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HomeMy WebLinkAboutCORRESPONDENCE - BID - 8844 MISCELLANEOUS CONCRETE (14)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: U2020-01242020 PROJECT TITLE: UInlet Repair at W. Drake Rd. & Dunbar ORIGINAL BID/RFP NUMBER & NAME: U8844, Miscellaneous Concrete MASTER AGREEMENT EFFECTIVE DATE: UFebruary 1, 2019 ARCHITECT/ENGINEER: UNA OWNER’S REPRESENTATIVE: UDouglas Groves WORK ORDER COMMENCEMENT DATE: UFebruary 3, 2020 WORK ORDER COMPLETION DATE: UMarch 15, 2020 MAXIMUM FEE: (time and reimbursable direct costs): U$11,136.56 PROJECT DESCRIPTION/SCOPE OF SERVICES: URepair 2 Type R Inlet Decks, replace adjacent curb & gutter and include Traffic Control, Flagging Hours, Dump Fees, Temp Patching, Base Material, Backfill and Topsoil. Actual Cost will be invoiced at contract unit prices. 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 UtwoU (2) 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 7 DocuSign Envelope ID: 05E9B01D-4DF6-4949-A888-A69D458C7409 February 4, 2020 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: Douglas Groves, Manager, Stormwater Maintenance Operations REVIEWED: Date: Dale Elliot, Senior Buyer REQUISITION ENTERED BY: Date: 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 7 DocuSign Envelope ID: 05E9B01D-4DF6-4949-A888-A69D458C7409 Melissa Walker 2/4/20 Coordinator, Finance February 4, 2020 February 4, 2020 February 4, 2020 February 4, 2020 Utilities Work Order Form Official Purchasing Form Last updated 10/2017 ATTACHMENT A WORK ORDER COST AND SCOPE DETAIL Page 3 of 7 DocuSign Envelope ID: 05E9B01D-4DF6-4949-A888-A69D458C7409 Estimate: W. Drake Rd & Dunbar Ave Item No. Description Unit Quantity Unit Price Total 202.04 Sawcut Concrete/Asphalt (8" <= 10") LF 27.00 $ 5.75 $ 155.25 202.07 Remove Concrete Curb & Gutter LF 11.00 $ 6.50 $ 71.50 202.09 Remove Concrete Driveway/Apron/Crosspan SF 32.00 $ 3.75 $ 120.00 207.01 Imported Topsoil CY 1.00 $ 45.00 $ 45.00 304.01 Aggregate Base Course/Recycled Concrete Base ≤ 5 Tons Ton 1.00 $ 39.00 $ 39.00 602.01 Reinforcing Steel Pound 100.00 $ 3.75 $ 375.00 604.13 Reconstruct Type R Inlet Deck – Remove and Replace (Detail M-604-12) Each 3.00 $ 1,250.00 $ 3,750.00 608.04 Vertical Curb and Gutter - No Sidewalk LF 11.00 $ 26.00 $ 286.00 608.19 Crosspan - 8" SF 32.00 $ 8.50 $ 272.00 608.43 Expansion and Caulking LF 12.00 $ 4.00 $ 48.00 608.46 Dump Fee Ton 5.00 $ 58.00 $ 290.00 630.02 Vertical Panel Without Light Per Each Per Day 150.00 $ 1.25 $ 187.50 630.06 Size A Sign With Stand Per Each Per Day 60.00 $ 2.00 $ 120.00 630.10 Cone With Reflective Strip Per Each Per Day 100.00 $ 0.85 $ 85.00 630.13 Advance Warning Flashing or Sequencing Arrow Panel Per Each Per Day 5.00 $ 45.00 $ 225.00 630.16 Traffic Control Supervisor Hour 40.00 $ 45.00 $ 1,800.00 630.17 Flagging Hour 40.00 $ 26.00 $ 1,040.00 $ 8,909.25 25% CONTINGENCY for Traffic Control Devices, Flagging Hours, Dump Fees, Temp Patching, Base Material, Backfill, Top Soil. Actual costs will be invoiced at contractual unit prices. $ 2,227.31 $ 11,136.56 SUB-TOTAL TOTAL COST Page 4 of 7 DocuSign Envelope ID: 05E9B01D-4DF6-4949-A888-A69D458C7409 Utilities Work Order Form Official Purchasing Form Last updated 10/2017 ATTACHMENT B WORK ORDER SCHEDULE DETAIL Page 5 of 7 DocuSign Envelope ID: 05E9B01D-4DF6-4949-A888-A69D458C7409 2/3/2020 2/10/2020 3/15/2020 Project Notice to Proceed Project Construction Project Final Completion/Acceptance Schedule for Concrete & Inlet Repairs - W. Drake Rd. & Dunbar Page 6 of 7 DocuSign Envelope ID: 05E9B01D-4DF6-4949-A888-A69D458C7409 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 7 of 7 DocuSign Envelope ID: 05E9B01D-4DF6-4949-A888-A69D458C7409 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? Certificate Of Completion Envelope Id: 05E9B01D4DF64949A888A69D458C7409 Status: Completed Subject: Please DocuSign: LEI -Inlet Repair at W. Drake Road & Dunbar Work Order.pdf Source Envelope: Document Pages: 8 Signatures: 6 Envelope Originator: Certificate Pages: 5 Initials: 0 Angel Anderson AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (UTC-08:00) Pacific Time (US & Canada) 215 N Mason Street Fort Collins, CO 80522 aanderson@fcgov.com IP Address: 198.59.47.100 Record Tracking Status: Original 2/3/2020 1:25:36 PM Holder: Angel Anderson aanderson@fcgov.com Location: DocuSign Signer Events Signature Timestamp Melissa Walker mjwalker@fcgov.com Coordinator, Finance City of Fort Collins – Utilities Financial Operations Security Level: Email, Account Authentication (None) Signature Adoption: Drawn on Device Using IP Address: 198.59.47.100 Sent: 2/3/2020 1:29:46 PM Viewed: 2/4/2020 10:12:37 AM Signed: 2/4/2020 10:12:47 AM Electronic Record and Signature Disclosure: Accepted: 12/20/2016 10:08:43 AM ID: d9d08390-1c30-4e0f-8970-cda5245e1382 Elliot Dale edale@fcgov.com Buyer City of Fort Collins Security Level: Email, Account Authentication (None) Signature Adoption: Uploaded Signature Image Using IP Address: 198.59.47.100 Sent: 2/4/2020 10:12:48 AM Viewed: 2/4/2020 1:20:04 PM Signed: 2/4/2020 1:20:56 PM Electronic Record and Signature Disclosure: Accepted: 7/17/2017 10:10:53 AM ID: ec325db7-18a4-43ec-adda-55edfc66426b Chris Hansen chansen@lightfieldenterprises.com General Manager Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 173.164.55.1 Sent: 2/4/2020 1:20:58 PM Viewed: 2/4/2020 1:28:13 PM Signed: 2/4/2020 1:30:46 PM Electronic Record and Signature Disclosure: Accepted: 2/4/2020 1:28:13 PM ID: 9c521670-2f32-425f-b7be-5d280bcfa993 Signer Events Signature Timestamp Accepted: 9/23/2016 12:48:18 PM ID: 9c37cd68-2529-4278-9e6b-666790f7bcdb Andrew S. Gingerich AGingerich@fcgov.com Director, Water Field Operations City of Fort Collins Utilities Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 73.243.86.150 Signed using mobile Sent: 2/4/2020 2:42:06 PM Viewed: 2/4/2020 3:38:34 PM Signed: 2/4/2020 3:38:41 PM Electronic Record and Signature Disclosure: Accepted: 9/23/2016 12:43:26 PM ID: 54958527-6090-40dd-bdca-d96cb40048ed Theresa Connor tconnor@fcgov.com Water Engineering & Field Services Operations Manager City of Fort Collins Utilities Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 24.9.116.148 Sent: 2/4/2020 3:38:42 PM Viewed: 2/4/2020 3:56:03 PM Signed: 2/4/2020 3:56:10 PM Electronic Record and Signature Disclosure: Not Offered via DocuSign In Person Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 2/4/2020 3:38:42 PM Certified Delivered Security Checked 2/4/2020 3:56:04 PM Signing Complete Security Checked 2/4/2020 3:56:10 PM Completed Security Checked 2/4/2020 3:56:10 PM Payment Events Status Timestamps Electronic Record and Signature Disclosure ELECTRONIC RECORD AND SIGNATURE DISCLOSURE From time to time, City of Fort Collins - Utilities Water Engineering Field Operations (we, us or Company) may be required by law to provide to you certain written notices or disclosures. 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Please also see the paragraph immediately above that describes the consequences of your electing not to receive delivery of the notices and disclosures electronically from us. Electronic Record and Signature Disclosure created on: 8/25/2016 10:28:47 AM Parties agreed to: Melissa Walker, Elliot Dale, Chris Hansen, Douglas E Groves, Andrew S. 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Douglas E Groves DeGroves@fcgov.com WATER UTIL FIELD OPERATIONS SUPERINTENDENT City of Fort Collins - Utilities Water Utilities Engineering Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 198.59.47.100 Sent: 2/4/2020 1:20:58 PM Viewed: 2/4/2020 2:41:44 PM Signed: 2/4/2020 2:42:05 PM Electronic Record and Signature Disclosure: (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: 05E9B01D-4DF6-4949-A888-A69D458C7409