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Moss Adams Contract# CITY OF TIGARD,OREGON ® PERSONAL SERVICES CONTRACT ACCOUNTING ASSISTANCE AND OVERSIGHT SERVICES THIS AGREEMENT made and entered into this 1 st day of July, 2008 by and between the City of Tigard, a municipal corporation of the State of Oregon, hereinafter called City, and Moss Adams, LLP,hereinafter called Contractor. RECITALS WHREAS, the City's 2008-2009 Fiscal Year budget provides for required professional services;and WHEREAS City has need for the services of a company with a particular training, ability, knowledge, and experience possessed by Contractor, and WHEREAS City has determined that Contractor is qualified and capable of performing the professional services as City does hereinafter require,under those terms and conditions set forth, THEREFORE the Parties agree as follows: 1. SERVICES TO BE PROVIDED Contractor shall initiate services immediately upon receipt of City's notice to proceed together with an executed copy of this Agreement. Contractor agrees to complete work that is detailed in Exhibit A and by this reference made a part hereof. Any and all work assigned by the City will be contained in subsequent scope of work as needed. This Agreement serves to outline the general services that will be expected of the Contractor. 2. EFFECTIVE DATE AND DURATION This Agreement shall become effective upon the date of execution, and shall expire, unless otherwise terminated or extended, on December 31, 2008. All work under this Agreement shall be completed prior to the expiration of this Agreement. 3. COMPENSATION The City agrees to pay Contractor $208.00 per hour for performance of those services described herein and in any subsequent agreements that arise from the work under this Agreement. Any and all payments made to the Contractor shall be based upon the following applicable terms: A. Payment by City to Contractor for performance of services under this Agreement includes all expenses incurred by Contractor, with the exception of expenses, if any identified in this Agreement as separately reimbursable. B. Payment will be made in installments based on Contractor's invoice, subject to the approval of the City Manager, or designee, and not more frequently than monthly. Payment shall be made only for work actually completed as of the date of invoice, and shall be made to Contractor within thirty (30) days of receipt of invoice. C. Payment shall not be considered acceptance or approval of any work or waiver of any defects therein. D. Contractor shall make payments promptly, as due, to all persons supplying labor or materials for the prosecution of this work. Tigard Personal Services Agreement Page 1 Contract# E. Contractor shall not permit any lien or claim to be filed or prosecuted against the City on any account of any labor or material furnished for work in accordance with this Agreement. F. Contractor shall pay to the Department of Revenue all sums withheld from employees pursuant to ORS 316.167 for work in accordance with this Agreement. G. For work in accordance with this Agreement, if Contractor fails, neglects or refuses to make prompt payment of any claim for labor or services furnished to Contractor or a subcontractor by any person as such claim becomes due, City's Finance Director may pay such claim and charge the amount of the payment against funds due or to become due the Contractor. The payment of the claim in this manner shall not relieve Contractor or their surety from obligation with respect to any unpaid claims. H. For work in accordance with this Agreement, Contractor shall pay employees at least time and a half pay for all overtime worked in excess of 40 hours in any one week except for individuals under the contract who are excluded under ORS 653.010 to 653.261 or under 29 USC sections 201 to 209 from receiving overtime. L The City certifies that sufficient funds are available and authorized for expenditure to finance costs of this contract. 4. OWNERSHIP City shall be the owner of and shall be entitled to possession of.any and all its working papers and work products of Contractor which result from this Agreement, excluding any "Contractor Materials" (defined below) contained or embodied therein. Contractor shall retain all right, title and interest in and to all Contractor Materials. "Contractor Materials" means its working papers and all discoveries, concepts and ideas, whether or not registrable under patent, copyright or similar statutes; including, without limitation, patents, copyright, trademarks, trade secrets, processes, methods, formulae, techniques, tools, solutions, programs, data and documentation, and related modifications, improvements and know-how, that Contractor, alone, or jointly with others, its agents or employees, conceives, makes, develops, acquires or obtains knowledge of at any time before, during, after or outside of this Agreement. The City will have a perpetual, irrevocable, nonexclusive, worldwide, royalty-free license to use, execute, reproduce, display, perform, distribute internally, and prepare for use "derivative works" as defined in the Copyright Act, 17 U.S.C. §101, based upon, the Contractor