HomeMy WebLinkAbout2002-178 Contract/CONT Chg Order 1-9 - LTM Inc CITY OF ASHLAND
CONTRACT FOR PUBLIC WORKS CONSTRUCTION
Contract made this 11th day of October , 2002, between the City of Ashland,
("City") and LTM, 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 Siskiyou Boulevard/Ashland Street Construction, Project
No. 99-38C, Siskiyou Boulevard Bid Schedule B. 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: See attached letter from Paula Brown, Public Works Director to LTM
dated August 22, 2002 and October 1'!, 2002.
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 $3,277,662.80 conditioned upon
the faithful performance of this contract upon the part of the Contractor.
5. 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.
PUBLIC WORKS Tel: 541-488-5587
20 E. Main Street Fax: 541-488-6006
Ashland,www.ashiandOregon 97520.0r.us TTY: 800-735-2900
\\COMPAQI\DATA\(~OV~pub-wrks\en§\dept-admin\ENE;INEER\PROJECT~1999\99-38B LTM Contract B Siskiyou
Bond No. 905-036-676
PERFORMANCE & PAYMENT BOND
The undersigned LTM Inc., as principal, further referred to in this bond as
Contractor, and LIBERTY MUTUAL INSURANCE COMPANY as surety, further referred
to in this bond as Surety, are jointly acid severally bound unto City of Ashland, as
obligee, further referred to in this bond as City, in the sum of $3,277,662.80.
Contractor and City have entered into a written contract dated October 11, 2002,
for the following project; Siskiyou Boulevard/ Ashland Street Construction Project 99-
38C; Siskiyou Boulevard Bid Schedule B. 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 makespayment 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.
2. 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.
4. 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.
PUBLIC WORKS Tel: 541488-5587
20 E. Man Street Fax: 541-488-6006
Ashland 0 on 91520 TTY: 800.735-2900
www.ash?and.cr.us
AC0ti1PAQI%OATA\GOV\pub-wrks\eng\dept-admin\ENGINEER\PR0JEM1999\99.368 LTM Contract 8 siskiyou
7. 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: 905-036-676
Bond Agent KPD Insurance Inc.
Address: P O Box 936
Medford OR 97501
Telephone: 541-245-1111
SIGNED this 16th day of October 2002.
WITNESS: CONTRACTOR: LTM Incorporated
By: ?
(Corporate Seal) Title: David A. Midtlyng
Vice President
Legal Address: P 0 Box 1145
Medfor OR 501
Attest: ?l
e H.
Vice Presidenrt orAsst e Sec. ,y andc ontrollerlls
WITN SS:
SURETY: LIBERTY MUTUAL INSURANCE COMPANY
By:
(Corporate Seal)
Title: Attorney-in-Fact
Legal Address: P 0 Box 402
Beaverton OR 97076-4025
Attest:
Corporate Secretary
PUBLIC WORKS T91:541-4$8-5567
20 E. Main Street Fax: S41-488-6006
Ashland. Oregon 97520 TTY; 800-735.2900
w ?,-
ww.ashland.or.us
\\COMPAQI\DATA\COV\pub-wrla\eng\dept-admin\ENCINEER\PROJECT\i999199.388 LTM Contract 8 Slskiyou
THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. 1089105
,This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the
extent herein stated.
LIBERTY MUTUAL INSURANCE COMPANY
BOSTON, MASSACHUSETTS
POWER OF ATTORNEY
KNOW ALL PERSONS BY THESE PRESENTS:
That Liberty Mutual Insurance Company (the "Company"), a Massachusetts mutual insurance company, pursuant to and by authority of the By-law and
Authorization hereinafter set forth, does hereby name, constitute and appoint MARGIE JOHNSON, ANNETTE J. CANTU, PATRICIA C. BOYD,
LINDA SHADDON, JERRY D. BALDING, JACKIE ANDERBERG, DANA BRINKLEY, ALL OF THE CITY OF SPRINGFIELD,
STATE OF OREGON .............................................................................................................................................................
...............................................................................................................................................................................................
each individually if there be more than one named, its true and lawful attorney-in-fact to make; execute; seal, acknowledge and deliver, for and on its behalf as
sUi y??d a LIMA ?t an deed, anY n all and rt kin as, bonds, recognizances and other surety obli ations in the penal sum not exceeding
NIFTY MIL AND 00/10D '* * ••?" ` *?**'?• DOLLARS $ 50,000 001F00*****
( ) each, and the execution of such
undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents, shall be as binding upon the Company as if they had been
duly signed by the president and attested by the secretary of the Company in their own proper persons.
•+" That this power is made and executed pursuant to and by authority of the following By-law and Authorization:
.N
0 ARTICLE XVI - Execution of Contracts: Section 5. Surety Bonds and Undertakings.
d Any officer or other official of the company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as
13 -
0 the chairman or the president may prescribe, shall appoint such attomeys-in-fact, as may be necessary to act in behalf of the company to make,
4) execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys-in-
cc fact, subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the company by their signature and
execution of any such instruments and to attach thereto the seal of the company. When so executed such instruments shall be as binding as if
signed by the president and attested by the secretary.
v y By the following instrument the chairman or the president has authorized the officer or other official named thereinto appoint attorneys-in-fact:
Cc Pursuant to Article XVI, Section 5 of the By-laws, Timothy C. Mulloy, an official of Liberty Mutual Insurance Company, is hereby authorized to appoint
such attorneys-in-fact as may be necessary to act in behalf of the company to make, execute, seal, acknowledge and deliver as surety any and all
y 7 undertakings, bonds, recognizances and other surety obligations. All Powers of Attorney attested to or executed by Timothy C. Mulloy in his capacity
13 as an officer or official of Liberty Mutual Insurance Company, whether before, on or after the date of this Authorization, including without limitation
M U) Powers of Attorney attested to or executed as Assistant Secretary of Liberty Mutual Insurance Company, are hereby ratified and approved.
O W
That the By-law and the Authorization set forth above are true copies thereof and are now in full force and effect.
•• N
_ IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Company and the corporate seal of Liberty
Mutual Insurance Company has been affixed thereto in Plymouth Meeting, Pennsylvania this 12th day of August 2002
CD N
LIBERTY MUTUAL INSURANCE COMPANY
t?
O? l
E c> B - -- y C. .M
O to TimofF4 C. Mull ssistant Secre ary
COMMONWEALTH OF PENNSYLVANIA ss -?
v COUNTY OF MONTGOMERY
ea C
G0 L On this 12th day of August 2002 before me, a Notary Public, personally came Timothy C. Mullov, to me known, and
v acknowledged that he is an official of Liberty Mutual Insurance Company; that he knows the seal of said corporation; and that he executed the above Power of
Attorney and affixed the corporate seal of Liberty Mutual Insurance Company thereto with the authority and at the direction of said corporation.
IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting, Pennsylvania, on the day and year first
above written.
Notary Public
CERTIFICATE
I, the undersigned, Assistant 9ecrefary of J,Merty Mutual Insurance Company, do hereby certify that the original power of attorney of which the foregoing is a full, true and correct
copy, is in full force and effect on rh2 date of this certificate; and I do further certify that the officer or official who executed the said power of attorney was one of the officers
or officials
specially authorized by the chairman or the president to appoint attorneys-in-fact as provided in Article XVI, Section 5 of the By-laws of Liberty Mutual Insurance Company.
This certificate and the above power of attorney may be signed by facsimile or mechanically rap oduced signatures under and by authority of the following vote of the board of
directors of Liberty Mutual Insurance Company at a meeting duly called and held on the 121h day of Ma,.0, 1980.
VOTED that the facsimile or mechanically reproduced signature of any assistant secretary 0 the company, wherever appearing upon a certified copy of any power of
attorney issued by the company in connection with surety bonds, shall be valid and binding upon the company with the same force and effect as though manually affixed.
IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed the corporate seal of the said company, this 16th day of OCtOber , 2002
l_ _ _ i - JA7h F. X. Hee, Assistant Secretary
CITY OF ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
VENDOR: 000100
LTM INC
P O BOX 1145
MEDFORD, OR 97501
FOB Point:
Terms: Net 10th of Month
Req. Del. Date: 12/01/2002
Special Inst:
CiTY RECORDER'S CO
10/31/2002
Page 1 / 2
0374~ I
SHIP TO: Ashland Public Works
(541) 488-5587
27-1/2 N MAIN STREET
ASHLAND, OR 97520
Req. No.:
Dept.: PUBLIC WORKS
Contact: Paula Brown
Confirming? NO
THIS IS A REVISED PURCHASE ORDER
BLANKET PURCHASE ORDER
Contract for the Siski¥ou Bird Redesign
Proiect 99-38B, This recluisition is
applicable to Bid Schedule B ONLY
Bid
Start Date: December 1, 2002
Completion Date: December 30, 2003
Insurance required/On file
Revised purchase order 03/20/2003,
Chan.qe Order No. 1 - Additional Storm
Pipe STA 37+75
Change Order No. 2 - Remove & Replace
Inlet at Morton
Chan.~e Order No. 3 - Storm Drain
Crossin.q at STA 14+50 Union St
Chan¢le Order No. 4 - Slurry backfill at
Harrison
Change Order. No. 5 - Inclement Weather
Stoppa.qe 12/19/02
Change Order No. 6 - Remove PCC in
Planter at Omars
Change Order No. 7 Broken Water
Service at STA 37+00
Change Order No. 8 -Temporarv Traffic
Arrows
SUBTOTAL
BILL TO: TAX
FREIGHT
TOTAL
3,139.00
399.50
354.20
2,995.14
345.09
142.26
',:.. · '.. i' ."' ' :~:'?'
Account Number 1 Amount ..... Account Number . _ ~0unt
E 260.08.12.00.704200 3,286,373.34
Signature
VENDORCOPY
CITY OF ASHLAND
20 E MAIN ST.
~.~ ASHLAND, OR 97520
~.- (541) 488-5300
10i3ii2002 "1
Page 2 / 2
I °3f42
VENDOR: 000100
LTM INC
P O BOX 1145
MEDFORD, OR 97501
SHIP TO: Ashland Public Works
(541) 488-5587
27-1/2 N MAIN STREET
ASHLAND, OR 97520
FOB Point:
Terms: Net 10th of Month
Req. Del, Date: 12/01/2002
Special Inst:
Req. No.:
Dept.: PUBLIC WORKS
Contact: Paula Brown
Confirming? NO
..... ~ ..... Change ...O.r.d. er ~o. 9: Dew. aterin.q Medians 142.101
· :'~"'!i?.!.,i~;"!';'..':,:.~. :'.~'.'.'.:::!=.!'"~'~'il :' :;.::'.. :i..i..',!.!,.:!':':, :i:'. ';::~'." "i!.~:;'.'.:::::.:.'. i:;. '..'::~". · .::!..:.:.....:.:
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I
~. :
SUBTOTAL 3,286,373.34
BILL TO: Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2010 TOTAL 3,286,373.34
ASHLAND, OR 97520
Account Number I Amount Account Number Amount
Authorized Signature VENDOR COPY
CITY OF ASHLAND
DEPARTMENT OF PUBLIC WORKS
PROJECT:
LOCATION:
CONTRACTOR:
CONTRACT CHANGE ORDER NO.
