CCR2006165.
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COMMON COUNCIL - CITY OF MUSKEGO
RESOLUTION #165-2006
AUTHORIZE ENTERING INTO PROFESSIONAL SERVICES AGREEMENT
WITH TRI-DATA, A DIVISION OF SYSTEM PLANNING CORPORATION FOR
AN ASSESSMENT OF THE CITY OF MUSKEGO'S PROVISION OF
FIRE/RESCUE SERVICE FOR MEETING PRESENT AND FUTURE
NEEDS OF THE COMMUNITY AND
DEVELOPMENT OF A MASTER PLAN FOR PROVISION OF FIRE/RESCUE
SERVICE
WHEREAS, The Agreement for Professional Services, as attached, has been reviewed
by the Finance Committee and has been recommended for approval.
NOW, THEREFORE, BE IT RESOLVED That the Common Council of the City of
Muskego, upon the recommendation of the Finance Committee, does hereby authorize
entering into the Agreement for Professional Services with Tri-Data, a Division of
System Planning Corporation.
BE IT FURTHER RESOLVED That the Mayor and Clerk-Treasurer are authorized to
sign the Agreement in the name of the City.
DATED THIS 22nd DAY OF Auqust ,2006.
SPONSORED BY:
FINANCE COMMITTEE
Ald. Nancy Salentine
Ald. Eileen Madden
Ald. Eric Schroeder
This is to certify that this is a true and accurate copy of Resolution #165-2006 which
was adopted by the Common Council of the City of Muskego.
8/06jmb
. Memo
To:
From:
Date:
Finance Committee and Common Council
City Administrator
August 15, 2006
Subject: Discussion and Action on Professional Services Agreement for Assessment of
the City's Provision of Fire/Rescue Service for Meeting Present and Future Needs of the
Community - Development of a Master Plan for Provision of Fire/Rescue Service
At the May, 2006 Committee of the Whole meeting, the Council reviewed the draft
request for proposals for the Fire/Rescue study. Following discussion, the Council
directed the staff to obtain proposals from consultants for the study work. In addition to
advertising in the trade publications, we invited four consulting firms to submit
proposals. The four firms were chosen because of past experience conducting studies
specific to Fire/Rescue services.
The following three (3) firms submitted proposals to do the project:
McGrath Consulting Group $28,750
Matrix Consulting Group $47,000
Tri-Data, a Division of System Planning Corporation $59,737
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A committee ofthe following individuals reviewed the proposals submitted: Mayor
Damaske, Ald. Schroeder, Police Chief Johnson, Director of Building
InspectionlEngineering McMullen, JeffVerburgt representing Tess Comers Fire Dept.
and Dominick D' Aquisto representing Muskego Fire Department and myself. The
committee went through a rating process concerning the proposals and how they best met
the City's needs as outlined in the City's RFP.
The committee has recommended that the Council authorize the Mayor to enter into a
consulting agreement with Tri-Data, a Division of System Planning Corporation for the
study. The committee recommended this firm over the others because beyond meeting
the City's needs with its proposal as outlined in the RFP, this firm has considerable
experience conducting studies involving fire/rescue services and some staff assigne~ to
the project have actually .served in this field. Cost did not steer the proposal evaluation
process. The intent of the evaluation process was to choose a firm that would produce
the best work product to meet the needs of the City.
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The recommended firm has worked for two Wisconsin communities from which we have
obtained references. The City of Middleton (City Administrator) and the City of
Waukesha (Fire Chief) both provided positive references for Tri-Data. Both individuals
we spoke to about Tn-data we personally/professionally know and both indicated they
would have no hesitation working with Tri-data again should the need arise. Their client
list is extensive and I will have it available at the meeting should you like to review it.
. As you will recall, specific dollars were not budgeted in the 2006 budget to complete a
firelrescue study. Staff recommends funds for this project come from fund balance
available in the Capital Expenditures Fund. Finance Department Supervisor Mueller
estimates the fund balance to currently be approx. $450,000 considering 2006 planned
expenditures.
Attached to this memo, is a draft of the professional services agreement that staff and the
City Attorney have put together. If authorized by the Council, the study would begin at
the beginning of Sept. and take approx. six (6) months to complete.
Should the Finance Committee/Common Council concur with the committee
recommendation, approval of the associated resolution would be appropriate at this time
authorizing the Mayor to enter into a professional services agreement with Tri-Data with
such agreement approved by the City Attorney as to content and form.
Jennifer
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AGREEMENT FOR PROFESSIONAL SERVICES
THIS IS AN AGREEMENT for professional services made between the CITY
OF MUSKEGO, a Wisconsin municipal corporation, W182 S8200 Racine Ave., P.O.
Box 749, Muskego, Wisconsin 53150-0749 (CITY) and TRIDATA, A DIVISION OF
SYSTEM PLANNING CORPORATION, a Delaware Corporation, 1000 Wilson
Boulevard, 30th Floor, Arlington Virginia 22209-22] ] (CONSULTANT).
The CITY intends to retain the CONSULTANT for professional services to
complete an assessment of the City of Muskego's provision of FirelRescue service for
meeting present and future needs of the community and for the development öf a master
plan for the provision of Fire/Rescue Service as described in Attachment A (hereinafter
called the project).
The CITY and CONSULTANT agree to the performance of professional services
by CONSULTANT and payment for those services by the CITY as set forth below.
Attachment A - Scope of Services, consisting of6 pages, including Exhibit]
Attachment B - Project Schedule, consisting of2 pages, including Exhibit 2
Attachment C - Compensation and Payment, consisting of3 pages, including
Exhibit 3
Attachment D - Terms and Conditions, consisting of I page
Attachment E - Insurance, consisting of 3 pages, including Exhibit 4
. This agreement (consisting of 1 page), together with the Attachments identified above,
and the entire project proposal except as amended in the attached exhibits constitute the
entire agreement between the CITY and CONSULTANT and supercede all prior written
or oral understandings. This agreement and said Attachments may only be amended,
supplemented, modified, or cancelled by a duly executed written instrument.
The parties have made and executed this agreement as of August _, 2006.
City of Muskego,
a Wisconsin Municipal Corporation (City)
Tri-Data, A Division of
System Planning
Corporation, a Delaware
Corporation (Consultant)
Signature:
Typed NamelTitIe: Charles Damaske, Mayor
Date:
Attest:
City CJerkITreasurer, Janice Moyer
Signature:
Typed Name/Title:
Date:
Attest:
Title:
(Provide Evidence of
Corporate Authority) .
ATTACHMENT A - SCOPE OF SERVICES
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Project Objectives
The completion of the project by the CONSULTANT and the work product produced
by the CONSULTANT will result in the CITY meeting two objectives:
a. The CITY will have increased knowledge and increased accountability
concerning the expenditure of tax dollars that support the operations of the
Fire Departments with which the CITY contracts for service.
b. The CITY will have a plan for the provision of FirelRescueservice for the
future following the CONSULTANT evaluation of various options
including: Staying with current arrangement of contracting with two
volunteer Fire Departments; moving to one combination volunteer
department, moving to one combination volunteer and paid department;
moving to a Public Safety Director (City employee) who would be
responsible for overseeing police, fire and rescue services; moving to
some combination of above noted options; or other option brought forth
by the CONSULTANT.
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Development of a Master Plan
The CONSULTANT shall develop a Master Plan for the provision of fire and rescue
service that will ensure the CITY has appropriately evaluated its needs and planned
for how to provide for those needs in a cost effective way while ensuring an
appropriate level of service for the community. The plan will address meeting
present needs for fire/rescue services as well as the need resulting from continued
residential and commercial growth. The Plan will serve to position the CITY to
provide the level of service the community expects as cost effectively and efficiently
as possible.
