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RES 2010-0412 - Bid of Hawkins Construction Company for reconstruction of W Center Rd from 148th St to US 275 } OF p1�H�.NF.+ `, ,: C711,17 n Public Works Department u`�i�►`�' ; F .,_ Oma oDrkDouglas Civic Center s rj► n eb 1819 Famam Street,Suite 601 +�� Omaha,Nebraska 68183-0601 �►��,C � Aril 13 2010 I r.4' i F'i- lr I _. _�: M, 402 444-5220 OP. ry Fax(402)444-5248 ��TFD moo" i�t i d t .. ._. City of Omaha r,, ,&°l' , '•.-''` ';'-' Robert G.Stubbe,P.E. Jim Suttle,Mayor Public Works Director Honorable President and Members of the City Council, Transmitted herewith is a resolution accepting and concurring with a bid award by the State of Nebraska Department of Roads (NDOR) for the reconstruction of West Center Road from 148th Street to U.S. 275 using stimulus funding made available to the City of Omaha under the American Recovery and Reinvestment Act (ARRA), Project SP-83-22. The City Council approved an Agreement with NDOR by Council Resolution No. 30 on January 12, 2010 for NDOR project STPD-38-7(106) which is the reconstruction of West Center Road from 148th Street to U.S. 275. NDOR received bids for this project on March 26, 2010 and is recommending award to the lowest bidder, Hawkins Construction Company, Omaha, Nebraska in the amount of$8,058,172.69 which will be paid from the ARRA NDOR Grant Fund 17116, Organization 117760, in the amount of $6,141,000 and the remainder of the project cost is covered by Federal and State funds with Omaha's 20% participation of$383,434.54 paid from the 2006 Transportation Bond Fund 13182, 2010 Issue Transportation Bond Organization 117115, in accord with the approved program agreement with NDOR for the project. NDOR is also asking the City Council to concur with this bid award by approval of the attached resolution. The Public Works Department requests your consideration and. approval of the attached Resolution. Respectfully submitted, Referred to City Council for Consideration: V—l-lD Z.q-c,ri f 2oIO R bert G. S ubbe, .E. Date M or' 0 fice Date Public Works Director Approved as to Funding: Pam Spaccafotella Date Finance Director fsi— 1474hf $645.00 per LS $645.00 Sadler Electric, Inc. $860.00 per LS $860.00 • Commonwealth Electric Company $1,494.00 per LS $1,494.00 47 900.047 VEHICLE PRIORITY CONTROL SYSTEM(OPTICOM)-12TH&CUMING PERMANENT SIGNALS Engineeer's Estimate 1 @ $4,500.00 per,LS $4,500.00 OK Electric Co., Inc. $1,181.00 per LS $1,181.00 Vierregger Electric Co., Inc. $964.00 per LS $964.00 Sadler Electric, Inc. $640.00 per LS $640.00 Commonwealth Electric Company $1,452.00 per LS $1,452.00 48 900.048 VEHICLE PRIORITY CONTROL SYSTEM(OPTICOM)-12TH&MIKE FAHEY PERMANENT SIGNALS Engineeer's Estimate 1' @ $4,500.00 per LS $4,500.00 OK Electric Co., Inc. $946.00 per LS $946.00 Vierregger Electric Co., Inc. $964.00 per LS $964.00 Sadler Electric, Inc. $640.00 per LS $640.00 Commonwealth Electric Company $1,540.00 per LS $1,540.00 Page 9 of 10, 2/24/2010 12:58:29 PM, Bid Tabulation, Generated by: admin for project OPW 51680 8:28 PM, Bid Tabulation, Generated by: admin for project OPW 51680 a a ,-1 U U H J C7 0 r) F 0 A WF ZO ZO ZO U A s U U) F x E a x acn Fa UOasOawOa WHd' UMFv' Zto40 m sZwC) oEoEM ) Z Cl co . 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O Cr) a a a U) E H Cr)W E ioOHN0HwOHmWo I H = N , MIOd aU1 Wto Cr) t- Hw () 0 W F H Z W U) Ur7U) U ,-) UlUr) U1U) tONWNWNWHlOC7 '.OU) 1OU) LOU) l01010HN a U N U) H H O O O 0 0 0 O 0 0 0 O O O O O W O ' • 0 H 0 0 0 000000000000 U) 0 O 0 0 O O O 0 ' • )4 H O O O O O U) O O O O O O O 0 0 0 0 dv Sr Sr POao W aoa O Z Z H H cn Z = a a a a a a - ��y+ w a W £ 00HHON W mXa, ZlnOtoONZOZa' ZOZH-IZNZrIAa In lolnrbCOKC01A Z W N U N U N A N W N H N U N rl N H N H N H m H m H m H m FC CO el r) rl M t0J M U) r) 44 H H O O O O O O O O 0 O 0 0 O O O 0 O O 0 0 OH 0 O O 0 O O O O O O 0 0 O O 0 O 0 0 0 0 , W H H >+ H ,'S N El H a, H`n U "' U "' U 0 00 E. w Cl) .0 .-1 W u m m o QN 0 -N al z W £ W C W P4 W U U H a It A; a H0 l m W H Pa Pl. 4 P. F E. z FC 4. 0 UU Z W >. >. >4 Uz H W b Cr. E. U El 00 z VF) F Cl)F F Cl)F E. Z 0 H H p A CJ H 0 0 Q H El 0 z a OM a 4 0 W Z W WOO z H z W H El W 0 >+ W A E H a a a U U H A 0 0 a E. W F E. F. 0 WF z O z0 z0 Cl) 0 3 U P1 E.-. ME a x a FP4 to0aN004coOP4wHwUpFdlzto4o to t- EOoC0CE0Fm0z m co - O z H H N H N H t- H O A U) > .-1 H H O N U1 0 Ul to W N H O O O U) c-1 H 0 0 O W _ H a • F0 • FO • El0 • • a • '.7 • U • d. • z • • a • 0 • • a H O aF �0 H4zH4 zH4 zoWIn oAdl NHo1Ho1W o1W o H u) .7o E. 0 HF Cl) HZHHEHHZHmUtoxNZNElN4tNAt� Ut- U00F WaNI-1m au O W O W O H F O H F O H F O H O 000oU0 O O H O HO W O H U) /.C10 ,'> W z O H a zq 4mx4mx4mx4 > 4zuU4Zrz40 P4 > < > 4 [444 El40v) 0 oa O ZO E0 X0 a H H 0 a a a Cl. w z H W X to0Ht- OHOoOHo1W0 I .-tc N I Mtodlaln W t.0 W NFO) mz0 W E. H E W Ulu0U) U aU) u a in U) t.0NtoNt.0Nt I-tt.00 WV) t.0 V) t0U) to tot0HN a U N m H F O O O O O O O O O O O O O O O W O a H 0 0 0 0 0 0 O 0 0 0 0 0 O 0 O U) 0 • ' a H O O O O O U) O O O O O 0 O O O 0 0 Letting: 10032601 Project No.: STPD-38-7(106) `Call: 265 Contract ID: 2137CX • NEBRASKA LOCAL PUBLIC AGENCY CONTRACT AND BOND CONTRACT THIS CONTRACT AND AGREEMENT, made and entered into this day of 20 , by and between the CITY OF OMAHA of the State of Nebraska,hereafter referred to as party of the first part or Owner,and HAWKINS CONSTRUCTION COMPANY of OMAHA,NE,party of the second part: WITNESSETH: That the party of the second part, for and in consideration of the sum of EIGHT MILLION, FIFTY EIGHT THOUSAND, ONE HUNDRED SEVENTY TWO AND 69/100 DOLLARS payable as set forth in the specifications constituting a part of this contract,hereby agrees to perform in accordance with the plans,specifications,and special provisions therefore, and in the location designated in the proposal form,the various groups of work, including all items contained in each specified group, awarded said party of the second part on the 15th day of April, 2010, as follows: being groups numbered GROUP 1, GROUP 3,GROUP 4,GROUP 5L,GROUP 6,GROUP 8,GROUP 8B,GROUP 10 on project number STPD-38-7(106) in DOUGLAS County(ies) in Nebraska as shown in the schedule of prices bid in the attached proposal which is a part of this contract. I That it is mutually understood and agreed by the parties hereto that the general and detailed plans, the Standard Specifications for Highway Construction of the Department of Roads of the State of Nebraska,which are on file in the office of the Department at Lincoln;the contractor's bond;the proposal;all special provisions;and all supplemental agreements are a part of this contract. That it is mutually understood and agreed by the parties that federal funds are a part of the financing of this project and that the parties must meet all laws, specifications, criteria, special provisions and requirements established by the Federal 1 Highway Administration for the use of federal funds. Therefore,the parties agree that since the federal government has made the State of Nebraska, Department of Roads its agent for the purposes of overseeing the project for protection of the federal '1 contributions, the State of Nebraska, Department of Roads shall have the same rights as the Owner and federal government in protection of their funding. It is understood and agreed by the parties that the State of Nebraska, Department of Roads is involved in this project only as a conduit and steward of federal and/or state funds. If a dispute arises between the parties they shall seek their remedies against each other or the federal government and shall hold the State of Nebraska,Department of Roads harmless from suit under this contract. The party of the second part expressly warrants that he/she has employed no third person to solicit or obtain this contract in his/her behalf,or to cause or procure the same to be obtained upon compensation in any way contingent, in whole or in part,upon such procurement,and that he/she has not paid,or promised or agreed to pay,to any third person in consideration of such procurement, or in compensation for services in connection herewith, any brokerage, commission, or percentage upon the amount to be received by him/her hereunder, and that he/she has not, in estimating the contract price demanded by him/her, included any sum by reason of any such brokerage,commission or percentage,and that all moneys payable to him/her hereunder • are free from obligation to any other person for services rendered,or supposed to have been rendered, in the procurement of this contract.He/She further agrees that any breach of this warranty shall constitute adequate cause for the annulment of this contract by the party of the first part and that the said party of the first part may retain for its own use.from any sums due or to become due hereunder,an amount equal to any brokerage,commission,or percentage,so paid or agreed to be paid. That the party of the second part further agrees to pay all laborers and mechanics for labor that shall be performed and pay for all material, supplies and equipment which is used or rented in performing the contract, and pay to the Unemployment Compensation Fund of the State of Nebraska the unemployment contributions and interest due under provisions of the Nebraska Employment Security Law on wages paid to individuals employed in the performance of this contract. All work required in carrying out this contract shall be performed in compliance with the laws of the State of Nebraska. The party of the second part further agrees to perform the work under the supervision of the Owner. The administrator • of the Federal Highway Administration or his/her authorized agent, including the State of Nebraska, Department of Roads shall have the right at all times,but not the duty,to inspect the work for eligibility for federal funding in accordance with the laws of the State of Nebraska, and the rules and regulations of the Administrator of the Federal Highway Administration of the United States,for the purpose of carrying out the provisions of Title 23,United States Code,as amended and supplemented(Federal Aid Highway Acts). 1 Revised 10-09 Con-20.3 0 0 0 , W H H >+ H ,'S N El H a, H`n U "' U "' U 0 00 E. w Cl) .0 .-1 W u m m o QN 0 -N al z W £ W C W P4 W U U H a It A; a H0 l m W H Pa Pl. 4 P. F E. z FC 4. 0 UU Z W >. >. >4 Uz H W b Cr. E. U El 00 z VF) F Cl)F F Cl)F E. Z 0 H H p A CJ H 0 0 Q H El 0 z a OM a 4 0 W Z W WOO z H z W H El W 0 >+ W A E H a a a U U H A 0 0 a E. W F E. F. 0 WF z O z0 z0 Cl) 0 3 U P1 E.-. ME a x a FP4 to0aN004coOP4wHwUpFdlzto4o to t- EOoC0CE0Fm0z m co - O z H H N H N H t- H O A U) > .