KIMLEY-HORN_INVOICE_30305607_MPD0555-24_H80 November(SR 264 Corridor Study ).pdf

No Partial - In Progress

0.00% 0

Billing Start Date

10/10/2024 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

350,026.80$ 350,026.80$ 350,026.80$ 350,026.80$ 11,477.63$ -$ $ 11,477.63 $ 338,549.17

4,615.79$ 4,615.79$ 4,615.79$ 4,615.79$ -$ $ - $ 4,615.79

TOTALS 354,642.59$ -$ 354,642.59$ -$ -$ 354,642.59$ -$ 354,642.59$ 11,477.63$ -$ 11,477.63$ 343,164.96$

Date Signed / Invoice Date

12/19/2024

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.

I certify that my typed in signature below is a legally-binding signature.

Please Leave Blank

Kristen Faltz SignatureSignature

Kristen.faltz@kimley-horn.com 480-485-5244 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)

Don Sneed Project Title

(For Research Project add SPR Number)

SR 264 Corridor Planning Study MPD Tracking Number

{Use Format: MPDnnnn-yy};

{RTAP use " MPDRTAP-yy"}

MPD0555-24ADOT 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 PO0000707300

Kristen.faltz@Kimley-horn.com Please Leave Blank

Prime PM Name (Notify if Unaccepted / Rejected / Paid)

Kristen Faltz DBE Commitment % How many DBE Subcontractors performed on the Project?

Invoice Number 30305607

Please Leave BlankPrime PM Email

Federal Funding for this Project (Locate in PO Reference/Description text)

FHWA

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 Project Kick-Off and Tech Memo 1 Project Work Plan and Schedule Review

Task 2 Travel

Area Reserved Color Key

Docusign Envelope ID: F6EA0310-11D7-480C-8B3C-1D3C72920FA4

X

12/19/2024Enter Date Received by MPD and Receipt Number

REC #1583333

12/23/2024 Accounts Payable DocuSign AP RECEIVED 12/23/24 mailto:Kristen.faltz@Kimley-horn.com mailto:Kristen.faltz@Kimley-horn.com mailto:Kristen.faltz@kimley-horn.com mailto:Kristen.faltz@kimley-horn.com mailto:Kristen.faltz@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

Michael Grandy* Principal 6.0 0.0 8.0 12.0 6.0 4.0 4.0 4.0 0.0 Chris Joannes* Project Manager 81.0 18.0 2.0 23.0 38.0 20.0 66.0 8.0 5.0 1.0 Kristen Faltz Planner 129.0 37.0 12.0 50.0 49.0 31.0 67.0 10.0 5.0 1.0 Jennifer Simpkins Technical Expert 0.0 0.0 10.0 5.0 0.0 0.0 0.0 0.0 0.0 Taylor Ehrick Technical Expert 14.0 0.0 2.0 20.0 14.0 0.0 16.0 8.0 0.0 Anita Johari Technical Expert 2.0 0.0 2.0 8.0 0.0 0.0 8.0 0.0 0.0 Joe Cuffari Planner 4.0 0.0 0.0 0.0 0.0 62.0 5.0 5.0 0.0 Greg Honiotes Analyst 2.0 1.0 0.0 168.0 50.0 48.0 45.0 30.0 10.0 4.0 Ajdin Spahic Analyst 0.0 0.0 70.0 30.0 50.0 0.0 30.0 10.0 0.0 Logan Lowery Analyst 0.0 0.0 90.0 30.0 42.0 0.0 30.0 10.0 0.0 Rachel Haughton Analyst 0.0 0.0 70.0 0.0 0.0 0.0 0.0 0.0 0.0 Giovanni Catanzaro Analyst 0.0 2.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Emma Luken Graphic Designer 10.0 0.0 4.0 4.0 8.0 73.0 20.0 10.0 0.0 Mike Dayton Administrative/Financial 12.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 Melissa Alvarez Graphic Designer 0.0 0.0 5.0 5.0 0.0 0.0 5.0 0.0 0.0

$ 37,136.88

Purchase Order Number PO0000707300

Vendor Hours Contribution Table & DBE Compliance Report MPD Tracking Number MPD0555-24

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.

$ 12,149.72 $ 1,120.15

This information will also be used if auditing the project for DBE Commercially Useful Function. Vendor's Invoice Number 30305607

Decreases in DBE Firm Participation or Removal MUST be Authorized by the BECO Office in Advance. Total Project Award 354,642.59$

Please update Actual Hours

Task 3 - Working Paper

1 - Identify Current and

Future Conditions

Task 4 - Identify

Deficencies and Evaluation

Criteria

Task 5 - Develop

Recommended Plan for

Improvements

Task 6 - Public and

Stakeholder Outreach

Task 7 - Draft Final Report

Task 8 - Final Report

Task 9 - GIS Data and

Study Closeout File

10 11

AZ Certified

DBE?

