4.4 SR 09-18-2023Request for Action
To Item Number
Ma Tor and Ci T Council 4.4
Agenda Section Meeting Date Prepared by
Consent A enda Se tember 18, 2023 Brandon Wisner, En ineerin Pro�ect Mana er
Item Description Reviewed by
American Engineering Testing (AE'I� Inc. Pond Cal Pormer, Cit T Administrator
Sampling for Rolling Hills Subdivision Reviewed by
Action Requested
Approve, by motion, service agreement for pond sediment sampling and analysis for $10,470.
Background/Discussion
The stormwater basins within the Rolling Hills Subdivision are nearing the end of their functional capacity and
need to be dredged out to original depths. In order for them to be dredged, the Minnesota Pollution Control
Agency requires the sediment to be tested prior to determine where the material can be disposed at or hopefully
re-used.
Financial Impact
Stormwater Management Budget $10,470
Mission/Policy/Goal
Meet changing needs - Agile
Attachments
■ AET Inc. Service Agreement
The Elk River Vision
A �arelco�ning co�n�nunity zvitb r•evolutionary and spirzted r•esour•cefulness, exceptional
service, and co�n�nunity engage�nent tbat encour•ages and inspir•es pr•osperzty.
R�O�IMER'EO �'P
M ���
Updated.• Januay 2023
September 7, 2023
AET Project No. P-0025977
AMERICAN
ENGINEERING TESTING
ACKNOWLEDGEMENT AND AGREEMENT OF SERVICES
Ryan Sandhoefner with the City of Elk River requested the services of American Engineering Testing,
Inc. (AET) for the referenced project on September 5, 2023.
Information from the requesting party includes the following:
Project Name:
Project Address:
Project Number:
Client Project Number
Client PO Number:
Client:
Client Address:
Client Contact:
Elk River Pond Sampling
(near) 9708 226th Ave NW
Elk River, MN 55330
AET Project No. P-0025977
Ryan Sandhoefner
13065 Orono Parkway
Elk River, MN 55330
Ryan Sandhoefner
Client E-Mail rsandhoefner(a�elkrivermn.qov
Client Phone 763.635.1053
SERVICE EXTENT/COMMUNICATION
AET's services will be provided on a one-time basis as requested by the Client or authorized
representative.
UNDERSTOOD SCOPE OF SERVICES
Ryan Sandhoefner has requested AET provide a scope of services to sample the sediment from six
stormwater ponds for the city of Elk River. Access to the ponds is via the right-of-way access in a
residential neighborhood.
The Minnesota Pollution Control Agency (MPCA) provides guidance on stormwater sampling in their
publication "Managing Stormwater Sediment Best Management Practices Guidance" (document ID `wq-
strm4-16.pdf'). Based on this guidance, AET proposes to conduct the following environmental tasks:
• Provide AET field personnel to collect up to 12 sediment samples for laboratory analysis from 6
ponds near 9708 226th Ave NW in Elk River, MN 55330.
• Twelve (12) sediment samples will be chemically analyzed for PAHs, cPAHs, arsenic, and
copper.
550 Cleveland Avenue North � Saint Paul, MN 55114
Phone (651) 659-9001 �(800) 972-6364 � Fax (651) 659-1379 � teamAET.com � AA/EEO
This document shall not be reproduced, except in full, without written approval from American Engineering Testing, Inc.
City of Elk River Pond Sampling
Elk River, Minnesota
September 7, 2023
AET Project No. P-0025977
AM EF! ICAN
ENGiNEERING TESTIN6
• Sediment samples will be collected to an approximate depth of 2 to 3 feet from the bottom of the
pond.
• Two (2) sediment samples will be taken from each of the 6 ponds in the vicinity of the inlet and
outlet of each pond. Locations will be logged with a GPS.
• Prepare a letter report discussing laboratory data upon completion of laboratory analysis.
The soil samples will be submitted to a subcontracted laboratory for a standard turnaround time
(approximately 2 weeks). AET will provide the laboratory report as part of a written report to the Client.
This proposal is valid for a period of 30 days from the date issued.
