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HomeMy WebLinkAboutC2007-027 - 1/16/2007 - NALABQRATC)RY SERVICE AGREEMENT FOREIVSIC URINE DRUG TESTING This ag~eemen# made and entered into on the __ __ j 1~ r~ _ day of .~cnl~("~, 2007, by and between Accu- Chem Labot~tories hereiaafter referred to as the lab, a division of EHS Inc., and the Juvenile Assessment Centt~r, Parha And Recreation, City of Corpus Christi hereinafter referned to as CLIEN'I' located at the adt~ess listed below : Juvenile Assessment Center Parks and Recreation City of Corpus Christi l26 Enterprize Parkway, Suite 104 Corpus C6risti, Teaas 78405 The pa~Eties to this agreement mt~ually desire that laboratorv reference services be provided by the lab as of the effectivre date mtntioned above. SECT.1. PERFORMANCE BY THE LABORATORY i The lab will maintain sccreditation mandated bv the United Staus Department of Health and Human Services for the purpose of performing dtug of abuse analysis. The lab currenfly cyperates under federal license #45-D(~'77860 of the Clinical Laboratory Improvement Act of 1988. The lab also is accredited by the Cc~tlege of Americ~ut Pathologists (CAP) #29272-01 for Forensic Urine Drug Testing and participates in the National Intercalitrration Prog~ram, sponsored by CAP. 2 The tab will supply all materials necessary for We collection and chain of custody of a valid specimen. i Courjtr services will be provided at no additional cost as follows. PostAge paid cont~iners eent via US MAIL will be pro~vided for shipmeirts of 1-6 samples. SECO1~iD DAY COURIER SERVICES via Federsl or DHL Eapr+ess will be provided for shipmenta of 7 or more samples. Any specimens not sWpped ~ccording to tlit above specificaNons w ilt be charged back to t6e CLIENT. ~ The 1~ shall be available for consultation on matters relating to dcugs of abuse analysis. ~, The lat~ agrees to perfam screen tests by Inimunological methodology. All confirmation tests will be performed by Gas Chromatography/Mass Spectrometrv (GC/MS). All specimens submitted to the lab for GC/MS Confirn~ation will require an initial screening by the lab. 6. Preiiminary• screen res~ts will be available within 24 hours of receipt of the specimen. Confirmation results shall be available within 48 hours atter time of request. Results wilt be phoned or f~ed to CLIElVT's office. All adginal copies of re~ords shai! be sent by US mail from the laboratory to CLIENT's of~`ice. Speci~ens that are coi~firmed positive at or above CLLENTs "cut-off' limits (Appendix I) will be kept for a period of 1 year in a frozen state. All records of analysis and chain of custody documentation will be stored for a period of 2 years. All records and samples will be stored by the lab and is the lab's responsibility. x. The l~b currently has ~n place workpiace guidelines eoncerning persons with AIDS and HIV infection and shall also develop and implement guidelines regarding confidentiality of AIDS and HIV related medical tnfor~sation for employoes of the lab and for client, inmates, patients, and residents served by the lab in ' ~u~,~ (~27 ~visions found ~n V.T.C.A . Health and Safety Code, Sections 85.113 and 85.115. O 1 ~ 16107 Ac~u-C"hem Laboratories t) The l~ agrees to comply with the attached insurance requirements of the CLIENT. SECT. II, LITIGATION & SUPPORT 1 This agreement shall be ~vemed in accordance with the laws of the state of Texas. 