-1 H H O N U1 0 Ul to W N H O O O U) c-1 H 0 0 O W _ H a • F0 • FO • El0 • • a • '.7 • U • d. • z • • a • 0 • • a H O aF �0 H4zH4 zH4 zoWIn oAdl NHo1Ho1W o1W o H u) .7o E. 0 HF Cl) HZHHEHHZHmUtoxNZNElN4tNAt� Ut- U00F WaNI-1m au O W O W O H F O H F O H F O H O 000oU0 O O H O HO W O H U) /.C10 ,'> W z O H a zq 4mx4mx4mx4 > 4zuU4Zrz40 P4 > < > 4 [444 El40v) 0 oa O ZO E0 X0 a H H 0 a a a Cl. w z H W X to0Ht- OHOoOHo1W0 I .-tc N I Mtodlaln W t.0 W NFO) mz0 W E. H E W Ulu0U) U aU) u a in U) t.0NtoNt.0Nt I-tt.00 WV) t.0 V) t0U) to tot0HN a U N m H F O O O O O O O O O O O O O O O W O a H 0 0 0 0 0 0 O 0 0 0 0 0 O 0 O U) 0 • ' a H O O O O O U) O O O O O 0 O O O 0 0 11 1 F[i Letting: 10032601 Project No.: STPD-38-7(106) 1' Call: 265 1 1 Contract ID: 2137CX If 1 t That in consideration of the foregoing, the parties understand that when the Owner authorizes payment(s)the Owner will see that prompt payment is made by the State of Nebraska, Department of Roads on behalf of the Owner and the Federal • Highway Administration of the amounts set forth herein,subject to the conditions set forth in this contract,or any part thereof,as ! herein described. It is further expressly understood and agreed that time is of the essence to this contract and that failure to complete the work before the expiration of the time allowance fixed in this contract, or after the expiration of such additional time as may be allowed by the Owner,would cause loss and expense to the party of the first part and such loss and expense would be uncertain 1 in itself and unsusceptible of certain computation. It also is understood and agreed that failure to comply with this contract, in some manner other than failure to comply with the fixed time allowance,would cause damage that would be difficult to compute i with certainty. Therefore,the party of the second part expressly agrees and promises to pay as reasonable liquidated damages such liquidated damages as are provided for in this contract. It is further understood and agreed that the Owner shall have the right to deduct from any moneys due to the party of the second part the amount of liquidated damages caused to be owing by failure to comply with this contract; or the Owner shall have the right to recover such liquidated damages from the party of the second part, from the surety, or from both the party of the second part and the surety, or may deduct part of such liquidated damages as are owing and recover the balance from the party of the second part,the surety, or both the party of the second part and the surety. It is further understood and agreed that the party of the second part shall not do any work or furnish any materials not covered and authorized by this contract, unless ordered in writing by the Owner. Any such work may be done or any such materials which may be furnished by the party of the second part without such written order, first being given,shall be at his/her • own risk, cost and expense; and the party of the second part hereby covenants and agrees that he/she shall make no claim for compensation for any work so done or any materials so furnished. IN WITNESS WHEREOF,the parties hereto have set their hands for the purpose herein expressed,to this and one other instrument(s)of like tenor,this day of ,20 I i THE CITY OF O AHA Mayor,Chairperson of the Board or Chief Executive Officer Party Jim Suttle, Mayor__ y of the _ Attest: ''t First Part ' y i ‘254 ,�t1 `- V or Owner �/ City Clerk 5 HAWKINS CONSTRUCTION COMPA Y ncipal(Signs rre) k James E. Gregory V Principal(Printed Name) Executive Vice President ✓ Party Titleof the . Second • 47-046-0612 Part Federal/D Number i 2 I: Revised 10-09 Con-20.3 er, included any sum by reason of any such brokerage,commission or percentage,and that all moneys payable to him/her hereunder • are free from obligation to any other person for services rendered,or supposed to have been rendered, in the procurement of this contract.He/She further agrees that any breach of this warranty shall constitute adequate cause for the annulment of this contract by the party of the first part and that the said party of the first part may retain for its own use.from any sums due or to become due hereunder,an amount equal to any brokerage,commission,or percentage,so paid or agreed to be paid. That the party of the second part further agrees to pay all laborers and mechanics for labor that shall be performed and pay for all material, supplies and equipment which is used or rented in performing the contract, and pay to the Unemployment Compensation Fund of the State of Nebraska the unemployment contributions and interest due under provisions of the Nebraska Employment Security Law on wages paid to individuals employed in the performance of this contract. All work required in carrying out this contract shall be performed in compliance with the laws of the State of Nebraska. The party of the second part further agrees to perform the work under the supervision of the Owner. The administrator • of the Federal Highway Administration or his/her authorized agent, including the State of Nebraska, Department of Roads shall have the right at all times,but not the duty,to inspect the work for eligibility for federal funding in accordance with the laws of the State of Nebraska, and the rules and regulations of the Administrator of the Federal Highway Administration of the United States,for the purpose of carrying out the provisions of Title 23,United States Code,as amended and supplemented(Federal Aid Highway Acts). 1 Revised 10-09 Con-20.3 0 0 0 , W H H >+ H ,'S N El H a, H`n U "' U "' U 0 00 E. w Cl) .0 .-1 W u m m o QN 0 -N al z W £ W C W P4 W U U H a It A; a H0 l m W H Pa Pl. 4 P. F E. z FC 4. 0 UU Z W >. >. >4 Uz H W b Cr. E. U El 00 z VF) F Cl)F F Cl)F E. Z 0 H H p A CJ H 0 0 Q H El 0 z a OM a 4 0 W Z W WOO z H z W H El W 0 >+ W A E H a a a U U H A 0 0 a E. W F E. F. 0 WF z O z0 z0 Cl) 0 3 U P1 E.-. ME a x a FP4 to0aN004coOP4wHwUpFdlzto4o to t- EOoC0CE0Fm0z m co - O z H H N H N H t- H O A U) > .-1 H H O N U1 0 Ul to W N H O O O U) c-1 H 0 0 O W _ H a • F0 • FO • El0 • • a • '.7 • U • d. • z • • a • 0 • • a H O aF �0 H4zH4 zH4 zoWIn oAdl NHo1Ho1W o1W o H u) .7o E. 0 HF Cl) HZHHEHHZHmUtoxNZNElN4tNAt� Ut- U00F WaNI-1m au O W O W O H F O H F O H F O H O 000oU0 O O H O HO W O H U) /.C10 ,'> W z O H a zq 4mx4mx4mx4 > 4zuU4Zrz40 P4 > < > 4 [444 El40v) 0 oa O ZO E0 X0 a H H 0 a a a Cl. w z H W X to0Ht- OHOoOHo1W0 I .-tc N I Mtodlaln W t.0 W NFO) mz0 W E. H E W Ulu0U) U aU) u a in U) t.0NtoNt.0Nt I-tt.00 WV) t.0 V) t0U) to tot0HN a U N m H F O O O O O O O O O O O O O O O W O a H 0 0 0 0 0 0 O 0 0 0 0 0 O 0 O U) 0 • ' a H O O O O O U) O O O O O 0 O O O 0 0 Letting: 10032601 Project No.: STPD-38-7(106) —^ i 'Call: 265 Bond No. 91BCSFL2666 Contract ID: 2137CX CONTRACT BOND KNOW ALL MEN BY THESE PRESENTS: That we HAWKINS CONSTRUCTION COMPANY as principal, and Hartford Fire Insurance Company as sureties,are held and firmly bound unto the CITY OF OMAHA of the State of Nebraska, in the penal sum of$8,058,172.69 dollars and for the payment of which we do hereby bind ourselves,our heirs,executors and administrators,jointly,severally,and firmly by these presents.• i I Date ,A.D.20 . The condition of the obligations is such that whereas, the above bounden HAWKINS CONSTRUCTION COMPANY of OMAHA, NE has been awarded by the CITY OF OMAHA, the various groups of work, including all items contained in each specified group of work being groups numbered:GROUP 1,GROUP 3,GROUP 4, GROUP 5L, GROUP 6, GROUP 8, GROUP 8B, GROUP 10 on Project No. STPD-38-7(106) in DOUGLAS County(ies), Nebraska, copy of which contract together with all of its terms, covenants, conditions and stipulations is incorporated herein and made a part hereof as fully and amply as if said contract were recited at length herein. NOW THEREFORE,if said HAWKINS CONSTRUCTION COMPANY as principal shall in all respects fulfill this said contract according to the terms and the tenor thereof, and shall faithfully discharge the duties and obligations therein assumed,then the above obligation is to be void and of no effect;otherwise to be and remain in full force and virtue in law. • It is expressly understood and agreed that this bond is given to secure and does secure not only the faithful performance • • by the principal herein named of said contract for the construction work as specified in said contract and in strict accordance with • the terms of said contract and the plans,specifications and all special provisions made a part thereof;but that it is given to secure and does secure also the payment by the said bounden HAWKINS CONSTRUCTION COMPANY of all overpayments • made to said principal by the Department of Roads,on behalf of the Owner,and of all just claims to all laborers and mechanics for labor that shall be performed, and for the payment of all material, supplies and equipment which is used or rented in performing the contract, and for the payment of all taxes, including contributions and interest due under the Nebraska Employment Security Law,'which may accrue, pursuant to Sections 77-3103 to 77-3112 or any other provision of law, to the State of Nebraska and the political subdivisions thereof on account of the execution and performance of this contract,and if such payments be made then this obligation shall be null and void;otherwise it shall remain in full force and effect. No contract shall be valid which seeks to limit the time to less than one year in which an action may be brought upon $ the bond covering the construction work,and this bond is made,executed and delivered with such understanding. Signed this 20th day of April ,20 10 Hartford Fire Insurance Company • Surety HAWKINS CONSTRUCTION COMPANY V ,/ ` ; Alto rey-in-Fact(Signature) rincipal(Signatrre) Maury J. Spieker Attorney-in-Fact(Printed Name) James E. Gregory V Principal(Printed Name) The Harry A. Koch Co. Agency/Business Name Executive Vice President Title 11949 Q Street, Omaha, NE 68137 t/ AgencyBusiness Address 402-861-7000 Phone Number • 3 Revised 10-09 Con-20.3 f the first part and that the said party of the first part may retain for its own use.from any sums due or to become due hereunder,an amount equal to any brokerage,commission,or percentage,so paid or agreed to be paid. That the party of the second part further agrees to pay all laborers and mechanics for labor that shall be performed and pay for all material, supplies and equipment which is used or rented in performing the contract, and pay to the Unemployment Compensation Fund of the State of Nebraska the unemployment contributions and interest due under provisions of the Nebraska Employment Security Law on wages paid to individuals employed in the performance of this contract. All work required in carrying out this contract shall be performed in compliance with the laws of the State of Nebraska. The party of the second part further agrees to perform the work under the supervision of the Owner. The administrator • of the Federal Highway Administration or his/her authorized agent, including the State of Nebraska, Department of Roads shall have the right at all times,but not the duty,to inspect the work for eligibility for federal funding in accordance with the laws of the State of Nebraska, and the rules and regulations of the Administrator of the Federal Highway Administration of the United States,for the purpose of carrying out the provisions of Title 23,United States Code,as amended and supplemented(Federal Aid Highway Acts). 