BOARD OF COUNTY COMMISSIONERS AGENDA THURSDAY, JUNE 11, 2015, 9:00A.M.

COMMISSION CHAMBERS, ROOM B-11 I. PROCLAMATIONS/PRESENTATIONS

1. Presentation on the "Prepare Kansas Program"-Cindy Evans, Extension.

II. UNFINISHED BUSINESS

1. Consider approval of request for authorization to negotiate services with CBIZ for a compensation study at a cost of$63,400.00---Human Resources.

III. CONSENT AGENDA

I. Consider acceptance ofthe May 2015 bank reconciltation statement-Treasurer.

2. Acknowledge receipt and consider approval of the Centers for Medicaid and Medicare (CMS) 855B Medicare Revalidation application-Health Agency.

IV. NEW BUSINESS

A. COUNTY CLERK- Cynthia Beck

1. Consider all voucher payments.

2. Consider correction orders.

B. PARKS AND RECREATION- John E. Knight

I. Consider authorization and execution of Contract C219-2015 with Bums and McDonnell to provide design services for the development of vegetative mats that will be used to improve water quality at Lake Shawnee at a cost of $3,200.00 with $3,000.00 covered by a grant and $200.00 covered by the Parks and Recreation operating budget.

2. Consider authorization and execution of Contract C220-2015 with Rod Peterson to provide music on September 20th, 2015 for the Friends of the Ted Ensley Garden group for a fee of$300.00.

3. Consider approval of new organizational structure changes within the Parks and Recreation department.

V. ADMINISTRATIVE COMMUNICATIONS

VI. EXECUTIVE SESSIONS

Shawnee County DEPARTMENTOFHUMANRESOURCES

Shawnee County Courthouse 200 SE 7th Street, Ste. B-28 Topeka, Kansas 66603-3932

Phone: (785) 251-4435 james. crowl@snco. us

MEMORANDUM

TO: Board of Shawnee County Commissioners

FROM: James M. Crowl, Interim Human Resources Director

DATE: June 3, 2015

RE: Request to negotiate services with CBIZ for a Compensation Study

Please place this item on the Monday, June 8, 2015 Commission agenda.

On May 18, 2015 the Board of County Commissioners authorized the issuance of a Request for . Proposals for a Compensation Study. The proposal submission deadline was June 2, 2015. Per Resolution 2014-1, Betty Greiner and I reviewed the proposals. We chose the proposal submitted by CBIZ as the most complete and responsive to the proposal specifications. Furthermore, CBIZ does have experience performing similar services for Kansas municipalities and can complete the project in time to provide information prior to the budget submission deadline for 2016.

CBIZ has proposed to perform the requested Compensation Study at a cost of $63,400.00. I request your authority to negotiate a contract with CBIZ to provide the services offered in its proposal at the proposed contract price.

If you have any questions, please do not hesitate to contact me at extension 4439.

c: Betty Greiner, Audit-Finance Director, Shawnee County

DATE:

TO:

FROM:

CC:

RE:

Shawnee County Office of County Treasurer

Room 101, Courthouse, Topeka, Kansas66603 Phone 785-233-8200 Ext. 5161

http://www.snco.us

LARRYMAH COUNTY TREASURER

MEMORANDUM

June 3, 2015

Shawnee County Board of Commissioners

Larry Mah, Shawnee County Treasure~

Lorna McPhail, Deputy Financial Administrator

May 2015 Bank Reconciliation

Please place this request on the Monday, June 8, 2015 Board of County Commission Consent agenda for final approval of the May 2015 bank reconciliation report. This bank reconciliation report has been reviewed and approved by the Deputy Financial Administrator.

Thank you for your time and consideration.

May 2015 Bank Reconciliation

Ending balance Per IFAS

Reconciling Items

Less:

Credit cards (posted to bank June 1, 2015)

Deposit in Transit (posted to bank June 1, 2015)

NSF check (posted to IF AS June 2, 2015)

Add:

Outstanding checks as of 05/31/2015

Credit Card payments (posted to IFAS in June 2015)

ACH Credit-WPS payments (SCHA) (posted to IFAS June 1, 2015)

ACH Credit-Palmetto payment {SCHA) (not posted in IFAS)

ACH Credit-UHG Community PL-HCCiaim Payments (SCHA) (posted to IFAS June 1, 2015)

ACH Credit- Amerigroup payments{SCHA) (posted to IF AS June 1, 2015)

ACH Credit-Ks Solutions payment {SCHA) (not posted to IFAS)

ACH Credit-St of Ks Smart payment {SCHA) (posted to IFAS June 1, 2015)

ACH Credit-Wisconsin Physician payment {SCHA) (posted to IFAS June 1, 2015)

ACH Credit-Lake Shawnee Golf (P&R) (posted to IFAS June 1, 2015)

Extra deposit (P & R) (posted to IFAS June 1, 2015)

ACH Credit-IRS payment (ROD) (posted to IFAS June 2, 2015)

IFAS issue in May 2015

Adjusted ending balance

Vault cash

Ending balance per UMB Bank

Difference

Prepared by: tjt Shawnee Co. Treasurer's Office 06/02/2015

$ 187,055,313.56

$ 187,055,313.56

$ $ $ $

$ $ $ $ $ $ $ $ $ $ $ $ $ $

$

$

$

31,684.63

200,644.05

88.52

232,417.20

1,228,011.47

4,590.98

115.62

84.11

1,284.51

4,647.09

284.64

246.18

1,070.37

31,794.52

5,541.31

69.00

0.01

1,277,739.81

188,100,636.17

4,000.00

188,096,636.17 188,100,636.17

June 8, 2015

TO:

FROM:

RE:

Shawnee County Health Agency

Board of Commissioners Shawnee County

Alice Weingartner~ Director, Community Health Center

-=:itt -o't

Leading the Way to a Healthier Shawnee County

CONSENT AGENDA- Acknowledge Signature on forms to complete Medicare Revalidation Application

Action Requested: Acknowledgement of Chairman Cook's signature on June 4, 2015 on forms submitted to complete the Centers for Medicaid and Medicare (CMS) 855B Medicare Revalidation application for the Shawnee County Health Agency.

AW/tnjc Encl.

1615 SW 8th Topeka, KS 66606 I 785.251.2000 www .shawnee he a lth.org

June 2, 2015

WPS Medicare

Shawnee County Health Agency 1615 SW 81

h Avenue- Topeka, KS 66606-1633 Ph. (785) 368-2000 Fax (785) 368-2098

www.shawneehealth.org

Alice Weingartner, Director Community Health Center Allison Alejos, Director Local Health Department

Medicare Provider Enrollment PO Box 8310 Omaha, NE 68108

RE: Shawnee County Health Agency 1615 SW 81

h Ave. Topeka, KS 66606-1633 PTAN: 110395 CONTROL NUMBER: 1396940

Dear Kimberly:

Enclosed you will find revisions to our CMS 855B form for the Shawnee County Health Agency, PTAN: II 0395. I have also included a copy of revision request letter.

Please feel free to contact me if you have any questions.

Sincerely,

~/~~ L();U~~vJ(r_e/'0 Alice Weingartner Community Health Center Director

Enclosures

AVW/kjo

Leading the way to a healthier Shawnee County.

CMS CENTERS FOR MEDICARE & MEDICAID SERVICES

May 20,2015

Attention: Kathy Ortega Shawnee County 1615 SW gth Avenue Topeka, KS 66606-1633

Control Number: 1396940 Contract: J5-855B

Dear Mr. Cook:

Medicare

We have received your revalidated Medicare enrollment application. Failure to submit a complete revalidation enrollment application(s) and all supporiing documentation within 30 days will result in deactivation of your Medicare billing privileges. In order to complete processing your application, please make the following revisions and/or supply the requested suppotiing documentation.

_Section 6A and 6B for Carolyn Albott who is currently on file as Director/Officer and Managing Employee,

_Section 6A and 6B for Maria Valdivia-Trinidad who is currently on file as Director/Officer

Certification Statement: You must also include a newly-completed and dated CMS 855B Certification Statement, PAGES 32 AND 33, with your return of this information.

The following required document(s) was not submitted:

_ CMS 588 -Part III- Enclose a preprinted voided check. (Starter checks and Deposit slips are not accepted) If this is not available to you- a current confirmation of account information (account name, Legal Business Name, Doing Business As name- if applicable, routing number, and account number) on bank letterhead that is signed by a bank employee for verification of your account is acceptable. This information may be faxed to 608-224-3514.

_Copy of business occupancy license/permit if one is required for any of your practice locations; otherwise, just include a signed & dated statement that indicates a business license is not needed.

Please make the following corrections to the CMS 588 EFT form:

_Part II: Please correct the Legal Business Name to match the Tax Document.

WPS. HEALTH INSURANCE

VVisconsin Physicians Service Insurance Corporation serving as a CMS Medicare Contractor P.O. Box 1787 • Madison, WI 53701 • Phone 608-221-4711

_Part V: Please submit a newly signed and dated signature section.

