Agreement PR1808.402 Mountain View Park Improvements

City of Chandler — Regular Meeting (2021-08-12)

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City of Chandler Job Order Project Agreement 
 
 
1 
Public Works & Utilities Department, Capital Projects Division  
Project Name: MOUNTAIN VIEW PARK SIDEWALK AND DRAINAGE IMPROVEMENTS 
Project No.: PR1808.402 
Rev. 9/18/2020 
 
 
CITY OF CHANDLER 
JOB ORDER PROJECT AGREEMENT  
 
Project Name: MOUNTAIN VIEW PARK SIDEWALK AND DRAINAGE IMPROVEMENTS 
Project No. PR1808.402 
 
This JOB ORDER PROJECT AGREEMENT (”Job Order”) is made this ________ day of _________ 2021 (“Effective 
Date”), by and between the City of Chandler, an Arizona municipal corporation, (“City”) and ForeSite Design 
& Construction, Inc., an Arizona corporation, (“JOC Contractor”) and is entered into pursuant to Job Order 
Master Agreement No. JOC1905.401 (“JOC Master Agreement”). City and JOC Contractor may be referred to 
individually as “Party” or collectively as “Parties”). 
 
City and JOC Contractor, in consideration of the mutual covenants herein set forth, agree as follows:   
 
RECITALS 
 
A. On or about January 17, 2020, the Parties entered into the JOC Master Agreement, which terms and 
conditions are made a part of and incorporated into this Job Order Project Agreement by this reference. 
 
B. City proposes to engage JOC Contractor to address ponding and drainage issues on the park site, and 
non-ADA compliant sidewalk replacement at the corner of Jentilly Lane and Morelos Street, within the 
existing Mountain View Park  as more fully described in Exhibit "A", which is attached to and made a part 
of this Job Order by this reference. 
 
C. JOC Contractor is ready, willing, and able to provide the services described in Exhibit “A” for the 
compensation and fees set forth and as described in Exhibit ”B”, which is attached to and made a part of 
this Agreement by this reference. 
 
ARTICLE 1.  DESCRIPTION OF WORK 
 
The Parties enter into this Job Order Project Agreement for the MOUNTAIN VIEW PARK SIDEWALK AND 
DRAINAGE IMPROVEMENTS, Project Number PR1808.402.  The scope of work consists of addressing 
ponding and drainage issues on the park site, and non-ADA compliant sidewalk replacement at the corner 
of Jentilly Lane and Morelos Street, within the existing Mountain View Park, all as more particularly set forth 
in Exhibit “A” attached hereto and incorporated herein by reference. 
 
The JOC Contractor will not accept any change of scope, or change in contract provisions, unless issued in 
writing, as a contract amendment or change order and signed by the authorized signatories for each party. 
 
Performance and Payment Bonds, as set forth in Exhibit “C” and Exhibit “D” respectively attached hereto 
and incorporated herein by reference, will be due prior to execution of each Job Order Project Agreement 
in the full amount of each Job Order.

City of Chandler Job Order Project Agreement 
2 
Public Works & Utilities Department, Capital Projects Division  
Project Name: MOUNTAIN VIEW PARK SIDEWALK AND DRAINAGE IMPROVEMENTS 
Project No.: PR1808.402 
Rev. 9/18/2020 
At project completion, JOC Contractor must complete Contractor's Affidavit Regarding Settlement of Claims 
and Certificate of Completion, as set forth in Exhibit “E” and Exhibit “F” respectively attached hereto and 
incorporated herein by reference. 
ARTICLE 2.  PROJECT PRICE 
City will pay JOC Contractor for completion of the Work in accordance with the JOC Master Agreement a fee 
not to exceed the Guaranteed Maximum Price of $141,966.64 Dollars determined and payable as set forth 
in JOC Master Agreement and Exhibit “B” attached hereto and made a part hereof by reference.  
ARTICLE 3.  CONTRACT TIME & SCHEDULE 
JOC Contractor agrees to complete all Construction within 75 calendar days from the Notice to Proceed 
(NTP) Date.  
ARTICLE 4.  PARTICIPANTS 
CITY: 
Construction Project Manager:  Jason Garcia 
Phone: 
480-782-3324
Email: 
jason.garcia@chandleraz.gov 
JOC CONTRACTOR: 
ForeSite Design & Construction, Inc. 
1425 N. Mondel Dr. 
Gilbert, AZ  85233 
JOC Contractor Representative:  Scott Breeding 
Phone: 
480-820-1345
Email: 
scott.breeding@foresite-inc.com 
SIGNATURE PAGE TO FOLLOW