1 Revised 10-09 Con-20.3 0 0 0 , W H H >+ H ,'S N El H a, H`n U "' U "' U 0 00 E. w Cl) .0 .-1 W u m m o QN 0 -N al z W £ W C W P4 W U U H a It A; a H0 l m W H Pa Pl. 4 P. F E. z FC 4. 0 UU Z W >. >. >4 Uz H W b Cr. E. U El 00 z VF) F Cl)F F Cl)F E. Z 0 H H p A CJ H 0 0 Q H El 0 z a OM a 4 0 W Z W WOO z H z W H El W 0 >+ W A E H a a a U U H A 0 0 a E. W F E. F. 0 WF z O z0 z0 Cl) 0 3 U P1 E.-. ME a x a FP4 to0aN004coOP4wHwUpFdlzto4o to t- EOoC0CE0Fm0z m co - O z H H N H N H t- H O A U) > .-1 H H O N U1 0 Ul to W N H O O O U) c-1 H 0 0 O W _ H a • F0 • FO • El0 • • a • '.7 • U • d. • z • • a • 0 • • a H O aF �0 H4zH4 zH4 zoWIn oAdl NHo1Ho1W o1W o H u) .7o E. 0 HF Cl) HZHHEHHZHmUtoxNZNElN4tNAt� Ut- U00F WaNI-1m au O W O W O H F O H F O H F O H O 000oU0 O O H O HO W O H U) /.C10 ,'> W z O H a zq 4mx4mx4mx4 > 4zuU4Zrz40 P4 > < > 4 [444 El40v) 0 oa O ZO E0 X0 a H H 0 a a a Cl. w z H W X to0Ht- OHOoOHo1W0 I .-tc N I Mtodlaln W t.0 W NFO) mz0 W E. H E W Ulu0U) U aU) u a in U) t.0NtoNt.0Nt I-tt.00 WV) t.0 V) t0U) to tot0HN a U N m H F O O O O O O O O O O O O O O O W O a H 0 0 0 0 0 0 O 0 0 0 0 0 O 0 O U) 0 • ' a H O O O O O U) O O O O O 0 O O O 0 0 Nebraska Department of Purchasing Agent Appointment FORM REVENUE and Delegation of Authority for Sales and Use Tax 17 PURCHASING AGENT APPOINTMENT Name and Address of Prime Contractor Name and Address of Governmental Unit or Exempt Organization Name Name HAWKINS CONSTRUCTION COMPANY City of Omaha, NE ,Street or Other Mailing Address Street or Other Mailing Address 2516 DEER PARK BLVD Omaha/Douglas Civic Ct., 1819 Farnam Street City State Zip Code City State Zip Code OMAHA NE 68109-0008 Omaha NE 68183 Name and Location of Project Appointment Information Name Effective Date STPD-38-7(106) in DOUGLAS COUNTY i&d/c /a Street.or Other Mailing Address Expiration Date 4/30/2012 ,City State Zip Code Nebraska Exemption Number(Exempt Organizations Only) NA -Identify Project STPD-38-7(106) WEST CENTER ROAD, 148th STREET-US 275/INDUSTRIAL ROAD The undersigned governmental.unit or exempt.organization appoints the above-named contractor and the contractor's delegated subcontractors as its agent to purchase and pay for building materials that will be annexed to real estate by them into the tax exempt construction project stated above. sign here ► Mayor �' � �� Authori ignature of Governmental Unit or Exempt Organization Title ate DELEGATION OF PRIME CONTRACTOR'S AUTHORITY Name and.Address of.Subcontractor Delegation Information Name Effective Date • Street or Other Mailing Address Expiration Date City State Zip Code Portion of Project The undersigned prime contractor hereby delegates authority to act as the purchasing agent of the named governmental unit or exempt organization to the above-named subcontractor. sign here ► Signature of Prime Contractor or Authorized Representative Title Date INSTRUCTIONS WHO MUST FILE. Any governmental unit or organization that is information on exempt entities.A contractor can confirm the exempt exempt from sales and use tax may appoint as its agent a prime status of a governmental unit or exempt organization by contacting contractor to purchase building materials and/or fixtures that will be the Nebraska Department of Revenue. annexed to property that belongs to or will belong to the The exemption from the payment of the Nebraska and local option governmental unit or exempt organization pursuant to a construction sales and use taxes only applies if the governmental unit or exempt contract with the governmental unit or exempt organization. The organization directly, or through its contractor, pays for the building appointment of the prime contractor as its agent is completed by issuing a Purchasing Agent Appointment and Delegation of Authority materials. IMPORTANT NOTE: When an organization that for Sales and Use Tax. Form 17. to the prime contractor. The Form requires licensure in order to be exempt(i.e.,nonprofit hospitals),but 17 is required to be given to the contractor BEFORE he or she is not licensed at the time of the construction project, the exempt annexes building materials. The governmental unit or exempt organization CANNOT issue either a purchasing agent appointment organization must identify the project (e.g., east wing. chapel or an exemption certificate. If the exempt organization becomes construction, or new school auditorium). Most nonprofit licensed upon completion of the project, it may apply for a refund of organizations are NOT exempt from sales tax in Nebraska. In addition, not all governmental units are exempt from Nebraska sales the tax paid or collected by the contractors. tax. Refer to Contractor Information on our Web site for additional NDOR www.revenue.ne.gov, (800) 742-7474(toll free in NE and IA), (402)471-5729 6-139-1970 Rev.4-2009 Supersedes 6-139-1970 Rev.2-2008 rees to pay all laborers and mechanics for labor that shall be performed and pay for all material, supplies and equipment which is used or rented in performing the contract, and pay to the Unemployment Compensation Fund of the State of Nebraska the unemployment contributions and interest due under provisions of the Nebraska Employment Security Law on wages paid to individuals employed in the performance of this contract. All work required in carrying out this contract shall be performed in compliance with the laws of the State of Nebraska. The party of the second part further agrees to perform the work under the supervision of the Owner. The administrator • of the Federal Highway Administration or his/her authorized agent, including the State of Nebraska, Department of Roads shall have the right at all times,but not the duty,to inspect the work for eligibility for federal funding in accordance with the laws of the State of Nebraska, and the rules and regulations of the Administrator of the Federal Highway Administration of the United States,for the purpose of carrying out the provisions of Title 23,United States Code,as amended and supplemented(Federal Aid Highway Acts). 1 Revised 10-09 Con-20.3 0 0 0 , W H H >+ H ,'S N El H a, H`n U "' U "' U 0 00 E. w Cl) .0 .-1 W u m m o QN 0 -N al z W £ W C W P4 W U U H a It A; a H0 l m W H Pa Pl. 4 P. F E. z FC 4. 0 UU Z W >. >. >4 Uz H W b Cr. E. U El 00 z VF) F Cl)F F Cl)F E. Z 0 H H p A CJ H 0 0 Q H El 0 z a OM a 4 0 W Z W WOO z H z W H El W 0 >+ W A E H a a a U U H A 0 0 a E. W F E. F. 0 WF z O z0 z0 Cl) 0 3 U P1 E.-. ME a x a FP4 to0aN004coOP4wHwUpFdlzto4o to t- EOoC0CE0Fm0z m co - O z H H N H N H t- H O A U) > .-1 H H O N U1 0 Ul to W N H O O O U) c-1 H 0 0 O W _ H a • F0 • FO • El0 • • a • '.7 • U • d. • z • • a • 0 • • a H O aF �0 H4zH4 zH4 zoWIn oAdl NHo1Ho1W o1W o H u) .7o E. 0 HF Cl) HZHHEHHZHmUtoxNZNElN4tNAt� Ut- U00F WaNI-1m au O W O W O H F O H F O H F O H O 000oU0 O O H O HO W O H U) /.C10 ,'> W z O H a zq 4mx4mx4mx4 > 4zuU4Zrz40 P4 > < > 4 [444 El40v) 0 oa O ZO E0 X0 a H H 0 a a a Cl. w z H W X to0Ht- OHOoOHo1W0 I .-tc N I Mtodlaln W t.0 W NFO) mz0 W E. H E W Ulu0U) U aU) u a in U) t.0NtoNt.0Nt I-tt.00 WV) t.0 V) t0U) to tot0HN a U N m H F O O O O O O O O O O O O O O O W O a H 0 0 0 0 0 0 O 0 0 0 0 0 O 0 O U) 0 • ' a H O O O O O U) O O O O O 0 O O O 0 0 • WHEN TO FILE. A prime contractor engaging in a construction contractor sales tax on any portion of the invoice involving the project with a governmental unit or exempt organization must receive annexation of materials to the specific project identified on the Form properly completed and signed Form 17 BEFORE any building 17. If these forms are not provided to the subcontractor operating materials are annexed. If Form 17 is not issued, the contractor must under Option 1.the subcontractor must collect and remit sales tax on • pay the sales and use taxes and the governmental unit or exempt the charge for the separately stated building materials portion of the organization may obtain a refund of the taxes paid by the contractor. invoice. If the Option 1 subcontractor does not separately state the WHERE TO FILE. A copy of the completed form should be charge for the building materials from contractor labor, then the • retained by the governmental unit or exempt organization issuing the entire charge is taxable to the prime contractor. Form 17. The original is to be retained by the prime contractor. Contractors operating under Option 2 (maintaining a tax-paid Copies of this form must be made by the prime contractor for inventory)who have been issued a Form 1.7 from a governmental unit delegation purposes to any subcontractors working on the project or an exempt organization, must furnish each vendor a copy of the identified on this form. Form 17 and a Form 13, completing Section C, Part 2. when purchasing building materials that will be annexed to real estate. APPOINTMENT INFORMATION.Enter the dates the purchasing Forms 13 and 17 must be retained with the vendor's and contractor's agent appointment will become effective and when it will expire. records for audit purposes. A contractor or subcontractor may This appointment will not allow any purchases Without payment of reproduce copies of these documents which will be furnished to the the tax by the prime contractor or subcontractor before the effective vendors for each invoice or order made by them. date or after the expiration date. The dates the delegation.becomes • effective and the expiration dates must be completed. The phrase Invoices from vendors for the purchase of building materials by the "upon completion" or similar phrase is not acceptable as an contractor as purchasing agent. or the authorized subcontractor.must expiration date. The governmental unit or exempt organization may clearly identify that such purchase is for the specific Form 17 project. need to issue another Form 17 if the project is not completed within CREDIT/REFUND OF SALES AND USE TAX. A contractor or the prior "effective" and "expiration" dates. Exempt organizations subcontractor who has been appointed as a purchasing agent before must enter their Nebraska Sales and Use Tax Exemption number. any materials are annexed, may withdraw sales or use tax-paid DELEGATION OF PRIME CONTRACTOR'S AUTHORITY. materials from inventory that will be annexed to real estate or used to The prime contractor may delegate his or her authority to act as the repair property annexed to real estate and receive a credit for the sales purchasing agent of the governmental unit or exempt organization to or use tax amount previously paid on those materials. a subcontractor. The prime contractor must complete his or her copy The contractor or subcontractor may take a credit either against his or • of Form 1.7 for each subcontractor who is delegated authority to act her current tax liability.or file a Claim for Overpayment of Sales and as a purchasing agent. Reproductions of this delegation must be tJse Tax. Form 7,and receive a refund of the sales or use tax paid on provided to the subcontractor, who must retain a copy for his or her those materials. records.and to the governmental unit or exempt organization. TOOLS,EQUIPMENT,AND SUPPLIES.The purchase, rental,or Enter the dates the delegation of the subcontractor will .become lease of tools, supplies. or equipment (i.e., scaffolding, barricades, effective.when it will expire,and the portion of the project delegated. machinery, etc.) by a contractor for use in the completion of an This delegation will not allow any purchases without payment of the exempt project CANNOT be purchased tax free, even if the tax by the subcontractor before the delegation date or after the contractor has been issued a Form 17. These items do not become expiration date. Any further delegation from a subcontractor to annexed to the real estate. additional subcontractors must be delegated by providing a copy of OPTION 1 CONTRACTOR ONLY. If an Option 1 contractor is the Form 17 that they received from the prime contractor and the only contractor involved in performing work for a governmental attaching it to a separate Form 17 with any further delegation to other• unit or exempt organization. a Form 17 is NOT required. The Option subcontractors. The purchasing agent appointment is limited to the 1 contractor must only obtain a Form 13, Section B.from the exempt contractor's purchase of building materials and/or fixtures for the • project owner. specific project and is only valid during the appointment dates shown on the Form 17. PENALTY. Any person who signs this document with the intent to evade payment of tax is liable for the sales and use tax, interest, and EXEMPT SALE CERTIFICATE. A prime contractor who has penalty,and may be found guilty of a misdemeanor. been appointed to act as a purchasing agent by a governmental unit or AUTHORIZED SIGNATURE. The purchasing agent appointment exempt organization, and who hires a subcontractor operating as an • must be signed by an officer of the exempt organization or proper Option 1 contractor, must provide to that subcontractor a completed government official. The delegation of prime contractor's authority copy of Form 17 and a Nebraska Resale or Exempt Sale Certificate. must be signed by the owner, partner, corporate officer. or other Form 13. with Section C. Part 2, completed. The subcontractor will individual authorized to sign by a power of attorney on file with the retain these forms in his or her records. and will not charge the Nebraska Department of Revenue. NDOR www.revenue.ne.gov, (800)742-7474(toll free in NE and IA), (402)471-5729 6-139-1970 Rev.4-2009 Supersedes 6-139-1970 Rev.2-2008 10 ,'> W z O H a zq 4mx4mx4mx4 > 4zuU4Zrz40 P4 > < > 4 [444 El40v) 0 oa O ZO E0 X0 a H H 0 a a a Cl. w z H W X to0Ht- OHOoOHo1W0 I .-tc N I Mtodlaln W t.0 W NFO) mz0 W E. H E W Ulu0U) U aU) u a in U) t.0NtoNt.0Nt I-tt.00 WV) t.0 V) t0U) to tot0HN a U N m H F O O O O O O O O O O O O O O O W O a H 0 0 0 0 0 0 O 0 0 0 0 0 O 0 O U) 0 • ' a H O O O O O U) O O O O O 0 O O O 0 0 RESOLUTION WHEREAS, there has been signed by the City of Omaha on the 15th day of January , 2010 , and the State on the 28th day of January 2010 , an agreement providing for the construction of a Federal Aid Project at the following location: West Center Road, 148th to U.S. 275. , and WHEREAS, in the above agreement, the City has pledged sufficient funds to finance its share of the cost of the construction of this project identified as STPD-38-7(106) , and WHEREAS, the above mentioned agreement provided that the City would pay costs as set forth in the agreement, and WHEREAS, the State and the City received bids for the construction of this project on March 26, 2010 , at which time one bids were received for the construction of the proposed work, and WHEREAS, the following contractor(s) has been selected as the low bidder to whom the contract(s) should be awarded: Hawkins Construction Company, Omaha, Nebraska Grading, Concrete Pavement, Culverts, Landscaping, Bridge at Sta. 1324+09.44, Specialty, Electrical and General Items: $8,058,172.69 NOW THEREFORE, in consideration of the above facts, the City Council of the City_ of- Omaha , by this resolution, takes the following official action: 1. The Council hereby concurs in the selection of the above mentioned contractor(s) to whom the,, contract(s) should be awarded. 2. The Council does not desire to perform any of the work with its own forces in lieu of performing the work by the contract method. . 3. The Council hereby authorizes the Mayor and the City Clerk of Omaha to sign the construction contract on behalf of said City. DATED THIS /3A DAY OF 40^// , A.D. aa/c CITY OF OMAHA ATTEST: /D Mayor 9740 Council Member <Amty Ci Clerk Moved the adoption of said1esolution. APPROVED.AS TO FORM: Roll Call: 4. yea, © nay. CON1-PN DEPUTY CITY ATTORNEY Resolution adopted, signed and billed as adopted. dates the delegation.becomes • effective and the expiration dates must be completed. The phrase Invoices from vendors for the purchase of building materials by the "upon completion" or similar phrase is not acceptable as an contractor as purchasing agent. or the authorized subcontractor.must expiration date. The governmental unit or exempt organization may clearly identify that such purchase is for the specific Form 17 project. need to issue another Form 17 if the project is not completed within CREDIT/REFUND OF SALES AND USE TAX. A contractor or the prior "effective" and "expiration" dates. Exempt organizations subcontractor who has been appointed as a purchasing agent before must enter their Nebraska Sales and Use Tax Exemption number. any materials are annexed, may withdraw sales or use tax-paid DELEGATION OF PRIME CONTRACTOR'S AUTHORITY. materials from inventory that will be annexed to real estate or used to The prime contractor may delegate his or her authority to act as the repair property annexed to real estate and receive a credit for the sales purchasing agent of the governmental unit or exempt organization to or use tax amount previously paid on those materials. a subcontractor. The prime contractor must complete his or her copy The contractor or subcontractor may take a credit either against his or • of Form 1.7 for each subcontractor who is delegated authority to act her current tax liability.or file a Claim for Overpayment of Sales and as a purchasing agent. Reproductions of this delegation must be tJse Tax. Form 7,and receive a refund of the sales or use tax paid on provided to the subcontractor, who must retain a copy for his or her those materials. records.and to the governmental unit or exempt organization. TOOLS,EQUIPMENT,AND SUPPLIES.The purchase, rental,or Enter the dates the delegation of the subcontractor will .become lease of tools, supplies. or equipment (i.e., scaffolding, barricades, effective.when it will expire,and the portion of the project delegated. machinery, etc.) by a contractor for use in the completion of an This delegation will not allow any purchases without payment of the exempt project CANNOT be purchased tax free, even if the tax by the subcontractor before the delegation date or after the contractor has been issued a Form 17. These items do not become expiration date. Any further delegation from a subcontractor to annexed to the real estate. additional subcontractors must be delegated by providing a copy of OPTION 1 CONTRACTOR ONLY. If an Option 1 contractor is the Form 17 that they received from the prime contractor and the only contractor involved in performing work for a governmental attaching it to a separate Form 17 with any further delegation to other• unit or exempt organization. a Form 17 is NOT required. The Option subcontractors. The purchasing agent appointment is limited to the 1 contractor must only obtain a Form 13, Section B.from the exempt contractor's purchase of building materials and/or fixtures for the • project owner. specific project and is only valid during the appointment dates shown on the Form 17. PENALTY. Any person who signs this document with the intent to evade payment of tax is liable for the sales and use tax, interest, and EXEMPT SALE CERTIFICATE. A prime contractor who has penalty,and may be found guilty of a misdemeanor. been appointed to act as a purchasing agent by a governmental unit or AUTHORIZED SIGNATURE. The purchasing agent appointment exempt organization, and who hires a subcontractor operating as an • must be signed by an officer of the exempt organization or proper Option 1 contractor, must provide to that subcontractor a completed government official. The delegation of prime contractor's authority copy of Form 17 and a Nebraska Resale or Exempt Sale Certificate. must be signed by the owner, partner, corporate officer. or other Form 13. with Section C. Part 2, completed. The subcontractor will individual authorized to sign by a power of attorney on file with the retain these forms in his or her records. and will not charge the Nebraska Department of Revenue. NDOR www.revenue.ne.gov, (800)742-7474(toll free in NE and IA), (402)471-5729 6-139-1970 Rev.4-2009 Supersedes 6-139-1970 Rev.2-2008 10 ,'> W z O H a zq 4mx4mx4mx4 > 4zuU4Zrz40 P4 > < > 4 [444 El40v) 0 oa O ZO E0 X0 a H H 0 a a a Cl. w z H W X to0Ht- OHOoOHo1W0 I .