HomeMy WebLinkAboutIDOT - Ansborough Avenue - 12/10/2018.. DOT
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February 14, 2019
Mohammad Elahi
City of Waterloo Engineering
715 Mulberry Street
City Hall
Waterloo, IA 50703
Re: Ansborough Avenue Improvements, City of Waterloo
Project Number STP -A-8155(757)-86-07; Agreement Number 2017-ICAAP-05
Dear Mr. Elahi:
Enclosed is a copy of an executed Consultant Agreement Amendment between City of Waterloo, Ament,
Inc., and the Iowa Department of Transportation for the above referenced project. This agreement
completes the consultant selection process.
In addition, City of Waterloo must comply with the provisions set forth in this agreement to ensure that
eligible project costs may receive federal aid reimbursement.
Thank you for your assistance. If you have questions, I can be reached by telephone at 515-239-1713 or
by e-mail at zachary.bitting@iowadot.us.
Sincerely,
Zi '13
Zac Bitting 1
Office of Systems Planning
Enclosures
cc: Michael Dryden, Ament, Inc. (signed consultant agreement)
Patricia Jacobs, Office of Finance (copy of enclosure)
.. I [515-239-1713]
D I [zachary.bitting@iowadot.us]
®I www.iowadot.gov
9
FEB 2'2 201S
Address:
[800 Lincoln Way, Ames, IA 50010]
Please return this copy to;
City Clerk & Finance Dept.
715 Mulberry St.
Waterloo, IA 50703
Contract No. [XXXXX]
Owner Project No. TOF-284
Iowa DOT Project No. STP -A-8155(757)--86-07
Standard Consultant Contract
For Local Public Agency Consultant Contracts with Federal -aid Participation
Supplemental Agreement No, 1
This SUPPLEMENTAL AGREEMENT #1, (amending the Original Standard Consultant Contract dated 6-11-2018)
made as of the date of the last party's signature below, is by and
BETWEEN City of Waterloo, Iowa, the Owner, located at:
715 Mulberry Street
City Hall
Waterloo, Iowa 50703
Phone: (319) 291-4440
FAX: (319) 291-4094
and Ament, Inc. (dba Ament Design), the Consultant, located at:
625 32nd Avenue SW
Cedar Rapids, lowa 52404
Phone: (319) 378-1401
FAX: (319) 378-1975
For the following Project: Ansborough Avenue Improvements, Ansborough Avenue from Black Hawk Road north
0.1 Miles to Downing Avenue, PCC Pavement Widening
The Owner has decided to proceed with the Project, subject to the concurrence and approval of the Iowa
Department of Transportation (Iowa DOT), and the Federal Highway Administration (FHWA), U.S. Department of
Transportation (when applicable).
The Owner desires to employ the Consultant to provide permanent acquisition plats and temporary easement
plats to accommodate the proposed construction on the Project. The Consultant is willing to perform these
services in accordance with the terms of this Agreement.
Page 1 of 23
TABLE OF CONTENTS
Article Number and Description
1 Initial Information
1.1 Project Parameters
1.2 Financial Parameters
1.3 Project Team
1.4 Time Parameters
1.5 Minimum Qualification Standards
2 Entire Agreement, Required Guidance and Applicable Law
2.1 Entire Agreement of the Parties
2.2 Required Guidance
2.3 Applicable Law
3 Form of Compensation
3.1 Method of Reimbursement for the Consultant
3.2 Subconsultant's Responsibilities for Reimbursement
4 Terms and Conditions
4.1 Ownership of Engineering Documents
4.2 Subconsultant Contract Provisions and FlowDown
4.3 Consultant's Endorsement on Plans
4.4 Progress Meetings
4.5 Additional Documents
4.6 Revision of Work Product
4.7 Extra Work
4.8 Extension of Time
4.9 Responsibility for Claims andLiability
4.10 Current and Former Agency Employees (Conflicts ofinterest)
4.11 Suspension of Work
4.12 Termination of Agreement
4.13 Right to Set-off
4.14 Assignment or Transfer
4.15 Access to Records
4.16 Iowa DOT and FHWA Participation
4.17 Nondiscrimination Requirements
4.18 Compliance with Title 49, Code of Federal Regulations, Part 26
4.19 Severabllity
Attachment A - Scope of Services
Attachment B - Specifications
Attachment C - Fees and Payments
Attachment C-1 — Cost Analysis Worksheet
Attachment D - Certification Regarding Debarment, Suspension, and Other Responsibility Matters
Attachment E - Certification of Consultant
Attachment F - Certification of Owner
Attachment G - Sample Invoice Form
Attachment H - Consultant Fee Proposal
Page 2 of 23
ARTICLE 1 INITIAL INFORMATION
This Agreement is based on the following information and assumptions.
