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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. 1 I!I \ `.' .,F.'r.:1•7 741.0.4. ..:ui r.:!r.!i p.:�a:F::•. :1\a\N:. ....... [it V I :f;ilv \• .. . .:1',F•. Page t of 6 r 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. 1111 1 'k......: i`' _ ._::I:;:It;-i'd;l:v. ca;l'. ....:Ri•.;IU\�I::I•..JI...:1�.111-.i r•i! 1 . I .L� 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. r: � .r . .. ... • ; ,..^a..r . ..'I :R... tta�t:;t.. ,q.. ,;�.`t I .ir.. .r., 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 -7se'rr pha" a I 6.1 ...... 103 63 Cw A..I�8� 2 -fa-SV7-Constri.iction Ph 20-- V I u u 0 47 7.1 lapel of offM par febw 7 124 116 8 ----32 as I Soo 746 vital coatsarft p "Cauvery,*ubvtinxxdL A w L040 6 11 532 8 13688 S 1320 S 3,200 kG20 S 2,200 6 6,434 Total CaotCastors— smo."aft, 2.831 6.68 020 ftw was 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 r T weuand DeNxaaon 73 days wed 2/15112 FA&W122iWrathy v4%Army Carps Idly? Mon WW12 Mon W4112 �— 25 1-sectedvocal lnvas6➢atbn 1daN Wed 2AW12 Wed y/9/12 - � Su"'W 73 days Wedy15112 Fd WM12 L. 1 I 3f -Dalannim Final&l ge Cona➢uredon and 5denb 73 days? Wad 2na/12 Fd 52912 r 22 -CLOMR 60 days Thl9/6/12 WedlIM12 1S3 1-IOA tOaaynl 20 tlrys MonW12 Pd WM12 -'30 t-IOA tCerratrarJbrll 20"fe Wn+a/16n2 FII/1/9ff2) r-1 P10*1,FINAL-EddbO_C-Schdla-03 Tab+l 0 PMWM Summary F4MWTeMe4 ,.__-- - -- Dade:Mon QW12 8W1 � �.. .,.. .. lalaslcne ® P/aleal9ummvy - 66wrW Ymatons Pa➢o 1 411Z / iz TmCs M. F�oSe < Ut. ,l �;�s c 0 m 1—►aO 11r 0 Wo � v N o our 1y Benc7i�$ , �. 89 ` m c rn Zw nr , E4. ''j� tt g- 1 O Tq -S o. 1Q s ES lit" ,4e C; 7 PM 17esis„ Pin4sP_ 1-40WC5 mq,, Za i 'Z 19er, Zo 1 z 3 TO Loy -Ti "t' 2- Q V% a v C S P/ i DCS � n cost / 0/ �o )� 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