HomeMy WebLinkAboutCORRESPONDENCE - PURCHASE ORDER - 9176804Requisition Form
Vendor: Today's Date: September 27, 2017 Requisition No.:
Ship To: Luke Unruh Date Entered:
Date Required: ASAP Date Approved:
Special Instructions: Date Denied:
Item # Quantity Unit Description Total Charge Number
1 1 Lump Sum $117,424.00 5010052705.535010.3660
Requested By: Authorized By:
Authorized By:
Unit Price
$117,424.00
Colorado Boring
Tim McCollough, Light & Power Operations Manager
LukeSupervisor Unruh, Electric Project Manager Janet McTague, Project Engineering
Directional boring services for circuit 938
Work Order # 5010052705
Total:
I\ENG\FORMS\986dd0cf-f61c-40bd-9441-babe7fc2443d.xls
DocuSign Envelope ID: BBFA86B0-8CA0-4861-8E61-D9CD4FFB29B7
180828 57793
9/28/17 hh
QUOTE
Quote # 7035
3813 Canal Dr. Ft.Collins, CO. 80524
970-494-1996 FAX 970-494-4449
Company City of Ft. Collins Power Date 4/18/2017
Address 700 Wood St. PO #
City, State Ft. Collins, CO. 80522 Rep
Phone Contact Luke Unruh
Qty Description Unit Price Total
0 Trenching $ 7.00 $ -
0 1-2" Directional Bore $ 8.00 $ -
0 1-3" Directional Bore $ 8.00 $ -
0 2-2" Directional Bore $ 9.00 $ -
0 2-3" Directional Bore $ 10.50 $ -
0 3-2" Directional Bore $ 11.50 $ -
0 1-4" Directional Bore $ 9.00 $ -
0 1-4" and 1-2" Directional Bore $ 10.50 $ -
0 1-4" and 2-2" Directional Bore $ 12.00 $ -
0 1-4" and 3-2" Directional Bore $ 14.50 $ -
0 2-2" and 2-3" Directional Bore $ 16.00 $ -
0 1-5" Directional Bore $ 10.00 $ -
0 2-5" Directional Bore $ 15.00 $ -
0 3-5" Directional Bore $ 17.00 $ -
0 1-6" Directional Bore $ 11.00 $ -
0 2-6" Directional Bore $ 16.00 $ -
0 3-6" Directional Bore $ 18.00 $ -
750 8-5" & 2-2" Directional Bore $ 96.00 $ 72,000.00
0 Mud Control Vacuum Machine per hour $ 125.00 $ -
0 Pothole in Paved Surfaces each $ 145.00 $ -
0 Pothole in Unpaved Surfaces each $ 75.00 $ -
1 Pothole Crew per day $ 950.00 $ 950.00
0 Pavement Pothole Restoration per sq. ft. $ 12.00 $ -
0 Concrete Pothole Restoration per sq. ft. $ 14.50 $ -
18 Dirt Pothole Restoration per sq. ft. $ 12.00 $ 216.00
0 Replace Sod per sq. ft. $ 1.00 $ -
2 Replace Paved Asphalt Surface per cubic ft. $ 10.00 $ 20.00
0 Replace Paved Concrete Surface per cu.ft. $ 24.00 $ -
0 Sawcut Asphalt less than 4" per ft. $ 2.10 $ -
0 Sawcut Concrete less than 4" per ft. $ 3.91 $ -
2 Core Drill Asphalt less than 4" each $ 45.00 $ 90.00
0 Core Drill Concrete less than 4" each $ 45.00 $ -
0 Install Vault 12"-18"-18" $ 45.00 $ -
0 Install Vault 14"-24"-18" $ 55.00 $ -
0 Install Vault 24"-36"-18" $ 65.00 $ -
0 Install Vault 36"-48"-30" $ 140.00 $ -
0 Install Vault 48"-96"-48" $ 25.00 $ -
Page 2
Qty Description Unit Price Total
0 Locate Private Sewer Lateral $ 210.00 $ -
0 Locate Private Water Lateral $ 65.00 $ -
0 3 Man Labor Crew per hour $ 135.00 $ -
1500 2" HDPE pipe $ 0.80 $ 1,200.00
0 3" HDPE pipe $ 1.45 $ -
0 Traffic Management Day Standard $ 485.00 $ -
0 Traffic Management Day 4 Hour Notice $ 685.00 $ -
0 Traffic Management Day Emergency $ 785.00 $ -
0 LS Additional 7pm - 7am . Weekend $ 210.00 $ -
0 Arrow Board Rental per day $ 65.00 $ -
0 Flagger per hour $ 38.00 $ -
0 Cones each per day $ 4.00 $ -
0 Sign Panel B per day $ 28.00 $ -
0 Sign Panel A per day $ 28.00 $ -
0 Sign Panel Special per day $ 31.00 $ -
0 Overnight Closure per day (no monitoring) $ 55.00 $ -
2 Mechanical/Bore Pits $ 300.00 $ 600.00
72 Mud control (Super Vacuum) per hr. $ 375.00 $ 27,000.00
0 Hydro Excavation per hr. $ 450.00 $ -
75 Pipe Spacers (material only) $ 135.00 $ 10,125.00
900 Steel Banding (material only) per ft. $ 1.22 $ 1,098.00
750 Assemble spacer and banding per ft. $ 5.50 $ 4,125.00
$ -
0 Perfromance and Payment Bonds $ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
Subtotal $ 117,424.00
Job Location Taxes
Lemay and Triby Total $ 117,424.00
Ft. Collins, CO.
