R-1850 - 01/14/2020 - AGREEMENTS - Resolutions Supporting Documents 7 Ff 6
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FRED BUCHOLZ RECORDER:
I
DUPAGE COUNITY ILL11,10I.-S
08/3i/20-0 1--02, AN
DOCUMENT # R2020-0196741
(Above Space For Recorder's Office Only)
VILLAGE OF OAK BROOK
1200 Oak Brook Road
Oak Brook,IL 60523-2255
RECORDED DOCUMENT TITLE PAGE
Title of Document: RESOLUTION NUMBER 2020-IDOT-FUND-R-1850 A RESOLUTION
REGARDING AN INTERGOVERNMENTAL AGREEMENT BETWEEN THE VILLAGEOFOAK
BROOK,ILLINOIS AND THE STATE OF ILLINOIS DEPARTMENT OF TRANSPORTATION
IN RELAIUN TO FUNDING OF SECTION NUMBER 17-00049-00-PV FOR IMPROVING AN
INTERSECTION AT NORTH YORK ROAD AND HARGER ROAD WITH NEW UNDER�jj
STRUCTURE AT SALT CREEK TRAIL
Property Address/es NORTH YORK ROAD AND HARGER ROAD INT
ERSECTION
(if vacant land,so state and list nearest cross�streets)
SECTION NO. 17-00049-00-PV
Name&Address of Applicant: ALL IDOT DISTRICT ONE LOCAL PUBLIC
201 CENTER CT Qr1U1 CIES
Name&Address of Responsible: Village of Oak Brook
Party to Receive Copy of: 1200 Oak Brook Roa7�_Qak Brook IL 60�523 �
Recorded Document and Billing:
G/L Account to be charged: 171-90400
Prepared By&Return to: Village of Oak Brook
1200 Oak Brook Road
Oak Brook, IL 60523-2255
Name&Address of Recipient N/A
of Consideration(when applicable):
G/L Account to be charged:
if
Illinois Department of Transportation
2300 South Dirksen Parkway/Springfield,Illinois 162764
June 16,2020
Ms.Charlotte Pruss
Village Clerk
1200 Oak Brook Road
Oak Brook, Illinois 60523
Subject: Village: Oak Brook
Section: 17-00049-00-PV
Project: BFN9(911)
Job: C-91-007-18
Construction Engineering Agreement
Consultant: Civiltech Engineering,Inc.
$681,075.00
Dear Ms.Pruss:
The department approved the subject agreement on January 23,2020.
A copy is enclosed. The village may authorize the consultant to proceed with the
engineering work.
No profit on photography.
Please contact Debbie Jarvis(Debbie.Jarvis@iIlinois.gov)if you have any
questions.
Sincerely, a
Gregory S.Lupton,P.E.
Local Project Implementation Engineer
Enclosure
cc: Gopal G.Lalmalani,Village President
Anthony Quigley Region 1 Attn:Chad Riddle-District 1
Attn: Project Control
Civiltech Engineering, Inc.
I Local Public Agency
L il�IOIS trent Consultant
Village of Oak Brook of 0 Transportation
county C Civiltech En ineerin Inc.
DuPa e C 0 Address
Section A N Two Pierce Place Suite 1400
L S City
Project No.
A Construction Engineering � State
Job No. G Services Agreement '
- - 0 - E For TA Zip Code
Contact Name/Phone/E-mail Address N Federal Participation
Doug Patchin;630.368.5270 C N Contact Name Phone/E mail Address
dpatchin@oak-brook.org Y T James D.Ewers; 3.3900
jewers@civiltech i n c.c.comcom
THIS AGREEMENT is made and entered into this ;9__ day of Z
Local Public Agency(LPA)and Consultant(ENGINEER)and covers certain professional engineering service connection wethe above
PROJECT described herein. Federalhe
-aid funds allotted to the LPA by the state of Illinois under the general supervision of the Illinois
Department of Transportation(STATE)will be used entirely or in part to finance engineering services as described under AGREEMENT
PROVISIONS.
WHEREVER IN THIS AGREEMENT or attached exhibits the following terms are used,they shall be interpreted to mean:
Regional Engineer Deputy Director Division of Highways,Regional Engineer,Department of Transportation
Resident Construction Supervisor Authorized representative of the LPA in immediate charge of the engineering details of the PROJECT
In Responsible Charge A full time LPA
employee authorized to administer inherent)
y governmental PROJECT activities
Contractor
Company or Companies to which the construction contract was awarded
Project Description
Name North York Road and Harger Road Route 2678&1446 Length 0.38 mi Structure No.
