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Imp. Proj. #634
Originating Department Parks and Recreation Shari French By: ! ! Approved for Agenda 6/8/98 n .Agenda Section Consent Item No. 6.10 RESOLUTION AWARDING CONTRACT FOR PLAYGROUND EQUIPMENT FOR HIDDEN VALLEY PARK (IMPROVEMENT PROJECT NO. 634) TO ARRIGONI BROTHERS Bids were open on Wednesday, June 3rd and have been evaluated by the engineers for playground equipment for Hidden Valley Park (Improvement Project 634). The Engineer's letter regarding bid evaluations is attached. Plans and specifications were approved at the May 26 Council Meeting. The 1998 CIP contains $125,000 for this purchase. The engineer's estimate was $107,200 including the alternate. Contractors Arrigoni Brothers Lakeland Nurseries • M - : • $106,383.00 $139,550.00 Alternate Bid $650.00 $710.00 I r-M. [c . $107,033.00 $140,260.00 As has been the practice, staff met with Hidden Valley Park neighbors in March to plan the new equipment. Those attending that meeting were invited to review the plan before Council approved in on May 26 Children attending Sonnesyn Elementary School also were invited to review the plan and give input All liked this plan and are looking forward to new equipment at their park. The existing equipment dates back to the 80's. The alternate is for an accessible picnic table. Staff recommends award to the low bidder, Arrigoni Brothers including the alternate. There is $125,000 in the Park CIP for 1998 for this project. The engineering expense for this project is expected to be approximately 15% of the total, or about $16,000. lu• M•\ � TO: • l Review: Administration: Finance: CITY OF NEW HOPE RESOLUTION NO. 98- 93 RESOLUTION AWARDING CONTRACT FOR PLAYGROUND EQUIPMENT FOR HIDDEN VALLEY PARK (IMPROVEMENT PROJECT NO. 634) TO ARRIGONI BROTHERS WHEREAS, pursuant to advertisement for bids for playground equipment for Hidden Valley Park, bids were received, opened and tabulated according to law, and the following bids were received complying with the advertisement: Contractors Total Base Bid Alternate Bid Total Bid Arrigoni Brothers $106,383.00 $650.00 $107,033.00 Lakeland Nurseries $139,550.00 $710.00 $140,260.00 WHEREAS, it appears that Arrigoni Brothers is the lowest responsible bidder. NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of New Hope, Minnesota: the Mayor and City Manager are hereby authorized and directed to enter into the attached contract with in the name of the City of New Hope for Hidden Valley Park Playground Equipment Improvements according to the plans and specifications for a total bid of $107,033.00 therefore approved by the City Council and on file in the office of the City Clerk. 2. The City Clerk is hereby authorized and directed to return forthwith to all bidders the deposits made with their bids, except that the deposits of the successful bidder and the next lowest bidder shall be retained until a contract has been signed. Adopted by the City Council of the City of New Hope, Hennepin County, Minnesota, this 8 day of June, 1998. Attest: 1�� City Clerk June 4, 1998 City of New Hope 4401 Xylon Avenue North New Hope, MN 55428 Re: Hidden Valley Park Playground Equipment BRA File No. 34226 Attn: Ms. Shari French Bear Shari: Bids were opened for the project stated above on Wednesday, June 3, 1998, Transmitted herewith is a copy of the bid tabulation for your information and file. Copies will also be distributed to each bidder. The following summarizes the results of the two bids received. Contractor Base Bid Low Arrigoni Bros. Company $106,383.00 #2 Lakeland Nurseries, Inc. $139,550.00 The low bidder on the project was Arrigoni Bros,; the Contractor whom successfully completed Corner Park for the City. Arrigoni Bros. Company Base Bid is $106,383.00 and Alternate No. 1 is $650.00. This compares favorably with the engineer's estimate for the base bid of $107,109.50 and $850.00 for Alternate No. L These bids have been reviewed and found to be in order. 'Therefore, we recommend that the project be awarded including Alternate No. 1 for a total Contract Award of $107,033.00. Should you have any questions, please feel free to call. My direct number is (612) 604 -4838. Respectfully, BONESTROO, ROSENE, ANDERLIK & ASSOCIATES, INC. AaA,4- 4km&q / q S Mark A. Hanson, P.E. MAH.jms:enc 2335 West Highway 36 a St. Paul, MN 55113 x 612-636-4600 n Fax: 612-636 -1311 Bonestroo, Rosene, Anderlik and Associates, Inc. is an Affirmative Action :'Equal Opportunity Employer Bon estr oo Principals: Otto G. Bonestroo, P.E. • Joseph C. Anderlik, P.E. • Marvin L. Soruala, PE. Richard E. Turner, P.E. • Glenn R. Cook, R.E. • Robert G. Schunicht, P.E. • Jerry A. Bourdon, P.E. see Robert W Rosene, P.E. and Susan M. Eberlin, C.P.A., Senior Consultants '''\ / Associate Principals: Howard A. Sanford, P.E. • Keith A. Gordon, P.E. • Robert R. Pfefferle, P.E. e ! P Richard W. Foster, RE. • David O. Loskota, P.E. • Robert C. Russek, A.I.A. • Mark A. Hanson, P.E. Michael T. Rautmann, P.E. • Ted K.Field, P.E. • Kenneth R Anderson, PE. • Mark R. Rolfs, RE. ,/`. ci Willia E., L.S. • Robert F. Kotsmith • Agnes M. Ring • ,k.1ichael P Rau, P.E. Sid lan �` R ck d RE. Engineers & Architects Offices: St. Paul, Rochester, Willmar and St. Cloud, MN • Milwaukee, W1 Website: www.bonestroo.com June 4, 1998 City of New Hope 4401 Xylon Avenue North New Hope, MN 55428 Re: Hidden Valley Park Playground Equipment BRA File No. 34226 Attn: Ms. Shari French Bear Shari: Bids were opened for the project stated above on Wednesday, June 3, 1998, Transmitted herewith is a copy of the bid tabulation for your information and file. Copies will also be distributed to each bidder. The following summarizes the results of the two bids received. Contractor Base Bid Low Arrigoni Bros. Company $106,383.00 #2 Lakeland Nurseries, Inc. $139,550.00 The low bidder on the project was Arrigoni Bros,; the Contractor whom successfully completed Corner Park for the City. Arrigoni Bros. Company Base Bid is $106,383.00 and Alternate No. 1 is $650.00. This compares favorably with the engineer's estimate for the base bid of $107,109.50 and $850.00 for Alternate No. L These bids have been reviewed and found to be in order. 'Therefore, we recommend that the project be awarded including Alternate No. 1 for a total Contract Award of $107,033.00. Should you have any questions, please feel free to call. My direct number is (612) 604 -4838. Respectfully, BONESTROO, ROSENE, ANDERLIK & ASSOCIATES, INC. AaA,4- 4km&q / q S Mark A. Hanson, P.E. MAH.jms:enc 2335 West Highway 36 a St. Paul, MN 55113 x 612-636-4600 n Fax: 612-636 -1311 I hereby certify that this is an exact rep ctio of kils received. Mark . Hanson, P.E. Registration No. 14260 No. Item Base Bid 1 Existing play equip. demolition and removal 2 Clear and grub trees /shrubs 3 Remove existing bituminous 4 Remove ex. timber wall & benches 5 Furnish & place modular masonry retaining wall and border (topsoil, sod, aggregate, all materials and labor incidental to contract) 6 Furnish and install new play sand 7 Clean existing sand 8 Concrete sidewalk on granular base 9 New bituminous trail 10 Concrete bench pads and picnic table pad 11 Furnish and install 4" perforated drain pipe 12 Furnish and install 6" PVC outlet pipe (incl. 6" x 6" wye with clean out) 13 Fum. & install HAWS 1114 drinking fountain (or approved equal) including all V copper tubing, ball valve, bleeder valve, 2" drain pipe, & connection to ex. water 14 Furnish and install 6' bench with back, Iron Mountain Forge Model 281 -6XP or approved equal 15 Furnish & install (1) climb & slide 119061A, or approved equal 16 Furnish & install (1) spring board M199 or approved equal 17 Furnish & install (1) super scoop, 123831A or approved equal 18 Furnish and install (1) wheelchair accessible super scoop, 123831B or approved equal Unit Q ty LS EA SY 5, LS SF 1,000 TN 200 LS 1 SF 1,100 SY 60 SF 832 LF 115 LF 110 Unit Price 2,000.00 500.00 1.00 2,000.00 21.00 12.00 500.00 3.50 20.00 4.00 8.00 10.00 Total 2,000.00 1,000.00 55.00 2,000.00 21,000.00 2,400.00 500.00 3,850.00 1,200.00 3,328.00 920.00 1,100.00 EA 1 1 5,000.00 5,000.00 EA 4 500.00 2,000.00 EA EA EA EA 1 1 1 1 1,500.00 2,200.00 400.00 400.00 1,500.00 2,200.00 400.00 400.00 BID TABULATION Tabulation of Two Low Bids of Two Received Bid No. 1 Bid No. 2 Arrigoni Bros. Lakeland Company Nurseries. Inc. Unit Price Total 3,969.50 3,969.50 104.00 208.00 20.00 1,100.00 5,891.00 5,891.00 30.00 30,000.00 12.00 2,400.00 1,452.00 Bonesti*00 Rosene Anderlik& Pro Name Hidden Valley Park Playground Equipment SON Pro No. 634 File No. 34 -98 -226 Associate 6.00 En inee s& Architects Bid Opening 11:30 A.M., C.D.S.T., Wednesday, June 3, 1998 Owner City of New Hope I hereby certify that this is an exact rep ctio of kils received. Mark . Hanson, P.E. Registration No. 14260 No. Item Base Bid 1 Existing play equip. demolition and removal 2 Clear and grub trees /shrubs 3 Remove existing bituminous 4 Remove ex. timber wall & benches 5 Furnish & place modular masonry retaining wall and border (topsoil, sod, aggregate, all materials and labor incidental to contract) 6 Furnish and install new play sand 7 Clean existing sand 8 Concrete sidewalk on granular base 9 New bituminous trail 10 Concrete bench pads and picnic table pad 11 Furnish and install 4" perforated