HomeMy WebLinkAbout001052 Original Contract City of Port Angeles
Record # 001052
`0�s""'-:1;1 City of Port Angeles
Fs Public Works&Utilities Dept.
Engineering Office
321 E.Fifth Street PUBLIC WORKS CONTRACT
Port Angeles WA 98362
Tel:360-417-4541
Fax: 360-417-4709 ❑ Request for Bid
® Contract
Contract Title: 715 Caroline House Demo Project Number: CON 2016-13
THIS CONTRACT is entered into the date last below written between the CITY OF PORT ANGELES, WASHINGTON
("CITY")AND Bruch &Bruch Construction, Inc ("CONTRACTOR").
1.WORK BY CONTRACTOR
The Contractor shall perform the work as described in Attachment"A"(Attachment"A"may include Contractor's
Proposal, Scope of Work, Statement of Work, Plans, Specifications, and any other related Contract Documents)
which is attached hereto and by this reference is incorporated herein.
2.TERM OF CONTRACT
All work under this Contract is to be completed as indicated (check one):
® All work under this Contract is to be completed by this date: April 7th, 2016.
❑ All work under this Contract is to be completed 20 days from the Notice to Proceed. No work is
to be performed prior to written Notice to Proceed by the City. (See attachment A for specific
schedule for work).
❑ The performance period under this Contract commences_calendar days after notice to
proceed and ends(xx days thereafter or after contract award.
3. PAYMENT
A. The City shall pay the Contractor for the work performed under this contract (check one):
® Force Account-Time and material, not to exceed: $5,000
Project Breakdown: Mobilization $680, Long Reach Excavator 200/hr
❑ Force Account-Time and actual expenses incurred, not to exceed: $
❑ Force Account- Unit prices set forth in the Contractor's bid or quote, not to exceed: $
❑ Firm Fixed Price set forth in Contractor bid or quote in the amount of: $
The Contractor shall do all work and furnish all tools, materials, and equipment, in accordance
with and as described in the Attachment"A".
The Contractor shall provide and bear the expense of all equipment, work and labor of any sort
whatsoever that may be required for the transfer of materials and for constructing and completing
the work provided for in this contract and every part thereof; except those indicated to be furnished by the
City of Port Angeles in Attachment A.
B. The Contractor shall maintain time and expense records, which may be requested by the City. The contractor
shall submit invoices to the City for payment for work performed. All invoices must reference the City's contract
number. Invoices shall be in a format acceptable to the City.
C. The City shall pay all invoices from the Contractor by mailing a City warrant within 30 days of receipt of a
properly completed invoice.
D. All records and accounts pertaining to this Contract are to be kept available for inspections by representatives
of the City for a period of three (3) years after final payment. Copies shall be made available to the City upon
request.
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E. If during the course of the Contract, the work rendered does not meet the requirements set forth in the
Contract, the Contractor shall correct or modify the required work to comply with the requirements of this
Contract. The City shall have the right to withhold payment for such work until it meets the requirements of the
Contract Documents.
4. RESPONSIBILITY OF CONTRACTOR
A. Safety. Contractor shall take all necessary precautions for the safety of employees on the work site and shall
comply with all applicable provisions of federal, state and local regulations, ordinances and codes. Contractor
shall erect and properly maintain, at all times, as required by the conditions and progress of the work, all
necessary safeguards for the protection of workers and the public and shall post danger signs warning against
known or unusual hazards.
B. Correction of Defects. Contractor shall be responsible for correcting all defects in workmanship and/or
materials discovered within one year after acceptance of this work. When corrections of defects are made,
Contractor shall be responsible for correcting all defects in workmanship and/or materials in the corrected work
for one year after acceptance of the corrections by the City. The Contractor shall start work to remedy such
defects within seven (7)days of mailing notice of discovery thereof by City and shall complete such work within a
reasonable time. In emergencies where damage may result from delay or where loss of service may result, such
corrections may be made by the City, in which case the cost shall be borne by the Contractor. In the event the
Contractor does not accomplish corrections at the time specified, the work will be otherwise accomplished and
the cost of same shall be paid by the Contractor.
