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HomeMy WebLinkAboutCORRESPONDENCE - RFP - 8286 CONSTRUCTION CONTRACTOR FOR PROJECTS AT THE WATER & WASTEWATER TREATMENT FACILITIES (58)Utilities Work Order – Construction Form Official Purchasing Form
Last updated 10/2017
FORT COLLINS UTILITIES
CONSTRUCTION WORK ORDER
PROCESS LABORATORY RENOVATION
WORK ORDER NO. WTF-GDS-PL-20180510
CONTRACTOR: Hydro Construction
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DocuSign Envelope ID: 0E6C33FB-C921-4EF8-9E28-51FCC63119F1
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
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Utilities Work Order – Construction Form Official Purchasing Form
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SECTION 00500
CONSTRUCTION WORK ORDER AGREEMENT FORMS
00525 Work Order, Notice of Award & Bid Schedule
00530 Work Order Notice to Proceed
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Utilities Work Order – Construction Form Official Purchasing Form
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SECTION 00525
WORK ORDER, NOTICE OF AWARD AND BID SCHEDULE
TO: Hydro Construction
WORK ORDER NUMBER: WTF-GDS-PL-20180510
PROJECT TITLE: Process Laboratory Renovation
ORIGINAL BID/RFP NUMBER & NAME: 8286, Construction Contractor for Projects at
the Water & Wastewater Treatment Facilities
MASTER AGREEMENT EFFECTIVE DATE: June 20, 2016
ARCHITECT/ENGINEER: CH2M Engineers
OWNER’S REPRESENTATIVE: Gregg D. Stonecipher
WORK ORDER COMMENCEMENT DATE: June 1, 2018
WORK ORDER COMPLETION DATE: March 1, 2019
MAXIMUM FEE: (time and reimbursable direct costs): $252,363.00
NOTICE OF AWARD DATE: 5/7/2018
OWNER: City of Fort Collins (hereinafter referred to as OWNER)
1. WORK. Pursuant to your MASTER AGREEMENT with OWNER dated June 20, 2016, and
your Work Order Proposal dated April 18, 2018, you have been awarded a Work Order for
Process Laboratory Renovation.
PROJECT DESCRIPTION & SITE LOCATION: The work will be performed at the Fort
Collins Water Treatment Facility Process Control Laboratory, in accordance with the
attached scope and cost.
2. CONTRACT PRICE, BONDS AND CERTIFICATES. The price of your Work Order is two
hundred fifty-two thousand three hundred sixty-three dollars and zero cents ($252,363.00).
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 1, 2019, and
after Substantial Completion, the date for Final Completion is May 1, 2019.
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
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.
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Utilities Work Order – Construction Form Official Purchasing Form
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1) Substantial Completion: five hundred dollars ($500.00) for each calendar day
or fraction thereof after March 1, 2019 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: Hydro Construction
By: Date:
Name: Title:
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Jim Eurich
May 17, 2018
COO
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:
Gregg D. Stonecipher, 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:
Mark Kempton, Water Production Manager
ACCEPTANCE: Date:
Carol Webb, Water Resources & Treatment 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)
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May 17, 2018
May 17, 2018
May 17, 2018
May 17, 2018
May 17, 2018
Utilities Work Order – Construction Form Official Purchasing Form
Last updated 10/2017
BID SCHEDULE
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April 18, 2018
Hydro Construction Company, Inc. - Scope of Services.
Fort Collins Water Treatment Facility – Process Laboratory Modifications
Provide assistance and efforts for modifications to Process Laboratory (per drawings as noted and
attached to Gregg Stonecipher email dated 4/9/18) consisting of existing cabinet, ceiling, floor and
plumbing demolition, patch drywall and paint exposed areas, install new ceiling tiles, new HVAC
diffusers, patch floor, install new piping to sink locations, remove and replace door passage sets, install
new lab casework and counters, remove and replace existing lighting fixtures with LED fixtures and
replace or install electrical elements associated with casework.
By others;
• Existing fume hood and base cabinets to be certified as cleaned and decontaminated.
