or repair of County-owned sewers, drains, water pipes, power lines, signal lines, tracks, communications system,other public work,public facility,or improvement of any government- owned utility; road right-of-way vacation; or for any other purpose where the County work involved would be aided by the removal or relocation of the utility facilities. Collectively,such matters are referred to below as the "public work." 6 IN THE MATTER OF THE APPLICATION OF j0 FL �'� w�F FOR A PRIVATE LINE UTILITY OCCUPANCY PERMIT TO CONSTRUCT, OPERATE, AND MAINTAIN OvER LiNe kMc L we ALONG AND UNDER F NO 0 ,A C UNTY MAINTAINED ROAD LOCATED IN MASON COUNTY,WASHINGTON Mici(tu.K;I-M c�$DiZ Application of J K i✓ , with principal residence located at Z Opd �� R ST by and through �I&e-L &J9 4W C_t , for a private line utility occupancy permit to construct,operate and maintain a private.waterline under county roads and highways in Mason County,Washington,as set forth in attached Exhibit`B",having come before the County Commissioners of Mason County,Washington during a regularly scheduled public meeting,on the day of ,2018,and that it is in the public interest to allow the private line utility occupancy permit herein granted; NOW THEREFORE,IT IS ORDERED that a non-exclusive private line utility occupancy permit be, and the same is hereby given and granted to operator, and its successors and assigns, hereinafter referred to as the"Permittee",for a period commencing from and after the date of the entry of this order for the purposes,at the location(s),and upon the express terms and conditions as described herein, and terminating as provided herein. 1. DEFINITIONS For the purposes of this private line utility occupancy permit, terms, phrases, words, and their derivations not defined herein that are defined in Title 12 of the Mason County Code or the Manual on Accommodating Utilities in the Mason County Right-of-Way published by the County Engineer(the"Manual"),shall have the same meaning or be interpreted as provided in Title 12 of the Mason County Code or the Manual. Words not defined here,in Title 12 of the Mason County Code or the Manual shall have their ordinary meaning. A reference to Title 12 of the Mason County Code or the Manual refers to the same as maybe amended,revised,updated,re-enacted or re-codified from time to time. II. GRANT The County of Mason(hereafter the"County')hereby grants to the Permittee a non-exclusive private line utility occupancy permit(hereinafter"Permit")which, once it becomes effective shall authorize the Permittee to enter upon the road rights-of-way located within the Permit Area for the purpose of maintaining,repairing,replacing, which grant shall be limited to the following described purpose(s): f&a vj vF "re(- A:sT A j Aa-n&J jG rg 1„ic.(( �e_rjjrcn) TRx t cc) 2z2 ©Z - -o ao t� �» z2zo2 -sZ-ao9Q S 1 ( %c * POW ZK LiN� TG 1 Such grant is subject to and must be exercised in strict accordance with and subject to this Permit, Title 12 of the Mason County Code, the Manual and all applicable laws, rules, regulations and ordinances. Permittee's exercise of any rights granted pursuant to the Permit is subject to the exercise of the County's police powers, and other regulatory powers as it may have or obtain in the future. No rights shall pass to the Permittee by implication. This Permit does not include permission to enter into or upon the road rights-of-way for any purposes others than the purposes expressly described herein. Permittee has a duty to notify the County of any change in use or condition of the utility facilities that may affect the status of the utility facilities as (a) private line(s) or the impact of the utility facilities upon the road rights-of-way. III. UTILITY PERMIT REQUIRED Permittee shall not commence or perform work to install, construct, maintain repair, replace adjust, connect,disconnect,rebuild,or relocate its utility facilities within the road rights-of-way (hereafter collectively or individually the "Work"), without first applying for, paying all associated fees, and obtaining a utility permit as required pursuant to Title 12 of the Mason County Code. In any utility permit so issued, the County may impose, as a condition of the granting the utility permit,such conditions and regulations as may be necessary for the protection, preservation and management of the road rights-of-way, including, by way of example and not limitation, for the purpose of protecting any structures in the road rights-of-way, maintaining proper distance from other utilities,ensuring the proper restoration of such road rights-of-way and structures,and for the protection of the County and the public and the continuity of pedestrian and vehicular traffic. Permittee shall first file with the County Engineer its application for a utility permit to do such Work together with plans and specifications showing at a minimum: A. The position, depth and location of all such utility facilities sought to be constructed, laid, installed or erected at that time, showing their relative position to existing county roads, rights-of-way or other county property upon plans drawn to scale,hereinafter collectively referred to as the"map of definite location; B. The class and type of material and equipment to be used, manner of excavation, construction, installation, backfill, erection of temporary structures, erection of permanent structures, traffic control, traffic turnouts and road obstructions; C. The manner in which the utility facility is to be installed; D. Measures to be taken to preserve safe and free flow of traffic; E. Structural integrity of the roadway,bridge, or other structure; F. Specifications for the restoration of the county road, right-of-way or other county property in the event that the road right of way will be disturbed by the Work; and 2 G. Provision for ease of future road maintenance and appearance of the roadway. Provision shall be made for known or planned expansion of the utility facilities,particularly those located underground or attached to bridges or other structures within the road right-of-way. The location,alignment and depth of the utility facilities shall conform with said map of definite location, except in instances in which deviation may be allowed thereafter in writing by the County Engineer pursuant to application by Permittee. All such Work shall be subject to the approval of and shall pass the inspection of the County Engineer. The Permittee shall pay all costs of and expenses incurred in the examination, inspection and approval of such work on account of granting the said utility permits. IV. RESTORATION OF ROAD RIGHT OF WAY In any Work which disturbs or causes damage to the road rights-of-way subject to this Permit, public or private property,the Permittee shall at its own expense and with all convenient speed, complete the work to repair and restore the county road right-of-way, or the public or private property so disturbed or damaged,and leave the same in as good or better condition as before the Work was commenced, to the reasonable satisfaction of the County Engineer. The Permittee shall pay all costs of and expenses incurred in the examination,inspection and approval of such restoration or repair. The County Commissioners and/or County Engineer may at any time do,order or have done any and all work that they consider necessary to restore to a safe condition such County road right-of- way or other County property left by the Permittee or its agents in a condition dangerous to life or property, and the Permittee,upon demand, shall pay to the County all costs of such work. V. PERMITTEE WORK IN RIGHT OF WAY Permittee expressly agrees and understands that,with regard to Work within the road rights-of- way: A. All of Permittee's utility facilities and Work within the road rights-of-way or other County property shall be performed in compliance with the provisions of Title 12 MCC, the Manual,the administrative regulations adopted by the County Engineer,other County-established requirements for placement of utility facilities in road rights-of-way, including the specific location of utility facilities in the road rights-of-way, and all applicable laws,rules,regulations and ordinances; B. In preparing plans and specifications for the Work the Permittee shall use the Manual. Prior to commencement of any Work,Permittee shall submit such plans and specifications to the County Engineer for review and approval together with the adequate exhibit depicting the existing or proposed location of the utility facility in relation to the road, including right-of-way or 3 easement lines; relationship to currently planned road revisions,if applicable; and all locations and situations for which deviations in depth of cover (including the proposed method of protection)or other locational standards that are anticipated; C. All Work subject to this Permit shall be done in such a manner as not to interfere, other than in ways approved by the County,with the construction,operation and maintenance of other utilities, public or private, drains, drainage ditches and structures, irrigation ditches and structures,located therein,nor with the grading or improvements of such County roads,rights-of- way or other County property; D. The owners and operators of all utility facilities (public or private) installed in the Permit Area or other county property prior in time to the utility facilities of the Permittee, shall have preference as to the alignment and location of such utilities so installed with respect to the Permittee. Such preference shall continue in the event of the necessity of relocating or changing the grade of any such county road or right-of-way; E. Permittee shall perform the Work and operate its utility facilities in a manner that minimizes interference with the use of the road rights-of-way by others,including others that may be installing utility facilities; and F. The County may require that Permittee's utility facilities be installed at a particular time, at a specific place,or in a particular manner as a condition of access to a particular road or road right-of-way; may deny access if a Permittee is not willing to comply with the County's requirements; and may remove, or require removal of, any utility facility that is not installed in compliance with the requirements established by the County,or which is installed without prior County approval of the time,place,or manner of installation and charge the Permittee for all the costs associated with removal; and may require Permittee to cooperate with others to minimize adverse impacts on the road and road rights-of-way through joint trenching and other arrangements. G. The County may inspect the utility facilities at any time reasonable under the circumstances to ensure compliance with this Permit and applicable law,including to ensure that the private line utility facilities are constructed and maintained in a safe condition. If an unsafe condition is found to exist, the County, in addition to taking any other action permitted under applicable law,may order the Permittee,in writing,to make the necessary repairs and alterations specified therein forthwith to correct the unsafe condition on a time-table established by the County which is reasonable in light of the unsafe condition. The County has the right to correct, inspect,administer,and repair the unsafe condition if the Licensee fails to do so,and to charge the Permittee therefor. The right of the County to conduct such inspections and order or make repairs shall not be construed to create an obligation therefore, and such obligation to construct and maintain its utility facilities in a safe condition shall at all times remain the sole obligation of the Permittee. 4 H. When required by the County,Permittee shall make information available to the public regarding any Work involving the ongoing installation, construction, adjustment, relocation, repair or maintenance of its utility facilities sufficient to show(1)the nature of the work being performed;(2)where it is being performed;(3)its estimated completion date;and(4)progress to completion. I. PERMITTEE IS PLACED ON NOTICE THAT FIBER OPTIC COMMUNICATIONS, POWER, CONTROL SYSTEMS, OTHER TYPES OF CABLES AND PIPELINES MAY BE BURIED ON THE RIGHT OF WAY. Before beginning any underground work,Permittee will contact the appropriate personnel to have such facilities located and make arrangements as to protective measures that must be adhered to prior to the commencement of any work within the road and road rights-of-way. In addition to the liability terms elsewhere in this Agreement, Permittee shall indemnify and hold the County and its elected and appointed officers,employees and agents harmless against and from all cost, liability, and expense whatsoever (including, without limitation, attorney's fees and court costs and expenses) arising out of or in any way contributed to by any act or omission of Permittee,its contractor, agents and/or employees,that cause or in any way or degree contribute to(1) any damage to or destruction of any such facilities by Permittee, and/or its contractor, agents and/or employees, on the County's property,(2) any injury to or death of any person employed by or on behalf of any entity, and/or its contractor, agents and/or employees, on the road rights-of-way, and/or(3) any claim or cause of action for alleged loss of profits or revenue,or loss of service,by a customer or user of services or products of such company(ies). J. Permittee shall continuously be a member of the State of Washington one number locator service under RCW 19.122, or an approved equivalent, and shall comply with all such applicable rules and regulations. K. Except in the event of emergency as described below,Permittee and its agents may not enter upon the permit area to perform work for which a utility permit is required, unless and except upon two-business days notice to the County Engineer. L. In the event of an emergency involving the threat of imminent harm to persons or property, and for purposes of taking immediate corrective action, Permittee and its agents may enter the Permit Area without advance notice to the County as long as such entry is for the sole purpose of addressing the emergency; provided however, that if any entry for such purposes would require issuance of a utility permit,Permittee shall give the County verbal or telephonic notice of the places where and the manner in which entry is required prior to such entry,promptly followed by written notice. In all cases,notice to the County shall be given as far in advance as practical prior to entry or as soon as practicable after entry upon the road right-of-way. M. Permittee shall promptly reimburse the County for its reasonable and direct costs incurred in responding to an emergency that is caused,created by or attributable to the presence, construction,maintenance,repair,or operation of Permittee's utility facilities in the road rights- of-way. 5 N. If, during any Work, Permittee or its agents discover scientific or historic artifacts, Permittee or its agents shall immediately notify the County of said discovery and shall protect such artifacts in a manner as specified by the County. Any such artifact shall be the property of the County if the County wishes to own it. VI. PROTECTION OF PUBLIC All Work done under this Permit shall be done in a thorough and workman-like manner. In the performance of any Work,including without limitation,the opening of trenches and the tunneling under county roads,right-of way or other county property,the Permittee shall leave such trenches, ditches and tunnels in such a way as to interfere as little as possible with public travel and shall take all due and necessary precautions to guard the same,so that damage or injury shall not occur or arise by reason of such Work;and where any of such trenches,ditches and tunnels are left open at night, the Permittee shall place warning lights, barricades and other appropriate protective devices at such a position as to give adequate warning of such Work. The Permittee shall be liable for any injury to person or persons or damage to property sustained arising out of its carelessness or neglect,or through any failure or neglect to properly guard or give warning of any trenches, ditches or tunnels dug or maintained by the Permittee. VII. POLICE POWERS The County,in granting this Permit,does not waive any rights which it now has or may hereafter acquire with respect to county roads,rights-of-way or other county property and this Permit shall not be construed to deprive the county of any powers,rights or privileges which it now has or may hereafter acquire to regulate the use of and to control the county roads, right-of-way and other county property covered by this Permit. The County retains the right to administer and regulate activities of the Permittee up to the fullest extent of the law. The failure to reserve a particular right to regulate, or reference a particular regulation, shall not be interpreted by negative implication or otherwise to prevent the application of a regulation to the Permittee. VIII. RELOCATION Permittee shall, in the course of any Work, comply with the following requirements: A. The Permittee shall,by a time specified by the County,protect, support,temporarily disconnect,relocate,or remove any of its utility facilities when required by the County by reason of traffic conditions; public safety; road right-of-way construction; road right-of-way repair (including resurfacing or widening);change of road right-of-way grade;construction,installation, or repair of County-owned sewers, drains, water pipes, power lines, signal lines, tracks, communications system,other public work,public facility,or improvement of any government- owned utility; road right-of-way vacation; or for any other purpose where the County work involved would be aided by the removal or relocation of the utility facilities. Collectively,such matters are referred to below as the "public work." 6 Permittee acknowledges and understands that any delay by Permittee in performing the above described work may delay, hinder, or interfere with the work performed by the County and its contractors and subcontractors done in furtherance of such Public Work and result in damage to the County,including but not limited to,delay claims. Permittee shall cooperate with the County and its contractors and subcontractors to coordinate such Permittee work to accommodate the Public Work project and project schedules to avoid delay,hindrance of,or interference with the Public Work. The County shall make available to the Permittee a copy of the Six Year Transportation Program and the County's annual construction program after adoption each year. It is anticipated these programs will aid the Permittee in planning construction programs. B. Permittee has a duty to protect its utility facilities from work performed by the County within the road rights-of-way. The rights granted to the Permittee herein do not preclude the County,its employees,contractors,subcontractors,and agents from blasting,grading,excavating, or doing other necessary road work contiguous to Permittee's utility facilities;providing that,the Permittee shall be given a minimum of forty-eight(48)hours notice of said blasting or other work in order that the Permittee may protect its utility facilities. C. In the event of an emergency,or where the utility facility creates or is contributing to an imminent danger to health, safety, or property,the County may protect, support,temporarily disconnect, remove, or relocate any or all parts of the utility facility without prior notice, and charge the Permittee for costs incurred. D. If any Person that is authorized to place facilities in the road right of way requests the Permittee to protect,support,temporarily disconnect,remove,or relocate the Permittee's utility facilities to accommodate the construction, operation, or repair of the facilities of such other person, the Permittee shall, after 30 days' advance written notice, take action to effect the necessary changes requested; provided that, if such project is related to or competes with Permittee's service,or if the effect of such changes would be to permanently deprive Permittee of the beneficial enjoyment of this Permit for its intended purposes through interference with the operation of Permittee's utility facilities or otherwise,Permittee shall not be required to relocate its utility facilities. Unless the matter is governed by a valid contract or a state or federal law or regulation, or unless the Permittee's utility facilities were not properly installed,the reasonable cost of the same shall be borne by the Person requesting the protection, support, temporary disconnection,removal, or relocation at no charge to the County, even if the County makes the request for such action. E. The Permittee shall, on the request of any person holding a valid permit issued by a governmental authority,temporarily raise or lower its wires to permit the moving of buildings or other objects. The expense of such temporary removal or raising or lowering of wires shall be paid by the person requesting the same. 7 The County of Mason will accept liability for direct and actual damages to said Permittee that are the result of the negligence of Mason County, its trustees, officers, employees, contractors, subcontractors or agents while performing County improvement or Public Works projects enumerated in Section VIII,paragraph B. Direct and actual damages are specifically limited to physical damage to properly installed and located infrastructure of the Permittee and the cost to repair such physical damage. Mason County retains the right to assert all applicable defenses in the event of a dispute including contributory_negligence on the part of the Permittee. Mason County shall in no way be liable for incidental damages claimed to arise from such actions. All Work to be performed by the Permittee under this section shall pass the inspection of the County Engineer. The Permittee shall pay all costs of and expenses incurred in the examination, inspection and approval of such work. IX. PRESERVATION OF MONUMENTS/MARKERS Before any Work is performed under this permit which may affect any existing monuments or markers of any nature relating to subdivisions,plats, roads and all other surveys, the Permittee shall reference all such monuments and markers. The reference points shall be so located that they will not be disturbed during the Permittee's Work and operations under this Permit. The method of referencing these monuments or other points to be referenced shall be approved by the County Engineer. The replacement of all such monuments or markers disturbed during construction shall be made as expeditiously as conditions permit in accordance with RCW 58.24 and WAC 332-120, and as directed by the County Engineer. The cost of monuments or other markers lost, destroyed, or disturbed, and the expense of replacement by approved monuments shall be borne by the Permittee. A complete set of reference notes for monument and other ties shall be filed with the office of the Mason County Engineer. X. VACATION OF ROAD RIGHT-OF-WAY If at any time the County shall vacate any County road or right-of-way or other County Property which is subject to rights granted by this Permit and said vacation shall be for the purpose of acquiring the fee or other property interest in said road or right-of-way for the use of the County, in either its proprietary or governmental capacity, then the Board of Mason County Commissioners may,at its option,and by giving thirty(3 0)days written notice to the Permittee, terminate this Permit with reference to such county road right-of-way or other County property so vacated,and the County of Mason shall not be liable for any damages or loss to the Permittee by reason of such termination. It has been the practice of Mason County to reserve easements for utilities at the time of road vacation,and will continue to be the practice until such time the Board of Mason County Commissioners direct a change of practice. 8 XI. FINANCIAL SECURITY A. Insurance It is intended that the following insurance requirements shall apply to the person performing the Work in the road right-of-way. Permittee and Permittee's contractors shall not perform or cause to be performed any Work, unless and until Permittee (to the extent Permittee performs any of the Work in the road right-of-way) or its contractors (to the extent Permittee's contractor performs any of the Work in the road right-of-way)provide certificates of insurance evidencing that Permittee or Permittee's contractors are in compliance with the following requirements, including,maintaining insurance in at least in the following amounts: 1.COMMERCIAL GENERAL LIABILITY insurance to cover liability,bodily injury,and property damage. The Commercial General Liability insurance shall be written on an occurrence basis, with an aggregate limit location endorsement for the Permit Area, and shall provide coverage for any and all costs,including defense costs,and losses and damages resulting from personal injury,bodily injury and death,property damage,products liability and completed operations arising out of the Work. Coverage must be written with the following limits of liability: Bodily and Personal InjM&Property Damage $ 1,000,000 per Occurrence $ 2,000,000 aggregate 2 WORKERS'COMPENSATION insurance shall be maintained by Permittee's contractor to comply with statutory limits for all employees, and in the case any work is sublet, the contractor shall require its subcontractors similarly to provide workers' compensation insurance for all the employees. 3.COMPREHENSIVE AUTO LIABILITY insurance shall include owned,hired, and non-owned vehicles on an occurrence basis with coverage of at least $500,000 per occurrence. The required insurance shall be maintained from the time that Work in the road right-of-way commences until the Work is complete and the utility permit issued for said Work has been released by the County Engineer, or his or her designee. If the Permittee or its contractors and subcontractors do not have the required insurance, the County may require such entities to stop operations until the insurance is obtained and approved. Permittee shall, or shall cause its contractors to, file with the application for a utility permit, certificates of insurance reflecting evidence of the required insurance in a form and content approved by the County's Risk Manager. All coverage shall be listed on one certificate with the same expiration dates. 9 The certificates shall contain a provision that coverages afforded under these policies will not be canceled until at least 30 days'prior written notice has been given to the County. In the event that the insurance certificate provided indicates that the insurance shall terminate or lapse during the period of the Work, then, in that event, the Permittee shall furnish, at least 30 days prior to the expiration of the date of such insurance, a renewed certificate of insurance as proof that equal and like coverage has been or will be obtained prior to any such lapse or termination during the balance of the period of the Permit. The County reserves the right, during the term of the Permit, to require any other insurance coverage or adjust the policy limits as it deems reasonably necessary utilizing sound risk management practices and principals based upon the loss exposures. Each insurance policy required pursuant to this Permit shall be primary and non-contributing as respects any coverage maintained by the County and shall include an endorsement reflecting the same. Any other coverage maintained by County shall be excess of this coverage herein defined as primary and shall not contribute with it. The certificate of insurance must reflect that the above wording is included in all such policies. Each insurance policy obtained pursuant to this Permit shall be issued by financially sound insurers who may lawfully do business in the State of Washington with a financial rating at all times during coverage of no less than rating of"A" and a class of"X" or better in the latest edition of"Best's Key Rating Guide"published by A.M.Best Company,or such other financial rating or rating guide approved in writing by the County's risk manager. In the event that at any time during coverage,the insurer does not meet the foregoing standards,Permittee shall give or shall cause its contractors to give prompt notice to the County and shall seek coverage from an insurer that meets the foregoing standards. The County reserves the right to change the rating or the rating guide depending upon the changed risks or availability of other suitable and reliable rating guides. Comprehensive general liability insurance policies and coverage obtained pursuant to this Permit shall include an endorsement(standard ISO form CG 24-17)deleting all exclusions for work or incidents occurring within any distance from a railroad track or railroad property,or on,over,-or under a railroad track. Insurance policies required pursuant to this Permit shall have no non-standard exclusions unless approved of by the County Risk Manager or designee. Commercial general liability insurance policies obtained pursuant to this Permit shall name the County as an additional insured without limitation,pursuant to an endorsement approved of by the County's Risk Manager or designee. Permittee or Permittee's Contractors' insurers, through policy endorsement, shall waive their rights of subrogation against the County for all claims and suits. The certificate of insurance must reflect this waiver of subrogation rights endorsement. 10 B. Contractor Bond. All contractors performing Work on behalf of Permittee shall be licensed and bonded. C. Limitation of Liability. to the fullest extent permitted by law, permittee shall, and shall cause its contractor(s) only as to subsection (9) below, to release, indemnify, defend and hold harmless the county and the county's legal representatives,officers(elected or appointed), employees and agents (collectively, "indemnitees") for, from and against any and all claims, liabilities, fines, penalties, costs, damages, losses, liens, causes of action, suits, demands, judgments and expenses(including,without limitation,court costs,attorneys' fees,and costs of investigation, removal and remediation and governmental oversight costs), environmental or otherwise(collectively"liabilities")of any nature,kind,or description, of any person or entity, directly or indirectly, arising out of,resulting from, or related to (in whole or in part): 1. this permit; 2. any rights or interests granted pursuant to this permit; 3. permittee's occupation and use of the road right of way; 4. permittee's operation of its utility facilities; 5. the presence of utility facilities within the right of way; 6. the environmental condition and status of the road right-of-way caused by, aggravated by, or contributed to,in whole or in part,by permittee or its agents; or 7. the acts,errors,or omissions of third parties when arising out of the,installation, construction, adjustment, relocation, replacement, removal, or maintenance of such third party utility facilities within the road rights-of-way when such work is performed under authority of the operator's utility permit or at the direction or under the control of the operator; or 8. any act or omission of permittee or permittee's agents; or 9.any act or omission of contractor or its employees, agents,or subcontractors when arising out of the work. Even if such liabilities arise from or are attributed to,in whole or in part, any negligence of any indemnitee. The only liabilities with respect to which permittee's obligation to indemnify the indemnitees does not apply are liabilities to the extent proximately caused by the sole negligence or intentional misconduct of an indemnitee or for liabilities that by law the indemniteees cannot be indemnified for. 11 Upon written notice from the county, permittee agrees to assume the defense of any lawsuit or other proceeding brought against any indemnitee by any entity,relating to any matter covered by this permit for which permittee has an obligation to assume liability for and/or save and hold harmless any indemnitee. Permittee shall pay all costs incident to such defense,including,but not limited to,attorneys'fees,investigators'fees,litigation and appeal expenses,settlement payments and amounts paid in satisfaction of judgments. Permittee will fully satisfy said judgment within ninety (90) days after said suit or action shall have finally been determined if determined adversely to mason county. upon the permittee's failure to satisfy said judgment within the ninety (90)day period,this permit shall at once cease and terminate and the county of mason shall have a lien upon permittee's utility facilities and all other facilities used in the construction, operation and maintenance of the permittee's utility system which maybe enforced against the property for the full amount of any such judgment so taken against any of the indemnitees Acceptance by the County of any Work performed by the Permittee at the time of completion shall not be grounds for avoidance of this covenant. XII. PERMIT NONEXCLUSIVE This Permit shall not be deemed to be an exclusive Permit. It shall in no manner prohibit the County of Mason from granting rights to other utilities under,along,across,over and upon any of the County roads, rights-of-way or other County property subject to this Permit and shall in no way prevent or prohibit the County of Mason from constructing, altering,maintaining or using any of said roads rights-of-way,drainage structures or facilities,irrigation structures or facilities, or any other county property or affect its jurisdiction over them or any part of them with full power to make all necessary changes, relocations, repairs, maintenance, etc., the same as the County may deem fit. XIII. SUCCESSORS AND ASSIGNS All the provisions, conditions, regulations and requirements herein contained shall be binding upon the successors and assigns of the Permittee and all privileges,as well as all obligations and liability of the Permittee, shall inure to its successors and assigns equally as if they were specifically mentioned wherever the Permittee is mentioned. Any reference in this Permit to a specifically named party shall be deemed to apply to any successor,heir,administrator,executor or assign of such party who has acquired its interest in compliance with the terms of this Permit or under law. XIV. TRANSFER/ASSIGNMENT Permittee may assign or transfer this Permit by contacting the County of Mason to obtain an Assignment Agreement. The Agreement must be signed and delivered back to the County of Mason. Assignees shall thereafter be responsible for all obligations of Permittee with respect to the Permit and guaranteeing performance under the terms and conditions of the Permit and that transferee will be bound by all the conditions of the Permit and will assume all the obligations of its predecessor. Such an assignment shall relieve the Permittee of any further obligations under 12 the Permit, including any obligations not fulfilled by Permittee's assignee; provided that, the assignment shall not in any respect relieve the Permittee, or any of its successors in interest, of responsibility for acts or omissions,known or unknown,or the consequences thereof,which acts or omissions occur prior to the time of the assignment. No Permit maybe assigned or transferred without filing or establishing with the county the insurance certificates, security fund and performance bond as may be required pursuant to this Permit. XV. ANNEXATION Whenever any of the County road rights-of-way or other county property as designated in this Permit,by reason of the subsequent incorporation of any town or city,or extension of the limits of any town or city, shall fall within the city or town limits; then, except to the extent allowed by law,this Permit shall terminate in respect to the said roads,rights-of-way or other county property so included with city or town limits;but this Permit shall continue in force and effect to all county road rights-of-way or other county property not so included in city or town limits. XVI. TERM/TERMINATION/REMEDIES A. Term. This Permit shall commence upon acceptance by the Permittee as provided at Section XVIII herein and continue in PERPETUITY until terminated or otherwise superseded by a subsequent franchise, private line utility occupancy permit, master road use permit or other agreement of the Parties. In the event that it is determined by a court of competent jurisdiction that,as a matter or law,the term provided for herein is unlawful,this Permit shall be deemed to have a term for the maximum period allowed by law,and if no such maximum period is readily and easily capable of being identified, for a term of not longer than fifty(50)years. B. Termination by County. Permittee has elected to obtain a Permit in lieu of a franchise agreement. Permittee understands and agrees that, unlike a franchise, this Permit may be terminated by the County with or without cause. This means that the County is not required to have or provide a reason for the termination and that the County may terminate this Permit in its sole discretion without penalty to the County and regardless of whether or not Permittee is or is not in default; provided that, the County may not terminate this Permit for a reason that is unlawful. The Parties agree that the only condition of termination by the County of this Permit is that the County must give not less than ninety (90) days written notice to the Permittee of termination. The County Engineer is authorized to exercise the right of the County to terminate this Permit. C. Termination upon Transfer/Assignment/Conveyance. This Permit shall automatically terminate upon: (1) assignment of the Permit without the prior written consent of the County in substantially the form of an Assignment Agreement (obtained by request), (2) transfer of the utility facilities located with the Permit Area without prior written notice to the County and mutual acceptance of an assignment of the Permit,(3)conveyance of the real property or any part thereof benefited by the installation and operation of the utility facilities without prior written notice to the County and mutual acceptance of an assignment of the Permit, or (4) use of the 13 utility facilities for the benefit of persons other than the owner/operator in a manner that no longer constitutes a de-minimis use of the road right-of-way. D. Termination upon Removal of Utility Facilities. This Permit and all of the rights, duties and obligations contained herein, shall terminate upon removal of all Permittee utility facilities from the road right-of-way or abandonment and de-commissioning in place to the reasonable satisfaction of and in the manner approved by the County Engineer and restoration of the road right-of way to the satisfaction of the County Engineer. E. Effect of Termination. On or before the effective date of termination or as otherwise mutually agreed to by the Parties,Permittee shall remove its utility facilities from the road rights- of-way and restore the road rights-of-way to the reasonable satisfaction of the County Engineer. In lieu of removal, the County Engineer may authorize abandonment in place and de- commissioning of the utility facilities in the manner approved by and to the reasonable satisfaction of the County Engineer. In the event that the Permittee fails to timely and completely perform such work,the County may perform or complete such work at the cost of the Permittee and Permittee shall be obligated to reimburse the County for such work within 30 days ofinvoice by the County. F. Remedies. In addition to the right of the County to terminate this Permit,the County has the right to exercise any and all of the following remedies, singly or in combination, in the event of Default. "Default"shall mean any failure of Permittee or its agents to keep,observe or perform any of Permittee's or its agent's duties or obligations under this Permit: 1. Damages. Permittee shall be liable for any and all damages incurred by County. 2. Specific Performance. County shall be entitled to specific performance of each and every obligation of Permittee under this Permit without any requirement to prove or establish that County does not have an adequate remedy at law. Permittee hereby waives the requirement of any such proof and acknowledges that County would not have an adequate remedy at law for Permittee's commission of an Event of Default hereunder. 3. Injunction. County shall be entitled to restrain, by injunction, the actual or threatened commission or attempt of an Event of Default and to obtain a judgment or order specifically prohibiting a violation or breach of this Permit agreement without, in either case, being required to prove or establish that County does not have an adequate remedy at law. Permittee hereby waives the requirement of any such proof and acknowledges that County would not have an adequate remedy at law for Permittee's commission of an Event of Default hereunder. 4. Alternative Remedies. Neither the existence of other remedies identified in this Permit nor the exercise thereof shall be deemed to bar or otherwise limit the right of the County to commence an action for equitable or other relief and/or proceed against Permittee and any guarantor for all direct monetary damages, costs and expenses arising from the Default and to recover all such damages,costs and expenses,including reasonable attorneys'fees.Remedies are 14 cumulative; the exercise of one shall not foreclose the exercise of others. XVII. SUBSEQUENT ACTION The County reserves for itself the right at any time upon ninety(90) days written notice to the Permittee, to so change, amend, modify or amplify any of the provisions or conditions herein enumerated to conform to any state statute or county regulation, relating to the public welfare, health, safety or highway regulation, as may hereafter be enacted, adopted or promulgated. XVIII. ACCEPTANCE Permittee shall execute and return to County a signed acceptance of the Permit granted hereunder. The acceptance shall be in the form of the acceptance attached hereto as Exhibit "A', and in accepting the Permit,Permittee warrants that it has carefully read the terms and conditions of this Permit and accepts all of the terms and conditions of this Permit and agrees to abide by the same and acknowledges that it has relied upon its own investigation of all relevant facts,that it has had the assistance of counsel or an opportunity to have assistance of counsel,that it was not induced to accept a Permit,that this Permit represents the entire agreement between the Permittee and the County.In the event the Permittee fails to submit the acceptance as provided for herein within the time limits set forth in this section,the grant herein is and shall become null and void. XIX. RECORDING OF MEMORANDUM OF PERMIT The Parties agree that a"Memorandum of Permit"in substantially the form attached hereto as Exhibit`B",shall be filed for record with the Office of the Mason County Auditor upon written acceptance by the Permittee. The cost and expense of such filing shall be borne by the Permittee if not already included in the fee for issuance of this Permit. Notwithstanding the foregoing,this Permit is not intended nor shall it be construed to create an interest in land or constitute the grant or conveyance of a real property interest by the County to the Permittee. The requirements of this Section XIX are intended solely to provide notice of the existence of this Permit and the terms and conditions there under, including inter-alia,the limitations upon assignment of the Permit. Permittee shall at the time of its acceptance of this Permit identify the assessor's tax identification number of the parcel or parcels benefited by this Permit and a legal description of each such parcel to be included in the Memorandum of Permit. XX. MISCELLANEOUS PROVISIONS A. Controlling Law/Venue. Any disputes concerning the application or interpretation of any of the provisions of this Permit shall be governed by the laws of the State of Washington. Venue of any action or arbitration brought under this Permit shall be in Mason County, Washington or the Western District of Washington if an action is brought in federal court, provided;however, that venue of such action is legally proper. 