Termini Intersection of North York Road and Harger Road
Description: The work consists of pavement reconstruction,resurfacing,and widening,underpass structure,HMA bike paths,retaining
walls,storm sewers,earth excavation,erosion control,landscaping,tree removal,proposed trees,lighting improvements and signal
improvements,and all incidental and collateral=landscaping,
to complete the project as shown on the plan.
Agreement Provisions
I. THE ENGINEER AGREES,
1. To perform or be responsible for the performance of the engineering services for the LPA,in connection with the PROJECT
hereinbefore described and checked below:
® a. Proportion concrete according to applicable STATE Bureau of Materials and Physical Research(BMPR)Quality
Control/Quality Assurance(OC/QA)training documents or contract requirements and obtain samples and perform
testing as noted below.
® b. Proportion hot mix asphalt according to applicable STATE BMPR QC/QA training documents and obtain samples
and perform testing as noted below.
® c. For soils,to obtain samples and perform testing as noted below.
® d. For aggregates,to obtain samples and perform testing as noted below.
NOTE: For 1 a.through 1d.the ENGINEER is to obtain samples for testing according to the STATE BMPR"Project
Procedures Guide",or as indicated in the specifications,or as attached herein by the LPA;test according to the
STATE BMPR"Manual of Test Procedures for Materials",submit STATE BMPR inspection reports;and verify
compliance with contract specifications.
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® e. Inspection of all materials when inspection is not provided at the sources by the STATE BMPR,and submit
inspection reports to the LPA and the STATE in accordance with the STATE BMPR"Project Procedures Guide"and
the policies of the STATE.
® f. For Quality Assurance services,provide personnel who have completed the appropriate STATE BMPR QC/QA
trained technician classes.
® g. Inspect,document and inform the LPA employee In Responsible Charge of the adequacy of the establishment and
maintenance of the traffic control.
® h. Geometric control including all construction staking and construction layouts.
® i. Quality control of the construction work in progress and the enforcement of the contract provisions in accordance with
the STATE Construction Manual.
® j. Measurement and computation of pay items.
® k. Maintain a daily record of the contractor's activities throughout construction including sufficient information to permit
verification of the nature and cost of changes in plans and authorized extra work.
® I. Preparation and submission to the LPA by the required forth and number of copies,all partial and final payment
estimates,change orders,records,documentation and reports required by the LPA and the STATE.
® m. Revision of contract drawings to reflect as built conditions.
® n. Act as resident construction supervisor and coordinate with the LPA employee In Responsible Charge.
2. Engineering services shall include all equipment,instruments,supplies,transportation and personnel required to perform the duties
of the ENGINEER in connection with the AGREEMENT.
3. To furnish the services as required herein within twenty-four hours of notification by the LPA employee In Responsible Charge.
4. To attend meetings and visit the site of the work at any reasonable time when requested to do so by representatives of the LPA or
STATE.
5. That none of the services to be furnished by the ENGINEER shall be sublet,assigned or transferred to any other party or parties
without the written consent of the LPA. The consent to sublet,assign or otherwise transfer any portion of the services to be
furnished by the ENGINEER shall not be construed to relieve the ENGINEER of any responsibility for the fulfillment of this
AGREEMENT.
6
The ENGINEER shall submit invoices,based on the ENGINEER's progress reports,to the LPA employee In Responsible Charge,
no more than once a month for partial payment on account for the ENGINEER's work completed to date. Such invoices shall
represent the value,to the LPA of the partially completed work,based on the sum of the actual costs incurred,plus a percentage
7.
(equal to the percentage of the construction engineering completed)of the fixed fee for the fully completed work.
That the ENGINEER is qualified technically and is entirely conversant with the design standards and policies applicable to
improvement of the SECTION,and that the ENGINEER has sufficient properly trained,organized and experienced personnel to
8. perform the services enumerated herein.
That the ENGINEER shall be responsible for the accuracy of the ENGINEER's work and correction of any errors,omissions or
ambiguities due to the ENGINEER'S negligence which may occur either during prosecution or after acceptance by the LPA. Should
any damage to persons or property result from the ENGINEER's error,omission or negligent act,the ENGINEER shall indemnify
the LPA,the STATE and their employees from all accrued claims or liability and assume all restitution and repair costs arising from
such negligence. The ENGINEER shall give immediate attention to any remedial changes so there will be minimal delay to the
contractor and prepare such data as necessary to effectuate corrections,in consultation with and without further compensation from
the LPA.
9.
10. That the ENGINEER will comply with applicable federal statutes,state of Illinois statutes,and local laws or ordinances of the LPA.