C. Warranty. Contractor shall be liable for any costs, losses, expenses or damages including consequential
damages suffered by the City resulting from defects in the Contractors work including, but not limited to, cost of
materials and labor expended by the City in making emergency repairs and cost of engineering, inspection and
supervision by the City. The Contractor shall hold the City harmless from any and all claims which may be made
against the City as a result of any defective work and the Contractor shall defend any such claims at its own
expense. Where materials or procedures are not specified in the Contract Document, the City will rely on the
professional judgment of the Contractor to make appropriate selections.
D. Nondiscrimination/Affirmative Action. Contractor agrees not to discriminate against any employee or applicant
for employment or any other persons in the performance of this Contract because of race, creed, color, national
origin, marital status, sex, age or handicap, or other circumstances as may be defined by federal, state or local
law or ordinance, except for a bona fide occupational qualification. Contractor agrees to post in conspicuous
places, available to employees and applicants for employment, notices to be provided by Contractor setting forth
the provisions of the nondiscrimination clause.
E. Employment. Any and all employees of the Contractor, while engaged in the performance of any work or
services required by the Contractor under this Contract, shall be considered employees of the Contractor only and
not of the City. Any and all claims that may arise under the Workers Compensation Act on behalf of said
employees, while so engaged, and all claims made by a third party as consequence of any negligent act or
omission on the part of the Contractor's employees, while so engaged on any of the work or services provided or
rendered herein, shall not be the obligation of the City.
5. COMPLIANCE WITH LAWS
The Contractor shall comply with all federal, state and local laws and regulations applicable to the
work done under this Contract. Any violation of the provisions of this paragraph shall be considered a violation of
a material provision of this Contract and shall be grounds for cancellation, termination or suspension of the
Contract by the City, in whole or in part, and may result in ineligibility for further work for the City.
6.TERMINATION OF CONTRACT
A.This Contract shall terminate upon satisfactory completion of the work described in Attachment"A" and final
payment by the City.
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B. The City may terminate the Contract and take possession of the premises and all materials thereon and finish
the work by whatever methods it may deem expedient, by giving 10 days written notice to the Contractor, upon
the occurrence of any one or more of the events hereafter specified.
1. The Contractor makes a general assignment for the benefit of its creditors.
2. A receiver is appointed as a result of the insolvency of the Contractor.
3. The Contractor persistently or repeatedly refuses or fails to complete the work required herein.
4. Contractor fails to make prompt payment to subcontractors for material or labor.
5. Contractor persistently disregards federal, state or local regulations and ordinances.
6. Contractor persistently disregards instructions of the Contract Administrator, or otherwise
substantially violates the terms of this Contract.
7. The City determines that sufficient operating funds are not available to fund completion of the work
contracted for.
C. In the event this Contract is terminated by the City, Contractor shall not be entitled to receive any further
amounts due under this Contract until the work specified in Attachment "A" is satisfactorily completed, as
scheduled, up to the date of termination. At such time, if the unpaid balance of the amount to be paid under this
Contract exceeds the expense incurred by the City in finishing the work, and all damages sustained by the City or
which may be sustained by reason of such refusal, neglect, failure or discontinuance of employment, such excess
shall be paid by the City to the Contractor. If the City's expense and damages exceed the unpaid balance,
Contractor and his surety shall be jointly and severally liable therefore to the City and shall pay such difference to
the City. Such expense and damages shall include all legal costs incurred by the City to protect the rights and
interests of the City under the Contract, provided such legal costs shall be reasonable.
7. OWNERSHIP OF DOCUMENTS
A. On payment to the Contractor by the City of all compensation due under this Contract, all finished or
unfinished documents and material prepared by the Contractor with funds paid by the City under this Contract
shall become the property of the City and shall be forwarded to the City upon its request.
B. Any records, reports, information, data or other documents or materials given to or prepared or assembled by
the Contractor under this Contract will be kept confidential and shall not be made available to any individual or
organization by the Contractor without prior written approval of the City or by court order.