*** All the above listed corrections may be faxed back to 608-224-3514. ***

Please submit the requested revisions and/or supporting documentation within 30 days of the postmarked date of this letter to the address listed below:

Regular Mail Wisconsin Physicians Service Medicare Provider Enrollment PO Box 8248 Madison, WI 53708-8248

Overnight Delivery Mailing Address Wisconsin Physicians Service Medicare Provider Enrollment 1717 W. Broadway Madison, WI 53713-1834

Finally, please attach a copy of this letter with your revised application. If you have any questions, please contact our office at 866-518-3285 between the hours of7:00 AM and 5:00PM Central Time. You may also contact me at 608-301-2721 or by fax at 608-224-3514.

Sincerely,

Kimberly Morton Provider Enrollment Analyst Wisconsin Physicians Service

SECTION 6: OWNERSHIP INTEREST AND/OR MANAGING CONTROL INFORMATION {INDIVIDUALS) (Continued)

A. Individuals with Ownership Interest and/or Managing Control-Identification Information If you are changing, adding, or deleting information, check the applicable box, furnish the effective date, and complete the appropriate fields in this section.

CHECK ONE OCHANGE DADO (2g DELETE

DATE (mmlddtywrJ 03/24/2011

The name, date of birth, and social security number of each person listed in this Section must coincide with the individual's information as listed with the Social Security Administration.

First Name Middle Initial Last Name Jr., Sr., etc. Title

Carolyn Alb ott

Date of Birth (mm!dd!yyyy) Place of Birth (State) Country of Birth

Social Security Number (Required) Medicare Identification Number (if issued) NPI (if issued)

What is the above individual's relationship with the supplier in Section 281? (Check all that apply.)

D 5 Percent or Greater Direct/Indirect Owner D Authorized Official 0 Delegated Official D Partner

[81 Director/Officer D Contracted Managing Employee [81 Managing Employee (W-2)

What is the effective date this owner acquired ownership of the provider identified in Section 2B 1 of this

application? (mmlddlyyyy) --------------

What is the effective date this individual acquired managing control of the provider identified in Section 2B 1 of this application? (mmlddlyyyy) --------------

NOTE: Furnish both dates if applicable.

CMS-8558 (07111) 25

SECTION 6: OWNERSHIP INTEREST AND/OR MANAGING CONTROL INFORMATION (INDIVIDUALS) (Continued)

B. Final Adverse Legal Action History Complete this section for the individual reported in Section 6A above. If reporting a change to existing information, check "change," provide the effective date of the change and complete the appropriate fields in this section.

D Change Effective Date: -------------------

1. Has this individual in Section 6A above, under any current or former name or business identity, ever had a final adverse legal action listed on page 13 of this application imposed against him/her?

DYES-Continue Below I1Sl NO-Skip to Section 8

2. If YES, report each final adverse legal action, when it occurred, the Federal or State agency or the court/administrative body that imposed the action, and the resolution, if any.

Attach a copy of the final adverse legal action documentation and resolution.

FINAL ADVERSE LEGAL ACTION DATE TAKEN BY RESOLUTION

CMS-8558 (07/11) 26

SECTION 6: OWNERSHIP INTEREST AND/OR MANAGING CONTROL INFORMATION (INDIVIDUALS) (Continued)

A. Individuals with Ownership Interest and/or Managing Control-Identification Information If you are changing, adding, or deleting information, check the applicable box, furnish the effective date, and complete the appropriate fields in this section.

CHECK ONE OCHANGE DADO 1&1 DELETE

DATE (mmtddlyyyyJ 04/01/2013

The name, date of birth, and social security number of each person listed in this Section must coincide with the individual's information as listed with the Social Security Administration.

First Name Middle Initial Last Name Jr., Sr., etc. Title

Maria Valdivia-Trinidad

Date of Birth (mmlddiYYW) Place of Birth (State) Country of Birth

Durango Mexico

Social Security Number (Required) Medicare Identification Number (if issued) NPI (if issued)

What is the above individual's relationship with the supplier in Section 281? (Check all that apply.)

D 5 Percent or Greater Direct/Indirect Owner

D Authorized Official

0 Delegated Official D Partner

[BI Director/Officer

0 Contracted Managing Employee

0 Managing Employee (W-2)

What is the effective date this owner acquired ownership of the provider identified in Section 2B 1 of this

application? (mmldd!yyyy) --------------

What is the effective date this individual acquired managing control of the provider identified in Section 2B 1 of this application? (mmldd!yyyy) --------------

NOTE: Furnish both dates if applicable.

CMS-8558 (07/11) 25

SECTION 6: OWNERSHIP INTEREST AND/OR MANAGING CONTROL INFORMATION (INDIVIDUALS) (Continued)

B. Final Adverse Legal Action History Complete this section for the individual reported in Section 6A above. If reporting a change to existing information, check "change," provide the effective date of the change and complete the appropriate fields in this section.

D Change Effective Date: _________ _

1. Has this individual in Section 6A above, under any current or former name or business identity, ever had a final adverse legal action listed on page 13 of this application imposed against him/her?

DYES-Continue Below rl9 NO-Skip to Section 8

2. If YES, report each final adverse legal action, when it occurred, the Federal or State agency or the court/administrative body that imposed the action, and the resolution, if any.

Attach a copy of the final adverse legal action documentation ·and resolution.

FINAL ADVERSE LEGAL ACTION DATE TAKEN BY RESOLUTION

CMS-8558 (07/11) 26

DEPARTMENT OF HEALTH AND HUMAN SERVICES Form Approved CENTERS FOR MEDICARE & MEDICAID SERVICES OMB No. 0938-0626

ELECTRONIC FUNDS TRANSFER (EFT) AUTHORIZATION AGREEMENT

PART 1: REASON FOR SUBMISSION

Reason for Submission:

D New EFT Enrollment D Check here if EFT payment is being made to

D Change to Current EFT Enrollment the Home Office of Chain

(e.g. account or bank changes) (Attach letter Authorizing EFT payment to

D Cancel EFT Enrollment Chain Home Office)

Since your last EFT authorization agreement submission, have you had a:

D Change of Ownership, and/or

D Change of Practice Location? If you checked either a change of ownership or change of practice location above, you must submit a change of information (using the Medicare enrollment application) to the Medicare contractor that services your geographical area(s} prior to or accompanying this EFT authorization agreement submission.

PART II: ACCOUNT HOLDER INFORMATION Provider/Supplier/Indirect Payment Procedure (IPP) Biller Legal Business Name

Shawnee County

Chain Organization Name or Home Office Legal Business Name (if different from Chain Organization Name)

Shawnee County Health Agency Account Holder's Practice Location Street Address

1615 SW 8th Avenue Account Holder's Practice Location City l Account Holder's Practice Location State I Account Holder's Practice Location Zip Code

Topeka KS 66606-1633

Tax Identification Number (designate D SSN or~ EIN) Medicare Identification Number (if issued)

0[IJ[J[I]@][I][IJ[IJ0[]]00 DJDJ@J@J~[[]DDDDDD Health Plan Identifier (HPID) or Other Entity identifier (OEID) (IPP Entities Only)

DDDDDDDDDD National Provider Identifier (NPI) National Provider Identifier (NPI) National Provider Identifier (NPI)

ITJ[§][§J[]]~[:±]OJ~[l][§J DDDDDDDDDD DDDDDDDDDD PART Ill: FINANCIAL INSTITUTION INFORMATION Financial Institution's Name

UMB Bank

Financial Institution's Street Address

5923 SW 29th Street

Financial Institution's City/Town Financial Institution's State/Province I Financial Institution's Zip/Postal Code Topeka KS 66614

Financial Institution's Telephone Number Financial Institution's Contact Person

(785) 273-9494 Becky Herl

Financial Institution Routing Number

OJ[QJITJ[QJ@J[QJ[I)[]]~ Provider's/Supplier's/IPP Entity's Account Number with Financial Institution Type of Account (check one)

wwmruwwwwmmooo ~ Checking Account D Savings Account

Please include a confirmation of account information on bank letterhead or a voided check. When submitting the documentation, it should contain the name on the account, electronic routing transit number, account number and type. If submitting bank letterhead, the bank officer's name and signature is also required. This information will be used to verify your account number.

PlEASE NOTE: In accordance with section 1104 of the Affordable Care Act, enrollment of electronic fund transfer (EFT) is for electronic fund transfer authorization only. EFT enrollment does not constitute enrollment as a . . . . provider or supplrer m the Medicare program.

Form CMS-588 (09/13)

PART IV: CONTACT PERSON Contact Person's Name

Kathy Ortega Contact Person's Telephone Number

(785) 251-2469

PART V: AUTHORIZATION

Contact Person's Title

Business Office Manager

Contact Person's E-mail Address

kathy.ortega@snco. us

I hereby authorize the Centers for Medicare & Medicaid Services (CMS) to initiate credit entries, and in accordance with 31 CFR part 210.6(f) initiate adjustments for any duplicate or erroneous entries made in error to the account indicated above. I hereby authorize the financial institution/bank named above to credit and/or debit the same to such account. CMS may assign its rights and obligations· under this agreement to CMS' designated fee-for-service contractor. CMS may change its designated contractor at CMS' discretion.

If payment is being made to an account controlled by a Chain Home Office, the Provider of Services hereby acknowledges that payment to the Chain Office under these circumstances is still considered payment to the Provider, and the Provider authorizes the forwarding of Medicare payments to the Chain Home Office.

