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HomeMy WebLinkAbout2003-027 Contract - Robco Inc CITY OF ASHLAND CONTRACT FOR PUBLIC WORKS CONSTRUCTION Contract made this -'/'~ day of ~,\ , '~OC~ ~ , between the City of Ashland, ("City") and RobCOl Inc. "(Contractor"). City and Contractor agree: 1. Contract Documents: This contract is made as a result of an Advertisement for Bid issued by City for the Strawberry Lane Local Improvement District Project No. 01-27. Contractor was awarded the bid as the lowest responsible bidder. In the event of any inconsistencies in the terms of this contract, the contract documents defined in the Advertisement for Bid and Contractor's bid, this contract shall take precedence over the contract documents which shall take precedence over the bid. 2. Scope: Contractor shall begin and complete the project described in the contract documents within the time prescribed in the contract documents. The following exceptions, alterations, or modifications to the contract documents are incorporated into this contract: 3. Price & Payment: City shall pay Contractor amounts earned under the contract. All payments will be made at the times and in the manner provided in the contract documents. 4. Bond: Contractor shall, within five days after execution of the contract and prior to doing any work under the contract, furnish bond to the City of Ashland in a form and with a surety satisfactory to City in the penal sum of $9141629.50 conditioned upon the faithful performance of this contract upon the part of the Contractor. Default: A default shall occur under any of the following circumstances: 5.1 If the Contractor fails to begin the work under contract within the time specified, or fails to perform the work with sufficient workers or equipment or with sufficient materials to insure the prompt completion of the project, or shall neglect or refuse to remove materials or perform anew such work as shall be rejected as defective or unsuitable, or shall discontinue the prosecution of the work. 5.2 If the Contractor shall become insolvent or declared bankrupt, or commit any act of bankruptcy or insolvency, or allow any final judgment to stand against the Contractor unsatisfied for a period of forty-eight (48) hours, or shall make an assignment for the benefit of creditors. 5.3 From any other cause whatsoever, shall not carry on the work in an acceptable manner. 6. Remedies: In addition to the rights and remedies to which the City may be entitled by law for the enforcement of its rights under this contract, City shall have full power and authority, without violating this contract, to take prosecution of the work from the Contractor, and appropriate or use any or all of the materials and equipment on the ground that may be suitable and acceptable and may cause a contract for the completion of this contract according to its terms and provisions, or use such methods as required for the completion of the contract, in any acceptable manner. All costs and charges incurred by the City together with the costs of completing the work under the contract, shall be deducted from any money due or which shall become due the Contractor. In case the expense so incurred by the City shall be less than the sum which would have been payable under the contract if it had been completed by the Contractor, then the Contractor shall be entitled to received the difference less any damages for delay to which the City may be entitled. In case such expense shall exceed the sum which would have been payable under the contract, the Contractor and the surety shall be liable and agree to and shall pay the City the amount of the excess with damages for delay of performance, if any. Prevailing Wage Rates:The Contractor shall pay a fee equal to one-tenth of one percent (0.1 percent) of price of this Contract. The fee shall be paid on or before the first progress payment or 60 days from the date work first begins on the Contract, whichever comes first. The fee is payable to the Bureau of Labor & Industries and shall be mailed or otherwise delivered to the Bureau at the following address: Bureau of Labor & Industries Wage & Hour Division Prevailing Wage Unit 800 N.E. Oregon