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HomeMy WebLinkAboutResolution 2022-22 06/20/2022 CITY OF SPRINGFIELD, OREGON 3133.33 RESOLUTION NO. ___________ A RESOLUTION ADOPTING THE 2021 OREGON STANDARD SPECIFICATIONS FOR CONSTRUCTION, AS AMENDED, AS THE CITY OF SPRINGFIELD STANDARD CONSTRUCTION SPECIFICATIONS WHEREAS, the Springfield Municipal Code section 3.000 Specifications adopts the Springfield Standard Construction Specifications applicable to all public improvement contracts, and provides that the City Council shall review and approve all changes to such specifications; and WHEREAS, the Springfield Development Code section 4.1.110 provides that specifications for the design, construction, reconstruction, or repair of streets, alleys, sidewalks, multi-use paths, bikeways, bus turnouts, accessways, curbs, gutters, street lights, traffic signals, street signs, sanitary sewers, stormwater management systems, street trees and planter strips within the public right-of-way, medians, round-rbanizable ; and WHEREAS, the 2021 Oregon Standard Specifications for Construction have been reviewed and approved by the City Engineer; and WHEREAS, the Common Council of the City of Springfield has reviewed the 2021 Oregon Standard Specifications ror Construction and finds it in the public interest to adopt such specifications as the Springfield Standard Construction Specifications, with changes specific to Springfield as provided in Exhibit A, NOW, THEREFORE, BE IT RESOLVED BY THE COMMON COUNCIL OF THE CITY OF SPRINGFIELD: Section 1: The Common Council of the City of Springfield does hereby by review, endorse and adopt the 2021 Oregon Standard Specifications for Construction with changes to Part 100, as provided in Exhibit A attached hereto and incorporated by reference. Section 2: This Resolution will take effect upon adoption by the Council and approval by the Mayor. Kvof 31ui ADOPTED by the Common Council of the City of Springfield this ___ day of _________, ____, 3133 1 )2!Bctfou!.!Qjtijpofsj* by a vote of _____ for and ____ against.6 _______________________ Mayor ATTEST: 7031033 __________________________ City Recorder Fyijcju!B!Qbhf!2!pg!281! (General Conditions for Construction for Certified Local Public Agencies Template based on the 2021 Oregon Standard Specifications. These instructions have been included to aid in the use of these specifications. Remove all instructions before preparing the final document. This document is essentially the Part 00100 from the 2021 edition of the Oregon Standard Specifications for Construction. These Specifications have been modified by the Certification User Group Standards subcommittee,book which includes APWA members, to provide a template as a starting point for Certified Local Public Agencies (Certified LPAs) use on federal-aid projects. The Certified LPA needs to first modify this template in track changes to establish their agency’s proposed general conditions for their FHWA projects and submit it to ODOT for review by ODOT and the Oregon DOJ. This requirement is also in the Certified LPAs Master Agreement. After that ODOT only needs to review future changes to the Certified LPAs template. ODOT recommends running the text through Notepad to clear existing formatting and inserting the text and applying the appropriate style in the template. References in this document to the FHWA Contract Administration Core Curriculum Manual (CACC) can be found at the following website: https://www.fhwa.dot.gov/programadmin/contracts/cacc.pdf This template is not a standalone document and must have additional boilerplate language or Certified LPA language included in the special provisions before it can be used as a Contract. For example, specified completion date(s) need to be added to 00180. The ODOT boilerplate special provisions published by the Project Control Office, Specifications Unit, are available on their website: https://www.oregon.gov/odot/Business/Pages/Standard_Specifications.aspx and may be helpful. In addition ODOT has developed samples for Certified LPAs to use related to Prevailing Wage Rates, Contract form, Liquidated Damages, Bond forms, and other sample documents are available on the ODOT Statewide Investment Management Section website: https://www.oregon.gov/odot/LocalGov/Pages/certification-guidance-forms.aspx In the following title insert the Certified Local Public Agency name for the title of this document and delete the parentheses. It is important that the Certified LPA update all the instances of the name of this document, and that the title is consistently used. For example in 00110.00. This is not a field at this time but something that must be updated throughout this document as well as the bidding and procurement documents the Certified LPA uses for these projects. Insert the name of the agency where it states (Certified LPA)) (The table of contents must be updated and or corrected after all the other edits are completed. To automatically update, right-click anywhere within the Table of Contents and choose “update field” then select “update page numbers only” or “update entire table”. If you have added or deleted subsections you will want to update the entire table. ODOT recommends running the text through Notepad to clear existing formatting and inserting the text and applying the appropriate style in the template.) Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!3!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!4!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!5!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!6!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!7!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!8!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!9!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!:!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!21!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!22!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!23!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!24!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!25!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!26!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!27!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!28!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!29!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!2:!pg!281! (Insert the agency specific provisions for 00120.00, 00120.01 and 00120.05 and submit it to ODOT along with all other modifications.) (This template includes suggested language for the Certified LPA to consider if the Certified LPA is using ODOT to prequalify bidders. If the Certified LPA is following a different prequalification process that process needs to be in agreement with the CACC and is subject to approval by ODOT and FHWA. See pp 127 in the CACC. Note: To ensure competitive bidding that does not unfairly impact non-local bidders, the Certified LPA should allow the submittal of Subcontractor Disclosure Forms and revision or withdrawal of bids by some electronic means like email or FAX. If the Certified LPA proposes edits to remove the FAX option, then the Certified LPA needs to provide an explanation or appropriate edits to allow email or other options.) COS will accept electronic means by email, FAX is not accepted. This is noted in our Instruction to Bidders. - (Insert the agency specific provisions and submit, see above instruction. Some Certified LPAs include this information in the invitation to bid or notice to bidders and cross-reference the applicable Sections here.) (Insert the agency specific provisions and submit, see above instruction. Some Certified LPAs include this information in the invitation to bid or notice to bidders and cross-reference the applicable Sections here.) Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!31!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!32!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!33!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!34!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!35!pg!281! (Update the following subsection as appropriate and submit.) (Update the following subsection as appropriate and submit.) Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!36!pg!281! (Certified LPA to update as needed if the Certified LPA has their own COI form and process) (Optional provision. Delete or update the following subsection as appropriate and submit. Note: Use of this provision requires inclusion of a limiting statement in the bid booklet.) Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!37!pg!281! (Update the following subsection as appropriate and submit.) Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!38!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!39!pg!281! (Optional provision. Delete or update the following subsection as appropriate and submit. Note: Including this option would require the Certified LPA to have an administrative structure and consultant services in place to fulfill this term. This may be appropriate for a complex, multi-year project.) Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!3:!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!41!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!42!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!43!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!44!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!45!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!46!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!47!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!48!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!49!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!4:!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!51!pg!281! (Optional provision. Delete or update the following subsection as appropriate and submit. Note: Including this option would require the Certified LPA to have an administrative structure and consultant services in place to fulfill this term. This may be appropriate for a complex, multi-year project.) Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!52!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!53!pg!281! (Optional language shown in orange below for consideration by the Certified LPA regarding FAX and email.) Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!54!pg!281! (ODOT modified the “3D” in the caption to eliminate a problem with the header so the header would show 00150.35 and not 00156.35. This addition of .0000 with font white size small however creates a problem that needs to be addressed in the TOC when it is generated. If the Certified LPA does not use or care about the header this addition of .0000 may be deleted.) Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!55!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!56!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!57!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!58!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!59!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!5:!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!61!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!62!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!63!pg!281! Standard Specification forMicrocomputer Signal Controller Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!64!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!65!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!66!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!67!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!68!pg!281! Manual of Field Test Procedures Nonfield-Tested Materials Acceptance Guide Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!69!pg!281! Nonfield Tested Materials Acceptance Guide Laboratory Manual of Test Procedures Laboratory Manual of Test Procedures Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!6:!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!71!pg!281! (If the LPA does not use statistical analysis for payment of materials the LPA will not want to use Section 00745(Statistical Acceptance) and consider Section 00744 (ACP), or if 00745 is used the LPA will want a Special Provision to modify 00745.17, 00745.50 and delete Subsection 00745.95. If Section 00755 is used subsections 00755.92 and 00755.93 may need modification. If Section 00756 is used subsections 00756.92 and 00756.93 may need modification.) Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!72!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!73!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!74!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!75!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!76!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!77!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!78!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!79!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!7:!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!81!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!82!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!83!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!84!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!85!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!86!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!87!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!88!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!89!pg!281! (Use a modified version of 00170.08 if the Certified LPA has an electronic document management system that is used during construction. If this subsection is deleted, a modification of Section 00210 may be necessary as it references 00170.08.) Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!8:!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!91!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!92!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!93!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!94!pg!281! Prevailing Wage Rates for Public Works Contracts in Oregon Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!95!pg!281! Required Contract Provisions Federal-aid Construction Contracts Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!96!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!97!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!98!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!99!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!9:!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!:1!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!:2!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!:3!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!:4!pg!281! (The Certified LPA needs to verify this matches 00199 and update as necessary.) Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!:5!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!:6!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!:7!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!:8!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!:9!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!::!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!211!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!212!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!213!pg!281! (Review and modify Conflict of Interest as necessary to match prior 00170.78) Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!214!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!215!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!216!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!217!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!218!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!219!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!21:!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!221!pg!281! (Certified LPA to verify software versions) Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!222!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!223!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!224!pg!281! (Certified LPA to verify software versions) (Certified LPA to verify software versions) Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!225!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!226!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!227!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!228!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!229!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!22:!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!231!pg!281! (If the Certified LPA modifies the 45 days below then all three Subsections 00150.91. 00180.80(c) and 00199.30(b) should be made consistent.) Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!232!pg!281! (Use only one of the bullets below starting with “Reasonably” delete the other one. The first one is in and aligns with the Oregon Standard. The second one is holdover Certified LPA language that was previously in 00180.50(d).) Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!233!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!234!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!235!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!236!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!237!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!238!pg!281! Handbook 44 Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!239!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!23:!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!241!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!242!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!243!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!244!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!245!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!246!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!247!pg!281! (The following subsections reflects that ODOT withholds 2.5% retainage if or when ODOT withholds retainage and the law allows up to a 5% withholding. See the percentages in (b) and (c) below:) Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!248!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!249!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!24:!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!251!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!252!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!253!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!254!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!255!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!256!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!257!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!258!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!259!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!25:!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!261!pg!281! (For Federal Funded projects the FHWA Contract Administration Core Curriculum Manual indicates that alternative dispute resolution is a State option (see Section 10(j) of the 2014 version). ODOT recommends that each Certified LPA have a manageable and effective multi-step process for addressing disagreements, disputes and claims. The following Section 00199 is a recommended process. Each Certified LPA, in consultation with its own legal counsel, should accept Section 00199 or modify it as needed to reflect the process and procedures the LPA deems appropriate for that Certified LPA (subject to review by ODOT). Each Certified LPA should also consider whether any changes are needed for Sections 00180.80 and 00195.95, which reference 00199. Each Certified LPA must also determine if it will include Section 00199.60, or include it with modifications, regarding the process for and appeals of Certified LPA records requests when the Contractor fails to provide the requested records. If included, changes to the Agency decision maker(s) may be necessary.) Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!262!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!263!pg!281! (If the Certified LPA modifies the 45 days below then all three Subsections 00150.91. 00180.80(c) and 00199.30(b) should be made consistent.) Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!264!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!265!pg!281! Under penalty of law for perjury or falsification, the undersigned, (Name), (Title), (Company) certifies that this claim for additional compensation for Work on the Contract is a true statement of the actual costs incurred (in the amount of $________, exclusive of interest) and is fully documented and supported under the Contract between the parties. Signature: Date: ___________________, 20___ Subscribed and sworn before me this ____ day of ________________, 20___ Notary Public My commission expires . Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!266!pg!281! Under penalty of law for perjury or falsification, the undersigned, (Name) (Title), (Company) certifies that this claim originating from the Subcontractor, Supplier or Entity (Company) for additional compensation for Work on the Contract is a reasonable statement, independently verified, of the costs incurred (in the amount of $________, exclusive of interest) and is fully documented and supported under the Contract between the parties. Signature: Date: ___________________, 20___ Subscribed and sworn before me this ____ day of ________________, 20__ Notary Public My commission expires . Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!267!pg!281! (Modify Public Works Director Title as needed in the following subsection) Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!268!pg!281! (The LPA will need to consult with counsel and the LPA management to determine if Step 2, or Step 3 are appropriate. Modify as needed, including references to the following subsections, and submit to ODOT.) (Modify Agency Director Title as needed in the following subsection) Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!269!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!26:!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!271!pg!281! Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!272!pg!281! A B Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!273!pg!281! C Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!274!pg!281! D E Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!275!pg!281! F G H I Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!276!pg!281! L M Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!277!pg!281! N Seethird notificationSeesecond notificationSeeFirst notification O P Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!278!pg!281! Q R Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!279!pg!281! S Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!27:!pg!281! T U V W Sftpmvujpo!Op/!3133.33 Fyijcju!B!Qbhf!281!pg!281! Sftpmvujpo!Op/!3133.33