$ of Contract Award $ 321,521.68

Task 1 - Project Kick-

Off and Technical

Memorandum 1 - Project

Work Plan and Schedule Review

Task 2 - Monthly Progress Reports

Staff Name

$ 57,964.12 $ 55,465.02 $ 2,625.84 $ 78,238.50 $ 47,952.84 $ 28,868.61

Docusign Envelope ID: F6EA0310-11D7-480C-8B3C-1D3C72920FA4

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 Sarah Herr Principal Patricia Castalia Project Manager Meghann Vance Analyst Katie Bubnekovich Analyst Stephanie Sherwood Geographic Information Brent Kober Geographic Information

Staff Name 1 2

$ 512.27 6 7 8 9 11

Desert Archaeology, Inc.

AZ Certified

DBE?

$ of Contract Award $ 33,120.91

3 104 5 $ 32,608.64

Notes, Comments

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

PO0000707300

30305607

Reporting Contact Information

Kimley-Horn and Associates, Inc. Kristen Faltz

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)

45645

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 MPD0555-24 SR 264 Corridor Planning Study

PROCUREMENT ACTION

Docusign Envelope ID: F6EA0310-11D7-480C-8B3C-1D3C72920FA4 dsneed@azdot.gov

Planning Program Manager - Tribal Planning 1611 W Jackson St, Phoenix, AZ 85007

Donald Sneed, Sr.

Project Delivery was within the agreed upon schedule.

MPD /

Technical Planning Services

Project Objectives have been met.

12/20/2024

X

Performance is within expected standards.

480.271.0483

Invoicing requirements were met.

Please process payment for the invoice and this reimbursement request.

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

206 S. 17TH AVENUE, MD 310B

ATTN: DON SNEED

PHOENIX, AZ 85007

Federal Tax Id: 56-0885615 For Services Rendered through Nov 30, 2024

Invoice Amount: $11,477.63

Invoice No: 30305607 Invoice Date: Nov 30, 2024

Project No: 291199020.3 Project Name: ADOT SR 264 STUDY Project Manager: FALTZ, KRISTEN

Client Reference: MPD0555-24 H80

PO0000707300

Description Contract Value Amount Earned to Date Previous Amount

Billed Current Amount

Due

SERVICES RENDERED 354,642.59 11,477.63 0.00 11,477.63

291199020.3 Total Invoice: $11,477.63

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

ARIZONA DEPARTMENT OF TRANSPORTATION

206 S. 17TH AVENUE, MD 310B

ATTN: DON SNEED

PHOENIX, AZ 85007

Invoice No: 30305607 Invoice Date: Nov 30, 2024

Project No: 291199020.3 Project Name: ADOT SR 264 STUDY Project Manager: FALTZ, KRISTEN

HOURLY NOT TO EXCEED 190368291199020.3W10563291199020.3CPM-1DTCPM

Task Category Description/Name Hrs/Qty Rate Current Amount

Due

PROJECT MANAGEMENT ANALYST CATANZARO, GIOVANNI 2.0 140.67 281.34

HONIOTES, GREG 1.0 140.67 140.67

PROJECT MANAGER JOANNES, CHRIS 18.0 250.08 4,501.44

PLANNER FALTZ, KRISTEN 37.0 177.14 6,554.18

TOTAL PROJECT MANAGEMENT4T 58.0 11,477.63

TOTAL LABOR AND EXPENSE DETAIL 11,477.63

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

81MRD

12/16/2024 ADOT MPD_0555-24_H80_Progress Report_Nov 2024(SR264 Corridor Study).docx 1 of 2

PROGRESS REPORT NO. 1

Arizona Department of Transportation

Task Assignment: MPD0555-24 H80 ADOT SR 264 Corridor Planning Study

Contract # CTR060474 Kimley-Horn Project No. 291199020

Reporting Period: Through November 30, 2024

Key Project Staff

Chris Joannes, Project Manager Kristen Faltz, Deputy Project Manager Greg Honiotes, Transportation Planner Giovanni Catanzaro, Planning Analyst

Progress and Accomplishments during the Reporting Period

Task 1 – Project Kick-off & Tech Memo 1 – Project Work Plan & Schedule Review Monthly meeting with PM team Prepare and finalize Project Management Plan Prepare Project Kick-Off Meeting Presentation Project Kick-Off Meeting and travel Develop Technical Working Group contact list Develop Data Needs spreadsheet Develop project basemap Develop agenda and presentation for Technical Working Group Meeting 1 Develop presentation and talking notes for Hopi Tribe Partnership Meeting update

Task 2 – Monthly Progress Reports No activity during invoice period

Task 3 – Working Paper 1 – Identify Current and Future Conditions

Task 4 – Identify Deficiencies and Evaluation Criteria

Task 5 – Develop Recommended Plan for Improvements

Task 6 – Public and Stakeholder Outreach

Task 7 – Draft Final Report

12/16/2024 ADOT MPD_0555-24_H80_Progress Report_Nov 2024(SR264 Corridor Study).docx 2 of 2

No activity during invoice period

Task 8 – Final Report

Task 9 – GIS Data and Study Closeout File

Contacts Made

ADOT PMT

TWG members

Information Generated

Project basemap Project Management Plan Crash Hot Spot Heat Map

Next Month Anticipated Activities

Complete TWG Meeting 1 Send Data Needs Request to TWG Complete Limited English Proficiency Analysis