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HomeMy WebLinkAbout20-058 - Razz Construction, Inc - S Boeing Access Road (BAR) Over Airport Way Bridge Seismic Retrofit Project20-058(a) Council Approval N/A Sheet 1 of 1 CITY OF TUKWILA CONTRACT CHANGE ORDER NO. 1 DATE: February 19, 2021 BUDGET NO.: 9130407.3000.153&.170 PROJECT NO.: 91310407 CONTRACT NO.: 20-058 PROJECT NAME: S Boeing Access Road over Airport Way Bridge Seismic Retrofit TO: Razz Constrution, Inc. You are hereby directed to make the herein described changes to the plans and specifications or do the following described work not included in the plans and specifications on this contract: NOTE: This change order is not effective until approved by the "Owner" and a notice to proceed is issued. Conditions: A. The following change, and work affected thereby, are subject to all contract stipulations and covenants; B. The rights of the "Owner" are not prejudiced; C. All claims against the "Owner" which are incidental to or as a consequence of this change are waived; and D. The Contractor must submit all Field Overhead and Home Office Overhead Rates for approval in advance of all change orders. CHANGE: See Attached Exhibit "A" We the undersigned Contractor, have given careful consideration to the change proposed and hereby agree, if this proposal is approved, that we will provide all equipment, furnish all materials, except as may otherwise be noted above, and perform all services necessary for the work above specified, and will accept as full payment therefore tt prices shown above and below. ACCEPTED: Date , Contractor ZZ L9 Z,. 2-\ By A -d u -k 7au-‘ k \C — Original Contract (without tax) Previous Change Order This Change Order (without tax) REV. CONTRACT AMOUNT $ 1,442,505.00 $ 0.00 Title fo3eck \\& ev-- APPROVED BY THE CITY OF TUKWILA Date 2/25/2021 $ 98,000.00 By (' ffew skae%t9 $ 1,540,505.00 Original Contract Time: 170 Working Days Additional Contract Time for this Change Order: 12 Days ;Updated Contract Time: 182 Working Days RIGINAL: City Clerk (1 of 2) Contractor (2 of 2) PW Project Finance File 1/1 City Engineer Mayor cc: Finance Department (w/encumbrance) Project Management File 01/2014) South Boeing Access Road over Airport Way Bridge Contract Change Order No. 1 Exhibit A Part 1 Review of the existing roadway pavement for matching new approach slabs with a direct pour against showed the pavement being uneven and rutted which would make the transition very difficult. A one - foot section for removal was directed (see attached detail). Additionally, to form the approach slabs, the existing asphalt shoulder had to be removed. The Contract did not have a bid item for HMA to replace the approach slab transition and to replace the asphalt shoulder. This change order adds a bid item for HMA class '/2" PG 58H-22 to be paid by the ton for replacing the shoulder and for backfilling the added one -foot transition section. The additional crushed surfacing base course (CSBC) will be paid for by the ton under the current bid item #18. The additional excavation and pavement removal will be paid under new bid as an agreed to lump sum The Construction Management team prepared an independent estimate and presented it to Razz Construction where the two parties then negotiated the final costs. Part 2 After excavation was completed for the pavement seat, the existing asphalt overlay of the bridge deck was found to be 6 inches in spots. For the compression seal to function properly, it was determined that a 1 -foot section of the overlay had to be removed. This revision led to a revised detail for the pavement seat and the approach slabs (see attached detail). This 1 -foot section then had to be replaced with concrete. Three options were reviewed for the replacement, WABO was then selected as it was the least expensive of the three with offering the same or better results. The Razz Construction submitted its price, The Construction management team then prepared an independent estimate. The two parties negotiated and settled on a Lump Sum amount for this work. 12 additional working day will be added to the contract to account for the additional work. Bid Item No. Description Quantity Unit Unit Price Cost CO #1-1 HMA 40 Ton $400 $16,000 CO #1-2 Additional excavation 1 LS $39,000 $39,000 CO #1-3 WABO placement 1 LS $43,000 $43,000 Total Change Order Cost $98,000 20-058 Council Approval 5/4/20 C-1 AGREEMENT FORM CONTRACT NO, S THIS AGREEMENT is made and entered into on this 15 day of IvV-- , 20 O, by and between the City of Tukwila, Washington ("Owner) and zr Lo INSirvo bib 'i.( Contractor') Now, therefore the parties agree as follows: 1, Project Contractor shall complete all work and furnish all labor, tools, materials, and equipment for the project entitled S BOEING ACCESS ROAD OVER AIRPORT WAY BRIDGE SEISMIC RETROFIT PROJECT, Project No. 91310407, including all changes to the Work and force account work, in accordance with the Contract Documents, as described in Section 1-04.2 of the Supplemental General Requirements. 2. Payments. Owner shall pay Contractor at the unit and lump sum prices, and by force account as specified in the Proposal according to the Contract Documents as to time, mariner, and condition of payment The payments to Contractor include the costs for all labor, tools, materials and equipment for the Work 3, Completion Date. Contract time shall commence upon Owner's Notice to Proceed date, The Work under this Agreement shall be completed within the time specified in the Proposal. If the Work under this Agreement is not completed within the time specified, as detailed in the Contract Documents, Contractor shall pay liquidated damages and all engineering inspection and supervision costs to Owner as specified in the Proposal. 4. Attorney's Fees. In the event litigation is commenced to enforce this Agreement, the prevailing party shall be entitled to recover its costs, including reasonable attorneys and expert witness fees. 5. Disclaimer. No Itability of Contractor shall attach to Owner by reason of entering into this Agreement, except as expressly provided in this Agreement. 6. Counterparts. This Agreement is executed in tw. identical oounterparts, by the parties, each of which shall for all purposes be deemed an original. CITY OF -RI LAWAii1GT (Owner) Attest This day et Oh4.€4-t-9 6,677(cth&t.t-9 City Clerk Approved as to Form: atriee LK, City Attorney Address for giving notices. 42-00 _.CovtlA C&I-1-ec B 1 vei -11,[4,4A\ct- j (A/A 0).8t 8 8 Razz Construction, Inc. (Contractor) By: Title President, Donald k Rasrru Attest: This Vtt day of 30J‘ Contractor's License No. FiAZZCC195KU Address for giving notices: 4055 Hammer Dr Bellingham, WA 98226 tp_ 2. 0 or* n S Boeing Access Road Over Airport Way Bridge Seismic Retrofit u Rev, 2-28-20 Provided to Builders Exchange of WA, Inc, For usage Conditions Agreerrent see orww.bxwa,com - Always Verify Scal C-2 PAYMENT AND PERFORMANCE BOND Bond to City of Tukwila, Washington Bond No. S014821 Construction In ployers Mutual Casualty Company (f rincipal) a Iowa corporation, and as a surety corporation authorized to become a surety upon Bonds of Contractors with municipal corporatio n in Washington State, are jointly and severally bound to the City of Tukwila, Washington ("Owner"), in the penal sum of One Million Four Hundred Forty-two Thousand Five Hundred Five and 00/100 Dollars ( r + the payment of which sum, on demand, we bind ourselves and our successors, heirs, administrators, executors, or personal repre ntatives, as the may be. This Payment and Performance Bond is provided to secure the performance of Principal in connection with a contract dated S , 20 Z0, between Principal and Ow ~ ° r for a project entitled S BOEING ACCES ROAD OVER AIRPORT WAY BRI ri E SEISMIC RETROFIT PROJECT, Contract No. Z0—©58 ("Contract"). The initial penal sum shall equal 1of the Total Bid Price, including sales tax, as specified in the Proposal submitted by Principal. NOW, THEREFORE, this Payment and Performance end shall be satisfied and released only upon the condition that Principal; • Faithfully performs all provisions of the Contract and changes authorized by Owner in the manner and within the time specified as may be extended under the Contract; • Pays all la µ rers, mechanics, subcontractors, lower tier subcontractors, material men, and all other persons or agents who supply labor, equipment, or materials to the Project; • Indemnifies and holds Owner, its officers, and agents harmless from and against all claims, liabilities, causes of action, damages, and costs forsuch payments for labor, equipment, and materials by satisfying all claims and demands incurred under the Contract, and reimbursing and paying Owner all expenses that Owner may incur in making good any default by Principal; and • Indemnifies and holds Owner harm! as from all claims, liabilities, causes of action, damages and costs, including property damages and personal injuries, resulting from any defect appearing' or developing in the material provided or workmanship performed under the Contract. The indemnities to Owner shall also inure to the benefit of the Consulting Engineers and other design professionals retained by Owner in connection with the Project. The liability of Surety shall be Iimited to the penal sum of this Payment and P rformance Bond, change, extension of time, alteration, or adds w n to the terms of the Contract or tao tlr Work to be performed under the Contract shall in any way affect Surety's obligation on the Payment and Performance Bond, Surety hereby waiv notice of any change, extension of time, alteration, or addition to the terms of the Contract or the Work, with the exception that Surety shall be notified if the Contract time is extended by more than twenty percent (2' ` ), if any modification or change increases the total amount to be paid under the Contract, Surety's obligation under this Payment and Performance Bond shall automatically incre .se in a like amount, Any such increase shall not exceed twenty-five percent (25%) of the original amount of the Payment and Performance Bond without the prior writ/ n con nt of Surety. rig AR wr' d ve Air y Retro Rev, 2-26-20 Pi n Performance Bond This Payment and Performance Bond shall be governed and construed by the laws of the State of Washington, and venue shall be in King County, Washington. IN WITNESS WHEREOF, the parties have executed this instrument in o (2) identical this 2 day of June 20 20 , Name and address of local office of agent and/or Surety Company: Employers Mutuai Casual 'iy Company pure of Auth on ed amici By Aficeon A. Ke Atrt in Fa (Attach Power of Attorney) Propel Insurance 01 Union St, Suite 3400 le W ffA 9B101 Surety pars executing bonds must appear on the currant Authorized In ura List in State of Washing tc per