HomeMy WebLinkAbout5883PROFESSIONAL SERVICES AGREEMENT
Security Vulnerability Assessment
The City of Bremerton ("City") and BenTech ("Consultant"), referred to collectively as the
"Parties," enter into the following Agreement for professional services:
I. Scope: The Consultant agrees to perform the services more specifically described in the
Scope of Work, dated October 31, 2018, including any attachments, attached hereto as Exhibit A,
which is incorporated by reference herein. The Scope of Work may be modified only pursuant to
Section VII.H of this Agreement. If the Scope of Work provides for unspecified additional
services such services shall only be performed upon the express written request of the City.
Consultant further represents that the services furnished under this Agreement will be performed
in accordance with generally accepted professional practices in effect at the time such services are
performed.
II. Term: The City and the Consultant agree that work will begin on the tasks described in
Exhibit A immediately upon execution of this Agreement. The parties agree that the work
described in Exhibit A is to be completed as provided for in the work schedule attached hereto as
Exhibit B; provided however, that additional time shall be granted by the City for excusable delays
or extra work as provided for in Section IKA of this agreement.
III. Compensation: In consideration of the services provided pursuant to this Agreement, the
City shall pay Consultant in an amount not to exceed $ 23,000. Consultant's charges and bills
shall conform to the fee schedule attached hereto as Exhibit C and incorporated herein by this
reference.
The Consultant shall submit regular billing statements detailing work performed and
amount charged on each task or portion thereof. The descriptions shall conform to and fall within
the categories set out in the Scope of Work and/or Fee Schedule. Upon receipt of a conforming
billing statement, the City shall promptly process payment. PROVIDED, HOWEVER, the City
reserves the right to prioritize scoped work and accelerate and/or delay work tasks under the time
frame set forth in Section II herein. The Consultant's labor rates and billing fees shall be as
delineated in Exhibit C.
Consultant shall not perform work beyond the Scope of Work, nor shall be compensated
for such work, unless the Scope of Work or amount of compensation is modified pursuant to this
Agreement. Consultant shall only be compensated for additional services if requested pursuant to
Section I and, if not otherwise provided, such compensation shall be in accordance with Exhibit
C.
If a billing statement does not conform to this Agreement, the City may withhold payment
until the statement is brought into compliance. Such withholding does not relieve Consultant of
its obligations under this Agreement.
IV. Relationship of Parties: Consultant represents that it is skilled in the matters addressed
in the Scope of Work and is performing independent functions and responsibilities within its field
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Bremerton/BenTec
Security Vulnerability Assessment
Rev. 07/2018
of expertise. Consultant and its personnel are independent Consultants and not employees of the
City. Consultant and its personnel have no authority to bind the City or to control the City's
employees and other Consultants. None of the benefits provided by the City to its employees,
including, but not limited to, compensation, insurance, and unemployment insurance are available
from the City to the employees, agents, representatives, or sub -consultants of the Consultant.
Consultant will be solely and entirely responsible for its acts and for the acts of Consultant's agents,
employees, representatives and sub -consultants during the performance of this Agreement. The
City may, during the term of this Agreement, engage other independent Consultants to perform
the same or similar work.
As an independent Consultant, Consultant is responsible for its own management. The
City's administration and enforcement of this Agreement shall not be deemed an exercise of
managerial control over Consultant or its personnel.
As an independent Consultant, Consultant is responsible for payment of all taxes and
licensing fees necessary to perform its obligations under this Agreement. These taxes and fees
include but are not limited to State industrial insurance, Business & Occupation, State professional
licensing, and City business licensing. If any taxes or fees due the City have been declared
delinquent, the City may withhold the delinquent amount, plus any additional charges arising from
the delinquency, from any payments due Consultant.
V. Indemnification:
A. Consultant shall defend, indemnify and hold the City, its officers, officials,
employees, agents and volunteers harmless from any and all claims, injuries, damages, losses or
suits, including all legal costs and attorney fees, arising out of or in connection with the
performance of this Agreement except for that portion of the injuries and damages caused by the
City's sole negligence, unless Consultant is conducting work pursuant to Subsection B below.
The City's review or acceptance of any of the work when completed shall not be grounds
to avoid any of these covenants of indemnification.
B. Architects, Engineers and Any Other Professional Listed In and Performing
Services Defined in RCW 4.24.115. Should a court of competent jurisdiction determine that
Consultant's services provided pursuant to this Agreement is subject to RCW 4.24.115, then, in
the event of liability for damages arising out of bodily injury to persons or damages to property
caused by or resulting from the concurrent negligence of the Consultant and the City, its officers,
officials, employees, agents and volunteers, the Consultant's liability hereunder shall be only to
the extent of the Consultant's negligence.
IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE
INDEMNIFICATION PROVIDED HEREIN CONSTITUTES THE CONSULTANT'S WAIVER
OF IMMUNITY UNDER INDUSTRIAL INSURANCE, TITLE 51 RCW, SOLELY FOR THE
PURPOSES OF THIS INDEMNIFICATION. THE PARTIES FURTHER ACKNOWLEDGE
THAT THEY HAVE MUTUALLY NEGOTIATED THIS WAIVER.
Page 2 of 7
Bremerton/BenTec
Security Vulnerability Assessment
Rev. 07/2018
The provisions of this section shall survive the expiration or termination of this Agreement.
VI. Insurance: The Consultant shall procure and maintain for the duration of the Agreement,
insurance against claims for injuries to persons or damage to property which may arise from or in
connection with the performance of the work hereunder by the Consultant, its agents,
representatives, employees, sub -consultants or sub -contractors.