If the account is drawn in the Physician's or Individual Practitioner's Name, or the Legal Business Name of the Provider/Supplier or IPP entity, the said Provider/Supplier or IPP entity certifies that he/she has sole control of the account referenced above, and certifies that all arrangements between the Financial Institution and the said Provider/Supplier or IPP entity are in accordance with all applicable Medicare regulations and instructions.

This authorization agreement is effective as of the signature date below and is to remain in full force and effect until CMS has received written notification from me of its termination in such time and such manner as to afford CMS and the Financial Institution a reasonable opportunity to act on it. CMS will continue to send the direct deposit to the Financial Institution indicated above until notified by me that I wish to change the Financial Institution receiving the direct deposit. If my Financial Institution information changes, I agree to submit to CMS an updated EFT Authorization Agreement.

SIGNATURE LINE Authorized/Delegated Official Name (Print)

Alice Weingartner

Authorized/Delegated Official Title

Director

Authorized/Delegated Official Telephone Number

(785) 251-2039

Authorized/Delegated Official E-mail Address

alice. wei ngartner@snco. us

Authorized!D7Jegited Official Signature (Note: Must·be o~iginal signature in black or blue ink.).

c f!Zt-·t i L-1 L!v~ f'-f4:·~'4-f~;'L PRIVACY ACT ADVISORY STATEMENT

Sections 1842, 1862(b) and 1874 of title XVIII of the Social Security Act authorize the collection of this information. The purpose of collecting this information is to authorize electronic funds transfers.

Per 42 CFR 424.510(e)(1), providers and suppliers are required to receive electronic funds transfer (EFT) at the time of enrollment, revalidation, change of Medicare contractors or submission of an enrollment change request; and (2) submit the CMS-588 form to receive Medicare payment via electronic funds transfer.

The information collected will be entered into system No. 09-70-0501, titled "Carrier Medicare Claims Records," and No. 09-70-0503, titled "Intermediary Medicare Claims Records" published in the Federal Register Privacy Act Issuances, 1991 Comp. Vol. 1, pages 419 and 424, or as updated and republished. Disclosures of information from this system can be found in this notice.

You should be aware that P.L. 100-503, the Computer Matching and Privacy Protection Act of 1988, permits the government, under certain circumstances, to verify the information you provide by way of computer matches.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-0626. The time required to complete this information collection is estimated to average 60 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, Attn: PRA Reports Clearance Officer, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.

DO NOT MAIL THIS FORM TO THIS ADDRESS. MAILING YOUR APPLICATION TO THIS. ADDRESS WILL SIGNIFICANTLY DELAY PROCESSING.

Form CMS·SBB {09/13) 2

INSTRUCTIONS FOR COMPLETING THE EFT AUTHORIZATION AGREEMENT

All EFT requests are subject to a 15-day pre-certification period in which all accounts are verified by the qualifying financial institution before any Medicare direct deposits are made.

PART 1: REASON FOR SUBMISSION Indicate your reason for completing this form by checking the appropriate box: New EFT enrollment, change to your EFT enrollment account information, or cancellation of your EFT enrollment. If you are authorizing EFT payments to the home office of a chain organization of which you are a member, you must attach a letter authorizing the contractor to make payment due the provider of service to the account maintained by the home office of the chain organization. The letter must be signed by an authorized official of the provider of service and an authorized official of the chain home office.

PART II: ACCOUNT HOLDER INFORMATION Line 1: Enter the provider's/supplier's/indirect payment procedure (IPP) biller's legal business name or the name of the

physician or individual practitioner, as reported to the Internal Revenue Service (IRS). The account to which EFT payments made must exclusively bear the name of the physician or individual practitioner, or the legal business name of the person or entity enrolled with Medicare. NOTE: Providers/suppliers/IPP billers must report the legal business name provided on the IRS CP-575 form.

Line 2: Enter the chain organization's name or the home office legal business name if different from the chain organization name. NOTE: Providers/suppliers/IPP billers must report the legal business name provided on the IRS CP-575 form.

Line 3: Enter the account holder's practice location street address.

Line 4: Enter the account holder's practice location city, state, and zip code.

Line 5: Enter the tax identification number as reported to the IRS. If the business is a corporation, provide the Federal employer identification number, otherwise provide your Social Security Number. If issued, enter the Medicare identification number assigned by a Medicare fee-for-service contractor. If you are not enrolled in Medicare, leave this field blank.

Line 6: IPP billers, enter the HPID or OEID assigned by CMS.

Line 7: Enter the 10 digit NPI number(s). The NPI is required to process this form. NOTE: Institutional providers enter only ONE NPI.

PART Ill: FINANCIAL INSTITUTION INFORMATION Line 8: Enter your Financial Institution's name (this is the name of the bank or qualifying depository that will receive the

funds). Note: The account name to which EFT payments will be paid is to the name submitted on Part II of this form.

Line 9: Enter the financial institution's street address.

Line 10: Enter the financial institution's city or town, state or province, and zip/postal code.

Line 11: Enter the bank or financial institutional telephone number and contact person's name.

Line 12: Enter the bank or financial institutional nine-digit routing number, including applicable leading zeros.

Line 13: Enter the provider's/supplier's/IPP entity's account number with the financial institution, including applicable leading zeros. Select the account type.

If you do not submit this information, your EFT authorization agreement will be returned without further processing.

PART IV: CONTACT PERSON Line 14: Enter the name and title of a contact person who can answer questions about the information submitted on this

CMS-588 form.

Line 15: Enter the contact person's telephone number. Enter the contact person's e-mail address.

PART V: AUTHORIZATION Line 16: By your signature on this form you are certifying that the account is drawn in the Name of the Physician or Individual

Practitioner, or the Legal Business Name of the person or entity. The person or entity has sole control of the account to which EFT deposits are made in accordance with all applicable Medicare regulations and instructions. All arrangements between the Financial Institution and the said person or entity are in accordance with all applicable Medicare regulations and instructions with the effective date of the EFT authorization. You must notify CMS regarding any changes in the account in suffiCient time to allow the contractor and the Financial Institution to act on the changes.

The EFT authorization form must be signed and dated by the same Authorized Representative or a Delegated Official named on the CMS-855 Medicare enrollment application which the Medicare contractor has on file. Include a telephone number where the Authorized Representative or Delegated Official can be contacted.

Mail this form with the original signature in black or blue ink (no facsimile signatures can be accepted) to the Medicare contractor that services your geographical area. An EFT authorization form must be submitted for each Medicare contractor to whom you submit claims for Medicare payment. To locate the mailing address for your fee-for-service contractor, go to: www.cms.gov/MedicareProviderSupEnroll.

Form CMS-588 Instructions (09/13) 3

May 27, 2015

RE:Shawnee County

Shawnee County Health Agency

To Whom It May Concern:

This is to verify the checking account information for the ACH, Debit and Credit entries for

Shawnee County.

Bank Routing Number: 101000695

Checking Account Number:

Please contact Shawnee County or UMB Bank with any questions.

Sincerely,

·~LythS Becky Her!

Vice President

UMB Bank

5923 SW 29th Street Topeka, l<ansas 6661 ~

785.273.9494 785.273.9496 Fax

umb.com

Member FDIC

CERTIFICATE OF OCCUPANCY City of Topeka

Development Services Division

This Certificate issued pursuant to the requirements of Section I I 0 of the 2006 International Building Code

certifying that at the time of issuance, this structure was in compliance with the various ordinances of the City

regulating building construction or use for the following:

Permit No: BLOC 2009300157

Group: B

Use: PROFESSIONAL

Design Occupant Load: 91

Sprinkler: NO NOT REQUIRED

Building Address: 21 15 SW lOTH AVE

Construction Type: V-B

locality: INT ALT- SHAWNEE COUNTY HEALTH

CLINIC

Owner of Building: BOARD OF COUNTY COMMISSIONERS OF SHAWNEE COUNTY KS 200 SE 7TH STREET ROOM I 00

Conditions: TOPEKA, KS 66603

PROIR. to alterations in use or construction within the existing basement, review and approval by the City ofT opeka - Development Services and Fire

Prevention Divisions shall be required.