The undersigned certifies neither the ENGINEER nor I have:
a) employed or retained for commission,percentage,brokerage,contingent fee or other considerations,any firm or person(other
than a bona fide employee working solely for me or the above ENGINEER)to solicit or secure this AGREEMENT;
b) agreed,as an express or implied condition for obtaining this AGREEMENT,to employ or retain the services of any firm or
person in connection with carrying out the AGREEMENT or
Page 2 of 9 BLR 05611(Rev.11/09/17)
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C) paid,or agreed to pay any firm,organization or person(other than a bona fide employee working solely for me or the above
ENGINEER)any fee,contribution,donation or consideration of any kind for,or in connection with,procuring or carrying out
the AGREEMENT.
d) are not presently debarred,suspended,proposed for debarment,declared ineligible or voluntarily excluded from covered
transactions by any Federal department or agency;
e) have not within a three-year period preceding the AGREEMENT been convicted of or had a civil judgment rendered against
them for commission of fraud or criminal offense in connection with obtaining,attempting to obtain or performing a public
(Federal,State or local)transaction;violation of Federal or State antitrust statutes or commission of embezzlement,theft,
forgery,bribery,falsification or destruction of records,making false statements or receiving stolen property;
f) are not presently indicted for or otherwise criminally or civilly charged by a government entity(Federal,State or local)with
commission of any of the offenses enumerated in paragraph(e)of this certification;and
g) have not within a three-year period preceding this AGREEMENT had one or more public transactions(Federal,State or local)
terminated for cause or default.
11. To pay its subconsultants for satisfactory performance no later than 30 days from receipt of each payment from the LPA.
12. To submit all invoices to the LPA within one year of the completion of the work called for in this AGREEMENT or any subsequent
Amendment or Supplement.
13. To submit BLR 05613,Engineering Payment Report,to the STATE upon completion of the work called for in the AGREEMENT.
14. To be prequalified with the STATE in Construction Inspection when the ENGINEER or the ENGINEER's assigned staff is named as
resident construction supervisor. The onsite resident construction supervisor shall have a valid Documentation of Contract
Quantities certification.
15. Will provide,as required,project inspectors that have a valid Documentation of Contract Quantities certification.
11. THE LPA AGREES,
1. To furnish a full time LPA employee to be In Responsible Charge authorized to administer inherently governmental PROJECT
activities.
2. To furnish the necessary plans and specifications.
3. To notify the ENGINEER at least 24 hours in advance of the need for personnel or services.
4. To pay the ENGINEER as compensation for all services rendered in accordance with this AGREEMENT,on the basis of the
following compensation formulas:
Cost Plus Fixed Fee
Formulas
❑ FF=14.5%[DL+R(DL)+OH(DL)+IHDC],or
® FF=14.5%[(2.3+R)DL+IHDC)
Where: DL=Direct Labor
IHDC=In House Direct Costs
OH=Consultant Firms Actual Overhead Factor
R=Complexity Factor
FF=Fixed Fee
SBO=Services by Others
Total Compensation=DL+IHDC+OH+FF+SBO
Specific Rate ❑ (Pay per element)
lump Sum ❑
5. To pay the ENGINEER using one of the following methods as required by 49 CFR part 26 and 605 ILCS 5/5-409'
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❑With Retainage
a) For the first 50%of completed work,and upon receipt of monthly invoices from the ENGINEER and the approval thereof by
the LPA,monthly payments for the work performed shall be due and payable to the ENGINEER,such payments to be equal to
90%of the value of the partially completed work minus all previous partial payments made to the ENGINEER.
b) After 50%of the work is completed,and upon receipt of monthly invoices from the ENGINEER and the approval thereof by
the LPA,monthly payments covering work performed shall be due and payable to the ENGINEER,such payments to be equal
to 95%of the value of the partially completed work minus all previous partial payments made to the ENGINEER.
c) Final Payment—Upon approval of the work by the LPA but not later than 60 days after the work is completed and reports have
been made and accepted by the LPA and the STATE,a sum of money equal to the basic fee as determined in this
AGREEMENT less the total of the amounts of partial payments previously paid to the ENGINEER shall be due and payable to
the ENGINEER.
®Without Retainage
a) For progressive payments—Upon receipt of monthly invoices from the ENGINEER and the approval thereof by the LPA,
monthly payments for the work performed shall be due and payable to the ENGINEER,such payments to be equal to the value
of the partially completed work minus all previous partial payments made to the ENGINEER.
b) Final Payment—Upon approval of the work by the LPA but not later than 60 days after the work is completed and reports have
been made and accepted by the LPA and STATE,a sum of money equal to the basic fee as determined in this AGREEMENT
less the total of the amounts of partial payments previously paid to the ENGINEER shall be due and payable to the ENGINEER.