Before beginning work on the project described in this Agreement, the Consultant shall
provide a Certificate of Insurance evidencing:
1. Automobile Liability insurance with limits no less than $100,000 combined
single limit per accident for bodily injury and property damage; and shall be in
accordance with the auto policy declarations provided by The Consultant, and
2. Commercial General Liability insurance written on an occurrence basis with
limits no less than $1,000,000 combined single limit per occurrence and general
aggregate for personal injury, bodily injury and property damage. Coverage shall
include but not be limited to: blanket contractual; products/completed
operations/broad form property damage; explosion, collapse and underground
(XCU) if applicable; and
3. Professional Liability insurance with limits no less than $1,000,000 limit per
occurrence/claim.
Any payment of deductible or self-insured retention shall be the sole responsibility of the
Consultant.
All required policies shall be provided on an "occurrence" basis except professional
liability insurance (if required), which may be provided on a "claims -made" basis.
The City shall be named as an additional insured on the Commercial General Liability
insurance policy, as respects work performed by or on behalf of the Consultant and a copy of an
endorsement that is acceptable to the City, which names the City as an additional insured shall be
attached to the Certificate of Insurance. The City reserves the right to receive a certified copy of
all the required insurance policies and endorsements. The City further reserves the right to reject
any unacceptable policies and/or endorsements.
The Consultant's Commercial General Liability insurance shall contain a clause stating that
coverage shall apply separately to each insured against whom claim is made or suit is brought,
except with respects to the limits of the insurer's liability.
The Consultant's insurance shall be primary and non-contributory insurance as respects the
City and shall contain a waiver of subrogation against the City for claims arising out of any
operations, liabilities and obligations to which coverage applies. It shall be an affirmative
obligation upon Consultant to advise the City's Risk Manager by fax at (360) 473-5161, or by
certified mail, return receipt requested to City of Bremerton, Attn: Risk Management, 345 6m
Street, Suite 100, Bremerton, WA 98337 within two days of the cancellation, suspension or
Page 3 of 7
Bremerton/BenTec
Security Vulnerability Assessment
Rev. 07/2018
substantive change of any insurance policy set out herein, and failure to do so shall be construed
to be a breach of this Agreement.
The City also reserves its unqualified right to require at any time and for any reason, proof
of coverage in the form of a duplicate of the insurance policy with all endorsements as evidence
of coverage.
VII. General Conditions:
A. Reports and Information: When requested by the City, Consultant shall furnish
periodic reports and documents on matters covered by this Agreement. The reports and documents
shall be furnished in the time and form requested. Consultant shall maintain accounting records
in accordance with Generally Accepted Accounting Principles ("GAAP") to substantiate all billed
amounts.
B. Ownership and Use of Records and Documents: Original documents, drawings,
designs and reports, including those in electronic format, developed under this Agreement are the
property of the City. All written information submitted by the City to the Consultant in connection
with the services performed by the Consultant under this Agreement will be safeguarded by the
Consultant to at least the same extent as the Consultant safeguards like information relating to its
own business. If such information is publicly available or is already in Consultant's possession or
known to it, or is rightfully obtained by the Consultant from third parties, Consultant shall bear no
responsibility for its disclosure, inadvertent or otherwise.
All data, documents and files created by Consultant under this Agreement may be stored
at Consultant's office in Index, Washington. Consultant shall make such data, documents, and
files available to the City upon its request at all reasonable times for the purpose of editing,
modifying and updating as necessary until such time as the City is capable of storing such
information in the City's offices. Duplicate copies of this information shall be provided to the City
upon its request, and at reasonable cost.
All documents, including all reports, drawings, specifications, computer software or other
items prepared or furnished by Consultant pursuant to this Agreement, are instruments of service
with respect to the project and are the property of the City. Any reuse by the City for other than
the specific purpose intended will be at City's sole risk.
The primary purpose of this work is to prevent, mitigate, and respond to criminal terrorist acts.
The information developed in this report is exempt from public disclosure under RCW 42.56 and
the Department of Homeland Security Protected Critical Infrastructure Information (PCII).
Email correspondence will be used to develop the project deliverables, see Appendix 1 on how to
designate email as being exempt from public disclosure.
For information on RCW 42.56 see Appendix 2, and for PCII, see Appendix 3.
Page 4 of 7
Bremerton/BenTec
Security Vulnerability Assessment
Rev. 07/2018
The final product report will be submitted by the City to the Department of Homeland Security
as PCII. PCII documents are exempt from public disclosure and only authorized users can view
or transmit the information.
C. Use of Photographs and Images. Consultant shall not use or distribute photographs
or images depicting City officials, personnel, property, or equipment whether prepared by
Consultant or provided by City without prior written consent of the City. The City will not
unreasonably withhold its consent.
D. Work Performed at Consultant's Risk: Consultant shall take all precautions
necessary and shall be responsible for the safety of its employees, agents, and sub -consultants in
the performance of the work hereunder and shall utilize all protection necessary for that purpose.
All work shall be done at Consultant's own risk, and Consultant shall be responsible for any loss
of or damage to materials, tools, or other articles used or held for use in connection with the work.
E. Place of Work: The Consultant shall perform the work authorized under this
Agreement at its offices in Index, Washington. Meetings with the City staff as described in Exhibit
A, Scope of Work, shall take place at the City's offices, or at locations mutually agreed upon by
the parties.
F. Entire Agreement: This Agreement and its Exhibits constitutes the entire
agreement between the Parties, and the Parties acknowledge that there are no other agreements,
written or oral, that have not been set forth in the text of this Agreement.
G. Severability. Should any part of this Agreement be found void, the balance of the
Agreement shall remain in full force and effect.
H. Modification: This Agreement may only be modified by written instrument signed
by both Parties.
I. Written Notices: All communications regarding this Agreement shall be sent to the
parties at the addresses listed below by registered or 1 st class mail, or by personal service, and
shall be deemed sufficiently given if sent to the addressee at the address stated in this Agreement
or such other address as may be hereafter specified in writing.
