DTMB-0414 (Rev 6/25)

DEPARTMENT OF TECHNOLOGY, MANAGEMENT AND

BUDGET

State Facilities Administration Design & Construction Division

CONSTRUCTION BID ADDENDUM NO. 4

This form identifies an Addendum to Bidding Documents, and incorporates interpretations or clarifications, modifications, acceptance of proposed “or equal” materials, and other information into the Bidding Documents. Addenda will be numbered by the Professional and distributed through www.michigan.gov/SIGMAVSS as an attachment.

TO:

ALL BIDDERS

DATE ISSUED

7/18/2025

PROJECT NAME

Michigan State Police Fire Alarm Upgrade (Oak Park and Northville)

FILE NUMBER

551/24350.MNB

PROFESSIONAL

TowerPinkster

PROJECT DIRECTOR

Chris Bahjet

BID OPENING DATE:

7/30/2025

ADDENDUM ITEMS: (attach additional sheets and drawings if required)

Clarification items:

1. Scope for Northville was removed in Addendum 3. See revised final bid drawings attached.

2. The new fire alarm panel location was moved from the basement to the first floor, in Files 144.

Contractual Changes:

1. Contract time: Change from 230 calendar days to 90 calendar days for substantial completion

(120 calendar days for final completion). Assuming one (1) crew with one (1) facility escort.

2. Consult the pink sheet forms attached. These forms are to be used by the awarded contractor.

Pre-bid RFI Questions:

1. Question: Is the intent to use EMT conduit or wiremold for surface raceway?

Answer: Use wiremold in any finished spaces. EMT is acceptable in storage room, electrical/mechanical rooms, garage areas. Low voltage wire may be ran in J-hook above ceilings.

2. Where and what panel should the new FACP get the dedicated 120V circuit from?

Answer: From the same source of the current fire alarm panel.

3. Where and what room should the new FACP get a data line from?

Answer: The State network is a secure network so MSP will provide the connection to the panel.

4. Do the FAA require a 120V circuit and data line?

Answer: The construction documents are a delegated design and the licensed fire alarm professional should include this information in the final drawings.

5. Are any UPSs required for the FACP panels or the FAA panels?

Answer: The construction documents are a delegated design and the licensed fire alarm professional should include this information in the final drawings.

http://www.michigan.gov/SIGMAVSS

6. Per the typical fire alarm riser, are IAM devices required in the basement of Oak Park for the OSY and WF devices?

Answer: The construction documents are a delegated design and the licensed fire alarm professional should include this information in the final drawings.

End of Addendum 4

ACKNOWLEDGEMENT: This Addendum must be acknowledged by the Bidder in the space provided in the Bid Summary and Bid Form. Failing to acknowledge Addenda may be cause for the Bid to be rejected. Addenda will become part of the Contract Documents.

PROFESSIONAL: Marcelo Guassi DATE: 7/18/2025

APPROVED BY:

PROJECT DIRECTOR: DATE: Click to enter date

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MSP FIRE ALARM UPGRADE (OAK PARK)

551/24350.MNB

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MICHIGAN STATE POLICE

Oak Park Michigan

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DRAWING INDEX

242 E. KALAMAZOO AVE, SUITE 100

KALAMAZOO, MICHIGAN 49007

PHONE: 269.343.6133

FAX: 269.343.6633

GENERAL

G 001 COVER SHEET

ELECTRICAL

EG 100 FIRE ALARM SYMBOLS AND GENERAL NOTES

DEMOLITION

ED 303 FIRST FLOOR FIRE ALARM DEMOLITION PLAN - OAK PARK

ELECTRICAL

E 303 FIRST FLOOR FIRE ALARM PLAN - OAK PARK

E 304 BASEMENT FIRE ALARM PLANS - OAK PARK

USE GROUP: B AND I3

CONSTRUCTION TYPE: IIB

AUTOMATIC SPRINKLERS: EXISTING - PARTIAL

PROJECT AREA

TOTAL FINISHED PROJECT: 15,503 SQ. FT.

REFERENCED CODES - OAK PARK

BUILDING: 2021 MICHIGAN BUILDING CODE AND 2012 NFPA 101 LIFE SAFETY CODE

ELECTRICAL: 2023 NATIONAL ELECTRICAL CODE WITH MICHIGAN AMENDMENTS

MICHIGAN STATE POLICE

14350 WEST 10 MILE ROAD

OAK PARK, MICHIGAN 48237

SITE ADDRESS - OAK PARK

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ISSUED FOR DATE

ADDENDUM 2 07-16-2025

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EAST HALL

CONFERENCE

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FILES

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STORAGE

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TOILET

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TOILET

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SQUAD

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M TOILET

INTERVIEW

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INTERVIEW

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WORK ROOM

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HALLWAY

FACP 1

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KEYED NOTES - ELECTRICAL - FIRE ALARM

1 CONNECT NEW FIRE ALARM TO EXISTING FIRE ALARM CONTROL PANEL CIRCUIT.

2 PROVIDE NEW DUCT TYPE SMOKE DETECTOR IN SUPPLY AND RETURN DUCT OF AIR

HANDLER.

3 PROVIDE WIREMOLD #500 SURFACE RACEWAY FOR NEW DEVICE.

4 CONNECT EXISTING DUCT TYPE SMOKE DETECTOR TO NEW FIRE ALARM SYSTEM.

5 CONNECT EXISTING FIRE ALARM SYSTEM AND SMOKE DETECTOR AT ELEVATOR TO NEW

FIRE ALARM SYSTEM.

6 TIE EXISTING GENERATOR START SIGNAL FROM AUTOMATIC TRANSFER SWITCH TO NEW

FIRE ALARM SYSTEM.

7 (NORTHVILLE) CONNECT NEW FIRE ALARM PANEL TO EXISTING CIRCUIT FOR ELEVATOR

FIRE ALARM PANEL.

3/16" = 1'-0"

FIRST FLOOR FIRE ALARM PLAN - OAK PARK

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ISSUED FOR DATE

ADDENDUM 4 JULY 17, 2025

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BASEMENT FIRE ALARM PLAN - OAK PARK

3/16" = 1'-0"

BASEMENT FIRE ALARM DEMOLITION PLAN - OAK PARK

KEYED NOTES - ELECTRICAL - DEMOLITION

1 REMOVE EXISTING FIRE ALARM SYSTEM AND ALL ASSOCIATED HARDWARE, WIRING, AND

CONDUIT BACK TO SOURCE. RETAIN 120V CIRCUIT FOR REUSE

KEYED NOTES - ELECTRICAL - FIRE ALARM

1 CONNECT NEW FIRE ALARM TO EXISTING FIRE ALARM CONTROL PANEL CIRCUIT.

2 PROVIDE NEW DUCT TYPE SMOKE DETECTOR IN SUPPLY AND RETURN DUCT OF AIR

HANDLER.

