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HomeMy WebLinkAboutWORK ORDER - RFP - 8546 CONSTRUCTION MANAGER GENERAL CONTRACTOR ON-CALLWork Order – Construction Form Official Purchasing Form Last updated 10/2017 FORT COLLINS CONSTRUCTION WORK ORDER LINCOLN CENTER DEWATERING WORK ORDER NO. OP-483743 DATE: March 8, 2018 CONTRACTOR / CM/GC: Haselden Construction, LLC DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 TABLE OF CONTENTS AGREEMENT FORMS 00525 Work Order, Notice of Award, Scope of Work & 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 00700 General Conditions Exhibit GC-A GC-A1 – GC-A2 00800 Supplementary Conditions 00900 Addenda, Modifications and Payment 00950 Work Order Change Order Form 00960 Application for Payment DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D 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 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 SECTION 00525 WORK ORDER, NOTICE OF AWARD AND BID SCHEDULE TO: Haselden Construction, LLC WORK ORDER NUMBER: OP-483743 PROJECT TITLE: Lincoln Center Dewatering ORIGINAL BID/RFP NUMBER & NAME: 8546 MASTER AGREEMENT EFFECTIVE DATE: 7/31/17 ARCHITECT/ENGINEER: Farnsworth Group Inc. OWNER’S REPRESENTATIVE: Brian Hergott MAXIMUM FEE: (time and reimbursable direct costs): $110,610 NOTICE OF AWARD DATE: 3/8/2018 OWNER: City of Fort Collins (hereinafter referred to as OWNER) 1. WORK. Pursuant to your MASTER AGREEMENT with OWNER dated July 31, 2017, and your Work Order Proposal dated February 27, 2018, you have been awarded a Work Order for Lincoln Center Dewatering. Project Description: Lincoln Center Dewatering to include installation of new sump pit and associated pumps and then seal off existing temporary sump pit at stage pit. (Permits by Owner) Scope of Services: The Construction Manager/General Contractor (CM/GC) will coordinate, schedule and oversee the entire construction of the Lincoln Center Dewatering project. Work shall include all necessary labor, materials and equipment (except items provided by Owner) to complete the work shown on the documents provided by Farnsworth Group dated 2/1/2018 and addendum 01 dated 2/20/18. CM/GC will be compensated for their work based on pay applications submitted monthly with detailed itemized cost breakouts for each task performed along with the proper labor and equipment rates as approved and within the not to exceed amount of the GMP price. The contractor shall furnish the City of Fort Collins with a performance and payment bond along with builder’s risk insurance and provide the Owner with a certificate of insurance with the correct limits. 2. CONTRACT PRICE, BONDS AND CERTIFICATES. The price of your Work Order is One Hundred Ten Thousand Six Hundred and Ten dollars ($110,610). 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 April 25, 2018, and the date for Final Acceptance is Thirty (30) calendar days past Substantial Completion. 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 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D 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: Four Hundred dollars ($400) for each calendar day or fraction thereof after April 25, 2018 until the work is Substantially Complete. 2) Final Acceptance: After Substantial Completion, Two Hundred dollars ($200) for each calendar day or fraction thereof after 30 calendar days 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: Haselden Construction, LLC By: Date: Name: Title: DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Derek Oliver Vice President 3/14/2018 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: Brian Hergott, Project Manager REVIEWED: Date: Elliot Dale, Senior Buyer APPROVED AS TO FORM: Date: Ryan Malarky, City Attorney II ACCEPTANCE: Date: Gerry Paul, Purchasing Director ATTEST: Date: Delynn Coldiron, City Clerk DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D 3/11/2018 3/12/2018 3/14/2018 3/14/2018 3/15/2018 Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 SECTION 00530 WORK ORDER NOTICE TO PROCEED WORK ORDER TITLE: Lincoln Center Dewatering WORK ORDER NUMBER: OP - 483743 TO: Haselden Construction, LLC Attn: Preston Nelson 330 S College Ave #300 Fort Collins, CO 80524 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 _____, 20___ and _______, 20__, respectively. Dated this _____________ day of ______________, 20____. CITY OF FORT COLLINS (OWNER) By: Brian Hergott, Facilities Project Manager ACKNOWLEDGMENT OF NOTICE Receipt of the above Work Order Notice to Proceed is hereby acknowledged this ________ day of _________, 20____. (CONTRACTOR) By: ___________________________________________ Name, Title DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D 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 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 SECTION 00610 PERFORMANCE BOND Bond No __ KNOW ALL MEN BY THESE PRESENTS: that Haselden Construction, LLC 330 S College Ave #300, Fort Collins, CO 80524 (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 One Hundred Ten Thousand Six Hundred and Ten dollars ($110,610) 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 31st day of July, 2017, a copy of which is hereto attached and made a part hereof, for the performance of The City of Fort Collins Work Order, titled Lincoln Center Dewatering, Work Order Number OP-483743, dated March 8th, 2018, 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. DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D 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. DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 SECTION 00615 PAYMENT BOND Bond No __ KNOW ALL MEN BY THESE PRESENTS: that Haselden Construction, LLC 330 S College Ave #300, Fort Collins, CO 80524 (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 One Hundred Ten Thousand Six Hundred and Ten dollars ($110,610) 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 31st day of July, 2017, a copy of which is hereto attached and made a part hereof, for the performance of The City of Fort Collins Work Order, titled Lincoln Center Dewatering, Work Order Number OP-483743, dated March 8th, 2018, 2017, 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. DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D 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. DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 SECTION 00630 CERTIFICATE OF INSURANCE CONTRACTOR shall insert his own standard form for Certificate of Insurance in accordance with the following requirements: 1. The Contractor will provide, from insurance companies acceptable to the City, the insurance coverage designated hereinafter and pay all costs. Before commencing work under this bid, the Contractor shall furnish the City with certificates of insurance showing the type, amount, class of operations covered, effective dates and date of expiration of policies, and containing substantially the following statement: “The insurance evidenced by this Certificate will not reduce coverage or limits and will not be cancelled, except after thirty (30) days written notice has been received by the City of Fort Collins.” In case of the breach of any provision of the Insurance Requirements, the City, at its option, may take out and maintain, at the expense of the Contractor, such insurance as the City may deem proper and may deduct the cost of such insurance from any monies which may be due or become due the Contractor under this Agreement. The City, its officers, agents and employees shall be named as additional insureds on the Contractor 's builder’s risk, general liability and automobile liability insurance policies for any claims arising out of work performed under this Agreement. 2. Insurance coverages shall be as follows: A. Workers' Compensation & Employer's Liability. The Contractor shall maintain during the life of this Agreement for all of the Contractor's employees engaged in work performed under this Agreement: 1. Workers' Compensation insurance with statutory limits as required by Colorado law. 2. Employer's Liability insurance with limits of $100,000 per accident, $500,000 disease aggregate, and $100,000 disease each employee. B. Builder’s Risk, Commercial General & Vehicle Liability. The Contractor shall maintain during the life of this Agreement such builder’s risk, commercial general liability and automobile liability insurance as will provide coverage for damage claims of personal injury, including accidental death, as well as for claims for property damage, which may arise directly or indirectly from the performance of work under this Agreement. Coverage for property damage shall be on a "broad form" basis. The amount of insurance for Commercial General and Vehicle, shall not be less than $1,000,000 combined single limits for bodily injury and property damage. The amount of insurance for builder’s risk shall be not less than 100% value of the work. In the event any work is performed by a subcontractor, the Contractor shall be responsible for any liability directly or indirectly arising out of the work performed under this Agreement by a subcontractor, which liability is not covered by the subcontractor's insurance. DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D 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: Lincoln Center Dewatering DATE OF SUBSTANTIAL COMPLETION: LOCATION: Fort Collins, Colorado OWNER: City of Fort Collins PROJECT OR SPECIFIED PART SHALL CONTRACTOR: Haselden Construction, LLC INCLUDE: WORK ORDER DATE: 3/8/2018 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: _________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 SECTION 00640 CERTIFICATE OF FINAL ACCEPTANCE DATE: TO: Haselden Construction, LLC You are hereby notified that on the ______ day of __________, 20__, the City of Fort Collins, Colorado, has accepted the Work completed by Haselden Construction, LLC, for the City of Fort Collins Work Order, titled Lincoln Center Dewatering, Work Order Number OP-483743. 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 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D 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: Haselden Construction, LLC (CONTRACTOR) WORK ORDER TITLE: Lincoln Center Dewatering WORK ORDER NUMBER: OP-483743 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 attorney’s fees, incurred as a result of such claims. 5. The parties acknowledge that the description of the project set forth above constitutes an adequate description of the property and improvements to which this Lien Waiver Release pertains. It is further acknowledged that this Lien Waiver Release is for the benefit of and may be relied upon by the OWNER, the lender, if any, and Surety on any labor and material bonds for the project. DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 Signed this ______ day of __________, ___. CONTRACTOR: Haselden Construction, LLC By: ___________________________________________ ___________________________________________ Name, Title ATTEST: _____________________________ Secretary STATE OF COLORADO ) )ss. COUNTY OF LARIMER ) Subscribed and sworn to before me this _________ day of __________, _____, by ________________________________________________________________. Witness my hand and official seal. My Commission Expires: ___________________________. _________________________ Notary Public DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 SECTION 00651 LIEN WAIVER RELEASE (SUBCONTRACTOR) TO: City of Fort Collins, Colorado (OWNER) FROM: Haselden Construction, LLC (CONTRACTOR) WORK ORDER TITLE: Lincoln Center Dewatering WORK ORDER NUMBER: OP-483743 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 attorney’s fees, incurred as a result of such claims. 5. The parties acknowledge that the description of the project set forth above constitutes an adequate description of the property and improvements to which this Lien Waiver Release pertains. It is further acknowledged that this Lien Waiver Release is for the benefit of and may be relied upon by the CONTRACTOR, OWNER, the lender, if any, and Surety on any labor and material bonds for the project. DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D 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 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D 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: Haselden Construction TITLE: Lincoln Center Dewatering WORK ORDER NUMBER: OP-483743 WORK ORDER DATE: 3/8/2018 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 Lincoln Center Dewatering on bond of , (Surety) _______________________________________ hereby approves of the Final Payment to the CONTRACTOR, and agrees that Final Payment to the CONTRACTOR shall not relieve the Surety Company of any of its obligations to the OWNER, as set forth in the said Surety Company's Bond. IN WITNESS WHEREOF, the Surety Company has hereunto set its hand this _________ day of _________ _, _____. ____________________________________________ (Surety Company) By: ________________________________________ (Name) Attorney-in-Fact ATTACH: Power of Attorney and Certificate of Authority of Attorney(s)-in-Fact. DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 SECTION 00670 APPLICATION FOR EXEMPTION CERTIFICATE DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 SECTION 00700 GENERAL CONDITIONS DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D 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 provisions of this Article 2 and of the General and Supplementary Conditions and Work DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 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. N/A 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. DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D 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 SC-14.1. Add the following language to the end of paragraph 14.1 of the General Conditions: DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 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. DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 SECTION 00900 ADDENDA, MODIFICATIONS AND PAYMENT 00950 Change Order 00960 Application for Payment DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D Work Order – Construction Form Official Purchasing Form Last updated 10/2017 SECTION 00950 CHANGE ORDER NO. PROJECT TITLE: Lincoln Center Dewatering CONTRACTOR: Haselden Construction, LLC WORK ORDER NUMBER: OP-483743 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: Haselden Construction, LLC By: Date: Name: Title: ACCEPTED: Date: Brian Hergott, Facilities Project Manager REVIEWED: Date: Elliot Dale, Senior Buyer ACCEPTED: Date: Name, Title ACCEPTED: Date: Gerry Paul, Purchasing Director (if greater than $60,000) DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D 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 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D 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 PRO- POLICY 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) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: I. The WHO IS AN INSURED section is amended to add as an Insured any person or organization whom the Named Insured is required by written contract to add as an additional insured on this coverage part, including any such person or organization, if any, specifically set forth on the Schedule attachment to this endorsement. However, such person or organization is an Insured only with respect to such person or organization!s liability for: A. unless paragraph B. below applies, 1. bodily injury, property damage, or personal and advertising injury caused in whole or in part by the acts or omissions by or on behalf of the Named Insured and in the performance of such Named Insured!s ongoing operations as specified in such written contract; or 2. bodily injury or property damage caused in whole or in part by your work and included in the products-completed operations hazard, and only if a. the written contract requires the Named Insured to provide the additional insured such coverage; and b. this coverage part provides such coverage. B. bodily injury, property damage, or personal and advertising injury arising out of your work described in such written contract, but only if: 1. this coverage part provides coverage for bodily injury or property damage included within the products completed operations hazard; and 2. the written contract specifically requires the Named Insured to provide additional insured coverage under the 11-85 or 10-01 edition of CG2010 or the 10-01 edition of CG2037. II. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with: A. coverage broader than required by the written contract; or B. a higher limit of insurance than required by the written contract. III. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property damage, or personal and advertising injury arising out of: A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: 1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and 2. supervisory, inspection, architectural or engineering activities; or B. any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this coverage part. IV. Notwithstanding anything to the contrary in the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance, this insurance is excess of all other insurance available to the additional insured whether on a primary, excess, contingent or any other basis. However, if this insurance is required by written contract to be primary and non-contributory, this insurance will be primary and non-contributory relative solely to insurance on which the additional insured is a named insured. V. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: CNA75079XX 0115 Page 1 of 2 http://formnet-ci.cna.com/glhtm/scn12800.htm 1/28/2016 Haselden Construction, LLC DocuSign Envelope #C4028808411 ID: 9B91934B-39B0- ✁ ✂ ✁ ✂ 4307- ✄ ✁ ✂ B825-✁ ✂ ☎ 162E6638D05D 1. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim; 2. except as provided in Paragraph IV. of this endorsement, agree to make available any other insurance the additional insured has for any loss covered under this coverage part; 3. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation, defense, or settlement of the claim; and 4. tender the defense and indemnity of any claim to any other insurer or self insurer whose policy or program applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires this insurance to be primary and non-contributory, this paragraph (4) does not apply to insurance on which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. VI. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to add the following definition: Written contract means a written contract or written agreement that requires the Named Insured to make a person or organization an additional insured on this coverage part, provided the contract or agreement: A. is currently in effect or becomes effective during the term of this policy; and B. was executed prior to: 1. the bodily injury or property damage; or 2. the offense that caused the personal and advertising injury for which the additional insured seeks coverage. Any coverage granted by this endorsement shall apply solely to the extent permissible by law. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA75079XX 0115 Page 2 of 2 http://formnet-ci.cna.com/glhtm/scn12800.htm 1/28/2016 DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D 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. 07/01/17 X 2,000,000 07/01/17 1,000,000 A IMA, Inc. - Colorado Division Liability, and Employers Liability Policies. Insured subject to the policy terms and conditions. The Umbrella Policy is excess of the General Liability, Automobile and Umbrella Liability Policies if required by written contract or agreement and with respect to work performed by City of Fort Collins, its officers, agents and employees are included as Additional Insureds on the General, Automobile City of Fort Collins 07/01/18 6950 South Potomac Street X Denver, CO 80202 1,000,000 X 07/01/18 PINNACOL ASSUR CONTINENTAL INS CO(CNA Insurance) 1-303-534-4567 VALLEY FORGE INS CO (CNA) X sadie55 52275515 52275515 1,000,000 2,000,000 RE: Work Order # OP-483743 Lincoln Center Dewatering. Fort Collins, CO 80522 X Haselden Construction, LLC Suite 100 1705 17th Street 07/01/17 Centennial, CO 80112 A B 6042783626 1,000,000 PD Ded: $10,000 C4028808411 C 07/01/18 300 LaPorte Ave X 5,000,000 USA X 1,000,000 X X X 41190 35289 20508 denaccounttechs@imacorp.com 5,000,000 07/01/18 1,000,000 1,000,000 X 03/13/2018 15,000 C4028808425 4082635 - CO ONLY 07/01/17 X 10,000 N DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D $ - $ - 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: DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D 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: DocuSign Envelope ID: 9B91934B-39B0-4307-B825-162E6638D05D