The Master Plan that is developed by the CONSULTANT will address the following
key areas:
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a. Capabilities of the current fire organizations, to include staffing, training,
vehicle and equipment inventory assessments. An analysis of current fire
classes and requirements to meet current fire classes as well as future
needs to maintain or raise ISO fire class insurance ratings.
b. Capabilities of the current rescue services, to includé staffing, training,
vehicle and equipment inventory assessments.
c. An analysis of the services each fire department provides to the City
including statistics for call and run data for each of the last five years
(200 I - 2005).
d. Assessment of the quality ofthe present levels of service for Fire and
Rescue including current response times.
e. Economic and financial circumstances of each Fire Department including
an analysis of the base contracts the City has with each Fire Department.
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f Determination of the expected level of service by the community and
decision makers (Mayor and Common Council).
g. As noted above, present options for providing fire and rescue service with
cost estimates the City may consider.
h. Based on feedback from the decision makers (Mayor and Common
Council) on service provision options presented by the CONSULTANT,
the Plan shall address an implementation plan for the service provision
option chosen by the Common Council over a specific recommended
period of time. Such plan shall address all operational and capital needs.
Project Approach I Study Steps
The project approach and steps to complete the study shall be as outlined in pages] 3
through] 6 of the proposal for this project submitted by Tri-Data dated June 30, 2006
and included as Exhibit] of Attachment A for reference.
The project will include a final presentation of the project and resulting Master Plan
to the City Council.
Additional Services
Additional services beyond the scope of this project as outlined herein shall be authorized
in advance in writing by the CITY.
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Designated City Contact Person
The designated City Contact person shall be the City Administrator (Jennifer Sheiffer).
The City Administrator shall serve as the City's representative with respect to the
services to be rendered under this agreement. The Administrator shall have complete
authority to transmit instructions, receive information, interpret and define City policieso
and decisions with respect to CONSULTANT's services for this project.
TIle City Administrator shall arrange for access to and make all provisions for
CONSULTANT to performo services under this agreement.
Acknowledgement of Existing Agreements witb Two Fire Departments Serving the
City 0
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The CONSULTANT acknowledges receipt (with the request for proposals sent by the
CITY) of the following five (5) existing agreements with the two Fire Departments
serving the City: Agreement Between the City of Muskego and the Muskego Volunteer
Fire Company, Agreement Between the City of Muskego and the Tess Corners Volunteer
Fire Company, First/Second Quarter Service Agreement Between the City and Tess
Comers Volunteer Fire Department, First/Second Quarter Service Agreement Between
the City and MuskegoVolunteer Fire Company and the 2006 Agreement for Ambulance
Services.
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2
City of Muskego: Development of a
Master Plan for Provision of Fire/Rescue Service
Exhibit 1
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· Staying with the current arrangement of contracting with two volunteer fire
departments
· Moving to one combination volunteer department
· Moving to one combination volunteer and paid department
· Moving to a city fire department, staffed with city employees
· Moving to a Public Safety Director (city employee) who would be responsible for
overseeing police, fire, and rescue services
· Moving to some combination of above
· Other
Study Steps
The study steps listed are listed below followed by a graphic depiction of the timeline. Key staff
who will participate on each task are shown for each task with the task leader.
Our approach begins with a kickoff meeting to confirm the contract's objectives and goals,
validate the program plan, finalize a timeline (including milestones and deliverable target dates),
review the expectations to validate stakeholder understanding and concurrence, and review
background information requirements. We will also plan the tight schedule of meetings for the
site visit.
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To the extent available, we would like to obtain a comprehensive set of data at the beginning of
the study, in advance of our first ''triage" trip. We understand that some of the data may not be
available or may take time to gather, and may be available later on.
As noted earlier, though we try to base our work on hard data tö the extent possible, we also
spend time soliciting qualitative information, suggestions, and perceptions from the vç:l~ious
stakeholders.
A comprehensive list of the data we would like to obtain can be found below.
Data we would like to obtain before we begin the first visit:
· Fire departments organization charts
· Map of fire stations (updated)
· Map of county and fire protection areas
· Personnel deployment (number of personnel in each unit)
· Past annual reports
· Latest ISO rating reports, with deficiency analysis, if any
· Most recent budget with any attendant information (with personnel costs broken out)
· Capital improvement and apparatus replacement program
· Fire, EMS, hazmat, rescue, and other emergency incident trend data for the past 5- 10 years
TriData, a Division of
System Planning Corporation
13 June 30, 2006
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City of Muskego: Development of a
MastC'r Plan for Provision of Fire/Rescue Service
· Response time profiles for fire and EMS calls, by geographic area and by fire unit.
(Ideally, second-in response times as well as first in would be provided, though rarely
available).
· Numbers of fires, deaths, injuries and dollar loss by type of occupancy and by cause
· Fire apparatus complement by station (age; manufacturer; type; last major
refurbishment, if any), including front-line and reserve engines, ladders, and other
units
· Mutual and automatic aid agreements other fire departments or órganizations
· Expected major capital improvements that would present new risks or affect existing
risks or travel times
· General obligation bond commitments and promises
· Directives regarding direction of the study (from city)
More specific data that will be needed for the response times:
· CAD data, to include incident number, date, address, call type, time received, time
dispatched, units dispatched, en route times, arrival times, clear times, whether call
was transported to hospital or not. If CAD is not available this data will have to be
assembled into an Excel document for our analysts.
· NFIRS data, to include call type, building type, whether building was sprinklered, fire
origin, fire containment, fire loss, injuries/deaths, etc.
This serves as "homework" for our review before the first series of meetings with fire department
and City officials. Some of this data will be collected during the course of the study if not readily
available at the start, however CAD data will be needed as early as possible for initial analysis.
The fire departments might begin to gather this data now, since any consultant hired should
want this data, and that helps speed up the start of the project.
.~~{~ß~~ After reviewing the background information provided, a three- or four-day site visit, comprising a
series of intensive meetings, will be held early in.the project. During the visit, we will have a
team meet with Fire/Rescue Services officials, including the fire chiefs, officers, and other
personnel deemed appropriate to discuss information collected and ramifications of any
. proposed changes to current operations (e.g., training off.icers, EMS officers, Haz Mat officers).
We will visit fire stations and hold informal discussions with some of the firefighters and officers.
We will tour the service areas to better understand the geography, risks present, and the road
system.
Following these initial meetings and field observations, we meet again at the end of this "triage
visit" with the City's designated project contact to summarize and triage the issues to be
considered in depth and to identify any that need less attention, and then reset priorities as
necessary to make sure that the key issues will receive adequate attention within the limited
study budget. The scope of work, how information will flow between our project team and the
City's project contact, and how the overall project will proceed are also discussed.
TriData, a Division of
System Planning Corporation
14 June 30, 2006
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City of Muskego: Development of a
Master Plan for Provision of Fire/Rescue Service
This step comprises an analysis of fire/rescue services operations, to determine the level of
service provided by and organizational cultures of the existing volunteer departments. A strong
level of familiarity with the departments is necessary to recommend changes to the existing
operations.
We will evaluate the line fire/rescue operations of the departments. We do this by observing
operations, reviewing SOP's, and interviews with firefighters, officers, am:Lspecial team
members. We look for compliance with required procedures (e.g., "Two-In/Two-Our) and
standard industry practices. We determine whether the department's own policies and SOPs
are being followed and whether they make sense. We will evaluate personnel training, and
records management. We will look at volunteer recruitment and retention, volunteer staffing
pattems, and turnout times; including the amount of time it takes for volunteers to reach their
apparatus to respond to calls.
Important in the deployment of a fire master plan is understanding the choices that are available
and their impact on risk. For example, there are choices regarding response time and the level
of risk the city (and community) is willing to accept We will discuss these choices early in the
project and provide any alternatives that might be available. Establishing the performance
benchmarks for service delivery are important and they allow the city to evaluate how well the
master plan is working as time progresses.
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Based on the information gathered above, T riData will:
· Identify trends affecting fire and emergency protection in Muskego, including
population growth, demographics, and risk
· Analyze trends in the number and size of fire, EMS, and other incidents in the past
five years, if -electronic data is available.
· Use statistical extrapolation and expert îudgment in the factors of influence to
develop an envelope of the trends to be expected, including projections of
reasonable ranges of fires, EMS calls, and other incidents over the next 1-5 and
5-10 years
W~ will analyze the current demand and risks and 19Qk at what ch?nges the city can reasonably
anticipate in demand for services and risks faced. We estimate demand two ways to form an
envelope of projections. The high estimate projects the trend in demand per capita, multiplied by
the projected population increase. The low estimate assumes that per capita demand will
remain as ìts current level, and that demand will be proportional to population growth. The
results of this analysis are compared to the existing capabilities to determine unmet needs. The
results of the work performed in this step will be used in the master plan part of the study
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City of Muskego: Development of a
Master Plan for Provision of Fire IRescue Service
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TriData team will develop a master plan, with options, that will ensure fire and rescue services are provided to the City of Muskego effectively and efficiently to ensure an appropriate level of service to the citizens at a reasonable cost.
This is perhaps the most crucial task in the study. Based on the detailed review of current service levels, and any gaps or deficiencies identified, and opportunities for improving efficiencies and cost effectiveness, we will develop a series of options for,.1he future including changing the services that are delivered and how they are delivered.
We will utilize a system of structured input and feedback involving jurisdictional decision makers, fire rescue service providers, and key stakeholders to develop the plan. The plan will be a multi-year, multiple option instrument designed to address both operational and capital needs for the next 5 to 10 years. Where appropriate, the plan will include cost estimates for major initiatives the city should consider.
Options will be presented for evaluation, including the positive and negative impacts of such actions. To do this process a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis will be initiated to look not only at the individual alternatives, but to also evaluate their potential impact upon the organizational environment.
We will produce a Draft Final Report with recommendations that will address each specific study .
task in the proposal. The report will include a list of recommendations.
The Draft Final Report will be submitted to the City's Project Manager for dissemination to others for review. In addition to readers from the City, we generally suggest having personnel from the fire department review the document for technical accuracy.
The draft report will include cost analysis for significant recommendations..
An important assumption in pricing this effort and keeping within in budget is that review comments sent to us by the City will be collected and combined in one document, and there will be one round of comments (unless there are errors in the revised final report). Additional rounds of review will be undertaken at cost.
After receiving comments on the Final Draft, we will make final changes, perform a final edit, and officially submit our final report.
TriData, a Division of
System Planning Corporation
16
June 30,2006
Exhibit 2
City of Muskego: Development of a
Master Plan for Provision of Fire jRescue Service
VI. SCHEDULING
The tentative timeline for the study is shown below. If the contract is executed by August 15,
2006, we can provide a Draft Master Plan by December 1, 2006, and a Final Master Plan one
month later, with the exact timing dependant on the availability of data and the length of review
desired by the department for internal review, and the changes required.
...,
.., 6. 1. Kickoff Conference Call
2. Collection/Review of Background
Items
11I11I11I11I11I11I010
.., ! 3. Triage Meetings On Site
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4. Review of Current Fire/Rescue
Operations
5. Risk and Demand Analysis
...... ! 6. Development of a Master Plan
9. Draft Master Plan
"I 10. Final Master Plan and
Presentation
11I11I11116
Final Master Plan Presentation
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TriData, a Division of
System Planning Corporation
18 June 30, 2006
. ATTACHMENT C - COMPENSATION AND PAYMENT
The compensation for this project shall be $59,737 on an all inclusive, not to exceed
basis.
The CONSULTANT has estimated and proposed 549 hours as a budget for th,is project.
Staff assigned to those hours are at the following hourly rates:
Philip S. Schaenman, President of TriData
Stephen Brezler, Project Manager
Patrick Simpson, Senior Research Analyst
Steven T. Lee, Research/GIS Analyst
Maria Argabright, Executive Assistant
$212.13
$140.96
$ 98.54
$ 60.35
$ 74.59
Staff assigned to the estimated and proposed hours for this project result in a proposed
cost of $59,737 (page I and 2 of cost proposal dated June 30, 2006, a copy of which is
included as Exhibit 3 to Attachment C for reference).
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The CITY acknowledges and accepts this as the proposed not to exceed budget for this
project unless amended by written agreement and approved by the Common Council.
However, the CITY respectfully expects where there is opportunity to bring this project
to successful completion for an amount less than the budgeted amount, CONSULTANT
shall make every effort to do that.
The CITY shaH make payment for services on a monthly basis upon receipt of a detailed
invoice indicating actual hours (by named individual and their hourly rate) spent on the
project as compared to the budgeted hours as proposed by the CONSULTANT. Travel
and other direct costs shall be detailed on the invoices as well.
The payment schedule shall be as follows:
September] 5,2006
October IS, 2006
November] 5, 2006
December 15,2006
January 15, 2007
Delivery of the final report/presentation
of the final report and masterplan.
$ 6,000 (approx. ]0% ofhudgeted amt.)
$]0,000 (approx. 17% of budgeted amt.)
$10,000 (approx. 17% of budgeted amt.)
$10,000 (approx. 17% of budgeted amt.)
$10,000 (approx. 17% of budgeted amt.)
Balance Outstanding
Invoices for services shall be sent to the attention of Ms. Jennifer Sheiffer, City
Administrator, W182 S8200 Racine Avenue, P.O. Box 749, Muskego, WI 53 I 50-0749.
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. ATTACHMENT B - PROJECT SCHEDULE
The project schedule shall be as outlined in the tentative timetable submitted by
Tn-Data as part of the proposal (page 18) dated June 30, 2006, a copy of which is
included as Exhibit 2, Attachment B for reference. A more definitive schedule shall be
determined and agreed upon by the CITY and CONSULTANT as outlined in the project
approach discussed in Exhibit 1 to Attachment A (page 13 of the Tri-data proposal, Study
Steps - Task]).
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The completion of the project however shall occur within six months of the
signing of the contract by the CITY and the CONSULTANT
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Exhibit 3
. COST OF SERVICES
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Direct
BREZLER. STEPHEN K.
SIMPSON, PATRICK L.
2
2
Total labor 4 $479
Direct
BREZLER, STEPHEN K.
SIMPSON, PATRICK L
ARGABRIGHT, MARIA V.
8
16
4
Total labor 28 $3003
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Direct
BREZLER, STEPHEN K. 40
. SIMPSON, PATRICK L. 40
Tolallabor 80 $9,580
Direct
BREZLER, STEPHEN K.
SIMPSON, PATRICK L
22
55
Total labor 17 $8;521
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TriData, a Division of
System Planning Corporation
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. Rate
Direct
BREZLER, STEPHEN K.
SIMPSON, PATRICK l.
LEE, STEVEN T.
8
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70
Total Labor 94 $6,929
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BREZLER, STEPHEN K.
SIMPSON, PATRICK L
LEE, STEVEN T.
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Total Labor 136 $13,197
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SCHAENMAN, PHILIP S.
BREZLER, STEPHEN K.
SIMPSON, PATRICK L
LEE, STEVEN T..
ARGABRIGHT, MARIA V.
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Total Labor 84 $7,885
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SCHAENMAN, PHILIP S
BREZlER, STEPHEN K.
SIMPSON, PATRiCK L
ARGABRIGHT, MARIA V.
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16
Total labor 46 $4,546
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SPC Travel $4,575
Total Travel $4,575
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Miscellaneous, FedEx, Reproduction $1,023
ITotai Cost 549 $59,737 ,
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TríData, a Division of
System Planning Corporation
2
ATTACHMENT D - TERMS AND CONDITIONS
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General Terms
The CONSULTANT agrees to perform all the work described in this agreement and
agrees to comply with all the terms and conditions herein for the amount stated in
Attachment C of this agreement.
The CONSULTANT shall comply with all federal, state, and local laws and regulations
and shall hold the CITY harmless for any violations thereof.
There will be no sub-consultants/associates used on this project.
The CONSULTANT shall deliver to the CITY one (1) original final report and one (1)
copy in a format the CITY and CONSULTANT agree to that is easily reproduced.
Upon completion of this project or termination of this Agreement, all original documents
shall be delivered to and become the property of the CITY.