3 PROVIDE WIREMOLD #500 SURFACE RACEWAY FOR NEW DEVICE.

4 CONNECT EXISTING DUCT TYPE SMOKE DETECTOR TO NEW FIRE ALARM SYSTEM.

5 CONNECT EXISTING FIRE ALARM SYSTEM AND SMOKE DETECTOR AT ELEVATOR TO NEW

FIRE ALARM SYSTEM.

6 TIE EXISTING GENERATOR START SIGNAL FROM AUTOMATIC TRANSFER SWITCH TO NEW

FIRE ALARM SYSTEM.

7 (NORTHVILLE) CONNECT NEW FIRE ALARM PANEL TO EXISTING CIRCUIT FOR ELEVATOR

FIRE ALARM PANEL.

THIS DRAWING SHEET IS INTENDED TO BE PLOTTED IN

COLOR. IF THIS TEXT APPEARS IN BLACK AND WHITE,

IT IS PLOTTED INCORRECTLY. DISCARD AND OBTAIN

AN ACCURATE DRAWING

ISSUED FOR DATE

ADDENDUM 4 JULY 17, 2025

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Table of Contents

PROJECT PROCEDURES

PRE-CONSTRUCTION SAFETY CHECKLIST

MEETING ATTENDANCE RECORD DEPARTMENT OF TECHNOLOGY, MANAGEMENT A

ND BUDG

RFI

DTMB-440 PAYMENT REQUEST

SWORN STATEMENT

DTMB-489 INSTRUCTIONS FOR PREPERATION OF BULLETIN COST QUOTATIONS

DTMB-0452 PROFESSIONALS INSPECTION RECORD

DTMB-437 GUARANTEE AND INDEBTEDNESS STATEMENT

DTMB-434 CERTIFICATION OF OFF-SITE MATERIAL STORAGE

DTMB-487 MATERIALS STORED ON PROJECT/JOB SITE

DTMB-485 BULLETIN REQUEST

DTMB-419 INSTRUCTIONS FOR SCHEDULE OF VALUE

DTMB-413 GENREAL RELEASE- VISITORS

DTMB-445 CERTIFICATE OF SUBSTANTIAL COMPLETION

ASBESTOS ABATEMENT ATTESTATION

CHECKLIST FOR CONTRACTOR’S SOIL EROSION

SESC INSPECTION REPORT

SAMPLE PROGRESS MEETING FORMAT

DTMB-499 DEFECTIVE WORK/NON-COMPLIANCE NOTICE

AGENCY WARRANTY PROCEEDURE

DTMB-2118 FIRE SYSTEM INTERRUPTION REQUEST

SUPERINTENDENT DESIGNATION

DAILY REPORT

CONTRACTOR CLOSEOUT CHECKLIST

5/9/2025

DTMB-0460 (R 04/25)

PROJECT PROCEDURES

DEPARTMENT OF TECHNOLOGY, MANAGEMENT AND BUDGET

Design and Construction Division

FILE NUMBER(S) CONTRACT NO.

AGENCY / PROJECT NAME / LOCATION

ORGANIZATIONAL MEETING DATE CONTRACT SUBSTANTIAL COMPLETION DATE

REPRESENTATIVES

STATE FACILITIES ADMINISTRATION REPRESENTATIVE (PROJECT

DIRECTOR OR MANAGER)

TELEPHONE / E-MAIL

FIELD REPRESENTATIVE TELEPHONE / E-MAIL

PROFESSIONAL SERVICE CONTRACTOR

PROFESSIONAL SERVICE CONTRACTOR REPRESENTATIVE TELEPHONE / E-MAIL

PROJECT AGENCY REPRESENTATIVE TELEPHONE / E-MAIL

AGENCY SAFETY CONTACT

CONTRACTOR

OFFICE CONTACT / PROJECT MANAGER TELEPHONE / E-MAIL

FIELD CONTACT / SUPERINTENDENT TELEPHONE / E-MAIL

CONTRACTOR SAFETY REPRESENTATIVE – 24 HOUR CONTACT TELEPHONE / E-MAIL (MUST list 2 numbers)

EMERGENCY CONTACT NUMBER FOR PROJECT AGENCY / FACILITY: .

PROFESSIONAL SERVICE CONTRACTOR REQUIREMENTS

1. The Professional Service Contractor (PSC) is required to submit a project inspection sheet (DTMB-

0452) for all site visits to the project. These sheets shall be submitted to the Project Director or Field Representative for signature, when billing for field hours.

CONTRACTOR REQUIREMENTS

1. Subcontractors and suppliers, if not previously submitted, the Contractor shall submit, within days, to the PSC, the Project Director, and the Field Representative, in accordance with the Contract.

2. Schedule of values, if not previously submitted, the Contractor shall submit, within days, to the PSC, the Project Director, and the Field Representative, in accordance with the Contract. No progress payments will be made prior to receipt and approval of a schedule of values.

3. Progress schedule, if not previously submitted, the Contractor shall submit, within days, to the PSC, the Project Director, and the Field Representative, in accordance with the Contract.

4. Shop drawings and samples to be submitted to the PSC for review. The number of copies required is . The PSC will distribute as discussed. No work shall be put in place without prior review by the PSC as per the Contract.

5. Contractor to submit daily reports at the frequency determined by the Project Team. Contractor to submit RFIs to PSCs for any questions.

6. Pay requests, shall be submitted including purchase order number, to the Project Director, Field Representative, and the PSC. The State will furnish payment vouchers (DTMB-0440) which must be used and submitted with backup including AIA G702/G703 for certification and schedule of values breakdown as well as a contractors Sworn Statement with each request. Processing sequence will be as follows:

a. Field Representative will review the payment rough draft with the PSC and initial the final payment request.

b. The payment request, which has the Field Representative’s initials, is to be sent to the PSC.

c. The PSC will review and, if in agreement, will certify and send the payment request to the

Project Director.

d. Final payments should not be submitted until all close out documents have been submitted and reviewed. Contract close out requirements are outlined in the contract. A contractor closeout check list is attached to assist the contractor in successfully completing the project.

7. The Contractor shall submit a substantial completion request by letter to the PSC with copies sent to the Project Director and Field Representative. The contractor shall develop a work completion list and finish said work prior to submission of a substantial completion request.

8. Liquidated damages for this project are $ per day after the date of Substantial Completion, and $ per day after the date of Final Completion, .

9. A Builders’ Risk Policy is not provided by the State of Michigan, however it is the Contractor’s responsibility to provide insurance as required by the Bonding Company and per the Contract.

10. The contractor is to immediately notify DCD if their State Project Registration (SPR) or any of their subcontractors SPR’s are no longer valid (i.e. suspended, revoked or not renewed) at any time

- 2 -during the term of the contract. Any contractors or subcontractors that are added to the project following initial commencement must have and maintain a valid SPR.