-tc N I Mtodlaln W t.0 W NFO) mz0 W E. H E W Ulu0U) U aU) u a in U) t.0NtoNt.0Nt I-tt.00 WV) t.0 V) t0U) to tot0HN a U N m H F O O O O O O O O O O O O O O O W O a H 0 0 0 0 0 0 O 0 0 0 0 0 O 0 O U) 0 • ' a H O O O O O U) O O O O O 0 O O O 0 0 0 H ap to 0 o N H 0 aan 0 M W 0 ON l0 'J Z • 0 0 0 0 •• •• H-+ II 0 as H W W n A a co En Aal (n En N q H 0 H H co 1 0 En H PO to q 0 H •• C.) ap W En h W 0 4n- H a H a B 0 U W O a O o H Z w zX Fp� FC W a X W 0 U q q n 2 M N N m q a • W H Z H H U U H ga a Ea-1 OZ En H piE-4 El En U q Z O H U N Z r- 0 N H H Ul U A En a H al H W H cn W 0 Z a Z 0 H U En q H En O t al Zi H •• 4-1 H EMI N 0H Ncl. t E Z 11( En N o (a1 a � 0 Z ua Hwa 0 MN wAON 0 0 0«0 Z C.) U 000 m -MEAN q o NON 5 o • Q ., H-I ution, takes the following official action: 1. The Council hereby concurs in the selection of the above mentioned contractor(s) to whom the,, contract(s) should be awarded. 2. The Council does not desire to perform any of the work with its own forces in lieu of performing the work by the contract method. . 3. The Council hereby authorizes the Mayor and the City Clerk of Omaha to sign the construction contract on behalf of said City. DATED THIS /3A DAY OF 40^// , A.D. aa/c CITY OF OMAHA ATTEST: /D Mayor 9740 Council Member <Amty Ci Clerk Moved the adoption of said1esolution. APPROVED.AS TO FORM: Roll Call: 4. yea, © nay. CON1-PN DEPUTY CITY ATTORNEY Resolution adopted, signed and billed as adopted. dates the delegation.becomes • effective and the expiration dates must be completed. The phrase Invoices from vendors for the purchase of building materials by the "upon completion" or similar phrase is not acceptable as an contractor as purchasing agent. or the authorized subcontractor.must expiration date. The governmental unit or exempt organization may clearly identify that such purchase is for the specific Form 17 project. need to issue another Form 17 if the project is not completed within CREDIT/REFUND OF SALES AND USE TAX. A contractor or the prior "effective" and "expiration" dates. Exempt organizations subcontractor who has been appointed as a purchasing agent before must enter their Nebraska Sales and Use Tax Exemption number. any materials are annexed, may withdraw sales or use tax-paid DELEGATION OF PRIME CONTRACTOR'S AUTHORITY. materials from inventory that will be annexed to real estate or used to The prime contractor may delegate his or her authority to act as the repair property annexed to real estate and receive a credit for the sales purchasing agent of the governmental unit or exempt organization to or use tax amount previously paid on those materials. a subcontractor. The prime contractor must complete his or her copy The contractor or subcontractor may take a credit either against his or • of Form 1.7 for each subcontractor who is delegated authority to act her current tax liability.or file a Claim for Overpayment of Sales and as a purchasing agent. Reproductions of this delegation must be tJse Tax. Form 7,and receive a refund of the sales or use tax paid on provided to the subcontractor, who must retain a copy for his or her those materials. records.and to the governmental unit or exempt organization. TOOLS,EQUIPMENT,AND SUPPLIES.The purchase, rental,or Enter the dates the delegation of the subcontractor will .become lease of tools, supplies. or equipment (i.e., scaffolding, barricades, effective.when it will expire,and the portion of the project delegated. machinery, etc.) by a contractor for use in the completion of an This delegation will not allow any purchases without payment of the exempt project CANNOT be purchased tax free, even if the tax by the subcontractor before the delegation date or after the contractor has been issued a Form 17. These items do not become expiration date. Any further delegation from a subcontractor to annexed to the real estate. additional subcontractors must be delegated by providing a copy of OPTION 1 CONTRACTOR ONLY. If an Option 1 contractor is the Form 17 that they received from the prime contractor and the only contractor involved in performing work for a governmental attaching it to a separate Form 17 with any further delegation to other• unit or exempt organization. a Form 17 is NOT required. The Option subcontractors. The purchasing agent appointment is limited to the 1 contractor must only obtain a Form 13, Section B.from the exempt contractor's purchase of building materials and/or fixtures for the • project owner. specific project and is only valid during the appointment dates shown on the Form 17. PENALTY. Any person who signs this document with the intent to evade payment of tax is liable for the sales and use tax, interest, and EXEMPT SALE CERTIFICATE. A prime contractor who has penalty,and may be found guilty of a misdemeanor. been appointed to act as a purchasing agent by a governmental unit or AUTHORIZED SIGNATURE. The purchasing agent appointment exempt organization, and who hires a subcontractor operating as an • must be signed by an officer of the exempt organization or proper Option 1 contractor, must provide to that subcontractor a completed government official. The delegation of prime contractor's authority copy of Form 17 and a Nebraska Resale or Exempt Sale Certificate. must be signed by the owner, partner, corporate officer. or other Form 13. with Section C. Part 2, completed. The subcontractor will individual authorized to sign by a power of attorney on file with the retain these forms in his or her records. and will not charge the Nebraska Department of Revenue. NDOR www.revenue.ne.gov, (800)742-7474(toll free in NE and IA), (402)471-5729 6-139-1970 Rev.4-2009 Supersedes 6-139-1970 Rev.2-2008 10 ,'> W z O H a zq 4mx4mx4mx4 > 4zuU4Zrz40 P4 > < > 4 [444 El40v) 0 oa O ZO E0 X0 a H H 0 a a a Cl. w z H W X to0Ht- OHOoOHo1W0 I .-tc N I Mtodlaln W t.0 W NFO) mz0 W E. 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O 4 N FC, O u) H W H O O O C O In O O CL' O C4 CD 14 OD W H A N W O A - H PG 0 . KC . • IX • Cu • w • r.>; • X • a • U • U • U • E. • H • H • H • W • ,.] • C7 ...1 E. \U O ON01 H OOH H N a' l0 '(-1 N M 10 l0 10 M � tn8ozN oe �] H u) r') H O H M Cl W O C7 O W H H N W N W N W M W M W M W m m U O H H W 8N OW Z Oa0 OIxO H '� HZH 'JH H � H 'J H •'� H ,7 H 'a H •7 H •7 CD CD401 CD > C a ZO O 0HHW H W HEAHOHHHOHOHOHOHOHOHOHOHOd' av' P. a' U) NO O H en Z El X 3 X £ X X X £ X £ £ a X W £ H HONWM4T LUU) W4NWOo4mNOWH WNWMWv' WtnWlo4NOOo Cr) 01 Z LA U o Z O C7 co3 0 [4 co a o U) O U) 0 a 0 X H U) H U) H X H PG H U) H U) H ',3 H U H U H U) H H W 0 0 0 0 O 0 0 coo 0 O O O O O O O O 0 OH Cl) O 0 O O 0 O O 0 O 0 O 0 O O O 0 O O O al estate. additional subcontractors must be delegated by providing a copy of OPTION 1 CONTRACTOR ONLY. If an Option 1 contractor is the Form 17 that they received from the prime contractor and the only contractor involved in performing work for a governmental attaching it to a separate Form 17 with any further delegation to other• unit or exempt organization. a Form 17 is NOT required. The Option subcontractors. The purchasing agent appointment is limited to the 1 contractor must only obtain a Form 13, Section B.from the exempt contractor's purchase of building materials and/or fixtures for the • project owner. specific project and is only valid during the appointment dates shown on the Form 17. PENALTY. Any person who signs this document with the intent to evade payment of tax is liable for the sales and use tax, interest, and EXEMPT SALE CERTIFICATE. A prime contractor who has penalty,and may be found guilty of a misdemeanor. been appointed to act as a purchasing agent by a governmental unit or AUTHORIZED SIGNATURE. The purchasing agent appointment exempt organization, and who hires a subcontractor operating as an • must be signed by an officer of the exempt organization or proper Option 1 contractor, must provide to that subcontractor a completed government official. The delegation of prime contractor's authority copy of Form 17 and a Nebraska Resale or Exempt Sale Certificate. must be signed by the owner, partner, corporate officer. or other Form 13. with Section C. Part 2, completed. The subcontractor will individual authorized to sign by a power of attorney on file with the retain these forms in his or her records. and will not charge the Nebraska Department of Revenue. NDOR www.revenue.ne.gov, (800)742-7474(toll free in NE and IA), (402)471-5729 6-139-1970 Rev.4-2009 Supersedes 6-139-1970 Rev.2-2008 10 ,'> W z O H a zq 4mx4mx4mx4 > 4zuU4Zrz40 P4 > < > 4 [444 El40v) 0 oa O ZO E0 X0 a H H 0 a a a Cl. w z H W X to0Ht- OHOoOHo1W0 I .-tc N I Mtodlaln W t.0 W NFO) mz0 W E. 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H co Z U W O H H H H U H Z FC z H 3 O En 0 WHU Z Z W H 0 p4 0 zq 1 U = W cn H c4C9 Ha O ONOmOH CO H4-1Z N CHm 1014 OHu1 COOC9 (NI 0cfm NHE u) oW OZ HH LA 104HOHOUlC r1HO 0 01 ( 0 01HO HH N m 4 olal o) En 0N >1 r40. — H r4 • 0H • • U) H 0 . 4 • U) • U • U) • Hq • W • Oil • Wb4 • E454 • U 1aH �U w U) oiz, 01ZHZN H 0 ONH OgDop4Tr4Z V Htor.CtoE NUHco c) Z IZ H Ul NH r10riONONUU mH0elNp40 �FCCrIz ri W .-HHrizr4HZ000UCO 1.3 .l zq CD C4 oEHav auniama U) O OHN > NU] m El � mU) W mUm W m124 W m00D4mamU O aa4 0 0 0 � H O U Z w O z H aH W E o W Hp4Np4m0 H U1C) l- OaoUrnO oOH W NCiHm = � W )no .2, W N U) N W N W N W N W U N E N O N U N H N U U co U m g m H U) m t0 U) m H m H H H O 0 0 0 0 W 0 0 0 0 0 0 0 0 O 0 0 ,-1 H O 0 0 0 0 U) 0 0 0 0 O 0 0 0 O O 0 performing work for a governmental attaching it to a separate Form 17 with any further delegation to other• unit or exempt organization. a Form 17 is NOT required. The Option subcontractors. The purchasing agent appointment is limited to the 1 contractor must only obtain a Form 13, Section B.from the exempt contractor's purchase of building materials and/or fixtures for the • project owner. specific project and is only valid during the appointment dates shown on the Form 17. PENALTY. Any person who signs this document with the intent to evade payment of tax is liable for the sales and use tax, interest, and EXEMPT SALE CERTIFICATE. A prime contractor who has penalty,and may be found guilty of a misdemeanor. been appointed to act as a purchasing agent by a governmental unit or AUTHORIZED SIGNATURE. The purchasing agent appointment exempt organization, and who hires a subcontractor operating as an • must be signed by an officer of the exempt organization or proper Option 1 contractor, must provide to that subcontractor a completed government official. The delegation of prime contractor's authority copy of Form 17 and a Nebraska Resale or Exempt Sale Certificate. must be signed by the owner, partner, corporate officer. or other Form 13. with Section C. Part 2, completed. The subcontractor will individual authorized to sign by a power of attorney on file with the retain these forms in his or her records. and will not charge the Nebraska Department of Revenue. NDOR www.revenue.ne.gov, (800)742-7474(toll free in NE and IA), (402)471-5729 6-139-1970 Rev.4-2009 Supersedes 6-139-1970 Rev.2-2008 10 ,'> W z O H a zq 4mx4mx4mx4 > 4zuU4Zrz40 P4 > < > 4 [444 El40v) 0 oa O ZO E0 X0 a H H 0 a a a Cl. w z H W X to0Ht- OHOoOHo1W0 I .