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Home My WebLink AboutResolutions - No. 91-197i RESOLUTION NO. 91-197 ---------------------- ---------------------- A RESOLUTION OF THE LODI CITY COUNCIL APPROVING MODIFYING THE PARKING LIMIT FROM TWO-HOUR TO TWO-HOUR OR ALL DAY PARKING WITH ZONE B PERMITS ON THE WEST SIDE OF CHURCH STREET FROM PINE STREET NORTH TO THE ALLEY (FIVE PARKING STALLS) AND THEREBY AMENDING TRAFFIC RESOLUTION NO. 87-163, SECTION 6 - PERMIT PARKING RESOLVED, that the Lodi City Council hereby approves the modification of the parking limit from two-hour to two-hour or all day parking with Zone B permits on the west side of Church Street from Pine Street north to the alley (five parking stalls); and BE IT FURTHER RESOLVED, that the Lodi City Council hereby approves amending Traffic Resolution No. 87-163, Section 6(A) - Permit Parking - to modify the parking limit from two-hour to two-hour or all day with Zone B permits on the west side of Church Street from Pine Street north to the alley (five parking stalls) - as shown on Exhibit A attached; and FURTHER RESOLVED, that the Traffic Resolution No. 87-163 Section 6 is further amended to authorize the City Manager to allow all -day parking for vehicles displaying Civic Center parking permits in designated downtown parking areas (Zone B). Dated: October 16, 1991 I hereby certify that Resolution No. 91-197 was passed and adopted by the City Council of the City of Lodi in a regular meeting held October 16, 1991 by the following vote: Ayes: Council Members - Pennino, Pinkerton, Sieglock, Snider and Hinchman (Mayor) Noes: Council Members - None Absent: Council Members - None Aw �t -6ax� Alice M. Rei the City Clerk 91-197 RES91197/TXTA.02J J la-- 1zjs c �lt11 w�� M 3C�oNd 4�1 1at J-1 i-:�, M1 Cl�) PH1-;�?N-4 1t w2Ga 33J�1d � 3 J.1» V 12%VxLY 1�175`�d 71H-7, L2 �4'tc: �4 'd5 X11- 1N3WIdVd30 SMOM Wend eN lclol Jo AilD W*7 _ f STATE OF CALIFORNIA—THE RESOURCES AGENCY PETE WILSON, Governor DEPARTMENT OF WATER RESOURCES 1416 NINTH STREET, P.O. BOX 942836 ,92 _ n.: SACRAMENTO, CA 94236-0001 �. (916) 653.5791 .. , vTrce 21 1992 Honorable David M. Hinchman, Mayor City of Lodi Post Office Box 3006 Lodi, California 95241-1910 - Dear Mayor Hinchman: Enclosed is an original executed Contract, Number E54402 between the City of Lodi in San Joaquin County, and the State of California, for a $4,758,000 loan under the Safe Drinking Water Bond Law of 1988. These funds are to assist your community in meeting safe drinking water standards for your domestic water supply. You must submit a summary of all bids to DWR before awarding construction contracts over $10,000, or contracts in any amount and for any purposes for which competitive bids are required under your enabling authority. Enclosed are copies of claim forms 4135, 4135A and 4135C, together with a sample of the completed forms. When requesting funds, you must submit the original and four copies of the forms and attachments for processing to the Department of Water Resources, Bond Financing and Administration Office, Attention: Sarah Richey, Room 816, Post Office Box 942836, Sacramento, California 94236-0001. If you have any questions about claim forms please call Sarah Richey at (916) 653-4763. I am pleased to assist the City -of Lodi in providing safe drinking water for the community it serves. If you need further information please contact Lorri Silva at (916) 653-9634. Sincerely, Ox'lginal signed by Chester M. Winn, Chief Division of Fiscal Services Enclosures cc: (see next page) Ar r Mr. Thomas A. Peterson, City Manager City of Lodi Post office Box 3006 Lodi, California 95241-1910 Mr.. Homer Vaughn, Acting District Engineer _Stockton District _ �Off-ice of Drinking Water Department of Health Services 31 E. Channel Street State Building, Room 270 Stockton, California 95202 i •r STATE OF CALIFORNIA—THE RESOURCES AGENCY PETE WILSON, Governor DEPARTMENT OF WATER RESOURCES 1416 NINTH STREET, P.O. BOX 942836 _ v •� SACRAMENTO, CA 94236-0001 i (916) 653.5791 JAN 2 1192 Honorable.David M. Hinchman, Mayor City of Lodi _ Post Office Box -3006 Lodi, California 95241-1910 Dear Mayor Hinchman: Enclosed is an original executed Contract, Number E54402 between the City of Lodi in San Joaquin County, and the State of California, for a $4,758,000 loan under the Safe Drinking Water Bond Law of 1988. These funds are to assist your community in meeting safe drinking water standards for your domestic water supply. You must submit a summary of all bids to DWR before awarding construction contracts over $10,000, or