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 XX, 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
CONTRACT ACCEPTANCE AND EXECUTION. The Board of Supervisors for Carson City, Nevada at their publicly noticed meeting of February 4, 2021, approved the acceptance of the attached Contract hereinbefore identified as CONTRACT No. 20300228 and titled
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 September 26, 2018 LA18.635 Xxxxxxx Xxxxx, E.I. Associate Engineer City of Fernley Public Works Department 000 Xxxxxx Xxxx Xxxx. Xxxxxxx, XX 00000 RE: Proposal for Engineering Services to Design a Waterline to Service the City of Fernley Wastewater Treatment Plant Dear Xx. Xxxxx: Lumos & Associates Inc. (Lumos) in pleased to provide this proposal for engineering services to design a potable waterline to serve the City of Fernley (City) Wastewater Treatment Plant (WWTP).
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. 1819-205. 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 Setting the Standard for EMS Billing Xxxxxxx Enterprises, LLC 00000 Xxx Xxxxxx Xxxxx April 11, 2019 CITY OF XXXXXX CITY Request for Proposal (RFP) No. 1819-205 Emergency Medical Billing Services for Xxxxxx City Fire Department Sett ng t St nda d f r MS i g Xxxxxx Xxxxxxx, Xxxxxxxxxx 00000 xxx.xxxxxxxxx.xxx RFP Contact: Xxxx Xxxxx Director Of Business Development (000) 000-0000 Direct Line xxxxxx@xxxxxxxxx.xxx TABLE OF CONTENTS PART ONE: QUALIFICATIONS Letter from our CEO 1 Sett ng t St nda d f r MS i g Qualifications 2 Experience 2 27 Years EMS Billing Experience 2 Customized Solutions 3 Responsibility Statement 3 EMS Partner Satisfaction 3 Workload Accomplishment 4 EMS Partner References (Proprietary and Confidential) 4 PART TWO: STAFFING Xxxxxx City Staffing History 5 Organization 5 Company Representative 6 Key Personnel 6 Staffing Chart 8 Staff Availability 9 Sub-Consulting Partners 9 City of Xxxxxx City Staff 10 PART THREE: TECHNICAL Partnership Continuation Statement 11 Standard Time-Table for Deliverables During First Year 11 Scope of Work 11 Methodology and Scope of Work 12 Quality Assurance 21 Project Reporting 22 Project Tools 24 PART FOUR: PRICE Cost Statement 30 Cost Proposal 30 Billing and Collection Services 30 Sett ng t St nda d f r MS i g APPENDICES
CONTRACT ACCEPTANCE AND EXECUTION. The Board of Supervisors for Carson City, Nevada at their publicly noticed meeting of March 19, 2020 approved the acceptance of the attached Contract hereinbefore identified as CONTRACT No. 19300156. 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 XXXXXX X. XXXXXXX, MAYOR DATED this 19th day of March 2020. ATTEST: XXXXXX XXXXXXX, CLERK-RECORDER DATED this 19th day of March 2020. SAMPLE INVOICE Invoice Number: Invoice Date: Invoice Period: Invoice shall be submitted to: Xxxxxx City Public Works Attn: Xxxxxx Xxxxxxx 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 SCOPE OF SERVICES Date: February 21, 2020 Project Number: (KA #217047-001) Project Name: Xxxxxx City Water Resource Recovery Facility – Electrical Improvements 2020
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 SCOPE OF SERVICES Xxxxxx City • Fallon • Lake Tahoe • Reno xxx.XxxxxXxx.xxx Reno 0000 Xxxxxxxxx Xxxxx Xxxx, Xxxxxx 00000 775.827.6111 October 24, 2019 Xxxxxxx Xxxxx, P.E., Senior Project Manager City of Fernley-Public Works Department 000 Xxxxxx Xxxx Xxxxxxxxx Xxxxxxx, Xxxxxx 00000 Subject: Proposal for Construction Services for the City of Fernley Depot Community Center Phase 1 Sewer Project Dear Xxxxxxx:
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 . Xxxxxx Xxxxxxxx, being first duly sworn, deposes and says: That Western Nevada Supply is the Contractor; that Xxxxxx Xxxxxxxx has read the foregoing Contract; and that Xxxxxx Xxxxxxxx understands the terms, conditions, and requirements thereof. CONTRACTOR BY: TITLE: FIRM: BUSINESS LICENSE #: Address: 000 X Xxxx Xxxx. City: State: V 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:
CONTRACT ACCEPTANCE AND EXECUTION. The Board of Supervisors for Carson City, Nevada at their publicly noticed meeting of May 21, 2020, approved the acceptance of the attached Contract hereinbefore identified as CONTRACT No. 19300135 and titled Xxxx Street Fiber Optic Project. 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 XXXXXX X. XXXXXXX, MAYOR DATED this 21st day of May, 2020. ATTEST: XXXXXX XXXXXXX, CLERK-RECORDER DATED this 21st day of May, 2020. 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.
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 • ...
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 . Western Nevada Supply, being first duly sworn, deposes and says: That Western Nevada Supply is the Contractor; that has read the foregoing Contract; and that he understands the terms, conditions, and requirements thereof. CONTRACTOR BY: TITLE:
