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R-2016-030 2016-03-28 RESOLUTION NO. R2016-30 A Resolution of the City Council of the City of Pearland, Texas, approving a change order with Texas Sterling Construction Company in the amount of $59,378.50 associated with the Bailey Road Reconstruction Project. BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF PEARLAND, TEXAS: Section 1. That certain change order associated with the Bailey Road Reconstruction Project,a copy of which is attached hereto as Exhibit"A"and made a part hereof for all purposes,is hereby authorized and approved. Section 2. That the City Manager or his designee is hereby authorized to execute and the City Secretary to attest the change order associated with the Bailey Road Reconstruction Project. PASSED, APPROVED and ADOPTED this the 28th day of March, A.D., 2016. � UYYv TOM REID MAYOR ATTEST: /r�. iA /� <<� off: ...�• . .A� NG L�'F'�, TR�� •' _ ..' Y SEA : TARY •.......... APPROVED AS TO FORM: DARRIN M. COKER CITY ATTORNEY Resolution No. R2016-30 CITY OF PEARLAND ,0 �Ae Exhibit "A" PROJECTS DEPARTMENT At Afit 3519 Liberty Drive,Suite 300 Pearland,TX 77581 ' " S www.cityofpearland.com/projects l$1. i s9> CHANGE ORDER Bailey Road Expansion from FM1128 to Veterans Date of Issuance: 02/02/2016 Change Order No.: 1 Contractor: Texas Sterling Construction Co. CoP Project No.: T08002 Consultant: CDM Smith P.O.No.: 152362 Explanation: This change order encompasses the following: This change order is for additions and deductions of quantities on various items and adding new items based on site condition. This includes increased quantities in jack and bore pipe with reduction in standard pipe,change in temporary asphalt pavement widening section for traffic control for school and PISD bus barn, revised signal quantities, removal of temporary signals at Bailey/Harkey and at Bailey/McLean intersections,and adding new temporary striping items to maintain traffic control at BaileyNeterans intersection. Description of Work Cost Time Admin 1 of 5 6.Revised 7/25108 rf CITY OF PEARLAND O 44.e PROJECTS DEPARTMENT V rn Fl G 3519 Liberty Drive,Suite 300 Pearland,TX 77581 It z AS �sl. i eqa www.cityofpearland.com/projects CHANGE ORDER Bailey Road Expansion from FM1128 to Veterans Date of Issuance: 02/02/2016 Change Order No.: 1 Contractor: Texas Sterling Construction Co. CoP Project No.: T08002 Consultant: CDM Smith P.O.No.: 152362 1 Revise the Quantity from 4668 to 4186 on Bid Item No.49.003.22, $(40,006.00) 0 Days "RC PIPE(CL III)(24 IN)" 2 Revise the Quantity from 177 to 438 on Bid Item No.69.003.42, $104,400.00 0 Days "JACK BOR OR TUN PIPE(24 IN)(RC)(CL III)" 3 Revise the Quantity from 30 to 44 on Bid Item No.70.003.43,"JACK $6,720.00 0 Days BOR OR TUN PIPE(30 IN)(RC)(CL IV)" 4 Revise the Quantity from 6000 to 4189 on Bid Item No.111.005.2, $(9,055.00) 0 Days "LIME TRT(EXIST MATL)(6")" 5 Revise the Quantity from 6000 to 4189 on Bid Item No.113.005.4, $(19,377.70) 0 Days "CEMENT TREAT(NEW BASE)(6")" 6 Revise the Quantity from 276 to 1441 on Bid Item No.114.005.5, $99,025.00 0 Days "ASPHALT STAB BASE(GR 2)(PG 64)" 7 Revise the Quantity from 512 to 324 on Bid Item