FEES
We propose to complete these services on a time and materials basis not to exceed the budget
estimate amount of $10,470.00. This budget is estimated on these categories:
1. Labor and Materials $5,400
2. Analytical costs (subcontract to a certified laboratory) $5,070
Total $10,470
TERMS/CONDITIONS
All AET Services are provided subject to the Terms and Conditions set forth in the enclosed Service
Agreement—Terms and Conditions, which, upon acceptance of this proposal, are binding upon you as
the Client requesting Services, and your successors, assignees, joint ventures and third-party
beneficiaries. Please be advised that additional insured status is granted upon acceptance of the
proposal.
ACCEPTANCE
AET requests written acceptance of this proposal in the Authorized Client Representative section
below, but the following actions shall constitute your acceptance of this proposal together with the
Terms and Conditions and Amendments: 1) issuing an authorizing purchase order for any of the
Services described above, 2) authorizing AET's presence on site or 3) written or electronic notification
for AET to proceed with any of the Services described in this proposal. Please indicate your acceptance
of this proposal by signing below and returning a copy to us. When you accept this proposal, you
represent that you are authorized to accept on behalf of the Client.
Page 2 of 3
City of Elk River Pond Sampling
Elk River, Minnesota
September 7, 2023
AET Project No. P-0025977
OTHER ATTACHMENTS (PART OF THIS AGREEMENT)
Service Agreement - Terms and Conditions
Proof of Insurance
W9
AET Representatives:
Prepared By:
�
Leif Johnson, PG
Geologist
Phone: 651-659-1320
Email: Ijohnson@teamAET.com
ACCEPTANCE AND AUTH
SIGNATURE:
AM EF! ICAN
EMGiNEERING TESTING
Reviewed 8 :
���
�. +� � � � �r;�. ,--
Eric Hesse, P.E.
Senior Engineer
Phone: 651-659-1307
Email: ehesse@teamAET.com
TION: AET Proposal No. P-0025977
PRINTED NAME: Brandon Wisner
COMPANY: City of Elk River
ADDRESS: 13065 Orono Parkway, Elk River, MN 55330
PHONE NUMBER AND EMAIL: 7636351054 bwisner�elkrivermn.gov
DATE: 9.8.2023
INVOICING INFORMATION (Provide Company AP Department Information if present).
AP CONTACT NAME: Amv Stanaler - Accountina Clerk
BILLING/MAILING ADDRESS: 13065 Orono Parkway, Elk River, MN 55330
AP PHONE NUMBER AND INVOICE EMAIL:7636351027 accountspayable(c�elkrivermn.gov
P.O. NO./ PROJECT NO.: Rolling Hills Storm Pond Sediment Testing
Page 3 of 3
ENVIRONMENTAL/ GEOTECHNICAL SERVICE AGREEMENT-TERMS AND CONDITIONS Page 1 of 4
SECTION 1 - RESPONSIBILITIES
1_1 - This Service Agreement — Terms and Conditions ("terms and conditions") is applicable to all services ("Services") provided by American
Engineering Testing, Inc. (AET). As used herein "Services" refers to the scope of services described in the proposal submitted by AET to Client.
The proposal, these terms and conditions and any appendices attached hereto shall comprise the agreement ("Agreement") between AET and
Client forServices described in the proposal and are binding upon the Client, its successors, assignees, joint ventures and third-party beneficiaries.
AET requests written acceptance of the ,4greement, but the following actions shall also constitute Client's acceptance of the Agreement: 1)
issuin� an authorizin� purchase order, task order, service order, or anv other documentation for anv of the Services. 2) authorizins AET's
presence on site, or 3) written or electronic notification for AET to proceed with anv of the Services. Issuance of a purchase order, task order
or service order by Client which contains separate terms and conditions will not take precedence or modify the terms and conditions contained
in this Service Agreement AND THE TERMS AND CONDITIONS OF THIS SERVICE AGREEMENT AND ANY CORRESPONDING PROPOSAL ISSUED
BY AET SHALL GOVERN UNLESS AUTHORIZED IN WRITING IN ADVANCE BY AET.
1_2 — Prior to AET performing Services, Client will provide AET with all information that may affect the cost, progress, safety and performance of
the Services. This includes, but is not limited to, information on proposed and existing construction, all pertinent sections of contracts between
Client and their Client and/or Owner which contain flow-down provisions to AET, if they are provided, site safety plans or other documents which
may control or affect AET's Services. If new information becomes available during AET's Services, Client will provide such information to AET in a
timely manner. Failure of Client to timely notify AET of changes to the project including, but not limited to, location, elevation, loading, or
configuration of the structure or improvement will constitute a release of any liability or indemnity obligations of AET for loss or damages related
to such changes. Client will provide a representative for timely answers to project-related questions by AET.
