HomeMy WebLinkAbout1 - Original Submission_ 20220405_4554_Change Order #1_signed by HoltDocuSign Envelope ID: 4303A14D-A734-48C2-B97E-C52D00611FD2
Ned Lever
Digitally signed by Ned Lever
DN: C=US,
E=ned.lever@ci.bremerton.wa.us, O=City of
Bremerton, OU=Engineering, CN=Ned Lever
Date: 2022.07.13 07:41:40-07'00'
Tom Knuckey Digitally signed by Tom Knuckey
Date: 2022.07.15 14:20:38 -07'00'
DocuSign Envelope ID: 4303A14D-A734-48C2-B97E-C52D00611FD2
7/21/2022
DocuSign Envelope ID: 4303A14D-A734-48C2-B97E-C52D00611FD2
PURCHASE ORDER NO. 20800 CITY OF BREMERTON
345 6TH STREET SUITE 100 BREMERTON, WA 98337-1873
V 131074 E HOLT SERVICES INC N 10621 TODD ROAD E g EDGEWOOD WA 98372
PAGE NO. 1
� I ENGINEERING DIVISION
I CITY OF BREMERTON
RL _J
P 345 6TH ST STE 500
TL BREMERTON WA 98337
O ATTN: NOREEN BOLO / BILL DAVIS _J
ORDER DATE: 12/17 /20 BUYER: PW&U - ENGINEERING REO. NO.: 20296 REQ. DATE:
TERMS: NET 3 0 DAYS F.O.B.: DESC.: ITEM# I
�<;,;t:· m�:��-4w�
ITEM#
QUANTITY UOM DESCRIPTION
i :\· .. · ;['JEERING DIVISION jJi ACCOUNT AMOUNT PROJECT CODE
01 594.34324 56510 103,877.00 4554
CERTI ICATION
I, the undersigned, do hereby certify under enalty of perjury, that th materials have been furnished, the services rendered or the labor erformed as described he ein, that any advance payment is due and payable pursuant to a co tract or is available as an ption for full or partial fulfillment of a contractual obligation, and th t the claim is a just, due and unpaid obligation
against the city and that I am authorized to au henticate and certify to sai claim.
APPROVED BY
t\J:::.1.1.1.··.··. !.
1
',',',,•,•:· �ff�(.J ..:-:-:,:·:·:·::::_-:: ·:·J
PAGE TOTAL $
TOTAL $
EXTENSION 1'03,877.00
103,877.00 103,877.00
6248 1/31/2021 594.34324-56510-4554 $87,479.44
Non PO Payment
Inv RPayApp1 1/31/2021 314-223.40 $4,012.82
Amount Disbursed $83,466.62
Attachment 1DocuSign Envelope ID: 4303A14D-A734-48C2-B97E-C52D00611FD2
Invoice
Date
1/31/2021
Invoice #
6248
Bill To
City of Bremerton
345 6th Street, Suite 100
Bremerton WA 98337
P.O. No.Terms
Net 30
Holt Project #
0009.40.21 Bremerton Rehab
Project
Well 6 Rehab
Total
SubtotalNEW REMIT TO ADDRESS:
PO Box 1659
Milton WA 98354
DescriptionQuantity Rate Amount
Mobilization1 5,000.00 5,000.00T
Water Quality Protection1 500.00 500.00T
Well 6R Video1 3,000.00 3,000.00T
Authorized Hourly174 350.00 60,900.00T
Well 1R Video1 6,000.00 6,000.00T
Well 1R Test Pump1 3,000.00 3,000.00T
One Roll 3/4" Bandit1 125.00 125.00T
3/4" Buckles (16)1 25.00 25.00T
11x2x1/4" Centralizer1 45.00 45.00T
PFD1 325.00 325.00T
Compressor Rental + 15%1 1,336.37 1,336.37T
Work dated 1.05.21 thru 2.05.21
Work ordered by Aaron Couch
Sales Tax-1801 Bremerton 9.00% 7,223.07
$87,479.44
$80,256.37
4554
02/17/2021
Project #
Initials
Date OK'd
By Noreen at 3:25 pm, Feb 08, 2021
DocuSign Envelope ID: 4303A14D-A734-48C2-B97E-C52D00611FD2
Invoice No. 6773 7/31/2021 594.34324-56510-4554 $28,503.50
DocuSign Envelope ID: 4303A14D-A734-48C2-B97E-C52D00611FD2
Invoice
Date
7/31/2021
Invoice #
6773
Bill To
City of Bremerton345 6th Street, Suite 100Bremerton WA 98337
P.O. No.Terms
Net 30
Holt Project #
0009.40.21 Bremerton Rehab
Project
Well 6 Rehab
Total
SubtotalNEW REMIT TO ADDRESS:
PO Box 1659Milton WA 98354
DescriptionQuantity Rate Amount
Pumping72 300.00 21,600.00T
Hourly Set Up Discharge and Remove13 350.00 4,550.00T
Work dated 2.15.21 thru 2.25.21Final
Sales Tax-1801 Bremerton 9.00% 2,353.50
$28,503.50
$26,150.004554
08/12/2021
Project #
Initials
Date OK'd
By Noreen Bolo at 1:20 pm, Aug 12, 2021
DocuSign Envelope ID: 4303A14D-A734-48C2-B97E-C52D00611FD2
Well 6R Rehabilitation
Holt Services
Units Qty Unit ($)Total Bid Qty Payment Qty Payment Quantity Payment Quantity Amount
1 Mobilization LS 1 $ 5,000.00 5,000.00$ 1.00 5,000.00 0.00 1.00 5,000.00$ 0.00 -$
2 Water Quality Protection LS 1 $ 500.00 500.00$ 1.00 500.00 0.00 1.00 500.00$ 0.00 -$
3 Well 6R Video Inspections (2)LS 1 $ 3,000.00 3,000.00$ 1.00 3,000.00 0.00 1.00 3,000.00$ 0.00 -$
4 Rehabilitations: Authorized Hourly Field Work HOURS 130 $ 350.00 45,500.00$ 174.00 60,900.00 13.00 4,550.00 187.00 65,450.00$ -57.00 (19,950.00)$
5 Rehabilitations: Authorized Hourly Shop Work HOURS 10 $10.00 100.00$ 0.00 0.00 0.00 -$ 10.00 100.00$
6 Well 1R Video Inspection LS 1 $ 6,000.00 6,000.00$ 1.00 6,000.00 0.00 1.00 6,000.00$ 0.00 -$
7 Provision of Well 1R Test Pump LS 1 $ 3,000.00 3,000.00$ 1.00 3,000.00 0.00 1.00 3,000.00$ 0.00 -$
8 Operate Well 1R Test Pump HOURS 24 $ 300.00 7,200.00$ 0.00 72.00 21,600.00 72.00 21,600.00$ -48.00 (14,400.00)$
9 Force Account LS 1 $ 25,000.00 25,000.00$ 1.00 1,856.37 0.00 1.00 1,856.37$ 1.00 23,143.63$
SUBTOTAL 95,300.00$ 80,256.37$ 26,150.00$ 106,406.37$ (11,106.37)$
Sales Tax at 9%8,577.00$ 7,223.07$ 2,353.50$ 9,576.57$ (999.57)$
TOTAL DUE 103,877.00$ 87,479.44$ 28,503.50$ 115,982.94$ (12,105.94)$
Change order #1
Amt:12,105.94$
Inv 1 Force Account
PFD 325
Shop Work 195
Compressor 1336.37
TOTAL 1856.37
BID ITEM DESCRIPTION
CONTRACT AMOUNT Total Completed Remaining In ContractInv 1 (#6248)Inv 2 (#6323)
Attachment 2 - WCD Cost SummaryDocuSign Envelope ID: 4303A14D-A734-48C2-B97E-C52D00611FD2
No. Force Account Item Quantity Unit Bid Unit Cost Bid Amount
1 Bariod Aqua-Clear PFD 1 LS 325 325.00$
2 Approved Shop Work & Materials 1 LS 195 $195.00
3 Compressor 1 LS 1336.37 $1,336.37
$1,856.37
AS CONSTRUCTED - FORCE ACCCOUNT SCHEDULE FOR WELL 6R REHABILITATION
Base Bid Total
DocuSign Envelope ID: 4303A14D-A734-48C2-B97E-C52D00611FD2