-tc N I Mtodlaln W t.0 W NFO) mz0 W E. 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W [Q H W g E >H 3 E. z N o z C7 a H W �C 0 O U E m z 0 w >H w 4 u a w q Z 0 H •• ••Z EAO E m w a a GIElo H E q W E ,a m a 4E W U z' U E IA H 4 H E w a wz aw u H U z FC W >, W W z cn a a H O X a A MI w A U w w a x W w w a a IX EH a aO 3 6 A C) z z �� a a z E N > q E. w A wE w a a N w w 0 • m H0 w ° ara, a m a aCD Ea r01 u10 Wo 0 o r- a, N oqo r0ul4 raa 0 o ] ozoa O Zi H H O W O ul H N N ,7 O O In ,-7 m m ul O W N a) O 0 0 O O ul O N H a • a • • a • W • 0 • pC • H • >4 • O • a • • W E • WE • x • U • W ,7H �U ulCul cra) VrETA NUC � UHO o 4o >4o0NEzHEa) Ar1 ,LE,:?.. a) O M E a) mz rHEN NWri NZN OHmE InNHENHHHW drH W H NZN W O W oOOU) o Woao or4oArl r) OH m M W .npG in �C � � � a Ax � FC � ,7 zA mUv. ]] w 4ICJr- W N N N NONONZN W N3 W NEOUWUEUHm0 O O z PI) FC U W 0 z O E A W l0 = L� QaD am OO 1 r1 Ell N •.7M W T In W l0Htr EA0r - 04 C4m = OaO3a) 01N W m0) Z W m t` M (C M w m U 3 w w C7 cn w co a a v m w E w �n a d r U C7 an ul W .n .n m H E 0 0 0 0 0 0 0 0 0 0 0 0 0 O o 0 0 0 0 H 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 z H aH W E o W Hp4Np4m0 H U1C) l- OaoUrnO oOH W NCiHm = � W )no .2, W N U) N W N W N W N W U N E N O N U N H N U U co U m g m H U) m t0 U) m H m H H H O 0 0 0 0 W 0 0 0 0 0 0 0 0 O 0 0 ,-1 H O 0 0 0 0 U) 0 0 0 0 O 0 0 0 O O 0 performing work for a governmental attaching it to a separate Form 17 with any further delegation to other• unit or exempt organization. a Form 17 is NOT required. The Option subcontractors. The purchasing agent appointment is limited to the 1 contractor must only obtain a Form 13, Section B.from the exempt contractor's purchase of building materials and/or fixtures for the • project owner. specific project and is only valid during the appointment dates shown on the Form 17. PENALTY. Any person who signs this document with the intent to evade payment of tax is liable for the sales and use tax, interest, and EXEMPT SALE CERTIFICATE. A prime contractor who has penalty,and may be found guilty of a misdemeanor. been appointed to act as a purchasing agent by a governmental unit or AUTHORIZED SIGNATURE. The purchasing agent appointment exempt organization, and who hires a subcontractor operating as an • must be signed by an officer of the exempt organization or proper Option 1 contractor, must provide to that subcontractor a completed government official. The delegation of prime contractor's authority copy of Form 17 and a Nebraska Resale or Exempt Sale Certificate. must be signed by the owner, partner, corporate officer. or other Form 13. with Section C. Part 2, completed. The subcontractor will individual authorized to sign by a power of attorney on file with the retain these forms in his or her records. and will not charge the Nebraska Department of Revenue. NDOR www.revenue.ne.gov, (800)742-7474(toll free in NE and IA), (402)471-5729 6-139-1970 Rev.4-2009 Supersedes 6-139-1970 Rev.2-2008 10 ,'> W z O H a zq 4mx4mx4mx4 > 4zuU4Zrz40 P4 > < > 4 [444 El40v) 0 oa O ZO E0 X0 a H H 0 a a a Cl. w z H W X to0Ht- OHOoOHo1W0 I .-tc N I Mtodlaln W t.0 W NFO) mz0 W E. H E W Ulu0U) U aU) u a in U) t.0NtoNt.0Nt I-tt.00 WV) t.0 V) t0U) to tot0HN a U N m H F O O O O O O O O O O O O O O O W O a H 0 0 0 0 0 0 O 0 0 0 0 0 O 0 O U) 0 • ' a H O O O O O U) O O O O O 0 O O O 0 0 r • 0 0 H H 0 t LID 1 0 N 0 U)m M 10 O N w W H C7 Aa rr El U H a ^ a F. H cn B a -- —+ + • O E+ o O B o • •• O o ch w H EEl 0 U th w U H -- a c a r)Q E. H a n w U) O 0 — H -- —+ + H PO H O ON cf. N 0 N H N C) No 0 l0 M V' N M d' Zn m U N N O. ) COao COao ao M m N N O M l0 l0 m d' X 0 ai 0 U1 N m m H H M N 0 a) V' U) U) o m N W H H H X X l0 N O N v' M M 10 w m U) co co H Ul H U) a) l0 Z, 0 H U) Ul CO U) O d' O m o ao N N N OD m a O 0 0 H l� N M H N N lO M w H U Z m H O N 0 r` r•C H H D4 (q N N C RHO •• •• a O O (? 0 0 0 O O O 0 O 0 O O O 0 0 0 0 WWW m H O O 0 0 0 0 0 0 0 0 0 O 0 0 0 O 0 O U) A at Vl w 0 O O 0 0 0 0 0 0 0 0 0 0 0 0 0 O O El H 0 Z U 10 0 d' l0 cr N H N U) N 0 o l0 M N H H v' Z O O H N N m m N m O cr H m N N O M M m M N H H U a U U 4. 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The Option subcontractors. The purchasing agent appointment is limited to the 1 contractor must only obtain a Form 13, Section B.from the exempt contractor's purchase of building materials and/or fixtures for the • project owner. specific project and is only valid during the appointment dates shown on the Form 17. PENALTY. Any person who signs this document with the intent to evade payment of tax is liable for the sales and use tax, interest, and EXEMPT SALE CERTIFICATE. A prime contractor who has penalty,and may be found guilty of a misdemeanor. been appointed to act as a purchasing agent by a governmental unit or AUTHORIZED SIGNATURE. The purchasing agent appointment exempt organization, and who hires a subcontractor operating as an • must be signed by an officer of the exempt organization or proper Option 1 contractor, must provide to that subcontractor a completed government official. The delegation of prime contractor's authority copy of Form 17 and a Nebraska Resale or Exempt Sale Certificate. must be signed by the owner, partner, corporate officer. or other Form 13. with Section C. Part 2, completed. The subcontractor will individual authorized to sign by a power of attorney on file with the retain these forms in his or her records. and will not charge the Nebraska Department of Revenue. NDOR www.revenue.ne.gov, (800)742-7474(toll free in NE and IA), (402)471-5729 6-139-1970 Rev.4-2009 Supersedes 6-139-1970 Rev.2-2008 10 ,'> W z O H a zq 4mx4mx4mx4 > 4zuU4Zrz40 P4 > < > 4 [444 El40v) 0 oa O ZO E0 X0 a H H 0 a a a Cl. w z H W X to0Ht- OHOoOHo1W0 I .-tc N I Mtodlaln W t.0 W NFO) mz0 W E. H E W Ulu0U) U aU) u a in U) t.0NtoNt.0Nt I-tt.00 WV) t.0 V) t0U) to tot0HN a U N m H F O O O O O O O O O O O O O O O W O a H 0 0 0 0 0 0 O 0 0 0 0 0 O 0 O U) 0 • ' a H O O O O O U) O O O O O 0 O O O 0 0 0 -1 Ei 'r t0 I B . 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A w FC C) U G, G, A q A U C) C) U U H I� M a >e Z Z En En al Z z Z Z a FC ZH Cz G. a a a 0 o EA H A 0 A A A GA GA C4 1a o 1 a w Mil a r.0 O o 0 En O 0 O 0 W En w w w w w 4, H w A X H G, I-] C., x 0 0 w w w C) U U u C) A q w E l z I-� Cl) V' M 0 0 E. E. Ea a a M Ma EAR Cry E+ P. o O FA z IC H z 00 VI I r 1 O z O z co w VI w to w Ul O co 0 VI O to 0 co O to N a N G, OIZ FA FA OH 003OOto 'J. Om 00 OHOH ri P; (V M M M rl CxNC4 MG, VI G, OCnHHO _ H lxi • E. • H • H • • r • r . C.) . C.) • U • U • U . Zi • Z. . z • z . Zi • • E' .4 El \U V' OH r-IEaTr HwrwCnrip4, rP: OzOzOZOHOHOHOHOHOEit000 tI.3 H Cl) Tr Ul RC to 4to 0 o fP4; in C) Ill C) VD O t0 0 t0 0 o PI 0 CA o w o w o Ell rx to ID 01 z RCw Ow 0x0 > xO > 0OHODHCArCHG. rHG4wU VIUVIUt0Mtor>: torxtoato (xtowr0N ( CA ZA VIW Vr6Aw6 .4 TroOcrEn0VIHVIHw _ V' _ VI _ w _ w _ VI _ w _ w _ Vlaa _ xrH O CFI N M w PS >C '7.� Tr >4intO ..7r10t" w w C VIN M VI CA t0to coln xi N tOtDCOCD '.701N0 X z w r 04 r w z r w r E I r U r U U r (4 r o4 0 ri CO N CD M m ri Co rA CO N 00 M CC V I CO U O r1 O1 w H E+ 0 0 0 0 0 0 0 0 O 0 0 0 0 0 0 0 0 0 0 a H 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 intment is limited to the 1 contractor must only obtain a Form 13, Section B.from the exempt contractor's purchase of building materials and/or fixtures for the • project owner. specific project and is only valid during the appointment dates shown on the Form 17. PENALTY. Any person who signs this document with the intent to evade payment of tax is liable for the sales and use tax, interest, and EXEMPT SALE CERTIFICATE. A prime contractor who has penalty,and may be found guilty of a misdemeanor. been appointed to act as a purchasing agent by a governmental unit or AUTHORIZED SIGNATURE. The purchasing agent appointment exempt organization, and who hires a subcontractor operating as an • must be signed by an officer of the exempt organization or proper Option 1 contractor, must provide to that subcontractor a completed government official. The delegation of prime contractor's authority copy of Form 17 and a Nebraska Resale or Exempt Sale Certificate. must be signed by the owner, partner, corporate officer. or other Form 13. with Section C. Part 2, completed. The subcontractor will individual authorized to sign by a power of attorney on file with the retain these forms in his or her records. and will not charge the Nebraska Department of Revenue. NDOR www.revenue.ne.gov, (800)742-7474(toll free in NE and IA), (402)471-5729 6-139-1970 Rev.4-2009 Supersedes 6-139-1970 Rev.2-2008 10 ,'> W z O H a zq 4mx4mx4mx4 > 4zuU4Zrz40 P4 > < > 4 [444 El40v) 0 oa O ZO E0 X0 a H H 0 a a a Cl. w z H W X to0Ht- OHOoOHo1W0 I .-tc N I Mtodlaln W t.0 W NFO) mz0 W E. 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The purchasing agent appointment exempt organization, and who hires a subcontractor operating as an • must be signed by an officer of the exempt organization or proper Option 1 contractor, must provide to that subcontractor a completed government official. The delegation of prime contractor's authority copy of Form 17 and a Nebraska Resale or Exempt Sale Certificate. must be signed by the owner, partner, corporate officer. or other Form 13. with Section C. Part 2, completed. The subcontractor will individual authorized to sign by a power of attorney on file with the retain these forms in his or her records. and will not charge the Nebraska Department of Revenue. NDOR www.revenue.ne.gov, (800)742-7474(toll free in NE and IA), (402)471-5729 6-139-1970 Rev.4-2009 Supersedes 6-139-1970 Rev.2-2008 10 ,'> W z O H a zq 4mx4mx4mx4 > 4zuU4Zrz40 P4 > < > 4 [444 El40v) 0 oa O ZO E0 X0 a H H 0 a a a Cl. w z H W X to0Ht- OHOoOHo1W0 I .-tc N I Mtodlaln W t.0 W NFO) mz0 W E. 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The purchasing agent appointment exempt organization, and who hires a subcontractor operating as an • must be signed by an officer of the exempt organization or proper Option 1 contractor, must provide to that subcontractor a completed government official. The delegation of prime contractor's authority copy of Form 17 and a Nebraska Resale or Exempt Sale Certificate. must be signed by the owner, partner, corporate officer. or other Form 13. with Section C. Part 2, completed. The subcontractor will individual authorized to sign by a power of attorney on file with the retain these forms in his or her records. and will not charge the Nebraska Department of Revenue. NDOR www.revenue.ne.gov, (800)742-7474(toll free in NE and IA), (402)471-5729 6-139-1970 Rev.4-2009 Supersedes 6-139-1970 Rev.2-2008 10 ,'> W z O H a zq 4mx4mx4mx4 > 4zuU4Zrz40 P4 > < > 4 [444 El40v) 0 oa O ZO E0 X0 a H H 0 a a a Cl. w z H W X to0Ht- OHOoOHo1W0 I .