APPENDIX G – CLOSEOUT DOCUMENTS Appendix G.01.1 (F.15.1) - MCDOT Construction Closeout Checklist (Contract/Project)

Appendix G.02.1 - MCDOT Construction Contract Closeout (Final Pay) Documents List

(includes the following document examples, referred to as exhibits for illustration)

Following documents are required as part of the Final Payment submittal package

Release of Retention Request (exhibit A)

Final Progress Estimate (Retention Release) (exhibit B)

Final Quantity Adjustment Change Order (exhibit C)

Certification of Performance and Payment of All Claims (COP) (exhibit D)

Contractor Affidavit (exhibit E)

Consent of Surety and Power of Attorney (exhibit F & G)

County SBE Participation Reporting Form (exhibit H)

Following Construction Engineer Reports, separate of the Final Payment package

Completion Report (exhibit I)

Pay Item Overrun / Underrun Explanation (exhibit J)

Final Quantity Adjustment Change Order (exhibit C)

Appendix G.03.1 - Environmental Compliance Certification Form

C /

P

Brief DescriptionCompleted

(Initial)Does Not

Apply

C Verify completion of work and construction quality; communicate additional workrequirements (punch list) to the contractor.

C Final Acceptance following completion of all punch list items and the Engineer has determined that all Contractor's field work is complete.

C Final Pay Estimate is for release of retention Only (unless Contractor posted securities in escrow). Payment of final work performed quantities is made with the prior Pay Estimate.

C Compares as‐built and as‐bid quantities and adjusts all quantities to 100% paid. Serves as change order for final contract amount. Part of Final Pay Estimate.

C MCDOT sent release authorization to bank for escrow account (if posted in‐lieu of retention)

C Summary of project, summary of change orders, recommending acceptance, sealed and signed by the Resident Engineer. Submitted with, but not part of Final Pay Estimate.

C This report includes all bid items that vary from estimated quantity by 10% or more, or dollar amounts over $15,000. Submitted with, but not part of Final Pay Estimate.

P Record Drawings (as‐builts) with Engineers seal and signature and Record Drawing Certification on cover sheet. Refer to MCDOT Record Drawing SOP

P Materials testing plan showing the original plan and the actual testing done, signed bythe Engineer.

P All photos and video logs taken before, during and after completion of projectsubmitted to MCDOT.

P Hard‐copy files per MCDOT Construction file standards. All electronic Record Document files prepared and submitted per the MCDOT Construction file standards.

P Location and data for new or relocated monuments have been sent to MCDOT Survey Branch.

P Submittals, O&M manuals, instructions submitted to MCDOT; also, if required by thecontract: spare parts for signals, irrigation systems, salvage items, etc.

P Sorted, bound, and labeled by lots/dates.

C MCDOT PM, ADOT LPA Certification Acceptance Coordinator, ADOT UPM PM andFHWA Coordinator invited to final inspection.

P Copy of Final Acceptance letter sent to MCDOT Federal Aid Coordinator (who will file and forward to ADOT/FHWA Coordinator as part of the MCDOT federal reimbursement request).

C Summary of conformance to labor standards: includes employee interviews, payroll certifications, and evidence of restitution if there were underpaid employees.

P A final materials closeout report requiring ADOT's Materials Group approval.

P Record Drawings (as‐builts) with Engineers seal and signature and Record Drawing Certification on cover sheet provided to MCDOT Federal Aid Coordinator.

C Training hours report and form must be provided to the MCDOT Federal‐Aidcoordinator (when Training is a contract requirement).

C Buy America checklist for materials certifications must be provided to the MCDOTFederal‐Aid Coordinator.

P Conditions specified in IGA has been satisfied.

P Conditions specified in TCE has been satisfied.

P All cost‐sharing partners have been invoiced for their final/total share of construction cost.

P Environmental Compliance Form is submitted. Construction Engineer Certification that mitigation measures completed according to EA. If exceptions, attach details.

