HomeMy WebLinkAbout2012-038-06/05/2012-AUTHORIZING THE CITY MANAGER TO EXECUTE A GRANT AGREEMENT WITH THE COLORADO DEPARTMENT OF TRANSPORTA RESOLUTION 2012-038
OF THE COUNCIL OF THE CITY OF FORT COLLINS
AUTHORIZING THE CITY MANAGER TO EXECUTE A GRANT
AGREEMENT WITH THE COLORADO DEPARTMENT OF TRANSPORTATION
FOR THE FUNDING OF DESIGN, CONSTRUCTION AND PROJECT MANAGEMENT
FOR STATE HIGHWAY 14 (MULBERRY) BRIDGE-RELATED UTILITY RELOCATIONS
WHEREAS,the Colorado Department of Transportation("CDOT")is working with the City
to design and construct a new bridge over the Poudre River on State Highway 14(Mulberry Street);
and
WHEREAS, in connection with construction of the new bridge, certain water and sewer
improvements of the City will need to be relocated and reconstructed; and
WHEREAS, CDOT has agreed to reimburse the City for its costs associated with the design
and construction of the new water and sewer improvements; and
WHEREAS, in order to obtain the agreed-upon reimbursement from CDOT, it is necessary
for the City to enter into a intergovernmental agreement establishing the terms and conditions for
the grant, in the form attached hereto as Exhibit"A' and incorporated herein by this reference (the.
"Grant Agreement'); and
WHEREAS, the City is authorized to enter into intergovernmental agreements, such as a
grant agreement, to provide any function, service or facility, under Article II, Section 16 of the
Charter of the City of Fort Collins and Section 29-1-203, C.R.S.
NOW, THEREFORE, BE IT RESOLVED BY THE COUNCIL OF THE CITY OF FORT
COLLINS as follows:
Section 1. That the City Council hereby finds that it is in the best interests of the City
to approve and adopt the Grant Agreement.
Section 2. That the City Manager is hereby authorized and directed to execute the Grant
Agreement on behalf of the City in substantially the form on Exhibit "A" attached hereto and
incorporated herein by this reference,with such additional terms and conditions as the City Manager,
in consultation with the City Attorney, determines to be necessary and appropriate to protect the
interests of the City or effectuate the purpose of this Resolution, including but not limited to the
amendment of the Grant Agreement to provide for reimbursement of construction costs upon final
determination of such costs.
Passed and adopted at a regular meeting of the Council of the City of Fort Collins this 5h
day of June A.D. 2012.
ayor
ATTEST: O�FORT COS
O SAL
W Ci lerk
• 6 Y
COLOW
EXHIBIT A
COLORADO DEPARTMENT OF TRANSPORTATION Routing# Po#
STANDARD UTILITY AGREEMENT UfilidcsProjcct# FBRO142-055 utilities WBS Element# .I0,2
This Agreement is for: Engineering Design Const.Project# FBRO142-055 Cont.wBS Element#j j,t()-
Construction Work
Construction Inspection Location: SH 14 Bridge over Poudre River in Ft. Collins
THIS "AGREEMENT" or"Contract'is between the State of Colorado acting by and through Colorado
Department of Transportation ("State"or"CDOT") and The City of Fort Collins
("Owner').
RECITALS:
1. It is necessary for CDOT to make certain improvements to the State Highway System (the"Highway
Improvements")which are located within Larimer County, on State Highway 14 C
between mite point 135.7 and 136.0
2. The Highway Improvements require the Owner to relocate, adjust,or install utility facilities ("the Work"),
which is generally described as follows:
Design and construction of replacement water and sanitary sewer lines to replace existing City
water and sewer lines that conflict with future CDOT bridge improvements. The initial contract
amount is for the design portion of the Work. After development and submission of design
plans and related itemized construction estimate, a funding letter request adjusting the
contract amount to include constructions costs for the Work will be submitted by the City
3. Authority exists in law and funds have been budgeted, appropriated, and otherwise made available by
CDOT for the Work.
4. All citations to rules, codes, documents, and laws refer to the most recent versions.
5. The Owner's Preliminary Plans (see Exhibit D) outline the Work. The Owner shalllprepare detailed
plans in conformance with Part 645, Subpart A of Title 23, Code of Federal Regulations (23 CFR
645A).
6. CDOT is authorized to pay the Owner for the performance of the Work pursuant to Sections 43-1-225,
CRS or 43-1-208, CRS.
7. CDOT and the Owner must comply with 23 CFR 645 and"Accommodation of Utilities within State
Highway System Rights of Way"(CDOT Policy Directive 390) to obtain federal participation in the costs
of the Work.
8. CDOT and the Owner desire to complete the Work as soon as possible.
1 CDOT Form#690 1/11
NOW THEREFORE,THE PARTIES AGREE:
1. Incorporations By Reference. Order of Precedence. The following are incorporated as terms and
conditions of this Agreement. Items a and c are publically available, item b is included in Paragraph 20
and items d through f are attached to the Agreement.
a. Title 23, Code of Federal Regulations, Part 645;
b. The Special Provisions in Paragraph 20;
c. COOT Policy Directive 390 ("Accommodation of Utilities within State Highway System Rights of
Way");
d. Utility Agreement Details (see Exhibit A);
e. Sample Option Letter( see Exhibit B);
f. Owner's Cost Estimate( see Exhibit C);
g. Owner's Preliminary Plans (see Exhibit D).
Any conflict between such terms shall be resolved by the priority they are listed above. This Agreement
shall be subject to the conflicting terms contained in item a,but shall prevail over conflicting terms
contained in items b through g.
2. Effective Date; Notice of Nonliability; Notice to Proceed. This Agreement shall not be effective or
enforceable until it is approved and signed by the Colorado State Controller or designee (the "Effective
Date"). The State shall not be liable to pay or reimburse Owner for any performance hereunder,
including but not limited to, costs or expenses incurred, or be bound by any provision hereof prior to the
Effective Date. COOT will Issue a written notice to proceed ("Notice to Proceed") authorizing the Owner
to proceed with the Work on or after the Effective Date. The Owner shall not begin performance of the
Work until receipt of the written Notice to Proceed from COOT: Upon receipt of written Notice to
Proceed, the Owner shall diligently perform the Work without interfering with the Highway
Improvements or causing avoidable delay. The Owner shall perform the Work in accordance with all
terms and conditions of this Agreement.
3. Timeframe for Completion of Work. The Owner shall coordinate the Work with the Highway
Improvements'construction, as directed by COOT, and shall complete the Work within 365 days of the
date on the Notice to Proceed.