City of Chandler Job Order Project Agreement 
A-1 
Public Works & Utilities Department, Capital Projects Division  
Project Name: MOUNTAIN VIEW PARK SIDEWALK AND DRAINAGE IMPROVEMENTS 
Project No.: PR1808.402 
Rev. 9/18/2020 
 
EXHIBIT A 
SCOPE OF WORK

ForeSite Design & Construction, Inc. 
1425 N. Mondel Drive, Gilbert AZ 85233 
480.820-1345  Fax 820-1305 
 
July 9th, 2021 
 
 
 
 
 
              Via email: Hafiz.Noor@chandleraz.gov 
 
 
 
 
 
 
Exhibit A 
Scope of Services / Schedule – Rev3 
 
 
 
City of Chandler - Mountain View Park Improvements 
 
All work shall be in accordance with the following documents: 
Plan Documents: (7 sheets) entitled: “Mountain View Park – Maintenance Improvements” – City Project 
No. PR1808.202 as prepared by epg design, dated May 2021. 
 
Scope of Work: 
The proposed work includes the removal of existing concrete sidewalks and turf to facilitate new grade 
work to raise the existing sidewalk elevations and allow proper drainage flow at Mountain View park 
located at 575 S. Twelve Oaks Boulevard, Chandler, Arizona 85226.  Scope of work to include: 
 
Kill existing turf for removal as shown 
 
Site demolition of concrete sidewalks and turf 
 
Relocation of existing irrigation heads to accommodate new turf layout 
 
Grade work to raise sidewalk elevations and create drainage flow to retention basin 
 
Placement of new concrete sidewalks 
 
Installation of new concrete header curb 
 
Installation off new vegetation 
 
Placement of new decomposed granite 
 
Placement of a new concrete spillway 
 
All sales tax is included 
 
Full time site supervision and associated contract administration is included 
 
Temporary protection and clean-up in included during the construction duration. 
 
Attached is an itemized breakdown of the proposal estimate to assist in the understanding of the project 
components.  The anticipated total schedule for this project is eleven (11) weeks for the improvement 
efforts including procurement of the materials.  Construction duration on site is 40 calendar days. 
 
In submitting this long lead material proposal, we agree: 
1. To hold the proposal open for Sixty (60) days after the date of this proposal. 
2. To accomplish the work in accordance with the JOC contract documents and the following 
clarifications, qualifications and exclusions listed below. 
 
Clarifications: 
1. ForeSite will be allowed to utilize the existing water and power sources on site during the construction 
activities of the project. 
 
2. Work will be performed during normal business hours – Monday through Friday, 6:00 am to 3:00 pm 
daily, unless otherwise authorized. 
 
3. The following allowances are included in the proposal and any unused portion of the allowance will be 
returned to the City of Chandler: 
- 
Materials testing allowance - $2,000 
- 
City’s Allowance - $10,000

ForeSite Design & Construction, Inc. 
1425 N. Mondel Drive, Gilbert AZ 85233 
480.820-1345  Fax 820-1305 
 
Exclusions: 
 
Plan review and Building Permit fees 
 
Development fees & utility company charges 
 
Hazardous material testing or removal 
 
Special Inspections or associated fees 
 
Dust control permit or fees 
 
ForeSite Design & Construction, Inc. is pleased to present our JOC proposal for the Mountain View Park 
Improvements project for the total sum of: One hundred Forty-one thousand, Nine hundred Sixty-six 
and 64/100th dollars: $ 141,966.64

EXHIBIT B 
FEE SCHEDULE 
 
City of Chandler Job Order Project Agreement 
B-1 
Public Works & Utilities Department, Capital Projects Division  
Project Name: MOUNTAIN VIEW PARK SIDEWALK AND DRAINAGE IMPROVEMENTS 
Project No.: PR1808.402 
Rev. 9/18/2020

ForeSite Design & Construction, Inc. 
1425 N. Mondel Drive, Gilbert  AZ 85233 
480-820-1345  fax 820-1305 
 
 
June 11th, 2021 
 
 
 