2 The lab is prepared to ~pport b,y personal appearance (as requested by subpoena) any and all te~ data releasmd to CLIENT. A fce per litigation package will be charged to CLIENT at the time of preparation. In the event that a pec~sonal appearance is required by the laboratory director, or qualified designee a profes~ional fce and a11 transponation elcpenses will be charged to CLIENT. A fee schedule is located in section N. 3 ln lieu of a personal appearance an affidavit can be made available to be filed with the clerk of the court at least 14 days prior to tt~e day upon which trial of said cause commences. An affidavit of business records (as foUnd in Te~as Rul~of Court, State, 1997. Rule 803(6) page 263, Rule 902(10) page 266) will be providod along with su~orting docutnents. A fee schedule is located in section N. •t CLIENT will be respons~ble for any incurred charges in Sect. II, # 2 and #3 in the event expert testimony is required tn~ any other party utilizing the services under this agreement. 5 The lab shall maintain professional liability insurance. SECT. III. PERFQRMANCE BY CLIENT 1 CLIENT shall update the lab of any changes and/or additions to CLIENT's list of collection sites. 2. CLIENT agrees to pay the lab for all services renciered 15 days from date of statement. A late charge for sen7oes rendered of i.0',~o per month (12% per annum) will be added to CLIENT's account for any amou~ts not paid within 30 days from the date of the invoice. All payments are payable in Richardson, Texas. SECT. ~V. FEES i The ~ will provide testing sen~ices on a fee for service basis. A monthly statement of account will be rende,r~d to CLIENT far these services. Statements will be sent directly to CLIENT's Accounts payable Depaitment. ~. All spocimens reoeived by the lab that are not analyzed (e.g., adulteration, insufficient quandty, leakage, imprc~er chain of custody etc~) will be chazged a processing and handling fee of $3.00 ea. The psities io this agreement have mutually agreed upon the following fees. Arialp}tical tees Tast Cq~e Doscriptioa ^ E-mail or Paz ^ U.S. uaa7 dslive,sY Deliv~erY 9g50s ~' Pane~ thc50 ~creen $12.00 ea. $12.50 ea. 9p50as ~+ Panel thc50 + Alc $14.00 ea. $14.50 ea. gC/ysg C~F c'onfirmation bp~ GC `MS $18.00 ea. $18.50 ea. LSD SCR~N LSD Screen $20.00 ea. $20.50 ea. I1QH71I,71N',!' Znhalart (Tcluzne) $25.00 ea. $25.50 ea. ADUL PArCL Adulteration Panel S 5.00 ea. $ 5.50 ea. Th~ druq~s tv be analyaed are liated in the attached Appeudix I. It is the r~ponsibility of CLI~7T to correctly indicate the proper test to be performFad. Litiaation and Su»~port Fees Expert Testimony iG or more yays notice $250.00 per appearance Expert Testimony Less than :.? days notice $500.00 per appearance "~iuigaY.i~n Package $ 50.00 ea. ?