4. Reimbursement. COOT will reimburse the Owner for all "Eligible Costs"(as defined by 23 CFR 645)
of the Work after COOT has received proper billing and is satisfied that the Work is complete. CDOT
and the Owner have estimated the costs of the Work(see Exhibit C). The amount COOT pays the
Owner under this Agreement will be full compensation for all Eligible Costs incurred by the Owner while
performing the Work.
5. Determination of Work Costs. The Owner will determine the direct and indirect work costs (as
defined by 23 CFR 645) ("Work Costs") accumulated under a work order accounting procedure
prescribed by a federal or State regulatory body for the Work, which shall not exceed $ 106,179.00
and is the maximum amount payable under this Agreement to Owner by the State, as determined by
the State from available funds. If the Work Costs are greater than$80,000, CDOT may retain 10% of
said billed Work Costs, up to a maximum of 5%of the original Agreement amount, prior to the required
audit by COOT, pursuant to section 24-91-103, CRS. If COOT retains payments pending an audit,
CDOT will either pay the Owner for Eligible Costs in excess of any previous payments, or the Owner
will reimburse COOT for any previous payments in excess of Eligible Costs.
6. Work Costs In Excess of Original Estimate. If, during the performance of the Work, the Owner
discovers that estimated Work Costs(see Exhibit C) are undervalued, the Owner must obtain an Option
Letter(see Exhibit B) or other amendment to this Agreement. COOT will not pay for Work or Work
Costs incurred prior to that Work or Work Cost being authorized on a fully executed document, such as
this Agreement, an Option Letter, or other amendment to this Agreement. The Owner must itemize all
Work Cost increases on the final billing.
2 CDOT Form#690 1/11
7. Timeframe for Submission of Billings. The Owner must submit all billings to CDOT for Work Costs
not later than 120 days after completing the Work. CDOT will pay the Owner no more than once per
month for satisfactory Work that is properly invoiced.
8. Separate Invoice for Easements. The Owner must invoice CDOT separately for all Work Costs
incurred to acquire an easement or replacement right-of-way under this Agreement.
9. Salvage Value of Materials Removed. The Owner must credit CDOT for the value of all salvaged
materials removed during the Work, as explained in 23 CFR 645.117(h). The Owner shall not dispose
of any salvage materials without CDOT inspection and approval of such disposal.
10. Recording Costs. The Owner and its subcontractors, if any, shall develop and record all Work Costs
in accordance with 23 CFR 645.117 and any other applicable regulations or procedures. The Owner
shall provide CDOT with all information and reports required by State or federal statute, rules,
regulations, or industry standards.
11. Records Retention. The Owner shall maintain a complete file of all records,documents,
communications, and/or other written materials which pertain to the Work. Further,the Owner shall
maintain such records for a period of three (3) years after the latter of:the date of termination of this
Agreement, final payment for the Work, or resolution of pending matters related to the Work. The
Owner shall be the custodian of all such records,documents, communications, and other materials,
however, these items shall be the property of CDOT,and shall be maintained by the Owner in a
reasonably usable and retrievable manner. This provision shall survive any termination clause.
12. Audit, Inspection of Records. and Monitoring. The Owner shall permit CDOT, the Federal
Government, or any other duly authorized agent of a governmental agency to audit, inspect, examine,
excerpt,copy and/or transcribe the Owner's records during the term of this Agreement and for the
period of record retention described immediately above. This provision shall survive any termination
clause. The Owner shall also permit the State, Federal Government, or any other duly authorized
agent of a governmental agency to monitor all activities conducted by the Owner pursuant to the terms
of this Agreement. The Owner shall further permit the monitor to review procedures and data, test
materials, conduct visual inspections, perform on-site inspections, or any other reasonable procedure.
13,Term of Agreement. Unless otherwise terminated in accordance with provisions of this Agreement,
this Agreement will terminate on the date CDOT makes final payment to the Owner.
14. Early Termination in the Public Interest. CDOT may terminate this Agreement at any time CDOT
determines that the Work no longer serves the best interest of CDOT and its public. CDOT shall effect
such termination by giving at least twenty(20) days advanced written notice of the termination date. In
the event of termination under this provision, the Owner shall be entitled to receive just and equitable
compensation for any satisfactory Work completed. Upon termination,the Owner shall be obligated to
immediately return any payment, information, or materials related to the Work.
15. Early Termination for Cause. If the Owner fails to perform in accordance with any provision of this
Agreement, CDOT shall give the Owner written notice of such failure, at least ten (10)days to cure or
justifiably explain such failure, and CDOT's intent to terminate this Agreement for cause. If such cure
or explanation is not satisfactorily resolved after at least ten (10) days, CDOT may terminate the
Agreement. If the Agreement is terminated for cause, Owner shall be obligated to immediately return
any payment, information, or materials related to the Work. If the Agreement is terminated for cause
but it is later determined that the Agreement should not have been terminated for cause, the rights and
obligations of the parties shall be as described in the preceding provision related to termination in the
public interest.
16. Indemnification. The Owner shall indemnify, save, and hold harmless CDOT,its employees and
agents, against any and all claims,damages, liability and court awards including costs, expenses, and
attorney fees and related costs, incurred as a result of any act or omission by the Owner, or its
employees, agents,subcontractors, or assignees pursuant to the terms of this Agreement. This
3 CDOT Form#690 1/11
provision shall survive the termination of the Agreement. CDOT may withhold payments due to Owner
pending resolution of any matter of indemnification.
17. Option Letter. CDOT may increase or decrease payment for Work Costs pursuant to this Agreement
by using an Option Letter for this Agreement substantially similar to Exhibit B. Any other modifications
not within the terms of this Paragraph must be executed by formal amendment to the Agreement.
18. Federal/State Requirements. The Owner shall strictly adhere to and comply with all applicable State and
Federal laws,rules and regulations in performance of the Work. The Owner shall also require compliance
with these statutes and regulations in all subcontractor agreements permitted under this Agreement. The
Owner must obtain CDOT approval prior to award of any subcontract between the Owner and any other
party for the performance of any part of the Work.
19. Legal Authority. The Owner, by and through its signatory,warrants that it possesses the legal
authority to enter into this Agreement and that it has taken all actions necessary to lawfully bind the
Owner to the Agreement.
20. Special Provisions. These Special Provisions apply to all contracts except where noted in italics.
1. Controller's Approval. §24-30-202(1), C.R.S. This Contract shall not be valid until it has been
approved by the Colorado State Controller or designee.
2. Fund Availability. §24-30-202(5.5), C.R.S. Financial obligations of the State payable after the current
fiscal year are contingent upon funds for that purpose being appropriated, budgeted, and otherwise
made available.
3. Governmental Immunity. No term or condition of this Contract shall be construed or interpreted as a
waiver, express or implied, of any of the immunities, rights, benefits, protections,or other provisions, of
the Colorado Governmental Immunity Act, §24-10-101, et seq.,C.R.S., or the Federal Tort Claims Act,
28 U.S.C. §§1346(b) and 2671 et seq., as applicable now or hereafter amended.
4. Independent Contractor. The Owner shall perform its duties hereunder as an independent contractor
and not as an employee. Neither the Owner nor any agent or employee of the Owner shall be deemed
to be an agent or employee of the State. The Owner and its employees and agents are not entitled to
unemployment insurance or workers compensation benefits through the State and the State shall not
pay for or otherwise provide such coverage for the Owner or any of its agents or employees.
Unemployment insurance benefits will be available to the Owner and its employees and agents only if
such coverage is made available by the Owner or a third party. The Owner shall pay when due all
applicable employment taxes and income taxes and local head taxes incurred pursuant to this Contract.
The Owner shall not have authorization, express or implied,to bind the State to any agreement, liability
or understanding, except as expressly set forth herein. The Owner shall (a) provide and keep in force
workers' compensation and unemployment compensation insurance in the amounts required by law, (b)
provide proof thereof when requested by the State, and(c) be solely responsible for its acts and those
of its employees and agents.
5. Compliance with Law. The Owner shall strictly comply with all applicable State and Federal laws,
rules and regulations in effect or hereafter established, including,without limitation, laws applicable to
discrimination and unfair employment practices.
6. Choice of Law. Colorado law, and rules and regulations issued pursuant thereto, shall be applied in
the interpretation, execution, and enforcement of this Contract. Any provision included or incorporated
herein by reference which conflicts with said laws, rules, and regulations shall be null and void. Any
provision incorporated herein by reference which purports to negate this or any other Special Provision
in whole or in part shall not be valid or enforceable or available in any action at law,whether by way of
complaint, defense,or otherwise. Any provision rendered null and void by the operation of this
provision shall not invalidate the remainder of this Contract, to the extent capable of execution.
7. Binding Arbitration Prohibited. The State of Colorado does not agree to'binding arbitration by any
extra-judicial body or person. Any provision to the contrary in this contact or incorporated herein by
reference shall be null and void.
4 CDOT Form#690 1/11
8. Software Piracy Prohibition. Governor's Executive Order D 002 00. State or other public funds
payable under this Contract shall not be used for the acquisition, operation, or maintenance of
computer software in violation of federal copyright laws or applicable licensing restrictions. The Owner
hereby certifies and warrants that, during the term of this Contract and any extensions, the Owner has
and shall maintain in place appropriate systems and controls to prevent such improper use of public
funds. If the State determines that the Owner is in violation of this provision,the State may exercise
any remedy available at law or in equity or under this Contract, including,without limitation, immediate
termination of this Contract and any remedy consistent with federal copyright laws or applicable
licensing restrictions.
9. Employee Financial Interest/Conflict of Interest. CRS §§24-18-201 and 24-50-507, C.R.S. The
signatories aver that to their knowledge, no employee of the State has any personal or beneficial
interest whatsoever n the service or property described in this Contract. The Owner has no interest
and shall not acquire any interest,direct or indirect, that would conflict in any manner or degree with the
performance of the Owner's services and the Owner shall not employ any person having such known
interests.
10.Vendor Offset. §§24-30-202 (1) and 24-30-202.4, C.R.S. (Not Applicable to intergovernmental
agreementsj Subject to§24-30-202.4(3.5), C.R.S., the State Controller may withhold payment under
the State's vendor offset intercept system for debts owed to State agencies for: (a) unpaid child support
debts or child support arrearages; (b) unpaid balances of tax, accrued interest, or other charges
specified in §39-21-101, et seq., C.R.S.; (c) unpaid loans due to the Student Loan Division of the
Department of Higher Education; (d) amounts required to be paid to the Unemployment Compensation
Fund; and (e) other unpaid debts owing to the State as a result of final agency determination or judicial
action.
11.Public Contracts for Services. §8-17.5-101, C.R.S. [Not Applicable to agreements relating to the
offer, issuance, or sale of securities, investment advisory services or fund management services,
sponsored projects, intergovernmental agreements, or information technology services or products and
services] The Owner certifies, warrants, and agrees that it does not knowingly employ or contract with
an illegal alien who will perform work under this Contract and will confirm the employment eligibility of
all employees who are newly hired for employment in the United States to perform work under this
Contract, through participation in the E-Verify Program or the Department program established
pursuant to§8-17.5-102(5)(c), C.R.S. The Owner.shall not knowingly employ or contract with an illegal
alien to perform work under this Contract or enter into a contract with a subcontractor that fails to certify
to Owner that the subcontractor shall not knowingly employ or contract with an illegal alien to i3erform
work under this Contract. Owner(a) shall not use E-Verify Program or Department program procedures
to undertake pre-employment screening of job applicants while this Contract is being performed, (b)
shall notify the subcontractor and the contracting State agency within three days if Owner has actual
knowledge that a subcontractor is employing or contracting with an illegal alien for work under this
Contract, (c) shall terminate the subcontract if a subcontractor does not stop employing or contracting
with the illegal alien within three days of receiving.the notice, and (d) shall comply with reasonable
requests made in the course of an investigation, undertaken pursuant to§8-17.5-102(5), C.R.S.,by the
Colorado Department of Labor and Employment. If the Owner participates in the Department program,
the Owner shall deliver to the contracting State agency, Institution of Higher Education or political
subdivision a written, notarized affirmation, affirming that the Owner has examined the legal work status
of such employee, and shall comply with all of the other requirements of the Department program. If
the Owner fails to comply with any requirement of this provision or§8-17.5-101 et seq., C.R.S.,the
contracting State agency, institution of higher education or political subdivision may terminate this
Contract for breach and, if so terminated, the Owner shall be liable for damages.
12. Public Contracts with Natural Persons. §24-76.5-101, C.R.S. The Owner, if a natural person
eighteen (18) years of age or older, hereby swears and affirms under penalty of perjury that he or she
(a) is a citizen or otherwise lawfully present in the United States pursuant to federal law, (b) shall
comply with the provisions of CRS §24-76.5-101 et seq., and (c) has produced one form of
identification required by CRS§24-76.5-103 prior to the effective date of this Contract.
END OF SECTION
5 CDOT Form#690 1/11
THE PARTIES HERETO HAVE EXECUTED THIS CONTRACT
* Person(s)signing for the Owner hereby swear and affirm that they are authorized to act on behalf of
the Owner and acknowledge that CDOT is relying on their representations to that effect and accept
personal responsibility for any and all damages CDOT may incur for any errors in such representation.
UTILITY OWNER: STATE OF COLORADO:
Name: The City of Fort Collins John W. Hickenlooper, GOVERNOR
Printed Legal Name of Utility Owner,
as registered with the Colorado Secretary of State
Name: by:
Signature of Authorized Representative * forthe Executive Director
Colorado Department of Transportation
By
Printed Name&Title of Authorized Representative
LEGAL REVIEW:
for John W. Suthers,Attorney General
by:
ALL CONTRACTS REQUIRE APPROVAL BY THE STATE CONTROLLER
§24-30-202, C.R.S. requires the State Controller to approve all State contracts. This Contract is not
valid until signed and dated below by the State Controller or delegate. The Owner is not authorized to
begin performance of the Work until such time. If Owner begins performing the Work prior thereto,
the State of Colorado is not obligated to pay Contactor for such performance or for any goods and/or
services provided hereunder.
STATE CONTROLLER
David J. McDermott, CPA
By:
Date:
6 CDOT Form#690 1111
COLORADO DEPARTMENT OF TRANSPORTATION Exhibit A
UTILITY AGREEMENT DETAILS
N/A
This Agreement provides for reimbursement of the following costs:
J Preliminary engineering by: —] Owner D Consultant
❑ Construction/Traffic by: Owner IJ SubAgreementor
Construction engineering/inspection by: ❑ Owner J Consultant
Existing utilities in conflict with highway construction are:
J on existing COOT right of way on right of way COOT will acquire or has since acquired
Ad'usted and/or relocated utilities will be located:
L within ultimate COOT n ht of way J within an easement acquired for the owner
Proof of real property interest or eligibility for reimbursement is:
Recorded title: County: book: page:
Affidavit attached Form#:
Local ordinance#: date:
n Easement(copies attached
Governmental subdivision C.R.S. Sec.43-1-225
A consultant was retained through:
J Competitive negotiation (attach certification of consultant).
✓j Existin ngoing written Agreement attach certification of consultant).
A construction SubAgreementor was or will be selected through:
71 com etitive bidding existing ongoing written Agreement
List any low-cost incidental work(eg., tree trimming, x-ray weld inspection, etc.) to be reimbursed under
this Agreement which will be awarded without competitive bidding:
N/A
If COOT and the Owner are each responsible for a share of the.total relocation costs, the estimate and
subsequent billings will be based on:
J Actual costs attributable to COOT
J Total work adjusted to COOT'spro-rata share document method of apportionment in estimate).
The work will involve:
_:] Replacement of a building, pumping station, substation, or any other similar unit (include credit for
N/A expired service life in estimate).
Betterment of a facility, other than one required by current industry codes or standards (include
NIA credit for betterment in estimate).
Recovery of materials for later reuse by Owner(include credit in estimate for salvage exceeding
NIA 1 $5,000 at current stock prices).
Where will the records of this Work be maintained Who will be the field liaison representative on this
and where shall the executed Agreement documents adjustment?
be sent?
Attention: Jay Rose Name: Jay Rose
Address: Address:(if different)
700 Wood St., Fort Collins Co
Phone# & e-mail address: Phone#&e-mail address:
970-224-6106 jmrose@fcgov.com
COOT representative signature and title: Phone#:
7 CDOT Form#690 1/11
FOR INFORMATION ONLY
STATE UTILITY AGREEMENT DETAILS NOTES
Exhibit A facilitates the Agreement review process and documents conformance with applicable
cost reimbursement criteria. Federal regulations on this subject are contained in 23 CFR, Parts
172, 635, and 645A. These regulations include conditions and limitations on federal-aid
participation in utility relocation costs. The following notes explain certain requirements to guide the
preparation of this and other Agreement documents.
ENGINEERING AND/OR CONSTRUCTION BY OWNERS FORCES: Owner must be adequately
staffed and equipped to perform satisfactorily and in a timely fashion; Construction work must be of
a minor nature routinely performed by the Owner's forces. (23 CFR 645.109, 635.205(b) and
45.115(a))
ENGINEERING CONSULTANT SERVICES: 1) Consultant selection subject to CDOT approval;
sub-Agreements exceeding $25,000 subject to price evaluation and approval by CDOT
Agreements and Consultants Office. (23 CFR 172.7) 2) Consultant under existing ongoing written
Agreement must regularly provide similar services for Owner's non-highway-related work; approval
subject to finding by CDOT that costs are reasonable. (23 CFR 645.109(b))
CONSTRUCTION SUBCONTRACTS: Construction under existing ongoing written Agreement
subject to finding by CDOT that costs are reasonable. (23 CFR 645.115(a)(3))
INCIDENTAL WORK: Incidental work awarded without competitive bidding subject to finding by
CDOT that costs are reasonable. (23 CFR 645.115(a)(4))
UTILITY PERMIT REQUIREMENT: CDOT permit required if adjusted facilities are located within
ultimate CDOT right-of-way.
EXCHANGING OF EASEMENTS: If replacement right-of-way is to be acquired, the CDOT Region
Right-of-Way section must handle the exchanging of easements with the Owner.
PLAN DETAIL: Detail plans to illustrate the work covered by Agreement. Verify the location of
existing and proposed facilities with respect to right-of-way boundaries and planned highway
construction. Show existing facilities in red and proposed facilities in green.
The CDOT representative signature on CDOT Utility Agreements Details certifies conformance
with applicable cost reimbursement criteria. Supporting documentation, if not included as part of
this Agreement, is maintained in the project file and provided upon request.
FOR INFORMATION ONLY
i
f
i
$ CDOT Form#690 1/11
f
a
i
SAMPLE OPTION LETTER Exhibit B
NOTE: This option is limited to the specific Agreement scenario listed below AND cannot be used in place
of exercising a formal amendment.
FY: Old Routing# Old PO#
Option Letter# New Routing# New PO#(if applicable)
A. FUNDING LEVEL UPDATE: Revised OWNER'S COST ESTIMATE (see Exhibit C-1) is attached.
B. REQUIRED PROVISIONS: In accordance with Paragraph 17 of the original Agreement between the
State of Colorado acting by and through the Colorado Department of Transportation ("CDOT") and
(the"Owner"),dated ("Agreement"), CDOT hereby
exercises its option to increase/decrease Work Costs (as defined in Paragraph 5 of the Agreement) based
on changes in the Work as specified on the attached revised Owner's Cost Estimate on Exhibit C-1. Exhibit
C to the Agreement is hereby deleted in its entirety and Exhibit C-1 is hereby incorporated by reference into
the Agreement.
The amount of Work Costs is increased/decreased by$ to a new Agreement value of$
as consideration for Work ordered under the Agreement. Paragraph 5
Determination of Work Costs in the Agreement is hereby modified accordingly. The total Agreement value
including all previous amendments, option letters,etc. is$
The effective date of this Option Letter is upon approval of CDOT Controller or delegate,whichever is later.
UTILITY OWNER: STATE OF COLORADO
Name: Bill Ritter, Jr., Governor
Printed Legal Name of Owner,
as registered with the Colorado Secretary of State
Name: By:
Signature of Authorized Representative forthe Executive Director
Colorado Department of Transportation
By:
Printed Name &Title of Authorized Representative
ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER
§24-30-202, C.R.S. requires the State Controller to approve all State Contracts. This Contract is not valid
until signed and dated below by the State Controller or delegate. The Owner is not authorized to begin
performance until such time. If the Owner begins performing prior thereto,the State of Colorado is not
obligated to pay the Owner for such performance or for any goods and/or services provided hereunder.
STATE CONTROLLER
David J. McDermott, CPA
By:
Colorado Department of Transportation
Date:
s
9 CDOT Form#690 1/11
t
x
OWNER'S COST ESTIMATE Exhibit C
10 CDOT Form#690 1111
OWNER'S PRELIMINARY PLANS Exhibit D
11 CDOT Form#690 1111
Utilities
City ® electric•stormwater•wastewater•water
700 Wood 51.
PO Box 580
Fort Collins,CO 80622
970.221.6700
970.221.6619619 tax 870.224.6003 TDD
utilities@tcgov.com togov.com/utp(ties
April 12,2012
Rudy Sipnefski
CDOT Region 4 Utilities
1420 2"a Street
Greeley, CO 80631
RE: CDOT STANDARD UTILITY AGREEMENT
Mr. Sipnefski:
Enclosed is a copy of the final Professional Service Agreement—Work Order
Form for design of the water and sanitary sewer line relocations associated with the
reconstruction of the Mulberry Street Bridge. The design work will be completed by
Stantec Consulting Services Inc.,one of our on-call design engineers.
In addition, I have enclosed an estimate for my time as the city project manager
on the utility relocations. Attached to this estimate is backup documentation as to my
hourly rate and hourly benefits.
I believe based on our telephone conversation that this is what CDOT requires to
prepare the STANDARD UTILITY AGREEMENT.
If you require any addition information please feel free to contact me at 970-224-
6106. Gam,
G�
James M.Rose
Utilities Project Manager
City of Fort Collins Colorado
cc: Owen Randall
PROFESSIONAL SERVICE AGREEMENT
WORK ORDER FORM
PURSUANT TO AN AGREEMENT BETWEEN
THE CITY OF FORT COLLINS
AND
STANTEC CONSULTING SERVICES INC.
DATED:JULY 15,2008
Work Order Number
Purchase Order Number.
Project Title: MULBERRY STREET / POUDRE RIVER WATER AND SANITARY SEWER LINE
RELOCATIONS
Commencement Date: June 2012
Completion Date: December 2012
Maximum Fee: (time and reimbursable direct costs): Not to exceed$ 95,579.00 (See affached EXHIBIT
B).
Project Description.(See attached Scope of Work—EXHIBIT A).
Scope of Services: (See attached Scope of Work—EXHIBIT A).
Professional agrees to perform the services identified City of Fort Collins
above and on the attached forms in accordance with
the terms and conditions contained herein and in the Submitted By.
Professional Services Agreement between the parties. James M. Rose,Special Projects Manager
In the event of a conflict between or ambiguity in the
terms of the Professional Services Agreement and Date:
this work order(including the attached forms)the
Professional Services Agreement shall control. Reviewed By:
Owen L. Randall,
Water Systems Engineering Manager
The attached forms consisting of eight(8)pages are Date:
hereby accepted and incorporated herein,by this
reference,and Notice to Proceed is hereby given. Approved By.
Jon Haukaas,
Professional: ST ONSU ING ERVf ES INC. Water Engineering and Field
Services Operations Manager
By:'Donald F.Silar
Date:
Title: Senior Associate
Approved By:
Date: q¢/ lzol Z Brian Janonis,
Utilities Executive Director
(over$1,000,000)
Approved By
James B.O'Neill 11,CPPO,FNIGP
Director of Purchasing and
Risk Management
(over$60,000.00)
Date:
Exhibit A
City of Fort Collins
MULBERRY STREET/ POUDRE RIVER WATER AND
SANITARY SEWER LINE RELOCATIONS
Scope of Services
INTRODUCTION
This scope of services represents the engineering services associated with the
relocation of the existing 12" cathodically protected water transmission pipeline and 42"
sanitary sewer trunkline crossings at the Cache La Poudre River immediately north of
State Highway 14 (a.k.a. Mulberry Street). This scope is intended to accompany, and
work in unison with, the project Work Plan/Fee Estimate (Exhibit B). The Work Plan is a
spreadsheet representing an overview of the project• with individual work tasks
represented in rows and anticipated professional staff and subconsultant effort
represented in columns.
The ultimate goal of the project is anticipated to be the determination of preferred
locations to which the water and sewer line can be relocated so to allow for the Colorado
Department of Transportation's (CDOT) proposed improvements to State Highway 14
and more specifically the bridge structure over the Poudre River and creation of
construction documents (i.e. drawings and specifications) for use by the City's On-Call
Contractor during construction of the relocated pipelines.
The project scope extends along the north side of State Highway 14 from the east
entrance road into the City's Mulberry Water Reclamation Facility (MWRF) to the east
bank of the Poudre River. More specifically the water line improvements will be made
between valves V19983 and V20667 and the sewer improvements will be made
between M16631 and M16630 as found on the City s '% Section Maps 091 and 101.
GENERAL
The remainder of this document describes our understanding of the scope of work.
Several assumptions were made in developing the scope:
e Stantec will coordinate with CDOT's as directed by the City's PM.
e Anderson Consulting Engineers (ACE) will prepare the CLOMR and Floodplain
Use Permit for the proposed relocations.
e CDOT has and will share their survey control (i.e. vertical and horizontal),
topographic, geotechnical, and wetland delineation datafinformation.
• All pipeline improvements and construction activities will be able to be performed
within the existing State Highway right-of-way and City property and thus will not
require property title research and the preparation of easements and/or right-of-
way descriptions.
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Page t of 6
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e Erosion control design(s) for use during construction and permitting will be done
by others.
• Any permitting for the construction of temporary coffer dams, other than that
included in a Nationwide 404 permit, will be done by others.
• Construction phase services are not included in this scope and can follow under
a separate agreement.
The Project Team will consist of the following:
City of Fort Collins
Jay Rose — Individual Projects Manager, (970) 224-6106 direct); (970)218-1733
cell; imrose@fcgov.com
Owen Randall—Chief Engineer
Link Mueller—Wastewater Reclamation Engineer
Subconsultant-Anderson Consulting Engineer (ACE)—Brad Anderson
Stantec
Don Silar - Project Manager, (970) 482-5922 office; (970 420-4081 cell;
dsilar@stantec.com
Tanner Randall - Project Engineer
Chris McLaughlin - Design Engineer
Jeromy Vigil - Survey
CDOT
Richard Christy — Project Manager, (970) 622-1280 office; (970) 590-2570 cell;
dchard.christv@dot.state.co.us
Pat Hickey—Environmental, (970) 350-2171 office, Patrick.Hickevrddot.state.co.us
Mark Guerrero—Survey, (970)350-2173 office, Mark.Guerrero@dot.state.co.us
Peter Sulmeisters—Right-of-Way, (970) 350-2157 office,
Peter.Sulmeisters @dot.state.co.us
Mel.Dahlberg —Drawing Files, (303)799-5103 office, mdahlberq@bhinc.com
Contractor
Jeff Moore — Project Manager, (303) 791-3600 ext. 432 office; (970) 217-1934
cell; imoore@garney.com
Gary Haas - (970) 219-9160.
All project deliverables will be made available to the City in electronic as well as hard
copy format(i.e. reproducible Mylars and paper copies). Electronic files will be prepared
and formatted in current industry standard software including AutoCAD (DWG) and
Adobe (PDF)formats.
SCOPE OF SERVICES
Task 1 -Meetings
1.1 Kick-Off Meeting: one (1) meeting will be held at the beginning of the project to
review the scope of work and schedule, and discuss expectations for this project.
FII• \ •�':1 c':• .!` <I• 'n n.u:a c.v;i;h! :r,•.r..:•C 1'•,dr ka;ti\\\�1t:L• ...:n 11'�\I 1•d;hc \ ,` 1: !
Page 2 of 6
1.2 CDOT Progress Meetings: Up to four(4) meetings will be held with Stantec, City,
and CDOT staff and consultant to review progress of the work, review data,
discuss approaches to improvements, and discuss needs and schedule.
1.3 In-House Progress/Design Meetings: Up to four (4) meetings will be held with
City, Garvey, Stantec, and Anderson Consulting Engineers (ACE) staff to review
progress of the work, review data, discuss and formulate approaches to
improvements, discuss needs and address prioritization of improvements. These
meetings will also be used as a forum for discussion with other City departments,
utility companies, subconsultants, and other relevant parties.
1.4 Data Collection Meetings: eleven (11) meetings will be held as follows:
• Meet with CDOT to collect survey and geotechnical data that they have
collected.
o Meet with CDOT to review construction drawings and discuss project
constraints and schedules.
o Meet with City of Fort Collins Recreation Department to review
pedestrian/bike trail realignment drawings and discuss constraints on
placement of water and sewer appurtenances.
a Meet with Natural Resources to review requirements for the Natural
Resource Permit.
o Meet with ACE to review CLOMR and Floodplain constraints.
o Meet with Army Corps of Engineers to discuss proposed project and
solicit their input relative to the need for an Individual or Nationwide
Permit.
o Meet with five utilities (i.e. Qwest, Xcel, PRPA, Comcast, and City Electric
Department)to collect utility maps and request field locates.
1.5 IGA (Design): one (1) meeting will be held with the City to review the IGA
prepared by CDOT for design of the pipelines.
1.6 IGA (Construction): one (1) meeting will be held with the City to review the IGA
prepared by CDOT for construction of the pipelines.
Task 2—Field Investigation
2.1 Stantec will review Utility's Quarter Section maps and utilize them for the location
of inline and lateral valves, underground vaults, fire hydrants, blow-offs, cathodic
protection (CP) test stations, manholes, concrete encasement, and other
appurtenances.
2.2 Stantec will coordinate with utility companies and departments to determine the
type, size and location of existing and future proposed lines in the vicinity of the
proposed water and sewer line relocations. "As-Built" plans for the water and
sewer are available.
2.3 Stantec will coordinate with CDOT to obtain survey control (i.e. vertical and
horizontal), topographic, geotechnical, right-of-way, and wetland delineation
information.
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Page 3 of 6
r
2.4 Stantec will coordinate with Lisa Voytko to obtain a copy of the aerial
photography recently taken of the MWRF and surrounding property. This will be
used as the background for the plan view on the plan & profile drawing(s).
2.5 Stantec will perform a field survey of the project site to obtain horizontal and
vertical locations of valve boxes, CP test stations, fire hydrant, manholes,
bike/pedestrian trail, air release/vacuum valve vault(s), existing bridge abutments
on the north side of the existing bridge, stormwater pipe, property fence,
horizontal and vertical control placed by CDOT (if available), and sanitary sewer
and waterline concrete encasements within the river.
2.6 Stantec will coordinate with ACE to obtain a copy of the floodplain permit, DFIRM
map(s), and information on the normal high water level for use in determining the
extent of the area under the Corps' (404 Permit) jurisdiction; exclusive of the
limits of the wetlands in this area.
2.7 Stantec will contact PRPA regarding coordination for crossing their utility corridor
and easement.
2.8 Stantec will meet with the City's Recreation Department to review any plans they
have for relocation of the bike trail in the location of the pipelines and Mulberry
Street Bridge.
Task 3 —Preliminary Design
The goal of this task Is to consolidate, review, and analyze data collected in the field and
obtained from interviews/meetings with City staff.
3.1 Stantec will prepare a preliminary site drawing showing the location of all existing
and proposed improvements in the area of the proposed relocations. This will
include wetland delineation, and geotechnical information if available from
CDOT. In addition, utility locate information will be shown. City has geotechnical
information from the waterline design.
3.2 Stantec will meet with City staff and their contractor to discuss possible locations
for realignment of the pipelines. The agenda for this meeting will include an item
to discuss the ability of the MWRF to reduce their discharge to the 42" sewer and
means and methods to accommodate this flow including by-pass pumping
options that will almost certainly be required during construction of the sewer.
3.3 Stantec will meet with the City and CDOT to discuss the City's preferred
approach to relocation of the lines and the schedule to perform the relocations.
3.4 Stantec will meet with the Army Corps of Engineers, CDOT, and City on site to
review the proposed re-alignments and discuss the need for a permit (i.e.
Individual or Nationwide) for the work.
Page 4 or 6
Task 4—Final Design
4.1 Stantec will perform design calculations to determine allowable pipe slopes,
reinforcing for concrete cut-off walls, thrust blocks and restrained joint pipe, and
riprap sizing.
4.2 Stantec will prepare a letter and exhibit describing the project and route to the
Army Corps of Engineers for their records. This assumes the project will fall
under the requirements for a Nationwide/General permit and that an Individual
permit will not be required. Should the Corps determine an Individual permit will
be required; this work (i.e. preparation of application, public meeting, response to
public responses, etc.) will involve additional services and fee.
4.3 Stantec and Anderson Consulting Engineers (ACE) will prepare a "No-Rise"
Certificate to meet the City of Fort Collins standards. Since it is anticipated that
the utility line relocations will not change the existing topography of the river
channel and surrounding wetlands, this effort should be minimal and involve
mapping of the final topography over the relocated lines, preparation of record
drawings showing the "as-built" conditions, cutting of existing and final cross-
sections over the improvements, and preparation of a certificate certifying no rise
will occur in this reach of the river due to the water and sanitary sewer line
relocations.
4.4 Stantec will coordinate with the City's Natural Resources Department and
prepare a permit for their review and approval.
4.5 Stantec will prepare two (2) plan & profile drawings depicting the proposed re-
alignments and appurtenances associated with the work. These are anticipated
to include, manholes, valves, fittings, test stations, concrete cut-off walls, riprap
for the banks of the river, concrete encasement of both lines, location of existing
utilities and site obstructions, locations of the proposed CDOT bridge and
pedestrian/bike trail, ground contours, and survey control.
4.6 Stantec will prepare a cover sheet for the drawings containing a vicinity map,
index to drawing sheets, project title and date, and City logo.
4.7 Stantec will prepare up to three (3) detail sheets including details for the concrete
cut-off walls, concrete encasement, manholes, valves and valve boxes, test
stations including posts, wire connections, and terminal box, pipe trench and
bedding sections, rip-rap, thrust blocks or restraint joints, and pedestrian/bike trail
details (e.g. cross section, reinforcing). Installation of anodes is not anticipated
as part of the water line installation and if it is felt these should be included, the
City will coordinate with RUSTNOT to size and locate these.
4.8 Stantec will review Utilitys standard list of specifications and determine what
Division 1, 2, 3 and 16 sections are necessary for the work to be completed by
the contractor. The sections selected will be reviewed and modified, if
necessary, to reflect the requirements of the project.
4.9 Stantec will prepare the CDOT right-of-way permit for submission to CDOT for
their review and approval.
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Page 5 of 6
Task 5—Administration
5.1 Stantec will perform in-house services to set up the project in our accounting
system; prepare scope, fee, billings and status reports; and schedule staff to
meet the City's requirements.
Task 6—"Bid" Phase
6.1 Coordination with "On-Call"Contractor
6.2 Coordination with Independent Estimator
6.3 Cost Resolution Meeting
It is understood that the City will select one of their "On-Cali" contractors to
participate in the design, determine construction related costs, perform
constructability reviews, and perform the actual installation of the sewer and
water lines. Therefore, bidding of the project will not be required but the
contractor will be required to prepare a construction cost estimate for the work.
As is required on City utility projects of this size, an independent party will also
estimate their opinion of the probable construction costs. Once these two
estimates are complete, a "Resolution Session" will be held to review each
estimate and determine if there are any discrepancies that would make the
estimates significantly different and attempt to resolve these discrepancies. The
hours and related costs under this task involve coordination with the contractor,
independent estimator, and City to answer questions that will help in finalizing the
cost estimate. Once the estimate is finalized and accepted by the City, it will be
forwarded to CDOT for preparation of an IGA for the construction phase of the
pipeline work.
Task 7—Construction Phase
7.1 The extent of services required of Stantec will be determined at a later date and
thus no tasks or costs have been included for this phase of the project.
DELIVERABLES
The following deliverables will be forwarded to the City and CDOT as required.
u Draft and final copies of drawings and specification, as required.
o Draft and final copies of permits.
u DVD containing all documents included in the"hard copies" '
END OF EXHIBIT A
Page 6 of 6
EXHIBIT B
EXHIBIT B:FEE ESTIMATE
MULBERRY STREET/POUDRE RIVER WATER AND SANITARY SEWER LINE RELOCATIONS
7
Pa!Rl p—09220=
Aftunsa.
3 31 3 68 1193
12 32 12 $ 4401 1
!A Dr.DNketbn w.0 t 2 1 22 1 8
1.5 4 4
4 4
awmnw:
db ---I I u 0 u 3
Task 2 Field Investigation I ff I 1 25... 5 440 V 1,069
2.2 52
ewdtnauonwthm 2_ 8 8 4 163 S 2477
2A %M��Awal Motoppo" 4 to--- 8 2ES $ 4090
M pws� I Laa $ 1
2A I�hWon with jind� E 2 4 321 $ 4,331
_M�& 2 a T 680 $ 103 $ 2053
2.7 ICQMdkW.*V,PRPA 1 4 ::::4�
28 IC*Wdb"m an liicrwflon Dapa"oM $ 1098
I— 6Wa14k- 14 48
-rw-k 3 Preliminary Design a 0 32 4 still $ 600
2 78 4 16 361 4,071
as 259 4
34 RawrPraPa.N Ruvpra4mWmam CWpad Ergin.an 2 103 $ 1393
78=44 Final Datsign 14
4.1 Nooftkutom;
24
42 —8
42 2 8 — 1.100 165 $ 2 6
4,4 t"uvw Ro�p- 11 1 8 8 —8 103 2,493
445 R�M I'tia&praft iftwMM, —4 3-2 3-2 225 $ 3038
2)
.a 2 —a 0 079
4
4.7 PrpM lietall Sh.W 154 $ 2,082
8 24 —40 — IS 4A 4 8 =8 791 10,683
4A ft�way�R 0 — 130 $ 1,760
�Lj 26 1 74 $ 1.093
-ra-srr Administration T.To .5 2.790
0
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CITY OF FORT COLLINS-ANTICIPATED SCHEDULE E%HISR C
ID TINh-4PIl4._ --- _. ----..._._....,- _.-- _o!PPJ _- Slarj,_- I Ln Jftnu&MIF&tmm I Raye u Au ZI-J§ r ere n h dl
' CITY Odap Wed 2J13/12 ea2MI12 ®jng
z I•City/Stentec to Prepare Scope and Fee Estimates 24 dale Wed y15r12 Mw M9112
3 •Forward Scope and Fee to COOT 2 says Tua 3W12 Wed3MI112
4 i-Coordinate with COOT as They Prepare IOA 20 days Thu 3=2 Wed4ner12
'--_t
s f-Chyto Present IOA to Legal and Council for Review and Approval 40 days Thu WIS112 Wed W13n2
e- Design Relocations(City/Stantec/Contractor) 60 days Thu Ww12 Wm 9/9n2
MOOM9Vd Army C6rps 66M Mon W4n2 Fd SW/2
B PMPMUM Of CLO)M by Arldennn ConoulNg En➢InsM 60 days M"7!ly12 I'd IGIIW12
8- Preparallon of Fbc6pom Use Pamdl byAndenen COMRIM En➢ooM 60 days Mon 7130/12 Fn+01ty72
+0 PH.gafallm of at a Leath to➢O COM3 let 9 NaMWWds 404 Penh 1 day? Wad 2/1912 Wed y16n2
I7 Preparaaon of NMlral R64d *Parmh 30 days IAan 7M)2 Pd MGM
12 Preparation of Roodplah Use Pend1 by Andnson Co UMg Eft"ars 60 days Mm Tt"12 FII 10119/12
�3 Smay 20 days Thu MAIM Wed 7/11/12
-4 laity Locales tsdays Thu W1N12 We67/4n2
IS '•Contractor Estimate 20 days Thu atb+2 Wtdlard/12
1
6 -City Independent Estimate 20 dap Thu9re/+2 wed IGM12
17 -Reconciliation of Estimates 10 days Thu 1OW12 Wed 10/17/12
19 -City/Contractor Work Order 10 days Thu 1011y12 Wed IM1112
1I-Coordinate with COOT as That'Prepare IGA 20 sap Thu++nn2 Wed 11rzW1z
City to Present IOA to Legal and Council for Review and Approval 40 days Thu lMW12 wed lr"3
21 �.Construction of Water and Sanitary Sower Relocations 00 days Thu M1413 Wed 4n7/13
tCDOT Coen Wed2/15r12 Wed 2nE112 v14 t
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T
weuand DeNxaaon 73 days wed 2/15112 FA&W122iWrathy v4%Army Carps Idly? Mon WW12 Mon W4112 �—
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)� f �� 103.01 Employee Salary Report
Fusines All
Employee Number{s):7201
Business Unit(s):All
From March 01,2012 through March 31,2012
Sorted by:Business Unit!Object Account/Employee I Pay Period End Data/Pay Type
Business Object Pay Period Hours Hourly
Employee - , Unit Account Subsidiary Subledger Pay Type End Date Worked Rate Amount
411111-Non DepartmentallProject Mngmt
ROSE,JAMES M-7201 411111 511010 1 REGULAR 18-Mar-12 40.00 539.59 $1,583.46
ROSE,JAMES M-7201 411111 511010 2 VACATION 18-Mar-12 40.00 $39.59 - $1,583.50
Total for ROSE,JAMES M 80.00 - $3.166.95
Total for 511010 80.00 $3,166.95
Total for Business Unit 411111-Non DepartmentaI/Pro)ect Mngmt 80.00 $3,166.95
Data as of 4non012
Page f of 3
.City� ns
f tt� 103.02 Employer Paid Benefits Report
Fund(s):All Employee Number(s):7201
Business Unit(s):All
From March 01,2012 through March 01,2012
Sorted By: Employee!Object Account/Work Date/Benefit Type
Business Object
Employee Unit Account Subsidlery Subledger Benefit Type Work Date Amount
6026410034-Transmission Main Repair Parts
ROSE,JAMES M-7201 5026410034 512010 3 MED-8 031012012 16.62
Total for 512010 16.62
ROSE,JAMES M-7201 5026410034 512020 3 DENTALI 03/012012 1.13
Total for 51202D 1.13
ROSE,JAMES M-7201 5026410034 512030 3 401-9361 03f0112012 11.88
Total for S12030 11.88
ROSE,JAMES M-7201 5026410034 512050 3 Medicare 03/01=12 2.14
ROSE,JAMES M-7201 5026410034 512050 3 Social Security 03/0112012 9.16
Total for 512050 11.30
ROSE,JAMES M-7201 502641 DD34 512060 3 Workers Comp 03101/2012 1.76
Total for 512060 1.76
ROSE,JAMES M-7201 5026410034 612070 3 BAS 1X 03/01/2012 0.23
ROSE,JAMES M-7201 5026410034 512070 3 BAS 1X ADID 0310112012 0.05
Total for 512070 028
ROSE.JAMES M-7201 5026410034 512080 3 LTD3 03/012012 0.58
Total for 512080 0.58
Total for ROSE,JAMES M 43.55
Total for Business Unit 5026410034-Transmission Mein Repair Parts 43.55
flum
Data as of 411 W2012
Page 1 of 2
Cityof 103.02 Employer Paid Benefits Report-
t Collins
Fund(s):All Employee Number(s):7201
Business Unit(s):All
From March 01,2012 through March 01,2012
Sorted By: Employee/Object Account I Work Date/Benefit Type
Business Object
Employee Unit Account Subsidiary Subledger Benefit Type Work Date Amount
5028416011-LaPorte Ave Valve Repl
ROSE,JAMES M-7201 5026415011 512010 3 MED-B 03101/2D12 18.82
Total for 512010 16.62
ROSE,JAMES M-7201 5026415011 512020 3 DENTAL1 0310112012 1.13
Total for 512D20 1.13
ROSE,JAMES M-7201 6026415011 512030 3 401-9361 03101/2012 11.88
Total for 512030 11.88
ROSE,JAMES M-7201 5028415011 512050 3 Medicare 03/01/2012 2.14
ROSE,JAMES M-7201 5026415011 512050 3 Social Severity o3/0112012 9.16
Total for 512050 11,30
ROSE,JAMES M-7201 6026415011 512060 3 Workers Comp 03/01=12 1.76
Total for 512060 1.78
ROSE.JAMES M-7201 5026415011 512070 3 BAS 1X 03/01/2012 0.23
ROSE,JAMES M-7201 5026415011 512070 3 SAS 1XADfD 03/01/2012 0.05
Totel for 512070 0.28
ROSE,JAMES M-7201 5026415011 512080 3 LTD3 03/012012 0.58
Total for 512080 0.58
Total for ROSE,JAMES M 43.55
Total for Business Unit 5026415011-LaPorte Ave Valve Rapt 43.55 ! kAS 7
Grand Total 87.10
Data as of 41102012 Page 2 of 2