HomeMy WebLinkAbout1 - Original Submission_ CO #7 Rev - Handrail Revisions - PM Executed - Burly SignedDocuSign Envelope ID: B23ECD0D-4A01-4F4B-BEFA-A96DDEF2AE74
6/11/2024
City of Bremerton
Mayor
6/12/2024
DocuSign Envelope ID: B23ECD0D-4A01-4F4B-BEFA-A96DDEF2AE74
CHANGE ORDER SUPPLEMENTAL DOCUMENTS
1. Change Order Checklist
2. DBE Utilization Certification Form (Active Construction, Inc.)
3. UDBE Written Confirmation Document (Burly Products, Inc.)
4. DBE Bid Item Breakdown
5. Bid Proposal (Bid Item A116)
6. RFI-008 (Modular Block Wall No Fall Protection)
7. Work Change Directive 3
8. Plan Sheet 96 Design Revision (8/18/23)
9. Serial Letter ACI-COB-004 (dated 11/9/23)
10. Plans Sheet 88 Redline (Reduction in Limits of Pedestrian Handrail)
11. Change Order Independent Cost Estimate
DocuSign Envelope ID: B23ECD0D-4A01-4F4B-BEFA-A96DDEF2AE74
WSDOT Local Agency Guidelines M 36-63.42 Page 52-17
September 2023
Appendix 52.106 Change Order Checklist
Change Order
Question Yes No N/A
1.Does the change order alter the termini, character, or scope of the work?☐☐☐
If yes, you must have H & LP approval to be eligible for federal funds.☐☐☐
If yes, you must submit a revised Page 1 of the prospectus.☐☐☐
2.Is the Change Order over $7,500.00 and outside the scope of work?☐☐☐
If yes, the change cannot be a change order and must be an independent work.☐☐☐
3.Does the Change Order detail all items involved with the change?☐☐☐
4.Does the Change Order include an adjustment in working days?☐☐☐
If yes, the time extension must be stated in the Change Order.☐☐☐
If yes, an independent engineer’s estimate of time must be included to document the extension.
☐☐☐
If no, that must be stated in the Change Order.☐☐☐
5.Does the Change Order alter the DBE Condition of Award?☐☐☐
If yes, you must obtain concurrence form Local Programs.☐☐☐
If yes, you must obtain the DBE’s signature on the Change Order.☐☐☐
6.Does the Change Order involve a material substitution?☐☐☐
If yes, you must determine if a material credit is appropriate.☐☐☐
7.If Change Order work started prior to it’s execution, prior verbal approval by the Approving Authority must be granted and documented.
☐☐☐
8.Has the Change Order been signed by the contractor?☐☐☐
9.Has the Change Order been executed by the Approving Authority?☐☐☐
If you are a “non CA Agency”, you must have the acting CA Authority’s approval.☐☐☐
10.Has an independent engineer’s estimate justifying the costs and time extensions been completed and documented?
☐☐☐
11.Has a detailed memo outlining the chronology of events, basis of need, costs and working days been prepared and placed in the file accompanying the Change Order?