Section 1-02.7 of the Standard Speclf eti P.O. Box 712• Moines, Iowa 50306-0712 INSURANCE POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT KNOW ALL MEN BY THESE PRESENTS, that: 1. Employers Mutual Casualty Company, an Iowa Corporation 2, EMCASCO Insurance Company, an Iowa Corporation 3, Union Insurance Company of Providence, an Iowa Corporation 4, Illinois EMCASCO Insurance Company, an 1, a Corporation 5, Dakota Fire Insurance Company, a North Dakota Corporation 6, EMC Property & Casualty Company, an Iowa Corporation hereinafter referred to ,.,:, erally as "C mW any" and collectively as "Companies", each d , by these pre ts, make, constitute and appoint: ALICEON A. KELTNER its true and lawful attorney-in-fact, with full power arxf authority conferred to sign, seal, and execute the Surety Bond: Any and All Bonds and to bind each C ,W.ny thereby as fully and to the same extent as if such instruments were signed by the duly authors rs of each such Company, and all of the acts of said attorney pursuant to the authority hereby given are hereby ratified and confirmed, The authority hereby granted shall expire April 1st 2021 , unless sooner revoked. AUTHORITY FOR POWER OF ATTORNEY This Power-of-Attorand executed pursuant to and by the authority of the following r ution of the Board of Directors of each of the Companies at the first regularly scheduled meeting of each company duly called and held in 1 RESOLVED; The President and Chief Executive Officer, any Vice Pr w , .nt the Treasurer and + Secretary of Employers Mutual Casualty Company shall have power and authority to (1) appoint attorneys -in -fact and authorize them to execute on behalf of each Company and attach the seal of the Company thereto, bonds and undertaki , r : ,r,rnizzances, contr of indemnity and other wrili obl r tory in the nature thereof; and (2) to remove any such attorney -In -fact at any time and revoke the power and authority given to him or her. Attorneys -in -fact shall have power and authority, subject to the terms and limitations of the power-of-attorney issued to them, to execute and iver on behalf of the Company, and to attach the seal of the Company thereto, bonds and undertaking , r nizances, contracts of indemnity and other writings obligatory in the nature thereof, and any such instrument executed by any such attorney-in-fact sh ». be fully and in alt respects binding upon the Company. CetificaIion as to the validity of any power-of-attomey authorized herein made by an officer of Employers Mutual Casually Company shall be fully and in alt respells binding upon this Company. The facsimile or mechanically reproduced signature of such officer, whether m.r+- heretofore or hereafler, wherever appearing upon a certified copy of any power-of-attorney of the Company, shall be valid and binding upon the Company with the same force and effect as though manually affixed, IN WITNESS THEREOF, the Companies have caused th presents to be signed for each by their officers as shown, and the Corporate seals to be hereto affixed this 1st day of July , 2018 Seals Bruce G. Kelley, OEO, Ch ' < of Todd Strother C dw anies 2, 3, 4, 5 & 6; President Vice Pr ::; nt of Companies 1, 2 & 6; Treasurer of Companies 1, 2, 3, 4 & 6 On this 1st day of July,2018 before me a Notary Public In and for the State of Iowa, personally appeared ruce G. Kelley and Todd Strother, who, being by me duty sworn, did say that they are, and are known to me to be the CEO, Chairman, President and Treasurer, and/or Vice President, respectively, of each of the Compan above; that the seals affixed to this instrument are the seals of said corpora ; that said instrument was signed and sealed on behalf of ch of the Compan .. by authority of their respective Boards of Directors; and that the said Bruce G. Kelley and Todd Strother, as such officers, acknowledged the execution of said instrument to be their voluntary act and deed, and 4•, voluntary act and deed of each of the Companies. My Commission Expires October 10, 2022. CERTIFICATE I, James D. CIough, Vice Pr.,W of the Companies, do hereby certify that the for this Power of Attorney pursuant thereto on 1st day of July , 2018 , ar Notary Pubf! in and for the State lova ng resolution of the Boards of Directors by each of the Companies, and true and correct and are still in full force and effect. In Testimony Whereof I have subscribed my name and affixed the facsimile seal of each Company this mm 29th day of June 2020 Vice President 7838 (9-19) 0000000 W6340 000 SSE 000000-00 "For verification of the authenticity of the Power of Attorney you may call (515) 345-; • RAZZCONS1 ACORDTM CERTIFICATE OF LIABILITY INSURANCE M/DDN 6/26DATE (MM/DD/YYYY) /2020 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER Propel Insurance Seattle Commercial Insurance 601 Union Street, Suite 3400 Seattle, WA 98101-1371INSURER CONTACT Rainey Lindholm PHONE 800 499-0933 FAX (A/c, No, Ext): (A/C, No): 866 577-1326 E-MAILDSS: rainey.Iindholm@propelinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # A : American Guarantee and Liability Ins.Co 26247 INSURED Razz Construction, Inc. 4055 Hammer Drive Bellingham, WA 98226 INSURER B : Navigators Specialty Insurance Company 36056 C : Alaska National Insurance Company 38733 INSURER D : Westchester Surplus Lines Insurance Co. P 10172 INSURER E : Zurich American Ins Co $100,000 INSURER F : CLAIMS -MADE I X I OCCUR COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 CONTRACTOR 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP ,(MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY GLA027223003 11/30/2019 11/30/2020 EACHOCCURRENCE$1,000,000 PREMISS IEa occur ence) $100,000 CLAIMS -MADE I X I OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE POLICY OTHER: X LIMIT APPLIES PER: PRO- JECT 1 LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE X X LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY _ X SCHEDULED AUTOS NON -OWNED AUTOS ONLY GLA027223003 11/30/2019 11/30/2020 IEaOMBaccidINEDent)SILIMIT $ 000 000NGLE 1, e BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B x UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE SE19EXC891790IC 11/30/2019 11/30/2020 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 $ DED X RETENTION $NOne E C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ECUTIVE OFFICER/MEMBER ER PROPRIETOR/PARTNER/EXECUTIVE (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below YN N / A WC3088749 19KWU09206 USLH Inclds WA Stop Gap 11/30/2019 11/30/2019 11/30/2020 11/30/2020 STATE ITF FORH E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1 ,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 D Pollution Llab G2819139A004 11/30/2019 11/30/2020 $1,000,000 Occurrence $2,000,000 Aggregate $5,000 Deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space Is requ red) The General Liability, Auto Liability and Umbrella Liability policies include a blanket automatic additional insured endorsement that provides additional insured status only when there is a written contract between the named insured and the entity that requires such status. RE: Boeing Access Road over Airport Way Bridge Seismic Retrofit Project The City of Tukwila is included as additional insured per the attached. CERTIFICATE HOLDER CANCELLATION City of Tukwila Public Works Department Tukwila City Hall 6200 Southcenter Boulevard Tukwila, WA 98188 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) 1 Of 1 #S4184587/M3924582 © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JMT00 Additional Insured — Automatic — Owners, Lessees Or Contractors ZURICH Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. Add'I. Prem Return Prem. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured: Address (including ZIP Code): This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. Section II — Who Is An Insured is amended to include as an additional insured any person or organization whom you are required to add as an additional insured on this policy under a written contract or written agreement. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf, in the performance of your ongoing operations or "your work" as included in the "products -completed operations hazard", which is the subject of the written contract or written agreement. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to: "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services including: a. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. U -GL -1175-F CW (04/13) Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Waiver Of Subrogation (Blanket) Endorsement ZURICH Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer Add'l. Prem Return Prem. GLA027223003 11/30/2019 11/30/2020 Propel Insurance $ $ THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition: If you are required by a written contract or agreement, which is executed before a Loss, to waive your rights of recovery from oth- ers, we agree to waive our rights of recovery. This waiver of rights shall not be construed to be a waiver with respect to any other operations in which the insured has no contractual interest. U -GL -925-B CW (12/01) Page 1of1 Coverage Extension Endorsement ZURICH'�� Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. Add'I. Prem Return Prem. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Business Auto Coverage Form Motor Carrier Coverage Form A. Amended Who Is An Insured 1. The following is added to the Who Is An Insured Provision in Section II — Covered Autos Liability Coverage: The following are also "insureds": a. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow for acts performed within the scope of employment by you. Any "employee" of yours is also an "insured" while operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your permission, while performing duties related to the conduct of your business. b. Anyone volunteering services to you is an "insured" while using a covered "auto" you don't own, hire or borrow to transport your clients or other persons in activities necessary to your business. c. Anyone else who furnishes an "auto" referenced in Paragraphs A.1.a. and A.1.b. in this endorsement. d. Where and to the extent permitted by law, any person(s) or organization(s) where required by written contract or written agreement with you executed prior to any "accident", including those person(s) or organization(s) directing your work pursuant to such written contract or written agreement with you, provided the "accident" arises out of operations governed by such contract or agreement and only up to the limits required in the written contract or written agreement, or the Limits of Insurance shown in the Declarations, whichever is less. 2. The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other Insurance — Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form: Coverage for any person(s) or organization(s), where required by written contract or written agreement with you executed prior to any "accident", will apply on a primary and non-contributory basis and any insurance maintained by the additional "insured" will apply on an excess basis. However, in no event will this coverage extend beyond the terms and conditions of the Coverage Form. B. Amendment — Supplementary Payments Paragraphs a.