Notices to be sent to:
CITY:
City of Bremerton PW&U
Attn: Cami Apfelbeck
100 Oyster Bay Ave N.
Bremerton, WA 98312
Bremerton/BenTec
Security Vulnerability Assessment
Rev. 07/2018
Notices to be sent to:
CONSULTANT:
Attn: Benjamin Keith
BenTech
9852 244th PL NE
Redmond, WA. 98053
Page 5 of 7
J. Waiver: Failure to enforce any provision of this Agreement shall not be deemed a
waiver of that provision. Waiver of any right or power arising out of this Agreement shall not be
deemed waiver of any other right or power.
K. Non -Waiver of Breach: The failure of the City to insist upon strict performance of
any of the covenants and agreements contained herein, or to exercise any option herein conferred
in one or more instances shall not be construed to be a waiver or relinquishment of said covenants,
agreements or options, and the same shall be and remain in full force and effect.
L. Compliance with Laws: Consultant shall comply with all applicable Federal, State,
and local laws in performing its obligations under this Agreement.
M. Choice of Law and Venue: This Agreement shall be interpreted according to the
laws of the State of Washington. Any judicial action to resolve disputes arising out of this
Agreement shall be brought in Kitsap County Superior Court.
N. Attorneys' Fees: In the event of litigation to enforce any of the terms or provisions
herein, each party shall pay all its own costs and attorney's fees.
O. Assignment: Any assignment of this agreement by the Contractor without the
written consent of the City shall be void.
VIII. Nondiscrimination: Consultant shall not discriminate in employment or services to the
public on the basis of race, color, national origin, sex, religion, age, marital status, disability, or
sexual orientation except for employment actions based on bona fide occupational qualification.
IX. Termination: This Agreement shall remain in force until completion and acceptance of
the services, terminated by written instrument upon mutual consent, or by the City of Bremerton
for convenience. This Agreement may be immediately terminated for cause by a Party if the other
Party substantially fails to perform through no fault of the terminating Party, and the non-
performing Party does not commence correction of the failure of performance within thirty (30)
days of the terminating Party's sending notice to the non-performing Party. Any Notice by
Consultant shall include a report showing the status of all items listed in the Scope of Work current
through the termination date.
If the City receives reimbursement by any federal, state, or other source for work described
in Section I herein, and that funding is withdrawn,.reduced or limited in any way, or the project is
cancelled or substantially reduced after the execution date of this Agreement and prior to the
completion of the work, the City may summarily terminate this Agreement.
Page 6 of 7
BremertonBenTec
Security Vulnerability Assessment
Rev. 07/2018
A. Excusable Delays: The right of Consultant to proceed shall not be terminated nor
shall Consultant be charged with liquidated damages for any delays in the completion of the
work due to: 1) any acts of the federal government in controlling, restricting, or requisitioning
materials, equipment, tools, or labor by reason of war, national defense, or other national
emergency; 2) any acts of the City, its consultants, or other public agencies causing such delay;
and 3) causes not reasonably foreseeable by the parties at the time of the execution of the
Agreement that are beyond the control and without the fault or negligence of the Consultant,
including, but not restricted to, acts of God, fires, floods, strikes, or weather of unusual severity.
PROVIDED, HOWEVER, that the Consultant must promptly notify the City within ten (10)
calendar days in writing of the cause of the delay. If, on the basis of the facts and the terms of
this Agreement, the delay is properly excusable, the City shall, in writing, extend the time for
completing the work for a period of time commensurate with the period of excusable delay.
B. Righj§ Upon Termination: In the event of termination, the City shall pay for all
services performed by the Consultant to the effective date of termination, as described on a final
invoice submitted to the City. After termination, the City may take possession of all records and
data within the Consultant's possession pertaining to this project which may be used by the City
without restriction. Any such use not related to the project which Consultant was contracted to
perform shall be without liability or legal exposure to the Consultant.
X. Suspension & Debarment. For contracts involving Federal funding, Consultant hereby
certifies, by signing this agreement, that neither it nor its principals are presently debarred,
suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
participation in this transaction by any Federal department or agency. Consultant shall provide
immediate written notice to the City if at any time it learns that it is or has become ineligible for
certification. Should Consultant enter into a covered transaction with another firm, Consultant
agrees by signing this agreement that it will verify that the firm with whom it intends to do
business is not debarred, suspended, ineligible, excluded or disqualified.
IN WITNESS WHEREOF, the parties below have executed this Agreement.
CITY:
CITY OF BREMERTON
By. �—
Print Name: Chat Martin
Its: Director. Public Works and Utilities
Date:
APPROVED TO FORM:
By:
Roger A. Lubovich, Bre eon City At rney
Aw
Page 7 of 8
Bremerton/BenTec
Security Vulnerability Assessment
Rev. 07/2018
CONSULTANT:
By - –ce =:;9 !
Print N e: Benjamin Keith
Its: Principle
Date: /Z i 44
Bylt �• ._l,�. .hi► r�i
AC't7RiC�� DATE (MMlDDlYYYY)
�,...- CERTIFICATE OF LIABILITY_ INSURANCE,ona/2o16
THIS CERTIFlCATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY
AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE ACONTRACT BETWEEN THE ISSUING INSURIWS),
AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the poNcy(les) must halve ADDITIONAL INSURED provisions or be endorsed. H SUBROGATION IS WAIVED, subject to the terms and
conditions of the policy, certain policies may require an endorsement. A statement on thb cer0licMe does not confer rights to the certificate holder In Neu of such endorsement(s).
