Construction_Administration_Forms.pdf

Construction Administration Forms

1. Change Order

2. Construction Change Directive

3. Unilateral Change Order

4. Work Directive

5. Conditional Waiver Upon Progress Payment

6. Unconditional Waiver Upon Progress Payment

7. Conditional Waiver Upon Final Payment

8. Unconditional Waiver Upon Final Payment

9. Declaration to Procure Progress Payment (Conditional)

10. Declaration to Procure Progress Payment (Unconditional)

11. Declaration to Procure Final Payment (Conditional)

12. Declaration to Procure Final Payment (Unconditional)

13.

14.

Affidavit of Final Completion

Contractor General Warranty Form

15. Consent of Surety to Release of Retention or Final Payment

16. Sworn Statement and Warranty Regarding Continuing Insurance Obligations

CHANGE ORDER

Agreement Date: Change Order #:

To: Date Issued:

The following change is hereby made a part of the Contract Documents enumerated in the Agreement Between Owner and Contractor on the date referenced above and shall be performed under the same terms and conditions as required by the original Contract Documents. Except as modified herein, the original Contract Documents and all prior amendments shall remain in full force and effect and all of the terms of the Contract Documents are hereby incorporated in this Change Order.

Description of this Change and Approved CPR/COR’s:

[Description of changes to Drawings and/or Specifications, insert CPR/COR # and Description] requested by Owner.

Reason:

Credit/Add

Original Contract Sum ……………………………………………………... $ Net change by previous Change Orders…………………………………. $ Contract Sum prior to this Change Order was…………………………… $ Contract Sum will be increased/decreased by this Change Order in the amount of ………………………………………………………………..

Adjusted Contract Sum including this Change Order is ……………... $ Contract Time will be increased/decreased by: ………………………… ________ days Calendar Date of Substantial Completion as of this Change Order…...

This Change Order is in full compromise and settlement of all adjustments to Contract Time and Contract Sum, and compensation for any and all delay, extended or additional field and home office overhead, disruption, acceleration, inefficiencies, lost labor or equipment productivity, differing site conditions, construction interferences and other extraordinary or consequential damages (hereinafter called “Impacts”), including any ripple or cumulative effect of said Impacts on the overall Work under the Contract arising directly or indirectly from the performance of Work described in this Change Order. By execution of this Change Order, Contractor agrees that this Change Order constitutes a complete accord and satisfaction with respect to all claims for schedule extension, Impacts, or any costs of any nature, character or kind arising out of or incidental to this Change Order.

City of Pasadena

100 North Garfield Avenue Pasadena, CA 91101

BY:

Name:

DATE:

OWNER

ARCHITECT:

ARCHITECT

CONTRACTOR

CONSTRUCTION CHANGE DIRECTIVE

Distribution to: OWNER □ ARCHITECT □ CONTRACTOR □

PROJECT:

DIRECTIVE NO.: ____________

ADDRESS: ______________________________________

DATE: ___________________

CONTRACT DATE: ___________________

TO CONTRACTOR: ___________________

CONTRACT FOR: ___________________

You are hereby directed to make the following change(s) to this Contract:

PROPOSED ADJUSTMENTS

1. The proposed basis of adjustment to the Contract Sum is:

[ ] Lump Sum (increase)(decrease) of $ __________________.

[ ] Unit Price of $ ______________ per _______________.

[ ] Daily time and materials records of actual costs plus a Contractor Fee for overhead and profit, as provided in Subparagraph 7.3.11 of AIA Document A201-2017, subject to a Not-To-Exceed Amount of

[ ] as follows:

2. The Contract Time is proposed to (be adjusted) (remain unchanged). The proposed adjustment, if any, is (an increase of days) (a decrease of days).

If Contractor disagrees with the proposed adjustments he must submit his own proposal within 10 days of date pursuant to Contract Documents or proposed adjustment will become final and binding on Contractor.

When signed by the Owner and Architect and received by the Contractor, this document becomes effective IMMEDIATELY as a Construction Change Directive (CCD), and the Contractor shall proceed with the change(s) described above.