S. CLAIMS
Any claim against the City for damages, expenses, costs or extras arising out of the performance of this Contract
must be made in writing to the City within thirty days after the discovery of such damage, expense or loss, and in
no event later than the time of approval by the City for final payment. Contractor, upon making application for
final payment, shall be deemed to have waived its right to claim for any other damages for which application has
not been made, unless such claim for final payment includes notice of additional claim and fully describes such
claim.
9. GENERAL ADMINISTRATION AND MANAGEMENT
The Director of the Public Works and Utilities Department or his/her designee shall have primary responsibility for
the City under this Contract and shall oversee and approve all work to be performed, coordinate communications,
and review and approve all invoices, under this Contract.
10. INDEMNIFICATION / HOLD HARMLESS
A. The Contractor shall defend, indemnify and hold the City, its officers, officials, employees and volunteers
harmless from any and all claims, injuries, damages, losses or suits including attorney fees, arising out of or in
connection with the performance of this Agreement, except for injuries and damages caused by the sole
negligence of the City.
B. Should a court of competent jurisdiction determine that this Agreement is subject to RCW 4.24.115, then, in
the event of liability for damages arising out of bodily injury to persons or damages to property caused by or
resulting from the concurrent negligence of the Contractor and the City, its officers, officials, employees, and
volunteers, the Contractor's liability hereunder shall be only to the extent of the Contractor's negligence. It is
further specifically and expressly understood that the indemnification provided herein constitutes the Contractor's
CON 2016-13 Page 3 Rev.4/8/2015
waiver of immunity under Industrial Insurance, Title 51 RCW, solely for the purposes of this indemnification. This
waiver has been mutually negotiated by the parties. The provisions of this section shall survive the expiration or
termination of this Agreement.
11. INSURANCE, BONDS, &RETAINAGE
A. The Contractor shall maintain insurance as set forth in Attachment B.
B. If the total bid amount including tax exceeds $35,000, this project will be awarded as a small works roster
contract and payment and performance bonds and retainage will apply in accordance with Washington State law.
A retainage of 5% will then be applicable to this contract. The Contractor shall obtain payment and performance
bonds in accordance with this Contract and all Attachments incorporated herein. Copies of the Bid Security
Transmittal Form, Performance and Payment Bond form, and Escrow Agreement for Retained Percentage form
are available from the Operations Office of Public Works &Utilities (Telephone 360-417-4541). Performance
Bond and Retainage forms are provided in Attachment C. The party to whom the Contract is awarded will be
required to execute the Contract and obtain the Performance and Payment Bond within ten (10) calendar days
from the date the notice of award is delivered to the bidder. Such bond(s) shall be on the form provided by the
Owner, specify the name, contact phone, and address of the surety, and shall include a power of attorney
appointing the signatory of the bond(s) as the person authorized to execute it(them).
12. PREVAILING WAGE
This Contract is subject to Chapters 39.12 and 49.28 RCW, amendments thereto and regulations issued
thereunder, relating to prevailing wages, benefits and other requirements. Workers shall receive no less than the
prevailing rate of wage. Bidders shall examine and be familiar with such requirements. No claim for additional
compensation will be allowed which is based upon a lack of knowledge or a misunderstanding of any such
requirements by the Bidder or a failure to include in Bidder's price adequate increases in such wages during the
performance of this Contract. The Contractor is advised to consult the Washington State Department of Labor
and Industries to determine the prevailing wages that must be paid.
This public works project is being done in Clallam County. Washington State wage determinations for Clallam
County Journeymen and Apprentices can be found at:
https://fortress.wa.gov/Ini/"wagelookup/`prvWagelookup.aspxx
https://fortress wa gov/Ini/wa elookup/ApprenticeWageLookup aspxx
The applicable wage determinations to use have an effective on the bid due date.
A copy of the applicable wage rates is available for viewing at the Port Angeles Public Works and Utilities
Contracts Office. In addition, this agency will mail a hard copy of the applicable wage rates upon request.
For a contract award under $2,500, and in accordance with RCW 39.12.040(2), the contractor or subcontractor is
authorized to submit a combined Statement Of Intent To Pay Prevailing Wages &Affidavit Of Wages directly to
the City of Port Angeles at final invoicing. Submission shall be made on the form developed by the Washington
State Department of Labor and Industries and available from the City of Port Angeles Public Works and Utilities
Department.
