Contingency_Request_Form_(SWFWMD).pdf

Exhibit "E"

Cooperative Funding Construction Contingency Justification Submit ONE form per contingency line item requested for District reimbursement up to 5% (2.5% District portion)

Project Name:

District Project Number:

Cooperator:

Contract Number:

Contingency Request Number:

Awarded Construction Contract Total ($):

Contingency Amount Requested ($):

Cumulative Contingency Amount Authorized to date ($): Total Cumulative Contract Price Including this Request ($): Maximum contingency eligible for reimbursement ($):

Contingency Request Description:

Contingency Line Item Justification1:

Cooperative Funding Resource Benefit2:

Cost/Negotiation Description3:

I hereby certify that this contingency request is necessary for the resource benefit required under the cooperative agreement and scope and costs were negotiated in good faith.

Contract Manager or Engineer of Record Date

1 Justification must document the need for the contingency line item, the circumstances under which the need was discovered, and why the item was not included within the original project scope. The District may deny reimbursement for additional costs due to design errors, rework and defects in the work.

ALTERNATE LANGUAGE: The District may deny reimbursement for additional costs resulting from delays, inefficiencies, rework or extra work.

2 Describe why the contingency line item is needed to fulfill the resource benefit required under the cooperative agreement.

3 Costs need to be justified and demonstrated to be reasonable. Provide unit price comparison, or recent competitive cost proposals, RS Means or FDOT cost data. Attach backup documentation. If no price comparisons or competitive quotes can be provided, a certification from the Engineer of Record or appropriate Professional Engineer stating that the cost is reasonable may be considered. The certification method is not preferred and will require justification that other methods were not available.

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