100 N. Garfield Avenue

ARCHITECT:

CONTRACTOR

UNILATERAL CHANGE ORDER

Distribution to: OWNER X ARCHITECT X CONTRACTOR X

PROJECT: UNILATERAL CHANGE NO:

ADDRESS:

ISSUE DATE:

CONTRACT DATE:

TO CONTRACTOR: CONTRACT FOR:

The following changes are hereby made a part of the Contract Documents enumerated in the Agreement Between Owner and Contractor on the date referenced above. Except as modified herein, the original Contract Documents and all prior amendments shall remain in full force and effect and all of the terms of the Contract Documents are hereby incorporated in this Unilateral Change Order.

Description Add/Deduct

TOTAL

Original Contract Sum ………………………………………………………. $ Net change by previous Change Orders and Construction Change Directives ………………………………………………………………………

Contract Sum prior to this Unilateral Change Order was………………… $ Contract Sum will be increased/decreased by this Unilateral Change Order in the amount of ……………………………………………………….

Adjusted Contract Sum including this Unilateral Change Order is… $ Contract Time will be increased/decreased by: ………………………….. ________ days Date of Substantial Completion as of this Unilateral Change Order is…..

When signed by the Owner and Architect and received by the Contractor, this document becomes effective IMMEDIATELY as a Unilateral Change Order (UCO).

ARCHITECT:

WORK DIRECTIVE

Distribution to: OWNER □ ARCHITECT □ CONTRACTOR □ FIELD □ OTHER □

PROJECT: (Name, Address) WORK DIRECTIVE NO.:

Project: ______________________________________________________ DATE:

ADDRESS: __________________________________________________

TO CONTRACTOR: __________________________________________ CONTRACT DATE:

(Name, Address):

CONTRACT FOR:

You are hereby directed to continue performance of the following Work, without delay, pending resolution of the dispute concerning such Work and maintain the cost data described in paragraph 7.3.4 of the General Conditions for the performance of such Work:

Provide labor and material according to the scope, procedures and schedule identified in Exhibit F, at no cost to the

Owner.

Work to commence on ___________________, 20_____.

Neither the issuance of this Work Directive nor the requirement for the Contractor to maintain cost data constitutes approval by the Owner of a change in the Work or Modification of the Contract Documents.

CONDITIONAL WAIVER AND RELEASE UPON PROGRESS PAYMENT

[California Civil Code § 8132]

NOTICE: THIS DOCUMENT WAIVES THE CLAIMANT’S LIEN, STOP PAYMENT NOTICE, AND

PAYMENT BOND RIGHTS EFFECTIVE ON RECEIPT OF PAYMENT. A PERSON SHOULD NOT RELY

ON THIS DOCUMENT UNLESS SATSIFIED THAT THE CLAIMANT HAS RECEIVED PAYMENT.

Identifying Information

Name of Claimant:

Name of Customer:

Job Location:

Owner:

Through Date:

Conditional Waiver and Release

This document waives and releases lien, stop payment notice, and payment bond rights the claimant has for labor and service provided, and equipment and material delivered, to the customer on this job through the Through Date of this document. Rights based upon labor or service provided, or equipment or material delivered, pursuant to a written change order that has been fully executed by the parties prior to the date that this document is signed by the claimant are waived and released by this document, unless listed as an Exception below. This document is effective only on the claimant’s receipt of payment from the financial institution on which the following check is drawn:

Maker of Check:

Amount of Check: $

Check Payable to:

Exceptions

This document does not affect any of the following:

(1) Retentions.

(2) Extras for which the claimant has not received payment.

(3) The following progress payments for which the claimant has previously given a conditional waiver and release but has not received payment:

Date(s) of waiver and release:

Amount(s) of unpaid progress payment(s):

(4) Contract rights, including (A) a right based on rescission, abandonment, or breach of contract, and

(B) the right to recover compensation for work not compensated by the payment.

Signature

Claimant’s Signature:

Claimant’s Title:

Date of Signature:

UNCONDITIONAL WAIVER AND RELEASE UPON PROGRESS PAYMENT

[California Civil Code § 8134]

NOTICE TO CLAIMANT: THIS DOCUMENT WAIVES AND RELEASES LIEN< STOP

PAYMENT NOTICE, AND PAYMENT BOND RIGHTS UNCONDITIONALLY AND STATES

THAT YOU HAVE BEEN PAID FOR GIVING UP THOSE RIGHTS. THIS DOCUMENT IS

ENFORCEABLE AGAINST YOU IF YOU SIGN IT, EVEN IF YOU HAVE NOT BEEN PAID. IF

YOU HAVE NOT BEEN PAID, USE A CONDITIONAL WAIVER AND RELEASE FORM.