~ilJc.. (""- -- -.~/V'--= .Miriam Berke D~, Develoomentsernces____ - · · ·

,/·

f -~~- . "-'-"--'~- .. ~~-~-z:::::.=::...o~.-z--===-~=-..:::=z=.c--.:::::::::.::.::-.,..>,~~~--,-...,.~-:-=~::--=-.=:c.:;:;:":::-_,:::_;:-::::-.::::·.:.~~~-=~"'~=-::;::=-c:::===-~- --.- ·-·- . _:_,__ .. r·j 1 · I

~ 4:::0

:".. CERTIFICATE OF OCCUPANCY II :j ~: ~~~ : ~ City of Topeka I; ,, ll"£1 "l '

ll ·~· Development Services Division II

~1:1 This Certificate issued pursuant to the requirements of Section I I 0 of the 2006 International Building Code li I 1,1 ~j certifying that at the time of issuance, this structure was in compliance with the various ordinances of the City f

~J regulating building construction or use for the following: J,

~ ~

~[, Pennit No: BLDC 2010300144 Construction Type: V-B l! i Group: B Locality: SNCO H.EAL TH CENTER~ EAST l,

I I I ' (~ Use: PROFESSIONAL ~~-W . t:j Design Occupant Load: 135 I! f~ Sprinkler: NO NOT REQUIRED J1

~ 1.1 ~J Building Address: 2025 SE CALIFORNIA AVE i. ~1 I~ ~ Owner of Building: BOARD OF COUNTY COMMISSIONERS ! f

·~J 200 SE 7TH ST RM I 00 i ~ . I

11 C d" . TOPEKA. KS 666030000 1 t-: on 1t10ns: I!

l;j 1: -~ ·l ~ ;

I j •:j !r q il t., I •

r~ 11 ~:, II ~ ' H !I I'' i'l

~~ ileL. 2 i! t • • · I' ~ ~ · . ./ w--~ Date: .J~tf:-u 1! ~-· Miriam Berke Director, Development Services RICHARD WORDEN Building Inspector i j r." ,.; t.J '1 r i ~ ij ~~· o··· '-~ ···. .... .. .......... """''~· ·~·'· ·· .. ·""'" ·' • · · .·· ·· ., ... · ·.C .. -.c ... :._.::: __ , .. 'O,.-" c.''·,,,_., ••- "=~:,:',.'""'""'"'""""''·""".;.:...:C:!_"~·""--:::::c::::.c:.'-';..:"-'--=::::.=::::::::;':;:.--=.:r~=. ......... ".::S'Z.::::,===c:::.:, ..... _.!;'c'-~~.,.J ..

CITY OF TOPEKA

May 29, 2015

Development Services 620 SE Madison Unit 6 Topeka, KS 66607-1118 Tel: (785) 368-3905 #3 www.topeka.org

Shawnee County Health Agency 1615 SW 8th Ave Topeka, KS 666064

Richard Faulkner, Manager Email: rfaulkner@topeka.org Fax: (785) 368-3915

RE: Certificate of Occupancy- Shawnee County Health Agency 1615 SW 81h Ave

To whom it may concern:

Pursuant to your request, the City of Topeka Development Services Division has reviewed the records on the above referenced property. The records on this property are limited for the time period it was constructed and there have been no major renovations requiring a certificate of occupancy since that time.

No Certificates of Occupancy were found for this project. Despite the absence in the City's record of a formal Certificate of Occupancy for this building, the City will not seek to block the occupancy of this building or order current occupants of this building to vacate the building solely on the basis of the absence in the City's record of a Certificate of Occupancy.

If you have any questions, please do not hesitate to contact me. 785-368-1615

David 8 Lundry Manager, Field Services Development Services Division

,. mrrtiftratt of Ql)rrupnury OlitlJ nf 'IDop.elm, ~ansas

irpurtmrnt nf 1Suil~iug 1JnapPrtinn

.-

This Certificctte issued pursuant to the requirements of Section 306 of the Uniform Building

Code certifying thctt at the time of issuance this structure was in compliance with the 11arious

ordinances of the City regulctting building cons~mction or use. For the following:

COMMUNITY CENTER-CLINIC Usc:ClassificationMATERNITY .& INFANT CARE-CENTRAL PARK CO!:VJ\.1g.Cf:2l~itNo. 1991060532

B-2 . Il-l HR . Group Type Constructron Ftrc Zone Use Zone _______ _

Owner of Building CITY OF TOPEKA

Building Address 15 34· SW CLAY.._S_T~;--___ __;_:...

"QL,u;•"'· \A_,..._>flL . : ~ -

Building Official

BYRON HOWELL CODE ENFORCEMENT DIREcrOR POST IH A CONSP'ICUOUii l'to.'CE

.· ......

SECTION 15: CERTIFICATION STATEMENT (Continued)

B. 1sr Authorized Official Signature I have read the contents of this application. My signature legally and financially binds this supplier to the laws, regulations, and program instructions of the Medicare program. By my signature, I certify that the information contained herein is true, correct, and complete and I authorize the Medicare fee-for-service contractor to verify this information. Ifl become aware that any information in this application is not true, correct, or complete, I agree to notify the Medicare fee-for-service contractor of this fact in accordance with the time frames established in 42 CFR § 424.516.

If you are changing, adding, or deleting information, check the applicable box, furnish the effective date, and complete the approp1iate fields in this section.

CHECK ONE 0 CHANGE ~ADD 0 DELETE

DATE (mmlddlyyyy) 01/12/2015 ~~(J\'·--0 ·'~::"[ ';> ' -

Authorized Official's Information and Signature First Name Middle Last Name Suffix (e.g., Jr., Sr.)

Kevin Initial J. Cook

Telephone Number Title/Position

(785) 233-8200 BCC Chairperson

Authorized Official Signature (First, Middle, Last Name, Jr., Sr., M.D., D.O., etc.) Date Signed (mm!dd!yyyy)

~ (\ ~ Ljt.i/;~ (blue ink preferred) )

C. 2No Authorized Official Signature I have read the contents of this application. My signature legally and financially binds this supplier to the laws, regulations, and program instructions of the Medicare program. By my signature, I certify that the information contained herein is true, correct, and complete and I authorize the Medicare fee-for-service contractor to verify this information. If I become aware that any information in this application is not true, correct, or complete, I agree to notify the Medicare fee-for-service contractor of this fact in accordance with the time frames established in 42 CFR § 424.516.

If you are changing, adding, or deleting information, check the applicable box, furnish the effective date, and complete the appropriate fields in this section.

CHECK ONE 0 CHANGE OADD 0 DELETE

DATE (mm!dd!yyyy)

Authorized Official's Information and Signature

First Name Middle Initial Last Name Suffix (e.g., Jr., Sr.)

Telephone Number Title/Position

Authorized Official Signature (First, Middle, Last Name, Jr., Sr., M.D., D.O., etc.) Date Signed (mmldd/yyyy)

All signatures must be original and signed in ink (blue ink preferred). Applications with signatures deemed not original will not be processed. Stamped, faxed or copied signatures will not be accepted.

CMS-8558 (07/11) 32

SECTION 16: DELEGATED OFFICIAL (OPTIONAL)

•

•

• •

•

You are not required to have a delegated official. However, if no delegated official is assigned, the authorized official(s) will be the only person(s) who can make changes and/or updates to the supplier's status in the Medicare program.

The signature of a delegated official shall have the same force and effect as that of an authorized official, and shall legally and financially bind the supplier to the laws, regulations, and program instructions of the Medicare program. By his or her signature, the delegated official certifies that he or she has read the Certification Statement in Section 15 and agrees to adhere to all of the stated requirements. A delegated official also ce1tifies that he/she meets the definition of a delegated official. When making changes and/or updates to the supplier's enrollment information maintained by the Medicare program, a delegated official certifies that the information provided is true, correct, and complete.

Delegated officials being deleted do not have to sign or date this application .

Independent contractors are not considered "employed" by the supplier, and therefore cannot be delegated officials.

The signature(s) of an authorized official in Section 16 constitutes a legal delegation of authority to all delegated official(s) assigned in Section 16.

If there are more than two individuals, copy and complete this section for each individual.

A. 1sr Delegated Official Signature If you are changing, adding, or deleting information, check the applicable box, furnish the effective date, and complete the appropriate fields in this section.

CHECK ONE ~CHANGE OADD 0 DELETE

! ·-~. \ .,0.,. \ DATE (mm!ddtyyyyJ 04/01/2015 > ~ •• .·.

' :r: ·. ·-··

·-

Delegated Official First Name Middle Initial Last Name Suffix (e.g., Jr., Sr.)

Alice V. Weingartner

Delegated Official Signature (First, Middle, Last Name, Jr., Sr., M.D., D.O., etc.) Date Signed (mmlddlyyyy)

c12f/{ f/it1 () u);zt '1£l/ffiY\- 6/'-1 j;s-

u Telephone Number

~Check here if Delegated Official is a W-2 Employee (785) 251-2039

Authorized Official's Signature Assigning this Delegation (First Middle, Last Name, Jr., Sr., Date Signed (mm!dd!yyyy) M.D., D.O., etc.)

(blue ink preferred)

CMS-8558 (07/11) 33

a SHAWNEE COUNTY

PARKS~RECREATION

May 13,2015

TO:

FROM:

RE:

Board of Commissioners Shawnee County

John E. Knight, ~irecto~)v Parks & RecreatiOn ·

Contract Approval - Burns and McDonnell Parks Division

SHAWNEE COUNTY

PARKS & RECREATION

JOHN E. KNIGHT DIRECTOR

3137 SE 29TH ST. TOPEKA, Ks 66605-1885

(785) 251-2600 j ohn.knight@snco. us

-:t -j

Shawnee County Parks and Recreation is requesting approval on the attached Contract with Burns and McDonnell to provide design services for the development of vegetative mats that will be used to improve water quality at Lake Shawnee.

On November 24, 2014, the Board of Commissioners approved Parks and Recreation to apply for a Water Restoration and Protection Strategy (WRAPS) grant from the Kansas Alliance for Wetlands and Streams (KA WS) in the amount of $17,000. There is a 30% match requirement or $6,786 for a total project cost of $24,286. Shawnee County Parks and Recreation was awarded the grant for the purchase and placement of these mats in Lake Shawnee as an ongoing effort to improve the water quality of the lake.