1_3 - AET is responsible only for performance of the Services. AET will not be held responsible for work or omissions by Client or any other party
working on the project. The Services do not include construction management, general contracting or surveying services. AET will not be
responsible for directing or supervising the work of other parties, unless specifically authorized and agreed to in writing.
1_4 — Client acknowledges the limitations inherent in sampling to characterize buried subsurface conditions. Variations in soil conditions occur
between and beyond sampled/tested locations. The passage of time, natural occurrences and direct or indirect human activities at the site or
distant from it may alter the actual conditions. Client assumes all risks associated with such variations in soil and subsurface conditions.
1_5 - AET is not responsible for interpretations or modifications of AET's recommendations by other persons.
1_6 - Should changed conditions be alleged, Client agrees to notify AET before evidence of alleged change is no longer accessible for evaluation.
1_7— Pricing in the proposal assumes use of these terms and conditions. AET reserves the right to amend pricing if Client requests modifications
to the Agreement or use of Client's alternate contract format. Any contract amendments made after Client has authorized the Services shall be
applicable only to Services performed after the effective date of such amendment. The proposal and these terms and conditions, including terms
of payment, shall apply to all Services performed prior to the effective date of such amendment.
1_8 - The AET proposal accompanying these terms and conditions is valid for thirty (30) days after the proposal issuance date to the Client. Any
attempt to authorize Services after the expiration date is subject to AET's right to revise the proposal as necessary.
SECTION 2- SITE ACCESS AND RESTORATION
2_1- Client will furnish AET safe and legal site access.
2_2 Client acknowledges that in the normal course of its Services, AET may unavoidably alter existing site conditions or affect the environment in
the area being studied. AET will take reasonable precautions to minimize alterations to the site or existing materials. Restoration of the site is the
responsibility of the Client.
SECTION 3- UNDERGROUND UTILITIES AND STRUCTURES (FACILITIES)
3_1 - AET's sole responsibility under this section will be to contact the state "call before you dig" notification center (e.g. Gopher State One
Call in Minnesota), if such an entity exists, for location information of public utilities only. AET shall have no obligation to proceed with the
work until Client has fully complied with all the requirements of this Section 3.
3.2 - Client will mark or cause to be marked the location of all other Facilities that service or are located on the site. AET shall be entitled to
rely upon the accuracy of all location information supplied by any source.
3_3 - Client acknowledges that location data may be incorrect or that some Facilities may not be capable of location and Client fully accepts
this risk and waives any claims against AET for incorrect locations or Facilities incapable of location._
3_4 - Client shall hold harmless, indemnify and defend AET from all claims, damages, losses, fines, penalties and expenses (including attorney's
fees) arising out of or related to the following: a) Facilities that are not shown or vary from the locations shown on any plans or drawings, b)
Facilities that are not located by or vary from the locations marked by Client, governmental or quasi-governmental locator programs, or private
utility locating services, or c) any other Facilities that are not disclosed or vary from locations provided by the Client. The obligation to defend
AET shall be independent of the obligation to indemnify and hold harmless AET and shall be with independent counsel acceptable to AET.
SECTION 4 - CONTAMINATION
4_1 - Client acknowledges and accepts all contamination risks which may be associated with the Services. Risks include, but are not limited to,
cross contamination created by linking contaminated zones to uncontaminated zones during the drilling process; containment and proper
disposal of known or suspected hazardous materials, drill cuttings and drill fluids; and decontamination of equipment and disposal and
replacement of contaminated consumables. Discovery of actual or suspected hazardous materials shall entitle AET to take immediate measures
it deems necessary in its sole discretion, including regulatory notification, to protect human health and safety, and/or the environment. Further,
discovery of such materials constitutes a changed condition for which Client agrees to pay associated additional cost.
4_2 - Client shall indemnify and hold AET harmless from all liability, damages, claims or costs resulting from contaminants on the site.
ACS417EG (O1/23) AMERICAN ENGINEERING TESTING, INC.
ENVIRONMENTAL / GEOTECHNICAL SERVICE AGREEMENT - TERMS AND CONDITIONS Page 2 of 4
SECTION 5 - SAFETY
5_1- Client shall inform AET of any known or suspected hazardous materials or unsafe conditions at the site. If, during the course of AET's Services,
such materials or conditions are discovered, AET reserves the right to take measures to protect AET personnel and equipment or to immediately
terminate Services. Client shall be responsible for payment of such additional protection costs.