☐☐☐
Appendix 52.106 Change Order Page 1 of 1Revised 4/30/2014
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DocuSign Envelope ID: B23ECD0D-4A01-4F4B-BEFA-A96DDEF2AE74
DocuSign Envelope ID: B23ECD0D-4A01-4F4B-BEFA-A96DDEF2AE74
DocuSign Envelope ID: B23ECD0D-4A01-4F4B-BEFA-A96DDEF2AE74
DocuSign Envelope ID: B23ECD0D-4A01-4F4B-BEFA-A96DDEF2AE74
DBE BID ITEM BREAKDOWN
CITY OF BREMERTON
WASHINGTON & 11TH STREET IMPROVEMENTS
BID DATE:6/1/2023 11:00AM
Name of DBE:Bid Item:Full/Partial:Description:Unit Price:Total Unit
Cost:
Amt Applied
Towards Goal:
O'BUNCO ENGINEERING A1 PARTIAL 1 LS SUB MOBILIZATION $9,689.00 $9,689.00 $9,689.00
O'BUNCO ENGINEERING A114 FULL 1 LS STRUCTURE SURVEYING $7,940.00 $7,940.00 $7,940.00
O'BUNCO ENGINEERING A115 FULL 1 LS ROADWAY SURVEYING $41,685.00 $41,685.00 $41,685.00
O'BUNCO ENGINEERING A122 PARTIAL 2 EA MONUMENT SURVEY $568.00 $1,136.00 $1,136.00
O'BUNCO ENGINEERING A123 PARTIAL 4 EA MONUMENT SURVEY $568.00 $2,272.00 $2,272.00
O'BUNCO ENGINEERING A127 FULL 1 LS ADA FEATURES SURVEYING $5,955.00 $5,955.00 $5,955.00
O'BUNCO ENGINEERING B33 FULL 1 LS ROADWAY SURVEYING $3,970.00 $3,970.00 $3,970.00
O'BUNCO ENGINEERING B35 PARTIAL 1 EA MONUMENT SURVEY $568.00 $568.00 $568.00
O'BUNCO ENGINEERING B42 FULL 1 LS ADA FEATURES SURVEYING $1,985.00 $1,985.00 $1,985.00
O'BUNCO ENGINEERING C17 FULL 1 LS ROADWAY SURVEYING $1,985.00 $1,985.00 $1,985.00
Subtotal:$77,185.00 $77,185.00
Name of DBE:Bid Item:Full/Partial:Description:Unit Price:Total Unit Cost:Amt Applied Towards Goal:
CASTANEDA LANDSCAPING A42 FULL 6 EA PSIPE - EASTERN WHITE PINE (6' HT)$300.00 $1,800.00 $1,800.00
CASTANEDA LANDSCAPING A43 FULL 3 EA PSIPE - EXCELSA CEDAR (6' HT)$300.00 $900.00 $900.00
CASTANEDA LANDSCAPING A44 FULL 3 EA PSIPE - INCENSE CEDAR (6' HT)$300.00 $900.00 $900.00
CASTANEDA LANDSCAPING A45 FULL 2 EA PSIPE - SHORE PINE (6' HT)$300.00 $600.00 $600.00
CASTANEDA LANDSCAPING A46 FULL 11 EA PSIPE - MUSASHINO ZELKOVA (2" CAL)$500.00 $5,500.00 $5,500.00
CASTANEDA LANDSCAPING A47 FULL 7 EA PSIPE - SCARLET SENTINEL MAPLE (2" CAL)$500.00 $3,500.00 $3,500.00
CASTANEDA LANDSCAPING A48 FULL 83 EA PSIPE - PACIFIC NINEBARK $25.00 $2,075.00 $2,075.00
CASTANEDA LANDSCAPING A49 FULL 66 EA PSIPE - OCEANSPRAY $25.00 $1,650.00 $1,650.00
CASTANEDA LANDSCAPING A50 FULL 33 EA PSIPE - THIMBLEBERRY $25.00 $825.00 $825.00
CASTANEDA LANDSCAPING A51 FULL 82 EA PSIPE - RED FLOWERING CURRANT $25.00 $2,050.00 $2,050.00
CASTANEDA LANDSCAPING A52 FULL 67 EA PSIPE - LEWIS MOCKORANGE $23.00 $1,541.00 $1,541.00
CASTANEDA LANDSCAPING A53 FULL 17 EA PSIPE - LITTLE BUNNY FOUNTAIN GRASS $18.00 $306.00 $306.00
CASTANEDA LANDSCAPING A54 FULL 4 EA PSIPE - DWARF MUGO PINE $25.00 $100.00 $100.00
CASTANEDA LANDSCAPING A55 FULL 55 EA PSIPE - MOUNT VERNON LAUREL $20.00 $1,100.00 $1,100.00
CASTANEDA LANDSCAPING A56 FULL 198 EA PSIPE - GEORGIA BLUE SPEEDWELL $20.00 $3,960.00 $3,960.00
CASTANEDA LANDSCAPING A57 FULL 60 EA PSIPE - EVERGREEN CANDYTUFT $20.00 $1,200.00 $1,200.00
CASTANEDA LANDSCAPING A58 FULL 88 EA PSIPE - LITTLE GEM CANDYTUFT $20.00 $1,760.00 $1,760.00
CASTANEDA LANDSCAPING A59 FULL 88 EA PSIPE - CREEPING OREGON GRAPE $18.00 $1,584.00 $1,584.00
CASTANEDA LANDSCAPING A60 FULL 70 EA PSIPE - WALL GERMANDER $20.00 $1,400.00 $1,400.00