1.1 Project Parameters
The objective or use is: to prepare permanent and temporary property acquisition plats for the Ansborough
Avenue Improvement Project from Black Hawk Road to Downing Avenue.
1.2 Financial Parameters
1.2.1 Amount of the Owner's budget for the Consultant's compensation is:
One thousand nine hundred eighty-six dollars and no cents ($1,986.00)
1.2.2 Amount of the Consultant's budget for the subconsultants' compensation is:
Zero
1.3 Project Team
1.3.1 The Owner's Designated Representative, identified as the Contract Administrator is:.
Mohammad Elahi, Traffic Engineer, City Traffic Operations Department.
The Contract Administrator is the authorized representative, acting as liaison officer for the
Owner for purpose of coordinating and administering the work under the Agreement. The work
under this Agreement shall at ail times be subject to the general supervision and direction of the
Contract Administrator and shall be subject to the Contract Administrators approval.
1.3.2 The Consultants Designated Representative is:
Michael G. Dryden, P.E.
1.3.3 The subconsultants retained at the Consultant's expense are identified in the following table:
Subconsultant
None
1.4 Time Parameters
Amount Authorized Maximum Amount Payable Method of Payment
1.4.1 The Consultant shall begin work under this Agreement upon receipt of a written notice to
proceed from the Owner.
1.4.2 Milestones for completion of the work under this Agreement as follows:
1. Preliminary design plans including type/size/location for all structures (preliminary design) and
detail elements for a design public hearing and construction right-of-way needs shall be
completed and accepted on or before January 15, 2019.
2. Final design, contract plans, and specifications and estimates shall be completed and in a
form acceptable to the Owner on or before Apri123, 2019.
3. Completion of all work under this agreement shall be on or before June 18, 2019 unless
extended by written approval of the Contract Administrator or adjusted by supplemental
agreement.
1.4.3 The Consultant shall not begin final design activities until after the Owner has been notified by
the Iowa DOT that FHWA Environmental Concurrence has been obtained. Upon receipt of such notice,
the Owner will provide the Consultant notice to proceed with final design activities.
1.5 Minimum Qualification Standards (MQS)
1.5.1 The Consultant and their subconsultants are required to meet the Minimum Qualifications
Standards (MQS) requirements of specified work categories as defined in the Iowa DOT's Policy and
Procedure Manual (PPM), Policy No. 300.04, at the time of contract execution, and for the duration of the
contract. Work under this contract will require the consultant team to meet the requirements of Work
Category Traffic Operations Design. Failure to meet the requirements during the contract wft rem
Page 3 of 23 r
FEB 2 2 2019
cancellation of any remaining portion of the contract.
1.5.2 All services within this agreement shall be performed by the Consultant or subconsultant who
meets the MQS of the specified work categories as defined Iowa DOT PPM 300.04. If no work
category exists for a particular service, normal methods of acceptance shall be used, such as
experience, typical licensure, certification or registration, or seals of approval by others.
ARTICLE 2 ENTIRE AGREEMENT, REQUIRED GUIDANCE, AND APPLICABLE LAW
2.1 Entire Agreement of the Parties. This Supplemental Agreement #1, along with the Original Standard
Consultant Contract, including its attachments, represents the entire and integrated agreement between
the Owner and the Consultant and supersedes all prior negotiations, representations or agreements,
either written or oral. This Agreement may be amended only by written instrument signed by both
Owner and Consultant. This Agreement comprises the documents listed as attachments in the Table of
Contents. The work to be performed by the Consultant under this Agreement shall encompass and
include all detail work, services, materials, equipment and supplies necessary to prepare and deliver the
scope of services provided in Attachment A.