~ffidauir af business record= $ 35.00 ea. SECT. ~r'. TERM AND TERMINATION I The term of this agreement shall commence on _~ ~ and shall continue undl terminated pursuant to SECT. V. #2. ~ Either party may cancel this agreement on 30 days written notice to the other party by certified mail or persogal deliven. It is understood that the employees of CLIENT or individuals acting as agents of CLIENT are not authorized to receive any type of personal payme~t, reimbursement, compensation, commission, grahuty or gifl for sen-ices pravided wider this ag~eement. The lab warrants that no employee or agent of CLIENT has been or will be retained to solicit or secure this agreement and the lab has not paid or agreed to pay and will not pay or a~ee co pay any employee of CLIENT auy fee, commission, percentage, broke~tage fee, gift or any other consic~ration, contingent upon the making of this agreement with CLIENT or as an inducement for entering into any agreement with CLIENT. The unauthorized offering or receipt of such paym~ts may result in the immediate termination of this agreement. The lab is providing CLIENT with forensic quality analytical data and a system of seivices designed to suppo~t the accuracy and reliability of its results rn legal and administrative proceedings. The lab agre~s to indemnifi and hold CLIENT harmless from and against any and all claims arising out of lab's submis&ion of data or 1~'s analvtica] results, whrch are false or incorrect, whether as a result of willful, intentional, or negligent act or ornission. Ttus agreement constit~es the entire agreement existing between or among the parties. No other oral or written statements not specifically incorporated herein, shali be of any force and effect. The parties rely solely upon the represevtation and terms contained in this agreement and no others. The peities hereto ha~ e caused this agreement ta be executed in multiple, originatly by their authorized agents, all as of the day and year written below. By ~'--" Date: ~ J~~~ V 1 ~ (CLI t By Date:~_~~ (i-~ ' i ~ ppprpyed e-s t0 FOfm: ~ i tG .. ~~ ~~ Y2 ___._. e,. ~isa A9u~ ~ ttornev pssistant C+ ~~r ~~ty Attomev ,,~ ._ . „„„,. .,,,~._ ~ _ APPENDIX I Analytica! Schedule for Dreig.c ofAbuse Testing in Urine DRU~ CLAS5 CUMPOUNDS S~'REENll~1G CONFIRMATIUr AMP~ETAMINES 500 ngJml Ampheta~nine 500 ng/ml !1~fethamphetamine SQQ ~/rpj b4ethylenadioxyamphetatnine 500 ng/ml Mcthylenedioaryethylart~hetartune SQQ ~/~ Methylenedioxvm~}tamph~amine 500 ng/inl BEN?ADIAZEPINES 200 ngJml Alprazolutn $0 IIg/ri]1 Chlordiazepoxidz 200 Iig/illl fl18ZC~3nk Zl1V ~~ Flurazepatn 2QQ ~/~j t..orazsPem 200 rig/ml Nordiaze~~~m 200 iig/ml O~cazepam 2pp ngfm1 Z'e-naupam 200 nglml BAR~'I'URATES 200 ng,/ml :~mobarb~tal 200 ng/rtll Butabarb~tal 200 ~/~ Butalbita: 200 rig/t1]I Pentobarbital 2QQ pg/Ipj Phenobarbitai 2Q~ t1g/mj Secobarbital 2QQ ~/~ cAr~rusnvoIDS 20 ~~ cooH 15 ng/ml COCAINE 300 ng/ml senzoVtf.:gOnin~' I SO ng/ml METHADONE 300 ng/ml 300 ng/ml Methado~~~ 300 ng/tnl EDDP 300 ~/m] OPIATES 300 ng/ml c'odeyne 300 ng/ml Hvdrocodone 30Q ~/tpj Hydromcrrphone 3Qp ng/~ Morphin~ 300 ng/ml O~cyooaom~ 300 ng/ml PHENCYCLIDINE 25 ng/ml Phencyclidine 2$ ~/~pj PROPQXYPHENE 300 ng/dl Propoxyphene 2$ Ilg/mj Norpropoxyphene 2$ i'~/Ipj C:ItF;ATININI; 20 mg/dl .