CASTANEDA LANDSCAPING A61 FULL 52 EA PSIPE - GOLDMOSS STONECROP $20.00 $1,040.00 $1,040.00
CASTANEDA LANDSCAPING A62 FULL 53 EA PSIPE - ANGELINA SPREADING STONECROP $20.00 $1,060.00 $1,060.00
CASTANEDA LANDSCAPING A63 FULL 52 EA PSIPE - BROADLEAF STONECROP $20.00 $1,040.00 $1,040.00
CASTANEDA LANDSCAPING A64 FULL 53 EA PSIPE - WOODLAND STONECROP $20.00 $1,060.00 $1,060.00
CASTANEDA LANDSCAPING A65 FULL 715 LF ROOT BARRIER $16.00 $11,440.00 $11,440.00
CASTANEDA LANDSCAPING A66 FULL 285 SY SEEDED LAWN INSTALLATION $3.60 $1,026.00 $1,026.00
CASTANEDA LANDSCAPING A67 FULL 60 SY MEDIUM COMPOST $11.60 $696.00 $696.00
CASTANEDA LANDSCAPING A68 FULL 430 SY TOPSOIL TYPE A $8.50 $3,655.00 $3,655.00
CASTANEDA LANDSCAPING A69 FULL 100 CY SANDY LOAM $50.00 $5,000.00 $5,000.00
CASTANEDA LANDSCAPING A70 FULL 910 SY BARK OR WOOD CHIP MULCH $5.50 $5,005.00 $5,005.00
CASTANEDA LANDSCAPING A72 FULL 1 LS IRRIGATION SYSTEM $109,250.00 $109,250.00 $109,250.00
Subtotal:$173,023.00 $173,023.00
Name of DBE:Bid Item:Full/Partial:Description:Unit Price:Total Unit
Cost:
Amt Applied
Towards Goal:
SUBSURFACE CONSTRUCTION A1 PARTIAL 1 LS SUB MOBILIZATION $21,600.00 $21,600.00 $21,600.00
SUBSURFACE CONSTRUCTION A29 FULL 1040 LF SHAFT 30 IN. DIAM $142.00 $147,680.00 $147,680.00
SUBSURFACE CONSTRUCTION A30 FULL 940 LF FURNISHING SOLDIER PIPE HP14 X 73 $100.00 $94,000.00 $94,000.00
SUBSURFACE CONSTRUCTION A31 FULL 200 LF FURNISHING SOLDIER PIPE HP12 X 53 $75.00 $15,000.00 $15,000.00
SUBSURFACE CONSTRUCTION A32 FULL 3270 SF LAGGING $21.00 $68,670.00 $68,670.00
Subtotal:$346,950.00 $346,950.00
Name of DBE:Bid Item:Full/Partial:Description:Unit Price:Total Unit
Cost:
Amt Applied
Towards Goal:
BURLEY PRODUCTS A1 PARTIAL 1 LS SUB MOBILIZATION $3,000.00 $3,000.00 $3,000.00
BURLEY PRODUCTS A116 FULL 540 LF PEDESTRIAN HANDRAIL $288.25 $155,655.00 $155,655.00
Subtotal:$158,655.00 $158,655.00
$755,813.00
Quantity:
Quantity:
TOTAL DBE AMOUNT:
Quantity:
Quantity:
DocuSign Envelope ID: B23ECD0D-4A01-4F4B-BEFA-A96DDEF2AE74
DocuSign Envelope ID: B23ECD0D-4A01-4F4B-BEFA-A96DDEF2AE74
Public Works and Utilities Department
345 6th Street, Suite 100 · Bremerton, WA 983 · (360) 473-5270 · FAX (360) 473-5398
Request for Information
Date: _____________________________________________ Request No.: _________________________________________
Project: ____________________________________________________________________________________________________
Project No.: __________________________________________ Contractor: ___________________________________________
Information Request Initiated By: _______________________________________________________________________________
Regarding: ___________________________________________ Specification Section: ___________________________________
Prepared By: ________________________________________________________________ Date: _______________________
Request: (For Contractor’s Use)
Response Assigned To:
Project Manager Project Engineer Resident Project Representative
Response: (For City’s Use)
Signed: ______________________________________________________________________ Date: ______________________
cc: ____________________________________________________________________________________________________
8/2/23 008
Washington & 11th St. Improvements
315-026 Active Construction, Inc.