(2) and a.(4) of the Coverage Extensions Provision in Section II — Covered Autos Liability Coverage are replaced by the following: (2) Up to $5,000 for the cost of bail bonds (including bonds for related traffic law violations) required because of an "accident" we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day because of time off from work. U -CA -424-F CW (04-14) Page 1 of 6 Includes copyrighted material of Insurance Services Office, Inc., with its permission. (1) Other than collision only if the Declarations indicate that Comprehensive Coverage is provided for any covered "auto"; (2) Specified Causes Of Loss only if the Declarations indicate that Specified Causes Of Loss Coverage is provided for any covered "auto"; or (3) Collision only if the Declarations indicate that Collision Coverage is provided for any covered "auto". However, the most we will pay for any expenses for loss of use is $100 per day, to a maximum of $3000. I. Personal Effects Coverage The following is added to the Coverage Provision of the Physical Damage Coverage Section: Personal Effects Coverage a. We will pay up to $750 for "loss" to personal effects which are: (1) Personal property owned by an "insured"; and (2) In or on a covered "auto". b. Subject to Paragraph a. above, the amount to be paid for "loss" to personal effects will be based on the lesser of: (1) The reasonable cost to replace; or (2) The actual cash value. c. The coverage provided in Paragraphs a. and b. above, only applies in the event of a total theft of a covered "auto". No deductible applies to this coverage. However, we will not pay for "loss" to personal effects of any of the following: (1) Accounts, bills, currency, deeds, evidence of debt, money, notes, securities, or commercial paper or other documents of value. (2) Bullion, gold, silver, platinum, or other precious alloys or metals; furs or fur garments; jewelry, watches, precious or semi-precious stones. (3) Paintings, statuary and other works of art. (4) Contraband or property in the course of illegal transportation or trade. (5) Tapes, records, discs or other similar devices used with audio, visual or data electronic equipment. Any coverage provided by this Provision is excess over any other insurance coverage available for the same "loss". J. Tapes, Records and Discs Coverage 1. The Exclusion in Paragraph B.4.a. of Section III — Physical Damage Coverage in the Business Auto Coverage Form and the Exclusion in Paragraph B.2.c. of Section IV — Physical Damage Coverage in the Motor Carrier Coverage Form does not apply. 2. The following is added to Paragraph 1.a. Comprehensive Coverage under the Coverage Provision of the Physical Damage Coverage Section: We will pay for "loss" to tapes, records, discs or other similar devices used with audio, visual or data electronic equipment. We will pay only if the tapes, records, discs or other similar audio, visual or data electronic devices: (a) Are the property of an "insured"; and (b) Are in a covered "auto" at the time of "loss". The most we will pay for such "loss" to tapes, records, discs or other similar devices is $500. The Physical Damage Coverage Deductible Provision does not apply to such "loss". U -CA -424-F CW (04-14) Page 3 of 6 Includes copyrighted material of Insurance Services Office, Inc., with its permission. agent, servant or employee of the "insured" to notify us of any "accident", claim, "suit" or "loss" shall not invalidate the insurance afforded by this policy. Include, as soon as practicable: (1) How, when and where the "accident" or "loss" occurred and if a claim is made or "suit" is brought, written notice of the claim or "suit" including, but not limited to, the date and details of such claim or "suit"; (2) The "insured's" name and address; and (3) To the extent possible, the names and addresses of any injured persons and witnesses. If you report an "accident", claim, "suit" or "loss" to another insurer when you should have reported to us, your failure to report to us will not be seen as a violation of these amended duties provided you give us notice as soon as practicable after the fact of the delay becomes known to you. P. Waiver of Transfer Of Rights Of Recovery Against Others To Us The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition: This Condition does not apply to the extent required of you by a written contract, executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of operations contemplated by such contract. This waiver only applies to the person or organization designated in the contract. Q. Employee Hired Autos — Physical Damage Paragraph b. of the Other Insurance Condition in the Business Auto Coverage Form and Paragraph f. of the Other Insurance — Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form are replaced by the following: For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented under a written contract or written agreement entered into by an "employee" or elected or appointed official with your permission while being operated within the course and scope of that "employee's" employment by you or that elected or appointed official's duties as respect their obligations to you. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". R. Unintentional Failure to Disclose Hazards The following is added to the Concealment, Misrepresentation Or Fraud Condition: However, we will not deny coverage under this Coverage Form if you unintentionally: (1) Fail to disclose any hazards existing at the inception date of this Coverage Form; or (2) Make an error, omission, improper description of "autos" or other misstatement of information. You must notify us as soon as possible after the discovery of any hazards or any other information that was not provided to us prior to the acceptance of this policy. S. Hired Auto — World Wide Coverage Paragraph 7a.(5) of the Policy Period, Coverage Territory Condition is replaced by the following: (5) Anywhere in the world if a covered "auto" is leased, hired, rented or borrowed for a period of 60 days or less, T. Bodily Injury Redefined The definition of "bodily injury" in the Definitions Section is replaced by the following: "Bodily injury" means bodily injury, sickness or disease, sustained by a person including death or mental anguish, resulting from any of these at any time. Mental anguish means any type of mental or emotional illness or disease. U -CA -424-F CW (04-14) Page 5 of 6 Includes copyrighted material of Insurance Services Office, Inc., with its permission. P-1 PROPOSAL (unit price) Contractor's Name Razz Construction, Inc. Contractor's State License No. RAZZCCI955KU City of Tukwila Project No. 91310407 To the Mayor and City Council City of Tukwila, Washington The undersigned (Bidder) hereby certifies that he personally examined the location and construction details of Work outlined in the Contract Documents for the City of Tukwila (Owner) project titled S BOEING ACCESS ROAD OVER AIRPORT WAY BRIDGE SEISMIC RETROFIT PROJECT, which project includes but is not limited to construction of new approach a|mbo, catcher b|ooka. girder stops, concrete bolstmrs, and steel column jackets at the S Boeing Access Road Over Airport Way Bridge; and has read and thoroughly understands these Documents which govern all Work embraced in thisimprovement and the methods by which payment will be made for said Work, and thoroughly understands the nature of said Work; and hereby proposes to undertake and complete all Work embraced in this improvement in accordance with these Contract Documents and at the following schedule of rates and prices. The Bidder understands that the quantities mentioned herein are approximate only and are subject to increase or decroesw, and hereby proposes to perform all quantities of work as either increased or decreased in accordance with the Contract Documents. As evidence of good faith, (check one) DO bid bond or 0 cash, 0 cashier's check, 0 certified check, or 0 postal money order made payable to the City of Tukwila equal to five percent (5%) of the Total Bid Price is attached hereto. Bidder understands that, should this offer be accepted by Owner within ninety (90) catendar days after the day of Bid Opening and the Bidder falls or refuses to enter into an Agreement and furnish the required Payment and Performance Bond and liability insurance within ten (10) calendar days after Notice of Award, the Contract shall be null and void and the Bid Deposit or Bond accompanying this Proposal shall be forfeited and become the property of Owner as liquidated damages, alt as provided for in the Bid Documents. Bidder shall attain Physical Completion of all Work in all respects within 170 working days from the date stated in the written Notice to Proceed. If the work is not completed within this time pehod. Bidder shall pay liquidated damages to Owner as specified in Section 1'08.9 of the Standard Specifications for every calendar day work is not Physically Complete after the expiration of the Contract time stated above. In addition, Bidder shall compensate Owner for actuat engineering inspection and supervision costs and any other legal fees incurred by Owner as a result of such delay. nBoeing Access Road OveAirport Way Bridge Seismic Retrofit Rev. 2-2e-20 P-2 S BOEING ACCESS ROAD OVER AIRPORT WAY BRIDGE SEISMIC RETROFIT PROJECT - SCHEDULE A Project No. 91310407 Note: Unit prices for all items, all extensions, and the total amount bid must be shown. Where conflict occurs between the unit price and the total amount specified for any item, the unit price shall prevail, and totals shall be corrected to conform thereto. For Schedule A, include applicable Sales Tax in the various Unit and Lump Sum prices. Item No. Item Description Quantity Unit Unit Price Amount BRIDGE 1. Mobilization 1 LS $ I Li Y/000. co 4; /LN0c0.00 2. Structure Surveying 1 LS Sla,C,00 A4, 0 00. cy:, 3. Type B Progress Schedule 1 LS /C60"' !t?.. 2„CC,0 4. Unexpected Site Changes Est FA $25,000.00 $25,000.00 5. Resolution of Utility Conflicts Est FA $30,000.00 $30,000.00 6. As -Built Recording 1 LS $ , GCOC.C) $ 1,6co, m 7. Contractor's Daily Diary 1 LS £ (0,,c,cefe, 4,a, 8. Reinbursement for Third Party Damage Est FA $25,000.00 $25,000.00 9. SPCC Plan 1 LS Ea/ z 3 aieso. Cc) 10. Portable Illumination 4 EA : '. " OCD A; 0...