~- .~ ~,~, , ,,~,., . .., EXHIBIT B INSITRANCE REQUIREMENTS l. "i~"'~,j IABILITY INSURANCE A"L~'" mu~t not commence work under this agreement until all insurance required herein has been obt~ined ~nd such insurance has been approved by the City. "Lab" must not allow any subcontractor to commet~e wark until all similar insurance reyuired of the subcontractor has been obtained. B"Lab" must furnish to the City's Risk Manager, two (2) copies of Certificates of Insurance, showing the following minimum caverage by insurance company(s) acceptable to the City's Risk Manager. The City must be named as an additional insured for the General Liability policy and a blanket waiver of subtogation is required c~n all applicable policies. ~__,__ __- _ ._.__ ~ TYPE ~F IN3URANCE MINIMUM INSURANCE COVERAGE fT_. __ i.,. _.~_ 30 dAyrvritte~ aotke of cancellation, non-renc~val,materiai Bodily Injury and Property Damage ~ change or tet~ination and a 10 day written notice of Per occurrence -Aggregate ~ ca~t~ttion f~ non-payment ot premium is required on all ~ certYlerttes ~ _~ _~__ -~-- -.. ~ Corrum~cial C',et~eral I.iability including $1,000,000 CONIBINED SINGLE LIIvIIT ; ~ _ Premises -- Operations ~ 2. Nroducts/ Completed Operations C~azard j 3. t~ontractual Liability € 4. Cndepemmdent Contractors ~ f E ~ MEDIGAl, PROFESSIONAL LIABILI'TY includmg: $1,000,000 COMBINED SINGLE LIIvIIT ~ I.aboraforv F.trors & Qmissions i . _ AUTOMOBII,E LIABII.I TY-c )WNEll_ NON-t)WNED $ t,000,000 CnMBINED SINGLE LIMIT ~ O~ R RF~T•t'ED ~ _ _ __ _ ; WF IICH COMPLIES WITH THE TEXAS WORKERS' s Wt_)ItKERS~ COMPENSATION COMPENSATION ACT t~ND PARAGRAPH II OF THIS F.XHIBIT ~ EMPLOYERS' L1A}3II.1 CY ~500,000 C In the event of accidents of any kind, "Lab" must furnish the Risk Manager with copies of a11 reports of such accidents within 1(? days of any accident. 2006 Ju~enik Asses~nent Center Lab Agreement uis rey i 1-29-06 ep Risk Mgmt II. ADI~'T O_~AL REQUIREMENTS a. '`La~'" mu~t obtain workers' campensation cc~verage through a licensed insurance company in accordance with "Texas law. The ~ontract for coverage must be written on a policy and endorsements apptaved by the Texas Department of Insurance Workers' compensation coverage must be in amourrts suP~cient to assure that all workers' c~mpensation obligations incurred by "Lab" are promptly met. B Certificate of Insurance • Thd City e~'Corpus Chri~uti must be named as an additional insured on the General liability coverage and a blanket waiver of subrogation is required on all applicable policies. If your in~rance company uses the standard ACORD form, the canceltation clause (bottom right) mwt be ~ended by adding the wording "changed or" between "be" and "canceled", and deleting the words, "endeavor to", and deleting the