Identifying Information

Name of Claimant:

Name of Customer:

Job Location:

Through Date:

Unconditional Waiver and Release

This document waives and releases lien, stop payment notice, and payment bond rights the claimant has for labor and service provided, and equipment and material delivered, to the customer on this job through the Through Date of this document. Rights based upon labor or service provided, or equipment or material delivered, pursuant to a written change order that has been fully executed by the parties prior to the date that this document is signed by the claimant are waived and released by this document, unless listed as an Exception below. The claimant has received the following progress payment:

(1) Retentions.

(2) Extras for which the claimant has not received payment.

(3) Contract rights, including (A) a right based on rescission, abandonment, or breach of contract, and (B) the right to recover compensation for work not compensated by the payment.

CONDITIONAL WAIVER AND RELEASE ON FINAL PAYMENT

[California Civil Code §8136]

NOTICE: THIS DOCUMENT WAIVES THE CLAIMANT’S LIEN, STOP PAYMENT NOTICE,

AND PAYMENT BOND RIGHTS EFFECTIVE ON RECEIPT OF PAYMENT. A PERSON

SHOULD NOT RELY ON THIS DOCUMENT UNLESS SATSIFIED THAT THE CLAIMANT HAS

RECEIVED PAYMENT.

Identifying Information

Name of Claimant:

Name of Customer:

Job Location:

Owner:

Conditional Waiver and Release

This document waives and releases lien, stop payment notice, and payment bond rights the claimant has for labor and service provided, and equipment and material delivered, to the customer on this job. Rights based upon labor or service provided, or equipment or material delivered, pursuant to a written change order that has been fully executed by the parties prior to the date that this document is signed by the claimant are waived and released by this document, unless listed as an Exception below. This document is effective only on the claimant’s receipt of payment from the financial institution on which the following check is drawn:

Maker of Check:

Amount of Check: $

Check Payable to:

Exceptions

This document does not affect any of the following:

Disputed claims for extras in the amount of: $

Signature

Claimant’s Signature:

UNCONDITIONAL WAIVER AND RELEASE ON FINAL PAYMENT

[California Civil Code §8138]

NOTICE TO CLAIMANT: THIS DOCUMENT WAIVES AND RELEASES LIEN, STOP

PAYMENT NOTICE, AND PAYMENT BOND RIGHTS UNCONDITIONALLY AND STATES

THAT YOU HAVE BEEN PAID FOR GIVING UP THOSE RIGHTS. THIS DOCUMENT IS

ENFORCEABLE AGAINST YOU IF YOU SIGN IT, EVEN IF YOU HAVE NOT BEEN PAID. IF

YOU HAVE NOT BEEN PAID, USE A CONDITIONAL WAIVER AND RELEASE FORM.

Identifying Information

Name of Claimant:

Name of Customer:

Job Location:

Unconditional Waiver and Release

This document waives and releases lien, stop payment notice, and payment bond rights the claimant has for labor and service provided, and equipment and material delivered, to the customer on this job. Rights based upon labor or service provided, or equipment or material delivered, pursuant to a written change order that has been fully executed by the parties prior to the date that this document is signed by the claimant are waived and released by this document, unless listed as an Exception below. The claimant has been paid in full.

Disputed claims for extras in the amount of: $

ISSUED FOR BID

2/10/2022

APPENDIX 2 – CONSTRUCTION ADMINISTRATION FORMS

00 04 02-10

DECLARATION TO PROCURE PROGRESS PAYMENT AND RELEASE OF CONTRACT RIGHTS

[Name of Releasing Company As It Appears On The Release]

[Project]: _____________________________________________________________________

[Through Date As It Appears On The Release]

The company named above has executed a Conditional Waiver and Release Upon Progress Payment, pursuant to Cal.

Civil Code section 8132 through the date shown above. The statutory form of release provides that it does not release extras furnished before the Through Date for which payment has not been received or the right to recover compensation for furnished labor, services, equipment or material that was not compensated by the progress payment. The statutory release also provides that it does not cover contract rights, including rights based on rescission, abandonment or breach of contract.

In order to induce payment of the amount shown in the statutory release, the undersigned individual hereby declares that the company named above did not furnish any extras or any labor, services, equipment or material before the Through Date that was not compensated by the progress payment, except for the items listed below.

By execution of this document, the company also hereby releases all contract rights and all other legal and equitable claims that it has with regard to labor, service, equipment or material furnished through the Through Date including rights and claims for direct and indirect costs based on rescission, abandonment, breach of contract, delay, disruption or acceleration.

This Declaration and Release of Contract Rights is conditional, and shall be effective only when the check described on the statutory Conditional Waiver and Release form that accompanies this document has been properly endorsed and paid by the bank upon which it is drawn.

EXCEPTIONS

[Record Any Exceptions In This Space. If No Exceptions, Write “None.”]

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Signed at

__________________________________ California, on [Location] [Date of Signature]

[Signature]

[Print Name]

[Title]

NOTE: This form is designed to accompany a statutory

CONDITIONAL WAIVER AND RELEASE UPON PROGRESS PAYMENT.

00 04 02-11

DECLARATION TO PROCURE PROGRESS PAYMENT AND RELEASE OF CONTRACT RIGHTS

[Project]: _____________________________________________________________________

[Through Date As It Appears On The Release]

The company named above has executed an Unconditional Waiver and Release Upon Progress Payment, pursuant to Cal. Civil Code section 8134 through the date shown above. The statutory form of release provides that it does not release extras furnished before the Through Date for which payment has not been received or the right to recover compensation for furnished labor, services, equipment or material that was not compensated by the progress payment.

The statutory release also provides that it does not cover contract rights, including rights based on rescission, abandonment or breach of contract.

In order to induce payment of the amount shown in the statutory release, the undersigned individual hereby declares that the company named above did not furnish any extras or any labor, services, equipment or material before the Through Date that was not compensated by the progress payment, except for the items listed below.

By execution of this document, the company also hereby releases all contract rights and all other legal and equitable claims that it has with regard to labor, service, equipment or material furnished through the Through Date including rights and claims for direct and indirect costs, based on rescission, abandonment, breach of contract, delay, disruption or acceleration.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

UNCONDITIONAL WAIVER AND RELEASE UPON PROGRESS PAYMENT.

00 04 02-12

DECLARATION TO PROCURE FINAL PAYMENT AND RELEASE OF CONTRACT RIGHTS

[Project]

[Date As It Appears On The Release]

The company named above has executed a Conditional Waiver and Release Upon Final Payment, pursuant to Cal. Civil Code section 8136 on the date shown above.

In order to induce payment of the amount shown in the statutory release, the undersigned individual hereby declares that the company named above did not furnish any extras or any labor, services, equipment or material on the Project that was not compensated by the final payment, except for the items listed below.

By execution of this document, the company also hereby releases all contract rights and all other legal and equitable claims that it has with regard to labor, service, equipment or material furnished on the Project including rights and claims for direct and indirect costs based on rescission, abandonment, breach of contract, delay, disruption or acceleration.

This Declaration and Release of Contract Rights is conditional, and shall be effective only when the check described on the statutory Conditional Waiver and Release form that accompanies this document has been properly endorsed and paid by the bank upon which it is drawn.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

CONDITIONAL WAIVER AND RELEASE UPON FINAL PAYMENT.

00 04 02-13

DECLARATION TO PROCURE FINAL PAYMENT AND RELEASE OF CONTRACT RIGHTS

[Project]

[Date As It Appears On The Release]

The company named above has executed an Unconditional Waiver and Release Upon Final Payment, pursuant to Cal. Civil Code section 8138 on the date shown above.

In order to induce payment of the amount shown in the statutory release, the undersigned individual hereby declares that the company named above did not furnish any extras or any labor, services, equipment or material on the Project that was not compensated by the final payment, except for the items listed below.

By execution of this document, the company also hereby releases all contract rights and all other legal and equitable claims that it has with regard to labor, service, equipment or material furnished on the Project including rights and claims for direct and indirect costs based on rescission, abandonment, breach of contract, delay, disruption or acceleration.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

UNCONDITIONAL WAIVER AND RELEASE UPON FINAL PAYMENT.

APPENDIX 2 – CONSTRUCTION ADMINISTRATION

FORMS

AFFIDAVIT OF FINAL COMPLETION

To: City of Pasadena

From:

Project: ________________________________________________

ADDRESS: ________________________________________________

Contract No.: ____________________________

Contract Date: ___________________________

I, , declare to the best of my knowledge and belief that:

1. I am the person and officer of

(“Contractor”) as indicated on the execution line of this affidavit; I am duly authorized to make this affidavit and to execute and deliver the attached Application for Final Payment and I am familiar with the terms and conditions of the construction contract for the Project (“Contract”);

2. The Work of the Contract has been completed in strict accordance with the Contract Documents;

3. No lawful debts of Contractor for labor or materials or other claims are outstanding for the Work.

4. No Federal Excise Tax has been included in the Contract Price;

5. No additional compensation, over and above the amount set forth in the enclosed Application for Final Payment is due Contractor under the Contract for the Work and any changes in the Work;

6. Upon receipt of Final Payment in the amount of $ , Contractor, on behalf of itself and its Subcontractors and Suppliers acknowledges that City and any and all employees of City and its authorized representatives will thereby be released from any and all Claims or liability for additional sums for Work or changes in the Work and Contractor encloses herewith an original duly executed and complete conditional waiver and release upon final payment in accordance with California Civil Code section 8138 from Contractor and from

7. Contractor has obtained release of all claims by Subcontractors, Suppliers and others against Contractor and the Project;

8. Contractor has no reason to believe that any third party has a valid claim against the Contractor, the Work, the Project or the City which has not been communicated in writing by the Contractor to City as of the date of this affidavit;

9. Any guarantees and warranties are in full force and effect;

10. I understand that this affidavit is made for the purpose of inducing City to consent to release of retention and to make Final Payment to Contractor and City will rely upon the accuracy of the matters stated in this affidavit.

I declare, under penalty of perjury of the laws of the State of California that the foregoing is true and correct.

Executed this day of , 20__ at , California.

(Signature)

(Name)

(Title)

CONTRACTOR GENERAL WARRANTY FORM

To: City of Pasadena

From:

Contract No.:

We, ______________________________, performed work at the above referenced project per our contract agreement and do hereby warrant that all labor and materials furnished and work performed are in accordance with the contract documents and authorized modifications thereto, and will be free from defects due to defective materials or workmanship for a period of one year from Date of Final Completion. This warranty commences on ____________ (Date of Final Completion) and expires on _____________ (One year from Commencement Date and/or Correction Date).

Should any defect develop during the warranty period due to improper materials, workmanship or arrangement, the defect, including adjacent work displaced, shall be made good by the undersigned at no expense to the Owner.

Written notice of defective work will be given to the Contractor. Should the Contractor fail to correct defective work within a reasonable time after receiving written notice, the Owner may, at his option, correct defects and charge the Contractor costs for such correction. The Contractor agrees to pay such charges upon demand.

Nothing in the above shall be deemed to apply to work which has been abused or neglected by the Owner.

Signature Date

Printed Name

Title

CONSENT OF SURETY TO RELEASE OF RETENTION OR FINAL PAYMENT

To Owner: City of Pasadena

Pasadena, CA 91101

Attention:

To Contractor: _______________________________________

Contract Date:

Bond No(s):

In accordance with the provisions of the Contract between Owner and Contractor, as indicated above, as Surety on bond number(s) , hereby consents to [full/partial] release of [retention/final payment] to Contractor and agrees that neither payment, nor any other act pursuant to final payment to Contractor, shall exonerate, abrogate, relieve or in any way discharge any duties or obligations of the Surety to Owner or any other obliges under the bond(s).

IN WITNESS, WHEREOF, consent to the foregoing is hereby given this _____________ day of _____________, 20___.

[INSERT NAME OF SURETY]

By

(Signature of authorized representative)

Its (Printed name and title)

STATE OF ______________ )

) ss.

COUNTY OF ____________ )

[Attach notary acknowledgement and power of attorney]

SWORN STATEMENT AND WARRANTY

REGARDING CONTINUING INSURANCE OBLIGATIONS

FROM:

(Name or Title of Person Making Declaration) [insert Contractor name and address]

TO: City of Pasadena

PROJECT:

ADDRESS:

DECLARATION

Attached hereto is a true and correct copy of the current Certificate of Insurance and Additional Insured Endorsement which complies with the insurance requirements of the aforementioned Project as set forth in the Construction Contract and incorporated into the undersigned’s Contract (“Contract”).

I declare under penalty of perjury under the laws of the State of California that the above statement is true and correct.

Signed on ________________, 20___, at _______________________________

(Date) (City, State)

(Signature of Individual Who is Making Declaration)