15 B. Liens. Permittee shall promptly pay and discharge any and all liens arising out of any Work done, suffered or permitted to be done by Permittee on any Permit area. C. Waiver. No waiver by either party of any provision of this Permit shall in any way impair the right of such party to enforce that provision for any subsequent breach,or either party's right to enforce all other provisions of this Permit. D.Attorney's Fees. If any action at law or in equity is necessary to enforce or interpret the terms of this Permit, the substantially prevailing Party or Parties shall be entitled to reasonable attorney's fees, costs and necessary disbursements in addition to any other relief to which such Party or Parties may be entitled. E. Amendment. This Permit may be amended only by a written contract signed by authorized representatives of Permittee and County of Mason. F. Severability. If any provision of this Permit is held to be illegal, invalid or unenforceable under present or future laws,such provision will be fully severable and this Permit will be construed and enforced as if such illegal,invalid or unenforceable provision is not a part hereof, and the remaining provisions hereof will remain in full force and effect. In lieu of any illegal,invalid or unenforceable provision herein,there will be added automatically as a part of this Permit, a provision as similar in its terms to such illegal,invalid or unenforceable provision as may be possible and be legal,valid and enforceable. G. Joint and Several Liability. Permittee acknowledges that, in any case in which Permittee and Permittee's contractors are responsible under the terms of this Permit, such responsibility is joint and several as between Permittee and any such Permittee's contractors; provided that,the Permittee is not prohibited from allocating such liability as a matter of contract. H. Notices. Any notice contemplated, required, or permitted to be given under this Permit shall be sufficient if it is in writing and is sent either by: (a)registered or certified mail, return receipt requested; or (b) a nationally recognized overnight mail delivery service, to the Party and at the address specified below; except as such Party and address may be changed by providing no less than thirty(3 0) days'advance written notice of such change in address. Permittee: ''L , cz— l.SO©O Lr/CcaCF ire ,Oe #3�r Attn: ...Joe Grantor: Mason County Public Works 100 W. Public Works Drive Shelton,WA 98584 16 I. Approvals. Nothing in this Permit shall be deemed to impose any duty or obligation upon the County to determine the adequacy or sufficiency of Permittee's plans and specifications or to ascertain whether Permittee's proposed or actual construction, installation, testing, maintenance,repairs,replacement,relocation,adjustment or removal is adequate or sufficient or in conformance with the plans and specifications reviewed by the County. No approval given, inspection made,review or supervision performed by the County pursuant to this Permit shall constitute or be construed as a representation or warranty express or implied by County that such item approved,inspected,or supervised,complies with laws,rules regulations or ordinances or this Permit or meets any particular standard, code or requirement,or is in conformance with the plans and specifications,and no liability shall attach with respect thereto.County and inspections as provided herein, are for the sole purpose of protecting the County's rights as the owner and manager of the road rights-of-way and shall not constitute any representation or warranty,express or implied, as to the adequacy of the design, construction, repair, or maintenance of the utility facilities, suitability of the permit area for construction, maintenance, or repair of the utility facilities, or any obligation on the part of the County to insure that work or materials are in compliance with any requirements imposed by a governmental entity. County is under no obligation or duty to supervise the design, construction, installation, relocation, adjustment, realignment,maintenance,repair, or operation of the utility facilities. J. Force Majeure. Neither Party hereto shall be liable to the other Party for any failure to perform an obligation set forth herein to the extent such failure is caused by war,act of terrorism or an act of God, provided that such Party has made and is making all reasonable efforts to perform such obligation and minimize any and all resulting loss or damage. K. Construction. All pronouns and any variations thereof shall be deemed to refer to the masculine, feminine or neuter, singular or plural, as the identity of the Party or Parties may require. The provisions of this Permit shall be construed as a whole according to their common meaning, except where specifically defined herein, not strictly for or against any party and consistent with the provisions contained herein in order to achieve the objectives and purposes of this Permit. L. Incorporation by Reference. All exhibits annexed hereto at the time of execution of this Permit or in the future as contemplated herein,are hereby incorporated by reference as though fully set forth herein. M. Calculation of Time. All periods of time referred to herein shall include Saturdays, Sundays, and legal holidays in the State of Washington, except that if the last day of any period falls on-any Saturday, Sunday, or legal holiday in the State of Washington,the period shall be extended to include the next day which is not a Saturday, Sunday,or legal holiday in the State of Washington. 17 N. Entire Agreement. This Permit is the full and complete agreement of County and Permittee with respect to all matters covered herein and all matters related to the use of the Permit Area by Permittee and Pennittee's Contractors, and this Permit supersedes any and all other agreements of the Parties hereto with respect to all such matters,including,without limitation,all agreements evidencing the Permit. O. No Recourse. Without limiting such immunities as the County or other persons may have under applicable law, Permittee shall have no monetary recourse whatsoever against the County or its officials,boards,commissions,agents,or employees for any loss or damage arising out of the County's exercising its authority pursuant to this Permit or other applicable law. P. Responsibility for Costs. Except as expressly provided otherwise, any act that Permittee is required to perform under this Permit shall be performed at its cost. If Permittee fails to perform work that it is required to perform within the time provided for performance,the County may perform the work and bill the Permittee. The Permittee shall pay the amounts billed within 30 days. Q. Work of Contractors and Subcontractors. Work by contractors and subcontractors are subject to the same restrictions,limitations,and conditions as if the Work was performed by the Permittee. The Permittee shall be responsible for all Work performed by its contractors and subcontractors,and others performing Work on its behalf,under its control,or under authority of its utility permit, as if the work were performed by it and shall ensure that all such work is performed in compliance with this Permit,Title 12 MCC,the Manual and other applicable law, and shall be jointly and severally liable for all damages and correcting all damage caused by them. It is the Permittee's responsibility to ensure that contractors, subcontractors, or other Persons performing work on the Permittee's behalf are familiar with the requirements of the Permit, Title 12 MCC,the Manual,and other applicable laws governing the work performed by them and further, for ensuring that such contractors and subcontractors maintain insurance as required herein. R. Survival of Terms. Upon the termination of the Permit,the Permittee shall no longer have the right to occupy the Permit area. However,the Permittee's obligations under this Permit to the County shall survive the termination of these rights according to its terms for so long as the Permittee's utility facilities shall remain in whole or in part in the road rights-of-way, except to the extent the County Engineer has approved abandonment in place. By way of illustration and not limitation, Permittee's obligations to indemnify, defend and hold harmless the County, provide insurance and a performance/payment bond pursuant to Section XI and Permittee's obligation to relocate its utility facilities pursuant to Section VIII,shall continue in effect as to the Permittee, notwithstanding any termination of the Permit, except to the extent that a County- approved transfer, sale, or assignment of the utility system is completed, and another entity has assumed full and complete responsibility for the utility facilities or for the relevant acts or omissions. 18 DATED at Shelton,Washington this day of 52018. APPROVED: BOARD OF COMMISSIONERS MASON COUNTY,WASHINGTON County Engineer Randy Neatherlin, Chair Approved as to form: Terri Drexler,Vice Chair Tim Whitehead, Ch. Deputy Prosecuting Attorney Kevin Shutty, Commissioner 19 EXHIBIT "A" ACCEPTANCE OF PERMIT Private Line Utility Occupancy Permit effective , 2018. UWe, amour the of parcel(s) and Uwe am/are the (Operator and) or(representative authorized to) accept Permit on behalf of Uwe certify that this Permit and all terms and conditions thereof are accepted by without qualification or reservation and guarantee performance hereunder. UWe certify that, to the best of my/our knowledge, the assessor's tax identification number of the parcel or parcels benefited by this Permit and a legal description of each such parcel are as described in the attached under Permit Exhibit`B". DATED this /7 day of QG%r��3t'/� , 2018. PERMITTEE(S) B t A STATE OF A ) _( )ss. COUNTY OF STU D FOM(S i ) I certify that I know or have satisfactory evidence that 0 EL U M E is the person who appeared before me, and said person acknowledged that(&he signed this instrument, on oath sta d that he he was authorized to execute thinstrument nd acknowledged it as the 1 t)Nl�f fn1Nt� ofthe473 -�1 dd -Z( 915 0-114Z612� 10'4 to be the free and voluntary act of such party for the uses and purposes mentioned in the instrument. * LA\J Dated: 0Qh O�I dv� BEVERLY A. CARLSON Notary Public STATE OF WASHINGTON Print Name (�- My commission expires Z NOTARY --•-- PUBLIC My Commission Expiresl2-22-2019 A - 1 RECORDED AT THE REQUEST OF AND AFTER RECORDING RETURN TO: ' County of Mason 100 West Public Works Drive Shelton WA 98584 Attn: County Engineer EXHIBIT"B" MEMORANDUM OF PERMIT Document Title(s): Grantor: COUNTY OF MASON a legal subdivision of the state of Washington Grantee: Legal Description: Assessor's Property Tax ParceFAccount Number(s): B-1 MEMORANDUM OF PRIVATE LINE UTILITY OCCUPANCY PERMIT THIS MEMORANDUM OF PERMIT is dated as of the_day of ,2018 between the County of Mason,a legal subdivision of the state of Washington("County")and (Permittee"). 1. Prop County has,pursuant to Private Line Utility Occupancy Permit granted to Permittee,the right,revocable at the will of the County,to use and occupy certain road rights- of-way for the construction,installation,adjustment,maintenance,removal,repair,relocation and operation of Permittee's utility facilities for the benefit of the herein described Property,upon the terms and conditions of that certain permit agreement between the parties accepted the day of , 2018 (the"Permit"),which terms and conditions are incorporated herein by this reference. The property to be benefited by this permit is situated in the Mason County, Washington, legally described in Exhibit B attached hereto (herein called the"Property"). The road right-of-way permit area("Permit Area") is also described in attached Exhibit B. 2. Term. The term of the Permit is in perpetuity unless terminated. 3. Termination. County in its sole discretion may terminate all or part of the Permit with or without cause upon no less than ninety(90)days written notice to the Permittee. Further, this Permit will automatically terminate upon assignment without the prior written consent of the County, or upon transfer of the Property without the prior written consent of the County to an assignment of the Permit or upon transfer of all or part of the utility facilities located in the Permit Area without the prior written consent of the County to an assignment of the Permit. 4. Purpose of Memorandum of Permit. This memorandum of permit is prepared for the purpose of recordation and notice and in no way modifies the Permit and is in no way intended to or should be construed to create or convey an interest in land or the road right-of-way. DATED this day of ,2018 COUNTY OF MASON County Engineer Approved as to form: Tim Whitehead,Ch.Deputy Prosecuting Attorney B-2 PERMITTEE Bomn✓z/ Title: STATE OF W ss. - COUNTY OF YJy D[401W(X A I certify that I know or have satisfactory evidence that �3-0t=L �,. F-(ZARA W is the person who appeared before me,and said person acknowledged that said person signed this instrument,on oath stated that said perxs• n was?utho ized tp execute the instrument and acknowledged ownership of parcel(s) go to be the free and voluntary act of such person/corporation for the uses and purposes mentioned in the instrum�e�nt.. n Dated this I aay of ocU 6' ,201il . Dated: X9VPA" (Signature of Notary) 61 L-A k BEVERLY A. CARLSON (Legibly Print of Stamp Name of Notary) STATE OF WASHINGTON Notary public in and for the state of , NOTARY --•-- PUBLIC residing at Loo-e:- My Commission Expires 12-22-2019 My appointment expires 2Z r q B-3 FORM OF MEMORANDUM OF PERMIT Permit Area Map 4730 NE North Shore Rd. AsiaS O Power Water& Septic Transport l` r � 010; yam. 4 B-4 Exhibit 1 - 4730 NE North Shore Rd. SO W 0 �Q �s Power Water& Septic Transport = 4, S 2202 S2 0 0900 ?2�0?52 00 010 ,r MASON COUNTY BRIEFING ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS FROM: Jerry W. Hauth, PE, Director/County Engineer C ndi Ticknor, 0&M/ER&R Manager DEPARTMENT: Public Works EXT: 450 BRIEFING DATE: November 19, 2018 PREVIOUS BRIEFING DATES: (If this is a follow-up briefing,please provide only new information,) ITEM: Surplus of Personal Property EXECUTIVE SUMMARY: ER&R has equipment and vehicles that have been replaced or are no longer needed. The attached notice lists of all of these items requested to be declared surplus and disposed of at an auction through Washington State Surplus (vehicles) and Ritchie Bros. Auctioneers/Iron Planet (equipment). This process is pursuant to the County's comprehensive procedure for the management of County property (Ordinance 84-04, Mason County Code Chapter 3.40, Management and Disposition of Property) and the laws of the state of Washington. RECOMMENDED OR REQUESTED ACTION: Recommend the Board authorize ER&R to declare the attached list of equipment and vehicles as surplus and allow ER&R to dispose of pursuant to Mason County code and state laws. Attachment: Notice Vehicle/Equipment information NOTICE OF SALE The Board of Mason County Commissioners has declared the following vehicles and equipment as surplus and will be disposed of at public auction. Vehicle List: Year Description Odometer 2008 Dodge Magnum 161,451 miles 2008 Dodge Magnum 160,090 miles 2008 Dodge Magnum 160,680 miles Equipment List: Year Description Hours 2000 John Deere brush cutter 8,777 hours Auctions will be held through Washington State Surplus Program (7511 New Market Street, Tumwater, WA 98512; Phone (360) 753-3508) and Ritchie Bros. Auctioneers/Iron Planet(214 Ritchie Lane, Chehalis, WA 98532; Phone: (360) 767-3000). Auction information regarding these items can be found on the Washington State Surplus web site: www_publicsMIus.com and the Ritchie Bros. Auctioneers web site: www.rbauction.com. Dated this day of November, 2018 BOARD OF COUNTY COMMISSIONERS OF MASON COUNTY, WASHINGTON Melissa Drewry, Clerk of the Board. cc: Cmmrs Engineer Journal(Shelton): Publ. It: 12/6/18 & 12/13/18 V November 19, 2018 Surplus List Vehicle No. Year Description Odometer/Hours Issues 00941 2002 HI-WAY Sander N/A rusted out, motor shot-will be disposed of 00808 2000 John Deere brush cutter 8,777 hours Transmission & boom is worn-out 00089 2008 Dodge Magnum 161,451 miles Suspension, high miles, leaks 00024 2008 Dodge Magnum 160,090 miles Suspension, high miles, leaks 00040 2008 Dodge Magnum 160,680 miles Suspension, oil pressure, leaks, high mile MASON COUNTY BRIEFING ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS FROM: Bart Stepp, Deputy Director/ Utilities and Waste Management DEPARTMENT: Public Works EXT: 652 BRIEFING DATE: November 19, 2018 PREVIOUS BRIEFING DATE: October 5, 2018; November 7, 2016; September 12, 2016 ITEM: Grinder Pump Contract with Correct Equipment EXECUTIVE SUMMARY: Mason County entered into a service maintenance agreement with Correct Equipment in January of 2017 to provide service for the grinder pumps for the North Bay and Belfair Sewer Systems. Public Works had issued a Request for Proposals for "Maintenance Services for Individual Sewer Grinder Pumps" in September, 2016 and Correct Equipment was the only respondent to the RFP. This is because Correct Equipment is the only licensed supplier of the E-One Pumps, in the state of Washington, that our systems utilize. Entering into this contract with Correct Equipment has freed up operator time for many other maintenance needs. Operators still respond to alarm calls and replace grinder pumps, but they no longer spend time in the shop repairing and testing pumps. Many of the pumps in this system are reaching their maximum operational life. The contract is expiring at the end of 2018 and Correct Equipment has provided us with updated pricing for the pumps for either an amendment or new service agreement. Their prices have been the same for the past two years. The Board has stated they do not want to enter into amendments that include price increases. Maintaining this service with Correct Equipment is needed as previously stated, the older grinder pumps in North Bay are failing at an increasing frequency. If we do not do an amendment the County could go out for another RFP, but Correct Equipment is the only vendor that can supply equipment meeting our specifications. We could also potentially do a sole source resolution with a new agreement that includes updated prices. Cost Impact to the Countv Annual costs to the County from this agreement are expected to be around $200,000. Most part prices have remained the same. The proposed price changes are: 1) Field Service Labor Rate: from $125/hour to $137.50/hour—This is almost never used, almost all labor in the field is completed by County Staff. 2) Shop Service Labor Rate: from $100/hour to $125/hour—This is for diagnosing old pumps and repair labor. 3) New drywell pump (D200): from $1,797.20 - $2,181 4) New wetwell pump (W200): from $1,770 - $1,823 —This represents 80 — 90 percent of the pumps installed in our systems. 5) Rebuilt Core: from $850 - $1,100 6) Pump disposal fee: from $50 - $100 Briefing Summary This will be paid for by either the North Bay Fund #403 or Belfair Fund #413 as part of their operations and maintenance budget. Over 90% of the old pumps at North Bay we replace are not repairable so the major cost in this agreement is new pumps. I estimate the price changes would result in an increased maintenance cost of between 5 — 10% per pump. That seems reasonable after two years after no price changes. RECOMMENDATION: Staff is asking the Board how they would like to proceed in extending our grinder pump service contract. Attachment 1. January 2017 Signed Agreement and Amendment 1 2. Proposed 2019 Prices Briefing Summary AGREEMENT BETWEEN MASON COUNTY DEPARTMENT OF PUBLIC WORKS AND CORRECT EQUIPMENT,INC. FOR GRINDER PUMP SYSTEM MAINTENANCE AGREEMENT INTRODUCTION This Agreement regarding servicing the GRINDER PUMP SYSTEM MAINTENANCE program is entered into this 22"d day of November,2016,between Mason County("County'),a political subdivision of the State of Washington,and Correct Equipment,Inc. ("Contractor"),doing business in the State of Washington. AUTHORITY TO MAKE CONTRACT This Agreement is in furtherance of the County's authority to provide for public health,safety and welfare,and is consistent with the Washington State Constitution Article XI,Section 11. PROCESS The County undertook a process in accordance with Chapter 36.94.190 RCW to select a firm to service grinder pumps in Mason County wastewater systems. The County determined that this process is the most advantageous for the County in awarding this Agreement;that the Contractor is qualified to provide the services sought by the County;and that the Contractor has offered to provide those services in a manner and at rates that the County finds to be in the best interests of the ratepayer living within the County and using the services,and in a manner that the County finds to be financially sound and advantageous compared to other methods.It is the intent of this Agreement to provide a two-year term relationship between the County and Contractor for repair and maintenance of wastewater grinder pumps. COSTS Costs are the prices set out by the Contractor in the submitted proposal and later negotiated as allowed 'in the Chapter 36.94.190 RCW and accepted by the County. Said costs will go into effect on January 1, 2017. The cost of service shall be computed on a monthly basis according to the service provided and costs established by this Agreement. DESIGNATED AGREEMENT ADMINISTRATION If at any time the Contractor is required to have County approval that approval shall come from the Public Works Director or their designee. The Director or their designee will work closely with the Contractor to confirm any approval(s)required by this Agreement. RESPONSE TO THE RFP The response of the Contractor to the RFP was submitted to the County on October 28,2016. Page 1 of 9 Contract for Grinder Pump Maintenance Services SERVICE AGREEMENT The Service Agreement includes this Agreement,and 1. The Request for Proposals; 2. The response to the Request for Proposals; 3. Any and all addendums to the Agreement;and 4. Any and all appendices,amendments,extensions to or extensions of the foregoing documents which the parties have agreed to in the manner prescribed by this Agreement. In the event of conflict(s)among service Agreement documents,then information from the latest documents (as determined by the date issued)shall supersede any earlier conflicting information. SCOPE OF WORK The Agreement calls for performance of work for a period of(2)two years beginning on January 1,2017, and ending on December 31,2018. The Agreement may be renegotiated,at the County's discretion,for an additional period of time. Subsequent Agreements will not be for less than one-year increments. The Contractor must provide sufficient personnel,equipment,supplies and maintenance to perform all operations and all incidental work in accordance with these Agreement documents and all applicable laws and regulations pertaining hereto. In general the Contractor will provide grinder pump maintenance services for Mason County Wastewater Systems per their attached proposal at the prices submitted in their proposal. RECORD KEEPING The Contractor shall at all times maintain an accounting system that uses generally accepted accounting principles for all services rendered in connection with this Agreement. The Contractor accounts and records covering these charges and all invoices and payments on account of this Agreement shall be open to inspection for any reasonable purpose by the County,their authorized representative and officers or employees at all times during the term of this Agreement and for six months thereafter. The County shall have the right to inspect and copy all documents,to interview any persons,and to review any evidence in the Contractor's possession or control,which may assist the County in determining what amounts are owed to the Contractor or County. COMPLIANCE WITH REGULATIONS The Contractor shall comply with all Federal,State and Local regulations,including Mason County's Sanitary Sewer Regulations. All activities will be conducted in accordance with applicable codes. PERMIT COMPLIANCE AND INDEMNIFICATION The Contractor will be required to perform all operations in complete compliance with all permits issued by the regulatory agencies. Any penalties levied by regulatory agencies for permit non-compliance due to actions of the Contractor will be paid by the Contractor at no cost to the County,or may be withheld from payment to the Contractor.The Contractor expressly agrees to indemnify and hold the County harmless for any penalties,interest and/or feed assessed or levied against it or the County due to non- compliance with any permits issued by a regulatory agency of the Federal,State,or County Government in connection with the services to be provided by the Contractor pursuant to this Agreement. Page 2 of 9 Contract for Grinder Pump Maintenance Services SEVERABILITY If any term or provision of this Agreement,or the application thereof,to any person or circumstances, shall to any extent be invalid or the application of such term or provision to persons or circumstances other than those as to which it is held invalid or unenforceable shall not be affected thereby,and each term and provision of this Agreement shall be valid and enforceable to the fullest extent allowed by law. Further,the parties shall negotiate in good faith regarding amendments to this Agreement that would, to the maximum extent possible,effectuate the intent of any provision determined to be invalid or unenforceable. MOBILIZATION The Contractor shall be responsible for mobilization of all personnel and equipment. NO THIRD PARTY BENEFICIARY The rights and obligations created by this Agreement are for the sole benefit of the parties,and neither person nor party shall be a beneficiary,intended or otherwise,of any such rights or be entitled to enforce any of the obligations created by this Agreement. ADDITIONAL WORK The County may from time to time request the Contractor to provide improvements or do additional work beyond the scope of this Agreement. Upon request by the County,the Contractor agrees to good faith consideration to negotiate accomplishment of the work desired by the County. If the Contractor agrees to negotiate,the parties shall determine the work to be done and the compensation to be paid. The County shall not be precluded from awarding Contracts to any person other than the Contractor for the accomplishment of any desired improvements if the County in its sole discretion deems such Contracts most beneficial to the County. In such case,the Contractor will cooperate and coordinate with any other Contractor or the County in allowing and facilitating installation of said improvements. WORK TO BE PERFORMED BY THE COUNTY OR OTHER CONTRACTORS During the period of this Agreement,the County(either with its own forces or under separate Contract) will require the cooperation of the Contractors in scheduling and coordination to avoid conflicts. The Contractor shall be responsible for becoming familiar with the various schedules and degree of disruption that may arise. The Contractor shall cooperate with the County in the coordination of operation in a manner that will provide the least amount of interference with the County's operation. JURISDICTION AND VENUE Any action of law or suit in equity or judicial proceeding arising out of this Agreement shall be instituted and maintained only in the courts of competent jurisdiction in Mason County,in the State of Washington. TECHNICAL REQUIREMENTS This section specifies minimum requirements for the operation of the grinder pump maintenance agreement program. The requirements established herein are the minimum prescribed requirements and are not intended in any way to be inclusive or in any way to limit the Contractor to specific procedures or methods,but rather are intended to ensure the expected quality of grinder pump maintenance. Contractor personnel shall be trained as required for specific tasks or functions in accordance with the specific responsibilities set forth in the Agreement for the various elements of this program. During Page 3 of 9 Contract for Grinder Pump Maintenance Services J periods of sickness and vacation,additional personnel must be available for the continued and uninterrupted operation of this maintenance program in the usual manner. SERVICE SCHEDULE The Contractor shall provide working grinder pumps and pick up grinder pumps needing repairs in accordance with an agreed upon schedule. The Contractor shall provide on-call provisions for grinder pumps in emergency situations when the County does not have a working pump available. ACCIDENT REPORTS The Contractor shall promptly report in writing to the Public Works Director,or their designee,all accidents whatsoever arising out of,or in connection with the performance of the work whether on,or adjacent to,grinder pump sites;giving full details and statements of witnesses. In addition,should death,serious injuries,or serious damage occur,the accident shall be reported by the Contractor immediately by telephone or messenger to the Public Works Director or their designee. INDEMNITY To the fullest extent permitted by law,the Contractor shall indemnify,defend and hold harmless Mason County,agencies of the county and all officials,agents and employees of the county,from and against all claims to the extent arising out of or resulting from the Contractor's performance of the Contract. "Claim"as used in this Agreement means any financial loss,claim,suit,action damage,or expense including but not limited to reasonable attorney's fees,attributable for bodily injury,sickness,disease or death,or injury to or destruction of tangible property including loss of use resulting there from.The Contractors obligation to indemnify,defend and hold harmless includes any claim by the Contractor's agents,employees,representatives or any subcontractor or its employees. The Contractor expressly agrees to indemnify,defend and hold harmless Mason County for any claim arising out of or incident to the Contractor's or any subcontractor's performance or failure to perform the Contract. The Contractor's obligation to indemnify,defend and hold harmless Mason County shall be reduced to the extent of any actual or alleged concurrent negligence of Mason County or its agents, agencies,employees and officials. INSURANCE At a minimum,the Contractor shall provide insurance that meets or exceeds the requirements detailed in"Exhibit A Insurance Requirements." CONTRACT ADMINISTRATION This Agreement shall be administered on behalf of the County by the Public Works Director or their designee. All communications to the Contractor by the Public Works Director shall be recognized as made on behalf of the County. All issues concerning Agreement provisions and requirements shall be directed to the Public Works Director. The following addresses shall be used for communication between parties: MASON COUNTY PUBLIC WORKS CORRECT EQUIPMENT,INC. Jerry Hauth Bob Thurston Public Works Director 14576 NE 95"'St. 100 W Public Works Drive Redmond,WA 98052 Shelton,WA 98584 Page 4 of 9 Contract for Grinder Pump Maintenance Services PROGRESS MEETINGS Periodically,progress meeting will be held between the parties.The meetings will be used to review and discuss activities and/or complaints accumulated during the contract period. It is the responsibility of the Contractor to prepare for and respond to matters brought to their attention prior to each meeting. The Contractor will also be required to present a brief report summarizing the program activity since the previous meeting. CONFLICT OF INTEREST If at anytime prior to commencement of,or during the term of this Agreement,the Contractor or any of its employees involved in the performance of this Agreement shall have or develop an interest in the subject matter of this Agreement that is potentially in conflict with the County's interest,then Contractor shall immediately notify County of the same. The notification of County shall be made with sufficient specificity to enable County to make an informed judgment as to whether or not County's interest may be compromised in any manner by the existence of the conflict,actual or potential. Thereafter,County may require Contractor to take reasonable steps to remove the conflict of interest. County may also terminate this Agreement according to the provisions herein for termination. TERMINATION Either party hereto may with or without cause terminate this Agreement by giving written notice of their intention to terminate to the other party by certified mail and return receipt requested. Such termination shall,thereafter,be effective six months following the date of written notice,during which period of time the terms and conditions of the Agreement shall remain in full force and effect. The County may terminate with cause if the Contractor does not comply with the terms of this Agreement. Such termination would occur after written notice to the Contractor and their failure to correct deficiencies within 30 days of the notice. COSTS ASSOCIATED WITH THIS AGREEMENT Mason County will be assessed the amounts shown below for services per the Contractor's Proposal during the course of the agreement. Prices may be renegotiated for any contract extensions. Inspection Rate: $100.00 per hour Field Service Rate: $125.00 per hour Shop Service Rate: $100.00 per hour Travel Rate: $110.00 per hour Stator Replacement: $130.66 Switch Replacement: $212.18 Control Bracket Replacement: $313.74 Motor Bearings Replacement: $339.52 EQD Repair,Pump Cable $49.84 Grinder Replacement: $278.34 Diagnosis&Reassembly: $50.00 Rebuilt certified core fee $850.00 The Contractor reserves the right to deem it inadvisable to repair a core,due to corrosion,wear,or breakage of critical parts,which would make the pump unreliable after the required repairs.In such cases a$50.00 diagnosis and disposal fee will be charged. New cores will be available for:Drywell Part #D200$1,797.20,Wetwell Part#U200$1,770.00. Page 5 of 9 Contract for Grinder Pump Maintenance Services METHOD OF PAYMENT Moson CoMty'witl pay the Contractor on a monthly basisforall work.performed;ptoviding"the Contractor.submits to Mason County a statement,which indicates services provided and.costs of said services,,by the 10"'of each month.. Payment will be made to Contractor within thirty(30)days ofthe receipt of a completeand accurate statement. Signed this _day of j�h --- ;2016, CONTRACTOR: BOARD OF COUNTY COMMISSIONERS: CORRECT EQUUI-PM.EN:T, INC. MASON CQUN 1NraTQN Signaaure Signature,Ch _ir aa& �!'r S d `- Printed Name Printed Name (.0rX-tC* Company Attest: Approved As To Form:. W, 111 C .Tl�aft e B.o eputy Prosecuting Attorney Page 6.of 9 Contract for Grinder Pump Malnteinance.Services EXHIBIT A INSURANCE REQUIREMENTS For the duration of this Agreement the Contractor shall maintain in effect all insurance as required herein and comply with all limits,terms and conditions stated therein. Work under this Agreement shall not commence until evidence of all required insurance and bonding is provided to the County. Evidence of such insurance shall consist of a completed copy of the Certificate of Insurance signed by the insurance agent for the Contractor and returned to the Mason County Deputy Director of Utilities/Waste Management. If for any reason,any material change in the coverage occurs during the course of this Agreement;such change will not become effective until 45 days after Mason County receives written notice of such change. The policy shall be endorsed and the certificate shall reflect that Mason County is an additional insured on the Contractor's general liability policy with respect to activities under this Agreement. The policy shall provide and the certificate reflect that the insurance afforded applies separately to each insured against whom a claim is made or suit is brought except with respect to limits of the company's liability. It is the responsibility of the Contractor to provide fire insurance for any equipment used by the Contractor. This fire insurance shall cover the entire replacement value of the equipment insured. A. MINIMUM Insurance Requirements: 1.Commercial General Liability Insurance using Insurance Services Office"Commercial General Liability" policy form CG 00 01,with an edition date prior to 2004,or the exact equivalent.Coverage for an additional insured shall not be limited to its vicarious liability.Defense costs must be paid in addition to limits.Limits shall be no less than$1,000,000 per occurrence for all covered losses and no less than $2,000,000 general aggregate,for bodily injury,personal injury,and property damage,including without limitation,blanket contractual liability. 2.Workers'Compensation on a state-approved policy form providing statutory benefits as required by law with employer's liability limits for the Contractors,with two(2)or more employees and/or volunteers,no less than$1,000,000 per accident for all covered losses. 3. Business Auto Coverage on ISO Business Auto Coverage form CA 00 01 including owned,non-owned and hired autos,or the exact equivalent.Limits shall be no less than$2,000,000 per accident,combined single limit.If Contractor owns no vehicles,this requirement may be satisfied by a non-owned auto endorsement to the general liability policy described above. If Contractor or the Contractor's employees will use personal autos in any way on this project,Contractor shall obtain evidence of personal auto liability coverage for each such person. B.Certificate of Insurance: A Certificate of Insurance naming County as the Certificate Holder must be provided to County within five(5)days of Contract execution. C.Basic Stipulations: 1.Contractor agrees to endorse third party liability coverage required herein to include as additional insureds County,its officials,employees and agents,using ISO endorsement CG 2010 with an edition date prior to 2004.Contractor also agrees to require all Contractors,subcontractors,and anyone else Page 7 of 9 Contract for Grinder Pump Maintenance Services involved in this Contractor on behalf of the Contractor(hereinafter"indemnifying parties")to comply with these provisions. 2.Contractor agrees to waive rights of recovery against County regardless of the applicability of any insurance proceeds,and to require all indemnifying parties to do likewise. 3.All insurance coverage maintained or procured by Contractor or required of others by Contractor pursuant to this Contract shall be endorsed to delete the subrogation condition as to County,or must specifically allow the named insured to waive subrogation prior to a loss. 4.All coverage types and limits required are subject to approval,modification and additional requirements by County.Contractor shall not make any reductions in scope or limits of coverage that may affect County's protection without County's prior written consent. 5.Contractor agrees to provide evidence of the insurance required herein,satisfactory to County, consisting of:a)certificate(s)of insurance evidencing all of the coverages required and,b)an additional insured endorsement to Contractor's general liability policy using Insurance Services Office form CG 20 10 with an edition date prior to 2004.Contractor agrees,upon request by County to provide complete, certified copies of any policies required within 10 days of such request.County has the right,but not the duty,to obtain any insurance it deems necessary to protect its interests.Any premium so paid by County shall be charged to and promptly paid by Contractor or deducted from sums due Contractor.Any actual or alleged failure on the part of County or any other additional insured under these requirements to obtain proof of insurance required under this Contract in no way waives any right or remedy of County or any additional insured,in this or in any other regard. 6. It is acknowledged by the parties of this Contract that all insurance coverage required to be provided by Contractor or indemnifying party,is intended to apply first and on a primary non-contributing basis in relation to any other insurance or self-insurance available to County. 7.Contractor agrees not to self-insure or to use any self-insured retentions on any portion of the insurance required herein and further agrees that it will not allow any indemnifying party to self-insure its obligations to County.If Contractor's existing coverage includes a self-insured retention,the self- insured retention must be declared to the County.The County may review options with Contractor, which may include reduction or elimination of the self-insured retention,substitution of other coverage, or other solutions. 8.Contractor will renew the required coverage annually as long as County,or its employees or agents face an exposure from operations of any type pursuant to this Contract.This obligation applies whether or not the Contract is canceled or terminated for any reason.Termination of this obligation is not effective until County executes a written statement to that effect. 9.The limits of insurance as described above shall be considered as minimum requirements. Should any coverage carried by Contractor or a subcontractor of any tier maintain insurance with limits of liability that exceed the required limits or coverage that is broader than as outlined above,those higher limits and broader coverage shall be deemed to apply for the benefit of any person or organization included as an additional insured and those limits shall become the required minimum limits of insurance in all Paragraphs and Sections of this Contract. Page 8 of 9 Contract for Grinder Pump Maintenance Services 10. None of the policies required herein shall be in compliance with these requirements if they include any limiting endorsement that has not been first submitted to County and approved of in writing. 11.The requirements in this Exhibit supersede all other sections and provisions of this Contract to the extent that any other section or provision conflicts with or impairs the provisions of this Exhibit. 12. Unless otherwise approved by County,insurance provided pursuant to these requirements shall be by insurers authorized to do business in Washington and with a minimum A.M. Best rating of A-:VII. 13.All insurance coverage and limits provided by Contractor and available or applicable to this agreement are intended to apply to the full extent of the policies.Nothing contained in this Contract limits the application of such insurance coverage. 