-tc N I Mtodlaln W t.0 W NFO) mz0 W E. 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M a M H M 0 U M g M a H El r-1 r-1 r-I H H rH r4 H ri H H H e-1 r-1 r-1 CO r-1 r-1 0 H O O 0 O O 0 0 0 0 0 0 0 0 0 0 Cl) 0 O lding materials and/or fixtures for the • project owner. specific project and is only valid during the appointment dates shown on the Form 17. PENALTY. Any person who signs this document with the intent to evade payment of tax is liable for the sales and use tax, interest, and EXEMPT SALE CERTIFICATE. A prime contractor who has penalty,and may be found guilty of a misdemeanor. been appointed to act as a purchasing agent by a governmental unit or AUTHORIZED SIGNATURE. The purchasing agent appointment exempt organization, and who hires a subcontractor operating as an • must be signed by an officer of the exempt organization or proper Option 1 contractor, must provide to that subcontractor a completed government official. The delegation of prime contractor's authority copy of Form 17 and a Nebraska Resale or Exempt Sale Certificate. must be signed by the owner, partner, corporate officer. or other Form 13. with Section C. Part 2, completed. The subcontractor will individual authorized to sign by a power of attorney on file with the retain these forms in his or her records. and will not charge the Nebraska Department of Revenue. NDOR www.revenue.ne.gov, (800)742-7474(toll free in NE and IA), (402)471-5729 6-139-1970 Rev.4-2009 Supersedes 6-139-1970 Rev.2-2008 10 ,'> W z O H a zq 4mx4mx4mx4 > 4zuU4Zrz40 P4 > < > 4 [444 El40v) 0 oa O ZO E0 X0 a H H 0 a a a Cl. w z H W X to0Ht- OHOoOHo1W0 I .-tc N I Mtodlaln W t.0 W NFO) mz0 W E. 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M a M H M 0 U M g M a H El r-1 r-1 r-I H H rH r4 H ri H H H e-1 r-1 r-1 CO r-1 r-1 0 H O O 0 O O 0 0 0 0 0 0 0 0 0 0 Cl) 0 O lding materials and/or fixtures for the • project owner. specific project and is only valid during the appointment dates shown on the Form 17. PENALTY. Any person who signs this document with the intent to evade payment of tax is liable for the sales and use tax, interest, and EXEMPT SALE CERTIFICATE. A prime contractor who has penalty,and may be found guilty of a misdemeanor. been appointed to act as a purchasing agent by a governmental unit or AUTHORIZED SIGNATURE. The purchasing agent appointment exempt organization, and who hires a subcontractor operating as an • must be signed by an officer of the exempt organization or proper Option 1 contractor, must provide to that subcontractor a completed government official. The delegation of prime contractor's authority copy of Form 17 and a Nebraska Resale or Exempt Sale Certificate. must be signed by the owner, partner, corporate officer. or other Form 13. with Section C. Part 2, completed. The subcontractor will individual authorized to sign by a power of attorney on file with the retain these forms in his or her records. and will not charge the Nebraska Department of Revenue. NDOR www.revenue.ne.gov, (800)742-7474(toll free in NE and IA), (402)471-5729 6-139-1970 Rev.4-2009 Supersedes 6-139-1970 Rev.2-2008 10 ,'> W z O H a zq 4mx4mx4mx4 > 4zuU4Zrz40 P4 > < > 4 [444 El40v) 0 oa O ZO E0 X0 a H H 0 a a a Cl. w z H W X to0Ht- OHOoOHo1W0 I .-tc N I Mtodlaln W t.0 W NFO) mz0 W E. 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CO N 61\ o CO ri ] N to r) d' W Ul z to z r W CO W rn W o W P, F .i Z W Ul '.� U) N U) N U) ri U) N .-a t0 it 10 cn W 01 t0 ) W E. t0 H l0 H W x l0 x t0 x N F O CU N Pl H E. ri H H H H ri H H H H H H H ri ri H W H .-1 H 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Cl) 0 W a U z .] H A 4 H H a W off 1 N MW W U1HwtoHrOOoOmOrCo rlaN W M W d H 1n tOW Z W N a N W N U N a N a N Ul d' N U] N a N U N U $ M U) M .T. M a M H M 0 U M g M a H El r-1 r-1 r-I H H rH r4 H ri H H H e-1 r-1 r-1 CO r-1 r-1 0 H O O 0 O O 0 0 0 0 0 0 0 0 0 0 Cl) 0 O lding materials and/or fixtures for the • project owner. specific project and is only valid during the appointment dates shown on the Form 17. PENALTY. Any person who signs this document with the intent to evade payment of tax is liable for the sales and use tax, interest, and EXEMPT SALE CERTIFICATE. A prime contractor who has penalty,and may be found guilty of a misdemeanor. been appointed to act as a purchasing agent by a governmental unit or AUTHORIZED SIGNATURE. The purchasing agent appointment exempt organization, and who hires a subcontractor operating as an • must be signed by an officer of the exempt organization or proper Option 1 contractor, must provide to that subcontractor a completed government official. The delegation of prime contractor's authority copy of Form 17 and a Nebraska Resale or Exempt Sale Certificate. must be signed by the owner, partner, corporate officer. or other Form 13. with Section C. Part 2, completed. The subcontractor will individual authorized to sign by a power of attorney on file with the retain these forms in his or her records. and will not charge the Nebraska Department of Revenue. NDOR www.revenue.ne.gov, (800)742-7474(toll free in NE and IA), (402)471-5729 6-139-1970 Rev.4-2009 Supersedes 6-139-1970 Rev.2-2008 10 ,'> W z O H a zq 4mx4mx4mx4 > 4zuU4Zrz40 P4 > < > 4 [444 El40v) 0 oa O ZO E0 X0 a H H 0 a a a Cl. w z H W X to0Ht- OHOoOHo1W0 I .-tc N I Mtodlaln W t.0 W NFO) mz0 W E. H E W Ulu0U) U aU) u a in U) t.0NtoNt.0Nt I-tt.00 WV) t.0 V) t0U) to tot0HN a U N m H F O O O O O O O O O O O O O O O W O a H 0 0 0 0 0 0 O 0 0 0 0 0 O 0 O U) 0 • ' a H O O O O O U) O O O O O 0 O O O 0 0 0 0 rI M F o —H w t 8 o N O Ito CO w 0 N w w F C7 A a in tit w U H a a F H 8 0 O F O A o •• O o e w H F�-> it 0 U vt vt w U H CO Qa 0 H a o A — _ H -- —+ -I- EA al F 01 w N 0 0 0 Ill H 0 to 0 LC/ 0 to to M 01 IZ A 4, B H1 H M 01 el H 01 0 0 0 to O w M o LC, t • X 0 Cl. 0 M co 0 in 01 to sr O H l0 O M O 0 N N F M V N tb o 01 W l0 0 N M N LIl M N N Z O H In N O Ul O d' CO inIIl 01 01 Ul 0 rl a O U sr H N N N sr in .4, w N w F UZ to to q H N 0 0 CG rC Mi EA CO U N N U CO F p: O O O 0 O O O O O O O O O O O t? t/t d1 F O O O O O O o O O O O O O 0 0 U) A ' U] w O O 0 O O O O O O O O O O O O w H O Z U H l0 10 d' 1--1 N N H 0 to M H N N H z 0 0 H H H N M N r1 N 0 CO O to 0) to M 01 F F U a • U U Cu M O o 0 0 0 to 0 0 rl 0 lD 01 CO l0 �a H CO N l0 ',I. I-1 CO CO N M x Z F H ri r1 FF .-iH H U A v M ----+ £ p p ry + A FC FC W W E, W FC . 0 7 W 0 00 O AO U) w w .-7 f7 H f7 A w Z >.7 a x x A x W x r4 Hi X >, o O o O >� O W O w o O o O x 0 0 EA 0 O H F o o O O g4 O o U O o O o z o 0 04 o O I-] O H O O O O O w C 4 O O O O H 0 0 0 FL 0 w o .7 CO F W • it O Ul EA o a to O Ul 04 H N N >, tM wOFON O Le) z to A.' Ul O Ul to A M tO 0 4 H 174 CO CO U) .-1 0 H u: 7, CD0 rt ONN A w O H 0 H C7 r♦ F IT a a x H Z Z Z Z\ C7 H H H 0 0 q Cr. w w EMI w F H x x x - >, Cr. F F N r� Ul C f7 �] 'T. N o \ H x zW 'Cu Cu W .0 W �7£ O m,� A H H w fa w W F W F 0 w >, `� Z N OU 7. W W W W 3 U w a A 3 O 0 a4 o >, > > > O z a Wq £ H F 4 xl F1 a w Z w 0 x WF 0INN A wF a s az U o Cr. a A to U F PG C9 F a O .O 01 pt CO ar N O N d' H 0 O H O H M N N Z U O "Z H H H w 01 01 O N >, d' >, r .'N H 01 O Cu o O F O ',>♦ O W O W O W N Cu c4 O _ H P4 • J >, F F C7 W C7 FC O O O O O H a F .0 H 14 HU N N N (RY� N2aOo2O N O O O 0 0 FF F IX XF Ul OUOAO4O O O (Y. OH r1 NHMH r1 ri sq rl rl rl0 A�' U Z W Ow OHo 0 000000 oxoAozo ,.7r10r1 rt ft ri > w O N zq 0fxoz0NoPOaoaaomo ).70HOHt- ao) F01Fa1Ft31FFCv1 U P4 C7 z X X X w w PO £ Z Z Z z U W N CI V' Otoww W rwR: CO 1 01Ho g r10NwMwd' 4Ulwww >C zw r- pprUlr- UrFrFrFar Cut` W COFODXODFCOeacoc4coc4cou: w ' H F H r1 H r1 H r1 H H r1 H H ri H H H a H 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 CUr.4 2(� r•C0RCar.10) 4 FCEFCFFCFFCOFCOFCOFCFHVl 0 0x O '.1.' H H \ U ry' A x fn Vl E E E Ul F H W E u) W to . r . CO N 61\ o CO ri ] N to r) d' W Ul z to z r W CO W rn W o W P, F .i Z W Ul '.� U) N U) N U) ri U) N .-a t0 it 10 cn W 01 t0 ) W E. t0 H l0 H W x l0 x t0 x N F O CU N Pl H E. ri H H H H ri H H H H H H H ri ri H W H .-1 H 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Cl) 0 W a U z .] H A 4 H H a W off 1 N MW W U1HwtoHrOOoOmOrCo rlaN W M W d H 1n tOW Z W N a N W N U N a N a N Ul d' N U] N a N U N U $ M U) M .T. M a M H M 0 U M g M a H El r-1 r-1 r-I H H rH r4 H ri H H H e-1 r-1 r-1 CO r-1 r-1 0 H O O 0 O O 0 0 0 0 0 0 0 0 0 0 Cl) 0 O lding materials and/or fixtures for the • project owner. specific project and is only valid during the appointment dates shown on the Form 17. PENALTY. Any person who signs this document with the intent to evade payment of tax is liable for the sales and use tax, interest, and EXEMPT SALE CERTIFICATE. A prime contractor who has penalty,and may be found guilty of a misdemeanor. been appointed to act as a purchasing agent by a governmental unit or AUTHORIZED SIGNATURE. The purchasing agent appointment exempt organization, and who hires a subcontractor operating as an • must be signed by an officer of the exempt organization or proper Option 1 contractor, must provide to that subcontractor a completed government official. The delegation of prime contractor's authority copy of Form 17 and a Nebraska Resale or Exempt Sale Certificate. must be signed by the owner, partner, corporate officer. or other Form 13. with Section C. Part 2, completed. The subcontractor will individual authorized to sign by a power of attorney on file with the retain these forms in his or her records. and will not charge the Nebraska Department of Revenue. NDOR www.revenue.ne.gov, (800)742-7474(toll free in NE and IA), (402)471-5729 6-139-1970 Rev.4-2009 Supersedes 6-139-1970 Rev.2-2008 10 ,'> W z O H a zq 4mx4mx4mx4 > 4zuU4Zrz40 P4 > < > 4 [444 El40v) 0 oa O ZO E0 X0 a H H 0 a a a Cl. w z H W X to0Ht- OHOoOHo1W0 I .