2.2 Required Guidance. All services shall be in conformity with the Specifications outlined in Attachment
B, the Iowa Department of Transportation Federal -aid Project Development Guide, Instructional
Memorandums to Local Public Agencies (l.M.$), and other standards, guides or policies referenced
therein. In addition, applicable sections of the U.S. Department of Transportation Federal Aid Policy
Guide (FAPG) shall be used as a guide in preparation of plans, specifications and estimates.
2.3 Applicable Law. The laws of the State of Iowa shall govern and determine ail matters arising out of or
in connection with this Agreement without regard to the choice of law provisions of Iowa law. In the
event any proceeding of a quasi-judicial or judicial nature is commenced in connection with this
Agreement, the exclusive jurisdiction for the proceeding shall be brought in the Black Hawk County
District Court of Iowa, Waterloo, Iowa. This provision shall not be construed as waiving any immunity to
suit or liability including without limitation sovereign immunity in State or Federal court, which may be
available to the Owner. The Consultant shall comply with all Federal, State and local laws and
ordinances applicable to the work performed under this Agreement.
ARTICLE 3 FORM OF COMPENSATION
3.1 Method of Reimbursement for the Consultant.
3.1.1 Compensation for the Consultant shall be computed in accordance with one of the
following compensation methods, as defined in Attachment C:
.1 [ ] Cost Plus Fixed Fee - Attachment C
.2 [ ] Lump Sum - Attachment C
.3 [X] Specific Rate of Compensation - Attachment C
.4 [ ] Unit Price - Attachment C
.5 [ ] Fixed Overhead Rate - Attachment C
3.1.2 When applicable, compensation for the subconsultants) shall be computed in accordance with
one of the payment methods listed in section 3.1.1. Refer to section 1.3.3 for identification of the
method of payment utilized in the subconsultant(s) contract. The compensation method utilized for
each subconsultant shall be defined within the subconsultant contract to the Consultant.
3.2 Subconsultant's Responsibilities for Reimbursement. The Consultant shall require the
subconsultants (If applicable) to notify them if they at any time determine that their costs will exceed
their estimated actual costs. The Consultant shalt not allow the subconsultants to exceed their
estimated actual costs without prior written approval of the Contract Administrator. The prime
Consultant is cautioned that cost under -runs associated with any subconsultants contract are not
available for use by the prime Consulfant or other subconsultant unless the Confract Administrator
Iowa DOT, and FHWA (when applicable) have given prior written approval.
Page 4 of 23
ARTICLE 4 TERMS AND CONDITIONS
Refer to the Original Standard Consultant Contract for Terms and Conditions which shall remain in full
effect.
IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by their proper officials
thereunto duty authorized as of the dates below.
Ament Design
By or
Michael G. Dryden, P.E.
Secretary/Treasurer
ATTE T• j
Date: ll didt�I''
kir � 1 Date: tD !F(
City of Waterloo, Iowa
ByDJLELKU-154-Cits---Date: / 100
Quentin M. Hart
Mayor
IOWA DEPARTMENT OF TRANSPORTATION
Accepted for FHWA Authorization*
By
Date: 2'/ i 76/
Name fM2& Al* 14.('‘`Y
Title P t/Z 7 tA, 0/1* of ff Y7[,' y
* The lows DOT Is not a party to this agreement. However, by signing this agreement, the Iowa DOT is indicating
the work proposed under this Agreement is acceptable for FHWA authorization of Federal funds.
Page 5 of 23
ATTACHMENT A
Scope of Services
It is understood by the Owner and the Consultant that the level and frequency of Progress Reporting
shall be mutually established for each project, taking into account the complexity and duration of the work
to be performed. For this specific project it is agreed that progress reporting will be provided on a monthly
basis.