Thank You
FORT COLLINS UTILITIES
WORK ORDER
PORTNER SUB CIRCUIT 938
WORK ORDER NO. 5010052705
DATE: 5-17-2017
CONTRACTOR: Colorado Boring Co.
DocuSign Envelope ID: 99729829-BBFA86B0-3785-8CA0-4630-4861-B65F-8E61-B3DC1E029B3E D9CD4FFB29B7
TABLE OF CONTENTS
AGREEMENT FORMS
00525 Work Order & Notice of Award 00530-1
00530 Work Order Notice to Proceed 00530-1
00600 Bonds and Certificates 00600
00610 Performance Bond 00610-1 – 00610-2
00615 Payment Bond 00615-1 – 00615-2
00630 Certificate of Insurance 00630-1
00635 Certificate of Substantial Completion 00635-1
00640 Certificate of Final Acceptance 00640-1
00650 Lien Waiver Release (CONTRACTOR) 00650-1 – 00650-2
00651 Lien Waiver Release (SUBCONTRACTOR) 00651-1 – 00651-2
00660 Consent of Surety 00660-1
00670 Application for Exemption Certificate 00670-1 – 00670-2
CONDITIONS OF THE CONTRACT
00900 Addenda, Modifications and Payment 0900-1
00950 Work Order Change Order Form 00950-1
00960 Application for Payment 00960-1 - 00960-4
DocuSign Envelope ID: 99729829-BBFA86B0-3785-8CA0-4630-4861-B65F-8E61-B3DC1E029B3E D9CD4FFB29B7
SECTION 00500
CONSTRUCTION WORK ORDER AGREEMENT FORMS
00525 Work Order, Notice of Award & Bid Schedule
00530 Work Order Notice to Proceed
DocuSign Envelope ID: 99729829-BBFA86B0-3785-8CA0-4630-4861-B65F-8E61-B3DC1E029B3E D9CD4FFB29B7
SECTION 00525
WORK ORDER, NOTICE OF AWARD AND BID SCHEDULE
TO: Colorado Boring Co.
WORK ORDER NUMBER: 5010052705
PURCHASE ORDER:
TITLE:
ORIGINAL BID/RFP NUMBER & NAME: 8546 Directional Boring & Trenching
ENGINEER:
OWNER’S REPRESENTATIVE: Luke Unruh
NOTICE OF AWARD DATE:
OWNER: City of Fort Collins (hereinafter referred to as OWNER)
1. WORK. You are hereby notified that your bid dated 4-18-2017, for the above Work Order
has been considered. Pursuant to your AGREEMENT with OWNER dated 11-25-2013, you
have been awarded a Work Order for this Work Order Description:
This project will consist of two directional bores.
Spacer Bore: A caseless bore installed under Fossil Creek consisting of 8-5” and 2-2”.
The contractor shall be responsible for the following items including but not limited to: Labor,
equipment, material and clean up. The location of this work is the intersection of Trilby and
Lemay.
2. CONTRACT PRICE, BONDS AND CERTIFICATES. The price of your Work Order is One
hundred seventeen thousand and four hundred twenty four dollars (117,424.00). Pursuant to
the AGREEMENT and the Contract Documents, Performance and Payment Bonds and
insurance are required.
3. CONTRACT TIMES. Pursuant to the AGREEMENT and the Contract Documents, the date
for Substantial Completion of this Work Order is 8-20-2017, and after Substantial
Completion, the date for Final Completion is 9-20-2017.
4. EXECUTION. One (1) copy of this proposed Work Order & Notice of Award, and
accompanying amendments or supplements to the Contract Documents (except any
applicable Drawings) incorporated herein, are provided. One (1) set of any applicable
Drawings will be delivered separately or otherwise made available to you immediately. You
must comply with the following conditions precedent within fifteen (15) days of the date of
this Notice of Award, that is, by 6-1-2017.
A. You must deliver to OWNER one (1) fully-executed counterpart of this Work Order,
including all amendments or supplements to the Contract Documents incorporated
herein. Each Work Order must bear your signature as provided.
B. You must deliver with the executed Work Order the Contract Security (Bonds) and
insurance, as specified in the Agreement and this Work Order.