11. For projects that do not require compliance with the Federal Davis-Bacon Act, the contractor is required to provide Certified Payrolls, including all subcontractors, directly to LEO Wage and Hour with the access provided at the time of registering and submitting payment for SPR. Certified payroll for projects with the State of Michigan Prevailing Wages are not to be submitted to DTMB at any time.

12. If a project is found to require asbestos abatement that was not originally included in the project scope, the contractor will be required to submit Section 00330 Asbestos Abatement Attestation confirming compliance with item 1 or item 3.

AGENCY REQUIREMENTS

1. The agency shall mark any and all known locations of utilities in the contract work area. (This does not relieve the Contractor of any contract responsibilities; i.e., calling Miss Dig or specific Contractor locator service requirements.)

2. The agency shall move or relocate furnishings, window coverings, or agency equipment, if so specified, as required for the Contractor to perform their contract duties.

3. The agency shall provide the necessary security oversight and access to the project site as required for the Contractor to perform their contract duties.

4. The agency shall provide “As-Built” information, if available, to the Contractor.

5. The agency shall follow through on Warranty issues as stated on the “Warranty Policy” of the

Department of Technology, Management and Budget.

6. Agency shall provide an asbestos report if one exists.

PRIOR TO STARTING WORK

1. The Contractor must purchase ALL REQUIRED PERMITS from the appropriate agencies, necessary for the proper execution of the work, prior to starting work on the project site. Evidence that the permits have been purchased shall be furnished to the PSC, Project Director, and the Field Representative before starting work and prior to the first payment request being processed.

2. The Contractor is to review with the agency its operating procedures, parking requirements, storage areas, working conditions, etc.

3. The contractor shall submit Safety Data Sheet’s (SDS’s) to the agency in accordance with the Michigan Occupational Safety and Health Act (MIOSHA), General Industry Standard Part 92, Construction Standard Part 42, also General Industry and Construction Health Standard Part 430.

This includes but is not necessarily limited to paints, solvents, roofing materials, or anything of a chemical nature. All SDS Sheets must be submitted prior to the delivery of any of these materials to the project site.

4. Prior to beginning work on site the Contractor shall install all required barricades, signs, and warning devices. The Contractor shall also post the Contract Prevailing Wages, Safety information, and employment notifications on the site.

5. SOIL EROSION / SEDIMENTATION & STORM WATER CONTROL MEASURES -

The Department of Technology, Management and Budget is an Authorized Public Agency per the requirements of PA 451 of 1994, Part 91 as amended and no other local or county SESC permits are required. For projects which include an earth disturbance greater than one acre, or which lie within 500 lineal feet of a lake, stream or wetland area (waters of the State), the contractor must submit an SESC Implementation Plan to the DTMB SESC Unit prior to the initiation of any earth change activities at the site. Upon review of the implementation plan submitted by the Contractor, the DTMB SESC Program representative will issue an “Authorization to Proceed with Earth Change”, which must be posted at the project site. Upon receipt of this authorization, the Contractor may begin earth change activities unless there is an MDEQ NPDES Storm Water

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Permit required for the project. For projects which include an earth disturbance of 5 acres or more, the Contractor is required to obtain an MDEQ Water Bureau NPDES Storm Water Permit prior to the initiation of any earth change activities. The MDEQ Water Bureau NPDES Storm Water Permit will have an associated fee cost.

HEALTH AND SAFETY

The Preconstruction Safety Checklist (attached) will be reviewed by the Project Director, Project Agency Rep, the Project Safety Rep and General Contractor. A copy of the Preconstruction Safety Checklist shall be posted in a visible location at the project site.

PROCEDURE FOR PROPOSED CHANGE ORDERS

Except in an emergency endangering life or property, no deviation from the contract documents will be allowed without the issuance and approval of the following documents:

1. The PSC will fill out a bulletin request (DTMB-0485). This bulletin request form shall be addressed to the PSC from the Project Director. After the Project Director and authorized agency representative approves the bulletin request, the PSC shall issue a Contract Bulletin to the Contractor. Copies of the Bulletin shall be sent to the Project Director and the Field Representative.

2. Upon receipt of the bulletin, the Contractor shall promptly (per specifications) prepare and submit a quotation to the PSC with copies sent to the Project Director and the Field representative. The Contractor shall reference the Bulletin number on their quotation. The quotation must be itemized and include:

a. Description of quantities and costs of materials.

b. Hours of labor, rates (including fringe benefits) and total labor cost.

c. Equipment rental charges.

d. Contractor’s overhead and profit (per the specification requirements).

e. Subcontractors to follow the same itemization as above.

f. The Contractor’s signature is required on quotation.

3. After review and evaluation, the PSC will submit a recommendation letter (accompanied by signed copy of the quotation, bulletin, and bulletin request) to the Project Director with a copy to the Field Representative and the Contractor.

4. Upon completing a review, the Project Director and/or the Field Representative will draft a contract change order that will be processed by the DTMB. The DTMB will issue a Contract Change Order to the Contractor.

TESTS

The Owner may provide testing services for those materials required to meet quality control standards specified in the contract. The Contractor will be responsible for testing required to meet code requirements of code inspecting authorities. Copies of the results of either testing methods to be distributed to the PSC and the Project Director with a copy to the Field Representative.

PROGRESS MEETINGS

Progress meetings will be held on the (first, second, third, or fourth)/(Monday, Tuesday, Wednesday, Thursday, or Friday) of each month at a.m./p.m., unless otherwise notified.

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Rev 04/19

PRE-CONSTRUCTION SAFETY CHECKLIST

DEPARTMENT OF TECHNOLOGY, MANAGEMENT AND BUDGET

STATE FACILITIES ADMINISTRATION

Design and Construction Division

Mailing Address: P.O. Box 30026, Lansing, MI 48909 Street Address: 3111 W. St. Joseph Street, Lansing, MI 48917

PROJECT NAME DATE

SIGMA CODING AGENCY NUMBER FILE NUMBER CONTRACT NUMBER DEPARTMENT/UNIVERSITY/COLLEGE

STATE FACILITIES ADMINISTRATION REPRESENTATIVE (PROJECT DIRECTOR OR MANAGER)

PHONE CELLULAR PHONE E-MAIL FAX

PROJECT AGENCY REPRESENTATIVE

PHONE CELLULAR PHONE E-MAIL FAX

AGENCY SAFETY CONTACT

PHONE CELLULAR PHONE E-MAIL FAX

CONTRACTOR

CONTRACTOR SAFETY REPRESENTATIVE *

ADDRESS

PHONE CELLULAR PHONE E-MAIL FAX

* The Contractor Safety Representative must be available at all times (24 hours, 7 days) to respond to safety and health-related issues at the project site.