PRODUCER
CONTACT
POLICY EFF
(MM/DD/YYYY)
NAME: David Whittlesey
David Whittlesey(792633J)
PHONE
FAX
1207 13th St Ste L
WC. NO, EXT): 425-329-4013
tA/C, No): 800-517-5661
E-NWL
Snohomish WA 98290-2000
ADDRESS: twhittlesey@farmersagent.com
INSURER(S) AFFORDING COVERAGE NAIL If
INSURED
INSURERA. Truck Insurance Exchange 21709
INSURER a: Farmers Insurance Exchange 21652
KEITH. BENJAMIN
INSURERC: Mid Century Insurance Company 21687
9852 244TH PL NE
iNsu"Ao: Hiscox Insurance Company Inc 10200
INSURER E:
REDMOND WA 98053
X506295333
INSURER F:
08122/2019
COVERAGES CERTIFICATE NUMBER.' REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY
REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHFR DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE
POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
AODTL
INSD
SueR
WVO
POLICY NUMBER
POLICY EFF
(MM/DD/YYYY)
I POLICY EXP
(MM/DD/YYYY)
LIARS
COMMERCIAL. GENERAL LIABILITY
CLAIMS -MADE OCU
E
EACH OCCURRENCE $ 2,000AW
$ �.
DAMAGE TO RENTED
PREMISES (Ea Occurrence) 75,000
MED EXP (Anyone person) S 5,000
I
i
PERSONAL & ADV INJURY $ 2.000. 0
A
X506295333
08/22/2018
08122/2019
GEN`LAGGREGATE LIMIT APPLIES PER
GENERAL AGGREGATE $ 4000
POLICY ❑ PROJECT ❑LOC
I
PRODUCTS •COMP/OP AGG $ 2,000,M-9
$
1 OTHER
AUTOMOaiLELiABILITY
i
COMSINEDSINGLELIMIT $
(Ea accident)
BODILY INJURY (Per penion) S
ANY AUTO
BODILY INJURY (Per accident) $
OWNEDAUTOS SCHEDULED
ONLY AUTOS
I
PROPERTY DAMAGE S
(Peraccident)
HIREDAUTOS NON -OWNED
ONLY AUTOSONLY
$
UMBRELLALIM
OCCUR
I
EACH OCCURRENCE S
AGGREGATE S
EXCESS LIAB
CLAIMS -MADE
I
DED RETENTION$
i
�
S
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
I
PER
STATUTE
OTHER S
E.L. EACH ACCIDENT $
ANY PROPRIETOR; PARTNERI Y/N
EXECUTIVE OFFICER/MEMBER
EXCLUDED' (Mandatory in NH)
N/A
j
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
$
If yes, describe under DESCRIPTION OF
OPERATIONS below
D
Professional Liability
IUDC-1803818-EO-18 j 08/22/2018
08/22/2019
Each Claim:
$1.0 ,
f
Aggregate'
$1,000.0
_ _
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached N more space is required)
I
CERTIFICATE HOLDER CANCELLATION
L,IIy Or bremerTOn SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Attn. Risk Management DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
345 6th St, Ste 100 AUTHORIZEDREP ii TA FIVE
Bremerton WA98337
ACORD 25 (2016/03) x:'1988-2015 ACORD CORPORATION. All Rights Reserved
31-1769 11-15 TheACORD nameand logo are registered marks of ACORD
A
Is
Fom, W-9
Request for Taxpayer
Give Form to the
(Rev. December 2014)
Identification Number and Certification
requester. Do not
Department of the Treasury
send to the IRS.
Internal Revenue Service
1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
Benjamin Keith
2 Business name/disregarded entity name, if different from above
N
BenTech
2.
c
3 Check appropriate box for federal tax classification; check only one of the following seven boxes:
4 Exemptions (codes apply only to
certain entities, not individuals; see
❑✓ Individual/sole proprietor or ❑ C Corporation ❑ S Corporation ❑ Partnership ❑ Trust/estate
instructions on page 3):
CL c
v
single -member LLC
❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) ►
Exempt payee code (if any)
0 2
Note. For a single -member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for
Exemption from FATCA reporting
r N
the tax classification of the single -member owner.
code (if any)
a❑Other
(see instructions) 0,(Applies
to accounts maintained outside the U.S.)
U
5 Address (number, street, and apt. or suite no.)
Requester's name and address (optional)
U
a
9852 244th PL NE
�
6 City, state, and ZIP code
in
Redmind, WA. 98053
7 List account number(s) here (optional)
IMB
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
Social security number
backup withholding. For individuals, this is generally your social security number (However, for a
resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other
page
- m _
antitiem. it is vnur Pmnlnver identification number IEINI. If you do not have a number. see How to pet a
TIN on page 3.
Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for
guidelines on whose number to enter.
Certification
Under penalties of perjury, I certify that:
or
identification number
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. 1 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. 1 am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
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 return. 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
generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the
instructions on page 3.
SignI Signature of �i`r—
Here U.S. 10 -person //nom Date ► /
General Instructio
Section references are to the Internal Revenue Code unless otherwise noted.
Future developments. Information about developments affecting Form W-9 (such
as legislation enacted after we release it) is at www.irs.gov/fw9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an information
return with the IRS must obtain your correct taxpayer identification number (TIN)
which may be your social security number (SSN), individual taxpayer identification
number (ITIN), adoption taxpayer identification number (ATIN), or employer
identification number (EIN), to report on an information return the amount paid to
you, or other amount reportable on an information return. Examples of information
returns include, but are not limited to, the following:
• Form 1099 -INT (interest earned or paid)
• Form 1099 -DIV (dividends, including those from stocks or mutual funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross proceeds)
• Form 1099-B (stock or mutual fund sales and certain other transactions by
brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 (home mortgage interest), 1098 -Lr (student loan interest), 1098-T
(tuition)
• Form 1099-0 (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident alien), to
provide your correct TIN.