DocuSign Envelope ID: 99729829-BBFA86B0-3785-8CA0-4630-4861-B65F-8E61-B3DC1E029B3E D9CD4FFB29B7
Failure to comply with these conditions within the time specified will entitle OWNER to consider
your Bid abandoned and to annul this Work Order & Notice of Award. Within ten (10) days after
you comply with those conditions, OWNER will return to you one (1) fully-signed counterpart of
this Work Order with any amendments or supplements to the Contract Documents attached.
CONTRACTOR’S NOTICE OF AWARD REPRESENTATION & EXECUTION:
CONTRACTOR agrees to perform the services identified above, in accordance with the terms
and conditions contained herein and in the AGREEMENT dated 11-25-2013, and the NOTICE
OF AWARD dated 5-17-2017, between the parties. In the event of a conflict between or
ambiguity in the terms of the AGREEMENT or specific Work Orders, the AGREEMENT shall
control.
CONTRACTOR: COLORADO BORING CO.
By: Date:
Name: Title:
DocuSign Envelope ID: 99729829-3785-4630-B65F-B3DC1E029B3E
DocuSign Envelope ID: BBFA86B0-8CA0-4861-8E61-D9CD4FFB29B7
OWNER’S ACCEPTANCE & EXECUTION:
This Work Order and the attached Contract Documents are hereby accepted and incorporated
herein by this reference and the attached Notice to Proceed is hereby given.
ACCEPTANCE: Date: _____
Luke Unruh, Projects Manager
ACCEPTANCE: Date:
Janet McTague, Project Engineering Supervisor
ACCEPTANCE: Date:
Tim McCollough, Light & Power Operations Manager
ACCEPTANCE: Date:
Kevin Gertig, Utilities Executive Director
(if greater than $1,000,000)
OWNER: CITY OF FORT COLLINS
REVIEW: ___________________________________________ Date: __________
Pat Johnson, Senior Buyer
ACCEPTANCE: ___________________________________________ Date: __________
Gerry Paul, Purchasing Director
(if greater than $60,000)
ATTEST:
City Clerk
(if greater than $1,000,000)
APPROVED AS TO FORM:
Senior Assistant City Attorney
(if greater than $1,000,000)
DocuSign Envelope ID: 99729829-3785-4630-B65F-B3DC1E029B3E
DocuSign Envelope ID: BBFA86B0-8CA0-4861-8E61-D9CD4FFB29B7
BID SCHEDULE
SECTION 00530
WORK ORDER NOTICE TO PROCEED
NOTICE TO PROCEED DATE:
WORK ORDER TITLE:
WORK ORDER NUMBER:
TO:
Attn:
This notice is to advise you:
That the Work Order and all amendments and supplements to the Contract Documents covering
the above described Work have been fully executed by the CONTRACTOR and the OWNER.
That the required CONTRACTOR's Performance and Payment Bonds and insurance have been
received by the OWNER. That the OWNER has approved the said Work Order and Contract
Documents.
Therefore, as the CONTRACTOR for the above described Work, you are hereby authorized and
directed to proceed within ( ) calendar days from receipt of this notice as required
by the Work Order and the AGREEMENT.
The dates for Substantial Completion and Final Acceptance shall be , and ,
respectively.
Dated this _____________ day of ___________, _____.
CITY OF FORT COLLINS (OWNER)
By: ___________________________________________
___________________________________________
Name & Title
ACKNOWLEDGMENT OF NOTICE
Receipt of the above Work Order Notice to Proceed is hereby acknowledged this
_____________ day of ___________, _____.
(CONTRACTOR)
By: ___________________________________________
___________________________________________
Name & Title
DocuSign Envelope ID: 99729829-BBFA86B0-3785-8CA0-4630-4861-B65F-8E61-B3DC1E029B3E D9CD4FFB29B7
2
SECTION 00600
BONDS AND CERTIFICATES
00610 Performance Bond
00615 Payment Bond
00630 Certificate of Insurance
00635 Certificate of Substantial Completion
00640 Certificate of Final Acceptance
00650 Lien Waiver Release (CONTRACTOR)
00651 Lien Waiver Release (SUBCONTRACTOR)
00660 Consent of Surety
00670 Application for Exemption Certificate
DocuSign Envelope ID: 99729829-BBFA86B0-3785-8CA0-4630-4861-B65F-8E61-B3DC1E029B3E D9CD4FFB29B7
5/98 PERFORMANCE BOND
00610- Page 1
SECTION 00610
PERFORMANCE BOND
Bond No __
KNOW ALL MEN BY THESE PRESENTS: that
(Firm)
(Address)
(an Individual), (a Partnership), (a Corporation), hereinafter referred to as the "Principal" and
(Firm)
(Address)
hereinafter referred to as "the Surety", are held and firmly bound unto City of Fort Collins, 300
LaPorte Ave, Fort Collins, Colorado 80522 a (Municipal Corporation) hereinafter referred to as
the "OWNER", in the penal sum of ($ ) in lawful money of the United States, for the
payment of which sum well and truly to be made, we bind ourselves, successors and assigns,
jointly and severally, firmly by these presents.