5_2 - AET shall only be responsible for safety of AET employees at the site; the safety of all others shall be Client's or other persons' responsibility.
SECTION 6 — SAMPLES
6_1 - Client shall inform AET of any known or suspected hazardous materials prior to submittal to AET. All samples obtained by or submitted to
AET remain the property of the Client during and after the Services. Any known or suspected hazardous material samples will be returned to the
Client at AET's discretion.
6_2 - Non-hazardous samples will be held for thirty (30) days and then discarded unless, within thirty (30) days of the report date, the Client
requests in writing that AET store or ship the samples. Storage and shipping costs shall be borne solely by Client.
SECTION 7 - PROJECT RECORDS
The original project records prepared by AET will remain the property of AET. AET shall retain these original records for a minimum of three years
following submission of the report, during which period the project records can be made available to Client at AET's office at reasonable times.
SECTION 8- STANDARD OF CARE
AET performs its Services consistent with the level of care and skill normally performed by other firms in the profession at the time of this service
and in this geographic area, under similar budgetary constraints.
SECTION 9 - INSURANCE
AET maintains insurance with coverage and minimum limits shown below. AET will furnish certificates of insurance to Client upon request.
9.1—
Workers' Compensation
Employer's Liability
Statutory Limits
$100,000 each accident
$500,000 disease policy limit
$100,000 disease each employee
Commercial General Liability
Automobile Liability
Professional/Pollution Liability Insurance
$1,000,000 each occurrence
$1,000,000 aggregate
$1,000,000 each accident
$1,000,000 per claim
$1,000,000 aggregate
9_2 - Commercial General Liability insurance will include coverage for Products/Completed Operations extending one (1) year after completion
of AET's Services as outlined in our proposal, Property Damage, Personal Injury, and Contractual Liability coverage applicable to AET's indemnity
obligations under this Agreement.
9_3 - Automobile Liability insurance shall include coverage for all owned, hired and non-owned automobiles.
9_4 - Professional/Pollution Liability Insurance is written on a claims-made basis and coverage will be maintained for one (1) year after
completion of AET's Services as outlined in our proposal. Renewal policies during this period shall maintain the same retroactive date.
9_5 - To the extent permitted by applicable state law, and upon Client's signing of the proposal, which includes these Terms and Conditions,
and return of the same to AET, or Client provided forms of acceptance as defined in Section 1.1; Client and Owner shall be named an "additional
insured" on AET's Commercial General Liability Policy (Form CG D414, which includes blanket coverage for the Additional Insured on a Primary
and Non-Contributory basis). Client and Owner shall also be named an "additional insured" on a Primary and Non-contributory basis on AET's
Automobile Liability Policy (Form CA T4 74). Any other endorsement, coverage or policy requirement may result in additional charges.
9_6 - AET will maintain insurance coverage required by this Agreement at its sole expense, provided such insurance is reasonably available, with
insurance carriers licensed to do business in the state in which the project is located and having a current A.M. Best rating of no less than A minus
(A-). Such insurance shall provide for thirty (30) days prior written notice to Client for notice of cancellation or material limitations for the policy
or ten (10) days' notice for non-payment of premium.
9_7 - AET reserves the right to charge Client for AET's costs for additional coverage requirements unknown on the date of the proposal, e.g.,
coverage limits or policy modification including waiver of subrogation, additional insured endorsements and other project specific requirements.
SECTION 10 - DELAYS
If delays to AET's Services are caused by Client or Owner, other parties, strikes, natural causes, pandemic, weather, or other items beyond AET's
control, a reasonable time extension for performance of the Services shall be granted, and AET shall receive an equitable fee adjustment.
ACS417EG (O1/23) AMERICAN ENGINEERING TESTING, INC.
ENVIRONMENTAL / GEOTECHNICAL SERVICE AGREEMENT - TERMS AND CONDITIONS Page 3 of 4
SECTION 11 - PAYMENT, INTEREST, AND BREACH
11.1- Invoices are due net thirty (30) days from the date of receipt of an undisputed invoice. Invoices will be paid without reductions for bond or
retention. Client will inform AET of invoice questions or disagreements within fifteen (15) days of invoice date; unless so informed, invoices are
deemed correct.
11.2 — Invoices remaining unpaid for sixty (60) days shall constitute a material breach of this Agreement, permitting AET, in its sole discretion and
without limiting any other legal or equitable remedies for such breach, to terminate performance of this Agreement and be relieved of any
associated duties to the Client or other persons. Further, AET may withhold from Client data and reports in AET's possession. If Client fails to cure
such breach, all reports associated with the unpaid invoices shall immediately upon demand be returned to AET and Client may neither use nor
rely upon such reports or the Services.
11.3 — AET reserves the right to pursue any unpaid invoice utilizing available remedies at law. AET explicitly reserves its Mechanic Lien or Bond
Claim rights for nonpayment of an undisputed invoice. Client is responsible for paying AET expenses and attorney fees related to collection of
past due invoices.
11.4 — AET reserves the right to charge a 2.5% fee on any payment made using a credit card or debit card.
SECTION 12 - CHANGE ORDERS
AET's proposal associated with this project may provide an estimated cost for the work. If the proposal amount is a time and material estimate,
or if changes occur affecting the project scope, estimated quantities, project schedule or other unforeseen conditions, AET will communicate
with Client request a change order. However, nothing in this agreement shall be construed in any way as a waiver of payment by Client to AET
for Services authorized under this agreement. Approval of a change order may be in writing, by electronic communication, or any directive for
additional Services.
SECTION 13 - MEDIATION
13.1 - Except for enforcement of AET's rights to payment for Services rendered or to assert and/or enforce its lien rights, including without
limitation assertion and enforcement of inechanic's lien rights and foreclosure of the same, Client and AET agree that any claim, dispute or other
matter in question arising out of or related to this Agreement shall be subject to mediation as a condition precedent to arbitration or the
institution of legal or equitable proceedings by either party; provided however that if either party fails to respond to a request for mediation
within sixty (60) days, the party requesting mediation may without further notice, proceed to arbitration or the institution of legal or equitable
proceedings.
13.2 - Mediation shall be in accordance with the Construction Industry Mediation Rules of the American Arbitration Association. Request for
mediation shall be in writing and the parties shall share the mediator's fee and any filing fees equally and each party shall pay their own legal
fees. The mediator shall be acceptable to both parties and shall have experience in commercial construction matters.
SECTION 14 - LITIGATION REIMBURSEMENT
Except for matters relating to non-payment of fees, which is governed by Section 11 hereof, payment of attorney's fees and costs associated with
lawsuits or arbitration of disputes between AET and Client, which are dismissed or are judged substantially in either party's favor, shall be paid
by the non-prevailing party. Applicable costs include, but are not limited to, attorney and expert witness fees, court costs, and other direct costs.
SECTION 15 - MUTUAL INDEMNIFICATION
15.1- Subject to the limitations contained in Sections 15 and 18, AET agrees to indemnify Client from and against damages and costs to the extent
caused by AET's negligent performance of the Services.
15.2 - Client agrees to indemnify AET from and against damages and costs to the extent caused by the intentional acts or negligence of the Client,
Owner, Client's contractors and subcontractors or other third parties.
15.3 - If Client has an indemnity agreement with other persons or entities relating to the project for which AET's Services are performed, the
Client shall include AET as an additional Insured.
15.4- AET's indemnification to the Client, including any indemnity required or implied by law, is limited solely to losses or damages caused by its
failure to meet the standard of care and only to the extent of its negligence.
SECTION 16 - NON-SOLICITATION
Each party to this Agreement (a "Party") agrees that it will not encourage, induce, or actively solicit any employee of the other party to leave
their employment for any reason, provided that neither Party is precluded from (a) hiring any such employee who has been terminated by a Party
or its subsidiaries prior to commencement of employment discussions between a Party and such employee, or (b) soliciting any such employee
by means of a general advertisement or through an employment agency that does not specifically pursue the employee, or (c) hiring employees
orformer employees of the other Party who contact the Party on its own accord. This Non-Solicitation provision shall be effective and enforceable
for six (6) months following termination of this Agreement.
SECTION 17 - MUTUAL WAIVER OF CONSEQUENTIAL DAMAGES
Except as specifically set forth herein and to the extent permitted by applicable law, Client and AET waive against each other, and each othe�'s officers,
directors, members, subcontractor, agents, assigns, successors, partners, and employees any and all claims for or entitlement to special, incidental,
indirect, punitive, or consequential damages arising out of, resultingfrom, or in any way related to the Services provided by AET underthis Agreement.
This mutual waiver of consequential damages includes, but is not limited to, the following: loss of profits; loss of revenue; rental costs/expenses
incurred; loss of income; loss of use of property, equipment, materials or services; loss of opportunity; loss of rent; loss of good will; loss of financing;
loss of credit; diminution of value; loss of business and reputation; loss of management or employee productivity or the services of such persons;
increased financing costs; cost of substitute facilities; cost of substitute goods/property/equipment; cost of substitute services; and/or cost of capital.
ACS417EG (O1/23) AMERICAN ENGINEERING TESTING, INC.
ENVIRONMENTAL / GEOTECHNICAL SERVICE AGREEMENT - TERMS AND CONDITIONS Page 4 of 4
This mutual waiver is applicable, without limitation, to all consequential damages due to either party's termination of this Agreement in accordance
with the provisions of the Agreement and related documents and shall survive any such termination.
SECTION 18 - LIMITATION OF LIABILITY
To the fullest extent permitted by applicable law, the total aggregate liability of AET and its officers, directors, partners, employees,
subcontractors, agents, and sub-consultants, to Client and/or ClienYs employees, officers, directors, members, agents, assigns, successors, or
partners, or anyone claiming through Client, for any and all injuries, damages, claims, losses, or expenses (including attorney's fees and costs)
arising out of, resulting from or in any way related to Services provided by AET from any cause or causes, including, but not limited to, its
negligence, professional errors and omissions, strict liability, breach of contract, or breach of warranty, shall not exceed the total compensation
in excess of costs received by AET for Services or $50,000, whichever is greater. The limitation of liability set forth herein does not apply to claims
arising solely out of or related to the willful or intentional acts of AET.
SECTION 19 - POSTING OF NOTICES ON EMPLOYEE RIGHTS
Effective June 21, 2010, prime contracts with a value of $100,000 or more and signed by federal contractors on projects with any agency of the
United States government must comply with 29 CFR Part 471, which requires physical posting of a notice to employees of their rights under
Federal labor laws. The required notice may be found at 29 Code of Federal Repulations Part 471, AppendixA to Subpart A. The regulation also
has a"flow-down" requirement for subcontractors under the prime agreement for subcontracts with a value of $10,000 or more. AET requires
strict compliance of its subcontractors working on federal contracts subject to this regulation. The regulation has specific requirements for
location of posting and language(s) for the poster.
SECTION 20 - TERMINATION
After 7 days' written notice, either party may elect to terminate this Agreement forjustifiable reasons. In this event, the Client shall pay AET for
all work performed, including demobilization and reporting costs to complete the Services.
SECTION 21 - SEVERABILITY
Any provisions of this Agreement later held to violate a law or regulation shall be deemed void, and all remaining provisions shall continue in
force. However, Client and AET will in good faith attempt to replace an invalid or unenforceable provision with one that is valid and enforceable,
and which comes as close as possible to expressing the intent of the original provision.
SECTION 22 - GOVERNING LAW
This Agreement shall be construed in accordance with the Laws of the State of Minnesota without regard to its conflicts of law provisions.
SECTION 23 - ENTIRE AGREEMENT
This Agreement, including these terms and conditions and attached proposal and appendices, is the entire agreement between AET and Client.
Regardless of inethod of acceptance of this Agreement by the Client, this Agreement supersedes any written or oral agreements, including
purchase/work orders or other Client agreements submitted to AET after the start of our Services. Any modifications to this Agreement must be
mutually acceptable to both parties and accepted in writing. No considerations will be given to revisions to AET's terms and conditions or alternate
contract format submitted by the Client as a condition for payment of AET's accrued Services.
ACS417EG (O1/23) AMERICAN ENGINEERING TESTING, INC.
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Form
(Rev. October 2018)
Department of the Treasury
Internal Revenue Service
Request for 'Taxpayer
Identification IVumber and Certification
► Go to www.irs.gov/FormW9 for instructions and the latest information.
Give Form to the
requester. Do not
send to the IRS.
1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
AMERICAN ENGINEERING TESTING, INC.
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❑ Individual/sole proprietor or
single-member LLC
❑ C Corporation ❑`' S Corporation ❑ Partnership
4 Exemptions (codes apply only to
certain entities, not individuals; see
instructions on page 3):
Exempt payee code (if any)
❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ►
Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting
LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is code (if any)
another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that
is disregarded from the owner should check the appropriate box for the tax classification of its owner.