1. Will this project take place inside or adjacent to an occupied State of Michigan building or facility?

Yes No

If yes, the project agency representative should be present at the pre-construction meeting and should be copied on all project information pertinent to the health and safety of the building occupants.

2. Does the contractor have in place a comprehensive employee safety and health program consistent with Michigan Occupational Safety and Health Act (MIOSHA-P.A.154 of 1974) standards?

Yes No

If yes, a copy must be on site while the contractor is on site.

If no, prior to starting work, the contractor must develop a written comprehensive health and safety program for his/her employees according to MIOSHA standards.

3. Does the project require utility or facility tie-ins or shut downs?

Yes No

If yes, review the responsibilities of the contractor and the project agency representative. Review lock-out/tag-out requirements if needed and document the procedures. (Attach a report if needed)

DMB-PRECON_SAFETY

Pre-Construction Safety Checklist

4. Will this project involve the use of chemicals or materials which may potentially pose an exposure risk to employees and/or building occupants (i.e., solvents, adhesives, epoxies, roofing compounds, etc.)?

Yes No

If yes:

The contractor will submit copies of all Safety Data Sheets (SDS’s) to the project agency representative.

The contractor will review with the project director, professional, and project agency representative the project schedule; address the need for temporary shutdown of ventilation, temporary evacuation of employees or building occupants; installation of temporary critical barriers or other processes which may be necessary to prevent exposure to chemicals or materials which may potentially pose an exposure risk.

Notes:

5. What potential health & safety hazards may currently exist that the agency is aware of on this project site?

Yes No N/A

If yes:

Chemicals or materials governed by MIOSHA that require a Safety Data Sheet (SDS)

Asbestos containing building materials

*Is there an Asbestos Containing Building Materials report available? Yes No *If yes, has the report been shared with the contractor? Yes No *Has the state agency notified their staff of the potential danger/hazard per MIOSHA General Industry Health Standard Part 305 (Asbestos for General Industry) and MIOSHA Construction Health Standard Part 602 (Asbestos for Construction)? Yes No

Lead containing materials

Mold within the project scope area limits

Other:

6. Additional safety items for review:

Construction noise and dust

Shut down of the fire protection systems

Hot work, welding, torch activities, etc… (Fire Watch)

Confined space entry

7. Signatures: By signing this checklist, I am acknowledging that I have read this document thoroughly and understand its contents.

STATE FACILITIES ADMINISTRATION REPRESENTATIVE DATE

PROJECT AGENCY REPRESENTATIVE DATE

AGENCY SAFETY CONTACT DATE

CONTRACTOR SAFETY REPRESENTATIVE DATE

This completed checklist will be posted on the project work site.

DTMB-0441 (R 19.02)

MEETING ATTENDANCE RECORD

DEPARTMENT OF TECHNOLOGY, MANAGEMENT AND BUDGET

State Facilities Administration

Design and Construction Division

PROJECT DESCRIPTION/LOCATION DATE TIME

FILE NUMBER CONTRACT NUMBER MEETING PLACE

PLEASE PRINT YOUR NAME FIRM YOU REPRESENT EMAIL ADDRESS TELEPHONE NUMBER

Request for Information RFI No.

Project Name

From Contractor: To Architect/Engineer: Owner:

General Contractor Address Line 1

Tel:

Fax:

Owner’s Name Address Line 1

Tel:

Fax:

Date:

From:

Company: Phone:

Type of Question:

❑ Site/Civil

❑ Structural

❑ Architectural

❑ Finishes

❑ Mechanical

❑ Plumbing

❑ Sprinkler

❑ Electrical

❑ Other

Reference Drawing:

Reference Spec:

Attachments:

Question:

Proposed Solution:

Reply:

By: Date:

DTMB-440 (Rev 2024.05.22) PSC Electronic PAYMENT REQUEST

PURCHASE ORDER NUMBER

VOUCHER NUMBER

SUBMIT REQUEST TO: DEPARTMENT OF TECHNOLOGY, MANAGEMENT AND BUDGET

DESIGN AND CONSTRUCTION DIVISION

Mailing Address: P.O. Box 30026, Lansing, MI 48909

Street Address: 3111 W. St. Joseph Street, Lansing, MI 48917 THIS FORM IS REQUIRED FOR USE BY PROFESSIONAL SERVICE AND CONSTRUCTION CONTRACTORS

ON CAPITAL OUTLAY AND MISCELLANEOUS OPERATING PROJECTS TO RECEIVE PAYMENT. AUTHORITY: 1984 PA 431

PURPOSE INCLUDED WITHIN THE APPROPRIATION OR AS OTHERWISE PROVIDED

INSTRUCTIONS TO CONTRACTOR: 1) FILL IN ALL APPROPRIATE FIELDS, AUTHORIZED AMOUNT*, EARNED TO DATE*, AND PREVIOUSLY REQUESTED*. ALL OTHER FIELDS ARE CALCULABLE. 3) AUTHORIZED SIGNATURE MUST APPEAR ON ALL

PAYMENT REQUESTS. 4) EMAILPAYMENT REQUEST AND ALL APPLICABLE BACKUP TO THE PROJECT DIRECTOR. RETAIN A COMPLETE COPY FOR YOUR RECORDS.

DEPARTMENT OR AGENCY DATE CONTRACT NUMBER

Department or Agency Today's Date Y Contract Number

NAME AND ADDRESS OF PSC/CONTRACTOR FILE NUMBER

Firm's Name File Number

Firm's Address 1

Firm's Address 2

Firm's City, ST Zip

LAST 4 DIGITS of FEDERAL ID NUMBER (IF NONE, SOCIAL SECURITY NUMBER). THIS IS REQUIRED FOR BILLING AND TAX

PURPOSES. PAYMENTS WILL NOT BE PROCESSED WITHOUT THIS INFORMATION:

Firm's ID No. *****-

DEPARTMENT CERTIFICATION: I CERTIFY THAT THE SERVICES REPRESENTED BY

THIS PAYMENT REQUEST WERE PROPERLY AUTHORIZED AND ARE FOR A

PROFESSIONAL SERVICES CONTRACTOR (PSC) CERTIFICATION: I CERTIFY THAT THE SERVICES LISTED BELOW ARE PROPER

CHARGES AGAINST THE STATE OF MICHIGAN

BY LAW. THE AMOUNTS ARE CORRECT AND PROPER AND ARE APPROVED FOR

PAYMENT.

