Exhibit 8 Contract Closeout Checklist~4.pdf

5781/gfd ITB # S-44300-00008316 DAS ITB Template Effective 12/01/2021 Page 1 of 4

EXHIBIT 8

Contract Closeout Compliance Checklist

Contract Number 181855 Contract Name Contractor Owner’s Authorized Rep. Joel Turner Joel.T.Turner@oha.oregon.gov

This checklist is intended to assist Agency and Contractor in complying with the Contract Closeout and Final Payment requirements in the General Conditions for Public Improvement Contracts, Sections K and E.6.

Owner will mark “NA” by any requirement that is not applicable to the Contract. Contractor’s and Owner’s Authorized Representatives shall place their initials by each requirement listed below that has not been marked “NA” by Owner, and provide a Signature at the end of the Checklist.

Keep a copy of the signed form in the Contract Administration file.

Requirements Mark NA if not applicable

Date completed

Contractor initials

Owner initials

K.1 Record Documents submitted

K.2 O & M Manuals submitted

K.3 Certification/Release of Claims

By Contractor’s Signature below, Contractor certifies and agrees to the following:

All Subcontractors and suppliers have been paid in full or will be paid in full out of the final payment, and in compliance with all prompt payment requirements. All disputes with property owners have been resolved, all obligations on the project have been satisfied, all monetary claims and indebtedness have been paid, and, to the best of the Contractor's knowledge, there are no claims of any kind outstanding against the project.

K.4 Completion notices submitted

Substantial Completion notice Date of substantial completion:

Final Completion notice Date of final completion:

K.5 Training sessions scheduled

5781/gfd ITB # S-44300-00008316 DAS ITB Template Effective 12/01/2021 Page 2 of 4

K.6 Extra materials provided (List individually):

K.7. Environmental Clean-up:

Contractor hereby notifies Owner that all environmental cleanup that was performed as a part of this contract has been disposed of in accordance with all applicable rules, regulations, laws, and statutes of all agencies having jurisdiction over such environmental pollution.

NA

K.8 Certificate of Occupancy received by Owner

K.9 Other Contractor Responsibilities

Complete OHA Facilities Planning & Safety Unit (FPS) Substantial Completion Notice Form and on-site inspection.

Receive FPS final Notice of Project Approval

E.6 Contractor’s final payment request submitted

Final payment request approved by Owner

CONTRACTOR’S AUTHORIZED REPRESENTATIVE:

Printed Name Title

Signature Date

OWNER’S AUTHORIZED REPRESENTATIVE:

Printed Name Title

Signature Date

PUBLIC HEALTH DIVISION, Center for Health Protection

Health Care Regulation and Quality Improvement Section

Health Facility Licensing and Certification Program

Tina Kotek, Governor

Project Substantial Completion Notice Form

Use this form for: Hospitals (including Hospital Satellites), End-Stage Renal Dialysis Facilities, Ambulatory Surgery Centers, Special Inpatient Care Facilities and Birthing Centers licensed by OHA Health Facility Licensing and Certification.

-or- Nursing Homes, Assisted Living Facilities and Residential Care Facilities licensed by DHS Safety, Oversight and Quality Unit.

INSTRUCTIONS:

To request an onsite inspection by Facilities Planning and Safety (FPS), please complete and return this form as directed below approximately three (3) weeks prior to receiving an Occupancy Permit from the authority having jurisdiction.

FPS will contact you directly to coordinate an onsite inspection date.

PLEASE NOTE:

Patients may not occupy the space until the following steps have been completed:

□ FPS completes an onsite inspection;

□ All deficiencies identified during inspection have been resolved;

□ FPS issues a final Notice of Project Approval; and

□ All OHA Health Facility Licensing and Certification requirements or All

DHS Safety, Oversight and Quality Unit requirements have been met.

PR# PR 22-141 Date: Enter today’s date.

Project Name: Meadow Unit Renovation Oregon State Hospital

Project Description: Interior renovation of JC Meadow Unit

Project Address: 92213 Dreas Way, Junction City OR 97448.

Expected Occupancy Date: Enter provider’s expected occupancy date.

#1 Requested Inspection Date: Preferred FPS inspection date.

#2 Requested Inspection Date: Alternative FPS inspection date.

Facility Contact: Joel Turner

Email Joel.t.turner@oha.oregon.gov

Phone (desk): (503) 881-3379 Cell: (503) 947-8157

Facilities Planning & Safety Unit rev. January 09, 2023 Page 4 of 4 (4)(a) FPS Project SC Notice

Design Team Contact: Name of design team representative attending inspection.

Email Enter email address.

Phone (desk): Enter office phone number. Cell: Enter cell phone number.

Distribute copies of this completed form as follows:

ALL projects, submit one (1) copy to:

Facilities Planning & Safety Oregon Health Authority – Public Health 800 NE Oregon Street, Suite 465 Portland, OR 97232 Phone: (971) 673-0540

Fax: (971) 673-0556 mailbox.fps@odhsoha.oregon.gov

ALL projects, submit one (1) copy to:

The City, County or State Building Codes Agency that issued the Building Permit for the project.

Nursing Homes, submit one (1) copy to:

Safety, Oversight and Quality Unit PO Box 14530 Salem, OR 97309 Phone: (503) 373-3227

NF.licensing@odhsoha.oregon.gov

Residential Care Facilities and Assisted Living Facilities, submit one (1) copy to your assigned licensing policy analyst at:

Safety, Oversight and Quality Unit PO Box 14530 Salem, OR 97309

Vickie Surico, Victoria.S.Surico@odhsoha.oregon.gov (971) 283-6116 Becky Mapes, Rebecca.MAPES@odhsoha.oregon.gov (503) 373-2076 Warren Bird, Warren.D.BIRD@odhsoha.oregon.gov (503) 373-1959 Kimberly Hector, Kimberly.S.Hector@odhsoha.oregon.gov (503) 373-0246 Meghan McClain, Meghan.K.Nielson@odhsoha.oregon.gov (503) 979-9635 Cassie Studer, Cassie.Studer@odhsoha.oregon.gov (503) 979-6073

FPS Office Use Only

Date Received: __________________ Plans Examiner: ___________________________

Inspection Date: __________________ Time: _____________________________________