HomeMy WebLinkAbout11320RESOLUTION NO. 11320
A RESOLUTION APPROVING AN AGREEMENT BETWEEN THE CITY OF PUEBLO, A
MUNICIPAL CORPORATION, AND HISTORITECTURE, L.L.C., TO CONDUCT AN EAST SIDE
HISTORIC AND ARCHITECTURAL CONTEXT STUDY, AND AUTHORIZING THE PRESIDENT
OF CITY COUNCIL TO EXECUTE SAME
WHEREAS, Ordinance 7787, adopted April 14th, 2008 budgeted and appropriated $14,000
to conduct an East Side Historic and Architectural Context Study; and
WHEREAS, Historitecture, L.L.C. was selected as most capable of providing services
advantageous for the study;
BE IT RESOLVED BY THE CITY COUNCIL OF PUEBLO, that:
.qFr.TinN 1
An Agreement dated June 23, 2008 between the City of Pueblo, a Municipal Corporation,
and Historitecture, L.L.C., a copy of which is attached and incorporated herein and having been
approved as to form by the City Attorney, is hereby approved.
.qFrTinN 9
The President of the City Council is hereby authorized to execute said Agreement on behalf
of the City of Pueblo, a Municipal Corporation, and the City Clerk shall affix the Seal of the City
thereto and attest same.
SECTION 3.
Funds in the amount of $14,000 shall be paid from Project PL0803 for services in
accordance with the terms of the contract.
INTRODUCED June 23, 2008
BY Vera Ortegon
Councilperson
r°T y
ATTE D BY: �. � y
PRESIf NT'ei Cif' Council
R es No
�J
M ID
Background Paper for Proposed
RESOLUTION
AGENDA ITEM # 7
DATE: JUNE 23, 2008
DEPARTMENT: PLANNING AND COMMUNITY DEVELOPMENT
JERRY M. PACHECO, DIRECTOR
TITLE
A RESOLUTION APPROVING AN AGREEMENT BETWEEN THE CITY OF PUEBLO,
A MUNICIPAL CORPORATION, AND HISTORITECTURE, L.L.C., TO CONDUCT AN
EAST SIDE HISTORIC AND ARCHITECTURAL CONTEXT STUDY, AND
AUTHORIZING THE PRESIDENT OF CITY COUNCIL TO EXECUTE SAME
ISSUE
Shall City Council enter into a contract with Historitecture, L.L.C. for consulting services
to complete an East Side Historic and Architectural Context Study?
RECOMMENDATION
Approval of Resolution
BACKGROUND
On April 14, 2008, City Council approved Ordinance 7787 which budgeted and
appropriated $14,000 for completion of an East Side Historic and Architectural Context
Study. The search committee selected Historitecture, LLC for the project since they met
all the qualifications advertised in the bid and they have a proven history working with
the City. The inventory will begin with approval of the present resolution, and be
completed June 30, 2009.
FINANCIAL IMPACT
Funds not to exceed $14,000 shall be paid from Project PLO803 to Historitecture, L.L.C.
for the East Side Historic and Architectural Context Study. The Colorado Historical
Society upon the completion of the project shall reimburse the City $14,000.
AGREEMENT
FOR PROFESSIONAL SERVICES
THIS AGREEMENT is made and entered this 23rd day of June 2008, by and between the City of Pueblo, a Municipal
Corporation ( "Client ") and I istoritecture, LLC, a Colorado Limited Liability Company, ( "Consultant ") for Consultant to render
professional consulting services for Client with respect to providing a in East Side Historic and Architectural Context Study for the
City's Historic Preservation Commission, and related ancillary services, hereinafter referred to as the "Project" Inconsideration ofe
mutual covenants hereinafter set forth, the parties agree as follows:
SECTION 1. GENERAL AND SCOPE OF SERVICES
(a) Consultant shall satisfactorily perform the professional consulting services forthe Project described in more detail in
Schedule 1 attached hereto and incorporated herein by reference (the "Basic Services "). Such services shall include all usual and
customary professional consulting services including any required drafting or design services incident to its work on the Project.