In case any dispute arises as to what are the prevailing rates of wages for a specific trade, craft or occupation
and such dispute cannot be adjusted by the parties in interest, including labor and management representatives,
the matter shall be referred for arbitration to the Director of the Department of Labor and Industries, and his
decision shall be final, conclusive, and binding on all parties involved in the dispute.
13. INTERPRETATION AND VENUE
This Contract shall be interpreted and construed in accordance with the laws of the State of Washington. The
venue of any litigation between the parties regarding this Contract shall be Clallam County, Washington.
14. BRANDS OR EQUAL
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e
When a'special "brand or equal" is named it shall be construed solely for the purpose of indicating the standards
of quality, performance, or use desired. Brands of equal quality, performance, and use shall be considered,
provided Contractor specifies the brand and model and submits descriptive literature when available. Any bid
containing a brand which is not of equal quality, performance, or use specified must be represented as an
alternate and not as an equal, and failure to do so shall be sufficient reason to disregard the bid.
15. INSPECTION AND REJECTION
All goods, services, work, or materials purchased herein are subject inspection and to approval by the City. Any
rejection of goods, services, work, or materials resulting because of nonconformity to the terms and specifications
of this order, whether held by the City or returned, will be at Contractor's risk and expense.
16. SUBLETTING OR ASSIGNING OF CONTRACTS
Neither the City nor the Contractor shall assign, transfer, or encumber any rights, duties or interest accruing from
this Contract without the express prior written consent of the other.
17. INDEPENDENT CONTRACTOR
The Contractor is and shall be at all times during the term of this Contract an independent contractor and not
an employee of the City.
18. EXTENT OF CONTRACT/MODIFICATION
This Contract, together with the attachments and/or addenda, represents the entire and integrated Contract
between the parties hereto and supersedes all prior negotiations, representations, or agreements, either written
or oral. This contract may be amended, modified or added to only by written instrument properly signed by both
parties hereto.
This Contract, together with the attachments and/or addenda, represents the entire and integrated Contract
between the parties hereto and supersedes all prior negotiations, representations, or agreements, either written
or oral. This contract may be amended, modified or added to only by written instrument properly signed by both
parties hereto.
19. SUBCONTRACTOR RESPONSIBILITY
The Contractor shall include the language of this section in each of its first tier subcontracts, and shall require each
of its subcontractors to include substantially the same language of this section in each of their subcontracts,
adjusting only as necessary the terms used for the contracting parties. The requirements of this section apply to
all subcontractors regardless of tier.
At the time of subcontract execution, the Contractor shall verify that each of its first tier subcontractors meets
the following bidder responsibility criteria:
- At the time of subcontract bid submittal, have a certificate of registration in compliance with chapter 18.27
RCW;
- Have a current state unified business identifier number;
- If applicable, have:
1) Industrial insurance coverage for the subcontractor's employees working in Washington as required in
Title 51 RCW;
2) An employment security department number as required in Tile 50 RCW; and
3) A state excise tax registration number as required in Tile 82 RCW;
4) An electrical contractor license, if required by Chapter 19.28 RCW;
5) An elevator contract license, if required by Chapter 70.87 RCW.
- Not be disqualified from bidding on any public works contract under RCW 39.06.010 or 39.12.065(3).
20. COMPENSATION AND METHOD OF PAYMENT.
CON 2016-13 Page 5 Rev.4/8/2015
A. The City shall pay the Contractor for work performed under this Contract as detailed in the bid, as incorporated
in the Contract.
B. Payments for work provided hereunder shall be made following the performance of such work, unless otherwise
permitted by law and approved in writing by the City. No payment shall be made for any work rendered by the
Contractor except as identified and set forth in this Contract.
C. Progress payments shall be based on the timely submittal by the Contractor of the City's standard payment
request form.
D. Payments for any alterations in or additions to the work provided under this Contract shall be in accordance with
the Request For Information (RFI) and/or Construction Change Order (CCO) process as set forth in the Standard
Specifications. Following approval of the RFI and/or CCO,the Contractor shall submit the standard payment request
form(s).
