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HomeMy WebLinkAboutCORRESPONDENCE - PURCHASE ORDER - 9191366Utilities Work Order Form Official Purchasing Form Last updated 10/2017 WORK ORDER PURSUANT TO A MASTER AGREEMENT BETWEEN THE CITY OF FORT COLLINS AND CONNELL RESOURCES, INC WORK ORDER NUMBER: UCR-2019-07 PROJECT TITLE: UStover Emergency Sewer Repair ORIGINAL BID/RFP NUMBER & NAME: U8106, Utility Infrastructure Construction Services for Water, Wastewater and Stormwater Facilities Capital Improvements MASTER AGREEMENT EFFECTIVE DATE: UAugust 17, 2015 ARCHITECT/ENGINEER: UNA OWNER’S REPRESENTATIVE: ULinsey Chalfant WORK ORDER COMMENCEMENT DATE: UJuly 14, 2019 WORK ORDER COMPLETION DATE: UAugust 30, 2019 MAXIMUM FEE: (time and reimbursable direct costs): $U36,880.00 PROJECT DESCRIPTION/SCOPE OF SERVICES: UConnell Resources performed an emergency repair on a 21" sanitary sewer main on the Shire CSA property between Stover and Uriah Ln. The work included mobilization, overnight bypass pumping, sewer repair and backfill, and restoration. 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: Connell Resources, Inc. By: Date: Name: Title: Page 1 of 5 DocuSign Envelope ID: C375359F-C5A2-4627-9292-DDFA2E6E3EAF John Warren Vice President July 29, 2019 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: Linsey, Chalfant, 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: Matt Fater, Director, Civil Engineering ACCEPTANCE: Date: Andrew Gingerich, Director, Water Field Operations 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: C375359F-C5A2-4627-9292-DDFA2E6E3EAF July 29, 2019 July 29, 2019 July 29, 2019 July 29, 2019 July 29, 2019 Utilities Work Order Form Official Purchasing Form Last updated 10/2017 ATTACHMENT A WORK ORDER COST OF SERVICES Page 3 of 5 DocuSign Envelope ID: C375359F-C5A2-4627-9292-DDFA2E6E3EAF Connell Resources, Inc. 7785 Highland Meadows Pkwy, #100 Fort Collins, CO 80528 Phone: (970) 223-3151 Fax: (970) 223-3191 Estimator: Dan Giesler QUOTATION Date: 7/19/2019 Submitted To: City Of Fort Collins - Utilities Bid Title Stover SS Emergency Address: 700 Wood St. Bid Number: Fort Collins, CO 80522 Project Location: Stover At Parker Contact: Linsey Chalfant Project City, State: Fort Collins, CO Phone: (970) 221-6700 Fax: (970) 221-6619 Engineer/Architect: Item # Item Description Estimated Quantity Unit Unit Price Total Price 01.027 21" Sewer, 8'-12' Depth - Repair 20.00 LF $425.00 $8,500.00 01.027 Bedding Haul 60.00 TON $45.00 $2,700.00 01.100 Mob, Set Up, Tear Down, Demob By-Pass 1.00 EACH $9,600.00 $9,600.00 10.001 Mobilization 1.00 EACH $2,400.00 $2,400.00 10.017 Site Management 0.40 WK $7,700.00 $3,080.00 29.021 Landscape Repairs 1.00 LS $10,600.00 $10,600.00 Total Bid Price: $36,880.00 ACCEPTED: The above prices, specifications and conditions are satisfactory and hereby accepted. Buyer: Signature: Date of Acceptance: CONFIRMED: Connell Resources, Inc. Authorized Signature: Estimator: Dan Giesler 970-223-3151 dgiesler@connellresources.com 7/19/2019 5:02:04 PM Page 1 of 1 Page 4 of 5 DocuSign Envelope ID: C375359F-C5A2-4627-9292-DDFA2E6E3EAF 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: C375359F-C5A2-4627-9292-DDFA2E6E3EAF 07/29/2019 Flood and Peterson PO Box 578 Greeley CO 80632 Dana Stewart, CIC, CISR (970) 266-7149 (970) 506-6845 DStewart@floodpeterson.com Connell Resources, Inc. 7785 Highland Meadows Parkway Suite 100 Fort Collins CO 80528 Charter Oak Fire Insurance Company 25615 Phoenix Insurance Company 25623 Travelers Property Casualty Company of America 25674 Pinnacol Assurance 41190 GL/AU/XS/WC x6/2020 A Y Y DT-CO-4794N532-COF-19 06/01/2019 06/01/2020 1,000,000 300,000 10,000 1,000,000 2,000,000 2,000,000 B Y Y DT-810-1N000952-19-26-G 06/01/2019 06/01/2020 1,000,000 C 10,000 CUP-8K942027-19-26 06/01/2019 06/01/2020 1,000,000 1,000,000 D Y Y 4029651 06/01/2019 06/01/2020 1,000,000 1,000,000 1,000,000 Project: 2191545 - Stover SS Repair City of Fort Collins is included as Additional Insured on General liability and Automobile liability as required by written contract with respects to liability arising out of work performed by the named insured. City of Fort Collins PO Box 580 Fort Collins CO 80522 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: C375359F-C5A2-4627-9292-DDFA2E6E3EAF