It you do not return Form W-9 to the requester with a TIN, you might be subject
to backup withholding. See What is backup withholding? on page 2.
By signing the filled -out form, you:
1. Certify that the TIN you are giving is correct (or you are waiting for a number
to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S. exempt payee. If
applicable, you are also certifying that as a U.S. person, your allocable share of
any partnership income from a U.S. trade or business is not subject to the
withholding tax on foreign partners' share of effectively connected income, and
4. Certify that FATCA code(s) entered on this form (if any) indicating that you are
exempt from the FATCA reporting, is correct. See What is FATCA reporting? on
page 2 for further Information.
Cat. No. 10231X Form W-9 (Rev. 12-2014)
Amended auto policy declarations
Policy number: 976 781424
Policy effective date: July 31, 2018
Page 6 of 8
Coverage detail for 1998 Ford Truck Expedition
eewrW Umits Deductible Promises
Automobile Liability Insurance Not applicable $284.27
® Bodily injury $50,000 each person
$100,000 each occur nc
Property Damage $100,000 each occurrence
Auto Collision Insurance Actual cash value $500 $111.05
+ Auto Comprehensive Insurance Actual cash value $250 $40.38
W Rental Reimbursement Not purchased'
4P
Towing and Labor Costs
Not purchased*
Underinsured Motorists Insurance
$65.29
Bodily Injury
$50,000 each person Not applicable
$100,000 each accident
40
Property Damage
$100,000 each accident Stated in policy
40
Automobile Medical Payments
$10,000 each person Not applicable $59.81
Personal Injury Protection Benefits Not Purchased*
® Sound System Not purchased'
Tape Not purchased'
Total promiuns kr 1991 Ford Tnwk bVedition860.80
' This coverage con provide you with valuable protsction. To help you stay
current with your insurance needs, contact year AiMtate agent to discus
coverage moons and other products and services UW can hey protect
you.
VIN 1FMPU18LOWL835473
Thank you for choosing Allstate
Q)Allstate-
You're in good hands.
Proof of Insurance Card Page 1 of 2
For your convenience, two insurance cards have been included for each vehicle. State law requires that one
of these cards be kept in each vehicle. Please place them in your vehicles by the effective date.
-------- --------------------------- ---------------
Allstate.
Allstate.
You're in good hands.
You're in good hands.
Please use the printed Insurance Cards below.
Please use the printed Insurance Cards below.
.............. -- ................................ -----------------
Allstate. f
.............................. -----..................................................
Allstate.
You're in good hands.
You're in good hands.
Please use the printed Insurance Cards below.
Please use the printed Insurance Cards below.
.................................................------------..................------------ .............--
Washington Motor Vehicle Liability Allstate®
._..._......_............. ----- ...... . ---- ..........................E
Washington Motor Vehicle Liability Allstate®
Insurance Identification Card
Insurance Identification Card
You're in good hands.
You're in good hands.
Allstate Fire and Casualty Insurance Company
Allstate Fire and Casualty Insurance Company
Benjamin E & Dianne Keith
Benjamin E & Dianne Keith
PO Box 385
PO Box 385
Index WA 98256-0385
Index WA 98256-0385
POLICY NUMBER YEAR / MAKE / MODEL
POLICY NUMBER YEAR / MAKE / MODEL
976 781424 2005 Dodge Van Grand Caravn
976 781424 2005 Dodge Van Grand Caravn
EFFECTIVE DATE VEHICLE ID NUMBER E
EFFECTIVE DATE VEHICLE ID NUMBER
07/31/18 2D4GP44L55R415563
07/31/18 2D4GP44L55R415563
EXPIRATION DATE
EXPIRATION DATE
01/31/19 E
01/31/19
This card must be carried in the vehicle at all times as evidence of insurance.
This card must be carried in the vehicle at all times as evidence of insurance.
............... .......... ........... ..... .... ......--..... L-----------------------------------------------------------------.............................................
Washington Motor Vehicle Liability
Allstatestate
i
Washington Motor Vehicle liability
Allstate.
Insurance Identification Card
nsuranceencaonar
You're in good hands.
you're in good hands.
Allstate Fire and Casualty Insurance Company
Allstate Fire and Casualty Insurance Company
Benjamin E & Dianne Keith
Benjamin E & Dianne Keith
PO Box 385
PO Box 385
Index WA 98256-0385
Index WA 98256-0385
POLICY NUMBER YEAR / MAKE / MODEL
POLICY NUMBER YEAR / MAKE / MODEL
976 781424 1998 Ford Truck Expedition
976 781424 1998 Ford Truck Expedition
EFFECTIVE DATE VEHICLE ID NUMBER
EFFECTIVE DATE VEHICLE ID NUMBER
07/31/18 1FMPU18LOWLB35473
07/31/18 1FMPU18LOWLB35473
EXPIRATION DATE
EXPIRATION DATE
01/31/19
01/31/19
This card must be carried in the vehicle at all times as evidence of insurance.
_...._. ------- -------------------- . ......... ..... — ----------- ........................
This card must be carried in the vehicle at all times as evidence of insurance.
----------------------------------------------------------------- ............
Security Vulnerability Assessment
Exhibit A
Scope of Work
October 31, 2018
Page 1 of 2
Overview
The primary purpose of this work is to prevent, mitigate, and respond to criminal terrorist acts.
The information developed in this report is exempt from public disclosure under RCW 42.56 and the
Department of Homeland Security Protected Critical Infrastructure Information (PCII).
Email correspondence will be used to develop the project deliverables, see Appendix 1 on how to
designate email as being exempt from public disclosure.
For information on RCW 42.56 see Appendix 2, and for PCII, see Appendix 3.
The final product report will be submitted to the Department of Homeland Security as PCII by the City.