6. The recipient shall not discriminate on the basis on the basis of race,color,national origin or sex in the award and performance of
any DOT-assisted contract or in the administration of its DBE program or the requirements of 49 CFR part 26. The recipient shall
take all necessary and reasonable steps under 49 CFR part 26 to ensure nondiscrimination in the award and administration of DOT-
assisted contracts. The recipient's DBE program,as required by 49 CFR part 26 and as approved by DOT,is incorporated by
reference in this agreement. Implementation of this program is a legal obligation and failure to carry out its terms shall be treated as
violation of this agreement. Upon notification to the recipient of its failure to carry out its approved program,the Department may
impose sanctions as provided for underpart 26 and may,in appropriate cases,refer the matter for enforcement under 18 U.S.C.
1001 and/or the Program Fraud Civil Remedies Act of 1986(31 U.S.C.3801 at seq.).
7. To submit approved form BC 775(Exhibit C)and BC 776(Exhibit D)with this AGREEMENT.
S. To certify by execution of this AGREEMENT that the selection of the ENGINEER was performed in accordance with the Local
Government Professional Services Selection Act 50 ILCS 510,the Brooks Act 40USC 11,and Procurement,Management,and
Administration of Engineering and Design related Services(23 CFR part 172). Exhibit C is required to be completed with this
agreement.
III. It is Mutually Agreed,
1. That the ENGINEER and the ENGINEER's subcontractors will maintain all books,documents,papers,accounting records and
other evidence pertaining to cost incurred and to make such materials available at their respective offices at all reasonable times
during the AGREEMENT period and for three years from the date of final payment under this AGREEMENT,for inspection by the
STATE,Federal Highway Administration or any authorized representatives of the federal government and copies thereof shall be
furnished if requested.
2. That all services are to be furnished as required by construction progress and as determined by the LPA employee In Responsible
Charge. The ENGINEER shall complete all services specified herein within a time considered reasonable to the LPA,after the
CONTRACTOR has completed the construction contract.
3. That all field notes,test records and reports shall be turned over to and become the property of the LPA and that during the
performance of the engineering services herein provided for,the ENGINEER shall be responsible for any loss or damage to the
documents herein enumerated while they are in the ENGINEER's possession and any such loss or damage shall be restored at the
ENGINEER's expense.
4. That this AGREEMENT may be terminated by the LPA upon written notice to the ENGINEER,at the ENGINEER's last known
address,with the understanding that should the AGREEMENT be terminated by the LPA,the ENGINEER shall be paid for any
services completed and any services partially completed. The percentage of the total services which have been rendered by the
ENGINEER shall be mutually agreed by the parties hereto.The fixed fee stipulated in numbered paragraph 4d of Section II shall be
multiplied by this percentage and added to the ENGINEER's actual costs to obtain the earned value of work performed.All field
notes,test records and reports completed or partially completed at the time of termination shall become the property of,and be
delivered to,the LPA.
5. That any differences between the ENGINEER and the LPA concerning the interpretation of the provisions of this AGREEMENT
shall be referred to a committee of disinterested parties consisting of one member appointed by the ENGINEER,one member
appointed by the LPA,and a third member appointed by the two other members for disposition and that the committee's decision
shall be final.
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6. That in the event the engineering and inspection services to be furnished and performed by the LPA(including personnel furnished
by the ENGINEER)shall,in the opinion of the STATE be incompetent or inadequate,the STATE shall have the right to supplement
the engineering and inspection force or to replace the engineers or inspectors employed on such work at the expense of the LPA.
7. That the ENGINEER has not been retained or compensated to provide design and construction review services relating to the
contractor's safety precautions,except as provided in numbered paragraph 11 of Section I.
8. This certification is required by the Drug Free Workplace Act(301LCS 580). The Drug Free Workplace Act requires that no grantee
or contractor shall receive a grant or be considered for the purpose of being awarded a contract for the procurement of any property
or service from the State unless that grantee or contractor will provide a drug free workplace. False certifiration or violation of the
certification may result in sanctions including,but not limited to,suspension of contract or grant payments,termination of a contract
or grant and debarment of contracting or grant opportunities with the Slate for at least one(1)year but no more than five(5)years.
For the purpose of this certification,"grantee"or"contractor'means a corporation,partnership or other entity with twenty-five(25)or
more employees at the time of issuing the grant,or a department,division or other unit thereof,directly responsible for the specific
performance under a contract or grant of$5,000 or more from the State,as defined in the Act.
The contractor/grantee certifies and agrees that it will provide a drug free workplace by:
(a) Publishing a statement:
(1) Notifying employees that the unlawful manufacture,distribution,dispensing,possession or use of a
controlled substance,including cannabis,is prohibited in the grantee's or contractors workplace.
(2) Specifying the actions that will be taken against employees for violations of such prohibition.
(3) Notifying the employee that,as a condition of employment on such contract or grant,the employee will:
(A) abide by the terms of the statement;and
(B) notify the employer of any criminal drug statute conviction for a violation occurring in the workplace
no later than five(5)days after such conviction.