It is understood by the Owner and the Consultant that the task detail associated with the 85% budget
notification shall be mutually established for each project in relation to the complexity and duration of the
work to be performed. For this specific project it is agreed that all work contemplated in the agreement
will be considered as one task(s). It is further agreed that the 85% budget notification requirements will
be required for this Agreement based on the volume of work assigned, duration, complexity, and rate of
progress anticipated on the project.
The Consultant will monitor and review updates to the Iowa DOT's Instructional Memorandums (I.M.$),
Road Design Manual, Standard Road Plans, Road Design Details. Updates requiring no additional effort
on the part of the Consultant will be incorporated into the work by the Consultant. If the Consultant is
of the opinion additional effort will be required, the Consultant will so notify the Contract
Administrator, in accordance with Paragraph 4.7. The Contract Administrator will provide written
approval or disapproval for the Consultant to incorporate said update into the work and indicate how
payment for such work will be addressed.
Project Identification
Refer to the Original Standard Consultant Contract for Project Identification which shall remain In full
effect
Scone of Services
Refer to the Original Standard Consultant Contract for Scope of Services, which shall remain in full effect,
and add the following.
11. Research and Data Collection
A. Research and Data Collection
6. Boundary Surveys — This item includes the field and office tasks needed to perform the research
and field measurements to determine the roadway right-of-way and intersecting property line
locations along the Project corridor(s) to the extent necessary to prepare property acquisition
plats and / or easement exhibits.
a. Research documents of public record at the Black Hawk County Recorder's office.
b. Order Title Reports for one (1) parcel at the southeast corner of the intersection of
Ansborough Avenue and Downing Avenue and one (1) parcel at the southwest corner
of the intersection of Ansborough Avenue and DowningAvenue.
c. Provide a field boundary survey to locate the east and west right of way lines for
Ansborough Avenue, the south right-of-way line for Downing Avenue and the property
lines for each of the two
(2) identified proposed right-of-way parcels.
d. Prepare Acquisition Plats and descriptions for two (2) parcels and Temporary Easement
Plats and descriptions for two (2) parcels.
e. Stake proposed right-of-way corners.
Vi. Deliverables
A. ENGINEER Deliverables
15. One (1) set of right-of-way and/or permanent easement acquisition plats with legal descriptions
[up to two (2)] and temporary construction easement exhibits with descriptions [up to two (2)],,,,„
Page 6 of 23
FEB 2 2 2015
along with accompanying transmittal letter to OWNER.
Page 7 of 23
ATTACHMENT B
Specifications
Refer to the Original Standard Consultant Contract for ATTACHMENT B, Specifications which shall remain in
full effect.
Page 8 of 23
ATTACHMENT C (referenced from 3.1)
Specific Rate of Compensation
3.1.1 FEES AND PAYMENTS
3.1.1.1 Fees. For full and complete compensation for all work, materials, and services furnished under the terms
of this Agreement, the Consultant shall be paid fees not to exceed the maximum amount payable under
this Agreement of $1,805.00.
The maximum amount payable will not be changed unless there is a substantial change in the magnitude,
scope, character, or complexity of the services from those covered in this Agreement. Any change in the
maximum amount payable will be by Supplemental Agreement.
A contingency amount of $ 181.00 has been established for this Agreement and is included in the
maximum amount payable. Written request by the Consultant indicating the need and written approval
by the Contract Administrator and concurrence from the Iowa DOT are needed prior to usage of the
contingency amount.
The current schedule of billing rates (direct labor rate, overhead, and fixed fee) are set forth in Attachment
C-1. The Consultant may submit for approval a revised rate schedule once during the contract period.
This revision may include a revised overhead rate and revised direct labor rates. The revised rate
schedule should be submitted to the Contract Administrator for approval and by the Contract
Administrator's written approval it shall become a part of this Agreement.
3.1.1.2 Reimbursable Costs. The Consultant shall be reimbursed for direct non -salary costs which are directly
attributable and properly allocable to the work. The Consultant will be required to submit a detailed listing
of direct non -salary costs incurred and certify that such costs are not included in the overhead expense
pool. These costs may include travel and subsistence, reproductions, computer charges, and materials
and supplies.