C Requirements have been completed and the contractor has submitted the Notice ofTermination to ADEQ or EPA (required for Indian Community land).

C Permits requirements for working within ADOT R/W have been satisfied and the"Permit Closing" letter returned.

C Requirements satisfied and letter sent to COE closing the permit.

C Requirements have been satisfied.

C Applies where contractor must acquire a permit form a utility or city, as specified inthe contract, and all permit requirements have been satisfied.

P Applies where MCDOT CM Consultant is responsible for permit inspection of utilitycompany work within project limits; permits returned to MCDOT.

P Permit form "Start/Completion/Emergency Notice" needs to be closed.

C Provided by the contractor ‐ signed by the authorized representative of the Surety with General Power of Attorney attached. Part of Final Pay Estimate (Retention Release).

C Two signed certifications by Contractor that all work has been fully completed and all claims paid. Part of Final Pay Estimate (Retention Release).

C MCDOT SBE report required with all payments. Part of Final Pay Estimate (Retention Release).

MCDOT Project Construction Engineer

MCDOT Closeout Checklist for Construction Contracts / Construction Projects C = Required for Contract Closeout (Final Payment) / P = Required for Construction Project Closeout

Project No.:

Document

Cons

truc

tion

Engi

neer

\ C

onsu

ltant

Res

iden

t Eng

inee

r

Final Inspection and Letter ofSubstantial Completion

Final Pay Estimate (Retention Release)

Pay Item Overrun and Underrun Explanation

Completion Report

Record Drawings

Materials Testing Plan

Photo and Video Logs

Project Files

Survey Monuments

Shop Drawings & O&M Manuals

Load Tickets

Fede

ral A

id P

roje

cts

Final Inspection

Final Acceptance Letter to ADOT

Labor Documentation Summary (including DBE Final Affidavits)

Materials Final Closeout

Record Drawings

On Job Training Closeout

Buy America

Project Name:

Submitted By / Date:

Date

Letter of Final Acceptance

Final Quantity Adjustment ChangeOrder

Escrow Release

MCDOT ROW Permit

ADOT Access Permit

Corps of Engineers 404 Permit

EPA Clean Water Act 401Certification

City and Utility Permits

Reviewed and Accepted

Cont

ract

or Consent of Surety

Certificate of Performance (COP) and Payment of Claims Affidavit

SBE participation report

TCE'

s an

d

IGA No.

TCE No.

Final Invoice to Partners

Perm

its

Environmental Assessment/Clearance ‐ Compliance Certification

SWPPP

MCDOT Utility Permits

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MCDOT CONSTRUCTION CONTRACT CLOSEOUT

(FINAL PAYMENT) DOCUMENTS

The following documents must be completed and submitted to MCDOT for construction contract

closeout (Final Payment). Examples of the described documents, referred to as exhibits for illustration

purposes, are included herein.

Note: The final payment on MCDOT construction projects is Only for release of monies retained on the

contract. Before proceeding with the final retention release payment estimate, the Construction

Engineer will prepare and submit a payment estimate for all remaining and final quantities of work

performed. The subsequent final payment (retention release) estimate should not be submitted until

the Construction Engineer has verified that payment has been made for all work performed.

Construction Engineer Prepared Progress Report Estimates

Progress Report Estimate for final work performed quantities This progress estimate is the last payment for work performed on the project. The resulting Total To Date Quantities of this progress estimate represent the final, reviewed and approved - quantities of work performed on the project. This progress estimate will be accompanied by the Contractors usual Maricopa County Small Business Enterprise (SBE) Program Participation Reporting Form that is required for all payments.

Final Progress Estimate (Retention Release) - SEE EXHIBIT B - The Final Progress Estimate for release of monies retained is submitted after the Progress Report Estimate for final work performed is paid. This document is developed utilizing the full progress estimate with ZQuantities and Dollars Earned. The Cover sheet must have a subsequent estimate number (i.e., if Estimate No. 4 was the final work performed payment, then the release document would be Estimate No. 5) FINAL - RETENTION RELEASE . The

of the progress estimate detailed line item sheets. This Final Progress Estimate is the second document in the retention release submittal package.

Release of Retention Request SEE EXHIBIT A - The Construction Engineer also completes the Release of Retention Release form required by the Finance Division for retention release. This internal MCDOT form summarizes the requested retention release and references the Final Progress Estimate. The form is signed by the Construction Engineer, the Chief Construction Engineer, the PC&I Division Manager, the Finance Support Supervisor and then the Finance Accountant once the release is completed. This Release of Retention Request is the first document in the retention release submittal package.

Final Quantity Adjustment (FQA) Change Order SEE EXHIBIT C - Accompanying the Final Progress

The FQA serves as a Change Order that adjusts the as-bid original contract amount to the final as-built cost of the project. It compares the as-bid and as-built quantities of each item and has the effect of adjusting all quantities to 100% paid. The FQA is the third document in the retention release submittal package.

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Contractor Submittals Required for Final Payment

Accompanying the Final Progress Report Estimate (Retention Release) are five documents which must

be submitted by the Contractor. These documents must be included in the retention release submittal

package and follow the Final Progress Estimate (Retention Release) and FQA in the order below.

Certificate of Performance (COP) SEE EXHIBIT D - County form provided in the Contract by which the Contractor certifies performance of the construction contract and payment of all claims.

SEE EXHIBIT E - which states that the contractor has fully performed all work required and that all claims have been paid.

- SEE EXHIBIT F - This is the Surety (Bonding Company) consent to final payment.

- SEE EXHIBIT G - The Consent of Surety must have with it the Power of Attorney confirming the authorized signature is valid.

SBE Participation Report - SEE EXHIBIT H - Accompanying the Final Progress Estimate (Retention Release) is the Contractors usual Maricopa County Small Business Enterprise (SBE) Program Participation Reporting Form that is required for all payments.

Note that for projects with a one-year landscape establishment period - the COP, Affidavit, Consent of

Surety with Power of Attorney are not submitted until the conclusion of the landscape establishment

period.

Construction Engineer Reports submitted in Support of Final Payment

The Construction Engineer will also provide the following reports when submitting the Final Payment

(Retention Release) package. The reports are considered separate documents from the Final Payment

Estimate package and are placed in the project records in support of the Final Payment and the

construction project closeout.

Completion Report SEE EXHIBIT I - The Construction Engineer must develop and submit a

the second and subsequent pages provide a brief narrative of work progress, and a final statement recommending project acceptance. The Construction Engineer must sign and seal this document. The following are referenced in, and are part of, the Completion Report

Pay Item Overrun/Underrun Explanation SEE EXHIBIT J - As part of the Completion Report and in support of the Final Payment Quantities, the Engineer must complete and submit a document titled

$15,000 or 10% must have an accompanying explanation giving the reason for the overrun or underrun.

Final Quantity Adjustment (FQA) Change Order The FQA which accompanies the Final Progress Report Estimate (Retention Release) is referenced in and also included as part of the Completion Report - -

EXHIBIT A

A-2

MARICOPA COUNTY DEPARTMENT OF TRANSPORTATION

PROGRESS REPORT ESTIMATE

Estimate No 6 (FINAL) Date: 5/7/2020Project High Friction Surface Treatment Work Order No: TT0581

Date Started Date Completed:Contractor : The Truesdell Corporation Address: 1310 W 23rd Street

Tempe, AZ 85282 Contractual

Percent Complete: 94% Completion Date: 03/30/20

JOB NUMBER: TT0581ACTIVITY CODE: TSYSOBJECT CODE: 9400-15

CREW: 4000Unit: 6472

C-64-19-089-5-00 See Attached2019-001

TOTAL EARNED BY CONTRACTOR $330,313.83LESS 0 % RETAINED/ESCROW $0.00NET AMOUNT DUE CONTRACTOR $330,313.83

DEDUCT PREVIOUS PAYMENTS $313,798.14OTHER DEDUCTIONS $0.00TOTAL DEDUCTIONS $313,798.14

AMOUNT EARNED THIS ESTIMATE $0.00

AMOUNT TO BE PAID TO CONTRACTOR THIS ESTIMATE (After Retention Withheld) $16,515.69

The undersigned Contractor certifies that the work covered by this application for payment has been completed in accordance

with the Contract Documents, and, pursuant to A.R.S. 34-221 or A.R.S. 34-609 as applicable, the Contractor has applied the

proceeds of previous payments to pay all subcontractors and material suppliers then due and owing.