SISKIYOU BOULEVARD CONSTRUCTION
SISKIYOU BOULEVARD
LTM INCORPORATED
1, 2, 3, 4, 5, 6, 7 & 8
DATE: MARCH 7, 2003
PROJECT NO.: 99-38, SCDL B
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 Additional Storm Pipe STA 37+75 Lump Sum $3,139.00 $3,139.00
CO 2 Remove & Replace Inlet at Morton Lump Sum $658.95 $658.95
CO 3 Storm Drain Crossing STA 14+50 Union Lump Sum $534.30 $534.30
CO 4 Slurry Backfill at Harrison Lump Sum $399.50 $399.50
CO 5 Inclement Weather Stoppage 12/19/02 Lump Sum $354.20 $354.20
CO 6 Remove PCC in Planter at Omars Lump Sum $2,995.14 $2,995.14
CO 7 Broken Water Service STA 37+ 00 Lump Sum $345.09 $345.09
CO 8 Temporary Traffic Arrows Lump Sum $142.26 $142.26
CO 9 Dewatering Medians Lump Sum $142.10 $142.10
Original Contract
Total this Change Order
Previous Change Orders
Revised Contract Total
$3,277,662.80
$8,710.54
$o.oo
$3,286,373.34
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.
En'gineer / / Date'
Accepted By:
LTM Incorporated
PO Box 1145
Medford OR 97501
Contractor
Date
ENGINEERING Tel: 541488-5347
20 E. Main Street Fax: 541-488-6006
Ashland, Oregon 97520 TTY: 800-735-2900
www.ashland.or.us
\\COMPAQ1\DATA\GOWpub-wrks\eng\dept-admin\ENGINEER\PROJEC'E1999k99-38 CO Sc B 1 2 3 4 5 6 7 8.doc
A request for a Purchase Order
REQUISTION FORM
THIS IS A REQUEST FOR A:
[ X ] Change Order (existing PO# 3742 Schedule B)
CITY OF
ASHLAND
Date of Request:~
Required Date of Delivery/Service~
Vendor Name: LTM INCORPORATED
Address: PO BOX 1145
City, State, Zip MEDFORD OR 97501
Phone:
Project Title: SlSKIYOU BOULEVARD RECONSTRUCTION
Project Number: 99-38
Services 0nly
Description
Siskiyou Blvd Reconstruction Project
Change Order No. I -Additional Storm Pipe STA 37+75
Change Order No. 2 -Remove & Replace Inlet at Morton
Change Order No. 3- Storm Drain Crossing at STA 14+50 Union St
Change Order No. 4- Slurry Backfill at Harrison
Change Order No. 5- Inclement Weather Stoppage 12/19/02
Change Order No. 6- Remove PCC in Planter at Omars
Change Order No. 7- Broken Water Service at STA 37+00
Change Order No. 8- Temporary Traffic Arrows
Change Order No. 9- Dewatering Medians
Total Prior Change Orders (None)
SoliCitation. Pr6.cess: ' ' · I
] 'Exempt [' ]. 3 written.~uotes (copies '
attached) .. .... ..
] Sole Source [ X ] invitation to Bid (copies, on .
rite)
] Less than. $5000 [ ] Reques'~ for PropoSal (copies
onfile) '. ' '
Total Cost
Account Number 260.08.12.00.704200
*Please attach the Otfginal signed contract and Insurance Cedificates.
Employee Signature: ~"~// /"~&~ Supervisor/Dept. Head Signature: ~
NOTE: By signing this requistiion foil, I ~t~fy tha the above request meets w~th Ctly of Ashland Solicitiatfon Process requirem,~*~ and can be pi~ed when n" ' ' -'-ecessary.-'"'
G:Pubwrks~Eng~99-38 LTM CO Sci B I 2 3 4 5 6 7 8 Requisition.xls Updated o~: 7115/02
374-7S
LTM Incorporated
Time and Materials Billing Summary
Project Name: SISKIYOU BLVD.
Job No.:
02271-209
EQUIPMENT
MATERIALS
rOM1/009M/O3rLTM Concrete 1 d $75.40 $75.40
01/09/031L M Slur 15 d $38.60 $579.00
MATERIAL TOTAL $654.40
SERVICES / MISC.
Costs Subtotal (no markup) $2,729.69
Labor Mark-up I? o $310.50
Materials/Equipment/Services Mark-up Jar"/o $224.11
6 too not,
Description of work: Added Pipe run $7bd-lt v4kAi Ome
AT,e+Vsvs`W "PAM eW Date: 01/29/2003
TM
ate'" DAILY EXTRA WORK REPORT
Date:
?oreman: /ete,,W i
Job Name: S/SKt kda
Job No: 01. 'L7 1 CA#
EMPLOYEE NAME CRAFT
RATE ST.
HOURS OT.
HOURS
DESCRIPTION OF WORK
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DAILY EXTRA WORK REPORT
Date:
foreman: ?/!.G,v d
Job Name: S ?5 K Yom pL ?9n,
Job No: 9 :) I -ter lio a zZ" / - Za9
EMPLOYEE NAME CRAFT
RATE ST.
HOURS OT.
HOURS
DESCRIPTION OF WORK
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Concrete and Rock Dispatch ................(541) 779-2303
An Equal Opportunity Employer f. t •E_f. }. 7-S Concrete Store ............................ (541) 282-0656
"Rock Solid Quality and Service" Operations and Asphalt ..................... (541) 770-296C
TERMS: Net 10th day of month following date of invoice. A late payment Service Charge Administration and Business ................. (541) 779-6304
of 2% per month will be charged on accounts 30 days past due from date of billing. This General Contractor P.O. BOX 1145, MEDFORD, OR 97501
Service Charge is an Annual Percentage Rate of 24%. Minimum Service Charge $I A0.
www.itminc.com CCB #56603 CSLB #56773,9
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May cause eye or skin injury. Contains Portland cement. Freshly Drivers are prohibited from delivering concrete except under the truck's owr
mixed cement, mortar, concrete, or grout may cause skin injury. power, and where site conditions permit the safe and proper operation o
TAKE THESE PRECAUTIONS: his equipment. Drivers are not permitted to add water to the mix to exceec
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2 Waar rnhhar hnnta and ninvan anri avniri nrninnnad cnntact nation of the customer and his acceptance of risk for any loss or damage
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3. In case of contact with'skin or eyes, FLUSH THOROUGHLY CUSTOMER'S REQUEST
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Concrete and Rock Dispatch ................ (541) 779-2303
An Equal Opportunity Employer f T i, -'I' f. h 7,9 Concrete Store ............................ (541) 282-0656
'Rock Solid Quality and Service" Operations and Asphalt ...:................. (541) 770-2960
TERMS: Net 10th day of month following date of Invoice. A late paymeriC.?i?yice Charge Administration and Business . . . . . . . . . . . . . . . . . (541) 779-6304
of 2% per month will be charged on accounts 30 days past due from , of billing.'This
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mixed cement, mortar, concrete, or grout may cause skin injury. power, and where site conditions permit the safe and proper operation of
TAKE THESE PRECAUTIONS: his equipment. Drivers are not permitted to add water to the mix to exceec
1. Avoid all contact with eyes. the maximum slump nor to go beyond. #ie curb line, except upon the authors'
2. Wear rubber boots and cloves. and avoid Drolonoed contact nation of the customer and his acceptance of risk for any loss or damage
directly with skin or through porous materials. WATER ADDED AT
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TERMS: Net 10th day of month following date ofinvoice. A late payment Service charge
of 2% per month will be charged on accounts 30-days past due from date of billing. This
Service Charge Is an Annual Percentage Rab of 24%. Minimum Servk a Charge $1A0.
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May cause eye or skin injury. Contains Portland cement.: Freshly
mixed cement, mortar, concrete,: or grout may cause skin injury.
?TAKE THESE PRECAUTIONS:
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2. Wear rubber boots and cloves. and avoid orolonned contact
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Concrete and Rock Dispatch ................(541) 779-2303
Concrete Store ............................ (541) 282-0656
Operations and Asphalt ..................... (541) 770-2960
Administration and Business ................. (541) 779-6304
General Contractor P.O. BOX 1145, MEDFORD, OR 97501
wwv Arninc.com CCB #56603 CSLB #567735
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Drivers are prohibited from delivering concrete except under the trucks own
power, and where site conditions permit the safe and proper operation of
his equipment. Drivers are not permitted to add water to the mix to exceed
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gals. to % load 'WHERE WOULD YOU UKE THE DRIVER TO WASH OUT?'
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77
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DRIVER
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y
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TRUCK PLANT SLUMP DUE AT JOB USE OF CONCRETE
,
COMMERCIAL RESIDENTIAL EXTRA ADMIX ARRIVE JOB: LEFT JOB:
TCM
DELIVERY INSTRUCTIONS
SPECIAL INSTRUCTIONS
TM Incorporated
Time and Materials Billing Summary
Project Name: SISKIYOU BLVD. Job No.: 02271-214
Description of work: Remove Inlet & Replace Pipe
W-r 4'-) Date: 01/29/2003
LABOR
EQUIPMENT
01/17/03 Picku 20078 2.50 $8.25 $20.63
01/17/03 JD 410E Backhoe 110083 2.50 $29.07 $72.68
01/17/03 LTM Bobtail 31058 1.50 $30.23 $45.35
EQUIP. TOTAL $138.65
SERVICES / MISC.
Costs Subtotal (no markup)
Labor Mark-up 22%
Materials/Equipment/Services Mark-up 17%
Submitted by:
Accepted by:
$573.78
$56.75
$53.69
TOTAL AMOUNT DUE $ .22
John Lotito, Jr -Construction Superintendent (?? /?Sg -!
Date:
MATERIALS
LTM
y DAILY EXTRA WORK REPORT
Date: l' l 7- a 3
C Foreman: 4Vf C?7'k
Job Name:. f 119/
5 r7?- Z,5,- f- 1-0
Job No: pZL7/ -L!
EMPLOYEE NAME CRAFT
RATE ST.
HOURS OT.
HOURS
DESCRIPTION OF WORK
1 72 Z ` A-
FAY 7, 114,
T, C ml L y , '/i Qi mac"
C. Po 1--t 5 14'- Z '/z,-
Qcmovvd ,Cry tf a tn 77,
T Fv Lrw
MISCELLANEOUS SUB, HAULERS, MOBS
it
CUSTOMER SIGNATURE
COMPANY EQUIPMENT
EQUIPMENT NO. HOURS
/ OOS Zz
100T 9 .Z.'/z.
RENTAL EQUIPMENT
EQUIPMENT NO. HOURS
01
K/Contracting/Jenn's Reports, etc./Misc Forms/Daily Extra Work Report
I
RM
155=0/,AO/WOO' • TELEPHONE •
Concrete and Rock Dispatch ................ (541) 779-230:
An Equal Opportunity Employer -• - : -• ;.;, Concrete Store ............................ (541) 282-0651
!.:..i r c ,..
"Rock Solid Quality and Service" Operations and Asphalt ..................... (541) 770-2961
TERMS: Net 10th day of month following date of Invoice. A late payment Service Charge Administration and Business ................. (541) 779-630,
of 291 per month will be charged on accounts 30 days past due from data of billing. This General Contractor P.O. BOX 1145, MEDFORD, OR 9750'
Service Charge is an Annual Percentage Rate of 24%. Minimum Service Charge $1.00.
www.itmine.com CCB #56603 CSLB #567731
±CAUT1iQN; UNLOADING
May cause eye or skin injury. Contains Portland cement. Freshly Drivers are prohibited from delivering concrete except under the trucks owl
mixed cement, mortar, concrete, or grout may cause skin injury. power, and where site conditions permit the safe and proper operation a
TAKE THESE PRECAUTIONS: his equipment. Drivers are not permitted to add water to the mix to exceed
1. Avoid all contact with eyes. the maximum slump nor to go beyond the curb line, except upon the authors
9 Woar nihhar hnnia arvi ninvaot and awnirl nminnnad nnntarl nation of the customer and his acceptance of risk for any loss or damage
directly with skin or through porous materials. WATER ADDED AT `
3. In case of contact with skin or eyes, FLUSH THOROUGHLY CUSTOMEWS REQUEST i `
r; {
WITH WATER. gals. to full load 1`;,,-? ?