Materials in each case solely in conjunction with the work product delivered hereunder. Any interest in the services and work products granted hereunder by Contractor to the City shall be effective upon and to the extent of payment by the City of the fees and expenses invoiced by Contractor pursuant to this Agreement. Notwithstanding anything to the contrary in this Agreement, Contractor and its personnel are free to use and employ their general skills; know-how, and expertise; and to use, disclose, and employ any generalized ideas, concepts, know-how, methods, techniques, or skills.gained or learned during the course of this Agreement so long as they acquire and apply such information without any unauthorized use or disclosure of confidential or proprietary,information of the City. 5. ASSIGNMENT/DELEGATION Neither party shall assign, sublet or transfer any interest in or duty under this Agreement without the written consent of the other.and no assignment shall be of any force or effect whatsoever unless and until the other party has so consented. If City agrees to assignment of tasks to a subcontract, Contractor shall be fully responsible for the acts or omissions of any subcontractors and of all persons Tigard Personal Services Agreement Page 2 Contract# employed by them, and neither the approval by City of any subcontractor nor anything contained herein shall be deemed to create any contractual relation between the subcontractor and City. 6. STATUS OF CONTRACTOR AS INDEPENDENT CONTRACTOR Contractor certifies that: A. Contractor acknowledges that for all purposes related to this Agreement, Contractor is and shall be deemed to be an independent contractor as defined by ORS 670.700 and not an employee of City, shall not be entitled to benefits of any kind to which an employee of City is entitled and shall be solely responsible for all payments,and taxes required by law. Furthermore,in the event that Contractor is found by a court of law or any administrative agency to be an employee of City for any purpose, City shall be entitled to offset compensation due, or to demand repayment of any amounts paid to Contractor under the terms of this Agreement, to the full extent of any benefits or other remuneration Contractor receives (from City or third party) as a result of said finding and to the full extent of any payments that City is required to make (to Contractor or to a third,party) as a result of said finding. B. The undersigned Contractor hereby represents that no employee of the City, or any partnership or corporation in which a City employee has an interest,has or will receive any remuneration of any description from.Contractor, either directly or indirectly, in connection with the letting or performance of this Agreement,except as specifically declared in writing. If this payment is to be charged against Federal funds, Contractor certifies that he/she is not currently employed by the Federal Government and the amount charged does not exceed his or her normal charge for the,type of service provided. Contractor and its employees, if any, are not active members of the Oregon Public Employees Retirement System and are not employed for a total of 600 hours or more in the calendar year by any public employer participating in the Retirement System. C. Contractor certifies that it currently has a City business license or will obtain one prior'to delivering services under this Agreement. D. Contractor is not an officer, employee, or agent of the City as those terms are used in ORS 30.265. 7. INDEMNIFICATION Contractor agrees to indemnify, hold harmless, and defend the City and/or City's officers, agents, employees, representatives and Council members, from, and against all liability, claims, demands, judgments, penalties and expense, including reasonable attorney's fees, arising from any and all liability, claims, demands, damages, actions, causes of action, and suits in equity of whatever.kind or nature assertedby a third party for discrimination based on protected class status(age,race,gender, origin, sex, disability and religion), bodily injury (including death) and damage to real property and tangible personal property, to the extent causes by Contractor's willful misconduct or negligent acts or omissions ("claims"). Moss Adams liability hereunder shall include all reasonable attorney's fees and actions out- of-pocket costs incurred by the City in the enforcement of this indemnification provision. City agrees to indemnify, defend and hold harmless the Contractor, including its partners and employees, for all liability arising from actions, suits, claims or demands, including reasonable attorney's fees, arising out of any action by a third party related to the Contractor's services under this Agreement. Tigard Personal Services Agreement Page 3 Contract# 8. LIMITATIONS EXCEPT FOR INDEMNIFICATION OBLIGATIONS SET FORTH IN SECTION 7, EACH PARTY'S TOTAL LIABILITY TO THE OTHER FOR ANY AND ALL DAMAGES WHATSOEVER ARISING OUT OF OR IN ANY WAY RELATED TO THIS AGREEMENT FROM ANY CAUSE, INCLUDING BUT NOT LIMITED TO CONTRACT LIABILITY OR CITY'S NEGLIGENCE, ERRORS, OMISSIONS, STRICT LIABILITY, BREACH OF CONTRACT OR BREACH OF WARRANTY SHALL NOT, IN THE AGGREGATE, EXCEED THE FEES PAID OR PAYABLE TO CONTRACTOR UNDER THIS AGREEMENT. IN NO EVENT WILL EITHER PARTY BE LIABLE TO THE OTHER FOR ANY SPECIAL, INDIRECT, INCIDENTAL, OR CONSEQUENTIAL DAMAGES IN CONNECTION WITH OR OTHERWISE ARISING OUT OF THIS AGREEMENT, EVEN IF ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. IN NO EVENT SHALL EITHER PARTY BE LIABLE FOR EXEMPLARY OR PUNITIVE DAMAGES ARISING OUT OF OR RELATED TO THIS AGREEMENT. 