KIMLEY-HORN_INVOICE_28318707_MPD_0021-21_H80_May(CPS STATEWIDE).pdf
PDF 981 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 a project designated as MPD0021-21 H80, involving a CPS Statewide Summary. The invoice is part of a contract (ADOT17-171963) with a purchase order number PO0000613378, and involves federal funding. The prime contractor is Kimley-Horn, and the ADOT Project Manager is Chris LaVoie.
The contract has a total awarded budget of $71,650.00, with the current invoice requesting reimbursement of $6,522.50 for professional services rendered through May 31, 2024. The work includes project management activities, addressing comments on the CPS Statewide Summary Report, making updates to the US 93 Mobility Performance Reassessment Report, and conducting a meeting with ADOT Northwest District, FHWA, and Mohave County. The invoice covers labor from various team members including consultants, analysts, and engineers, with billable hours ranging from 0.5 to 10.0 hours at rates between $125.00 and $275.00. The project has a 0.00% DBE (Disadvantaged Business Enterprise) commitment, and no DBE subcontractors participated in the work.
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Text version
No Partial - In Progress
0.00% 0
Billing Start Date
5/1/2024 Billing
End Date 5/31/2024
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
1,500.00$ 1,500.00$ -$ 1,500.00$ 1,500.00$ -$ $ - $ 1,500.00
32,245.00$ 37,905.00$ 70,150.00$ 59,275.00$ 10,875.00$ 59,275.00$ 10,875.00$ 6,522.50$ -$ $ 6,522.50 $ 4,352.50
TOTALS 33,745.00$ 37,905.00$ 71,650.00$ 59,275.00$ -$ 12,375.00$ 59,275.00$ 12,375.00$ 6,522.50$ -$ 6,522.50$ 5,852.50$
Date Signed / Invoice Date
6/27/2024 Date Signed / Invoice Date
Phone Number Phone Number
Please leave blank
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.
3) I certify that my typed in signature below is a legally-binding signature.
Please Leave Blank
Michael Grandy SignatureSignature
Michael.Grandy@Kimley-Horn.com Email AddressEmail Address
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
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
Billing Summary / Reimbursement Request For use by: Vendors / Contractors / Suppliers of MPD
(Version 07/01/2023)
Chris LaVoie Project Title
(For Research Project add SPR Number)
CPS Statewide Summary MPD Tracking Number
{Use Format: MPDnnnn-yy};
{RTAP use " MPDRTAP-yy"}
MPD0021-21 H80ADOT 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 PO0000613378
Michael.Grandy@Kimley-Horn.com Please Leave Blank
Prime PM Name (Notify if Unaccepted / Rejected / Paid)
Michael Grandy DBE Commitment % How many DBE Subcontractors performed on the Project?
Invoice Number 28318707
Please Leave BlankPrime PM Email
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
Task 1 - Expenses
Task 2 - CPS Statewide Summary Labor
Area Reserved Color Key
DocuSign Envelope ID: 561E849B-4D59-4D5B-B473-04BCA3D85C64DocuSign Envelope ID: CB4FC116-B7B9-4E87-849E-D14335EE0DEC
X
Enter Date Received by MPD and Receipt Number
REC #1466520
06/28/2024
7/1/2024AP Accounts Payable DocuSign mailto:Michael.Grandy@Kimley-Horn.com mailto:Michael.Grandy@Kimley-Horn.com mailto:Michael.Grandy@Kimley-Horn.com mailto:Michael.Grandy@Kimley-Horn.com mailto:Michael.Grandy@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 Brent Crowther Consultant 13.0 Michael Grandy Consultant 119.0 17.5 Raj Christian Consultant 3.0 Keith Christian Engineer 9.0 Kristen Faltz Analyst 24.0 Deanna Haase Technical Expert 0.0 0.5 Chris Joannes Planner 8.0 Eve Fillingham Planner 0.0 Matthew Hernandez Planner 0.0 Angela McHugh Planner 0.0 Jason Getz GIS 55.0 Taylor Dunkle Engineer 133.0 4.5 Karina Trejo Analyst 10.0 0.5 Dan Iwicki Engineer 24.0 Ajdin Spahic Analyst 0.0 Isaac Wotherspoon Analyst 0.0 Logan Prescott Analyst 126.0 Greg Honiotes Analyst 0.0 6.0 Jessie Jensen Admin/Financial 0.0 Bill Tran Analyst 0.0 Mike Dayton Admin/Financial 9.0 1.0
Purchase Order Number PO0000613378
Vendor Hours Contribution Table & DBE Compliance Report MPD Tracking Number MPD0021-21 H80
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 28318707
Decreases in DBE Firm Participation or Removal MUST be Authorized by the BECO Office in Advance. Total Project Award 71,650.00$
Please update Actual Hours
AZ Certified
DBE?