contracts in any amount and for any purposes for which competitive bids are required under your enabling authority. Enclosed are copies of claim forms 4135, 4135A and 4135C, together with a sample of the completed forms. When requesting funds, you must submit the original and four copies of the forms and attachments for processing to the Department of Water Resources, Bond Financing and Administration Office, Attention: Sarah Richey, Room 816, Post Office Box 942836, Sacramento, California 94236-0001. If you have any questions about claim forms please call Sarah Richey at (916) 653-4763. I am pleased to assist the City of Lodi in providing safe drinking water for the community it serves. If you need further information please contact Lorri Silva at (916) 653-9634. Sincerely, Chester M. Winn, Chief Division of Fiscal Services Enclosures cc: (see next page) Q rr - '.J Enclosed is an original executed Contract, Number E54402 between the City of Lodi in San Joaquin County, and the State of California, for a $4,758,000 loan under the Safe Drinking Water Bond Law of 1988. These funds are to assist your community in meeting safe drinking water standards for your domestic water supply. You must submit a summary of all bids to DWR before awarding construction contracts over $10,000, or contracts in any amount and for any purposes for which competitive bids are required under your enabling authority. Enclosed are copies of claim forms 4135, 4135A and 4135C, together with a sample of the completed forms. When requesting funds, you must submit the original and four copies of the forms and attachments for processing to the Department of Water Resources, Bond Financing and Administration Office, Attention: Sarah Richey, Room 816, Post Office Box 942836, Sacramento, California 94236-0001. If you have any questions about claim forms please call Sarah Richey at (916) 653-4763. I am pleased to assist the City of Lodi in providing safe drinking water for the community it serves. If you need further information please contact Lorri Silva at (916) 653-9634. Sincerely, Chester M. Winn, Chief Division of Fiscal Services Enclosures cc: (see next page) City Construction Loan Contract No. E54402 FOR A CONSTRUCTION LOAN UNDER THE CALIFORNIA SAFE DRINKING WATER BOND LAW OF 1988 E54(11-16-89) TABLE OF CONTENTS SPECIAL CONTRACT PROVISIONS Section Page 1. Purpose of Loan ............................................... 1 2. Incorporation of Standard Conditions, Security Requirements, and Plans and Specifications..... .................................. 1 3. Estimate of Project Cost ...................................... 2 4. Loan Amount ................................................... 2 5. Supplier's Cost ............................................... 2 6. Requirements for Disbursement ................................. 2 7. Rate of Interest .............................................. 2 8. Water Conservation ............................................ 2 9. Operation and Maintenance of Project .......................... 3 10. Other Assistance .............................................. 3 11. Repayment of Principal and Interest ........................... 3 12. Project Officials and Notices ................................. 4 EXHIBIT A LOAN CONTRACT STANDARD CONDITIONS Article Pave A-1. Definitions................................................... Al A-2. Term of Contract .............................................. A2 A-3. Basic Conditions Precedent .................................... A3 A-4. Compliance with Laws, Regulations, and Permit Requirements.... A3 E54(11-16-89) -i- f TABLE OF CONTENTS (continued) Article Page A-5. Loan Disbursements by State ................................... A4 (a) Cost Statement ........................................... A4 _. (b) Disbursement ............................................. A4 (c) Withholding of Loan Disbursements by Supplier............ A4 A-6. Withholding of Loan Disbursements by State .................... A4 (a). Conditions. for -Withholding ............................... A4 (b) Withholding Entire Loan Commitment ....................... A4 (c) Withholding Balance of Loan Commitment ................... A4 A-7. Timing and Manner of Project Construction ..................... A5 (.a) Project. Completion Date .................................. A5 (b) Construction Pursuant to Project Plans and Specifications A5 (c) Determination of Project Completion ...................... A5 (d) Competitive Bidding ...................................... A5 (e) Sign Referring to Safe Drinking Water Bond Law Financing. A5 (f) Audit Requirement ........................................ A6 A-8. Statement of Principal Amount of Loan ......................... A6 (a) Remittance of Unexpended Funds ........................... A6 (b) Transmission of Statement to Supplier .................... A6 A-9. Repayment of Principal Amount of Loan ......................... A6 (a),.Repayment Terms .......................................... A6 (b) Advance Payment Option ................................... A8 A-10. Interest Payments ............................................. A8 A-11. Delinquency in Interest Payment ............................... A8 A-12. Security Requirements ......................................... A8 A-13. Payment Capacity Impairments .................................. A8 (a) Transfer of Water Outside of Service Area ................ A8 (b) Changes in Supplier's Organization ....................... A9 A-14,. Accounting and Deposit of Joan Proceeds ....................... A9 (a) Separate Accounting of Loan Disbursements and Interest; - . Records .................................................. A9 (b) Disposition of Money Disbursed ........................... A9 (c):. Interim and Final Audits ................................. A9 A-15. Reports on Expenditures and Project Construction .............. A9 A-16. Inspections of Project by State and State Department of Health Services...................................................... A9 A-17. Prohibition Against Disposal of Project Without State Permis- sion.......................................................... A10 E54(11-16-89) -ii- TABLE OF CONTENTS (continued) Article Page A-18. Nondiscrimination Clause ...................................... A10 A-19. Worker's Compensation Clause .................................. All A-20. Successors and Assigns ........................................ All A-21. State to be.Held Harmless...-... ............................... All A-22. Remedies not Exclusive ........................................ All A-23. Amendments ................................................... All A-24. Opinions and Determinations .................................. All A-25. Contracting Officer of the State ............................. All A-26. Waiver of Rights ............................................. Al2 A-27. Notices........................................................ Al2 A-28. Inspection of Books, Records, and Reports .................... Al2 A-29. Suit on Contract ............................................. Al2 A-30. Claims Dispute Clause ........................................ Al2 EXHIBIT B LOAN CONTRACT SECURITY REQUIREMENTS B-1. No Priority for Additional Loans ............................. Bl B-2. Rates and Charges ............................................ B1 B-3. Performances and Assurances .................................. B1 B-4. Security Interest ............................................ B1 B-5. Default Provisions ........................................... B1 B-6. Reserve Fund ................................................. B2 E54(11-16-89) -iii- FA - CONTRACT NO. E54402 STATE OF CALIFORNIA THE RESOURCES AGENCY DEPARTMENT OF WATER RESOURCES CONTRACT BETWEEN STATE OF CALIFORNIA DEPARTMENT OF WATER RESOURCES AND CITY OF LODI UNDER THE CALIFORNIA SAFE DRINKING WATER BOND LAW OF 1986 THIS CONTRACT, entered into by and between the State of California, acting by and through its Department of Water Resources, herein referred to as the "State" and the City of Lodi . a public agency in the County of San Joaquin . State of California, duly organized, existing, and acting pursuant to the laws thereof, herein referred to as the "Supplier", which parties do hereby agree as follows: CONTRACT SPECIAL PROVISIONS SECTION 1. PURPOSE OF LOAN This loan is made by the State to the Supplier to assist in financing construction of a project that will enable the Supplier to meet safe drinking water standards established pursuant to Chapter 7 (commencing with Section 4010 ) of Part 1 of Division 5 of the Health and Safety Code. Loan funds may be used only for such Eligible Project as defined in the final plans and specifications, approved by the State Department of Health Services, and any revisions thereof, and Article A-1 of the Loan Contract Standard Conditions. Supplier is solely responsible for design, construction, operation and maintenance of the project. Review or approval of plans, specifications, bid documents or other construction documents by the State is solely for the purpose of