9. INSURANCE Contractor and its subcontractors shall maintain insurance acceptable to City in full force and effect throughout the term of this contract. Such insurance shall cover all risks arising directly or indirectly out of Contractor's activities or work hereunder, including the operations of its subcontractors of any tier. The policy or policies of insurance maintained by the Contractor and its subcontractor shall provide at least the following limits and coverages: A. Commercial General Liability Insurance Contractor shall obtain, at contractor's expense, and keep in effect during the term of this contract, Comprehensive General Liability Insurance covering Bodily Injury and Property Damage on an "occurrence" form (1996 ISO, or equivalent). This coverage shall include Contractual Liability insurance for the indemnity provided under this contract. The following insurance willbe carried: Coverage Limit General Aggregate 2,000,000 Products-Completed Operations Aggregate 1,000;000 Personal&Advertising Injury 1,000,000 Each Occurrence 1,000,000 Fire Damage (Any one fire) 50,000 Medical Expense (Any one person) 5,000 B. Commercial Automobile Insurance Contractor shall also obtain, at contractor's expense, and keep in effect during the term of the contract, Commercial Automobile Liability coverage including coverage for all owned, hired, and non-owned vehicles. The Combined Single Limit per occurrence shall not be less than $1,000,000. Tigard Personal Services Agreement Page 4 Contract# C. Workers' Compensation Insurance The contractor,its Subcontractors, if any, and all employers providing work, labor, or materials under this Contract that are subject employers under the Oregon Workers' Compensation Law shall comply with ORS 656.017, which requires them to provide workers' compensation coverage that satisfies Oregon law for all their subject workers. Out-of-state employers must provide Oregon workers' compensation coverage for their workers who work at a single location within Oregon for more than 30 days in a calendar year. Contractors who perform work without the assistance or labor of any employee need not obtain workers' compensation coverage. All non-exempt employers shall provide Employer's Liability Insurance with coverage limits of not less than$500,000 each accident. D. Additional Insured Provision The Commercial General Liability Insurance and Commercial Automobile Insurance policies and other policies the City deems necessary shall include the City, its officers, directors, and employees as additional insureds with respect to this contract. E. Notice of Cancellation. There shall be no cancellation, material change, exhaustion of aggregate limits or intent not to renew insurance coverage without 30 days written notice to the City. Any failure to comply with this provision will not affect the insurance coverage provided to the City. The 30 days notice of cancellation provision shall be physically endorsed on to the policy. F. Insurance Carrier Rating Coverages provided by the Contractor must be underwritten by an insurance company deemed acceptable by the City. The City reserves the right to reject all or any insurance carrier(s) with an unacceptable financial rating. G. Certificates of Insurance As evidence of the insurance coverage required by the contract, the Contractor shall furnish a Certificate of Insurance to the City. No contract shall be effected until the required certificates have been received and approved by the City. The certificate will specify and document all provisions within this contract. A renewal certificate will be sent to the above address 10 days prior to coverage expiration. H. Independent Contractor Status The service or services to be rendered under this contract are those of an independent contractor. Contractor is not an officer, employee or agent of the City as those terms are used in ORS 30.265. I. Primary Coverage Clarification The parties agree that Contractor's coverage shall be primary to the extent permitted by law. The parties further agree that other insurance maintained by the City is excess and not contributory insurance with the insurance required in this section. J. Cross-Liability Clause A cross-liability clause or separation of insureds clause will be included in all general liability, professional liability, pollution and errors and omissions policies required by this contract. Contractor's insurance policy shall contain provisions that such policies shall not be canceled or their limits of liability reduced without thirty (30) days prior notice to City. A copy of each insurance policy, Tigard Personal Services Agreement Page 5 Contract# certified as a true copy by an authorized representative of the issuing insurance company, or at the discretion of City, in lieu thereof, a certificate in form satisfactory to City certifying to the issuance of such insurance shall be forwarded to: City of Tigard Attn: Loreen Mills 13125 SW Hall Blvd. Tigard, Oregon 97223 Such policies or certificates must be delivered prior to commencement of the work. The procuring of such required insurance shall not be construed to limit contractor's liability hereunder. Notwithstanding said insurance, Contractor shall be obligated for the total amount of any damage, injury, or loss caused by negligence or neglect connected with this contract. 