E. The Contractor shall submit payment requests with a completed Application for Payment form, an example of
which is included in Attachment D to this Contract. This form includes a lien waiver certification and shall be
notarized before submission. Applications for payment not signed or notarized shall be considered incomplete and
ineligible for payment consideration.The City shall initiate authorization for payment after receipt of a satisfactorily
completed payment request form and shall make payment to the Contractor within approximately thirty (30) days
thereafter. Final payment requests shall also include a Certification of Work Completion and Acceptance located in
Attachment D).
IN WITNESS WHEREOF, the parties have executed this Contract as of April 6, 2016.
CONTRACTOR CITY OF PORT ANGELES
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Tax ID #:
BY:
Phone Number: ---2) => Z `�1 C ATTORNEY
ATTEST:
BY:
CITY CLERK
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CON 2016-13 Page 6 Rev.4/8/2015
City of Port Angeles ATTACHMENT "A"
Engineering Office WORK BY CONTRACTOR
Public Works and Utilities Department
360-417-4541
The contractor shall do all work and furnish all tools, materials, and equipment in order to accomplish the project
described below. Unless otherwise provided for in the Statement of Work, the Contractor will be responsible for
obtaining and paying for any and all permits required for this work.
General Scope: House demolition.
Location: 715 Caroline Street, Port Angeles WA.
Site Point of Contact: Jonathan Boehme at 360-417-4811.
Work Hours and Schedule: The contractor will be allowed to work from 7 AM to 10 PM, Monday through
Friday. Work outside of these hours may be requested from and is at the discretion of the Assistant Deputy
Director of Public Works.
Permits: None.
Work Requirements:
1.0 Project Description
This contract is for the demolition of a house at 715 Caroline due to a house fire. The fire department is unable to
completely extinguish the fire without first pulling the house down. The Contactor shall pull down the house so the
Fire Department is able to completely extinguish the fire. The City will pay time and material costs plus standard
markups as detailed in WSDOT Specifications 1-09.6 for the demolition.
2.0 Standard Specifications
This contract incorporates the current Washington State Department of Transportation's Standard
Specifications for Road, Bridge and Municipal Construction referred to herein as the Standard
Specifications and the City ofPortAngeles Urban Services Standards and Guidelines(current
edition).
Contractor shall follow the WSDOT Specification 1-09.6 Force Account for all work.
3.0 Drawings:
The following listed drawings are part of this contract:
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CON 2016-13 Page 7 Rev.4/8/2015
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Project Site- Not Drawn to Scale
CON 2016-13 Page 8 Rev.4/8/2015
City of Port Angeles ATTACHMENT "B"
Engineering Office INSURANCE
Public Works and Utilities Department
360-417-4541
INSURANCE REQUIREMENTS FOR
CONSTRUCTION AND SERVICE CONTRACTS
Insurance
The Contractor shall procure and maintain for the duration of the Agreement, insurance against claims for injuries
to persons or damage to property which may arise from or in connection with the performance of the work
hereunder by the Contractor, their agents, representatives, employees or subcontractors.
No Limitation
Contractor's maintenance of insurance, its scope of coverage and limits as required herein shall not be construed
to limit the liability of the Contractor to the coverage provided by such insurance, or otherwise limit the City's
recourse to any remedy available at law or in equity.
Minimum Scope of Insurance
Contractor shall obtain insurance of the types described below:
1. Automobile Liability insurance covering all owned, non-owned, hired and leased vehicles. Coverage shall
be written on Insurance Services Office (ISO) form CA 00 01 or a substitute form providing equivalent
liability coverage. If necessary, the policy shall be endorsed to provide contractual liability coverage.
2. Commercial General Liability insurance shall be written on ISO occurrence form CG 00 01 and shall cover
liability arising from premises, operations, independent contractors, products-completed operations, stop
gap liability, personal injury and advertising injury, and liability assumed under an insured contract. The
Commercial General Liability insurance shall be endorsed to provide the Aggregate Per Project
Endorsement ISO form CG 25 03 1185 or an equivalent endorsement. There shall be no endorsement or
modification of the Commercial General Liability Insurance for liability arising from explosion, collapse or
underground property damage. The City shall be named as an insured under the Contractor's Commercial
General Liability insurance policy with respect to the work performed for the City using ISO Additional
Insured endorsement CG 20 10 10 01 and Additional Insured-Completed Operations endorsement CG 20
37 10 01 or substitute endorsements providing equivalent coverage.
