Exhibit 4 - Project Agreement Form - Pages 1-3.docx

Statewide Remediation Contract Project Agreement Form Exhibit 4

This form is used when a Contractor has been requested to perform remediation services under the statewide remediation contract. All terms, conditions, specifications, and requirements of the Statewide Remediation Contract apply. This Project Agreement becomes part of the Statewide Remediation Contract and memorializes the specific service request and cost.

Effective Date: PA#:

Parties Involved for this Project:

State Entities

Agency (State entity with affected property):

Agency Representative(s) and contact information:

Office of Risk Management (ORM); If requested services are due to an insurance-related event.

ORM Designated Representative(s) and contact info:

and Contractor

Contractor Co. Name: Project Contact Name:

Contract Ph#: Contact Email:

Involved Building(s), if multiple buildings are involved, attach a separate list if needed:

Item # State ID Bldg. Name Claim Number 1.)

2.)

3.)

Project Location (City):

In consideration of the mutual promises, covenants, and agreements contained herein and within the awarded Contract for such good and valuable consideration, the receipt and sufficiency of which are hereby acknowledge, the parties agree as follows:

The Contractor hereby agrees to furnish all services, labor, materials, equipment, and other items reasonably necessary to complete the work for the Project as described within the scope of work and in accordance with the Contract.

Project is estimated to be:

☐ $100,000 or Less (Xactimate estimate is used for scope and billing)

For Projects $100,000 or less, the Contractor shall supply an Xactimate estimate and diagram. The Xactimate estimate provides the scope of work and project cost. Projects expected to be $50K or less shall be submitted within 24 hours of inspection or sooner; $50,000.01 to $100,000 shall be submitted within 48 hours of inspection or sooner. All reporting, including photographs, moisture mapping with readings, and all other documentation and contract requirements, must be fulfilled as noted in the ITB.

☐ Over $100,000 (NTE with written scope, Rate Schedules used for billing) For Projects over $100,000, the Contractor will provide a written scope of work and a Not-to-Exceed (NTE) amount. Billing/Invoicing for the Project is based on the Contractor’s Rate Schedules for the scope of work agreed upon. All reporting, such as photographs, moisture mapping with readings, and all other documentation and contract requirements, must be fulfilled, as noted in the ITB.

Document Submission This document and its attachments are to be emailed to Sedgwick and ORM-Remediation@la.gov. All pending items are to be submitted by the due date. If this project does not involve insurance (ORM and its TPA), the agency representative will provide an email address for document submissions.

The subject line of the email must be formatted as follows: [Agency] [Building Name], [Claim number], [description, e.g. NTE or Scope or NTE & Scope].

Subject Line Examples:

Remediation: ULL Admin Bldg, Claim 4A2109BX439, NTE Remediation: ULL Admin Bldg, Claim 4A2109BX439, NTE & Scope Remediation: Bogue Chitto State Park, Multi Bldgs, ref claim 4A2109ZY511, NTE Failure of the Contractor to provide the appropriate documentation, Xactimate estimate, or written scope of work with NTE by the due date may result in a reduction of the amount owed by the State or removal from the Project.

Signatures: