HomeMy WebLinkAboutAdvanced Broadcast Solutions^ .t(" .IZ.
Technical Services Agreement
Installation Scope of Work
city
Of
Auburn, Washington
August 29, 2008
Prepared by:
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8735 South 212th Street ~~~~~~~orls
Kent, Washington 98031
P: 206.870.0244
F: 206.299.9990
Contact: Mark Siegel, President
mark@advancedbroadcastsolutions.com
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Table of Contents
TECHNICAL CONSULTATION SERVICES AGREEMENT 3
INTRODUCTION AND EXECUTIVE SUMMARY 3
SCOPE OF WORK
3
KICKOFF MEETING
3
REVIEW OF TECHNICAL FACILITIES AND OPERATIONS
4
INTERMEDIATE STUDY REVIEW
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REPORT PREPARATION
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PROJECT MILESTONES
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DELIVERABLES
4
KICKOFF MEETING DELIVERABLES
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REPORT AND PRESENTATION
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QUALIFICATIONS & PHILOSOPHY, CORE VALUES ERROR! BOOKMARK NOT DEFINED.
BIOGRAPHIES OF PROPOSED PROJECTTEAM ERROR! BOOKMARK NOT DEFINED.
MARK D. $IEGEL, EXECUTIVE IN CHARGE ........................................ERROR! BOOKMARK NOT DEFINED.
LARRY BRANDT, $ENIOR BROADCAST ENGINEER ...............................ERROR! BOOKMARK NOT DEFINED.
KENNETH M. SCOTT, DIRECTOR OF BROADCAST ENGINEERING ...........ERROR! BOOKMARK NOT DEfINED.
MARK WARNER, VICE PRESIDENT .................................................ERROR! BOOKMARK NOT DEFINED.
IN HOUSE TECHNICAL CAPABILITIES ERROR! BOOKMARK NOT DEFINED.
TYPES OF FACILITIES ....................................................................ERROR! BOOKMARK NOT DEFINED.
TYPES Of SERVICES .....................................................................ERROR! BOOKMARK NOT DEFINED.
FINANCIAI TERMS AND CONDITIONS ERROR! BOOKMARK NOT DEFINED.
FINANCIAL ................................................................................ERROR! BOOKMARK NOT DEFINED.
CHANGE ORDERS 5
STANDARD TERMS AND CONDITIONS 6
ACCEPTANCE 9
ADDITIONAL 10
SIGNATURES 15
2 City of Auburn, Washington: Technical Services Agreement
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INTRODUCTION AND EXECUTIVE SUMMARY
Advanced Broadcast Solutions is a high technology firm specializing in high-
definition and new media consulting services, system design, technical
integration and procurement for the electronic media industry. ABS prides itself
in being agile and efficient and able to respond quickly to our customer's needs.
Our lengthy broadcast and industrial experience will bring the knowledge and
resources of similar previous projects to City of Auburn. Our technical expertise
is second to no one else in the video production industry.
ABS has been asked to provide the City of Auburn with a replacement for their
current Leightronix Pro-8 control system. After researching the available product
offerings from several vendors and reviewing the workflow and stated needs as
set forth by Brian Gabarino, Chrissy Malave and Kathy Price at the City of
Auburn, ABS is ready to recommend that the City of Auburn proceed with a
purchase agreement with Advanced Broadcast Solutions to provide a Leightronix
Nexus Video Server/System Controller.
For this project, we have been given access to review the physical layout of the
City of Auburn's Council Chambers Control Room and have received copies of as-
built drawings of the existing system. After consultation with our engineering
staff and with Leightronix, we propose to undertake the following scope of work.
SCOPE OF WORK
The following section describes the services, work packages, tasks and
deliverables to be provided to City of Auburn by Advanced Broadcast Solutions.
KICKOFF MEETING
A one-day meeting will be scheduled at the City of Auburn business office as
soon as possible after execution of the Technical Services Aqreement between
City of Auburn and Advanced Broadcast Solutions. The purpose of this working
session is to establish project communications between City of Auburn and ABS
and to develop project efficiencies. Some specific tasks that are to be
accomplished during this meeting are:
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• Establish a contact list of City of Auburn and ABS personnel critical to the
project
• Review the contract Scope of Work and the proposed project Gantt chart
time line
• Review and set project goals, processes and milestones.
• Negotiate a non-disclosure agreement between Advanced Broadcast
Solutions and City of Auburn if required.
Note: During any project it is critical that the Customer provide a central contact
person to work with the consultant. An individual with knowledge of Corporate
and Group structure, key individuals, operational flows, business nuances and
business philosophy is important to the successful gathering of information.
Such an individual is usually a mid-level manager from engineering, operations,
business or accounting. ABS is requesting that someone be assigned to this
Technical Services Aqreement to help with:
• Identifying personnel and setting up interview schedules with City of
Auburn managers, stafF and business partners if required by the
Agreement
• Securing operational schedules and production project descriptions for
internal production efForts, if available
• Identifying individuals with essential insight into City of Auburn stations
technology and operations
REVIEW OF TECHNICAL FACILITIES AND OPERATIONS ,
Technical Services Agreement: begin with information gathering related to the
existing technical facilities and operations of City of Auburn properties.
In addition to analysis of current equipment and operations, ABS will review the
suitability of existing HVAC components, studio lighting, connectivity to cable and
satellite distributors and general workflow.
DELIVERABLES
4 City of Auburn, UVashington: Technical Services Agreement
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KickofF Meeting: ABS and City of Auburn staff meet to discuss project timeline,
installation date for new equipment, and cut-over procedures from Pro-8 Control
System to Nexus Control System and City of Auburn stafF training on new Nexus
system.
Upon approval of dates, times and cut-over procedures, ABS will initiate product
ordering and shipment. We estimate that Leightronix can deliver within 2-4
weeks of order.
ABS will set-up, test and program the Nexus with a schedule provided by City of
Auburn stafF to make sure that the new system performs as required.
ABS will initiate loading new Nexus system into City of Auburn equipment rack in
the space vacated by two JVC VCR machines.
Remove the two JVC VCR units and prepare for cut-over to Nexus from the Pro-8
system. Footage and slide material will be loaded into Nexus by City of Auburn
staff under supervision of ABS.
Using existing wiring ABS will connect the replacement Leightronix unit to the
current in place City of Auburn systems.
Upon approval by City of Auburn, ABS will perform cut-over operation to Nexus
and make certain that Nexus is operating correctly.
ABS and City of Auburn will coordinate for a training day with Leightronix trainer
to come in and train City of Auburn staff.
Sign-ofF by City of Auburn once ABS shows completion of project.
There is no requirement for any additional cabling. City of Auburn agrees that
existing cables in system should be adequate for completion of the project; if
cables are found not adequate then a change order will be executed to replace
cables.
Desired changes to the Scope of Work are to be submitted in writing by the
requesting party (original document on company letterhead or facsimile of same
5 City of Auburn, 1Nashington: Technical 5erviees Agreement
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constitute "in writing" for the purpose of Change Orders). ABS will evaluate the
impact of the requested change and submit to Customer, in writing, an
Agreement Change Quotation, detailing the requested change, adjustments to
pricing and completion timing, if any. Return of the Agreement Change
Quotation to ABS with signature of authorized agent of the Customer shall be
considered acceptance of same and shall be considered a binding part of this
Agreement. For this project, ABS is using existing City of Auburn cabling to wire
in the Leightronix Nexus system. Should any of this wiring fail to function
properly according to accepted broadcast engineering standards, ABS will
consider this a Change Order item. The City of Auburn shall pay for any
additional cabling needed to complete this project.
DESIGN - applies if called for in the Scope of Work of the Agreement
Acceptance of Design: Customer agrees that their written approval of Design
Drawings signifies formal technical acceptance of said designs, pursuant to which
ABS shall carry out its obligations under this agreement. Customer agrees that
delays in approvals may result in an overall delay in the completion of the Scope
of Work. Customer agrees to make its technical representative(s) available to
ABS from time to time during the execution of this Scope of Work, at any
manufacturer facility, build or installation site for consultation and review of
design or OEM merchandise suitability for applications specified. Customer shall
have seven business days to review submission for acceptance or request
modification. The submissions will be scheduled into the Gantt chart. Delays in
review of submissions will directly affect the timeline / Gantt chart. ABS will
notify customer the effect of delay. After seven business days if a written request
for modification or acceptance is not received the submission will be deemed
accepted.
INSTALLATION - applies if called for in the Scope of Work of the
Agreement
Installation Site Conditions: Customer acknowledges and agrees that site
conditions at customer site must be acceptable to ABS as stated below for site
installation. All construction in the rooms in which equipment shall be installed
shall be complete before equipment installation begins: walls shall be painted,
papered or otherwise coated; ceilings and floor coverings shall be properly and
appropriately installed; permanent electrical power and lighting shall be properly
6 City of Auburn, Washington: Technical Services Agreement
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and appropriately installed and fully operational. Without limiting the generality
of the foregoing, minimum site environmental conditions shall be as follows: (1)
HVAC (heating, ventilation and air conditioning) capable of maintaining a
temperature of between 68 and 75 degrees Fahrenheit and a relative humidity of
60% to 75%; (2) relatively dust free; and (3) impervious to external weather.
Warran : ABS warrants that installation will be implemented according to
Custom er-a pproved Design Drawings.
Other EcLuipment: Customer agrees that ABS is not responsible for the condition
of or proper operation of any 'other' equipment, which Customer or other
vendors are supplying to the system, which is not supplied through ABS. When
such 'other' equipment is to be integrated into system at the ABS facility or
installation site, the responsibility for shipment, insurance, and the on-time
arrival of such equipment at the ABS facility, or to the installation site, is that of
the Customer. Delays in arrival of 'other' equipment for integration may result in
overall delay in completion of the Scope of Work and increases in the cost to the
Customer of the execution of this Agreement.
EQUIPMENT - applies if called for in the Scope of Work of the
Agreement
OEM Merchandise: ABS agrees to sell, and the customer agrees to buy, the
required Original Equipment Manufacturer (OEM) merchandise as specified in
Customer-approved Design Drawings. ABS will provide written pricing proposal(s)
for said equipment. Customer shall be bound to purchase said equipment upon
receipt of a written purchase order and necessary deposits by ABS. ABS will
order no equipment other than installation supplies as defined in this Agreement,
without written purchase order (or signed ABS Sales Agreement by an authorized
agent of customer, if Customer does not typically issue purchase orders in the
normal course of business) and necessary deposits (original document or
facsimile constitutes "written" as referenced in this clause only). Prices for said
merchandise will be F.O.B. ABS Kent, Washington facility or U.S. point-of-
shipment if drop shipped for expedited handling, exclusive of present and future
taxes, duties, or assessments of any kind applicable to the relevant taxing
authorities.
Customer acknowledges and agrees that it will review the Equipment List and
shall satisfy itself that the OEM merchandise listed is suitable for the purpose
that the Customer intends at the time this Agreement is made and is suitable for
7 City of Auburn, Washington: Technical Services Agreement
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the application(s) specified in custom er-a pproved Design Drawings. Issuance of
any implement of purchase, including but not limited to, Purchase Order, Letter
of Intent or down payment for any OEM merchandise shall be considered proof
of Customer satisfaction and suitability. If (a) Customer's requirements change
from those which were understood at the time this Agreement was made or
Design Drawings are approved or (b) Original Equipment Manufacturer's changes
in any Equipment result in unsuitability or fitness for the intended purpose at a
time subsequent to the execution of this Agreement or Customer purchase, or
(c) Customer selects other than ABS-recommended OEM merchandise without
consultation with or against the recommendation of ABS, ABS shall not be
responsible for any consequences resulting from any such change. In the event
that Customer purchases equipment directly from another source other than ABS
to be integrated under this agreement, as provided by the Equipment List or
other written proposal, ABS will levy Customer a 5% surcharge against the
published list price of said equipment for the purposes of managing, integration
and handling.
ABS is not liable for equipment delivery delays due to OEM or delays in issuance
of purchase orders by Customer. ABS further declares that it will strive to meet
or better all estimated equipment delivery dates, however such dates are only
estimates. Any delay in acceptance of this Agreement or in payment for OEM
merchandise (including but not limited to down payment) may result in delays in
Scope of Work completion.
Equipment Specification: Customer understands and agrees that specifications
and design of products is subject to change by manufacturer prior to delivery in
order to improve performance or reliability, or because of material unavailability.
Customer shall have no right of prior approval of such modifications unless such
changes affect the form, fit or function of the merchandise.
Shipment Terms: It is understood and agreed by and between Customer and
ABS that shipment of all OEM merchandise and installation materials shall be
F.O.B. manufacturer by surface transport (unless otherwise agreed in writing by
both parties). It is further understood that Customer shall be responsible for
freight charges and insurance costs from manufacturer to ABS and from ABS to
Customer (which shall be prepaid by ABS and billed to Customer), due and
payable by Customer within 10 days after delivery (as required by tariffi). Subject
to the security interest of ABS in the OEM merchandise and installation materials,
risk of loss or damage to the Equipment shall pass from ABS to the Customer
8 City of A+aburn, Washingtcan: Technica{ Services Agreement
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when Equipment is shipped from ABS' facility or from the U.S. point-of-shipment
if dropped shipped for expedited delivery.
Equiqment Returns: ABS will accept merchandise returns under the following
conditions:
a. Customer received incorrect hardware due to an error on the part
of ABS.
b. Equipment arrived at customer site in inoperable condition either
due to manufacturing defects or damage in shipment.
c. Customer elects to return equipment for any reason other than
specified in (a) and (b) of this section.
d. For this contract only, Leightronix has agreed to honor a 45-day
no-questions asked return policy on the Nexus hardware.
Installation, integration, training and shipping charges are not
refundable. The City of Auburn would still be liable for labor and
materials charges incurred by ABS to both perform initial
installation and restore the system back to its Pro-8 configuration.
The system restoration would be handled as a change order as
per ABS Terms and Conditions and is not quoted here.
In the event that Customer elects to return merchandise under part "c" of this
section ABS will charge the customer a restocking fee to be determined by the
manufacturer and ABS, including shipping.
In any event, returns require a Return Materials Authorization memo from ABS to
Customer containing charges (if any) and shipping information.
ACCEPTANCE
It is understood that final completion of this project is defined as the date that
the Customer generated post installation punch list is completed by ABS or its
assigns, and is signed by the Customer, or in the case of studies and reports final
completion is defined as the date of delivery of the documentation as stated in
the contract. All monies agreed to under this contract are due and payable
immediately after the post installation punch list is signed off by the Customer or
documentation is delivered per the contract. In all cases when thirty days have
passed from the date that ABS requests the Customer deliver a final punch list to
ABS, the project will be considered accepted by the Customer and all monies are
9 City of Auburn, Washington: Technical ServiGes Agreement
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due and payable. Final drawing set, if included in this agreement will be
delivered to the Customer within the time period agreed to in this contract, after
final payment is received by ABS.
ADDITIONAL
Proprietary Rights: Title to and ownership of all processes, methods, designs,
specifications, memoranda, drawings, reports, trade secrets, know-how,
technical materials, software (whether in machine-readable or printed form),
inventions, discoveries, patentable and copyrightable work product and other
intellectual property rights used, produced or developed by Advanced Broadcast
Solutions ("ABS'~ in the performance of its obligations under this Agreement,
and including without limitation derivative works, compilations, or collective
works thereof and all related technical know-how and all rights therein (the "ABS
Proprietary Property'~ are and shall remain the property of ABS or its suppliers.
The foregoing notwithstanding, all Design Drawings and other documents
produced in the execution of this Agreement shall be the property of Customer
and are not part of the ABS Proprietary Property. Except for the rights expressly
granted to Customer hereunder, ABS retains and reserves for itself all other
rights in and to the ABS Proprietary Properry. Customer shall not take any action
to jeopardize, limit or interfere in any manner with ABS's ownership of or rights
with respect to the ABS Proprietary Property. Further, Customer shall not remove
or alter any trademark, copyright or other proprietary notices, legends, symbols,
or labels appearing on the materials and documentation delivered to Customer
and Customer shall reproduce such notices on all copies of such materials and
documentation to the extent that such notices appear on the ABS Proprietary
Property.
Indemnitv: ABS shall have no obligation or liability for, and Customer shall
defend, indemnify and hold ABS harmless and, at ABS's request, defend ABS
and/or its suppliers from and against any and all claims, liabilities, losses,
damages, expenses and costs (including attorneys' fees and costs) based upon:
(A) any change in Customer's requirements from those which were specified at
the time this Agreement was made, or manufacturer's changes in any Equipment
10 City of Auburn, Washington; Technical Services Agreement
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resulting in unsuitability or fitness for the intended purpose at a time subsequent
to the execution of this Agreement; (B) use, operation or combination of
Equipment in a manner that is inconsistent with the manner of usage or
operation expressly prescribed by ABS or the manufacturer of such Equipment;
(C) any modifications of the OEM merchandise or Materials installation not
specifically authorized in writing by ABS or performed by ABS.