No.155.009.4, $(1,880.00) 0 Days "CONDT(PVC)(SCHD 80)(2")" 8 Revise the Quantity from 119 to 50 on Bid Item No.156.009.5, $(1,035.00) 0 Days "CONDT(PVC)(SCHD 80)(3")" 9 Revise the Quantity from 206 to 272 on Bid Item No.157.009.6, $1,056.00 0 Days "CONDT(PVC)(SCHD 80)(4")" 10 Revise the Quantity from 1235 to 960 on Bid Item No.158.009.7, $(3,025.00) 0 Days "CONDT(PVC)(SCHD 80)(2")(BORE)" 11 Revise the Quantity from 1271 to 960 on Bid Item No.159.009.8, $(5,598.00) 0 Days "CONDT(PVC)(SCHD 80)(4")(BORE)" 12 Revise the Quantity from 60 to 220 on Bid Item No.161.009.10, $320.00 0 Days "ELEC CONDR(NO.4)INSULATED" 13 Revise the Quantity from 1010 to 1220 on Bid Item No.162.009.11, $315.00 0 Days "TRAY CABLE(4 COND., NO. 12)" 14 Revise the Quantity from 3100 to 5140 on Bid Item No.168.009.17, $ 1,632.00 0 Days "TRF SIG CBL(TY A)(12 AWG)(2 CONDR)" 15 Revise the Quantity from 3100 to 5200 on Bid Item No.169.009.18, $2,100.00 0 Days "TRF SIG CBL(TY A)(12 AWG)(4 CONDR)" 16 Revise the Quantity from 4200 to 5300 on Bid Item No.170.009.19, $1,760.00 0 Days "TRF SIG CBL(TY A)(12 AWG)(7 CONDR)" Admin 2 of 5 6.Revised 7/25/08 CITY OF PEARLAND PROJECTS DEPARTMENT v ,• y 3519 Liberty Drive, Suite 300 Pearland,TX 77581 TEX AS www.cityofpearland.com/projects FSy. rgga CHANGE ORDER Bailey Road Expansion from FM1128 to Veterans Date of Issuance: 02/02/2016 Change Order No.: 1 Contractor: Texas Sterling Construction Co. CoP Project No.: T08002 Consultant: CDM Smith P.O.No.: 152362 17 Revise the Quantity from 4 to 2 on Bid Item No.184.009.33,"TEMP $(84,000.00) 0 Days TRAF SIGNALS" 18 Revise the Quantity from 1630 to 2590 on Bid Item No.186.009.35, $960.00 0 Days "EMERGENCY PREEMPTION CABLE" 19 Add Item No.218.009.36,"ELEC CONDR(NO.6)BARE" $3,468.80 0 Days 20 Add Item No.219.005.21, "WK ZN PAV MRK NON-REMOV WH $318.00 0 Days ARROW' 21 Add Item No.220.005.22,"WK ZN PAV MRK NON-REMOV WH $413.40 0 Days WORD" 22 Add Item No. 221.005.23,"WK ZN PAV MRK NON-REMOV(W)8" $867.00 0 Days (SLD)" Please attach back-up documentation. Cost&Time Change Summary Cost Time Original Contract: $21,299,999.00 635 Days Previous Change Order(s): $- 0 Days Contract prior to this Change Order: $21,299,999.00 635 Days Net increase(decrease)from this Change Order: $59,378.50 0 Days Revised Contract: $21,359,377.50 635 Days Finance Approval: Date RECOMMENDED: RECOMMENDED: By: Date By: Date Consultant Construction Manager ACCEPTED*: APPROVED: By: Date By: Date Contractor Owner 'Contractor agrees to perform change(s)included in the Change Order for the price and time indicated. The prices for changes included all costs associated with this Change Order. No work is to be done until this change order is executed. No payment to the Contract(or Consultant)shall be made for work included in the change order until the Contractor's pay estimate is updated. Revise the project plans and specifications as referenced and insofar as the original project drawings and specifications are inconsistent,this Change Order governs. Upon execution by all parties,the following changes identifies for the contract value and/or contract time shown,are made part of the contract. Admin 3 of 5 6.Revised 7/25108 CHANGE ORDER NO.1 ATTACHMENT"A" February 02,2016 PROJECT: Bailey Road Expansion from FM1128 to Veterans PROJECT NO.: ORIGINAL CONTRACT REVISED CONTRACT ITEM DESCRIPTION UNIT QTY UNIT COST TOTAL QTY UNIT COST TOTAL NET CHANGE ADJUSTED CONTRACT QUANTITY: Drainage 49.003.2 RC PIPE(CL III)(24 IN) LF 4,668 $83.00 $387,444.00 4,186 $347,438.00 -$40,006.00 2 69.003.4 JACK BOR OR TUN PIPE LF 177 $400.00 $70,800.00 438 $175,200.00 $104,400.00 2 (24 IN)(RC)(CL III) 70.003.4 JACK BOR OR TUN PIPE IF 30 $480.00 $14,400.00 44 $21,120.00 $6,720.00 3 (30 IN)(RC)(CL IV) Signalization 155.009. CONDT(PVC)(SCHD 80) LF 512 $10.00 $5,120.00 324 $3,240.00 -$1,880.00 4 (2") 156.009. CONDT(PVC)(SCHD 80) LF 119 $15.00 $1,785.00 50 $750.00 -$1,035.00 5 (3") 157.009. CONDT(PVC)(SCHD 80) LF 206 $16.00 $3,296.00 272 $4,352.00 $1,056.00 6 (4") 158.009. CONDT(PVC)(SCHD 80) LF 1,235 $11.00 $13,585.00 960 $10,560.00 -$3,025.00 7 (2")(BORE) 159.009. CONDT(PVC)(SCHD 80) LF 1,271 $18.00 $22,878.00 960 $17,280.00 -$5,598.00 8 (4")(BORE) 161.009. ELEC CONDR(NO.4) IF 60 $2.00 $120.00 220 $440.00 $320.00 10 INSULATED 162.009. TRAY CABLE(4 COND., LF 1,010 $1.50 $1,515.00 1,220 $1,830.00 $315.00 11 NO.12) 168.009. TRF SIG CBL(TY A)(12 LF 3,100 $0.80 $2.480.00 5,140 $4,112.00 $1,632.00 17 AWG)(2 CONDR) 169.009. TRF SIG CBL(TY A)(12 LF 3,100 $1.00 $3,100.00 5,200 $5,200.00 $2,100.00 18 AWG)(4 CONDR) 170.009. TRF SIG CBL(TY A)(12 LF 4,200 $1.60 $6,720.00 5,300 $8,480.00 $1,760.00 19 AWG)(7 CONDR) 184.009. TEMP TRAF SIGNALS EA 4 $42,000.00 $168,000.00 2 $84,000.00 -$84,000.00 33 186.009. EMERGENCY LF 1,630 $1.00 $1,630.00 2,590 $2,590.00 $960.00 35 PREEMPTION CABLE Traffic Control Facilities 111.005. LIME TRT(EXIST MATL) SY 6,000 $5.00 $30,000.00 4,189 $20,945.00 -$9,055.00 2 (6") 113.005. CEMENT TREAT(NEW SY 6,000 $10.70 $64,200.00 4,189 $44,822.30 -$19,377.70 4 BASE)(6") 114.005. ASPHALT STAB BASE TON 276 $85.00 $23,460.00 1,441 $122,485.00 $99,025.00 5 (GR 2)(PG 64) ADD ITEM(S)TO CONTRACT: Signalization 218.009. ELEC CONDR(NO.6) LF 2,710 $1.28 $3,468.80 $3,468.80 36 BARE Traffic Control Facilities 219.005. WK ZN PAV MRK EA 6 $53.00 $318.00 $318.00 21 NON-REMOV WH ARROW 220.005. WK ZN PAV MRK EA 6 $68.90 $413.40 $413.40 22 NON-REMOV WH WORD 221.005. WK ZN PAV MRK LF 1,020 $0.85 $867.00 $867.00 23 NON-REMOV(W)8" (SLO) Admin 4 of 5 6.Revised 7/25/08 NET TOTAL CHANGE ORDER#1: $59,378.50 ORIGINAL CONTRACT AMOUNT: $21.299,999.00 CHANGE ORDER#1: $59,378.50 REVISED CONTRACT AMOUNT: $21,359,377.50 Admin 5 of 5 6 Revised 7/25/08 Bailey Road Reconstruction Change Order No. 1-Overrun on Jack and Bore and reduction of standard pipe Engineer Calculations ITEM 69-JACK BOR OR TUNNEL(24" RCP)(RC)(CL Ill) Sheet No. Station Quantity(LF) 289 88+19 44 LF 292 100+90 43 LF 299 139+22 70 LF 302 152+41 107 LF 302 153+23 107 LF 319 228+96 67 LF Total Quantity 438 LF Contract Quantity 177 LF Change Order Quantity Added +261 LF ITEM 70-JACK BOR OR TUNNEL(30" RCP)(RC)(CL III) Sheet No. Station Quantity(LF) 297 125+96 44 LF Total Quantity 44 LF Contract Quantity 30 LF Change Order Quantity Added +14 LF ITEM 49-RC PIPE(CL III)(24 IN) Sheet No. Station Quantity(LF) 289 88+19 -44 LF 292 100+90 -43 LF 297 125+96 -44 LF 299 139+22 -70 LF 302 152+41 -107 LF 302 153+23 -107 LF 319 228+96 -67 LF Change Order Quantity Deducted -482 LF 888888888822 p pp oo $ O N .D .n 00 N N 8 .0 .O 00 n b 0w0 O O O N .+f if n 41 O N c •"■ - M N .y N.1 M b }0 b V O 88888888888 . 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Office: (281) 821-9091 BAILEY ROAD - COPE FAX: (281) 821-2995 Transmittal #: 11 Date: 02/05/2016 To: From: ATTN: Cara Davis VictorFricke City of Pearland Project Manager 3519 Liberty Dr. Phone: 281-821-9091 Pearland, TX 77581 Fax: 281-821-2995 Email: victor.fricke @strlco.com RE: Pricing for Signal and Striping Items Please see the attached and/or enclosed documents. Notes: Please see the attached pricing. Thank You. Thank you, Signature of Recipient if Required: 44- Victor Fricke CC: rim 1` February 5,2016 Cara Davis Project Manager,City of Pearland 3519 Liberty Drive Pearland,TX 77581 Project: Bailey Road Improvements Control: 0912-31-289 Re: Change Order Pricing 2/5/16 Ms. Davis, As per our previous discussions,TSC respectfully submits pricing for the items listed below to be included in the contract. The Electrical Conductor(No. 6)Bare is to be added as per discussions with our subcontractor Reliable Signal and Solutions,CDM Smith and the City of Pearland. The striping items are to be included to maintain the traffic control at the Veterans/Bailey Rd. intersection. Item Unit Price UM Quantity Total Price ELEC CONDR(NO 6) BARE $1.28 LF 2710 $3,468.80 WZ PV MK NON-REMOV WH ARROW $53.00 EA 6 $318.00 WZ PV MK NON-REMOV WH WORD $68.90 EA 6 $413.40 WZ PV MK NON-REMOV 8"WH SOL $0.85 LF 1020 $867.00 Sincerely, CC Victor Fricke Project Manager >z. Texas Sterling Construction Co. Or* TEXAS STERLING CONSTRUCTION CO. 20810 FERNBUSH•HOUSTON,TEXAS 77073•(281)821-9091•FAX(281)821-2995 I` Reliable Signal "i r 6 lighting Solutions. LC CHANGE PROPOSAL NO. 1 COST BREAKDOWN DATE : February 5, 2016 GENERAL CONTRACTOR : Texas Sterling Construction OWNER : City of Pearland PROJECT# : T08002 -Control#0912-31-289 LOCATION : Bailey Rd. Reconstruction from Veterans to FM 1128 DESCRIPTION OF WORK : #6 Bare Cable MATERIALS UNIT NON DESCRIPTION UNIT QTY PRICE TAXABLE TAXABLE #6 Bare Solid LF 2800 $ 0.42 $ 1,176.00 SUBTOTAL $ 1,176.00 PROFIT& COMPENSATION 25% $ 294.00 MATERIAL TOTAL $ 1,470.00 EQUIPMENT UNIT NON DESCRIPTION UNIT QTY PRICE TAXABLE TAXABLE 3/4 Ton truck&Trailer HR 10 $ 25.00 $ 250.00 Bucket Truck HR 10 $ 30.00 $ 300.00 SUBTOTAL $ 550.00 PROFIT& COMPENSATION 15% $ 82.50 EQUIPMENT TOTAL $ 632.50 SUBCONTRACTOR UNIT NON DESCRIPTION UNIT QTY PRICE TAXABLE TAXABLE EA 0 $ - $ - SUBTOTAL $ - PROFIT& COMPENSATION 5% $ - EQUIPMENT TOTAL $ - Page 1 of 2 t "ler Reliable Signal -I�� 6 Lighting Solutions. LLC CHANGE PROPOSAL NO. 1 COST BREAKDOWN DATE : February 5, 2016 GENERAL CONTRACTOR : Texas Sterling Construction OWNER : City of Pearland PROJECT# : T08002-Control#0912-31-289 LOCATION : Bailey Rd. Reconstruction from Veterans to FM 1128 DESCRIPTION OF WORK : #6 Bare Cable LABOR UNIT NON DESCRIPTION UNIT QTY PRICE TAXABLE TAXABLE FOREMAN/ELECTRICIAN HR 10 $ 24.00 $ 240.00 UNDERGROUND OPERATOR HR 10 $ 22.00 $ 220.00 LABORERS HR 20 $ 12.00 $ 240.00 SUBTOTAL $ 700.00 PROFIT& COMPENSATION 15% $ 105.00 LABOR BURDEN 55% $ 385.00 GENERAL NOTES: LABOR TOTAL $ 1,190.00 TOTAL t$ 3,292.50 PRICE PER FT $ 1.21 Page 2 of 2 Texas Sterling Construction Company-ELEC CONDR(NO 6)BARE Description Unit Unit Qty. Total OT Cost& Price Price Hours Factor Markup Summary TSC Labor HR 1.17 S0 00 HR 1.17 50.00 HR 1.17 $0.00 HR 1.17 $0.00 HR 1.17 $0.00 Sub-total Labor 0 MH $0.00 55%Labor Burden $0.00 Total Labor $0.00 TSC Equipment HR $0.00 $0 00 $0.00 $0.00 $0.00 $0.00 Sub-total Equipment $0.00 Total Equipment $0.00 TSC Material Sub-total Material $0.00 Total Material $0.00 Subcontractor ELEC CONDR(NO 6)BARE $1.21 LF 2710 $3,279.10 SO 00 $0.00 S0.00 Sub-total Subcontractor $3,279.10 Total Subcontractor $3,279.10 $3,279.10 'Total Cost $3,279.10 LS 1 TOTAL $3,279.101 Markup and Bond Markup(5%) $163.96 Bond Cost(1%) $32.79 Total Markup and Bond TOTAL $196.751 'Total Pdcln• LS 1 TOTAL $3,475.851 'Unit Price 51.281 INTiRSTATE QUOTATION 18219 County Road 127 1 ARCADES Pearland, Texas 77581 �...' CHG ORS 1 # Ofc (281) 993-2828 MARKINGS Fax (281) 993-2826 www,ibmarkings.webs.com PROJECT: 0115-11 0912-31-289 COUNTY: BRAZORIA HIGHWAY: BAILEY ROAD JOB 1512 BID DATE: 2/5/16 Item Desc S.P. Approx. Unit Bid Extended No. Code No. Bid Item Description U/M Quantities Price Price 662 2012 WZ PV MK NON-REMOV 8" WH SOL. LF 1,020.0 0.800 816.00 662 2017 WZ PV MK NON-REMOV WH ARROW EA 6.0 50.000 300,00 662 2027 WZ PV MK NON-REMOV WH WORD EA 6.0 65.000 390.00 JOB 15895 TOTAL 1,506.00 Notes Two week notice required prior to move in No prior cleaning Excludes any applicable taxes Quotation may be withdrawn if not signed and accepted within 30 days Quotation based on compliance with credit terms and conditions Quotation prepared by Interstate Barricades 6c Markings Submitted by: bated: 2/5/2016 Accepted by: Dated: Company: We look forward to working with you on this project;please fax accepted quotations to our Pearland office at 281-993-2826. THANK YOU! Texas Sterling Construction Company-WZ PV MK NON-REMOV WH ARROW Description Unit Unit Qty. Total OT Cost& Price Price Hours Factor Markup Summary TSC Labor HR 1.17 50.00 HR 1.17 S0.00 HR 1.17 $0.00 HR 1.17 $0.00 HR 1.17 50.00 Sub-total Labor 0 MH $0.00 55%Labor Burden $0.00 Total Labor $0.00 TSC Equipment HR $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Sub-total Equipment $0.00 Total Equipment $0.00 TSC Material Sub-total Material $0.00 Total Material $0.00 Subcontractor WZ PV MK NON-REMOV WH ARROW $50.00 EA 6 $300.00 $0.00 $0.00 $0.00 Sub-total Subcontractor $300.00 Total Subcontractor 5300.00 $300.00 !Total Cost $300.00 LS 1 TOTAL $300.0011 Markup and Bond Markup $15.00 Bond Cost(1%) $3.00 !Total Markup and Bond TOTAL $18.00 (Total Pricing .- LS 1 TOTAL $318.00 Unit Price _ $53.001 Texas Sterling Construction Company-WZ PV MK NON-REMOV WH WORD Description Unit Unit Qty. Total OT Cost& Price Price Hours Factor Markup Summary TSC Labor HR 1.17 $0.00 HR 1.17 $0.00 HR 1.17 $0.00 HR 1.17 $0.00 HR 1.17 $0.00 Sub-total Labor 0 MH $0.00 55%Labor Burden $0.00 Total Labor $0.00 TSC Equipment HR $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Sub-total Equipment $0.00 Total Equipment $0.00 TSC Material Sub-total Material $0.00 Total Material $0.00 Subcontractor WZ PV MK NON-REMOV WH WORD $65 00 EA 6 $390.00 S0.00 $0.00 $0.00 Sub-total Subcontractor $390.00 Total Subcontractor $390.00 $390.00 (Total Cost $390.00 LS 1 TOTAL $390.001 Markup and Bond Markup $19.50 Bond Cost(1%) $3.90 `Total Markup and Bond TOTAL $23.401 !Total Pricing LS 1 TOTAL $413.44 !Unit Price ses.94 Texas Sterling Construction Company-WZ PV MK NON-REMOV 8"WH SOL Description Unit Unit Qty. Total OT Cost& Price Price Hours Factor Markup Summary :TSC Labor HR 1.17 $0.00 HR 1.17 $0.00 HR 1.17 $0.00 HR 1.17 $0.00 HR 1.17 $0.00 Sub-total Labor 0 MH $0.00 55%Labor Burden $0.00 Total Labor $0.00 TSC Equipment HR S0.00 s0.00 $0.00 $0.00 $0.00 $0.00 Sub-total Equipment $0.00 Total Equipment $0.00 TSC Material Sub-total Material $0.00 Total Material $0.00 Subcontractor WZ PV MK NON-REMOV 8"WH SOL $0.80 LF 1020 $816.00 $0.00 $0.00 50.00 Sub-total Subcontractor $816.00 Total Subcontractor $816.00 $816.00 'Total Cost $816.00 LS 1 TOTAL $816.001 Markup and Bond Markup $40.80 Bond Cost(1%) $8.16 'Total Markup and Bond TOTAL $48.96' 'Total Pricing LS 1 TOTAL 5864.96' 'Unit Price $0.85' Form (Rev.09/10)2146-L CONSTRUCTION CONTRACT CHANGE ORDER NUMBER: 1 Page 1 of 1 1.CONTRACTOR: Texas Sterling Construction Co. CCSJ: 0912-31-289 2.Change Order Work Limits:Sta. N/A to Sta. N/A Project: T08002 3.Type of Change(on federal-aid non-exempt projects): Minor (Major/Minor) Highway: Bailey Road 4.Describe the change and the reason for the change order. When necessary,include County: Brazoria exceptions to this agreement. District: Hou This change order is for additions and deductions of quantities on various items and adding new items based on site condition. This includes increased quantities in jack and bore pipe with reduction in standard pipe,change in temporary asphalt pavement Contract widening section for traffic control for school and PISD bus barn,revised signal Number: quantities,removal of temporary signals at Bailey/Harkey and at Bailey/McLean intersections,and adding new temporary striping items to maintain traffic control at BaileyNeterans intersection. Revised signal sheets(395,405,417&432)&Removal of temporary 5.New or revised plan sheet(s)are attached and numbered: signals sheets(398-403&408-415) Each signatory hereby warrants that each has the authority to execute this Change Order. - By signing this change order,the contractor agrees to waive any and all The following information must be provided claims for additional compensation due to any and all other expenses; additional changes for time,overhead and profit or loss of compensation Time Ext.#: N/A Days added on this C.O.: 0 as a result of this change.Further,the contractor agrees that this agreement is made in accordance with Item 4 and the Contract.Exceptions should be noted in the response for#5 above. Amt.added by this change order: $59,378.50 For TxDOT use only: THE CONTRACTOR Date Days participating: By Amount participating: Typed/Printed Name Signature Date Typed/Printed Title Mark D.Wooldridge,P.E. 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