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HomeMy WebLinkAbout2021-12-20-I01K_06 Ute Ave-Ashworth Rd Intersection_Pmt Est 4AGENDA ITEM: CITY OF WAUKEE, IOWA CITY COUNCIL MEETING COMMUNICATION MEETING DATE: December 20, 2021 AGENDA ITEM:Consideration of approval of Payment Estimate No. 4 to Concrete Technologies, Inc. for the Ute Avenue & Ashworth Road Intersection Improvements project in the amount of $196,001.77. FORMAT:Consent Agenda SYNOPSIS INCLUDING PRO & CON: Concrete Technologies, Inc. requested Payment Estimate No. 4 for the work completed on the Ute Avenue & Ashworth Road Intersection Improvements project in the amount of $196,001.77. Snyder & Associates, Inc. has reviewed the payment estimate and recommends payment. The partial payment is for the pay period ending November 30, 2021. This pay estimate is for class 10 excavation, water main and storm sewer installation as well as stored traffic signal materials. FISCAL IMPACT INCLUDING COST/BENEFIT ANALYSIS: $196,007.77 COMMISSION/BOARD/COMMITTEE COMMENT: STAFF REVIEW AND COMMENT: RECOMMENDATION: Approve Payment Estimate No. 4 ATTACHMENTS: I. Payment Estimate No. 4 II. Letter of Recommendation PREPARED BY:Beth Richardson REVIEWED BY:Sara Kappos SKK PUBLIC NOTICE INFORMATION – NAME OF PUBLICATION: DATE OF PUBLICATION: I1K6 2727 SW SNYDER BOULEVARD | P.O. BOX 1159 | ANKENY, IA 50023-0974 autofill v:\projects\2020\120.0783.01\construction\pay_2021-12-15_letterpayapp04.docm December 15, 2021 Mr. Rudy Koester, P.E. City of Waukee 805 University Avenue Waukee, IA 50263 RE: PARTIAL PAYMENT APPLICATION NO. 04 UTE AVENUE AND ASHWORTH ROAD INTERSECTION PROJECT Dear Rudy: Enclosed is partial payment application 04 for the Ute Avenue and Ashworth Road Intersection project. This application includes work completed during the month of November 2021, including partial payment of class 10 excavation, water main and storm sewer installation. This payment application also covers payment for stored traffic signal materials per the enclosed invoice. We recommend payment of $196,001.77 to the prime contractor, Concrete Technologies, Inc. of Grimes, Iowa. Please place this payment application on the next available city council meeting agenda for approval. Sincerely, SNYDER & ASSOCIATES, INC. Nathan Carhoff, P.E. Project Manager Enclosure PAY_2021-12-15_PartialPaymentApplication04.xlsx APPLICATION FOR PARTIAL PAYMENT NO. 4 PROJECT:Ute Avenue & Ashworth Road Intersection Improvements S&A PROJECT NO.: 120.0783.01 OWNER:City of Waukee CONTRACTOR:Concrete Technologies, Inc. ADDRESS:1001 SE 37th Street Grimes, IA 50111 DATE:December 15, 2021 PAYMENT