wording after "left". In lieu of modification of the ACORD for~, separate policy endorsements addressing the same substantive requirements are mandatory. • The nama of the project must be listed under "Description of Operations". • At a mini~m, a 30-day written notice of cancellation, material change, non-renewal or tennination to the Risk Manager is required. C° If t~e Certificate of Insurance on its face does not show the e~stence of the coverage required by items 1 B( I)-(4), an authorized representative of the insurance company must include a letter specifically sta~ing whether items l B. (1)-(4) are included or excluded. 3006 Juvenile Asse.~se~ent Center lab agreement ~ns rec~ : 1-29-06 ep Risk Mgmt. ` ACORD,~ CERTIFICATE OF LIABILITY INSURANCE DATE~MMfDD/YYYV) i/9/zoo~ aROOUCe~t ~ ~ ~~--T THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Roach Howard 8mi*_h & Bartor. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 933~ ~sJ FreeMay ti~5oo ' HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Dailas TX ?524ti ` (9"2) 231-;?00 . .. 13i-i.'68 . ~ ~ ~NSURERS AFFORDING COVERAGE NAIC # lNSURED tiSORERA Evanaton Inauran_ce om _a_n 20230 Snvir..,,.-Healt.h Sy~stems. Inc - --- -- ~ tis~~REee Central Mutual Ina Co P~ Y ~~~ 1~ ~~~ rvSJREP ~~ ~~ 99G N Bowaex Rd ~kEO~ ~I - Richardaon TR 75~81 ~vSuREkD : NSURER E I THE POLICIES OF INSURANCE US?ED BELOW HAVE BEEN SSUEC 10 THE WSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMEN? TERM OR CONDITION O~ ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED B~ THE POLIC ES DESCRIBED HERE:IN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH ROLICIES 4GGREGATE LIMITS SHO~NN MAY h4VE BEEN REDUCED BV PAID CLPIMS __ _ _ - - - - _ -- _ _ _ _ VSR ~ADD'L ~ ~ POLICY EFFECTNE ~ POLICY EXPIRATION _TR INERQ TlGE OF INSURANCE .______ . POLICY'JUMBER . ~gTE IMMlDDNY) DATE IMM/DD7YY1 LIMITS GENERAL LIABILITY ~. EACH OCCURRENCE._ _ . S .~ O_00 . 00_O B % ':-'-MME~~':i- - ~~~.b. ~~~-~ `M-835"~20 5'30l2006 5/30 2007 DAMAGETORENTED ---~ ~~ !3ENER.^i. " ; ,. " / , PREMISES_{Ea occurenc~ $ _ _ X Cl- ^df~ MADE "~_. MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ InCluded GENERALAGGREGATE S _ . _ ~ ------- ------ - -_ _ .._ _. . '~Eti ~~~~ < GGRE ~~G~~ E ~IMIT 4~FL ~ , ~~- =k PRODUCTS - COMP/OP AGG I $ PRO- I .:_ Ji. X ?CiLICv JECT -.._..~.__ .------- AUTOMOBILE ~,.IABILITY . . COMBWEDSINGLELIMIT S B X~*'AL' jAP?98001 ^'30%~006 5/30/2007 (Eaaccidenq 1,000,000 ~_ owr~,~c -.uros BOOILY INJURY ~ "~i. HEOI .. -r_L~ ~.UTOS (Per person) . _ _ . . . ._ . .. _ .. . 4 . .. . __. . . X dP.2ED %+ -~... ~ I BODILV INJURY ~ $ EE AUTpS X ^Ji N-0V~~v (Peraccident) __ _ . . ._ _ ... . . . __. . . PROPERTY DAMAGE $ (Per accident) -- ~-~--. .~.-- --__-__. .-----... . __ _ _ GARAGE ~,IAB~U' ~~' ..- .. _. ~_ AUTO ONLY - EA ACCIDENT $ :,r.: r q~.', ~ _ . EA ACC '~ OTHER THAN ~ - $ ----- - ~ ~ -- - ~ '~, AUTO ONLY: AGG $ --~_.~ -. .-.-.--_-.-_ -.--. . ~ E%i.ESS/UMBREL:..A LIABILIT" ~~ _ ~~~~. EACH OCCURRENCE $ . C~AiMS ~4~~:);. ~~'..CU~ ' AGGREGATE $ $ [i~~ DUC?'...71! $ . R~TENTic.iN $ _. - - ~ .