3. Workers'Compensation coverage as required by the Industrial Insurance laws of the State of
Washington.
Minimum Amounts of Insurance
Contractor shall maintain the following insurance limits:
1. Automobile Liability insurance with a minimum combined single limit for bodily injury and property
damage of$1,000,000 per accident.
2. Commercial General Liability insurance shall be written with limits no less than $1,000,000 each
occurrence, $2,000,000 general aggregate and $2,000,000 products-completed operations aggregate
limit.
Other Insurance Provision
The Contractor's Automobile Liability and Commercial General Liability insurance policies are to contain, or be
endorsed to contain that they shall be primary insurance as respect the City. Any insurance, self-insurance, or
CON 2016-13 Page 9 Rev.4/8/2015
insurance pool coverage maintained by the City shall be excess of the Contractor's insurance and shall not contribute
with it.
Acceptability of Insurers
Insurance is to be placed with insurers with a current A.M. Best rating of not less than A: VII.
E. Verification of Coverage
Contractor shall furnish the City with original certificates and a copy of the amendatory endorsements, including
but not necessarily limited to the additional insured endorsement, evidencing the insurance requirements of the
Contractor before commencement of the work.
F. Subcontractors
The Contractor shall have sole responsibility for determining the insurance coverage and limits required, if any, to
be obtained by subcontractors, which determination shall be made in accordance with reasonable and prudent
business practices.
G. Notice of Cancellation
The Contractor shall provide the City and all Additional Insureds for this work with written notice of any policy
cancellation, within two business days of their receipt of such notice.
H. Failure to Maintain Insurance
Failure on the part of the Contractor to maintain the insurance as required shall constitute a material breach of
contract, upon which the City may, after giving five business days notice to the Contractor to correct the breach,
immediately terminate the contract or, at its discretion, procure or renew such insurance and pay any and all
premiums in connection therewith, with any sums so expended to be repaid to the City on demand, or at the sole
discretion of the City, offset against funds due the Contractor from the City.
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ATTACHMENT"C" ESCROW AGREEMENT for RETAINED PERCENTAGE
715 Caroline House Demo
Escrow No.:
City of Port Angeles Contract No. CON 2016-13
Completion Date:
TO: 6. In the event the City orders you,in writing,to reconvert the
investments and return all monies,you shall do so within thirty
(30)days of receipt of the order.
7. The Contractor agrees to compensate you for your services in
accordance with your current published schedule of applicable
escrow fees. Payment of all fees shall be the sole responsibility
THIS ESCROW AGREEMENT is for the investment of the retained of the Contractor and shall not be deducted from any monies
percentage of the above contract,in accordance with chapter 60.28 of placed with you pursuant to this agreement until and unless the
the Revised Code of Washington. It is limited to FDIC insured City directs the release to the Contractor of the investments and
Washington State Chartered Banks who are covered by the State of monies held hereunder,whereupon you shall be entitled to
Washington Public Deposit Protection Act. reimburse yourself from such monies for the entire amount of
your fee.
The undersigned, (as"Contractor"),has 8. This agreement shall not be binding until signed by both parties
directed the CITY OF PORT ANGELES(as"City"),to deliver to and accepted by you.
you its warrants which shall be payable to you and/or the contractor. 9. This document contains the entire agreement between you,the
The warrants are to be held and disposed of by you in accordance Contractor,and the City,with respect to this Escrow,and you
with the following instruction: are not a party to,nor bound by any instrument or agreement
other than this. You shall not be required to take notice of any
INSTRUCTIONS default or any other matter,nor be bound by nor required to
give notice or demand,nor required to take any action whatever
1. Upon delivery the warrants shall be endorsed by you and except as herein expressly provided. You shall not be liable for
forwarded to the City for collection. You shall use the monies any loss or damage not caused by your own negligence or
to purchase investments selected by the Contractor and willful misconduct.
approved by the City. You may follow the last written
direction received by you from the Contractor,for each CONTRACTOR
purchase,provided the direction otherwise conforms with this
agreement. Acceptable investments are: Federal Tax 1.D.No.
