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CONTRACT & LEASE INTERNAL COORDINATION SHEET
Contract/Lease Number: Tracking Number: Hal - iy
Grant Funded: YES NO Sf
Contractor/Lessee Name: BS
Purpose | Zane Zoxphowte
Date/Term: “73D 1. LJ GREATER THAN $50,000
Amount: 76 DD 2. L] GREATER THAN $25,000
Department: HA 3. L] $25,000 or LESS
Dept. Monitor Name: (rodu oon Weak LA
Document has been reviewed and includes any attachments or exhibits.
Purchasing Review
LYM ————— ou F-dErtp
Purchasing Dire Ncror Me , Joanne Kublik
Risk Management Review
Approved as written:
SK DEK 3 sate 1-29 - (+
Risk\Wanager or designée O Kay Godwin or Krystal King
Ye
County Attorney Review
roved as SNC) q_
Date: 26 | U.
Coupty At} At (aphey Gregory T. Stewart or Lynn Hoshihara
ee
Following Okaloosa County approval:
Contracts & Grants
Document has been received:
Date:
Contracts & Grants Manager
Express Employment Professionals Staffing Agreement
At Express Services, Inc. (Express) dba Express Employment Professionals (referred to as “Express”, “We” or “Our”), we make it easy for
you to do business with us. The first step to establishing a successful staffing relationship is to ensure a clear understanding of each party’s
responsibilities. We appreciate your business and look forward to the opportunity to support you with outstanding professional employment
services in consideration of your agreement to the following terms and conditions:
1. We hire associates as Express employees, and provide all wages, taxes, withholding, workers’ compensation, and unemployment insurance.
Medical benefits and vacation pay are also available to associates who qualify. We recruit and assign associates to you to perform the job
duties you specify. You agree to notify us if those duties or the workplace of an associate changes.
2. Express complies with all Federal, State, and Local employment laws and regulations. You agree to provide our associates with a safe,
suitable workplace and equipment, and to comply with all applicable federal, state, and local employment laws including proper workplace-
specific OSHA training that adequately addresses potential hazards at your worksite. You agree to indemnify and hold Express harmless
from claims or damages resulting from your non-compliance with applicable laws and regulations. Express pays associates promptly, based
on information approved by you. You agree to pay the charges based on the time card or other mutually acceptable recording method by the
invoice due date.
3. A monthly service charge of (18% per annum) may be assessed on charges remaining unpaid 30 days after the invoice date. We are entitled
to reasonable collection fees, attorney fees, and other expenses incurred to collect all charges on your account(s). Bill rates are subject to
change with appropriate notice.
A. It is our goal that associates perform their jobs to your satisfaction; however, if you are not satisfied with an Express associate for any reason
within the first 48 hours of the assignment, you will not be charged for the first four (4) hours-of the associate’s work and a replacement will
be provided.
5. We provide insurance to cover Express associates for Workers’ Compensation, Commercial General Liability, Employers Liability, Fidelity
Bond, Errors and Omissions, and Hired/Non-Owned Automobile coverage in an amount not less than $1,000,000 per occurrence. You agree
to maintain liability insurance for any motor vehicle, forklift, or other motorized mobile equipment operated by an Express associate, and
agree to waive all rights of recovery against Express as the employer of the Express associate.
6. You agree that you will not request or allow our associates to offer professional opinions concerning any financial audits, certifications or
financial statements, SEC filings or provide management consulting or financial advice. Nor will our associates be permitted sign-off
authority for architectural or engineering projects or construction or other cost estimates. All services performed by our associates shall be
under your direction, supervision and control and you shall be responsible for ensuring that the services meet your requirements and agree
that we are not responsible for the accuracy and correctness of the resulting work product.
7. You shali ensure that Express’ associates’ job duties do not permit access to valuable property of any type or nature, including, but not
limited to cash, securities, credit card numbers, charges, or account numbers.
8. You shall ensure that none of Express’ associates are permitted to drive any vehicles or motorized equipment including forklifts. The term
“vehicle” as used in the Agreement means a motor vehicle, trailer, semi-trailer and any other motorized mobile equipment (for example:
forklift) designed for travel or transportation purposes on public roads, in warehouses, or any other locations at which such a vehicle would
be used.
9. You supervise, direct, and control the work performed by Express associates, and assume responsibility for all operational results, including
losses or damage to property or data in the care, custody, or control of an Express associate. To the extent permitted by law, you agree to
indemnify and hold us harmless from losses, claims or damages due to your negligence, but in no way shall anything in this agreement be
considered a waiver of your Sovereign Immunity as set out in the Florida Statutes.
10. We offer an evaluation hire program designed to provide you with associates on a trial basis priot to converting them to your payroll. To take
advantage of our evaluation hire program, you agree to negotiate a pre-determined trial period or fee prior to an associate’s assignment to
you.
11. Express allows you to hire associates already assigned to you if your invoices are current and you agree to pay an acceptable payroll transfer
fee (up to 30% of an associate’s expected annual earnings) to convert an Express associate to your payroll.
12. You agree, for a period of 180 days from the date of introduction or last date on assignment, whichever is later, not to hire directly or use
Express associates through another staffing firm without paying a liquidation fee of 30% of the Express associate’s expected annual
compensation, unless otherwise agreed to by us in writing.
13.Express will, at your written request, conduct criminal history checks and drug screens as permitted by state law. The costs vary depending
upon the specific test or report ordered and the charges will be agreed upon prior to ordering the tests and/or reports.
Thank you for your business. We look forward to a mutually beneficial relationship.
Company: Date
Agent’s Name and Title (please print) A Agent’s Signature.
Express Representatixé »/ /: ,
Signature CL; 4 n Date ? $ o | 204 Y
C 7
County of Okaloosa
Evaluation Hire/Temporary Staffing
Basic Clerical: Work Comp Code 8810
Pay Rate $8.00 - Bill Rate $ 12.58
Pay Rate $9.00 - Bill Rate $13.14
Pay Rate $10.00 - Bill Rate $14.27
Pay Rate $11.00 - Bill Rate $ 15.40
Pay Rate $12.00 - Bill Rate $16.52
Light Industrial/Janitorial: Work Comp Code 9014
Pay Rate $8.00 ~ Bill Rate $12.52
Pay Rate $9.00 - Bill Rate $13.72
Pay Rate $10.00 - Bill Rate $14.93
Pay Rate $11.00 - Bill Rate $16.14
Pay Rate $12.00 - Bill Rate $17.35
° SUI
*Bill Rate includes:
Qe Recruitin en ee ee a ee enn ne ae ere eine eae canes nes en ce ee
° Selection process
° Drug testing
° Background screening
° Skills assessment
° Reference checks
° Associate benefit options
° Workers’ compensation liability
° Unemployment liability
° Payroll administration
° W2 administration
. FICA
. FUI
Express Services, Inc.
Workers Compensation Policy Schedule:
Policy periods: 10/1/14-15
The Insurance Company of the State of Pennsylvania
Policy No. WC028234551
NAIC# 19429
States Covered: CA
IHinois National Insurance Co.
Policy No. WC028234552
NAIC# 23817
States Covered: ME
INinois National Insurance Co.
Policy No. WC028234559
NAIC# 23817
States Covered: FL
National Union Fire Insurance Company of Pittsburgh, PA
Policy No. WC028234553
NAIC# 19445
States Covered: MA, ND, WI, WY
National Union Fire Insurance Company of Pittsburgh, PA
Policy No. XWC6636320
NAIC# 19445
States Covered: OH
National Union Fire Insurance Company of Pittsburgh, PA
Policy No. XWC6636321
NAIC# 19445
States Covered: WA
_New Hampshire insurance Company
Policy No. WC028234554
NAIC# 23841
States Covered: AR, CO, DC, DE, HI, ID, MS, MT, NM, NV, OK, RI, SD, TN, TX, WV
New Hampshire Insurance Company
Policy No. WC028234555
NAIC# 23841
States Covered: IL, KY, NC, NH, UT, VT
New Hampshire Insurance Company
Policy No. WC028234556
NAIC# 23841
States Covered: NJ, PA
New Hampshire Insurance Company
Policy No. WC028234557
NAIC# 23841
States Covered: AK, AZ, GA, VA
New Hampshire Insurance Company
Policy No. WC028234558
NAIC# 23841
States Covered: AL, CT, IA, IN, KS, LA, MD, MI, MN, MO, NE, NY, OR, SC
Miscellaneous Attachment: M480401
Master ID: 1352730, Certificate ID: 13140373
®
ACCORD
Wee
CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYYYY)
10/1/2014
10/1/2015
THIS CERTIFICATE !S 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 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 Lockton Companies
CONTACT
NAME:
444 W. 47th Street, Suite 900 PHONE ; FAX
Kansas City MO 64112-1906 EMAL HA ok
816) 960-9000 y
( ) INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A: New Hampshire Insurance Company 23841
nore 0 EXPRESS SERVICES, INC. INSURERB : Zurich American Insurance Company 16535
DBA: EXPRESS EMPLOYMENT PROFESSIONALS insuRERc: American Guarantee and Liab. Ins. Co. 26247
9701 BOARDWALK BOULEVARD INSURER D :
OKLAHOMA CITY, OK 73162 WSURERE.
INSURER E:
COVERAGES — EXPSE01 CERTIFICATE NUMBER: 13140373 REVISION NUMBER: XXXXXXK
THIS 18 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
ADDL]
SUBR
LTR TYPE OF INSURANCE INsD| wvD (aMODYYYY) (MIDOIYYYY) LIMITS
B [X | COMMERCIAL GENERAL LIABILITY N | N | PRAS854213-02 10/1/2014 | 10/1/2015 [each OccURRENCE $5,000,000
| CLAIMS-MADE [x Jeccur PREMISES (Es ovcurrence) $ 1,000,000
x STAFFING SERVICE MED EXP (Any one person) $ 10,000
| PERSONAL &ADVINJURY | $ 5,000,000
| GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $_ 5,000,000
|X} Povey FRO- Loc PRobucTs - comp/op AGG | $_ 5,000,000
OTHER: $
B | AUTOMOBILE LIABILITY N [_N | PRAS854213-02 10/1/2014 | 10/1/2015 | VENEDSINGIETIMIT™ Ts + 400.000
ANY AUTO BODILY INJURY (Per person) |$ XXXXXXX
| ALL OWNED | | SCHEDULED BODILY INJURY (Per accident)]| $ XX XXX XK
'X | ninep autos |X| Autos =? | Per eccen) $ XXKXKKN
n eS LAT AUTOS - ee een ‘ ; S XXXXXKX oe
C |__| UMBRELLALIAB | X | occur N | N | UMB5498877-02 | 10/1/2014 | 10/1/2015 | EACH OCCURRENCE $ 20,000,000
X_| EXCESS LIAB CLAIMS-MADE AGGREGATE $_ 20,000,000
DED | | RETENTION $ __ |S XXXXXXX
A AND EMSLOYERS' VIABILITY YIN N SEE ATTACHED POLICY #'S 10/1/2014 10/1/2015 x | STATUTE| ER
A ROR TORTARTIERERECUTNE Dra