__. _. _.. -~- --.__._.-- -----~ $ _. . .---_. _----.._ - ~---- - ' ~~ WC STATU- ' OTH- WORKERS COMPENSATION ANU , . TQ_R_Y LIM1T~___ i ER . . . _. . - ... EMPLOVERS' LIRBIL'TY c. L ACH FCC DENT 5 ANY PROPRIETOR/PF.R?NER/EXEG'J"! ~P . . _ _ . ~ OFF~CER!MEMBER ExC~J~ED9 EL DISEASE - EA EMPLOVEE ~ ~ ~ $ ~ If yes descnbe ufWe~ SPECIAL PROV4$IONS talow -_ -_.-. __._-~. ____.__.____ ~. E.L DISEASE - POLICY LIMIT __'_ _ . .._ _ . I ~$ OTHER ~, $1,000~000 Each CZS1ID I $3,000,000 Aggregate B Pra£easi.nnal E&O .~M-835226 5'30/2006 5/30/2007 '' Claimi Made DESCRFPTION OF OPERATIONS / LOCATIONS ~ VEHICLES ~ EXCLUSIONS P DDED 8" FNDORSEMENT I SPECIAL PROVISIONS Re: Juvenile Asaessment Center Lab. Where required by written contract or agreement, City of Corpus Christi ie named additional_ insured ,n the above referenced general liability policy. SHOULD ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUtNG INSURER WILL ENDEAVOR TO MAIL 1~ DAYS WRIT7EN City of Corpus Chrietti Attn: Lisa AgLtilar NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE ~EFT, BUT FAILURE TO DO 50 SHALL 12G1 Geop8id IMPOSE NO OBIIGATION OR LIABILITY OF ANY NIND UPON THE INSURER, ITS AGENTS OR REGRESENTATIVES. CorpuB Chlisti TX 78401 4UTHORIZEDREPRESENTA7IVE ACORD 25 (2001108) ~ O ACORD CORPORATION 1988 ; ~,r _.a. _ _ _ ~- _- _ _ _--- - ~!4 ~~~~, CERTIFICATE OF LIABILITY INSURANCE °"~~""~°""'""' 01/08/2007 ;~~++~~-' ~~ THIS CERTlFICATE IS ISSl1EQ AS A MATTER OF INFORlIA710N LUMBERMAN'S UNDERWRITING ALLIANCE ONI.Y ANQ CONFERS NO Rt(3HTS UPON THE CERTIFICATE 4100 ALPHA ROAD, SUITE 610 ~ HOLDER. THt3 CERTIFICATE DOES NOT AMEND, EXTEND OR DALLAS, TX 75244 ~ ALTER 7HE COVERAGE AFFORDED BY THE POLICIES BELOW. 9?2-243-1558 INSURERS AFFORDING COYERAGE ~ NAIC ~ __. __ _ ._ _ - - -- --_ .._ _ - --- - _ _ ~_ - . st~uREO u+suc~cza: LUMBERMEN'S UNDERWRITING ALLIANCE 2310$ ACCORD h+UMAN RESOURCES ,~~HEH~, -~'~~-~-~~-y` - 210 PARKAVENUE SUITE 1200 -- __._._ __ ._____ _ _- _ ------~ - .__.~ C)KLAHOMA CITY OK 73102 ~NSURER G _ _ . ____ _ _ ' ~ FNaURER ^ . ~ . THE POUCES OF Mtv RfQU~tEulq MAY pERTAIN, T3+ POUCIES. AGGR! ~ IISTED BELOW HAVE BEEN ISSUED r0 THE INSURED NAMED ABOVE FOR THE POLICY AER100 IND{GATED. NOTWITFiSTANpN+lG OR CONDITION OF Af1Y CONTRACT QR OTHER OOCUMENT WITH RESPECT 70 WMlCH TFMS CERTIFICA7E MAY BE ISSUED OR ~ICE IIFFORDEO BY TFiE POlIC1E5 DESCRIBED HEREIlJ IS SUBJECT 70 ALL THE TERMS, EXCLUSIONS AND CWJD(TIONS OF SUCH TS SHOWN MAY HAV~ eEEN REfXICED 8Y PAID ClA1MS _. ___ _. _ _____. . .~ ~OIICYEi TIVE Y67PIRATION I~iF.._ .. _..,-_ POIKvNUMBBR. .. _. ~ OAl'E/MMai1DM'1 DATEArAQfYYl LIM(TE ~ GlMERAL Ll~6~R~ . _~ ~~ __ ; ~^,(~Gld[GIAI GENEAA~ lL~E31t IT * . i ~ ~~ G(AiMS MAllf ~ !)C~:IIr~ ~ ._. . .i ._.. ____. _ . GEh'L AGGREGA7E LN~tF APPIiES~ aE k ~ `- ~--^ -- - ~. ; ~POI.~CYi ~~._LOc . .. AUTOMOiLE LiA6ktPf -. • . . . . . ..-~ ANV Ai7i~C ~ _ ~ pLLJYMIEC,AU~OS ; . ~ SGNEp~.EUAUTOS ~ _...~ MIREQAU?OS ,. 1 NOr~.OMiNEDAUTOS , : ; i _y __ _ _-. ~ . GAtlA6E LIABILI~I' i '~ AF1~' IWiSJ ' ~'~. EXClSERi~IlELLAl1A#IIITY'..__.... . _ .