Negotiated Prices
-
$                      
Survey - 82 Bravo LLC
2,580.00
$              
Demolition - Mark's Valley Grading
8,554.00
$              
Earthwork - Mark's Valley Grading
14,459.00
$            
Landscape - Blue Sage Landscaping
23,401.00
$            
Concrete - J&R Contracting
26,913.00
$            
Steel Railing - Skyce Steel
5,300.00
$              
2,000.00
$              
-
$                      
33,169.68
$            
-
$                      
-
$                      
SUBTOTAL (NEGOTIATED PRICES):
116,376.68
$          
9.50%
11,055.78
$            
TOTAL (NEGOTIATED PRICES + OVERHEAD & PROFIT):
127,432.46
$          
Sales Tax Percentage (Current Tax Rate) Material & Equip only
5.07%
595.89
$                 
General Liability Insurance Percentage (Actual Cost per Job Order)
1,694.85
$              
Builder's Risk Insurance Percentage (Actual Cost per Job Order)
710.20
$                 
Payment Bond (Actual Cost per Job Order)
1,533.24
$              
Performance Bond (Actual Cost per Job Order)
-
$                      
SUBTOTAL (INSURANCE, BONDS, & TAXES):
4,534.18
$              
COMBINED TOTAL (TOTAL + INSURANCE, BONDS, & TAXES):
131,966.64
$          
City's Allowance
10,000.00
$            
TOTAL JOB ORDER:
141,966.64
$  
EXHIBIT "B"
JOB ORDER COST PROPOSAL
SUMMARY SHEET
Overhead and Profit (Coefficient per Job Order Master Agreement)
Per the Job Order Master Agreement - This Fee Table includes all fees, costs, insurance and bond premiums, allowances, 
construction contingency, and taxes of any type necessary to fully, propertly and timely perform and construct the Work.  Also 
per the Job Order Master Agreement - For any portion of the Work which, either through this Contract, Change Order or 
otherwise, is performed and paid for on a cost, or time and materials basis, the costs may be reimbursed to JOC Contractor 
and chargeable against the Contract Price will be determined as set forth in MAG 109.5.
Construction Labor (if applicable)
Insurance, Bonds, & Taxes
Price of Subcontractor(s)
Price of Subconsultant(s)
General Conditions
Preconstruction Labor (if applicable)
Materials Testing - Allowance

28
5
12
19
26
2
9
16
23
30
6
13
20
27
4
11
18
25
1
Jun
Jul
Aug
Sep
Oct
Nov
2021
ID
Description
Original Duration
Start
Finish
PRE-CONSTRUCTION
Project Wide
35
06/30/21
08/19/21
PROPOSAL PROCESS
4 activities
CONSTRUCTION
Project Wide
23
08/20/21
10/05/21
Procurement
22 activities
PARK IMPROVEMENTS
47
08/20/21
10/26/21
Area Wide
42 activities
CLOSEOUT
Project Wide
5
10/27/21
11/03/21
Area Wide
4 activities
Project Start
Project Finish
Data Date
Start Date:  06/30/21
Data Date:  06/30/21
Run Date:  07/09/21
 210709 - Mountain View Park Proposal r3.ppx
Page  1A
City of Chandler
Mountain View Park Improvements
210709 - Proposal Schedule r3

ForeSite Design & Const., Inc.
Spreadsheet Report
Page 1
Mountain View Park Improvements - Rev 1
6/11/2021 11:53 AM
City Of Chandler
Mountain View Park Improvements
210607 - JOC Proposal - Rev1
Project name
Mountain View Park Improvements - Rev 1
575 S Twelve Oaks Blvd.
Chandler
AZ 85226
Estimator
MItchell Sullivan
Labor rate table
1.0X w\brd
Job size
1 ls
Duration
7 wk
Report format
Sorted by 'Group phase/Phase'
'Detail' summary