drain pipe 12 Furnish and install 6" PVC outlet pipe (incl. 6" x 6" wye with clean out) 13 Fum. & install HAWS 1114 drinking fountain (or approved equal) including all V copper tubing, ball valve, bleeder valve, 2" drain pipe, & connection to ex. water 14 Furnish and install 6' bench with back, Iron Mountain Forge Model 281 -6XP or approved equal 15 Furnish & install (1) climb & slide 119061A, or approved equal 16 Furnish & install (1) spring board M199 or approved equal 17 Furnish & install (1) super scoop, 123831A or approved equal 18 Furnish and install (1) wheelchair accessible super scoop, 123831B or approved equal Unit Q ty LS EA SY 5, LS SF 1,000 TN 200 LS 1 SF 1,100 SY 60 SF 832 LF 115 LF 110 Unit Price 2,000.00 500.00 1.00 2,000.00 21.00 12.00 500.00 3.50 20.00 4.00 8.00 10.00 Total 2,000.00 1,000.00 55.00 2,000.00 21,000.00 2,400.00 500.00 3,850.00 1,200.00 3,328.00 920.00 1,100.00 EA 1 1 5,000.00 5,000.00 EA 4 500.00 2,000.00 EA EA EA EA 1 1 1 1 1,500.00 2,200.00 400.00 400.00 1,500.00 2,200.00 400.00 400.00 BID TABULATION Tabulation of Two Low Bids of Two Received Bid No. 1 Bid No. 2 Arrigoni Bros. Lakeland Company Nurseries. Inc. Unit Price Total 3,969.50 3,969.50 104.00 208.00 20.00 1,100.00 5,891.00 5,891.00 30.00 30,000.00 12.00 2,400.00 1,452.00 1,452.00 5.25 5,775.00 16.00 960.00 6.00 4,992.00 11.00 1,265.00 13.00 1,430.00 4,274.00 4,274.00 367.00 1,468.00 1,521.00 1,521.00 3,407.00 3,407.00 799.00 799.00 842.00 842.00 34- 98- 226.bt BT -1 49 Furnish and install resilient surfacing (incl. aggregate & concrete, quanity based on full thickness and includes bevel SF 435 12.00 5,220.00 16.50 7,177.50 20 Swing set, 8' high, 4 swings, I molded bucket seat, 1 tot seat, 2 solid flat seats wide enough for average adult male #100051C, or approved equal EA 1 2,100.00 2,100.00 2,753.00 2,753.00 21 Furnish and install dragon spring animal M113 or approved equal EA 1 700.00 700.00 1,585.00 1,585.00 22 Furnish and install You and Me M164, or approved equal EA 1 750.00 750.00 1,626.00 1,626.00 23 Furnish and install play structure with slides, poles, platforms, play features, kick plates, etc. (submit detailed drawing of equivalent structure) EA 1 30,000.00 30,000.00 37,222.00 37,222.00 24 Furnish and install I adventure house M661, or approved equal EA 1 12,800.00 12,800.00 12,683.00 12,683.00 25 Furnish and install 2 -1/2" cal. 'Northwood' Maple (mulch incidental to contract) EA 7 330.00 2,310.00 400.00 2,800.00 26 Furnish & install 2 -1/2" cal. 'Marshall's Seed- less' Green Ash (mulch incidental to contract) EA 5 330.00 1,650.00 390.00 1,950.00 Total Base Bid 106,383.00 139,550.00 Alternate No. l 27 Furnish and install 8' -0" portable fusion coating ADA picnic table with 2 (6 ") PVC & bolt fittings for locking LS 1 650.00 650.00 710.00 710.00 Total Alternate No. 1 650.00 710.00 Firm Name Arrigoni Bros. Company Lakeland Nurseries, Inc. Address 817 Vandalia Street 770 N. Bus Hwy 71 City, State, Zip St. Paul, Mn Willmar, MN 56201 Phone 612 -645 -9321 320 - 235 -0081 Fax 612- 645 -9322 320 -235 -2871 By Dennis J. Arrigoni Ray Stenglein Title President Secretary 5% Bid Security Bid Bond Bid Bond Addenda Acknowledged 1 1 34- 98- 226.bt BT -2 13onestroo Item Rosene ARRIGONI BROS. COMPANY Bidder Total Base Bid 105 , 883.00 Anderik & Assoclate Address 817 VANDALIA ST. 612- 645 -9321 Telephone No. Total Price Engineers b Architects City, State, Zi Fax No. 612 -645 -9322 PROPOSAL HIDDEN VALLEY PARK PLAYGROUND EQUIPMENT CITY PROJECT NO. 634 FILE NO, 34 -98 -226 NEW HOPE, MINNESOTA 1998 Opening Time: 11:30 A.M., C.D.S.T. Opening Date: Wednesday, June 3, 1998 Honorable City Council City of New Hope 4401 Xylon Avenue North New Hope, Minnesota 55428 Dear Council Members: The undersigned, being familiar with your local conditions, having made the field inspections and investigations deemed necessary, having studied the plans and specifications for the work including Addenda Nos. I and being familiar with all factors and other conditions affecting the work and cost thereof, hereby proposes to furnish all labor, tools, materials, skills, equipment and all else necessary to completely construct the project in accordance with the plans and specifications on file with you and Bonestroo, Rosene, Anderlik & Associates, Inc., 2335 West Highway 36, St. Paul, MN 55113, as follows: No. Item Unit Qty. Unit Price Total Price Base Bid 1 Existing play equip. demolition and removal LS 1 $ 2000.00 $ 2000.00 2 Clear and grub trees /shrubs EA 2 $ 500.00 $ 500.00 3 Remove existing bituminous SY 55 6 PPI $ 1.00 $ 55.00 4 Remove ex. timber wall & benches LS 1 $ 2000.00 0 0.00 5 Furnish & place modular masonry retaining wall and border (topsoil, sod, aggregate, all materials and labor incidental to contract) SF 1,000 $ 21, 000.00 $ 21, 000.00 34226promb2 P -1 6 Furnish and install new play sand TN 200 $ 12. 00 $ 2400.00 7 Clean existing sand LS 1 $ 500.00 $ 500.00 8 Concrete sidewalk on granular base SF 1,100 $ 3.50 $ 3850.00 9 New bituminous trail Sy 60 &(/ $ 20.00 $ 1200.00 10 Concrete bench pads and picnic table pad SF 832 $ 4.00 $ 3328.00 11 Furnish and install 4" perforated drain pipe LF 115 $ 8.00 $ 9 20.00 12 Furnish and install 6" PVC outlet pipe (incl. 6" x 6" wye with clean out) LF 110 $ 10.00 $ 1100.00 13 Furn. & install HAWS 1114 drinking fountain (or approved equal) including all V copper tubing, ball valve, bleeder valve, 2" drain pipe, & connection to ex. water EA 1 $ 5000.00 $ 5000.00 14 Furnish and install 6' bench with back, Iron Mountain Forge EA 4 $ 500.00 $ 2000.00 Model 281 -6XP or approved equal 15 Furnish & install (1) climb & slide 119061A, or approved equal EA 1 $ 1500.00 $ 1500.00 16 Furnish & install (1) spring board M199 or approved equal EA 1 $ 2200.00 $ 2200.00 17 Furnish & install (1) super scoop, 123831A or approved equal EA 1 $ 400.00 $ 400.00 18 Furnish and install (1) wheelchair accessible 400.00 400.00 super scoop, 123831B or approved equal EA 1 $ $ 19 Furnish and install resilient surfacing (incl. aggregate & concrete, quanity based on full thickness and includes bevel SF 435 $ 12.00 $ 5220.00 20 Swing set, 8' high, 4 swings, 1 molded bucket seat, 1 tot seat, 2 solid flat seats wide enough for average adult male #100051C, or approved equal EA 1 $ 2100.00 $ 2100.00 21 Furnish and install dragon spring animal M113 or approved equal EA 1 $ 700.00 $ , 700.00 34226pro.wb2 P_2 22 Furnish and install You and Me M164, or approved equal EA 23 Furnish and install play structure with slides, poles, platforms, play features, kick plates, etc. (submit detailed drawing of equivalent structure) EA 24 Furnish and install I adventure house M661, or approved equal EA 25 Furnish and install 2 -1/2" cal. 'Northwood' Maple (mulch incidental to contract) EA 26 Furnish & install 2 -1/2" cal. 'Marshall's Seed- less' Green Ash (mulch incidental to contract) EA Total Base Bid Alternate No. 1 27 Furnish and install W -0" portable fusion coating ADA picnic table with 2 (6 ") PVC & bolt fittings for locking LS Total Alternate No. 1 1 $ 750.00 $ 750.00 1 $ 30,000.00 $ 30,000.00 1 $ 12,800.00 $ 12,800.00 330.00 7 $ 2310.00 5 $ 330.00 $ 1650.00 $ 105,883.00 1 $ 650.00 $ 650.00 650.00 34226pro.wb2 P -3 The final amount of the contract shall be determined by multiplying the final measured quantities of the various items actually constructed and installed by the unit prices therefor, in the manner prescribed in the specifications. However, the low bidder shall be determined by adding the sums resulting from multiplying the quantities stated by the unit prices bid therefor. Accompanying this bid is a bidder's bond, certified check or cash deposit in the amount o f BID BOND , which is at least five percent (5 %) of the amount of my /our bid made payable to the Owner, and the same is subject to forfeiture in the event of default on the part of the undersigned or failure on the part of the undersigned to execute the prescribed contract and bond within fifteen (15) days after its submittal to me /us. In submitting this bid, it is understood that the Owner retains the right to reject any and all bids and to waive irregularities and informalities therein and to award the contract to the best interests of the Owner. In submitting this bid, it is understood that payment will be by cash or check. It is understood that bids may not be withdrawn for a period of 45 days after the date and time set for the opening of bids. It is understood that the Owner reserves the right to retain the certified check or bond of the three lowest bidders as determined by the Owner for a period not to exceed 45 days after the date set for the opening of bids. Respectfully submitted, ( A Corporation) ARRIGONI BROS . COMPANY (An Individual) Name (A Partnership) , L9" / Signer PRESIDENT Title Dennis J. Anigani President Printed Name of Signer 34226pro.wb2 P -4 JUN .J b ?dtj M •Ud F,1 + +11 :lw, ''!w N1.tti!T1"UU'l N AB', NU, ! o 1 M W. ti t 1 l t / uwj f p ti .s • • F;' :1. C ` . ,1 Q � ` 1 f \ y vi f ` W a V p i� r e• I r wll r p r t f i p 9 p. Z uo Attorneys At Law 8525 EDINBROOK CROSSING, STE. 201 BROOKLYN PARK, MINNESOTA 55443 -1999 TELEPHONE (612) 424 -8811 ® TELEFAx (612) 493 -5193 GORDON L. J ENSEN* WILLIAM G. SWANSON STEVEN A.SONDRALL MICHAEL R. LAFLEUR MARTIN P. MALECHA BRETT A. PERRY* C. ALDEN PEARSONt OF COUNSEL LORENS