PERIOD OF SERVICE FROM:

TO:

SIGNATURE OF AUTHORIZED DEPARTMENTAL AGENT DATE SIGNATURE OF PSC DATE

GIVE COMPLETE DESCRIPTION OF SERVICES RENDERED AS IT APPEARS ON THE CONTRACT ORDER

PROFESSIONAL SERVICES FOR: Insert Scope of Work as it appears in the Contract Order Amount

Authorized Earned to Previously Remaining % Amount of

Project Phase Amount* Date* Billed* Balance Complete This Request

100 Study $0.00 $0.00 $0.00 $0.00 $0.00

100 Reimbursables $0.00 $0.00 $0.00 $0.00 $0.00

200 Analysis $0.00 $0.00 $0.00 $0.00 $0.00

200 Reimbursables $0.00 $0.00 $0.00 $0.00 $0.00

300 Schematic Design $0.00 $0.00 $0.00 $0.00 $0.00

300 Reimbursables $0.00 $0.00 $0.00 $0.00 $0.00

400 Preliminary Design $0.00 $0.00 $0.00 $0.00 $0.00

400 Reimbursables $0.00 $0.00 $0.00 $0.00 $0.00

500 Final Design/Bidding Documents $0.00 $0.00 $0.00 $0.00 $0.00

500 Reimbursables $0.00 $0.00 $0.00 $0.00 $0.00

600 Construction Admin/Office $0.00 $0.00 $0.00 $0.00 $0.00

600 Reimbursables $0.00 $0.00 $0.00 $0.00 $0.00

700 Construction Admin/Field $0.00 $0.00 $0.00 $0.00 $0.00

700 Reimbursables $0.00 $0.00 $0.00 $0.00 $0.00

800 Supplemental Design $0.00 $0.00 $0.00 $0.00 $0.00

800 Reimbursables $0.00 $0.00 $0.00 $0.00 $0.00

TOTAL AMOUNT $0.00 $0.00 $0.00 $0.00 0% $0.00

FOR DEPARTMENT USE ONLY

REV DEPT AGY ACTG TEMPLATE UNIT LOC OBJ DOBJ PROG PHASE Amount

$0.00

PROGP APPN FUND SFUND ACTV FUNC TASK TASKO

FUNDING PROFILE FUNDING PRIORITY BSA BFY

TOTAL: $0.00

DTMB-440 (Rev 08/24/18) Construction Electronic

PAYMENT REQUEST

SUBMIT REQUEST TO: DEPARTMENT OF TECHNOLOGY, MANAGEMENT AND BUDGET

DESIGN AND CONSTRUCTION DIVISION

Mailing Address: P.O. Box 30026, Lansing, MI 48909

VOUCHER NUMBER

INSTRUCTIONS TO CONTRACTOR: 1) USE SEPARATE REQUEST FORM FOR EACH CONTRACT ORDER. 2) FILL IN ALL APPROPRIATE FIELDS, ORIGINAL CONTRACT AMOUNT, APPROVED CONTRACT CHANGE ORDERS, AMOUNT COMPLETED, LESS PREVIOUS PAYMENTS. ALL OTHER FIELDS ARE

CALCULABLE. 3) AUTHORIZED SIGNATURE MUST APPEAR ON ALL PAYMENT REQUESTS. 4) FORWARD PAYMENT REQUEST AND ALL BACKUP TO PROFESSIONAL SERVICES CONTRACTOR (PSC) OR PROJECT DIRECTOR IF NO PSC.

DEPARTMENT OR AGENCY DATE CONTRACT NUMBER

Department or Agency Today's Date Y Contract Number

NAME AND ADDRESS OF PSC/CONTRACTOR FILE NUMBER

Firm's Name File Number

Firm's Address 1

Firm's Address 2

Firm's City, ST Zip

LAST 4 DIGITS of FEDERAL ID NUMBER (IF NONE, SOCIAL SECURITY NUMBER). THIS IS REQUIRED FOR BILLING AND TAX PURPOSES.

PAYMENTS WILL NOT BE PROCESSED WITHOUT THIS INFORMATION:

Firm's ID No. *****-

DEPARTMENT CERTIFICATION: I CERTIFY THAT THE SERVICES REPRESENTED BY THIS PAYMENT REQUEST WERE PROPERLY

AUTHORIZED AND ARE FOR A PURPOSE INCLUDED WITHIN THE APPROPRIATION OR AS OTHERWISE PROVIDED BY LAW.

THE AMOUNTS ARE CORRECT AND PROPER AND ARE APPROVED FOR PAYMENT.

CONTRACTOR'S CERTIFICATION: I CERTIFY THAT THE SERVICES LISTED BELOW ARE PROPER CHARGES AGAINST THE STATE OF MICHIGAN

SIGNATURE OF AUTHORIZED DEPARTMENTAL AGENT DATE SIGNATURE OF CONTRACTOR DATE

Project Name: Insert Project Name as it appears in the Contract Order Amount

a. Original Contract Amount:

b. Approved Contract Change Orders to date:

c. Current Contract Amount:

d. Amount Completed & Stored on Site:

e. Less Previous Payment:

f. Amount Due this Request:

g. Balance to Complete:

h. Percent Complete:

0%

TOTAL DUE $0.00

NOTE: MUST ATTACH SCHEDULE OF VALUES &/OR OTHER SUPPORTING DOCS

DTMB-440 (Rev 2024.05.24) DCCS Electronic PAYMENT REQUEST

VOUCHER NUMBER

SUBMIT REQUEST TO: DEPARTMENT OF TECHNOLOGY, MANAGEMENT AND BUDGET

DESIGN AND CONSTRUCTION DIVISION

Mailing Address: P. O. BOX 30026, Lansing, MI 48909

Street Address: 3111 W. St. Joseph Street, Lansing, MI 48917

INSTRUCTIONS TO CONTRACTOR: 1) FILL IN ALL APPROPRIATE FIELDS, AUTHORIZED AMOUNT*, EARNED TO DATE*, AND PREVIOUSLY REQUESTED. ALL OTHER FIELDS ARE CALCULABLE. 3) AUTHORIZED SIGNATURE MUST APPEAR ON ALL PAYMENT REQUESTS. 4) EMAIL PAYMENT REQUEST FORM AND APPLICABLE BACKUP TO PROJECT DIRECTOR.

DEPARTMENT OR AGENCY DATE CONTRACT NUMBER

Department or Agency Today's Date Y Contract Number

NAME AND ADDRESS OF PSC/CONTRACTOR FILE NUMBER

Firm's Name File Number

Firm's Address 1

Firm's Address 2

Firm's City, ST Zip

LAST 4 DIGITS of FEDERAL ID NUMBER (IF NONE, SOCIAL SECURITY NUMBER). THIS IS REQUIRED FOR BILLING AND TAX PURPOSES.

PAYMENTS WILL NOT BE PROCESSED WITHOUT THIS INFORMATION:

Firm's ID No. *****-

DEPARTMENT CERTIFICATION: I CERTIFY THAT THE SERVICES REPRESENTED BY

THIS PAYMENT REQUEST WERE PROPERLY AUTHORIZED AND ARE FOR A PURPOSE

CONTRACTOR'S CERTIFICATION: I CERTIFY THAT THE SERVICES LISTED BELOW ARE PROPER CHARGES AGAINST THE STATE OF

MICHIGAN

INCLUDED WITHIN THE APPROPRIATION OR AS OTHERWISE PROVIDED BY LAW.

THE AMOUNTS ARE CORRECT AND PROPER AND ARE APPROVED FOR PAYMENT. PERIOD OF SERVICE FROM:

TO:

SIGNATURE OF AUTHORIZED DEPARTMENTAL AGENT DATE SIGNATURE OF PSC/CONTRACTOR DATE

GIVE COMPLETE DESCRIPTION OF SERVICES RENDERED AS IT APPEARS ON THE CONTRACT ORDER

SERVICES FOR:

Insert Scope of Work as it appears in the Contract Order

Amount

Service

Authorized

Amount*

Earned to

Date*

Previously

Billed*

Remaining

Balance

Cmplt

Amount of

This Request

Design Services

$0.00 $0.00 $0.00 $0.00

Design Reimbursable

Construction Services

General Conditions

Management

Management Reimbursable

Fees (% of Construction Services)

TOTAL AMOUNT $0.00 $0.00 $0.00 $0.00 0% $0.00

MDOT Contract ID Number eg. I-96 from U.S 23 to Kent Road

SWORN STATEMENT

STATE OF MICHIGAN )

) ss.

COUNTY OF )

<<<name of person signing sworn statement>>>, being duly sworn, deposes and says: That <<<name of company>>> is a/the <<<select one>>>(contractor)(subcontractor)(supplier) for an improvement to the following described public works situated in County, Michigan, described as follows:

Contract No. <<< DCD contract Ynumber >>> Project Name: <<< DCD Project Name >>>

That the following is a statement of each subcontractor and supplier and laborer, for which laborer the payment of wages or fringe benefits and withholdings is due but unpaid, with whom the <<<same selection as above>>>(contractor)(subcontractor)(supplier) has <<<select one>>>(contracted)(subcontracted)(supplied material)(supplied labor) for performance under the contract with the owner, lessee, or general contractor thereof, and that the amounts due to the persons as of the date hereof are correctly and fully set forth opposite their names, as follows:

Name of Subcontractor, Supplier, or Laborer

Type of Improvement Furnished

Total Contract

Price

Amount Already

Paid

Amount Currently

Owing

Balance to

Complete

Amount of Laborer

Wages Due But Unpaid

Retention

Amount of Laborer Fringe Benefits and Withholdings Due But Unpaid

SUB TOTALS

Name of Subcontractor, Supplier, or Laborer

Type of

Improvement Furnished

Total

Contract

Price

Amount

Already

Paid

Amount

Currently

Owing

Balance to

Complete

Amount of Laborer

Fringe Benefits

TOTALS

That the (contractor) (subcontractor) has not procured material from, or subcontracted with, any person other than those set forth on the reverse side and owes no money for the improvement other than the sums set forth on the reverse side.

Deponent further says that he or she makes the foregoing statement as the (contractor)(subcontractor)(supplier) or as <<<authorized agent if signator is not officer or employee of company>>> of the (contractor)(subcontractor)(supplier) for the purposes of representing to the owner, lessee, or general contractor of the public works described on the reverse side and his or her agents that the public works described on the reverse side is free from claims of construction or bond liens, or the poss ibility of construction or bond liens, except as specially set forth on the reverse side hereof..

WARNING TO DEPONENT: A PERSON, WHO WITH INTENT TO DEFRAUD, GIVES A

FALSE SWORN STATEMENT FOR THE PURPOSE OF OBTAINING PAYMENT IS SUBJECT TO

CRIMINAL and CIIVIL PENALTIES AS PROVIDED BY LAW.

(Deponent)

Subscribed and sworn to before me this day of

, 20 .

, Notary Public

County, Michigan

My commission expires:

Acting in County

91742v2

SWORN STATEMENT

STATE OF MICHIGAN )

) ss.

COUNTY OF )

, being duly sworn, deposes and says: That is a/the (contractor)(subcontractor)(supplier) for an improvement to the following described public works situated in County, Michigan, described as follows:

Contract No. ; Project Name:

That the following is a statement of each subcontractor and supplier and laborer, for which laborer the payment of wages or fringe ben efits and withholdings is due but unpaid, with whom the (contractor)(subcontractor)(supplier) has (contracted)(subcontracted)(supplied material)(supplied labor) for the improvement on the above referenced public works project and that the amounts due to the persons as of the date hereof are correctly and fully set forth opposite their names, as follows:

Name of Subcontractor, Supplier, or Laborer

Type of Improvement Furnished

Total Contract

Price

Amount Already

Paid

Amount Currently

Owing

Balance to

Complete

Amount of Laborer

Fringe Benefits

SUB TOTALS

Name of Subcontractor, Supplier, or Laborer

Type of

Improvement Furnished

Total

Contract

Price

Amount

Already

Paid

Amount

Currently

Owing

Balance to

Complete

Amount of Laborer

Fringe Benefits

TOTALS

That the (contractor) (subcontractor) has not procured material from, or subcontracted with, any person other than those set forth on the reverse side and owes no money for the improvement other than the sums set forth on the reverse side.

Deponent further says that he or she makes the foregoing statement as the (contractor)(subcontractor)(supplier) or as of the (contractor)(subcontractor)(supplier) for the purposes of representing to the party from whom payment is requested and to the prime contractor who has furnished a payment bond covering the public works project described on the reverse side and his or her agents that the public works described on the reverse side is free from claims of payment bond liens, or the possibility of payment bond liens, except as specially set forth on the reverse side hereof.

WARNING TO DEPONENT: A PERSON, WHO WITH INTENT TO DEFRAUD, GIVES A

FALSE SWORN STATEMENT FOR THE PURPOSE OF OBTAINING PAYMENT IS SUBJECT TO

CRIMINAL and CIIVIL PENALTIES AS PROVIDED BY LAW.

(Deponent)

Subscribed and sworn to before me this day of

, 20 .

91742

, Notary Public

County, Michigan

My commission expires:

Acting in County

DTMB-0489 (R 6/16)

DEPARTMENT OF TECHNOLOGY, MANAGEMENT AND BUDGET

STATE FACILITIES ADMINISTRATION

INSTRUCTIONS TO CONTRACTORS FOR PREPARATION OF BULLETIN

COST QUOTATIONS FOR CONTRACT CHANGE ORDERS

1. Upon receipt of the bulletin, the contractor has the responsibility to:

a. Submit detailed cost quotation as promptly as possible. It must be dated and signed. Lump sum proposals will not be accepted and will be returned to the contractor for resubmittal by the professional service contractor.

b. Prepare the cost breakdown for each item covered in the bulletin, in detail, (in accordance with the following guidelines) setting forth the material, labor, labor fringes, equipment costs with overhead, profit and/or handling fees.