Street #32 Portland OR 97232 8. Living Wage Rates: If the amount of this contract is $15,000 or more, Consultant is required to comply with chapter 3.12 of the Ashland Municipal Code by paying a living wage, as defined in this chapter, to all employees performing work under this contract and to any subcontractor who performs 50% or more of the service work under this contract. Consultant is also required to post the attached notice predominantly in areas where it will be seen by all employees. The Contractor shall fully comply with the provisions of ORS 279.348 through B~:ino/~GrL~aldi ~ -- City Administrator Date: 279.365 pertaining to prevailing wage rates. CONTRACTOR Its: ~._ ~./,,~ Date: REVIEWED AS TO CONTENT: Dep~rtment Head Date: Coding: (For City use only) BOND # 552889P PERFORMANCE & PAYMENT BOND The undersigned ROBCO, INC. , as principal, further referred to in this bond as Contractor, and DEVELOPERS SURETY AND ZNDEMNZ?Y COM?4N~S surety, further referred to in this bond as Surety, are jointly and severally bound unto City of Ashland, as obligee, further referred to in this bond as City, in the sum of NTNE HUNDRED ~'0URTEEN THOUSAND SIX HUNDRE]DoIlars ($914,629.50). TWENTY-NINE AND 50/100 *** Contractor and City have entered into a written contract dated , for the following project: STRAWBERRY LANE LOCAL IMPROVEMENT DISTRICT. This contract is further referred to in this bond as the Contract and is incorporated into this bond by this reference. The conditions of this bond are: If Contractor faithfully performs the Contract within the time prescribed by the Contract, and promptly makes payment to all claimants, as defined in ORS 279.526 through 279.542, then this obligation is null and void; otherwise it shall remain in full force and effect. If Contractor is declared by City to be in default under the Contract, the Surety shall promptly remedy the default, perform all of Contractor's obligations under the contract in accordance with its terms and conditions and pay to City all damages that are due under the Contract. 3. This bond is subject to claims under ORS 279.526 through 279.542. This obligation jointly and severally binds Contractor and Surety and their respective heirs, executors, administrators, successors. Surety waives notice of modification of the Contract or extension of the Contract time. 6. Nonpayment of the bond premium shall not invalidate this bond. The bond number and the name, address, and telephone number of the agent authorized to receive notices concerning this bond are as follows. Bond Number: 55288910 Bond Agent ANCHOR INSURANCE & SURETY, INC. Address: 1201 SW 12TH AVE.. SUITE 500 PORTLAND, OR 97205 Telephone: (503) 224-2500 SIGNED this WITNESS: (Corporate Seal) WITNESS: (Corporate Seal) day of ~,..,./ · 2003. CONTRACTOR: By: Title: Legal Address: ROB/~O ~ INC. /x,.----~q PO BOX 1570 GRANTS PASS, OR 97528 Co rpora'tb=F~ecretary SURETY: By: Title: Legal Address: Attest: DEVELOPERS SURETY AND INDEMNITY COMPANY VICKI L. NICHOLSON ATTORNEY-IN-FACT FIVE CENTERPOINTE DR., SUITE 530 WITNESS FOR SURETY POWER OF ATTORNEY FOR DEVELOPERS SURETY AND INDEMNITY COMPANY INDEMNITY COMPANY OF CALIFORNIA PO BOX 19725, IRVINE, CA 92623 · (949) 263-3300 KNOW ALL MEN BY THESE PRESENTS, that except as expressly limited, DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, do each severally, but not jointly, hereby make, constitute and appoint: · **John D. Klump, Vicki L. Nicholson, Philip O. Forker, Gloria Bruning, Richard W. Kowalski, Jenni£er Keene, jointly or severally*** as the true and lawful Attorney(s)-in-Fact, to make, execute, deliver and acknowledge, for and on behalf of said corporations as sureties, bonds, undertakings and contracts of suretyship giving and granting unto said Attorney(s)-in-Fact full power and authority to do and to perform every act necessary, requisite or proper to be done in connection therewith as each of said corporations could do, but reserving to each of said corporations full power of substitution and revocation, and all of the acts of said Attorney(s)-in-Fact, pursuant to these presents, are hereby ratified and confirmed. This Power of Attorney is granted and is signed by facsimile under