Contract (PO) Number: T26459

Release Number: 79

Specification Number: BO9681902

Name of Contractor: F.H. PASCHEN/S.N. NIELSEN, INC

City Department: CmCAGO DEPARTMENT OF TRANSPORT AnON

Title of Contract: BRIDGE RECONSTRUCTION/REHABILIT AnON

Dollar Amount of Release: $48,559.08

Release Description: BRIDGE RECONSTRUCTION/REHABILIT A TION

BRIDGE RECONSTRUCTION & REHABILITAION-JOB ORDERCONTRACT

Procurement Services Contact Person: BYRON WHITTAKER

Vendor Number: 1055528

Submission Date:

CITY OF CHICAGOBLANKET RELEASE Original (Department)

Furnish the supplies end/or MfYiees described below In conformence with conditions Mt for1h '-eIn 8Id kt ~ oftIr-

RELEASENUMBER

SITENAME

A

DELIVERYDATE

PAGENUMBER

RELEASEDATE

03/13/2005

PURCHASEORDER126459 7Q

SPECIFICA TICNNUMBER

B09681902

VENDORNUMBER

1055528 1

DELIVER TO: 84-084 ORDERED FROM:

,

BlANKET RELEASE

THIS SIGNED RELEASE IS YOUR AUTHORITY TO FURNISH THE SPECIFIED SUPPLIES AND /OR SERVICES IN ACCORDANCEWITH THE TERMS AND CONDITIONS OF THE BLANKET AGREEMENT NUMBER: T26459

THIS PURCHASE IS FOR DEPARTMENT: 84 - CHICAGO DEPARTMENT OF TRANSPORTAnON

SUBMIT THE ORIGINAL INVOICE TO:

~

PO

Line TOTAL COST

48,558.08

.~~ -5--c~(!,5 . ~ - ~J.l~~-~~- !NT

Une COMMODITY INFORMATION QUANTITY UOM COST1 96819 48.559.08 USD 1.00

BRIDGE RECONSTRUCTIONIREHABIUTATIONBRIDGE RECONSTRUCTION & REHABILITAlON-JOB ORDER CONTRACT

Dist BFY FUND COST CTR APPR ACCNT ACTV PRO.ECT RPT CAT GENRL FUTR1 004 0961 0842055 9004 220540 0000 90004151 00000o 00000 0000

2 005 0897 0842055 8506 220540 0000 60246151 00000o 00000 00001 SHIPMENT TOTAL:

RELEASE TOTAL: 48,551.08

- -Payment on thli order will be made upon receipt of en original yendor Involee form r8f8f8ncing dill Older.

S~1t the original InYOice to the d8partmem ~ 8boY8.Mark 811 peckeg" and papers with the purc~ number.

Any deliveries COfIt8iIWIg ovef8hIpmefD will be reflected ur-.. 0CherwiM ~ In dill P'K~.This pwc~ is lubject to the City of Chic8g0 General Conditions for Suppll... Work, or Profelslonal Conaulting Servte..; SpecIal Conditions, Disclosure

OwnersNp. Acceptance Page, as applicable, wfIIeh ere attec:hed hereto or Inc:orpor8led herein by r8f8f8nC8.

Job Order Contract

To:-

Department of: Bure8u of Bridges and Transit

01/24/2005Date:

Sub-Order Total: $48,559.08

DISCLOSURE OF RETAINED PARTIES

A. Definitions and Disclosure Requirements.1. I As used herein, the term 8Contrador" means a person or entity who has any contrad or lease with the

'City of Chicago.

2. Pursant to Executive Order 97-1, every city contract and lease must be accompanied by a disclosure statementproviding certain information and attorneys, lobbyists, accountants, consultants, subcontractors, andother persons whom the Contractor has retained or expects to retain with respect to the contrad or lease.In particular, the Contrador must disclose the name of each such person, his or her business address,the naure of the relationship, and the amount of fees paid or estimated to be paid.

