11-101 Mimi Bratz & Associates, Don Burnett Bicycle Pedestrian Bridge Award Plaque CITY OF
;�/ AGREEMENT
(z /) CITY OF CUPERTINO
, A 10300 Torre Avenue
Cupertino, CA 95014
CUPERTINO
V / 408 -77i' -3200 NO. r5
BY THIS AGREEMENT, ma. - -nd entered into this day of , , by and between the CITY OF
CUPERTINO (Hereinafter referred to as CITY) and Mimi Braatz and Associates; Address:
(Hereinafter
referred as CONSULTANT), in consideration of their mutual covenants, the parties hereto agree as follows:
CONSULTANT shall provide or furnish the following specified services and /or materials:
Design and Delivery of an Award Plaque for the Don Burnett Bicycle- Pedestrian Bridge
EXHIBITS: The following attached exhibits hereby are made part of this Agreement: N/A
TERMS: The services and /or materials furnished under this Agreement shall commence on September 12, 2011
and shall be completed before November 30, 2011.
COMPENSATION: For the full performance of this Agreement, CITY shall pay CONSULTANT:
Time and Material Basis Not to Exceed $2,000.00 without Written Approval from The City
California Labor Code, Section 1771 requires the payment of prevailing wages to all workers employed on a Public Works contract in excess of
$1,000.00.
GENERAL TERMS AND CONDITIONS
Hold Harmless. Consultant shall, to the fullest extent allowed by law, w th respect to all services performed in connection with the Agreement,
indemnify, defend, and hold harmless the City and its officers, officials, agents, employees and volunteers from and against any and all liability,
claims, actions, causes of action or demands whatsoever against any of them, including any injury to or death of any person or damage to property
or other liability of any nature, whether physical, emotional, consequential or otherwise, arising out, pertaining to, or related to the performance of
this Agreement by Consultant or Consultant's employees, officers, officials, agents or independent contractors. Such costs and expenses shall
include reasonable attorneys' fees of counsel of City's choice, expert fees and all other costs and fees of litigation.
Insurance. Should the City require evidence of insurability, Consultant shall file with City a Certificate of Insurance before commencing any services
under this Agreement. Said Certificate shall be subject to the approval of City's Director of Administrative Services.
Non - Discrimination. No discrimination shall be made in the employment of persons under this Agreement because of the race, color, national
origin, ancestry, religion or sex of such person.
Interest of Consultant. It is understood and agreed that this Agreement is not a contract of employment in the sense that the relationship of master
and servant exists between City and undersigned. At all times, Consultant shall be deemed to be an independent consultant and Consultant is not
authorized to bind the City to any contracts or other obligations in executirg this agreement. Consultant certifies that no one who has or will have
any financial interest under this Agreement is an officer or employee of City.
Changes. This Agreement shall not be assigned or transferred without the written consent of the City. No changes or variations of any kind are
authorized without the written consent of the City.
CONTRACT CO- ORDINATOR and representative for CITY shall be:
Carmen Lynaugh, Public Works Projects Manager; 408 - 777 " -3215 Liej ENTERED
This Agreement shall become effective upon its execution by CITY, in witness thereof, the parties have executed this
Agreement the day and year first written above.
CONSU!..TANT: CITY OF UPERTINO:
..
By / �, By L.......
Name: Pi v , s Y 12_ Carmen Lynaugh
Title 8 /,Oy1Jk / pvi h(i pia Public Works Projects Manager
Soc. Sec. # or Tax f D
APPROVALS EXPENDITURE DISTRIBUTION
DEPART .,,: •D -DAT 4CCOUNTNUMRFR AMOUNT
- 7 3 c / / 110- 8101 -7014 $2,000.00
iii /�l� I . ' ,..7,/,;_.10/09//1
■
Other Consultant Agreement
Form W -9 Request for Taxpayer Give form to the
(Rev. October 2007) Identification Number and Certification requester. Do not
Department of the Treasury send to the IRS.