Design costs are $3,200 with the grant covering $3,000 and Shawnee County responsible for $200. There is sufficient funding in the operating budget of the parks and recreation department to cover our share of the cost.

JEK/lrk TB Attachment

October 23, 2014

Mr. Terry L. Bertels, Parks Director Shawnee County Parks and Recreation 313 7 SE 29th Street Topeka, KS 66605

Ms. Judy Boltman, District Manager Shawnee County Conservation District 3231 SW Van Buren Topeka, KS 66611

Re: Proposal for Floating Wetland System, Lake Shawnee, Topeka, Kansas

Dear Mr. Bertels and Ms. Boltman:

SH.AVVNEE COUNT) OONTRACt #~~-ae~

Thank you for the opportunity to discuss with you the restoration needs for Lake Shawnee (the Lake). As discussed, we have prepared the following proposal to assist Shawnee County and Shawnee County Conservation District (County) with development of plans for installing a Beemat floating wetland system. The purpose of this work is to provide the basis for design and installation of a restoration plan to remove nutrients in association with a Middle Kansas River WRAPS grant.

SCOPE OF SERVICES Task 1. Beemat Floating Wetland System Plan. Burns & McDonnell will prepare a written plan that will define the following project elements:

• Aerial Plan view of the approximate location of the Beemats. • Detailed site plan that shows three Beemat treatment units including a total of 72 Beemats

separated into three treatment units of 24 mats configured in two rows of 12 mats each.

• Plan narrative including a schedule of recommended wetland plants, installation instructions, and operation and maintenance recommendations.

• Schedule and Estimate of Probable Construction Cost.

• The plan will be sent for review by the County with revisions prepared as appropriate.

Task 2. Plan Implementation Assistance. Burns & McDonnell will assist the County with the following activities:

• Ordering Beemats and plant materials. • Participate in one site visit to provide assistance with installation.

Task 3. Additional Services. Bums & McDonnell will be available to assist the County with monitoring and operation and maintenance needs as requested.

ASSUMPTIONS

The following assumptions were made in preparing the costs for the above scope of work:

• The County will place the final orders for materials. • The County has the primary responsibility for installation of the Beemat system(s) including

equipment, materials, and labor.

• Funding for the project including the Fee for Bums & McDonnell's assistance will be provided by current grant or other resources available to the County.

PROPOSAL SCHEDULE Burns & McDonnell will proceed upon execution of this Letter Proposal and anticipates the following time requirements for implementing the Project:

• Beemat Installation Plan - one week including review by County • Beemat and plant materials ordering and delivery- two weeks • Preparation of anchoring system -two weeks (concurrent with preceding task)

• Beemat installation - one week

PROPOSAL FEE The proposed, not-to-exceed cost of the environmental services described in this proposal is $3,000. The work is proposed to be conducted under the attached Terms and Conditions. Billing will be based on a lump sum, not-to-exceed fee.

If the proposal meets with your approval, please sign and date in spaces provided below and on the Terms and Conditions. Return one copy of the proposal with the attached Terms and Conditions and retain one signed copy for your files. As requested by Mr. John Bond, we have also prepared a draft of the Application/Contract for Financial Assistance document for your use.

If you have any questions or comments, please contact Dr. Gregory Howick at (816) 822-3845. Burns & McDonnell greatly appreciates the opportunity to be of service to the County.

Sincerely,

4/da. ~· 7~ Mark Van Dyne Senior Vice President

Accepted by: _____________ _ Title: _________________ _

Signature:----------------,---

Date: _____ _

Cc: Mr. John Bond, Kansas Alliance for Wetlands and Streams Mr. Dennis Haag, Burns & McDonnell

Approved as to Legality and Form: Date r" § s-

TERMS AND CONDITIONS FOR PROFESSIONAL SERVICES

Project: Lake Shawnee Floating Wetland

Client: Shawnee County, Kansas

1. SCOPE OF SERVICES For the above-referenced Project, Burns & McDonnell Engineering Company, Inc. (BMcD) will perform the services set forth in the above­referenced Letter, Proposal, or Agreement, in accordance with these Terms and Conditions. BMcD has relied upon the information provided by Client in the preparation of the Proposal, and shall rely on the information provided by or through Client during the execution of this Project as complete and accurate without independent verification.

2. PAYMENTS TO BMCD A. Compensation will be as stated in the above-referenced Letter, Proposal, or Agreement. Statements will be in BMcD's standard format and are payable upon receipt. Time is of the essence in payment of statements, and timely payment is a material part of the consideration of this Agreement. A late payment charge will be added to all amounts not paid within 30 days of statement date and shall be calculated at 1.5 percent per month from statement date. Client shall reimburse any costs incurred by BMcD in collecting any delinquent amount, including reasonable attorney's fees. If a portion of BMcD's statement is disputed, Client shall pay the undisputed portion by the due date. Client shall advise BMcD in writing of the basis for any disputed portion of any statement.

B. Taxes as may be imposed on professional consulting services by state or local authorities shall be in addition to the payment stated in the above-referenced Letter, Proposal, or Agreement.

3. INSURANCE A. During the course of performance of its services, BMcD will maintain Worker's Compensation insurance with limits as required by statute, Employer's Liability insurance with limits of $1,000,000, and Commercial General Liability and Automobile Liability insurance each with combined single limits of $1 ,000,000.

B. If the Project involves on-site construction, construction contractors shall be required to provide (or Client may provide) Owner's Protective Liability Insurance naming Client as a Named Insured and BMcD as an Additional Insured or to endorse Client and BMcD using ISO form CG 20 10 11 85 endorsement or its equivalent as Additional Insureds on all construction contractor's liability insurance policies covering claims for personal injuries and property damage in at least the amounts required of BMcD in 3A above. Construction contractors shall be required to provide certificates evidencing such insurance to Client and BMcD. Contractor's compensation shall include the cost of such insurance including coverage for contractual and indemnification obligations herein.

C. Client and BMcD release each other and waive all rights of subrogation against each other and their officers, directors, agents, or employees for damage covered by property insurance during and after the completion of BMcD's services. A provision similar to this shall be incorporated into all construction contracts entered into by Client, and all construction contractors shall be required to provide waivers of subrogation in favor of Client and BMcD for damage covered by any construction contractor's property insurance.

4. INDEMNIFICATION A. To the extent allowed by law, Client will require all construction contractors to indemnify, defend, and hold harmless Client and BMcD from any and all loss where loss is caused or alleged to be caused in whole or in part by the construction contractors, their employees, agents, subcontractors or suppliers.

B. If this Project involves construction and BMcD does not provide consulting services during construction including, but not limited to, on­site monitoring, site visits, site observation, shop drawing review, and/or design clarifications, Client agrees to indemnify and hold harmless BMcD from any liability arising from this Project or Agreement, except to the extent caused by BMcD's negligence.

Date of Letter, Proposal, or Agreement: 23 October 2014

Client Signature:

5. PROFESSIONAL RESPONSIBILITY- LIMITATION OF REMEDIES A. BMcD will exercise reasonable skill, care, and diligence in the performance of its services and will carry out its responsibilities in accordance with customarily accepted professional practices. If BMcD fails to meet the foregoing standard, BMcD will perform at its own cost, the professional services necessary to correct errors and omissions reported to BMcD in writing within one year from the completion of BMcD's services for the Project. No warranty, express or implied, is included in this Agreement or regarding any drawing, specification, or other work product or instrument of service.

B. In no event will BMcD be liable for any special, indirect, or · consequential damages including, without limitation, damages or losses

in the nature of increased Project costs, loss of revenue or profit, lost production, claims by customers of Client, and/or governmental fines or penalties.

C. BMcD's aggregate liability for all damages connected with its services for the Project not excluded by the preceding subparagraph, whether or not covered by BMcD's insurance, will not exceed $100,000.

D. These mutually negotiated obligations and remedies stated in this· Paragraph 5, Professional Responsibility - Limitation of Remedies, are the sole and exclusive obligations of BMcD and remedies of Client, whether liability of BMcD is based on contract, warranty, strict liability, tort (including negligence), indemnity, or otherwise.

6. PERIOD OF SERVICE AND SCHEDULE The provisions of this Agreement have been agreed to in anticipation of the orderly and continuous progress of the Project through completion of the services stated in the Proposal. BMcD's obligation to render services hereunder will extend for a period that may reasonably be required for the completion of said services. BMcD shall make reasonable efforts to comply with deliverable schedules (if any) and consistent with BMcD's professional responsibility.

7. COMPUTER PROGRAMS OR MODELS Any use, development, modification, or integration by BMcD of computer models or programs does not constitute ownership or a license to Client to use or modify such computer models or programs.

8. ELECTRONIC MEDIA AND DATA TRANSMISSIONS A. Any electronic media (computer disks, tapes, etc.) or data transmissions furnished (including Project Web Sites or CAD file transmissions) are for Client information and convenience only. Such media or transmissions are not to be considered part of BMcD's instruments of service. BMcD, at its option, may remove all indicia of its ownership and involvement from each electronic display.

B. BMcD shall not be liable for loss or damage directly or indirectly, arising out of Client's use of electronic media or data transmissions.