\ i aa,c7 00 11. Contractor Provided Uniformed Police Officers 120 HR $105,60 la_i tete,C)-0e) 12. Traffic Control Supervisor 1 LS $7, (400,C0d7V CO 13. Temporary Erosion & Sediment Control and Water Pollution Prevention (including SWPPP Implementation) 1 LS tat 043t9 02) ek..i.,, . , 14. Project Temporary Traffic Control 1 LS 3(423, .500 Ct t3 (423, 603 , ec 15. Removal of Structures and Obstructions 1 LS4;a4.5(00C).6)-& "Sa5/300, C70 16. Structure Excavation Class A Incl. Haul 200 CY (ft raO,CC) $ d4,CGC)C67,,, 17. Shoring or Extra Excavation Cl. A 1 LS 18. Crushed Surfacing Base Course 30 TON $ ‘i4,00 $ 750. Cr? 19. Work Platform and Containment System 1 LS k \t ;CO tl,a-i6 'LO. DO 20. Conc. Class 4000 for Bridge 28 CY C a4000.CV \SS C., , ())�C 21. St. Reinf. Bar for Bridge 3900 LB. 1 \ ,e-70. S -7,9flotv 22. Expansion Joint System Compression Seal - Superstr. 115 LF $ 0)300 L i 23. Bridge Approach Slab 342 SY 1 L g6,(x) //5,, , $. 24. Transverse Stop Bearing 16 EA $ 3G9.co ty 80)a Co 25. Epoxy Dowels 580 EA 0 tq OD A WO_ OC.„) 26. Column Jacketing 1 LS '`V.393, 27. Drain Pipe 4 In. Diam. 70 LF $1()0 bC," $ 7 000, C)6) S Boeing Access Road Over Airport Way Bridge Seismic Retrofit Rev. 2-28-20 Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal Proposal P-3 ROADWAY 28. FA -Site Cleanup of Bio. and Physical Hazards Est FA $15,000.00 $15,000.00 29. Roadside Cleanup Est FA $15,000.00 $15,000.00 30. Property Restoration Est FA $15,000.00 $15,000.00 Schedule A Total $ � y qt2505. O TOTAL BID PRICE $ S Boeing Access Road Over Airport Way Bridge Seismic Retrofit Rev. 5-13-14 Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal P-4 Bids Submitted on Computer Printouts Bidders, at their option, in lieu of hand writing in the unit prices in figures in ink on the Bid forms above, may submit an original computer printout sheet with their bid, as long as the following requirements are met: 1. Each sheet of the computer printout must contain the exact same information as shown on the hard -copy bid form — Project Name, Schedule Name, column headings — in the order shown, totals, etc. 2. The computer printout of the Bid Proposal must have the exact certification language shown below, signed by the appropriate officer of the firm. 3. If a computer printout is used, the bidder must still execute that portion of the unit price Bid form which acknowledges the Bid Guaranty, Time of Completion, and all addenda that may have been issued, etc. If any of these things are missing or out of order, the bid may be rejected by the Owner. The unit and lump sum prices shown on acceptable printouts will be the unit prices used to tabulate the Bid and used in the Contract if awarded by the City. In the event of conflict between the two, unit Bid prices will prevail over the extended (Total) prices. If the Bid submitted by the bidder contains both the form on these Bid Proposal sheets, and also a computer printout, completed according to the instructions, the unit bid prices shown on the computer printout will be used to determine the bid. Put this certification on the last sheet of the Bid computer printout, and sign: (YOUR FIRM'S NAME) certifies that the unit prices shown on this complete computer print-out for all of the bid items contained in this Proposal are the unit and lump sum prices intended and that its Bid will be tabulated using these unit prices and no other information from this print-out. (YOUR FIRM'S NAME) acknowledges and agrees that the total bid amount shown will be read as its total bid and further agrees that the official total Bid amount will be determined by multiplying the unit Bid prices shown in this print-out by the respective estimated quantities shown on the Bid form then totaling all of the extended amounts. Signed: Title: Date: S Boeing Access Road Over Airport Way Bridge Seismic Retrofit Rev. 2-28-20 Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal Proposal P-5 By signing below, Bidder acknowledges receipt and understanding of the following Addenda to the Bid Documents: Addendum No. 1 2 Date of Receipt Addendum No. 3/11/2020 3 3/18/2020 4 Date of Receipt 3/31/2020 NOTE: Failure to acknowledge receipt of Addenda may be considered as an irregularity in the Bid Proposal and Owner reserves the right to determine whether the bid will be disqualified. By signing below, Bidder certifies that Bidder has reviewed the insurance provisions of the Bid Documents and will provide the required coverage. It is understood that Owner may accept or reject all bids. The Surety Company which will furnish the required Payment and Performance Bond is Employers Mutual Casualty Company of PO Box 712, Des Moines, Iowa 50306 (Name) (Address) Bidder: Razz Construction, Inc. Signature of Authorized Official: Printed Name and Title: Address: Circle One: Individual / Partnership / Joint Venture Donald A. Rasmussen) Fc f \ cQ )[ >s--- 4055 Hammer Drive, Bellingham WA 98226 Corporation Phone No.: 360-752-0011 ext. 102 State of Incorporation: Washington Date: 4/7/2020 This address and phone number is the one to which all communications regarding this proposal should be sent. NOTES: 1. If the Bidder is a co -partnership, give firm name under which business is transacted; proposal must be executed by a partner. If the Bidder is a corporation, proposal must be executed in the corporate name by the president or vice-president (or any other corporate officer accompanied by evidence of authority to sign). 2. A bid must be received on all items. If either a unit price or an extension is left blank (but not both) for a bid item, the Owner will multiply or divide the available entry by the quantity, as applicable, and enter it on the bid form. If there is no unit price or extension for one or more bid item(s), the proposal will be rejected. 5 Boeing Access Road Over Airport Way Bridge Seismic Retrofit Rev. 5-13-14 Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal P-6 BID SECURITY Bid Deposit: The undersigned Principal hereby deposits a Bid Deposit with the City of Tukwila in the form of a cash deposit, certified or cashier's check, or postal money order in the amount of dollars ($ ). -- OR -- Bid Bond: The undersigned, Razz Construction Inc. (Principal), and Employers Mutual Casualty Company (Surety), are held and firmly bound unto the City of Tukwila (Owner) in the penal sum of Five percent (5%) of Bid Amount dollars ($ 5% of Bid Amount ), which for the payment of which Principal and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally. The liability of Surety under this Bid Bond shall be limited to the penal sum of this Bid Bond. Conditions: The Bid Deposit or Bid Bond shall be an amount not less than five percent (5%) of the total bid, including sales tax and is submitted by Principal to Owner in connection with a Proposal for S BOEING ACCESS ROAD OVER AIRPORT WAY BRIDGE SEISMIC RETROFIT PROJECT, Project No. 91310407, according to the terms of the Proposal and Bid Documents. Now therefore, a. If the Proposal is rejected by Owner, or b. If the Proposal is accepted and Principal shall duly make and enter into an Agreement with Owner in accordance with the terms of the Proposal and shall furnish a bond for the faithful performance of said Project and for the payment of all persons performing labor or furnishing materials in connection therewith, with Surety or Sureties approved by Owner, then this Bid Security shall be released; otherwise it shall remain in full force and effect and Principal shall forfeit the Bid Deposit or Surety shall immediately pay and forfeit to Owner the amount of the Bid Bond, as penalty and liquidated damages. The obligations of Surety and its Bid Bond shall be in no way impaired or affected by any extension of time within which Owner may accept bids; and Surety does hereby waive notice of any such extension. Signed and dated this 24th Razz Construction Inc. day of March Principal Signature of Authorized Offic (-46\619-WW Title Name and address of local office of agent and/or Surety Company: , 20 20 Employers Mutual Casualty Company Surety By ag--- 3.t Attorney in Fact (Attach Power of Attorney) Aliceon A. Keltner Propel Insurance 601 Union St, Suite 3400 Seattle, WA 98101 Surety companies executing bonds must appear on the current Authorized Insurance List in the State of Washington per Section 1-02.7 of the Standard Specifications. S Boeing Access Road Over Airport Way Bridge Seismic Retrofit Rev. 2-28-20 P.O. Box 712 • Des Moines, Iowa 50306-0712 EMC INSURANCE POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT KNOW ALL MEN BY THESE PRESENTS, that: 1. Employers Mutual Casualty Company, an Iowa Corporation 2. EMCASCO Insurance Company, an Iowa Corporation 3. Union Insurance Company of Providence, an Iowa Corporation 4. Illinois EMCASCO Insurance Company, an Iowa Corporation 5. Dakota Fire Insurance Company, a North Dakota Corporation 6. EMC Property & Casualty Company, an Iowa Corporation hereinafter referred to severally as "Company" and collectively as "Companies", each does, by these presents, make, constitute and appoint: ALICEON A. KELTNER its true and lawful attomey-in-fact, with full power and authority conferred to sign, seal, and execute the Surety Bond: Any and All Bonds and to bind each Company thereby as fully and to the same extent as if such instruments were signed by the duly authorized officers of each such Company, and all of the acts of said attorney pursuant to the authority hereby given are hereby ratified and confirmed. The authority hereby granted shall expire April 1st 2021 , unless sooner revoked. AUTHORITY FOR POWER OF ATTORNEY This Power -of -Attorney is made and executed pursuant to and by the authority of the following resolution of the Boards of Directors of each of the Companies at the first regularly scheduled meeting of each company duly called and held in 1999: RESOLVED: The President and Chief Executive Officer, any Vice President, the Treasurer and the Secretary of Employers Mutual Casualty Company shall have power and authority to (1) appoint attorneys -in -fact and authorize them to execute on behalf of each Company and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof; and (2) to remove any such attomey-in-fact at any time and revoke the power and authority given to him or her. Attorneys -in -fact shall have power and authority, subject to the terms and limitations of the power-of-attomey issued to them, to execute and deliver on behalf of the Company, and to attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof, and any such instrument executed by any such attorney-in-fact shall be fully and in all respects binding upon the Company. Certification as to the validity of any power-of-attorney authorized herein made by an officer of Employers Mutual Casualty Company shall be fully and in all respects binding upon this Company, The facsimile or mechanically reproduced signature of such officer, whether made heretofore or hereafter, wherever appearing upon a certified copy of any power-of-attorney of the Company, shall be valid and binding upon the Company with the same force and effect as though manually affixed. IN WITNESS THEREOF, the Companies have caused these presents to be signed for each by their officers as shown, and the Corporate seals to be hereto affixed this 1st day of July , 2018 • Seals pSO�,. S,,R9y ,' z: SEAL • / :w: SEAL 4 Rra . G 9.