10. METHOD & PLACE OF SUBMITTING NOTICE,BILLS AND PAYMENTS All notices, bills and payments shall be made in writing and may be given by personal delivery, mail or by fax. Payments may be made by personal delivery, mail, or electronic transfer. The following addresses shall be used to transmit notices,bills,payments,and other information: CITY OF TIGARD Moss ADAMS LLP Attn: Loreen Mills,Asst. to City Manager Attn: Debbie Smith-Wagar Address: 13125 SW Hall Blvd. Address: 805 SW Broadway,Suite 1200 Tigard,Oregon 97223 Portland, Oregon 97205 Phone: (503) 718-2417 Phone: (503) 478-2231 Fax: (503) 684-7291 Fax: (503) 274-2789 Email Address: loreen@dgard-or.gov Email Address: Debbie.smith-wagarmossadams.com and when so addressed, shall be deemed given upon deposit in the United States mail,postage prepaid, or when so faxed, shall be deemed given upon successful fax. In all other instances, notices, bills and payments shall be deemed given at the time of actual delivery. Changes may be made in the names and addresses of the person to who notices,bills and payments are to be given by giving written notice pursuant to this paragraph. 11. MERGER This writing is intended both as a final expression of the Agreement between the parties with respect to the included terms and as a complete and exclusive statement of the terms of the Agreement. No modification of this Agreement shall be effective unless and until it is made in writing and signed by both parties. 12. PROFESSIONAL SERVICES The City requires that services provided pursuant to this agreement shall be provided to the City by a Contractor that does not knowingly represent clients on matters contrary to City interests. Further, Contractor shall not knowingly provide services under this Agreement by entering into subcontractor agreements to engage services of an attorney and/or other professional who individually, or through members of his/her same firm,represents clients on matters contrary to City interests. Should the Contractor represent clients on matters contrary to City interests or provide services under this Agreement by entering into subcontractor agreements to engage the services of an attorney and/or other professional who individually, or through members of his/her same firm, represents clients on Tigard Personal Services Agreement Page 6 Contract# matters contrary to City interests, Contractor shall consult with the appropriate CITY representative regarding the conflict. After such consultation, the Contractor shall have seven (7) days to eliminate the conflict to the satisfaction of the City. If such conflict is not eliminated within the specified time period, the agreement may be terminated pursuant to this Agreement. 13. TERMINATION The parties agree that any decision by either,party to terminate this Agreement before the 31"day of December, 2008 shall be accompanied by fifteen (15) days written notice to the other party prior to the date termination would take effect. There shall be no penalty for early termination upon proper notification and neither party shall be liable to the other for any damages that occur as a result of Contractor ceasing to render services. If City terminates the contract pursuant to this paragraph, it shall pay Contractor for services rendered prorated to the date of termination. 14. ACCESS TO RECORDS City shall have access to such books, documents, papers and records of Contractor as are directly pertinent to this Agreement for the purpose of making audit, examination,excerpts and transcripts. 15. FORCE MATEURE Neither City nor Contractor shall be considered in breach or default because of any delays in completion and responsibilities hereunder due to causes beyond the control and without fault or negligence on the part of the parties so disenabled,including but not restricted to, an act of God or of a public enemy, civil unrest, volcano, earthquake, fire, flood, epidemic, quarantine restriction, area-wide strike, freight embargo, unusually severe weather, untimely performance of the other party, its representatives, advisors or agents or delay of subcontractor or supplies due to such cause; provided that the parties so disenabled shall within ten (10) days from the beginning of such delay, notify the other party in writing of the cause of delay and its probable extent. Such notification shall not be the. basis for a claim for additional compensation. Each party shall,however, make all reasonable efforts to remove or eliminate such a cause of delay or default and shall, upon cessation of the cause, diligently pursue performance of its obligation under the Agreement. 