Kimley-Horn and Associates November Inv 30264473-MPD0562-24.pdf
PDF 706 KB Posted
- Attached to
- Master Agreement AZ|CTR060474
- Contract number
- CTR060474
- Issued by
- Arizona
About this file
This document is a billing summary and reimbursement request from Kimley-Horn and Associates Inc. to the Arizona Department of Transportation (ADOT), Multimodal Planning Division, for the Bisbee Community Connections Master Plan project. The contract involves Purchase Order PO0000715026, with Contract Number CTR060474-7, and is tracked under MPD0562-24. The primary point of contact for ADOT is Jennifer Hobert, and for Kimley-Horn is Rebeca Field.
The total project award is $598,809.32, with this specific invoice requesting $11,079.09 for services rendered through November 30, 2024. The invoice covers project management, coordination, public involvement planning, and existing conditions review tasks performed by team members including Rebeca Field, Anthony Pratt, Jake Senne, and Aidan Johan. The project has a 0.00% Disadvantaged Business Enterprise (DBE) commitment, and no DBE subcontractors were involved. The billing period is from November 1, 2024, to November 30, 2024, and the invoice was submitted on January 16, 2025, with a vendor performance report indicating that project objectives were met and performance was within expected standards.
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Text version
No Partial - In Progress
0.00% 0
Billing Start Date
11/1/2024 Billing
End Date 11/30/2024
Originally Awarded Budget Amount
Approved Modifications
Amount
Total Awarded Budget
$ Invoiced Previously
$ Rejected or Disallowed on
Previous Invoices
$ Remaining Project Budget (Total
Awarded - $ Invoiced Previously + $
Rejected on Prev.
Invoices)
$ Paid by ADOT Previously
Purchase Order Balance Prior to
This Invoice (Total Awarded -
$ Paid)
$ Invoiced Today
$ Disallowed ($ Invoiced
Exceeds Remaining
Budget)
Net Amount Due for
This Invoice
Balance After This Invoice
593,309.32$ -$ 593,309.32$ -$ -$ 593,309.32$ -$ 593,309.32$ 11,079.09$ -$ $ 11,079.09 $ 582,230.23
5,500.00$ -$ 5,500.00$ -$ -$ 5,500.00$ -$ 5,500.00$ -$ -$ $ - $ 5,500.00
TOTALS 598,809.32$ -$ 598,809.32$ -$ -$ 598,809.32$ -$ 598,809.32$ 11,079.09$ -$ 11,079.09$ 587,730.23$
Date Signed / Invoice Date
1/16/2025
Date Signed / Invoice Date
Phone Number Phone
Number
Please leave blank
Federal Funding for this Project (Locate in PO Reference/Description text)
Submitter Certification (Required with Every Invoice)
The ADOT Project Manager is required to review for each of these items.
By approving this invoice, you certify these requirements are met
White Field = Entry in Field Permitted
Pink Field = Mandatory Field
SUMMARY OF WORK FOR WHICH PAYMENT IS REQUESTED
Task or Deliverable Description from PO Line (Identifies which PO line(s) should be received for this submission) Additional Optional Information
CTR060474-7 / 844236-1 / MPD0562-24:
Bisbee Community Connections Master Plan CTR060474-7 / 844236-2 / Travel Community Connections Master Plan
Area Reserved Color Key rebeca.field@kimley-horn.com Please Leave Blank
Prime PM Name (Notify if Unaccepted / Rejected / Paid)
Rebeca Field DBE Commitment % How many DBE Subcontractors performed on the Project?
Invoice Number 30264473
Please Leave BlankPrime PM Email
Billing Summary / Reimbursement Request For use by: Vendors / Contractors / Suppliers of MPD
(Version 07/01/2023)
Jennifer Hobert Project Title
(For Research Project add SPR Number)
Bisbee Community Connections Master Plan Commentaire
MPD Tracking Number {Use Format: MPDnnnn-yy};
{RTAP use " MPDRTAP-yy"}
MPD0562-24ADOT PM Name
Prime Contractor Firm Name KIMLEY-HORN AND ASSOCIATES INC Is the Prime an AZ Certified
DBE?