14.Contractor agrees to require insurers to provide notice to County prior to cancellation of such liability coverage in accordance with the notice provisions of the applicable policies.Contractor shall assure that this provision also applies to any subcontractors,joint ventures or any other party engaged by or on behalf of contractor in relation to this agreement.Certificate(s)are to reflect that the issuer will provide notice to County of any cancellation of coverage in accordance with the notice provisions of the applicable policies. 15.County reserves the right at any time during the term of the Contract to change the amounts and types of insurance required by giving the Contractor ninety(90)days advance written notice of such change. If such change results in substantial additional cost to the Contractor,the County and Contractor may renegotiate Contractor's compensation. 16.Requirements of specific coverage features are not intended as limitation on other requirements or as waiver of any coverage normally provided by any given policy.Specific reference to a coverage feature is for purposes of clarification only as it pertains to a given issue and is not intended by any party or insured to be all-inclusive. 17.Contractor agrees to provide immediate notice to County of any claim or loss against Contractor arising out of the work performed under this agreement.County assumes no obligation or liability by such notice,but has the right(but not the duty)to monitor the handling of any such claim or claims if they are likely to involve County. Page 9 of 9 Contract for Grinder Pump Maintenance Services Purchased Services Contract Amendment CORRECT EQUIPMENT, INC. Amendment#1 The CONTRACT between COUNTY and CONTRACTOR is amended as follows: 1_ Appendix 1, E-One grinder pump equipment costs, is added to the contract as a list of eligible charges to the contract. 2. The diagnosis and disposal fee of a grinder pump that cannot be repaired is$100, not$50. Amendment dated this day of W 2017. CORRECT E IPM NT: BOARD OF COUNTY COMMISSIONERS MASON COUNTY WASHINGTON b hurl n, Partner Kevin Shutty, hair APPROVED AS TO FORM: Tim Whitehea ;Chief DPA` From: Bob Thurston<bobt@correctequipment.com> To: Bart Stepp<bstepp@co.mason.wa.us> Date: 10/5/2018 10:37 AM Subject: RE: Renewal Attachments: Eone Parts Price List 10-24-16.pdf Bart- I have attached the parts price list and core prices will be as follows. Field Service rate $137.50 Shop rate $125.00 Drywell D200 $2,181.00 Wetwell W200 $1,823.00 CEI Rebuilt core $1,100.00 Used core disposal $100.00 Best Regards, Bob Thurston Correct Equipment 111 Sparrow Crt Port Ludlow, WA 98365 (360) 301-3535 bobt@correctequipment.com —Original Message-- From: Bart Stepp[mailto:bstepp@co.mason.wa.us] Sent: Friday, October 05, 2018 8:16 AM To: Bob Thurston Subject: Re: Renewal Hi Bob, Get me an updated price sheet for everything and I will get started on an addendum for the contract. Thanks, Bart Bart Stepp, PE Mason County Deputy Director Public Works-Utilities and Waste Division 100 Public Works Drive Shelton, WA 98584 (360)427-9670 x652 BStepp@co.mason.wa.us >>> Bob Thurston<bobt@correctequipment.com>9/25/2018 6:01 PM »> Environment One Corporation-2000 Series Grinder Pump Online Configuration Page I of 17 r Online Product Catalog (USA) EN+e6:•e c.ecvRro -av Home::View Cart:i My Account Crystal Hudson Monday,October 24,2016 Sign Off All Service Parts Welcome Crystal Hudson of Correct Equipment to the Configurator. Select the items you wish to order and press the Next button below. Cancel 7 Next» ❑ THERMAL PROTECTOR,50Hz,AUS/NZ(EXTREME)(5204) NA0112P03 5204 1 $15.17 Assemblies(Service Codes 1000-1999) Description Part Number Service List Code Price ❑ MOTOR HSG ASM,W/MOTOR&SEAL KIT,AUS/NZ EXTREME(1220) NC0036G02 1220 $397.29 ❑ CONTROL BRACKET ASM,220V/50HZ(POLAND) ND0112G06 1205 $220.66 Control Bracket for Poland. ❑ Motor Asm,Armature Kit PA0316G01 1019 $1,242.36 ❑ Discharge Vave Asm,210,Copper(shipped loose,not soldered) PB00238G01 1058 $417.00 ❑ 2000 SERIES CUTTER WHEEL ASSEMBLY PB0008G02 1003 $141.69 ❑ MECHANICAL SEAL KIT w/(4)MAIN O-RINGS&(7)LOCKNUTS NC0040G01 1208 $50.39 ❑ EQUALIZER,AMGP ONLY PC0786G01 1090 $139.09 ❑ TOP HOUSING w/STUD KIT(2000),replaces 2061 PA1289G01 1069 $321.74 ❑ EQD,PLUG AND HOUSING,NO CABLE(2000) PB0581GO5 1063 $152.30 ❑ ANTI—SIPHON CHECK VALVE ASM,SS DISCHARGE PB0104G02 1064 $173.04 ❑ CONTROL BRACKET ASM,240V(2000) PB0702GO1 1065 $220.66 ❑ SENSING BELL PC0461P01 1001 $24.66 ❑ FLAPPER ASM PA0076G01 1002 $15.50 ❑ REDUNDANT CHECK VALVE ASM,1-1/4'SOCKET x 1-1/4'SLIP PCO051G01 1007 $41.77 ❑ SEAL PACKAGE ASM PA0329G01 1008 $64.74 ❑ SIGNAL LIGHT PKG ASM PA0060G02 1012 $27.03 p CHECK VALVE ASM(COPPER DISCHARGE) PB0104G01 1017 $173.10 ❑ TERMINAL BLOCK ASM,240V PA0225G02 1018 $49.15 ❑ TOP HOUSING ASM,UUCAN(200) PCO207GO1 1033 $447.65 ❑ POPPER FLAPPER ASM PA0245G01 1035 $14.87 ❑ COPPER PIPE ASM PBO105G01 1037 $68.86 ❑ CORE BOLT ASM,w/WASHER PBO186G01 1043 $7.48 ❑ CORE BOLT ASM,w/o WASHER PB0186G02 1046 $6.90 ❑ BREATHER ASSEMBLY,10'(200) PB0477G07 1049 $82.42 ❑ U—TUBEASM(COPPER) PB0235GO2 1052 $199.98 ❑ BREATHER ASM,OLD STYLE(200) PB0477GO6 1054 $279.89 ❑ BRACKET,BREATHER,w/HOSE CLAMP(200) PB0264PO2 1055 $164.88 ❑ BREATHER ASM PB0477GO4 1057 $83.36 http://www.eoneezorder.com/Catalog/Product/Views/IstltemsParts.asp?Type=2&Categor... 10/24/2016 Environment One Corporation-2000 Series Grinder Pump Online Configuration Page 2 of 17 ❑ DISCH VALVE ASM(COPPER)(210/212)PARTS SHIPPED LOOSE-Pricing is Net,Not List PB0238GO1 1058 $417.00 ❑ VALVE LATCH ASM(for copper valves) PB0239GO1 1059 $91.82 ❑ BREATHER CABLE ASM,Std,7'Breather Cable(2000) PC0579GO1 1060 $212.27 ❑ BREATHER VENT,FIELD ASM PA1325G01 1061 $27.23 ❑ EQD,RECEPTACLE AND HOUSING,NO CABLE(2000) PB0581GO4 1062 $134.49 ❑ CONTROL BRACKET ASM,120V(2000) PB0702GO2 1066 $389.57 ❑ BREATHER CABLE ASM, 12'Breather Cable(2000 FM) PC0579G03 1067 $310.03 ❑ STUD INSTALLATION KIT(2000),replaces 6029 PA1289G02 1068 $63.33 ❑ HOOD,EQD,w/o 3/4 in.NPT HOLE and#10-32 INSERT(Blank,for Shipping) PC0563PO2 1070 $20.73 1 ❑ ANTI-SIPHON CHECK VALVE ASM(AMGP,1000,METERING,IDU) PB0104G04 1076 $180.85 ❑ PUMP STAND KIT(INCL.SUCTION HOUSING,SHROUD),AMGP/GGS PC0742GO1 1077 $208.32 ❑ CABLE ASM,IDU,BD-ALARM,3-WIRE,2000 IDU ONLY PA1510G01 1078 $39.81 E] CABLE ASM,IDU,BD ON-OFF,4-WIRE,2000 IDU ONLY PB0707GO1 1079 $98.46 ❑ CIRCUIT BOARD ASM,2000 IDU ONLY PC0830GO1 1080 $309.96 ❑ GATE VALVE,SOCKET WELD,4 IN. PA1445P01 1081 $212.42 ❑ ALARM(BUZZER)ASSEMBLY,2000 IDU PB0749GO1 1082 $63.05 ❑ TOP HOUSING ASM,2000 IDU(INCL.NUTS,WASHERS,GASKETS,STUDS) PD0262G14 1083 $437.17 1 ❑ DISCHARGE KIT,IDU(INCL.ELBOW,1-THREADED NIPPLE)PARTS ONLY PB0748GO1 1084 $43.44 ❑ INLET KIT,IDU(INCL.GATE VALVE,GROMMET,6-PIPE,VALVE STOP) PB0747GO1 1085 $392.14 ❑ AMGP BREATHER CABLE ASM(EQUALIZER INCLUDED) PC0579GO9 1086 $333.77 ❑ 2000 IDU CONTROL BRACKET PB0702GO8 1087 $266.59 ❑ MOTOR HOUSING ASSEMBLY(2000,AMGP) PC0837GO1 1088 $263.46 ❑ HOSE FLEX DISCHARGE KIT,48' PC0542G01 1093 $148.17 ❑ HOSE FLEX DISCHARGE KIT,60' PC0542G02 1094 $151.04 ❑ HOSE FLEX DISCHARGE KIT,72' PC0542GO3 1095 $171.22 ❑ HOSE FLEX DISCHARGE KIT,84' PC0542G04 1096 $178.68 ❑ HOSE FLEX DISCHARGE KIT,96' PC0542G05 1097 $183.37 ❑ SLIDE FACE RECEIVER ASSMEBLY PCO542G10 1098 $94.97 ❑ ELECTRICAL SERVICE KIT,2000 IDU PA1722G01 1100 $778.13 ❑ TOP HOUSING SERVICE KIT,2000 IDU(units prior to 9/17/01) PA1723G01 1101 $434.88 ❑ T260 Replacement Board,SVC,NO SODC,240V PA1880G01 1103 $387.42 ❑ T260 Replacement Board,240V,2P,With SODC PA1880G02 1104 $514.71 ❑ T260 Replacement Board,SVC,NO SODC,120V PA1880G07 1108 $499.71 ❑ T260 Replacement Board, 120V,with SODC PA1880G08 1109 $510.98 ❑ TOP HOUSING ASSEMBLY,I-SERIES NC0030G01 1201 $341.97 ❑ TRANSCEIVER ASSEMBLY,240 VOLT 160 HZ NB0035GO1 1202 $233.31 ❑ CUTTER WHEEL,MACHINED/HARDENED NC0008P02 1203 $111.69 ❑ CHECK VLV ASM W/RCV,1-1/2NPT,DW NC0032G03 1207 $223.92 ❑ CORE CABLE ASSEMBLY,7',WIRELESS ND0037G02 1209 $212.27 ❑ CORE CABLE ASSEMBLY,12',WIRELESS ND0037G03 1210 $310.67 i I ❑ LEVEL SENSING ASSEMBLY,WIRELESS NCO033G02 1211 $340.78 ❑ LEVEL SENSING ASSEMBLY,HARDWIRED NC0033G01 1212 $239.31 http://www.eoneezorder.com/Catalog/Product/V iews/1stltemsParts.asp?Type=2&Categor... 10/24/2016 Environment One Corporation-2000 Series Grinder Pump Online Configuration Page 3 of 17 ❑ EQUALIZER TUBE ASSEMBLY,9',FOR T CABLE NCO035G01 1213 $32.58 ❑ EQUALIZER TUBE ASSEMBLY, 14',FOR 12'CABLE NC0035G02 1214 $39.09 ❑ LEVEL SENSING ASM,I SERIES,HARDWIRED NC0033G03 1215 $307.82 ❑ TEMP ADAPTER KIT,EXTREME CORE TO 2000 CABLE,6 FT ND0052G02 1216 $160.08 ❑ TEMP ADAPTER KIT,EXTREME CORE TO 2000 CABLE,1 FT ND0052G03 1217 $125.34 ❑ TEMP ADAPTER KIT,2000 CORE TO EXTREME CABLE,1 FT ND0052G04 1218 $125.34 ❑ LEVEL SENSOR ASM,HARDWIRED,12FT CABLE NC0033G05 1221 $290.45 ❑ ADAPTER KIT,EXTREME CORE TO 2000 CABLE ND0052G05 1222 $125.34 ❑ ADAPTER KIT,2000 CORE TO EXTREME CABLE ND0052G06 1223 $125.34 ❑ CORE CABLE ASSEMBLY,7',HARDWIRED ND0037G06 1260 $212.27 ❑ EQD ASSEMBLY,SUPPLY CABLE SIDE,NO CABLE ND0036G01 1262 $78.42 ❑ EQD ASSEMBLY,CORE SIDE ND0037G01 1263 $110.85 ❑ ANTI-SYPHON CHECK VALVE ASM,FOR DRYWELL NCO032G01 1264 $173.03 i ❑ CONTROL BRACKET ASSEMBLY,240 VOLT/60 HZ ND0112G01 1265 $220.66 ❑ CONTROL BRACKET ASSEMBLY,120 VOLT/60 HZ ND0112G02 1266 $272.46 ❑ CORE CABLE ASSEMBLY, 12',HARDWIRED ND0037G07 1267 $263.41 ❑ TOP HOUSING ASSEMBLY,DRYWELL NC0031G01 1269 $321.74 ❑ ANTI-SYPHON CHECK VALVE ASM,FOR WETWELL&UPGRADE NC0032G02 1276 $180.84 ❑ DISCHARGE KIT,I-SERIES,SERVICE NCO041G01 1284 $99.21 ❑ MOTOR HOUSING ASSEMBLY,SERVICE WITH MOTOR STATOR/SEAL KIT NC0036G01 1288 $346.39 ❑ EQUALIZER ASSEMBLY NC0034G01 1290 $81.86 Plastic and Metal Parts(Service Codes 2000-2999) Part Number Service List Description Code Price ❑ SS DISCHARGE,STRAIGHT(200,2000) PS0497G01 2064 $147.48 ❑ LIFTING HOOKS 3/8(2000) PA1147P01 2065 $2.79 ❑ AMGP/1000 SERIES 1 1/4"NPTANTI-SIPHON ADAPTER PA0233G02 2067 $47.91 ❑ AMGP COVER ASM,SERVICE-INCLUDES O-RING FOR AMGP PD0228G10 2068 $115.57 ❑ LEVEL SENSOR HOUSING,ALARM SIDE,HARDWIRED ND0013P08 2215 $40.33 ❑ LEVEL SENSOR HOUSING,ON/OFF SIDE,HARDWIRED/WIRELESS ND0012P07 2216 $47.36 ❑ SS STRAIGHT DISCHARGE-EXTREME NB0074GO1 2264 $147.48 ❑ CAP,SWITCH,15/32-32 AME PA0532P01 2102 $7.22 ❑ NUT,EQD TIGHTENING,BLACK,SUPPLY CABLE SIDE ND0003P01 2201 $4.23 ❑ SPLIT NUT FOR CONTROL COVER,HARDWIRED NB0007P02 2202 $2.22 ❑ EQUALIZER TUBING,BLACK,PER FOOT NB0012P01 2203 $1.04 ❑ GROMMET,MOTOR HOUSING,INTERNAL NB0002P01 2204 $1.04 ❑ CLIP,RETAINING,LEVEL SENSING HOUSING BOTTOM NB0010P01 2205 $0.72 ❑ RETAINER,PRESSURE SWITCH ND0014P01 2208 $1.37 ❑ S-CLIP,CORE CABLE/VENT TUBING NB0046P01 2209 $0.78 ❑ HUB BASE,TOP HOUSING LATCH,D-SERIES NB0023P01 2210 $14.53 I ❑I PAWL,TOP HOUSING LATCH,D-SERIES NB0024P01 2211 $5.68 SPINDLE,MOLDED SLEEVE,TOP HOUSING LATCH,D-SERIES NB0025P01 2212 $4.23 http://www.eoneezorder.com/Catalog/Product Views/1stItemsParts.asp?Type=2&Categor... 10/24/2016 i Environment One Corporation-2000 Series Grinder Pump Online Configuration Page 4 of 17 ❑ CONTROL HOUSING,STANDARD PAINT,D-SERIES,WIRELESS NCO037GO2 2213 $208.48 ❑ CONTROL HOUSING,STANDARD PAINT,D-SERIES,HARDWIRED NCO037GO1 2214 $208.48 ❑ EQD SOCKET HOUSING,SUPPLY CABLE SIDE NCO043GO1 2259 $50.39 ❑ EQD PIN HOUSING,CORE CABLE SIDE NCO044GO1 2260 $44.09 ❑ STAINLESS STEEL DISCHARGE CANDY CANE,SWAGED,EXTREME NCO073GO1 2263 $79.54 ❑ PIN,LIFTING,D-SERIES TOP HOUSING NA0006POl 2265 $2.79 ❑ CONTROL HOUSING,STANDARD PAINT,W-SERIES,WIRELESS NCO037GO4 2267 $165.82 ❑ CONTROL HOUSING,STANDARD PAINT,W-SERIES,HARDWIRED NCO037GO3 2268 $165.82 ❑ STAND,CORE,5/16 INCH ROD,SS(1 SIDE) NB0006PO2 2269 $23.97 ❑ FTG,COUPLING,1 1/4 PVC SCH80 THREAD BOTH ENDS 0372-830012 2270 $9.75 ❑ LEVEL SENSOR HOUSING,ALARM SIDE,WIRELESS ND0013PO7 2207 $38.65 ❑ TUBING,EPDM, 10 IN LG PA0735PO3 2053 $1.46 ❑ VALVE WYE(SS DISCHARGE) PDO012PO2 2054 $53.07 ❑ ELBOW DISCHARGE,SS(200) PC0475GOI 2071 $109.63 ❑ COVER,TOP HOUSING, 120V(2000) PC1162P02 2072 $12.03 ❑ ELBOW(AMGP,IDU,METERING) PBO827GO1 2074 $73.68 ❑ ELBOW DISCHARGE,SS,SWAGED(2000) PBO801GO1 2075 $75.69 ❑ BALL VALVE(IDU) PA1444POl 2077 $34.99 ❑ TUBING,22',EPDM(200) PA0735P15 2003 $3.21 ❑ COPPER ADAPTER,MALE 0346-DL 2004 $30.09 ❑ TUBING,EPDM, 15 IN LG PA0735P13 2015 $2.66 ❑ TUBING,COPPER,1.25 x 6.50 PB0058POl 2018 $14.26 ❑ TUBING,EPDM,50FT PA0735P14 2019 $93.84 ❑ INLET FLANGE,4 PVC PCO191PO6 2049 $61.73 ❑ ELBOW,1-1/4 NPT BRASS PB0248PO5 2050 $31.36 ❑ NIPPLE,1-1/4 NPT x2 BRASS PB0248PO6 2051 $23.79 ❑ SPLIT RING,SS,SWAGED DISCHARGE PA1028PO2 2079 $1.55 ❑ BRACKET,DISCHARGE SUPPORT,AMGP PBOS45POl 2080 $14.09 ❑ HOOD,EQD,w/o#10-32 INSERT(For Old GG Tank,w/EQD Bracket) PC0563PD4 2081 $8.38 ❑ HOSE CLAMP,7/16 IN NYLON(used on equalizer tubing) PA1815POI 2083 $1.72 ❑ SLIP JOINT NUT,1-1/2 IN PVC(SS DISCHARGE) PA0986POl 2056 $1.26 ❑ SPLIT RING,SS DISCHARGE PA1028POl 2057 $3.77 ❑ HOOD,EQD HOUSING(STANDARD 2000) PC0563POl 2059 $23.53 ❑ COVER,TOP HOUSING,240V(2000) PC1162POl 2062 $10.28 ❑ FLOAT VALVE ALARM ASM PC0465GO1 2002 $52.23 ❑ TUBING,EPDM,6 IN LG PA0735PO2 2052 $0.98 ❑ VALVE HOUSING(SS DISCHARGE) PCO048PO2 2055 $23.53 ❑ SS DISCHARGE,U-TUBE,SWAGED(2000) PBOB02GOI 2063 $79.53 ❑ PUMP STAND,WIRE FORM(2000) PC0728POl 2069 $58.73 ❑ VALVE SEAT PA0232GO1 2078 $14.51 http://www.eoneezorder.com/Catalog/Product/V iews/1stItemsParts.asp?Type=2&Categor... 10/24/2016 Environment One Corporation-2000 Series Grinder Pump Online Configuration Page 5 of 17 Hardware(Service Codes 3000-3999) Part Number Service List Description Code Price ❑ CORD GRIP,1/2 INCH NPT W/O-RING(FOR HARDWIRED LEVEL SENSOR HOUSING) NA0045G02 3212 $13.65 ❑ FTG,QD,PLUG,1/8FPT(3046) 0368-002 3046 $19.55 ❑ FTG,QD,SOCKET,1/8FPT(3044) 0368-001 3044 $43.30 ❑ WASHER,1/4,SS,FOR HUB BASE RET.SCREW 0707-0012 3211 $1.05 ❑ SCREW,HUB BASE RETAINING,1/4-20 X.38 LG PA1399P03 3210 $0.98 ❑ AMGP BREATHER CLAMP,SS,SPRING PA1290P01 3149 $1.75 ❑ SCREW,ALARM BOARD,SENTRY(PLASTITE 45,#10X 1/2) 0210-508Z 3150 $0.28 ❑ SPRING PIN,.187 DIA X.75 LG,SS FOR CHECK VALVE 0714-093S 3201 $0.32 ❑ SPRING PIN,.250 DIA X 1.50 LG,SS FOR CONTROL COVER 0714-139S 3202 $0.91 ❑ WASHER,.19 X.63 X.04 SS NA0011 P01 3203 $0.13 ❑ SCREW,PHILIP,RD HEAD,SS,6-32 X 2.50 0010-3040 3204 $0.53 ❑ SCREW,PLASTITE 45,#4 X 1/2,SS 0210-208S 3205 $0.20 ❑ PLUG, 1/8 NPT,SS NA0002POl 3206 $1.88 ❑ SCREW,SOCKET HEAD,10-24 X.50,PRE-COTE,CONTROL BRACKET NA0015POl 3207 $0.20 1 ❑ SCREW,PLASTITE,SH,SS,48-2#10-14 X 1.25(EXTREME TOP HSG) NA0025POl 3208 $0.40 ❑ SCREW,PHILIPS,RD HEAD,SS,6-32 X 3.00 LG 0010-3048 3209 $0.53 ❑ SCREW,LOCK,HEX MACH,10-24 X 0.75 LG PA1398P01 3224 $0.71 ❑ D-HOOK,LIFTING NB0042POl 3230 $7.56 ❑ WASHER,SPRING LOCK,SS#10(SHROUD) 0708-5002 3005 $0.06 ❑ WASHER,PLAIN,SS,1/4(TIE ROD BOTTOM) 0707-6002 3006 $0.13 ❑ SCREW,SELF-TAP,#6 x.37(PRESSURE SWITCH) 0203-BT306C 3009 $0.13 ❑ SCREW,TAMPER PROOF,8-32 PA0117P01 3014 $0.63 ❑ WASHER,PLAIN,SS,#8(TAMPER PROOF) 0707-4002 3015 $0.06 ❑ WASHER,SPRING LOCK,SS 1/4(SUCTION HOUSING) 0708-6002 3022 $0.13 ❑ SCREW,HEX HD,1/4-20 x.75 PA1399POl 3023 $0.42 ❑ SCREW,SL HX HD,10-24 x 1.50(CAST IRON ONLY) PA1027POl 3024 $0.71 ❑ CONNECTOR,3/4 IN NPT(12-2,14-2) 0608-002 3040 $23.04 ❑ SCREW,DRIVE,SS,#4 x.188(NAME PLATE) 0005-4003 3049 $0.13 ❑ NUT,STOP(ELASTIC),1/4-24(TIE ROD) 0719-252OSS 3050 $0.98 ❑ SCREW,PHILLIPS PN HD,8-32 x.44(CONTROLS) 00234007 3051 $0.13 ❑ SCREW,SLOTTED FL HD,10-32 x.38(CAPACITOR) 0037-5006 3058 $0.29 ❑ CONNECTOR,(12-3)CABLE 0635-2535 3091 $20.19 ❑ WASHER,FLAT,SS,1/4 PA0201POl 3095 $1.19 ❑ SCREW,O-RING(CORE BOLT) PBO153P01 3096 $3.21 ❑ WASHER,PLAIN,SS,3/8(O-RING SCREW) PA0277POl 3097 $0.55 ❑ SCREW,HEX HD,1/4-20 x 1.6 2 0073-6026 3104 $0.50 ❑ SCREW,HEX HD,1/4-20 x 1.50 0073-6024 3105 $0.83 ❑ VALVE STEM,BREATHER PA0382POl 3111 $4.11 ❑ O-RING, 1.287 x 1.707(COPPER DISCHARGE) 0310-323B 3114 $1.11 BOLT,5/16-18 x 1.75(2000 MOTOR) 0073-7028 3119 $1.53 http://www.eoneezorder.com/Catalog/ProductfViews/1stltemsParts.asp?Type=2&Categor... 10/24/2016 Environment One Corporation-2000 Series Grinder Pump Online Configuration Page 6 of 17 ❑ WASHER,SPRING LOCK,5/16 0708-7002 3121 $0.21 ❑ SCREW,CAPTIVE,10-32 x.75(2000 EQD) PA1134POl 3122 $0.83 ❑ CORD GRIP,3/4 IN NPT,.35-.63(2000,EXTREME EQD,IH) PA1150P06 3123 $7.13 ❑ STUD,TOP HOUSING(2000) P130634P02 3124 $6.14 ❑ LOCKN UT,5/16'SS(2000) 0719-3218SS 3125 $1.05 ❑ FLAT WASHER,5/16'SS(2000) 0707-7002 3126 $0.55 ❑ CLAMP,BREATHER(2000) PA0332P03 3127 $0.29 ❑ FLAT WASHER,#10(plastic inlet shroud) 0706-5002 3128 $0.35 ❑ SCREW,10-24 HXHD PRCOAT W/LOCKTITE(inlet shroud,motor,ground screw),2000 PA1398P03 3129 $0.42 ❑j EYE BOLT(AMGP) 0391-003 3130 $3.99 ❑ SCREW,HEX,SS,5/16-18x2.00 LG 0073-7032 3131 $1.53 ❑ RETAINING RING,STAND,SS,4PK(AMGP,1000) PA2190POl 3132 $3.09 ❑ CHECK VALVE SCREW 0052-5014 3133 $0.55 ❑ CHECK VALVE WASHER PA0247POl 3134 $0.35 ❑ BUTTON HEAD SCREW,(2000 IDU;HOLDS ON PCB&OVERLAY) 0097-3006 3135 $0.13 ❑ STAND OFF,#6.75 LG(2000 IDU) 0402-0017 3136 $0.57 ❑ PLUG EXPANSION PA1007POl 3137 $0.55 SCREW,HXHD 1/4-20x1 PRCOAT W/LOCKTITE(SUCTION HOUSING)NOT USED IN PA1399P02 3138 $0.55 ❑ PLACE OF.75 1/4-20 BOLT ❑ SCREW, 10-32(HOLD DOWN SCREWS FOR IDU COVER) 0028-5008 3139 $0.13 ❑ HUMMEL CONNECTOR,1/2 NPT(2000 IDU) PA1150P08 3140 $8.72 ❑ LOCKNUT FOR HUMMEL(2000 IDU) PA1306P02 q3143 $2.24 ❑ SCREW,PHIL,PAN HD,1/4-20 x 75,IDU CORE BOLT 0022-6012 $0.29 ❑ 5/16-18,SS,NUT(FOR EYEBOLT) 0702-7002 $0.55 SCREW,PHIL,PAN HD(HOLDS ALARM TO MOUNTING BRACKET,2000 IDU) 0022-0004 $0.13 ❑ GROUNDING STRIP,AL,IDU PB0704POl 3146 $46.08 ❑ SCREW,CAPTIVE,10-32x1.25 PA1134P02 3147 1 $2.10 Tools(Service Codes 4000-4999) Part Number Service List Description Code Price ❑ LOCTITE 641,10 mL,BEARINGS 0323-049 4210 $30.18 ❑ PRESS ON TOOL,SWITCH END BEARING(200 SERIES) PB0210POl 4022 $77.71 ❑ SOCKET,TAMPER PROOF,#6 PA0302POl 4001 $13.57 ❑ GREASE,SILICONE,5.3 OZ 0302-005 4017 $31.55 ❑ PIPE SEALER,TFE,8 OZ 0303-006 4018 $26.96 ❑ HAND PUMP,VACUUM/PRESS PA1019G01 4019 $250.05 ❑ PRESS-ON TOOL,PUMP BEARING PB0211P01 4021 $144.87 ❑ SEAL ASM TOOL,CERAMIC/CARBON PB0209POl 4028 $82.65 ❑ METER,VOLT/AMP/OHM PA1018POl 4033 $146.67 ❑ BEARING PULLER,SWITCH PA0347POl 4034 $157.04 ❑ BEARING PULLER,PUMP PA0347P02 4035 $261.52 http://www.eoneezorder.com/Catalog/Product/Views/IstltemsParts.asp?Type=2&Categor... 10/24/2016 Environment One Corporation-2000 Series Grinder Pump Online Configuration Page 7 of 17 ❑ TEST FIXTURE,SENSING BELL PB0534GO1 4038 $149.90 ❑ MOLEX PIN REMOVER(2000 SERIES) PA1277POl 4039 $75.57 i I ❑ MOTOR AIR TEST FIXTURE(2000 SERIES) PA1198POl 4041 $20.79 i ❑ TAMPER PROOF SOCKET,#20 PA0595POl 4042 $46.36 ❑ METER,VOLT/OHM PA1018P02 4043 $146.67 ❑ BREATHER TEST FIXTURE(2000 SERIES) PA1706G01 4044 $6.46 ❑ PRESS ON TOOL,UPPER BEARING(2000 SERIES) PB021OP02 4045 $110.09 i ❑ SILICONE,MOLYCOTE 55,5.3 OZ NA0008P02 4201 $47.51 F1LEVEL SENSING SIMULATOR(VNRELESS) NC0026G01 4202 $202.28 ❑ SCREWDRIVER,5/32 HEX DRIVE,HOLDING TIP NA0101 P01 4203 $11.47 ❑I SERVICE TAGS,BOX OF 100 TAGS(PRICE IS NET) PA2026POl 4204 $52.64 ❑ LOCTITE 598,0.5 OZ,CABLE ENTRY NA0161P02 4205 $10.20 ❑ MANOMETER FIELD TEST KIT(PRICE IS NET) NB0158G01 4206 $427.03 i ❑ MANOMETER SHOP TEST KIT(PRICE IS NET) NB0158G02 4207 $561.29 ❑ HAND TOOL,CRIMPER(PRICE IS NET) NA0237POl 4208 1 $608.00 ❑ BOTTOMING TAP,M32 x 1.5(PRICE IS NET) NA0237P02 4209 $133.31 Motor Parts Description Part Number Service List P Code Price ❑ Motor Head PE0020P03 5014 $700.00 ❑I MOTOR ASM,250V,50HZ,AUS/NZ,20001(5038) PB0711GO3 5038 $546.25 ❑ CENTRIFUGAL MECHANISM(200 NEW GE) PA1172P02 5027 $113.85 ❑ ROTOR,MOTOR,EXTREME NC0007P01 5201 $408.88 ❑ MOTOR HEAD,STANDARD(INCLUDES 1208 SEAL KIT) NCO038G01 5237 $143.20 i ❑ THERMAL PROTECTOR,240V 60Hz(EXTREME) NA0112POl 5202 $13.84 ❑ THERMAL PROTECTOR,120V 60Hz(EXTREME) NA0112P02 5203 $38.69 _ ❑ BEARING,PUMP END(200,20.0_0,,EXTREME) _ _ _ _ PA0109P01 5015 $33.38 ❑ CAPACITOR,430 UF,110V(200) PA0108POl 5016 $27.38 ❑ END CAP,CAPACITOR(200) PA0108P02 5017 $4.19 ❑ BRACKET,CAPACITOR(200) PA0108P03 5018 $19.84 ❑ BEARING,SWITCH END(200) PA0109P02 5021 $34.07 ❑ THERMAL PROTECTOR,REPLACEMENT KIT(200) PA1910G01 5024 $69.22 ❑ WASH ER,SHIM,.015 THICK(200) PA0107POl 5026 $2.73 ❑ CAPACITOR,START,125V,W/68K RES(2000,EXTREME) NA0193POl 5029 $54.54 ❑ BRACKET,CAP MTG(2000) PA1042POl 5030 $8.38 ❑ SWITCH,MOTOR START,120/240(2000,EXTREME) PA0475P03 5031 $55.66 ❑ THERMAL PROTECTOR,240V(2000) PA0303P03 5032 $13.83 MOTOR ASM, 120/240V,FIELD,ARMATURE,BEARINGS PB0711GO1 5033 $663.12 ❑ (2000,1000,AMGP,SUBMERSIBLE,IDU) WASHER,WAVE SPRING,(2000,EXTREME) PA1010POl 5034 $1.96 ❑ BEARING,TOP(2000,EXTREME) PA1181POl 5035 $73.32 ❑ THERMAL PROTECTOR,120V(2000) PA0303P05 5036 $38.69 http://www.eoneezorder.com/Catalog/Product/V iews/IstltemsParts.asp?Type=2&Categor... 10/24/2016 Environment One Corporation-2000 Series Grinder Pump Online Configuration Page 8 of 17 ❑ MOTOR HEAD,MACH,STD(2000) PD023OP03 5037 $157.53 O-Ring and Gasket(Service Codes 6000-6999) Description Part Number Service List Code Price ❑ SIKATAPE,1"x 1/8",50'ROLL,BLACK PA1058P02 6040 $62.72 ❑ FLOOD PLAIN GASKET KIT PA1763G01 6050 $39.13 ❑ O-RING,18MM X 2MM BUNA N(LEVEL SENSOR CORD GRIP) NA0519POl 6206 $1.14 ❑ O-RING,.426 X.566 BUNA N(LEVEL SENSOR BARB FITTING) 0310-013B 6233 $0.51 ❑ GROMMET,PUMP CABLE,BLACK NB0039POl 6204 $1.05 ❑ GROMMET,EQUALIZER TUBE,BLUE ND0024POl 6205 $1.24 ❑ GROMMET,6 HOLE OVERMOLD,EQD,SUPPLY CABLE SIDE NB0002P02 6201 $2.29 ❑ O-RING,CASTING 4.975 X 5.525,BUNA N,EXTREME 0310-A29B 6202 $2.80 i ❑ SEAL,LEVEL SENSING HOUSING,EXTREME NB0043POl 6203 $3.39 I ❑ EQD O-RING,2.489 X 2.629,BUNA N 0310-037B 6230 $5.29 1 ❑ GASKET,TOP HOUSING NB0077POl 6231 $9.75 ❑ CV/AS O-RING,1.609 X 1.887,BUNA N 0310-223B 6232 $0.73 ❑ O-RING,CAST AMGP COVER 0310-269B 6051 $3.43 ❑ O-RING,7.984 x 8.262,R&M MOTOR HEAD 0310-266 6001 $9.92 ❑ GASKET,R&M ELBOW PB0002POl 6005 $2.94 i ❑ O-RING,7.725 x 8.145,GE MOTOR HEAD 0310-368B 6010 $7.75 ❑ GASKET,ELBOW(GE OLD) PA0099POl 6011 $3.44 ❑ O-RING,.171 x.449,TIE ROD(200) 0310-201B 6022 $0.35 ❑ O-RING, 1.350 x 1.770,TOP HOUSING DISCHARGE(200) 0310-324 6024 $4.95 E] O-RING,.239 x.379,CORE BOLT 0310-010B 6025 $0.13 ❑ GROMMET,BLACK,SUPPLY&14 GA BREATHER CABLE(2000) PB0525P12 6028 $4.05 ❑ TOP HOUSING GASKET,FLAT(AMGP, 1000) PB0533PO2 6029 $17.40 i ❑ GASKET,EQD,AMGP/2000S PB0576P01 6030 $5.30 ❑ GASKET,TOP HOUSING TO TANK(2000) PA1155POl 6031 $10.62 ❑ O-RING,1.234 x 1.512,SS DISCHARGE PA0987POl 6032 $0.87 ❑ GASKET,FLANGE,SS ELBOW PA0941 P01 6033 $2.01 I ❑ BLUE GROMMET,SS DISCHARGE TO VALVE PB0503PO2 6034 $4.40 ❑ GROMMET,BUNA-N,TOP HSG/DISCHARGE,BLK PBO569POl 6035 $5.72 ❑ O-RING,.145 x.285,CAPTIVE SCREW EQD 0310-007E 6036 $0.42 I ❑ GROMMET,CABLE THROUGH TOP HOUSING(2000) PA1149POl 6037 $5.24 i ❑ O-RING,SLIDE FACE(1.57 x.197)(AMGP,1000,300) PA0514POl 6038 $5.16 ❑ GASKET,8 HOLE(200) PB0039P01 6012 $32.27 ❑ O-RING, 13.975 x 14.525 TOP HOUSING(200) 0310-457 6014 $15.71 ❑ SEALING RING,3/4 0634-5263 6016 $3.85 . ❑ GASKET,COVER,9 HOLE(200) PB0069POl 6021 $27.58 ' ❑ O-RING FOR CABLE CONNECTOR(2000,AMGP,1000,EXTREME) 0310-214B 6041 $0.55 ❑ GASKET,ELBOW,SS(2000,1000,AMGP,IDU,SUBMER.,METERING) PA1017 101 6042 $1.40 TOP HOUSING GASKET,MOLDED(2000,IDU) PC0727POl 6043 $18.08 http://www.eoneezorder.com/Catalog/Product/V iews/lstltemsParts.asp?Type=2&Categor... 10/24/2016 Environment One Corporation-2000 Series Grinder Pump Online Configuration Page 9 of 17 EJ ElGROMMET,DISCH,EPDM,1.66,IDU&IH PB0690P01 6044 $21.23 ❑ GASKET,TOP HOUSING(IDU) PA1521P0l 6045 $21.93 ❑ O-RING FOR HUMMEL CONNECTOR(IDU&EXTREME LATCH MECHANISM) 0310-1168 6046 $0.42 ❑ O-RING,1.266 ID,BACK-UP PA1680P0l 6047 $1.03 ❑ GASKET,8.48 DIAMETER,IDU COVER PC0851P01 6048 $20.45 ❑ O-RING,30 mm x 5 mm,AMGP DISCHARGE PA1751 P01 6049 $2.54 ❑ O-RING,MOTOR(2000) 0310-2616 6039 $1.68 Electrical Parts(Service Codes 7000-7999) ServiList Ce Description Part Number CodePrice ❑ PRESSURE SWITCH,ALARM(200) PB0122P0l 7003 $45.81 ❑ OF CABLE,COIL,14-2,UL PA0327P0l 7009 $37.64 ❑ RESISTOR,1200,20W PA0101P01 7037 $18.72 ❑ TRANSFORMER,BUCK BOOST,AUTO(DUPLEX 0.75 KVA) PA0219P03 7068 $768.36 ❑ WIRE ASM,BLACK,2 TERM PA0236G13 7072 $3.50 ❑ WIRE ASM,WHITE,1 TERM PA0236G03 7073 $3.28 ❑ RESISTOR,5000,20W(200) PA0101P02 7076 $16.69 ❑ ALARM EQD,15A,125V,FEMALE(ERICSON,200) PA0460P03 7087 $109.98 ❑ GROMMET,OVAL,12/2&1412UF(ERICSON TO OF CABLE) PA0460P07 7089 $4.88 ❑ PRESSURE SW,ON/OFF(2000) PA1016P0l 7090 $59.55 ❑ PRESSURE SW,ALARM(2000) PA1016P02 7091 $59.55 ❑ EQD INSERT,MALE(six pin) PA1074PO4 7095 $24.84 ❑ RELAY,SOLID STATE,25A(possible replacement for 7070) PA1004P0l 7092 $81.55 ❑ CONNECTORASM,3 PIN RECEPTACLE MOLEX(2000) PA1182G03 7097 $6.57 ❑ CONNECTOR ASM,4.PIN RECEPTACLE MOLEX(2000) PA1182G04 7099 $7.26 ❑ POWER CORD,240V(2000 IDU) PA1461 PO2 7110 $43.99 ❑ CONTACTOR,MOTOR,120V(2000 flat control bracket) PA1476P02 7111 $117.14 I ❑ TERMINAL,FLG,FLG,22-18GA,RED PA0491P01 7115 $1.11 i ❑ PRESSURE SWITCH,ON/OFF(200) PB0122P03 7002 $38.69 ❑ OF CABLE,COIL,12-2,UL PA0327P02 7008 $41.26 ❑ CONTACTOR,MOTOR START,120 PA1162P0l 7035 $72.54 ❑ TRANSFORMER,BUCK BOOST,AUTO(SIMPLEX 0.5 KVA) PA0219P02 7067 $430.89 ❑ TERMINAL,STA-KON,16-14GA(T260) PA0205P02 7071 $0.84 ❑ WIRE ASM,WHITE,2 TERM PA0236G15 7074 $3.56 ❑ WIRE ASM,BLACK,1 TERM PA0236G14 7075 $3.28 ❑ ALARM EQD,15A,125V,PLUG(ERICSON,200) PA0460P0l 7085 $71.22 I ❑ POWER EQD, 15A,250V,PLUG(ERICSON,200) PA0460P02 7086 $99.31 I ❑ POWER EQD,15A,250V,FEMALE(ERICSON,200) PA0460PO4 7088 $83.66 ❑ RESISTOR ASM,15K, 12W(2000) PA0101 PO6 7093 $35.47 ❑ EQD INSERT,FEMALE(six pin) PA1074P03 17094 $23.04 CONNECTOR ASM,3 PIN PLUG MOLEX(2000) PA1182G01 7096 1 $6.22 http://www.eoneezorder.com/Catalog/ProductfViews/IstItemsParts.asp?Type=2&Categor... 10/24/2016 Environment One Corporation-2000 Series Grinder Pump Online Configuration Page 10 of 17 ❑ CONNECTOR ASM,4 PIN PLUG MOLEX(2000) PA1182G02 7098 $7.55 ❑ SPLICE KIT FOR TRAY CABLE(approved for underground use) PC0606G01 7102 $78.34 ❑ MECHANICAL RELAY,240V(200 replacement for 7070) PA1162P02 7103 $76.82 ❑ CONTACTOR,MOTOR 220V/240V(Alarms panels and 2000 Series flat control bracket) PA1476P01 7104 $57.47 ❑ PRESSURE SWITCH,ON-OFF(2000 IDU) PA1016P07 7105 $74.45 ❑ PRESSURE SWITCH,ALARM(2000 IDU) PA1016P08 7106 $74.45 ❑ OVERLAY,DIAGNOSTIC CENTER(IDU) PBO694P01 7107 $83.79 ❑ BATTERY HOLDER(IDU) PA0839P03 7108 $19.90 ❑ LITHIUM BATTERY(IDU) PA0839P05 7109 $35.40 ❑ RESISTOR,HEATER,120V(2000 flat control bracket) PA0101 P10 7112 $18.72 ❑ TERMINAL 250F,22-18 AWG 0642-003 7114 $0.98 ❑ SPLICE,18-16 AWG,BLUE PA0748P01 7116 $0.71 ❑ CAP,EQD SOCKET SUPPLY CABLE SIDE NB0004P01 7201 $3.39 ❑ CAP,EQD,PIN CORE CABLE SIDE NB0003P01 7202 $4.43 ❑ BOARD ASM,TRANSPONDER,WIRELESS NB0038G01 7203 $46.33 ❑ PRESSURE SWITCH,ON/OFF,IDU HARDWIRED W/O-RINGS NB0083G05 7205 $74.45 ❑ PRESSURE SWITCH,ALARM,IDU HARDWIRED W/O-RINGS NB0083G06 7206 $74.45 ❑ PRESSURE SWITCH,ON/OFF W/O-RINGS NB0083GO1 7290 $59.55 ❑ PRESSURE SWITCH,ALARM W/O-RINGS NB0083G02 7291 $59.55 -DO NOT ORDER"PART IS OBSOLETE,INSTEAD ORDER PA1476P01 (SERVICE NA0023P01 7204 $0.00 ❑ NUMBER 7104)-Part Was CONTACTOR,MOTOR,240V,240V DIN,EXTREME ❑ WIRE CRIMP,3-WIRE NA0014P01 7207 $1.18 ❑ FERRULE RED PA2072P02 7208 $0.55 ❑ PRESSURE SW,ALARM,AUS/NZ(EXTREME)WITH O-RINGS(7220) NB0083G07 7220 $75.43 [:],ON/OFF PRESSURE SWITCH,PLATED,FOR WIRELESS AND EXPLOSION PROOF NB0083G11 7292 $74.45 ❑ ALARM PRESSURE SWITCH,PLATED,FOR WIRELESS AND EXPLOSION PROOF NB0083G12 7293 $74.45 D-Series Parts List Description Part Number CodeCe Price ❑ SUCTION HOUSING,EXTREME,STD ND0018P01 8210 $163.67 ❑ STATOR/LINER ASSY,EXTREME NC0039G01 8203 $80.66 ❑ STATOR(OIL-RESIST)/LINER ASM,EXTREME NC0039G03 8205 $237.97 ❑ SHREDDER RING,EXTREME ND0008P01 8206 $86.66 ❑ INLET SHROUD,EXTREME ND0004P01 8207 $9.92 ❑ STATOR AND LINER ASSEMBLY,M3 REDUCED PRESSURE,EXTREME NC0039G02 8213 $80.66 ❑ STATOR,PUMP PCO249P01 8003 $89.24 ❑ PUMP LINER PB0011P01 8004 $5.10 ❑ STATOR,OIL RESISTANT PA0928P01 8005 $232.87 ❑ SHREDDER RING,MACHINED(200,2000) PA001OPO4 8006 $86.65 ❑ INLET SHROUD,PLASTIC(need mounting hardware)for AMGP,2000,1000,IDU PC0002P08 8007 $9.92 ❑ ROTOR,MACHINED AND POLISHED PC0054P02 8008 $163.75 http://www.eoneezorder.com/Catalog/ProductfV iews/1stItemsParts.asp?Type=2&Categor... 10/24/2016 Environment One Corporation- 2000 Series Grinder Pump Online Configuration Page 11 of 17 ❑ GROOVE PIN,5/32 0721-EO58 8009 1 $0.71 1 ❑ SUCTION HOUSING(AMGP,2000,1000,IDU) PD0028P02 8010 j $180.04 Miscellaneous Parts Part Number Service List Description Code Price ❑ CLAMP,120 IN.LB.BAND,(200) PA0210P01 9001 $45.81 ❑ TUBE CONNECTOR,1/8 NPT 0307-002 9002 $6.49 ❑ BRACKET,PRESSURE SVNTCH(200) PA0007P01 9006 $3.63 ❑ LABEL,CAUTION PA0172P01 9009 $1.26 ❑ LABEL,-NEVER THROTTLE- PA0022P01 9026 $1.26 ❑ TIE ROD(200) PA0126P02 9043 $30.33 ❑ PADLOCK,BRASS,1 IN.SHACKLE PA0168P02 9051 $11.17 ❑ FLAPPER PA0077P01 9054 $7.67 ❑ NAMEPLATE,200S,240V PCO079P01 9065 $3.77 ❑ TOP HOUSING COVER PAINTED(200 nine hole) PB0183G019068 $34.76 ❑ MOD.STRAP,TIE ROD PLATE(200) PBO149P01 9073 $9.50 ❑ LABEL,FOR SIGNAL LEADS PA0026P01 9075 $1.26 ❑ LABEL,FOR POWER LEADS PA0020P01 9076 $1.26 ❑ LABEL,FOR OUTDOOR USE PA0147P01 9077 $1.26 ❑ VALVE STEM(200) PA0355P01 9083 $2.73 ❑ TANK WRENCH ASM,15',FOR 61'STATION PA1002G01 9084 $53.54 ❑ TANK WRENCH ASM,33',FOR 74'STATION PA1002G02 9085 $56.83 ❑ TANK WRENCH ASM,45',FOR 93'STATION PA1002G03 9086 $60.10 i ❑ TANK WRENCH ASM,69',FOR 105'STATION PA1002G04 9087 $109.27 ❑ TANK WRENCH ASM,79',FOR 124'-129'STATIONS PA1002G05 9088 $112.55 ❑ TANK WRENCH ASM,93',FOR 140'STATIONS PA1002G06 9089 $114.73 ❑ TANK WRENCH ASM,115',FOR 160'STATIONS PA1002G07 9090 $120.20 ❑ WRENCH EXTENSION ASM,48',FOR 200'STATIONS PB0510GO1 9091 $55.73 ❑ SEALANT,SIKAFLEX PA03591302 9094 $28.77 ❑ ROPE FOR CORE,25',10'USEABLE,FOR 10'ACCESSWAY,SERVICE(9095) PA0290P03 9095 $23.26 ❑ CASTING PLUG,WIRELESS NB0008P01 9202 $1.96 ❑ NOTE TAG,TOP HOUSING NA0033P01 9204 $0.24 ❑ FITTING,LSH BARB,SS W/O-RING(LEVEL SENSOR HOUSING) NB0058GO2 9201 $12.53 i ❑ NAMEPLATE,EXTREM,SS NB0044P01 9203 $1.17 I Panel Parts Description Part Number ServiList Code Ce Price ❑ REPLACEMENT LATCH KIT,SENTRY(1 LATCH) PA2186G01 9542 $7.05 ❑ ALARM REPLACEMENT PC BOARD,SENTRY PROTECT,240V NB0072G21 9543 $316.33 ❑IMEMBRANE OVERLAY,DEADFRONT,SENTRY PROTECT,240V,2P NB0082G02 9544 $161.14 ❑ LAMP SOCKET,SPRING TABS,SCREW BASE PA2039P03 9531 1 $17.30 http://www.eoneezorder.com/Catalog/Product/V iews/1stItemsParts.asp?Type=2&Categor... 10/24/2016 Environment One Corporation-2000 Series Grinder Pump Online Configuration Page 12 of 17 ❑ LAMP, 130V,15W,BAYONET BASE PA2040PO4 9547 $2.60 ❑ LAMP SOCKET,BAYONET PA2039P05 9548 $19.13 ❑ REPLACEMENT BULB,250V,10W(9519) PA1189P02 9519 $7.82 REPLACEMENT BULB,250V,10W(9519) ❑ ALARM REPLACEMENT PC BOARD,DUPLEX PROTECT PLUS,240V,(1 BOARD) N60072G25 9552 $361.43 ❑ CABLE,MALE-MALE,4 PIN.7'LONG,24AWG NA0314POl 9553 $20.57 ❑ ADAPTER ASM,T260,FOR 240V WIRELESS CORES NC0014G04 9540 $172.19 ❑ ADAPTER ASM,T260 W/PHLA,FOR 240V WIRELESS CORES NC0014G10 9541 $231.04 ❑ ALARM REPLACEMENT PC BOARD,SIMPLEX SENTRY,240/120 PB0939G21 9522 $214.51 ❑ ALARM REPLACEMENT PC BOARD,SIMPLEX SENTRY,PRESTAT PB0957G21 9526 $365.49 ❑ BREAKER,SERVICE DISCONNECT,2 POLE,30A,SENTRY PB0722POl 9527 $85.70 ❑ BUZZER,ALARM,SENTRY PA1717P01 9528 $40.41 1. ❑ GASKET,BUZZER,ALARM,SENTRY PA1688POl 9529 $1.17 ❑ BULB,ALARM,130V,15W,SENTRY PA2040P02 9530 $2.35 ❑ RELAY,AUTO XFR,GEN RECEPTACLE,SENTRY PA1927P02 9532 $90.65 ❑ HOUR METER,DIN MT,SENTRY,240V PA1501 P01 9533 $108.73 ❑ LENS AND GASKET ASSEMBLY,SENTRY PA2138G01 9534 $31.44 ❑ ALARM PC BD ASM,260,STD(3R Enclosure) PA1094G01 9502 $383.61 ❑ BREAKER,2 POLE,15A 0663- 5 9503 $58.16 ❑ BREAKER,1 POLE,15A 0663- 9504 $25.98 THQP115 0663- ❑ THQP120 BREAKER,1 POLE,20A 9505 $34.49 HQ ❑ PUSH BUTTON SWITCH,SPST,N.O. PA0536POl 9506 $15.22 ❑ REPLACEMENT BULB,130V PA1186P01 9507 $7.82 ❑ LAMP ASM,ALARM MOD PANELS PA0548P03 9508 $35.47 ❑ AC CURRENT RELAY,SPST 20A PA0808POl 9509 $212.33 ❑ BLEEDING RESISTOR,PANEL,240V(2000) PA1216P02 9510 $24.30 ❑ FUSE,MOD 250/260 ALARM BOARD,6 AMP(2000) 0633408 9511 $4.68 ❑ REPLACEMENT BD,MOD250 PANEL,120V&240V(3R&4X WITH DINRAIL) PA1093G18 9512 $214.51 ❑ ALARM PCB ASM,260(4X ENCLOSURE/DIN RAIL ASM) PA1094G09 9513 $263.38 ❑ CIRCUIT BREAKER,1 POLE,15A,DIN RAIL MT PB0682P01 9514 $26.67 ❑ CIRCUIT BREAKER,2 POLE,15A,DIN RAIL MT PBO683POl 9515 $53.20 ❑ CIRCUIT BREAKER, 1 POLE,20A,DIN RAIL MT, 120V PUMPS PB0682PO2 9516 $95.24 ❑ FUSE,TIME-LAG,5x20 MM, 1A(2000 IDU) HA0038P06 9517 $4.82 Accessway Parts Description Part Number ServiList Code Ce Price ❑ GROMMET,2 PVC.1/4 WALL PB0686PO9 9602 $5.11 ❑ GROMMET 6 IN.(INLET SDR35-3/8 IN WALL) PA0558P12 9606 $67.66 ❑I LID ASM,200 SERIES REPLACEMENT PB0887GO1 9607 $324.15 ❑ VENT SCREEN(FLOOD PLAIN) PB0221PO4 9609 ❑ VENT NIPPLE(THREADED BY GLUE,2 IN PVC X 2.5 IN LG-MUSH VENT KIT) PA0926P02 9610 http://www.eoneezorder.com/Catalog/Product/Views/1stItemsParts.asp?Type=2&Categor... 10/24/2016 Environment One Corporation -2000 Series Grinder Pump Online Configuration Page 13 of 17 ❑ SLIP JOINT NUT,2 PVC PA0946P0l 9611 $7.83 ❑I REPLACEMENT LID ASSEMBLY(2000 SERIES) PC0569G05 9615 $85.15 ❑ HANGER,BREATHER CABLE(2000) PB0624P02 9616 $1.32 ❑ ELECTRICAL SHROUD,TANK(2000) PD0250P0l 9617 $30.51 ❑ HINGE RING FOR TANK LID PA0446P02 9618 $3.08 ❑ 1/4-20x1'BOLTS FOR TANK LID 0073-6016 9619 $0.55 ❑ WASHER,PLAIN,SS 1/4 0706-6002 9620 $0.13 ❑ GROMMET,4'PVC PIPE,1/2 WALL(IDU,DH152,FG...) PB0686P02 9621 $39.58 ❑ 1000 SERIES LID PC0598G01 9623 $405.34 ❑ BAND CLAMP FOR 2000 LID ASSEMBLY PD0253P0l 9624 $160.53 ❑ GROMMET 4 IN.(INLET SDR 35-1/4 IN WALL) PB0686P03 9603 $49.31 ❑ GROMMET 4 IN.(INLET SCH 40-1/4 IN WALL) PB0686P0l 9604 $29.76 ! ❑ COVER KIT,REPLACEMENT LID,D-Series Extreme NC0022G05 9626 $85.15 ❑ GROMMET 6 IN.(INLET SCH40-3/8 IN WALL) PA0558P09 9605 $67.66 Service Center Kits The pricing below is list pricing unless otherwise specified. Description Part Number Service List P Code Price El Tank SPECIAL EQUIPMENT FOR IN-HOUSE SERVICE CENTERS(Dry Well Test PA2074G04 $649.03 Tank for 2000/Extreme Series)-Pricing is net price,no multiplier is to be applied Includes: • 2000/200 Series Test Tank(PC0567G03) • Simplex Sentry Panel,Wired for IH091(SA1A010BOAM) • 2000 Series to Extreme Series Core Adapter(ND0052G06) El CORE(For New Service Centers Only;Not to be Re-sold)-Pricing is net price,no REBUILT $1,211.21 multiplier is to be applied CORE Call factory for availability REQUIRED MINIMUM PARTS STOCK FOR SERVICE CENTERS PA2074G01 $2,814.32 El (2000/1000/AMGP/Extreme Series) REQUIRED SPECIAL TOOLS FOR FIELD SERVICE CENTERS PA2074G02 $510.26 ❑ (2000/1000/Gatorgrinder/AMGP)-Pricing is net price,no multiplier is to be applied REQUIRED SPECIAL TOOLS FOR IN-HOUSE SERVICE CENTERS ❑ (2000/1000/Gatorgrinder/AMGP/Extreme Series)-Pricing is net price,no multiplier is to be PA2074G03 $502.67 applied ❑ TRIPOD PUMP REMOVAL UNIT-Pricing is net price,no multiplier is to be applied PB0483G01 $1,856.94 SPECIAL TOOLS,FIELD SVC CTRS(Extreme/Hard Wred)-Pricing is net price,no multiplier PA2074G06 $1,496.25 Elis to be applied SPECIAL TOOLS,FIELD SVC CTRS(Extreme/Wireless)-Pricing is net,no multiplier is to be PA2074G07 $1,627.51 ❑ applied REQUIRED SPECIAL EQUIPMENT FOR IN-HOUSE SERVICE CENTERS(Wet Well Test ❑ Tank for 1000/AMGP/Gatorgrinder/Extreme Series)-Pricing is net price,no multiplier is to be PA2074G05 $494.61 applied Includes: • W-Series Test Tank(ND0078G01) • Simplex Sentry Panel,Wired for IH091(SAIAO10BOAM) • 2000 Series to Extreme Series Core Adapter(ND0052GO6) Parts with No Service Code Description Part Number CodeCe Price ❑ SEAL PKG KIT,SILICON CARBIDE PA0329G02 $339.35 START SWTCH,240V,50HZ PA0475P05 $55.66 http://www.eoneezorder.com/Catalog/Product/Views/1stItemsParts.asp?Type=2&Categor... 10/24/2016 Environment One Corporation-2000 Series Grinder Pump Online Configuration Page 14 of 17 ❑ 1I ❑ LOCKNUT,3/4 IN.NPT,HUMMEL PA1306P01 $1.50 ❑ CONTACTOR,MOTOR,120V, NA0023P02 $75.32 ❑ EXP TRANSCEIVER ASSEMBLY,240V NB0035GO4 $527.00 ❑ PLUG-DISC,HDPE VENT HUB,2.15 PA1875POl $0.00 ❑ SWITCH,HOA 3POLE/POSN,DIN-RAIL PA1596P02 $397.64 ❑ DEAD FRONT,PROTECT,240V W/SERVICE DISCONNECT NB0082GO4 $161.14 ❑ BRACKET,CONTROL,METERING,240V,EXTREME ND0045G06 $154.37 ❑ IDU BUZZER,SOLID STATE(Buzzer for IDU cover) 0397 $88.64 SC616NL ❑ BATTERY WIRE(FOR 9V BATTERY) PA0839P02 $2.84 ❑ T260 Replacement Board,240V,2P,with SODC and Deadfront PA1880G10 $667.55 ❑ ROTOR ASM(ARMATURE)-FOR ALL ASSEMBLIES(2000) PC0495P02 $408.88 ❑ DEADFRONT ASM,PROTECT PLUS,240V 2P NB0101G02 $305.70 ❑ BRACKET,CONTROLS 120V METERING ND0045G07 $192.87 ❑ HOUR METER FIED INSTALL KIT FOR A T260 IN A FIBERGLASS ENCLOSURE PA1983G03 $337.32 ❑ WASHER,PLAIN,SS,3/8W 0706-8012 $0.42 ❑ HOUR MTR KIT,T260 SENTRY.FIELD INST PA1983G05 $338.78 ❑ ALARM BOARD,FLORIDA KEYS ONLY P130939G25 $214.51 NOTE:THE ABOVE PART IS FOR THE FLORIDA KEYS PROJECT ONLY ❑ 1-1/4 HALF NIPPLE,THREADED X GLUE(USED ON SLIDEFACE RECEIVER PA0179P03 $10.53 ❑ DEADFRONT,8X10,2P,NO PTR PB0954P11 $29.26 ❑ THREADED INSERT,PUSH IN,#8-32,SENTRY DEADFRONT PA2056P01 $1.37 ❑ NUT,STOP(ELASTIC),BRS,318-16 0719-3816B $2.04 ❑ GROMMET,WET WELL VENT PA1507POl $2.70 ❑ HOUR MTR KIT,SENTRY,FIELD INST PA1983G04 $232.51 ❑ Pipe,2 Inch IPS,SDR26,Grey,PVC-Per Foot RPVC-0023 $3.29 ❑ GROMMET,4 DR35,5/8 WALL PB0686P14 $46.08 ❑ 200S AW REPL KIT,NO FLG,2'SIM PC1112G01 $700.44 ❑ 200S AW REPL KIT,FLG,2'SIM PC1112G02 $823.35 ❑ 200S AW REPL KIT,NO FLG,2'DUP PC1112G03 $1,165.21 ❑ 200S AW REPL KIT,FLG,2'DUP PC1112G04 $1,253.00 ❑ 200S AW REPL KIT,NO FLG,3'SIM PC1112G05 $807.57 ❑ 200S AW REPL KIT,FLG,3'SIM PC1112G06 $945.64 ❑ 200S AW REPL KIT,NO FLG,3'DUP PC1112G07 $1,253.18 ❑ 200S AW REPL KIT,FLG,3'DUP PC1112G08 $1,298.86 ❑ Field Joint Kit,WHM1R 48 NA0217G02 $89.25 ❑ J-BOLT,6-INCH TANK EXTENSION NA0327POl $1.78 ❑ GASKET FOR SENSING BELL TESTER PA1006POl $12.02 ❑ GROMMET,6 DR35 PIPE,5/8 WALL PA0558P14 $108.00 ❑ GROMMET,6 DWV PIPE,5/8 WALL PA0558P15 $149.00 ❑ HOSE FLEX DISCH KIT,108,AMGP PC0542GO6 $165.77 ❑ HOSE FLEX DISCH KIT,132,AMGP PC0542GO8 $234.20 http://www.eoneezorder.com/Catalog/Product/V iews/IstltemsParts.asp?Type=2&Categor... 10/24/2016 Environment One Corporation-2000 Series Grinder Pump Online Configuration Page 15 of 17 ❑ HOSE FLEX DISCH KIT,144,AMGP PC0542G09 $246.48 ❑ SWITCH,ROCKER,DF PA1687P03 $11.17 i ❑ BULB,250V,10W,BAYONET PA1189P02 $7.82 ❑ ENCLOSURE ASM,10X12 SENTRY W/DOOR&LAMP PC1165G02 $149.14 I ❑ D-SERIES PRESSURE TEST KIT,SIMPLEX PC0655GO1 $360.50 ElD-SERIES PRESSURE TEST KIT,DUPLEX PC0655G02 $522.21 ❑ GROMMET,4 DWV,5/8 WALL PB0686P13 $39.44 ❑ RELAY ASSEM,DPDT,230V P130875P03 $86.65 ❑ DISCHARGE MANIFOLD,FIELD INST KIT PB0886GO1 $203.05 ❑ AUXILLARY GEN RECEPT WITH MANUAL TRANSFER PA2064POl $309.15 ' ❑ HANDLE,VALVE,LEFT SIDE SWING PC0490P01 $24.58 ❑ Support plate,cast SS Ball Valve(Carbon Steel) PA1275POl $8.91 VALVE ASM,CAST SS,200 SERIES REPLACEMENT,3 BOLTS-Bolts to 200 Series Brass PC0589G02 $368.57 ❑ Flanges VALVE ASM,CAST SS,200 SERIES REPLACEMENT,4 BOLTS-Bolts to 200 Series Cast PC0589GO4 $384.71 ❑ Iron Flanges ❑ HANDLE,VALVE,RIGHT SIDE SWING PC049OP02 $24.58 Pump Stand,5/16 in.Rod,SS,R6.7 in.-Extreme Small Stand for use with 200 Series N60006P03 $31.27 ❑ Replacements(must order 2 each per core) ❑ Control Bracket,Molded Base,Extreme NC0005POl $4.68 ❑ ENCLOSURE ASM,8X10 SENTRY W/DOOR&LAMP PC1165G01 $106.76 ❑ L-Gasket,Top Housing,IH NBO170POl $21.93 ❑ Valve Assembly,Cast Stainless Steel,2014 PC0632G01 $1,095.35 ❑ FITTING,BULKHEAD,3/4 FNPT PA1768POl $42.25 ❑ SCREW,HEX HD,SS,3/8-16X1.50 0073-8024 $1.61 ❑ CABLE ASM,METER PUMP,30 FT NO EQD ND0037G22 $164.15 ❑ SCREW,PH TRUSS HEAD,#8-32 X 3/8 L PA2088P01 $0.59 ❑ RELAY,120V,DPDT,DIN-RAIL MOUNT PB0875PO2 $56.00 ❑ DEADFRONT ASM,PROTECT PLUS,240V 2PW/SD&DUPLEX SENTRY NB0101G04 $323.07 ❑ Discharge,Stainless Steel Receiver Assembly(SS Slide Face Receiver) NC0337G01 $155.00 i ❑ GROMMET,2 IN.PIPE,ADAPTAFLEX PA0558P06 $627 ❑ ALARM DELAY KIT,SIMPLEX PA1786G02 $128.47 ❑ WASHER,PLAIN,TYPE A,SS,#6 0707-3002 $0.14 ❑ HANGER,BREATHER CABLE,COMPENSATION(FOR EQUALIZER) PCO803POl $10.18 ❑ HOOK,SNAP,SS(FOR EQUALIZER) PA1650POl $4.40 ❑ ELBOW,SWAGED,SS,SUBMERSIBLE PC0669PO3 $156.19 ❑ TERMINAL BLOCK,DIN-RAIL,50 AMP PA1412P02 $2.88 ❑ EQD EXTENSION CORD ASM,5' P60579G01 $165.86 ❑ PRESSURE SW,ALARM,JAPAN(ALSO HIGH SPRINGS ON/OFF) PA1016P05 $57.54 ❑ PRESSURE SW,ALARM,2000 JAPAN(ALSO HIGH SPRINGS ALARM) PA1016P09 $74.45 ❑ ADAPTER,1/4BARB FITTING,PVC P130737P02 $15.15 ❑ STATOR,250V,50HZ PC0495PO8 $242.36 I ❑ GG,EQD MOD KIT,BRACKET REMOVAL PB0931G01 $20.00 ❑ T260 Replacement Board,240V,2p,NO SODC,DF PA1880G09 $540.28 http://www.eoneezorder.com/Catalog/ProductfV iews/1stItemsParts.asp?Type=2&Categor... 10/24/2016 Environment One Corporation-2000 Series Grinder Pump Online Configuration Page 16 of 17 ❑ PRESSURE SW,ON/OFF,SPRINGWATER ON/OFF PA1016P11 $74.45 I ❑ PRESSURE SW,ALARM SUBM PA1016P14 $74.45 ❑ D-FRONT,REPL,PS,240V OR 120V,SD(PreSTAT) PB1002G02 $159.22 ❑ CHECK VALVE ASM,W/RED.CHK VALVE(200,2000) PB0104G03 $223.92 ❑ TOP HOUSING,RCV,SERVICEASM(EXTREME) NC0031G03 $458.61 I ❑ SS DISCH CC,SWAGED,USE W/RCV(ALL) PD0296POl $91.75 ❑ GASKET,GREEN WATERTIGHT LID,67.5 PA1130P02 $20.46 ❑ HOSE FLEX DISCH KIT,120in.AMGP PC0542G07 $213.17 ❑ REDUNDANT CHECK VALVE ASM,1-1/4"MALE NPT x 1-1/2"MALE NPT PC0051G03 $45.45 ❑ BACKING PLATE SCREEN PA1314P01 $4.11 i ❑ VALVE ASSEMBLY,CAST,SS,SIMPLEX PC0589G01 $480.18 ❑ TUBING,PVC,CLEAR, 1/4 IN.ID,1/8 IN.WALL PA1627POl $2.12 ❑ BREATHER CABLE ASSEMBLY,AMGP,12 FT. PC0579G10 $417.56 ❑ CONTROL BRACKET BASE FOR 2000/AMGP/IDU PD0299POl $4.68 ❑ ALARM PCB,SENTRY,WITH DEADFRONT,SERVICE 120V1240V PB0939G23 $214.51 ❑ MOTOR WINDING ASM,120/240V,SERVICE PB0711GO4 $254.26 Parts-Shipped in 24 Hours The parts on this list will be shipped from the factory within 24 hours of your order being processed. Description Part Number Service List Code Price ❑ MOTOR WINDING ASM, 120/240V,SERVICE-24 hrparts delivery PB0711 GO4 $254.25 ❑ SENSING BELL-24 hrparts delivery PC0461 P01 1001 $24.66 ❑ SEAL PACKAGE ASM-24 hr parts delivery PA0329G01 1008 $64.74 i ❑ BREATHER VENT,FIELD ASM-24 hrparts delivery PA1325G01 1061 $27.23 ❑ CUTTER WHEEL,MACHINED/HARDENED-24 hrparts delivery NC0008P02 1203 $111.69 ❑ MECHANICAL SEAL KIT w/(4)MAIN O-RINGS&(7)LOCKNUTS-24 hrparts delivery NCO040G01 1208 $50.39 i ❑ TEMP ADAPTER KIT,EXTREME CORE TO 2000 CABLE,1 FT-24 hrparts delivery ND0052G03 1217 $125.34 i i ❑ CASE QTY OF 24:CONTROL BRACKET ASSEMBLY,240 VOLT/60 HZ[5%discount ND0112G01- $5,030.91 reflected in list price]-24 hr parts delivery BX i ❑ MOTOR HOUSING ASSEMBLY,SERVICE WITH MOTOR STATOR/SEAL KIT-24 hr parts NC0036G01 1288 $346.39 delivery ❑ CORD GRIP,3/4 IN NPT,.35-.63(2000,EXTREME EQD,IH)-24 hrparts delivery PA1150P06 3123 $7.13 j ❑ CLAMP,BREATHER(2000)-24 hrparts delivery PA0332P03 3127 $0.29 ❑ BEARING,PUMP END(200,2000,EXTREME)-24 hrparts delivery PA0109POl 5015 $33.38 MOTOR ASM,120/240V,FIELD,ARMATURE,BEARINGS❑ pg0711G01 5033 $663.12(2000,1000,AMGP,SUBMERSIBLE,IDU)-24 hrparts delivery ❑ BEARING,TOP(2000,EXTREME)-24 hrparts delivery PA1181 P01 5035 $73.32 ❑ STUD INSTALLATION KIT(2000),replaces 6029-24 hrparts delivery PA1289G02 1068 $63.33 ❑ GASKET,EQD,AMGP/2000S-24 hrparts delivery PBO576P01 6030 $5.30 ❑ BLUE GROMMET,SS DISCHARGE TO VALVE-24 hrparts delivery PB0503PO2 6034 $4.40 ❑ TOP HOUSING GASKET,MOLDED(2000,IDU)-24 hrparts delivery PC0727P01 6043 $18.08 I ❑ O-RING,CAST AMGP COVER-24 hr parts delivery 0310-269B 6051 $3.43 ❑ O-RING,CASTING 4.975 X 5.525,BUNA N,EXTREME-24 hrparts delivery 0310-429B 6202 $2.80 j i http://www.eoneezorder.com/Catalog/Product/V iews/IstltemsParts.asp?Type=2&Categor... 