and by authority of the following resolutions adopted by the respective Board of Directors of DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, effective as of November 1, 2000: RESOLVED, that the Chairman of the Board, the President and any Vice President of the corporation be, and that each of them hereby is, authorized to execute Powers of Attorney, qualifying the attorney(s) named in the Powers of Attorney to execute, on behalf of the corporations, bonds, undertakings and contracts of suretyship; and that the Secretary or any Assistant Secretary of the corporations be, and each of them hereby is, authorized to attest the execution of any such Power of Attorney; RESOLVED, FURTHER, that the signatures of such officers may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures shall be valid and binding upon the corporation when so affixed and in the future with respect to any bond, undertaking or contract of suretyship to which it is attached. IN WITNESS WHEREOF, DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA have severally caused these presents to be signed by their respective Executive Vice President and attested by their respective Secretary this 8'h day of November, 2000. By: David H. Rhodes, Executive Vice President By: Walter A. Crowell, Secretary STATE OF CALIFORNIA COUNTY OF ORANGE ) )SS. ) On November 8, 2000, before me, Diane J. Kawata, personally appeared David H. Rhodes and Walter A. Crowell, personally known to me (or proved to me on the basis of satisfactory evidence) to be the persons whose names are subscribed to the within instrument and acknowledged to me that they executed the same in their authorized capacities, and that by their signatures on the inst:~ument the entity upon behalf of which the persons acted, executed the instrument. WITNESS my hand and official seal. Signature [C~ ~,~ ~.~..~ CERTIFICATE The undersigned, as Chief Operating Officer of DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, does hereby certify that the foregoing Power of Attorney remains in full force and has not been revoked, and furthermore, that the provisions of the resolutions of the respective Boards of Directors of said corporations set forth in the Power of Attorney, are in force as of the date of this Certificate. This Certificate is executed in the City of lrvine, Californla, the _~f~ day of 1~. f/~'// By ~ ~'~ David G. Lane, Chief Operating Officer ID-1380 (11/00) ACORD. CERTIFICATE OF LIABILITY INSURANCI[o g , DATE .DD ) 04/10/03 PRODUCER Anchor Insurance Portland 1201 SW 12th Ave., Suite 500 Portland OR 97205-2030 Phone= 503-224-2500 Fax= 503-224-9830 INSURED THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURERA: Transcontinental Insurance Co. Robco, Inc. PO Box 1570 Grants Pass OR 97528 ~NSURERB: Continental Casualty Co. ~NSURERC: Transportation Insurance Co. INSURER D: INSURER E: ;OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NO'FWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1, 000, 000 A X COMMERCIAL GENERAL LIABILITY TCP2057732211 09/01/02 09/01/03 FIRE DAMAGE (Any one fire) $ 300, 000 ICLAIMSMADE ~-1 OCCUR MED EXP (Any one person) $ 10,000 PERSONAL&ADVINJURY $ l, 000,000 GENERAL AGGREGATE $ 2, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,000 I POLICY ~--~PRO' JECT tr LOC Pollution 1,000, 000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1, 000, 000 ]~ X ANY AUTO BUA2057732225 09/01/02 09/01/03 (La accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ i (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ 1,000, 000 C X I OCCUR {--~ CLAIMS MADE 2057732239 09/01/02 09/01/03 AGGREGATE $ 1, 000, 000 $ I DEDUCTIBLE $ X RETENTION $10,000 $ I WC STATU- 0 tH- WORKERS COMPENSATION AND I TORY LIM TS ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ E.L. DISEASE- EA EMPLOYEE $ E.L. DISEASE- POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS AS RESPECTS "ALL OPERATIONS " OF THE NAMED INSURED, SUBJECT TO POLICY TERMS AND CONDITIONS. RE: STRAWBERRY LANE LOCAL IMPROVEMENT DISTRICT. THE CITY OF ASHLAND, ITS OFFICERS, EMPLOYEES AND AGENTS ARE INCLUDED AS ADDITIONAL INSUREDS. COVERAGE PROVIDED IS PRIMARY AND NON-CONTRIBUTORY CERTIFICATE HOLDER [ Y [ ADDITIONAL INSURED; INSURER