PCII documents are exempt from public disclosure and only authorized users can view or transmit the
information.
A.1 Security Review
Execute a regional overview of all existing installed, working systems and security improvements.
Review all support infrastructure to support existing solutions, interview site managers as an
existing system evaluation with recommendations from those managers.
Review existing security for items A1.1 through A.1.4 listed below. Conduct site visits for
additional details.
A.1.1 Reservoir 4
Review existing PCII report.
Review existing security, provide recommendations on fencing, video cameras, DVR, access
control and intrusion detection. Do on site review of all conditions, measurements and
facilities.
A.1.2 Casad Dam
Review existing PCII report.
Review existing security, provide recommendations on fencing, video cameras, DVR, access
control and intrusion detection. Do on site review of all conditions, measurements and
facilities.
A.1.3 Advanced Disinfection Facility
Review existing video camera and DVR system recommend replacement hardware, access
control and software. Consult with City of Bremerton Information Technology for coordination
on equipment to be used, at this location and others
A.1.4 McKenna Falls Control and Screen Building
Provide recommendations on video cameras, DVR, and a secured facility for DVR
equipment.
Provide recommendations on security for access gate at 9600 W McKenna Falls Road
(Forestry Office).
A.2 Reports
Security Vulnerability Assessment
Exhibit A
Scope of Work
October 31, 2018
Page 2 of 2
Provide an initial written report on above items A.1.1 through A.1.4.
Provide an in person verbal report to management/stakeholders at City of Bremerton Public
Works and Utilities, 100 Oyster Bay Ave, Bremerton, WA 98312, at a mutually agreeable time
and date.
Based on management/stakeholders comments from the above meeting, provide final
recommendations.
Final recommendations will be in a format mutually acceptable to City and Contractor.
Send the final report to
Cami Apfelbeck, Water Utility Manager
City of Bremerton, Public Works & Utilities
100 Oyster Bay Ave N
Bremerton WA 98312
Final report documents to be sent on a CD or DVD, with delivery tracking.
2
Security Vulnerability Assessment
Exhibit B
Deliverables and Work Schedule
October 31, 2018
Page 1 of 2
Deliverables
Task
Description of Tasks
Hours
Rate
Cost
Totals
B.1
Execute a regional overview of all existing
16
$135.00
2,160.00
2,970.00
Security
installed, working systems and security
Travel:6
+810.00
Review
improvements. Review all support infrastructure
to support existing solutions, interview site
managers as an existing system evaluation with
recommendations from those managers: 2 days
+ 1 travel unit @ 6 hours
B.1.1
Review existing PCII report. 1.5 hr.
14
135.00.00
1,890.00
1,890.00
Reservoir
Review existing security, provide
4
recommendations on fencing, video cameras,
DVR, and intrusion detection. Do on site review
of all conditions, measurements and facilities. 1
day plus office time
B.1.2
Review existing PCII report. 1.5 hr.
14
135.00
1,890.00
1,890.00
Casad Dam
Review existing security, provide
recommendations on fencing, video cameras,
DVR, and intrusion detection. Do on site review
of all conditions, measurements and facilities. 1
day plus office time
B.1.3
Review existing video camera and DVR system
10
135.00
1,350.00
1,350.00
Advanced
recommend replacement hardware and
Disinfection
software. Consult with City of Bremerton
Facility
Information Technology for coordination on
equipment to be used, at this location and others
1 day plus office time
B.1.4
Provide recommendations on video cameras,
10
135.00
1,350.00
1,350.00
McKenna
DVR, and a secured facility for DVR equipment.
Falls
Provide recommendations on security for access
Control and
gate at 9600 W McKenna Falls Road (Forestry
Screen
Office). 1 day plus office time
Building
B.3.1
Provide an initial written report on above items
20
135.00
2,700.00
2,700.00
Reports
A.1.1 through A.1.4, PCII protected.
B.3.2
Provide an in person verbal report to
10
135.00
1,350.00
1,350.00
Meeting
management at City of Bremerton Public Works
and Utilities, 100 Oyster Bay Ave, Bremerton,
WA 98312, at a mutually agreeable time and
date. 1 travel @ 6, 4 hours meeting time
budgeted
BA Travel
Transportation 5 trips minimum to accomplish
30
135.00
4,050.00
4,050.00
B.1.1 - B.1.3, 6 hours ptrip
B.5
Hotel stays for tasks B.1.1 - B.1.4 p night not to
3
135.00
405.00
405.00
Lodging
exceed nightly rate of $135.00 per night not
including local taxes and fees.
B.6
Administrative costs, Exhibit prep, Clerical work,
25
135.00
3,375.00
3,375.00
Documentation, Report work, Overhead
Security Vulnerability Assessment
Exhibit B
Deliverables and Work Schedule
October 31, 2018
Page 2 of 2
Total Estimated Cost $21,330
Total Cost not to Exceed $23,000
Work Schedule
Complete the work effort and produce the described meeting and documents within 90 days of the
notice to proceed or Jan 31, 2019, whichever comes first.
Security Vulnerability Assessment
Exhibit C
Labor, Fees, Rates and Billing Agreement
October 31, 2018
Page 1 of 1
Task
Description
Rate p H
C1.1
Site visits, interviews, research, initial document preparation under
135.00
Ben Keith dba BenTech
section B deliverables, phone conferences and discussions,
Base Labor Rate
meetings with The City, travel, presentation time, and all products
and services delivered or to be delivered as per Exhibit B. All hourly
billing will be in quarter hour 15 -minute increments, rounded up to
the next quarter hour increment.
C1.2
Ben Keith dba BenTech will submit itemized invoice billings for
Billing
services, product, and costs to the PM on a biweekly based
schedule. Deposit billing will be submitted upon mutual acceptance
of PSA.