3. The Contrador is not required to disclose employees who are paid solely throu~ the Contradots

regular payrol.4. 8Lobbyist8 means any person (a) who for compensation or on behalf of any person other than himself undertakes

to influence any legislative or administrative action, or (b) any part of whose duties as an employeeof another includes undertaking to influence any legislative or administrative action.

B. Certification .Contractor hereby certifies as follows

1. This Disclosure relates to the following transadlon:

Project name: 04-84-5-026.8 Columbus Dr. Pedestrian Tunnel Extras

Specification, loan or other Identifying number: BO~681902

F.H. Paschen, S.N. Nielsen, Inc.2. Name of Contrador:

3. EACH AND EVERY attorney, lobbyist, accountant, consultant, subcontractor, or other person retained or anticipatedto be retained by the Contrador with respect to or in connection with the contrad or lease is listed below

(attad1 additional pages if necessary):

. .CHECK HERE IF NO SUCH PERSONS HAVE BEEN RETAINED OR ARE ANTICIPATED TO BE RETAINED

February 24, 2005

City of ChicagoRichard M. Daley, Mayor

Ms. Mary A. DempseyInterim Chief Procurement OfficerDepartment of Procurement ServicesCity Hall, Room 40312.1 North LaSalle StreetChicago, IL 60602

Attention: Catherine MellonCity JOC Manager

Re: JOC ProjectProject Title:

Estimated Cost:Specification #:Funding Source:

Department of Transportation

Miguel d'EscotoCommissioner

0Ieri HerambDeputy Commi\1ioner

Bureau of Administration &. Planning

Suite 60030 North LaSalle Str~t~o. Dlinois 60602-2570(312) 744-5697(312) 744-4399 (FAX)(312) 744-7215 (TrY)

www .cityofcbica&o.org/t~rtation

04-84-5-O26BColumbus Drive Underpass Emergency Repairs(extra # 2 )S 50,000.00F.B. Paschen TO-96819-02-O104-961-84-2055-9004-0540-90004-151

Dear Ms. Dempsey:

We request that the above referenced project be contracted under the JobOrder Contracting (JOC) Method. Attachment A describes the scope ofwork and the appropriateness for using JOC for this project.

If you concur with our recommendation, please sign below and return acopy for our files.

S~)L.z=-Miguel d'EscotoCommissioner

APPROVED: ~~:==- ~Mary A.-Dempsey 7-'"'Interim Chief Procurement Officer

cc: Peter Palaparthifile

~jlm - AApproved: ~~

BFO1 b JOC I«)A COOT

ATrACHMENTA--

Project Number: 04-84-5- -

COOT #E-4-225-

Department: T~rtation

TelephoneNumber:

--(312) 742-4771Project Manager: Jim Adams

- -

and 2 below. As appropriate, complete items- - For- the proPosed projects please complete items

3, 4 and 5

(Attach to the MOA)

1.- - -Please describe the major features of the project:

- - - This ex-tra is acontinuatiOn oftheorigirlii[ projec~ which was the rehabilitation of the

pedestrian underpass under Columbus Drive at Monroe Street. The work includes

tasks that were unforeseen at the time the design plans were made. These tasks

include the removal of an abandoned duct bank, repair of a buried electrical conduit,

and installation of additional dowel bars in the roof slab. City forces are not available

to perform this work. Thus we are requesting the use of a Job Order Contract.

-PleasecxPtain WhY this project oou!d not bebid using the C1iY's tiadltTonalbid~rocess and the need to- use the JOC ~rocurement ~ystem:

2- - ~ -- - - -- -The project entails a relatively small scope of work. It would not be ~ orroSteffective for us to perform the work through the City's traditional bid process.

3 r If this project is a one trade project, PleaSe provide additloDal eXplanation Of why it

would be in the Ci 's best interest to do the ro.ect under JOC:N.A.

- - ~ ---"!fit ismticip~ed that-oYer 2S %ofthe ~ject well be non-prepriccd, please providean explanation on why laC should be used:

4

N.A

5- -' --

If some elements of the proposed lOC project scope of work are covered by CityTerm Agreements, these elements should be removed from the JOC project scope ofwork. If!t is not desirable t~ do so, please ex~~:N.A.