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Cusromers Representative
5. Keep children away. j?gals. to 1/3 load 'WHERE WOULD YOU LIKE THE DRIVER TO WASH OUT?
ID PO. N MBER ; 111,
y
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SOLD TO
'!';? it`ii?.. DELIVER TO
L'1'• 1,E f$ Ii?_.4-2??}..t
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„
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PHASE", ?T
QUrWT?tY aL11Nt1Y ?+ UiilTQF
rM ORL7ERED DELIVERED 6 MEASURE
"
J
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!7 CY
TRUCK PLANT SLUMP DUE AT JOB USE OF CONCRETE
COMMERCIAL RESIDENTIAL EXTRA ADMIX ARRIVE JOB: LEFT,JOB:
TOrAL
DELIVERY INSTRUCTIONS
SPECIAL INSTRUCTIONS
.icy? Mj?
t
LTM Incorporated
Time and Materials Billing Summary
Project Name: SISKIYOU BLVD.
Description of work: Storm Drain Crossing @ st. # 14+50
UA1,0,4.1
LABOR
EQUIPMENT
MATERIALS
Job No.: 02271-212
Date: 01/29/2003
?e
TM Slur 10 d $38.60
r
l
l $386.00
TM Concrete 1
yd $78.60
01/15/03
y $78.60
MATERIAL TOTAL $464.60
SERVICES / MISC.
Costs Subtotal (no markup) $464.60
Labor Mark-up 22% $0.00
Materials/Equipment/Services Mark-up 17% $78.98
1so/o
TOTAL AMOUNT DUE $5
Submitted by:
John Lotito, Jr - Construction Superintendent -?
Accepted by: Date:
TM
DAILY EXTRA WORK REPORT
?- )ate:
Foreman: ,eiGs¢ 401; ?rj7&
Job Name: SrSK f ?a awc>
Job No: -0 z -7 r - L /Z
EMPLOYEE NAME CRAFT
RATE ST.
HOURS OT.
HOURS
DESCRIPTION OF WORK
S Ti4 /?f3 ?
` T7 rr' o
c-V
L F STE,-
7v psc P o
• s
MATERIALS USED
DESCRIPTION SUPPLIER QTY.
w ?L' ? odor.
Goy
MISCELLANEOUS SUB, HAULERS, MOBS
4
CUSTOMER SIGNATURE
I COMPANY EQUIPMENT
EQUIPMENT NO. HOURS
I RENTAL EQUIPMENT
EQUIPMENT NO. HOURS I
H:/Contracting/Jenn's Reports, etc./Misc Forms/Daily Extra Work Report
RM 4 0 4
L ?
An Equal Opportunity Employer TICKIET 41- 7 840";
19ock Solid Quality and Service"
TERMS: Net 10th day of month following date of invoice. A late payment Service Charge
of 2% per month will be charged on accounts 30 days past due from date of billing. This
Service Charge is an Annual Percentage Rate of 24%. Minimum Service Charge $1.00.
CA,U'TION
May cause eye or skin injury. Contains Portland cement. Freshly
mixed cement, mortar, concrete, or grout may cause skin injury.
TAKE THESE PRECAUTIONS:
1. Avoid mall contact with eyes.
2. Wear rubber boots and aloves. and avoid Drolonaed contact
e TELEPHONE e
Concrete and Rock Dispatch ................(541) 779-2303
Concrete Store ............................ (541) 282-0656
Operations and Asphalt ..................... (541) 770-2960
Administration and Business ................. (541) 779-6304
General Contractor P.O. BOX 1145, MEDFORD, OR 97501
www.itminc.com CCB #56603 CSLEI #567735
UNLOADING
Drivers are prohibited from delivering concrete except under the truck's own
power, and where site conditions permit the safe and proper operation of
his equipment. Drivers are not permitted to add water to the mix to exceed
the maximum slump nor to go beyond the curb line, except upon the authori-
zation of the customer and his acceptance of risk for any loss or damage.
directly with skin or through porous materials.
FLUSH THOROUGHLY
I
f
h
ki WATER ADDED AT
1.
contact wit
n or eyes,
n case o
s
WITH WATER QUPMMER`S REQUEST
l
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oad
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1. Keep children away. CT gals. to V9 load "WHERE WOULD 1bU LIKE THE DRIVER To WASH ourr
ro . f1a NuMsER . a a ps . ;
SOLD TO DELIVER TO
N MAP
f
T L r.
t
DRIVER
DAVID
4
, 20 MPH
;RUCK PLANT SLUMP , . DUE AT JOB USE OF CONCRETE.
x)MMERCIAL RESIDENTIAL EXTRA ADMIX ARRIVE J LEFT JOB^
'
TOTAL
)SLIVERY INSTRUCTIONS
IPECIAL INSTRUCTIONS f (_;, titYt`..i %0 a hiGE T
LAW M-.
RM 78405
/ncolporated a TELEPHONE e
Concrete and Rock Dispatch ................(541) 779-2303
An Equal Opportunity Employer T 'l i ^ T it 7 3 =+ 0 Concrete Store ............................ (541) 282-0656
"Rock Solid Quality and Service" 1 Operations and Asphalt ..................... (541) 770-2960
TERMS: Net loth day of month following date of invoice. A late payment service Charge Administration and Business ................. (541) 779-6304
of 2% per month will be charged on accounts 30 days past due from date of billing. This General Contractor P.O. BOX 1145, MEDFORD, OR 97501
Service Charge is an Annual Percentage Rate of 24%. Minimum Service Charge $1.00.
www.Itminc.com CCB #56603 CSLB #567735
U r?
t 1? UN OAD- 1'"'
May cause eye or skin injury. Contains Portland cement. Freshly Drivers are prohibited from delivering concrete except under the truck's own
mixed cement, mortar, concrete, or grout may cause skin injury. power, and where site conditions permit the safe and proper operation of
TAKE THESE PRECAUTIONS: his equipment. Drivers are not permitted to add water to the mix to exceed
1. Avoid:all contact with eyes. the maximum slump nor to go beyond the curb line, except upon the authori-
9 Woar ruhhor hnnto and nirwAA and avnirl nrnlnnnerl Cnnta& cation of the customer and his acceptance of risk for any loss or damage.
directly with skin or through porous materials. WATER ADDED AT
3. In case of contact with skin or eyes, FLUSH THOROUGHLY CUSTOMERS REQUEST
WITH WffER. -teals. to full load
tl
ti
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If
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en
on promp
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tat
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sts, get me
a
4. -gals. to 2/3 bad Customer's Representative
5. Keep children away. -gals. to 1/3 load "WHERE WOULD YOU LIKE THE DRIVER TO WASH OUT?"
,
}
-77
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r
i7
.
1W DAM
trrl?
Ex+y .
SOLD TO DELIVER TO
I. G. Q ?X ief;3R CJl i
P- ."E• t:-t4Si .. i_0011" U!=' E• iv f It l
DRIVER
PIrlASE s 202.1)`_ LE :t?6a;1
"r'
TY 00166.U&
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TRUCK PLANT SLUMP DUE AT JOB USE OF CONCRETE
' +
COM CTRL RESIDENTIAL EXTRA ADMIX ARRIVE JO : LEFT JOB:
DELIVERY INSTRUCTIONS
SPECIAL INSTRUCTIONS
s
LTM Incorporated
Time and Materials Billing Summary
Project Name: SISKIYOU BLVD.
Description of work: Slurry Backfill
?k2.LrSO?c.G - ?Eplfl
LABOR
IPMENT
MATERIALS
Job No.
Date:
02271-210
3gl.ga
Costs Subtotal (no markup) $386.00
Labor Mark-up ° $0.00
Materials/Equipment/Services Mark-up o $65.62
,s0 o
TOTAL AMOUNT DUE .6
Submitted by:
John Lotito, Jr - Construction Superintendent
a
Accepted by: Date: qq D
SERVICES / MISC.
TM
DAILY EXTRA WORK REPORT
Date:
Floreman: ecu-e
Job Name: 5? S t<l lvJ ,?jGV?
Job No: &977-Z /-,XPf,0r
CRAFT ST. OT.
EMPLOYEE NAME RATE HOURS HOURS DESCRIPTION OF WORK
I +-yy
MATERIALS USED
DESCRIPTION SUPPLIER QTY.
SGV?Ge?E !'N `o
Y.
MISCELLANEOUS SUB, HAULERS, MOBS
e
CUSTOMER SIGNATURE
COMPANY EQUIPMENT
EQUIPMENT NO. HOURS
RENTAL EQUIPMENT
EQUIPMENT NO. HOURS
K/Contracting/Jenn's Reports, etc./Misc Forms/Daily Extra Work Report
L rJffJ117C0r,00,r,?A9e
An Equal Opportunity Employer
"Rock Solid Quality and Service"
TERMS: Net 10th day of month following date of invoice. A late payment Service Charge
of 2% per month will be charged on accounts 30 days past due from date of billing. This
Service Change is an Annual Percentage Raft of 24%. Minimum Service Charge Si.oo.
C CA TION
May cause eye or skin injury. Contains Portland cement. Freshly
mixed cement, mortar, concrete, or grout may cause skin injury.
TAKE THESE PRECAUTIONS:
1. Avoid-all contact with eyes.
9_ Waar njhhar hnntc and nit ac anti avniri nrninnnarl nnntar_t
RM ( 3 32
*TELEPHONE e
Concrete and Rock Dispatch ................ (541-) 779-230:
Concrete Store ............................(541) 282-065f
Operations and Asphalt ..................... (541) 770-296C
Administration and Business ................. (541) 779-6304
General Contractor P.O. BOX 1145, MEDFORD, OR 97501
www.Itminc.com CCB #56603 CSLB #587735
UNLOADING
Drivers are prohibited from delivering concrete except underthe truck's own
power, and where site conditions permit the safe and•,proper operation 01
his equipment. Drivers are not permitted to add watee"to the mix to exceed
the maximum slump nor to go beyond the curb ling,excegPupon the autho6
zation of the customer and his acceptance of; k for any loss or damage.
directly with skin or through porous materials. WATER ADDED AT 6
3. In case of contact with skin or eyes, FLUSH THOROUGHLY CUSTOMERS REQUEST :
WITH WATER. -gals. to full load '
4. If irritation persists, get medical attention promptly. ,gals. to 2/3 bad c stomers Representative
5. Keep children away. _ gals. to 1/3 bad `WHERE ouLD You LIKE THE DRIVER To WASH OUTr
11ME
SOLD TO DELIVER 7D..
:_i. .•l+ f.Y t.f-,;• <..rt,I_.;?I
..'r=tic. i... ;: lit' 1N E`
Rs l••il
ANM
...
r
pHpS 6 DRIVER
50P.
LC'kV4 AED
17AF5F Cow DESCRIPTION
, , r
0 0,
TRUCK PLANT SLUMP DUE AT JOB USE OF CONCRETE
„
COMMERCIAL l RESIDENTIAL EXTRA ADMIX a LEFT JOB:
ARRIVE JOB:
+ i..
i TOTAL
y ,r•
DELIVERY INSTRUCTIONS .w.:Fj.;x .` i !-•I --k +' '.aL [i..:?r?r.