ForeSite Design & Const., Inc.
Spreadsheet Report
Page 2
Mountain View Park Improvements - Rev 1
6/11/2021 11:53 AM
Phase
Description
Takeoff Quantity
Labor Amount
Material
Amount
Sub Amount
Equip Amount
Other Amount
Total Amount
GENERAL REQUIREMENTS
1.002
Project Manager
Project Manager
2.34 wk
6,591.31
-
-
-
-
6,591.31
Buyout & Writing subcontracts
0.50 wk
1,408.40
-
-
-
-
1,408.40
1.003
Project Superintendent
Project Superintendent
7.00 wk
16,660.00
-
-
-
-
16,660.00
1.005
Project Engineer
Project Engineer
0.50 wk
957.00
-
-
-
-
957.00
1.011
General Field Supervisor
General Field Supervisor
18.00 hr
1,267.56
-
-
-
-
1,267.56
1.209
Plans & Specifications
Plans
40.00 sht
-
40.00
-
-
-
40.00
1.309
Information Technology
IT Expense
414.00 hr
-
-
-
670.68
-
670.68
1.310
Field Office Supplies
Job Office Supplies
1.75 mo
-
43.75
-
-
-
43.75
1.311
Field office equipment rental
On Site Computer
1.75 mo
-
-
-
437.50
-
437.50
1.329
Communications
Monhtly Usage (in town)
414.00 hr
-
-
-
182.16
-
182.16
1.602
Foresite Equipment
Foresite 3/4 Ton Pick up/Wk
10.36 wk
-
-
-
1,087.59
-
1,087.59
1.615
Gas & Minor Maint.
Gas & Minor Maint.
10.36 wk
-
-
-
880.43
-
880.43
SITEWORK
2.001
Temporary Fencing
One Time In and Out
1.00 ls
-
-
-
350.00
-
350.00
Over 600lf
500.00 lf
-
-
-
1,250.00
-
1,250.00
2.008
Trash Hauling Service
Jobsite Dumpsters
1.00 ea
-
450.00
-
-
450.00
2.009
General Clean-up
General Clean-up
10.00 hr
465.80
50.00
-
12.50
-
528.30
2.012
Temporary Toilet
Temporary Toilet
1.00 mo
-
-
-
95.00
-
95.00
2.015
Survey & Layout
Site Layout
1.00 ls
0.00
0.00
2,580.00
-
-
2,580.00
2.020
Quality Control
Matrls Test & Sampling Allow.
1.00 ls
-
2,000.00
0.00
-
-
2,000.00
2.050
Selective Demolition (EA)
Site Demolition
1.00 ls
-
-
8,554.00
-
-
8,554.00
2.101
SWPP Requirements
SWPP inlet protection
3.00 ea
180.00
75.00
15.00
-
270.00
2.200
Site Grading
Earthwork
1.00 ls
-
-
14,459.00
-
-
14,459.00
2.900
Landscaping

ForeSite Design & Const., Inc.
Spreadsheet Report
Page 3
Mountain View Park Improvements - Rev 1
6/11/2021 11:53 AM
Phase
Description
Takeoff Quantity
Labor Amount
Material
Amount
Sub Amount
Equip Amount
Other Amount
Total Amount
2.900
Landscaping
Landscaping
1.00 ls
-
-
23,401.00
-
-
23,401.00
CONCRETE
3.050
Concrete Conceptual
Concrete work
1.00 ls
-
-
26,913.00
-
-
26,913.00
STEEL
5.505
(LF)Misc. Steel Fab.
Scupper Railing
1.00 ls
-
-
5,300.00
-
-
5,300.00
Estimate Totals
Description
Amount
Totals
Rate
Labor
27,530.07
Material
2,658.75
Subcontract
81,207.00
Equipment
4,980.86
Other
116,376.68
116,376.68
OVERHEAD AND PROFIT
11,055.78
9.500 %
GL & Auto INSURANCE
1,694.85
1.330 %
Installation Floater Policy
710.20
0.550 %
JOC Bond Rate
1,533.24
14,994.07
131,370.75
Chandler Sales Tax - Mtrl & Eq
595.89
7.800 %
Owner's Contingency
10,000.00
Total
141,966.64

EXHIBIT C 
 
City of Chandler Job Order Project Agreement 
C-1 
Public Works & Utilities Department, Capital Projects Division  
Project Name: MOUNTAIN VIEW PARK SIDEWALK AND DRAINAGE IMPROVEMENTS 
Project No.: PR1808.402 
Rev. 9/18/2020 
PERFORMANCE BOND 
ARIZONA STATUTORY PERFORMANCE BOND 
PURSUANT TO TITLES 28, 34, AND 41, ARIZONA REVISED STATUTES 
(Penalty of this bond must be 100% of the Contract amount) 
 
KNOW ALL MEN BY THESE PRESENTS THAT:___________________________________________________ 
(hereinafter "Principal"), and __________________________________________________________ (hereinafter "Surety"), a 
corporation organized and existing under the laws of the State of ______________ with its principal office in the City of 
_____________________________, holding a certificate of authority to transact surety business in Arizona issued by the 
Director of Insurance pursuant to Title 20, Chapter 2, Article 1, as Surety, are held and firmly bound unto 
__________________________(hereinafter "Obligee") in the amount of ________________________________________________ 
(Dollars) ($___________), for the payment whereof, Principal and Surety bind themselves, and their heirs, administrators, 
executors, successors and assigns, jointly and severally, firmly by these presents. 
 
