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25 <br /> Consultant/Address/Telephone <br /> Local Agency <br /> Standard Consultant <br /> Agreement <br /> ®Architectural/Engineering Agreement <br /> ❑ Personal Services Agreement <br /> Agreement Number <br /> OCSS12 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 /> CI Cost El Yes ® No <br /> Federal ID Number or Social Security Number <br /> ❑Actual Cost Not To Exceed ok <br /> ❑ Fixed Overhead Rate % Do you require a 1099 for IRS? Completion Date <br /> Fixed Fee $ El Yes ® No January 31, 2014 <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 ® 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-1a 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 ❑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 2012 <br /> between the Local Agency of City of Everett ,Washington,hereinafter called the"AGENCY", <br /> and the above organization hereinafter called the"CONSULTANT". <br /> DOT Form 140-089 EF Page 1 of 8 <br /> Revised 3/2008 r� <br /> 222 <br />