(b) To the extent Consultant performs any of the Project work through subcontractors or subconsultants, Consultant
shall be and remain as fully responsible for the full performance and quality of services performed by such subcontractors as it is for
services performed directly by Consultant.
(c) To the extent Consultant requires access to private property to perform its services hereunder, Consultant shall be
required to make arrangements to obtain such access. However, in the event Client has already secured access for Consultant to any
such property through a right of entry agreement, access agreement, letter of consent or other instrrrnent, Consultant shall fully comply
with and be subject to the terms and conditions set forth therein. A copy of any such instrument will be provided to Consultant upon
request.
SECTION 2. CONSULTANT'S RESPONSIBILITIES
(a) Consultant shall be responsible for the professional quality, technical accuracy and timely completion of Consultant's
work, including that performed by Consultant's subconsultants and subcontractors, and including drawings, reports and other services,
irrespective of Client's approval of or acquiescence in same.
(b) Consultant shall be responsible, in accordance with applicable law, to Client for all loss or damage to Client caused
by Consultant's negligent act or omission; except th at Consultant hereby irrevocably waives and excuses Client and Client's attorneys
from compliance with any requirement to obtain a certificate of review as a condition precedent to commencement of an action,
including any such requirements set forth in Section 13 -20 -602, C. R. S. or similar statute, whether now existing or hereafter enacted.
(c) Consultant shall be completely responsible for the safety of Consultant's employees in the execution ofwork under
this Agreement and shall provide all necessary safety and protective equipment for said employees.
(d) Consultant acknowledges that time is of the essence with respect to the completion of its services under this
Agreement. Consultant represents that Schedule 3 attached hereto is the schedule by which Consultant proposes to accomplish its
work, with time periods for which it will commence and complete each major work item. Except to the extent the parties agree to time
extensions for delays beyond the control of Consultant, Consultant shall adhere to this schedule and perform its work in a timely
manner so as not to delay Client's timetable for achievement of interim tasks and final completion of Project work. Consultant further
acknowledges that its schedule has accounted for all reasonably anticipated delays, including those inherent in the availability oftools,
supplies, labor and utilities required for the work, the availability of information which must be obtained from any third parties, and all
conditions to access to public and private facilities.
(e) Before undertaking any work or incurring any expense which Consultant considers beyond or in addition to the
Scope of Work described in Schedule 1 or otherwise contemplated by the terms of this Agreement, Consultant shall advise Client in
writing that (i) Consultant considers the work beyond the scope of this Agreement, (ii) the reasons that Consultant believes the out of
scope or additional work should be performed, and (iii) a reasonable estimate of the cost of such work. Consultant shall not proceed
with any out of scope or additional work until authorized in writing by Client. The compensation for such authorized work shall be
negotiated, but in the event the parties fail to negotiate or are unable to agree as to compensation, then Consultant shall be
compensated for its direct costs and professional time at the rates set forth in Schedule 2 attached hereto.
SECTION 3 FEES FOR SERVICES, PAYMENT
(a) Client will pay to Consultant as full compensation for all services required to be performed by Consultant under this
Agreement, except for services for additional work or work beyond the scope of this Agreement, the maximum sum of U.S. $
14.000.00 ,computed asset forth in Schedule 2.
(b) Consultant shall submit periodic, but not more frequently than monthly, applications lon payment, aggregating to not
more than the maximum amount set forth above, for actual professional services rendered and for reimbursable expenses incurred.
Applications for payment shall be submitted based upon the hourly rates and expense reimbursement provisions set forth in Schedule 2
attached hereto, and shall contain appropriate documentation that such services have been performed and such expenses incurred.
Thereafter, Client shall pay the Consultant for the amount of the application within 45 days of the date such application is received.
(c) No separate or additional payment shall be made for profit, overhead, local telephone expenses, lodging, routine
photocopying, computer time, secretarial or clerical time or similar expenses unless otherwise provided and listed in Schedule 2.
(d) No compensation shall be paid to Consultant for services required and expenditures incurred in correcting
Consultant's mistakes or negligence.