Steven Crandall, Sr.
Modular Block Wall No Fall Protection Plan Sheet 96 & 97
Plan Sheet 97 shows the elevations of the new Modular Block Walls being 3' of exposed face in
some areas. There is no fall protection shown in the plans for installation at the walls. Please
confirm that no fall protection will be required.
Steven Crandall, Sr 8/2/23
Nick Ataie, City of Bremerton
4
Plan Sheet 96 depicts handrail at various locations adjacent to walls MW1, MW3, and MW4 to
account for fall protection and/or as required for the sidewalk grade. No additional handrail is
necessary. Handrail depicted is to be located/mounted in the sidewalk per the plans and
specifications. A work change directive will be forthcoming as there is no bid item in Schedule B for
handrail other than as included under Item B38 (CEMENT CONC. STEPS WITH RAILING). The
City will utilize Bid Item A116 (PEDESTRIAN HANDRAIL) as a basis for this change.
8/7/23
per email response
DocuSign Envelope ID: B23ECD0D-4A01-4F4B-BEFA-A96DDEF2AE74
PAGE 1 OF 1
CITY OF BREMERTON
WORK CHANGE DIRECTIVE (WCD)
WCD #: _______ Date: ________
YOU ARE DIRECTED TO PROCEED PROMPTLY WITH THE FOLLOWING CHANGE(S):
ATTACHMENT(S):
If a claim is made that the above change(s) have affected Contract Price or Contract Times any claim for a Change Order
is based thereon will involve one or more of the following methods of determining the effect of the change(s). The
Change Order will be executed in accordance with Section 1-04.4 of the WSDOT Standard Specifications, or Article 10 of
the General Conditions.
Method of determining change in Contract Price: Method of determining change in Contract Times:
Unit Price Contractor’s Records
Lump Sum Engineer’s Records
Time & Materials
Other: Other:
Estimated increase (decrease) in Contract Price: Estimated increase (decrease) in Contract Times:
$ . Substantial Completion: 0 days;
If the change involves an increase, the estimated Ready for final payment: 0 days;
amount is not to be exceeded without further If the change involves an increase, the estimated times
authorization. are not to be exceeded without further authorization.
RECOMMENDED: AUTHORIZED:
CONTRACTOR CITY OF BREMERTON
By: ____________________________________________ By: _________________________________________
Project Name: WASHINGTON AND 11TH
STREET IMPROVEMENTS
Project #: 315026, STPUL-9918(017)
Contractor: ACTIVE CONSTRUCTION, INC.
NTP Date: 8/7/2023
003 9/6/2023
Per City response to RFI 008 (Modular Block Wall No Fall Protection), attached Design Revision Package 2 (DR 002) includes a revision to PlanSheet 96. This revision includes station/offset callouts for proposed sidewalk handrail. This WCD includes revisions to Plan Sheet 96 included inDR 002. This WCD does not constitute a change in contract price or contract time and only provides a formal directive of the change noted. Anyadjustment in contract price(s) or contract time will be made in accordance with 1-04.4 (Changes). Unless otherwise approved, method ofdetermining change in contract price will be based on Existing Item A116 (PEDESTRIAN HANDRAIL) or under a future-RFP based onjustification for an alternate unit price.
Design Revision Package 2 (DR 002) which includes a revision for Plan Sheet 96.