(b) Establishing a drug free awareness program to inform employees about:
(1) the dangers of drug abuse in the workplace;
(2) the grantee's or contractors policy of maintaining a drug free workplace;
(3) any available drug counseling,rehabilitation and employee assistance program;and
(4) the penalties that may be imposed upon an employee for drug violations.
(c) Providing a copy of the statement required by subparagraph(a)to each employee engaged in the performance
of the contract or grant and to post the statement in a prominent place in the workplace.
(d) Notifying the contracting or granting agency within ten(10)days after receiving notice under part(B)of
paragraph(3)of subsection(a)above from an employee or otherwise receiving actual notice of such conviction.
(e) Imposing a sanction on,or requiring the satisfactory participation in a drug abuse assistance or rehabilitation
program by,any employee who is convicted,as required by section S of the Drug Free Workplace Act.
(f) Assisting employees in selecting a course of action in the event drug counseling,treatment and rehabilitation is
required and indicating that a trained referral team is in place.
(g) Making a good faith effort to continue to maintain a drug free workplace through implementation of the Drug Free
Workplace Act.
9, The ENGINEER or subconsultant shall not discriminate on the basis of race,color,national origin or sex in the performance of this
AGREEMENT. The ENGINEER shall carry out applicable requirements of 49 CFR part 26 in the administration of DOT-assisted
contracts. Failure by the ENGINEER to carry out these requirements is a material breach of this AGREEMENT,which may result in
the termination this AGREEMENT or such other remedy as the LPA deems appropriate.
10. When the ENGINEER is requested to complete work outside the scope of the original AGREEMENT,a supplemental AGREEMENT
will be required.Supplements will also be required for the addition or removal of subconsultants,direct costs,the use of previously
unspecified staff,and other material changes to the original AGREEMENT.
Page 5 of 9
Printed on 11/21/2019 4:05:00 PM BLR 05611(Rev.11/09/17)
A reement Summa
Prime Consultant: IN Number
Civiltech Engineering, Inc. — A reement Amount
36-3606666 1624,075.00
Sub-Consultants:
Midland Standard Engineering TIN Number&Testin , Inc. A reement Amount
20-2435502 $57,000.00
Sub-Consultant Total: $57,000.00
Prime Consultant Total: $624,075.00
Total for all Work: $681,075.00
Executed by the LPA:
Village of Oak Brook
(MunicipalitylTownship/County)
ATTES
By: _
By:
Village Cl
St O F 04,t Title: Village Manager
va
(SEAL) yam~ 90
G y
Executed by the ENGINEER:
ATTEST: elotj TY � Civiltech Engineering, Inc.
By: (�
By:
Title: Vice President
Title: President
Page 6 of 9
Printed on 11/21/2019 4:05:00 PM BLR 05611 (Rev. 11/09/17)
Exhibit A-Construction Engineering
Route: FAU 2678 York Rd and FAU 1446 Hager Rd
Local Village of Oak Brook
(Municipality/Township/County) 'Firm's approved rates on f7withSection: 17-00049-00-PV Bureau of Accounting and A
Project: BFN9(911)
Job No.: C-91-007-18 Overhead Rate (OH) 117.73 %
Complexity Factor(R) 0.00
Calendar Days
Cost Plus Fixed Fee Methods of Compensation:
Fixed Fee 1 ❑ 14.5%[DL + R(DL) + OH(DL) + IHDC]
Fixed Fee 2 ® 14.5%[(2.3 + R)DL + IHDC]
Specific Rate ❑
Lump Sum ❑
Cost Estimate of Consultant's Services in Dollars
Element of Work Employee
Classification Man- Payroll Payroll Costs Overhead Services by In-House
Hours Rate (DL) (OH"DL) Others Direct Costs Fixed Fee
(SBO) (IHDC) (FF) Total
See attached Cost Estimate of
Consultant's Services
Totals 0.00
Page 7 of 9
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BLR 05611 (Rev. 11/09/17)
Exhibit A-Construction Engineering
COST ESTIMATE OF CONSTRUCTION SERVICES
PHASE III ENGINEERING SERVICES
York-Harger Intersection& Underpass Improvement
Village of Oak Brook
Route: FAU 2678&1446;York-Harger Intersection&Underpass Improvement
Local Agency: Village of Oak Brook
Section No.: 17-00049-00-PV 'Includes annual increase(3%)for work in 2020
Project No.: BFN9(911) '•Rnn's approved Over Head rate on file with IDOTs
Job No.: C-91-007-18 Bureau of Accounting and Auditing is 117.73%
County: DuPage "`Labor x rector
x 2. =Rxed Fee
Complexity factor(R=0.00 0.00)
Consultant:Clvlltech En Ineerin ,Inc.