Q.BRYNESTAD a 'Real Property Law Specialist Certified By The Minnesota State Bar Association tQualified ADR Neutral June 26, 1998 Dennis Arrigoni Arrigoni Brothers Company 817 Vandalia Street St. Paul, MN 55114 RE: Hidden Valley Playground Improvements City of New Hope Our File No. 99.10,000 )-. ' � As we discussed, enclosed you will find the four copies of the Contracts and Bonds for the above - referenced project. Also enclosed you will find pages from the Contracts and Bonds, with notations on what needs to be completed. The individual pages are also flagged. Please complete and return to me within the very near future. The Contracts and Bonds must be approved before work on the project can begin. Do not hesitate to call if you have any questions. Sincerely, Martin P. Malecha Assistant City Attorney Enclosures cc: Valerie Leone, City Clerk ' Tom Schuster, Contract Manager Steven A. Sondrall, City Attorney 1 , Attorneys At Law 8525 EDINBROOK CROSSING, STE. 201 BROOKLYN PARK, MINNESOTA 55443 -1999 TELEPHONE (612) 424 -8811 • TELEFAX (612) 493 -5193 GORDON L. JENSEN* WILLIAM G. SWANSON STEVEN A.SONDRALL MICHAEL R. LAFLEUR MARTIN P. MALECHA BRETT A. PERRY C. ALDEN PEARSONt OF COUNSEL LORENS Q.BRYNESTAD *Real Property Law Specialist Certified By The Minnesota State Bar Association tQualified ADR Neutral July 7, 1998 Valerie Leone City of New Hope 4401 Xylon Avenue North New Hope, MN 55428 RE: Hidden Valley Playground Improvements City Project No. 634 Our File No. 99.10,000 Dear Valerie: Enclosed please find four copies of the contract and bonds for the above - referenced project, as well as the certificate of insurance. All are in order from a legal standpoint. Be sure to call me if you have any questions. Sincerely, pul IV' R Martin P. Malecha Assistant City Attorney cc: Daniel J. Donahue, City Manager Kirk McDonald, Management Assistant Tom Schuster, Contract Manager Mark Hanson, City Engineer Steven A. Sondrall, City Attorney July 17, 1998 4401 Xylon Avenue North New Hope, Minnesota 55426 -4898 Mr. Dennis J. Arrigoni, President Arrigoni Bros. Company 817 Vandalia St. St. Paul, MN 55114 City Hall: 612- 531 -5100 Police: 612 -531 -5170 Public Works: 612- 533 -4823 TDD: 612 -531 -5109 SUBJECT: HIDDEN VALLEY PLAYGROUND IMPROVEMENTS (IMPROVEMENT PROJECT NO. 634) City Hall Fax: 612 -531 -5136 Police Fax: 612 -531 -5174 Public Works Fax: 612 - 533 -7650 Fire Dept. Fax: 612 -531 -5175 Enclosed are two fully executed copies of the contract documents for New Hope Project No. 634. One copy is for your records and the second copy should be transmitted to your bonding company. This contract was awarded by the New Hope City Council on June 8, 1998, for $107,033. Enclosed is a "Withholding Affidavit for Contractors" (IC -134 form). We cannot make final payment to contractors until this is approved by the Minnesota Department of Revenue and submitted to our office (Minnesota Statute 290.97). The form contains instructions for completion. Sincerely, Valerie Leone City Clerk, CMC enc. cc: Mark Hanson, City Engineer Steve Sondrall, City Attorney Shari French, Director of Parks & Recreation Tom Schuster, Contract Manager Family Styled City 4 A For Family living JI OFFICIAL FILE COPY HIDDEN VALLEY PLAYGROUND IMPROVEMENTS FILE NO. 34-98-226 CITY PROJECT NO. 634 NEW HOPE, MINNESOTA 1998 Index Project Directory Advertisement for Bids Information to Bidders Proposal Special Provisions 01200. Project Meetings 01300. Submittals 01400. Quality Control 01600. Material and Equipment 02070. Demolition and Removal 02200. Earthwork 02231. Crushed Aggregate Base Course 02502. Subsurface Drains 02510. Plant Mixed Bituminous Paving 02520, Concrete Paving 02521. Concrete Sidewalks 02830. Modular Masonry Retaining Wall 02860. Playground Equipment 02900. Planting 02930. Turf Establishment Conditions of the Contract I hereby certify that this plan, specification, or report was prepared by me or under my direct supervision and that I am a duly Registered Professional Engineer under the laws of the State of Minnesota. Date: W 20, 1998 Reg. No. 25048 34-98-226 0 1998 Bonestroo, Rosene. Anderlik & Associates, Inc. gffim1•�� OWNER: City of New Hope Attn: Shari French 4401 Xylon Avenue North New Hope, MN 55428 (612) 531-5100 CIVIL ENGINEER: Bonestroo, Rosene, Anderlik & Associates, Inc. Randall D. Neprash 2335 West Highway 36 Saint Paul, MN 55113 (612) 604-4703 LANDSCAPE ARCHITECT: Bonestroo, Rosene, Anderlik & Associates, Inc. Chris A. Behringer 2335 West Highway 36 Saint Paul, MN 55113 (612) 604-4852 34-98-226 Q 1998 Bonestroo, Rosene, Anderlik & Associates, hie. PROJECT DIRECTORY Sealed bids will be received by the City of New Hope, Minnesota at the City Hall, at 4401 Xylon Avenue, until 11:30 A.M., C.D.S.T., on Wednesday, June 3, 1998, at which time they will be publicly opened and read aloud for the furnishing of all labor and materials and all else necessary for the following: 1998 Hidden Valley Park Improvements, City Project No. 634 Demolish and remove existing play equipment. burnish and install new play equipment with miscellaneous site improvements. Miscellaneous site improvements work includes but is not limited to modular block retaining wall and play edge, concrete walk and pad, site furniture, drinking fountain and landscaping. Plans and specifications, proposal forms and contract documents may be seen at the office of the City Clerk, New Hope, Minnesota, and at the office of Bonestroo, Rosene, Anderlik & Associates, Inc., Consulting Engineers, 2335 W. Trunk Highway 36, St. Paul, MN 55113, (612) 636-4600. Each bid shall be accompanied by a bidder's bond naming the City of New Hope as obligee, certified check payable to the Clerk of the City of New Hope or a cash deposit equal to at least five percent (5%) of the amount of the bid, which shall be forfeited to the City in the event that the bidder fails to enter into a contract. The City Council reserves the right to retain the deposits of the three lowest bidders for a period not to exceed 45 days after the date and time set for the opening of bids. No bids may be withdrawn for a period of forty-five (45) days after the date and time set for the opening of bids. Payment for the work will be by cash or check. Contractors desiring a copy of the plans and specifications and proposal forms may obtain them from the office of Bonestroo, Rosene, Anderlik & Associates, Inc., upon payment of a non-refundable fee of $20.00. See "Information to Bidders" for plan/specification fee policy. The City Council reserves the right to reject any and all bids, to waive irregularities and informalities therein and further reserves the right to award the contract to the best interests of the City. Daniel Donahue, City Manager City of New Hope, Minnesota 34-98-226 0 1998 Bonestroo, Rosene, Anderlik & Associates, Inc. 1. BID PROPOSAL: Each planholder has been furnished a specification, plan set and one extra proposal. Bids shall be submitted on the separate Proposal Form designated "BID COPY". The Proposal containing the bid shall be submitted in a sealed envelope. 1) Plans and specifications shall only be available on a non-refundable, per plan basis, with all contractors and vendors being charged the same. Planholders may obtain more than one set of plans and specifications for the stipulated amount, however, all are non-refundable. 11 11111 11 1111111 1 111 3. INDIVIDUAL DRAWINGS AND SPECIFICATION SHEETS: - Individual drawings and specifications sheets may be purchased at the rate of Five Dollars ($5.00) per sheet of drawings and Twenty-five cents ($0.25) per sheet of specifications for which no refund will be made. 4. BID TABULATION: Planholders submitting a bid will be mailed a Bid Tabulation. Planholders not submitting a bid may purchase a copy of the Bid Tabulation for Five Dollars ($5.00). 34-98-226 (D 1998 Bonewoo, Rosene, Anderlik & Associates, Inc. in Bonestr oo Rose st Anderlik Bidder: Arri oni Bros. Company Total Base Bid $106,383.00 Total Price LS A nde r li a Address: 817 Vandalia Street Telephone No. 645 -9321 2,000.00 EA St. • Mliwauke St. Paul i City, State, Zip: St. Paul, MN 55114 Fax No. 645 -9322 PROPOSAL HIDDEN VALLEY PARK PLAYGROUND EQUIPMENT CITY PROJECT NO. 634 FILE NO. 34 -98 -226 NEW HOPE, MINNESOTA 1998 Opening Time: 11:30 A.M., C.D.S.T. Opening Date: Wednesday, June 3, 1998 Honorable City Council City of New Hope 4401 Xylon Avenue North New Hope, Minnesota 55428 Dear Council Members: The undersigned, being familiar with your local conditions, having made the field inspections and investigations deemed necessary, having studied the plans and specifications for the work including Addenda Nos. 1 and being familiar with all factors and other conditions affecting the work and cost thereof, hereby proposes to furnish all labor, tools, materials, skills, equipment and all else necessary to completely construct the project in accordance with the plans and specifications on file with you and Bonestroo, Rosene, Anderlik & Associates, Inc., 2335 West Highway 36, St. Paul, MN 55113, as follows: No. Item Base Bid 1 Existing play equip. demolition and remova 2 Clear and grub trees /shrubs 3 Remove existing bituminous 4 Remove ex. timber wall & benches 5 Furnish & place modular masonry retaining wall and border (topsoil, sod, aggregate, all materials and labor