A. Bills, certificates, notes or bonds of the
United States; By.
B. Other obligations of the United States Title:
or its agencies;
C. Obligations of any corporation wholly Address:
owned by the Government of the United
States;
D. Indebtedness of the Federal National DATE" _
Mortgage Association; CITY OF PORT ANGELES
E. Time deposits in commercial banks;
F. Other investments, except stocks, By:
selected by the Contractor, subject to Title:
express prior written consent of the
City DATE:
2. The investments shall be in a form which allows you alone to THE ABOVE ESCROW AGREEMENT RECEIVED AND
reconvert them into money if you are required to do so by the ACCEPTED on the day of 20 .
City.
3. The investments must mature on or prior to the date set for the BANK
completion of the contract,including extension there of or
thirty(30)days following the final acceptance of the work.
By:
4. When interest on the
investments accrues and is paid, you Title:
shall collect the interest and forward it Address:
to the Contractor unless otherwise
directed by the Contractor.
5. You are not authorized to deliver to the Contractor all or any DISTRIBUTION:
part of the investments held by you pursuant to this agreement City Clerk Contractor
(or any monies derived from the sale of such investments,or Financial Institution File Copy
the negotiation of the City's warrants)except in accordance
with the written instructions from the City. Compliance with
such instructions shall relieve you of any further liability
related thereto.
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I
City of Port Angeles ATTACHMENT "D"
Engineering Office
Public Works and Utilities Department FORMS
360-417-4541
REQUEST FOR INFORMATION (RFI) FORM
PROJECT NAME:
PROJECT/CONTRACT NUMBER:
ORIGINATOR: Owner Contractor
ITEM:
REFERENCE DRAWING OR SPECIFICATION:
DESCRIPTION OF CLARIFICATION/REQUEST:
DATE REPLY REQUESTED: CRITICAL TO SCHEDULE: ' YES NO
ORIGINATOR SIGNATURE: DATE:
COMMENTS:
RFI Number:
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CON 2016-05 Page 12 Rev. 8/30/2011
pODaTANa
CONTRACT CHANGE ORDER (CCO) NO.
Project Name Date
Contractor Project No.
DESCRIPTION OF WORK
You are ordered to perform the following described work upon receipt of an approved copy of this Change Order:
1. Describe work here
2. Additional work, etc....
Such work will be compensated by: check one or more of the following as applicable [ ] Increase or[ ]Decrease in bid
items; [ ]Force Account; [ ]Negotiated Price: The described work affects the existing contract items and/or adds and/or
deletes bid items as follows:
Item Description RFI# Qty. Unit S Cost Per Unit S Cost Net S Cost Adj.Days
No.
I Orig.
Rev.
2 Orig.
Rev.
ORIGINAL CURRENT EST.NET CHANGE TOTAL CHANGE ORDERS, EST.CONTRACT AFTER
CONTRACT CONTRACT THIS CHANGE ORDER INCLUDING THIS ONE THIS CHANGE ORDER
DAYS:XX DAYS: YY DAYS: ZZ DAYS:XX+ZZ-YY DAYS: YY+ZZ
*Amount with applicable sales tax included
All work,materials and measurements to be in accordance with the provisions of the original contract and/or the standard specifications and special
provisions for the type of construction involved. The payments and/or additional time specified and agreed to in this order include every claim by the
Contractor for any extra payment or extension of time with respect to the work described herein,including delays to the overall project.
APPROVED BY: T SIGNATURE: DATE:
PROJECT ENGINEER
CITY ENGINEER
CONTRACTOR
PUBLIC WORKS&UTILITIES DIRECTOR
3
CITY MANAGER
CITY COUNCIL APPROVAL DATE:
CON 2016-05 Page 13 Rev. 8/30/2011
CONTRACTOR'S APPLICATION FOR PAYMENT
PROJECT PROJECT NO.