$ of Contract Award $ 99,687.50
Staff Name $ 99,687.50
DocuSign Envelope ID: 561E849B-4D59-4D5B-B473-04BCA3D85C64DocuSign Envelope ID: CB4FC116-B7B9-4E87-849E-D14335EE0DEC
TOTALS 533.0 30.0
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 5.0
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
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
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
Staff Name 1 2
Staff Name 1 2
Staff Name
Staff Name 1 2
6 7 8 9 11
AZ Certified
DBE?
$ of Contract Award $ -
3 10
$ of Contract Award $ -
4 5
AZ Certified
DBE?
10 113 4 5 6 7 8 9
10 11
AZ Certified
DBE?
$ of Contract Award $ -
3 4 5 8 96 7
AZ Certified
DBE?
$ of Contract Award
6 7
4 5 103 8 9
DocuSign Envelope ID: 561E849B-4D59-4D5B-B473-04BCA3D85C64DocuSign Envelope ID: CB4FC116-B7B9-4E87-849E-D14335EE0DEC
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
###### 60.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5.00 0.00 0.00 0.00 0.00
Staff Name 1 2
TOTALS
8 96 7 10 11
AZ Certified
DBE?
$ of Contract Award
3 4 5
Notes, Comments
DocuSign Envelope ID: 561E849B-4D59-4D5B-B473-04BCA3D85C64DocuSign Envelope ID: CB4FC116-B7B9-4E87-849E-D14335EE0DEC
Contact Division/Unit
Title Location Address
Email Telephone
Supplier Name Supplier Contact
Contract No. Purchase Order #
Date Invoice #
Project Title Interim VPR
Email Date
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:
Procurement Officer
PO0000613378
28318707
Reporting Contact Information
Kimley-Horn and Associates, Inc. Michael Grandy
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
Describe details of the action taken:
based on, {with MPD revisions to performance section}:
ADOT Vendor Performance Report (11/21)
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 MPD0021-21 H80 CPS Statewide Summary
PROCUREMENT ACTION
DocuSign Envelope ID: 561E849B-4D59-4D5B-B473-04BCA3D85C64DocuSign Envelope ID: CB4FC116-B7B9-4E87-849E-D14335EE0DEC
Performance is within expected standards.
480-670-3444
Chris LaVoie
Project Objectives have been met.
None
X
Project Delivery was within the agreed upon schedule.
1611 W Jackson Phoenix, AZ 85007 clavoie@azdot.gov
7/1/2024
Program Manager
Invoicing requirements were met.
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
ADOT MULTIMODAL PLANNING DIVISION
ATTN: CHRIS LAVOIE
206 S. 17TH AVE., MD 310B
PHOENIX, AZ 85007
Federal Tax Id: 56-0885615 For Services Rendered through May 31, 2024
Invoice Amount: $6,522.50 Invoice No:
Invoice Date:
Project No:
Project Name:
28318707 May 31, 2024
291199015.3
CPS STATEWIDE SUMMARY
Project Manager: GRANDY, MICHAEL
Client Reference: ADOT17-171963
PO#0000613378
Description Contract Value Amount Earned to Date Previous Amount
Billed Current Amount
Due
SERVICES RENDERED 71,650.00 65,797.50 59,275.00 6,522.50
291199015.3 Total Invoice: $6,522.50
If you have questions, please contact Mike Dayton at (602) 789-3848, or Mike.Dayton@kimley-horn.com 81MRD
DocuSign Envelope ID: 561E849B-4D59-4D5B-B473-04BCA3D85C64DocuSign Envelope ID: CB4FC116-B7B9-4E87-849E-D14335EE0DEC
ARIZONA DEPARTMENT OF TRANSPORTATION
ADOT MULTIMODAL PLANNING DIVISION
ATTN: CHRIS LAVOIE
206 S. 17TH AVE., MD 310B
PHOENIX, AZ 85007
Invoice No: 28318707 Invoice Date: May 31, 2024
Project No: 291199015.3 Project Name: CPS STATEWIDE SUMMARY
Project Manager: GRANDY, MICHAEL
COST PLUS MAX 002072291199015.3W10563291199015.3CPM-1DTCPM
Task Category Description/Name Hrs/Qty Rate Current Amount
Due
STATEWIDE SUMMARY ADMIN/FINANCIAL DAYTON, MIKE 1.0 125.00 125.00
CONSULTANT GRANDY, MICHAEL 7.5 260.00 1,950.00
TECHNICAL EXPERT HAASE, DEANNA 0.5 275.00 137.50
TOTAL STATEWIDE SUMMARY3T 9.0 2,212.50
MOBILITY REASSESSMENT ANALYST HONIOTES, GREG 6.0 135.00 810.00
TREJO, KARINA 0.5 135.00 67.50
CONSULTANT GRANDY, MICHAEL 10.0 260.00 2,600.00
ENGINEER DUNKLE, TAYLOR 4.5 185.00 832.50
TOTAL MOBILITY REASSESSMENT4T 21.0 4,310.00
TOTAL LABOR AND EXPENSE DETAIL 6,522.50
This page is for informational purposes only. Please pay amount shown on cover page.