Termination
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The obligation to provide further services under this agreement may be terminated by
either party upon thirty (30) days written notice in the event of substantial failure by the
other party to perform in accordance with the terms of this agreement.
Controlling Law
This agreement is to be governed by the law of the State of Wisconsin.
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ATTACHMENT E- INSURANCE
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A certificate of insurance on a form approved by the City of Muskego included here as
Exhibit 4 to Attachment E.
The CONSULTANT shall maintain through the course of contracted work insurance as
specified below.
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General Liability
Automobile
Workers Compo
Excess Liability
Errors & Omission
Professional Liability
$] ,000,000/$1,000.,600'
$] ,000,000 /$1 ,000,000
$],000,000/$],000,000
$] ,000,000
$] ,000,000/$1,000,000
$5,000,000
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CERTIFICATE OF INSURANCE
PROJECT: 2006 Muskego Fire Study
This is to certify that the policies listed below have been issued to lhe insured named below by the Company(s) indicated below and are in force
at lhis dale. The insurance coverages lisled will not be canceled, materially changed or renewal refused unlil at least thirty (30) days written
notice has been given to the OWNER.
. The holder of lhis certificate is a party to the Certificate of Insurance pursuant to the Agreement between Cily of Muskego and CONSULTANT.
COMPANIES AFFORDING COVERAGES
COMPANY A COMPANY C
LETTER LETTER
AGENCY NAME: AGENCY NAME:
ADDRESS: ADDRESS:
.' .:
SIGNATURE: SIGNATURE:
AUTHORIZED REPRESENTATIVE AUTHORIZED REPRESENTATIVE
DATE: DATE: I
I
! COMPANY B COMPANY 0
I LETTER LETTER
AGENCY NAME: AGENCY NAME:
ADDRESS: ADDRESS:
SIGNATURE: SIGNATURE:
AUTHORIZED REPRESENTATIVE AUTHORIZED REPRESENTATIVE
. DATE: DATE:
NAME AND ADDRESS OF INSURED: NAME(S) AND ADDRESS(S) OF ADDITIONALLY INSURED:
NAME: NAME: City of Muskego
ADDRESS: ADDRESS W182 S8200 Racine Avenue
PO Box 749
Muskego, WI 53150
NAME:
ADDRESS:
NAME AND ADDRESS OF CERTIFICATE HOLDER:
NAME: City of Muskego NAME:
ADDRESS: W182 S8200 Racine Avenue ADDRESS:
PO Box 749
Muskego. WI 53150 NAME:
ADDRESS
.
Policy
Company Type of Policy Expiration
Limits of Liability in Thousands (000) Letter Insurance Number Date
Statutory
WORKERS' Each Acc
COMPENSATION AND Disease-Policy Limit
EMPLOYER'S LIABILITY Disease-Each Employee
MOTOR VEHICLE CSL 1,000
LIABILITY
.
o ANY AUTO Bodily Injury
o ALL OWNED AUTOS (Per Person)
o SCHEDULED AUTOS ,- Bodily Injury
o HIRED AUTOS (Per Accident)
o NON-OWNED AUTOS Property o GARAGE LIABILITY
0
General 1,000
GENERAL LIABILITY Aggregate
o COMMERCIAL GEN Prods-Comp/Ops
LIABILITY Agg.
o CLAIMS MADE Pers. & Advg. o OCCURRENCE Injury
o OWNER'S & Each Occurrence
1,000
CONTRACTOR'S
PROTECTIVE
0 Fire Damage
(Anv One Fire)
0 Medical Expense
(Any One Person)
o CONTRACTUAL Contractual 1,000
LIABILITY Liability
o COMPLETED
Completed OPERATIONS
Operations
EXCESS LIABILITY Aggregate Each Occurrence
o UMBRELLA FORM 1,000 1,000
o OTHER THAN
1,000 1,000 UMBRELLA FORM
OTHER 5,000
Professional Liability
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/SPECIAL TIES
DATE ISSUED
. AUTHORIZED SIGNATURE