10/24/2016 Environment One Corporation -2000 Series Grinder Pump Online Configuration Page 17 of 17 ❑ PRESSURE SW,ON/OFF(2000)-24 hrparts delivery PA1016POl 7090 $59.55 ❑ PRESSURE SW,ALARM(2000)-24 hr parts delivery PA1016P02 7091 $59.55 ❑ EQD INSERT,FEMALE(six pin)-24 hrparts;delivery PA1074P03 7094 $23.04 ❑ EQD INSERT,MALE(six pin)-24 hrparts delivery PA1074PO4 7095 $24.84 ❑ CONTACTOR,MOTOR 220V/240V(2000 flat control bracket)-24 hr parts delivery PA1476P01 7104 $57.47 ! ❑ PRESSURE SWTCH,ON/OFF W/O-RINGS-24 hrparts delivery NB0083GO1 7290 $59.55 I ❑ PRESSURE SWITCH,ALARM W/O-RINGS-24 hrparts delivery NB0083GO2 7291 $59.55 I ❑ ROTOR,MACHINED AND POLISHED-24 hrparts delivery PC0054P02 8008 $163.75 ❑ CASE QTY OF 30:STATOR/LINER ASSY,EXTREME[5%discount reflected in list price]-24 NC0039G01- $2,298.00 j hr parts delivery BX ❑ CASE QTY OF 24:CONTROL BRACKET ASM,240V(2000)[5%discount reflected in list PB0702G01- $5,030.91 i price]-24 hrparts delivery BX ❑ CONVERSION KIT,200 SERIES TANK with EXTREME CORE,PERMANENT-24 hr parts ND0059G01 $86.32 delivery ❑ O—RING,MOTOR(2000)-24 hr parts delivery 0310-261 B 6039 $1.68 ❑I SEAL,LEVEL SENSING HOUSING,EXTREME-24 hr parts delivery NB0043POl 6203 $3.39 ❑ O—RING FOR CABLE CONNECTOR(2000,AMGP, 1000,EXTREME)-24 hrparts delivery 0310-214B 6041 $0.55 i ❑ Conversion Kit,2000 Series Tank with EXTREME Core,Permanent-24 hrparts delivery ND0058G01 1224 $64.47 Cancel Next» Environment,One Corporation 1 2773 BalBown Road.Niskayuna,New York 123309-1090 1 Voice:518.346.6161 1 FAX:518.346.6187 http://www.eoneezorder.com/Catalog/Product/Views/1stltemsParts.asp?Type=2&Categor... 10/24/2016 MASON COUNTY BRIEFING ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS FROM: Jerry W. Hauth, P.E, Director/County Engineer DEPARTMENT: Public Works EXT: 450 BRIEFING DATE: November 19, 2018 PREVIOUS BRIEFING DATES: (If this is a follow-up briefing,please provide only new information,) ITEM: Call for Bids: Asphalt Emulsion for 2019 EXECUTIVE SUMMARY: Emulsified asphalt is utilized for road maintenance. We normally bid for prices and utilize asphalt emulsion as needed, where needed. RECOMMENDED OR REQUESTED ACTION: Recommend the Board of County Commissioners authorize Public Works to advertise, set bid opening date/time, award contract, and allow Chair to sign all pertinent documents for call for bids to furnish Mason County with Asphalt Emulsion for 2019. Contract awards will be announced during a regular meeting of the Board. Attachments: None Briefing Summary MASON COUNTY BRIEFING ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS FROM: Jerry W. Hauth, RE, Director/County Engineer DEPARTMENT: Public Works EXT: 450 BRIEFING DATE: November 19, 2019 PREVIOUS BRIEFING DATES: (If this is a follow-up briefingplease provide only new information,) ITEM: Call for Bids: 2019 Paint Line EXECUTIVE SUMMARY: The 2019 striping service provider will perform all striping for our maintenance program. Our striping program consists of approximately 340 miles of roadway. We normally paint approximately half the mileage in mid-June, weather permitting and the remainder in late-August following the completion of our chipseal program. Striping has normally required two weeks in June and one week in August. RECOMMENDED OR REQUESTED ACTION: Recommend the Board of Commissioners authorize Public Works to advertise, set bid date/time, award contract and allow the Chair to sign all pertinent documents for routine Paint Line for 2019. The contract award will be announced during a regular meeting of the Board of County Commissioners. Attachments: None MASON COUNTY BRIEFING ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS FROM: Jerry W. Hauth, P.E, Director/County Engineer DEPARTMENT: Public Works EXT: 450 BRIEFING DATE: November 19, 2018 PREVIOUS BRIEFING DATES: (If this is a follow-up briefing, please provide only new information,) ITEM: Call for Bids: Manufacturing and Stockpiling of Chipseal Aggregate for 2019 EXECUTIVE SUMMARY: The approximate quantities of materials to be manufactured and stockpiled: . 12,000 Tons of 1/2"— Manufacturing and Stockpiling Chipseal Aggregate RECOMMENDED ACTION: Recommend the Board of County Commissioners authorize Public Works to advertise, set bid opening date/time, award contract and allow Chair to sign all pertinent documents for the 2019 Manufacturing and Stockpiling of Chipseal Aggregate. Contract awards will be announced during a regular meeting of the Board. Attachments: None MASON COUNTY BRIEFING ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS FROM: Jerry W. Hauth, P.E, Director/County Engineer DEPARTMENT: Public Works EXT: 450 BRIEFING DATE: November 19, 2018 PREVIOUS BRIEFING DATES: (If this is a follow-up briefing,please provide only new information,) ITEM: Call for Bids: Asphaltic Materials for 2019 EXECUTIVE SUMMARY: The purpose of the call for bids is to solicit bids for the procurement of road maintenance materials use by Mason County Public Works. The annual purchases of these materials are expected to exceed $50,000; therefore a formal competitive bidding is required. As per RCW 36.32.256, the county reserves the right to award the bid to more than one vendor, per item, when hauling distance is a factor. Mason County does not guarantee a minimum purchase of these materials. Pricing will be fixed for this time period. RECOMMENDED OR REQUESTED ACTION: Recommend the Board authorize Public Works/ER&R to advertise, set bid opening date/time, award and allow Chair to sign all pertinent documents for the call for bids to furnish Mason County with Asphaltic Materials. Contract award(s) will be announced at a scheduled meeting of the Board of Mason County Commissioners. Attachments: None MASON COUNTY BRIEFING ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS FROM: Jerry W. Hauth, P.E, Director/County Engineer DEPARTMENT: Public Works EXT: 450 BRIEFING DATE: November 19, 2018 PREVIOUS BRIEFING DATES: (if this is a follow-up briefing,please provide only new information,) ITEM: Call for Bids: Culvert Pipes and Culvert Linings for 2019 EXECUTIVE SUMMARY: The purpose of the call for bids is to solicit bids for the procurement of culvert pipes and/or culvert linings used by Mason County Public Works. The annual purchases of these materials may exceed $50,000; therefore a formal competitive bidding process is required. As per RCW 36.32.256, the county reserves the right to award the bid to more than one vendor, per item, when hauling distance is a factor. Mason County does not guarantee a minimum purchase of these materials. Pricing will be fixed for this time period. RECOMMENDED OR REQUESTED ACTION: Recommend the Board authorize Public Works/ER&R to advertise, set bid opening, award, sign contract, if needed, and allow Chair to sign all pertinent documents for the call for bids to furnish Mason County with culvert pipe and linings. Contract award(s) will be announced at a scheduled meeting of the Board of Mason County Commissioners. Attachments: None MASON COUNTY BRIEFING ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS FROM: Jerry W. Hauth, P.E, Director/County Engineer DEPARTMENT: Public Works EXT: 450 BRIEFING DATE: November 19, 2018 PREVIOUS BRIEFING DATES: (If this is a follow-up briefing, please provide only new information,) ITEM: Vendor List for Road Maintenance Surfacing Materials for 2019 EXECUTIVE SUMMARY: Public Works would like to open our annual solicitation to prospective suppliers in order to establish a "Surfacing Materials Vendor List" for various types and smaller quantities of rock and sand to be used on projects throughout Mason County, on an as needed basis. Having an active vendor list with set prices will enable Mason County Public Works to evaluate relative costs from multiple suppliers and ensure an efficient and most cost effective method. All materials quoted must meet the specifications included in the solicitation and should generally be available at the supplier's source. After vendor quotations are received, Public Works will finalize the list of qualified suppliers. Material suppliers placed on the approved vendor list are expected to honor their agreed unit prices; however, Mason County does not guarantee a minimum purchase of materials. RECOMMENDED OR REQUESTED ACTION: Recommend the Board authorize Public Works to use written and/or telephone solicitations to establish a 2019 Surfacing Materials unit pricing vendor list. Attachments: None MASON COUNTY BRIEFING ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS FROM: Jerry W. Hauth, RE, Director/County Engineer DEPARTMENT: Public Works EXT: 450 BRIEFING DATE: November 19, 2018 PREVIOUS BRIEFING DATES: (If this is a follow-up briefing,please provide only new information,) ITEM: Vendor List for Vehicle and Equipment Tire Repair and Towing Services for the 2019 EXECUTIVE SUMMARY: Public Works/ER&R would like to open our annual solicitation to prospective vendors for vehicle and equipment tire repair and towing services for the 2019 calendar year. These services are utilized on an 'gas needed" basis and solicited annually. The services may be awarded to several companies. RECOMMENDED OR REQUESTED ACTION: Recommend the Board authorize for Public Works/ER&R to use written and/or telephone solicitations for tire repair and towing services for the 2019 calendar year and sign and award contract(s). Mason County does not guarantee a minimum purchase of these services. Attachments: None Briefing Summary MASON COUNTY BRIEFING ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS FROM: Kell Rowen, Planning Manager DEPARTMENT: Community Services EXT: 286 BRIEFING DATE: November 19, 2018 PREVIOUS BRIEFING DATES: None ITEM: Place on November 27, 2018 Action Agenda to publish a Notice of Hearing for December 18, 2018 to consider adopting the Public Benefit Rating System. EXECUTIVE SUMMARY: The Mason County Planning Advisory Commission voted (4-0) to recommend approval of the Public Benefit Rating System. The BOCC made recommended changes during their scheduled briefing on October 16, 2018 and remanded the PBRS back to the PAC. PAC is holding a public hearing on November 19, 2018 to consider BOCC changes and is expected to make a recommendation of approval. The PAC vote and subsequent draft PBRS will be briefed before the BOCC prior to the BOCC Public Hearing date of December 18, 2018. BUDGET IMPACTS: The PBRS will change the way property tax reductions are applied under the current Open Space program. RECOMMENDED OR REQUESTED ACTION: Approval to place on November 27, 2018 Action Agenda a Notice of Public Hearing for December 18, 2018 to consider adopting the PBRS. ATTACHMENTS: Notice of Hearing Briefing Summary 11/14/2018 NOTICE OF HEARING NOTICE IS HEREBY GIVEN that the Board of Mason County Commissioners will hold a public hearing at the Mason County Courthouse Building I, Commission Chambers, 411 North Fifth Street, Shelton, WA 98584 on Tuesday, December 18, 2018, at 9:30 A.M. SAID HEARING will be to consider adopting the Public Benefit Rating System If you have questions, please contact Kell Rowen (360) 427-9670, Ext. 286. If special accommodations are needed, please contact the Commissioners' office, 427- 9670, Ext. 419. DATED this 27th day of November 2018 BOARD OF COUNTY COMMISSIONERS MASON COUNTY, WASHINGTON Clerk of the Board cc: Journal- Publish 2x: December 6& 13, 2018 (Bill: Community Development—615 W. Alder,Shelton, WA 98584) MASON COUNTY BRIEFING ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS FROM: David Windom DEPARTMENT: MCCS EXT: 260 BRIEFING DATE: Nov 19, 2018 PREVIOUS BRIEFING DATES: If this is a follow-up briefing, please provide only new information N/A ITEM: Water Resources Streamflow Restoration Project Planning Grant EXECUTIVE SUMMARY: (If applicable, please include available options and potential solutions): • Provides monetary support for the county requirement to participate in planning efforts in WRIA's 14, 15 and 22 per ESSB 6091, sections 202 and 203. • This grant will provide funding for research and data collection for decision making BUDGET IMPACTS: Increase of$92,300 for a revised maximum consideration of$92,300 RECOMMENDED OR REQUESTED ACTION: Approve ATTACHMENTS: Water Resources Streamflow Restoration Project Planning Grant Application Briefing Summary 11/9/2018 WATER RESOURCES STREAMFLOW RESTORATION PROJECT PLANNING GRANT Organization: Mason County Community Services WRSRPPG-2018-MACoCs-00046 General Information Project Title Water Resources Streamflow Restoration Planning for WRIA 14, 15, and 22 Project Short Description WRSRPPG-2018-MACoCs-00046, Water Resources Streamflow Restoration Planning for WRIA 14, 15, and 22. This grant supports the planning and committee work necessary to meet the requirements of ESSB 6091 by providing the financial resources for Mason County to conduct the bulk of the planning and regulation writing that supports having a plan for regulation, restoration and enhancement in WRIAs 14,15, and 22. Project Long Description The grant allows Mason County staff to meet the requirements of ESSB 6091 to support and participate in watershed restoration and enhancement as required in sections 202 and 203. Staff will support the activities of the committee by developing and presenting research, evaluating current regulations and developing regulations that meet committee needs. These funds also provide county staff the ability to work with tribes on research around instream flows both currently and historically, the number and location of exempt wells, develop long range estimates of consumptive water uses, and use these results to inform the committee decisions. The staff will use these funds to develop the science and math to ensure that decision making is fact based and supported by measurable standards that will serve as goals posts into the near future while ensuring that development can take place for the estimated influx of more than 22,000 in population growth over the next 20 years. Total Cost $92,300.00* Total Eligible Cost$92,300.00* Effective Date. 1/19/2018 Expiration Date 6/30/2019 Ecology Water Resources Program Project Category v Streamflow Restoration Grant Will Environmental Monitoring Data be collected? Overall Goal The over all goal of this process is to have a completed agreement between the committee members that will provide guidance on watershed management and restoration for WRIA's 14,15, and 22. This work will lead to agreement on regulation and mitigation projects under both 202 and 203 sections of ESSB 6091. By having a completed agreement before the deadline it avoids the process having to move to Ecology for rule making. 11/09/2018 Page 1 of 2 WATER RESOURCES STREAMFLOW RESTORATION PROJECT PLANNING GRANT Organization: Mason County Community Services WRSRPPG-2018-MACoCs-00046 Project Characterization Project Themes Select a primary and secondary theme that best describes the work to be achieved during this project. Primary Theme: Water Supply Secondary Theme(s): Streamflow Restoration Streamflow Restoration Project Website If your project has a website, please enter the web address below. After entering a website and saving, another blank row will appear. Up to three websites may be provided. Website Title/Name Web Address WRIA 14 https://www.ezview.wa.gov/site/alias_1962/37326/w atershed restoration and enhancement - wria 14. aspx 11/09/2018 Page 2 of 2 r WATER RESOURCES STREAMFLOW RESTORATION PROJECT PLANNING GRANT Organization:Mason County Community Services WRSRPPG-2018-MACoCs-00046 Recipient Contacts Project Manager David Windom Contact Information David Windom Director 615 West Alder Shelton,Washington 98584 (360)427-9670 dwindom@co.mason.wa.us Authorized Signatory David Windom Contact Information David Windom Director 615 West Alder Shelton,Washington 98584 (360)427-9670 dwindom@co.mason.wa.us Billing Contact Kathy Chaussee Contact Information Kathy Chaussee 615 West Alder Shelton,Washington 98584 (360)427-9670 11/09/2018 Page 1 of 7 WATER RESOURCES STREAMFLOW RESTORATION PROJECT PLANNING GRANT Organization:Mason County Community Services WRSRPPG-2018-MACoCs-00046 Recipient Contacts kathyc@co.mason.wa.us Other recipient signatures on printed agreement Name Title 11/09/2018 Page 2 of 7 WATER RESOURCES STREAMFLOW RESTORATION PROJECT PLANNING GRANT Organization:Mason County Community Services WRSRPPG-2018-MACoCs-00046 Scope of Work-Task 1 Project Admin:1 Task Number 1 Task Title Project Administration/Management Task Cost $46,150.00 Task Description A.The RECIPIENT will administer the project.Responsibilities will include,but not be limited to: maintenance of project records;submittal of requests for reimbursement and corresponding backup documentation,progress reports and recipient closeout report(including photos);compliance with applicable procurement,contracting,and interlocal agreement requirements;application for,receipt of,and compliance with all required permits,licenses,easements,or property rights necessary for the project;and submittal of required performance items. B.The RECIPIENT must manage the project.Efforts will include:conducting,coordinating,and scheduling project activities and assuring quality control.Every effort will be made to maintain effective communication with the RECIPIENT's designees;the DEPARTMENT;all affected local, state,or federal jurisdictions;and any interested individuals or groups.The RECIPIENT must carry out this project in accordance with any completion dates outlined in this agreement. dsk Goal Statement Properly managed project that meets agreement and Ecology administrative requirements. Task Expected Outcomes *Timely and complete submittal of requests for reimbursement,quarterly progress reports and recipient closeout report. Properly maintained project documentation Recipient Task Coordinator David Windom To Add a Row To Delete a Row Enter a deliverable Delete data entered in a row When done,click the SAVE button When done,click the SAVE button After SAVE a new row will appear Repeat these steps for each deliverable Deliverable# Description Due Date Received? EIM Study ID EIM System Link Latitude Longitude Location Address (ECY Use 11/09/2018 Page 3 of 7 WATER RESOURCES STREAMFLOW RESTORATION PROJECT PLANNING GRANT Organization:Mason County Community Services WRSRPPG-2018-MACoCs-00046 Scope of Work-Task 1 Project Admin:1 Only) 1.1 Progress Reports 1/30/2019 1.2 Recipient Closeout Report 6/30/2019 11/09/2018 Page 4 of 7 1 WATER RESOURCES STREAMFLOW RESTORATION PROJECT PLANNING GRANT Organization:Mason County Community Services WRSRPPG-2018-MACoCs-00046 Scope of Work-Additional Tasks:2-Watershed assesment and data collection Task Number 2 Task Title Watershed assesment and data Task Cost $46,150.00* collection Task Description Task Description This task will provide the watershed restoration and enhancement committee with mathematical models and data by evaluating previous work from the mid-2000's,current literature,providing a parcel specific water usage model that can be extrapolated to greater than single parcel areas,modeling the use of rainwater captured by elevated impervious surfaces to offset consumptive use,determining consumptive use and differentiating seasonal uses,estimations of irrigation and irrigation impacts,as well other data. The information will include population growth estimates,population growth estimations by areas within the county,and determining which types of water supplies will support new development while inventorying current service provisions. This task takes the hypothetical"exempt well use has eventual and cumulative Impacts on stream flow", attempts to measure that hypothetical and then look at low impact development as a"positive eventual and cumulative influencer of in stream flows." Task Goal Statement Task Goals The goal is to provide the committee with useful,measurable,data and mitigation measures to develop the watershed management plan.This information should be timely,accurate,and present both the impacts to streams both positive and negative as well as impacts to development. The ultimate goal is to have a watershed management plan that all partners can agree to support in order to prevent the implementtaion of the provisions of ESSB 6091 that would turn rule making over to Ecology to develop and implement. This task fulfills the county requirement to participate in watershed management,restoration and enhancement at outlined in sections 202 and 203 of ESSB 6091. 11/09/2018 Page 5 of 7 1 WATER RESOURCES STREAMFLOW RESTORATION PROJECT PLANNING GRANT Organization:Mason County Community Services WRSRPPG-2018-MACoCs-00046 Scope of Work-Additional Tasks:2-Watershed assesment and data collection Task Expected Outcomes This task will provide the committee with background information,literature review,an assessment of current populations,future populations and an estimation of the locations where future development will occur.A model of consumptive use and mitigation measures that can be extrapolated to larger geographic areas will be developed. Recipient Task Coordinator David Windom Deliverables Deliverable# Description Due Date Received? EIM Study ID EIM System Link Latitude Longitude Location (ECY Use Address Only) 2.1 Conduct a review 12/31/2018 of past work on this watershed concentrating on WRIA 14.Review the previous plan which was submitted but not approved. 2.2 Develop a parcel 3/31/2019 specific water model that looks at the changes in water when property is developed. 2.3 Provide population 12/31/2018 growth estimates and expected development 11/09/2018 Page 6 of 7 WATER RESOURCES STREAMFLOW RESTORATION PROJECT PLANNING GRANT Organization:Mason County Community Services WRSRPPG-2018-MACoCs-00046 Scope of Work-Additional Tasks:2-Watershed assesment and data collection patterns to the committee. 2.4 Assess the 6/1/2019 potential impacts of low impact development as mitigation to residential water use. 11/09/2018 Page 7 of 7 4 WATER RESOURCES STREAMFLOW RESTORATION PROJECT PLANNING GRANT Organization: Mason County Community Services WRSRPPG-2018-MACoCs-00046 Scope of Work Summary Task Title Task Cost Project Administration/Management $46,150.00 Watershed assesment and data $46,150.00 collection Total $92,300.00 Total Eligible Costs (from the General Information Form) $92,300.00 11/09/2018 Page 1 of 3 i WATER RESOURCES STREAMFLOW RESTORATION PROJECT PLANNING GRANT Organization: Mason County Community Services WRSRPPG-2018-MACoCs-00046 Budget Proposal Estimate your proposal's total budget needs by task and by element for State Fiscal Year(FY) 1, FY 2 and beyond. 2017-July 1, 2016 to June 30, 2017 2018-July 1, 2017 to June 30, 2018 2019 -July 1, 2018 to June 30, 2019 2020-July 1, 2019 to June 30, 2020 2021 -July 1, 2020 to June 30, 2021 2022-July 1, 2021 to June 30, 2022 Total Eligible Costs (from General Information form) $92,300.00 Bv Task Task Title Task Cost FY 1 FY 2 Additional Fiscal Years Total 2018 2019 Project $46,150.00 $23,075.00 $23,075.00 $46,150.00 Administration/Man agement Watershed $46,150.00 $23,075.00 $23,075.00 $46,150.00 assesment and data collection Total $92,300.00 $46,150.00 $46,150.00 $0 $92,300.00 ly Element dement FY 1 FY 2 Additional Fiscal Years F Total (2018) (2019) Salaries- 1 $0 $0 Benefits- 1 $0 $0 Salaries and Benefits Combined $32,860.00 $32,860.00 $65,720.00 - 1 Contracts $0 Travel $250.00 $250.00 $500.00 Equipment-2 $0 Goods/services-3 $4,000.00 $4,000.00 $8,000.00 Overhead -4 $9,040.00 $9,040.00 $18,080.00 Total $46,150.00 $46,150.00 $0 $92,300.00 If you receive a grant, you are responsible for procuring professional, personal, or other services using sound business judgment and good administrative procedures consistent with applicable state, and local laws, orders, regulations, and permits. This includes issuance of invitation of bids, requests for proposals, selection of contractors, award of sub-agreements, and other related procurement matters. 1 Fill in either the"Salaries"field and the "Benefits" field or fill in the"Salaries and Benefits Combined" field ! Upload an itemized list of all equipment, its cost, and explain why the equipment is needed. 11/09/2018 Page 2 of 3 1 WATER RESOURCES STREAMFLOW RESTORATION PROJECT PLANNING GRANT Organization: Mason County Community Services WRSRPPG-2018-MACoCs-00046 Budget Proposal Equipment is defined as tangible, personal property with a useful life of more than one year and an acquisition cost of more than $ 5,000 per functional unit or system. Equipment will be tracked on the Equipment Purchase Report in EAGL. 3 Upload an itemized list of all Goods and Services 4 Overhead cannot exceed the rate identified in the Ecology publication—Administrative Requirements for Recipients of Ecology Grants and Loans Managed in EAGL, current version. Upload Documents Click the Browse button Select your file Click Save, your file will appear in the List of uploaded documents Repeat for each file To Delete a file, select the Delete checkbox next to the file and click SAVE Additional Comments 11/09/2018 Page 3 of 3 MASON COUNTY BRIEFING ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS FROM: David Windom DEPARTMENT: MCCS EXT: 260 BRIEFING DATE: Nov 19, 2018 PREVIOUS BRIEFING DATES: If this is a follow-up briefing, please provide only new information N/A ITEM: Medicaid Administrative Claiming Grant EXECUTIVE SUMMARY: (If applicable, please include available options and potential solutions): To support Medicaid related outreach activities performed by Local Health Jurisdictions to Washington State Medicaid eligible residents within its jurisdiction. This is a continuation of the current contract. BUDGET IMPACTS: Increase depends on the numbers of contacts made. Low estimates are around $20,00 with high estimates of$35,000 RECOMMENDED OR REQUESTED ACTION: Approve ATTACHMENTS: HCA Contract Number K3072 Briefing Summary 11/9/2018 Washington StateCONTRACT Health Care thorny for HCA Contract Number: K3072 Local Health Jurisdiction THIS AGREEMENT made by and between Washington State Health Care Authority, hereinafter referred to as "HCA," and the party whose name appears below, hereinafter referred to as the "Contractor." CONTRACTOR NAME CONTRACTOR doing business as(DBA) Mason County Health Dept. CONTRACTOR ADDRESS WASHINGTON UNIFORM Post Office Box 1666 BUSINESS IDENTIFIER(UBI) Shelton, WA 98584 CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR E-MAIL ADDRESS Lydia Buchheit (360)427 9670 x404 I diab co.mason.wa.us HCA PROGRAM HCA DIVISION/SECTION Medicaid Administrative Claiming MAC HCS HCA CONTACT NAME AND TITLE HCA CONTACT ADDRESS Jon Brogger PO Box 45506 Olympia,WA 98504 HCA CONTACT TELEPHONE HCA CONTACT E-MAIL ADDRESS 360 725-1647 1 jon.brogger@hca.wa. ov IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF CFDA NUMBER(S) FFATA Form THIS CONTRACT? 93.778 Required ®YES []NO I [-]YES ®NO CONTRACT START DATE CONTRACT END DATE TOTAL MAXIMUM CONTRACT January 1,2019 December 31,2020 AMOUNT No max PURPOSE OF CONTRACT: The purpose of this Contract is to support Medicaid related outreach and linkage activities performed by Local Health Jurisdictions LHJ to Washington State residents who live within its jurisdiction. ATTACHMENTS/EXHIBITS. When the box below is marked with an X,the following Exhibits/Attachments are attached and are incorporated into this Contract Amendment by reference: ❑ Exhibit(s)(specify): ® Attachment(s)(specify): Attachment 1 —Federal Compliance, Certification and Assurances Attachment 2—MAC Coordinator Manual (Incorporated by reference) ® Schedule(s)(specify):Schedule A—Statement of Work ❑ No Exhibits/Attachments The terms and conditions of this Contract are an integration and representation of the final, entire and exclusive understanding between the parties superseding and merging all previous agreements, writings, and communications, oral or otherwise, regarding the subject matter of this Contract. The parties signing below warrant that they have read and understand this Contract, and have authority to execute this Contract. This Contract shall be binding on HCA only upon si nature bv HCA. CONTRACTOR SIGNATURE PRINTED NAME AND TITLE DATE SIGNED HCA SIGNATURE PRINTED NAME AND TITLE DATE SIGNED TABLE OF CONTENTS 1 OVERVIEW.................................................................................................................................4 1.1 PURPOSE................................................................................................................................4 1.2 STATEMENT OF WORK (SOW) .............................................................................................4 2 SPECIAL TERMS AND CONDITIONS.......................................................................................4 2.1 TERM.......................................................................................................................................4 2.2 COMPENSATION AND PAYMENT.........................................................................................4 2.3 BILLING AND INVOICE...........................................................................................................5 2.4 CONTRACT MANAGER CONTACT INFORMATION..............................................................6 2.5 NOTICES .................................................................................................................................6 2.6 ORDER OF PRECEDENCE ....................................................................................................7 3 GENERAL TERMS AND CONDITIONS.....................................................................................8 3.1 DEFINITIONS...........................................................................................................................8 3.2 ACCESS TO DATA..................................................................................................................9 3.3 ADVANCE PAYMENT PROHIBITED.......................................................................................9 3.4 AMERICANS WITH DISABILITIES ACT(ADA)OF 1990, PUBLIC LAW 101-336, also referred to as the "ADA"28 CFR Part 35............................................................................................9 3.5 ASSIGNMENT..........................................................................................................................9 3.6 ATTORNEYS' FEES..............................................................................................................10 3.7 CHANGE IN STATUS............................................................................................................10 3.8 CONFIDENTIAL INFORMATION.PROTECTION ..................................................................10 3.9 CONFIDENTIAL BREACH - REQUIRED NOTIFICATION....................................................10 3.10 CONFLICT OF INTEREST.....................................................................................................11 3.11 CONFORMANCE...................................................................................................................11 3.12 COVENANT AGAINST CONTINGENT FEES .......................................................................11 3.13 DEBARMENT.........................................................................................................................12 3.14 DISPUTES .............................................................................................................................12 3.15 FORCE MAJEURE.................................................................................................................12 3.16 GOVERNING LAW.................................................................................................................12 3.17 INDEMNIFICATION ...............................................................................................................13 3.18 INDEPENDENT CAPACITY OF THE CONTRACTOR..........................................................13 3.19 INDUSTRIAL INSURANCE COVERAGE ..............................................................................13 3.20 INSURANCE..........................................................................................................................14 3.21 LEGAL AND REGULATORY COMPLIANCE.........................................................................14 3.22 LICENSING, ACCREDITATION AND REGISTRATION........................................................14 3.23 LIMITATION OF AUTHORITY ...............................................................................................15 3.24 NO THIRD-PARTY BENEFICIARIES ....................................................................................15 3.25 NONDISCRIMINATION..........................................................................................................15 3.26 OVERPAYMENT AND ASSERTION OF LIEN ......................................................................15 3.27 PUBLICITY..............................................................................................................................15 3.28 RECORDS, DOCUMENTS, AND REPORTS........................................................................15 3.29 REGISTRATION WITH DEPARTMENT OF REVENUE........................................................16 3.30 REMEDIES NON-EXCLUSIVE..............................................................................................16 3.31 RIGHT OF INSPECTION .......................................................................................................16 3.32 RIGHTS IN DATA/COPYRIGHT............................................................................................16 3.33 SAFEGUARDING OF INFORMATION ..................................................................................17 3.34 SEVERABILITY......................................................................................................................17 3.35 SITE SECURITY....................................................................................................................17 Washington State Page 2 of 49 Contract No. K3072 Health Care Authority 3.36 SUBCONTRACTING..............................................................................................................17 3.37 SUBRECIPIENT.....................................................................................................................18 3.38 SURVIVABILITY.....................................................................................................................19 3.39 SYSTEM SECURITY.............................................................................................................19 3.40 TAXES....................................................................................................................................19 3.41 TERMINATION.......................................................................................................................19 3.42 WAIVER.................................................................................................................................22 Schedules Schedule A: Statement of Work (SOW) Attachments Attachment 1 — Federal Compliance, Certification and Assurances Attachment 2—MAC Coordinator Manual (Incorporated by reference) Washington State Page 3 of 49 Contract No. K3072 Health Care Authority 1 OVERVIEW 1.1 PURPOSE The purpose of this Contract is to support Medicaid related outreach and linkage activities performed by Local Health Jurisdictions (LHJ)to Washington State residents who live within its jurisdiction. These activities assist residents who have no or inadequate medical coverage, and includes explaining the benefits of the Medicaid program, assisting them in the Medicaid application and renewal processes, and linking them to Medicaid covered services. This Agreement provides a process for partially reimbursing the Contractor for the time its staff spend performing Medicaid Administrative Claiming (MAC) activities. 1.2 STATEMENT OF WORK (SOW) The Contractor shall provide the goods and/or services and staff as described in Schedule A, Statement of Work. 2 SPECIAL TERMS AND CONDITIONS 2.1 TERM Subject to its other provisions, the Term under this Contract shall be from January 1, 2019 through December 31, 2020 unless terminated sooner as provided herein. HCA, at its sole discretion, may extend this Contract for three (3)additional one-year periods unless terminated sooner as provided herein. Work performed without a contract or amendment, signed by authorized representative of both parties, shall be at the sole risk of the Contractor. HCA shall not pay any costs incurred before a contract or any subsequent amendment is fully executed. 2.2 COMPENSATION AND PAYMENT - Compensation payable to the Contractor for satisfactory performance of the work under this Agreement will be made on a cost reimbursement bases and shall be based on the following: 2.2.1 There is no maximum consideration payable to the Contractor under the Agreement; 2.2.2 The Federal Financial Participation Rate shall be: 2.2.2.1 50%, except; 2.2.2.2 75%for appropriately documented Skilled Professional Medical Personnel and appropriately documented Interpreter staff. See Schedule A, Section 9, d and g, and Section 10. 2.2.3 Federal funds disbursed through this Contract were received by HCA through OMB Catalogue of Federal Domestic Assistance (CFDA) Number: 93.778. Contractor agrees to comply with applicable rules and regulations associated with these federal Washington State Page 4 of 49 Contract No. K3072 Health Care Authority funds and has signed Attachment 1, Federal Compliance, Certification and Assurances, attached. 2.2.4 HCA will not issue reimbursement for any quarters where HCA receives credible evidence or suspected evidence of a system failure that has the potential to impact the integrity of the reimbursement request. This includes but is not limited to failures related to the time study, MER calculation, claim calculation, or reconciliation. 2.2.4.1 HCA will pursue corrective action as needed, and will restore payment after any issues related to the reimburmsent request are resolved, and the requested amount is accurate. 2.3 BILLING AND INVOICE Contractor shall submit correct invoices to the HCA Contract Manager for all amounts to be paid by the HCA hereunder. All invoices submitted must meet with the approval of the Contract Manager or his/her designee prior to payment, which approval shall not be unreasonably withheld. Contractor shall only submit invoices for Services or Deliverables as permitted by this section of the Contract. The Contractor shall not bill the HCA for services performed under this Contract, and the HCA shall not pay the Contractor if the Contractor is entitled to payment or has been or will be paid by any other source, including grants, for such services/deliverables. Contractor shall submit properly itemized invoices to include the following information, as applicable: 2.3.1 HCA Contract number K3072; 2.3.2 Contractor name, address, phone number; 2.3.3 Description of Services; 2.3.4 Date(s)of delivery; 2.3.5 Net invoice price for each item; 2.3.6 Applicable taxes; 2.3.7 Total invoice price; and 2.3.8 Payment terms and any available prompt payment discount. HCA will return incorrect or incomplete invoices, to the Contractor for correction and reissue. The Contract Number must appear on all invoices, bills of lading, packages, and correspondence relating to this Contract. Invoices shall describe and document to the HCA's satisfaction, a description of the work performed; the progress of the project; and fees. If expenses are invoiced, provide a detailed breakdown of each type. Payment shall be considered timely if made by the HCA within thirty(30)days of receipt of properly completed invoices. Payment shall be sent to the address designated by the Contractor. (Note: Failure to submit a properly completed IRS form W-9 may result in delayed payments.) Upon expiration of the Contract, any claims for payment for costs due and payable under this Contract that are incurred prior to the expiration date must be submitted by the Washington State Page 5 of 49 Contract No. K3072 Health Care Authority Contractor to HCA within sixty (60) days after the Contract expiration date. Belated claims shall be paid at the discretion of the HCA and are contingent upon the availability of funds. The HCA may, in its sole discretion, terminate the Contract or withhold payments claimed by the Contractor for services rendered if the Contractor fails to satisfactorily comply with any term or condition of this Contract. HCA will not make advance payments or payments in anticipation of services or supplies to be provided under this Contract. Electronic Payment: The State of Washington prefers to utilize electronic payment in its transactions. Contractor will be expected to register as a statewide vendor. This allows Contractors to receive payments from all participating state agencies by direct deposit, which is the State's preferred method of payment. Forms necessary for registration can be obtained at www.ofm.wa.gov. 2.4 CONTRACT MANAGER CONTACT INFORMATION The individuals listed below, or their successors shall be the main points of contact for services provided under this Contract. HCA's Contract Manager or his/her successor is responsible for monitoring the Contractor's performance and shall be the contact person for all communications regarding contract performance, deliverables, and invoices. The Contract Manager has the authority to accept or reject the services provided and if satisfactory, certify acceptance of each invoice submitted for payment. Notifications regarding changes to this section must be in writing (e-mail) and maintained in the project file, but will not require a formal contract amendment. The Contract Manager for HCA is: Name: Jon Brogger Title: Program Manager Address: PO Box 45506 Olympia, WA 98501 Email: jon.brogger@hca.wa.gov Phone: 360-725-1647 The Contract Manager for Contractor is: Name: Lydia Buchheit Title: Address: Post Office Box 1666 Shelton, WA 98584 Email: lydiab@co.mason.wa.us Phone: (360)427 9670 x404 2.5 NOTICES Whenever one party is required to give notice to the other under this Contract, it shall be deemed given if mailed by United States Postal Services, registered or certified mail, return receipt requested, postage prepaid and addressed as follows: 2.5.1 In the case of notice to the Contractor, notice will be sent to: Washington State Page 6 of 49 Contract No. K3072 Health Care Authority Attention: Lydia Buchheit Mason County Health Dept. Post Office Box 1666 Shelton, WA 98584 2.6.2 In the case of notice to HCA, send notice to: Attention: Contract Administrator Health Care Authority Division of Legal Services Contract Services Post Office Box 42702 Olympia, WA 98504-2702 2.5.3 Notices shall be effective on the date delivered, as evidenced by the return receipt or the date returned to the sender for non-delivery other than for insufficient postage. 2.5.4 Either party may change its address for notification purposes at any time by mailing a notice in accord with this Section, stating the change and setting for the new address, which shall be effective on the tenth (10th) day following the effective date of such notice unless a later date is specified. 