Page 1 of 2
TO: City of Port Angeles DATE:
Public Works&Utilities Department
P.O.Box 1150
Port Angeles,WA 98362
FROM: PAYMENT REQUEST NO.
PERIOD From: to [end of period]:
STATEMENT OF CONTRACT ACCOUNT
1 Original Contract Amount(Excluding Sales Tax) $
2 Total Value of Approved Change Order No(s). (Excluding Sales Tax) $
3 Adjusted Contract Amount[1+2] $
4 Value of Work Completed to Date (per attached breakdown) $
5 Material Stored on Site(per attached breakdown and material receipts) $
6 Subtotal [4+5] $
7 8.4%Sales Tax(at 8.4%of Subtotal),As Applicable $
8 Less Amount Retained(at 5%of subtotal) $
9 Subtotal [6+7-8] $
10 Total Previously Paid $
11 AMOUNT DUE THIS REQUEST[9-10] $
WAIVER OF CLAIMS FOR EXTRA COST OR TIME: The undersigned Applicant waives and
releases, up through the date hereof, any and all claims for costs or item extensions arising out of or
relating to extra or changed work or delays or acceleration not specifically identified and reserved in the
amounts identified below or previously acknowledged in writing by the City of Port Angeles.
CERTIFICATE OF THE CONTRACTOR: I hereby certify that the work performed and the
materials supplied through the ending period date noted above represent the actual value of
accomplishment under the terms of the contract(and all authorized changes)between the Applicant and
the City of Port Angeles, relating to the above referenced project, and that the remaining contract
balance is sufficient to cover all costs of completing the work in accordance with the contract
documents.
Continued on Page 2
CON 2016-05 Page 14 Rev. 8/30/2011
CONTRACTOR'S APPLICATION FOR PAYMENT
Page 2 of 2
I also certify that all lower-tier payments, less applicable retention, have been made by the Applicant for the
periods covered by previous payment(s)received by the Applicant to (1) all lower-tier subcontractors/suppliers,
and(2) for all materials, equipment and labor used or in connection with the performance of this contract. I
further certify that I have complied with all federal, state and local tax laws, including Social Security laws and
Unemployment Compensation laws and Workmen's Compensation laws, insofar as applicable to the performance
of this work, and have paid all such taxes,premiums and/or assessments arising out of the performance of the
work.
I further certify that,to the best of my knowledge, information and belief, all work for which previous payment(s)
have been received shall be free and clear of liens,claims, security interests and encumbrances in favor of the
Contractor, subcontractors,material suppliers, or other persons or entities making a claim by reason of having
provided labor, materials and equipment relating to the work.
Within seven(7) days of receipt of the payment requested herein, all payments, less applicable retention, will be
made through the period covered by this pay request to all my lower-tier subcontractors/suppliers and for all
materials, equipment, labor,taxes and assessments arising out of the performance of all said lower-tire work.
DATED:
CONTRACTOR:
SIGNATURE:
PRINTED NAME AND TITLE:
SUBSCRIBED AND SWORN to before me this day of , 20
Notary Public in and for the State of ,
residing at
My appointment expires
APPROVAL:
Project Manager
Date
City Engineer 3
Date
CON 2016-05 Page 15 Rev. 8/30/2011
poRrgN
CERTIFICATION OF
WE
SA�o� WORK COMPLETION AND ACCEPTANCE
PROJECT:
PROJECT NO.:
All work on the above referenced project has been completed in accordance with the contract documents and the
final inspection and the warranty provision included therein or relating thereto.
The final estimate in the amount of$ , including any applicable taxes, has been reviewed and
is in agreement with our records. I further certify that the final estimate amount shown above is a true and
correct statement showing all the monies due me from the City of Port Angeles for work performed and material
furnished under this contract. City Council acceptance and final payment, including retained percentages, is
hereby respectfully requested.
, Contractor, hereby releases the City of Port Angeles, Washington, from any
and all liens arising out of this Contract or is, herewith, providing a bond covering all unpaid obligations for work,
materials, equipment or any other liens outstanding on this Contract.
CONTRACTOR:
ADDRESS:
AUTHORIZED OFFICIAL: DATE:
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