2. Following are sample guidelines for use in preparing detailed cost breakdown for each item in the bulletin being quoted:

a. Material Cost:

List material giving unit cost x number of units = cost

Add 6% sales tax

Add applicable shipping costs

Subtotal Material Costs $

b. Labor Cost - List for each trade the:

Hourly rate x number of hours = labor cost

Add Labor Fringes as applicable:

F.I.C.A

M.E.S.C.

Pension Contribution

Vacation Contribution

H.E.W. Insurance

Add total fringes labor

(This is not mandatory, but is helpful if presented labor costs are excessive.)

Labor Cost

Subtotal Labor Cost $

c. Equipment (heavy, i.e., cranes, earth moving, hoists, etc.):

Rental charge or equivalent per day of week, including operating costs except labor.

Subtotal Equipment Cost $

d. Overhead & Profit - Suggested Percentages

(1) Work performed by prime contractor, up to 15% total for overhead and profit.

(2) On work performed by subcontractor, the prime contractor is allowed up to 5% handling charge, unless otherwise stated in the contract documents.

(3) Work performed by subcontractor up to 15% total for overhead and profit.

Subtotal Overhead and Profit $

e. Time Impact and General Conditions Costs

TOTAL COST ITEM $

NOTE: When contract documents stipulate unit prices, the following procedure will be used. Unit price costs based on those established in contract documents times the number of actual or measured units. $

This is an instructional form for use in the preparation of contract changes. Authority: 1984 PA 431

INSTRUCTIONS TO PROFESSIONAL SERVICES CONTRACTOR FOR

REVIEW OF CONTRACTORS BULLETIN COST QUOTATION AND

RECOMMENDATION FOR CONTRACT CHANGE ORDER

The professional has the responsibility to see that the contractor submits quotation on time and upon receipt to carefully review the Contractor's cost quotations promptly before submitting to State Facilities Administration with their recommendation.

The Professional Services Contractor shall:

1. Ensure the contractor has prepared the cost breakdown for each item in accordance with the sample and guidelines as outlined in instruction to contractor. If the breakdown is not complete, the quotation will be returned to contractor for resubmittal.

2. Carefully evaluate all quantities and costs submitted by the contractor and, if necessary, check proposed quantities with the State field representative before submitting the recommendation to State Facilities

Administration for processing the contract change order.

3. With each recommendation for a contract change order, the Professional Services Contractor shall submit an updated financial statement showing the:

a. "B" construction funds in the work order.

b. The current "B" contract amounts.

c. The resultant contingency balance (original contract amount plus aggregate of all change orders).

4. Time and General Conditions Evaluations

-2-

DTMB-0452 (Rev 04/19)

PROFESSIONAL'S INSPECTION RECORD

DEPARTMENT OF TECHNOLOGY, MANAGEMENT AND BUDGET

This form is required to verify visits by the professional service contractor on the job site. Complete this form and attach it to the appropriate payment voucher for services rendered. (Authority: 1984 PA 431)

PROFESSIONAL SERVICE CONTRACTOR DATE

SIGMA CODING AGENCY NUMBER FILE NUMBER CONTRACT NUMBER

PROJECT NAME

DEPARTMENT/AGENCY

DATE PROFESSIONAL PURPOSE OF VISIT TRAVEL TIME SITE TIME

FIELD REPRESENTATIVE OR CONTRACT ADMINISTRATOR DATE

PROFESSIONAL SERVICE CONTRACTOR DATE

DTMB-0437 (R 04/19)

GUARANTEE AND INDEBTEDNESS STATEMENT

RETURN TO: DEPARTMENT OF TECHNOLOGY, MANAGEMENT AND BUDGET

State Facilities Administration

Design and Construction Division

This form is required to receive final payment for the contract. Upon completion, submit a completed form to the address above. Authority: 1984 PA 431

The undersigned provides the following statements covering the work defined in the contract dated:

SIGMA CODING AGENCY NUMBER FILE NUMBER CONTRACT NUMBER

PROJECT NAME

GUARANTEE

We guarantee that all labor and materials furnished and the Work performed by us in connection with the subject work are in accordance with the plans and specifications, authorized alterations and additions that should any defects develop or become apparent for a period of year(s) from date of acceptance the same shall, upon written notice, be made good by us without expense to the Owner, and that any other Work, affected in correcting such defects shall also be made good. In addition to the above guarantee, the following additional items are guaranteed as noted:

INDEBTEDNESS STATEMENT

We certify that all payrolls, material bills, and other indebtedness connected with the work on the subject project have been paid in full.

COMPANY NAME AND CONTRACTOR'S SIGNATURE DATE

WITNESS SIGNATURE DATE

cc: Agency

Designer

APPROVALS

DTMB-0434 (R 04/19)

CERTIFICATION OF OFF-SITE MATERIAL STORAGE

RETURN TO: DEPARTMENT OF TECHNOLOGY, MANAGEMENT AND BUDGET

State Facilities Administration

Design and Construction Division

DEPARTMENT/AGENCY DATE

CONTRACTOR NAME AND ADDRESS

1. The materials are stored on property owned or leased by the Contractor or owned by the agency.

2. The materials are insured against loss by fire, theft, flood or other hazards.

3. The materials are properly stored and are protected against loss or damage.

4. The materials are in accordance with the plans and specifications and would normally, in the opinion of the Contractor, entitle him/her to payment upon delivery to the project site.

5. The materials are specifically allotted, identified, and reserved for the project.

6. Each item and its cost is listed in the request for payment together with the location of the storage facilities.

7. The foregoing conditions will be continued in force until the items have been delivered to the project site.

I certify that the above-listed items are true and correct.

CONTRACTOR'S SIGNATURE DATE

We agree that this certification concerning the subject Contract will not relieve us of any responsibility as surety for the Contractor.

SURETY COMPANY REPRESENTATIVE'S SIGNATURE DATE

SURETY COMPANY'S NAME AND ADDRESS

DTMB-0487 (R 04/19)

MATERIALS STORED ON PROJECT/JOB SITE

RETURN TO: DEPARTMENT OF TECHNOLOGY, MANAGEMENT AND BUDGET

Design and Construction Division

SIGMA CODING FILE NUMBER AGENCY NUMBER DATE

DEPARTMENT/AGENCY CONTRACT NUMBER

ITEM NO. PREVIOUSLY STORED STORED THIS MONTH USED THIS MONTH BALANCE STORED

I certify that the above listed items are true and correct.