-tc N I Mtodlaln W t.0 W NFO) mz0 W E. H E W Ulu0U) U aU) u a in U) t.0NtoNt.0Nt I-tt.00 WV) t.0 V) t0U) to tot0HN a U N m H F O O O O O O O O O O O O O O O W O a H 0 0 0 0 0 0 O 0 0 0 0 0 O 0 O U) 0 • ' a H O O O O O U) O O O O O 0 O O O 0 0 C-25A CITY OF OMAHA • LEGISLATIVE CHAMBER Omaha,Nebraska RESOLVED BY THE CITY COUNCIL OF THE CITY OF OMAHA: WHEREAS, the City Council approved an Agreement with the State of Nebraska Department of Roads (NDOR) by Council Resolution No. 30 on January 12, 2010 for Federal Funding for the reconstruction of West Center Road from 148th Street to U.S. 275, this project is known as Project SP-83-22; and, WHEREAS, in the above agreement the City of Omaha has pledged sufficient funds to finance its share of the cost of construction of this project identified as STPD-38-7(106), and that the City of Omaha would pay costs as set forth in the agreement; and, WHEREAS, the State and the City received bids for the construction of this project on March 26, 2010, at which time one bid was received for the construction of the proposed work; and, WHEREAS, the following contractor has been selected by NDOR as the low bidder to whom the contract should be awarded, Hawkins Construction Company, Omaha, Nebraska for the sum of$8,058,172.69; and, WHEREAS, the cost of this project will be paid from the ARRA NDOR Grant Fund 17116, Organization 117755, with $6,141,000 of the contract cost being reimbursed by NDOR with ARRA funds and the remainder of the project cost is covered by Federal and State funds with Omaha's 20% participation of$383,434.54 paid from the 2006 Transportation Bond Fund 13182, 2010 Issue Transportation Bond Organization 117115, in accord with the approved program agreement with NDOR for the project. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF OMAHA: THAT, as recommended by the Mayor, the City Council concurs with the bid award to Hawkins Construction Company for Project SP-83-22, being the reconstruction of West Center Road from 148th Street to U.S. 275, in the amount of$8,058,172.69, with $6,141,000 to be paid from the ARRA NDOR Grant Fund 17116, Organization 117760, with remainder of the contract cost being paid by Federal and State funds with the City's 20% share in the amount of $383,434.54 being paid from the 2006 Transportation Bond Fund 13182, 2010 Issue Transportation Bond Organization 117115, in accord with the approved program agreement with NDOR for the project By Councilmember Adopted City Clerk Approved Mayor , tM wOFON O Le) z to A.' Ul O Ul to A M tO 0 4 H 174 CO CO U) .-1 0 H u: 7, CD0 rt ONN A w O H 0 H C7 r♦ F IT a a x H Z Z Z Z\ C7 H H H 0 0 q Cr. w w EMI w F H x x x - >, Cr. F F N r� Ul C f7 �] 'T. N o \ H x zW 'Cu Cu W .0 W �7£ O m,� A H H w fa w W F W F 0 w >, `� Z N OU 7. W W W W 3 U w a A 3 O 0 a4 o >, > > > O z a Wq £ H F 4 xl F1 a w Z w 0 x WF 0INN A wF a s az U o Cr. a A to U F PG C9 F a O .O 01 pt CO ar N O N d' H 0 O H O H M N N Z U O "Z H H H w 01 01 O N >, d' >, r .'N H 01 O Cu o O F O ',>♦ O W O W O W N Cu c4 O _ H P4 • J >, F F C7 W C7 FC O O O O O H a F .0 H 14 HU N N N (RY� N2aOo2O N O O O 0 0 FF F IX XF Ul OUOAO4O O O (Y. OH r1 NHMH r1 ri sq rl rl rl0 A�' U Z W Ow OHo 0 000000 oxoAozo ,.7r10r1 rt ft ri > w O N zq 0fxoz0NoPOaoaaomo ).70HOHt- ao) F01Fa1Ft31FFCv1 U P4 C7 z X X X w w PO £ Z Z Z z U W N CI V' Otoww W rwR: CO 1 01Ho g r10NwMwd' 4Ulwww >C zw r- pprUlr- UrFrFrFar Cut` W COFODXODFCOeacoc4coc4cou: w ' H F H r1 H r1 H r1 H H r1 H H ri H H H a H 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 CUr.4 2(� r•C0RCar.10) 4 FCEFCFFCFFCOFCOFCOFCFHVl 0 0x O '.1.' H H \ U ry' A x fn Vl E E E Ul F H W E u) W to . r . CO N 61\ o CO ri ] N to r) d' W Ul z to z r W CO W rn W o W P, F .i Z W Ul '.� U) N U) N U) ri U) N .-a t0 it 10 cn W 01 t0 ) W E. t0 H l0 H W x l0 x t0 x N F O CU N Pl H E. ri H H H H ri H H H H H H H ri ri H W H .-1 H 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Cl) 0 W a U z .] H A 4 H H a W off 1 N MW W U1HwtoHrOOoOmOrCo rlaN W M W d H 1n tOW Z W N a N W N U N a N a N Ul d' N U] N a N U N U $ M U) M .T. M a M H M 0 U M g M a H El r-1 r-1 r-I H H rH r4 H ri H H H e-1 r-1 r-1 CO r-1 r-1 0 H O O 0 O O 0 0 0 0 0 0 0 0 0 0 Cl) 0 O lding materials and/or fixtures for the • project owner. specific project and is only valid during the appointment dates shown on the Form 17. PENALTY. Any person who signs this document with the intent to evade payment of tax is liable for the sales and use tax, interest, and EXEMPT SALE CERTIFICATE. A prime contractor who has penalty,and may be found guilty of a misdemeanor. been appointed to act as a purchasing agent by a governmental unit or AUTHORIZED SIGNATURE. The purchasing agent appointment exempt organization, and who hires a subcontractor operating as an • must be signed by an officer of the exempt organization or proper Option 1 contractor, must provide to that subcontractor a completed government official. The delegation of prime contractor's authority copy of Form 17 and a Nebraska Resale or Exempt Sale Certificate. must be signed by the owner, partner, corporate officer. or other Form 13. with Section C. Part 2, completed. The subcontractor will individual authorized to sign by a power of attorney on file with the retain these forms in his or her records. and will not charge the Nebraska Department of Revenue. NDOR www.revenue.ne.gov, (800)742-7474(toll free in NE and IA), (402)471-5729 6-139-1970 Rev.4-2009 Supersedes 6-139-1970 Rev.2-2008 10 ,'> W z O H a zq 4mx4mx4mx4 > 4zuU4Zrz40 P4 > < > 4 [444 El40v) 0 oa O ZO E0 X0 a H H 0 a a a Cl. w z H W X to0Ht- OHOoOHo1W0 I .-tc N I Mtodlaln W t.0 W NFO) mz0 W E. H E W Ulu0U) U aU) u a in U) t.0NtoNt.0Nt I-tt.00 WV) t.0 V) t0U) to tot0HN a U N m H F O O O O O O O O O O O O O O O W O a H 0 0 0 0 0 0 O 0 0 0 0 0 O 0 O U) 0 • ' a H O O O O O U) O O O O O 0 O O O 0 0 C-25A CITY OF OMAHA LEGISLATIVE CHAMBER Omaha,Nebraska PAGE 2 BE IT FURTER RESOLVED THAT: THAT, the City Council hereby authorizes the Mayor and the City Clerk to sign the construction contract on behalf of the City of Omaha, and that the Mayor and the City Clerk are also authorized to sign the attached NDOR documents. 1473hf APPROVED AS TO FORM: 42-V MCITY ATTORNEY DATE - �. Councilmember ,2O10 Adopted -,AP 1 :"` IF:-.lP'Q - \: 1747., City Clerk V/ ) Approved:% - Mayor 1-' DATE: / 7 • • • Page 10 of 10, 2/24/2010 12:58:29 PM, Bid Tabulation, Generated by: admin for project OPW 51680 ion, Generated by:admin for project OPW 51680 W 51930 nC Approved.... Mayor • ECS A 6 0 C�r.Qrq..N 6 0 M•-t W O Z 00 O O O 6 r�• O O W r4' pl-p pa cn 0 Q\ O v, • O• .... t7,E• c:87. ..!-' 05-''' w(Dt9•..,,R:,.,:ipct. ,,,,,_,' ,_ri: ri ,c)'. sr: .....,--- 6: (14 (;). 61 c42 11 ''''". Z. gypCD o V l o a o o a a� � °� Va“::) O f w cD 5 O F+� n5. Y cCD ,7y Nod �� , p �C o. t , Q' O � izo a0 � la, Via•, '- v� ° �' Z O g a �, � o ao m aacn a, , ,- NOS cr � • 4 — ,,,,,,0. : 5r. 6,9. r,.)",_ .4,.,T,.!; ; :4;k<E" ' \ t h P J C CD Z. `o ai R (D ` - ` i •N O O Pt- v, A.' °, fa, C " 00 p, c0D • (� n „ M „ N Z GO 0 �y w � iti 0 0' , � E. 0O 0' p, ° O w N p. n • ..• ;may' `nk i • -Ti 1 i e. '!^. ., , S -' •'�e' ' t( i J ,. „�" f m i contract cost being reimbursed by NDOR with ARRA funds and the remainder of the project cost is covered by Federal and State funds with Omaha's 20% participation of$383,434.54 paid from the 2006 Transportation Bond Fund 13182, 2010 Issue Transportation Bond Organization 117115, in accord with the approved program agreement with NDOR for the project. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF OMAHA: THAT, as recommended by the Mayor, the City Council concurs with the bid award to Hawkins Construction Company for Project SP-83-22, being the reconstruction of West Center Road from 148th Street to U.S. 275, in the amount of$8,058,172.69, with $6,141,000 to be paid from the ARRA NDOR Grant Fund 17116, Organization 117760, with remainder of the contract cost being paid by Federal and State funds with the City's 20% share in the amount of $383,434.54 being paid from the 2006 Transportation Bond Fund 13182, 2010 Issue Transportation Bond Organization 117115, in accord with the approved program agreement with NDOR for the project By Councilmember Adopted City Clerk Approved Mayor , tM wOFON O Le) z to A.' Ul O Ul to A M tO 0 4 H 174 CO CO U) .-1 0 H u: 7, CD0 rt ONN A w O H 0 H C7 r♦ F IT a a x H Z Z Z Z\ C7 H H H 0 0 q Cr. w w EMI w F H x x x - >, Cr. F F N r� Ul C f7 �] 'T. N o \ H x zW 'Cu Cu W .0 W �7£ O m,� A H H w fa w W F W F 0 w >, `� Z N OU 7. W W W W 3 U w a A 3 O 0 a4 o >, > > > O z a Wq £ H F 4 xl F1 a w Z w 0 x WF 0INN A wF a s az U o Cr. a A to U F PG C9 F a O .O 01 pt CO ar N O N d' H 0 O H O H M N N Z U O "Z H H H w 01 01 O N >, d' >, r .'N H 01 O Cu o O F O ',>♦ O W O W O W N Cu c4 O _ H P4 • J >, F F C7 W C7 FC O O O O O H a F .0 H 14 HU N N N (RY� N2aOo2O N O O O 0 0 FF F IX XF Ul OUOAO4O O O (Y. OH r1 NHMH r1 ri sq rl rl rl0 A�' U Z W Ow OHo 0 000000 oxoAozo ,.7r10r1 rt ft ri > w O N zq 0fxoz0NoPOaoaaomo ).70HOHt- ao) F01Fa1Ft31FFCv1 U P4 C7 z X X X w w PO £ Z Z Z z U W N CI V' Otoww W rwR: CO 1 01Ho g r10NwMwd' 4Ulwww >C zw r- pprUlr- UrFrFrFar Cut` W COFODXODFCOeacoc4coc4cou: w ' H F H r1 H r1 H r1 H H r1 H H ri H H H a H 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 CUr.4 2(� r•C0RCar.10) 4 FCEFCFFCFFCOFCOFCOFCFHVl 0 0x O '.1.' H H \ U ry' A x fn Vl E E E Ul F H W E u) W to . r . CO N 61\ o CO ri ] N to r) d' W Ul z to z r W CO W rn W o W P, F .i Z W Ul '.� U) N U) N U) ri U) N .-a t0 it 10 cn W 01 t0 ) W E. t0 H l0 H W x l0 x t0 x N F O CU N Pl H E. ri H H H H ri H H H H H H H ri ri H W H .-1 H 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Cl) 0 W a U z .] H A 4 H H a W off 1 N MW W U1HwtoHrOOoOmOrCo rlaN W M W d H 1n tOW Z W N a N W N U N a N a N Ul d' N U] N a N U N U $ M U) M .T. M a M H M 0 U M g M a H El r-1 r-1 r-I H H rH r4 H ri H H H e-1 r-1 r-1 CO r-1 r-1 0 H O O 0 O O 0 0 0 0 0 0 0 0 0 0 Cl) 0 O lding materials and/or fixtures for the • project owner. specific project and is only valid during the appointment dates shown on the Form 17. PENALTY. Any person who signs this document with the intent to evade payment of tax is liable for the sales and use tax, interest, and EXEMPT SALE CERTIFICATE. A prime contractor who has penalty,and may be found guilty of a misdemeanor. been appointed to act as a purchasing agent by a governmental unit or AUTHORIZED SIGNATURE. The purchasing agent appointment exempt organization, and who hires a subcontractor operating as an • must be signed by an officer of the exempt organization or proper Option 1 contractor, must provide to that subcontractor a completed government official. The delegation of prime contractor's authority copy of Form 17 and a Nebraska Resale or Exempt Sale Certificate. must be signed by the owner, partner, corporate officer. or other Form 13. with Section C. Part 2, completed. The subcontractor will individual authorized to sign by a power of attorney on file with the retain these forms in his or her records. and will not charge the Nebraska Department of Revenue. NDOR www.revenue.ne.gov, (800)742-7474(toll free in NE and IA), (402)471-5729 6-139-1970 Rev.4-2009 Supersedes 6-139-1970 Rev.2-2008 10 ,'> W z O H a zq 4mx4mx4mx4 > 4zuU4Zrz40 P4 > < > 4 [444 El40v) 0 oa O ZO E0 X0 a H H 0 a a a Cl. w z H W X to0Ht- OHOoOHo1W0 I .-tc N I Mtodlaln W t.0 W NFO) mz0 W E. 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