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HomeMy WebLinkAboutCORRESPONDENCE - RFP - 8820 DIRECTIONAL BORING AND TRENCHING ON-CALL (3)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 SAGE TELECOMMUNICATIONS CORP. OF COLORADO, LLC WORK ORDER NUMBER: U2019-10302019 PROJECT TITLE: U906 E. Elizabeth Stormwater Replacement Project ORIGINAL BID/RFP NUMBER & NAME: U8820, Directional Boring & Trenching On- Call MASTER AGREEMENT EFFECTIVE DATE: U03/11/2019 ARCHITECT/ENGINEER: UNA OWNER’S REPRESENTATIVE: UDouglas Groves WORK ORDER COMMENCEMENT DATE: UNovember 4, 2019 WORK ORDER COMPLETION DATE: UNovember 11, 2019 MAXIMUM FEE: (time and reimbursable direct costs): $7,188.75 U PROJECT DESCRIPTION/SCOPE OF SERVICES: UComplete 15 potholes of existing utilities, 5 in soft surfaces and 10 in hard surfaces, including traffic control services and necessary right-of- way permits. Actual cost will be invoiced at contract unit pricing. See the 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 1 (UoneU) 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: Sage Telecommunications Corp. of Colorado, LLC By: Date: Name: Title: Page 1 of 5 DocuSign Envelope ID: ED6307EC-2300-46CD-A226-C6CC20D6F011 Project Manager November 20, 2019 Domingo Torres 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: Douglas Groves, Manager, Stormwater Operations REVIEWED: Date: Pat Johnson, Senior Buyer REQUISITION ENTERED: Date: ACCEPTANCE: Date: Sandra Bratlie, Civil Engineer III 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: ED6307EC-2300-46CD-A226-C6CC20D6F011 Melissa Walker Coordinator, Finance 11/7/19 November 8, 2019 November 12, 2019 November 12, 2019 November 27, 2019 November 29, 2019 Utilities Work Order Form Official Purchasing Form Last updated 10/2017 ATTACHMENT A WORK ORDER COST & SCOPE DETAIL Page 3 of 5 DocuSign Envelope ID: ED6307EC-2300-46CD-A226-C6CC20D6F011 Page 4 of 5 DocuSign Envelope ID: ED6307EC-2300-46CD-A226-C6CC20D6F011 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: ED6307EC-2300-46CD-A226-C6CC20D6F011 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) © 1988-2016 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY C 5,000,000 01/31/2020 TB2-631-004260-019 Manashi Mukherjee X ATL-004595606-07 1,000,000 5,000,000 WC5-631-004260-049 (MN.WI) X 33600 5,000,000 of Marsh USA Inc. N 01/31/2019 X 0 01/31/2020 01/31/2020 AS2-631-004260-029 B 10,000,000 5,000,000 X 10030 LM Insurance Corporation 1,000,000 X 01/08/2019 01/31/2019 The following is Additional Insured as respects General Liability and Auto Liability only if required by written contract and coverage applies only as respects work performed by the Insured for the Additional Insured. All coverage terms, conditions and exclusions of the policy apply. Additional Insured: City of Fort Collins. X 01/31/2019 300 La Porte Ave Fort Collins, CO 80522 City of Fort Collins 10,000 A Westchester Fire Insurance Company CN102986923-upl-GAWU-19-20 01/31/2020 5,000,000 G22049860013 B 10,000,000 23035 1,000,000 1,000,000 WA5-63D-004260-039 (AOS) 1560 Sawgrass Corporate Pkwy, Suite 300 Marsh USA Inc. X Sunrise, FL 33323 X of Colorado, LLC Sage Telecommunications Corp. Denver, CO 80229 6700 Race Street X X 01/31/2019 Attn: Engineering Dept 01/31/2019 A . 01/31/2020 Liberty Mutual Fire Insurance Company DocuSign Envelope ID: ED6307EC-2300-46CD-A226-C6CC20D6F011