incidental to contract) 6 Furnish and install new play sand 7 Clean existing sand 8 Concrete sidewalk on granular base 9 New bituminous trail Unit Qty. Unit Price Total Price LS 1 2,000.00 2,000.00 EA 2 500.00 1,000.00 SY 55 1.00 55.00 LS 1 2,000.00 2,000.00 SF 1,000 21.00 21,000.00 TN 200 12.00 2,400.00 LS 1 500.00 500.00 SF 1,100 3.50 3,850.00 SY 60 20.00 1,200.00 34- 98- 226\contract.wU P -1 10 Concrete bench pads and picnic table pad SF 11 Furnish and install 4" perforated drain pipe LF 12 Furnish and install 6" PVC outlet pipe (incl. 920.00 6" x 6" wye with clean out) LF 13 Furn. & install HAWS 1114 drinking fountain (or approved equal) including all 1" copper tubing, ball valve, bleeder valve, 2" drain pipe, & connection to ex. water EA 14 Furnish and install 6' bench with back, Iron Mountain Forge EA Model 281 -6XP or approved equal 15 Furnish & install (1) climb & slide 119061A, or approved equal EA 16 Furnish & install (1) spring board M199 or approved equal EA 17 Furnish & install (1) super scoop, 123831A or approved equal EA 18 Furnish and install (1) wheelchair accessible super scoop, 123831B or approved equal EA 19 Furnish and install resilient surfacing (incl. aggregate & concrete, quanity based on full thickness and includes bevel SF 20 Swing set, Thigh, 4 swings, 1 molded bucket seat, 1 tot seat, 2 solid flat seats wide enough for average adult male #100051C, or approved equal EA 21 Furnish and install dragon spring animal M113 or approved equal EA 22 Furnish and install You and Me M164, or approved equal EA 23 Furnish and install play structure with slides, poles, platforms, play features, kick plates, etc. (submit detailed drawing of equivalent structure) EA 832 4.00 3,328.00 115 8.00 920.00 110 10.00 1,100.00 1 5,000.00 5,000.00 4 500.00 2,000.00 1 1,500.00 1,500.00 1 2,200.00 2,200.00 1 400.00 400.00 1 400.00 400.00 435 12.00 5,220.00 1 2,100.00 2,100.00 1 700.00 700.00 1 750.00 750.00 1 30,000.00 30,000.00 34- 98- 226\contract.wU P -2 24 Furnish and install 1 adventure house M661, or approved equal EA 25 Furnish and install 2 -1/2" cal. 'Northwood' Maple (mulch incidental to contract) EA 26 Furnish & install 2 -1/2" cal. 'Marshall's Seed- less' Green Ash (mulch incidental to contras EA Total Base Bid Alternate No. 1 27 Furnish and install 8' -0" portable fusion coating ADA picnic table with 2 (6 ") PVC & bolt fittings for locking LS Total Alternate No. 1 34 -98- 226 \contract.wb2 P -3 1 12,800.00 12,800.00 7 330.00 2,310.00 5 330.00 1,650.00 106,383.00 1 650.00 650.00 650.00 The final amount of the contract shall be determined by multiplying the final measured quantities of the various items actually constructed and installed by the unit prices therefore, in the manner prescribed in the specifications. However, the low bidder shall be determined by adding the sums resulting from multiplying the quantities stated by the unit prices bid therefore. Accompanying this bid is a bidder's bond certified check, or cash deposit in the amount of five percent (5 %) of amount bid , which is at least five percent (5 %) of the amount of my /our bid made payable to the Owner, and the same is subject to forfeiture in the event of default on the part of the undersigned or failure on the part of the undersigned to execute the prescribed contract and bond within fifteen (15) days after its submittal to me /us. In submitting this bid, it is understood that the Owner retains the right to reject any and all bids and to waive irregularities and informalities therein and to award the contract to the best interests of the Owner. In submitting this bid, it is understood that payment will be by cash or check. It is understood that bids may not be withdrawn for a period of 45 days after the date and time set for the opening of bids. It is understood that the Owner reserves the right to retain the certified check or bond of the three lowest bidders as determined by the Owner for a period not to exceed 45 days after the date set for the opening of bids. Respectfully submitted, (A Corporation) Arrigoni Bros. Company (An Individual) Name (A Partnership) Deoma �, 411460d Signer President Title Dennis J. Arrigoni Printed Name of Signer 34- 98- 2261contract.wK P -4 UNITED FIRE & CASUALTY COMPANY HOME OFFICE - CEDAR RAPIDS, IOWA u(I CERTIFIED COPY OF POWER OF ATTORNEY (Original on file at Home Office of Company — See Certification) VOW ALL MEN BY THESE PRESENTS, That the UNITED FIRE & CASUALTY COMPANY, a corporation duly organized and existing Ider the laws of the State of Iowa, and having its principal office in Cedar Rapids, State of Iowa, does make, constitute and , point D. R. DOUGHERTY, OR JACK CEDARLEAF II, OR R. J. LARSEN, OR E. LANGE, OR CHRISTINE M. HANSEN, OR KURT C. LUNDBLAD, OR C. A. HOUSH, ALL INDIVIDUALLY P 0 BOX 64717 ST PAUL MN 55164 true and lawful Attorney(s) —in — Fact with power and authority hereby conferred to sign, seal and execute in its behalf all rvful bonds, undertakings and other obligatory instruments of similar nature as follows: ANY AND ALL BONDS d to bind UNITED FIRE & CASUALTY COMPANY thereby as fully and to the same extent as if such instruments were signed by e duly authorized officers of UNITED FIRE & CASUALTY COMPANY and all the acts of said Attorney, pursuant to the authority !reby given are hereby ratified and confirmed. The Authority hereby granted shall expire JANUARY 8th 2000 unless sooner revoked. This power of Attorney is made and executed pursuant to and by authority of the following By —Law duly adopted by the )ard of Directors of the Company on April 18, 1973. "Article V — Surety Bonds and Undertakings." Section 2, Appointment of Attorney -in -Fact. "The President or any Vice President, or any other officer of the Company, may, from time to time, appoint by written certificates attorneys -in -tact to act in behalf of the Company In the execution of policies of Insurance, bonds, undertakings and other obligatory instruments of like nature. The signature of any officer authorized hereby, and the Corporate seal, may be affixed by facsimile to any powerof attorney or special power of attorney or certification of either authorized hereby; such signature and seal, when so used, being adopted by the Company as the original signature of such officer and the original seal of the Company, to be valid and binding upon the Company with the some force and effect as though manually affixed. Such attorneys -in -fact, subject to the limitations set forth In their respective certificates of authority shall have full power to bind the Company by their signature and execution of any such Instruments and to attach the seal of the Company thereto. The President or any Vice President, the Board of Directors or any other officer of the Company may at any time revoke all power and authority previously given to any attorney- Indact. IN WITNESS WHEREOF, the UNITED FIRE & CASUALTY COMPANY has caused these presents to be signed by its vice president and its corporate seal to be hereto affixed this + ►�%'�. 8th day of JANUARY A.D. 1998 CO®POtAtE °— UNITED FIRE & CASUALTY COMPANY o AXAL r 44 NUnnr" B' Y AVice President ate of Iowa, County of Linn, ss: i this 8th day of JANUARY 1998, before me personally came JEFFREY A. CHAPIN me known, who being by me duly sworn, did depose and say: that he resides in Cedar Rapids, State of Iowa; that he is a ce President of the UNITED FIRE & CASUALTY COMPANY, the corporation described in and which executed the above strument; that he knows the seal of said corporation; that the seal affixed to the said instrument is such corporated seal; that was so affixed pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto Irsuant to like authority, and acknowledges same to be the act and deed of said corporation. 4 SHERYL A. McVAY Notary Public ' MY COMMISSION EXPIRES ow. March 4,2000 My commission expires MARCH 4 X2000 CERTIFICATION the undersigned officer of the UNITED FIRE & CASUALTY COMPANY, do hereby certify that I have compared the foregoing rpy of the Power of Attorney and affidavit, and the copy of the Section of the By —Laws of said Company as set forth in said twer of Attorney, with the ORIGINALS ON FILE IN THE HOME OFFICE OF SAID COMPANY, and that the same are correct anscripts thereof, and of the whole of the said originals, and that the said Power of Atto ey has not been revoked and is tw in full force and effect. In testimony whereof I have hereunto subcribed my name and affix the corporate seal o the Company this 15th day of June 19 98 4 COIPOfAiE BXAL � Secretary �uuaoq�p Bond No 54-9907 :! • ,• I Ugig KNOW ALL MEN BY THESE PRESENTS: that Arrigoni Bros. Company as Principal, (hereinafter called Contractor) and, United F ire & Cap uel t y 0-rhpany as Surety (hereinafter called Surety) are held and firmly bound unto City of New Hope as Obligee (hereinafter called Obligee) for the use and benefit of claimants as hereinbelow defined, in the amount of $107,033.00 or One hundred seven thousand, thirty three and 001100 Dollars. * *Award is based on Base Bid plus Alternate Bid for the payment whereof Contractor and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, Contractor has by written agreement dated 1 , entered into a contract with Obligee for construction of Hidden Valley Park Playground Equipment in accordance with Drawings and