� i '1 a-� fd •r-1-. 1953 : 0. o ,, ,,OJd1 Bruce G. Kelley, Companies 2, 3, of Companies 1, Companies 1, 2, (tEO, Ch • ` ' an of 4, 5 & 6; President 2 & 6; Treasurer of 3,4&6 Todd Strother Vice President On this 1st day of July,2018 before me a Notary Public in and for the State of Iowa, personally appeared Buce G. Kelley and Todd Strother, who, being by me duly sworn, did say that they are, and are known to me to be the CEO, Chairman, President and Treasurer, and/or Vice President, respectively, of each of the Companies above; that the seals affixed to this instrument are the seals of said corporations; that said instrument was signed and sealed on behalf of each of the Companies by authority of their respective Boards of Directors; and that the said Bruce G. Kelley and Todd Strother, as such officers, acknowledged the execution of said instrument to be their voluntary act and deed, and the voluntary act and deed of each of the Companies. My Commission Expires October 10, 2022. oribALit Nota Publ i Notary n and for the State •{ Iowa CERTIFICATE I, James D. Clough, Vice President of the Companies, do hereby certify that the foregoing resolution of the Boards of Directors by each of the Companies, and this Power of Attorney issued pursuant thereto on 1st day of July , 2018 , are true and correct and are still in full force and effect In Testimony Whereof I have subscribed my name and affixed the facsimile seal of each Company this 24th day of March , 2020 . J Vice President 7838 (9-19) 0000000 W6340 000 SSE 000000-00 "For verification of the authenticity of the Power of Attorney you may call (515) 345.2689." P-7 NON -COLLUSION DECLARATION STATE OF WASHINGTON ) ) ss. COUNTY OF KING ) The undersigned, being first duly sworn, on oath states that the person, firm, association, partnership, joint venture, or corporation named in the Bid Proposal has (have) not, either directly or indirectly, entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free competitive bidding in connection with the City of Tukwila project named S BOEING ACCESS ROAD OVER AIRPORT WAY BRIDGE SEISMIC RETROFIT PROJECT, Project No. 91310407. Razz Construction, Inc. Name of Firm Signature of Authorized Official President Title Signed and sworn to before me on this day of , 20',c• Signature of Notary Public in and for the State of Washington, residing at My appointment expires: /6/WPag2) SEAL To report bid rigging activities call: NOTICE TO ALL BIDDERS 1-800424-9071 A► w .A. _AV A ...., w AS, SABRINA DELZELL Notary Public State of Washington Commission # 20100811 My Comm. Expires Oct 8, 2023 The U.S. Department of Transportation (USDOT) operates the above toll-free "hotline" Monday through Friday, 8:00 a.m. to 5:00 p.m., eastern time. Anyone with knowledge of possible bid rigging, bidder collusion, or other fraudulent activities should use the "hotline" to report such activities. The "hotline" is part of USDOT's continuing effort to identify and investigate highway construction contract fraud and abuse and is operated under the direction of the USDOT Inspector General. All information will be treated confidentially and caller anonymity will be respected. S Boeing Access Road Over Airport Way Bridge Seismic Retrofit Rev. 2-28-20 Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal Failure to return this Declaration as part of the bid proposal package will make the bid nonresponsive and ineligible for award. NON -COLLUSION DECLARATION I, by signing the proposal, hereby declare, under penalty of perjury under the laws of the United States that the following statements are true and correct: 1. That the undersigned person(s), firm, association or corporation has (have) not, either directly or indirectly, entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free competitive bidding in connection with the project for which this proposal is submitted. 2. That by signing the signature page of this proposal, I am deemed to have signed and to have agreed to the provisions of this declaration. NOTICE TO ALL BIDDERS To report rigging activities call: 1-800-424-9071 The U.S. Department of Transportation (USDOT) operates the above toll-free "hotline" Monday through Friday, 8:00 a.m. to 5:00 p.m., eastern time. Anyone with knowledge of possible bid rigging, bidder collusion, or other fraudulent activities should use the "hotline" to report such activities. The "hotline" is part of USDOT's continuing effort to identify and investigate highway construction contract fraud and abuse and is operated under the direction of the USDOT Inspector General. All information will be treated confidentially and caller anonymity will be respected. SR DOT 0F7o/r2m012172-0361 EF Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal Disadvantaged Business Enterprise Utilization Certification To be eligible for Award of this Contract the Bidder shall fill out and submit, as a supplement to its sealed Bid Proposal, a Disadvantaged Business Enterprise (DBE) Utilization Certification. The Contracting Agency shall consider as non- responsive and shall reject any Bid Proposal that does not contain a DBE Utilization Certification which properly demonstrates that the Bidder will meet the DBE participation requirements in one of the manners provided for in the proposed Contract. Refer to the instructions on Page 2 when filling out this form or the Bid may be rejected. An example form has been provided on Page 3. The successful Bidder's DBE Utilization Certification shall be deemed a part of the resulting Contract. Box 1: Razz Construction, Inc. certifies that the DBE firms listed below have been contacted regarding participation on this project. If this Bidder is successful on this project and is awarded the Contract, it shall assure that subcontracts or supply agreements are executed with named DBEs. (If necessary, use additional sheets.) Box 2- € • 40 - a .111•)r- , .0, 0, • Re ir Column 1 Name of DBE (See instructions) J Column 2 Project Role (See instructions) Column 3 Description of Work (See instructions) J Column 4 Dollar Amount Subcontracted to DBE (See instructions) Column 5 Dollar Amount to be Applied Towards Goal (See instructions) -6, ' ' \\,, a 5(), 0 c/%60 966 Ce 116 ,'1\12.6, M.0) cC-thre, iti, S 11/1 $ l'El 5 /77 C,C, cc Disadvantaged Business Enterprise Total DBE Commitment o ar rnoun Z., Condition of Award Contract Goal Box 3 5 By checking Box 5 the Bidder is stating that their attempts to solicit sufficient DBE participation to meet the OA Contract goal has been unsuccessful and good faith effort will be submitted in accordance with Section 1-02.9 of the Contract Box 4 DOT Form 272-056 Provided tc!lEgn.gqiIPPAPchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal Instructions for Disadvantaged Business Enterprise Utilization Certification Form Box 1: Name of Bidder (Proposal holder) submitting Bid. Box 2: Name of the Project. Column 1: Name of the Disadvantaged Business Enterprise (DBE). DBE firms can be found using the Diversity Management and Compliance System web page: haps://wsdot.diversitycoml liance.co50, Repeat the name of the DBE for each Project Role that will be performed. Column 2: The Project Role that the DBE will be performing as follows; • Prime Contractor • Subcontractor • Subcontractor (Force Account) • Work sublet as Force Account must be listed separately. • Manufacturer • Regular Dealer • Work sublet to a Regular Dealer must be listed separately. • Regular Dealer status must be approved prior to Bid submittal by the Office of Equal Opportunity, Washington State Department of Transportation, on each Contract. • Broker • Work sublet to a Broker must be listed separately. List each project role to be performed by a single DBE individually on a separate row. The role is used to determine what portion of the amount to be subcontracted (Column 4) may be applied toward meeting the goal (column 5). Column 3: Provide a description of work to be performed by the DBE. The work to be performed must be consistent with the Certified Business Description of the DBE provided at the Diversity Management and Compliance System web page https:/lwsdot.diversit comoliance.com • A Bidder subletting a portion of a bid item shall state "Partial" and describe the Work that is included. • For example; "Electrical (Partial) — Trenching". • "Mobilization" will not be accepted as a description of Work. Column 4: List the total amount to be subcontracted to each DBE for each Project Role they are performing. Column 5: This is the dollar amount for each line listed in the certification that the prime intends to apply towards meeting the COA Contract goal. It may be that only a portion of the amount subcontracted to a DBE in Column 4 is eligible to be credited toward meeting the goal See Note 1, Note 2, Note 3. The Contracting Agency will utilize the sum of this column (Box 4) to determine whether or not the bidder has met the goal. In the event of an arithmetic error in summing column 5 or an error in making appropriate reductions in the amounts in column four, See Note 1, Note 2, Note 3, then the mathematics will be corrected and the total (Box 4) will be revised accordingly. Note 1: For Work sublet as Force Account the bidder may only claim 50% of the amount subcontracted (Column 4) towards meeting the goal (Column 5). This information will be used to demonstrate that the DBE contract goal is met at the time that the bidder submits their bid. For example; amount sublet as force account = $100,000 (Column 4) equates to ($100,000 X 50%) _ $50,000 (Column 5) to be applied towards the goal, Note 2: For Work sublet to a Regular Dealer the bidder may only claim 60% of the cost of the materials or supplies (Column 4) towards meeting the goal (Column 5). For example; Material cost = $100,000 (Column 4) equates to ($100,000 X 60%) = $60,000 (Column 5) to be applied towards the goal Note 3: For Work sublet to a Broker the bidder may only claim the fees paid to a Broker towards meeting the goal (Column 4). For example; amount sublet to a broker = $100,000 (Column 4) equates to ($100,000 X reasonable fee %) = $ (Column 5) to be applied towards the goal. Box 3: Box 3 is the COA Contract goal which is the minimum required DBE participation. The goal stated in the Contract will be in terms of a dollar amount or a percentage in the Contract. When expressed as a percentage you