• Adjustable tables, desks and risers.
• Refrigerator
Cost of Work $252,363.00
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DocuSign Envelope ID: 0E6C33FB-C921-4EF8-9E28-51FCC63119F1
Standard Estimate Report Page 1
FCWTF Process Lab 4/18/2018 10:20 AM
Project name FCWTF Process Lab
Estimator J Eurich
Labor rate table Labor - Bare
Equipment rate table Equipment
Report format Sorted by 'Structure/Group phase'
'Detail' summary
Allocate addons
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Standard Estimate Report Page 2
FCWTF Process Lab 4/18/2018 10:20 AM
Item Description Takeoff Qty
Labor
Amount
Material
Amount
Subcontract
Amount Name
Equipment
Amount
Other
Amount
Total
Amount
* unassigned *
1000.000 GENERAL CONDITIONS
20 Bond 1.00 ls - - - 4,543 4,543
14 Project Manager 8.00 wk 11,360 0 - 0 - 11,360
14 Superintendent 8.00 wk 18,176 0 - - 18,176
20 Temporary Toilets 2.00 mo - 0 - - 321 321
10 Safety 1.00 ls 0 0 750 - 1,069 1,819
12 Trash 8.00 wk 0 0 - - 428 428
GENERAL CONDITIONS 29,536 750 6,360 36,646
962.00 Labor hours
640.00 Equipment hours
1900.000 OWNED EQUIPMENT
35 Roust-a-bout 0.75 mo - - - 600 - 600
45 Connex Box 0.75 mo - - - 375 - 375
10 Jobsite Truck 0.75 mo - - - 750 - 750
OWNED EQUIPMENT 1,725 1,725
2000.000 SITEWORK
60 Demo Casework 1.00 ls 2,386 - - 0 187 2,573
60 Demo Ceiling 1.00 ls 795 - - 0 80 875
60 Demo Floor 1.00 ls 596 - - 0 107 703
60 Demo Plumbing 1.00 ls 1,590 - - 0 107 1,697
SITEWORK 5,368 481 5,849
216.00 Labor hours
7000.000 THERMAL & MOIST PROTECT
-sub Sub - Caulking 1.00 ls - - 1,500 0 - 1,500
THERMAL & MOIST PROTECT 1,500 1,500
8000.000 DOORS & WINDOWS
80 Passage Sets 3.00 ea 85 330 - - - 415
DOORS & WINDOWS 85 330 415
3.00 Labor hours
9000.000 FINISHES
-sub Drywall 400.00 sf - - 5,600 0 - 5,600
10 Tile Replace 80.00 sf - - 1,600 0 - 1,600
20 2 x 2 Ceiling Tile 600.00 sf 1,591 3,852 - - - 5,443
60 Vinyl Cove Base 6" 130.00 lf 0 1,040 - - 1,040
10 Interior Paint 1.00 ls - - 4,500 0 - 4,500
FINISHES 1,591 3,852 12,740 18,183
48.01 Labor hours
11000.000 EQUIPMENT
10 Sink Vent 1.00 ls 0 0 1,500 0 - 1,500
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Standard Estimate Report Page 3
FCWTF Process Lab 4/18/2018 10:20 AM
Item Description Takeoff Qty
Labor
Amount
Material
Amount
Subcontract
Amount Name
Equipment
Amount
Other
Amount
Total
Amount
EQUIPMENT 1,500 1,500
12000.000 FURNISHINGS
10 Lab Casework 1.00 ls 0 81,000 0 0 - 81,000
FURNISHINGS 81,000 81,000
1.00 Labor hours
15000.000 MECHANICAL
sub Plumbing 1.00 ls - - 23,592 0 - 23,592
002 HVAC 1.00 ls - - 21,401 0 - 21,401
MECHANICAL 44,993 44,993
16000.000 ELECTRICAL
-sub Electrical Sub 1.00 ls - - 32,793 - 32,793
ELECTRICAL 32,793 32,793
* unassigned * 36,579 85,182 94,276 1,725 6,841 224,603
1,230.01 Labor hours
640.00 Equipment hours
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DocuSign Envelope ID: 0E6C33FB-C921-4EF8-9E28-51FCC63119F1
Standard Estimate Report Page 4
FCWTF Process Lab 4/18/2018 10:20 AM
Estimate Totals
Description Amount Totals Hours Rate Cost Basis Cost per Unit Percent of Total
Labor 36,579 1,230.006 hrs 14.49%
Material 85,182 33.75%
Subcontract 94,276 37.36%
Equipment 1,725 640.000 hrs 0.68%
Other 6,841 2.71%
224,603 224,603 89.00
Profit & Overhead 27,760 11.000 % T 11.00%
Total 252,363
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DocuSign Envelope ID: 0E6C33FB-C921-4EF8-9E28-51FCC63119F1
May June July August September October November December January February March April May
Project Notice to Proceed
Project Construction
Project Substantial Completion
Project Final Acceptance
Schedule for Hydro's Process Laboratory Renovation Work Order
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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: Process Laboratory Renovation
WORK ORDER NUMBER: WTF-GDS-PL-20180510
TO: Hydro Construction, 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
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Utilities Work Order – Construction Form Official Purchasing Form
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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
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Utilities Work Order – Construction Form Official Purchasing Form
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SECTION 00610
PERFORMANCE BOND
Bond No __
KNOW ALL MEN BY THESE PRESENTS: that
Hydro Construction, Inc.
(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 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.
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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.
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Utilities Work Order – Construction Form Official Purchasing Form
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SECTION 00615
PAYMENT BOND
Bond No __
KNOW ALL MEN BY THESE PRESENTS: that
Hydro Construction, Inc.
(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 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.
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Utilities Work Order – Construction Form Official Purchasing Form
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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.
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Utilities Work Order – Construction Form Official Purchasing Form
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SECTION 00630
CERTIFICATE OF INSURANCE
CONTRACTOR shall submit Certificate of Insurance in compliance with the Work Order
Documents.
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Utilities Work Order – Construction Form Official Purchasing Form
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SECTION 00635
CERTIFICATE OF SUBSTANTIAL COMPLETION
TO: CITY OF FORT COLLINS (OWNER) PROJECT TITLE: Process Laboratory
Renovation
DATE OF SUBSTANTIAL COMPLETION: LOCATION: Fort Collins, Colorado
OWNER: City of Fort Collins
PROJECT OR SPECIFIED PART SHALL CONTRACTOR: Hydro Construction, Inc.
INCLUDE:
WORK ORDER DATE:
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: _________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
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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
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SECTION 00650
LIEN WAIVER RELEASE
(CONTRACTOR)
TO: City of Fort Collins, Colorado (OWNER)
FROM: Hydro Construction, Inc. (CONTRACTOR)
WORK ORDER TITLE: Process Laboratory Renovation
WORK ORDER NUMBER: WTF-GDS-PL-20180510
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.
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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
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SECTION 00650
LIEN WAIVER RELEASE
(SUBCONTRACTOR)
TO: City of Fort Collins, Colorado (OWNER)
FROM: Hydro Construction, Inc. (CONTRACTOR)
WORK ORDER TITLE: Process Laboratory Renovation
WORK ORDER NUMBER: WTF-GDS-PL-20180510
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.
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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
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SECTION 00660
CONSENT OF SURETY
TO: City of Fort Collins, Colorado (hereinafter referred to as the "OWNER")
CONTRACTOR: Hydro Construction, Inc.
TITLE: Process Laboratory Renovation
WORK ORDER NUMBER: WTF-GDS-PL-20180510
WORK ORDER DATE:
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.
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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
provisions of this Article 2 and of the General and Supplementary Conditions and Work
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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:
NA
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. None
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.
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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
SC-14.1. Add the following language to the end of paragraph 14.1 of the General Conditions:
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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.
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SECTION 00900
ADDENDA, MODIFICATIONS AND PAYMENT
00950 Change Order
00960 Application for Payment
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SECTION 00950
CHANGE ORDER NO.
