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HomeMy WebLinkAboutCORRESPONDENCE - PURCHASE ORDER - 9178073 (2)Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 FORT COLLINS UTILITIES CONSTRUCTION WORK ORDER WALNUT STREET WATER MAIN REPLACEMENT WORK ORDER NO. 201714 DATE: November 29, 2017 CONTRACTOR: Connell Resources, Inc. Page 1 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 TABLE OF CONTENTS AGREEMENT FORMS 00525 Work Order, Notice of Award & Bid Schedule 00530 Work Order Notice to Proceed 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 00800 Supplementary Conditions 00900 Addenda, Modifications and Payment 00950 Work Order Change Order Form 00960 Application for Payment ADDITIONAL DOCUMENTS Attachment A DRAWING INDEX Page 2 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 SECTION 00500 CONSTRUCTION WORK ORDER AGREEMENT FORMS 00525 Work Order, Notice of Award & Bid Schedule 00530 Work Order Notice to Proceed Page 3 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 SECTION 00525 WORK ORDER, NOTICE OF AWARD AND BID SCHEDULE TO: Connell Resources, Inc. WORK ORDER NUMBER: 201714 PROJECT TITLE: Walnut Street Water Main Replacement ORIGINAL BID/RFP NUMBER & NAME: 8106, Utility Infrastructure Construction Services for Water, Wastewater and Stormwater Facilities Capital Improvements MASTER AGREEMENT EFFECTIVE DATE: August 17, 2015 ARCHITECT/ENGINEER: Ditesco Project and Construction Services OWNER’S REPRESENTATIVE: James Rose WORK ORDER COMMENCEMENT DATE: November 30, 2017 WORK ORDER COMPLETION DATE: May 30, 2018 MAXIMUM FEE: (time and reimbursable direct costs): $411,117.60 NOTICE OF AWARD DATE: November 30, 2017 OWNER: City of Fort Collins (hereinafter referred to as OWNER) 1. WORK. Pursuant to your MASTER AGREEMENT with OWNER dated August 17, 2015, and your Work Order Proposal dated November 17, 2017, you have been awarded a Work Order for Walnut Street Water Main Replacement. PROJECT DESCRIPTION & SITE LOCATION: Walnut Street Water Main Replacement: all labor, equipment, and materials required to replace the existing 6 and 4 inch water mains in Walnut Street with a new 8 inch water main. The project includes the installation of 11 new service connections, 2 fire line service connections, and 2fire hydrants. Restoration work includes the replacement of 8 inches of disturbed road areas with 8 inches of concrete with a 2 inch asphalt cap. 2. CONTRACT PRICE, BONDS AND CERTIFICATES. The price of your Work Order is Four hundred eleven thousand one hundred seventeen and sixty cents ($411,117.60). Pursuant to the AGREEMENT and the Work Order Documents, Performance and Payment Bonds and insurance are required. 3. CONTRACT TIMES. Pursuant to the MASTER AGREEMENT and the Work Order Documents, the date for Substantial Completion of this Work Order is March 30, 2018, and after Substantial Completion, the date for Final Completion is May 30, 2018. 4. LIQUIDATED DAMAGES. OWNER and CONTRACTOR recognize that time is of the essence of this Work Order and that OWNER will suffer financial loss if the Work is not completed within the times specified in paragraph 3 above, plus any extensions thereof allowed in accordance with Article 12 of the General Conditions. They also recognize the delays, expenses and difficulties involved in proving in a legal proceeding the actual loss suffered by OWNER if the Work is not completed on time. Accordingly instead of requiring Page 4 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 any such proof, OWNER and CONTRACTOR agree that as liquidated damages for delay (but not as penalty) CONTACTOR shall pay OWNER the amounts set forth hereafter. 1) Substantial Completion: Five hundred dollars ($500.00) for each calendar day or fraction thereof after March 30, 2018 until the work is Substantially Complete. 2) Final Acceptance: After Substantial Completion, Two hundred dollars ($200.00) for each calendar day or fraction thereof after 60 calendar day period, until the Work is ready for Final Payment and Acceptance. 