C1.3
Billing Terms: ALL submitted and presented bills will be considered
Billing Terms
to be due and payable upon receipt at The City. Said itemized
billing invoices will be delivered by email electronically as
attachments in PDF format to the email address of the City's PM or
agreed upon individual. Production of printed copies if requested
by The City will be billed as a separate line item at the scheduled
fee cost.
C1.4
Upon execution and acceptance by both parties of the PSA,
Deposits for Ordered
BenTech will bill the City for a deposit for startup costs of 33%, or
Work per Ex B
1/3 of the estimated cost of the consultant's work at the agreed
upon amount of $21,300 rounded up to the nearest $100 -dollar
increment.
Security Vulnerability Assessment
Appendix 1
October 24, 2018
• Email Exemption from Public Disclosure
• Identification of Exempt and Non -Exempt Email
• PCII protection for final work product
Security Vulnerability Assessment Exemption from Public Disclosure
City of Bremerton Public Works, Water Resources
Water Resources has retained a security consultant to develop detailed specifications on security at
several facilities. The primary purpose of this work is to prevent, mitigate, and respond to criminal
terrorist acts.
Per RCW 42.56, Public Records, Section 420 Security, the following information relating to security is
exempt from disclosure under this chapter:
(1) Those portions of records assembled, prepared, or maintained to prevent, mitigate, or respond to
criminal terrorist acts, which are acts that significantly disrupt the conduct of government or of the
general civilian population of the state or the United States and that manifest an extreme indifference to
human life, the public disclosure of which would have a substantial likelihood of threatening public
safety, consisting of.•
(a) Specific and unique vulnerability assessments or specific and unique response or deployment plans,
including compiled underlying data collected in preparation of or essential to the assessments, or to the
response or deployment plans; and
(b) Records not subject to public disclosure under federal law that are shared by federal or international
agencies, and information prepared from national security briefings provided to state or local
government officials related to domestic preparedness for acts of terrorism;
Email correspondence will be used to develop the project deliverables. The final product report will be
delivered as Dept. of Homeland Security Protected Critical Infrastructure Information (PCII). PCII
documents are exempt from public disclosure and only authorized users can view or transmit the
information, see https://www.dhs.gov/pcii-program.
For exempt Email include the information in (parentheses s)
Subject: (Exempt from Public Disclosure) Subject
Email Signature:
Exempt from Public Disclosure: This e-mail message and its attachments contain material that is exempt
from public disclosure per RCW 42.56.420, (1)(a) & (b). It is intended solely for the use of the individual
named above. If you are not the intended recipient, or the person responsible to deliver it to the
intended recipient, you are hereby advised that any dissemination, distribution or copying of this
communication is prohibited. If you have received this e-mail in error, please immediately notify the
sender by reply e-mail and delete and/or destroy the original and all copies of the e-mail message.
For non -Exempt Email include the information in (pa renthesespaFens)
Subject: (Public Document)
Email Signature:
This email is subject to public disclosure.
Security Vulnerability Assessment
Appendix 2
October 24, 2018
RCW 42.56 Public Records
Security Vulnerability Assessment
Appendix 3
October 24, 2018
Department of Homeland Security
• PCII Program Fact Sheet
• Penalties for Violations of the PCII Program
t' OYARi',yE
" Homeland Protected Critical Infrastructure
EENO S�"J� Security Information (PCII) Program
OVERVIEW
The Protected Critical Infrastructure Information (PCII) Program, created by Congress under the Critical Infrastructure
Information (CII) Act of 2002 and implemented in the Code of Federal Regulations (6 CFR Part 29), protects CII
voluntarily shared with the Federal Government for homeland security purposes. The vast majority of the Nation's critical
infrastructure is owned and operated by the private sector, thus voluntary collaboration between the private and public
sectors is crucial in its security.
PCII PROGRAM PROTECTIONS
Protects PCII from release through:
• Freedom of Information Act (FOIA) disclosure requests
• State, Local, Tribal or Territorial (SLTT) disclosure laws
• Use in civil litigation
• Use for regulatory purposes
PCII USES
Supports homeland security and its ability to understand and identify:
• Security risks and threats from physical and cyber -attack
• Vulnerabilities and mitigation strategies during special events
• Critical infrastructure security during planning and emergencies
AUTHORIZED USERS OF PCII
Federal, State, Local, Tribal or Territorial government employees and their designated contracted personnel are authorized
access to PCII if they have:
• Completed PCII Authorized User training on the proper handling and safeguarding of PCII
• Homeland security duties and responsibilities
• A valid need -to -know
• Signed a non -disclosure agreement (non -Federal employees only)
SUBMITTERS OF PCII
Examples of organizations who submit CII for PCII protections are:
• Critical infrastructure owners and operators
• State, Local, Tribal or Territorial (SLTT) governments
• Collaborative homeland security working groups
QUALIFICATIONS FOR PCII PROTECTIONS
To qualify for PCII protections, information must be related to the security of the critical infrastructure and a submitter
must attest the CII is:
• Voluntarily submitted
• Not customarily found in the public domain
• Not submitted in lieu of compliance with any regulatory requirement
CONTACT INFORMATION
To learn more about the PCII Program please visit us at www.dhs.gov/PCII or contact the PCII Program Office at PCII-
Assistna,hq.dhs.g_ov. PCII Program Help Desk Phone: 866-844-8163.
July 2018
�y--XK E
°. Homeland
Security
Penalties for Violations of the
Protected Critical Infrastructure
Information (PCII) Program
The Protected Critical Infrastructure Information (PCII) Program, part of the Department
of Homeland Security's (DHS) National Protection and Programs Directorate, is a
congressionally authorized program that protects qualifying information that the private
sector voluntarily submits to the government and that is validated as PCII. The Critical
Infrastructure Information Act of 2002 and 6 Code of Federal Regulations Part 29 protect
PCII from public disclosure and unauthorized use.