__._ .__. ... ~ ,. ~ OCCLIR . . _~ ClRlMS ~/a4E OEOUGTI6~E RETEI~fON : _ - _ --- - - _ ---- --_ _ _ ____ _ _ Mq111CERi C RON AIO ~ E~1011Ci~'~Y . p +~~vvrtav~rO!~ ,Newi~c~T~ '75426 QFFICERME116E11i1CCLUCE,p? M. ,OapO~ S -ROVI oaor --.._._~~'._.__ ..__. ~ ~ 01MER - ---- ---- . ._ _ ~ 04l01/2006 ! 04l01l2007 fiACM GENERALAGGREGATE PROOUCTS~C~MPqPACG S COMBWEDSINGIElIM1T s (Ea ~cddant) .__._.-__.. . _.. ? BOOLYINJURY .. ~ _-_.. . ~ lPervena+? t"_' -- . BODILYIN.K/RY s ~~ (Pa xs+deirt) k_~. _.-,. __ J _ PiiOP-E•"R'fYDAMAGE s AUTQONLY>EAACCIOENT = QTMER THAN . ~A ACC ~ S _.. AUTOONIY: AGG ~ S EACM OCCURRENCE S ~ccaecy,rE s _ _.- s - ~ _ i .._ s _._. __ X YYC S A7 . OTN. E.~. EACIi ACCtOENI 5 ~ E1.DLSEASE~EAEYDL~VEE S ~ ~~ DEiCft~tONOfOPEII~AON6IL~IOATOMS7VEHtC~EB/EXCWSqNSADUEDBYENDOR3EYEMfiS-ECIALPROVISIONS ~ ~ ~ COV~GE APPL2~3 ONLZ TO THOSS ~1PLOYS~S LE113ED TO BDT lIOT 3BBCONTR71CTOlt3 OF 7-CCD-CH~S L7IHORATORIES CLIENT # 2151 _.. LE.!' . ~"' CgRT~1CA'~ Hf~,OER ~ ~ CANCELLATION tl' ~ SNOUID ANY OF TNE ASOYE OtSCR16lD ~OUCIlS OE CANCELLED iEFORE TNE EXPrtAT10N ' ACCU-CHEMB 1.~80RATORIES OATE THEREOF, t11E ISSYWG NSURER YNtL EN}EAVOA TO MAII ~ DAYS WRITTEN I 990 NORTH O~ISER RQAD. SUITE 800 NpME TO T1+E CERTiFiCATE MOLDER NAMED TO THE LEF7, WT FALURE TO 00 80 fHALL ' RICHARDSON.1`X 75081 ~ ~ MIP0.4E NO OBLtGATIOiI OR LUl81UTY OF ANV KMO UPOM THE WSURER, ITS A6ENT5 OR ~~~, REPRESEi/TATNES. AUTNOR¢EOREPRESENTATVE ~/}~ r ~ ~ '~ f . ', vJi.c~ ~75,. ----T-_~~_--~'-.. , Yl ~ ACURD25(2dd1l~tl - _____ _.__----._..-___------_ _._.------------- 'ACOROCORPORATfON1988 S R [YUMBER ~ TO lISS(GNED BY~F'CY ~ C~ ~. PUR lNG DIViSION C hr~i st'i CITY OF CORPUS CHRISTI DISCLOSURE UF 1NTERE3T C iry of Co~us Clvisti Ordi~wice I 71 l 2, as ameaded, ~~res a!!pas or fmns seeicing to do business with the Citp to t~e ~follawi~ ittfott~tion. Evay q~stion must eb ar~werad. If the questean is net applicabk, at~!er w~A". See revcrrse sidt for definitions. 'ANY AM . ~r / ~,G~p1'E.~,rorre5 ~~ ~a.(~ J~(S~en~S,~.~G d4~(. C~tt - ~"~i~rrc.. - - - P. ~ BOx: ST~ET~ r4 /~l. ~Dlru S~' t 1~d '~.' ~i0 CITY: I~ C T1.Ot~.~~c~J r ZiP: 50 8 I ~ -- ~__._._ FIRt-~ IS; 4. Assoia~ion ~~ S. Other S( ~P } C) 3. Sole O~mer {) DISCLOSURE QUESTIUNS [f tio~! space is necessary , please c~se tl~e rea~se side of this or attach separate sheet. I. te th~ names af each `~nployee" of tije Ci~y«of Ccupus hrssti having aa "ownership interesi" coastituting 3' ot mo~e of the owners~ip m the above named ~rm. Na~e -u f dob Title and City Departmtnt {if knovv~) 2• S~te th~ pa~tttex of cach "ttfficiaP' af the Cit~ af Carpus Christi having an "ovvnership intexest" cajstitutirig 3% ar more ofthc awnership in the ai~ove ~mod firm." Narne Title ~c. t a.- . rutmes o eac o t Citry o cx~us t~ vmg an awnet p~nteres cdns ' 3% ar more o~'the owncrship in the abave naEnad "firm. N~~ Bo~rd, Commission, or Committee `~--C ~,. 