81MRD
DocuSign Envelope ID: 561E849B-4D59-4D5B-B473-04BCA3D85C64DocuSign Envelope ID: CB4FC116-B7B9-4E87-849E-D14335EE0DEC
6/27/2024 ADOT MPD_0021-21_H80_Update_Progress Report_May 2024(CPS STATEWIDE).docx 1 of 1
PROGRESS REPORT NO. 12
Arizona Department of Transportation
Task Assignment: MPD0021-21 H80
CPS Statewide Summary Contract # ADOT17-171963
Kimley-Horn Project No. 291199015
Reporting Period: Through May 31, 2024
Key Project Staff
Michael Grandy, Project Manager Taylor Dunkle, Project Engineer
Progress and Accomplishments during the Reporting Period
Task 1 – CPS Statewide Summary Conducted project management activities.
Addressed comments on CPS Statewide Summary Report.
Made updates to US 93 Mobility Performance Reassessment Report.
Prepared for and conducted meeting with ADOT Northwest District, FHWA, Mohave County on
5/15 to provide an update on assessment and impacts of anticipated Entrata development
Contacts Made
Coordinated with Paul Patane as well as ADOT Northwest District, Mohave County, and FHWA.
Information Generated
None this month.
Next Month Anticipated Activities
Finalize the US 93 Mobility Performance Reassessment Report.
Refine the CPS Statewide Summary Report to account for US 93 Mobility Performance
Reassessment.
DocuSign Envelope ID: 561E849B-4D59-4D5B-B473-04BCA3D85C64DocuSign Envelope ID: CB4FC116-B7B9-4E87-849E-D14335EE0DEC
Certificate Of Completion Envelope Id: 561E849B4D594D5BB47304BCA3D85C64 Status: Completed
Subject: Complete with Docusign: KIMLEY-HORN_INVOICE_28318707_MPD_0021-21_H80_May(CPS STATEWIDE).pdf
Source Envelope:
Document Pages: 8 Signatures: 1 Envelope Originator:
Certificate Pages: 1 Initials: 0 Mike Dayton
AutoNav: Enabled
EnvelopeId Stamping: Enabled
Time Zone: (UTC-05:00) Eastern Time (US & Canada)
401 Fayetteville St.
Suite 600
Raleigh, NC 27601
Mike.Dayton@kimley-horn.com
IP Address: 137.83.223.169
Record Tracking Status: Original
6/27/2024 6:25:06 PM
Holder: Mike Dayton
Mike.Dayton@kimley-horn.com
Location: DocuSign
Signer Events Signature Timestamp Chris LaVoie
Clavoie@azdot.gov
PM
ADOT
Security Level: Email, Account Authentication (None)
Signature Adoption: Pre-selected Style
Using IP Address: 162.59.200.193
Sent: 6/27/2024 6:27:01 PM
Viewed: 6/28/2024 10:09:16 AM
Signed: 6/28/2024 10:10:40 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
In Person Signer Events Signature Timestamp
Editor Delivery Events Status Timestamp
Agent Delivery Events Status Timestamp
Intermediary Delivery Events Status Timestamp
Certified Delivery Events Status Timestamp
Carbon Copy Events Status Timestamp
Witness Events Signature Timestamp
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 6/27/2024 6:27:01 PM
Certified Delivered Security Checked 6/28/2024 10:09:16 AM
Signing Complete Security Checked 6/28/2024 10:10:40 AM
Completed Security Checked 6/28/2024 10:10:40 AM
Payment Events Status Timestamps
DocuSign Envelope ID: CB4FC116-B7B9-4E87-849E-D14335EE0DEC
| BillingReport |
| VendorHoursContribution |
| Vendor Performance Report |
| 2024-07-01T09:24:34-0700 | |
| Digitally verifiable PDF exported from www.docusign.com |
File details come from the government source that posted it. Updated .