TBD
X TBD
Nick Ataie, PE (Project Manager)
X Existing Item A116 (or as developed under RFP)
DocuSign Envelope ID: B23ECD0D-4A01-4F4B-BEFA-A96DDEF2AE74
"WWGGWWWWWWWWWWWWWWWWWWWWWWWWGGSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSXX X X X X
EOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHU5016 Lacey Boulevard SE, Lacey, Washington 98503
(360) 491-3399 Fax (360) 491-3857 BREMERTON WA LOWER SIDEWALK RAMP GRADING
WASHINGTON & 11TH
IMPROVEMENT PROJECT
LSW LINE
LOWER WASHINGTON AVE
LW LINE
MODULAR BLOCK WALL DETAIL - ADJACENT TO PROPERTY
NOT TO SCALE
CEMENT CONCRETE STEPS WITH RAILING - ADJACENT TO PROPERTY
NOT TO SCALE
MODULAR BLOCK WALL DETAIL -
ADJACENT TO ROAD
NOT TO SCALE
CEMENT CONCRETE STEPS WITH RAILING - ADJACENT TO ROAD
NOT TO SCALE
08/31/2023
DocuSign Envelope ID: B23ECD0D-4A01-4F4B-BEFA-A96DDEF2AE74
DocuSign Envelope ID: B23ECD0D-4A01-4F4B-BEFA-A96DDEF2AE74
DocuSign Envelope ID: B23ECD0D-4A01-4F4B-BEFA-A96DDEF2AE74
ACTIVECONSTRUCTIONINC.A.C.I.PROJECT #23-030QTYUOM RATE TOTAL 2.00 LS $1,500.00$3,000.001.00 LS $2,500.00$2,500.0048.00 LF $402.52$19,321.170.00 @$0.000.00 @$0.000.00 @$0.000.00 @$0.000.00 @$0.00$24,821.1731% $0.00$0.0021% $0.00$0.008.70% $0.0021% $0.00$0.0021% $0.00$0.0012% $2,978.54$27,799.71$27,799.71ACIRFP-002 Cost Proposal - Pedestraian Handrail Lower WAWashington & 11th St. ImprovementsDESCRIPTION OF WORK WEEK WORK PERFORMED :Furnish & Install Pedestrian Handrail on Lower WA Sidewalk per RFP-002SUBCONTRACTOR COSTS DESCRIPTIONBurly Proposal - MobilizationsBurly Proposal - EngineeringBurly Proposal - Furnish & Install Pedestrian Handrail (Incl. Use Tax)SUBTOTAL EQUIPMENTTAX ON MATERIALS (N/A ON WATER & SEWER)MARK-UP ON MATERIALSSUBTOTAL MATERIALSSUBTOTAL SUBCONTRATOR MARK-UP ON LABOR SUBTOTAL LABORMARK-UP ON EQUIPMENTGRAND TOTALMARK-UP ON SERVICESSUBTOTAL SERVICESMARK-UP ON SUBCONTRACTORSSUBTOTAL SUB-CONTRACTOR COSTDocuSign Envelope ID: B23ECD0D-4A01-4F4B-BEFA-A96DDEF2AE74
Burly Products Quotation
3999 W. St. Joe Ave. Quote Number:2023-11-09-01
Post Falls ID, 83854 Quote Date:11/9/2023
Washington State DBE D1M0023827 Page:1 of 2
Idaho State DBE 2246850
Voice: 208-262-9531
Fax: 208-262-9541
Cust. #
5110 River Rd E.ATTN:
WA 98443 Phone:253-248-1091
Fax:253-248-1093
Bid Item Qty Unit Price Total Price
Total -$
2 Mobilizations (Field Verifications) 1,500.00$ 3,000.00$
48 375.51$ 18,024.48$
1 2,500.00$ 2,500.00$
1,296.69$
Total 24,821.17$
Includes: One Set of Shop Drawing based on Contract Drawings, Revisions will be charged at standard shop rate
Excludes Retainage
Actual Quantities Prevail
Bid is All or Nothing without prior approval.
Supply and Installed
Conditions of Proposal:
Excludes Material escalation
Quote Valid for 30 Days
STEEL: BUY AMERICA Steel qualification. We reserve 1% of this quote for our Foreign Steel Misc.
Includes: Freight, Burly Product will determine most cost effective method. Additional shipments will not be included.
Pedestrian Handrail (Galvanized Steel)
Engineering
Tax
Description
Supply Only
Includes: Sleeves or Embed/Resin Bonded Anchors
Excludes: Epoxy Resin for Resin Bonded Anchors
Excludes: Field Welding, Field Painting
Excludes: Installation
Excludes: Contract survey and field verification
Excludes: Electrical, Lighting, Conduit
Excludes: Engineering and Design
Excludes: Sales Tax
Excludes: Temp Fencing or Safety Railing
Supply Only option
Supply and Install option
Includes: Sleeves or Embed/Resin Bonded Anchors
Excludes: All Modular Block and Concrete Flatwork
Excludes: Temp Safety Railing at edge or elevated work - by Prime Contractor.