THE CONDITIONS OF THIS OBLIGATION are such that whereas the Principal entered into a
certain Agreement with the OWNER, dated the day of , 2 , a copy of which is
hereto attached and made a part hereof, for the performance of The City of Fort Collins Work
Order, titled , Work Order Number , dated the day of , , a copy
of which is hereto attached and made a part hereof.
NOW, THEREFORE, if the Principal shall well, truly and faithfully perform its duties, all the
undertakings, covenants, terms, conditions and agreements of said Work Order and Agreement
during the original term thereof, and any extensions thereof which may be granted by the
OWNER, with or without Notice to the Surety and during the life of the guaranty period, and if
the Principal shall satisfy all claims and demands incurred under such Work Order and
Agreement, and shall fully indemnify and save harmless the OWNER from all cost and damages
which it may suffer by reason of failure to do so, and shall reimburse and repay the OWNER all
outlay and expense which the OWNER may incur in making good any default, then this
obligation shall be void; otherwise to remain in full force and effect.
PROVIDED, FURTHER, that the said Surety, for value received, hereby stipulates and agrees
that no change, extension of time, alteration or addition to the terms of the Work Order and
Agreement or to the Work to be performed thereunder or the Specifications accompanying the
same shall in any way affect its obligation on this bond; and it does hereby waive notice of any
such change, extension of time, alteration or addition to the terms of the Work Order and
Agreement or to the Work or to the Specifications.
PROVIDED, FURTHER, that no final settlement between the OWNER and the CONTRACTOR
shall abridge the right of any beneficiary hereunder, whose claim may be unsatisfied.
PROVIDED, FURTHER, that the Surety Company must be authorized to transact business in
the State of Colorado and be acceptable to the OWNER.
DocuSign Envelope ID: 99729829-BBFA86B0-3785-8CA0-4630-4861-B65F-8E61-B3DC1E029B3E D9CD4FFB29B7
5/98 PERFORMANCE BOND
00610- Page 2
IN WITNESS WHEREOF, this instrument is executed in three (3) counterparts, each one of
which shall be deemed an original, this _____ day of ___________, _____.
IN PRESENCE OF: Principal
(Title) (Title)
(Corporate Seal)
(Address)
IN PRESENCE OF: Other Partners
_____________________________ By:
_____________________________ By:
IN PRESENCE OF: Surety
_____________________________ By:
_____________________________
(Address)
(Surety Seal)
NOTE: Date of Bond must not be prior to date of Agreement. If CONTRACTOR is
Partnership, all partners should execute Bond.
DocuSign Envelope ID: 99729829-BBFA86B0-3785-8CA0-4630-4861-B65F-8E61-B3DC1E029B3E D9CD4FFB29B7
5/98 CERTIFICATE OF INSURANCE
00630- Page 1
SECTION 00615
PAYMENT BOND
Bond No __
KNOW ALL MEN BY THESE PRESENTS: that
(Firm)
(Address)
(an Individual), (a Partnership), (a Corporation), hereinafter referred to as the "Principal" and
(Firm)
(Address)
hereinafter referred to as "the Surety", are held and firmly bound unto City of Fort Collins, 300
LaPorte Ave, Fort Collins, Colorado 80522 a (Municipal Corporation) hereinafter referred to as
the "OWNER", in the penal sum of ($ ) in lawful money of the United States, for the
payment of which sum well and truly to be made, we bind ourselves, successors and assigns,
jointly and severally, firmly by these presents.
THE CONDITIONS OF THIS OBLIGATION are such that whereas the Principal entered into a
certain Agreement with the OWNER, dated the day of , 2 , a copy of which is
hereto attached and made a part hereof, for the performance of The City of Fort Collins Work
Order, titled , Work Order Number , dated the day of , , a copy
of which is hereto attached and made a part hereof.
NOW, THEREFORE, if the Principal shall make payment to all persons, firms, subcontractors,
and corporations furnishing materials for or performing labor in the prosecution of the Work
provided for in such Work Order and Agreement and any authorized extension or modification
thereof, including all amounts due for materials, lubricants, repairs on machinery, equipment
and tools, consumed, rented or used in connection with the construction of such Work, and all
insurance premiums on said Work, and for all labor, performed in such Work whether by
subcontractor or otherwise, then this obligation shall be void; otherwise to remain in full force
and effect.
PROVIDED, FURTHER, that the said Surety, for value received, hereby stipulates and agrees
that no change, extension of time, alteration or addition to the terms of the Work Order and
Agreement or to the Work to be performed thereunder or the Specifications accompanying the
same shall in any way affect its obligation on this bond; and it does hereby waive notice of any
such change, extension of time, alteration or addition to the terms of the Work Order and
Agreement or to the Work or to the Specifications.
