Company Form 57 for Lake County Indiana

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LAKE COUNTY FORM 57: July 1, 2020

County Form 57 - NON EMERGENCY REPAIRS LESS THAN $5,000

CONTRACT #___________________

NON EMERGENCY REPAIRS LESS THAN $5,000

PROJECT NAME: _____________________

This CONTRACT is entered into by ___________________ (“Contractor”) and the Lake County Board of Commissioners, (“Board”).

I. PUBLIC WORK PURCHASING METHOD

The purchasing authority is identified by an “x” below:

Method Code

Statute

Brief Description

▢ PW 8

IC 36-1-12-4.9

Public Work less than $2,500 for which a minimum of one quote is needed

▢ PW 9

IC 36-1-12-4.9

Public Work $2,500 But less than $5,000 for which a minimum of two quotes are needed

II. CONTRACT PRICE The total contract price is ________________________ Dollars and No Cents ($ ) payable from the ______________________ budget.

III. CONTACT PERSONS: The Board’s representative is ______________ and the Contractor’s representative is __________________________.

IV. START DATE: The date the contract is signed, and the purchase order is issued.

V. SCOPE OF WORK INCLUDES: The plans and specifications and quotes submitted.

VI. IN CORPORATION BY REFERENCE: All of the terms contained in Indiana Statutes for public works applicable to this scope of work are incorporated by reference.

VII. Worker’s Compensation Insurance.

a. ▢ The Contractor shall carry Worker’s Compensation Insurance on its employees and require that there be carried Worker’s Compensation Insurance for all the employees and its subcontractors consistent with IC 22- 3 and/or any subsequently enacted applicable statute.

b. ▢ The Worker’s Compensation Insurance shall be effective for acts occurring during the entire life of this contract.

VIII. Public Liability and Property Damage Insurance.

a. The Contractor shall carry public liability and property damage insurance in amounts as outlined below by the “x”:

▢ Seven hundred thousand dollars ($700,000) for the death or injury to one (1) person in anyone (1) occurrence and five million dollars ($5,000,000) for injury to or death of all persons in the occurrence as required by IC 34-13-3-4

▢ provide public liability and property damage insurance in the amount of One Million Dollars ($1,000,000) for each occurrence and Two Million Dollars ($2,000,000) in the general aggregate.

b. The Board, Lake Board offices and their elected officials, Lake Board Departments, and Lake Board employees shall be named as an additional insured and be fully protected.

SIGNED:

_______________________________________________________________

COMPANY NAME

_______________________________________________________________

COMPANY REPRESENTATIVE SIGNATURE

The parties hereto have caused this Contract consisting of two (2) pages to be executed on the _______day of __________________________, 20____.

LAKE COUNTY BOARD OF COMMISSIONERS

_________________________________________________________

FINANCIAL CONSULTANT