Prepared: 11/14/2019
r.•
Payrdl,Burden&
Payroll Payroll Fringe Costs: Fixed
Rate* Costs Overhead&Expenses Fee" TOTAL
x 1.177 Labor x 0.3157
Construction Engineering: Res.Engr.V 2,663 54,10% $ 55.62 $ 148,116 $ 174,377 $ 46,760 $ 369,253
Asst.RE(Res.Engr.111) 1,975 40.13% $ 39.57 $ 78,151 $
92,007 $ 24,672 $ 194,830
Inspector(Res.Engr.I) 0 0.00% $ 30.39 $ _ $
Intern(Field Tech.I) 0 $ $
0.00% $ 38.86 $ $ _ $ _ $
Chief Layout Specialist 184 3.74% $ 35.02 $ 6,444 $
7,587 $ 2,034 $ 16,065
Structural Engr.IV 48 0.98% $ 42.23 $ 2,027 $
2,386 $ 640 $ 5,053
Sr.Proj.Mngr. 52 1.06% $ 70.00 $ 3,640 $
4,285 $ 1,149 $ 9,074
Direct Expenses: SUBTOTAL
1.)Vehicle Expense $ 594,275
2.)Material Testing $ 29,150
3.)Soils Monitoring $ 57,000
4.)Printing Expense $
5.)Photo ra h $ Soo
rr rr
$ 150
:r r
1.)530 Days @$55.00/Day
2.)Material Testing(Midland Standard Engineering&Testing,Inc.)
3.)Soils Monitoring
4.)Estimated printing expense for Record Drawings
5.)Estimated photography expense
I11Inob Department Engineering Payment Report
of Transportation (Submit with Final Invoice)
Prime Consultant
Name Civiltech Engineering, Inc.
Address Two Pierce Place, Ste. 1400, Itasca, IL 60143
Telephone 630.773.3900
TIN Number 36-3606666
Project Information
Local Agency Village of Oak Brook
Section Number 17-00049-00-PV
Project Number BFN9(911)
Job Number C-91-007-18
This form is to verify the amount paid to the Sub-consultant on the above captioned contract. Under penalty of law for
perjury or falsification, the undersigned certifies that work was executed by the Sub-consultant for the amount listed below.
Sub-Consultant Name TIN Number Actual Payment
Midland Standard Engineering & Testing, Inc 20-2435502 from Prime
Sub-Consultant Total.
Prime Consultant Total:
Total for all Work
Completed:
Signature and title of Prime Consultant Date
Note: The Department of Transportation is requesting disclosure of information that is necessary to accomplish the
statutory purpose as outlined under state and federal law. Disclosure of this information is REQUIRED and shall be
deemed as concurring with the payment amount specified above.
For information about IDOTs collection and use of confidential information review the department's Identity Protection Policy.
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Exhibit C
Federal Qualification Based Selection(QBS)Checklist
Local Public Agency Village of Oak Brook
Section Number 17-00049-00-PV
Project Number BFN9(911)
Job Number C-91-007-18
The LPA must complete Exhibit C, if federal funds are used for this engineering agreement and the value will exceed
$25,000. The LPA must follow federal small purchase procedures,if federal funds are used and the engineering agreement
has a value less than$25,000.
❑Form Not Applicable(engineering services less than$25,000)
1. Do the written QBS policies and procedures discuss the initial administration (procurement, management, and
administration)concerning engineering and design related consultant services? ❑Yes ❑No
2. Do the written QBS policies and procedures follow the requirements as outlined in Section 5-5 and specifically
Section 5-5.06(e)of the BLRS Manual? ❑Yes ❑ No
If no,IDOT's approval date:
3. Was the scope of services for this project clearly defined? ®Yes ❑No
4. Was public notice given for this project? ❑Yes ❑No Due date of submittal:04/28/2017
Method(s)used for advertisement and dates of advertisement:_
Village of Oak Brook selected Civiltech Engineering for Phases I II &III in Feb of 2017 prior to the requirement of
this form.
5. Do the written QBS policies and procedures cover conflicts of interest? ❑Yes ❑No
6. Do the written QBS policies and procedures use covered methods of verification for suspension and debarment?
❑Yes ❑No
7. Do the written QBS policies and procedures discuss the method of evaluation? ❑Yes ❑No
Criteria for this project Weighting Criteria for this project Weighting
%
8. Do the written QBS policies and procedures discuss the method of selection? ❑Yes ❑No
Selection committee(titles)for this project:
Top three consultants selected for this project in order: 1)_
2)— 3)
If less than 3 responses were received,IDOT's approval date:
9. Was an estimated cost of engineering for this project developed in-house prior to contract negotiation?
®Yes ❑No
10. Were negotiations for this project performed in accordance with federal requirements? ®Yes ❑No
11. Were acceptable costs for this project verified?
®Yes ❑No ❑LPA will rely on IDOT review and approval of costs.