Project Status
(Select from Drop Down) Purchase Order Number PO0000715026
White Field with RED Text
= Urgent Information
Pink with Red Text = Entry/Correction Required Pale Orange = Form Calculated field
Teal = Label Only - Do not Enter Text
Grey = Disregard Field
FMS PROCESSING - SECTION RESERVED FOR FMS PROCESSING
Invoice Received for Processing Please Leave Blank
Date Received by Optional Comment Optional NoteDate Received by
ADOT PROGRAM/PROJECT MANAGER REVIEW
Invoicing aligns with Progress and Awarded Budget / Pricing
Support Documents align to Invoice and adequately supports costs
Status Reason for Rejection
Progress toward Scope aligns with Awarded Requirements Invoice Approved
Invoice Rejected
Confirmed - Zero DBE SubContractors performed work on the Project
Please Leave Blank
ADOT PM Signature RequiredTravel charges are in accordance with State/ADOT Policy
SignatureSignature rebeca.field@kimley-horn.com 520.352.8657 Email AddressEmail Address
Submitter: I hereby certify / confirm the above statements Optional 2nd Submitter: I hereby certify / confirm the above statements
This section is only applicable to the FINAL reimbursement request submission - Please leave blank.
Pursuant to 2 CFR 200.415: By signing this report, I certify to the best of my knowledge and belief that the report is true, complete, and accurate, and the expenditures, disbursements and cash receipts are for the purposes and objectives set forth in the terms and conditions of the Federal award. I am aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to criminal, civil or administrative penalties for fraud, false statements, false claims or otherwise. (U.S. Code Title 18, Section 1001 and Title 31, Sections 3729-3730 and 3801-3812).
I Confirm DBE Goal Committment was made for the Project and No AZ DBE Firms Participated.
I certify that my typed in signature below is a legally-binding signature.
Please Leave Blank
Docusign Envelope ID: 3B622086-893F-4283-A16E-22376A6EAF39
X
1/16/2025
REC #1598157
Enter Date Received by MPD and Receipt Number
AP RECEIVED 1/16/25Accounts Payable DocuSign1/16/2025 mailto:rebeca.field@kimley-horn.com mailto:rebeca.field@kimley-horn.com mailto:rebeca.field@kimley-horn.com mailto:rebeca.field@kimley-horn.com mailto:rebeca.field@kimley-horn.com
Prime Firm Name DBE % 0.00% Task No
Awarded $ Functional Role Plan Actual Plan Actual Plan Actual Plan Actual Plan Actual Plan Actual Plan Actual Plan Actual Plan Actual Plan Actual Plan Actual
Rebeca Field Project Manager 15.0 Brent Crowther Principal and QA/QC 0.0 Anthony Pratt Deputy Project Manager 14.5 Aidan Johan Planning/Prioritization 20.5 Joseph Cuffari Public Involvement Specialist 0.0 Jake Senne Path Design Lead 0.5
Tim Rhine Cost Analysis / Traffic Analysis 0.0
SubContractor Firm DBE % 0.00%
Task No Awarded $
Functional Role Plan Actual Plan Actual Plan Actual Plan Actual Plan Actual Plan Actual Plan Actual Plan Actual Plan Actual Plan Actual Plan Actual
4 5 6 7 8 9 11
AZ Certified
DBE?
$ of Contract Award $ -
3 10
Staff Name
Staff Name 1 2
5 6 7 8 9 10 11
AZ Certified
DBE?
$ of Contract Award $ - 1 2
Purchase Order Number PO0000715026
Vendor Hours Contribution Table & DBE Compliance Report MPD Tracking Number MPD0562-24 The hours reported on this table are provided to enable visual assessment by the ADOT Project Manager of progress on work tasks. Race Conscious DBE Goal Commitment 0.00%
This information will also be used to verify that the level of team member and/or individual designated for the task is actually performing the work.
This information will also be used if auditing the project for DBE Commercially Useful Function. Vendor's Invoice Number 30264473
Decreases in DBE Firm Participation or Removal MUST be Authorized by the BECO Office in Advance. Total Project Award 598,809.32$ Please update Actual Hours
3 4
Docusign Envelope ID: 3B622086-893F-4283-A16E-22376A6EAF39
Contact Division/Unit
Title Location Address
Email Telephone
Supplier Name Supplier Contact
Contract No. Purchase Order #
Date Invoice #
Project Title Interim VPR
Email Date
Describe details of the action taken:
based on, {with MPD revisions to performance section}:
ADOT Vendor Performance Report (11/21)
1/16/2025
Describe Compliance with Invoicing Requirements:
Describe Project Delivery Compared with Schedule:
Describe Project Outcomes Compared with Objectives:
Describe Vendor Performance
Services, Goods or Equipment:
Describe the performance issue. Be accurate, complete and factual. Use an attachment if necessary.