16. NON-WAIVER The failure of City to insist upon or enforce strict performance by Contractor of any of the terms of this Agreement or to exercise any rights hereunder should not be construed as a waiver or relinquishment to any extent of its rights to assert or rely upon such terms or rights on any future occasion. 17. NON-DISCRIMINATION Contractor agrees to comply with all applicable requirements of federal and state civil rights and rehabilitation statues, rules, and regulations. Contractor also shall comply with the Americans with Disabilities Act of 1990, ORS 659.425, and all regulations and administrative rules established pursuant to those laws. 18. EXTRA(CHANGES)WORK Only the City's Project Manager for this Agreement, Loreen Mills, Assistant to the City Manager, may authorize extra (and/or change) work. Failure of Contractor, to secure authorization for extra work shall constitute a waiver of all right to adjustment in the contract price or contract time due to such Tigard Personal Services Agreement Page 7 Contract# unauthorized extra work and Contractor thereafter shall be entitled to no compensation whatsoever for the performance of such work. 19. ATTORNEY'S FEES In case suit or action is instituted to enforce the provisions of this contract, the parties agree that each party shall pay its own attorney fees and court costs,including attorney's fees and court costs on appeal. 20. GOVERNING LAW The provisions of this.Agreement shall be construed in accordance with the provisions of the laws of the State of Oregon. Any action or suits involving any question arising under this Agreement must be brought in the appropriate court of the State of Oregon. 21. COMPLIANCE WITH STATE AND FEDERAL LAWS/RULES Contractor shall comply with all applicable federal, state and local laws, rules and regulations, including, but not limited to, the requirements concerning working hours, overtime, medical care, workers compensation insurance, health care payments, payments to employees and subcontractors and income tax withholding contained in ORS Chapter 279B, the provisions of which are hereby made a part of this agreement. 22. CONFLICT BETWEEN TERMS It is further expressly agreed by and between the parties hereto that should there be.any conflict between the terms of this instrument in the proposal of the contract, this instnunent shall control and nothing herein shall be considered as an acceptance of the said terms of said proposal conflicting herewith. 23. AUDIT Contractor shall maintain records to assure conformance with the terms and conditions of this Agreement, and to assure adequate performance and accurate expenditures within the contract period. Contractor agrees to permit City, the State of Oregon, the federal government, or their duly authorized representatives to audit all records pertaining to this Agreement to assure the accurate expenditure of funds. 24. SEVERABILITY In the event any provision or portion of this Agreement is held to be unenforceable or invalid by any court of competent jurisdiction, the validity of the remaining terms and provisions shall not be affected to the extent that it did not materially affect the intent of the parties when they entered into the agreement. 25. CONDITIONS OF SUPPLYING A PUBLIC AGENCY Where applicable, Contractor must make payment promptly as due to persons supplying Contractor labor or materials for the execution of the work provided by this order. Contractor must pay all contributions or amounts due from Contractor to the Industrial Accident Fund incurred in the performance of this order. Contractor shall not permit any lien or claim to be filed or prosecuted against Buyer or any subdivision of City on account of any labor or material to be furnished. Contractor further agrees to pay to the Department of Revenue all sums withheld from employees pursuant to ORS 316.167. Tigard Personal Services Agreement Page 8 Contract# 26. HOURS OF LABOR In cases of contracts for personal services as defined in ORS 279A.055,any labor shall be paid at least time and a half for all hours worked in excess of forty (40) hours in any one week, except for those individuals excluded under ORS 653.010 to 653.260 or under 29 USC SS 201-209. 27. COMPLETE AGREEMENT This Agreement and attached exhibits constitutes the entire Agreement between the parties. No waiver, consent, modification, or change of terms of this Agreement shall bind either party unless in writing and signed by both parties. Such waiver, consent, modification, or change if made, shall be effective only in specific instances and for the specific purpose given. There are no understandings, agreements, or representations, oral or written, not specified herein regarding this Agreement. Contractor, by the signature of its authorized representative, hereby acknowledges that he has read this Agreement,understands it and agrees to be bound by its terms and conditions. IN WITNESS WHEREOF, City has caused this Agreement to be executed by its duly authorized undersigned officer and Contractor has executed this Agreement on the date hereinabove first written. CITY OF Moss ADAMS By: Au rized ity Representative By: Authorized Contractor R resentative