SPECIAL INSTRUCTIONS
TM Incorporated
Time and Materials Billing Summary
Project Name: SISKIYOU BLVD. Job No.: 02271-206
Description of work: Severe wind shutdown
Date: 01/29/2003
LABOR
EQUIPMENT
12/19/02 Pickup 20123 0.50 $8.25 $4.13
12/19/02 JD 644G Loader 130080 3.00 $45.26 $135.78
12/19/02 LTM 10 yd Bobtail 31084 1.00 $30.23 $30.23
EQUIP. TOTAL $170.14
MATERIALS
SERVICES / MISC.
d
Costs Subtotal (no markup)
Labor Mark-up 22%
Materials/Equipment/Services Mark-up 17%
TOTAL AMOUNT DUE
Submitted by:
Accepted by:
John Lotito, Jr - Construction Superintendent
Date:
$308.31
$30.40
$28.92
$3 3
1-0 0 14 (,P-
(0
LTM
DAILY EXTRA WORK REPORT
Date:
Foreman:
Ala
Job Name:
Job No: bZ,Z'I l-- ,
EMPLOYEE NAME CRAFT
RATE ST.
HOURS OT.
HOURS
DESCRIPTION OF WORK
y N 4 j-
?
?
e --
S
MATERIALS USED
DESCRIPTION SUPPLIER QTY.
MISCELLANEOUS $UB, HAULERS, MOBS
CUSTOMER SIGNATURE
COMPANY EQUIPMENT
EQUIPMENT NO. HOURS
RENTAL EQUIPMENT
EQUIPMENT NO. HOURS
Qfal
?e
K/Contracting/Jenn's Reports, etc./Misc Forms/Daily Extra Work Report
TM Incorporated
Time and Materials Billing Summary
Project Name: SISKIYOU BLVD.
Description of work: Remove PCC in Planter
Subb"arr evAlc2cr% ... arA?
LABOR
PMENT
Job No.: 02271-204
Date: 01/29/2003
12/16/02 Picku 20123 2.00 $8.25 $16.50
12/16/02 Cat 320 Excavator 150062 4.00 $60.48 $241.92
12/16/02 LTM 10 yd Bobtail 31085 4.00 $30.23 $120.92
12/16/02 LTM 12 yd Bobtail 31081 6.00 $32.75 $196.50
12/16/02 LTM 12 yd Bobtail 31054 2.50 $32.75 $81.88
12/16/02 LTM 10 yd Bobtail 31058 3.50 $30.23 $105.81
12/16/02 LTM 12 yd Bobtail 31082 4.50 $47.94 $215.73
EQUIP. TO TAL $979.25
MATERIALS
SERVICES / MISC.
Costs Subtotal (no markup) $2,604.87
Labor Mark-up 22% $182.87
Materials/Equipment/Services Mark-up 17% $301.52
ISYv a qS iq
TM ,
DAILY EXTRA WORK REPORT
? k
,_Qats:
!
Foreman:
Job Name:
??
c
Job No:
ST. OT.
I EMPLOYEE NAME I RATE I HOURS I HOURS I DESCRIPTION OF WORK
MATERIALS USED
DESCRIPTION SUPPLIER QTY.
MISCELLANEOUS SUB, HAULERS, MOBS
Z
i
CUSTOMER SIGNATURE
COMPANY EQUIPMENT
EQUIPMENT NO. HOURS
RENTAL EQUIPMENT
EQUIPMENT NO. HOURS
K/Contracting/Jenn's Reports, etc./Misc Forms/Daily Extra Work Report
DAILY EXTRA WORK REPORT
Date: L _ c-2- _
:foreman:
Job Name: ow'j
Job No: bU'Z,7-1-1 l- wllk
EMPLOYEE NAME CRAFT
RATE ST.
HOURS OT.
HOURS
DESCRIPTION OF WORK
f,
6L3 Ac kl-. I
_._..,o -IT-- L.P
?v
MISCELLANEOUS (SUB, HAULERS, MOBS)
MATERIALS USED
DESCRIPTION SUPPLIER QTY.
CUSTOMER SIGNATURE
COMPANY EQUIP MENT
EQUIPMENT NO. HOURS
za ?z3 p
l SO ? (a,Z ?„r
3
St _
3 S-*.k 6-w< 1
RENTAL EQUIPMENT
EQUIPMENT NO. HOURS
4(-
Fq-
K/Contracting/Jenn's Reports, etc./Misc Forms/Daily Extra Work Report
L.L.A.D. INC.
P.O. BOX 516
AEDFORD, OR 97501-8526
BILL TO
L.T.M.
P.O. BOX 1145
MEDFORD, OR 97501
Invoice
DATE INVOICE #
12/16/2002 4198
SHIP TO
L.T.M.
P.O. BOX 516
MEDFORD, OR 97501
P.O. NO. TERMS JOB # CODE #
,
Net 30
02271-204 r
Tee
-31990'
DATE ORDERED DESCRIPTION CLASS AMOUNT
12-13-02 ASHLAND ST.& SISKIYOU, ASHLAND.
Saw cut 331 L asphalt over concrete 12 in. deep @ S 2.40 ft
SAW CUT
794.40
Thank you for your business.
Total $794.40
,CATION OF JOB
TM Incorporated
Time and Materials Billing Summary
Project Name: SISKIYOU BLVD.
Description of work: Broken H2O service st# 37+00
LABOR
EQUIPMENT
MATERIALS
SERVICES / MISC.
Job No.: 02271-202
Date: 01/29/2003
Costs Subtotal (no markup)
Labor Mark-up 22%
Materials/Equipment/Services Mark-up 17%
TOTAL AMOUNT DUE
Submitted by:
John Lotito, Jr - Construction Superintendent
Accepted by: Date:
$300.09
$39.92
$20.17
34,E ?j
ILI_
TM 11
DAILY EXTRA WORK REPORT
Date:
Foreman: 'SC(f
Job Name:
Job No: G M-1- Z/-
,)'Z-CRAFT ST. OT.
EMPLOYEE NAME RATE HOURS HOURS DESCRIPTION OF WORK
r c 1 4-
-E• fe 63
0 t
` L. U tc v' r
+ sd eed
MATERIALS USED
DESCRIPTION SUPPLIER QTY.