PERIOD: November 1, 2021 to November 30, 2021 1. CONTRACT SUMMARY: Original Contract Amount:$4,768,652.70 CONTRACT PERIOD: TOTAL WORKING DAYS Original Contract Date: August 2, 2021 Net Change by Change Order:$119,330.55 Original Contract Completion Date: August 6, 2022 Contract Amount to Date:$4,887,983.25 2. WORK SUMMARY:Added by Change Order: 0 Total Work Performed to Date:$1,135,133.95 Contract Completion Date: August 6, 2022 Retainage: 5%$56,756.70 Time Used to Date: 110 Total Earned Less Retainage:$1,078,377.25 Contract Time Remaining: 259 Less Previous Applications for Payment:$882,375.48 AMOUNT DUE THIS APPLICATION:$196,001.77 3. CONTRACTOR'S CERTIFICATION: The undersigned CONTRACTOR certifies that: (1) all previous progress payments received from OWNER on account of Work done under the contract referred to above have been applied to discharge in full all obligations of CONTRACTOR incurred in connection with the Work covered by prior Applications for Payment; and (2) title to all materials and equipment incorporated in said Work or otherwise listed in or covered by the application for Payment are free and clear of all liens, claims, security interests, and encumbrances Concrete Technologies, Inc. CONTRACTOR By DATE:December 15, 2021 4. ENGINEER'S APPROVAL: Payment of the above AMOUNT DUE THIS APPLICATION is recommended: Snyder & Associates, Inc. ENGINEER By DATE:December 15, 2021 5. OWNER'S APPROVAL City of Waukee OWNER By DATE: PAY_2021-12-15_PartialPaymentApplication04.xlsx 6.DETAILED ESTIMATE OF WORK COMPLETED: CONTRACT ITEMS COMPLETED WORK ITEM PLAN UNIT UNIT COST COST QTY.CO #COST NO.DESCRIPTION QTY.TOTAL TO DATE TOTAL 2.1 Clearing and Grubbing 507 UNIT $47.75 $24,218.80 $- 2.2 Clearing and Grubbing 1 ACRE $10,600.00 $10,600.00 $- 2.3 Topsoil, On-site 8,256 CY $6.35 $52,425.60 3,302.4 $20,970.24 2.4 Excavation, Class 10 31,706 CY $10.60 $336,083.60 15,853.0 $168,041.80 2.5 Below Grade Excavation (Core Out)500 CY $10.60 $5,300.00 $- 2.6 Subgrade Preparation 25,378 SY $3.20 $81,209.60 $- 2.7 Subgrade Treatment (Cement or Fly Ash)500 SY $12.75 $6,375.00 $- 2.8 Subgrade Treatment (Geogrid, Type I)500 SY $7.50 $3,750.00 $- 2.9 Subbase, Modified, 6 Inch Depth 23,060 SY $9.25 $213,305.00 $- 2.10 Removal of Structure, Retaining Wall 102 LF $47.75 $4,870.50 $- 2.11 Removal of Known Pipe Culvert 612 LF $31.75 $19,431.00 $- 3.1 Trench Foundation 100 TON $63.50 $6,350.00 $- 4.1 Sanitary Sewer Gravity Main, Trenched, PVC, 6 Inch 148 LF $84.75 $12,543.00 148 $12,543.00 4.2 Sanitary Sewer Gravity Main, Trenchless, PVC, 6 Inch 50 LF $159.00 $7,950.00 50 $7,950.00 4.3 Removal of Sanitary Sewer, DIP, 8 Inch 20 LF $106.00 $2,120.00 20 $2,120.00 4.4 Removal of Sanitary Sewer, PVC, 12 Inch 20 LF $106.00 $2,120.00 20 $2,120.00 4.5 Sanitary Sewer Cleanout 4 EACH $555.00 $2,220.00 2 $1,110.00 4.6 Sanitary Sewer Service Connection 1 LS $1,590.00 $1,590.00 1 $1,590.00 4.7 Storm Sewer, Trenched, Class III RCP, 15 Inch 2,274 LF $74.25 $168,844.50 356 $26,433.00 4.8 Storm Sewer, Trenched, Class III RCP, 18 Inch 143 LF $79.50 $11,368.50 143 $11,368.50 4.9 Storm Sewer, Trenched, Class IV RCP, 18 Inch 309 LF $84.75 $26,187.75 $- 4.10 Storm Sewer, Trenched, Class III RCP, 24 Inch 38 LF $106.00 $4,028.00 8 $848.00 4.11 Pipe Culvert, Trenched, RCP, 12 Inch 28 LF $74.25 $2,079.00 28 $2,079.00 4.12 Pipe Culvert, Trenched, CMP, 18 Inch 134 LF $106.00 $14,204.00 80 $8,480.00 4.13 Pipe Culvert, Trenched, Remove and Reinstall, CMP, 15 Inch 42 LF $132.50 $5,565.00 $- 4.14 Pipe Apron, CMP, 18 Inch 6 EACH $795.00 $4,770.00 4 $3,180.00 4.15 Pipe Apron, RCP, 12 Inch 2 EACH $1,905.00 $3,810.00 2 $3,810.00 4.16 Pipe Apron, RCP, 15 Inch 4 EACH $1,485.00 $5,940.00 1 $1,485.00 4.17 Pipe Apron, RCP, 18 Inch 2 EACH $1,585.00 $3,170.00 $- 4.18 Pipe Apron, RCP, 24 Inch 1 EACH $1,585.00 $1,585.00 $- 4.19 Footing for Concrete Pipe Apron, RCP, 15 Inch 4 EACH $1,585.00 $6,340.00 1 $1,585.00 4.20 Footing for Concrete Pipe Apron, RCP, 18 Inch 2 EACH $1,585.00 $3,170.00 $- 4.21 Footing for Concrete Pipe Apron, RCP, 24 Inch 1 EACH $1,585.00 $1,585.00 $- 4.22 Pipe Apron Guard, 12 Inch 1 EACH $1,060.00 $1,060.00 1 $1,060.00 4.23 Pipe Apron Guard, 15 Inch 4 EACH $1,060.00 $4,240.00 $- 4.24 Subdrain, Type 1, 6 Inch 3,330 LF $10.90 $36,297.00 $- 4.25 Subdrain Cleanout, Type A1, 6 Inch 1 EACH $450.00 $450.00 $- 4.26 Subdrain Outlets and Connections, Outlet Into Structure, 6 Inch 32 EACH $345.00 $11,040.00 $- 4.27 Subdrain Outlets and Connections, Outlet to Ditch, 6 Inch 6 EACH $400.00 $2,400.00 $- 5.1 Water Main, Trenched, PVC, 8 Inch 45 LF $84.75 $3,813.75 $- 5.2 Water Main, Trenched, PVC, 12 Inch 193 LF $74.25 $14,330.25 193 $14,330.25 5.3 Water Main, Trenched, PVC, 16 Inch 2,686 LF $122.00 $327,692.00 1,160 $141,520.00 5.4 Water Main, Trenchless, PVC, 8 Inch 40 LF $159.00 $6,360.00 $- 5.5 Water Main, Trenchless, PVC, 16 Inch 490 LF $212.00 $103,880.00 $- 5.6 Fitting, 90 Degree Bend, 8 Inch 1 EACH $530.00 $530.00 $- 5.7 Fitting, 11.25 Degree Bend, 12 Inch 3 EACH $795.00 $2,385.00 $- 5.8 Fitting, 11.25 Degree Bend, 16 Inch 6 EACH $1,060.00 $6,360.00 3 $3,180.00 5.9 Fitting, 22.5 Degree Bend, 12 Inch 2 EACH $530.00 $1,060.00 $- PAY_2021-12-15_PartialPaymentApplication04.xlsx 5.10 Fitting, 22.5 Degree Bend, 16 Inch 4 EACH $1,060.00 $4,240.00 1 $1,060.00 5.11 Fitting, 45 Degree Bend, 12 Inch 1 EACH $850.00 $850.00 1 $850.00 5.12 Fitting, 16 Inch x 6 Inch Tee 11 EACH $1,270.00 $13,970.00 5 $6,350.00 5.13 Fitting, 16 Inch x 8 Inch Tee 2 EACH $2,650.00 $5,300.00 $- 5.14 Fitting, 16 Inch x 12 Inch Cross 1 EACH $2,120.00 $2,120.00 1 $2,120.00 5.15 Fitting, 16 Inch x 6 Inch Reducer 1 EACH $1,060.00 $1,060.00 $- 5.16 Water Service Pipe, Copper, 1 Inch 574 LF $26.50 $15,211.00 170 $4,505.00 5.17 Valve, Gate, 8 Inch 2 EACH $3,705.00 $7,410.00 $- 5.18 Valve, Gate, 12 Inch 2 EACH $5,825.00 $11,650.00 1 $5,825.00 5.19 Valve, Gate, 16 Inch 5 EACH $7,945.00 $39,725.00 1 $7,945.00 5.20 Tapping Valve Assembly, 12 Inch 1 EACH $6,885.00 $6,885.00 1 $6,885.00 5.21 Fire Hydrant Assembly 14 EACH $5,930.00 $83,020.00 5 $29,650.00 5.22 Fire Hydrant Assembly, Remove and Salvage 1 EACH $1,590.00 $1,590.00 1 $1,590.00 5.23 Line Stop, 12 Inch 1 EACH $15,885.00 $15,885.00 $- 5.24 Meter Pit 1 EACH $1,060.00 $1,060.00 $- 5.25 Meter Pit, Relocate 3 EACH $1,060.00 $3,180.00 $- 5.26 Meter Pit, Remove 1 EACH $1,060.00 $1,060.00 $- 6.1 Manhole, SW-401, 48 Inch 8 EACH $3,710.00 $29,680.00 4 $14,840.00 6.2 Intake, SW-501 10 EACH $3,495.00 $34,950.00 4 $13,980.00 6.3 Intake, SW-503 8 EACH $4,325.00 $34,600.00 $- 6.4 Manhole Adjustment, Minor 3 EACH $425.00 $1,275.00 $- 6.5 Manhole Adjustment, Major 3 EACH $1,060.00 $3,180.00 $- 6.6 Connection to Existing Manhole 2 EACH $1,590.00 $3,180.00 1 $1,590.00 6.7 Remove Intake 1 EACH $1,590.00 $1,590.00 $- 7.1 Pavement, PCC, 6 Inch 2,445 SY $52.00 $127,140.00 1,735.95 $90,269.40 7.2 Pavement, PCC, 9 Inch 18,686 SY $79.50 $1,485,537.00 $- 7.3 Median, PCC, 6 Inch 167 SY $57.75 $9,644.25 $- 7.4 Median, PCC, 15 Inch 102 SY $98.75 $10,072.50 $- 7.5 PCC Pavement Samples and Testing 1 LS $11,315.00 $11,315.00 $- 7.6 Removal of Driveway, Paved 787 SY $10.60 $8,342.20 196.75 $2,085.55 7.7 Removal of Driveway, Granular 274 SY $4.25 $1,164.50 $- 7.8 Shared Use Path, PCC, 6 Inch 2,726 SY $40.50 $110,403.00 $- 7.9 Special Subgrade Preparation for Shared Use Path 3,268 SY $5.30 $17,320.40 $- 7.10 Sidewalk, PCC, 5 In.121 SY $53.50 $6,473.50 $- 7.11 Sidewalk, PCC, 6 In.24 SY $56.50 $1,356.00 $- 7.12 Detectable Warnings, Cast Iron, Natural Finish 212 SF $52.50 $11,130.00 $- 7.13 Driveway, Paved, PCC, 6 Inch 1,978 SY $56.50 $111,757.00 $- 7.14 Driveway, Granular 440 SY $10.60 $4,664.00 $- 7.15 Driveway, Temporary Granular 966 SY $12.75 $12,316.50 $- 7.16 Shoulder, Granular 1,351 SY $37.00 $49,987.00 156.50 $5,790.50 7.17 Pavement Removal 8,128 SY $9.55 $77,622.40 812.80 $7,762.24 8.1 Traffic Signals 1 LS $382,720.00 $382,720.00 $- 8.2 Painted Pavement Markings, Durable 359 STA $53.00 $19,027.00 $- 8.3 Painted Symbols and Legends, Durable 20 EACH $400.00 $8,000.00 $- 8.4 Grooves Cut for Pavement Markings 359 STA $39.25 $14,090.75 $- 8.5 Grooves Cut for Symbols and Legends 20 EACH $185.50 $3,710.00 $- 8.6 Temporary Traffic Control 1 LS $25,945.00 $25,945.00 0.20 $5,189.00 8.7 Sign Assembly, Remove 16 EACH $127.00 $2,032.00 $- 8.8 Sign Assembly, Remove and Reinstall 15 EACH $127.00 $1,905.00 $- 8.9 Sign Assembly, Furnish and Install, Type A 28 EACH $420.00 $11,760.00 $- 8.10 Portable Dynamic Message Signs 28 CDAY $215.00 $6,020.00 28 $6,020.00 9.1 Conventional Seeding, Seeding, and Mulching, Wetland 0.02 ACRE $47,650.00 $953.00 $- 9.2 Hydraulic Seeding, Seeding, and Fertilizing, Type 1 2.2 ACRE $1,165.00 $2,563.00 $- PAY_2021-12-15_PartialPaymentApplication04.xlsx 9.3 Hydraulic Seeding, Seeding, Fertilizing, and Mulching, Type 1 3.4 ACRE $3,600.00 $12,240.00 $- 9.4 Hydraulic Seeding, Seeding, Fertilizing, and Mulching, Type 4 5.6 ACRE $2,915.00 $16,324.00 $- 9.5 SWPPP Preparation 1 LS $1,590.00 $1,590.00 1 $1,590.00 9.6 SWPPP Management 1 LS $2,650.00 $2,650.00 0.25 $662.50 9.7 Filter Sock, 12 Inch 4,376 LF $2.15 $9,408.40 210 $451.50 9.8 Filter Sock, Removal 4,376 LF $0.35 $1,531.60 $- 9.9 Temporary RECP, Type 2D (Short Term)10,470 SY $1.35 $14,134.50 $- 9.10 Rip Rap, Class E 38 TON $106.00 $4,028.00 $- 9.11 Silt Fence or Silt Fence Ditch Check 5,510 LF $1.60 $8,816.00 424.3 $678.88 9.12 Silt Fence or Silt Fence Ditch Check Removal of Sediment 5,510 LF $0.05 $275.50 $- 9.13 Silt Fence or Silt Fence Ditch Check Removal of Device 5,510 LF $0.05 $275.50 $- 9.14 Stabilized Construction Entrance 897 SY $12.75 $11,436.75 $- 9.15 Inlet Protection Device, Drop-in 18 EACH $170.00 $3,060.00 $- 9.16 Inlet Protection Device, Maintenance and Removal 18 EACH $26.50 $477.00 $- 9.17 Flow Transition Mat 749 SF $15.90 $11,909.10 $- 9.18 Removal and Reinstallation of Existing Fence, Wood, 48 Inch 81 LF $65.00 $5,265.00 $- 9.19 Removal of Fence 1,338 LF $6.25 $8,362.50 $- 10.1 Demolition Work, Septic Tank Abandonment 1 LS $10,590.00 $10,590.00 0.8 $8,472.00 11.1 Construction Survey 1 LS $23,190.00 $23,190.00 0.20 $4,638.00 11.2 Monument Preservation and Replacement 1 LS $5,295.00 $5,295.00 $- 11.3 Mobilization 1 LS $156,500.00 $156,500.00 0.40 $62,600.00 11.4 Maintenance of Postal Service 1 LS $7,105.00 $7,105.00 $- 11.5 Remove and Reinstall Mailbox 8 EACH $400.00 $3,200.00 $- 11.6 Maintenance of Solid Waste Collection 1 LS $4,865.00 $4,865.00 $- 11.7 Concrete Washout 1 LS 11,475.00 $11,475.00 $- TOTAL ORIGINAL CONTRACT = $4,768,652.70 $729,203.36 STORED MATERIALS SUMMARY A.Storm Sewer Pipe, RCP, 15 Inch, 18 Inch and 24 Inch 3,544 LF $21.68 $76,818.84 3,544 $76,818.84 B.Water Main Pipe, PVC, 8 Inch, 12 Inch and 16 Inch 2,280 LF $62.51 $142,520.00 2,280 $142,520.00 C.Water Main Fittings, Valves, Accessories 42 EACH $3,860.48 $162,140.23 42 $162,140.23 D.Storm Sewer Structures, SW-401, SW-501, and SW-503 34 EACH $810.02 $27,540.52 26 $21,060.52 E.Storm Sewer Structures, Aprons 5 EACH $488.60 $2,443.00 5 $2,443.00 F.Traffic Signal Equipment 1 LS $47,272.49 $-1 $- TOTAL STORED MATERIALS = $411,462.59 $404,982.59 CHANGE ORDER SUMMARY: 2.3 Topsoil, On-site -34 CY $6.35 $(215.90)1 $- 2.4 Excavation, Class 10 937 CY $10.60 $9,932.20 1 $- 2.6 Subgrade Preparation 566 SY $3.20 $1,811.20 1 $- 2.9 Subbase, Modified, 6 Inch Depth 554 SY $9.25 $5,124.50 1 $- 2.11 Removal of Known Pipe Culvert 22 LF $31.75 $698.50 1 $- 4.7 Storm Sewer, Trenched, Class III RCP, 15 Inch 284 LF $74.25 $21,087.00 1 $- 4.8 Storm Sewer, Trenched, Class III RCP, 18 Inch 401 LF $79.50 $31,879.50 246 1 $19,557.00 4.10 Storm Sewer, Trenched, Class III RCP, 24 Inch 16 LF $106.00 $1,696.00 1 $- 4.11 Pipe Culvert, Trenched, RCP, 12 Inch -28 LF $74.25 $(2,079.00)-28 1 $(2,079.00) 4.12 Pipe Culvert, Trenched, CMP, 18 Inch -80 LF $106.00 $(8,480.00)-80 1 $(8,480.00) 4.14 Pipe Apron, CMP, 18 Inch -4 EACH $795.00 $(3,180.00)-4 1 $(3,180.00) 4.15 Pipe Apron, RCP, 12 Inch -2 EACH $1,905.00 $(3,810.00)-2 1 $(3,810.00) 4.16 Pipe Apron, RCP, 15 Inch 1 EACH $1,485.00 $1,485.00 1 $- PAY_2021-12-15_PartialPaymentApplication04.xlsx 4.18 Pipe Apron, RCP, 24 Inch 1 EACH $1,585.00 $1,585.00 1 $- 4.19 Footing for Concrete Pipe Apron, RCP, 15 Inch 1 EACH $1,585.00 $1,585.00 1 $- 4.21 Footing for Concrete Pipe Apron, RCP, 24 Inch 1 EACH $1,585.00 $1,585.00 1 $- 4.22 Pipe Apron Guard, 12 Inch -1 EACH $1,060.00 $(1,060.00)-1 1 $(1,060.00) 4.23 Pipe Apron Guard, 15 Inch 1 EACH $1,060.00 $1,060.00 1 $- 4.24 Subdrain, Type 1, 6 Inch 820 LF $10.90 $8,938.00 1 $- 4.26 Subdrain Outlets and Connections, Outlet Into Structure, 6 Inch 6 EACH $345.00 $2,070.00 1 $- 4.27 Subdrain Outlets and Connections, Outlet to Ditch, 6 Inch -2 EACH $400.00 $(800.00)1 $- 6.1 Manhole, SW-401, 48 Inch 4 EACH $3,710.00 $14,840.00 1 $- 6.2 Intake, SW-501 4 EACH $3,495.00 $13,980.00 1 $- 7.2 Pavement, PCC, 9 Inch 605 SY $79.50 $48,097.50 1 $- 7.13 Driveway, Paved, PCC, 6 Inch -10 SY $56.50 $(565.00)1 $- 7.15 Driveway, Temporary Granular 128 SY $12.75 $1,632.00 1 $- 7.16 Shoulder, Granular -904 SY $37.00 $(33,448.00)1 $- 8.2 Painted Pavement Markings, Durable -13 STA $53.00 $(689.00)1 $- 8.4 Grooves Cut for Pavement Markings -13 STA $39.25 $(510.25)1 $- 9.3 Hydraulic Seeding, Seeding, Fertilizing, and Mulching, Type 1 0.1 ACRE $3,600.00 $360.00 1 $- 9.4 Hydraulic Seeding, Seeding, Fertilizing, and Mulching, Type 4 0.1 ACRE $2,915.00 $291.50 1 $- 9.7 Filter Sock, 12 Inch 1,457 LF $2.15 $3,132.55 1 $- 9.8 Filter Sock, Removal 1,457 LF $0.35 $509.95 1 $- 9.9 Temporary RECP, Type 2D (Short Term)158 SY $1.35 $213.30 1 $- 9.10 Rip Rap, Class E 13 TON $106.00 $1,378.00 1 $- 9.15 Inlet Protection Device, Drop-in 4 EACH $170.00 $680.00 1 $- 9.16 Inlet Protection Device, Maintenance and Removal 4 EACH $26.50 $106.00 1 $- 9.17 Flow Transition Mat -100 SF $15.90 $(1,590.00)1 $- TOTAL CHANGE ORDERS = $119,330.55 $948.00 TOTAL CONTRACT & CHANGE ORDERS $4,887,983.25 $1,135,133.95 630-543-1300 630-543-5050 INVOICE 10435 ARGONNE WOODS DRIVE WOODRIDGE IL 60517 Fax: Page:1 of 1 132681Invoice: Invoice Date:11/11/2021 12/11/2021Due Date: Ship To:To:16328 VAN MAANEN ELECTRIC, INC VAN MAANEN ELECTRIC, INC 500 IOWA SPEEDWAY DR 500 IOWA SPEEDWAY DR ATTN AUSTIN O'BRIEN NEWTON IA 50208 USA NEWTON IA 50208 USA Fax:641-791-9484 A/P Email:AP@VANMAANENELECTRIC.COM Customer PO:1228 Sales Person: Pack Slip: DOUG RIPLEY 112521 Terms: Ordered On:Sales Tax ID: NET 30 8/5/2021 # NOT ON CERT / WAUKEE, CITY OF FOB: Ship Via: Ship Date:DESTINATION-FRT INCLUDED BEST WAY DEFAULT 11/5/2021 Location: Project Desc: Contract: Quote No: Tracking No: TCC Order No:728646 WAUKEE, IA ASHWORTH RD. & UTE AVE. 640972 RMA: Line Part Number/Description Quantity Unit Price Ext Price 1 ATC CONTROLLER 1.00 EA 3,795.00 /1 3,795.00 ECONOLITE ATC RACK MOUNT CONTROLLER $ 3,795.00Invoice Total: 12/11/2021Payment Due: Goods & Services: Total Misc Charges: Taxes:0.00 0.00 3,795.00 Tax RateTaxable Amt Amount TAX DETAIL Description IAENEWTON50 3,795.00 0.000 0.00% Remit To: Traffic Control Corp, 10435 Argonne Woods Drive, Woodridge, IL 60517 Subject to current Terms & Conditions available at www.trafficcontrolcorp.com Sign up to receive invoices via email. Send request to AccountingDept@TCC1.com SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CANCELLATION © 1993-2015 ACORD CORPORATION. All rights reserved.ACORD 27 (2016/03) The ACORD name and logo are registered marks of ACORD THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS EVIDENCE OF PROPERTY INSURANCE 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. PROPERTY INFORMATION LOCATION/DESCRIPTION COVERAGE INFORMATION COVERAGE / PERILS / FORMS AMOUNT OF INSURANCE DEDUCTIBLE PHONE(A/C, No, Ext): (A/C, No):FAX E-MAILADDRESS: AGENCY THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST. CUSTOMER ID #:AGENCY SUB CODE:CODE: INSURED LOAN NUMBER POLICY NUMBER TERMINATED IF CHECKED CONTINUED UNTILEXPIRATION DATEEFFECTIVE DATE THIS REPLACES PRIOR EVIDENCE DATED: COMPANY DATE (MM/DD/YYYY)EVIDENCE OF PROPERTY INSURANCE REMARKS (Including Special Conditions) MORTGAGEE ADDITIONAL INSURED LOSS PAYEE ADDITIONAL INTEREST NAME AND ADDRESS AUTHORIZED REPRESENTATIVE LOAN # PERILS INSURED BASIC BROAD SPECIAL LENDER'S LOSS PAYABLE 12/8/2021 515-244-0150 LMC Insurance & Risk Management 4200 University Ave., Suite 200 West Des Moines, IA 50266-5945 License#: 1001000272 515-244-9535 l Continental Insurance Company 333 South Wabash Chicago, IL 60604 Van Maanen Electric, Inc. 500 Iowa Speedway Dr. Newton, IA 50208 6081088006 08/01/2021 08/01/2022 X Scheduled Equipment - Special Cause of Loss See Remarks 5,000 RE: Stored Materials for the UTE Avenue and Ashworth Road Intersection improvements project stored at Van Maanen Warehouse, materials being stored valued at $ 47,272.49. City of Waukee320 W Hickman RoadWaukee, IA 50263 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CANCELLATION © 1993-2015 ACORD CORPORATION. All rights reserved.ACORD 27 (2016/03) The ACORD name and logo are registered marks of ACORD THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS EVIDENCE OF PROPERTY INSURANCE 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. PROPERTY INFORMATION LOCATION/DESCRIPTION COVERAGE INFORMATION COVERAGE / PERILS / FORMS AMOUNT OF INSURANCE DEDUCTIBLE PHONE(A/C, No, Ext): (A/C, No):FAX E-MAILADDRESS: AGENCY THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST. CUSTOMER ID #:AGENCY SUB CODE:CODE: INSURED LOAN NUMBER POLICY NUMBER TERMINATED IF CHECKED CONTINUED UNTILEXPIRATION DATEEFFECTIVE DATE THIS REPLACES PRIOR EVIDENCE DATED: COMPANY DATE (MM/DD/YYYY)EVIDENCE OF PROPERTY INSURANCE REMARKS (Including Special Conditions) MORTGAGEE ADDITIONAL INSURED LOSS PAYEE ADDITIONAL INTEREST NAME AND ADDRESS AUTHORIZED REPRESENTATIVE LOAN # PERILS INSURED BASIC BROAD SPECIAL LENDER'S LOSS PAYABLE 12/8/2021 515-244-0150 LMC Insurance & Risk Management 4200 University Ave., Suite 200 West Des Moines, IA 50266-5945 License#: 1001000272 515-244-9535 Continental Insurance Company 333 South Wabash Chicago, IL 60604 Van Maanen Electric, Inc. 500 Iowa Speedway Dr. Newton, IA 50208 6081088006 08/01/2021 08/01/2022 X Scheduled Equipment - Special Cause of Loss See Remarks 5,000 RE: Stored Materials for the UTE Avenue and Ashworth Road Intersection improvements project stored at Van Maanen Warehouse, materials being stored valued at $ 47,272.49. Concrete Technologies, Inc3150 SE Miehe DrGrimes, IA 50111