PROVIDED, FURTHER, that no final settlement between the OWNER and the CONTRACTOR
shall abridge the right of any beneficiary hereunder, whose claim may be unsatisfied.
PROVIDED, FURTHER, that the Surety Company must be authorized to transact business in
the State of Colorado and be acceptable to the OWNER.
DocuSign Envelope ID: 99729829-BBFA86B0-3785-8CA0-4630-4861-B65F-8E61-B3DC1E029B3E D9CD4FFB29B7
5/98 CERTIFICATE OF INSURANCE
00630- Page 2
IN WITNESS WHEREOF, this instrument is executed in three (3) counterparts, each one of
which shall be deemed an original, this _____ day of ___________, _____.
IN PRESENCE OF: Principal
(Title) (Title)
(Corporate Seal)
(Address)
IN PRESENCE OF: Other Partners
_____________________________ By:
_____________________________ By:
IN PRESENCE OF: Surety
_____________________________ By:
_____________________________
(Address)
(Surety Seal)
NOTE: Date of Bond must not be prior to date of Agreement. If CONTRACTOR is
Partnership, all partners should execute Bond.
DocuSign Envelope ID: 99729829-BBFA86B0-3785-8CA0-4630-4861-B65F-8E61-B3DC1E029B3E D9CD4FFB29B7
5/98 CERTIFICATE OF INSURANCE
00630- Page 3
SECTION 00630
CERTIFICATE OF INSURANCE
CONTRACTOR shall insert his own standard form for Certificate of Insurance.
DocuSign Envelope ID: 99729829-BBFA86B0-3785-8CA0-4630-4861-B65F-8E61-B3DC1E029B3E D9CD4FFB29B7
4
SECTION 00635
CERTIFICATE OF SUBSTANTIAL COMPLETION
TO: CITY OF FORT COLLINS (OWNER) PROJECT TITLE:Portner Sub Circuit 938
DATE OF SUBSTANTIAL COMPLETION: LOCATION: Fort Collins, Colorado
OWNER: City of Fort Collins
PROJECT OR SPECIFIED PART SHALL CONTRACTOR:
INCLUDE:
CONTRACT DATE:
The Work performed under this Work Order, pursuant to the Contract Documents, has been
inspected by authorized representatives of the OWNER, CONTRACTOR, and the ENGINEER
and the project (or specified part of the project, as indicated above) is hereby declared to be
substantially completed on the above date.
A tentative list of items to be completed or corrected is appended hereto. This list may not be
exhaustive, and the failure to include an item on it does not alter the responsibility of the
CONTRACTOR to complete all the Work in accordance with the Contract Documents.
_____________________________ By: __________________________ ________
PROJECT MANAGER AUTHORIZED REPRESENTATIVE DATE
The CONTRACTOR accepts the above Certificate of Substantial Completion and agrees to
complete and correct the items on the tentative list within the time indicated.
_____________________________ By: __________________________ ________
CONTRACTOR AUTHORIZED REPRESENTATIVE DATE
The OWNER accepts the project or specified area of the project as substantially complete and
will assume full possession of the project or specified area of the project at 12:01 a.m., on
. The responsibility for heat, utilities, security, and insurance
under the Contract Documents shall be as set forth under "Remarks" below.
CITY OF FORT COLLINS ________ By: __________________________ ________
OWNER AUTHORIZED REPRESENTATIVE DATE
REMARKS: _________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
DocuSign Envelope ID: 99729829-BBFA86B0-3785-8CA0-4630-4861-B65F-8E61-B3DC1E029B3E D9CD4FFB29B7
5/98 CERTIFICATE OF FINAL ACCEPTANCE
000640- Page 1
SECTION 00640
CERTIFICATE OF FINAL ACCEPTANCE
DATE: ________________, _____
TO:
Gentlemen:
You are hereby notified that on the day of , , the City of Fort Collins,
Colorado, has accepted the Work completed by , for the City of Fort Collins Work Order,
titled , Work Order Number .
A check is attached hereto in the amount of $ . as Final Payment for all Work
done, subject to the terms of the Contract Documents, including the Work Order, which is dated
, and the AGREEMENT, which is dated .
In conformance with the Work Order and Contract Documents for this project, your obligations
and guarantees will continue for the specified time from the following date:
___________________, _____.
Sincerely,
City of Fort Collins
OWNER
By: ___________________________________________
___________________________________________
Name & Title
ATTEST: _________________________________________
___________________________________________
Name & Title
DocuSign Envelope ID: 99729829-BBFA86B0-3785-8CA0-4630-4861-B65F-8E61-B3DC1E029B3E D9CD4FFB29B7
5/98 LIEN WAIVER RELEASE(CONTRACTOR
00650 Page 1
SECTION 00650
LIEN WAIVER RELEASE
(CONTRACTOR)
TO: City of Fort Collins, Colorado (OWNER)
FROM: (CONTRACTOR)
WORK ORDER TITLE:
WORK ORDER NUMBER:
1. The CONTRACTOR acknowledges having received payment, except retainage from the
OWNER for all work, labor, skill and material furnished, delivered and performed by the
CONTRACTOR for the OWNER or for anyone in the construction, design, improvement,
alteration, addition or repair of the above described project.