LETTER: __ CANCELLATION CITY OF ASHLAND DEPARTMENT OF PUBLIC WORKS 20 EAST MAIN ST. ASHLAND OR 97520 ASHLA- 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ~1~1~1' MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, I -- - ~,CORD 25-S (7/97) Certificate of Insurance Page 1 of 1 EIEF'Cr" FORATION 400 High St SE Salem, OR 97312-1000 Toll Free 1-800-285-8525 HAIL TO: CITY OF ASHLAND 20 E. MAIN STREET ASHLAND, OR 97520 OREGON WORKERS' COHPENSATZON CERTZFZCATE OF INSURANCE CERTIFICATE HOLDER: CITY OF ASHLAND 20 E. MAIN STREET ASHLAND, OR 97520 JThepolicy of insurance listed below been to policy has issued the insured named below for the period indicated. The insurance afforded by the policy described herein is subject to all the terms, exclusions and conditions of such policy. POLICY NO. POLICY PERIOD ISSUE DATE 280393 10/01/2002 TO 10/01/2003 04/08/2003 INSURED: ROBCO INC PO BOX 1570 GRANTS PASS, OR 97528-0133 BROKER OF RECORD: LIHZTS OF LZABILZTY: Bodily Injury by Accident $500,000 each accident Bodily Injury by Disease $500,000 each employee Bodily Injury by Disease $500,000 policy limit DESCRIPTION OF OPERATIONS/LOCATIONS/SPECIAL ZTEHS: Strawberry Lane Local Improvement District Project #01-27 IHPORTANT: The coverage described above is in effect as of the issue date of this certificate. It is subject to change at any time in the future. This certificate is issued as a matter of information only and confers no rights to the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policies above. CANCELLATZON: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL MAIL 30 DAYS' WRITI'EN NOTICE TO THE ABOVE NAMED CERTIFICATE HOLDER. AUTHORIZED REPRESENTATIVE https://saifonline, saif. com/online/certs/certForm.aspx 4/8/2003 CITY OF ASHLAND 20 E MAIN ST. ASHLAND, OR 97520 (541) 488-5300 VENDOR: 007060 ROBCO INC PO BOX 1570 GRANTS PASS, OR 97528 FOB Point: Terms: Net Req. Del. Date: 5/1/2003 Special Inst: CITY RECORDER'S COPY 7;i/2003 'r SHIP TO: Ashland Public Works (541 ) 488-5587 51 WlNBURN WAY ASHLAND, OR 97520 Req. No.: Dept.: PUBLIC WORKS Contact: Paula Brown Confirming? No Page 1 / 1 041'08 THIS IS A REVISED PURCHASE ORDER Lane ;al Im BID Date: Mal 1, 2003 Insurance re( uired/On file NOTE: See attached s )readsheet for Revised order 07/08/2004 Revised purchase order 07/08/2004 Revised purchase order 07/08/2004 91 13,428.00 13,855.00 3,589.00 *** This is a change order. *** BILL TO: Account Payable SUBTOTAL 1,030,872.00 20 EAST MAIN ST TAX 0.001 541-552-2028 FREIGHT 0.00 ASHLAND, OR 97520 TOTAL 1,030,872.00 E 260.08.41.00.704100 3,589.00 E 260.08.41.00.704200 ' 1,000,000.00 E 675.08.17.00.602400 27,283.00 //// II// 1 (//_/ ?. Authorized Signature VENDOR COPY REQUISTION FORM THIS IS A REQUEST FOR A: [X ] Change Order (existing PO# ) / ~ Vendor Name: ROBCO INC. CITY OF LAN D Date of Request: ~il.!,i~~ij Required Date of Delivery/Service: Address: PO BOX 1570 City, State, Zip GRANTS PASS OR 97528 Phone: Project Title: STRAWBERRY LANE LOCAL IMPROVEMENT DISTRICT PROJECT Project Number: 01-27 Services Only Description Strawberry Lane, Nutley and Alnutt Street Improvements ~anitary sewer on Nutley Strawberry Lane Sanitary Sewer Finish to cast in place wall Solicitation Process: [ ] Exempt [ ] 3 Written Quotes (copies attached) [ ] Sole Source [ X ] Invitation to Bid (copies on , [ ] Less than $5000 [ ] Request for Proposal (copies on file) Total Cost Account Number ~"7 *Please attach the O#ginal signed contract and Insurance Certificates. Account Number Employee Signature: Supervisor/Dept. Head Signature: .,~//-~',,'~ ..... NOTE: By signing this requistiion form, I certify tha the above request meets with Ctiy of Ashland Solicitiation Process requi~/r~ent~/and can be provided when necessary. G:Pubwrks\Eng\01-27 Robco CO 1 Updated on: 7/15/02 CITY OF ASHLAND DEPARTMENT OF PUBLIC WORKS CONTRACT CHANGE ORDER NO. 1 PROJECT: LOCATION' CONTRACTOR: STRAWBERRY LANE LID STRAWBERRY LANE, ALNUTT & NUTLEY ROBCO INC. DATE: ,JUNE 29, 204 PROJECT NO.: 01-27 You are requested to perform the following described work upon receipt of an approved copy of this document or as described by the Engineer: Item No. Description Quantity Unit Price Amount CO 1-1A