Reimbursement of costs is limited to those that are attributable to the specific work covered by this
Agreement and allowable under the provisions of the Code of Federal Regulations (CFR), Title 48,
Federal Acquisition Regulation System, Subchapter E., Part 30 (when applicable), and Part 31, Section
31.105 and Subpart 31.2. In addition to Title 48 requirements, for meals to be eligible for reimbursement,
an overnight stay will be required.
3.1.1.3 Premium Overtime Pay. Notapplicable.
3.1.1.4 Payments. Monthly payments for work completed shall be based on the services completed at the time
of the billing and substantiated by monthly progress reports in a form that follows the specific rate
schedule. The Contract Administrator Will check such progress reports and payment will be made for
the hours completed at each rate and for direct non -salary costs incurred during said month. The Owner
shall retain from each monthly payment for construction inspection or construction administration services
0% of the amount due.
Invoices shall clearly identify the beginning and ending dates of the prime's and subconsultant's billing
cycles. All direct and indirect costs incurred during the billing cycle shall be invoiced. Costs incurred from
prior billing cycles and previously not billed, will not be allowed for reimbursement unless approved by the
Contract Administrator.
Upon completion, delivery and acceptance of all work contemplated under this Agreement, the
Consultant shall submit one complete invoice statement of costs incurred and amounts earned.
Payment of 100% of the total cost claimed, inclusive of retainage, if applicable, will be made upon receipt
and review of such claim. The Consulfanf agrees to reimburse the Owner for possible overpayment
determined by final audit.
Page 9 of 23
ATTACHMENT C-1
Cost Analysis Worksheet
Contract STP -A-8155(757)--86-07, Base Agreement
1. Labor Cost (Prime Only)
Employee Classification Hours Rate Amount
Manager / Director 2 $165.00 $330.00
Senior Engineer / Architect / Land 0 $150.00 0.00
Surveyor
Engineer / Architect / Land Surveyor 0 $125.00 0.00
Engineer / Architect / Survey Intern 2 $100.00 200.00
Technician II 10 $90.00 900.00
Technician I 0 $70.00 0.00
Administrative 1 $75.00 75.00
Labor Total
15 ' $1,505.00
11. Direct Project Expenses (Prime only) Quantity Rate
Mileage (miles) 0 $0.545
Reproductions (each) 0 $0.20
Postage (oz.) 0 $0.50
CAD Time (hours) 0 $14.75
Lodging 0 $100.00
Title Reports 1 $300.00
Spikes/Lath 0 $1.00
Survey Supplies 0 $2.50
Amount
$0.00
0.00
0.00
0.00
0.00
300.00
0.00
0.00
Total Direct Expenses = $300.00
111. Estimated Actual Costs (EAC) (Prime Only) (I + H) = $1,805.00(Rounded)
IV. Contingency (prime only) ( 10% of 1 + 11) = $181.00(Rounded)
V. Subconsultant Expenses
None (Lump Sum Fee) $0.00
Total Subconsultant Costs = $0.00
V1. Specific Rate of Compensation Agreement Total (lll + IV + V) =
(Maximum Amount Payable)
$1,986.00*
* Includes contingency amounts (Prime & Subconsultants) totaling $181.00
Total initial Authorized Costs (Excluding All Contingency Amounts) = $1,805.00
Page 10 of 23
FEB 2 2 Ms
ATTACHMENT D
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS -- PRIMARY COVERED TRANSACTIONS
Instructions for Certification
1. By signing and submitting this proposal, the prospective primary participant is providing the certification set out
below.
2. The inability of a person to provide the certification required below will not necessarily result in denial of
participation in this covered transaction. The prospective participant shall submit an explanation of why It
cannot provide the certification set out below. The certification or explanation will be considered in connection
with the department or agency's determination whether to enter into this transaction. However, failure of the
prospective primary participant to furnish a certification or an explanation shall disqualify such person from
participation in this transaction.
3. The certification In this clause is a material representation of fact upon which reliance was placed when the
department or agency determined to enter into this transaction. If it is later determined that the prospective
primary participant knowingly rendered an erroneous certification, in addition to other remedies available to the
Federal Government, the department or agency may terminate this transaction for cause or default.
4. The prospective primary participant shall provide immediate written notice to the department or agency to
whom this proposal is submitted if at any time the prospective primary participant learns that its certification
was erroneous when submitted or has become erroneous by reason of changed circumstances.
5. The terms "covered transaction, ""debarred, ""suspended," "ineligible," "lower tier covered transaction,"
"participant," "person" "primary covered transaction," "principal," "proposal," and "voluntarily excluded," as
used in this clause, have the meanings set out in the definitions and coverage sections of the rules
implementing Executive Order 12549. You may contact the department or agency to which this proposal is
being submitted for assistance in obtaining a copy of those regulations.
6. The prospective primary participant agrees by submitting this proposal that should the proposed covered
transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person
who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered
transaction, unless authorized by the department or agency entering into this transaction.
7. The prospective primary participant further agrees by submitting this proposal that it will include the clause
titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier
Covered Transaction," provided by the department or agency entering into this covered transaction, without
modification in all lower tier covered transactions and in all solicitations for lower tier covered transactions.
8. A participant In a covered transaction may rely upon a certification of a prospective participant in a lower tier
covered transaction that it is not debarred, suspended, Ineligible, or voluntarily excluded from the covered
transaction, unless it knows that the certification is erroneous. A participant may decide the method and
frequency by which it determines the eligibility of its principals. Each participant may, but is not required to,
check the Nonprocurement List.
9. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order
to render in good faith the certification required by this clause. The knowledge and information of a participant
is not required to exceed that which is normally possessed by a prudent person in the ordinary course of
business dealings.
10. Except for transactions authorized under paragraph 6 of these instructions, if a participant in a covered
transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred,
ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to
the Federal Government, the department or agency may terminate this transaction for cause or default.
Page 11 of 23
Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered
Transactions
(1) The prospective primary participant certifies to the best of its knowledge and belief, that it and its
principals:
(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily
excluded from covered transactions by any Federal department or agency;
(b) Have not within a three-year period preceding this proposal been convicted of or had a civil judgment
rendered against them for commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a
public transaction; violation of Federal or State Antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving
stolen property;
(c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity
(Federal, State or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this
certification; and
(d) Have not within a three-year period preceding this application /proposal had one or more public
transactions (Federal, State or local) terminated for cause or default.
(2) Where the prospective primary participant is unable to certify to any of the statements in this certification, such
prospective participant shall attach an explanation to this proposal.
State of Iowa
Black Hawk County
I Michael G. Dryden, Secretary/Treasurer of the
Ament Design Company, being duly sworn (or under penalty of perjury under the laws of the United States and the
State of Iowa) do hereby certify that the above Statements are true and correct.
(Signature)
Subscribed and sworn to this /VA day of
(montl4 (year)
Page 18 of 24
FEB 2 2 2019
ATTACHMENT E
CERTIFICATION OF CONSULTANT
hereby certify that I, Michael G. Dryden, am the Secretary/Treasurer and duly authorized representative of the
firm of Ament Design, whose address is 625 32nd Avenue SW, Cedar Rapids, Iowa 52404, and that neither the
above firm nor I has:
(a) Employed or retained for a commission, percentage, brokerage, contingent fee, or other consideration,
any firm or person (other than a bona fide employee working solely for me or the above Consultant) to
solicit or secure this contract,
(b) Agreed, as an express or implied condition for obtaining this contract, to employ or retain the services of
any firm or person in connection with carrying out the contract, or
(c) Paid, or agreed to pay, to any firm, organization or person (other than a bona fide employee working solely
for me or the above Consultant) any fee, contribution, donation or consideration of any kind for, or in
connection with, procuring or carrying out the contract; except as here expressly stated (if any):
I acknowledge that this certificate is to be furnished to the Iowa Department of Transportation and the Federal
Highway Administration, U.S. Department of Transportation, in connection with this contract involving participation
of Federal -aid highway funds, and is subject to applicable, State and Federal laws, both criminal and civil.
Signature ' Date
Page 19 of 24
ATTACHMENT F
CERTIFICATION OF OWNER
1 hereby certify that I, Quentin M. Hart, am the Mayor and the duly authorized representative of the Owner, and
that the above consulting firm or his representative has not been required, directly or indirectly as an express or
implied condition in connection with obtaining or carrying out this contract to:
(a) Employ or retain, or agree to employ or retain, any firm or person, or
(b) Pay, or agree to pay, to any firm, person, or organization, any fee, contribution, donation, or consideration
of any kind; except as here expresslystated (if any):
I acknowledge that this certificate is to be furnished to the to the Iowa Department of Transportation and the
Federal Highway Administration, U.S. Department of Transportation, in connection with this contract involving
participation of Federal -aid highway funds, and is subject to applicable State and Federal laws, both criminal and
civil.
Signature
( ,s,(6J uk.. Date
Page 14 of 23
Fib 2 Z LOIS
Consultant Name
Consultant Address
Consultant Address
Invoice No.
Invoice Period Covered
Consultant Job No.
ATTACHMENT G
Page 6
Specific Rate Progressive Invoice
Date
Client Project No.
County
Client Project Description
Client Contract No.
Contract Cumulative Current
Estimate To Date Period
Labor Dollars
Direct Expenses
Mileage
Per Diem
CADD
Estimated Actual Costs
[Prime Only] (See Note 1)
Subconsultants (including authorized
contingency)
Name
Name
Name
Total
Authorized Contingency
Total Authorized Amount
Total Billed To Date
Remaining Authorized Balance
Unauthorized Contingency
Prime
Subconsultant Name
Subconsultant Name
Labor Hours
Note 1: Do not include Subconsultant Expenses. Include Labor Dollars and Direct Expenses for Prime
Consultant only.
Page 15 of 23
Consultant Name
Consultant Address
Consultant Address
Invoice.No.
Invoice Period Covered
Consultant Job No.
ATTACHMENT G
Page 7
Specific Rate Final Invoice
Date
Client Project No.
County
Client Project Description
Client Contract No.
Contract Cumulative Current
Estimate To Date Period
Labor Dollars (2002)
Labor Dollars (2001)
Labor Dollars (2000)
Labor Dollars (1999)
Direct Expenses
Mileage
Per Diem
CADD
Estimated Actual Costs
[Prime Only] (See Note 1)
Subconsultants (including authorized
contingency)
Name
Name
Name
Total
Authorized Contingency
Total Authorized Amount
Total Billed To Date
Remaining Authorized Balance
Unauthorized Contingency
Prime
Subconsultant Name
Subconsultant Name
Labor Hours (2002)
Labor Hours (2001)
Labor Hours (2000)
Labor Hours (1999)
Note 1: Do not include Subconsultant Expenses. Include Labor Dollars and Direct Expenses for Prime
Consultant only
Page 16 of 23
ATTACHMENT G
Page 8
Specific Rate Final Invoice Instructions
•
Employee Labor Hours and Dollars: A final cumulative job cost report that shows a breakdown of labor by
fiscal year, employee name, employee labor hours and employee labor rate is required. In lieu of a final job
cost report, a summary of the aforementioned information is needed. The summary should be supported by
monthly job cost detail.
• Direct Expenses: A final cumulative job cost report that shows a breakdown of direct expenses by specific
item (mileage, CADD, per diem, etc....) by fiscal year is required. Direct expense items charged should
identify the number of units (miles, hours, prints, copies, feet, etc....) and the rate applied by fiscal year. In lieu
of a final job cost report, a summary of the aforementioned information is needed. The summary should be
supported by monthly job costdetail.
• Subconsultant: Final invoice requirements for subconsultants with specific rate contracts are the same as the
requirements for the prime consultant. It is the prime consultant's responsibility to assure such an invoice is
acquired and attached to the prime's final invoice.
Page 17 of 23