must multiply the percentage times the sum total of all bid items as submitted in the Bidder's Proposal to determine the dollar goal and write it in Box 3. In the event of an error in this box, the Contracting Agency will revise the amount accordingly. Box 4: Box 4 is the sum of the values in column 5. This value must equal or exceed the COA Contract goal amount written in Box 3 or; Box 5: Check Box 5 if insufficient DBE Participation has been achieved and a good faith effort is required. Refer to the subsection titled, Selection of Successful Bidder/Good Faith Efforts (GFE) in the Contract. See the Disadvantaged Business Enterprise Participation specification in the Contract for more information. DOT FormFR272-056 RR Provided tcFUI951E ��Lchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal Disadvantaged Business Enterprise Utilization Certification To be eligible for Award of this Contract the Bidder shall fill out and submit, as a supplement to its sealed Bid Proposal, a Disadvantaged Business Enterprise (DBE) Utilization Certification. The Contracting Agency shall consider as non- responsive and shall reject any Bid Proposal that does not contain a DBE Utilization Certification which properly demonstrates that the Bidder will meet the DBE participation requirements in one of the manners provided for in the proposed Contract. Refer to the instructions on Page 2 when filling out this form or the Bid may be rejected. An example form has been provided on Page 3. The successful Bidder's DBE Utilization Certification shall be deemed a part of the resulting Contract. Box 1: A Plus Construction Company certifies that the DBE firms listed below have been contacted regarding participation on this project. If this Bidder is successful on this project and is awarded the Contract, it shall assure that subcontracts or supply agreements are executed with named DBEs. (If necessary, use additional sheets.) Box 2: US 395, Spokane City Limits to Stevens County Line - Paving and Safety Column 1 Name of DBE (See instructions) Column 2 Project Role (See instructions) Column 3 Description of Work (See instructions) Column 4 Dollar Amount Subcontracted to DBE (See instructions) Column 5 Dollar Amount to be Applied Towards Goal (See instructions) A Plus Construction Company Prime Asphalt and concrete paving, asphalt milling, preleveling and pavement repair N/A 900,000 In the Line Services, Inc. Subcontractor (Force Account) Crack sealing 20,000 10,000 In the Line Services, Inc. Subcontractor Guideposts, joint seal, pavement markers, temporary signage, construction sign installation 200,000 200,000 The Everything Guys, LLC Regular Dealer Rental and sales of highway construction and related equipment and materials 100,000 60,000 Optimus Prime Trucking, Inc. Subcontractor Dump Trucking 50,000 50,000 Metalheads, Inc. Manufacturer Dowel Bars 75,000 75,000 Erosion Under Control Co. Broker Erosion control blankets, straw bales and wattles, sand bags 15,000 250 .'41\1C)V.'V) 'V4i'lltIS"' Disadvantaged Business Enterprise 356,968.16 Condition of Award Contract Goal Box 3 Total DBE Commitment Dollar Amount 1,295, Box 4 5�By checking Box 5 the Bidder is stating that their attempts to solicit sufficient DBE participation to meet the OA Contract goal has been unsuccessful and good faith effort will be submitted in accordance with Section 1-02.9 of the Contract DOT Form 272-056 Provided to .119102s° change of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal P-17 RESPONSIBLE BIDDER DETERMINATION FORM Attach additional .sheets as necessary to fully provide the information required Name of Bidder: Razz Construction, Inc. Address of Bidder: 4055 Hammer Drive Bellingham WA 98226 City State Zip Code Contractor's License No. RAZZCCI955KU WA State UBI No. 602504498 License Bond Registration No. S442706 Dept. of L&I Worker's Comp. Acct. No. 846,666-01 Bidder is a(n): 0 Individual 0 Partnership 0 Joint Venture Igl Incorporated in the state of WA List business names used by Bidder during the past 10 years if different than above: Razz Construction, Inc. Bidder has been in business continuously from Bank Reference First Federal Bank 14 Year Brian Feller Account Officer 360-714-6805 Officer's Phone No. No. of regular full-time employees: 39 Number of projects in the past 10 years completed: _ ahead of schedule X on schedule behind schedule Bidder has had experience in work comparable to that required for this Project: As a prime contractor for 14 years. As a subcontractor for years. List the supervisory personnel to be employed by the Bidder and available for work on this project (Project Manager, Principal Foreman, Superintendents, and Engineers): Name Title How Lonq With Bidder Lo 2.z10 My pia -Tr s�� ,.1�- �` y S Boeing Access Road Over Airport Way Bridge Seismic Retrofit Rev. 2-28-20 Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal P-18 Name the Surveyor to be used on this Project, who will directly supervise all surveying activities. Attach a resume outlining the experience and qualifications of the Surveyor. Is the Surveyor licensed in the State of Washington (a PLS)? E Yes ❑ No Surveyor's Name: Northline Survey List all those projects, of similar nature and size, completed by Bidder within the past 10 years, including projects for meeting the Bidder's Prior Work Experience Constructing Steel Column Jacketing requirement described in Section 1-02.14 of the Special Provisions. Include a reference for each. Any attached preprinted project listing must include all this information. Bidder must have at least 10 years experience working on projects of similar nature and size. Year Contract Please See Listing Attached. Project Name Completed Amount Owner/Reference Name and Phone List all projects undertaken in the last 10 years which have resulted in partial or final settlement of the Contract by arbitration or litigation in the courts: Contract Name of Client and Project Amount San Juan County Buck Bay Bridge $609,098.00 WSDOT - Squalicum Creek Channel $1,018,935.00 Total Claims Amount of Arbitrated Settlement or Litigated of Claims -� L moo, 3e k) ±-?SI7,Cip 0 Has Bidder, or any representative or partner thereof, ever failed to complete a contract? El No 0 Yes If yes, give details: Has Bidder ever had any Payment/Performance Bonds called as IN No 0 Yes If yes, please state: a result of its work? Project Name Contracting Party Bond Amount S Boeing Access Road Over Airport Way Bridge Seismic Retrofit Rev. 2-28-20 Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal Name of Job Owner Contact Phone/ Fax Contract Amt Date Awarded West Badger Whatcom County Public Works Dept. Doug Burghart 360-778-6277 $2,076,377.55 4/10/20 Rd/Bertrand Creek Bridge No. 50 322 N. Commercial Street Suite 301 Bellingham, WA. 98225 Bridge Redeck Projects King County Road Services Donald Bleasdale 206-477-3646 $571,566.00 7/2/2019 Hannegan Rd/Ten Mile Whatcom County Public Works Dept Doug Burghart $1,117,808.00 3/23/18 Creek Bridge No 236 360-778-6277 Replacement 322 N. Commercial Street Suite 301 Bellingham, WA. 98225 Major Maintenance of City of Tukwila Steve Carstens 306-431-2446 $2,688,958.00 6/19/17 Three Bridges Project 6300 Southcenter Blvd. Suite 100 Tukwila, WA. 98188 Slater Rd -Jordan Creek Whatcom County Public Works Dept Doug Ranney 360-778-6200 $2,713,911.30 3/24/17 Fish Passage Barrier 322 N. Commercial Street Suite 301 360-778-6201 Bellingham, WA. 98225 Deer Harbor Bridge San Juan County Public Works Francois Bariault 360-370-0500 $1,817,827.20 5/3/16 Replacement 55 Second Street Friday Harbor, WA. 360-378-6405 98250 Forbes Creek Bridge City of Kirkland Tuan Phan 425-587-3828 $544,113.20 6/3/15 Seismic Retrofit 123 Fifth Ave kirkland, WA. 98033 425-587-3844 148th Ave NE Bridge City of Remond Dennis Brunelle 425-556-2713 $212,724.77 1/17/15 Seismic Upgrade 15670 NE 85th Street Redmond, WA 98073 Getchell Road Bridge WSDOT John Chi, P.E. 425-225-8740 $116,157.57 7/12/13 Seismic P.O. Box 47360 Olympia, WA. 98504 Responsible Bidder Determination Form P-19 Has Bidder ever been found guilty of violating any State or Federal employment laws? lel No ❑ Yes If yes, give details: Has Bidder ever filed for protection under any provision of the federal bankruptcy laws or state insolvency laws? E1 No ❑ Yes If yes, give details: Has any adverse legal judgment been rendered against Bidder in the past 5 years? 1 No ❑ Yes If yes, give details: Has Bidder or any of its employees filed any claims with Washington State Workman's Compensation or other insurance company for accidents resulting in fatal injury or dismemberment in the past 5 years? 1 No ❑ Yes If yes, please state: Date Type of Injury Agency Receiving Claim The undersigned warrants under penalty of Perjury that the foregoing information is true and accurate to the best of his/her knowledge. The undersigned authorizes the City of Tukwila to verify all information contained herein. Signature of Bidder Title: President Date: 4/6/2020 Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal P-20 PROPOSED EQUIPMENT AND LABOR SCHEDULE (Use additional sheets if required) Equipment to be used: DESCRIPTION/TYPE YEAR CONDITION OWN/RENT S Q'T14US L., 2010 MoD(c, zzt , 1- 9 Labor to be used: Razz Construction, Inc. Name of Bidde A Signature of Authorized Official President Title S Boeing Access Road Over Airport Way Bridge Seismic Retrofit Rev. 2-28-20 Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal P-21 PROPOSED SUBCONTRACTORS Name of Bidder Razz Construction, Inc. In accordance with RCW 39.30.060 as amended, every bid that totals $1 million or more shall include below the names of the subcontractors with whom the Bidder, if awarded the contract, will subcontract for performance of the work of: HVAC (heating, ventilation, and air conditioning); plumbing as described in chapter 18.106 RCW; and electrical as described in chapter 19.28 RCW, or to name itself for the work. The Bidder shall not list more than one subcontractor for each category of work identified, unless subcontractors vary with bid alternates, in which case the Bidder must indicate which subcontractor will be used for which alternate. Failure of the Bidder to submit as part of the bid the names of such subcontractors or to name itself to perform such work or the naming of two or more subcontractors to perform the same work shall render the prime contract bidder's bid nonresponsive and, therefore, void. The successful Bidder must have the written permission of the Owner to make any change to this list. Percent of total bid to be performed by Bidder On % Schedule/Bid Item Numbers % of Total Name Subcontractor will perform Bid HVAC Plumbing Electrical S Boeing Access Road Over Airport Way Bridge Seismic Retrofit Rev. 2-28-20 Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal Construction Inc. Letter of Transmittal TO: City of Tukwila DATE: 4/7/2020 6200 Southcenter Boulevard ATTN: Adam Cox Tukwila, WA 98188 JOB: S. Boeing Access Road Over Airport Way Bridge Seismic Retrofit RE: Supplemental Information WE ARE SENDING YOU THE FOLLOWING ITEMS: Plans Letter Contract Specs Submittals Shops Samples X Other See Below DATE PAGES COPIES DESCRIPTION 1 Disadvantage Business Enterprise Utilization Certification 272-056 1 UDBE Bid Item Breakdown Form 272-054 1 DBE Trucking Credit Form 272-058 1 PNW UDBE Written Confirmation Document 1 Twisted Metal UDBE Written Confirmation Document THESE DOCUMENTS ARE TRANSMITTED x for Approval approved as submitted Resubmit copies for approval For your use Approved as noted Submit copies for distribution As requested Return for corrections Return corrected prints Please return after loan COMMENTS: We look forward to working with you. Signed: Sabrina, Contract Administrator If enclosures are not as noted, please notify us at once. 4055 Hammer Drive Bellingham, WA 98226-7665 Ph: (360) 752-0011 Fx: (360) 752-0099 Email: cheryla@razzconstruction.com r)* dif • ... r 4 oisadvantaged siness E terprise Utilization Certification To be eligible for Award of this Contract the Bidder shall fill out and submit, as a supplement to its sealed Bid Proposal, a Disadvantaged Business -Enterprise (DBE) Utilization Certification. The Contracting Agency shall consider as non- responsive and shall reject any Bid Proposal that does not contain•a DBE Utilization Certification which properly demonstrates that the Bidder will meet the DBE participation requirements in one of the manners provided for in the proposed Contract. Refer to the instructions on Page 2 when filling out this form or the Bid may be rejected. An example form has been provided on Page 3. The successful Bidder's DBE Utilization Certification Shall be deemed a part of the resulting Contract. Box 1: Razz Construction, Inc. certifies that the DBE firms listed below have been contacted regarding participatn on this project. If this Bidder is successful on this project and is awarded the Contract, it shall assure that subcontracts or supply agreements are executed'with named DBEs. (If necessary, use additional sheets.) Box2. € • ' ' a• A • ' fp. )r - • \\, „„;,!.lb f;T5 COlOmn 1 Name of DBE (See instructions) Caumn 2. Project Wile (See:instructions) , COlUmn 3 Description of Work (See instructions) 'Column.4 •Dollar Ainount . Subcontracted •to DBE (See instructions) Column 5 Dollar Amount to be Applied Towards Goal "(See insfructions) Pijtrr-AL 1•X.P.) '-"gX tiO -‘11tt.-\fici Iberwucliaar.,0044. SU sc.Aidtiarda. R. tr'i la° QC -A 'Tel 1. 114 S-T'A (L S _ 501 67 C9 EX, 50 1 M4,0111-54 Crei(ge .c;k- CAD Lt,,, Irv. j&I 7.-4,c.k,-fr t etc_ Si/ I ,,--- 1 ,72,574 -1 to Cat ,-, 719 ,0007 ..rwl,577-a-P )1"7 ei-4A C. . , 41 Disadvantaged Business Enterprise 6 Total.DBE Commitment Dollar AmOunt 0 , to (s7 Condition of Award Contract Goal Box 3 Box 4 5 By checking Box 5 the Bidder is stating that their attempts to solicit sufficient DBE participation to meet the OA Contract goal has: been unsuccessful and gobd faith effort will be submitted in accordance with Section 1-02.9 of the Contract DOT Form 272-056 rovided tcf%villcicHR2c)Rehange of WA, Inc, For usage Conditions Agreement see www.bxwa.com - Always Verify Scal Instructio s for Disadvantaged .Business Enter. rise Utilization Certification Form Box 1: Name of Bidder (Proposal holder) submitting Bid. Box 2: Name of the Project. Column 1: Name of the Disadvantaged Business Enterprise (DBE). DBE firms can be found using the Diversity Management and Compliance System web page: https://wsdot.diversitycompiiance.com. Repeat the nameof the DBE for each. ProjectRole that will be performed. Column "2`. The Project Role that the DBE will .be performing as follows; • Prime Contractor • Subcontractor • Subcontractor (Force Account) • Work sublet as Force Adcount must be listed separately. Manufacturer • Regular Dealer • Work sublet to a Regular Dealer must be listed separately. • Regular Dealer status must be approved prior to Bid submittal by the Office of Equal Opportunity, Washington State Department of Transportation, on each Contract. • Broker • Work sublet to a Broker must be listed. separately. List each project role to be performed by a"single DBE individually on a separate row. The role: is used to determine what portion of the amount tobe subcontracted (Column 4) may be applied toward meeting the goal (column 5). Column 3: Provide a description of work to be performed by the DBE. The work to be performed must be consistent with the Certified Business Description of the DBE provided at the Diversity. Management and Compiiance System web page httos:/Iwsdot.diversitycomolianre.com • A Bidder subletting a portion of a bid item shall state"Partial" and describe the Work that is included. • For example; "Electrical (Partial) — Trenching". "Mobilization" will not be: accepted as: a description of Work. Column 4: List the total amount to be subcontracted to each DBE for each Project Role they are performing. Column 5: This is the dollar amount for each line listed in the certification that the prime intends to apply towards meeting the COA Contract goal. it maybe that only a.portion of the amount subcontracted to a. DBE in Column 4 is. eligible to be credited toward meeting the goal See Note 1, Note 2, Note 3. The Contracting Agency will utilize the sum of this column (Box 4) to determine whether or not the bidder has met the goal. In the event of an arithmetic error in _summing column:5 or an error in making appropriate reductions in the amounts in: column four, See Note 1., Note 2, Note 3, then the mathematics will be corrected and the total (Box -4) will be revised accordingly. Note 1: For Work sublet as Force Account the bidder may only claim 50% of the amount subcontracted (Column 4) towards_ meeting the goal (Column 5). This information will be used to demonstrate "that the DBE contract goal is met at the time that the bidder submits their bid. For example;, amount sublet as force account = $100,000 (Column 4) equates to ($100,000 X 50%) = $50,000 (Column 5) to be applied towards the goal. Note 2: For Work sublet to a Regular Dealer the bidder may only claim 60% of the cost of the materials or supplies (Column 4) towards meeting the goal (Column 5). For example; Material cost = $100,000 (Column 4) equates to ($100,000 X 60%) = $60,000 (Column 5) to be applied towards the goal Note 3: For Work sublet to a Broker the bidder may only claim the fees paid to a Broker towards meeting the goal (Column 4). For example; amount sublet to a broker = $100,000 (Column 4) equates to ($100,000 X reasonable fee %) _ $ (Column 5) to be applied towards the goal. Box 3: Box 3 is the COA Contract goal which is the minimum required DBE participation. The goal stated in the Contract will be in terms of a dollar amount or a percentage in the Contract. When expressed .as a percentage you must multiply the percentage times the sum total of all bid items as submitted in the Bidder's Proposal to determine the dollar goal and write it in Box 3. In the event of an error in this box, the Contracting Agency will revise the amount accordingly. Box 4: Box 4 is the sum of the values in column 5. This value must equal or exceed the COA Contract goal amount written in Box 3 or; Box 5: Check Box 5 if insufficient DBE Participation" has been achieved and a good faith effort is required. Refer to the subsection titled, Selection of Successful Bidder/Good Faith .Efforts (GFE) in the Contract. See the Disadvantaged Business EnterpriseParticipatian specification in the Contract for more information. DOT Form 272-056��{ PBi Provided tJii].718 s2° change of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal Disadvantaged Business Enterprise Utilization Certification To be eligible for Award of this Contract the Bidder shall fill out and submit, as a supplement to its .sealed Bid Proposal, a Disadvantaged Business Enterprise (DBE) Utilization Certification.. The Contracting Agency shallconsider as:non- responsive and shall reject any Bid Proposal that does not contain.a •DBE Utilization Certification which properly demonstrates that the Bidder will meet:the DBE participation requirements in'one of the manners'provided for in the proposed Contract: Refer to the instructions on Page 2 -When filling out:this farm or the' Bid may be rejected. An example:form has been provided on Page 3. The successful Bidder's DBE Utilization Certification shall be deemed a part of the resulting Contract. Box 1: A Plus Construction Colnpany• certifies-thatthe DBE firms listed belowhave been contacted regarding participation on this project. If this Bidder is` successful•on this project and is awarded the' Contract, itshall. assure that subcontracts or supply agreements are.executed with named DBEs. (If necessary, use additional sheets.) Box 2: US 395,. S polcane City Limits to Stevens: County Line: -Paving and Safety Column 1 Name of DBE (See instructions) Column 2 Project Role (See:instructions) Column 3 Description ofWOrk (See instructions) Column 4 Dollar Amount Subcontracted to DBE (See.instructions) Column Dollar Amount. to. be Applied Towards Goal . (See instructions) A Plus Construction Company Prime Asphalt and concrete paving, .asphalt milting,:preleveling and pavement repair N/A 900,000 In the Line Services, Inc: Subcontractor (Force Account) Crack sealing 120000 [0,000 In the Line Services, Inc. Subcontractor Guideposts, joint seal, pavement markers, temporary signage, construction sign installation 200,000 200;000 The Everything Guys, LLC Regular Dealer Rental and:salcs of highway construction and related equipment and materials 100,000 60,000 Optimus Prime Trucking, Inc. Subcontractor Dump -Trucking 50,000 50,000 Metalheads, Inc. Manufacturer Dowel Bars 75,000 75,000 Erosion Under Control Co. Broker Erosion control blankets, straw bales andwattles; sand bags 15.000 250 IssIVVV-"Vi V°64:)Cals-P*iii" Disadvantaged Business Enterprise 356,968.16 Condition of Award Contract Goal Box 3 Total DBE Commitment -Dollar Amount 1295,250 Box 4 5 By checking Box 5 the Bidder is stating that their attempts to solicit sufficient DBE participation to meet the OA Contract goal has been unsuccessful andgood faith effort will be submitted in accordance with Section 1-02.9 of the Contract DOT Form 272=056 Provided to M5BIPachange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal � Washington State VI/ Dep ent of Tr, sportatdon Underutilized Disad „ antaged usiness Enterprise (UDBE) Bid Item Breakdow `} Form 1. Contract Number 91310407 2. Contract Name S. Boeing Access Road Over Airport Way Bridge Seismic Retrofit 3. Prime Contractor Razz Construction, Inc. 4. Prime Contractor Representative Name Donald A. Rasmussen 5. Prime: Contractor Representative Phone Number 360-752-0011 6. Prime Contractor Representative. Email donr@razzconstruction.com Column 1 Name of UDBE See InstructionsCost ( ) Column 2 Bid Rem # (See Instructions) Column 3 Full/Partial (See"Instructions) Column 4 Quantity (See Instructions) Column 5 Description (See Instructions) Column 8 `Dollar Unit Price (See Instructions) Column7 Total Unit (See Instructions) Column 8 Amount to, be Applied Towards Goal (SeeInstructions) N -°R' 4�A� 21 P 31 o tR rn-00 r o "yatnizonce L �'j 1 -- Oa 5`l9 Du -S'395 z Sy�'N X333= c���°- �g1 ` 51)96(4) Subtotal: $ 0.00 $13.00 Name of UDBE Bid Item # Full/Partial Quantity Description Unit Price Total Unit Cost Dollar Amount to be Applied Towards; Goal 1vre.