12. Do the written QBS policies and procedures cover review and approving for payment,before forwarding the request
for reimbursement to IDOT for further review and approval? ❑Yes ❑No
13. Do the written QBS policies and procedures cover ongoing and finalizing administration of the project(monitoring,
evaluation,closing-out a contract,record retention,responsibility,remedies to violations or breaches to a contract,
and resolution of disputes)? ❑Yes ❑No
Page 9 of 9 BLR 05611(Rev.11/09/17)
Printed on 11/21/2019 4:0500 PM
York-Harger Intersection & Underpass Improvement
Summary of Direct Costs
Route: FAU 2678 & 1446; York-Harger Intersection &Underpass Improvement
Local Agency: Village of Oak Brook
Section No.: 17-00049-00-PV
Proj. No.: BFN9(911)
Job No.: C-91-007-18
County: DuPage
Contract No.: 61 G16
Direct Costs:
Printing Expense
Assume 2 large sets for working drawings & 1 set for final "As-Builts"
Bond Prints: 3 sets X 200 sheets/set X $0.86 per sheet = $516.00
Total = $516.00
Say: $500.00
Assume 15 sets of developed digital pictures @$10.00 ea. = $150.00
Total: $150.00
iVehicle Expense
530 vehicle days required @ $55.00 per day = $29,150.00
Total: $29,150.00
e�91 Qtino� p� trn�t
�� Direct Costs Check Sheet
COMPANY NAME: Civiltech Engineering,Inc.
PTB NUMBER March 2020 Letting;York/Harger-Oak Brook
TODAY'S DATE: 2/412020
Per Diem (per GOVERNOR'S TRAVEL CONTROL
BOARD) Up to state rate maximum $000 $000
Lodging(per GOVERNOR'S TRAVEL CONTROL
BOARD) Actual cost(Up to state rate maximum)
$0.00,' $0.00
Air Fare Coach rate,actual cost,requires minimum two weeks'notice,
with prior IDOT approval $0.00 $0.00
Vehicle Mileage(per GOVERNOR'S TRAVEL
CONTROL BOARD) Up to state rate maximum $0.00 $0.00
Vehicle Owned or Leased $32.50/half day(4 hours or less)or$65/full day
530 $5500 $29,15000
Vehicle Rental Actual cost(Up to$55/day) 1
Tolls $0.00 $0.00
Actual cost
Parking $0.00 $0 00
Actual cost $0.00
Overtime $0.00
Premium portion(Submit supporting documentation) 0 $19.16 $0.00
Shift Differential Actual cost(Based on firm's policy)
Overnight Delivery/Postage/Courier Service $0.00 $0.00
Actual cost(Submit supporting documentation) 0
$24.00 $0.00
Copies of Deliverables/Mylars(In-house) Actual cost(Submit supporting documentation) 600
$0.83 $50.00
Copies of Deliverables/Mylars(Outside) Actual cost(Submit supporting documentation) 0
$
$3.00 $0.00
Project Specific Insurance Actual cost
Monuments(Permanent) Actual cost $0.00 $0.00
Photo Processing Actual cost $0.00 $0.00
2-Way Radio(Survey or Phase III Only) Actual cost 15 $10.00 $150.00
$0.00 $0.00
Telephone Usage(Traffic System Monitoring Only) Actual cost
$0.00 $0,00
CADD Actual cost(Max$15/hour)
Web Site Actual cast(Submit supporting documentation) $0.00 $0.00
00 $0.00
Advertisements
Actual cast(Submit supporting documentation) $0.
$0.00
Public MeetingFacility Rental $0.00
y Actual cost(Submit supporting documentation)
Public Meeting Exhibits/Renderings 8 Equipment Actual cost( supporting Submit su g documentation) $0.00 $0.00 Recording Fees Actual cost $0.00 $000
Transcriptions(specific to project) Actual cost $0.00 $0,00
Courthouse Fees $0 00 $000
Actual cost $0,00
Storm Sewer Cleaningand Televising $0.00
9 Actual cost(Requires 2-3 quotes with IDOT approval) $0.00 $0.00
Traffic Control and Protection Actual cost(Requires 2-3 quotes with IDOT approval)
Aerial Photography and Mapping Actual cost(Requires 2-3 quotes with IDOT approval) $0.00 $0.00
Utility Exploratory Trenching Actual cost(Requires 2-3 quotes with IDOT approval) $000 $0.00
Testing of Soil Samples' Actual cost $0.00 $0.00
Lab Services' Actual cost(Provide breakdown of each cost) $0.00 $0.00
$0.00 $0.00
Equipment and/or Specialized Equipment Rental' Actual cost(Requires 2-3 quotes with IDOT approval)
$0.00 $0.00
$0.00' $0.00
$0.001 $000
$0.00 $000
$000 $0.00
$0.00 $0.00
$0.00 $000
$000 $0.00
$000 $0.00
$0.00 $000
TOTAL DIRECT COST $000 $0.00
other allowable costs are needed and not listed,please add in the above spaces provided. $29,800.80
LEGEND
W O.=Work Order
J S.=Job Specific
PRINTED 2/4/2020
BIDE 436(Rev.09/30/13)
York-Harger Intersection&Underpass Improvement
Village of Oak Brook
Anticlpated Contractor's Schedule
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MIDLAND STANDARD ENGINEERING&TESTING,INC.
