KIMLEY-HORN_INVOICE_30222754_MPD_0021-21_H80_November(HISTORICAL CPS).pdf

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

15,500.00$ 15,500.00$ 2,892.50$ -$ 12,607.50$ 2,892.50$ 12,607.50$ 1,455.00$ -$ $ 1,455.00 $ 11,152.50

TOTALS 15,500.00$ -$ 15,500.00$ 2,892.50$ -$ 12,607.50$ 2,892.50$ 12,607.50$ 1,455.00$ -$ 1,455.00$ 11,152.50$

Date Signed / Invoice Date

12/18/2024

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

Task 1 - Historical CPS Update

Task 2 - Expenses

Area Reserved Color Key

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 30222754

Please Leave BlankPrime PM Email

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)

Historical Corridor Profile Study Update 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 PO0000711308-1

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

Michael Grandy SignatureSignature

Michael.Grandy@Kimley-Horn.com 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: 55BC8950-995D-47DE-AB79-00ECB4E9BF23

X

12/18/2024Enter Date Received by MPD and Receipt Number REC # 1582849

AP RECEIVED 12/20/24Accounts Payable DocuSign12/20/2024 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 0.0 Michael Grandy Consultant 12.0 1.0 Raj Christian Consultant 0.0 Keith Christian Engineer 0.0 Kristen Faltz Analyst 0.0 Deanna Haase Technical Expert 0.0 0.5 Chris Joannes Planner 0.0 Eve Fillingham Planner 0.0 Matthew Hernandez Planner 0.0 Angela McHugh Planner 0.0 Jason Getz GIS 0.0 Taylor Dunkle Engineer 23.0 4.0 Karina Trejo Analyst 0.0 Dan Iwicki Engineer 0.0 Ajdin Spahic Analyst 0.0 Isaac Wotherspoon Analyst 0.0 Logan Prescott Analyst 0.0 Logan Lowery Analyst 0.0 0.5 Greg Honiotes Analyst 0.0 Jessie Jensen Admin/Financial 0.0 Tamie Schofield Admin/Financial 63.0 1.0 Bill Tran Analyst 0.0 Mike Dayton Admin/Financial 2.0 1.0

$ 15,500.00 Staff Name 7 8 9 10 11

AZ Certified

DBE?

$ of Contract Award $ 15,500.00

1 2

Purchase Order Number PO0000711308-1

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 30222754

Decreases in DBE Firm Participation or Removal MUST be Authorized by the BECO Office in Advance. Total Project Award 15,500.00$

Please update Actual Hours

3 4 5 6

Total 100.0 8.0

Docusign Envelope ID: 55BC8950-995D-47DE-AB79-00ECB4E9BF23

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

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

100.00 8.00 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 0.00 0.00 0.00 0.00 0.00

AZ Certified

DBE?

$ of Contract Award $ -

3 4 5

10 113 4 5 6 7 8 9

Notes, Comments

3 6 7 118 9

TOTALS

Staff Name

AZ Certified

DBE?

$ of Contract Award $ -

4 5 10

8 96 7

1 2

$ of Contract Award $ -

4 5

AZ Certified

DBE?

6 7 8 9 11

AZ Certified

DBE?

$ of Contract Award $ -

3 10

Staff Name 1 2

Staff Name

Staff Name 1 2

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)

45644

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 Historical Corridor Profile Study Update

PROCUREMENT ACTION

Vendor Performance Report Procurement Office 1655 W. Jackson St., MD 100P

Phoenix, AZ 85007

Email: Procurement@azdot.gov

Documenting positive or negative performance and procurement actions, as requested

Reporting Contact Information

Procurement Officer

PO0000711308-1

30222754

Reporting Contact Information

Kimley-Horn and Associates, Inc. Michael Grandy

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: 55BC8950-995D-47DE-AB79-00ECB4E9BF23

Performance is within expected standards.

12/20/2024

MPD / Corridor Planning

CLaVoie@azdot.gov

PM

Project Delivery was within the agreed upon schedule.

X

480-670-3444

1611 W Jackson St, Phoenix, AZ 85007

Project Objectives have been met.

Invoicing requirements were met.

Transportation and Safety Planning

Chris LaVoie

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 Nov 30, 2024

Invoice Amount: $1,455.00

Invoice No:

Invoice Date:

Project No:

Project Name:

30222754 Nov 30, 2024

291199015.3

HISTORICAL CPS UPDATE

Project Manager: GRANDY, MICHAEL

Client Reference: ADOT17-171963

PO#0000711308-1

Description Contract Value Amount Earned to Date Previous Amount

Billed Current Amount

Due

SERVICES RENDERED 15,500.00 4,347.50 2,892.50 1,455.00

291199015.3 Total Invoice: $1,455.00

If you have questions, please contact Mike Dayton at (602) 789-3848, or Mike.Dayton@kimley-horn.com 81MRD

Invoice No: 30222754 Invoice Date: Nov 30, 2024

Project No: 291199015.3 Project Name: HISTORICAL CPS UPDATE

STUDY

Project Manager: GRANDY, MICHAEL

ARIZONA DEPARTMENT OF TRANSPORTATION

ADOT MULTIMODAL PLANNING DIVISION

ATTN: CHRIS LAVOIE

206 S. 17TH AVE., MD 310B

PHOENIX, AZ 85007

HOURLY NOT TO EXCEED 002072291199015.3W10563291199015.3CPM-1DTCPM

Task Category Description/Name Hrs/Qty Rate Current Amount

Due

ADDITIONAL SERVICES CPS ADMIN/FINANCIAL SUPPORT DAYTON, MIKE 1.0 125.00 125.00

SCHOFIELD, TAMIE 1.0 125.00 125.00

ANALYST LOWERY, LOGAN 0.5 135.00 67.50

CONSULTANT GRANDY, MICHAEL 1.0 260.00 260.00

ENGINEER DUNKLE, TAYLOR 4.0 185.00 740.00

TECHNICAL EXPERT HAASE, DEANNA 0.5 275.00 137.50

TOTAL ADDITIONAL SERVICES CPS6T 8.0 1,455.00

TOTAL LABOR AND EXPENSE DETAIL 1,455.00

This page is for informational purposes only. Please pay amount shown on cover page.

81MRD

12/18/2024 ADOT MPD_0021-21_H80_Update_Progress Report_Nov 2024(HISTORICAL CPS).docx 1 of 1

PROGRESS REPORT NO. 2

Arizona Department of Transportation

Task Assignment: MPD0021-21 H80 Historical CPS Update

Contract # ADOT17-171963 Kimley-Horn Project No. 291199015

Reporting Period: Through November 30, 2024

Key Project Staff

Michael Grandy, Project Manager Taylor Dunkle, Project Engineer

Progress and Accomplishments during the Reporting Period

Task 1 – Historical CPS Update Conducted project management activities.

Conducted internal quality checks on Excel data summarized from CPS Rounds 1 through 4 for inclusion in ADOT CPS website GIS webmap.

Contacts Made

Coordinated with Chris LaVoie.

Information Generated

None this month.

Next Month Anticipated Activities

Meet with ADOT GIS Group to review historical CPS data collected and address comments.