Lnt-u '' n g Date Date Tigard Personal Services Agreement Page 9 Contract# EXHIBIT A SERVICES TO BE PROVIDED Scope of Services In this engagement, the Contractor will provide the City with the following consulting services: • Assist with preparation of audit work papers. • Prepare Management Discussion & Analysis for review by City Manager. • Assist as the City's liaison between City staff and external auditor. • Review Debt Management and issuance work with Interim Finance Director as needed. • Assist Interim Finance Director with Debt Management and issuance questions on an as needed basis. • Assist staff with accounting& financial software questions on an as needed basis. Limitations The City is responsible for making all financial records and related information available to Contractor and for the accuracy and completeness of that information. The Contractor may advise the City about appropriate accounting principles and their application and may assist in the preparation of the City's financial statements, but the City is responsible for the financial statements. This responsibility includes the establishment and maintenance of adequate records and effective internal controls over financial reporting, the selection and application of accounting principles, and the safeguarding of assets. The City is responsible for adjusting the financial statements to correct material misstatements. The City is also responsible for identifying and ensuring that the City complies with applicable laws and regulations. The Contractor will not audit or review the City's financial statements and, accordingly, will not express an opinion or any other form of assurance on them. The City agrees to take full responsibility for the Contractor's services as if they had been provided by the City's own employees, including, without limitation, the Contractor's assistance in preparing the financial statements. The City further agrees that the Contractor's name, brand or other identifying information will not be included in or otherwise associated with the services, including, without limitation, the City's financial statements. Nothing in this Agreement is intended to create privity between the Contractor and any third party regarding the services set forth herein. This engagement cannot be relied upon to disclose errors, fraud, or illegal acts that may exist. However, the Contractor will inform the appropriate level of management of any material errors and of any evidence or information that comes to our attention during the performance of our services that fraud may have occurred. In addition, the Contractor will report to the City any evidence or information that comes to our attention during the performance of our services regarding illegal acts that may have occurred unless they are clearly inconsequential. Please note that as a result of the limitation and indemnification provisions in this Agreement, Contractor will not be independent under applicable professional standards with respect to the City regarding the services provided under this Agreement. Tigard Personal Services Agreement Page 10 Contract# The City's Responsibilities The City agrees to accept the responsibilities set forth below related to this engagement: • Make all management decisions and perform all management functions (although Contractor may provide advice, research materials, and recommendations to assist management in making decisions). • Designate an individual with suitable skill, knowledge, and/or experience to oversee Contractor's services. • Evaluate the adequacy and results of the services performed. • Accept responsibility for the results of the services performed. • Establish and maintain internal controls including monitoring ongoing activities. If any issues or concerns in this area arise during the course of our engagement, Contractor will discuss them with the City prior to continuing with the engagement. Tigard Personal Services Agreement Page 11 [-F--Ail I WN CITY OF TIGARD CONTRACT SUMMARY FORM (THIS MUST ACCOMPANYEACH CONTRACT BEFORE AUTHORIZATION SIGNATURE CAN BE ACQUIRED) Title of Contract: Personal Services Contract Accounting Assistance Contract#: (Assigned after execution) and Oversight Services Contractor: Moss Adams LLP Total: $Not to exceed$90,000 Brief Overview: Provide accounting assistance and oversight for the City's Financial Operations Department. Work with outside auditors during the annual audit and provide guidance and training to staff employees within that department. Changes Made To Minor changes done by Purchasing and Risk. Boilerplate Contract Type of Contract: ❑ Purchase Agreement ❑ Personal Service ❑ Construction ❑ Other Start Date: 7/1/08 End Date: LCRB Award Date: Contract Manager:Loreen Mills Extension: 2417 De artment: Risk Management Quotes/Bids/Proposals: COMPANY AMOUNT / SCORE Department Comments: De artment Signature Date: Purchasing Comments: Purchasing S' Date: 1 1 Q Administration: Date: 7 Certificate of Insurance Recerd? ❑ Yes ❑ No ❑ Self-Insured Form Received Business Tax Current? 13 Yes ❑ No Contractor License Current? ❑ Yes ❑ No Federal TIN/1099 #: Bonds Required: ❑ Yes ❑ No Accounting String: Fund Division Account Total