Excludes: Temporary Fall Protection
Excludes: Utility Conflicts
Contractor Responsible for all damage to equipment supplied to project
Excludes: Post Sleeves or Cast In Place Anchor Installation
Excludes: All Traffic Control, Flagging, Cues and Lane Closures - by others
Excludes: Bathroom Facilities (Portable Toilet)
Excludes: Construction Access
Project Name
Washington & 11th Street Improvement
Tacoma
Estimator
14ACI - Active Construction
DocuSign Envelope ID: B23ECD0D-4A01-4F4B-BEFA-A96DDEF2AE74
"""SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSX X X X X X X X"""BTBTBTCO"""CCCSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSX X X X X X X X
TB TB TB TB
TBTBTBTBTBTBTBTBTBTBTBTBTBTBCOWWWW22+00
5016 Lacey Boulevard SE, Lacey, Washington 98503
(360) 491-3399 Fax (360) 491-3857 BREMERTON WA LOWER ROADWAY P&P 1
WASHINGTON & 11TH
IMPROVEMENT PROJECT
LOWER WASHINGTON AVE.
WASHIN
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T
O
N
A
V
E
.
09/13/2023
54.0 ft
Location of first handrail sleeve Handrail sleeve location exactly54 LF from first sleeveLIMITS OF PROPOSEDHANDRAIL TO BE REMOVED54 LF
DocuSign Envelope ID: B23ECD0D-4A01-4F4B-BEFA-A96DDEF2AE74
Project:
Contract:
Contractor: Active Construction, Inc
Change Order: 7
Estimate By:
DESCRIPTION
CONTRACT BID ITEM
Bid Item Description Quanity Unit Unit Cost Total Cost
A116 PEDESTRIAN HANDRAIL 540 LF 330.00$ 178,200.00$
ESTIMATED CONTRACT BID ITEM BREAKDOWN
1 Engineering 1 LS 2,500.00$ 2,500.00$
2 Mobilizations (Field Verifications) 2 EA 1,500.00$ 3,000.00$
3 Pedestrian Handrail 540 LF 259.634$ 140,202.51$
4 Tax (9.2%)1 LS 13,404.63$ 13,404.63$
5 Mark-Up on Subcontractors (12%) 1 LS 19,092.86$ 19,092.86$
178,200.00$
PROPOSED COST ESTIMATE
1 Additional Engineering per WCD #03 1 LS 2,500.00$ 2,500.00$
2 Additional Mobilizations (Field Verifications) per WCD #03 2 EA 1,500.00$ 3,000.00$
3A Pedestrian Handrail Bid Item Credit / Deduction 54 LF (259.634)$ (14,020.25)$
3B Additonal Pedestrian Handrail per WCD #03 48 LF 259.634$ 12,462.45$
3C Additonal Tooling & Fabrication Labor per WCD #03 1 LS 5,000.00$ 5,000.00$
4 Tax (9.2%)1 LS 822.68$ 822.68$
5 Mark-Up on Subcontractors (12%) 1 LS 1,171.79$ 1,171.79$
8,436.66$
PROPOSED BID ITEM SUMMARY
Bid Item Description Quanity Unit Unit Cost Total Cost
A116 PEDESTRIAN HANDRAIL 486 LF 330.00$ 160,380.00$
NEW PEDESTRIAN HANDRAIL - SPECIAL 48 LF 467.85$ 22,456.91$
Nick Ataie, PE (City of Bremerton)
Construction of additional pedestrian handrail (48 LF) in accordance with Work Change Directive #03 and reduction in estimated quantity of
Bid Item A116 of 48 LF.
CHANGE ORDER INDEPENDENT COST ESTIMATE
Washington and 11th Street Improvements
315026, Federal Aid No. STPUL-9918(017), TIB No. 8-2-152(028)-1
Date: 2/16/2024
TOTAL
TOTAL
DocuSign Envelope ID: B23ECD0D-4A01-4F4B-BEFA-A96DDEF2AE74