4. S~tte t~a~ aames of each e~ioyee or offic,~r of a"consultarrt" for the City of Corpus Christi wt~o warked an ar~y n~ ~ted ta tf~e sub~ct of th~s contract xnd has an "awnership it~teresP' constitnting 3% or more of tl~ o~rr~sF~ in the above :ts~od "firm.,, t'ottsaitani `?ic.! ~- CERTIFICATE [ certfy ffiat all inform~ionpr ovided is true and correc~ as of the date of this statemcnt, t~at i have nat ~d~hdd d~clost~ of information r~uested' and thtt suppl~tr~ental statements will bc pcomptly sub t~ ~e City of Corp~es Chris~, Te~s ss changes occ~ir. Certtl~ing P~erson: Lt 5Q ~~~ ttJ ~~ Trtle: ~~GC,$ t hC~s /Y~ Sign~iture of Certifying Persaa: _ pa~: ~~ ~~-IO ~~~RD <~~~>~~ ~~,~~r~;. ~:~~ Attachment A Statement of Services 3~hi~ Statem~nt of ~ervices 1~'S~~~S"~> i~ made ane subiect to the Consultin~ Services Agreement between City of Corpus Christi t"Cl~ent~'i and s~fard Global Re~ources. Inc ~"+~~t;,rd"~? dated Februan~ ~3. ?005 ("Aoreement"). 1. Ser~~ices ~ ~~ixior~ shall provide the t~'onsulting Servi. es of the follow~ing Consultants on a time and materials basis, and Client shall pay 1c~r cuc~h serv~ces at tho~e hourh rates set '~~rth ~~pposite each name as well as pay for all reasonable travel and out of pocket e~~penses unless as set fc?tth belo•=v with ini; ials c~i hoth parties. Consultant. Houriv Rate Additional Rate l. Craig Baumgartner 25Q. all inclusive , 3 ii. Timeta~leiSchedule%Start & Ectimated E~.nd Date. Start Date~ January 8. ~00 % Estima~d End Date: Februar~~ ~,, 200- Schedute: t8) hours per da~ and a minimu~ri of lorty (40) huurs per week, except Holidays (New Year's Day, Memorial Day, lndependence Day. Labc~r Day. l'hanks~iving Da~ and Christmas Day). " Total Number of services provided under this Statement of Services shall not exceed 100 hours. The Client is not responsible for payments for services prrrvided by Oxford in excess of 100 hours. tl. Pavmeat Terms a. Client shall pay Oxforr *or all t~me spent ~~erformin~ the Sc~rvices at the hourl~ rates specified above. Reasonable travel and c~ut-of-pocket expenses are not ,ncluded ii~ these rees unles~, noted here in as follows and initialed by both parties in the line 1~elc~~v: E~pense~ ~t,tes Rate is al I inclusive Initia(s~ __~ by Oxf~rd. , by Client. B. A~~ti~ and all payments ~iue heret.mder shal ~ be dur ~~~ithin ;(~ days of the date of invoice. III. Client I~formation: >~ The Client hereb~~ des~~nate< John Sendejar ~~s Client Manager (Phone No.361-826-3867) as who shall have overall respunsibility far directing an~i manaQin~.! the hourly~ Serti~ices performed and all interaction with Oxford. The Client shall ~ive prompt written n~~tice of ~ny change in desi~mee. All notices required ar permitted to be given under this SOS shall be Qiven to the above name~ desi~~nee. urile~~~ otheruise direc=ed in Nmiting. OXFORD l, RESOGRCES, INC. CLIF NT ~y ~ ~(~C ~l:L_ ~y: N~me~ Kell~ S. I~uane Na~ T~tle: C~ontract Spec~alist Titl I~ate: Dece~nber '+'). ?006 Date ~ ~ ~ `'~~~j' ~ ~ _il; ~ ~~!~~ ce< ,~-~ em~nt i~ ~ -~~ 1Fr ~b. ,,~~~-~ ~ -'~n~ ~ (~ ~~~ <<~rd ~;'~c t i I ,.,,~~ _ ._ Ii ~ A' .{,~ ~ ~r~:~' t ~ ,~v vut ~ ~. -~-'~- 1-l 1,v~~ N ~ ~,~(-i y Z ~3 `~ ~ -~. C t~~,,~-~~ f -~-5 ; ~t ~-~ "f"~-~ ; ~~"`F-f-o~v~e~ .