What Is a Violation of PCII Procedures?
A violation is any unauthorized disclosure or unauthorized use (i.e., not for homeland
security purposes). Any officer or employee of the United States or of any department or
agency thereof is subject to penalties if they
Source: DHS
• Publish;
• Divulge;
• Disclose; or
• Make protected critical infrastructure information known in any manner or to any extent not authorized by law.
PCII is specially marked and must be safeguarded, both physically and electronically, under specific procedures to avoid
any improper disclosures. All of these protections ensure that submitted information is protected and is used only by
authorized homeland security professionals and used only for homeland security purposes. Individuals granted access to
PCII should:
• Understand access and disclosure requirements.
• Guide their actions to adhere to the highest ethical standards to safeguard PCII.
• Take reasonable steps to ensure that they follow PCII safeguarding policies and procedures.
The Penalties: Criminal and Administrative
Specifically, PCII authorized users at all levels of government, to include contract support personnel, are subject to the
criminal code and to the applicable laws within their jurisdictions.
FederalTitle 18 United States Code Homeland Security Act of 2002 and 6 Code of
• Fined up to $250,000 Disqualification or removal from the PCII Program by
• Imprisoned up to one year the PCII Program Manager for any entity or person who:
• Fined and imprisoned • Violates PCII procedures;
• Removed from office or employement • Uses PCII for an inappropriate purpose; or
• Breaches PCII agreements.
Terminated entities or persons may appeal to the Under
Secretary of the National Protection and Programs
Directorate.
Contact Information
For additional information on penalties for violating PCII Program procedures, please contact the PCII Program Office at
PCII-Assist(dhq. dhs. gov.
January 2017
My DOR
My DOR Unauthenticated Business Lookup KEITH, BENJAMIN
Tax Information
Entity name:
KEITH, BENJAMIN
Entity type:
Sole Proprietor
DBA name:
BENTECH
Excise tax account ID #:
603-596-865
UBI #:
603-596-865
Opened:
April 1, 2016
Closed:
Mailing address:
9852 244TH PL NE
REDMOND WA 98053-8638 USA
NAICS:
541511 - Custom Computer Programming Services
541512 - Computer Systems Design Services
Reseller Perm it(s)
Filter
Reseller permit #
Status Effective date Expiration date
New search Back to results
A37369518 Active Nov -16-2016 Nov -15-2018
Business License Locations Filter
Business name License account ID # Location address
BENTECH 603596865-001-0001 9852 244TH PL NE REDMOND WA 98053-8638
The Business Lookup information is updated nightly.
Search date and time: 11/2/2018 3:36:20 PM
Working together to fund Washington's future
BETWEEN THE CITY OF BREMEWMNANDBENTECH
PROJECT: Security Vullttn erabil.ity . :sscssnncaat
CONSULTANT: BenTech
TE: January 11, 2019
mis CONTRACT M0.1VIFICATION AGREEMENT SPECIFICALLY AMENDS THE
GREE N' (the "Contract") #5883 entered into between the City of Bremerton and
BenTech (in November 01, 2018.
All provisions in the Contract small remain in full force and effect except s pear° sspy aaacadificd
by this &)cur na nzt.
For valuable consideration and by mutual consent of the parties, the modifications to tlr
t",'o tr°act. are as follows:
1.
Section 11. Tai , is modified. as follows:
The Parties agree that the aark described in l xhibit A is to be completed n p ar(I-It 31 0
provided however, that additional time shalt be granted by the City.for excusable delays or extra
tarty as provided .ror in Section IXA ofthe Contract.,
This modifies the original termination date reaj"the Contract, which was (J;anaaxy Sip 2019)m
a
Consultant nmt ccepts all requirements of this Contract Modification by endorsing below
Consultant further agrees that this Contract Modification constitutes full and final
s ttlaame nt of all of the o.usultant's clainnns for contract time and for all costs of any kind,
including ithout l:imit tio.n., costs of delays related tea any oric:. either covered or affected
by this Contract Modification, claims related to on:::::site or home office overhead, or lest
larofiltsm This Contract Modification does not limit the "ity"s right to bring as claim for hast
The ande si tined consultant approves the foregoing Contract c.t odific do as to the changes,
if° any, in the contract price specified for each it nt, inchading anyand all supervision costs
and other miscellaneous costs relating to the chinge in. work, rk, nd as to than extension of time
adlo ed, if any, for completion of the entire work. due to said Contract Modification.
This document will become a sanlaph,, ennt ofthe contract and all: provisions will apply hereto.
It is understood that this Contract Modification shall be effective when approved by the Chy
of:l aremerton.
Pagw I of 2
Contract Madif catiatt
Rev. 07/18
The parties whose names appear below warrant that they are authorized to enter .into a
onfiract modification tbat is bindingas the parties of this contract. Ism addition, Consultant
warrants that it Itas arwill inform the surety of this change, and shall tame appropriate action,
to modif
y any bands required under the contract to address this an .
IN WITNESS . RE(, -)F, the its have executed. this Contract Modification on the iday
and year first written aba e.
CONSULT
Print "ar� amp:i Keith
Its: Principle. _
at�"a�.._�m�"m.
APPROVED ' " ET S TO i*"O
r m
BY: �
R001.��ii1, . �n s � ,
RAI gz1V.epahFoaunprT01 . S ON r0Bid E,'VCa;ttntrBc;t Mbdificafl n. ;ev, 07 201R.do
Page 2 of 2
Contract Mortification
Rev. 07/18
THE CITY OF RE MERTON
Br -
Print, i ac ha martin
Iii- Piablic Works & Utilities 13irector
(A�
By; -_.. a ._ :
GEL � Vii & C5-t,'y ieri