5. EXECUTION. Work Order Documents must be executed in DocuSign within fifteen (15) calendar days of the date of this Notice of Award. Contractor shall attach Payment and Performance Bonds and Certificate of Insurance(COI) to the Work Order Documents in DocuSign. In addition, one original set of executed Bonds and COI shall be provided to the Buyer. Failure to comply with these conditions within the time specified will entitle OWNER to consider your Work Order Proposal abandoned and to annul this Work Order & Notice of Award. CONTRACTOR’S NOTICE OF AWARD REPRESENTATION & EXECUTION: CONTRACTOR agrees to perform the services identified above, in accordance with the terms and conditions contained herein, the MASTER AGREEMENT, and the NOTICE OF AWARD between the parties. In the event of a conflict between or ambiguity in the terms of the MASTER AGREEMENT or specific Work Orders, the MASTER AGREEMENT shall control. CONTRACTOR: Connell Resources, Inc. By: Date: Name: Title: Page 5 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 John Warren December 1, 2017 Vice President Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 OWNER’S ACCEPTANCE & EXECUTION: This Work Order and the attached Documents are hereby accepted and incorporated herein by this reference. ACCEPTANCE: Date: James Rose, Special Project Manager REVIEWED: Date: Pat Johnson, Senior Buyer APPROVED AS TO FORM: Date: Name,City Attorney's Title (if greater than $1,000,000) ACCEPTANCE: Date: Owen Randall, Water Systems Engineering Division Manager ACCEPTANCE: Date: Matt Fater, Water Engineering & Field Services Operations 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 6 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 November 29, 2017 November 29, 2017 December 6, 2017 December 7, 2017 December 7, 2017 Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 BID SCHEDULE Page 7 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 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: 11/17/2017 Submitted To: City Of Fort Collins - Utilities Walnut RECON St Waterline - Linden To College Bid Title Address: 700 Wood St. Bid Number: Fort Collins, CO 80522 Project Location: Walnut St Contact: Jay Rose Project City, State: Fort Collins, CO Phone: (970) 221-6700 Fax: (970) 221-6619 Engineer/Architect: Ditesco Line # Item Description Estimated Quantity Unit Unit Price Total Price PH 1 - Walnut From Pine To Linden 10 Mobilization 1.00 EACH $5,280.00 $5,280.00 20 Flow Fill Street Crossing Waterline 36.00 CY $135.00 $4,860.00 30 Office Trailer, Generator & Toilets 3.00 MO $5,060.00 $15,180.00 40 Site Management 12.00 WK $3,930.00 $47,160.00 50 Pothole Existing Utilities 15.00 EACH $224.00 $3,360.00 60 Vacuum Excavation 3.00 DY $3,150.00 $9,450.00 70 Construction Surveying - ALLOWANCE 1.00 LS $2,330.00 $2,330.00 80 Temp Pedestrian Fence (Mob, Install, Demob) 1,200.00 LF $5.10 $6,120.00 90 6" PVC Waterline 170.00 LF $160.00 $27,200.00 100 8" PVC Waterline 490.00 LF $126.00 $61,740.00 110 6" Tie To Existing 3.00 EACH $2,960.00 $8,880.00 120 Cap Old Existing 6" Waterline 4.00 EACH $995.00 $3,980.00 130 6" Gate Valve W/ Box 4.00 EACH $1,130.00 $4,520.00 140 Fire Hydrant 1.00 EACH $5,130.00 $5,130.00 150 Shut Down, Flush & Reconnect Fire Sprinkler System 2.00 EACH $2,040.00 $4,080.00 160 8" Tie To Existing 2.00 EACH $3,080.00 $6,160.00 170 8" Cap W/ Temp Blow Off 1.00 EACH $1,670.00 $1,670.00 180 8" X 1" Water Service To Curbstop 3.00 EACH $3,540.00 $10,620.00 190 8" X 3/4" Water Service To Curbstop 4.00 EACH $3,330.00 $13,320.00 200 8" X 2" Service To Curbstop 2.00 EACH $4,760.00 $9,520.00 210 8" Gate Valve W/ Box 2.00 EACH $1,570.00 $3,140.00 220 6" 90 Bend 1.00 EACH $414.00 $414.00 230 8" 45 Bend 2.00 EACH $468.00 $936.00 240 8" X 6" Swivel Tee 4.00 EACH $604.00 $2,416.00 250 8" X 8" Tee 1.00 EACH $668.00 $668.00 260 Remove Asphalt With Hoe 1,100.00 SY $7.90 $8,690.00 270 Curb & Gutter - 18" Top 65.00 LF $32.70 $2,125.50 280 12" X 12" Concrete Band 43.00 LF $32.70 $1,406.10 290 8" Concrete Pavement Under Asphalt Sawcut, Rem / Repl (7' W, 6,250.00 SF $12.60 $78,750.00 With Dowels, Prep, Conc) 300 Roadway Pavers Section(8" Slab, 2" Base, Rd Rated Pavers) 310.00 SF $57.50 $17,825.00 310 Colored Concrete Sidewalk 6" 400.00 SF $11.60 $4,640.00 320 Sidewalk Pavers 300.00 SF $40.80 $12,240.00 320 Ground Heater 11.00 DY $554.00 $6,094.00 330 10" Concrete Pavement - Sawcut, Removal, Prep, Conc 220.00 SF $13.60 $2,992.00 340 Asphalt Paving Paver Patch - 3" Overlay Of Concrete In Pine 190.00 TON $95.90 $18,221.00 Total Price for above PH 1 - Walnut From Pine To Linden Items: $411,117.60 11/17/2017 11:24:45 AM Page 1 of 2 Page 8 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 Total Bid Price: $411,117.60 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 11/17/2017 11:24:45 AM Page 2 of 2 Page 9 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 ID Task Mode Task Name Duration Start Finish 1 Mobilization / Traffic Control Set-up 4 days Tue 1/2/18 Fri 1/5/18 2 Waterline Installation / Testing 25 days Mon 1/8/18 Fri 2/9/18 3 Install - Services, Fireline and Hydrants 13 days Mon 2/12/18 Wed 2/28/18 4 Pour Concrete - Street & Intersection 10 days Thu 3/1/18 Wed 3/14/18 5 Brick Pavers 12 days Thu 3/15/18 Fri 3/30/18 6 Project Complete 0 days Fri 3/30/18 Fri 3/30/18 Project Co 30 2 5 8 11 14 17 20 23 26 29 1 4 7 10 13 16 19 22 25 28 3 6 9 12 15 18 21 24 27 30 2 January 2018 February 2018 March 2018 April 2018 Task Split Milestone Summary Project Summary Inactive Task Inactive Milestone Inactive Summary Manual Task Duration-only Manual Summary Rollup Manual Summary Start-only Finish-only External Tasks External Milestone Deadline Progress Manual Progress Page 1 Project: Walnut basic 11.27.17 Date: Mon 11/27/17 Walnut St Waterline Page 10 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 SECTION 00530 WORK ORDER NOTICE TO PROCEED NOTICE TO PROCEED DATE: WORK ORDER TITLE: Walnut Street Water Main Replacement WORK ORDER NUMBER: 201714 TO: Connell Resources, Inc Attn: This notice is to advise you: That the Work Order and all amendments and supplements to the Work Order 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 Work Order 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 day of Month, Year. (CONTRACTOR) By: ___________________________________________ Name, Title Page 11 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 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 Page 12 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 SECTION 00610 PERFORMANCE BOND Bond No __ KNOW ALL MEN BY THESE PRESENTS: that Connell Resources, Inc. 7785 Highlands Meadows Parkway Suite 100 Windsor, CO 80528 (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 Master Agreement with the OWNER, dated the Day day of Month, Year, 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 Project Title, Work Order Number PM's Tracking #, dated Work Order Date, 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 Master 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 Master 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 Master 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 Master 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. Page 13 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 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 Work Order. If CONTRACTOR is Partnership, all partners should execute Bond. Page 14 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 SECTION 00615 PAYMENT BOND Bond No __ KNOW ALL MEN BY THESE PRESENTS: that Connell Resources, Inc. 7785 Highlands Meadows Parkway Suite 100 Windsor, CO 80528 (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 Master Agreement with the OWNER, dated the Day day of Month, Year, 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 Project Title, Work Order Number PM's Tracking #, dated Work Order Date, 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 Master 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 Master 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 Master 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. Page 15 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 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 Work Order. If CONTRACTOR is Partnership, all partners should execute Bond. Page 16 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 SECTION 00630 CERTIFICATE OF INSURANCE CONTRACTOR shall submit Certificate of Insurance in compliance with the Work Order Documents. Page 17 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 SECTION 00635 CERTIFICATE OF SUBSTANTIAL COMPLETION TO: CITY OF FORT COLLINS (OWNER) PROJECT TITLE: Walnut Street Water Main Replacement DATE OF SUBSTANTIAL COMPLETION: LOCATION: Fort Collins, Colorado OWNER: City of Fort