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HomeMy WebLinkAboutCORRESPONDENCE - BID - 8844 MISCELLANEOUS CONCRETE (13)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 LIGHTFIELD ENTERPRISES, INC WORK ORDER NUMBER: U5036450017 PROJECT TITLE: U2900 Blk Moore Lane WWMR ORIGINAL BID/RFP NUMBER & NAME: U7658, Misc. Concrete MASTER AGREEMENT EFFECTIVE DATE: UJuly 15, 2014 ARCHITECT/ENGINEER: UNA OWNER’S REPRESENTATIVE: UAndrew Gingerich WORK ORDER COMMENCEMENT DATE: UMay 27, 2019 WORK ORDER COMPLETION DATE: UMay 31, 2019 MAXIMUM FEE: (time and reimbursable direct costs): U$10,675.46 PROJECT DESCRIPTION/SCOPE OF SERVICES: UConcrete removal and replacement on Spring Creek Trail near 2900 Blk of Moore Lane. Traffic control to be self-performed by Lightfield Enterprises. 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 UoneU (1) 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: Lightfield Enterprises, Inc. By: Date: Name: Title: Page 1 of 5 DocuSign Envelope ID: ABAFDA24-8EC0-4892-8B12-893F2D07DD31 May 30, 2019 Chris Hansen General Manager 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: Andrew Gingerich, Director, Water Field Operations REVIEWED: Date: Dale Elliot, Senior Buyer APPROVED AS TO FORM: Date: Name,City Attorney's Title (if greater than $1,000,000) 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 5 DocuSign Envelope ID: ABAFDA24-8EC0-4892-8B12-893F2D07DD31 May 24, 2019 May 24, 2019 June 2, 2019 Utilities Work Order Form Official Purchasing Form Last updated 10/2017 ATTACHMENT A WORK ORDER COST AND SCOPE DETAIL Page 3 of 5 DocuSign Envelope ID: ABAFDA24-8EC0-4892-8B12-893F2D07DD31 Invoice Invoice Date 5/21/2019 Invoice # 51217 Bill To City of Fort Collins Water Department P.O. Box 580 Fort Collins, CO 80522 Attn: James Carder Project Location Attn: Andrew Gingerich Attn: Jim McChesney 2914 Moore Lane & Spring Creek Trail WO#5036450017 P.O./ Work Order #. #5036450017 Terms Net 30 Thank you for your business. Phone # 9704843880 Fax # 970-416-6230 E-mail smagdaleno@lightfieldenterprises.com Total Balance Due Please Remit To: 2600 Midpoint Drive Fort Collins CO 80525 Description of Work and Materials QuantityUnit Cost Amount Asphalt Patching 1 EA 1,638.00 1,638.00 Concrete Remove & Replace 1 EA 8,270.96 8,270.96 Traffic Control 1 EA 766.50 766.50 We appreciate your business! $10,675.46 $10,675.46 Page 4 of 5 DocuSign Envelope ID: ABAFDA24-8EC0-4892-8B12-893F2D07DD31 Utilities Work Order Form Official Purchasing Form Last updated 10/2017 ATTACHMENT B CERTIFICATE OF INSURANCE CONTRACTOR shall submit Certificate of Insurance in compliance with the Contract Documents. Page 5 of 5 DocuSign Envelope ID: ABAFDA24-8EC0-4892-8B12-893F2D07DD31 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 5/23/2019 The Harry A. Koch Co. P.O. Box 45279 Omaha NE 68145-0279 402-861-7000 National Union Fire Ins Co. of Pitt 19445 LIG46636 New Hampshire Ins Company 23841 Lightfield Enterprises 2600 Midpoint Drive Fort Collins CO 80525 188554515 A X 1,000,000 X 300,000 25,000 1,000,000 2,000,000 X X Y 3506965 6/1/2019 6/1/2020 2,000,000 A 1,000,000 X 4544903 6/1/2019 6/1/2020 B X N 25893880 6/1/2019 6/1/2020 1,000,000 1,000,000 1,000,000 RE: Miscellaneous Concrete Contract (Bid# 8844). Certificate holder is additional insured for General Liability and Auotmobile Liability if required by written contract executed prior to loss. City of Fort Collins Purchasing Division PO Box 580 Fort Collins CO 80522 DocuSign Envelope ID: ABAFDA24-8EC0-4892-8B12-893F2D07DD31