Nutley St sanitary sewer 2260 LF $28.00 $6,328.00 CO 1-1B Replace Nutley St sanitary sewer manhole 1 each $2,500.00 $2,500.00 CO 1-1C Replace Nutley St sanitary sewer co 1 each $1,850.00 $1,850.00 CO 1-1D Connect to existing manhole I each $500.00 $500.00 CO 1-1E Pump/reroute Nutley St sewer Lump sum $2,150.00 $2,150.00 CO 1-1F Reconnect existing sanitary sewer service 2 each $50.00 $100.00 Total for CO1-1 $13,428.00 CO1-2A Strawberry Lane sanitary sewer 165 LF $27.00 $4,455.00 CO1-2B Strawberry Lane sanitary sewer manholes 3 each $2.200.00 $6,600.00 CO1-2C Additional labor at utility conflict 8 hours $350.00 $2,800.00 Total for COI-2 $13,855.00 CO1-3 Add architectural finish to cast in place wall 485 SF $7.50 $3,589.00 Original Contract Amount Total this Change Order Previous Change Order Revised Contract Total $914,629.50 $30,872.00 $o.oo $945,501.50 ENGINEERING Tel: 541-488-5347 20 E. Main Street Fax: 541-488-6006 Ashland, Oregon 97520 TTY: 800-735-2900 www.ashland.or, us G:\pub-wrks\eng\dept-admin\ENGINEER\PROJEC'R2001\01.27 Ch Od 1 .doc ,"'.'1 Approved By: Accepted By: The time provided for completion of this contract is increased by no calendar days. This document shall become an amendment to the contract and all provisions of the contract will apply. Recommended By: e~ ~"-'"'~~~ - Engine Date E Date co~ntra~-~r:- ---' G'--'~ Date ROBCO Inc. PO Box 1570 Grants Pass OR 97528 ENGINEERING Tel: 541-488-5347 20 E. Main Street Fax: 541-488-6006 Ashland, Oregon 97520 TTY: 800-735-2900 www.ashland.or, us G:\pub-wrks\eng\dept-admin\ENGINEER\PROJEC-r~2001\01_27 Ch Od 1.doc CITY OF ASHLAND 20 E MAIN ST. ASHLAND, OR 97520 (541) 488-5300 CITY RECORDER'S COPY Page 1 VENDOR: 007060 ROBCO INC PO BOX 1570 GRANTS PASS, OR 97528 SHIP TO: Ashland Public Works (541) 488-5587 27-1/2 N MAIN STREET ASHLAND, OR 97520 FOB Point: Terms: Net Req. Del. Date: 05/01/2003 Special Inst: Req. No.: Dept.: PUBLIC WORKS Contact: Paula Brown Confirming? No BLANKET PURCHASE ORDER Construction Project No 01-27 Date of Contract: April 7, 2003 Completion Date: November 30, 2003 Contin.qenc¥ 85,370.50 =.. NOTE: See attached spreadsheet for detailed list of accounts SUBTOTAL 1,000,000.00 BILL TO: Account Payable TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 541-552-2010 TOTAL 1,000,000.00 ASHLAND, OR 97520 " · .... Account Number Amount 'Account Number "' · · AmOUnt E 260.08.41.00.704200 1,000,000.00 - ~Jt'h orized Sign~'ture VENDOR COPY CiTY OF SHLAND NOTICE OF TRANSMITTAL TO: KARl OLSON DATE: PURCHASING PROJECT: JOB NO.: SUBJECT: APRIL 21, 2003 STRAWBERRY LANE LID 01-27 CONTRACT DOCUMENTS THE FOLLOWING ITEMS ARE BEING SENT TO YOU: Please find attached one original fully executed Public Works contract for the Strawberry Lane LID construction project, requisition and insurance certificate with ROBCO Inc. ENCLOSED UNDER SEPARATE COVER REMARKS: COPIES TO: Department of PU%~lic .~,~)rks By: Dawn Title: AdministratiVe Assistant PUBLIC WORKS Tel: 541488-5587 20 E. Main Street Fax: 541488-6006 Ashland, Oregon 97520 TTY: 800-735-2900 www.ashland.or.us G:\pub-wrks\eng\dept-admin\ENGINEER\PROJECT~2001\01-27 Contract Robco in house NOT.doc REQUISITION CITY OF -ASHLAND No. PW 94- FY 2003 Department Public Works Vendor ROBCO Inc. PO Box 1570 Grants Pass OR 97528 Account No. 260.08.41.00.704200 Date April 4, 2003 Requested Delivery Date Deliver To Jim Olson Via Paula Brown ASAP (* Note: Please allow approximately two(2) weeks for delivery on items not generally caried in stored, and approximately two (2) months on printing jobs ) Item No. Quantity Unit Description Use of Purchasing Office Only Unit Price Total Price PO No. Strawberry Lane Local Improvement $ 914,629.50 Construction Project No. 01-27 Contingency $ 85,370.50 See attached spreadsheet for further account TOTAL $ 1,000,000.00 for Kari: BID /RFP / EXEMPT: Bid Contract Start Date: May 1, 2003 Contract Completion Date: 11/31/03 Insurance on file: I YES I NO Project No: 01-27 Job No. Unit No. I hereby certify that the above items are necessary for the operation of this department and are budgeted ~nt Head or Authorized Person Issued By Date Received By G:Pubwrks\eng\deptadmin\engineer\project\01-27 Robco requisition.xls XXo~oXX