Collins PROJECT OR SPECIFIED PART SHALL CONTRACTOR: Connell Resources, Inc. INCLUDE: WORK ORDER DATE: November 29, 2017 The Work performed under this Work Order, pursuant to the Work Order 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 Work Order 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 Work Order Documents shall be as set forth under "Remarks" below. CITY OF FORT COLLINS ________ By: __________________________ ________ OWNER AUTHORIZED REPRESENTATIVE DATE REMARKS: _________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Page 18 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 SECTION 00640 CERTIFICATE OF FINAL ACCEPTANCE DATE: TO: You are hereby notified that on the Day day of Month, Year, the City of Fort Collins, Colorado, has accepted the Work completed by Contractor Company Name, for the City of Fort Collins Work Order, titled Project Title, Work Order Number PM's Tracking #. Your continuing obligations and guarantees for the Project will be as provided in the Work Order and Work Order Documents. Sincerely, City of Fort Collins OWNER By: ___________________________________________ ___________________________________________ Name, Title Page 19 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 SECTION 00650 LIEN WAIVER RELEASE (CONTRACTOR) TO: City of Fort Collins, Colorado (OWNER) FROM: Connell Resources, Inc. (CONTRACTOR) WORK ORDER TITLE: Walnut Street Water Main Replacement WORK ORDER NUMBER: 201714 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. Page 20 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 Signed this ______ day of __________, ___. CONTRACTOR: Company Name 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 Page 21 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 SECTION 00650 LIEN WAIVER RELEASE (SUBCONTRACTOR) TO: City of Fort Collins, Colorado (OWNER) FROM: Connell Resources, Inc. (CONTRACTOR) WORK ORDER TITLE: Walnut Street Water Main Replacement WORK ORDER NUMBER: 201714 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. Page 22 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 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 Page 23 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 SECTION 00660 CONSENT OF SURETY TO: City of Fort Collins, Colorado (hereinafter referred to as the "OWNER") CONTRACTOR: Connell Resources, Inc. TITLE: Walnut Street Water Main Replacement WORK ORDER NUMBER: 201714 WORK ORDER DATE: November 29, 2017 In accordance with the provisions of the Work Order and Master Agreement between the OWNER and the CONTRACTOR as indicated above, for the Work Order titled Work Order Project Title 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. Page 24 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 Page 25 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 Utilities Work Order – Construction Form Official Purchasing Form Page 26 of 35 Last updated 10/2017 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 SECTION 00800 SUPPLEMENTARY CONDITIONS These Supplementary Conditions amend or supplement the General Conditions of the Construction Contract (EJCDC General Conditions 1910-8, 1990 edition, with City of Fort Collins Modifications, Rev. 9/94) and other provisions of the Work Order Documents as indicated below. SC-1 DEFINITIONS SC-1.38. Add the following language to the conclusion of paragraph 1.38 of the General Conditions: 1.38. Substantial Completion. .... Substantial Completion is further defined as that degree of completion of the operating facilities or systems of the Project defined in the Work Order sufficient to provide the OWNER the full time, uninterrupted, continuous, beneficial operation of the modifications, and all inspections required have been completed and identified conditions corrected. SC-1.43.A. Add the following new paragraph immediately after paragraph 1.43 of the General Conditions: 1.43.A. Work Order--A written document executed by OWNER and CONTRACTOR that provides for the construction of the Work, or a portion of the Work pursuant to the Master Agreement and all as required by the Work Order Documents, and that becomes a Work Order Document when executed. SC-2 PRELIMINARY MATTERS SC-2.8. Delete paragraph 2.8 of the General Conditions entirely and replace