Prepared by Date

Owner's Representative

Contractor Date

Submitted by Date

Approved By Date

Division Manager, Permitting, Construction and Inspection

11/12/2019

The Truesdell Corporation

Construction Engineer

C-64-19-089-5-00

2019-001

MCDOT Accounting Only

EXHIBIT B

B-2

B-3

EXHIBIT C

For

EXHIBIT D

EXHIBIT E

EXHIBIT F

EXHIBIT G

EXHIBIT H

EXHIBIT I

EXHIBIT J

EXHIBIT C

ENVIRONMENTAL COMPLIANCE CERTIFICATION

It is the contractor's responsibility to assure compliance with the AZPDES Stormwater Construction General Permit, from the beginning of the project when the NOI is issued to the end of the project with the NOT is issued by ADEQ. The contractor shall also fully comply with all mitigation measures of the Environmental Clearance in the contract. This certification is signed by the Resident Engineer to verify the items below have been completed and to communicate the status of final erosion control and soil stabilization for the project upon issuance of Final Acceptance to the contractor.

MCDOT PROJECT NO. FEDERAL NO.

MCDOT PROJECT NAME:

PRIME CONTRACTOR:

RESIDENT ENGINEER NAME:

AGENCY / FIRM NAME:

TELEPHONE NUMBER:

As the Resident Engineer in responsible charge of the work completed for this project, I certify the following:

1. Certificates of Compliance are on file for all erosion control products used as permanent erosion control BMPs. 2. Certificates of Compliance by the Arizona Crop Improvement Association (ACIA) or the North American Weed Management

Association (NAWMA) that all products using wheat straw are free of noxious weeds. 3. All SWPPP records are complete and accurate, and are included within the project file records. 4. A copy of the contractor's Notice of Intent (NOI) and Notice of Termination (NOT) are within the project records. 5. Any oil, coolant, grease, fuel or other material spills or waste from on-site vehicle and equipment cleaning and maintenance have

been fully contained, collected, and properly disposed of. 6. There is no evidence of petroleum product or other liquid spills on the ground within the project. 7. No waste material or debris were dumped or stored in any wash, channel or ditch. 8. Detention or sediment basins (if applicable) were constructed to reasonable conformance with the plans. 9. Sediment logs or sediment wattles are installed on roadway excavation/embankment slopes which receive seeding as a

permanent erosion control measure. 10. There is no evidence that sediment is leaving the site. 11. All permanent soil stabilization (seeding or decomposed granite) have been applied in conformance with the contract

documents. 12. For projects with 401/404 Permits, the permit requirements have been satisfied. 13. MCESD Requirements have been met and/or Final Inspection is completed. 14. Any known archeological sites/areas remain in-tact and undisturbed. 15. Removal of asbestos or lead containing materials was performed according to the requirements of the removal and disposal

plans that the contractor is required to develop, submit and obtain approval of prior to implementation. 16. The contractor arranged for a bird nest survey by a qualified biologist and complied with the provisions of Migratory Bird Treaty

Act for vegetation removal activities that occurred between February 1 and August 31. 17. The contractor complied with the Maricopa County Air Quality Rule 310 – Fugitive Dust Sources and any required air quality

permits from any agencies having jurisdiction. 18. Contractor complied with all notification requirements in the Environmental Clearance or contract documents. 19. Any other requirements in the Environmental Clearance or contract documents.

Resident Engineer Signature Date