WHEREAS, the Principal has entered into a certain written contract with the Obligee, dated  
 
the ____________ day of _______________________, 20___ for construction of MOUNTAIN VIEW PARK SIDEWALK AND 
DRAINAGE IMPROVEMENTS, PR1808.402 which contract is hereby referred to and made a part hereof as fully and to 
the same extent as if copies at length herein. 
 
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that if the Principal faithfully performs and 
fulfills all the undertakings, covenants, terms, conditions and agreements of the contract during the original term of the 
contract and any extension of the contract, with or without notice of the Surety, and during the life of any guaranty 
required under the contract, and also performs and fulfills all the undertakings, covenants, terms, conditions, and 
agreements of all duly authorized modifications of the contract that may hereafter be made, notice of which 
modifications to the Surety being hereby waived, the above obligation is void.  Otherwise it remains in full force and 
effect. 
 
PROVIDED, HOWEVER that this bond is executed pursuant to the provisions of Title 34, Chapter 2, Article 2, 
Arizona Revised Statutes, and all liabilities on this bond will be determined in accordance with the provisions of Title 34, 
Chapter 2, Article 2, Arizona Revised Statutes, to the same extent as if it were copied at length in this Contract. 
 
The prevailing party in a suit on this bond may recover as part of the judgment reasonable attorney fees that 
may be fixed by a judge of the court. 
 
Witness our hands this ________________ day of ____________________, 20__. 
____________________________________ 
PRINCIPAL         
 
SEAL 
___________________________________ 
             AGENT OF RECORD 
By _________________________________ 
____________________________________ 
SURETY  
 
SEAL 
___________________________________ 
               AGENT ADDRESS

EXHIBIT D 
 
City of Chandler Job Order Project Agreement 
D-1 
Public Works & Utilities Department, Capital Projects Division  
Project Name: MOUNTAIN VIEW PARK SIDEWALK AND DRAINAGE IMPROVEMENTS 
Project No.: PR1808.402 
Rev. 9/18/2020 
PAYMENT BOND 
ARIZONA STATUTORY PAYMENT BOND 
PURSUANT TO TITLES 28, 34, AND 41, OF THE ARIZONA REVISED STATUTES 
(Penalty of this Bond must be 100% of the Contract amount) 
 
KNOW ALL MEN BY THESE PRESENTS THAT:________________________________________________  
 
(hereinafter "Principal"), as Principal, and _________________________________________(hereinafter "Surety"), a corporation 
organized and existing under the laws of the State of __________________   with its principal office in the City of 
__________________, holding a certificate of authority to transact surety business in Arizona issued by the Director of the 
Department of Insurance pursuant to Title 20, Chapter 2, Article 1, as Surety, are held and firmly bound unto 
________________________  (hereinafter "Obligee") in the amount of ________________________________________________ 
(Dollars) ($___________), for the payment whereof, the Principal and Surety bind themselves, and their heirs, 
administrators, executors, successors and assigns, jointly and severally, firmly by these presents. 
 
WHEREAS, the Principal has entered into a certain written contract with the Obligee, dated the _________ day of 
_______________________, 20___ for construction of MOUNTAIN VIEW PARK SIDEWALK AND DRAINAGE 
IMPROVEMENTS, PR1808.402 which contract is hereby referred to and made a part hereof as fully and to the same 
extent as if copied at length herein. 
 
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that if the Principal promptly pays all moneys 
due to all persons supplying labor or materials to the Principal or the Principal's subcontractors in the prosecution of 
the work provided for in said contract, this obligation is void. Otherwise it remains in full force and effect. 
 
PROVIDED, HOWEVER that this bond is executed pursuant to the provisions of Title 34, Chapter 2, Article 2 
Arizona Revised Statutes, and all liabilities on this bond will be determined in accordance with the provisions, conditions 
and limitations of Title 34, Chapter 2, Article 2, Arizona Revised Statutes, to the same extent as if it were copied at length 
in this Contract. 
 