Limitation of Liabilitv: (a) to the extent allowed by applicable law, in no event
shall ABS or its suppliers be liable for any loss of profits, loss of use or data,
interruption of business, or for indirect, special, incidental or consequential
damages of any kind, (b) in no event will ABS or its suppliers be liable for any
claim against Customer by any third party, (c) in no event shall ABS or its
suppliers be liable for (i) any representation or warranty made to any third party
by Customer; (ii) failure of the equipment to perform; or (iii) the results
produced or information obtained by or through the equipment, (d)
notwithstanding anything in this agreement to the contrary and except for death
or personal injury caused by the negligence of ABS, ABS' entire liability to
customer for damages concerning performance or nonperformance by ABS or in
any way related to the subject matter of this agreement, and regardless of
whether the claim for such damages is based in contract or in tort, shall not
exceed the amount received by ABS from customer hereunder.
Confidentialitv: "Confidential Information" shall mean this Agreement and all
information a party discloses to the other which has been either (i) characterized
in writing as confidential at the time of its disclosure or (ii) orally characterized as
confidential at the time of disclosure and reduced to writing and designated
"Confidential" subsequent to such disclosure, except for information which the
receiving party can demonstrate: (a) is previously rightFully known to the
receiving parry without restriction on disclosure; (b) is or becomes, from no act
or failure to act on the part of the receiving party, generally known in the
relevant industry or public domain; (c) is disclosed to the receiving party by a
third party as a matter of right and without restriction on disclosure; or (d) is
independently developed by the receiving party without access to the
Confidential Information. Each receiving party shall at all times, both during the
term hereof and for a period of at least 3 years after termination, keep in
confidence all the disclosing party's Confidential Information using a standard of
care the receiving parry uses with its own information of this nature, but in no
event less than reasonable care. The receiving party shall not use the disclosing
party's Confidential Information other than in the course of its duties hereunder.
11 City of Auburn, Washington; Technical Services Agreement
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Without the prior written consent of the disclosing parry, the receiving party shall
not reveal the disclosing party's Confidential Information except on a"need to
know" basis to an employee or contractor (including, without limitation,
attorneys, architects and other professionals providing services to Customer in
connection with the development of the Facility) and shall notify such parties of
the confidential nature of such information. If a receiving party is legally
compelled to disclose any of the disclosing party's Confidential Information, then,
prior to such disclosure, the receiving party will (x) assert the confidential nature
of the Confidential Information and (y) cooperate fully with the disclosing party
in protecting against any such disclosure and/or obtaining a protective order
narrowing the scope of such disclosure and/or use of the Confidential
Information. In the event such protection is not obtained, the receiving party
shall disclose the Confidential Information only to the extent necessary to comply
with applicable legal requirements.
Warran : ABS warrants that it will perform its services under this Agreement in
a professional manner and that the Design Drawings and other documentation
delivered to Customer will be of a quality consistent with such materials
produced by other competent professional organizations engaged in the business
in which ABS is engaged. The express warranties set forth in this agreement
constitute the only warranties made by ABS. ABS makes no other representation
or warranty of any kind, whether express or implied (either in fact or by
operation of law). ABS expressly disclaims all implied warranties or conditions
including those of title, merchantability, non-infringement and fitness for a
particular purpose. The above limitations shall apply to the extent allowed by
applicable law.
Warranty Term: ABS warrantees its services and work product for one full year
from the date of customer written acceptance of ABS installed systems, or from
the date of receipt of final payment from customer, whichever is first. ABS
installed hardware is warranted by the manufacturer and ABS provides no other
warranty for said equipment either expressed or implied.
Extended Services: ABS offers extended services to its customers at extra cost.
Extended services provide service support beyond the limits of the ABS warranty.
Extended Services are not included as part of this agreement unless fully
executed Extended Services agreement is attached to this document.
Extended services include:
12 City of Auburn, ltVashirrgton: Technical Services Agreerrrent
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• RMA assistance for system equipment failures that occur during the term
of manufacturer's warranty.
• System maintenance consulting via telephone for installed components
that are beyond the scope of the ABS and manufacturers warrantees.
• On site troubleshooting, travel and living at customer's expense, for
system failures that occur beyond the scope of the standard ABS
wa rra nty.
Payment Default: If the Customer shall default in the payment of any
indebtedness to ABS when and as the same shall become due and payable and if
such default shall continue for a period of ten (10) days after written notice of
such default shall have been given to the Customer by e-mail, registered or
certified mail, then, all of the liabilities and obligations of the Customer to ABS
whether then due or not, shall, at the option of ABS and without further notice to
the Customer, become due and payable. Customer shall be charged cumulative
interest of one percent (1.5%) per month on all amounts past due.
Miscellaneous: (a) This Agreement may be amended only by writing, signed by
both parties. (b) Neither this Agreement or any right or obligation shall be
assigned, either in whole or in part, by either ABS or Customer by operation of
law or otherwise without the prior written consent of the other. Any purported
assignment or transfer contrary to the foregoing shall be null and void and of no
force or effect. (c) This Agreement shall be governed by and construed under
the laws of the State of Washington, U.S.A., without reference to its conflicts of
law provisions. (d) Any dispute regarding this Agreement shall be subject to the
exclusive jurisdiction of the applicable court in the State of Washington, and the
parties agree to submit to the personal and exclusive jurisdiction and venue
thereof (e) This Agreement will not be governed by the United Nations
Convention of Contracts for the International Sale of Goods. (f) This Agreement
creates no agency, partnership, joint venture, or employment relationship and
neither Customer nor ABS nor their respective agents have any authority to bind
the other party in any respect whatsoever. (g) The section headings herein are
used for convenience only and shall have no substantive meaning. (h) If the
application of any provision hereof to any particular facts shall be held to be
illegal, invalid or unenforceable by any competent court, then (i) the legality,
validity and enforceability of such provision as applied to any other facts and the
legality, validity and enforceability of other provisions hereof shall not be affected
and (j) such provision shall be reformed without further action by the parties
13 1 City of Auburn, Washingtan: Technical Services Agreement
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hereto only to the extent necessary to make such provision valid and enforceable
when applied to the particular facts. (k) Each party shall be excused from any
delay or failure in performance hereunder, except the payment of monies by
Customer to ABS, caused by reason of any occurrence or contingency beyond its
reasonable control, including acts of God (e.g., earthquakes, floods, mudslides
and inclement weather) or the public enemy, expropriation or confiscation,
changes in law, acts of war, rebellion or sabotage or damage resulting there
from, fires, explosions, accidents, riots, strikes and other labor unrest or
concerted acts of workers, or delays or other unforeseen actions by Original
Equipment Manufacturers. The obligations and rights of the party so excused
shall be extended on a day-to-day basis for the period of time equal to that of
the underlying cause of the delay. (I) This Agreement constitutes the entire
agreement between the parties concerning the subject matter hereof and
supersedes all proposals or prior agreements whether oral or written, and all
communications between the parties relating to the subject matter of this
Agreement and all past courses of dealing or industry custom. The terms and
conditions of this Agreement shall prevail over any conflicting purchase order or
other written instrument submitted by Customer. (m) This Agreement is written
in the English language only, which language shall be controlling in all respects.
(n) This Agreement may be executed in any number of counterparts or by
facsimile, each of which when so executed shall be deemed an original and all of
which taken together shall constitute one and the same agreement. (o) If any
dispute arises under this Agreement, the prevailing party shall be reimbursed by
the other party for any and all legal fees and costs associated therewith.
Notices: Notices required or permitted to be given under this Agreement shall be
sent by nationally recognized overnight courier service or by facsimile to the
address or facsimile number of the relevant party below and shall be effective
when received.
City of Auburn notice address:
Kathy Price
IS Network Administrator
City of Auburn
25 West Main Street
Auburn, WA 98001
kprice@auburnwa,gov
253-288-3179
14 City of Auburn, Washington: Technical Services Agreement
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WITNESS OUR HANDS this day of ii~; 4E~~'\:EZ ,.--t z3~-, 2008 at
F~`~v-.~►-,~cl~ _,7~lrl.r~i r1JC .
For:
Advanced Broadcast Solutions, LLC
(Printed name)
(Title of authorized agent)
(Date signed)
For Customer:
(Customer corporate name)
Y • / J • W L„/
(Signature of authorized agent)
40kiuE M ' ReMp Ae-r-
(Printed name)
I I lQ~ e.T7) P-1
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(Title of authorized agent)
g/--~-~~6 9"
(Date signed)
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