2.6 ORDER OF PRECEDENCE Each of the items listed below is incorporated by reference into this Contract. In the event of an inconsistency, the inconsistency shall be resolved by giving precedence in the following order: • Applicable Federal and State of Washington statutes and regulations; • Special Terms and Conditions; • General Terms and Conditions; • Schedule A—Statement of Work; • Attachment 1 — Federal Compliance, Certification and Assurances; • Attachment 2— MAC Coordinator Manual; and • Any other provision, term or material incorporated herein by reference or otherwise incorporated. Washington State Page 7 of 49 Contract No. K3072 Health Care Authority 3 GENERAL TERMS AND CONDITIONS 3.1 DEFINITIONS As used throughout this Contract, the following terms shall have the meaning set forth below: "Allowable Expense" means an expenditure which meets the test of the appropriate OMB Circular(see Section I. Federal Compliance of Attachment 1). The most significant factors affecting allowability of expenses are: 1) they must be necessary and reasonable, 2)they must be allocable, 3)they must be authorized or not published under state or local laws and regulations, and 4)they must be documented. "Authorized representative" means the person in HCA to whom signature authority has been delegated, in writing, acting within the limits of his/her authority. "Business Associate" is as defined in 45 CFR, Part 160.103 and includes any entity that performs or assists in performing a function or activity involving the use/disclosure of Individually Identifiable Health Information or involving any other function or activity regulated by HIPAA; or provides legal, accounting, actuarial, consulting, data aggregation, management, accreditation, or financial service where the services involve Individually Identifiable Health Information. "Business Days and Hours" means Monday through Friday, 8:00 a.m. to 5:00 p.m., Pacific Time, except for holidays observed by the state of Washington. "Confidential Information" means information that may be exempt from disclosure to the public or other unauthorized persons under chapter 42.56 RCW or chapter 70.02 RCW or other state or federal statutes. Confidential Information includes, but is not limited to, any information identifiable to an individual that relates to a natural person's health, finances, education, business, use or receipt of governmental services, names, addresses, telephone numbers, social security numbers, driver license numbers, financial profiles, credit card numbers, financial identifiers and any other identifying numbers, law enforcement records, HCA source code or object code, or HCA or State security information. "Contract" means this Contract document, all schedules, exhibits, attachments, and amendments. "Contractor" means that firm, provider, organization, individual or other entity performing services under this Contract. It shall include any subcontractor retained by the prime contractor as permitted under the terms of this Contract. "Effective Date" means the first date this Contract is in full force and effect. It may be a specific date agreed to by the parties; or, if not so specified, the date of the last signature of a party to this Contract. "Equipment" means an article of non-expendable, tangible property having a useful life of more than one year and an acquisition cost of$5,000 or more. Washington State Page 8 of 49 Contract No. K3072 Health Care Authority "Health Care Authority"(HCA) means the Washington State Health Care Authority, any division, section, office, unit or other entity of HCA, or any of the officers or other officials lawfully representing HCA. "Protected Health Information" has the same meaning as in the HIPAA Rules except that in this Contract the term includes only information created by any of its contractors, or received from or on behalf of HCA, and relating to Clients. "PHI" means Protected Health Information. "Statement of Work" or"SOW" means a detailed description that captures and defines the work activities, deliverables, and timeline the Contractor is required to perform under this Contract. SOW is usually incorporated in a contract, indirectly be reference or directly as an attachment. "Subrecipient" means a contractor operating a federal or state assistance program receiving federal funds and having the authority to determine both the services rendered and disposition of program. See OMB Circular A-133 for additional detail. "Successor" means any entity or individual which, through amalgamation, consolidation, or other legal succession becomes invested with rights and assumes burdens of the first contractor/vendor or any person who succeeds to the office, rights, responsibilities or place of another. 3.2 ACCESS TO DATA In compliance with Chapter 39.26 RCW, the Contractor shall provide access to data generated under this Contract to HCA, the Joint Legislative Audit and Review Committee, and the State Auditor at no additional cost. This includes access to all information that supports the findings, conclusions, and recommendations of the Contractor's reports, including computer models and methodology for those models. 3.3 ADVANCE PAYMENT PROHIBITED No advance payment shall be made for services furnished by the Contractor pursuant to this Contract. 3.4 AMERICANS WITH DISABILITIES ACT(ADA) OF 1990, PUBLIC LAW 101-336, also referred to as the "ADA" 28 CFR Part 35 The Contractor must comply with the ADA, which provides comprehensive civil rights protection to individuals with disabilities in the areas of employment, public accommodations, state and local government services, and telecommunications. 3.5 ASSIGNMENT With the prior written consent of HCA, which consent shall not be unreasonably withheld, Contractor may assign this Contract including the proceeds hereof, provided that such assignment shall not operate to relieve Contractor of any of its duties and obligations hereunder, nor shall such assignment affect any remedies available to HCA that may arise from any breach of the sections of this Contract, Statements of Work, or warranties made herein including but not limited to, rights of setoff. Washington State Page 9 of 49 Contract No. K3072 Health Care Authority HCA may assign this Contract or Statements of Work to any public agency, commission, board, or the like, within the political boundaries of the state of Washington, provided that such assignment shall not operate to relieve HCA of any of its duties and obligations hereunder. 3.6 ATTORNEYS' FEES In the event of litigation or other action brought to enforce contract terms, each party agrees to bear its own attorney's fees and costs. 3.7 CHANGE IN STATUS In the event of substantive change in the legal status, organizational structure, or fiscal reporting responsibility of the Contractor, Contractor agrees to notify the HCA of the change. Contractor shall provide notice as soon as practicable, but no later than thirty(30)days after such a change takes effect. 3.8 CONFIDENTIAL INFORMATION PROTECTION Contractor acknowledges that some of the material and information that may come into its possession or knowledge in connection with this Contract or its performance may consist of Confidential Information. Contractor agrees to hold Confidential Information in strictest confidence and not to make use of Confidential Information for any purpose other than the performance of this Contract, to release it only to authorized employees or Subcontractors requiring such information for the purposes of carrying out this Contract, and not to release, divulge, publish, transfer, sell, disclose, or otherwise make the information known to any other party without HCA's express written consent or as provided by law. Contractor agrees to implement physical, electronic, and managerial safeguards to prevent unauthorized access to Confidential Information. Contractors that may come into contact with Protected Health Information will be required to complete a Business Associate agreement, as required by federal or state laws, including HIPAA, prior to the commencement of any work. Immediately upon expiration or termination of this Contract, Contractor shall, at HCA's option: (i) certify to HCA that Contractor has destroyed all Confidential Information; or(ii) return all Confidential Information to HCA; or(iii)take whatever other steps HCA requires of Contractor to protect HCA's Confidential Information. HCA reserves the right to monitor, audit, or investigate the use of Confidential Information collected, used, or acquired by Contractor through this Contract. Violation of this section by Contractor or its Subcontractors may result in termination of this Contract and demand for return of all Confidential Information, monetary damages, or penalties. The obligations set forth in this Section shall survive completion, cancellation, expiration, or termination of this Contract. 3.9 CONFIDENTIAL BREACH— REQUIRED NOTIFICATION Washington State Page 10 of 49 Contract No. K3072 Health Care Authority Upon a breach or suspected breach of confidentiality, the Contractor shall immediately notify the HCA Privacy Officer. For the purposes of this Contract, "immediately"shall mean within one calendar day. The Contractor will take steps necessary to mitigate any known harmful effects of such unauthorized access including, but not limited to, sanctioning employees, notifying subjects, and taking steps necessary to stop further unauthorized access. The Contractor agrees to indemnify and hold harmless HCA for any damages related to unauthorized use or disclosure of Confidential Information by the Contractor, its officers, directors, employees, Subcontractors or agents. Any breach of this clause may result in termination of the Contract and the demand for return of all Confidential Information. Contractor acknowledges the HCA is subject to chapter 42.56 RCW and that this Contract and any Work Orders shall be a public record as defined in chapter 42.56 RCW. Any specific information that is claimed by Contractor to be Proprietary Information must be clearly identified as such by Contractor. To the extent consistent with chapter 42.56 RCW, HCA shall maintain the confidentiality of all such information marked Proprietary Information in their possession. If a public disclosure request is made to view Contractor's Proprietary Information, HCA will notify Contractor of the request and of the date that such records will be released to the requester unless Contractor obtains a court order from a court of competent jurisdiction enjoining that disclosure. If Contractor fails to obtain the court order enjoining disclosure, HCA will release the requested information on the date specified 3.10 CONFLICT OF INTEREST HCA may terminate this Contract, by written notice to the Contractor, if it is found, after due notice and examination, that there is a violation of the Ethics in Public Service Act, Chapter 42.52 RCW, or any other laws regarding ethics in public acquisitions and procurement and performance of contracts. In the event this Contract is so terminated, HCA shall be entitled to pursue the same remedies against the Contractor as it could pursue in the event of a breach of the contract by the Contractor. 3.11 CONFORMANCE If any provision of this Contract violates any statute or rule of law of the State of Washington, it is considered modified to conform to that statute or rule of law. 3.12 COVENANT AGAINST CONTINGENT FEES The Contractor warrants that no person or selling agent has been employed or retained to solicit or secure this Contract upon an agreement or understanding for a commission, percentage, brokerage or contingent fee, excepting bona fide employees or bona fide established agents maintained by the Contractor for the purpose of securing business. HCA shall have the right, in the event of breach of this clause by the Contractor, to annul this Contract without liability or, in its discretion, to deduct from the contract price or Washington State Page 11 of 49 Contract No. K3072 Health Care Authority consideration or recover by other means the full amount of such commission, percentage, brokerage or contingent fee. 3.13 DEBARMENT The Contractor, by signing this Contract, certifies that the Contractor is not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded in any Washington State or Federal department or agency from participating in transactions (debarred). The Contractor agrees to include the above requirement in any and all subcontracts into which it enters, and also agrees that it will not employ debarred individuals. The Contractor shall immediately notify HCA if, during the term of this Contract, Contractor becomes debarred. HCA may immediately terminate this Contract by providing Contractor written notice, if Contractor becomes debarred during the term hereof. 3.14 DISPUTES The parties shall use their best, good faith efforts to cooperatively resolve disputes and problems that arise in connection with this Contract. Both parties will continue, without delay, to carry out their respective responsibilities under this Contract while attempting to resolve the dispute under this section. When a genuine dispute arises between HCA and the Contractor regarding the terms of this Contract or the responsibilities imposed herein that cannot be resolved at the project management level, either party may submit a request for a dispute resolution to the HCA Contract Administrator who shall oversee the following Dispute Resolution Process: HCA shall appoint a representative to a dispute panel; the Contractor shall appoint a representative to the dispute panel; HCA's and Contractor's representatives shall mutually agree on a third person to chair the dispute panel. The dispute panel shall thereafter decide the dispute with the majority prevailing. A party's request for a dispute resolution must: 3.14.1 Be in writing, 3.14.2 State the disputed issues, 3.14.3 State the relative positions of the parties, 3.14.4 State the remedies sought, 3.14.5 State the Contractor's name, address, and his/her department Contract number, 3.14.6 Be mailed to HCA Contracts Office, PO Box 42702, Olympia, WA 98504-2702 within thirty (30) calendar days after the party could reasonably be expected to have knowledge of the issue which he/she now disputes. This dispute resolution process constitutes the sole administrative remedy available under this Contract. The parties agree that this resolution process shall precede any action in a judicial and quasi-judicial tribunal. 3.15 FORCE MAJEURE A party shall not be liable for any failure of or delay in the performance of this Contract for the period that such failure or delay is due to causes beyond its reasonable control, including but not limited to: acts of God, war, strikes or labor disputes, embargoes, government orders or any other force majeure event. 3.16 GOVERNING LAW Washington State Page 12 of 49 Contract No. K3072 Health Care Authority This Contract shall be governed, in all respects, by the law and statutes of the state of Washington, without reference to conflict of law principles. The jurisdiction for any action hereunder shall be exclusively in the Superior Court for the state of Washington and the venue of any action hereunder shall be in the Superior Court for Thurston County, Washington. 3.17 INDEMNIFICATION Contractor shall defend, indemnify, and hold HCA harmless from and against all claims, including reasonable attorneys' fees resulting from such claims, for any or all injuries to persons or damage to property arising from intentional, willful or negligent acts or omissions of Contractor, its officers, employees, or agents, or Subcontractors, their officers, employees, or agents, in the performance of this Contract. Contractor's obligation to defend, indemnify, and hold HCA harmless shall not be eliminated or reduced by any alleged concurrent HCA negligence. 3.18 INDEPENDENT CAPACITY OF THE CONTRACTOR The parties intend that an independent contractor relationship will be created by this Contract. The Contractor and his or her employees or agents performing under this Contract are not employees or agents of HCA. The Contractor will not hold himself/herself out as or claim to be an officer or employee of HCA or of the State of Washington by reason hereof, nor will the Contractor make any claim of right, privilege or benefit which would accrue to such employee under law. Conduct and control of the work will be solely with the Contractor. 3.19 INDUSTRIAL INSURANCE COVERAGE Prior to performing work under this Contract, the Contractor shall provide or purchase industrial insurance coverage for the Contractor's employees, as may be required of an "employer" as defined in Title 51 RCW, and shall maintain full compliance with Title 51 RCW during the course of this Contract. Should the Contractor fail to secure industrial insurance coverage or fail to pay premiums, as may be required under Title 51 RCW, HCA may deduct the amount of premiums and any penalties owing from the amount payable to the Contractor under the Contract and transmit the same to the Department of Labor and Industries, Division of Insurance Services. This provision does not waive any right under RCW 51.12.050 to collect from the Contractor amounts paid by HCA. Washington State Page 13 of 49 Contract No. K3072 Health Care Authority 3.20 INSURANCE The Contractor shall provide insurance coverage as set out in this section. The intent of the required insurance is to protect the State should there be any claims, suits, actions, costs, damages or expenses arising from any negligent or intentional act or omission of the Contractor or subcontractor, or agents of either, while performing under the terms of this Contract. The Contractor shall provide insurance coverage that shall be maintained in full force and effect during the term of this Contract, as follows: 3.20.1 Commercial General Liability Insurance Policy- Provide a Commercial General Liability Insurance Policy, including contractual liability, in adequate quantity to protect against legal liability arising out of contract activity but no less than $1,000,000 per occurrence. Additionally, the Contractor is responsible for ensuring that any subcontractors provide adequate insurance coverage for the activities arising out of subcontracts. 3.20.2 Business Automobile Liability. In the event that services delivered pursuant to this Contract involve the use of vehicles, either owned, hired, or non-owned by the Contractor, automobile liability insurance shall be required covering the risks of bodily injury (including death)and property damage, including coverage for contractual liability. The minimum limit for automobile liability is: $1,000,000 per occurrence, using a Combined Single Limit for bodily injury and property damage. 3.20.3 The insurance required shall be issued by an insurance company/ies authorized to do business within the state of Washington, and shall name HCA and The State of Washington, its agents and employees as additional insured's under the insurance policy/ies. All policies shall be primary to any other valid and collectable insurance. Contractor shall instruct the insurers to give HCA 30 days advance notice of any insurance cancellation. Upon request, Contractor shall submit to HCA, a certificate of insurance that outlines the coverage and limits defined in the Insurance section. If a certificate of insurance is requested, Contractor shall submit renewal certificates as appropriate during the term of the contract. 3.21 LEGAL AND REGULATORY COMPLIANCE During the term of this Contract, Contractor shall comply with all local, state, and federal licensing, accreditation and registration requirements/standards, necessary for the performance of this Contract and all other applicable federal, state and local laws, rules, and regulations. 3.22 LICENSING, ACCREDITATION AND REGISTRATION Washington State Page 14 of 49 Contract No. K3072 Health Care Authority The Contractor shall comply with all applicable local, state, and federal licensing, accreditation and registration requirements/standards, necessary for the performance of this Contract. 3.23 LIMITATION OF AUTHORITY Only the HCA Authorized Representative or his/her designee by writing (delegation to be made prior to action)shall have the express, implied, or apparent authority to alter, amend, modify, or waive any clause or condition of this Contract. Furthermore, any alteration, amendment, modification, or waiver or any clause or condition of this Contract is not effective or binding unless made in writing and signed by the Authorized Representative. 3.24 NO THIRD-PARTY BENEFICIARIES The HCA and the Contractor are the only parties to this contract. Nothing in this Contract gives or is intended to give any benefit of this contract to third parties or third persons. 3.25 NONDISCRIMINATION During the performance of this Contract, the Contractor shall comply with all federal and state nondiscrimination laws, regulations and policies. 3.26 OVERPAYMENT AND ASSERTION OF LIEN In the event that overpayments or erroneous payments have been made to the Contractor under this Contract, HCA shall provide written notice to Contractor and Contractor shall refund the full amount to HCA within thirty(30)days of the notice. HCA may secure repayment, plus interest, if any, through the filing of a lien against the Contractor's real property, or by requiring the posting of a bond, assignment or deposit, or some other form of security acceptable to HCA. 3.27 PUBLICITY The Contractor agrees to submit to HCA all advertising and publicity matters relating to this Contract wherein HCA's name is mentioned or, in RCA's judgment, the language used may infer or imply a connection with RCA's name. The Contractor agrees not to publish or use such advertising and publicity matters without the prior written consent of HCA. 3.28 RECORDS, DOCUMENTS, AND REPORTS The Contractor shall maintain books, records, documents, magnetic media, receipts, invoices and other evidence relating to this Contract and the performance of the services rendered, along with accounting procedures and practices, all of which sufficiently and properly reflect all direct and indirect costs of any nature expended in the performance of this Contract. At no additional cost, these records including materials generated under this Contract, shall be subject at all reasonable times to inspection, review, or audit by HCA, the Office of the State Auditor, and state and federal officials so authorized by law, rule, regulation, or agreement. The Contractor shall retain such records for a period of six(6) years after the date of final payment. Washington State Page 15 of 49 Contract No. K3072 Health Care Authority If any litigation, claim or audit is started before the expiration of the six (6)year period, the records shall be retained until all litigation, claims, or audit findings involving the records have been resolved. 3.29 REGISTRATION WITH DEPARTMENT OF REVENUE The Contractor shall complete registration with the Washington State Department of Revenue and be responsible for payment of all taxes due on payments made under this Contract. 3.30 REMEDIES NON-EXCLUSIVE The remedies provided in this Contract shall not be exclusive, but are in addition to all other remedies available under law. 3.31 RIGHT OF INSPECTION The Contractor shall provide access to its facilities to HCA, or any of HCA's officers, or to any other authorized agent or official of the state of Washington or the federal government, at all reasonable times, in order to monitor and evaluate performance, compliance, and/or quality assurance under this Contract. 3.32 RIGHTS IN DATA/COPYRIGHT Unless otherwise provided, all materials produced exclusively under this Contract shall be considered "works for hire" as defined by the U.S. Copyright Act and shall be owned by HCA. HCA shall be considered the author of such Materials. In the event the Materials are not considered "works for hire" under the U.S. Copyright laws, Contractor hereby irrevocably assigns all right, title, and interest in Materials, including all intellectual property rights, to HCA effective from the moment of creation of such Materials. Materials means all items in any format and includes, but is not limited to, data, reports, documents, pamphlets, advertisements, books, magazines, surveys, studies, computer programs, films, tapes, and/or sound reproductions that derive exclusively from the Contractor's work under this Contract. Ownership includes the right to copyright, patent, register and the ability to transfer these rights. For Materials that are delivered under the Contract, but that incorporate pre-existing materials not produced under the Contract, Contractor hereby grants to HCA a nonexclusive, royalty-free, irrevocable license (with rights to sublicense others) in such Materials to translate, reproduce, distribute, prepare derivative works, publicly perform, and publicly display. The Contractor warrants and represents that Contractor has all rights and permissions, including intellectual property rights, moral rights and rights of publicity, necessary to grant such a license to HCA. The Contractor shall exert all reasonable effort to advise HCA, at the time of delivery of Materials furnished under this Contract, of all known or potential invasions of privacy contained therein and of any portion of such document which was not produced in the performance of this Contract. HCA shall receive prompt written notice of each notice or claim of copyright infringement received by the Contractor with respect to any data delivered under Washington State Page 16 of 49 Contract No. K3072 Health Care Authority this Contract. HCA shall have the right to modify or remove any restrictive markings placed upon the data by the Contractor. 3.33 SAFEGUARDING OF INFORMATION The use or disclosure by any party, of any information concerning HCA, for any purpose not directly connected with the administration of HCA's or the Contractor's responsibilities with respect to services provided under this Contract, is prohibited except by written consent of HCA. 3.34 SEVERABILITY If any provision of this Contract, or the application thereof to any person(s) or circumstances is held invalid, such invalidity shall not affect the other provisions or applications of this Contract that can be given effect without the invalid provision, and to this end the provisions or application of this Contract are declared severable. 3.35 SITE SECURITY While on HCA premises, Contractor, its agents, employees, or subcontractors shall conform in all respects with physical, fire or other security policies or regulations. Failure to comply with these regulations may be grounds for revoking or suspending security access to these facilities. HCA reserves the right and authority to immediately revoke security access to Contractor staff for any real or threatened breach of this provision. Upon reassignment or termination of any Contractor staff, Contractor agrees to promptly notify HCA. 3.36 SUBCONTRACTING Neither the Contractor, nor any Subcontractors, shall enter into subcontracts for any of the work contemplated under this Contract without prior written approval of HCA. In no event shall the existence of the subcontract operate to release or reduce the liability of the Contractor to HCA for any breach in the performance of the Contractor's duties. Additionally, the Contractor is responsible for ensuring that all terms, conditions, assurances and certifications set forth in this Contract are included in any subcontracts. Contractor and its subcontractors agree not to release, divulge, publish, transfer, sell or otherwise make known to unauthorized persons confidential information without the express written consent of HCA or as provided by law. If, at any time during the progress of the work, the HCA determines in its sole judgment that any subcontractor is incompetent or undesirable, the HCA shall notify the Contractor, and the Contractor shall take immediate steps to terminate the subcontractor's involvement in the work. The rejection or approval by the HCA of any subcontractor or the termination of a subcontractor shall not relieve the Contractor of any of its responsibilities under the Contract, nor be the basis for additional charges to the HCA. The HCA has no contractual obligations to any subcontractor or vendor under contract to the Contractor. The Contractor is fully responsible for all contractual obligations, financial or otherwise, to their subcontractors. Washington State Page 17 of 49 Contract No. K3072 Health Care Authority The Contractor may only enter into vendor subcontracts, and is prohibited from entering into subrecipient subcontracts for the MAC program. 3.37 SUBRECIPIENT 3.37.1 General If the Contractor is a sub-recipient of federal awards as defined by Office of Management and Budget (OMB) Circular A-133 and this Contract, the Contractor shall: 3.37.1.1 Maintain records that identify, in its accounts, all federal awards received and expended and the federal programs under which they were received, by Catalog of Federal Domestic Assistance (CFDA)title and number, award number and year, name of the federal agency, and name of the pass-through entity; 3.37.1.2 Maintain internal controls that provide reasonable assurance that the Contractor is managing federal awards in compliance with laws, regulations, and provisions of contracts or grant agreements that could have a material effect on each of its federal programs; 3.37.1.3 Prepare appropriate financial statements, including a schedule of expenditures of federal awards; 3.37.1.4 Incorporate OMB Circular A-133 audit requirements into all agreements between the Contractor and its Subcontractors who are sub-recipients; 3.37.1.5 Comply with any future amendments to OMB Circular A-133 and any successor or replacement Circular or regulation; 3.37.1.6 Comply with the applicable requirements of OMB Circular A-87 and any future amendments to OMB Circular A-87, and any successor or replacement Circular or regulation; and 3.37.1.7 Comply with the Omnibus Crime Control and Safe streets Act of 1968, Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title II of the Americans with Disabilities Act of 1990, Title IX of the Education Amendments of 1972, The Age Discrimination Act of 1975, and The Department of Justice Non-Discrimination Regulations, 28 C.F.R. Part 42, Subparts C.D.E. and G, and 28 C.F.R. Part 35 and 39. (Go to http://oip.gov/about/offices/ocr.htm for additional information and access to the aforementioned Federal laws and regulations.) 3.37.2 Single Audit Act Compliance If the Contractor is a sub-recipient and expends $500,000 or more in federal awards from any and/or all sources in any fiscal year, the Contractor shall procure and pay for a single audit or a program-specific audit for that fiscal year. Upon completion of Washington State Page 18 of 49 Contract No. K3072 Health Care Authority each audit, the Contractor shall: 3.37.2.1 Submit to the Authority contact person the data collection form and reporting package specified in OMB Circular A-133, reports required by the program-specific audit guide (if applicable), and a copy of any management letters issued by the auditor; 3.37.2.2 Follow-up and develop corrective action for all audit findings; in accordance with OMB Circular A-133, prepare a "Summary Schedule of Prior Audit Findings." 3.37.3 Overpayments If it is determined by the Authority, or during the course of a required audit, that the Contractor has been paid unallowable costs under this or any Program Agreement, the Authority may require the Contractor to reimburse the Authority in accordance with OMB Circular A-87. 3.38 SURVIVABILITY The terms and conditions contained in this Contract, which by their sense and context are intended to survive the completion, cancellation, termination, or expiration of the Contract, shall survive. 3.39 SYSTEM SECURITY Contractor agrees not to attach any Contractor-supplied computers, peripherals or software to the HCA Network without prior written authorization from RCA's Information Systems Manager. Contractor-supplied computer equipment, including both hardware and software, must be reviewed;by the HCA Information Services prior to being connected to any HCA network connection and that it must have up to date anti-virus software and personal firewall software installed and activated on it. Unauthorized access to HCA networks and systems is a violation of HCA Policy 06-03 and constitutes computer trespass in the first degree pursuant to RCW 9A.52.110. Violation of any of these laws or policies could result in termination of the contract and other penalties. 3.40 TAXES Unless otherwise indicated, HCA will pay sales and use taxes, if any, imposed on the services acquired hereunder. Contractor must pay all other taxes including, but not limited to, Washington Business and Occupation Tax, other taxes based on Contractor's income or gross receipts, or personal property taxes levied or assessed on Contractor's personal property. HCA, as an agency of Washington State government, is exempt from property tax. 3.41 TERMINATION 3.41.1 TERMINATION FOR CAUSE In the event the Contractor violates any material term or condition of this Contract or any Work Order, or fails to fulfill in a timely and proper manner its material obligations Washington State Page 19 of 49 Contract No. K3072 Health Care Authority under this Contract or any Work Order, as applicable, then comply with the conditions of this Contract in a timely manner, HCA has the right to suspend or terminate this Contract. HCA shall notify the Contractor, in writing, of the need to take corrective action. If corrective action is not taken within three (3) days, or other time period agreed to in writing, the Contract may be terminated. HCA reserves the right to suspend all or part of the Contract, withhold further payments, or prohibit the Contractor from incurring additional obligations of funds during investigation of the alleged compliance breach and pending corrective action by the Contractor or a decision by HCA to terminate the Contract. In the event of termination, the Contractor shall be liable for damages as authorized by law including, but not limited to, any cost difference between the original Contract and the replacement or cover Contract and all administrative costs directly related to the replacement Contract, e.g., cost of the competitive bidding, mailing, advertising, and staff time. If it is determined that the Contractor: (i)was not in default, or (ii) failure to perform was outside of his or her control, fault or negligence, the termination shall be deemed a "Termination for Convenience" and the provisions of Subsection 3.43.3 will apply. 3.41.2 TERMINATION DUE TO CHANGE IN FUNDING, SUSPENSION OR CONTRACT RENOGTIATION If the funds HCA relied upon to establish this Contract are withdrawn, reduced or limited, or if additional or modified conditions are placed on such funding, after the effective date of this contract but prior to the normal completion of this Contract: 3.41.2.1 At RCA's discretion, the Contract may be renegotiated under the revised funding conditions. 3.41-2-2 At RCA's discretion, HCA may give notice to Contractor to suspend performance when HCA determines that there is reasonable likelihood that the funding insufficiency may be resolved in a timeframe that would allow Contractor's performance to be resumed prior to the normal completion date of this contract. 3.41.2.2.1 During the period of suspension of performance, each party will inform the other of any conditions that may reasonably affect the potential for resumption of performance. 3.41.2.2.2 When HCA determines that the funding insufficiency is resolved, it will give Contractor written notice to resume performance. Upon the receipt of this notice, Contractor will provide written notice to HCA informing HCA whether it can resume performance and, if so, the date of resumption. For purposes of this subsection, "written notice" may include email. 3.41.2.2.3 If the Contractor's proposed resumption date is not acceptable to HCA and an acceptable date cannot be negotiated, HCA may terminate the contract by giving written notice to Contractor. The parties agree that the Washington State Page 20 of 49 Contract No. K3072 Health Care Authority Contract will be terminated retroactive to the date of the notice of suspension. HCA shall be liable only for payment in accordance with the terms of this Contract for services rendered prior to the retroactive date of termination. 3.41.2.3 HCA may immediately terminate this Contract by providing written notice to the Contractor. The termination shall be effective on the date specified in the termination notice. HCA shall be liable only for payment in accordance with the terms of this Contract for services rendered prior to the effective date of termination. No penalty shall accrue to HCA in the event the termination option in this section is exercised. 3.41.3 TERMINATION FOR CONVENIENCE When, at HCA's sole discretion, it is in the best interest of the State, HCA may terminate this Contract in whole or in part by providing ten (10) Business Day's notice. If this Contract is so terminated, HCA shall be liable only for payment in accordance with the terms of this Contract for services rendered prior to the effective date of termination. The Contractor, at their discretion, may terminate this Contract in whole or in part by providing fifteen (15) Business Day's written notice to HCA before the beginning of the next calendar quarter. 3.41.4 TERMINATION PROCEDURES Upon termination of this Contract, HCA, in addition to any other rights provided in this Contract or available under law, may require the Contractor to deliver to HCA any property specifically produced or acquired for the performance of such part of this Contract as has been terminated. HCA shall pay to the Contractor the agreed upon price, if separately stated, for completed work and service accepted by HCA and the amount agreed upon by the Contractor and HCA for(i)completed work and services for which no separate price is stated; (ii) partially completed work and services; (iii) other property or services which are accepted by HCA; and (iv)the protection and preservation of property, unless the termination is for default, in which case the HCA shall determine the extent of the liability. Failure to agree with such determination shall be a dispute within the meaning of the "Disputes" clause of this Contract. HCA may withhold from any amounts due the Contractor such sum as HCA determines to be necessary to protect HCA against potential loss or liability. Upon receipt of notice of termination, and except as otherwise directed by the HCA, the Contractor shall: 3.41.4.1 Stop work under the Contract on the date, and to the extent specified in the notice; 3.41.4.2 Place no further orders or subcontracts for materials, services, or facilities except as may be necessary for completion of such portion of the work Washington State Page 21 of 49 Contract No. K3072 Health Care Authority under the Contract that is not terminated; 3.41.4.3 Assign to HCA, in the manner, at the times, and to the extent directed by HCA, all the rights, title, and interest of the Contractor under the orders and subcontracts so terminated; in which case HCA has the right, at its discretion, to settle or pay any or all claims arising out of the termination of such orders and subcontracts; 3.41.4.4 Settle all outstanding liabilities and all claims arising out of such termination of orders and subcontracts, with the approval or ratification of HCA the extent HCA may require, which approval or ratification shall be final for all the purposes of this clause; 3.41.4.5 Transfer title to HCA and deliver in the manner, at the times, and to the extent directed by HCA any property which, if the Contract has been completed, would have been required to be furnished to HCA; 3.41.4.6 Complete performance of such part of the work as shall not have been terminated by HCA; and 3.41.4.7 Take such action as may be necessary, or as HCA may direct, for the protection and preservation of the property related to this Contract which is in the possession of the Contractor and in which HCA has or may acquire an interest. 3.41.5 TERMINATION FOR WITHDRAWAL OF AUTHORITY In the event that the authority of HCA to perform any of its duties is withdrawn, reduced, or limited in any way after the commencement of this Contract and prior to normal completion, HCA may terminate this Contract in whole or in part, under Section 3.43.3 of this Contract. No penalty will accrue to HCA in the event this section is exercised. This Section shall not be construed so as to permit HCA to terminate this Contract in order to acquire similar Services from a third party. 3.42 WAIVER Waiver of any default shall not be deemed to be a waiver of any subsequent default. Waiver of breach of any provision of this Contract shall not be deemed to be a waiver of any other or subsequent breach and shall not be construed to be a modification of the terms of this Contract unless stated to be such in writing signed by HCA and attached to the original Contract. Washington State Page 22 of 49 Contract No. K3072 Health Care Authority SCHEDULE A STATEMENT OF WORK 1. DEFINITIONS Definitions specific to this Agreement. The words and phrases listed below, as used in this Agreement, shall each have the following definitions: a) "A19-1A" or "A19" means the State of Washington Invoice Voucher used by contractors and vendors to submit claims for payment in return for goods and/or services provided to HCA or its Clients. b) "Activity Code" or "Code" means the code assigned to the daily activities performed by Contractor staff in order to identify the percentage of time spent on any given activity. c) "Administrative Fee" means the dollar amount charged to the Contractor by HCA based on a percentage of each Contractor's billing for Federal Financial Participation claimed at the federally approved match rate, to offset HCA's costs incurred in administering this Agreement. d) "Allocated" or"Allocated Cost" means an Operating Expense that is Allocated across more than one cost pool. e) "Budgeting, Accounting and Reporting System" or"BARS" or"BARS manual" The BARS Manual prescribes accounting and reporting for local governments in accordance with RCW 43.09.200 and found at this website http://www.sao.wa.gov/local/BarsManual/Pages/BarsManual GAAP.aspx#.VY3K 03bLcs. f) "Billing Quarter" means a calendar quarter consisting of three (3)consecutive calendar months beginning with the first date of the calendar quarter during which this Agreement starts. The Contractor shall use Billing Quarters as the time periods for which claims for Federal Financial Participation are made. g) "Centers for'Medicare and Medicaid Services" or"CMS" means the federal office under the United States Department of Health and Human Services responsible for the administration of the Medicare, Medicaid and Children's Health Insurance Program. h) "Centers for Medicare and Medicaid Services School-Based Administrative Claiming Guide" or"CMS Guide"or"Guide" means the document issued by CMS in 2003 and any supplements, amendments or successor; incorporated herein by reference which provides guidance to States for developing and managing Medicaid Administrative Claiming programs. i) "Certified Public Expenditure" or"CPE" means the sources of funds certified as actual expenditures by a local or public governmental entity and used as the State share in order to receive federal matching Medicaid funds, or Federal Financial Participation (FFP). j) "CPE Local Match Certification" means RCA's form the Contractor must submit with each quarterly invoice to report the source of funds certified as public expenditures and therefore eligible to be used as match for the MAC program. Washington State Page 23 of 49 Contract No. K3072 Health Care Authority k) "Client" means an individual served within budget unit or cost center of the Contractor. 1) "Cognizant Agency" means the single agency representing all others in dealing with grantees in common areas and who reviews and approves grantees' indirect cost rates. OMB published a list of Cognizant Agency assignments for some State agencies, cities and counties on January 6, 1986 (51 FR 552). The Cognizant Agency for governmental units not on that list is the one that provides the most grant funds to the entity. m) "Coordinator Manual" or"Manual" means the HCA document or its successor including any updates, that describes how the Contractor must manage their MAC program and provides program guidance. n) "Corrective Action Plan" or"Corrective Action" means the written description of the plan the Contractor will complete in order to correct any finding or deficiency as identified by HCA or government entity. o) "Cost Allocation Plan" or"CAP" means the HCA document that describes the allocation methodology that includes a description of the procedures HCA will use to identify and measure costs for a MAC program and must be approved by CMS. p) "Data" means the information that is disclosed or exchanged as described in the CAP, manual or this Agreement. q) "Direct Charge Method" means the method of accounting for Direct Costs without a step- down allocation for single funding sources expenses wholly attributed to the MAC program. r) "Direct Cost" means an Operating Expense that is wholly attributable to the MAC program and is not included in an Indirect Cost Rate. Direct costs must be a single cost objective, and must be certified quarterly. s) "Direct Medical Service" means the provision of a medical, dental, vision, mental health, family planning, pharmacy, substance abuse or a Medicaid covered service and all related activities, administrative or otherwise, that integral to, or an extension of the healthcare service." t) "Eligible Staff" or"Participant" or"RMTS Participant" means an employee of the Contractor that is in compliance with all federal, state, and HCA regulations including this agreement, the CAP, the manual, CMS guidance and any other requirements for participation in,the Medicaid Administrative Claiming program and whose costs are for eligible for claiming their staff time costs for conducting Medicaid Administrative Claiming activities. u) "Federal Financial Participation" or"FFP" means the federal payment (or federal "match")that is available at a rate of 50% for amounts expended by a state "as found necessary by the Secretary for the proper and efficient administration of the state plan" per 42 Code of Federal Regulations (CFR§433.15(b)(7). An enhanced FFP rate of seventy five percent(75%) is available for certain SPMP or interpretation administrative costs. Only permissible, non-federal funding sources are allowed to be used as the state match for FFP. Washington State Page 24 of 49 Contract No. K3072 Health Care Authority v) "Fiscal Coordinator" means the Contractor's employee who is assigned to be the liaison between HCA and the Contractor for the accounting purposes of this Agreement. The contractor may assign the fiscal and RMTS coordinator roles to the same staff if desired. w) "Indirect Cost" means an Operating Expense that is Allocated across more than one program. Indirect costs are only allowable for FFP reimbursement by the application of an Indirect Cost Rate approved by the Contractor's Cognizant Agency. The indirect cost must be certified by the Contractor annually using the HCA Certificate of Indirect Costs form. x) "Integral Activity" or"Extension Activity" means an activity that is necessary for or incidental to the provision of a direct medical service y) "MAC Activity" or"Allowable Activity" or"Reimbursable Activity" or"Claimable Activity" means an activity that is administrative in nature, and necessary for the proper and efficient administration for the Medicaid state plan which must be in compliance as described in applicable federal, state, HCA and CMS Regulations, the CAP, Manual, and this Agreement. z) "Manual" or"Coordinator Manual" means the document that describes how the Contractor must implement the CAP locally and includes detailed instructions for implementing and monitoring the MAC program at the local level. The Manual is incorporated into this Agreement by reference. aa) "Medicaid Administrative Claiming" or"MAC" means the program within title XIX of the Social Security Act (the Act)authorizing federal grants to states for a proportion of expenditures for medical assistance under the approved Medicaid state plan, and for expenditures necessary for administration of the state plan. This joint federal-state financing of expenditures is described in section 1903(a) of the Act, which sets forth the rates of federal financing for different types of expenditures. In order for Medicaid administrative expenditures to be claimed for federal matching fui ids an allocation methodology must appears in the state's approved Public Assistance Cost Allocation Plan (42 CFR§433.34) and be described in detail in a MAC CAP. bb) "Medicaid Administrative Claiming Program Specialist" means the HCA employee assigned responsibility for oversight and monitoring of the Contractor's MAC program and claiming and identified as the point of contact on this Agreement. cc) "Medicaid Eligibility Rate" or"MER" means the proportional share of Medicaid individuals to the total number of individuals in the target population (Contractor's jurisdiction) as defined in the CAP, manual and this Agreement. dd) "Medicaid Outreach Unit" means the unit within HCA's Health Care Services division that administers and monitors Washington State's MAC program. ee) "National Institutional Reimbursement Team (NIRT)" means the group of individuals comprised from both the CMS central office and regional offices who are responsible for providing technical assistance to the states on Medicaid institutional reimbursement issues and the development and promulgation of all Medicaid institutional reimbursement regulations and policies including review and approval of donated funds certified as public expenditures (CPE). Washington State Page 25 of 49 Contract No. K3072 Health Care Authority ff) "Operating Expense" means those costs incurred by the Contractor to perform business activities and includes both Direct Costs and Indirect Costs. Only operating expenses necessary to operate the Contractor's MAC program are allowable for FFP reimbursement. gg) "Potential Medicaid Client" means a Washington resident who may be determined by HCA to meet the eligibility criteria for enrollment in Medicaid. hh) "Random Moment Time Study(RMTS)" or"System" or"Time Study" means an electronic System that quantifies the daily activities of eligible time study Participants through a statistically valid sampling methodology and allocates allowable participant costs to the MAC program. The System calculates the amount of FFP reimbursement based on the Contractors RMTS results, staff costs, MER, costs and other applicable calculations as described in the CAP, manual and this Agreement. ii) "Regulation" means any federal, state, or local Regulation, rule, or ordinance. jj) "RMTS Consortium" "RMTS Consortia" or"Consortium" or"Consortia" means a group of Contractors who have organized together based on similar duties their staff perform, organizational structure, type of programs, scope of work, or regional working relationships and will participate in a single time study together in order to achieve statistical validity. kk) "RMTS Coordinator" means an employee of the Contractor who is assigned to be the time study liaison between HCA and the Contractor for purposes of this Agreement. The contractor may assign the fiscal and RMTS coordinator roles to the same staff if desired. II) "Skilled Professional Medical Personnel" or"SPMP" means an individual who has completed a two-or-more-year program leading to an academic degree or certificate in a medically related profession, demonstrated by possession of a medical license, certificate or other document issued by a recognized National or State medical licensure or certifying organization or a degree in a medical field issued by a college or university certified by a professional medical organization. mm) "State Fiscal Year" means a twelve-month period beginning on July 1st of one calendar year and ending on June 30th of the following calendar year. nn) "State Medicaid Plan" means the comprehensive written commitment by HCA, submitted under 1902(a) of the Social Security Act and approved by the Centers for Medicare and Medicaid Services, to administer or supervise administration of a Medicaid program in accordance with Federal and state requirements. oo) "Subcontract" means any separate agreement or contract between the Contractor and an individual third party or entity("Subcontractor")to perform all or a portion of the duties and obligations that the Contractor is obligated to perform pursuant to this Contract. Washington State Page 26 of 49 Contract No. K3072 Health Care Authority 2. GENERAL The Contractor shall provide services and deliverables, and otherwise do all things necessary for or incidental to the performance of work as set forth below. The Contractor must: a) Provide the necessary staff to perform the allowable MAC activities described in the Cost Allocation Plan (CAP), and perform the work necessary to ensure all applicable laws, regulations and guidelines specific to the MAC program and this Agreement are in compliance including, but not limited to: i) Code of Federal Regulation (CFR) Title 42 and Title 45. ii) 1903(w)(6)(A) of the Social Security Act. iii) Medicaid School-Based Administrative Claiming Guide May 2003. iv) Revised Code of Washington (RCW). v) Washington Administrative Code (WAC). vi) The MAC Coordinator Manual. vii) OMB 2 CFR 225 Cost Principles for State, Local, and Indian Tribal Governments. viii) OMB Circular A-133 and Compliance Supplement. ix) Washington State Medicaid Plan. x) Secretary of State (SOS) records retention schedule. b) Maintain documentation to support each administrative claim submitted to HCA for reimbursement as required by federal, state, HCA and CMS Regulations, the CAP, the Manual and this Agreement. The documentation must be sufficiently detailed in order to determine whether the activities are necessary for the proper and efficient administration of the Medicaid State Plan and support the appropriateness of the administrative claim. The Contractor must: i) Maintain all documentation related to staff participation in the RMTS according to section 1902(a)(4)of the Act and 42 CFR§431.17; see also 45 CFR§ 74.53 and 42 CFR § 433.32(a) (requiring source documentation to support accounting records)and 45 CFR § 74.20 and 42 CFR§ 433.32(b and c) (retention period for records)and as described in the Medicaid School-Based Administrative Claiming Guide May 2003; ii) Maintain all documentation related to MAC claiming, according to section 1902(a)(4) of the Act and 42 CFR §431.17; see also 45 CFR § 74.53 and 42 CFR §433.32(a) (requiring source documentation to support accounting records) and 45 CFR§ 74.20 and 42 CFR §433.32(b and c) (retention period for records)and as described in Medicaid School-Based Administrative Claiming Guide May 2003; iii) Comply with the SOS records retention schedule; iv) Assure all documentation is immediately accessible and available, must be in a useful and readable format, and must be stored electronically within the System at every opportunity as determined by HCA; v) Provide any and all information and documentation requested by HCA within thirty (30) business days, or within a written, mutually agreed upon time frame; and Washington State Page 27 of 49 Contract No. K3072 Health Care Authority vi) Submit any audit related to its MAC program to HCA within thirty (30) business days of receipt of the final report. This includes but is not limited to SAO Audits, OMB Circular A- 133 and Compliance Supplement Audits, Federal Reviews or Federal Audits. The contractor must provide to HCA, any corrective action related to MAC findings and questioned costs within thirty (30) business days of submission. c) Abide by all roles, responsibilities, limitations, restrictions, and documentation requirements including but not limited to those described in the CAP, Manual, and this Agreement. 3. RESPONSIBILITIES a) Contractor: The Contractor is responsible for monitoring its MAC program to ensure compliance with all applicable laws, regulations and guidelines specific to the MAC program as described in this Agreement and comply with all roles, responsibilities, limitations, restrictions, and documentation requirements described in the CAP, Manual, and this Agreement that includes, but is not limited to, the following. The Contractor must: i) Only include LHJ staff in the claimed reimbursement (through the RMTS or direct charge method)who are eligible to participate. The Contractor is prohibited from including any staff in the RMTS or the claimed reimbursement unless their job positions comply with the criteria described in the CAP, the Manual and this Agreement. Staff who may be eligible to be included in the RMTS or claimed reimbursement must: (1) Not be included in another MAC time study or reimbursement claim; (2) Be directly employed or contracted by the LHJ; (3) Be reasonably expected to perform MAC related activities; (4) Have all federal dollars appropriately off-set according to the CAP and Manual; (5) Not be included in the calculation of an indirect cost rate that is used to calculate FFP reimbursement; (6) Not include any Federally Qualified Health Clinic(FQHC) staff whose costs are included in the FQHC cost report; (7) Be job positions that fit within these job categories: nurses, other medical professionals, other professional classifications, community outreach and linkage classifications, manager/supervisor/administrator classifications, or administrative support classifications as described in the CAP and manual; and ii) Designate staff for each of the following roles: RMTS Coordinator and Fiscal Coordinator to be responsible for daily oversight and management of the Contractor's MAC program; (1) The RMTS and Fiscal Coordinator roles may be assumed by one individual if desired. Washington State Page 28 of 49 Contract No. K3072 Health Care Authority (2) The Contractor must submit contact information to the HCA Contract Manager for each coordinator, including their assigned role, name, telephone number, fax number, email, and address prior to participation in the MAC program, within five (5) business of the change. (3) The Coordinators must participate in the monthly statewide coordinator conference calls. (4) The Coordinators must participate in any scheduled RMTS consortium conference calls. (5) The Coordinators must ensure federal, state and HCA MAC policies are implemented. (6) The Contractor must ensure the Coordinators accurately perform all responsibilities listed in the CAP, Manual and this Agreement. iii) Certify all data entered into the System is true and accurate, and based on actual expenditures incurred during the period of performance of the invoice. This certification must be maintained within the System. This includes, but is not limited to: calendaring, Staff/Participant lists, salary and benefits, direct charges or other claimed costs, indirect rate, MER and any other data used to generate a claim to HCA for reimbursement; iv) Verify all data that is determined necessary to be stored electronically within the System or other associated websites, or databases as described in the CAP, Manual and this Agreement is physically entered and stored according to the SOS Retention Schedule. This data includes, but is not limited to: calendaring, Staff/Participant lists, salary and benefits, direct charges or other claimed costs, indirect rate, MER and any other data used to generate a claim to HCA for reimbursement; v) Prepare an annual MER proposal to include the MER calculation and formula, the data sources used to determine the MER, the data collection process, the Contractor's monitoring process to ensure accuracy of the MER and any other relevant information; (1) The proposal must be submitted to HCA no later than December first of each year; (2) The proposal must be updated and re-submitted if the data source or collection, calculations, or monitoring changes thirty(30) business days prior to the change. vi) Submit a quarterly MER certification with each invoice validating the accuracy of the MER; vii) Submit a quarterly CPE certification identifying the revenue account codes as found in the BARS manual with each invoice validating the accuracy of the CPE; viii) Submit an annual certificate of indirect costs that certifies the indirect cost rate proposal submitted to their Cognizant Agency; ix) Certify the accuracy of all data used to determine a quarterly MAC reimbursement by signing the A19 by an authorized representative. This certification extends to all RMTS data and financial data; Washington State Page 29 of 49 Contract No. K3072 Health Care Authority x) Complete a one hundred percent (100%)code review of all RMTS moments to ensure the code and narrative correlate, within forty five (45) calendar days after the end of the quarter; A) Monitor the RMTS non response rate and identify any deficiencies in staff responses. Corrective action must: (1) Be implemented within ten (10) business days; and (2) Be documented and available to HCA upon request. xii) Use a System that is statistically valid and in compliance with all state, and federal laws and Regulations whether through a third-party or other means as stated in the CAP; xiii) Not participate in a time study or claiming process for the HCA MAC program with any entity that does not have an executed agreement with HCA. xiv) Not participate in an RMTS consortium without prior written approval from HCA; (1) If identified as a Lead Agency for the RMTS Consortium, the Contractor must perform the Lead Agency duties described in the CAP and Manual and participate in the current statewide LHJ Steering Committee. xv) Ensure all interpreter staff have been tested and certified by Washington State Department of Social and Health Services (DSHS)as defined by DSHS; (1) The contractor is prohibited from claiming the enhanced seventy five percent (75%) rate for any interpretation activities unless the staff has been certified by DSHS; (2) The contractor is prohibited from claiming the enhanced seventy five percent(75%) rate for any interpretation activities unless MAC activities performed is part of the staffs assigned job duties; and (3) The contractor is prohibited from claiming the enhanced seventy five percent(75%) rate unless an allowable MAC activity was performed on behalf of children under twenty one (21). xvi) Ensure all Coordinators and Participants have completed and have certified their understanding of the training prior to participating in the MAC program, and annually thereafter. The contractor is prohibited from allowing any staff to participate in the program unless they have completed and have certified their understanding of the training. The Contractor must: (1) Ensure all Coordinators receive HCA approved training prior to participation; (2) Ensure all Participants certify completion of the online training before performing any duties within the System or participating in the RMTS; (3) Ensure all Participants fully understand each activity code and how to answer moments according to what activity they are doing exactly at the sampled moment; Washington State Page 30 of 49 Contract No. K3072 Health Care Authority (4) Train all Participants to maintain proper documentation for MAC related activities; (5) Only use training materials that have been approved in writing by HCA; and (6) Track the completion and certification of training within the System, and must be available upon request by HCA. xvii) Comply with all HCA revisions and RMTS/claiming requirements as described in the Manual; xviii) Only use the activity codes (or their successor) in the Manual as approved by HCA, for participation in MAC and are responsible for ensuring all Participating Staff understand each code. b) Health Care Authority HCA is responsible for performing oversight of the Contractor's MAC program to ensure the effective administration of the MAC program and complying with all roles, responsibilities, limitations, restrictions, and documentation requirements described in the CAP, Manual, and this Agreement includes, but is not limited to, the following. HCA must: i) Maintain oversight of the Contractor's MAC program and monitoring activities including review of all components of the time study, claiming, training, or anything MAC related. The contractor is required to monitor its own MAC program to ensure compliance with all applicable Regulations and facilitating HCA's oversight of the program; ii) Direct the MAC activities reimbursable at the enhanced seventy five percent (75%) rate for all Skilled Professional Medical Personnel (SPMP) participating in the Contractor's MAC program. The contractor is prohibited from claiming the enhanced rate for any SPMP activities without express, written approval from HCA, see section 10 below; iii) Review the Contractor's monitoring activities to ensure monitoring is occurring and any identified issues are addressed as deemed appropriate by HCA. This includes, but is not limited to, review of time study responses, accuracy of coding, appropriateness of code changes, sufficiency of backup documentation, non-response rates; iv) Verify the Contractor has entered all necessary data into the System and verify all data entered was certified by the Contractor as accurate; v) Review all claimed costs prior to issuing reimbursement to ensure they are allowable, reasonable, and are supported by documentation that is sufficiently detailed to permit HCA, CMS, or others to determine whether the costs are necessary for the proper and efficient administration of the state plan. This includes but is not limited to; source documentation of staff costs, operating expenses, and subcontracted vendor costs. vi) Review the RMTS Consortia organization and membership, including the Lead Agency identified, annually and issuing an official notice of approval or denial. The Contractor is Washington State Page 31 of 49 Contract No. K3072 Health Care Authority prohibited from participating in a Consortium without express, written approval of the Consortia organization and membership; vii) Review all MAC related training materials prior to their use in the MAC program and issuing an official notice of approval or denial. This includes multimedia video, audio, digital or other electronic sources, and paper based training materials. The Contractor is prohibited from using any training materials without express, written approval from HCA; viii) Evaluate RMTS and claiming data prior to issuing quarterly reimbursements to ensure the RMTS results and claimed costs are appropriate according to all applicable laws, Regulations and guidelines specific to the MAC program. This evaluation will also be used to identify trends, best practices for the MAC program, quality assurance, training needs, areas in need of improvement, or other concerns related to the MAC program and HCA's oversight responsibilities; ix) Issue corrective action plans as necessary and determined by HCA's oversight capacity that includes but is not limited to, quarterly reviews of RMTS and claiming data, the contractor's failure to be in compliance with all applicable laws, Regulations and guidelines specific to the MAC program and this Agreement, or other quality assurance needs. The contractor is required to comply with any corrective action plan issued. Failure to do so will result in sanctions that may include, but is not limited to, reduced reimbursement and/or termination of this Agreement; and x) Produce and update the CAP, manual, contracts, training materials, or other MAC related documentation as needed and make it available to the Contractor. 4. MINIMUM RESPONSE RATE AND NON-RESPONSES Non-responses are moments not completed by Participant within five (5) business days, with the exception of expired moments where the Participant was on paid or unpaid leave. The return rate of valid responses for the RMTS must be a minimum of eighty five percent(85%). The following remedial action is required of the Contractor if the RMTS response rate drops below eighty five percent (85%). a) Non-response rates greater than fifteen percent(15%): i) HCA will send written notification to the Contractor requesting a Corrective Action Plan to ensure a minimum eighty five percent (85%) compliance rate for the RMTS is achieved in subsequent quarters. ii) The Contractor must develop and submit the plan to HCA for approval within thirty (30) business days of HCA's notification. iii) Failure to provide a timely corrective action plan within thirty (30) business days may result in the Contractor being prohibited from participation in MAC for the following quarter. iv) An eighty five percent(85%)compliance rate for the RMTS must be met in the following quarter. Washington State Page 32 of 49 Contract No. K3072 Health Care Authority b) Non-response rates greater than fifteen percent (15%)for two (2) consecutive quarters: i) HCA will reduce reimbursement by thirty five percent(35%)for the second consecutive quarter. ii) The Contractor will be notified via Certified Mail of the reduced reimbursement. iii) Eighty five percent (85%) compliance rate for the RMTS must be met in the following quarter. c) Non-response rates greater than fifteen percent (15%)for three (3) consecutive quarters: i) HCA will notify the affected Contractor via certified mail of the denied reimbursement for the third consecutive quarter and prohibited participation in MAC. ii) None of the affected Contractors may claim for any denied or reduced reimbursement from the three consecutive quarters of non-compliance. The Contractor may be prohibited from participating in MAC for the following quarter(4th consecutive quarter), and will be notified as such through the HCA notification. 5. CORRECTIVE ACTION PLANS HCA will pursue a corrective action plan if a Contractor fails to meet any MAC program requirements described in the CAP, Manual, this Agreement or as determined by HCA. HCA will peruse a corrective action plan if the contractor fails to address or correct any problems timely and sufficiently as determined by HCA. The Contractor must develop and submit a corrective action plan response to HCA for approval within thirty (30) business days of HCA's notification or as otherwise stated in this agreement or mutually agreed upon in writing. If a Contractor fails to meet the requirements outlined in the corrective action plan, HCA will impose sanctions that may include, but are not limited to; conducting more frequent reviews, delayed or denied payment of MAC claims, recoupment of funds, or termination of this Agreement. Examples of Contractor actions that may result in corrective action and/or sanctions include, but are not limited to: a) Repeated and/or uncorrected errors in financial reporting; b) Failure to maintain adequate documentation; c) Failure to cooperate with state or federal staff; d) Failure to provide accurate and timely information to state or federal staff as required; e) Failure to meet time study minimum response rates; f) Failure to meet statistical validity requirements; and g) Failure to comply with the terms and conditions of this agreement. 6. ADMINISTRATIVE FEE HCA charges MAC contractors an administrative fee to offset HCA's costs for the administration of the MAC program. The rate is based on the costs associated with the staff effort spent on MAC related work for an entire State Fiscal Year(SFY) and is billed as a line item on the quarterly claim form A-19-1 A submitted by the MAC contractor. This cost is divided by the dollar amount of administrative claims submitted by the participating contractors in the MAC program for the same Washington State Page 33 of 49 Contract No. K3072 Health Care Authority SFY. The calculated rate is used on the claims for the subsequent SFY. At the end of the period, the rate used will be validated using the actual claimed expenditures for that period and any variances will be settled with the contractor during the second quarter of the new SFY. 7. TIMELY FILING AND OVERPAYMENT REQUIREMENTS: The Contractor must submit invoices for reimbursement to HCA for review and approval within one hundred twenty (120) calendar days following the end of each Billing Quarter. Upon approval, the Contractor must submit a signed A19-1A invoice voucher within thirty (30) calendar days. a) Invoices submitted after one hundred twenty (120) calendar days following the end of the Billing Quarter may result in corrective action. b) HCA will not offset negative balances against future Al 9s. The contractor must immediately remit a check to HCA for any funds requiring repayment. c) HCA is not a recovery agent and any overpayments that are at or beyond the one hundred eighty (180) calendar day mark will be turned over to the Office of Financial Recovery (OFR). d) HCA will not seek reimbursement for any invoice received after the 23rd month of the two-year federal filing deadline. 8. CALCULATING THE FFP AND GENERATING AN INVOICE a) The Contractor is responsible for ensuring all data (including all RMTS and financial data) used to calculate the amount of FFP submitted to HCA for reimbursement is accurate, based on actual expenses incurred during the period of performance, and complies with all federal, state, HCA and CMS Regulations, the CAP, Manual and this Agreement. The Contractor must certify the accuracy of all data used to calculate the amount of FFP by an authorized representative signing the A-19. The Contractor must use a System that is statistically valid and in compliance with all state, and federal laws and Regulations whether through a third- party or other means as stated in the CAP to calculate the amount of FFP and generate a claim. i) The Contractor must submit invoices to HCA for FFP on a quarterly basis; ii) All data used to calculate the FFP must be from the same period of service; iii) All data used to calculate the FFP must be the actual cost/expenditure and not approximated; iv) The FFP is determined by calculating the total adjusted costs, multiplying these costs by the adjusted RMTS results, and the applicable Medicaid Eligibility Rate (MER), adding any direct charges, and then applying the appropriate FFP rate; v) The invoice must be generated within one hundred twenty (120) calendar days of the end of the quarter; and vi) The invoice is generated based on following five components: Washington State Page 34 of 49 Contract No. K3072 Health Care Authority (1) Cost pool construction; (2) Calculating allowable Medicaid administrative time via the System or direct charge method and documentation; (3) Calculation and application of the pertinent MER; (4) Calculation and application of the indirect cost rate; and (5) Application of the appropriate FFP rate. b) Cost pool construction i) The Contractor must comply with all federal, state, HCA and CMS Regulations, the CAP, Manual, and this Agreement when constructing cost pools. ii) The Contractor is prohibited from including any unallowable costs in any cost pool. iii) The Contractor must include all costs used to calculate the FFP reimbursement to one of these six cost pools: (1) Cost Pool 1: MAC SPMP; (2) Cost Pool 2: MAC Non-SPMP; (3) Cost Pool 3a and 3b: Non-MAC; (4) Cost Pool 4: MAC Direct Charge—enhanced; (5) Cost Pool 5: MAC Direct Charge—non-enhanced; and (6) Cost Pool 6: Allocated. iv) Costs included in the calculation of an indirect cost rate are prohibited from being assigned to any of the six cost pools except by application of the indirect cost rate. v) All costs assigned to each cost pool must be allowable and comply with the descriptions in the CAP and manual. c) Calculating allowable Medicaid Administrative Time i) The Contractor must only use the RMTS or the Direct Charge method to calculate the percent of reimbursable time. ii) The Contractor must use the RMTS for all eligible staff who are not certified as a Single Cost Objective. (1) The Contractor must use the RMTS results produced by the System. (2) The Contractor is prohibited from altering the RMTS results and certifies the accuracy of the data by signing the A19 by an authorized Contractor representative. Washington State Page 35 of 49 Contract No. K3072 Health Care Authority iii) The Contractor may only use the Direct Charge method for staff who are certified as a Single Cost Objective. (1) These staff are required to document their daily work activities in fifteen (15) minute increments. (a) Daily logs must be maintained according to the SOS record's retention schedule. (b) All daily logs must have a quarterly summary rolling up all time over the quarter. (2) These staff must complete a single cost objective certification quarterly using an HCA approved form. (3) Each single cost objective staff must be reported individually on the invoice. (4) The invoice must report the name, the actual amount of time spent performing allowable MAC activities, and total dollar amount claimed for reimbursement for each staff. d) Direct Charge for Interpretation Service Contracts iv) The Contractor may only direct charge for a portion of Interpretation Service contracts for allowable interpretation activities as described in this Agreement. (1) Services direct charged must be for interpretation activities identified as allowable activities within the Manual, the CAP, and this Agreement. The Contractor is prohibited from including any other portion of an Interpretation Services Contract in the calculation for FFP reimbursement. (2) Each interpretation activity must be documented to HCA's satisfaction, in fifteen (15) minute increments, using a patient encounter form that includes the following data elements: (a) Appointment time/duration, (b) Client Name/ID information, (c) Interpreter Agency, (d) Interpreter Name, (e) Interpreter signature, (f) Language/communication type, (g) MAC code and duration, and (h) Requestor or nurse name (i) The forms must be maintained according to SOS Record's retention schedule. (3) The above data from all patient encounter forms, except Client Name/ID Information, must be transferred onto a single spreadsheet that is searchable and sortable. This may be accomplished by direct data entry into the System so long as the data is extractable into an searchable and sortable spreadsheet. Washington State Page 36 of 49 Contract No. K3072 Health Care Authority (4) The invoice must report a summary for each Interpretation Service contract including the names of the interpreting staff, the total amount of time spent performing allowable MAC activities, and total dollar amount claimed for reimbursement. (5) The contractor is prohibited from altering the information on the patient encounter forms and certifies the accuracy of the data entered into the spreadsheet and the System by signing the A19 by an authorized Contractor representative. e) Calculation and application of the pertinent MER. i) All MERs must be calculated quarterly; ii) All MERs must be based on the quarter claimed; iii) All MAC activities that that benefit the Contractor's Clients directly and are performed within a program that identifies Clients must use a Client-based MER as described in the CAP and manual; iv) All MAC activities that benefit the Contractor's Clients directly and are performed within a program that operates a primary care or specialty clinic must use a clinic-based MER as described in the CAP and manual; v) All MAC activities that benefit a larger population in the geographical region served by the Contractor, or in programs that do not identify Clients or collect demographic data must use the modified county-wide MER; and vi) The Contractor is required to collect and maintain demographic data used to determine Medicaid enrollment for all Clients served within budget units whose costs are included in the FFP reimbursement. The Contractor is prohibited from including clients from any budget unit that is not allowable within the MAC program. (1) All data related to Medicaid enrollment and the MER must be maintained according to the SOS records retention schedule; (2) The information collected must be sufficiently detailed to determine Medicaid enrollment through RCA's ProviderOne System; (3) The information must be entered in the Contractor's Client information System or data base; (4) The Contractor must produce a single electronic list of all unduplicated Clients served over the quarter within thirty (30) business days of the end of the quarter; (5) The Contractor is prohibited from including the same Client more than once (duplicating)on the quarterly list; and (6) The Contractor must submit the quarterly list to either their third parry System operator or other System operator which calculates the Client-based and clinic-based MER. f) Calculation and application of the indirect cost rate Washington State Page 37 of 49 Contract No. K3072 Health Care Authority i) All indirect cost rates must be developed in accordance with all applicable regulations and guidelines including the Office of Management and Budget 2 CFR Chapter I, Chapter II, part 200, et al (OMNI Circular); ii) The Contractor is required to have an indirect cost rate proposal approved by their Cognizant Agency; iii) The Contractor is required to certify the accuracy of the indirect cost rate annually using HCA form 02-568 Certificate of Indirect Costs; iv) The Contractor is required to verify all costs submitted to HCA for reimbursement are not duplicated through the indirect rate or any other mechanism; and v) The Contractor is prohibited from requesting duplicate FFP for any cost. g) Application of the appropriate FFP rate The Contractor is: i) Permitted to claim seventy five percent (75%)enhanced FFP only for specific allowable MAC activities accurately reported to SPMP or Interpretation activity codes as described in the Manual. The Contractor is: (1) Required to verify the accuracy of activities reported to activity codes 12b and 7d; and (2) Prohibited from claiming seventy five percent (75%) FFP for any other activities. ii) Permitted to claim fifty percent (50%)for all other accurately reported MAC activity codes; and iii) Required to certify the accuracy of the FFP claimed for reimbursement by signing the A19. h) Certified Public Expenditures The Contractor: i) Is prohibited from using any source of funds that do not comply with federal, state, HCA and CMS Regulations, the CAP, Manual and this Agreement as CPE; ii) Is required to certify all sources of funds used as for CPE are accurate, allowable, and in compliance with all federal, state, HCA and CMS Regulations, the CAP, Manual and this Agreement quarterly by completeing a Certified Public Expenditure Local Match Certification quarterly and by signing the A19. The quarterly CPE certification may be completed electronically through the System; iii) Is required to use the Budgeting, Accounting and Reporting System (BARS manual) prescribed accounting and reporting for local governments, found at this website http://www.sao.wa.gov/local/BarsManual/Pages/BarsManual GAAP.aspx#.yy3K 03bLc Washington State Page 38 of 49 Contract No. K3072 Health Care Authority s, to identify and document the revenue account codes for all local matching funds reported as CPE iv) Is required to ensure the source of all CPE funds are not federal tax money and are not used as a match for federal money(by the Contractor or any other agency); v) Must only use these funds to supplement, not supplant the amount of federal, state and local funds otherwise expended or services provided under this Agreement; vi) Must have funds available for MAC activities and the funds must be within the Contractor's control and budget; vii) Is prohibited from using provider-related donations or impermissible heath care related tax source for CPE; viii) Is prohibited from using any private donations or non-public funds as a source for CPE without authorization from CMS' Center for Medicaid and State Operations' National Institutional Reimbursement Team (NIRT); ix) Is prohibited from requiring or allowing private non-profits to participate in the financing of the non-federal share of expenditures; (1) Is prohibited from allowing non-governmental units to voluntarily provide, or be contractually required to provide, any portion of the non-federal share of the Medicaid expenditures. x) Is prohibited from using funds payable under this Agreement for lobbying activities of any nature. The contractor certifies that no state or federal funds payable under this Agreement shall be paid to any person or organization to influence, or attempt to influence, either directly or indirectly, an officer or employee of a state or federal agency, or an officer or member of any state or federal legislative body o committee regarding the award, amendment, modification, extension, or renewal of a state or federal contract grant; and A) Must expend the total computable cost to all Subcontracted vendors for performance of allowable MAC activities. (1) The Contractor is prohibited from submitting a request for FFP reimbursement to HCA until they have actually incurred the total computable cost; and (2) The Contractor is prohibited from requiring the Subcontractor to provide the non- federal share of the payment, or return any portion of the total computable cost to the Contractor. i) Revenue Offset The Contractor is: Washington State Page 39 of 49 Contract No. K3072 Health Care Authority i) Prohibited from submitting a request for FFP reimbursement to HCA unless all funds are appropriately offset according to all federal, state, HCA and CMS Regulations, the CAP, Manual and this Agreement; ii) Required to certify the accuracy of the funds that are offset and the accuracy of the requested FFP reimbursement by signing the A19; iii) Required to ensure there is no duplication in FFP reimbursement between programs or cost objectives; iv) Financially responsible for repayment of any duplicated funds; v) Required to provide documentation that Coordinators have been trained and fully understands the scope of work and terms of each funding source; and vi) The Contractor is required to perform an assessment to determine whether each cost objective contained within the MAC budget unit(s) has potential to overlap with MAC; (1) The Contractor is prohibited from using any source of funds contained within the MAC budget unit until they have been assessed and determined appropriate; (2) The Contractor must complete the assessment annually and submit the assessment to the HCA Contract Manager no later than January 31 st or within thirty(30) business days of completion, whichever comes soonest; (3) If the assessment determines any portion of the scope of work overlaps with MAC activities, the entire cost objective is deemed to overlap and is prohibited from being used as CPE; and (4) Required to identify costs that must be offset, and verify the remaining net costs are allowable for inclusion in the MAC program and eligible for FFP reimbursement. 9. SKILLED PROFESSIONAL MEDICAL PERSONNEL(SPMP) Contractor staff who have completed a two-or-more-year program leading to an academic degree or certificate in a medically related profession, demonstrated by possession of a medical license, certificate or other document issued by a recognized National or State medical licensure or certifying organization, or a degree in a medical field issued by a college or university certified by a professional medical organization are eligible for a seventy five percent (75%)enhanced reimbursement for specific MAC activities. Years of experience in the administration, direction, or implementation of the Medicaid program is not considered the equivalent of professional training in a field of medical care. The Contractor is permitted to perform SPMP activities as directed by HCA's Chief Medical Officer(CMO)to assist in achieving HCA's goals and administering the Medicaid State Plan. The Contractor must: a) Monitor and ensure that FFP reimbursement for SPMP activities are in compliance with all federal, state, HCA and CMS Regulations, the CAP, Manual and this Agreement. Federal requirements include 42 CFR§432.2, 432.45, 432.50, and 433.15; b) Have all forms and documents supporting the designation of an SPMP entered into the System and retained according to the SOS record's retention schedule: Washington State Page 40 of 49 Contract No. K3072 Health Care Authority c) Not, and is prohibited from requesting seventy five percent(75%) enhanced reimbursement for: i) Any staff who are not certified as an SPMP, as stated above; ii) Any staff whose position descriptions do not require certified SPMP duties or responsibilities; iii) Any staff who are not directly employed by the Contractor; iv) Medical assistance expenditures; v) Any SPMP activities that are not directed by HCA's CMO and explicitly described in this Agreement (All other allowable MAC activities performed by an SPMP are eligible for 50% FFP); and vi) Any activities that are not directly related to the administration of the State Medicaid plan. d) Provide HCA with a written report documenting progress, accomplishments, barriers and suggested recommendations related to the performance of SPMP activities as requested by HCA, within a mutually agreed upon time frame; e) Participate in program planning and policy development meetings as requested by HCA; i) The meetings will include discussions related to, but not limited to, reviewing the SPMP reports and related topics or the effectiveness of the activities performed in support of RCA's goals and the Medicaid State Plan. f) Comply with any changes to the allowable SPMP activities as directed by the CMO; i), Failure to comply with CMO directives may result in termination of SPMP participation in the MAC program. g) Monitor and ensure that all activities reimbursed at the seventy five percent(75%) enhanced FFP are in support of the Medicaid State Plan and fall within the categories below. All other allowable MAC activities performed by an SPMP are eligible for fifty percent(50%) FFP; h) Comply with any changes to allowable SPMP activities as directed by the CMO that may include, but is not limited to: i) Clinical consultation with medical providers regarding best practices and adequacy of medical care covered by Medicaid. Includes, but is not limited to the following areas: (1) Pediatric immunization issues. (2) Access to Baby and Child Dentistry(ABCD) Emerging treatment/therapies for high risk populations. ii) Coordination of Medicaid-covered medical services for medically at-risk populations. Washington State Page 41 of 49 Contract No. K3072 Health Care Authority (1) Medically fragile children. (2) High risk pregnant women. (3) Homeless individuals. (4) Individuals with multiple medical conditions. iii) Case staffing on the medical aspects of cases requiring Medicaid-covered services. (1) Medically involved children in foster care. (2) High risk pregnant women. (3) Individual with communicable diseases requiring extraordinary/non-standard medical care. iv) Planning and coordination with local medical providers to facilitate earlier referrals and treatment for high-risk populations. (1) Children in foster care. (2) Homeless individuals. (3) Children with developmental delays or behavioral challenges v) Providing medical consultation to the state regarding the Medicaid state plan. (1) Consultation with medical providers to improve birth outcomes for Medicaid children. (2) Consultation with school personnel to improve health outcomes for children exhibiting developmental delays or behavioral challenges due to medical condition, family stress or other factors. vi) Pediatric immunizations. Washington State Page 42 of 49 Contract No. K3072 Health Care Authority ATTACHMENT 1 FEDERAL COMPLIANCE, CERTIFICATIONS, AND ASSURANCES In the event federal funds are included in this agreement,the following sections apply:I. Federal Compliance and II.Standard Federal Assurances and Certifications. In the instance of inclusion of federal funds,the Contractor may be designated as a sub-recipient and the effective date of the amendment shall also be the date at which these requirements go into effect. I. FEDERAL COMPLIANCE-The use of federal funds requires additional compliance and control mechanisms to be in place. The following represents the majority of compliance elements that may apply to any federal funds provided under this contract. For clarification regarding any of these elements or details specific to the federal funds in this contract, contact the Health Care Authority. a. Source of Funds:Federal funds to support this agreement are identified by the Catalog of Federal Domestic Assistance (CFDA)number 93.778. The sub-awardee is responsible for tracking and reporting the cumulative amount expended under HCA IA Contract No. K3072. b. Period of Availability of Funds:Pursuant to 45 CFR 92.23, Sub-awardee may charge to the award only costs resulting from obligations of the funding period specified in CFDA 93.778, unless carryover of unobligated balances is permitted, in which case the carryover balances may be charged for costs resulting from obligations of the subsequent funding period. All obligations incurred under the award must be liquidated no later than 90 days after the end of the funding period. c. Single Audit Act: A sub-awardee(including private, for-profit hospitals and non-profit institutions) shall adhere to the federal Office of Management and Budget(OMB)Circular A-133, as well as all applicable federal and state statutes and regulations. A sub-awardee who expends$500,000 or more in federal awards during a given fiscal year shall have a single or program-specific audit for that year in accordance with the provisions of OMB Circular A-133. d. Modifications:This agreement may not be modified or amended, nor may any term or provision be waived or discharged, including this particular Paragraph, except in writing, signed upon by both parties. 1. Examples of items requiring Health Care Authority prior written approval include, but are not limited to, the following: i. Deviations from the budget and Project plan. ii. Change in scope or objective of the agreement. iii. Change in a key person specified in the agreement. iv. The absence for more than three months or a 25% reduction in time by the Project Manager/Director. v. Need for additional funding. vi. Inclusion of costs that require prior approvals as outlined in the appropriate cost principles. vii. Any changes in budget line item(s)of greater than twenty percent(20%)of the total budget in this agreement. 2. No changes are to be implemented by the Sub-awardee until a written notice of approval is received from the Health Care Authority. e. Sub-Contracting:The sub-awardee shall not enter into a sub-contract for any of the work performed under this agreement without obtaining the prior written approval of the Health Care Authority. If sub- contractors are approved by the Health Care Authority,the subcontract,shall contain, at a minimum, sections of the agreement pertaining to Debarred and Suspended Vendors, Lobbying certification, Audit requirements, and/or any other project Federal, state, and local requirements. f. Condition for Receipt of Health Care Authority Funds:Funds provided by Health Care Authority to the sub-awardee under this agreement may not be used by the sub-awardee as a match or cost-sharing provision to secure other federal monies without prior written approval by the Health Care Authority. Washington State Page 43 of 49 K3072 Health Care Authority Attachment 1 g. Unallowable Costs:The sub-awardees'expenditures shall be subject to reduction for amounts included in any invoice or prior payment made which determined by HCA not to constitute allowable costs on the basis of audits, reviews,or monitoring of this agreement. h. Citizenship/Alien Verification/Determination:The Personal Responsibility and Work Opportunity Reconciliation Act(PRWORA)of 1996 (PL 104-193)states that federal public benefits should be made available only to U.S. citizens and qualified aliens. Entities that offer a service defined as a "federal public benefit"must make a citizenship/qualified alien determination/verification of applicants at the time of application as part of the eligibility criteria. Non-US citizens and unqualified aliens are not eligible to receive the services. PL 104-193 also includes specific reporting requirements. i. Federal Compliance:The sub-awardee shall comply with all applicable State and Federal statutes, laws, rules, and regulations in the performance of this agreement,whether included specifically in this agreement or not. j. Civil Rights and Non-Discrimination Obligations During the performance of this agreement,the Contractor shall comply with all current and future federal statutes relating to nondiscrimination. These include but are not limited to:Title VI of the Civil Rights Act of 1964(PL 88-352),Title IX of the Education Amendments of 1972 (20 U.S.C. §§ 1681-1683 and 1685-1686), section 504 of the Rehabilitation Act of 1973(29 U.S.C. §794), the Age Discrimination Act of 1975(42 U.S.C. §§6101- 6107), the Drug Abuse Office and Treatment Act of 1972 (PL 92-255),the Comprehensive Alcohol Abuse and Alcoholism Prevention,Treatment and Rehabilitation Act of 1970(PL 91-616), §§523 and 527 of the Public Health Service Act of 1912(42 U.S.C. §§290dd-3 and 290ee-3),Title VIII of the Civil Rights Act of 1968(42 U.S.C. §§3601 et seq.), and the Americans with Disability Act(42 U.S.C., Section 12101 et seq.) http://www.hhs.gov/ocr/civilrights HCA Federal Compliance Contact Information Federal Grants and Budget Specialist Health Care Policy Washington State Health Care Authority Post Office Box 42710 Olympia,Washington 98504-2710 II. CIRCULARS `COMPLIANCE MATRIX'-The following compliance matrix identifies the OMB Circulars that contain the requirements which govern expenditure of federal funds. These requirements apply to the Washington State Health Care Authority(HCA), as the primary recipient of federal funds and then follow the funds to the sub-awardee, Mason County Health Dept.. The federal Circulars which provide the applicable administrative requirements, cost principles and audit requirements are identified by sub- awardee organization type. III. OMB CIRCULAR ENTITY TYPE ADMINISTRATIVE COST AUDIT REQUIREMENTS REQUIREMENTS PRINCIPLES State. Local and Indian Tribal A-102&Common A-87 A-133 Governments and Rule Governmental Hospitals Non-Profit Organizations and A-110 A-122 A-133 Non-Profit Hospitals Colleges or Universities and A-110 A-21 A-133 Affiliated Hospitals For-Profit Organizations A-110 48 CFR 31.2 Requirements established by the pass-through entity, pursuant to A- 133, §_.210(e) Washington State Page 44 of 49 K3072 Health Care Authority Attachment 1 Definitions: "Sub-recipient";means the legal entity to which a sub-award is made and which is accountable to the State for the use of the funds provided in carrying out a portion of the State's programmatic effort under a sponsored project.The term may include institutions of higher education,for-profit corporations or non-U.S. Based entities. "Sub-award and Sub-grant'are used interchangeably and mean a lower tier award of financial support from a prime awardee(e.g.,Washington State Health Care Authority)to a Sub-recipient for the performance of a substantive portion of the program.These requirements do not apply to the procurement of goods and services for the benefit of the Washington State Health Care Authority. IV. STANDARD FEDERAL CERTIFICATIONS AND ASSURANCES - Following are the Assurances, Certifications, and Special Conditions that apply to all federally funded (in whole or in part)agreements administered by the Washington State Health Care Authority. CERTIFICATIONS 1. CERTIFICATION REGARDING Should the contractor not be able to provide this DEBARMENT AND SUSPENSION certification, an explanation as to why should be placed after the assurances page in the contract. The undersigned (authorized official signing for the contracting organization) certifies to the best The contractor agrees by signing this contract of his or her knowledge and belief, that the that it will include,without modification,the clause contractor, defined as the primary participant in titled "Certification Regarding Debarment, accordance with 45 CFR Part 76, and its Suspension, In eligibility, and Voluntary principals: Exclusion--Lower Tier Covered Transactions" in all lower tier covered transactions (i.e., a) are not presently debarred, suspended, transactions with sub-grantees and/or proposed for debarment, declared ineligible, contractors) and in all solicitations for lower tier or voluntarily excluded from covered covered transactions in accordance with 45 CFR transactions by any Federal Department or Part 76. agency; b) have not within a 3-year period preceding this 2. CERTIFICATION REGARDING DRUG- contract been convicted of or had a civil FREE WORKPLACE REQUIREMENTS judgment rendered against them for commission of fraud or a criminal offense in The undersigned (authorized official signing for connection with obtaining, attempting to the contracting organization) certifies that the obtain,or performing a public(Federal,State, contractor will,or will continue to, provide a drug- or local) transaction or contract under a free workplace in accordance with 45 CFR Part public transaction; violation of Federal or 76 by: State antitrust statutes or commission of embezzlement, theft, forgery, bribery, a) Publishing a statement notifying employees falsification or destruction of records, making that the unlawful manufacture, distribution, false statements, or receiving stolen dispensing, possession or use of a controlled property; substance is prohibited in the grantee's workplace and specifying the actions that will c) are not presently indicted or otherwise be taken against employees for violation of criminally or civilly charged by a such prohibition; governmental entity(Federal, State, or local) with commission of any of the offenses b) Establishing an ongoing drug-free awareness enumerated in paragraph (b) of this program to inform employees about certification; and (1) The dangers of drug abuse in the workplace; d) have not within a 3-year period preceding this (2) The contractor's policy of maintaining a contract had one or more public transactions drug-free workplace; (Federal,State,or local)terminated for cause (3)Any available drug counseling, or default. rehabilitation, and employee assistance programs; and Washington State Page 45 of 49 K3072 Health Care Authority Attachment 1 (4) The penalties that may be imposed upon For purposes of paragraph (e) regarding agency employees for drug abuse violations notification of criminal drug convictions,Authority occurring in the workplace; has designated the following central point for receipt of such notices: c) Making it a requirement that each employee to be engaged in the performance of the Legal Services Manager contract be given a copy of the statement WA State Health Care Authority required by paragraph (a)above; PO Box 42700 Olympia, WA 98504-2700 d) Notifying the employee in the statement required by paragraph (a), above, that, as a condition of employment under the contract, 3. CERTIFICATION REGARDING LOBBYING the employee will— (1)Abide by the terms of the statement,- and Title 31, United States Code, Section 1352, (2)Notify the employer in writing of his or her entitled "Limitation on use of appropriated funds conviction for a violation of a criminal drug to influence certain Federal contracting and statute occurring in the workplace no later financial transactions," generally prohibits than five calendar days after such conviction; recipients of Federal grants and cooperative agreements from using Federal (appropriated) e) Notifying the agency in writing within ten funds for lobbying the Executive or Legislative calendar days after receiving notice under Branches of the Federal Government in paragraph (d)(2) from an employee or connection with a SPECIFIC grant or cooperative otherwise receiving actual notice of such agreement. Section 1352 also requires that each conviction. Employers of convicted person who requests or receives a Federal grant employees must provide notice, including or cooperative agreement must disclose lobbying position title,to every contract officer or other undertaken with non-Federal (nonappropriated) designee on whose contract activity the funds. These requirements apply to grants and convicted employee was working, unless the cooperative agreements EXCEEDING $100,000 Federal agency has designated a central in total costs(45 CFR Part 93). point for the receipt of such notices. Notice shall include the identification number(s) of The undersigned (authorized official signing for each affected grant; the contracting organization)certifies,to the best of his or her knowledge and belief,-that: f) Taking one of the following actions,within 30 calendar days of receiving notice under (1) No Federal appropriated funds have been paragraph (d), (2), with respect to any paid or will be paid, by or on behalf of the employee who is so convicted— undersigned, to any person for influencing or (1)Taking appropriate personnel action attempting to influence an officer or against such an employee, up to employee of any agency, a Member of and including termination, Congress, an officer or employee of consistent with the requirements of Congress, or an employee of a Member of the Rehabilitation Act of 1973, as Congress in connection with the awarding of amended; or any Federal contract,the making of any (2)Requiring such employee to Federal grant,the making of any Federal participate satisfactorily in a drug loan,the entering into of any cooperative abuse assistance or rehabilitation agreement, and the extension, continuation, program approved for such renewal, amendment, or modification of any purposes by a Federal,State,or Federal contract, grant, loan,or cooperative local health,law enforcement,or agreement. other appropriate agency; (2) If any funds other than Federally g) Making a good faith effort to continue to appropriated funds have been paid or will be maintain a drug-free workplace through paid to any person for influencing or implementation of paragraphs (a), (b), (c), attempting to influence an officer or (d), (e), and (f). employee of any agency, a Member of Congress, an officer or employee of Washington State Page 46 of 49 K3072 Health Care Authority Attachment 1 Congress,or an employee of a Member of directly or through State or local governments, by Congress in connection with this Federal Federal grant, contract, loan, or loan guarantee. contract, grant, loan, or cooperative The law also applies to children's services that agreement,the undersigned shall complete are provided in indoor facilities that are and submit Standard Form-LLL, "Disclosure constructed, operated, or maintained with such of Lobbying Activities,"in accordance with Federal funds. The law does not apply to its instructions. (If needed, Standard Form- children's services provided in private residence, LLL, "Disclosure of Lobbying Activities,"its portions of facilities used for inpatient drug or instructions, and continuation sheet are alcohol treatment, service providers whose sole included at the end of this application form.) source of applicable Federal funds is Medicare or Medicaid, or facilities where WIC coupons are (3) The undersigned shall require that the redeemed. language of this certification be included in the award documents for all subcontracts at Failure to comply with the provisions of the law all tiers (including subcontracts, may result in the imposition of a civil monetary subcontracts, and contracts under grants, penalty of up to$1,000 for each violation and/or loans and cooperative agreements) and that the imposition of an administrative compliance all sub-recipients shall certify and disclose order on the responsible entity. accordingly. By signing the certification, the undersigned This certification is a material representation of fact certifies that the contracting organization will upon which reliance was placed when this comply with the requirements of the Act and will transaction was made or entered into.Submission not allow smoking within any portion of any indoor of this certification is a prerequisite for making or facility used for the provision of services for entering into this transaction imposed by Section children as defined by the Act. 1352, U.S. Code. Any person who fails to file the required certification shall be subject to a civil. The contracting organization agrees that it will penalty of not less than$10,000 and not more than require that the language of this certification be $100,000 for each such failure. included in any subcontracts which contain provisions for children's services and that all sub- 4. CERTIFICATION REGARDING PROGRAM recipients shall certify accordingly. FRAUD CIVIL REMEDIES ACT(PFCRA) The Public Health Services strongly The undersigned (authorized official signing for encourages all recipients to provide a the contracting organization) certifies that the smoke-free workplace and promote the non- statements herein are true, complete, and use of tobacco products.This is consistent accurate to the best of his or her knowledge, and with the PHS mission to protect and advance that he or she is aware that any false,fictitious,or the physical and mental health of the fraudulent statements or claims may subject him American people. or her to criminal, civil, or administrative penalties. The undersigned agrees that the 6. CERTIFICATION REGARDING contracting organization will comply with the DEBARMENT, SUSPENSION,AND Public Health Service terms and conditions of OTHER RESPONSIBILITY MATTERS award if a contract is awarded. INSTRUCTIONS FOR CERTIFICATION 1) By signing and submitting this proposal, the 5. CERTIFICATION REGARDING prospective contractor is providing the ENVIRONMENTAL TOBACCO SMOKE certification set out below. Public Law 103-227, also known as the Pro- 2) The inability of a person to provide the Children Act of 1994(Act), requires that smoking certification required below will not not be permitted in any portion of any indoor necessarily result in denial of participation in facility owned or leased or contracted for by an this covered transaction. The prospective entity and used routinely or regularly for the contractor shall submit an explanation of why provision of health, day care, early childhood it cannot provide the certification set out development services, education or library below.The certification or explanation will be services to children under the age of 18, if the considered in connection with the department services are funded by Federal programs either or agency's determination whether to enter Washington State Page 47 of 49 K3072 Health Care Authority Attachment 1 into this transaction. However, failure of the transaction, unless it knows that the prospective contractor to furnish a certification is erroneous. A participant may certification or an explanation shall disqualify decide the method and frequency by which it such person from participation in this determines the eligibility of its principals. transaction. Each participant may, but is not required to, 3) The certification in this clause is a material check the Non-procurement List(of excluded representation of fact upon which reliance parties). was placed when the department or agency 9) Nothing contained in the foregoing shall be determined to enter into this transaction. If it construed to require establishment of a is later determined that the prospective system of records in order to render in good contractor knowingly rendered an erroneous faith the certification required by this clause. certification, in addition to other remedies The knowledge and information of a available to the Federal Government, the participant is not required to exceed that department or agency may terminate this which is normally possessed by a prudent transaction for cause of default. person in the ordinary course of business 4) The prospective contractor shall provide dealings. immediate written notice to the department or 10) Except for transactions authorized under agency to whom this contract is submitted if paragraph 6 of these instructions, if a at any time the prospective contractor learns participant in a covered transaction that its certification was erroneous when knowingly enters into a lower tier covered submitted or has become erroneous by transaction with a person who is suspended, reason of changed circumstances. debarred, ineligible, or voluntarily excluded 5) The terms covered transaction, debarred, from participation in this transaction, in suspended, ineligible, lower tier covered addition to other remedies available to the transaction, participant, person, primary Federal Government, Authority may covered transaction, principal, proposal, and terminate this transaction for cause or voluntarily excluded, as used in this clause, default. have the meanings set out in the Definitions and Coverage sections of the rules 7. CERTIFICATION REGARDING implementing Executive Order 12549. You DEBARMENT, SUSPENSION,AND may contact the person to whom this contract OTHER RESPONSIBILITY MATTERS is submitted for assistance in obtaining a PRIMARY COVERED TRANSACTIONS copy of those regulations. 6) The prospective contractor agrees by 1) The prospective contractor certifies to the submitting this contract that, should the best of its knowledge and belief,that it and its proposed covered transaction be entered principals: into,it shall not knowingly enter into any lower a) Are not presently debarred, suspended, tier covered transaction with a person who is proposed for debarment, declared debarred, suspended, declared ineligible, or ineligible, or voluntarily excluded from voluntarily excluded from participation in this covered transactions by any Federal covered transaction, unless authorized by department or agency; Authority. b) Have not within a three-year period 7) The prospective contractor further agrees by preceding this contract been convicted of or submitting this contract that it will include the had a civil judgment rendered against them clause titled "Certification Regarding for commission of fraud or a criminal offense Debarment, Suspension, Ineligibility and in connection with obtaining, attempting to Voluntary Exclusion -- Lower Tier Covered obtain, or performing a public(Federal, State Transaction," provided by HHS, without or local) transaction or contract under a modification, in all lower tier covered public transaction; violation of Federal or transactions and in all solicitations for lower State antitrust statutes or commission of tier covered transactions. embezzlement, theft, forgery, bribery, 8) A participant in a covered transaction may falsification or destruction of records, making rely upon a certification of a prospective false statements, or receiving stolen participant in a lower tier covered transaction property; that it is not debarred, suspended, ineligible, c) Are not presently indicted for or or voluntarily excluded from the covered otherwise criminally or civilly charged by Washington State Page 48 of 49 K3072 Health Care Authority Attachment 1 a governmental entity (Federal, State or public transactions (Federal, State or local) with commission of any of the local)terminated for cause or default. offenses enumerated in paragraph (1)(b) of this certification;and 2) Where the prospective contractor is unable to d) Have not within a three-year period certify to any of the statements in this preceding this contract had one or more certification, such prospective contractor shall attach an explanation to this proposal. CONTRACTOR SIGNATURE REQUIRED SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE Please also print or type name: ORGANIZATION NAME: (if applicable) DATE Washington State Page 49 of 49 K3072 Health Care Authority Attachment 1 MASON COUNTY BRIEFING ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS FROM: Michael MacSems DEPARTMENT: DCD EXT: 571 BRIEFING DATE: November 19, 2018 ITEM: To appoint or reappoint two members to two new three-year terms on the Mason County Historic Preservation Commission. EXECUTIVE SUMMARY: (If applicable, please include available options and potential solutions): The Mason County Historic Preservation Commission is a seven (7) member commission which serves to identify and actively encourage the conservation of Mason County's historic resources. Currently two seats will expire on November 30th, Mason County has received four applications for these two seats. Both incumbents have reapplied as well as two members of the public. The MCHPC voted at their November 8th (members R. Calvin and S. Neil abstained) to forward a recommendation to the BOCC to reappoint current members Rick Calvin (chair) and Stephanie Neil (professional experience) to the MCHPC due to their exceptional importance to the ongoing operations and expertise of the current commission. It is understood that ultimately the BOCC will decide which two individuals to appoint. There is a timeliness issue in order to avoid open seats at the December 13th meeting. BUDGET IMPACTS: None RECOMMENDED OR REQUESTED ACTION: At the November 27th meeting, reappoint Rick Calvin and Stephanie Neil to the Mason County Historic Preservation Commission for new three-year terms ending in November 2021. ATTACHMENTS: Applications from Rick Calvin, Stephanie Neil, David Dally and Peggy Hosford and the 2018 HPC membership roster. Briefing Item Summary Form Appointments.doc 2018 Mason County Historic Preservation Commission Membership List Stephanie Neil Professional Expertise Nov 2018 91 E Morris Creek Dr. Belfair,WA 98528 Works for Squaxin Cultural Resources,formerly with USFS Steve Rose Vice Chair Nov 2019 P.O.Box 1215 Allyn,WA 98524 Christina Lee Williams Nov 2020 23 01 E Anthony Rd Grapeview,WA 98546 Patricia Jerrells Nov 2019 320 SE Nighthawk PI Shelton,WA 98584 Edgar Huber Professional Expertise Nov 2020 111 SE Emerald Drive Shelton,WA 98584 Principle Investigator/Project Manager at SRI Lorilyn F.Rogers Nov 2019 W 229 Wyandottte Shelton,WA 98584 Rick Calvin Chair Nov 2018 2461 E Grapeview Loop Rd Grapeview,WA 98546 Rhonda Foster Ex-Officio Member THPO Squaxin Tribe SE 70 Squaxin Ln Shelton,WA 98584 Kris Miller Ex-Officio Member THPO Skokomish Tribe N 541 Tribal Center Shelton,WA 98584 Dios coati MASON COUNTY COMMISSIONERS 411 NORTH FITTH STREET SHELTON WA 98554 Fax 360-427-8437, Voice 360-427-9670, Ext.499;275-4467 or 482-5269 1854 I AM SEEKING APPOINTMENT TO Mason County Historic Preservation Commission NAME: Richard Calvin ADDRESS: 2461 E.Grapeview Loop Road Grapeview WAPHONE:360-801-0938 CITY/ZIP: 98546 Grapeview VOTING PRECINCT: WORK PHONE: 360-731-0308(OR AREA IN THE COUNTY YOU LIVE) E-MAIL: mchperCalvin@aol.com ------------------------------------------------------------------------------------------- COMMUNITY SERVICE EMPLOYMENT:(IF RETIRED. PREVIOUS EXPERIENCE) (ACTIVITIES OR MEMBERSHIPS) Mason County Historic Preservation COMPANY: Puget Sound Naval Shipyard 18 YRS Commission POSITION: Project Manager COMPANY: YRS POSITION: ------------------------------------------------------------------------------------------- In your words,what do you perceive is the role or purpose of the Board, Committee or Council for which you are applying: While the purpose and duties of the MCHPC are numerous,the most prevelant activities of the MCHPC is advising the BOCC on matters related to Mason County History. Maintaining and administering the Mason County Historic Register, including reviewing and recommending action on Historic Register applications an', Cerificates of _Appropriateness. Promoting and developing opportunities for the public to identify and preserve Mason County history through public education and outreach. What interests, skills do you wish to offer the Board,Committee,or Council? I have a deep interest and affinity for Mason County and regional history with a sincere desire to assist the community in connecting with and preserving our history.To support this desire I have the demonstrated management, administFatove and teambuilding skills to support the MGHPG- with there assigned duties and pFojerts. Please list any financial, professional, or voluntary affiliations which may influence or affect your position on this Board: (i.e.create a potential conflict of interest) I have no known conflicts of interests. Your participation is dependent upon attending certain trainings made available by the County during regular business hours (such as Open Public Meetings Act and Public Records).The trainings would be at no cost to you.Would you be able to attend such trainings? Yes Realistically,how much time can you give to this position? Quarterly NY x Weekly Dail Office Use Only 10/29/18 Appointment Date Signature Date Tenn Expire Date MASON COUNTY COMMUSSIONERS 411 NORTH FUFTH STREET SHELTON WA 98584 Fax 360-427-8437; Voice 360-427-9670, Ext. 419,,275-4467 or 482-5269 I_AM SEEKING APPOINTMENT TO Mason County Historic Preservation Commission NAME. Stephanie Neil ADDRESS: 341 NE Old Belfair Hwy PHONE: 360-275-4101 CITY/ZIP: VOTING PRECINCT: WORK PHONE: 360-972-6631 9852& Belfair (OR AREA IN THE COUNTY YouuvE) E-MAIL stephvanb@hotmail.com -`-----------------------------------------------------------------------------------'------ COMMUNITY SERVICE EMPLOYMENT: (IF RETIRED. PREVIOUS EXPERIENCE) (ACTIVITIES OR MEMBERSHIPS) COMPANY: Squaxin,lsland Tribe,4 years, YRS POSITION: Archaeologist COMPANY: USDA Forest Service, 6 years YRS POSITION: Archaeologist -------------------------------------------------------------------------------------------- In your words,what do you perceive Is the role or purpose of the Board, Committee or Council for which you are applying: The purpose of the HPG is to encourage preservation of the historic r co Ir . .s in Macon County and make recommendations to the Board of County Commissioners related to historic preservation. HPC works to identify and that are listed on the register, engages and educates the public about historic places and resources and funds historic preservation work through the CLG grant program. What interests, skills do you wish to offer the Board, Committee,or Council? raGptlnn Please list any financial, professional, or voluntary affiliations which may influence or affect your position on this Board: (Le, create a potential conflict of Interest) I vrark#erthe a are applying for Heritage Preservation grants I recuse myself from the discussion and decision. Your participation is dependent upon attending certain trainings made available by the County during regular business hours (such as Open Public Meetings Act and Public Records).The trainings would be at no cost to you.Would you be able to attend such trainings? Yes Realistically,how much time can you give to this position? Quarterly 2 Monthly Weekly Daily I Office Use Only r c Appointment gate Signature Date Temi Ex&e Dale___,___ Mason County Commissioners 10/31/18 415 N. 5th St. Shelton, WA 98584 Dear Commissioners, I am interested in serving on the f1istoric Preservation Commission. I have lived in Mason County Since 199'7. 1 currently serve as 'Treasurer at the Mason County Historical Society. Attached is a copy of my resume with work experience, although I am currently retired. Also attached is the Application for this position. Thank you for any consideration you may give this matter. Warmest regards, David P.Daily 321 SE McComb Way Shelton, WA 98584 360.791..8933 DavidD_TWI@msn.com G`G:CMMR5 Neathedn,shutty, Drexler Cie")14 1�G� f IWASO IV COUNTY CaWYMS-FtONEPS 411 AF0RIHPrFTI-1ST.T, NOV 05 2018 4 SR EUTON MA 98584 5-40 mawn County Fax,360-4-97-8437;Voice 36CL427-"7AEA419:277or482-5269 CGITImIssioners I ANISEeKl KIG APP0ltjTMEIjT Historic Preseivagoh Commission NWG.David Dally ADDRESS-.321 SE McQoMb Way ,.360,427.7644 CITYWP: X0 T,'_h K-Z P R E Q I ELC—T. 300.791.8933 98684 (OPARFAlf.47 HE COMV You..,Arcadia &MAIL [)aV-IdEl_TVVI@Msn.com ----------- --------------—- =IMUNITy Sem/tCL EMPLOYMENT:LiFPETIREQ.PFtE VfOUS EXPERIENCE) •Mason County lIsTerilrs UaRhow rOMP_ANr- Tr_emiajriL-W_jst,Inq..20 years Cammittee 'Volunteer at Maspji GoO.ty HistofJOI Society p0SfflQ,-,t: President CO3jjjr-.,Ajqy. Paragon Slatisulfirig 2 years poa-MON: IT/Management Consultant ------------------ --7---- ------- in your-vords,what do you peroelve is the role or purpose of Ilio Board,GoMrMt1:60 oir'lCoufloll Jbir which you eireapplying: I perceive the Tole of this commission 1 to preserve and protect the of Mason County.The commission can raise awa nesg I Is e rb WU"SP tl ers] "Iurlulofton"nd— What Interests,SK-108 rid you v4sh to offer the Board,Conimittea,or Council? 51 year career in.ma'napernent,ita.and financial consulting. Lifelong interest in history, Please litt any finan o1aI,prof"alonal, or voluntary affiliations which may Influenco or affect your position on this a-00d; (1,e,create a potential conflict of fnteres4 I serve as Treasurer of the Mason Courtly H Lstorioal 6Qctety.),f necessary,I would recuse myself from any decisions rpow-ftn the HistoricalSoclit—y. Your rarildipatIon Is dependent upon stleii0inij Ofth trainings Triode available by the GouffiNy during regular buslix-sa hours (suoi as Op.6n Public Meet rigs Aot and Public Records).The traillings would be at no cost.to you,Would you be able to wWdeuO frainings! Yes Reaft.tically,how much time can you give to this position? ovarterly X Monthly weeNy n,* Ofte 1180 Obly 6 hours f-_ql -_j e Arpcitaji-vmt Date— V11" � w h . J 1- > (�(,r 50 Years IT consulting for industry leaders such as IBM,Citicorp,Control Data,and FIserv. 40 Years Marketing and Sales success specializing in Credit Union Hardware/Software solutions. • Credit Union Volunteer:Board of Directors.ALM and Supervisor Committees. • Business Owner and Manager Sales and Production. Involved in literally hundreds of Credit Union IT searches, Credit Union Experience 3/1/10 to Present President Consultantfor CU IT Solutions, Tremaine-West,Inc. Tech.Planning,Net solutions, Shelton,WA 9.8584 Merger/Conversion Management 2/1/08 to 3/111.0 VP Business Development Consultant for CU IT Solutions, The Paragon Consulting Croup Tech.Planning, Compliance, Olympia„WA MegerlConvension Management. 1/2001 to 1/2010 Board/Committee Member Board and Committee Member: ' Peninsula Community FCU Supervisory,ALM,Compensation 1/94 to 2/l/08 President Consultant for CU IT Solutions Tremaine-West,Inc, Tech.Planning, Net solutions, Shelton,WA 98584 &Conversion Management. 11/96 to 12/98 President Mortgage Outsource Relationships, lUynden,NW,Inc Kiosk based video conferencing Tacoma,WA 98499 Solutions, 6194 to 12/96 Director of CU Relations Cooperative Marketing Information American Income Life System for Credit Unions. Redmond,WA 98052 i David P. Dally, President Credit Union Experience 3/9A to 4194 Sr.Sales Executive Sold In-House Systems and Services Viserv,Galaxy 2000 Division to Credit Unions in the Western Olympia,WA 98502 Ifalf of the United States. 9/85 to 3192 Sr,Sales Executive Sold In-House Systems and Services Control Data:XP Systems to Credit Unions in the Mid-West and Olympia,WA 98502 Western Regions of the United States. 2180 to 9/85 Sr,Sales Executive Sold in-House Systems and Services Citicorp-ICCI/CBSI/Galaxy to Credit Unions and Banks Nationwide. Stamford,CT 2/77 to 2/80 NW Regional Manager Managed 3 Data Centers,with a sueof 18 Applied Theory Associates/ lT Professionals providing On-.Gine Summit Information SysOms Services to 31 Credit Unions in the Corvallis,OR Northwest: Foundation of IT Expertise 9/75 to 2/77 Vice-President Market and install a now software product . Solar$ystems,Inc designedforlarge bgtaCenters. Chicago,IL 2173 to 9/75 Sr.Operations,A.ni lyst Brought order and control to a Data Center 13axtet-Travenol Laboratories employing 250 IT peofessionals. Deerfield,IL l 1174 to 2/73 Sr.Systems Analyst Designed and Implemented a Marketing Blue Cross Association Information System producing natiomvirte Chicago,IL market and trend analysis 3/69 to 11/70 Programmer Atislyst Systems and Programiming in Sara Lee,Inc, Accounting and Billing Systems Deerfield,M. 3167 to 3/69 Sr.,Computer Operator Operated three famllles afComputers IBM and taught myself three progranjoing Chicago,IL languages Education 1965 B,S.in Eusiness Management,North Park College,Chicago,IL 1969 Asseoiates in Data processing,.Harper College,Chicago,IL Programming Languages:COBOL,Autocoder,Basic,RPGI7,&PL4 MieroSo3t.Fatniliarty: Wprd;Excel,PowerPoint,Project,Access,SQL, Windows,VISIO,Windows 2006 Server,Citrix _ Cc:CMMRS Neatherlin, Shutty, Drexler 0-9 Co � 1'`vl Clerk1lYC01VMSSIONERS �I FIFTH STREET 1j'" '40112 NO SHELTON WA 98584 ill Fax 360-427-8437;Voice 360-427-9670, Ext.419;275-4467 or 482-5269 Mason County Commissioners t I AM SEEKING APPOINTMENT TO �G� Cd NAME: ADQRESS: �d `3�� PHONE: 364) — 45 CITY2IP: /� VOTING PRECINCT: /115E, Sr�fa WORK PHONE: --- SW4110 N -`'15`64 (OR AREA IN THE COUNTY YOU LIVE) � E-MAIL pQyy y�ir�SFerd�hl�}'YJ�aGPp rn ------------------------------------------------------------------------------------------- COMMUNITYSERVICE EMPLOYMENT: (IF RETIRED. PREVIOUS EXPERIENCE) ACTNRI OR MB SHIP � � � COMPANY: ry`A!!