The prevailing party in a suit on this bond may recover as part of the judgment reasonable attorney fees that 
may be fixed by a judge of the court. 
 
Witness our hands this ________________ day of ____________________, 20__. 
____________________________________ 
PRINCIPAL         
 
SEAL 
___________________________________ 
                 AGENT OF RECORD 
By _________________________________ 
____________________________________ 
SURETY  
 
SEAL 
___________________________________ 
                  AGENT ADDRESS

EXHIBIT E 
 
City of Chandler Job Order Project Agreement 
E-1 
Public Works & Utilities Department, Capital Projects Division  
Project Name: MOUNTAIN VIEW PARK SIDEWALK AND DRAINAGE IMPROVEMENTS 
Project No.: PR1808.402 
Rev. 9/18/2020 
CONTRACTOR'S AFFIDAVIT REGARDING SETTLEMENT OF CLAIMS 
 
________________________, Arizona 
 
Date ____________________________ 
Project Name: MOUNTAIN VIEW PARK SIDEWALK AND DRAINAGE IMPROVEMENTS 
Project No.:  
PR1808.402 
To the City of Chandler, Arizona 
Gentlemen: 
This is to certify that all lawful claims for materials, rental of equipment and labor used in connection with 
the construction of the above project, whether by subcontractor or claimant in person, have been duly 
discharged. 
 
The undersigned, for the consideration of $________________________, as set out in the final pay estimate, as 
full and complete payment under the terms of the contract, hereby waives and relinquishes any and all 
further claims or right of lien under, in connection with, or as a result of the above described project.  The 
undersigned further agrees to indemnify and save harmless the City of Chandler against any and all liens, 
claims or liens, suits, actions, damages, charges and expenses whatsoever, which said City may suffer arising 
out of the failure of the undersigned to pay for all labor performances and materials furnished for the 
performance of said installation. 
 
Signed and dated at ________________, this _________ day of _______________ 20_____. 
 
 
__________________________________ 
                CONTRACTOR 
 
By _______________________________ 
STATE OF ARIZONA 
 
) 
) SS 
COUNTY OF MARICOPA 
) 
 
The foregoing instrument was subscribed and sworn to before me this __________ day of __________________ 
20 _________. 
 
___________________________________ 
 
 
 
 
 
                         Notary Public 
 
                     
 
___________________________________ 
 
 
 
 
 
                         My Commission Expires

EXHIBIT F 
 
City of Chandler Job Order Project Agreement 
F-1 
Public Works & Utilities Department, Capital Projects Division  
Project Name: MOUNTAIN VIEW PARK SIDEWALK AND DRAINAGE IMPROVEMENTS 
Project No.: PR1808.402 
Rev. 9/18/2020 
 
CERTIFICATE OF COMPLETION 
Project: 
MOUNTAIN VIEW PARK SIDEWALK AND DRAINAGE IMPROVEMENTS   
Project No.: 
PR1808.402 
 
 
(TO BE COMPLETED BY CONTRACTOR) 
 
I HEREBY CERTIFY THAT ALL GOODS AND/OR SERVICES REQUIRED BY CITY OF CHANDLER PROJECT NO. 
PR1808.402 HAVE BEEN DELIVERED IN ACCORDANCE WITH THE CONTRACT DOCUMENTS AND BID 
SPECIFICATIONS AND ALL ACTIVITIES REQUIRED BY THE CONTRACTOR UNDER THE CONTRACT HAVE BEEN 
COMPLETED AS OF ____________________________. 
 
 
                          (Date) 
FIRM NAME: 
________________________________ 
 
PRINCIPAL: 
________________________________ 
         (Name) 
 
________________________________ 
      (Signature) 
 
________________________________ DATE: ___________________ 
          (Title) 
 
CERTIFIED BY ENGINEER/CONSULTANT (IF APPLICABLE): 
 
_________________________________ 
 
DATE: ____________________ 
      (Signature) 
 
_________________________________ 
 
        (Firm Name) 
  
PROJECT ACCEPTED BY USER DEPARTMENT 
 
_________________________________ 
 
DATE: ____________________ 
         (Signature) 
 
_________________________________ 
 
          (Dept. /Div.) 
_______________ Date of Final Walk-Through 
 
_______________ Date As-Built Received 
 
_______________ City As-Built Number