2. In consideration of such payment and other good and valuable consideration, the receipt
and adequacy of which are hereby acknowledged, the CONTRACTOR voluntarily waives
all rights, claims and liens, including but not limited to, mechanic's liens, Miller Act claims
(40 U.S.C.A. 270 a and b), stop notices, equitable liens and labor and material bond rights
which the CONTRACTOR may now or may afterward have, claim or assert for all and any
work, labor, skill or materials furnished, delivered or performed for the construction,
design, improvement, alteration, addition or repair of the above described project, against
the OWNER or its officers, agents, employees or assigns, against any fund of or in the
possession or control of the OWNER, against the project or against all land and the
buildings on and appurtenances to the land improved by the project.
3. The CONTRACTOR affirms that all work, labor and materials, furnished, delivered or
performed to or for the construction, design, improvement, alteration, addition or repair of
the project were furnished, delivered or performed by the CONTRACTOR or its agents,
employees, and servants, or by and through the CONTRACTOR by various
Subcontractors or materialmen or their agents, employees and servants and further
affirms the same have been paid in full and have released in full any and all existing or
possible future mechanic's liens or rights or claims against the project or any funds in the
OWNER'S possession or control concerning the project or against the OWNER or its
officers, agents, employees or assigns arising out of the project.
4. The CONTRACTOR agrees to defend and hold harmless the OWNER, the lender, if any,
and the Surety on the project against and from any claim hereinafter made by the
CONTRACTOR's Subcontractors, materialmen, employees, servants, agents or assigns
against the project or against the OWNER or its officers, employees, agents or assigns
arising out of the project for all loss, damage and costs, including reasonable attorneys
fees, incurred as a result of such claims.
5. The parties acknowledge that the description of the project set forth above constitutes an
adequate description of the property and improvements to which this Lien Waiver Release
pertains. It is further acknowledged that this Lien Waiver Release is for the benefit of and
may be relied upon by the OWNER, the lender, if any, and Surety on any labor and
material bonds for the project.
DocuSign Envelope ID: 99729829-BBFA86B0-3785-8CA0-4630-4861-B65F-8E61-B3DC1E029B3E D9CD4FFB29B7
5/98 LIEN WAIVER RELEASE(CONTRACTOR
00650 Page 2
Signed this ______ day of __________, ___.
CONTRACTOR:
By: ___________________________________________
___________________________________________
Name & Title
ATTEST:
_____________________________
Secretary
STATE OF COLORADO )
)ss.
COUNTY OF LARIMER )
Subscribed and sworn to before me this _________ day of __________, _____, by
________________________________________________________________.
Witness my hand and official seal.
My Commission Expires: ___________________________.
_________________________
Notary Public
DocuSign Envelope ID: 99729829-BBFA86B0-3785-8CA0-4630-4861-B65F-8E61-B3DC1E029B3E D9CD4FFB29B7
5/98 LIEN WAIVER RELEASE (SUBCONTRACTOR)
00650 Page 3
SECTION 00650
LIEN WAIVER RELEASE
(SUBCONTRACTOR)
TO: City of Fort Collins, Colorado (OWNER)
FROM: (CONTRACTOR)
WORK ORDER TITLE: Portner Sub Circuit 938
WORK ORDER NUMBER: 5010052705
1. The Subcontractor acknowledges having received payment from the CONTRACTOR for
all work, labor, skill and material furnished, delivered and performed by the Subcontractor
for the CONTRACTOR or for anyone in the construction, design, improvement, alteration,
addition or repair of the above described project.
2. In consideration of such payment and other good and valuable consideration, the receipt
and adequacy of which are hereby acknowledged, the Subcontractor voluntarily waives all
rights, claims and liens, including but not limited to, mechanic's liens, Miller Act claims (40
U.S.C.A. 270 a and b), stop notices, equitable liens and labor and material bond rights
which the Subcontractor may now or may afterward have, claim or assert for all and any
work, labor, skill or materials furnished, delivered or performed for the construction,
design, improvement, alteration, addition or repair of the above described project, against
the CONTRACTOR or its officers, agents, employees or assigns, against the project or
against all land and the buildings on and appurtenances to the land improved by the
project.
3. The Subcontractor affirms that all work, labor and materials, furnished, delivered or
performed to or for the construction, design, improvement, alteration, addition or repair of
the project were furnished, delivered or performed by the Subcontractor or its agents,
employees, and servants, or by and through the Subcontractor by various sub-
subcontractors or materialmen or their agents, employees and servants, and further
affirms the same have been paid in full and have released in full any and all existing or
possible future mechanic's liens or rights or claims against the project or against the
CONTRACTOR or its officers, agents, employees or assigns arising out of the project.