Internal Revenue Service
Name (as sbowwn on your income tax return)
m L> rad to ELLfe -v po.cie4 ...IA c ,
a erent from above
Business name, if d d h a ll 64 Broatz_ 4-A s ceAa c.„
Check appropriate box: ❑ IndividuaVSole proprietor tg, Corporation ❑ Partnership
y company. ( 9 y p p p) ❑ Exempt
` ❑ Limited liability Enter the tax classification (D=disregardec entity, C=corporation, P= partnership) ■
payee
o 2 ❑ Other (see instructions) ►
c c Address (number, s)reet, and apt. or suite no.) ,. Requester's name and address (optional)
(e St WC it ( C)Gtt
s City, state, and ZIP code
O.
CO - vi ( )ra ge ) 01 (/3-7(.5---
$ List account number(s) here (optional)
co
Part I Taxpayer Identification Number (TIN)
Enter your T!N in the-appropriate box. The TIN provider must match the name giver) an Lane 1 to avoid Socia! security number
backup withholding. For individuals, this is your social security number (SSN). However, for a resident
alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is
your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. or
Note. If the account is in more than one name, see the chart on page L. for guidelines on whose Emnloyer identification number
number to enter. '
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal
Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has
notified me that I am no longer subject to backup withholding, and
3. I am a U.S. citizen or other U.S. person (defined below).
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup
withholding because you have failed to report all interest and dividends on your tax retum. For real estate transactions, item 2 does not apply.
For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement
arrangement (IRA), and generall, , p. ments other tha interest and dividends, you are not required to sign the Certification, but you must
provide your correct TIN. See e i structions on pa 4.
Sign Signature of
Here U.S. person ifj,P i iii,4 A�la it ii ;6. -('? .---- Date ► 671F,..3/1' t i
General Instructio s ( efinjtio of a U.S. person. r federal tax purposes, you are
onsi ed a U.S. person if you are:
Section references are to the nternal Revertiue Code unless • An individual who is a U.S. citizen or U.S. resident alien,
otherwise noted.
• A partnership, corporation, company, or association created or
Purpose of Form organized in the United States or under the laws of the United
A person who is required to file an information return with the States,
IRS must obtain your correct taxpayer identification number (TIN) • An estate (other than a foreign estate), or
to report, for example, income paid to you, real estate e A domestic trust (as defined in Regulations section
transactions, mortgage interest you paid, acquisition or 301.7701 -7).
abandonment of secured property, cancellation of debt, or
contributions you made to an IRA. Special rules for partnerships. Partnerships that conduct a
trade or business in the United States are generally required to
Use Form W -9 only if you are a U.S. person (including a pay a withholding tax on any foreign partners' share of income
resident alien), to provide your correct TIN to the person from such business. Further, in certain cases where a Form W -9
requesting it (the requester) and, when applicable, to: has not been received, a partnership is required to presume that
1. Certify that the TIN you are giving is correct (or you are a partner is a foreign person, and pay the withholding tax.
waiting for a number to be issued), Therefore, if you are a U.S. person that is a partner in a
2. Certify that you are not subject to backup withholding, or partnership conducting a trade or business in the United States,
provide Form W -9 to the partnership to establish your U.S.
3. Claim exemption from backup withholding if you are a U.S. status and avoid withholding on your share of partnership
exempt payee. If applicable, you are also certifying that as a income.
U.S. person, your allocable share of any partnership income from The person who gives Form W -9 to the partnership for
a U.S. trade or business is not subject to the withholding tax on purposes of establishing its U.S. status and avoiding withholding
foreign partners' share of effectively connected income. on its allocable share of net income from the partnership
Note. If a requester gives you a form other than Form W -9 to conducting a trade or business in the United States is in the
request your TIN, you must use the requester's form if it is following cases:
substantially similar to this Form W -9. • The U.S. owner of a disregarded entity and not the entity,
Cat. No. 10231X Form W -9 (Rev. 10 -2007)