-r c, LLC., 2,42 P 2l . i c t .e-' - 4oi 8, Vf5 I o5t—z! `90,0 Subtotal: $ 0.00 1 Ch Name of UDBE Bid Item # Full/Partial Quantity Description Unit Price Total Uri. Cost Dollar Amount to be Applied Towards Goal Subtotal: $ 0.00 $ 0.00 Name of; UDBE Bid item # Full/Partial Quantity Description Unit Price Total Unit, Cost Dollar Amount to be Applied Towards Goal Subtotal: $ 0.00 $ 0.00 TOTAL UDBE Dollar Amount: --$-0700 ~ --$-O e6--- 1 DOT Form 272-054 Revised 01/2020 Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com — Always Verify Scal iL(0,a1 CeCo Instructions for Underutilized Disadvantaged Business Enterprise (UDBE) Bid Item Breakdown Form Box 1: Provide the Contract Number as statedin the project information webpage. Box 2: Provide the Name of the project as stated in the project information webpage. Box 3: Provide the Name of the bidder (Proposal holder) submitting Bid. Box 4: Provide the name of the prime contractor's representative available tocontact regarding this form. Box 5: Provide the phone number of the prime contractor's representative available to contact regarding this form. Box 6: Provide the email of the prime contractor's representativeavailable to contact regarding this -form. Column 1: Provide the Name of the Underutilized Disadvantaged Business Enterprise (iJDBE) Firm. UDBE Firms can be found using thesearch tools underthe Firm Certification section of the Diversity Managernent and Compliance System (DMCS) webpage https://wsdot.diversitycompliance.com. Column 2: Provide the Bid Item Number (as it appears in the engineer's estimate bid check report) available on the project information webpage. Column 3: If the UDBE is performing only partof the bid item, mark "Partial". If the UDBE isperforming the entire bid item, mark "Complete". Column4: Provide -the estimated quantity for the specific bid item. For trucking firms, usehour :or another unit of measure. Column:5: Provide a description of the work to be performed by the UDBE. Calm -in 6: Provide the price per unit and specify the type of unit used. For trucking firms, use hour or another unit of measure. Column 7: Provide the estimated total unit cost amount per bid item. Column` 8: Provide the amount of the bid item being used to fulfil the UDBE goal. The work to be performed must be consistent with the Certified Business Description of the UDBE provided in the DMCS webpage https://wsdot. diversitycompliance.com. Mobilization up to 10% is acceptable. If mobilization is more than 10% additional information and/or justification may be requested. The total amount shown for each DBE shall match the amount shown on the DBE Utilization Certification Form. Use Additional Sheets if necessary. DOT Form 272-054 Revised 05/2019 Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal Vj;W shingto i State Department of Tr p Underutilized iisdvantaged usiness F)Trucking Credit Form rtato.n Enterprise (U PART A: TO BE COMPLETED BY THE BIDDER This form is in support: of the trucking commitment identified on the UDBE Utilization Certification Form submitted with the proposal. Please note that UDBE's must be certified prior to time of submittal. , t,. Boeing Access Road Over Airport Way Bridge Seismic Retrofi Federal Aid # Contract # 91310407 Project Name Fax (5 Go) 5a-co99 If listing items by hours, or by lump. sum: amounts, please provide calculations to substantiate the quantities fisted. Bid Item EmailDate OV4fn (.(c �-.z r Item Description Gt / ti ,o) 0 D EE !CVC .;-� : r,` l �.Y.\\ `(1 ok c_,e aC� �I %� S J Use additional sheets as necessary. Bidder em rk6.`7 _ Golf► { U C-k•on1 In c,. Name/Title (please print) (�ot\_0_>-\,,.Q i'i. ��Avvws-->eini qc, ,d.,w Phone (5Cov' — co\` Fax (5 Go) 5a-co99 Signature ./ I certify that the above information is completeand accurate. Address ., mac. \v15V,DaM,w �a�5 �.M� '(�� y'$ aZ(::, EmailDate OV4fn (.(c �-.z r C.r Ski u QA:(Nr, , corp Gt / ti ,o) 0 PART B: TO BE COMPLETED BY THE UDBE TRUCKING FIRM Note: DBE/UDBE trucking firm participation may only be credited as DBE/UDBE participation for the value of the hauling services, not for the materials being hauled :unless the trucking firm is also recognized as.a supplier of the materials used on theproject and approved for this project as a regular dealer. 1. Type. of Material expected to be hauled? Nl 2. Number of fully operational trucks expected to be used on this project? 3. Number of trucks and trailers owned by the UDBE that will be used on this project? 4. Number of trucks and trailers leased by the UDBE that will be used on this project? Tractor/trailers: Dump trucks: Tractor/trailers: Dump trucks: Tractor/trailers: Durnp trucks: UDBE Firm Name Name/Title (please print) Certification Number Phone Fax Signature I certify that the above information is complete and accurate. Address Email Date DOT Form 272-058 Revised 05/2019 Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal Submit this form to DBEDOC@wsdot.wa.gov, Instruction to Bidder: The Bidder shall complete and submit the Underutilized Disadvantaged Busin Trucking Credit Form in accordance with Section 1-02,9of the Contract. INSTRUCTIONS s Enterprise (UDBE) Please note.—All Fields are required PART A: TO BE COMPLETED BY THE BIDDER Federal Aid: Include the project .federal -aid number. County: Specify' the County where the project will take place. Contract .#: Specify the Project Contract Number which can be found in the Engineer's estimate bidcheckreport. Bid Item: Provide the Bid Item Number (as it appears in the engineer's estimate bid check report) for which trucking services will be. utilized. Item Description: Provide description of the bid .item (as it appears in the engineer's estimate bid check report) for which trucking will be utilized. Bidder: In this section, provide the bidder's legal name, title, Business address, Phone and email. The, bidder's representative signature is required in addition to the date the form was signed. PART B: TO BE COMPLETED BY THE UDBE TRUCKING FIRM Question 1.: Specify type of material that will be hauled (Le. Sand, HMA, gravel) Question 2: Specify the total number of operational trucks that will be used on the project Question 3: Specify the total number of operational trucks and trailers owned by the UDBE that will be used on the project. Question 4: Specify the total number of operational trucks and trailers leased by the UDBE that will be used on the project. UDBE Firm: In this section, provide. the UDBE Firm's legal name, UDBE Firm's representative legal name and title, certification Number (Found in the firm's OMWBE Profile page in the OMWBE directory), Business address, Phone, fax. and email. The UDBE Firm's representative signature is required in addition to the date the form was. signed. DOT Form 272-058 Revised 05/2019 Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal WiWashington State Department of Transportation Underutilized Disadvantaged Business Enterprise (UDBE) Written Confirmation Document See Contract Provisions.: UDBE Document Submittal Requirements Disadvantaged Business Enterprise Participation THIS FORM SHALL ONLY BE SUBMITTED TO A UDBE THAT IS LISTED ON THE CONTRACTOR'S UNDERUTILIZED DISADVANTAGED BUSINESS ENTERPRISE UTILIZATION CERTIFICATION. THE CONTRACTOR SHALL COMPLETE PART A PRIOR TO SENDING TO THE UDBE. PART A: To be completed by the bidder The entries below shall be consistent with what is shown on the Bidder's Underutilized Disadvantaged Business Enterprise Utilization Certification. Failure to do so will result in Bid rejection. Contract Title: 6. 66 1'D CS (IC Ai 972)0s— y 6 Q41Pace Bidder's -{aBidder's Business Name: Ra-`z..z_ j C6n��� �e �c� v ) 1(\ c . �v UDBE's Business Name: pkj\J„) � c C . c{ � C, Description of UDBE's Work: .n.Q s" Dollar Amount to be Applied Towards UDBE Goal: Dollar Amount to be Subcontracted to UDBE*: 'Optional Field PART B: To be completed by the Underutilized Disadvantaged Business Enterprise As an authorized representative of the Underutilized Disadvantaged Business Enterprise, I confirm that we have been contacted by the Bidder with regard to the referenced project for the purpose of performing the Work described above. If the Bidder is awarded the Contract, we will enter into an agreement with the Bidder to participate in the project consistent with the information provided in Part A of this form. Name (printed): �� ll)? ra_A 2Z Signature: Title: Address: DOT Form 422-031U Revised 02/2018 31(nc l2coTh Ave Se gc.ect Pco' u r LoA/ 9`64°12 Date: Lf (0. (wz-o gton DeapsaltImentSotfaT7ansportation Disadvantaged Business Enterprise (DBE) Written Confirmation Document See Cont.- • I .Provisions: DBE Document ,S'ubmittal Requirements 1)isadvanta,ged Busines.s Enterprise Participation THIS FORM SHALL ONTX BE SUBNIRTED To A. DBE IS LISTED ON ITIE CONTRACTOR'S DISADVANTAGED L';NIT'APRISE: UTILIZATION CT.:RITFICATION. THE, CONTRACTOR SHALE... COMPLETE PART A PRIOR TO SENDING TO T1iF DI3E. PART A: To be completed by Abe, bidder The entries below shall he consistent with what is shown on the Bidder's Disadvantaged Business Enterprise titilization Certification. Failure to do so will result in Bid rejection. Contract Title: S. Boeing Access Road Over Airport Way Bridge Seismic Retrofit Bidder's Business Name: Razz Construction, Inc. DBE's Business Name: Twisted Metal, LLC Description of DBE's Work: Column Jackets Steel Dollar Amount to be Applied Towards DBE Goal: $ppipp000 Dollar Amount to be Subcontracted to DBE*: *Optional Field PART 13: To be COMpleted by_tbe Disadvantaged Business Enterprise As an authorized representative of the Disadvantaged Business .1..nterprisc, 1 conlirm that we have been contacted by the Bidder with regard to the referenced project tbr the purpose of performing the Work described above. If the Bidder is :.i.warded the Contract, we will enter into an agreement with the Bidder to participate in the project consistent ‘vith the information provided in Part A of this form_ Name (printed): Signature: Title: Address: DOT Form 422-031 Revised 02/201E3 Tiid MetcLI F)os_ ?co/ SvexmA, Date: