HomeMy WebLinkAbout09934
ORDINANCE NO. 9934
AN ORDINANCE APPROVING A PROFESSIONAL
SERVICES AGREEMENT IN AN AMOUNT NOT TO EXCEED
$48,870 BETWEEN THE CITY OF PUEBLO AND RAFTELIS
FINANCIAL CONSULTANTS, INC. FOR THE 2021 BIENNIAL
WASTEWATER RATE REVIEW
WHEREAS, Section 16-6-26 of the Pueblo Municipal Code requires biennial review of
wastewater rates and fees; and
WHEREAS, Raftelis Financial Consultants, Inc. was selected as the Rate Consultant of
Record for wastewater utility fees; NOW, THEREFORE,
BE IT ORDAINED BY THE CITY COUNCIL OF PUEBLO, that:
SECTION 1.
The Agreement for Professional Services by and between Pueblo, a Municipal
Corporation, and Raftelis Financial Consultants, Inc., a true copy of which is attached
hereto and incorporated herein by reference (the “Agreement”) having been approved as
to form by the City Attorney, is hereby approved.
SECTION 2.
Work performed under this Agreement includes review and analysis of wastewater
rates and charges, including user charges, excessive strength surcharges, industrial
pretreatment charges, and system development fee use policies, and related ancillary
services with respect to the 2021 biennial review.
SECTION 3.
Funds for payment for professional services under said Agreement shall be paid
from appropriated funds budgeted in the City’s 2021 Budget from the Sewer User Fund.
SECTION 4.
The Mayor is authorized to execute and deliver the Agreement on behalf of Pueblo,
a municipal corporation, acting by and through its Wastewater Enterprise.
SECTION 5.
The officers and staff of the City are authorized to perform any and all acts
consistent with the intent of this Ordinance and the attached Agreement, to implement
the policies and procedures described therein.
SECTION 6.
This Ordinance shall become effective on the date of final action by the Mayor and
City Council.
Action by City Council:
Introduced and initial adoption of Ordinance by City Council on May 10, 2021 .
Final adoption of Ordinance by City Council on May 24, 2021 .
President of City Council
Action by the Mayor:
☒ Approved on May 26, 2021 .
□ Disapproved on based on the following objections:
_
Mayor
Action by City Council After Disapproval by the Mayor:
□ Council did not act to override the Mayor's veto.
□ Ordinance re-adopted on a vote of , on
□ Council action on _______ failed to override the Mayor’s veto.
President of City Council
ATTEST
City Clerk
City Clerk’s Office Item # R-2
Background Paper for Proposed
Ordinance
COUNCIL MEETING DATE: May 10, 2021
TO: President Lawrence W. Atencio and Members of City Council
CC: Mayor Nicholas A. Gradisar
VIA: Marisa Stoller, City Clerk
FROM: Nancy Keller, Wastewater Director
SUBJECT: AN ORDINANCE APPROVING A PROFESSIONAL SERVICES AGREEMENT IN
AN AMOUNT NOT TO EXCEED $48,870 BETWEEN THE CITY OF PUEBLO AND
RAFTELIS FINANCIAL CONSULTANTS, INC. FOR THE 2021 BIENNIAL
WASTEWATER RATE REVIEW
SUMMARY:
This Ordinance accepts an agreement between the City and our Rate Consultant of Record,
Raftelis Financial Consultants, Inc. for professional services associated with providing sanitary
sewer rate consulting.
PREVIOUS COUNCIL ACTION:
Resolution No. 13214 awarded an agreement between the City of Pueblo and Raftelis Financial
Consultants, Inc., and named Raftelis Financial Consultants, Inc. as the Rate Consultants of
Record for the Pueblo Wastewater Department, on April 27, 2015.
BACKGROUND:
Section 16-6-26 of the Pueblo Municipal Code requires biennial review of sanitary sewer rates
and fees. As an enterprise of the City of Pueblo, the Wastewater Department is obligated to
collect sufficient funds through its rates and fees to pay for its operations. Operating and
maintaining the infrastructure of these facilities entails increasing costs. Raftelis Financial
Consultants, Inc. was selected as the Rate Consultant of Record for wastewater utility fees. The
attached professional services agreement between the City and Raftelis Financial Consultants,
Inc. provides for the required biennial rate review and financial plan study in 2021.
FINANCIAL IMPLICATIONS:
Funding for the professional services related to the rate review are available from the Sewer User
Fund.
BOARD/COMMISSION RECOMMENDATION:
Not applicable.
STAKEHOLDER PROCESS:
Not applicable.
ALTERNATIVES:
Not applicable. The Municipal Code requires that sanitary sewer rates be reviewed no less often
than every two years. Raftelis Financial Consultants, Inc. was selected as the City’s Wastewater
Rate Consultant of Record through a competitive bid process in April of 2015.
RECOMMENDATION:
Approve.
Attachments:
Professional Services Agreement Raftelis Financial Consultants, Inc.
AGREEMENT
FOR PROFESSIONAL SERVICES
THIS AGREEMENT is made and entered this 26''day of April 2021 by and between Pueblo, a Municipal
Corporation (hereinafter referred to as "Client") and Raftelis Financial C'onsultants, Inc (hereinafter referred to as
"Consultant"')for Consultant to render professional Date Review services for Client with respect to wastewater Financial
Plan Study,hereinafter and related ancillary services, hereinafter referred to as the "Project." In consideration of the
mutual covenants hereinafter set forth,the parties agree as follows:
SECTION 1. GENERAL AND SCOPE OF SERVICES.
(a) Consultant shall satisfactorily perform the professional planning and consulting services for the Project
described in more detail in Schedule I attached hereto and incorporated herein by reference(the"Basic Services"). Such
services shall include all usual and customary professional rate review andconsultitg services including any required
drafting or design services incident to its work on the Project. In the event this Agreement follows the selection of
Consultant by Client pursuant to a Request for Proposals or REP,all of the requirements of that Request for Proposal or
REP are incorporated herein by reference,unless any requirement is expressly excluded in Schedule I.
(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 or subconsultants as it is for services performed directly by Consultant or Consultant's employees.
(c) To the extent Consultant requires access to private property to perform its sery ices 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 instrument,Consultant shall fully comply with and he subject to the terms and conditions set forth
therein. A copy of any such instrument will he 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 ill 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 that 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 of
work 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 of tools, supplies, labor. and utilities
required for the work,the availability of information which must be obtained li•oni 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 I or otherwise contemplated by the terms of this Agreement,
Consultant shall advise Client in writing that(i)Consultant considers the work beyond the scope ofthis 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
CA apprvd form 3112/1(1--In,kvsd 7/I/I3
in writing by Client. The compensation for such authorized work shall he 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.
SEC'TION 3. FEES FOR SERVICES.PAYME N'f.
(a) Client will pay to Consultant as lull compensation for all services required to be performed by
Consultant under this Agreement,except for services for additional work or work beyond the scope ofthis Agreement,
the maximum sum of tI.S.$8,870,computed as set forth in Schedule 2.
(b) Consultant shall submit periodic, but not more frequently than monthly, applications for payment,
aggregating to not more than the maximum amount set forth above, fur 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. (hereafter,Client shall pay Consultant fur 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).
(t) 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 he
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 hind 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.
(c) 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 furnished 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, when all information
reasonably necessary for Client to responsibly render a decision has been furnished. 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 is not within the
custody or control of Client but must be procured front others.
SECTION 5. 'TERM AND'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
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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,work product and materials as Consultant
may have accumulated in performing this Agreement, together with all finished work and work in progress.
(b) Upon termination ofthis 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 I 0 days of termination provided such latter costs could not be avoided
or were incurred in mitigating loss or expenses to Consultant or(Tient. 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 ofthis Agreement or Consultant's services is for breach ofthis Agreement by
Consultant,or for other fault of Consultant including but not limited to an Erilure to timely proceed With work,or to pay
its employees and consultants,or to perforin 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 to Client 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(e)ofthis 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 he 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 ofClient,which consent may be granted or withheld in Client's sole and absolute discretion 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).
(h) The minimum insurance coverage which Consultant shall obtain and keep in force is as follows:
(i) Workers'Compensation Insurance complying with statutory requirements in Colorado and in
any other state or states where the work is performed. The Workers' Compensation Insurance policy shall
contain an endorsement waiving subrogation against the Client.
(ii) Commercial General liability Insurance. The Consultant shall secure and maintain during
the period of this agreement/contract and for such additional time as work on the project is being performed.
Commercial General Liability Insurance issued to and covering the liability,ofthe contractor with respect to all
work performed by him and all his subcontractors under the agreement/ contract, to be written on a
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comprehensive policy form. This insurance shall he written in amounts not less than $1,000,000 for each
occurrence and aggregate for personal injury including death and bodily injury and $1,000,000 for each
occurrence and aggregate for property damage. This policy of insurance shall name the City of Pueblo, its
agents,officers,and employees as additional insureds. This policy shall have all necessary endorsements to
provide coverage without exclusion for explosion and collapse hazards,underground property damage hazard,
blanket contractual coverage,as well as Owner's and Contractor's Protective Liability(OCP)coverage. The
policy shall also provide coverage for contractual liability assumed by Contractor under the provisions of the
Agreement/Contract,and "Completed Operations and Projects Liability"coverage.
(iii) Professional Liability Insurance with coverage of not less than $1,000,000, and with a
deductible of not more than $ 15 000.
(iv) Comprehensive Automobile Liability Insurance. The Consultant shall procure and maintain
during the period of the agreement/contract and for such additional time as work on the project is being
performed, Comprehensive Automobile Liability Insurance. -this insurance shall be written with limits of
liability for and injury to one person in any single occurrence of not less than $350,000 and for any injury to
two or more persons in any single occurrence of not less than S1,000,000. -this insurance shall include
uninsured/underinsured motorist coverage and shall protect the Consultant from any and all claims arising from
the use both on and()tithe site ofthe project of automobiles,trucks,tractors.backhoes,and similar equipment
whether owned, leased, hired, or used by Consultant.
(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. 10 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 ofthe terms of this Agreement which are for the benefit ofClient.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 ofthe 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
assign or reassign Project work to any person to whom Client has reasonable objection.
SECTION 10. REQUIRED FEDERAL PROVISIONS.
STICTION I l. MISCELI.ANEOUS.
(a) Notices. Any and all notices or other communications required or permitted by tins 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:
Nancy Keller, Wastewater Director, City of Pueblo, 1300 South Queens Avenue, Pueblo, CO. 81001 or
to Consultant Todd C'ristiano, Senior Manama;_Raftelis Financial Consultants, Inc., 5619 DTC Parkway,
Suite 175, Greenwood Village, CO 80111. 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
('5 apprvd form 3/12/I --In Idv,d 7/I/13 4
either Client or Consultant in relation thereto not expressly set forth in this instrument and its attachments is null and
void. In the case of any conflict between the terms of this Agreement for Processional Services and terms of Schedule l
or any other attachment hereto, the terms of this Agreement shall govern.
(c) Successors and Assigns. This Agreement shall be binding on the parties hereto and on their successors
and assigns; provided, however, neither this Agreement, nor any part thereof, nor any moneys due or to become due
hereunder to Consultant may he assigned by it without the written consent of Client,which consent may be withheld in
Client's sole and absolute discretion. Any assignment or attempted assignment in violation of this subsection shall be
void.
(d) Amendments. No amendment to this Agreement shall be made nor he 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 ofColorado. Any unresolved dispute arising from or concerning any breach of this Agreement shall be decided in
a state court of competent jurisdiction located in Pueblo,Colorado.
(t) Equal Employment 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. (`unsultant shall endeavor to ensure 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. flatly 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 ofthe.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 he determined to be contrary to
law or the terms of any federal grant,then this entire Agreement shall be void.
SECTION 12. STAFF-IMPOSED MANDATES PROHIBITING ILLEGAL ALIENS FROM PERFORMING WORK.
(a) At or prior to the time for execution of this Agreement(which may be referred to in this section as
this"Contract"), Consultant(which may be referred to in this section as"Contractor")shall submit to the Purchasing
Agent of City its certification that it does not knowingly employ or contract with an illegal alien who will perform
work under this Contract and that the Contractor will participate in either the 'E-Verify Program"created in Public
Law 208, 104'Congress. as amended and expanded in Public Law 156, 108'(l'ongress,as amended, that is
administered by the United States Department of Homeland Security or the"Department Program"established
pursuant to §8-17.5-10215)(c)C.R.S.that is administered by the Colorado Department of Labor and Employment in
order to confirm the employment eligibility of all employees who are newly hired for employment to perform work
under this Contract.
(h) Contractor shall not:
(1) Knowingly employ or contract with an illegal alien to perform work under this contract.
(II) Inter into a contract with a subconsultant that fails to certify to Contractor that the
subconsultant shall not knowingly employ or contract with an illegal alien to perform work under this Contract.