�:47'(7 POSITION: { ,$YVl�{-tfi �'�'T� (��✓l/ !l y� COMPANY: �f0�1 C:Q /!rel G�� YR POSITION: G✓a c 'lil� -------------------------------------------------------------------------------------------- In your words,what do you perceive is the role or urpose of the Board` Committee or Council for which you are applying: b A [''c7to Y-t2io e What interests, skills do you wish to off r the Boards Committee,or Council? a t C'a /��� ,( c� Pleade [fsi"any inapc�a], professional or volun ry affilla io sJwhicTi may influence or affect your position on this Board: (i.e.create a potent`�(ia �onfli�f in re ) n Your participation is dependent upon attending certain trainings made available by the County during regular business hours (such as Open Public Meetings Act and Public Records).The trainings would be at no cost to you.Would you be able to attend such trainings? Realistically,how much time can you give to this position?p Quart Monthly z eekly Daily " -_& Only o Appointmenf_Date Signature Date To TM Expire Date Attachment B MASON COUNTY BRIEFING ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS FROM: Kristopher Nelsen, PAC Manager DEPARTMENT: Community Services EXT: 359 BRIEFING DATE: 11/19/2018 PREVIOUS BRIEFING DATES: If this is a follow-up briefing, please provide only new information ITEM: Ten-year DCD fee schedule review. EXECUTIVE SUMMARY: (If applicable, please include available options and potential solutions): Community Services Department and division of community development's fee schedule has not made an adjustment since 2008 to base rates, service fees, or general evaluation chart. Considering inflation, cost of service, rise of the annual Building Valuation Data, as well as comparable and neighboring jurisdictions, base rates on average should have increased by 1% each year. If an annual 1% was added each year since 2008, the rate today would be impacting payees at 10.5%. To alleviate the direct impact to developers and builders, and balance disproportionate rates, the department proposes no more than a 10% rate increase be considered starting January 1st, 2019. Where applicable, single base fees should be simplified to the nearest dollar nearing corresponding department rates. BUDGET IMPACTS: Level department rates. RECOMMENDED OR REQUESTED ACTION: Approve proposed fee schedule adjustments and set public hearing date. ATTACHMENTS: Fee schedules with proposed changes highlighted (8 Pages). Briefmg Summary 11/8/2018 MASON COUNTY • COMMUNITY SERVICES Building,Planning,Environmental Health,Community Health BUILDING PERMIT FEE INFORMATION EFFECTIVE: July 1, 2018 (Proposal January 1, 2019 near 10%) VALUATION BASED FEES: Building permits and plan review fees are to be based upon the building valuation. Mason County will utilize the International Code Council's "Building Valuation Data" as published in the August edition of the Building Safety Journal. The square footage valuations from this table will be implemented on the first day of September following publication and remain in force though August of the following year (updated annually). For occupancies or structure types not addressed by the building valuation table please refer to Table 1. The building permit fee is based on Table 1 (as shown below) and the plan review fee is calculated at 65% of the building permit fee. The plan check fee will be collected when the building plans and applications are submitted. In addition, all other review fees and addressing fee, if applicable, will be collected at submittal. The building permit fee, and other associated fees, will be collected when the permit is issued. Table 1 — Building Permit Fees Total Valuation Fee $1.00 to$500.00 $156.00 minimum* $501.00 to$2,000.00 $156.00 minimum* $2,001.00 to$25,000.00 $156.00 minimum* or$76.17 for the first$2,000.00 plus $15.40 for each additional $1,000.00, or fraction thereof, to and including $25,000.00. Whichever is seater _ $25,001.00 to$50,000.00 $430.37 for the first$25,000.00 plus $11.11 for each additional $1,000.00, or fraction thereof, to and including $50,000.00. $50,001.00 to$100,000.00 $708.12 for the first$50,000.00 plus $7.70 for each additional $1,000.00, or fraction thereof, to and including $100,000.00. $100,001.00 to $500,000.00 $1,093.12 for the first$100,000.00 plus $6.16 for each additional $1,000.00, or fraction thereof, to and including $500,000.00. $500001.00 to$1,000,000.00 $3,557.12 for the first$500,000.00 plus$5.22 for each additional$1,000.00, or fraction thereof, to and including $1,000,000.00. $1,000,000.00 and up $6,166.35 for the first$1,000,000.00 plus $3.46 for each additional $1,000.00, or fraction thereof *Permit fees shall be as set forth in Table 1. A minimum fee of$156.00 will be assessed or adjusted fee(based upon departmental cost considerations)assigned at the discretion of the Building Official and/or Community Services Director. • For plumbing and mechanical fees, please refer to the attached tables 1-B and 1-C. • For Land Modification permit fees see table 1-D • Planning fees are per"Planning Program Permit Fees" documents • Technology fee per Mason County Ordinance 84.17. • State Building fee collected per RCW 19.27.085. • For additional fee information please contact the Permit Assistance Center at(360)427-9670 ext. 352. Mason County Ordinance#42-18, update to Ord.123-08. Table 1-A PERMIT FEES AND VALUATIONS EFFECTIVE JANUARY 1,2009 Mason County Ordinance X***-***adopted**-**-2018 Proposal Residential(and accessory)building valuations 1)New construction,and remodels greater than 50%,of"R"occupancies(including finished basements and additions) are valued per the most current August version of the(ICC)International Code Council's Building Valuation Data for the specified occupancy. 2)Private garages,storage buildings,green houses and similar structures shall be valued as Utility,Miscellaneous 3)Remodels less than 50%shall be valued at 50%of the table value from the ICC Building Valuation Data for the occupancy specified NOTE:all footnotes of Building Valuation Data as published by ICC shall apply MISCELLANEOUS VALUATIONS *Covered Decks/Carport: per sq.ft $20.38 $22.00 *Fences: per sq.ft $11.24 $12.00 *Decks: per sq.ft $14.34 $15.00 *Retaining Walls: per sq.ft $21.61 $23.00 MISCELLANEOUS VALUATIONS(Shoreline Related) *Bulkheads: Per WAC173-27-040(2)(a)the valuation *Boat ramps: for these projects must be at cost,or fair *Docks,Piers,Floats: market value,whichever is higher.A written *Stairs and Landings: contractor's bid or engineer's estimate *Pilings: of cost must be submitted at application RESIDENTIAL PERMIT FEES(Plan Review fees may apply where applicable) MANUFACTURED HOUSING FEES *Manufactured Homes:(see below if perimeter"concrete"foundation system) flat fee $528.50 $550.00 *Modular Home or(Manufactured Home with perimeter concrete foundation) flat fee $679.50 $720.00 *MH Title Elimination: flat fee $33.50 $40.( *MH Runners/Tiedowns: flat fee $151.50 $156.( Miscellaneous *Foundation Only:(SEE POLICY FOR IMPORTANT DETAILS) flat fee $151.50 $156.00 *Window replacement in existing openings(SEE POLICY FOR IMPORTANT DETAILS) flat fee $117.50 $120.00 *Roofing Only(Residential): flat fee $117.50 $120.00 *Demolition Fee: flat fee $117.50 $120.00 *Below ground tank removal/abandonment: flat fee $73.00 $80.00 *Site Inspection/Investigation: per trip $73.00 $80.00 *Final Inspection/Expiredpermit: per trip $73.00 $80.00 *Plan Review Revisions: per hour $73.00 $80.00 *Re-inspect Fee: per trip $73.00 $80.00 *Geotechnical/Stormwater Review(for related building structural issues) per 1/2 hr. $36.50 $40.00 *Addressing Fee: flat fee $173.50 $185.00 *Bldg.Inspections/Adj.Counties: base fee plus mileage $143.50 $156.00 *Appeals of Administrative Decisions flat fee $567.00 $660.00 *Large scale copies(plans): per page $4.50 *Land Use Prosecutor/Deputy Prosecutor Research and/or Consultation fee: per hour actual cost to department *Structures or work requiring permits for which no fee is specifically indicated:signs,pools, etc.,will be valued utilizing submitted written contractor's bid or engineer's cost information,or closest related item for which a fee is determined. A minimum permit fee of$141.00 will be assessed, $156.00 or adjusted fee assigned at the discretion of the Building Official and/or,Community Development Director. PLUMBING FEES MECHANICAL FEES *Base and fixture fees,Table 1-B *Base and unit fees,Table 1-C PERMIT FEES/PLAN REVIEW *Permit fees shall be as set forth in Table 1. A minimum fee of$141.00 will be assessed,or adjusted $156.0 fee assigned at the discretion of the Building Official and/or Community Development Director. Plan review fees,where not otherwise provided for or indicated,shall be established at 65%of the building permit fee or a rate of$73.00 per hour $80.00 with a one-hour minimum charge. VIOLATION/STOP WORK ORDER PENALTIES AND FINES *Shall be assessed pursuant to Title 14,Title 15,and codes adopted at time of submittal. ' Table 1-A(continued) STOCK PLAN FEES *A full plan review fee based upon square footage,occupancy,and use of the building will be collected when the initial stock plan is submitted along with a 1 hour charge for the initial stock plan set-up. The plan review fee for the subsequent submittals is the greater of 20%of the building permit fee,or 1 hour charged at the current rate. The reduced plan check fee will cover review of site specific conditions and is intended to cover processing costs. If additional reviews are needed because of a geo-technical report or similar issues,hourly fees will be assessed based upon the current adopted fee schedule in effect at the time the building permit application was received. Stock plan use and limitations will be per current Mason County stock plan policy at time of submittal. Commercial Structures&Improvements,Permit and Plan Review Fees VALUATION 1)New construction,and remodels greater than 50%,of all occupancies are valued per the most current August version of the International Code Council's Building Valuation Data for the specified occupancy 2.)Written Contractor's Bid or Engineer's Estimate of cost if not specified in the published Building Valuation Data. 3.)Remodels less than 50%,permit and plan review fees shall be based upon 50%of the valuation for the occupancy group listed in the Building Valuation Data as published by the ICC PERMIT FEES/PLAN REVIEW *Permit fees shall be as set forth in Table 1. A minimum fee of$141.00 will be assessed,or adjusted $156.00 fee assigned at the discretion of the Building Official and/or Community Development Director. Plan review fees,where not otherwise provided for or indicated,shall be established at 65%of the building permit fee or a rate of$73.00 per hour $80.00 with a one-hour minimum charge. *Plan review fees for compliance to the Non-Residential Energy Code shall be established at the rate of$73.00 per hour, $80.00 with a%hour minimum and shall be paid at the time the permit is issued. *Tank installation,or removal,permit fees will be valued per criteria of#2 above,or will be a minimum fee base of $168.50,whichever is greater. Additionally IFC and IBC plan check fees may apply. $190.00 *Re-roof permit fees for commercial structures will be based upon the above criteria or will be a minimum fee base of$168.50,whichever is greater. Additionally IFC and IBC plan review fees may apply. $190.00 *Change in Tenant Applications $141.00 Additionally IFC and IBC plan review fees may apply $156.00 *Commercial Coach$528.50. A separate plan review fee and building permit fee will be charged for additional structures,such as landings,ramps,etc. *Modular structure placed on permanent foundation systems$679.50.A separate plan review fee and $720.00 building permit fee will be charged for additional structures,such as landings,ramps,etc. PLUMBING FEES MECHANICAL FEES *Base and fixture fees,Table 1-B *Base and unit fees,Table 1-C LAND MODIFICATION *Fees per Table 1-D Additional Review/Inspection fees may apply. INTERNATIONAL FIRE CODE/ASSOCIATED FEES *Plan review fees for fire code compliance of building plan reviews,shall be established at 50%of the IBC plan review fee or a rate of$73.00 per hour with a one hour minimum(whichever is greater). $80.00 *Fire related reviews and site visits for large lot short plat/subdivisions are based on the hourly rate of$73.00 $80.00 per hour with a one hour minimum charge. *Fire related plan review and inspection fees where not otherwise provided for,or indicated,shall be at a rate of $73.00 per hour with a one hour minimum charge $80.00 *Automatic Fire Alarms:Fees to be assessed based upon submitted contractor bid and the adopted fee schedule as depicted in Table 1. Exception: The permit fee will be a minimum fee base of$168.50.Plan review fees will be $190.00 calculated at 65%of permit fee. *Fixed Fire Suppression:Fees to be assessed based upon submitted contractor bid and the adopted fee schedule as depicted in Table 1. Exception: The permit fee will be a minimum fee base of$168.50. Plan review fees will be $190.00 calculated at 65%of permit fee. *Automatic Sprinkler:Fees to be assessed per Building Standards valuation data or upon submitted contractor bid at the discretion of the Fire Marshal.Exception: The permit fee will be a minimum fee base of$168.50. Plan review fees will $190.00 be calculated at 65%of permit fee. Fire Apparatus Road Review: $73.00 per site $80.00 Burn Permit: $160.50 per site $175.00 Fireworks related fees-Local permit and license fees(limits pursuant to RCW70.77.555). *Retail Fireworks Stand Permit: $100.00 for one retail sales permit for one selling season in a year. Cost includes processing,permit,and inspections. *Public Fireworks Display Permit: $250.00 minimum permit fee and min.%hr plan review fee or the total hourly cost to the jurisdiction,whichever is the greatest. This cost shall include supervision,overhead,equipment,hourly wages and fringe benefits of the employees involved and include administrative costs. In no case shall the costs total more than five thousand dollars for any one display permit. TABLE 1-B Propc..I Residential Plumbing Permit Fees EFFECTIVE: JANUARY 1,2009 Permit Issuance FEE Base Fee for issuing each permit $24.70 $25.00 Base Fee for issuing each supplemental permit $12.40 $13.00 Unit Fee Schedule(In addition to items 1 and 2 above) For each plumbing fixture on one trap or a set of fixtures on one trap (including water,drainage piping and associated backflow protection) $8.70 $9.00 For each building sewer and each trailer pack sewer $18.50 $19.00 Rainwater systems-per drain(inside building) $8.70 $9.00 For each cesspool(where permitted) $30.90 $31.00 For each private sewage disposal system $49.40 $55.00 For each water heater and or vent $8.70 $9.00 For each gas-piping system of one to five outlets $6.20 $7.00 For each additional gas piping system outlet,per outlet $1.20 $2.00 For each industrial waste pretreatment interceptor including its trap and vent, except kitchen-type grease interceptors functioning as fixture traps $8.70 $9.00 For each installation,alteration or repair of water piping and/or water treating equipment,each $8.70 $9.00 For each repair or alteration of drainage or vent piping,each fixture $8.70 $9.00 For each lawn sprinkler system on any one meter including associated backflow protection devices $8.70 For atmospheric-type vacuum breakers not included in item 12: 1 to 5 $6.20 $7.00 over 5,each $1.20 $2.00 For each backflow protective device other than atmospheric type vacuum breakers: 2 inch(51 mm)diameter and smaller $8.70 $9.00 over 2 inch(51 mm)diameter $18.50 $20.00 For each gray water system $49.40 $50.00 For initial installation and testing for a reclaimed water system $73.00 $80.00 For each annual cross-connection testing of a reclaimed water system(including Initial test) $73.00 $80.00 For each medical gas piping system serving one to five inlets(s)/outlet(s)for a specific gas $61.80 $65.00 For each additional medical gas inlet(s)/outlet(s) $6.20 $7.00 Other Inspections and Fees Inspections outside of normal business hours* $109.10 $120.00 Reinspection fee $73.00 $80.00 Inspections for which no fee is specifically indicated* $73.00 $80.00 Additional plan review for changes,additions or revisions to approved plans(1/2 hour minimum)* $73.00 $80.00 *Per hour based on hours worked or cost to the jurisdiction,whichever is greater. This cost shall include supervision,overhead,equipment,hourly wages and fringe benefits of all the employees involved Mason County Ordinance#123-08 adopted 11-18-2008 f Table 1-C Mechanical Permit Fees Proposal Effective:January 1,2009 2018 P ;suance For the issuance of each mechanical permit $28.50 $30.00 For issuing each supplemental permit for which the original permit has not expired,been canceled or finaled $9.00 $10.00 Unit Fee Schedule Furnaces For the installation or relocation of each forced-air or gravity-type furnace or burner,including ducts and vents attached to such appliance,up to and including 100 Btu/h(29.3 kW $18.30 $19.00 For the installation or relocation of each floor furnace,including vent $18.30 $19.00 For the installation or relocation of each suspended heater,recessed wall heater or floor-mounted unit heater $18.30 $19.00 For the installation or relocation of each forced-air or gravity-type furnace or burner,including ducts and Vents attached to such appliance $22.50 $23.00 Appliance Vents For the installation,relocation or replacement of each appliance vent installed and not included in another permit $9.00 $10.00 Repairs or Additions For the repair of,alteration of,or addition to each heating appliance,refrigeration unit,cooling unit, Absorption unit or each heating,cooling absorption or evaporative cooling system,including installation of Controls regulated by the Mechanical Code $16.90 $17.00 Boilers,Compressors and Absorption Systems(Incl.Heat Pump) For the installation or relocation of each boiler or compressor to and including 3 horsepower(10.6 kW), Or each absorption system to and including 100,000 Btu/h(29.3kW) $18.20 $19.00 For the installation or relocation of each boiler or compressor over three horsepower(10.6kW)to And including 15 horsepower(52.7kW),or each absorption system over 100,000 Btu/h(29.3 kW)to And including 500,000 Btu/h(146.6kW) $33.50 $35.00 For the installation or relocation of each boiler or compressor over 30 horsepower(52.7 kW)to and Including 30 horsepower(105.5 kW),or each absorption system over 500,000 Btu/h(146.6 kW)to and Including 1,000,000 Btu/h(293.1 kW) $46.00 For the installation or relocation of each boiler or compressor over 30 horsepower(105.5 kW)to and Including 50 horsepower(176 kW),or each absorption system over 1,000,000 Btu/h(293.1 kW)to And including 1,750,000 Btu/h(512.9 kW) $68.50 $70.00 For the installation or relocation of each boiler or compressor over 50 horsepower(176 kW)or each Absorption system over 1,750,000 Btu/h(512.9 kW) $114.60 $115.00 Air Handlers For each air-handling unit to and including 10,000 cubic fee per minute(cfm)(4719L/s),including attached ducts. $13.20 $14.00 Note: This fee does not apply to an air-handling unit which is a portion of a factory-assembled appliance, Cooling unit,evaporative cooler or absorption unit for which a permit is required elsewhere in the Mechanical Code. For each air-handling unit over 10,000 cfm(4719L/s) $22.40 $23.00 Miscellaneous $13.20 $14.00 Ventilation and Exhaust For each ventilation fan connected to a single dud $9.00 $10.00 For each ventilation system which is not a portion of any other permitted heating or air-conditioning system $13.20 $14.00 For the installation of each hood which is served by mechanical exhaust,including the ducts for each hood $13.20 $14.00 Incinerator For the installation or relocation of each domestic-type incinerator $22.50 $23.00 For the installation or relocation of each commercial or industrial-type incinerator $18.00 Miscellaneous For each appliance or piece of equipment regulated by the Mechanical Code but not classed in other Appliance categories,or for which no other fee is listed in the table $13.20 $14.00 Other Inspections and Fee: Inspections outside of normal business hours,per hour(minimum charge two hours) $73.00 $80.00 Re-inspection Fee $73.00 $80.00 Inspections for which no fee is specifically indicated,per hour(minimum charge one-half hour) $73.00 $80.00 Additional plan review required by changes,additions or revisions to plans or to plans for which an Initial review has been completed(minimum charge-one-half hour) $73.00 $80.00 Liquid propane tank,above ground tank,below ground fuel storage tank(Residential Only)*commercial per Table 1-A $73.00 $80.00 Solid Fuel Burning Equipment: Wood,Pellet,LP and fireplace,barbeque appliances $73.00 $80.00 Mason County Ordinance#123-08 adopted 11-18-2008 t _ Table 1-D G-P � 2009 GRADING FEE'S Proposal % 2018 • <' Prior to each inspection,grading permit greater than two(2)years of age from zissuance date will be charged per inspection at current inspection rate. ,�����•H11tr3�'`��c Grading 2009 $2,018.00 PLAN REVIEW $ 36.46 $40.00 PERMIT FEES $ 36.46 $40.00 INSPECTION FEE $ 73.00 per hour $80.00 GRADING PLAN REVIEW FEES 50 cubic yards (38.2 m3) or less.................................................................................. NO-FEE 51 to 100 cubic yards (40 m3 to 76.5 m3)..................................................................... $ 36.46 $40.00 101 to 1,000 cubic yards (77.2 m3 to 764.6 m3)............................................................ $ 57.41 $60.00 1,001 to 10,000 cubic yards(765.3 m3 to 7645.5 m3).................................................... $ 76.41 $80.00 10,001 to 100,000 cubic yards (7646.3 m3 to 76 455 m3)............................................... $ 52.70 $55.00 for the first 10,000 cubic yards (7645.5 m3), plus.......................... ............ $ 38.01 $40.00 for each additional 10,000 yards (7645.5 m3) or fraction thereof. 100,001 to 200,000 cubic yards(76 456 m3 to 76 455 m3)............................................ $ 418.52 $460.00 for the first 100,000 cubic yards (76 455 m3), plus...................................... $ 20.56 $22. for each additional 10,000 yards(7645.5 m3) or fraction thereof. 200,001 cubic yards (152 912 m3) or more................................................................... $ 624.09 $680.00 for the first 200,000 cubic yards (152 911 m3), plus...................................... $ 11.25 $12.00 for each additional 10,000 yards (7645.5 m3) or fraction thereof. Additional plan review required by changes, additions or revisions to approved plans....................................................................... $ 73.00 Per Hour $80.00 (minimum charge--one hour) (Inspection fee per trip) GRADING PERMIT FEES 50 cubic yards (38.2 m3)or less................................................................................... $ 36.46 $40.00 51 to 100 cubic yards (40 m3 to 76.5 m3)........................................................................ $ 57.41 $60.00 101 to 1,000 cubic yards (77.2 m3 to 764.6 m3).............................................................. $ 57.41 $60.00 for the first 100 cubic yards (76.5 m3) plus................................................ $ 27.15 $30.00 for each additional 100 cubic yards (76.5 m3)or fraction thereof. 1,001 to 10,000 cubic yards(765.3 m3 to 7645.5 m3)..................................................... $ 301.77 $330.00 for the first 1,000 cubic yards (764.6 m3), plus........................................... $ 22.50 $24.00 for each additional 1,000 cubic yards (764.6 m3) or fraction thereof. 10,001 to 100,000 cubic yards (7646.3 m3 to 76 455 m3)................................................ $ 504.24 $550.00 for the first 10,000 cubic yards (7645.5 m3), plus........................................ $ 102.40 $110.00 for each additional 10,000 yards(7645.5 m3) or fraction thereof. 100,001 cubic yards (76 456 m3) or more...................................................................... $1,425.83 $1,560.00 for the first 100,000 cubic yards(76 455 m3), plus....................................... $ 56.63 $60.00 for each additional 10,000 yards (7645.5 m3) or fraction thereof. Inspections same hourly rate as above' Mason County Ordinance 9123-08 adopted 11-18-2008 Building Plan Building Plan Building Plan Valuation Permit Review Valuation Permit Review Valuation Permit Review $1.00 to $500.00 v56:4Q S8t1tKl?' $70,001.00 to $71,000.00 $.956:64 1621 2 $154,001.00 to $155,000.00 $1,6 34 5:'1 pg�,p7:: $501.00 to $600.00 $156:00 smbo $71,001.00 to $72,000.00 $963'74 $62643 $155,001.00 to $156,000.00 _$1,67560 $ '1,Ogg07i $601.00 to $700.00 5156 00 $80 00 $72,001.00 to $73,000.00 $971.44 $631 43 $156,001.00 to $157,000 OC $1,657 66 '$'1,09308 $701.00 to $800.00 5156 OQ $8000 $73,001.00 to $74,000.00 5979 14 $63644 $157,001.00 to $158,000.00 $1,68782 $ 1,097.08 1.00 to $900.00 $156.00 580.00. $74,001.00 to $75,000.00 $S'-86.84 $641.44 $158,001.00 to $159,000.00 - $1,69398 $ 1,101.08 1.00 to $1,000.00 $156 00 s80,09 $75,001.00 to $76,000.00 $994 54 $64645 $159,001.00 to $160,000.00 $1,70014 $"1,105 09 a-i,uu1.00 to $1,100.00 $15500 s8066`. $76,001.00 to $77,000.00 51.00224 $651.45. $160,001.00 to $161,000.00 ( $1,706.30 $ 1,109.29 $1,101.00 to $1,200.00 $156 OC S8000 $77,001.00 to $78,000.00 51,579.94 $656.46 $161,001.00 to $162,000 OC $1,712.46 $ 1;113.10 $1,201.00 to $1,300.00 $156.00 .580.00: $78,001.00 to $79,000.00 $1617.64 .$66146, $162,001.00 to $163,000.00 -$1,71862 5.:;1117.10 $1,301.00 to $1,400.00 $15600 $86,6,0,; $79,001.00 to $80,000.00 "51,02534 $6664Tj $163,001.00 to $164,000.00 $1,72478 S<1121.10 $1,401.00 to $1,500.00 5156.000 $8000 $80,001.00 to $81,000.00 $1.03304 $67147 $164,001.00 to $165,000.00 $1,730.94 <$ 1,125.11 $1,501.00 to $1,600.00 $15600 580.00. $81,001.00 to $82,000.00 5104074 $676.48' $165,001.00 to $166,000.00 ::$1,73710:.:.$ 1129.11 $1,601.00 to $1,700.00 $156.00 $m2ol: $82,001.00 to $83,000.00 51,04844 $166,001.00 to $167,000.00 $14326 $`:113312 $1,701.00 to $1,800.00 :156 CC, sBOM,:: $83,001.00 to $84,000.00 51.C56 4 8x 6;49. $167,001.00 to $168,000.00 $1,74942 5'.1,137.12 $1,801.00 to $1,900.00 5807 $84,001.00 to $85,000.00 56384 581.4 $168,001.00 to $169,000.00 $1,75558 $ 1,141.12 $1,901.00 to $2,000.00 S800D $85,001.00 to $86,000.00 $1071 54 $69660( $169,001.00 to $170,000.00 $1,767 74 $ ',1,145,13 $2,001.00 to $3,000.00 '1-:x,0- 58000 $86,001.00 to $87,000.00 51,07924 $70150- $170,001.00 to $171,000.00 $1,76790 $ :1,149.13 $3,001.00 to $4,000.00 s 15872 S90 CD $87,001.00 to $88,000.00 : $`.C8394 $706.51` $171,001.00 to $172,000.00 :.$1,77406 $ 1,153.14 $4,001.00 to $5,000.00 - S60:00 $88,001.00 to $89,000.00 $1.C94.64 $711:51 $172,001.00 to $173,000.00 :$1,78022: 5;,1,157,14 $5,001.00 to $6,000.00 S1 C S770 $89,001.00 to $90,000.00 $1,10234 $716.52 $173,001.00 to $174,000.00 $1,78638 $ :1;16114 1 $6,801;.139 to $7,000;.00 _1571 n0 $90,001.00 to $91,000.00 51.11004 $721 52 $174,001.00 to $175,000.00 $1,79254 $"1,16515 $7,001.00 to $8,000.00 51,55c $709.57 $91,001.00 to $92,000.00 S1,117 74 $726.53 $175,001.00 to $176,000.00 51,798.70 5. 1169.,5 $8,001.00 to $9,000.00 5 1 8398 :$119.58 $92,001.00 to $93,000.00 125.44 $73153 $176,001.00 to $177,000.00 ..$1,80486 $:;.1;173.16 $9,001.00 to $10,000.00 $16938 512959 $93,001.00 to $94,000.00 $177,001.00 to $178,000.00 > $1,81102 $ 21177.16 $10,001.00 to $11,000.00 $214'6 5139.60; $94,001.00 to $95,000.00 $74154 $178,001.00 to $179,000.00 >` S1,81718 'S` 1,181.16 $11,001.00 to $12,000.00 526015 514961-:: $95,001.00 to $96,000.00 $T16B5?. $179,001.00 to $180,000.00 $1.82334 S 1;185.17 $12,001.00 to $13,000.00 524558 515962` $96,001.00 to $97,000.00 $7_515°r $180,001.00 to $181,000.00 $1,82950 S< 1,189.17 $13,001.00 to $14,000.00 . $26096 516963. $97,001.00 to $98,000.00 $181,001.00 to $182,000.00 $1,835.66: S' 1,193.18 $14,001.00 to $15,000.00 527638 $17964' $98,001.00 to $99,000.00 $182,001.00 to $183,000.00 ;.$1,847 82 S: 1,197.18 — ---- $15,001.00 to $16,000.00 $291,:78 $.189..6,5 $99,001.00 to $100,000.00 $183,001.00 to $184,000.00 ;$1,84798 5; 1,201,18 $16,001.00 to $17,000.00 $3417x$ 590$ . : $100,001.00 to $101,000.00 $184,001.00 to $185,000.00 $1,85414 $`1;205 19 $17,001.00 to $18,000.00 '$3 $ -IR329.187 $101,001.00 to $102,000.00 $."458. $185,001.00 to $186,000.00 61,860.30. 5 1,209.19 $18,001_00 to $19,000.00 $337:R8 'S2:1$;436 $102,001.00 to $103,000.00 51 '97 82 Y7j $186,001_00 to $187,000.00 $1,866 46. $ 1,21320 $19,001.00 to $20,000.00 $35344. . :522919': $103,001.00 to $104,000.00 $1,20398 $78299 59; $187,001.00 to $188,000.00 $1,87262 $ 1;217.20 $20,001.00 to $21,000.00 $388>� :'.5239'';!'9;: $104,001.00 to $105,000.00 $121Q14 $786.59 $188,001.00 to $189,000.00 '$1,878.78 $ :1,22120 : $105,001.00 to $106,000.00 $1210 $79969 $ 1,225.21$21,001.00 to $22,000.00 $$4'8 540 ; $22,001.00 to $23,000.00 $399-58 -5259 2<: $106,001.00 to $107,000.00 ,.$122246 $79.4.: . $190,001.00 to $191,000.00 $1,891 10 $ :'1,22921. $23,001.00 to $24,000.00 $41496 $26973 $107,001.00 to $108,000.00 $1,22862 $79469: $191,001.00 to $192,000.00 S1,89726 $ :1,233.22 $24.001.00 to $25,000.00 $43038 527974 $108,001.00 to $109,000.00 51 23478 $80261' $192,001.00 to $193,000.00 $1,90342 S 1,237.22 .00 to $26,000.00 : $441.49 S28697 $109,001.00 to $110,000.00 $1,240.94 $80661 $193,001.00 to $194,000.00 $1,909.58 $ 1,241.22 .00 to $27,000.00 $45260 $29419 $110,001.00 to $111,000.00 51,247.10 $81061 $194,001.00 to $195,000.00 $1,915.74 5 1,245,23. $21,001.00 to $28,000.00 $46371 $30141' $111,001.00 to $112,000.00 51,25326 $814.62 $195,001.00 to $196,000.00 $1,921.90 S 1,249.23. $28,001.00 to $29,000.00 $47462 $30863 $112,001.00 to $113,000.00 5125942 $8186 $196,001.00 to $197,000.00 $1,92806 S 1,253.24 $29,001.00 to $30,000.00 548593 $31585 $113,001.00 to $114,000.00 51,26558 $822W $197,001.00 to $198,000.00 $1,934.22 $ 1,25724 $30,001.00 to $31,000.00 $497.04 $323.07% $114,001.00 to $115,000.00 $1..27174 $82663` $198,001.00 to $199,000.00 $1,940.38 $ 1,261.24 $31,001.00 to $32,000.00 550615 $330.29 $115,001.00 to $116,000.00 ;I 51,277.90 $530.53 $199,001.00 to $200,000.00 S1,94554 S 1,2^0525 $32,001.00 to $33,000.00 5519 26 5337 52 $116,001.00 to $117,000.00 ''r, $19284 06 $83464 $200,001.00 to $201,000.00 51.95270 s 1,269 25 $33,001.00 to $34,000.00 $530 37 $34474: $117,001.00 to $118,000.00 '..$1,290.22 .$838.64 $201,001.00 to $202,000.00 $1,958.86: S 1;273 26 $34,001.00 to $35,000.00 $541:48 $351 96. $118,001.00 to $119,000.00 $1,296.38 .$842.65 $202,001.00 to $203,000.00 $1,96502 1 1,277 2 $35,001.00 to $36,000.00 555259 $359,j$ $119,001.00 to $120,000.00 51,392;54 $$q§& $203,001.00 to $204,000.00 $1,97118 S 12812- $36,001.00 to $37,000.00 $563.70 $$8610' $120,001.00 to $121,000.00 $130876 88$605:;: $204,001.00 to $205,000.00 $1,97734 S 1,2852 $37,001.00 to $38,000.00 $51481 537367` $121,001.00 to $122,000.00 $1 3T486 $06466 $205,001.00 to $206,000.00 31,j.9.AW9"$' 1289:7 $38,001.00 to $39,000.00 $685:92 5360.84 $122,001.00 to $123,000.00 $1,321.02 $858(56 $206,001.00 to $207,000.00 $198966 5 $39,001.00 to $40,000.00 $%,7,03 538807 $123,001.00 to $124,000.00 51.327.18 5862.67. $207,001.00 to $208,000.00 ':$1.995.32 S 129,' $40,001.00 to $41,000.00 Owl S105'29 $124,001.00 to $125,000.00 $1,333.34 $86667( $208,001.00 to $209,000.00 $2,001 98 S ';1;30120 $41,001.00 to $42,000.00 $ 8;25 S40251 $125,001.00 to $126,000.00 51.339 50 $870 617r $209,001.00 to $210,00000 $2,000 14 OS 29 $42,001.00 to $43,000.00 $6 :36 S409.73 $126,001.00 to $127,000.00 51,345.66 $87468 $210,001.00 to $211,000.00 $2.0".4 C0 S 1 0;� $43,001.00 to $44,000.00 $64 :47 541695` $127,001.00 to $128,000.00 $1,351.62 $87866 $211,001.00 to $212,000.00 S2,0204o S 1°,330 $44,001.00 to $45,000.00 $652658 5424'17` $128,001.00 to $129,000.00 I'. $1,357.98 $882,60.. $212,001.00 to $213,000.00 $2;02662 5''1.317.30 $45,001.00 to $46,000.00 $6.0.69 5431:4 $129,001.00 to $130,000.00 $1,364.14 588660.1 $213,001.00 to $214,000.05 $2;03278 $46,001.00 to $47,000.00 $634:80 5438;62 $130,001.00 to $131,000.00 : 51,370.30 5890.69 $214,001.00 to $215,000.00 S?03S S 1 325 i $47,001.00 to $48,000.00 $66%81 $445.,64 $131,001.00 to $132,000.00 ::$1,376.46 $89470, $215,001.00 to $216,000.00 52,045'0. $:.1,329.31 $48,001.00 to $49,000.00 $6;t? 2 .::�S�i..t9..<06' $132,001.00 to $133,000.00 $1,382.62 $898''7dt< $216,001.00 to $217,000.05 52,051 26. S 1,3335' $49,001.00 to $50,000.00 $708:13 51,689.78 $8 . $217,001.00 to $218,000.00 $2;05742<: S 1.337.3:, $50,001.00 to $51,000.00 . 571583 $4966.29. $134,001.00 to $135,000.00 : $1,394,94 ,00,:1. $218,001.00 to $219,000.00 524 5a r. S 1,341.:) $51,001.00 to $52,000.00 $72353 $475 29 $135,001.00 to $136,000.00 S1,gpj1Q $$jQ };" $219,001.00 to $220,00000 $2,069 74 $ 1,345 63 $52,001.00 to $53,000.00 573123 $47530' $136,001.00 to $137,000.00 51,407126 S91� 2` $220,001.00 to $221,000.05° 52.0,,590 $ 1,34933 $53,001.00 to $54,000.00 $738 93 S46030 $137,001.00 to $138,000.00 413 42 E8 72': $221,001.00 to $222,000.00 $2,082 CC S 1 353 3 $54,001.00 to $55,000.00 $746.63 $48531 $138,001.00 to $139,000.00 : 51,41958 5$22173. $222,001.00 to $223,000.00 52,08822 $<:.1,357,34 $55,001.00 to $56,000.00 $754.33 5490.'31 7139,001.00 to $140,000.00 ;1.42574 .$2673 $223,001.00 to $224,000.00 S?.09438 S 1,361.34 $56,001.00 to $57,000.00 $762 03 S495.32 $140,001.00 to $141,000.00 8',_431 90 $930.73 $224,001.00 to $225,000.00 52.16_56 1,36)3� $57,001.00 to $58,000.00 5769.73 S500.322 5141,001.05 to $142,000.00 1.438.06 $934.74 $225,001.00 to $226,000.00 52 106 70 $ 369 35 $58,001.00 to $59,000.00 577743 >$5g533;: $142,001.00 to $143,000.00 4,1122 $93874 $226,001.00 to $227,000.00 $2,11286 $::1373.36 $59,001.00 to $60,000.00 $785"•.3 551033'.' $143,001.00 to $144,000.00 ___�39 $94275 $227,001.00 to $228,000.00 $2 119^2 S 1,377.3x' Q�^^^1.00 to $61,000.00 5792.53 S51534 $144,001.00 to $145,000.00 _ 54 $940.9'5. $228,001.00 to $229,000.00 5_2125.16 S 138.3 1.00 to $62,000.00 $900.53 $520.34: $145,001.00 to $146,000.00 -C $95975": $229,001.00 to $230,000.00 S?_,13134 $ 1,38537 1.00 to $63,000.00 $80823 $52535 $146,001.00 to $147,000.00 $95476 $230,001.00 to $231,000.00 52.137 50 s` 1,3693-, $63,001.00 to $64,000.00 $815.93 $530.35 $147,001.00 to $148,000.00 _____ $955761: $231,001.00 to $232,000 CC S2.14366 $ 1,3933%; 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Fees are being adjusted by the CPIU of +3.6%. For convenience, fees are also rounded down to the nearest $5.00. See attached previous resolution. A $500.00 WRIA fee has been added to the EH Fee schedule per Senate Bill 6091. This fee is set by state and not subject to these increases. Due to the new Water Adequacy process from this SB, the Major/Minor EH plan review fees have been replaced with two $110.00 fees (no increases) for tracking and procedural purposes. All adjustments to fee schedule are shown in Red. BUDGET IMPACTS: None. RECOMMENDED OR REQUESTED ACTION: None at this time, within scope of previous resolution. ATTACHMENTS: Copy of Resolution 70-13, Draft 2019 Fee Schedule. Briefing Summary 11/13/2018 RESOLUTION NO. -70 r 13 TO AMEND RESOLUTION NO. 145-08 ENVIRONMENTAL HEALTH FEES WHEREAS,the provision of public health services and activities within Mason County requires the collection of fees to compliment other sources of revenue, WHEREAS, it is the role and responsibility of Mason County Board of County Commissioners to set policy for Mason County Public Health concerning the funding of public health programs and activities in Mason County and to set fees accordingly, WHEREAS,the Mason County Board of health met on November 26,2013 and reviewed and deliberated on the appropriate fees for public health goods and services,and WHEREAS,the proposed Environmental Health Fees for 2014 were approved by the Mason County Board of Health on November 26, 2013, THEREFORE,IT IS ESTABLISHED THAT Mason County Public Health, Environmental Health Fees are amended for 2014 as shown in Attachment A,effective January 1, 2014. IT IS FURTHER ESTABLISHED THAT Mason County Public Health,Environmental Health Fees will be increased each year after 2014 by the amount of the July to July Consumer Price Index(CPN)—All Urban Consumers with a maximum increase of 5%. APPROVED this 1-714/t day of MC . ,2013. BOARD OF COUNTY COMMISSIONERS — y. Randy Peatheilin, Cha-'irperson Terri Jef&e , o missioner Tim Sheldon,Commissioner ATTEST: Mindi Brock,Clerk of the Board APPROVED AS TO FORM: Tim Whitehead,Chief Civil Deputy Prosecuting Attorney Mason County Community Services DRAFT- Environmental Health Fee Schedule-2019 Drinking Water Program Plan Review Private 2 Party $249 $250 3-14 Connections $•569 $575 Existing System Approval $489 $415 Re-submittal $135 Well Construction Permit $248 $250 Well Decommissioning $32-0 $330 Well Site Inspection $285 $210 Re-inspection $135 Group B or Individual Sanitary Survey $3-A5 $390 Water System Health Letter $80/hr Waiver/Variance $2Q $250 Water Adequacy Review-See building permit plan review Technical Assistance (per hour) $80/hr Appeal $3fi8 $165 School Inspection Plan review(per hour) $80/hr Pre-school $80/hr Elementary School $80/hr Middle School $80/hr High School $80/hr Day Care $80/hr Technical Assistance (per hour) $80/hr Water Recreation Facility Year-round Operation $489 $415 Additional pool or spa $80 SeasonalOperation $320 $330 Additional pool or spa $45 Tech nicalAssistance (per hour) $80/hr Vector Process&ship vector specimen $45 Mason County Environmental Health Fee Schedule-2019 1 of 6 Solid Waste Program Municipal Landfill Application $80/hr Renewal $3�5 $390 Closure/ Post Closure $390 Transfer Station, Moderate Risk Waste Facility Application $430 $445 Renewal $329 5330 Per Ton (Fee set by resolution) $1.50 Monofill, Inert Disposal/Landfill Application $48.5 $500 Renewal $329 $330 Closure/Post Closure $249 $275+ Woodwaste,Woodwaste recycling,Composting, Limited purpose landfill, Medical Incinerator,Waste to energy, Treatment facility Application $.599 $610 Renewal $37-5 $390 Closure/Post Closure $2-60 $265 Piles,Surface Impoundments Application $329 $330 Renewal $249 $250 Tire Pile, Recycling,Conditional Exempt Waste Facility, Drop Box Application $329 $330 Renewal $249 $250 Non-inert Construction Demo Landfill Application $7-55 $780 Renewal $430 $445 Closure/Post Closure $245+ $305+ Energy Recovery/Inceneration Application $4,970 $4,210 Renewal $4450 $1,500 Technical Assistance (per hour) $80/hr Waiver $250 Appeal $3.{0 $165 Hazardous Material Cleanup Illegal Drug Lab Plan Review $249 $250 Per hour over 3 hours $80/hr Mason County Environmental Health Fee Schedule-2019 2 of 6 Food Service Permit Fees Restaurants Complex Large $42-5 $750 Complex Small $485 $500 Non-complex Large $32-9 $330 Non-complex Small $240 $250 Taverns Complex Large $42-5 $750 Complex Small $48& $500 Non-complex(no Food) $249 $250 Mobiles Complex $4S8 $495 Non-complex $248 5250 Kitchens Large $249 $250 Small $� $170 Confectionery $445 $170 Espresso $i5 $170 Bed & Breakfast $465 $170 Bakery $240 $250 School/Jail Food Service Central Kitchen $22Q $250 Satellite Kitchens $170 Headstart/Preschool $265 $210 Re-inspections Initial $80 Follow-up $135 Technical Assistance (per hour) $80/hr Plan Review(per hour) $80/hr Appeal/Office Conference $468 5165 Catering Off Premises Vending- Licensed Restaurant $46b $170 Catering with Commessary Only $249 $250 Grocery/Markets 0-3 Checkstands Base fee $249 $250 4+Checkstands Base fee $2-85 $290 For Each Department Add: Bakery $80 Meat $80 Seafood $80 Mason County Environmental Health Fee Schedule-2019 3 of 6 Deli $125 Espresso $80 Food Handlers Card (fee set by State) $10 Duplicate for Lost Food Handlers Card $3 Temporary Food Event Low Risk Foods Regular Tax Exempt Single Event $45 $30 Multiple up to 21 days $80 $60 Farmer's Market $70 $55 Moderate Risk Foods Single Event $80 $60 Multiple up to 21 days $r� $170 $125 Farmer's Market $4&9 $155 $115 High Risk Foods Single Event $125 $90 Multiple up to 21 days $240 $250 $4-80 $185 Farmer's Market $230 $235 $175 Expedited Food Permit Additional 50%of fee Land Use Fees BLA(office review) $125 Large Lot Subdivision Application fee $390 Per Parcel fee $30 Short Subdivision $37-5 $390 Subdivision Application fee $-5bO $575 Per Parcel fee $30 Other review(per hour) $80/hr Pre-application meeting- Major EH Plan Review $24-5 $220 Change in Tennant- Minor EH Plan Review $110 Building Plan Review/Change of Use Onsite Sewage o. DFORI(iAg BeiateF nVailability Geffib:.ed! MoneF EH Plan Review MajeF EH Plan Review Building Plan Review/Change of Use-Onsite Sewage: $110 Building Plan Review/Change of Use- Drinking Water Availability: $110 Water Resource Inventory Area (WRIA) Fee, (set by State) $500 Technical Assistance (per hour) $80/hr Mason County Environmental Health Fee Schedule-2019 4 of 6 Licensed Onsite Professionals Certified Installer Test(through WOSSA) Annual $249 $250 Certified Pumper Inspection<1 hour,additional time billed per hour $80 Annual $249 $250 Certified O&M Specialist Test(through WOSSA) Annual $249 $250 Washington State DOL Certified Designer Inclusion on Mason County list-Annual Listing $30 Onsite Sewage System Fees Individual permit $449 $455 Installation $ 475 $220 Extension (< 1 year through September 30) $135 Homeowner install -in addition to installation fee $185 Tank Only $220 Community/Commercial $1,$=9 $1,055 Base+$75/hr>8 hrs Per connection (payable with design submittal $135 Re-inspection/Re-submittal $135 O&M Processing/Data entry to Carmody $10 Winter Observation $465 $500 EH Review(Non-refundable)CRT Water $24.5 $220 Septic $2$5 $210 Both $368 $370 Property Evaluation $29b $305 Dye Test(supplies extra) $80/hr Appeal $469 $165 Waiver/Variance Staff/EH $-69 $165 Health Officer/DOH/Director $249 $250 Technical Assistance (per hour) $80/hr Mason County Environmental Health Fee Schedule-2019 5 of 6 Other EH Fees Technical Assistance all EH Programs $80/hr Fee for copies(set by State) $0.15 SEPA(set by DCD) Filing fees(Fee set by Auditor) Scanning fee(per document/permit) $10 Operating without a permit Double permit fee Technology Surcharge (set by DCD for electronic permitting) Per resolution 70-13,the following Environmental Health fees may be increased each year by the amount of the July to July Consumer Price index(CPIU)-All Urban Consumers,with a maximum increase of 5%. The CPIU used for this 2019 Fee Schedule is 3.6%. Fees are also rounded to the nearest$5.00 as long as amount does not exceed the maximum increase of 5%. Mason County Environmental Health Fee Schedule-2019 6 of 6 MASON COUNTY BRIEFING ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS FROM: Alex Paysse DEPARTMENT: Community Services, EXT: 279 Environmental Health BRIEFING DATE: 11/19/2018 PREVIOUS BRIEFING DATES: NA If this is a follow-up briefing, please provide only new information ITEM: Request to replace Environmental Health Specialist EXECUTIVE SUMMARY: (If applicable, please include available options and potential solutions): Sean McGuire has resigned from Mason County. Request to hire regular FTE for vacant position. BUDGET IMPACTS: None, this position is included in 2019 budget. RECOMMENDED OR REQUESTED ACTION: Recommend board approves to fill vacant position. ATTACHMENTS: None. Briefing Summary 11/14/2018 MASON COUNTY BRIEFING ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS FROM: Leo Kim, CPA DEPARTMENT: Auditor's Office Financial Services EXT: 472 Mason County Audit Committee BRIEFING DATE: 11/19/18 PREVIOUS BRIEFING DATES: n/a If this is a follow-up briefing, please provide only new information ITEM: Mason County Audit Items Update EXECUTIVE SUMMARY: (If applicable, please include available options and potential solutions): • Clerk's Office— working together on accounting items, • Community Development — Restricted revenue and expenditures need better controls BUDGET IMPACTS: None RECOMMENDED OR REQUESTED ACTION: Review ATTACHMENTS: Briefing PDF Mason County, WA Audit Issues As of November,2018 Financial/Single Audit—.Findings • Federal Highway Grant—Davis Bacon Compliance. • Financial Statement—Suspense fund reporting • Belfair Sewer and Rustlewood Sewer financial condition —on going. Contact: Bart PW • Current Expense— Financial Condition—should be ok. • Capital Assets — Yearly physical inventory for governmental funds — land, building and other improvements excluding infrastructure. Accountability—_Exit Items • Trackable Assets (Small&Attractive Assets)—seems to be progressing ok. • Jail Inmate Property—contacted Sheriff's Office. Department level. • Building Department—Controls over restricted revenues and uses. Contacted Building Department. Department level. Management Letters • Sheriff's Department Restricted Funds—should be ok. • Budget Compliance—ongoing. Potential/Pendine Audit Items • Clerk's Office—Federal grant compliance, cash receipting,bank reconciliations. • Department of Commerce (DOC)—Financial Management Policies—in progress • HR/PR—Policy/Procedure for TDD-Temporary Duty Disability • LGIP interest credit to bank statement as of December but we record in January. Manually add to financial statements to avoid non-material journal entries. 1