(e) Compensation for authorized work beyond the scope of this Agreement shall be governed by the provisions of
Section 2(e).
() In the event services under this Agreement are phased and to be performed in more than one fiscal year or are
subject to annual appropriation, Consultant acknowledges that funds only in the amount of initial appropriation are available and it
shall confirm availability of funds before proceeding with work exceeding initial and subsequent annual appropriations.
SECTION 4. CLIENT'S RESPONSIBILITIES
(a) Client agrees to advise Consultant regarding Client's Project requirements and to provide all relevant information,
surveys, data and previous reports accessible to Client which Consultant may reasonably require.
(b) Client shall designate a Project Representative to whom all communications from Consultant shall be directed and
who shall have limited administrative authority on behalf of Client to receive and transmit information and make decisions with respect
to the Project. Said representative shall not, however, have authority to bind Client as to matters of governmental policy or fiscal
policy, nor to contract for additions or obligations exceeding a value which is the lesser of $5000 or 5% of the maximum contract
price.
(e) Client shall examine all documents presented by Consultant, and render decisions pertaining thereto within a
reasonable time. The Client's approval of any drawings, specifications, reports, documents or other materials or product famished
hereunder shall not in any way relieve Consultant of responsibility for the professional adequacy of its work.
(d) Client shall perform its obligations and render decisions within a reasonable time under the circumstances
presented. Based upon the nature of Client and its requirements, a period of 14 days shall be presumed reasonable for any decision not
involving policy decision or significant financial impact. A period of 46 days shall be presumed reasonable for Client to act with
respect to any matter involving policy or significant financial impact. The above periods of presumed reasonableness shall be
extended where information reasonably required by Consultant is not within the custody or control of Client but must be procured from
others.
SECTION 5. TERMINATION
(a) Client reserves the right to terminate this Agreement and Consultant's performance hereunder, at any time upon
written notice, either for cause or for convenience. Upon such termination, Consultant and its subcontractors shall cease all work and
stop incurring expenses, and shall promptly deliver to Client all data, drawings, specifications, reports, plans, calculations, summaries
and all other information, documents and materials as Consultant may have accumulated in performing this Agreement, together with
all finished work and work in progress.
(b) Upon termination of this Agreement for events or reasons not the fault of Consultant, Consultant shall be paid at the
rates specified in Schedule 2 for all services rendered and reasonable costs incurred to date of termination; together with any
reasonable costs incurred within 10 days of termination provided such latter costs could not be avoided or were incurred in mitigating
loss or expenses to Consultant or Client. In no event shall payment to Consultant upon termination exceed the maximum compensation
provided for complete performance in Section 3(a).
(c) In the event termination of this Agreement or Consultant's services is for breach of Us Agreement by Consultant, or
for other fault of Consultant including but not limited to any failure to timely proceed with work, or to pay its employees and
consultants, or to perform work according to the highest professional standards, or to perform work in a manner deemed satisfactory
by Client's Project Representative, then in that event, Consultant's entire right to compensation shall be limited to the lesser of(a)the
reasonable value of completed work or (b) payment at the rates specified in Schedule 2 for services satisfactorily performed and
reimbursable expenses reasonably incurred, prior to date of termination.
(d) Consultant's professional responsibility for its completed work and services shall survive any termination
SECTION 6. SITE ACCESS
In the event the Project will require access to property not under the control of Client, Consultant and Consultant's
employees and consultants shall obtain all additional necessary approval and clearances required for access to such property. Client
shall assist Consultant in obtaining access to such property at reasonable times but makes no warranty or representation whatsoever
regarding access to such property. Notwithstanding the foregoing, Consultant understands and agrees that entry to some property by
Consultant may be subject to compliance by Consultant with the terms and conditions of an access agreement in accordance with
section 1(c) of this Agreement.
SECTION 7, USE OF DOCUMENTS
(a) Plans, drawings, designs, specifications, reports and all other documents prepared or provided by Consultant
hereunder shall become the sole property of Client, subject to applicable federal grant requirements, and Client shall be vested with all
rights therein of whatever kind and however created, whether by common law, statute or equity. Client shall have access at all
reasonable times to inspect and make copies of all notes, designs, drawings, specifications, and all other technical data or other
documents pertaining to the work to be performed under this Agreement. In no event shall Consultant publish work product developed
pursuant to this Agreement except (i) with advance written consent of Client and (ii) in full compliance with the requirements of this
Agreement and applicable federal regulations.
SECTION 8. INSURANCE AND INDEMNITY
(a) Consultant agrees that it shall procure and will maintain during the term of this Agreement, such insurance as will
protect it from claims under workers' compensation acts, claims for damages because of personal injury including bodily injury,
sickness or disease or death of any of its employees or of any person other than its employees, and from claims or damages because of
injury to or destruction of property including loss of use resulting therefrom; and such insurance will provide for coverage in such
amounts as set forth in subparagraph (b).
(b) The minimum insurance coverage which Consultant shall obtain and keep in force is as follows:
(1) Workers' Compensation Insurance complying with statutory requirements in Colorado and in any other
state or states where the work is performed.
(ii) Comprehensive General and Automobile Liability Insurance with limits not less than Six Hundred
Thousand and No /100 Dollars ($600,000.00) per person and occurrence for personal injury, including but not limited to death and
bodily injury, and Six Hundred Thousand and No/ 100 Dollars ($600,000.00) per occurrence for property damage.
(iii) Professional Liability Insurance with coverage of not less than $1,000,000, and with a deductible
acceptable to Client.
(c) Consultant agrees to hold harmless, defend and indemnify Client from and against any liability to third parties,
arising out of negligent acts or omissions of Consultant, its employees, subcontractors and consultants.
SECTION 9. SUBCONTRACTS
(a) Client acknowledges that Consultant is the prime contractor and the only party with whom Client has a contractual
relationship under this Agreement. To the extent Consultant performs any Project activities through subconsultants or subcontractors,
Consultant shall contractually bind each of its subconsultants and subcontractors by subcontract agreement to all of the terms of this
Agreement which are for the benefit of Client, and Client shall be a third party beneficiary of those subcontract provisions.
(b) Consultant shall indemnify and defend Client from all claims and demands for payment for services provided by
subcontractors of Consultant.
(c) Consultant acknowledges that, due to the nature of the services to be provided under this Agreement, the Client has
a substantial interest in the personnel and consultants to whom Consultant assigns principal responsibility for services performed under
this Agreement. Consequently, Consultant represents that it has selected and intends to employ or assign the key personnel and
consultants identified in its proposal submitted to Client prior to execution of this Agreement to induce Client to enter this Agreement.
Consultant shall not change such consultants or key personnel except after giving notice of a proposed change to Client and receiving
Client's consent thereto. Consultant shall not assignor reassign Project work to any person to whom Client has reasonable objection.
SECTION 10. MISCELLANEOUS
(a) Notices Any and all notices or other communications required or permitted by this Agreement or by law to be
served on or given to either Consultant or Client by the other party shall be in writing and shall be deemed duly served and given when
personally delivered to the party to whom it is directed, or in lieu of such personal service, when deposited in the United States mail,
first -class postage prepaid, addressed to the Client, Attention: Wade Broadhead, Planning Department, 211 F. D Street, Pueblo,
Colorado 81003, or to Consultant, Attention: Adam Thomas, PO BOX 419, Estes Park, CO 80517. Either party may change his
address for the purpose of this paragraph by giving written notice of such change to the other party in the manner provided in this
paragraph.
(b) Entire Agreement This instrument contains the entire agreement between Consultant and Client respecting the
Project, and any other written or oral agreement or representation respecting the Project or the duties of either Client or Consultant in
relation thereto not expressly set forth in this instrument and its attachments is null and void.
(c) Successors andAssims This Agreement shall be binding onthe parties hereto and on their successors and assigrK
provided, however, neither this Agreement, nor any part thereof, nor any moneys due or to become due hereunder to Consultant may be
assigned by it without the written consent of Client.
(d) Amendments No amendment to this Agreement shall be made nor be enforceable unless made by written
amendment signed by an authorized representative of Consultant and by Client in accordance with the requirements of Section 4(b) of
this Agreement or upon authorization of Client's governing board.
(e) Choice of Law This Agreement shall be governed and interpreted in accordance with the laws of the State of
Colorado. Any unresolved dispute arising from or concerning any breach of this Agreement shall be decided in a stale court of
competent jurisdiction located in Pueblo, Colorado.
( Equal Emplq=ent Opportunity In connection with the performance of this Agreement, neither Consultant nor its
consultants shall discriminate against any employee or applicant for employment because of race, color, religion, sex, national origin,
disability or age. Consultant shall endeavor to insure that applicants are employed, and that employees are treated during employment
without regard to their race, color, religion, sex, national origin, disability or age.
(g) Severability If any provision of this Agreement, except for Section 2, is determined to be directly contrary to and
prohibited by law or the requirements of any federal grant or other Project funding source, then such provision shall be deemed void
and the remainder of the Agreement enforced. However, it is the intent of the parties that Section 2 of this Agreement not be
severable, and that if any provision of said section be determined to be contrary to law or the tetras of any federal grant, then this entire
Agreement shall be void.
SECTION 11 — STATE - IMPOSED MANDATES PROHIBITING ILLEGAL ALIENS FROM PERFORMING WORK
(a) Prior to or within ten (10) days of execution of this Agreement, Consultant shall submit to the Purchasing Agent of
the Client its certification that it does not knowingly employ oubcontract with an illegal alien and that the Consultant has participated or
attempted to participate in the "Basic Pilot Program" created in Public Law 208, 104 Congress, as amended and expanded in Public
law 156, 108" Congress, as amended, that is administered by the United States Department of Homeland Security in order to confirm
the employment eligibility of all employees who are newly hired for employment in the United States.
(b) Consultant shall not:
(I) Knowingly employ or contract with an illegal alien to perform work under this contract;
(II) Enter into a contract with a subconsultant that fails to certify to Consultant that the subconsultant shall not
knowingly employ or contract with an illegal alien to perform work under this contract.
(c) The following state - imposed requirements apply to this contract:
(I) The Consultant shall have confirmed or attempted to confirm the employment eligibility of all of its
employees who are newly hired for employment in the United States through participation in the Basic Pilot Program and, if the
Consultant is not accepted into the Basic Pilot Program prior to entering into this contract, that the Consultant shall apply to participate
in the Basic Pilot Program every three months until the Consultant is accepted or this Contract has been fully completed, whichever
occurs earlier. This provision shall not be required or effective if the Basic Pilot Program is discontinued.
(II) The Consultant is prohibited from using the Basic Pilot Program procedures to undertake preemployment
screening of job applicants while this Contract is being performed.
(III) If the Consultant obtains actual knowledge that a subconsultant performing work under this contract
knowingly employs or contracts with an illegal alien, the Consultant shall be required to:
A. Notify the subconsultant and the Client's Purchasing Agent within three (3) days that the
Consultant has actual knowledge that the subconsultant is employing or contracting with an illegal alien; and
B. Terminate the subcontract with the subconsultant if within three (3) days of receiving the notice
required pursuant to subparagraph (c)(III)A. above the subconsultant does not stop employing or contracting with the illegal alien;
except that the Consultant shall not terminate the contract with the subconsultant if, during such three (3) days, the subconsultant
provides information to establish that the subconsultant has not knowingly employed or contracted with an illegal alien.
(I V) 'The Consultant is required to comply with any reasonable request by the Colorado Department of Labor and
Employment (hereinafter referred to as "CDLE ") made in the course of an investigation that CDLE is undertaking pursuant to its
authority under §8 -17.5- 102(5), C.R.S.
(d) Violation of this Section 12 by the Consultant shall constitute a breach of contract and grounds for termination. In
the event of such termination, the Consultant shall be liable for Client's actual and consequential damages.
(e) As used in this Section 12, the term "subconsultant" shall mean any subconsultant or subcontractor of Consultant
rendering services within the scope of this Agreement.
SECTION 12. PERA LIABILITY
The Contractor shall reimburse the City for the full amount of any employer contribution required to be paid by the City of
Pueblo to the Public Employees' Retirement Association ( "PERA ") for salary or other compensation paid to a PERA retiree
performing contracted services for the City under this Agreement. The Contractor shall fill out the questionnaire attached as Exhibit A
and submit the completed form to City as part of the signed Agreement.
written.
IN WITNESS WHEREOF, the parties hereto have made and executed this Agreement as of the day and year first above
CITY OF PUEBLO, A MUNICIPAL CORPORATION
By
President of the City Council
ATTEST:
City rk
G\__MMIA - 13 X91C9],1ON&A
�
City Attorney cz
CONSULTANT:
Historitectwe Ada timite Liability Company
Name: Adam Thomas
Title: Architectural Historian
SCHEDULE 1
SCOPE OF SERVICE
SPECIFICATION OF WORK:
Element
- Scope
a.
Facilitate a kickoff meeting in the community to explain the
historical and architectural context development process, to
answer questions, and to receive suggestions about local sources
of information.
b.
Initial consultation with the Historical & Architectural Survey
Coordinator at the Colorado Historical Society Office of
Archaeology and Historic Preservation (OAI-IP).
c.
Conduct archival and historic research in Pueblo and in any other
p ertinent repositories.
d.
Submit a draft context report, addressing the social, economic,
demo a hic, and architectural changes in the neighborhood.
e.
Meet with City of Pueblo staff and Commissioners after a first
review of the Draft report for their input.
I.
Incorporate revisions and recommendations from the above
reviews and from OAFlP into the final context and submit four
hard -bound copies and an electronic version (PDF format) on
CD -ROM to OAHP. Submit to the City three hard -bound copies
and an electronic version (PDF format) on CD -ROM
g.
Present the final context and OAHP review findings at a
community meeting near the conclusion of the project.
3. REOUIRED STANDARDS
The client will develop the historic context based on guidelines established in the Secretary of the Interior's
Standards for Preservation Planning and contained in the current Colorado Cultural Resource Survey
Manual.
4. PRODUCTS: The following products will be delivered to the Society as set forth in
Attachment D. FOUR (4) ORIGINAL COPIES OF PRODUCTS (WITH THE EXCEPTION
OF CULTURAL RESOURCE INVENTORY FORMS) MUST BE DELIVERED TO THE
SOCIETY.
a) Draft Context Study
b) Interim and Final Financial Reports
c) Minutes from two public meetings (kickoff and presentation of the findings)
d) Final Context Study Report (4 copies) and CD -ROM
Universal Consulting Form— Approved by CA 10116107 -7-
SCHEDULE 2
FEESCHEDULE
PROJECT PERFORMANCE AND PAYMENT SCHEDULE
City of Pueblo East Side Neighborhood Historic and Architectural Context Study
Project Title
Project Number
Scope Element
Date Due
Society Response
Payment
Contract Approved By
April 21, 2008
Council
Select Consultant
May 20, 2008
Commence project
June 1, 2008
Kickoff Meeting with
June 30, 2008
Staff and the community
to explain the project and
g ather data sources
Consult with S11PO
June 30, 2008
Conduct research in
June 2008 —
Pueblo and related
March 2009
locations
First Interim Status and
September
$6300.00
Financial Reports
2009
Draft Context report
March 15,
delivered to
2009
SHPO/Pueblo
Meet with Pueblo CLG
April 2009
Staff and Commissioners
to discuss the report
Second and Interim
April 31, 2009
$3830.00
Status and Financial
Report
Final community meeting
May 31, 2009
to present the results
Final Report & CD ROM
June 15, 2009
Third and Final Interim
June 30, 2009
$3,870.00
Status and Financial
Report
TOTAL
$14,000
Universal Consulting Pmm— Approved by CA 10 /16/07 -8-
SCHEDULE3
PROJECT TIME SCHEDULE
PROJECT PERFORMANCE AND PAYMENT SCHEDULE
City of Pueblo East Side Neighborhood Historic and Architectural Context Study
Project Title