CONTRACTOR'S SIGNATURE DATE

This form is required to request payment for material stored on the project/job site. Please submit with payment request. (Authority: 1984 PA 431)

DTMB-0485 (R 2/18)

State Facilities Administration

BULLETIN REQUEST NO. Enter #

The purpose of this form is to document proposed changes to the construction contract and assure that the project team is aware of the impact of the proposed change to the overall project cost and schedule. Professional to complete this form and obtain authorization from the Project Director at a regular project meeting or via email.

FILE NUMBER

File No.

DEPARTMENT/AGENCY

Department

DATE

Click enter date

LOCATION

Project Location

PROJECT NAME

Project Name

PROFESSIONAL (Firm and Individual)

PSC First & Individual CONSTRUCTION CONTRACTOR and CONTRACT ‘Y’ NUMBER

Construction Contractor & Y No.

Describe the proposed construction contract change (reference the letter quotes, correspondence, RFIs etc. prompting the requested contract change):

Click or tap here to enter text.

Reason(s) for construction contract change:

Categorize the total estimated construction cost change (add/deduct):

☐ Design Omission ☐ Design Error ☐ Scope Change ☐ Field Condition

Estimated total construction cost change: $ $$$ (Add ☐ / Deduct☐)

Estimated construction contract time adjustment: Enter Days calendar days (Add ☐ / Deduct☐)

Estimated Bulletin release date for pricing: Click to enter date

Estimated additional PSC fee: $ $$$ (only if Scope Change or Unknown Field Condition)

The PSC’s services will be compensated according to the contract terms (see following notes):

• Design Omission: No increase in the PSC’s total contract.

• Design Error: No compensation. The Professional is obligated for design cost.

• Scope Change or Field Conditions: Additional work required by previously unknown building or site factors or Owner's request for scope change. Compensation will be at the hourly rate and requires a PSC contract modification.

Do not prepare a Bulletin unless the DTMB DCD Project Director authorizes the change.

Authorized: Date: date Concur: Date: date

Project Director Agency Point of Contact

Approved Copy to: File, DCD Field Representative, Agency POC, PSC

DTMB-0419 (Rev. 6/16)

INSTRUCTIONS FOR SCHEDULE OF VALUE

Before submission of the first application for payment, the contractor must submit a schedule of values, approved by the Department of Technology, Management and Budget, project manager, of the various tasks that must be performed to complete all the work. The schedule must show each task and the corresponding value of the task, including separate monies allocated for

General Condition items and project close out. The aggregate total value for all tasks must be equal to the total contract sum.

1. Refer to contract division/subject listing.

2. Select divisions appropriate to the specific contract.

3. List the divisions along with applicable subject, including the subject code number of each.

4. List the required data for each area.

5. Use additional sheets if necessary.

SAMPLE SCHEDULE OF VALUE

Division

Item

Quantity

Unit

Contract

Amount

Percent

Complete

Amount

1. General Conditions 01001 – 01700

2. Site Work

02010 – 02950

3. Concrete

03100 -03500

4. Masonry

04100 – 04500

5. Metals

05100 -05800

6. Wood and Plastics

06100 - 06500

7. Thermal and Moisture Protection

07100 – 07900

8. Doors and Windows

08100 – 08900

9. Finishes

09100 – 09950

10. Specialties

10100 – 10900

11. Equipment

11050 – 11990

12. Furnishings

12100 – 12800

13. Special Construction

13010 – 13700

14. Conveying Systems

14100 – 14800

15. Mechanical

15010 – 15900

16. Electrical 16010 - 16900

The items listed on the left are categorical titles and are not intended to be used for payment purposes. Generally, it will be necessary to expand the schedule to more clearly establish the actual tasks that will be performed.

DTMB-0413 (R 04/19)

GENERAL RELEASE - VISITORS

STATE OF MICHIGAN

DEPARTMENT OF TECHNOLOGY, MANAGEMENT AND BUDGET

SIGMA CODING PROJECT NUMBER FILE NUMBER DATE

DEPARTMENT/AGENCY/LOCATION

PROJECT NAME

In consideration of permission granted to the undersigned to enter and inspect the premises owned by the State of Michigan and/or operated by the above named agency, upon which property the identified project is being constructed, which permission is given as a courtesy to me (us) and for my (our) benefit only, I (we) herewith agree for myself (ourselves) and for my (our) heirs, executors and administrators that I (we) will do and release and forever discharge the State of Michigan and/or the above named agency and/or the contractors or subcontractors who may be performing work on the said premises from all manner of claims, actions or causes of action which I (we) may suffer while on the said premises, whether the said injury or damage may be due to the act or negligence of the said State of Michigan or of the above named agency or of any contractor or subcontractor or otherwise, it is understood that I (we) accept full responsibility for the above mentioned risk.

In witness whereof, I (we) have hereunto set my (our) hand this day of , 201 .

SIGNATURE(S) OF VISITOR(S) AUTHORIZING RELEASE

Print Name Signature

PROJECT NAME CONTRACT PRICE

APPROVALS

DTMB-0445 (R 08/21)

CERTIFICATE OF SUBSTANTIAL COMPLETION

DEPARTMENT OF TECHNOLOGY, MANAGEMENT AND BUDGET

State Facilities Administration

Design and Construction Division

DATE OF SUBSTANTIAL COMPLETION:

FINAL COMPLETION DATE:

The work performed under the subject contract between the State of Michigan and the contractor named at the location listed, has been inspected and found to be in compliance with the contract documents, including duly authorized changes, except for the list of the exceptions noted. The Contractor agrees to complete or correct these items on or before (date):

CONTRACTOR NAME AND ADDRESS

PROFESSIONAL

1. SCOPE: This Certificate of Substantial Completion is for the entire Work or the parts of the Work listed in Attachment A .

2. DIVISION OF RESPONSIBILITIES: The responsibilities between the Owner and Contractor for security, operation, safety, maintenance, heat and utilities, insurance and warranties and guarantees, pending final payment (or Substantial Completion of the entire

Work), shall be as shown on Attachment B.

3. DOCUMENTS ATTACHED: The following documents are attached to and made a part of this Certificate:

PUNCH LIST

Provide all Closeout Documents

AGENCY REPRESENTATIVE DATE

CONTRACTOR DATE

STATE FACILITIES ADMINISTRATION DATE

PROFESSIONAL DATE

White - Contract Green - Project Manager Canary - Professional Service Contractor Pink - Contractor Goldenrod - Agency

Items of work must be completed before final payment can be made and the contract close out. Authority: 1984 PA 431.

Bidding and Contract Document (R 03/25) Project Name: *** File No. ***

ASBESTOS ABATEMENT ATTESTATION

SUBMISSION REQUIRED WITH ALL BIDS

Pursuant to the Public Entity Asbestos Removal Verification Act, PA 59 of 2024, MCL 338.3371 et seq. (“the Act”), the Owner will conduct the background investigation as required of any asbestos abatement contractor, or a general contractor that contracts with an asbestos abatement contractor, for the abatement of asbestos.