PROJECT TITLE: Process Laboratory Renovation
CONTRACTOR: Hydro Construction, Inc.
WORK ORDER NUMBER: WTF-GDS-PL-20180510
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)
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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
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ATTACHMENT A
DRAWING INDEX
WORK ORDER # WTF-GDS-PL-20180510
WORK ORDER TITLE Process Laboratory Renovation
BY: CH2M Engineers
Sheet Title Drawing Revision Date
2 Architectural /Structural Legend April 2018
3 Laboratory Floor Plan
4 Elevations
5 Elevations
6 Lab Cabinet Section
7 Demolition Plan
8 HVAC/Plumbing
9 Electrical Plan Symbols
10 Luminaire Schedule
11 Pollution Control Lab Lighting and Receptacles
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SECTION 00610
PERFORMANCE BOND
Bond No _34BCSHU4609D
KNOW ALL MEN BY THESE PRESENTS: that
Hydro Construction Company, Inc.
77 NW Frontage Road
Fort Collins, CO 80524
(an Individual), (a Partnership), (a Corporation), hereinafter referred to as the "Principal" and
Hartford Fire Insurance Comoanv
One Hartford Plaza, Hartford CT 06155
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 Two Hundred Fiftv-Two Thousand Three Hundred Sixtv-
Three & 00/100 Dollars ($252^63^0) in lawful money of the United States, for the paymenTof
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 20th day of June. 2016, a copy of which
is hereto attached and made a part hereof, for the performance of The City of Fort Collins Work
Order, titled Process Laboratory Renovation, Work Order Number WTF-GDS-PL-20180510.
dated June 1, 2018, a copy of which is hereto attached and made a part hereof. RFP #8286
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.
DocuSign Envelope ID: 0E6C33FB-C921-4EF8-9E28-51FCC63119F1
IN WITNESS WHEREOF, this instrument is executed in three (3) counterparts, each one of
which shall be deemed an original, this 1st day of June _2018
IN PRESENCE OF:
/' J <3^-^-/
^/"£'
(Title)
(Corporate Seal)
Principal
Hydro Construction Company. Inc..
<<-!:- ^ ^
(Title)
77 NW Frontaae Road
Fort Collins, CO 80528
ODQ
(Address)
IN PRESENCE OF: Other Partners
By:_
By:_
irAlj>RESENCE OF:
i\ii^
_Witness_
{/^ A^
Surety^Hartford Fire Insurance Company
SO^JL^ \a^_
Darlene Krings, Attorney-in-^act
One Hartford Plaza. Hartford. CT 061 S'5
(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.
DocuSign Envelope ID: 0E6C33FB-C921-4EF8-9E28-51FCC63119F1
SECTION 00615
PAYMENT BOND
Bond No _34BCSHU4609D
KNOW ALL MEN BY THESE PRESENTS: that
H_vdrp Construction Company, Inc.
77 NW Frontaae Road
Fort Collins. CO 80524
(an Individual), (a-PartfiwsNp), (a Corporation), hereinafter referred to as the "Principal" and
Hartford Fire Insurance Company
One Hartford Plaza. Hartford CT_061 55
hereinafter referred to as "the Surety", are held and firmly bound unto City of Fort Collins^SOO LaPorte
Ave, Fort Collins. Colorado 80522 a (Municipal Corporation) hereinafter referred to as the "OWNER", in
the penal sum of Two Hundred Fifty-Two Thousand Three Hundred Sixtv-Three S 00/100 Dollars
($252, 363. 00) 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 20th day of June. 2016, a copy of which is hereto attached
and made a part hereof, for the performance of The City of Fort Collins Work Order, titled Process
Laboratory Renovation, Work Order Number WTF-GDS-PL-20180510, dated June 1, 2018, a copy of
which is hereto attached and made a part hereof. RFP #8286
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.
. City.of.
f:6r'fCollins Utilities Work Order - Construction Form Officia! Purchasing Form ~^>
Last updated 10/2017
DocuSign Envelope ID: 0E6C33FB-C921-4EF8-9E28-51FCC63119F1
IN WITNESS WHEREOF, this instrument is executed in three (3) counterparts, each one of which shall be
deemed an original, this 1st day of June . 2018.
IN PRESENCE OF:
^^ ^ A'i^TL^U^^--
/'w
(Title)
(Corporate Seal)
Principal
Hydro Construction Company. Inc..
-\^..fi^'u\,^ -^.u,
(Title)
77 NW Frontage Road,
Fort Collins. CO 80524
(Address)
^1
IN PRESENCE OF: Other Partners
By:_
By:_
IN-RRESENCE OF:
l\AJl r i^f^j? A i M j^)
_Witness M
Surety: Hartford Fire Insurance Company
I^Ut,.
Krings, Attorn ey-in-Fajbt
One Hartford Plaza. Hartford CT 061 55
(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.
.City.of.
f:6rtColllns Utilities Work Order - Construction Form Official Purchasing Form ^>
Last updated W/2017
DocuSign Envelope ID: 0E6C33FB-C921-4EF8-9E28-51FCC63119F1
POWER OF ATTORNEY
Direct Inquiries/Claims to:
THE HARTFORD
BOND, T-12
One Hartford Plaza
Hartford, Connecticut 06155
KNOW ALL PERSONS BY THESE PRESENTS THAT:
Agency Name:
Agency Code:
Bpnd. Claims@thehartford. com
call: 888-266-3488 or fax: 860-757-5835
FLOOD & PETERSON INSURANCE INC
34-340869
X I Hartford Fire Insurance Company, a corporation duly organized under the laws of the Slate of Connecticut
: x ) Hartford Casualty Insurance Company, a corporation duly organized under the laws of the State of Indiana
X [ Hartford Accident and Indemnity Company, a corporation duly organised tinder the laws of the State of Connecticut
Hartford Underwriters Insurance Company, a corporation duly organized under the laws of the State of Connecticut
Twin City Fire Insurance Company, a corporation diily organized under the laws of the State of Indiana
Hartford Insurance Company of Illinois, a corporation duly organized under the laws of the State of Illinois
Hartford Insurance Company of the Midwest, a corporation duly organized under the laws of the State of Indiana
Hartford Insurance Company of the Southeast, a corporation duly organized under the iaws of the State of Florida
having their home office in Hartford, Connecticut, (hereinafter collectively referred to as the "Companies") do hereby make, constitute and appoint,
up to the amount of Unlimited :
Melanie Lathouwers, Russell D. Lear, Darlene Krings, Kelly T. Urwiller, Steven J. Blohm,
Wesley J. Butorac, Dulce R. Huggins, Royal Lovell, Kristen Pereiro, K'Anne E. Vogel of
GREELEY, Colorado
their true and lawful Attomey(s)-in-Fact, each in their separate capacity if more than one is named above, to sign its name as surety(ies) only as
delineated above by ^, and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the
nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and
executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law.
In Witness Whereof, and as authorized by a Resolution of the Board of Directors of the Companies on May 6, 2015 the Companies have
caused these presents to be signed by its Senior Vice President and its corporate seals to be hereto affixed, duly attested by its Assistant
Secretary. Further, pursuant to Resolution of the Board of Directors of the Companies, the Companies hereby unambiguously affirm that they are
and will be bound by any mechanically applied signatures applied to this Power of Attorney.
T^h/^- is[^'v"'. f! '"»ii
!'''"^^i. 'i'w^^y ^'*s^"^ ^'*jii
John Gray, Assistant Secretary M. Ross Fisher, Senior Vice President
STATE OF CONNECTICUT
COUNTY OF HARTFORD } ss. Hartford
On this 11th day of January, 2016, before me personally came M, Ross Fisher, to me known, who being by me duly sworn, did depose
and say: that he resides in the County of Hartford, State of Connecticut; that he is the Senior Vice President of the Companies, the corporations
described in and which executed the above instrument; that he knows the seals of the said corporations; that the seals affixed to the said
instrument are such corporate seals; that they were so affixed by authority of the Boards of Directors of said corporations and that he signed his
name thereto by like authority.
^^
fffw""^ / < ^- ,
Nora M. Siranko
Notary I'ublit:
CERTIFICATE My Commission expires March 31. 2018
I, the undersigned, Assistant Vice President of the Companies, DO HEREBY CERTIFY that the above and foregoing is a true and correct
copy of the Power of Attorney executed by said Companies, which is still in full force effective as of June l, 2018
Signed and sealed at the City of Hartford.
Kevin Heckman, Assistant Vice President
DocuSign Envelope ID: 0E6C33FB-C921-4EF8-9E28-51FCC63119F1
05/14/2018
Flood and Peterson
PO Box 578
Greeley CO 80632
Dana Stewart, CIC, CISR
(970) 266-7149 (970) 506-6845
DStewart@floodpeterson.com
Hydro Construction Company Inc.
77 NW Frontage Road
Fort Collins CO 80524
Phoenix Insurance Company 25623
Travelers Indemnity Company 25658
Travelers Property Casualty Company of America 25674
Pinnacol Assurance 41190
GL/AU/XS/WC x4/19
A Y DT-CO-8G990899-PHX-18 04/01/2018 04/01/2019
1,000,000
300,000
10,000
1,000,000
2,000,000
2,000,000
B Y DT-810-8G990899-IND-18 04/01/2018 04/01/2019
1,000,000
C
10,000
Y CUP-2J40080A-18-26 04/01/2018 04/01/2019
10,000,000
10,000,000
D Y 2091550 04/01/2018 04/01/2019
1,000,000
1,000,000
1,000,000
RE: WTF-GDS-PL-20180510 Process Laboratory Renovation
City of Fort Collins is included as Additional Insured on the General, Automobile, and Umbrella Liability Policies if required by written contract or agreement
and with respect to work performed by Insured subject to the policy terms and conditions.
City of Fort Collins
700 Wood Street
Fort Collins CO 80521-1945
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
INSURER(S) AFFORDING COVERAGE
INSURER F :
INSURER E :
INSURER D :
INSURER C :
INSURER B :
INSURER A :
NAIC #
NAME:
CONTACT
(A/C, No):
FAX
E-MAIL
ADDRESS:
PRODUCER
(A/C, No, Ext):
PHONE
INSURED
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
OTHER:
(Per accident)
(Ea accident)
$
$
N / A
SUBR
WVD
ADDL
INSD
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
$
$
$
PROPERTY DAMAGE $
BODILY INJURY (Per accident)
BODILY INJURY (Per person)
COMBINED SINGLE LIMIT
AUTOS ONLY
AUTOS ONLY AUTOS
NON-OWNED
OWNED SCHEDULED
ANY AUTO
AUTOMOBILE LIABILITY
Y / N
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
DESCRIPTION OF OPERATIONS below
If yes, describe under
ANY PROPRIETOR/PARTNER/EXECUTIVE
$
$
$
E.L. DISEASE - POLICY LIMIT
E.L. DISEASE - EA EMPLOYEE
E.L. EACH ACCIDENT
ER
OTH-
STATUTE
PER
(MM/DD/YYYY) LIMITS
POLICY EXP
(MM/DD/YYYY)
POLICY EFF
LTR TYPE OF INSURANCE POLICY NUMBER
INSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB EACH OCCURRENCE $
AGGREGATE $
$
OCCUR
CLAIMS-MADE
DED RETENTION $
PRODUCTS - COMP/OP AGG $
GENERAL AGGREGATE $
PERSONAL & ADV INJURY $
MED EXP (Any one person) $
EACH OCCURRENCE $
DAMAGE TO RENTED
PREMISES (Ea occurrence) $
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY
PRO-
JECT LOC
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
DocuSign Envelope ID: 0E6C33FB-C921-4EF8-9E28-51FCC63119F1
$ -
$ -
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 37 of 38
DocuSign Envelope ID: 0E6C33FB-C921-4EF8-9E28-51FCC63119F1
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 36 of 38
DocuSign Envelope ID: 0E6C33FB-C921-4EF8-9E28-51FCC63119F1