COMPANY EQUIPMENT
EQUIPMENT NO. HOURS
Z
MISCELLANEOUS (SUB. HAULERS, MOBS) I
1
iw
CUSTOMER SIGNATURE
I l mob (0-2- 1 l I
RENTAL EQUIPMENT
(EQUIPMENT NO. HOURS
K/Contracting/Jenn's Reports, etc./Misc Forms/Daily Extra Work Report
TM Incorporated
Time and Materials Billing Summary
Project Name: SISKIYOU BLVD. Job No.: 02271-201
Description of work: Temporary Arrows
Date: 01/29/2003
LABOR
EQUIPMENT
MATERIALS
SERVICES / MISC.
Submitted by:
Accepted by:
Date:
0
XtsC/0
TOTAL AMOUNT DUE $ 14- .51
John Lotito, Jr - Construction Superintendent
Costs Subtotal (no markup) $123.71
Labor Mark-up 22% $12.21
Materials/Equipment/Services Mark-up 17% $11.60
LTM
DAILY EXTRA WORK REPORT
Date: ?`L 03' O `Z-
oreman: S ; Mc C
Job Name:
Job No: QZZ-`l (-?f) (
EMPLOYEE NAME CRAFT
RATE ST.
HOURS OT.
HOURS
DESCRIPTION OF WORK
C
r
MATERIALS USED
DESCRIPTION SUPPLIER QTY.
w t-- F
MISCELLANEOUS SUB, HAULERS, MOBS
iT
CUSTOMER SIGNATURE
I COMPANY EQUIPMENT
EQUIPMENT NO. HOURS
RENTAL EQUIPMENT
EQUIPMENT NO. HOURS
J?
H:/Contracting/Jenn's Reports, etc./Misc Forms/Daily Extra Work Report
CANTEL OF MEDFORD, INC.
?Fj 3981 CRATER LAKE HWY.
OF M D F O R 1 N C MEDFORD, OREGON 97504
(541) 773-2765
LTM, INC.
PO BOX 1145
Cu, ID: 445
Medford, OR 97501
Telehone: 541-779-6304
Page Number....... 1
Invoice Number..... 014395
Invoice Date..... 12/ 4/02
P. O. At HC222293
P.O. Date: 12/ 3/02
Desc:
SALES CHARGES
S111317 559 PAVEMENT TAPE V11TE 1190 SOLO 1 68.23
68.23
SALES SUBTOTAL:
o?
Terms: Net 30 days from date of invoice.
1'/z% per month will be charged if not paid
within 30 days of invoice date.
IRIGINM.
THANK YOU - We Appreciate Your Business!
68.23
TOTAL NON-TAXABLE: 68.23
TAX: 1.91
INVOICE TOTAL: 68.23
68.23
TM Incorporated
Time and Materials Billing Summary
Project Name: SISKIYOU BLVD. Job No.: 02271-207
Description of work: Dewatering Median
Date: 01/29/2003
LABOR
EQUIPMENT
MATERIALS
MATERIAL TOTAL
SERVICES / MISC.
Costs Subtotal (no markup) $241.14
Labor Mark-up 22% $21.74
Materials/Equipment/Services Mark-up 17% $24.19
TOTAL AMOUNT DUE $2 .07
Submitted by: t ? ?
John Lotito, Jr - Construction Superintendent IS
Accepted by: Date:
V.
1
TM ,
DAILY EXTRA WORK REPORT
Date:' -
Foreman:
Job Name: V,
Job No: L ZZ. - Z ?? 7
EMPLOYEE NAME CRAFT
RATE ST.
HOURS OT.
HOURS
DESCRIPTION OF WORK
MATERIALS USED
DESCRIPTION SUPPLIER QTY.
MISCELLANEOUS (SUB, HAULERS, MOBS) I
- 4-11
A
1 I
CUSTOMER SIGNATURE
COMPANY EQUIPMENT
EQUIPMENT NO. HOURS
RENTAL EQUIPMENT
EQUIPMENT NO. HOURS
K/Contracting/Jenn's Reports, etc./Misc Forms/Daily Extra Work Report
....................... CITY RECORDER'S COPYPage 1/1
Cl'l'~ OF ASHLAND
20 ~ MAI~ ST.
ASHLAND, OR 97520 03742
~'~ (541) 488-5300
VENDOR: 000100 SHIP TO: Ashland Public Works
LTM lNG (541) 488-5587
P O BOX 1145 27-1/2 N MAIN STREET
MEDFORD, OR 97501 ASHLAND, OR 97520
FOB Point: Req. No.:
Terms: Net 10th of Month Dept.: PUBLIC WORKS
Req. Del. Date: 12/01/2002 Contact: Paula Brown
Special Inst: Confirming? NO
BLANKET PURCHASE ORDER
Project 99-38B, This requisition is
Start Date: December 1, 2002
Insurance required/On file
SUBTOTAL 3,277,662.80
BILL TO: Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2010 TOTAL 3,277,662.80
ASHLAND, OR 97520
E 260.0812.00.704200 3,277,662.80
//'
/~orized Signature VENDOR COPY
CITY OF
ASHLAND
REQUISITION
No. PW 308D- FY 2003
Department PUBLIC WORKS
Vendor LTM INCORPORATED
PO BOX 1145
MEDFORD OR 97501
Account No. 260.08.12.00.704200
Date November 4, 2002
Requested Delivery Date ASAP
Deliver To PAULA BROWN
Via PAULA BROWN
(' 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.
Contract for the Siskiyou Boulevard Redesign
Project 99-38B. This requisition is applicable to
Bid Schedule B ONLY. $ 3,277,662.80
TOTAL $ 3,277,662.80 $ 3,277,662.80
for Kari:
BID /RFP /EXEMPT: BID
Contract Start Date: December 1, 2002
Contract Completion Date: Dec-03
Insurance on file: YES NO
Project No: 99-38B
Job No. Unit No. I hereby certify that the above items are necessary for the operation
of this department and are budgeted
Department Head or Authorized Person
Issued By
Date
Received By
ii,
G: PubwrkslengldeptadmiMeng ineerlproject11999\99-38B LTM B Requisitionxls ORIGINAL