Specifications prepared by Bonestroo, Rosene, Anderlik & Associates, Inc. which contract is by reference made a part hereof, and is hereinafter referred to as the Contract. NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION is such that, if Contractor shall promptly make payment to all claimants as hereinafter defined, for all labor and material used or reasonably required for use in the performance of the Contract and shall keep the Project free and clear of all liens as provided in the Contract, then this obligation shall be void; otherwise it shall remain in full force and effect, subject, however, to the following conditions: 1. Claimant is defined as one permitted by applicable law to file a Public Contractor's Bond claim for labor, material, or both, used or reasonably required for use in the performance of the Contract, labor and material being construed to include without limitation that part of water, gas, power, light; heat, oil, gasoline, telephone service, rental of equipment, insurance premiums, taxes, and any items for which a claim or lien may be filed against the Obligee under the applicable law. 2. The above named Contractor and Surety hereby jointly and severally agree with the Obligee that every claimant as herein defined, who has not been paid in full may sue on this bond for the use of such claimant, prosecute the suit to final judgment for such sums as may be justly due claimant, and have execution thereon. The Obligee shall not be liable for the payment of any costs or expenses of any such suit. ** Award is based on Base Bid plus Alternate Bid. ©1998 Bonestroo, Rosene, General Construction Contract Anderlik & Associates, Inc. 58 Between City & Contractor 3. No suit or action shall be commenced hereunder by any claimant: (a) Unless claimant shall have filed a public contractors bond claim in the form and within the time provided under applicable law, or (b) After expiration of time for enforcement of a public Contractors bond claim by legal action. 4. The amount of this bond shall be reduced by and to the extent of any payment or payments made in good faith hereunder. 5. The Contractor and Surety shall keep the Project free and clear of liens and shall promptly remove any and all liens filed against the Project by claimants. 6. The Obligee's right of action on this bond, or for the breach thereof, shall not be limited by the conditions set forth in paragraphs 1 through 3 above. Arrigoni Bros. Company 41 - Witness Contractor a By , Signatur (Typed or Printed name of Signer) Title By _ Signatur (Typed or Printed name of Signer) Title (If the contractor is a partnership or joint venture, all partners or co- venturers must execute this Bond.) O 1998 Bonestroo, Rosene, General Construction Contract Anderlik & Associates, Inc. 59 Between City & Contractor CERTIFICATE OF ACKNOWLEDGMENT BY PRINCIPAL (For use where Contractor is individual or partnership) State of Minnesota ) ) SS. County of ) On this day of , 19 ,before me personally appeared , to me known to be the person described in and who executed the foregoing bond, and acknowledged that _he executed the same as the free act and deed of the individual. (Notarial Seal) Signature of Notary Public CERTIFICATE OF ACKNOWLEDGMENT (For use where Contractor is a corporation) State of Minnesota ) ) SS. County of Ramsey ) On this 15thday of June 19 98 , before me personally appeare and . -r.._. , to me personally known who, being by me duly sworn, did say t at they are respecti ly the and V - , of Arrigoni Bros. Company that the seal affixed to the foregoing instrument is the corporate seal of said corporation, and that said instrument was executed in behalf of the corporation by authority of its Board of Directors, and said �r and ! h,� ®` x>< owledged the instrument to be the free act and deed of said corporation. COMNtE M. AUEN tPow 1-0., RAMSEY COUNt S (Notarial Seal) ignature of Notary Public . UNITED FIRE & CASUALTY COMPANY, P. 0, BOX 73909, CEDAR RAPIDS, IA 52407 Full Name & Address of Surety Company's Home Office JACK CEDARLEAF II, CEDARLEAF, CEDARLEAF & CEDARLEAF, INC., 360 W. LARPENTEUR AVE. Full Name, Address, Phone, and Contact Person of Local Bond Agency ST PAUL, MN 55113 If this bond is executed outside of the State of Minnesota, it must be countersigned on the Performance Bond by a Minnesota resident agent of the Surety Company. Name & Address of Agent Affixing Countersignature MEMORANDUM: Affix here Power of Attorney and Acknowledgment of Corporate Surety. © 1998 Bonestroo, Rosene, General Construction Contract Anderlik & Associates, Inc. 57 Between City & Contractor UNITED FIRE & CASUALTY COMPANY HOME OFFICE — CEDAR RAPIDS, IOWA 91 CERTIFIED COPY OF POWER OF ATTORNEY (Original on file at Home Office of Company — See Certification) OW ALL MEN BY THESE PRESENTS, That the UNITED FIRE & CASUALTY COMPANY, a corporation duly organized and existing ler the laws of the State of Iowa, and having its principal office in Cedar Rapids, State of Iowa, does make, constitute and ,oint D. R. DOUGHERTY, OR JACK CEDARLEAF II, OR R. J. LARSEN, OR E. LANGE, OR CHRISTINE M. HANSEN, OR KURT C. LUNDBLAD, OR C. A. HOUSH, ALL INDIVIDUALLY P 0 BOX 64717 ST PAUL MN 55164 true and lawful Attorneys ? —in —Fact with power and authority hereby conferred to sign, seal and execute in its behalf all ful bonds, undertakings and other obligatory instruments of similar nature as follows: ANY AND ALL BONDS to bind UNITED FIRE & CASUALTY COMPANY thereby as fully and to the same extent as if such instruments were signed by duly authorized officers of UNITED FIRE & CASUALTY COMPANY and all the acts of said Attorney, pursuant to the authority eby given are hereby ratified and confirmed. The Authority hereby granted shall expire JANUARY 8th 2000 unless sooner revoked. This power of Attorney is made and executed pursuant to and by authority of the following By —Law duly adopted by the ird of Directors of the Company on April 18, 1973. "Article V — Surety Bonds and Undertakings." Section 2, Appointment of At torn ey - in- Fact. "The President or any Vice President, or any other officer of the Company, may, from time to time, appoint by written certificates attorneys -in -tact to act In behail of the Company In the execution of policies of Insurance, bonds, undertakings and other obligatory instruments or like nature. The signature of any officer ,authorized hereby, and the Corporate seal, may be affixed by facsimile to any powerof attorney or special power of attorney or certification of either authorized hereby; such signature and seal, when so used, being adopted by the Company as the original signature of such officer and the original seal of the Company, to be valid and binding upon the Company with the same force and effect as though manually affixed. Such attorneys -in -fact, subject to the limitations set forth In their respective certificates or authority shall have full power to bind the Company by their signature and execution of any such instruments and to attach the seal of the Company thereto. The President or any Vice President, the Board of Directors or any other officer of the Company may at any time revoke all power and authority previously given to any atiorney -in -fact. IN WITNESS WHEREOF, the UNITED FIRE & CASUALTY COMPANY has caused these presents 1110111", to be signed by its vice president and its corporate seal to be hereto affixed this b. kij'c. 8th day of JANUARY A.D. 1998 COItORAPE S UNITED FIRE & CASUALTY COMPANY lftAL �„ r �NUrunp By AVice President to of Iowa, County of Linn, ss: this 8th day of JANUARY 1998, before me personally came JEFFREY A. CHAPIN me known, who being by me duly sworn, did depose and say: that he resides in Cedar Rapids, State of Iowa; that he is a e President of the UNITED FIRE & CASUALTY COMPANY, the corporation described in and which executed the above rument; that he knows the seal of said corporation; that the seal affixed to the said instrument is such corporated seal; that vas so affixed pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto suant to like authority, and acknowledges same to be the act and deed of said corporation. y� m C , `• SHERYL A. McVAY Notary Pu is F t V MY COMMISSION EXPIRES owe March 4,2000 My commission expires MARCH 4 X2000 CERTIFICATION ie undersigned officer of the UNITED FIRE & CASUALTY COMPANY, do hereby certify that I have compared the foregoing ry of the Power of Attorney and affidavit, and the copy of the Section of the By —Laws of said Company as set forth in said ver of Attorney, with the ORIGINALS ON FILE IN THE HOME OFFICE OF SAID COMPANY, and that the same are correct scripts thereof, and of the whole of the said originals, and that the said Power of Atto By has not been revoked and is v in full force and effect. ` nurrrn, In testimony whereof I have hereunto subcribed my name and affix the corporate seal o the ar' Mk' Company this 15th day of June 19 98 CORPORATE ._ BILL Secretary mono �. �uu+ar + +t LV�u CERTIFICATE OF LIABILITY INSURANCBPID SL DATE (MM /DDNY) ARRIG -1 03/30/99 CEIR THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Insurance Services, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1 Shingle Creek Pkwy, #510 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Leapolis MN 55430 COMPANIES AFFORDING COVERAGE ly J. Carlson 612 - 585 -9610 COMPANY A General Casualty Companies do. 612- 585 -9000 Fax No.612- 585 -9009 iD COMPANY B COMPANY Arrigoni Brothers Company and Dennis Arrigoni C COMPANY 817 Vandalia Street St. Paul MN 55114 D RAGES iIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD DICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS :RTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, (CLUSIONS A CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM /DDNY) POLICY EXPIRATION DATE (MM /DDNY) n LIMITS ENERAL LIABILITY GENERAL AGGREGATE $ 3 { COMMERCIAL GENERAL LIABILITY CC10219769 04/01/99 V 04/01/00 PRODUCTS - COMP /OPAGG $ 1,000,000 CLAIMS MADE [ X] OCCUR PERSONAL & ADV INJURY $ 500,000 EACH OCCURRENCE $ 500,000 OWNER'S & CONTRACTOR'S PROT FIRE DAMAGE (Any one fire) $ 100,000 MED EXP (Any one person) $ 5 UTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 500000 { ANY AUTO CBA0219769 04/01/99 04/01/00 BODILY INJURY _ $ ALL OWNED AUTOS SCHEDULED AUTOS (Per person) BODILY INJURY $ HIRED AUTOS NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ ARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: ANY AUTO EACH ACCIDENT $ AGGREGATE $ XCESS LIABILITY EACH OCCURRENCE $ 5 AGGREGATE $5,000,000 q UMBRELLA FORM CC10219769 04/01/99 04/01/00 $ OTHER THAN UMBRELLA FORM /ORKERS COMPENSATION AND X TO IMI - OTH- TORY L LIMITS ER MPLOYERS' LIABILITY EL EACH ACCIDENT $100, iEPROPRIETOR/ INCL CWCO219769 04/01/99 04/01/00 EL DISEASE - POLICY LIMIT $ 500, 000 ARTNERS /EXECUTIVE EL DISEASE - EA EMPLOYEE $ 100,000 FFICERS ARE: EXCL THEIR sired or Leased CCIO219769 04/01/99 04/01/00 Limit $200,000 9quipement Ded $500 PTION OF OPERATIONS /LOCATIONSNEHICLES /SPECIAL ITEMS Hidden Valley Park Playground Equipment City Project N �634 l e No. i8 -226. IFICATE HOLDER CANCELLATION BONESTR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL MAIL City of New Hope 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, attn: Valerie Leone 4401 Xylon Ave. No. ` New Hope, MN 55428 MN 55113 C AUTHOR ED REPRE ENT IVE Mi 1xx - 6 0 D 25--S (1/95) " ACORD CORPORATION 1988 s • 17 111711 • Originating Department I Approved for Agenda ( Agenda Section Parks and Recreation 1 1 819199 1 Consent Item No. BY Shari French By. 6.6 RESOLUTION APPROVING CHANGE ORDER #1 WITH ARRIGONI BROTHERS COMPANY FOR IMPROVEMENT PROJECT NO. 634 (HIDDEN VALLEY PARK PLAYGROUND EQUIPMENT PROJECT) REQUESTED ACTION Staff and the engineers are recommending that the City Council approve change order #1 to the contract with Arrigoni Brothers Company. This relates to Improvement Project #634, which is for new play equipment for Hidden Valley Park. The change order is a deduct as City staff determined that the drinking fountain included in this project was not needed due to design. The total for this change order is a deduct of $5,000.00. BACKGROUND The original cost estimate for improvement project #634 was $107,033. The actual costs including change order #1 is $102,719.20. This includes $686.20 in minor differences between estimated quantities and actual quantities used. This amounts to 0.67% over the revised contract amount. FUNDING Park CIP funding was used to fund this project. ATTACHMENTS The change order is attached. MOTION BY SECOND BY y� TO: F .19158 - 710 1 CITY OF NEW HOPE RESOLUTION NO. 99 - 118 RESOLUTION APPROVING CHANGE ORDER #1 WITH ARRIGONI BROTHERS COMPANY FOR IMPROVEMENT PROJECT NO. 634 (HIDDEN VALLEY PARK PLAYGROUND EQUIPMENT PROJECT) WHEREAS, the City of New Hope authorized on June 8, 1998, Improvement Project No. 634, (Hidden Valley Park Playground Equipment Project) for the contractual sum of $107,033.00; and WHEREAS, after the bid was awarded the drinking fountain was determined not to be needed because of its design; and WHEREAS, Change order #1 for this work totals a deduct of $5,000.00, which brings the total contractual sum to $102,033.00. NOW, THEREFORE, BE IT RESOLVED, that the City Council of the City of New Hope approves change order no. 1 to the contract with Arrigoni Brothers Company as part of Improvement Project No. 634 (Hidden Valley Park Playground Equipment Project). Adopted by the City Council of the City of New Hope, Hennepin County, Minnesota, this 9th day of August 1999. 104 FAM 1- Z - J Attest: City Clerk FA Bonestro Rosene Owner: Cit of New Hope, 4401 X' lon Ave New Hoe MN 55428 > Anderlik & Associates Contractor: Arri oni Brothers Co., 817 Uadalia St, St Paul, MN 55114 Date:' June 30, 1999 Engineers &Arct)itects waukee Bond Co.: United Fire & Casualty, 360 W La enteur Ave, St Paul, MN 5511.3 Bond No. 54 -99497 4401 Xylon Avenue North New Hope, Minnesota 55428 -4898 August 11, 1999 Arrigoni Brothers Company 817 Vadalia St. St. Paul, MN 55114 City Hall: 612- 531 -5100 Police: 612 -531 -5170 Public Works: 612- 533 -4823 TDD: 612 - 531 -5109 Subject: Change Order No. 1 - Improvement Project No. 634 City Hall Fax' 612 -531 -5136 Police Fax 612 - 531 -5174 Public Works Fax. 612 - 533 -7650 Fire Dept. Fax 612 - 531 -5175 Enclosed are two fully executed copies of the above - referenced Change Order for your records. Please forward one copy to your bonding company. The change order was approved on August 9, 1999, by the New Hope City Council. If you have any questions, please contact me. Sincerely, ,_ 4 -- LC— Valerie Leone City Clerk, CMC enc. cc: Shari French, Director of Parks and Recreation Mark Hanson, City Engineer Family Styled City N For Family Living A, Originating Department Parks & Recreation By: Shari French Approved for Agenda �' 8/9/99 Agenda Section Consent Item No. 6.7 MOTION TO ACCEPT IMPROVEMENT PROJECT NO. 634 (HIDDEN VALLEY PARK PLAYGROUND EQUIPMENT) AND APPROVE FINAL PAY REQUEST TO ARRIGONI BROTHERS COMPANY IN THE AMOUNT $7,087.26 REQUESTED ACTION Staff is recommending that the Council accept Improvement Project 634 and approve final payment to Arrigoni Brothers Company in the amount of $7,087.26. All appropriate paperwork has been received by the City in order to close out this project. BACKGROUND This project involved the replacement of the play equipment at Hidden Valley Park and the restoration of the site after construction. FUNDING The cost of this project totals $102,719.20. This is $686.20 over the revised contract amount with is 0.67% due to minor differences between estimated quantities bid and actual quantities used. There was a $5,000 deduct due to the elimination of the drinking fountain from the project due to the design. Funding is to come from Parks CIP. ATTACHMENTS The Engineer's letter recommending final payment is attached. • s c •• � W03 I: RFAT &R \Parks \Final 634 W ' Iii Bonestroo, Rosene, Anderlik and Associates, Inc. is an Affirmative ActionlEqual Opportunity Employer Principals: Otto G. Bonestroo, P.E. - Joseph C. Anderlik, P.E. - Marvin L. Sorvala, RE. Glenn R. Cook, RE. - Robert G. Schunicht, R.E. - Jerry A. Bourdon, RE. - Robert W. Rosene, P.E., Richard E. Turner, RE. and Susan M. Eberlin, C.P.A., Senior Consultants Associate Principals: Howard A. Sanford, R.E. - Keith A. Gordon, RE. - Robert R. Pfefferle, RE. - Richard W. Foster, R.E. - David O. Loskota, RE. - Robert C. Russek, A.I.A. - Mark A. Hanson, R.E. Michael T. Rautmann, R.E. - Ted K.Fieid, R.E. • Kenneth P Anderson, RE. - Mark R. Rolfs, RE, Sidney P Williamson, RE., L.S. - Robert F. Kotsmith - Agnes M. Ring - Allan Rick Schmidt, R.E. Offices: St. Paul, Rochester, Willmar and St. Cloud, MN - Milwaukee, WI Website: www.bonestroo.corn July 21, 1999 Ms Shari French Public Works Director City of New Hope 4401 Xylon Ave N New Hope, MN 55428 -4898 Re: Hidden Valley Park Play Ground Equipment Client Project No. 634 BRA File No. 34 -98 -226 Dear Shari, Transmitted herewith are four (4) copies of Request for Payment No. 3 and Final, Change Order No.l, and also the required- signed Minnesota Withholding Form IC -134 for the above - mentioned project. The work on this project has been satisfactorily completed and we recommend payment at this time. The final amount is approximately 0.67% over the revised contract amount due to minor differences between estimated quantities bid and actual quantities used.. Please distribute as follows: 1 copy City of New Hope 2 copies Contractor and Bonding Company 1 copy Bonestroo, Rosene, Anderlik & Associates Inc Should you have any questions regarding this, please feel free to call me at (651) 604 -4838. Very Truly Yours, BONES ROO, OSE , ANDERLIK & ASSOCIATES, INC. Mark -: Hanson MAH:dsb Enclosures O tt. Paul, MN 55113 ■ 651 - 636 -4600 ■ Fax: 651-636 -1311 / REQUEST FOR PAYMENT HIDDEN VALLEY PARK PLAYGROUND EQUIPMENT CITY PROJECT NO. 634 File No. 34 -98 -226 SUMMARY 1 Original Contract Amount 2 Change Order - Addition 3 Change Order - Deduction 4 Revised Contract Amount 5 Value Completed to Date 6 Material on Hand 7 Amount Earned 8 Less Retainage 0% 9 Subtotal 10 Less Amount Paid Previously 11 AMOUNT DUE THIS REQUEST FOR PAYMENT NO. 3 /Final Recommended for Approval by: BONESTROO, ROSENE NDERLIK & ASSOCIATES, INC. Approved by Contractor: ARRIGONI BROS. COMPANY A $ 107,033.00 $ 5,000.00 $ 102,033.00 $ 102,719.20 $ 0.00 $ 102,719.20 $ 0.00 $ 102,719.20 $ 95,631.94 $ 7,087.26 Specified Contract Completion Date: Date: 1:\34 \34226 \Word \REQUEST3.WB2 Bonestro Rosene Owner: City of New Hope, 4401 Xylon Ave N, New Hope, MN 55428 Date: June 30, 1999 Anderlik Associates For Period: November 5, 1998 to June 30, 1999 Request No: 3/Final Engineers &Architects St Paul•Milwauk Contractor: Arri oni Bros. Company, 817 Vandalia St, St Paul, MN 55114 REQUEST FOR PAYMENT HIDDEN VALLEY PARK PLAYGROUND EQUIPMENT CITY PROJECT NO. 634 File No. 34 -98 -226 SUMMARY 1 Original Contract Amount 2 Change Order - Addition 3 Change Order - Deduction 4 Revised Contract Amount 5 Value Completed to Date 6 Material on Hand 7 Amount Earned 8 Less Retainage 0% 9 Subtotal 10 Less Amount Paid Previously 11 AMOUNT DUE THIS REQUEST FOR PAYMENT NO. 3 /Final Recommended for Approval by: BONESTROO, ROSENE NDERLIK & ASSOCIATES, INC. Approved by Contractor: ARRIGONI BROS. COMPANY A $ 107,033.00 $ 5,000.00 $ 102,033.00 $ 102,719.20 $ 0.00 $ 102,719.20 $ 0.00 $ 102,719.20 $ 95,631.94 $ 7,087.26 Specified Contract Completion Date: Date: 1:\34 \34226 \Word \REQUEST3.WB2 No. Item Unit Base Bid Amount 1 Existing play equip. demolition and removal LS 2 Clear and grub trees /shrubs EA 3 Remove existing bituminous SY 4 Remove ex. timber wall & benches LS 5 Furnish & place modular masonry retaining 500.00 wall and border (topsoil, sod, aggregate, all 1,000.00 materials and labor incidental to contract) SF 6 Furnish and install new play sand TN 7 Clean existing sand LS 8 Concrete sidewalk on granular base SF 9 New bituminous trail SY 10 Concrete bench pads and picnic table pad SF 11 Furnish and install 4" perforated drain pipe LF 12 Furnish and install 6" PVC outlet pipe (incl. 1,100.00 6" x 6" wye with clean out) LF 13 Furn. & install HAWS 1114 drinking fountain (or approved equal) including all 1" copper tubing, ball valve, bleeder valve, 2" drain pipe, & connection to ex. water EA 14 Furnish and install 6' bench with back, Iron Mountain Forge EA Model 281 -6XP or approved equal 15 Furnish & install (1) climb & slide 119061A, or approved equal EA 16 Furnish & install (1) spring board M199 or approved equal EA 17 Furnish & install (1) super scoop, 123831A or approved equal EA 18 Furnish and install (1) wheelchair accessible super scoop, 123831B or approved equal EA 19 Furnish and install resilient surfacing (incl. aggregate & concrete, quanity based on full thickness and includes bevel SF Contract Unit Quantity Amount Quantity Price to Date to Date 1 2,000.00 1 2,000.00 2 500.00 2 1,000.00 55 1.00 55 55.00 1 2,000.00 1 2,000.00 1,000 21.00 1119 23,499.00 200 12.00 372.3 4,467.60 1 500.00 1 500.00 1,100 3.50 412 1,442.00 60 20.00 90 1,800.00 832 4.00 421 1,684.00 115 8.00 115 920.00 110 10.00 110 1,100.00 1 5,000.00 0 4 500.00 4 2,000.00 1 1,500.00 1 1,500.00 1 2,200.00 1 2,200.00 1 400.00 1 400.00 1 400.00 1 400.00 435 12.00 399.3 4,791.60 1:\34 \34226 \Word \REQ U EST3. WB2 20 Swing set, 8' high, 4 swings, 1 molded bucket seat, 1 tot seat, 2 solid flat seats wide enough for average adult male #100051 C, or approved equal EA 1 2,100.00 1 2,100.00 21 Furnish and install dragon spring animal M113 or approved equal EA 1 700.00 1 700.00 22 Furnish and install You and Me M164, or approved equal EA 1 750.00 1 750.00 23 Furnish and install play structure with slides, poles, platforms, play features, kick plates, etc. (submit detailed drawing of equivalent structure) EA 1 30,000.00 1 30,000.00 24 Furnish and install i adventure house M661, or approved equal EA 1 12,800.00 1 12,800.00 25 Furnish and install 2 -1/2" cal. 'Northwood' Maple (mulch incidental to contract) EA 7 330.00 7 2,310.00 26 Furnish & install 2 -1/2" cal. 'Marshall's Seed- less' Green Ash (mulch incidental to contract) EA 5 330.00 5 1,650.00 Total Base Bid 102,069.20 Alternate No. 1 27 Furnish and install 8' -0" portable fusion coating ADA picnic table with 2 (6 ") PVC & bolt fittings for locking LS 1 650.00 1 650.00 Total Alternate No. 1 650.00 Total Base Bid 102,069.20 Total Alternate No. 1 650.00 Total Work Completed to Date 102,719.20 1:\34 \34226 \Word \REQUEST3.WB2 PROJECT PAYMENT STATUS Owner CITY OF NEW HOPE Project No. 634 File No. 34 -98 -226 Contractor ARRIGONI BROS. COMPANY CHANGE ORDERS No. Date Dewrintinn Amnnnt 1 06/30/99 Delete Item No. 13 - Foundation 5,000.00 2 81,024.00 2 10/06/98 3 18,659.14 5,033.26 100,665.20 Total Change Orders $5,000.00 PAYMENT SUMMARY No. Period Pavment Retainage Comnleted 1 Start 10/06/98 76,972.80 4,051.20 81,024.00 2 10/06/98 11/05/98 18,659.14 5,033.26 100,665.20 3 4 5 6 7 8 9 10 Material on Hand Total Payment to Date $95,631.94 Original Contract $107,033.00 Retaina e, Payment No. 3/F Chan e Orders 5,000.00 Total Amount Earned $95,631.94 Revised Contract $112,033.00 1:\34 \34226 \Word \REQUEST3. W B2 Please type or print clearly. This will be your mailing label for returning the completed form. — — — — — — — — — — — Company name i Daytime phone Minnesota withholding tax ID number r Arr��oni Brothers Ca I — 8037242 Address Total contract amount Month /year work began 817 Vandalia St $ 102 719.20 July 1998 City State Zip Code I Amount still due Month /year work ended — — — St Paul _ _ — — — J $ 7087.26 ,Tune 1999 Project number Project location 634 Hidden y Park Project owner Address City State Zip code Citv of New Hone New None MN 55497 Did you have employees work on this project? Yes El No If no, who did the work? Check the box that describes your involvement in the project and fill in all information requested. Sole contractor ❑ Subcontractor Name of contractor who hired you Prime contractor — you subcontracted out any work on this project, all of your subcontractors must file their own IC -134 affidavits and have them certified by the Department of Revenue before you can file your affidavit. For each subcontractor you had, fill in the information below and attach a copy of each subcontractor's certified IC -134. If you need more space, attach a separate sheet. Business name Address Owner /Officer All Season's Landscape & Design 14848 Hwy 7 E. Hutchinson J. Krasowski Minnesota Fla—round 1nE P 9 De- 27328 Gelden Valley -MN 55425 Ron Lehman Hoffman & McNamara 2601 Glendale Rd Hastings MN 55033 Dennis McNamara i declare that all information 1 have filled in on this form is true and complete to the best of m knowledge and belief. 1 authorize the Department of Revenue to disclose pertinent information relating to this project, including sending copies of this form, to the prime contractor if / am a subcontractor, and to any subcontractors if / am a prime contractor, and to the contracting agency. CorAftctor's signature. Title Dnta to: MN Degf. of Revenue, WithhgKing Division, Mail Station 6610, St. Paul, MN 55146-6610 Based on records of the Minnesota Department of Revenue, I certify that the contractor who has signed this certificate has fulfilled all the requirements of Minnesota Statutes 290.92 and 290.97 concerning the withholding of Minnesota income tax from wages paid to employees relating to contract services with the state of Minnesota and /or its subdivisions. Departmen wee approval'- . ;rM Date Stock No. 5000134 )Rev. 11/96) Printed on recycled paper with 10 post- consumer waste using soy -based ink. Who must file? If you are a prime contractor, a contractor or a subcontractor who did work on a project for the state of Minnesota or any of its local government subdivisions — such as a county, city or school district — you must file Form IC -134 with the Minnesota Department of Revenue. This affidavit must be certified and returned before the state or any of its subdivisions can make final payment for your work. When file The IC -134 cannot be processed until you finish the work. If you send it in for certification before the project is completed, it will be returned to you unprocessed. If you are a subcontractor or sole contractor, send in the form when you have completed your part of the project. If you are a prime contractor, send in the form when the entire project is completed and you have received certified affidavits from all of your subcontractors. How to ile If you have fulfilled the requirements of Minnesota withholding tax laws, the Department of Revenue will sign your affidavit and return it to you. If any withholding payments are due to the state, Minnesota law requires that payment be made by money order, cashiers check, certified check or cash (M.S. 290.97). Submit the certified affidavit to your prime contractor or to the government unit for which the work was done in order to receive your final payment. 1r i - - Mail to: MN Dept. of Revenue Withholding Tax Division Mail Station 6610 St. Paul, MN 55146 -6610 You must fill in your Minnesota withholding tax ID number on the form. You must have a Minnesota tax ID number if you have employees who work in Minnesota. If you do not have a Minnesota ID number, you must apply for one. Call (612) 282 -5225 or 1- 800 -657- 3605. Or write to the following address to request an application (Form ABR). Minnesota Tax Forms Mail Station 1421 St. Paul, MN 55146 -1421 If you have no employees and did all the work yourself, you do not need a Minnesota tax ID number. If this is the case, fill in your Social Security number in the space for Minnesota tax ID number and explain who did the work. Use of information The Department of Revenue needs all the information, except your phone number, to determine if you have met all state income tax withholding requirements. If all required information is not provided, the IC -134 will be returned to you for completion. All information on this affidavit is private by state law. It cannot be given to others without your permission, except to the Internal Revenue Service, other states that guarantee the same privacy and certain government agencies as provided by law. assistance If you need help or additional information to fill out this form, call (612) 282 -9999 or 1- 800 - 657 -3594. Hearing, speech or visually impaired? TDD /TTY users may contact the department through the Minnesota Relay Service. Call 1 -800- 627 -3529. If you need information in an alternative format, such as Braille, large print or audio tape, we will provide it. If you need more IC -134 forms, call (612) 296 -4444 or 1- 800 - 657 -FORM. Or write to: Minnesota Tax Forms Mail Station 1421 St. Paul, MN 55146 -1421 06/28/1999 09:33 651-645-9322 0 =4 3 OWK4111111 Naso "e orprint clearly. This will be your mailing label for returning the completed form. ------------------ \ Company name Daytime phone I ALL �F_A�ON LAN WCAPc F Dep&4 t 1AfC 32t 5 t, - (O(p ( Address' . ......... Total contract amount 14e48 141• Y 7 C . $ I(P, 3ZR , 50 City State Zip Code X�o still due I U TCW I N SON , (4114 55350 $ Ri 5 00 2 Project number Project location 14 t j r_) F_ tJ) Va L-L-E , Y' 'PA P-V- I �- 130pN6 AVE t�EW HOPIS H� �J Q(,kA 3 q ZZ C4C E P_ 0 P 3 2 _"�� - - -1-1 ------ __ 11 _ � — Project owner Address city State Zip code f4ew i4cpc, H1 ( 4LIQ )("/Lc)t\) AVC fJ- 06W _14O PE H t1i 559 d8 Did you have employees work on this projectil X Yes [I No if no, who did the work? Check the box that describes your involvement in the project and fill in all information requested. ❑ Sole contractor tR Subcontractor Name of ronfrocta,r who hired yov A %J Address I VANOAUA S N" L, m J 55 Lir F Prime contractor—If you subcontracted out any work on this project, all of your subcontractors must file their own IC -1 34 affidavits and have them certified by the Department of Revenue before you can file your affidavit- For each subcontractor you hod, fill in the information below and attach a copy of each subcontractor's certified IC -1 34. if you need more space, attach a separate sheet. Business name Address 1jTol�tW Minnesota withholding tax 10 number i 8 ?_ 3 - 7 3 5 . qWq6r CLffLlcelt L I i declort that all information I hove filled in on this form is true and complete to the best of my knowfedga and belief. I ovthoriza the beportmem of Revenue to disclose pertinent information relating to this project, including sending copies of this form, to the prime contractor if I am a subcontractor, and to any subcontractors if I am a prime con and to the contracting agency. . . . . . . .......................................... T - T -11. Contractor's signature its pate Ot - a 3 9 f3 MN_ of Revenue, Withholding Division, Mail Station 6610, St, Paul, MN 55146-6610 C"ficate of Compliance Based on records of the Minnesota Department of Revenue, I certify that the Contractor who has signed this certificate has fulfilled all the requirements of Minnesota Statutes 290.92 and 290.97 concerning the withholding of Minnesota income tax from wages paid to employees relating to contract services with the state of Minnesota and/or its subdivisions. Department of Revenue QPPrqYqJ . I - P Otte ////- / �- 40:e, 0 & � A - 11,1ki � n loon Stock No. 5000134 (Rev. 11/961 printed on recycled paper with 10% post-consumer waste using so4ased ink. MINNESOTA Department of Revenue ;ZISSS Withholding Affidavit for Contractors IC -1 34 2 r z This affidavit must be approved by the Minnesota Deportment of Revenue before the state of Minnesota or any of its subdivisions can make final payment to contractors. Project number Project location t Project owner Address City State Zip code E . l. - Q_�k 0 I Did you have employees work on this project? Yes ❑ No If no, who did the work? CL Check the box that describes your involvement in the project and fill in all information requested. ❑ Sole contractor Subcontractor Name o o ntractor w ho ho hired o r Address 0 ------ ❑ Prime contractor—if you subcontracted out any work on this project, all of your subcontractors must file their own IC -1 34 affidavits and have them certified by the Deportment of Revenue before you can file y our affidavit. For each subcontractor you had, fill in the information below and attach a copy of each subcontractor's certified IC -1 34. If you 0 need more space, attach a separate sheet. W. Business name Address Owner/Officer I declare that all information / have filled in on this form is true and complete to the best of my knowledge and belief. I authorize the Department of Revenue to disclose pertinent information relating to this project, including se nding copies of this form, to the prime contractor if I am a subcontractor, and to any subcontractors if I am a pri contra tor, and to the contracting agency. n – or's signature Date Title aA�al - 'a 9 X t.2 �. MIN Dept. of Revenue, Withholffing ivision, Mail Station 6610, St. Paul, MN 5 5 1 46 -66 1 0 Certificate of Compliance Based on records of the Minnesota Department of Revenue, I certify that the contractor who has signed this certificate has fulfilled all the requirements of Minnesota Statutes 290.92 and 290.97 concerning the withholding of Minnesota income tax from wages paid to employees relating to contract services with the state of Minnesota and/or its subdivisions. Department of Revenue approval Date Stock No. 5000 1 34 (Rev. 11 /96) Primed on recvcied n—, with 1 O°' —0--rn— --t. i .based ink, Please type or print clearly. This will be your mailing label for returning the completed form. — — — — Company name I — — — — — — — — — — MC CO. Daytime phone 1 43 9 463 1 Minnesota withholding tax ID number 64OFFMAN S (691) 1 SS C703L Is I Address 2601 Lil enG , -- 55033 I Total contract amount Month/year work began STINGS MINNESOTA 8 City State Zip Code Amount still due J $ Month/year work ended I Project number Project location t Project owner Address City State Zip code E . l. - Q_�k 0 I Did you have employees work on this project? Yes ❑ No If no, who did the work? CL Check the box that describes your involvement in the project and fill in all information requested. ❑ Sole contractor Subcontractor Name o o ntractor w ho ho hired o r Address 0 ------ ❑ Prime contractor—if you subcontracted out any work on this project, all of your subcontractors must file their own IC -1 34 affidavits and have them certified by the Deportment of Revenue before you can file y our affidavit. For each subcontractor you had, fill in the information below and attach a copy of each subcontractor's certified IC -1 34. If you 0 need more space, attach a separate sheet. W. Business name Address Owner/Officer I declare that all information / have filled in on this form is true and complete to the best of my knowledge and belief. I authorize the Department of Revenue to disclose pertinent information relating to this project, including se nding copies of this form, to the prime contractor if I am a subcontractor, and to any subcontractors if I am a pri contra tor, and to the contracting agency. n – or's signature Date Title aA�al - 'a 9 X t.2 �. MIN Dept. of Revenue, Withholffing ivision, Mail Station 6610, St. Paul, MN 5 5 1 46 -66 1 0 Certificate of Compliance Based on records of the Minnesota Department of Revenue, I certify that the contractor who has signed this certificate has fulfilled all the requirements of Minnesota Statutes 290.92 and 290.97 concerning the withholding of Minnesota income tax from wages paid to employees relating to contract services with the state of Minnesota and/or its subdivisions. 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Clty������ w� m� ��� ���—) �/° . � / Month/y)york, ended Did you have employees work on this project? Proiect number: !f none, explain who did the work: i Proiect location: A4� r7 Protect owner: Please type or print clearly above, This will be your Total contract arriqlpt mailing label for returning the completed form. —)y 7), Teleptione number Amount still due [heck the box that describes your involvement /n the projec and fill in all information requested in that category: _ Sole contractor Subcontractor If you subcontractor, \ ' 4 (�/; ` �4 � �f�� ___+_-/ Prime Contractor |f you subcontracted out any work on this project, all of your subcontractors must file their own |C'134 affidavits and have them certified by the Department of Revenue before you can file your affidavit, For each subcontractor you had, fill in the business information below, and attach a copy of each subcontractor's certified IC-1 34. (If you need more space, attach a separate sheet.) Business name Address Owner/Officer Minnesota Department of Revenue, Business Trust Tax Section Mail Station 6610, St. Paul, MN 55146 Certificate cf Compliance with Minnesota Income Tax Withholding Law Based on records of the Minnesota Department of Revenue, | certify that the contractor who has signed this Certificate has fulfilled all the requirements of Minnesota Statutes 29O.S2 and 29O.S7 concerning the withholding of Minnesota income tax from wages paid w employees relating *o contract services with the state of Minnesota and/or its subdwisions� �p�--- -------- -----------------' - -- »» ' s - �� _ Siocx No 5,000134