Other (see instructionsl ►
5 Address (number, street, and apt. or
550 CLEVELAND AVE. N..
6 City, state, and ZIP code
ST. PAUL, MN 55114
7 List account number(s) here (optiona
(Applies [o accounts maintained outside the U.S,)
name and address (optional)
❑ Trust/estate
�{, Taxpayer ldentification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
backup withholding. For individuals, this is generally your sociai security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN, later.
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and
Number To Give the Requester for guidelines on whose number to enter.
or
number
DDe�����0�'
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. i am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments
other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
/�
519n Signature of.•
Here U.S. persdti ►
General Instructions
Date ►
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Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/FormW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
identification number (fIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not limited to, the following.
• Form 1099-INT (interest earned or paid)
• Form 1099-DIV (dividends, including those from stocks or mutual
funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds)
• Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 (home mortgage interest), 1098-E (student loan interest),
1098-T (tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might
be subject to backup withholding. See What is backup withholding,
later.
Cat. No. 10231X Form W-9 (Rev. 10-2018)
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ACORO�
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AMERCON-12
CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYYYY)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER ''��'c�wc a av�e-e.�.�uv
Hub International Great Piains
245 E. Roselawn Avenue
Suite 31
Saint Paul, MN 55117-1940
INSURED AMERICAN CONSULTING SERVICES INC
AMERICAN ENGINEERING TESTING INC
AMERICAN PETROGRAPHIC SERVICES INC
550 CLEVELAND AVE N
ST PAUL, MN 55114-1804
Ann Ross
:xr�: (651) 288-5137
. ann.ross@hubinternational.com
INSURER(S) AFFORDING COVERAGE
n:The Phoenix Insurance Compai
e;The Travelers Indemnity Compar
�;Travelers Property Casuaity Comp�
�:The Travelers Indemnity Comp;
e:Continental Casualty Company
F:
286-0560
25623
of America 25666
y of America 25674
25658
20443
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR 7ypE OF INSURANCE ADDL SUBR pOLICY NUMBER P�LICY EFF POLICY EXP LIMITS
LTR N VD MM/DD MlDD
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ Z�OOO�OOO
CLAIMS-MADE � OCCUR P630539K8896PHX23 1/1/2023 �/�/2024 DAMAGETORENTED ��QQQ�OQQ
PREMISES Ea occurrence $
MEDEXP An one erson $ �0,00�
PERSONAL &ADV INJURY $ Z,OOO,OOO
GEN'LAGGREGATELIMITAPPLIESPER: GENERALAGGREGATE $ 4,000,000
POLICY �X jE� � LOC PRODUCTS-COMP/OPAGG g 4,000,000
OTHER: $
B AUTOMOBILE LIABILITY Ea aBcitleD�SINGLE LIMIT $ Z,OOO,OOO
X ANYAUTO 8102L6457122343G 1/1/2023 1/1/2024 BODILYINJURY Per erson �
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY Per accident $
AUTOS ONLY AU�TOS ONL� PROPERTY DAMAGE
Per acc'ident $
$
C+ X UMBRELLA LIAB X OCCUR � � EACH OCCURRENCE $ � O,OOO,OOO
EXCESSLIAB CLAIMS-MADE CUP3K2260092343 1/1/2023 1/1/2024 AGGREGATE g �0,000,000
DED X RETENTION $ 0 $
D WORKERS COMPENSATION X
AND EMPLOYERS' LIABILITY STATUTE ER,__.,,,__.
UB9H9151012343G 1/1/2023 1/1/2024 1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE Y� N E.L. EACH ACCIDENT $
OFFICER/MEMBEREXCLUDED? �N N�A
(Mandatory in NH) E.�. DISEASE - EA EMPLOYE $ �'���'���
if yes, describe under 1 000 000
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ ' '
E PROF/POLL LIABILITY ECH254066939 1/1/2023 1/1/2024 EACH CLAIM 10,000,000
E RETR0:070287 ECH254066939 1/1/2023 1/1/2024 AGGREGATE 15,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 707, Additional Remarks Schedule, may he attached if more space is required)
RENEWALS: contracts@teamAET.com
ILLUSTRATION CERTIFICATE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
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ACORD 25 (2016/03) O 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD