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HomeMy WebLinkAboutWORK ORDER - BID - 7658 MISCELLANEOUS CONCRETE ANNUAL (19)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 BANNER CONCRETE WORK ORDER NUMBER: 2018-002 PROJECT TITLE: Concrete work for the Rick Drive improvement project ORIGINAL BID/RFP NUMBER & NAME: 7658 – Misc. Concrete MASTER AGREEMENT EFFECTIVE DATE: July 15, 2014 ARCHITECT/ENGINEER: NA OWNER’S REPRESENTATIVE: Doug Groves WORK ORDER COMMENCEMENT DATE: March 12, 2018 WORK ORDER COMPLETION DATE: April 15, 2018 MAXIMUM FEE: (time and reimbursable direct costs): $25,000.82 PROJECT DESCRIPTION/SCOPE OF SERVICES: Install new inlets, curb gutter sidewalk, and cross-pans for the Rick Drive improvement project. 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 (one) 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: Banner Concrete By: Date: Name: Title: Page 1 of 5 DocuSign Envelope ID: AF6BB3DB-91D1-410A-AC80-641125CDE02E March 20, 2018 Tyson Vogel owner 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: Doug Groves, Drainage System Maintenance Division Superintendent REVIEWED: Date: Pat Johnson, Senior Buyer APPROVED AS TO FORM: Date: Name,City Attorney's Title (if greater than $1,000,000) ACCEPTANCE: Date: Andrew Gingerich, Water Field Operations Interim Manager ACCEPTANCE: Date: Matt Fater, Water Engineering & Field Services Operations Interim Manager 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: AF6BB3DB-91D1-410A-AC80-641125CDE02E March 19, 2018 March 19, 2018 March 20, 2018 March 20, 2018 Utilities Work Order Form Official Purchasing Form Last updated 10/2017 ATTACHMENT A WORK ORDER SCOPE OF SERVICES & COST DETAIL Page 3 of 5 DocuSign Envelope ID: AF6BB3DB-91D1-410A-AC80-641125CDE02E 3/12/2018 Item Description Unit Unit Price Estimated Quantity Estimated Costs 1 Reconstruct curb inlet deck Each $ 506.86 2 $ 1,013.72 2 Reconstruct curb inlet deck - Additional foot opening LF $ 56.32 20 $ 1,126.40 3 Reconstruct type R inlet deck Each $ 619.50 7 $ 4,336.50 4 Reconstruct type R inlet deck - Additional foot opening LF $ 112.64 30 $ 3,379.20 5 Vetical curb & gutter - No sidewalk LF $ 23.10 100 $ 2,310.00 6 Expansion and caulking LF $ 5.92 100 $ 592.00 7 Driverover curb, gutter, & 6" sidewalk LF $ 29.29 100 $ 2,929.00 8 Flatwork - 6" SF $ 3.95 100 $ 395.00 9 Crosspan - 8" SF $ 5.63 1000 $ 5,630.00 10 Valley Pan - 6" SF $ 7.88 20 $ 157.60 11 Non reinforced concrete wall - 8" SF face $ 16.90 37 $ 625.30 12 Laboer Grading Hour $ 33.79 30 $ 1,013.70 13 Form Setter Grading Hour $ 33.79 30 $ 1,013.70 14 Skid Steer Grading Hour $ 95.74 5 $ 478.70 $ - Total Estimated Costs $ 25,000.82 Concrete Work for the Rick Drive Improvements Project # 5040440032 Banner Concrete Estimated Costs PO # TBD Page 4 of 5 DocuSign Envelope ID: AF6BB3DB-91D1-410A-AC80-641125CDE02E 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: AF6BB3DB-91D1-410A-AC80-641125CDE02E ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD PRODUCER CONTACT NAME: PHONE FAX (A/C, No, Ext): (A/C, No): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXP TYPE OF INSURANCE (MM/DD/YYYY) (MM/DD/YYYY) LIMITS AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- LOC JECT PRODUCTS - COMP/OP AGG OTHER: $ COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH- STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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. 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). COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD JCAMPBELL PFS Insurance 03/19/2018 BANNCON-01 A S2302963 B 4146285 A S2302963 1,000,000 1,000,000 1,000,000 2,000,000 1,000,000 2,000,000 15,000 500,000 1,000,000 1,000,000 X X X X X X 03/01/2018 03/01/2019 03/01/2018 03/01/2019 03/01/2018 03/01/2019 If required by written contract, the Certificate Holder is included as Additional Insured for ongoing operations under General Liability and Automobile Liability. PFS Insurance Group 4848 Thompson Parkway Suite 200 Johnstown, CO 80534 (970) 635-9400 (970) 635-9401 City of Fort Collins 215 North Mason Fort Collins, CO 80524 Banner Concrete, LLC 1313 Duff Dr #3 Fort Collins, CO 80524 Selective Insurance Company of America Pinnacol Assurance Co 39926 41190 X X info@mypfsinsurance.com DocuSign Envelope ID: AF6BB3DB-91D1-410A-AC80-641125CDE02E