Project Number
Scope Element
Date Due
Society Response
Payment
Contract Approved By
April 21, 2008
Council
Select Consultant
May 20, 2008
Commence project
June 1, 2008
KickoffMeetingwith
June 30, 2008
Staff and the community
to explain the project and
g ather data sources
Consult with SHPO
June 30, 2008
Conduct research in
June 2008 —
Pueblo and related
March 2009
locations
First Interim Status and
September
Financial Reports
2009
Draft Content report
March 15,
delivered to
2009
SHPO/Pueblo
Meet with Pueblo CLG
April 2009
Staff and Commissioners
to discuss the report
Second and Interim
April 31, 2009
Status and Financial
Report
Final community meeting
May 31, 2009
to present the results
Final Report & CD ROM
June 15, 2009
Third and Final Interim
July 1, 2009
Status and Financial
Report
TOTAL
$14,000
Universal Consulting Forth — ApprovM by CA 10 /16/07 -9-
EXHIBIT A
COLORADO PUBLIC EMPLOYEES RETIREMENT ASSOCIATION
SUPPLEMENTAL QUESTIONNAIRE TO BE ANSWERED BY
ANY BUSINESS PERFORMING SERVICES FOR THE CITY OF PUEBLO
Pursuant to section 24-51-1101(2), C.R.S., salary or other compensation from the employment, engagement, retention or
other use of a person receiving retirement benefits (Retiree) through the Colorado Public Employees Retirement Association
(PERA) in an individual capacity or of any entity owned or operated by a PERA Retiree or an affiliated party by the City of pueblo
to perform any service as an employee, contract employee, consultant, independent contractor, or through other arrangements, is
subject to employer contributions to PERA by the City of Pueblo. Therefore, as a condition of contracting for services with the City
of Pueblo, this document must be completed, signed and returned to the City of Pueblo:
(a) Are you, or do you employ or engage in any c acity, including an independent contractor, a PERA Retiree who will
perform any services for the City of Pueblo? Yes. N�.
(b) If you answered "yes" to (a) above, please answer the following question: Are you an individual, sole proprietor or
partnership, or a business or company owned or operated by a PERA Retiree or an affiliated party? Yes , No_ If you
answered "yes" please state which of the above entities best describes your business:
(c) If you answered `Ives" to both (a) and (b), please provide the name, address and social security number of each such
PERA Retiree.
Name
Address
Name
Address
Security Number Social Security Number
(If more than two, please attach a supplemental list)
Failure to accurately complete, sign and return this document to the City of Pueblo may result in your being denied the
privilege or doing business with the City of Pueblo.
If you answered "yes" to both (a) and (b), you agree to reimburse the City of Pueblo for any employer contribution required
to he paid by the City of Pueblo to PERA for salary or other compensation paid to you as a PERA Retiree or paid to any employee
or independent contractor of yours who is a PERA Retiree performing services for the City of Pueblo. You further authorize the
City of Pueblo to deduct and withhold all such contributions from any moneys due or payable to you by the City of Pueblo under any
current or future con et or other an nt for services between you and the City of Pueblo.
Signed •� 20-
GT 57(yi �c �f . G G C
By. A %4- I�ovase
usm.
For purposes of responding to question (b) above, an "affiliated party" includes (1) any person who is the named beneficiary or
cobeneficiary on the PERA account of the PERA Retiree; (2) any person who is a relative of the PERA Retiree by blood or adoption to and
including parents, siblings, half - siblings, children, and grandchildren; (3) any person who is a relative of the PERA Retiree by marriage to and
including spouse, spouse's parents, stepparents, stepchildren, stepsiblings, and spouse's siblings; and (4) any person or entity with whom the
PERA Retiree has an agreement to share or otherwise profit from the performance of services for the City of Pueblo by the PERA Retiree other
than the PERA Retiree's regular salary or compensation.
Universal Consulting Form - Approved by CA 10116/07 - to-