4. The Subcontractor agrees to defend and hold harmless the CONTRACTOR, the lender, if
any, and the Surety on the project against and from any claim hereinafter made by the
Subcontractor's sub-subcontractors, materialmen, employees, servants, agents or assigns
against the project or against the CONTRACTOR or OWNER, lender or Surety or their
officers, employees, agents or assigns arising out of the project for all loss, damage and
costs, including reasonable attorneys fees, incurred as a result of such claims.
5. The parties acknowledge that the description of the project set forth above constitutes an
adequate description of the property and improvements to which this Lien Waiver Release
pertains. It is further acknowledged that this Lien Waiver Release is for the benefit of and
may be relied upon by the CONTRACTOR, OWNER, the lender, if any, and Surety on any
labor and material bonds for the project.
DocuSign Envelope ID: 99729829-BBFA86B0-3785-8CA0-4630-4861-B65F-8E61-B3DC1E029B3E D9CD4FFB29B7
5/98 LIEN WAIVER RELEASE (SUBCONTRACTOR)
00650 Page 4
Signed this ______ day of _________, ___.
SUBCONTRACTOR:
By: ___________________________________________
___________________________________________
Name & Title
ATTEST:
_____________________________
Secretary
STATE OF COLORADO )
)ss.
COUNTY OF LARIMER )
Subscribed and sworn to before me this _________ day of __________, _____, by
__________________________________________________________________.
Witness my hand and official seal.
My Commission Expires: ___________________________.
__________________________________
Notary Public
DocuSign Envelope ID: 99729829-BBFA86B0-3785-8CA0-4630-4861-B65F-8E61-B3DC1E029B3E D9CD4FFB29B7
5/98 CONSENT OF SURETY 00660-Page
1
SECTION 00660
CONSENT OF SURETY
TO: City of Fort Collins, Colorado (hereinafter referred to as the "OWNER")
CONTRACTOR: Colorado Boring Co
TITLE: Portner Sub Circuit 938
WORK ORDER NUMBER: 5010052705
CONTRACT DATE:
WORK ORDER DATE:
In accordance with the provisions of the Work Order and Contract between the OWNER and the
CONTRACTOR as indicated above, for the Work Order titled on bond of
, (Surety) _______________________________________
hereby approves of the Final Payment to the CONTRACTOR, and agrees that Final Payment to
the CONTRACTOR shall not relieve the Surety Company of any of its obligations to the
OWNER, as set forth in the said Surety Company's Bond.
IN WITNESS WHEREOF, the Surety Company has hereunto set its hand this _________ day of
_________ _, _____.
____________________________________________
(Surety Company)
By: ________________________________________
(Name) Attorney-in-Fact
ATTACH: Power of Attorney and Certificate of Authority of Attorney(s)-in-Fact.
DocuSign Envelope ID: 99729829-BBFA86B0-3785-8CA0-4630-4861-B65F-8E61-B3DC1E029B3E D9CD4FFB29B7
5/98 AGREEMENT 00800 Page 1
SECTION 00670
APPLICATION FOR EXEMPTION CERTIFICATE
DocuSign Envelope ID: 99729829-BBFA86B0-3785-8CA0-4630-4861-B65F-8E61-B3DC1E029B3E D9CD4FFB29B7
Special Notice
Contractors who have completed this application in the past, please note the following changes
in procedure:
The Department will no longer issue individual Certificates of exemption to subcontractors. Only
prime contractors will receive a Contractor’s Exemption Certificate on exempt projects.
Upon receipt of the Certificate, the prime contractor should make a copy for each subcontractor
involved in the project and complete it by filling in the subcontractor’s name and address and
signing it.
The original Certificate should always be retained by the prime contractor. Copies of all
Certificates that the prime contractor issued to subcontractors should be kept at the prime
contractor’s place of business for a minimum of three years and be available for inspection in
the event of an audit.
Once an 89# has been assigned to you, please use the next five numbers following it for any
applications submitted for future projects. This should be your permanent number. For
instance, if you were assigned 89-12345-0001, every application submitted thereafter should
contain 89-12345 on the application. The succeeding numbers will be issued by the
Department of Revenue. DO NOT enter what you believe to be the next in sequence as this
may delay processing of your application.
DocuSign Envelope ID: 99729829-BBFA86B0-3785-8CA0-4630-4861-B65F-8E61-B3DC1E029B3E D9CD4FFB29B7
SECTION 00900
ADDENDA, MODIFICATIONS AND PAYMENT
00950 Change Order
00960 Application for Payment
DocuSign Envelope ID: 99729829-BBFA86B0-3785-8CA0-4630-4861-B65F-8E61-B3DC1E029B3E D9CD4FFB29B7
2 5/98 AGREEMENT 00960 Page
SECTION 00950
CHANGE ORDER FORM
CHANGE ORDER NO.
