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CORRESPONDENCE - PURCHASE ORDER - 9185829
Utilities Work Order Form Official Purchasing Form Last updated 10/2017 WORK ORDER PURSUANT TO A MASTER AGREEMENT BETWEEN THE CITY OF FORT COLLINS AND DITESCO PROJECT & CONSTRUCTION SERVICES WORK ORDER NUMBER: U201902 PROJECT TITLE: USherwood Street Water Main Replacement ORIGINAL BID/RFP NUMBER & NAME: U8745 Engineering Services for Water, Wastewater and Stormwater Facilities Capital Improvements – On-Call MASTER AGREEMENT EFFECTIVE DATE: UAugust 07, 2018 ARCHITECT/ENGINEER: UDitesco Project and Construction Services OWNER’S REPRESENTATIVE: UJames Rose WORK ORDER COMMENCEMENT DATE: UJanuary 18, 2019 WORK ORDER COMPLETION DATE: USeptember 20, 2019 MAXIMUM FEE: (time and reimbursable direct costs): U$57,798.00 PROJECT DESCRIPTION/SCOPE OF SERVICES: UEngineering Design services for the replacement of the six (6) inch one hundred thirty (130) year old water main in Sherwood Street between Laurel Street and Myrtle Street. The project includes the replacement of existing valves in the intersection of Sherwood and Myrtle and the installation of twenty-six (26) new water service connections from the new eight (8) inch main to existing meter pits. See attached supporting documentation. Service Provider agrees to perform the services identified above and on the attached forms in accordance with the terms and conditions contained herein and in the Master Agreement between the parties. In the event of a conflict between or ambiguity in the terms of the Master Agreement and this Work Order (including the attached forms) the Master Agreement shall control. The attached forms consisting of UsevenU (7) pages are hereby accepted and incorporated herein, by this reference, and Notice to Proceed is hereby given after all parties have signed this document. SERVICE PROVIDER: Ditesco Project & Construction Services By: Date: Name: Title: Page 1 of 12 DocuSign Envelope ID: E9F94AB1-4470-49DD-AAB3-995C69BD2E38 Owner/Manager January 24, 2019 KEITH MEYER Utilities Work Order Form Official Purchasing Form Last updated 10/2017 OWNER’S ACCEPTANCE & EXECUTION: This Work Order and the attached Contract Documents are hereby accepted and incorporated herein by this reference. ACCEPTANCE: Date: James Rose, Civil Engineer III REVIEWED: Date: Pat Johnson, Senior Buyer APPROVED AS TO FORM: Date: Name,City Attorney's Title (if greater than $1,000,000) ACCEPTANCE: Date: Owen Randall, Civil Engineering Director ACCEPTANCE: Date: Andrew Gingerich, Director - Water Field Services ACCEPTANCE: Date: Theresa Connor, Deputy Director – Water Engineering & Field Services ACCEPTANCE: Date: Kevin Gertig, Utilities Executive Director (if greater than $1,000,000) ACCEPTANCE: Date: Gerry Paul, Purchasing Director (if greater than $60,000) ACCEPTANCE: Date: Darin Atteberry, City Manager (if greater than $1,000,000) ATTEST: Date: City Clerk (if greater than $1,000,000) Page 2 of 12 DocuSign Envelope ID: E9F94AB1-4470-49DD-AAB3-995C69BD2E38 January 16, 2019 January 16, 2019 January 24, 2019 January 24, 2019 January 25, 2019 January 28, 2019 Utilities Work Order Form Official Purchasing Form Last updated 10/2017 ATTACHMENT A WORK ORDER SCOPE OF SERVICES & COST DETAIL Page 3 of 12 DocuSign Envelope ID: E9F94AB1-4470-49DD-AAB3-995C69BD2E38 Page 1 of 5 2133 S. Timberline Road, Suite 110 Fort Collins, CO 80525 ditescoservices.com Delivery by email to: jmrose@fcgov.com January 7, 2019 Mr. Jay Rose City of Fort Collins Utilities 700 Wood Street Fort Collins, CO 80521 RE: Sherwood Waterline Engineering Design Proposal and Scope of Work Dear Jay: Thank you for giving Ditesco the opportunity to provide engineering services for the Sherwood Waterline Project. Our attached scope of services includes waterline replacement design for the 6-inch waterline in Sherwood Street from Laurel Street to Myrtle Street. The intent of this design proposal is to provide for replacement of aged infrastructure that is well over 100 years old. The existing Sherwood waterline was constructed in 1888. Currently, the design phase will span to early summer with construction planned for mid to late summer 2019. Thank you again for this opportunity. Our firm is built around successful relationships, successful projects and successful outcomes. Please let me know if you have any questions or require further information regarding this proposal, I can be reached by phone at 970.988.8605 and email keith.meyer@ditescoservices.com. Sincerely, Keith Meyer, P.E. Enc. scope of services Cc: Jill Burrell file Page 4 of 12 DocuSign Envelope ID: E9F94AB1-4470-49DD-AAB3-995C69BD2E38 Page 2 of 5 Exhibit A Sherwood Waterline Engineering Design Scope of Services Project Understanding The City of Fort Collins Utilities planned a waterline replacement project as part of the 2018 Water Distribution System Masterplan. The 6-inch waterline in Sherwood Street was built in 1888 and is over 130 years old. The project plans to replace approximately 1 block of waterline (730 lineal feet). It is expected the 6-inch waterline will be replaced with a new, 8-inch waterline to meet peak demand and fire flow conditions. Overall, our scope of services is to provide engineering design services for the 6-inch waterline replacement. We expect the design to include traditional cut-cover technologies. We also expect detailed coordination for each service connection, valve connections in Laurel and Myrtle (as applicable) and fire hydrant installation. The overall schedule is expected to last approximately 7 months with construction planned for late summer 2019. This project will be delivered using the Utilities Alternative Project Delivery System (APDS). Design plans and specifications will be developed to the level of completion decided by the APDS team. The City will be utilizing Connell Resources, Inc. throughout the design and construction process. Phase: Design • Field Inspection. During the early portions of the design phase, we will inspect and determine the water line serve type, location and connection details necessary for each resident along Sherwood. This work will not only formulate the needed construction details but will assist in planning service outages or potential temporary service connections. • We will work with Connell to further obtain potholing information related to utility crossings in the area that may affect the profile design of all pipelines. We will utilize surveying data collected as part of our design effort. • Ditesco will provide full design and construction drawings to at least a 90% completion level for this project including: - Cover - General Notes - Site Layout/Control - Demolition - Water Plan/Profile (3-5 sheets) - Reconstruction/Paving Plan (2 sheets) - Service Connection Details (2-4 sheets) - Construction Details (3-4 sheets) - Total Sheet Count: Approx. 15-20 sheets • Ditesco will prepare and finalize CSI formatted technical specifications, if it is determined to be necessary for the project. If needed, we will also prepare the necessary contract parts to support creation of a final construction work order with the APDS contractor. • Ditesco will attend design phase meetings with City staff and Connell Resources as needed. For these meetings, we will prepare meeting agendas, hand out information and meeting minutes. We have assumed bi-weekly meetings for the duration of design and weekly meetings during construction. Page 5 of 12 DocuSign Envelope ID: E9F94AB1-4470-49DD-AAB3-995C69BD2E38 Page 3 of 5 Deliverables: • Expected Deliverables and Format: o Plan set in both PDF format and digital (AutoCAD Civil 3D ver. 2018) o Technical Specifications in PDF format o Pothole Map and utility table in PDF Format o Weekly Meetings: Agendas, Meeting Minutes, both in PDF format Schedule The anticipated schedule is as follows. A detailed CPM schedule is also attached. Design: January through April 2019 Construction: May through July 2019 Fee Estimate We have based our fee estimate on the following assumptions of the project schedule. • 2.5-month design phase • 2-month construction phase • Potholing will be provided by Connell Resources and City of Fort Collins • Topographic surveying is included and covers Sherwood from Laurel to Myrtle Total Estimated Fee: $57,798.00 A detailed task breakdown is included. Please find this on page 5 of this scope of work proposal. The fee shown above is to be billed on a time and material basis based on the rates shown in the table on page 4 and 5 of this proposal. All reimbursable expenses will be billed at direct cost. Page 6 of 12 DocuSign Envelope ID: E9F94AB1-4470-49DD-AAB3-995C69BD2E38 Page 4 of 5 Ditesco City of Fort Collins Utilities Consulting Engineering Services – Water, Wastewater, Stormwater 2018-2019 Wage Rate Schedule Principal: $136.00 – $154.00 per hour Project Manager: $120.00 - $139.00 per hour Associate Project Manager $110.00 - $124.00 per hour Project Engineer: $95.00 - $120.00 per hour Construction Manager/Resident Engineer: $112.00 - $132.00 per hour CAD Design: $67.00 - $88.00per hour Administrative: $57.00 - $69.00 per hour Mileage Reimbursement: IRS Rate Subconsultant Markup 5% of cost All other costs at direct expense Terms 30 days net Page 7 of 12 DocuSign Envelope ID: E9F94AB1-4470-49DD-AAB3-995C69BD2E38 City of Fort Collins Utilities Sherwood Waterline 1/6/2019 Keith Meyer Jill Burrell Josh Ooms / Natalie Pace Rhonda Bunner Cassidy Hill Principal Project Manager Project Engineer CAD Design Administrative (hrs) (hrs) (hrs) (hrs) (hrs) $140 $120 $110 $80 $65 Design Phase $28,686 PM 1.1 - Contract Management (Invoicing and Budget Management) 4 4 0 0 0 $1,040 CM 1.4 - SharePoint Document Management 0 0 0 0 6 $390 PM 1.2 - Meetings/Correspondence (Design Progress Meetings) 9 17 17 0 0 $5,216 PM 1.2 - External Meetings with Engineering Dept, Streets, etc. 2 2 0 0 0 $520 PE 1.6 - Site Investigation (services, owner coordination, field work) 4 16 20 0 0 $4,680 PE 1.1 - Design (Civil Engineering) - Construction Drawings Site Topographical Survey 2 4 6 4 0 $ 3,140.00 $4,880 Demolition 0 2 4 6 0 $1,160 Plan and Profile Waterline; joint restraints 1 2 6 20 0 $2,640 Details/Sections 2 4 8 16 0 $2,920 Site Plan 0 1 4 4 0 $880 Utility Potholing 0 2 4 6 0 $1,160 - Specifications 0 3 8 0 4 $1,500 - Address Review Comments 1 4 4 8 0 $1,700 Construction Phase $27,652 CM 1.6 - Preconstruction Photos 0 0 4 0 0 $440 CM 1.7 - Preconstruction Meeting 2 2 2 0 2 $870 CM 1.9 - Submittal/Shop Drawing Review 0 2 4 0 0 $680 CM 1.10 - Progress Meetings 4 15 15 0 0 $3,988 CM 1.14 - Resident Engineering (half time) 0 8 166 0 0 $19,114 CM 1.15 - Weekly Reports 0 0 6 0 6 $1,050 CM 3.1 - Punch List Walkthrough 0 2 2 0 0 $460 CM 3.2 - Record Drawings 0 1 2 6 0 $820 CM 3.4 - Project Close Out 0 1 1 0 0 $230 Other direct costs (mileage, reproduction, etc) $1,460 Work Effort Subtotal 31 92 283 70 18 $56,338 ODCs $1,460 Cost per labor category $4,306.75 $11,013.00 $31,108.00 $5,600.00 $1,170.00 Effort (days) 4 11 35 9 2 Effort (weeks) 1 2 7 2 0 Hours per day 0.2 0.7 2.1 0.5 0.1 Total Contract Value: $57,798 Assumptions: - 2.5 month project duration (design only) - Project Start - January 2019 - Project End - April 2019 - Construction - May to July 2019 Phase/Task Description Classification Sub Consultants Task Total Page 5 of 5 Page 8 of 12 DocuSign Envelope ID: E9F94AB1-4470-49DD-AAB3-995C69BD2E38 ID Task Mode Name Leveling Delay Duration Start Finish 1 Sherwood Waterline 0 edays 138 days Mon 1/7/19 Wed 7/17/19 2 Design Phase 0 edays 30 days Mon 1/7/19 Fri 2/15/19 3 Start Design Phase 0 edays 0 days Thu 1/10/19 Thu 1/10/19 4 Site Investigation 0 edays 30 days Mon 1/7/19 Fri 2/15/19 5 Utility Locating 0 edays 15 days Mon 1/7/19 Fri 1/25/19 6 Site Surveying 0 edays 15 days Mon 1/28/19 Fri 2/15/19 7 Potholing - Connell 0 edays 10 days Mon 1/28/19 Fri 2/8/19 8 Waterline Service Investigation - each home/residence 0 edays 20 days Thu 1/10/19 Wed 2/6/19 9 Contracting 0 edays 92 days Thu 1/10/19 Fri 5/17/19 10 Ditesco Work Order 0 edays 10 days Thu 1/10/19 Wed 1/23/19 11 Connell Work Order (preconstruction phase) 0 edays 10 days Thu 1/10/19 Wed 1/23/19 12 Construction Documents 0 edays 31 days Mon 2/18/19 Mon 4/1/19 13 Plan and Profile 0 edays 15 days Mon 2/18/19 Fri 3/8/19 14 Details 0 edays 4 days Mon 3/11/19 Thu 3/14/19 15 Specifications 0 edays 4 days Fri 3/15/19 Wed 3/20/19 16 Submittal 0 edays 0 days Wed 3/20/19 Wed 3/20/19 17 City Review Period 0 edays 8 days Thu 3/21/19 Mon 4/1/19 18 Design Phase Complete 0 edays 0 days Mon 4/1/19 Mon 4/1/19 19 Permitting 0 edays 5 days Tue 4/2/19 Mon 4/8/19 20 ROW Construction Permit - City Engineering 0 edays 5 days Tue 4/2/19 Mon 4/8/19 21 Construction Contracting Phase 0 edays 42 days Thu 3/21/19 Fri 5/17/19 22 Final Cost Proposal from Connell Resources 0 edays 15 days Thu 3/21/19 Wed 4/10/19 23 Independent Estimate 0 edays 15 days Thu 4/11/19 Wed 5/1/19 24 Final Work Order with Connell (to Purchasing) 0 edays 12 days Thu 5/2/19 Fri 5/17/19 25 Notice to Proceed 0 edays 0 days Fri 5/17/19 Fri 5/17/19 26 Construction Phase 0 edays 43 days Mon 5/20/19 Wed 7/17/19 27 Connell Resources 0 edays 43 days Mon 5/20/19 Wed 7/17/19 28 Mobilization 0 edays 1 day Mon 5/20/19 Mon 5/20/19 29 Utility Locates/Potholing 0 edays 5 days Tue 5/21/19 Mon 5/27/19 30 Traffic Control 0 edays 1 day Tue 5/21/19 Tue 5/21/19 31 Demolition/Excavation 0 edays 4 days Tue 5/28/19 Fri 5/31/19 32 Pipeline Installation (100-ft per day; 740 LF) 0 edays 8 days Mon 6/3/19 Wed 6/12/19 33 Fill and Chlorinate/Disinfect 0 edays 2 days Thu 6/13/19 Fri 6/14/19 34 Service tie overs 0 edays 10 days Mon 6/17/19 Fri 6/28/19 35 Myrtle Intersection 0 edays 6 days Mon 7/1/19 Mon 7/8/19 36 Final Patching and Road Restoration 0 edays 4 days Tue 7/9/19 Fri 7/12/19 37 Substantial Completion 0 edays 0 days Fri 7/12/19 Fri 7/12/19 38 Punch List 0 edays 3 days Mon 7/15/19 Wed 7/17/19 39 Final Acceptance 0 edays 0 days Wed 7/17/19 Wed 7/17/19 5 days 7 days 17 days 17 days 29 days 29 days 4 days 12/2312/30 1/6 1/13 1/20 1/27 2/3 2/10 2/17 2/24 3/3 3/10 3/17 3/24 3/31 4/7 4/14 4/21 4/28 5/5 5/12 5/19 5/26 6/2 6/9 6/16 6/23 6/30 7/7 7/14 7/21 7/28 January February March April May June July 1st Half 2nd Half Critical Critical Split Task Split Milestone Slack Slippage Summary Utilities Work Order Form Official Purchasing Form Last updated 10/2017 ATTACHMENT B WORK ORDER SCHEDULE OF SERVICES Page 10 of 12 DocuSign Envelope ID: E9F94AB1-4470-49DD-AAB3-995C69BD2E38 ID Task Mode Name Leveling Delay Duration Start Finish 1 Sherwood Waterline 0 edays 138 days Mon 1/7/19 Wed 7/17/19 2 Design Phase 0 edays 30 days Mon 1/7/19 Fri 2/15/19 3 Start Design Phase 0 edays 0 days Thu 1/10/19 Thu 1/10/19 4 Site Investigation 0 edays 30 days Mon 1/7/19 Fri 2/15/19 5 Utility Locating 0 edays 15 days Mon 1/7/19 Fri 1/25/19 6 Site Surveying 0 edays 15 days Mon 1/28/19 Fri 2/15/19 7 Potholing - Connell 0 edays 10 days Mon 1/28/19 Fri 2/8/19 8 Waterline Service Investigation - each home/residence 0 edays 20 days Thu 1/10/19 Wed 2/6/19 9 Contracting 0 edays 92 days Thu 1/10/19 Fri 5/17/19 10 Ditesco Work Order 0 edays 10 days Thu 1/10/19 Wed 1/23/19 11 Connell Work Order (preconstruction phase) 0 edays 10 days Thu 1/10/19 Wed 1/23/19 12 Construction Documents 0 edays 31 days Mon 2/18/19 Mon 4/1/19 13 Plan and Profile 0 edays 15 days Mon 2/18/19 Fri 3/8/19 14 Details 0 edays 4 days Mon 3/11/19 Thu 3/14/19 15 Specifications 0 edays 4 days Fri 3/15/19 Wed 3/20/19 16 Submittal 0 edays 0 days Wed 3/20/19 Wed 3/20/19 17 City Review Period 0 edays 8 days Thu 3/21/19 Mon 4/1/19 18 Design Phase Complete 0 edays 0 days Mon 4/1/19 Mon 4/1/19 19 Permitting 0 edays 5 days Tue 4/2/19 Mon 4/8/19 20 ROW Construction Permit - City Engineering 0 edays 5 days Tue 4/2/19 Mon 4/8/19 21 Construction Contracting Phase 0 edays 42 days Thu 3/21/19 Fri 5/17/19 22 Final Cost Proposal from Connell Resources 0 edays 15 days Thu 3/21/19 Wed 4/10/19 23 Independent Estimate 0 edays 15 days Thu 4/11/19 Wed 5/1/19 24 Final Work Order with Connell (to Purchasing) 0 edays 12 days Thu 5/2/19 Fri 5/17/19 25 Notice to Proceed 0 edays 0 days Fri 5/17/19 Fri 5/17/19 26 Construction Phase 0 edays 43 days Mon 5/20/19 Wed 7/17/19 27 Connell Resources 0 edays 43 days Mon 5/20/19 Wed 7/17/19 28 Mobilization 0 edays 1 day Mon 5/20/19 Mon 5/20/19 29 Utility Locates/Potholing 0 edays 5 days Tue 5/21/19 Mon 5/27/19 30 Traffic Control 0 edays 1 day Tue 5/21/19 Tue 5/21/19 31 Demolition/Excavation 0 edays 4 days Tue 5/28/19 Fri 5/31/19 32 Pipeline Installation (100-ft per day; 740 LF) 0 edays 8 days Mon 6/3/19 Wed 6/12/19 33 Fill and Chlorinate/Disinfect 0 edays 2 days Thu 6/13/19 Fri 6/14/19 34 Service tie overs 0 edays 10 days Mon 6/17/19 Fri 6/28/19 35 Myrtle Intersection 0 edays 6 days Mon 7/1/19 Mon 7/8/19 36 Final Patching and Road Restoration 0 edays 4 days Tue 7/9/19 Fri 7/12/19 37 Substantial Completion 0 edays 0 days Fri 7/12/19 Fri 7/12/19 38 Punch List 0 edays 3 days Mon 7/15/19 Wed 7/17/19 39 Final Acceptance 0 edays 0 days Wed 7/17/19 Wed 7/17/19 5 days 7 days 17 days 17 days 29 days 29 days 4 days 12/2312/30 1/6 1/13 1/20 1/27 2/3 2/10 2/17 2/24 3/3 3/10 3/17 3/24 3/31 4/7 4/14 4/21 4/28 5/5 5/12 5/19 5/26 6/2 6/9 6/16 6/23 6/30 7/7 7/14 7/21 7/28 January February March April May June July 1st Half 2nd Half Critical Critical Split Task Split Milestone Slack Slippage Summary Utilities Work Order Form Official Purchasing Form Last updated 10/2017 ATTACHMENT C CERTIFICATE OF INSURANCE CONTRACTOR shall submit Certificate of Insurance in compliance with the Contract Documents. Page 12 of 12 DocuSign Envelope ID: E9F94AB1-4470-49DD-AAB3-995C69BD2E38 01/17/2019 Flood and Peterson PO Box 578 Greeley CO 80632 Javier Perez (970) 356-0123 (970) 330-1867 JPerez@FloodPeterson.com Ditesco, LLC 2133 S Timberline Rd Unit 110 Fort Collins CO 80525-4372 Cincinnati Insurance Co 10677 The Continental Insurance Company 35289 Lloyd's of London 43389 CL1810525479 A Y Y ECP 0458347 10/03/2018 10/03/2019 1,000,000 1,000,000 10,000 1,000,000 2,000,000 2,000,000 A Y Y ECP 0458347 10/03/2018 10/03/2019 1,000,000 Uninsured motorist combined single limit 1,000,000 B 2097624212 03/15/2018 03/15/2019 500,000 500,000 500,000 C Professional Liability B0621PDITE000118 10/05/2018 10/03/2019 Each Claim $ 1,000,000 Aggregate $ 2,000,000 Retention $ 10,000 Project: Sherwood Street Water Main Replacement The City of Fort Collins is included as Additional Insured as required by written contract but only as respects to liability arising out of work performed by the named insured. Waiver of subrogation applies. City of Fort Collins 700 Wood Street Fort Collins CO 80521 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME: CONTACT (A/C, No): FAX E-MAIL ADDRESS: PRODUCER (A/C, No, Ext): PHONE INSURED COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ PROPERTY DAMAGE $ BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOS ONLY AUTOS NON-OWNED OWNED SCHEDULED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT ER OTH- STATUTE PER (MM/DD/YYYY) LIMITS POLICY EXP (MM/DD/YYYY) POLICY EFF LTR TYPE OF INSURANCE POLICY NUMBER INSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB EACH OCCURRENCE $ AGGREGATE $ $ OCCUR CLAIMS-MADE DED RETENTION $ PRODUCTS - COMP/OP AGG $ GENERAL AGGREGATE $ PERSONAL & ADV INJURY $ MED EXP (Any one person) $ EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY DocuSign Envelope ID: E9F94AB1-4470-49DD-AAB3-995C69BD2E38 Project Summary Rolled Up Critical Rolled Up Critical Split Inactive Task Inactive Milestone Inactive Summary Manual Task Duration-only Manual Summary Rollup Manual Summary Start-only Finish-only External Tasks External Milestone Deadline Progress 2019-01-07_Sherwood Waterline Page 1 of 1 Sun 1/6/19 3:24 PM Page 11 of 12 DocuSign Envelope ID: E9F94AB1-4470-49DD-AAB3-995C69BD2E38 Project Summary Rolled Up Critical Rolled Up Critical Split Inactive Task Inactive Milestone Inactive Summary Manual Task Duration-only Manual Summary Rollup Manual Summary Start-only Finish-only External Tasks External Milestone Deadline Progress 2019-01-07_Sherwood Waterline Page 1 of 1 Sun 1/6/19 3:24 PM Page 9 of 12 DocuSign Envelope ID: E9F94AB1-4470-49DD-AAB3-995C69BD2E38