410 Nolen Drive
South Elgin,Illinois 60177
(847)844-189Sf(847)844-3875
November 23,2019
Mr.James D.Ewers,P.E.
Civiltech Engineering,Inc.
Two Pierce Place
Suite 1400
Itasca,Illinois 60143
Re: Quality Assurance Inspection and Testing Services
York Road&Harger Road Intersection Improvements
DuPage County,Illinois
Dear Mr.Ewers:
We have prepared this unit rate and cost estimate proposal to provide Quality Assurance
services for your projects in DuPage, Illinois. In this proposal we have included rates for
personnel,equipment and materials to conduct field inspection for earthwork,field inspection
of subgrade soils and backfill,portland cement concrete and hot mix asphalt,laboratory testing
and documentation required.
We propose to provide the necessary inspections and testing using experienced, certified
personnel and recognized test procedures developed by IDOT,ASTM,AASHTO,ACI,etc. Our
services would be provided at the request of your designated representative on a unit rate basis
in accordance with the Schedules of Services and Fees-Attachment 1,included in this proposal
package. The final cost of these services will be based upon the total amount of work
performed. We are staffed and equipped to aid you in the successful completion of your
projects and are available to discuss any aspect of our proposal at your convenience.
Based on the project information submitted we have prepared cost estimates for the
anticipated work. The estimate submitted assumes PREVAILING WAGE work.The final cost of
these services will be based upon the total amount of work performed.
Sincerely,
MIDLAN S�ANDARD N EERING&TESTING,INC.
( .L4'
William D.Prigge,P.E.
President
W DP/mlj
Attachment 1:Schedule of Services and Fees
Attachment 1.1:Cost Estimate
11Q[g Local Public Agency Resident
of Va Construction Supervisor/In
Responsible Charge
Anthony J. Quigley, P.E.
Deputy Director Division of Highways County DuPage
Regional Engineer Municipality Village of Oak Brook i
Department of Transportation Section 17-00049-00-PV I
201 W. Center Ct. Route FAU 2678& 1446
Schaumburg, Illinois 60196 Contract No. 61G16
Job No. C-91-007-17
Project BFN9(911)
❑ I recommend the following individual as a local public agency employee qualified to be resident construction supervisor
and to be in responsible charge of this construction project.
�j 1 certify that I am in responsible charge as defined by the department of this construction project. Since the local public
agency does not have a local public agency employee qualified to be the resident construction supervisor, I am
r mmending a consulting engineer to s�rPe� res' ent const an supervisor.
2/ �1S11
eV 1
D e Signature and Title(for the Local Public Agency)
I
Arthur F. Polhowicz P.G.
Applicants Name(Type or Print)The following describes my educational background, experience and other qualifications to be resident construction
supervisor of this construction project for the Local Public Agency.
For Consultants: I certify that my firm is prequalified in Construction Inspection and my Documentation of Contract
Quantities certificate number is 15-0103.
Mr. Arthur F. Politowicz of Civiltech Engineering will be the Field Inspecting Resident Engineer(F.I.R.E.)for this project. Mr
Politowicz has completed multiple Federal projects that were Let through IDOT Civiltech Engineering is prequalified by IDOT
in Special Services. Construction Inspection.
/12 ► Zd
Date Signature of Field Inpecting Resident Engineer(FIRE)
Applicant _ .bb TWe of Applicant
Based on the above information and my knowledge of cants experience and trainingt is my o 'nion that the
applicant is qualified to serve as the resident constru77=:;ZJJ
prot
// e
Approved �.7 Zv e4c e
Date -- ig /s R ' n �r
cc: Engineer of Local Roads and Streets, Central Bureau of Local Roads and Streets
Engineer of Construction, Central Bureau of Construction
Resident Construction Supervisor
Local Public Agency
Printed 1/21/2020 Page t of 2
ec 775(Rev 09/10,92)