MPD Tracking Number MPD0562-24 Bisbee Community Connections Master Plan
Commentaire
PROCUREMENT ACTION
Vendor Performance Report Procurement Office 1739 W. Jackson St., Ste. A, MD 100P
Phoenix, AZ 85007
Email: Procurement@azdot.gov
Documenting positive or negative performance and procurement actions, as requested
Reporting Contact Information
Procurement Officer
MULTIMODAL PLANNING DIVISION
MPD PLANNING TEAM
Jennifer Hobert
Bisbee Community Connections Master Plan
PO0000715026
30264473
Jhobert@azdot.gov
Reporting Contact Information
KIMLEY-HORN AND ASSOCIATES INC Rebeca Field
CTR060474-7
DateSignature of Agency Representative
MPD Contracts will submit an electronic copy of the completed form to the ADOT Procurement Office at Procurement@azdot.gov.
Reporting incident, no action requested.
Requesting action:
Docusign Envelope ID: 3B622086-893F-4283-A16E-22376A6EAF39
Invoicing requirements were met.
None
Performance is within expected standards.
Project Objectives have been met.
X
1/16/2025
Project Delivery was within the agreed upon schedule.
mailto:Jhobert@azdot.gov mailto:Jhobert@azdot.gov mailto:Jhobert@azdot.gov mailto:Jhobert@azdot.gov mailto:Jhobert@azdot.gov mailto:Jhobert@azdot.gov
Please remit payment electronically to: If paying by check, please remit to:
Account Name: KIMLEY-HORN AND ASSOCIATES, INC. KIMLEY-HORN AND ASSOCIATES, INC.
Bank Name and Address: WELLS FARGO BANK, N.A., SAN FRANCISCO, CA 94104 P.O. BOX 913221 Account Number:
ABA#:
2073089159554 121000248
DENVER, CO 80291-3221
Please send remittance information to: payments@kimley-horn.com
10pt blank space
ARIZONA DEPARTMENT OF TRANSPORTATION
MULTIMODAL PLANNING DIVISION
ATTN: JENNIFER HOBERT
1611 W. JACKSON ST., MD 310B
PHOENIX, AZ 85007
Federal Tax Id: 56-0885615 For Services Rendered through Nov 30, 2024
Invoice Amount: $11,079.09
Invoice No: 30264473 Invoice Date: Nov 30, 2024
Project No: 291199022.3 Project Name: BISBEE CONNECTIONS PLAN Project Manager: FIELD, REBECA
Client Reference: CTR060474
PO0000715026
Description Contract Value Amount Earned to Date Previous Amount
Billed Current Amount
Due
SERVICES RENDERED 598,809.32 11,079.09 0.00 11,079.09
291199022.3 Total Invoice: $11,079.09
If you have questions, please contact Sheryl Perkins at (623) 335-1433 or Sheryl.Perkins@kimley-horn.com 81SSP
ARIZONA DEPARTMENT OF TRANSPORTATION
MULTIMODAL PLANNING DIVISION
ATTN: JENNIFER HOBERT
1611 W. JACKSON ST., MD 310B
PHOENIX, AZ 85007
Invoice No: 30264473 Invoice Date: Nov 30, 2024
Project No: 291199022.3 Project Name: BISBEE CONNECTIONS PLAN Project Manager: FIELD, REBECA
HOURLY NOT TO EXCEED 010070291199022.3W10563291199022.3CPM-1DTCPM
Task Category Description/Name Hrs/Qty Rate Current Amount
Due
PM & COORDINATION ANALYST SENNE, JAKE 0.5 140.68 70.34
PROJECT MANAGER FIELD, REBECA 13.0 250.08 3,251.04
PRATT, ANTHONY 14.5 250.08 3,626.16
TOTAL PM & COORDINATION3T 28.0 6,947.54
PUBLIC INVOL PLAN PROJECT MANAGER FIELD, REBECA 2.0 250.08 500.17
TOTAL PUBLIC INVOL PLAN1T 2.0 500.17
EXISTING CONDITIONS REV PLANNER JOHAN, AIDAN 20.5 177.14 3,631.38
TOTAL EXISTING CONDITIONS REV1T 20.5 3,631.38
TOTAL LABOR AND EXPENSE DETAIL 11,079.09
This page is for informational purposes only. Please pay amount shown on cover page.
81SSP
| 2025-01-16T11:02:20-0800 | |
| Digitally verifiable PDF exported from www.docusign.com |
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