CONTRACT ACCEPTANCE AND EXECUTION. The Board of Supervisors for Carson City, Nevada at their publicly noticed meeting of July 2, 2020 approved the acceptance of the attached Contract hereinbefore identified as CONTRACT No.

CONTRACT ACCEPTANCE AND EXECUTION. The City Council of Fernley, Nevada, at their publicly noticed meeting of , 20 , approved the acceptance of this Contract. Further, the City Council authorizes the Mayor of Fernley, Nevada to set his hand to this document and record his signature for the execution of this Contract in accordance with the action taken. FERNLEY: XXX XXXXXXXXX, MAYOR DATED this day of , 20 . ATTEST: XXX XXXXXXX, CITY CLERK DATED this day of , 20 . , being first duly sworn, deposes and says: That is the Contractor; that has read the foregoing Contract; and that understands the terms, conditions, and requirements thereof. CONTRACTOR BY: TITLE: FIRM: BUSINESS LICENSE #: Address: City: State: Zip Code: Telephone: / Fax #: E-mail Address: (Signature of Contractor) DATED this day of , 20 . STATE OF ) ) ss County of ) On this day of , in the year 20 , before me, / Notary Public, personally appeared , personally known to me or proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to this instrument, and acknowledged that he executed it. WITNESS my hand and official seal. Notary's Signature My Commission Expires: ATTACHMENT A Xxxxxx City • Fallon • Lake Tahoe • Reno xxx.XxxxxXxx.xxx‌ Reno 0000 Xxxxxxxxx Xxxxx Xxxx, Xxxxxx 775.827.6111 July 3, 2018 LA18.465 Xxxxxxx Xxxxx, Associate Engineer City of Fernley-Public Works Department 000 Xxxxxx Xxxx Xxxxxxxxx Xxxxxxx, XX 00000 RE: Proposal for Independent Assurance Testing Services for the City of Fernley Xxxxxx Xxxx Reconstruction Project Lumos & Associates, Inc. is looking forward to working with the City of Fernley to provide independent assurance testing services on the Xxxxxx Xxxx Reconstruction Project. Please review the attached Scope of Services and Fees, which are summarized below: $55,375 Task 1: Independent Assurance Testing $50,600 Task 2: On Call Services (Time & Materials, Not to Exceed) $5,000 $60,375 Total: $55,600 Please feel free to contact either myself or Xxxxx Xxxx should you have any questions. Sincerely, Xxxxx Xxxxx Xxxxxx X. Xxxx, PE Project Manager, Construction Division Director, Construction Division Attachments: Exhibit A1 – Scope of Services Exhibit A2 – Cost of Services Exhibit B1 – Minimum Required Sampled and Tests Exhibit B2 – AASHTO Accreditation Certificate Exhibit B3 – Quality Control Fee Schedule Cc: Xxxxx Xxxxxxx, P.E., City Engineer City of Fernley-Public Works Department L:\Marketing\Proposals\2018 Proposals\LA18.465 - Xxxxxx Xxxx IA Testing\Proposal\LA18.465_Cov...

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CONTRACT ACCEPTANCE AND EXECUTION. The Board of Supervisors for Carson City, Nevada at their publicly noticed meeting of September 6, 2018 approved the acceptance of the attached Contract hereinbefore identified as CONTRACT No. 1819-099. Further, the Board of Supervisors authorizes the Mayor of Carson City, Nevada to set his hand to this document and record his signature for the execution of this Contract in accordance with the action taken. CARSON CITY, NEVADA ATTEST: XXXXXX X. XXXXXXX, MAYOR DATED this 6th day of September 2018. XXXXX XXXXXXXXXXX, CLERK-RECORDER DATED this 6th day of September 2018. SAMPLE INVOICE Invoice Number: Invoice Date: Invoice Period: Invoice shall be submitted to: Carson City Public Works Attn: Xxxxx Xxxxx 0000 Xxxxx Xxx Carson City NV 89701 Line Item # Description Unit Cost Units Completed Total $$ Total for this invoice Original Contract Sum $ Less amount previously billed $ = contract sum prior to this invoice $ Less this invoice $ =Dollars remaining on Contract $ ENCLOSE COPIES OF RECEIPTS & INVOICES FOR EXPENSES & OUTSIDE SERVICES South Xxxxxx Street and Xxxxxxx Street Roundabout Scope of Work‌ Xxxxxx-Xxxx and Associates, Inc. (“Xxxxxx-Xxxx” or “CONSULTANT”) is pleased to submit this Scope of Work to Carson City (“CITY”) to provide professional engineering services for the design of a roundabout at South Xxxxxx Street and Xxxxxxx Street. The roundabout design completed by the CONSULTANT will be an intersection improvement incorporated into a complete streets design project along the South Xxxxxx Street Corridor which is being designed by the CITY. Our project understanding and scope of services for the roundabout design, are detailed below. UNDERSTANDING AND ASSUMPTIONS ▪ CONSULTANT understands that CITY staff will design the overall Xxxxxx Street corridor. ▪ The roundabout construction documents are a subset of a larger, complete bid package that will be prepared by the CITY. CONSULTANT will provide roundabout plans and technical specifications for CITY to incorporate into the complete bid package. ▪ CITY will provide CONSULTANT with horizontal and vertical design information that is sufficient for CONSULTANT to tie proposed roundabout improvements into CITY’s overall design. ▪ Construction staging plans and traffic control plans are not required. It is assumed the contractor will prepare and submit construction staging plans and traffic control plans for approval. ▪ CONSULTANT understands the CITY is obtaining and providing survey to the CONSULTANT that wi...

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CONTRACT ACCEPTANCE AND EXECUTION. The Board of Supervisors for Carson City, Nevada at their publicly noticed meeting of August 1, 2019 approved the acceptance of the attached Contract hereinbefore identified as CONTRACT No. 19300012. Further, the Board of Supervisors authorizes the Mayor of Carson City, Nevada to set his hand to this document and record his signature for the execution of this Contract in accordance with the action taken. CARSON CITY, NEVADA ATTEST: XXXXXX X. XXXXXXX, MAYOR DATED this 1st day of August, 2019. XXXXXX XXXXXXX, CLERK-RECORDER DATED this 1st day of August, 2019. SAMPLE INVOICE Invoice Number: Invoice Date: Invoice Period: Vendor Number: Invoice shall be submitted to: Xxxxxx City Sheriff’s Office Attn: Xxxxx Xxxx 000 Xxxx Xxxxxx Xx Carson City NV 89701 Line Item # Description Unit Cost Units Completed Total $$ Total for this invoice Original Contract Sum $ Less amount previously billed $ = contract sum prior to this invoice $ Less this invoice $ =Dollars remaining on Contract $ ENCLOSE COPIES OF RECEIPTS & INVOICES FOR EXPENSES & OUTSIDE SERVICES

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CONTRACT ACCEPTANCE AND EXECUTION. The Board of Supervisors for Carson City, Nevada at their publicly noticed meeting of December 19, 2019, approved the acceptance of the attached Contract hereinbefore identified as CONTRACT No. 19300069 and titled Health Department Boiler Replacement. Further, the Board of Supervisors authorizes the Mayor of Carson City, Nevada to set his hand to this document and record his signature for the execution of this Contract in accordance with the action taken. CARSON CITY, NEVADA ATTEST: XXXXXX X. XXXXXXX, MAYOR DATED this 19th day of December, 2019. XXXXXX XXXXXXX, CLERK-RECORDER DATED this 19th day of December, 2019. Bond #: Doc. No. 2151 (Rev. 11-17-99) KNOW ALL MEN BY THESE PRESENTS, that I/we as Principal, hereinafter called CONTRACTOR, and a corporation duly organized under the laws of _, as Surety, hereinafter called the Surety, are held and firmly bound unto Carson City, Nevada a consolidated municipality of the State of Nevada, hereinafter called CITY, for the sum of $ (state sum in Words) for the payment whereof CONTRACTOR and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents.

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CONTRACT ACCEPTANCE AND EXECUTION. The Board of Supervisors for Carson City, Nevada at their publicly noticed meeting of June 20 2019 approved the acceptance of the attached Contract hereinbefore identified as CONTRACT No. 1920-001. Further, the Board of Supervisors authorizes the Mayor of Carson City, Nevada to set his hand to this document and record his signature for the execution of this Contract in accordance with the action taken. CARSON CITY, NEVADA ATTEST: XXXXXX X. XXXXXXX, MAYOR DATED this 20th day of June, 2019. XXXXXX XXXXXXX, CLERK-RECORDER DATED this 20th day of June, 2019. FEE AND PAYMENT SCHEDULE‌ Service Agreement Term: 7/1/19 – 6/30/22 Services: Fees: Claims Administration of: Workers’ Compensation, General Liability, Auto Liability, Law Enforcement Liability, E&O and EPL Claims CCMSI will manage all workers’ compensation claims for the Life of Agreement for an annual fee as follows: Workers’ Compensation: No Claim Cap July 1, 2019 – June 30, 2020 $28,750 July 1, 2020 – June 30, 2021 $30,187 July 1, 2021 – June 30, 2022 $31,696 Takeover Claims with Date of Injury Between $45.00 per month while 7/1/92-6/30/03 claim remains open Workers’ Compensation Claim Definitions  Indemnity Claims – Claims involving lost-time, questionable compensability, legal involvement, subrogation, second injury fund, probable permanent impairment/disability, jurisdictional issues, coverage issues or claims involving complex issues that are assigned or transferred to the indemnity adjuster for claims handling.  Medical Only Claims – Claims which have no issues of lost time, no evidence of other indemnity benefit exposure, no obvious question of compensability, no evidence of potential subrogation or second injury fund recovery, no evidence of problematic medical issues and no requirement or need for any formal statements.  Report Only/Incident Only Claims – Reported claims which require only input into RMIS system and requires no claims management activity. CCMSI will manage all General Liability, Auto Liability, Law Enforcement Liability, E&O, and EPL claims for the Life of Agreement on a per-claim fee as follows: G/L – Bodily Injury $995.00 per claim A/L – Bodily Injury $995.00 per claim G/L – PD $550.00 per claim A/L – PD $550.00 per claim Law Enforcement Liability $1,025.00 per claim EPL/E&O Annual Administration • Designated client service team • Development of specific client service requirements • Monthly loss reporting • Quarterly claim reviews at client’s request • Issuance of 1099’s • ...

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