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• <br /> 4 <br /> Consultant/Address/Telephone <br /> Local Agency <br /> Standard Consultant <br /> Agreement <br /> ®Architectural/Engineering Agreement <br /> ❑ Personal Services Agreement <br /> Agreement Number <br /> Project Title And Work Description <br /> Federal Aid Number On-Call Surveying Services <br /> Agreement Type(Choose one) <br /> ❑ Lump Sum <br /> Lump Sum Amount $ <br /> ❑ Cost Plus Fixed Fee <br /> Overhead Progress Payment Rate <br /> Overhead Cost Method DBE Participation <br /> ❑ Actual Cost ❑ Yes ® No <br /> Federal ID Number or Social Security Number <br /> ❑ Actual Cost Not To Exceed % <br /> N/A <br /> ❑ Fixed Overhead Rate % Do you require a 1099 for IRS? Completion Date <br /> Fixed Fee $ ❑Yes ® No January 31, 2012 <br /> ® Specific Rates Of Pay Total Amount Authorized $ 230,000.00 <br /> ® Negotiated Hourly Rate <br /> Management Reserve Fund $ 20,000.00 <br /> ❑ Provisional Hourly Rate <br /> ❑ Cost Per Unit of Work Maximum Amount Payable$ 250,000.00 <br /> Index of Exhibits (Check all that apply): <br /> ®Exhibit A-1 Scope of Work ❑ Exhibit G-2 Fee-Sub Specific Rates <br /> ®Exhibit A-2 Task Order Agreement ❑ Exhibit G-3 Sub Overhead Cost <br /> ❑Exhibit B-1 DBE Utilization Certification ® Exhibit H Title VI Assurances <br /> ® Exhibit C Electronic Exchange of Data ® Exhibit I Payment Upon Termination of Agreement <br /> ❑Exhibit D-1 Payment-Lump Sum ® Exhibit J Alleged Consultant Design Error Procedures <br /> ❑Exhibit D-2 Payment-Cost Plus 0 Exhibit K Consultant Claim Procedures <br /> ®Exhibit D-3 Payment-Hourly Rate ❑Exhibit L Liability Insurance Increase <br /> ❑Exhibit D-4 Payment-Provisional ® Exhibit M-la Consultant Certification <br /> ❑Exhibit E-1 Fee-Lump/Fixed/Unit ® Exhibit M-lb Agency Official Certification <br /> ®Exhibit E-2 Fee-Specific Rates ® Exhibit M-2 Certification-Primary <br /> ® Exhibit F Overhead Cost ®.Exhibit M-3 Lobbying Certification <br /> Exhibit G Subcontracted Work El Exhibit M-4 Pricing Data Certification <br /> ❑Exhibit G-1 Subconsultant Fee ❑ App.31.910 Supplemental Signature Page <br /> THIS AGREEMENT,made and entered into this day of , 2009 , <br /> between the Local Agency of City of Everett ,Washington,hereinafter called the"AGENCY", <br /> and the above organization hereinafter called the"CONSULTANT". <br /> 14 <br /> DOT Form 140-089 EF Page 1 of 8 <br /> Revised 3/2008 <br />