(c) The tollowirtg state-imposed requirements apply to this contract:
(I) The Contractor shall have confirmed the employment eligibility of all employees who are
newly hired for employment to perform work under this Contract through participation in either the E-Verify
Program or Department Program.
(II) The Contractor is prohibited from using either the F:-Verify Program or Department Program
procedures to undertake pre-employment screening of job applicants while this Contract is being performed.
(III) If the Contractor obtains actual knowledge that a subcontractor or subconsultant performing
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work under this Contract knowingly employs or contracts with an illegal alien.the Contractor shall be required
to:
A. Notify the subconsultant and the Client's Purchasing Agent within three(3)days
that the Contractor has actual knowledge that the subcontractor/subconsultant is employing or
contracting with an illegal alien; and
B. Terminate the subcontract with the subcontractor/subconsultant if within three(3)
days of receiving the notice required pursuant to subparagraph (c)(lll)A. above the
subcontractor/subconsultant does not stop employing or contracting with the illegal alien:except that
the Contractor shall not terminate the contract with the subcontractor/subconsultant if, during such
three (3) days, the subcontractor/subconsultant provides information to establish that the
subcontractor/subconsultant has not knowingly employed or contracted with an illegal alien.
(IV) The Contractor 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 Contractor shall constitute a breach of contract and grounds for
termination. In the event of such termination, the Contractor shall be liable for Client's actual and consequential
damages.
(e) As used in this Section 12, the terms "subcontractor" and "subconsultant" shall mean any
subconsultant or subcontractor of Consultant rendering services within the scope of this Agreement.
SECTION 13. Reserved.
SECTION 14. PERA LIABILITY
Consultant shall reimburse the City for the fill amount of any employer contribution required to he paid by the
City of Pueblo to the Public Employees' Retirement Association(''PFRA") for salary or other compensation paid to a
PERA retiree performing contracted services for the City under this Agreement. The Consultant shall fill out the
questionnaire attached as Exhibit A and submit the completed form to Client as part of the signed Agreement.
IN WITNESS WHEREOF,the parties hereto have made and executed this Agreement as of the day and year first
above written.
CITY OF PUEBLO, A MUNICIPAL CORPORATION RAFT'ELIS FINANCIAL CONSULTANTS
'
E3y_2(.. 7 _- 13y: C C
Mayor •
Attest: l� Title: .56-3 tyi_ 1�(:t✓1G7�,<��
City Cler.
[ SEAL]
BALANCE OF APPROPRIATION EXISTS FOR TI IIS CONTRACT AND FUNDS ARE AVAILABLE.
64? c5"
D'rector of Finance
APPROVED AS IO FORM:
('A:wpm"form 3/12;1it—Ins R csd'7!I/13 6
City Attorney
^
[XI-11131"T' 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 capacity, including an independent contractor,a PER,A Retiree who will
perform any services for the City of Pueblo? Yes No (: lust rrgn behm trheiber;•00 attylrer cs u, no l
(b) If you answered"yes"to(a)above,please answer the following question: Are you I)an individual,2)sole proprietor
or partnership, or 3) 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 listed entities(1,2,or 3)best describes your business:
(c) If you answered"yes"to both(a)arid(h),please provide the name,address,and social security number of each such
PERA Retiree.
Name Name
Address Address
Social Security Number Social Security Number
(If more than two, please attach a supplemental list)
Ifyou answered"yes"to both(a)and(b),you agree to reimburse the City of Pueblo for any employer contribution required
to be 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 contract or other arrangement for services between you and the City of Pueblo.
Failure to accurately complete,sign and return this document to the City of Pueblo may result in
your being denied the privilegeilof doing business with the City of Pueblo.
Signed fj ( v vi20
(244 c
7.
Name: 6.0.5 f'“4.0.1(
Title: 5e t x�1" J'LG6 r►et
I'or purposes of responding to question (til above. an "affiliated party' includes (I t any person who is the named beneficiary or
cobeneficiary on the P1 RA account of the PERA Retiree: (2)any person ssho is a relative ol'the PF.RA Retiree by blood or adoption to and
aquiline parents.siblings.hall-siblings.children.and grandchildren:131 any person echo 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 kith whom the
PERA Retiree has an agreement to share or otherwise profit Front the performance ol'sert ices tier the City.of Pueblo by the PER Retiree other
than the PFR A Retiree's regular salary or compensation.
8