9. DOCUMENTS A. All documents prepared by BMcD pursuant to this Agreement are instruments of service in respect of the Project specified herein. They are not intended or represented to be suitable for reuse by Client or others in extensions of the Project beyond that now contemplated or on any other Project. Any reuse, extension, or completion by Client or others without written verification, adaptation, and permission by BMcD for the specific purpose intended will be at Client's sole risk and without liability or legal exposure to BMcD.

B. In the event that BMcD is to reuse, copy or adapt all or portions of reports, plans, or specifications prepared by others, Client represents that Client either possesses or will obtain permission and necessary rights in copyright, patents, or other proprietary rights and will be responsible for any infringement claims by others. Client warrants the completeness, accuracy, and efficacy of the information, data, and design provided by or through Client (including prepared for Client by

rely on to perform and complete Its services.

10. ESTIMATES, SCHEDULES, FORECASTS, AND PROJECTIONS Estimates, schedules, forecasts, and projections prepared by BMcD relating to loads, interest rates and other financial analysis parameters, construction costs and schedules, operation and maintenance costs, equipment characteristics and performance, and operating results are opinions based on BMcD's experience, qualifications, and judgment as a professional. Since BMcD has no control over weather, cost and availability of labor, cost and avallabllity of material and equipment, cost of fuel or other utilities, labor productivity, construction contractor's procedures and methods, unavoidable delays, construction contractor's methods of determining prices, economic conditions, government regulations and laws (including the interpretation thereof), competitlve bidding or market conditions, and other factors affecting such estimates or projections, BMcD does not guarantee that actual rates, costs, quantities, performance, schedules, etc., will not vary significantly from estimates and projections prepared by BMcD.

11. POLLUTION In view of the uncertainty involved in investigating and recommending solutions to environmental problems and the abnormal degree of risk of claims imposed upon BMcD In performing such services, notwithstanding the responsibility of BMcD set forth In Paragraph 5A to the maximum extent allowed by Jaw, Client agrees to release, defend, Indemnify and hold harmless BMcD and its officers, directors, employees, agents, consultants and subcontractors from all liability, claims, demands, damages, losses, and expenses including, but not limited to, claims of Client and other persons and organizations, reasonable fees and expenses of attorneys and consultants, and court costs, except where there has been a final adjudication that the damages were caused by BMcD's willful disregard of its obligations under this Agreement. Such indemnification includes claims arising out of, or in any way relating to, the actual, alleged, or threatened dispersal, escape, or release of, or failure to detect or contain, chemicals, wastes, liquids, gases, or any other material, irritant, contaminant, or pollutant.

12. ON-SITE SERVICES A. Project site visits by BMcD during investigation, observation, construction or equipment installation, or the furnishing of Project representatives shall not make BMcD responsible for construction means, methods, techniques. sequences, or procedures; for construction safety precautions or programs; or for any construction contractor(s') failure to perform its work in accordance with the contract documents.

B. Client shall disclose to BMcD the location and types of any known or suspected toxic, hazardous, or chemical materials or wastes existing on or near the premises upon which work is to be performed by BMcD's employees or subcontractors. If any hazardous wastes not identified by Client are discovered after a Project is undertaken, Client and BMcD agree that the scope of services, schedule, and compensation may be adjusted accordingly. Client agrees to release BMcD from all damages related to any pre-existing pollutant, contaminant, toxic, or hazardous substance at the site.

13. CHANGES Client shall have the right to make changes within the general scope of BMcD's services, with an appropriate change. in compensation and schedule, upon execution of a mutually acceptable amendment or change order signed by authorized representatives of Client and BMcD.

14. TERMINATION Services may be terminated by Client or BMcD by seven (7) days' written notice In the event of substantial failure to perform in accordance with the terms hereof by the other party through no fault of the terminating party. If. so terminated, Client shall pay BMcD all amounts due BMcD for all services properly rendered and expenses Incurred to the date of receipt of notice of termination, plus reasonable costs incurred by BMcD In terminating the services. In addition, Client may terminate the services for Client's convenience upon payment of twenty percent of the yet unearned and unpaid estimated, lump ·sum, or not-to-exceed fee, as applicable.

15. DISPUTES, NEGOTIATIONS, MEDIATION A. The parties shall participate in good faith negotiations to resolve any and all disputes. C. The parties agree that any dispute between them, Including any action against an officer, director or employee of a party, arising out of or related to this Agreement, whether in contract or tort, not resolved through direct negotiation, shall be resolved by litigation in the state or federal courts located In Shawnee County, Kansas, and each · party expressly consents to jurlsdlctlon therein ..

B. Causes of action between the parties shall accrue, and applicable statutes of limitation shall commence to run the date BMcD's services are substantially complete.

16. WITNESS FEES· A. BMcD's employees shall not be retained as expert witnesses, except by separate written agreement.

B. Client agrees to pay BMcD pursuant to BMcD's then current schedule of hourly labor billing· rates for time spent by any employee of BMcD responding to any subpoena by any party In any dispute as an occurrence witness or to assemble and produce documents resulting from BMcD's services under this Agreement.

11. CONTROLLING LAW This Agreement shall be subject to, interpreted and enforced according to the laws of the State of Kansas without regard to any conflicts of law provisions.

18. RIGHTS AND BENEFITS- NO ASSIGNMENT BMcD's services will be performed solely for the benefit of Client and not for the benefit of any other persons or entities. Neither Client nor BMcD shall assign or transfer Interest in this Agreement without the written consent ofthe other.

19. ENTIRE CONTRACT These Terms and Conditions and the above-referenced Letter, Proposal, or Agreement contain the entire agreement between BMcD and Client relative to BMcD's services for the Project herein. All previous or contemporaneous agreements, representations, promises, and conditions relating to BMcD's services for the Project are superseded. Since terms contained in purchase orders do not generally apply to professional services, In the event Client issues to BMcD a purchase order, no preprinted terms thereon shall become part of this Agreement. Said purchase order documents, whether or not signed by BMcD, shall be considered only as an internal document of Client to facilitate administrative requirements of Client's operations.

20. SEVERABILITY Any unenforceable provision here!n shall be amended to the extent necessary to make lt enforceable; if not possible, it shall be deleted and all other provisions shall remain in full force and affect.

-END-

Approved as to Legality ·Jnd Form: Date b ·C. rr . .. -_,.,..._·_~-- ~~J (~ . · .. : 'f'. CO. COUNSELOI~

NOTES:

Schedule of Hourly Professional Service Billing Rates

Position Classification

General Office*

Technician*

Assistant*

Staff*

Senior

Associate

Classification Level

5

6

7 8 9

10 11

12 13

14 15 16 17

Hourly Billing Rate

$58.00

$68.00

$79.00 $110.00 $122.00

$135.00 $146.00

$160.00 $176.00

$188.00 $198.00 $203.00 $210.00

1. Position classifications listed above refer to the firm's internal classification system for employee compensation. For example, "Associate", "Senior'', etc., refer to such positions as "Associate Engineer'', "Senior Architect", etc.

2. For any nonexempt personnel in positions marked with an asterisk(*), overtime will be billed at 1.5 times the hourly labor bllllng rates shown.

3. Project time spent by corporate officers will be billed at the Level17 rate plus 25 percent.

4. For outside expenses incurred by Burns & McDonnell, such as authorized travel and subsistence, and for services rendered by others such as subcontractors, the client shall pay the cost to Burns & McDonnell plus 10%.

5. A technology charge of $9.95 per labor hour will be billed for normal computer usage, computer aided drafting (CAD) long distance telephone, fax, photocopy and mail services. Specialty items (such as web and video conferencing) are not Included In the technology charge.

6. Monthly invoices will be submitted for payment covering services and expenses during the preceding month. Invoices are due upon receipt. A late payment charge of 1.5% per month will be added to all amounts not­paid within 30 days of the Invoice date.

7. The services of contracUagency personnel shall be billed to Owner according to the rate sheet as if such contract/agency personnel is a direct employee of Burns & McDonnell.

8. The rates shown above are effective for services through December 31, 2014, and are subject to revision thereafter.

Form BMR814

•• SHAWNEE COUNTY

PARKS~RECREATION June 3, 2015

TO:

FROM:

RE:

Board of Commissioners

Shawnee County j John E. Knight, Director Parks & Recreation

Contract-Service Partner Recreation Division

SHAWNEE COUNTY

PARKS & RECREATION

JOHN E. KNIGHT

DIRECTOR 3137 SE 29TH ST.

TOPEKA, Ks 66605-1885 (785) 251-2600

john.knight@snco.us

Board of Commissioners approval is requested on the attached Contract. Contracts are a valuable tool used by Parks & Recreation to provide compensation to individuals and/or partners who desire to share their service, skills and talent with the public as independent contractors.

One of the recommendations of the Master Plan is to develop and review partnerships. The Master Plan suggested the following approach to organizing the department's partnership pursuits. The department is now using the following five ( 5) areas of focus to organize existing and future

partnerships. Operational Partners: Other entities and organizations that can support the efforts of

Shawnee County Parks and Recreation to maintain facilities and assets, promote an1enities and park usage, support site needs, provide programs and events, and/or maintain the integrity of natural/cultural resources through in-kind labor, equipment, or materials.

Vendor Partners: Service providers and/or contractors that can gain brand association and notoriety as a preferred vendor or suppmier of Shawnee County Parks and Recreation in exchange for reduced rates, services, or some other agreed upon benefit.

Service Partners: Are nonprofit organizations and/or friends groups that support the efforts of the department to provide programs and events, and/or serve specific constituents in the community collaboratively.

Co-branding Partners: Are private for-profit organizations that can gain brand association and notoriety as a supporter of Shawnee County Parks and Recreation in exchange for sponsorship or co-branded programs, events, marketing and promotional campaigns, and/or advertising

opportunities. Resource Development Partner: A private, nonprofit organization with the primary purpose

to leverage private sector resources, grants, other public funding opporttmities, and resources from individuals and groups within the community to support the goals and objectives of the department on mutually agreed strategic initiatives.

Parks & Recreation is requesting approval of the following Contract which is an example of a Service Partnership that helps the department meet the Community Vision for Programming. Contractor Service Provided Rod Peterson Provide music for the Friends of the Ted Ensley Garden

group on September 20,2015, for a fee of$300.

The community's vision for programming is "to reach out to people of all ages too encourage them to experience parks and recreation facilities through well designed programs that create a lifetime of memories." To meet this vision, a goal was established to "continue existing core programs of; preschool-age programs, athletics for youth and adults, youth and adult life skill programs, camps, wellness and fitness programs, senior programs, aquatic programs, and special events, and include new core programs in outdoor adventure, adaptive recreation, and senior services."

There is sufficient funding in the Parks & Recreation Budget for this request.

JEK/gcl RL Attachment

SHAWNEE COUNTY CONTRACT NO. C ~D-~Ol5

INDEPENDENT CONTRACTOR AGREEMENT FOR SERVICES THIS AGREEMENT is between THE BOARD OF COUNTY COMMISSIONERS OF THE

COUNTY OF SHAWNEE, KANSAS (County) and Rod Peterson.

1. SERVICES TO BE PERFORMED

Contractor agrees to perform the following services for County:

Provide music for the Friends of the Ted Ensley Garden group.

This Agreement shall commence on September 20, 2015, and shall end on September 20, 2015, unless this Agreement is terminated sooner or extended in accordance with its terms.

2. PAYMENT

In consideration of the services to be performed by Contractor, County agrees to pay Contractor as follows:

Task Duties Compensation Provide music Provide music for the Friends of the Ted $300.00

Ensley Garden group from 6:30-8:00pm. ·

Contractor shall be responsible for all expenses incurred while performing services under this Agreement. This includes equipment; supplies; telephone expenses; automobile and other travel expenses; meals and entertainment; insurance premiums; and all salary, expenses and other compensation paid to Contractor's employees or contract personnel Contractor hires to complete the work under this Agreement.

3. INDEPENDENT CONTRACTOR STATUS AND CERTIFICATION

Contractor is an independent Contractor, not a County employee. Contractor's employees or contract personnel are not County employees. Contractor and County agree to the following rights consistent with an independent Contractor relationship:

a. Contractor has the right to perform services for others during the term of this Agreement.

b. Contractor has the sole right to control and direct the means, manner and method by which the services required by this Agreement will be performed.

c. Contractor shall not be assigned a work location on County premises, and Contractor has the right to perform the services required by this Agreement at any place, location or time.

1

d. Contractor will furnish all equipment and materials used to provide the services required by this Agreement.

e. Contractor has the right to hire assistants as subcontractors, or to use Contractor's employees to provide the services required by this Agreement.

f. Contractor or Contractor's employees or contract personnel shall perform the services required by this Agreement and Contractor agrees to the faithful performance and delivery of described services in accordance with the time frames contained herein; County shall not hire, supervise or pay any assistants to help Contractor.

g. Neither Contractor nor Contractor's employees or contract personnel shall receive any training from County in the skills necessary to perform the services required by this Agreement.

h. County shall not require Contractor or Contractor's employees or contact personnel to devote full time to performing the services required by this Agreement.

Further, Contractor hereby certifies:

1. That Contractor is not an employee of County and thereby Contractor waives any and all claims to benefits otherwise provided to employees of the County, including, but not limited to: medical, dental, or other personal insurance, retirement benefits, unemployment benefits, and liability or worker's compensation insurance.

J. Contractor must provide Federal Tax or Social Security Number on required Form W-9.

k. That Contractor understands that he/she is solely responsible, individually for all taxes and social security payments applicable to money received for services herein provided. Contractor understands that an IRS Form 1099 will be filed by the County for all payments received.

4. INDEMNIFICATION AND HOLD HARMLESS

Contractor shall save, hold harmless, and indemnify County, its officers, agents and employees, from and against all claims, causes of action, liabilities, expenses and costs, including reasonable attorneys' fees, for injury of any person or damage to property arising out of, or connected with, work performed under this Agreement which is the result of any acts or omissions, whether negligent or otherwise, of Contractor, its officers, agents, subcontractors or employees.

5. INSURANCE

The County shall not be required to purchase, any insurance against loss or damage to any personal property to which this contract relates, nor shall this contract require the County to establish a "self-insurance" fund to protect against any such loss or damage. Subject to the provisions of the Kansas Tort Claims Act (K.S.A. 75-6101 et seq.), the Contractor shall bear the risk of any loss or damage to any personal property to which Contractor holds title.

2

6. OWNERSHIP OF PRODUCTS/DOCUMENTS

Contractor hereby assigns to County all rights to all products, reports, documents, photographs, videos, data, and drawings produced by Contractor as a result of its services to County during the term of this Agreement.

7. TERMINATION DUE TO LACK OF FUNDING APPROPRIATION.

Shawnee County is subject to the Kansas Cash Basis Law, K.S.A. 10-1101 et seq. If, in the judgment of the Financial Administrator, Audit-Finance Office, sufficient funds are not appropriated to continue the function performed in this agreement and for the payment of the charges hereunder, County may terminate this agreement at the end of its current fiscal year. County agrees to give written notice of termination to Contractor at least thirty (30) days prior to the end of its current fiscal year. Contractor shall have the right, at the end of such fiscal year, to take possession of any of Contractor's equipment, leased or otherwise, provided to County under the contract. County will pay to the Contractor all regular contractual payments incurred through the end of such fiscal year, plus contractual charges incidental to the return of any such equipment. Upon termination of the agreement by County, title to and possession of any equipment purchased by the County under the contract, but not fully paid for, shall revert to Contractor at the end of County's current fiscal year. The termination of the contract pursuant to this paragraph shall not cause any penalty to be charged to the County or the Contractor.

8. ANTI-DISCRIMINATION CLAUSE.

The Contractor agrees: (a) to comply with the Kansas Act Against Discrimination (K.S.A. 44-1001 et seq.) and the Kansas Age Discrimination in Employment Act, (K.S.A. 44-1111 et seq.) and the applicable provisions of the Americans With Disabilities Act (42 U.S.C. 12101 et seq.) [ADA] and to not discriminate against any person because ofrace, religion, color, sex, disability, national origin or ancestry, or age in the admission of access to or treatment or employment in, its programs or activities; (b) to include in all solicitations or advertisements for employees, the phrase "equal opportunity employer"; (c) to comply with the reporting requirements set out in K.S.A. 44 1031 and K.S.A. 44-1116; (d) to include those provisions in every subcontract or purchase order so that they are binding upon such subcontractor or vendor; (e) that a failure to comply with the reporting requirements of (c) above or if the Contractor is found guilty of any violation of such acts by the Kansas Human Rights Commission, such violation shall constitute a breach of contract; (f) if the contracting agency determines that the Contractor has violated applicable provisions of ADA, that violation shall constitute a breach of contract; (g) if(e) or (f) occurs, the contract may be cancelled, terminated or suspended in whole or in part by the County. Parties to this contract understand that subsections (b) through (e) of this paragraph number 5 are not applicable to a Contractor who employs fewer than four employees or whose contract with the County totals $5,000 or less during this fiscal year.

9. ACCEPTANCE OF CONTRACT.

3

This contract shall not be considered accepted, approved or otherwise effective until the required approvals and certifications have been given and this is signed by the Board of County Commissioners of the County of Shawnee, Kansas.

10. ARBITRATION, DAMAGES, WARRANTIES.

Notwithstanding any language to the contrary, no interpretation shall be allowed to find the County has agreed to binding arbitration, or the payment of damages or penalties upon the occurrence of a contingency. Further, the County shall not agree to pay attorney fees and late payment charges; and no provisions will be given effect which attempts to exclude, modify, disclaim or otherwise attempt to limit implied warranties of merchantability and fitness for a particular purpose.

11. REPRESENTATIVE'S AUTHORITY TO CONTRACT.

By signing this document, the representative of the Contractor thereby represents that such person is duly authorized by the Contractor to execute this document on behalf of the Contractor and that the Contractor agrees to be bound by the provisions thereof.

12. TERMINATION OF AGREEMENT

This Agreement may be terminated by either party by giving the other party written notice of the intent to terminate. The notice must specify a date upon which the termination will be effective, which date may not be less than 7 calendar days from the date of mailing the notice. Only services satisfactorily performed up to the date of receipt of notice shall be compensated by County and such compensation shall be pursuant to the terms of this Agreement. Notice shall be deemed received 3 days after mailing in the United States mail, using first class mail, postage prepaid.

13. MISCELLANEOUS PROVISIONS

a. This Agreement shall be entered into in Shawnee County, Kansas, and shall be construed and interpreted according to the law of the State of Kansas.

b. All notices and other communications in connection with this Agreement shall be in writing and shall be considered given 3 days after mailing in the United States mail, using first class mail, postage prepaid, to the recipient's address as stated in this Agreement.

c. Contractor shall comply with all federal, state and local laws requiring business permits, certificates and licenses required to carry out the ·services to be performed under this Agreement.

d. Contractor may not assign any rights or obligations under this Agreement without County's prior written approval.

e. This Agreement constitutes the entire agreement between the parties and may only be modified or extended by a written amendment signed by the parties hereto.

4

f. The invalidity, illegality, or unenforceability of any provision of this Agreement or the occurrence of any event rendering any portion or provision of this Agreement void shall in no way affect the validity or enforceability of any other portion or provision of this Agreement. Any void provision shall be deemed severed from this Agreement, and the balance of this Agreement shall be construed and enforced as if this Agreement did not contain the particular portion or provision held to be void.

g. Nothing in this Agreement shall be construed to give any rights or benefits to anyone other than County and Contractor.

IN WITNESS WHEREOF, County and Contractor have executed this Agreement.

ATTEST:

COUNTY BOARD OF COUNTY COMMISSIONERS SHAWNEE COUNTY, KANSAS

__________ ,Chair

Dme: _______________ _

Cynthia A. Beck, Shawnee County Clerk

CONTRACTOR

dZL~ Printed Name: Rod Peterson

Address: 3621 SW Holly Ln, Topeka, KS 66604

Date: -~J.!:':un':.!:e~l c..:2~0~1""'-5 ________ _

5

Approved as to Legality and Form: Date fv1-'s

-----.. "' . ~ ~$ .. ~ 3Sr CO. COUI·:sELOR

: .. SHAWNEE COUNTY

PARKS~RECREATION

June 2, 2015

TO:

FROM:

RE:

Board of Commissioners Shawnee County

John E. Knight, Director", Parks & Recreation . ~

Organizational Structure Changes

SHAWNEE COUNTY

PARKS & RECREATION

JOHN E. KNIGHT

DIRECTOR

3137 SE29TH ST. TOPEKA, Ks 66605-1885

(785) 251-2600 j ohn.knight@snco. us

--e,-3

Board of Commissioners approval is requested for the department to begin organizational structure changes within the department. These initial changes and subsequent changes are designed to maximize efficiency of service and address the recommendation of the Master Plan to align the department by function with lead and support groups and divisions.

Prior to the merger of Parks and Recreation departments in 2012, no guiding document or Master Plan was in place for either department. A comprehensive Master Plan was developed in 2013 and 2014 and being implemented in 2015 using the following guiding principles and objectives:

• Sustainably grow the best practices and quality services of the department. • Serve the relevant park and recreational needs of existing City of Topeka and Shawnee County residents who help suppmi the Shawnee County Parks and Recreation Department in meeting those needs. · • Further position the county as a regional and statewide destination, while protecting the accessibility of city and county facilities for residents. • Support the county to qualify for enhanced partnerships and funding opportunities in both the public and private sectors. • Leave a positive legacy for current and future generations of Shawnee County.

As implementation of the Master Plan progresses, it is necessary and important to adjust the organizational structure. Specifically the department needs to update the department's organizational structure based on the loss of 20% of the work force over the last year, 37.5% over the past five years, and 10% reduction to support depatiments of the county. Further the department, to maximize efficiency of service, needs to align the organization by function with lead and support groups and divisions. Attached you will find a chart that illustrates how this realignment may begin to look.

Please know that this is just an initial step in the process of aligning the department by function. As this realignment and as the Master Plan are implemented additional areas where additional changes will become evident.

To accomplish this new mission and vision, Shawnee County Parks & Recreation will be transitioning from the traditional organizational model made up of the typical divisions funded through the Parks & Recreation Budget of the Shawnee County General Fund. These divisions were: Administration, Parks, Park Police, Recreation, and Golf Course. The new divisions, separated by function will be; Administration, Green Spaces/Land, Asset Management, Recreation, Outdoor Adventure and a Business Division. These divisions have been organized to put those sub-divisions with similar responsibilities together working for one goal. Below is an overview of how the divisions will be broken down and the pieces that will be compiled to form that division.

The Administration Division will be responsible for the payroll and other human resources functions like the personnel recruitment including advertising, interviews, and pre-employment health and drug screens, etc. This Division maintains all financial records; accounts payable and receivable; track revenue; maintain inventory records; for dissemination to the Board of County Commissioners and other department/divisions. Prepare and author correspondence from administrative staff; take shelter house reservations and recreation program registrations; address public questions via telephone, monitor, implement and develop the department's customer service plan, written correspondence, and in person; greet public; prepare reports for dissemination to the Board of County Commissioners and for public distribution. This Division is also responsible for West Lawn Memorial Cemetery business operations.

The Green Spaces/Land Division will be responsible for managing, maintaining and developing two (2) Regional/Destination parks; Lake Shawnee and Gage Park, eleven (11) Community Parks, eleven (11) natural areas, numerous Neighborhood Parks and over 43 miles of Trails. Supervisors with responsibilities over horticulture, grounds maintenance, and natural area development and management are part of this Division. Primarily for coordination of Maintenance personnel and equipment, the Golf Course sub-division works closely with this division with the maintenance portion of the three (3) Shawnee County owned Golf Courses specifically; the 18-hole Lake Shawnee, the 18-hole Cypress Ridge and the 9-hole Forbes Golf Courses.

The Asset Management Division will be responsible for the management of all department assets, including facilities, equipment and vehicles with an estimated value of over $70,000,000, including, one hundred twenty (120) facilities. Supervisors with responsibilities over Park Planning, Shelter House preparation, Horticulture, Grounds Maintenance, and Building Maintenance assist with these areas. This Division is also responsible for Trail system management, capital projects, grant opportunities and long-range planning. Also working within this Division is the Park Police, which is comprised of certified law enforcement officers with full police power to enforce not only park rules but state and local laws as well. Park Police also work closely with other law enforcement agencies for consistent communication of current crime trends and also meet with local Neighborhood Improvement Associations and Neighborhood Associations to effectively administer crime prevention with the Parks.

The Recreation Division will be responsible for the management and operation of recreational programming, recreation center operation, neighborhood outreach, coordination with smaller cities within Shawnee County to address their recreational needs and an extensive before/after school program and summer camp program. In addition to the provision of services provided within Shawnee County facilities, partnerships with other governmental agencies and school districts are utilized throughout the county. Through cooperative relationships, programs are offered in over forty ( 40) elementary schools in the seven (7) school districts in Shawnee County including; Auburn-Washburn #437, Seaman #345, Shawnee Heights #450 and Topeka #501 School Districts. Facilities are also used in the towns of Auburn, Berryton, Dover, Rossville, Silver Lake, and Tecumseh to provide a wide variety of recreational programs for Shawnee County residents of all ages.

The Outdoor Adventure Division will be responsible for all seasonal facility operations of the department. This Division includes a comprehensive Sports Division with youth and adult sports covering multiple sports and competition levels. The operations of special community-wide events through coordination with partners both on County properties and within the community are managed through this Division. This Division also includes all seasonal operations which include Old Prairie Town, concession stands, mini-train, carousel, campground, marina, etc., as well as all aquatic operations from Community Pools to destination Aquatic Parks. This Division will be responsible for the development and addition of the new amenities that young professionals want in their community to include: dog parks, an outdoor adventure aerial park a downtown special event venue, an adventure sports facility, hockey/ice sports facility, sports field house, and a fresh food market.

The Business Division is currently under development but the intent is for this Division to be responsible for the development of a new Business Development plan for the department that can focus on business development, grants, working with the parks foundations, development of a conservancy for Gage Park and Lake Shawnee, sponsorships, business plans, and cost of service assessments. This Division also is responsible for a comprehensive Volunteer program, Advertising and Marketing of the entire Department, Communications and Public Information, coordination with the SCPR Foundation, development of additional funding sources and grants and to be the lead for the acquisition of accreditation through NRP A and CAPRA.

From May 11 through May 27 the department held, Master Plan Educational Sessions for all employees. These sessions were designed for employees to begin to understand and comprehend the components of the Master Plan. The next step would be to open, advertise, interview and hire for positions. This reorganization plan was developed with assistance of Betty Greiner, Director of Administrative Services and Jim Crowl, Interim Human Resources Director. Specifically, Board of Commissioners approval is requested to create three (3) new Superintendent positions, for the Green Spaces/Land, Recreation and Outdoor Recreation Divisions and modify one (1) soon to be vacant position to a Communications and Public Information Supervisor. Additionally, the department requests to reclassify a Parks and Recreation Administration Officer from range 25 to range 28. Should the positions be filled by current employees, the vacated positions will be eliminated and not back filled. At no time will the department exceed the approved budgeted dollar amount nor full time equivalent FTE's positions approved by the Board of Commissioners.

JEK/gcl Attachment

/