CONTRACTOR:
WORK ORDER TITLE & NO. :
DESCRIPTION:
1. Reason for change:
2. Description of Change:
3. Change in Contract Cost:
4. Change in Contract Time:
ORIGINAL CONTRACT COSTS $ ________________
TOTAL APPROVED CHANGE ORDER(S) $ ________________
TOTAL PENDING CHANGE ORDER(S) $ ________________
TOTAL THIS CHANGE ORDER $ ________________
TOTAL % OF ORIGINAL CONTRACT, THIS CO: _______________ %
TOTAL % OF ORIGINAL CONTRACT, ALL CO’S: _______________ %
ADJUSTED CONTRACT COST $ ________________
(Assuming all change orders approved)
ACCEPTED BY: _____________________________________ DATE: ____________
Contractor's Representative
ACCEPTED BY: _____________________________________ DATE: ____________
Project Manager
REVIEWED BY: _____________________________________ DATE: ____________
Title:
APPROVED BY: _____________________________________ DATE: ____________
Title:
APPROVED BY: _____________________________________ DATE: ____________
(Purchasing Agent if > $60,000)
cc: City Clerk Architect/Engineer
Finance Purchasing
Project Manager Contractor
DocuSign Envelope ID: 99729829-BBFA86B0-3785-8CA0-4630-4861-B65F-8E61-B3DC1E029B3E D9CD4FFB29B7
SECTION 00960
PAYMENT APPLICATION
DocuSign Envelope ID: 99729829-BBFA86B0-3785-8CA0-4630-4861-B65F-8E61-B3DC1E029B3E D9CD4FFB29B7
Section 00960
APPLICATION FOR PAYMENT PAGE 1 OF 4
OWNER: City of Fort Collins PROJECT: APPLICATION NUMBER:
APPLICATION DATE:
PERIOD BEGINNING:
ENGINEER: CONTRACTOR: PERIOD ENDING:
PROJECT NUMBER:
CHANGE ORDERS Application is made for Payment as shown below in connection with Contract
NUMBER DATE AMOUNT
The present status of the account for this Contract is as
follows:
1
2 Original Contract Amount:
3 Net Change by Change Order:
Current contract Amount: $0.00
Total Completed and Stored to Date:
Less Previous Applications:
Amount Due this Application - Before Retainage: $0.00
Less Retainage:
Net Change by Change Order $0.00 AMOUNT DUE THIS APPLICATION: $0.00
CERTIFICATION:
The undersigned CONTRACTOR certifies that all obligations of CONTRACTOR incurred in connection with
the Work have been satisfied as required in Paragraph 14.3. of the General Conditions of the Contract.
The above Amount Due This Application is requested by the CONTRACTOR.
Date: By:
Payment of the above Amount Due This Application is recommended by the ENGINEER.
Date: By:
Payment of the above Amount Due This Application has been reviewed by the OWNER'S Project Manager.
Date: By:
Payment of the above Amount Due This Application is approved by the OWNER.
Date: By:
DocuSign Envelope ID: 99729829-BBFA86B0-3785-8CA0-4630-4861-B65F-8E61-B3DC1E029B3E D9CD4FFB29B7
CONTRACT AMOUNTS
APPLICATION FOR
PAYMENT PAGE 2 OF 4
Work
Completed
Work
Completed
Work
Completed Stored
Bid
This
Month
Previous
Periods
To
Date Materials Total
Item This Earned Percent
Number Description Quantity Units
Unit
Price Amount Qty. Amount Qty. Amount Qty. Amount Period
To
Date Billed
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
TOTALS $0.00 $0.00 $0.00 $0.00 $0.00
DocuSign Envelope ID: 99729829-BBFA86B0-3785-8CA0-4630-4861-B65F-8E61-B3DC1E029B3E D9CD4FFB29B7
CHANGE ORDERS APPLICATION FOR PAYMENT PAGE 3 OF 4
Work
Completed
Work
Completed
Work
Completed Stored
Bid
This
Month
Previous
Periods
To
Date Materials Total
Item This Earned Percent
Number Description Quantity Units
Unit
Price Amount Qty. Amount Qty. Amount Qty. Amount Period
To
Date Billed
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $0.00
TOTALS CHANGE
ORDERS $0.00 $0.00 $0.00 $0.00 $0.00
PROJECT TOTALS $0.00 $0.00 $0.00 $0.00 $0.00
DocuSign Envelope ID: 99729829-BBFA86B0-3785-8CA0-4630-4861-B65F-8E61-B3DC1E029B3E D9CD4FFB29B7
STORED MATERIALS
SUMMARY PAGE 4 OF 4
On Hand Received Installed On Hand
Item Invoice Previous This This This
Number Number Description Application Period Period Application
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
TOTALS $0.00 $0.00 $0.00 $0.00
DocuSign Envelope ID: 99729829-BBFA86B0-3785-8CA0-4630-4861-B65F-8E61-B3DC1E029B3E D9CD4FFB29B7