it with the following paragraph: 2.8. Preconstruction Conference. Within ten days after the Work Order Times for a Work Order start to run, but before any Work at the site is started, a conference attended by CONTRACTOR, ENGINEER and others as appropriate will be held to establish a working relationship among the parties as to the Work and to discuss the schedules referred to in paragraph 2.6, procedures for handling Shop Drawings and other submittals, processing Applications for Payment, and maintaining required records. SC-2.10. Add the following new paragraph immediately after paragraph 2.9 of the General Conditions: 2.10. Work Order Required for All Work. References to the Master Agreement in this Article 2 and in the General and Supplementary Conditions and Work Order Documents notwithstanding, no Work shall be initiated or performed until CONTRACTOR has received a signed and executed Work Order, and the Notice to Proceed, from OWNER; and no provision of this Article 2 or of the General and Supplementary Conditions and Work Order Documents shall permit or require any action of CONTRACTOR in the absence of a signed and executed Work Order. All Page 27 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 provisions of this Article 2 and of the General and Supplementary Conditions and Work Order Documents referencing the Master Agreement or other parts of the Work Order Documents, or permitting or requiring any action of CONTRACTOR, shall be read as referencing and, as appropriate, requiring a signed and executed Work Order. SC-4 AVAILABILITY OF LANDS; SUBSURFACE AND PHYSICAL CONDITIONS; REFERENCE POINTS SC-4.2.1.2. Add the following new paragraph immediately following paragraph 4.2.1.2 of the General Conditions: 4.2.1.2.1. No drawing of physical conditions in or relating to existing surface or subsurface structures (except Underground Facilities referred to in paragraph 4.3) which are at or contiguous to the site have been utilized by the Engineer in preparation of the Work Order Documents, except the following: SC-5 BONDS AND INSURANCE SC-5.4.7. Include the following parties or entities as additional insureds, as provided in paragraph 5.4.7 of the General Conditions: 5.4.7.1. City of Fort Collins, Colorado, PO Box 580, Fort Collins, CO 80522. 5.4.7.2. list all entities to be included as named additional insureds SC-5.4.8.1. Add the following new paragraph immediately following paragraph 5.4.8 of the General Conditions: 5.4.8.1. Limits of Liability. The limits of liability for the insurance required by the paragraph numbers of the General Conditions listed below are as follows: For Paragraphs 5.02.A.1 and 5.02.A.2: Coverage A - Statutory Limits; Coverage B - $100,000 / $100,000 / $500,000. For Paragraphs 5.02.A.3 and 5.02.A.5: The Commercial General Liability policy will have limits of $1,000,000 combined single limits (CSL). This policy will include coverage for Explosion, Collapse, and Underground coverage unless waived by the Owner. For Paragraph 5.02.A.6: The Comprehensive Automobile Liability Insurance policy will have limits of $1,000,000 combined single limits (CSL). For Paragraph 5.02.B.3: This policy will include completed operations coverage / product liability coverage with limits of $1,000,000 combined single limits (CSL). This policy shall also include an Umbrella Excess Liability as follows: General liability and automobile liability insurance in an amount not less than $1,000,000 per occurrence in excess of the above stated primary limits. Page 28 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 SC-6 CONTRACTOR’S RESPONSIBILITIES SC-6.14.3. Add the following new paragraph immediately after paragraph 6.14.2 of the General Conditions: 6.14.3. The following Laws or Regulations are included in the Work Order Documents as mandated by statute or for the convenience of the CONTRACTOR. Other Laws and Regulations apply which are not included herein, and are within the CONTRACTOR's duty and responsibility for compliance thereto: 6.14.3.1. Notice to owners of Underground Facilities is required prior to excavations in the vicinity of such facilities. 6.14.3.2. Unless otherwise decided by reason of the amount of the Work Order Price involved, or other good reason, before or at the time that the contract is awarded to a corporation outside the State of Colorado, such corporation must carry out the proper procedure to become authorized to do business in the State of Colorado, designate a place of business therein, and appoint an agent for service of process. Such corporation must furnish the OWNER with a certificate from the Secretary of State of Colorado has been issued by its office and there shall also be procured from the Colorado Secretary of State or certified copy of the designated of place of business and appointment of agent for service of process, or a letter from the Colorado Secretary of State that such designation of place of business and agent for service of process have been made. 6.14.3.3. The CONTRACTOR must conform to the rules and regulations of the Industrial Commission of Colorado. Particular reference is made to rules and regulations governing excavation Work adopted by the Industrial Commission of Colorado. SC-11 CHANGE OF CONTRACT PRICE SC-11.6.2.7. Add the following new paragraph to paragraph 11.6.2 of the General Conditions: 11.6.2.7. Cost of the Work. Allowances for profit, overhead and mark-up prescribed by the Master Agreement shall be used in lieu of any CONTRACTOR'S fee, overhead, profit or mark-up allowances as prescribed in paragraphs 11.6.2.1, 11.6.2.2, and 11.6.2.3. SC-12 CHANGE OF CONTRACT TIMES SC-12.3. Add the following language to the end of paragraph 12.3 of the General Conditions: 12.3. .... Lost days due to abnormal weather conditions will be allocated as required. SC-14 PAYMENTS TO CONTRACTOR AND COMPLETION Page 29 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 SC-14.1. Add the following language to the end of paragraph 14.1 of the General Conditions: 14.1. Schedule of Values. .... Progress payments on the fixed fee shall be in proportion to the cumulative actual Cost of the Work as a percentage of the Allowable Cost of the Work. An amount not to exceed fifteen (15%) percent of the fixed fee shall be advanced to the Contractor for mobilization in the first progress payment. Page 30 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 SECTION 00900 ADDENDA, MODIFICATIONS AND PAYMENT 00950 Change Order 00960 Application for Payment Page 31 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 SECTION 00950 CHANGE ORDER NO. PROJECT TITLE: CONTRACTOR: [Contractor] WORK ORDER NUMBER: PO NUMBER: DESCRIPTION: 1. Reason for Change: Why is the change required? 2. Description of Change: Provide description of the changes to the Work 3. Change in Work Order Price: 4. Change in Work Order Time: ORIGINAL WORK ORDER PRICE $ .00 TOTAL APPROVED CHANGE ORDER .00 TOTAL PENDING CHANGE ORDER .00 TOTAL THIS CHANGE ORDER .00 TOTAL % OF THIS CHANGE ORDER % TOTAL C.O.% OF ORIGINAL WORK ORDER % ADJUSTED WORK ORDER COST $ .00 CONTRACTOR: Company Name By: Date: Name: Title: ACCEPTED: Date: City PM Name, Title REVIEWED: Date: Name, Buyer or Senior Buyer ACCEPTED: Date: Name, Title ACCEPTED: Date: Gerry Paul, Purchasing Director (if greater than $60,000) Page 32 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 SECTION 00960 APPLICATION FOR PAYMENT PROJECT Page 1 of 1 OWNER: ENGINEERS: ADDRESS: NUMBER DATE AMOUNT $ - $ - $ - NUMBER DATE AMOUNT FUND OBJECT Amount Due this Pay Application (before retainage): $ - $ - 0.00% Payment of the above Amount Due This Application has been reviewed by the OWNER'S Project Manager BY: DATE: DATE: NAME & TITLE: BY: DATE: NAME & TITLE: Official Purchasing Form Last updated 10/2017 Net Change by Change Order: Change order %: Original Contract Amount Net Change by Change Order Revised Current Contract Amount Total Work Completed to Date: Total Stored to Date: CHANGE ORDERS PAY APPLICATION Application is made for Payment as shown below in connection with the Contract. The present status of the account for this Contract is as follows: CONTRACTOR: $ - $ - RETAINAGE $ -NumbersCharge $ - $ - Less Previous Payments: Total Completed and Stored Materials to Date: Less Retainage $ - $ - $ - AMOUNT DUE THIS APPLICATION: $ - The above Amount Due this Application is requested by the CONTRACTOR's Project Manager. BY: PO NUMBER ADDRESS: ADDRESS: APPLICATION NUMBER APPLICATION DATE PERIOD BEGINNING PERIOD ENDING PROJECT NUMBER Retainage to Date: NAME & TITLE: Total (after retainage): Payment of the above Amount Due This Application is approved by the OWNER. Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 Unit Price Total Quanitity Total Quantity Total Quantity Total 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 $ - $ - $ - $ - $ - 0.00% $ - $ - $ - $ - $ - 0.00% Official Purchasing Form Last Updated 10/2017 Total to Date Less Retention Change Orders to Date (see attached) $ - $ - CONTRACT SUMMARY Total Due Adjusted Contract Amount $ - Total Change Order Work to Date (see attached) Value of Work in Place Percent Complete Including Stored Materials Less Retention @ 10% up to 50% complete, 5% beyond 50% of Adjusted Contract Crosscheck Total Completed to Date Total Materials Remaining @ Site $ - $ - $ - Original Contract Amount Less Previous Billings $ - $ - $ - $ - Utilities Work Order – Construction Form Official Purchasing Form Last updated 10/2017 ATTACHMENT A DRAWING INDEX WORK ORDER # 201714 WORK ORDER TITLE: Walnut Street Water Main Replacement BY: Ditesco Project and Construction Services Sheet Title Drawing Revision Date 1. Cover Sheet 11/20/2017 2. General Notes 11/20/2017 3. Existing Conditions and Demolition Plan 11/20/2017 4. Overall Site Plan 11/20/2017 5. Construction Phasing Plan for Phases 2A, 2B, & 3 11/20/2017 6. Traffic Control Plan 11/20/2017 7. City of Fort Collins System Map 11/20/2017 8. Waterline Plan and Profile Phase 1 – Pine Street 11/20/2017 9. Waterline Plan and Profile Phase 2A – Pine Street 11/20/2017 10. Waterline Plan and Profile Phase 2A, 2B, & 3 11/20/2017 11. Fire Service Plan & Profile Northern Hotel & Pots 11/20/2017 12. Fire Hydrant Assembly Plan and Profile 11/20/2017 13. Waterline Connection Details 11/20/2017 14-18 Water Service Connection Details 11/20/2017 19-20. General Details 11/20/2017 21. Geotechnical Test Hole Boring Detail Sheet 11/20/2017 Page 35 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) AUTHORIZED REPRESENTATIVE CANCELLATION CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) JECT LOC POLICY PRO- GEN'L AGGREGATE LIMIT APPLIES PER: CLAIMS-MADE OCCUR COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ DED RETENTION $ CLAIMS-MADE OCCUR $ AGGREGATE $ UMBRELLA LIAB EACH OCCURRENCE $ EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS PER STATUTE OTH- ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNED AUTOS AUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ 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. INSD ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) OTHER: 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 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: INSURED PHONE (A/C, No, Ext): PRODUCER ADDRESS: E-MAIL FAX (A/C, No): CONTACT NAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INS025 (201401) 11/30/2017 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 Travelers Indemnity Company 25658 Travelers Property Casualty Company 25674 Pinnacol Assurance 41190 2017 GL/AU/XS/WC A X X X DTCO4794N532COF17 6/1/2017 6/1/2018 1,000,000 300,000 10,000 1,000,000 2,000,000 2,000,000 B X X X DT8104794N532IND17 6/1/2017 6/1/2018 1,000,000 C X X X 10,000 CUP4J906749-17-26 6/1/2017 6/1/2018 10,000,000 10,000,000 D N 4029651 6/1/2017 6/1/2018 X 500,000 500,000 500,000 Re: CRI# 2171089- Walnut Street Waterline Certificate holder is included as Additional Insured as required by written contract with respects to liability arising out of work performed by the named insured. D Stewart, CIC, CISR/ City of Fort Collins 215 N Mason St Fort Collins, CO 80522 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 $ - $ - Combined Total Completed to Date Total Contract Amount Total This Period Previous Billings Balance Remaining Percent Complete PAY REQUEST Item # Description Quantity Cost Remaining Percent UOMComplete Contract Summary This Period Previous Total to Date Period Ending: Page 34 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7 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. CERTIFICATION BU SCOPE OF WORK CHANGE ORDERS RECONCILIATION CHANGE ORDERS INVOICE NUMBER Total Change Order Work to Date: $ - $ - Retainage Previous: Change in Retainage: Page 33 of 35 DocuSign Envelope ID: 728D68AE-29A4-40BA-8B83-B1E0069031A7