proper administration of loan funds by the State and shall not be deemed to relieve or restrict the Supplier's responsibility. SECTION 2. INCORPORATION OF STANDARD CONDITIONS AND SECURITY REQUIREMENTS, AND PLANS AND SPECIFICATIONS AND SUPPLIER COMMITMENTS This Contract incorporates Exhibit A, "Loan Contract Standard Conditions" (hereinafter referred to as "Standard Conditions") and Exhibit B, "Loan Contract Security Requirements" (hereinafter referred to "Security Requirements), and any attachments thereto. Upon their completion, the final plans and specifications approved by the State Department of Health Services and referred to in Section 1 also shall be attached and are incorporated herein and made a part of this Contract. The Supplier accepts and agrees to comply with all terms, provisions, conditions, and commitments of this -54(11-16-89) -1- r SECTION 9. OPERATION AND MAINTENANCE OF PROJECT For a period of 20 years, which is the reasonably expected life of the Project, in consideration of the loan made by the State, the Supplier agrees to commence and to continue operation of the Project upon completion and shall cause the Project to be operated in an efficient and economical manner; shall provide'__for the-making'of all repairs, renewals, and replacements necessary to the efficient operation of the same; and shall cause the same to be maintained in as good and efficient condition as upon its construction, ordinary and reasonable wear and depreciation excepted. Refusal of the Supplier to operate and maintain the Project in accordance with this provision may, at the option of the State, be considered a material breach of Contract and may be treated as default under Article B-5 of Exhibit B. SECTION 10. OTHER ASSISTANCE Supplier certifies that it has applied for and made reasonable efforts to secure federal assistance for the Project and has secured the approval of_the___$.tate_and the --State Department of Health Services to make application for federal assistance in order to maximize and to utilize best the amounts of such assistance available. Supplier further agrees that if federal funds become available for this Project within three years of Project completion, Supplier will remit to the State all or a portion of the federal funds received up to the amount necessary to discharge the remaining debt, provided remittance is not contrary to the terms upon which federal funds were received. SECTION 11. REPAYMENT OF PRINCIPAL AND INTEREST The Supplier shall execute a fiscal services agreement with a Fiscal Agent in a format acceptable to the State. A Fiscal Agent shall be retained until .the Principal Amount of the Loan and interest have been paid in full. The Supplier shall open a special account with the Fiscal Agent into which sufficient funds sha-11-be•maintained for servicing the loan as provided in Article B-6 of the Security Requirements. Funds from this account shall be used only for payment of principal and interest on the loan when due, or any delinquencies thereon, until the loan is repaid in full. Once a fiscal services agreement has been approved by the State, the Supplier shall not amend the agreement, close the special account, or retain a new Fiscal Agent without 90 days advance notice and prior written approval of a new fiscal services agreement by the State. A public agency may employ the services of its controller or treasurer as Fiscal Agent only with the prior written approval of the State. The State shall have no obligation to disburse funds until the - Fiscal Agent has been engaged and the agreement between the Supplier and the Fiscal Agent has been approved by the State. E54(11-16-89) -3- SECTION 12. PROJECT OFFICIALS AND NOTICES The State Project Manager shall be the Chief, Division of Fiscal Services of the Department of Water Resources. The State Project Manager shall be the State's representative for administration of the Contract and shall have authority to make determina- tions and findings with respect to each controversy arising under or in connection with the interpretation, performance,,or payment for work performed under the Contract. _Disputes shall be resolved in accordance with Article A-30 of Exhibit A. The Supplier Project Director shall be the Public Works Director for the City of Lodi The Supplier Project Director shall be the Supplier's representative for the administration of the Contract and shall have full -authority to act on behalf of the Supplier. All communi- cations given to the Project Director shall be as binding as if given to the Supplier. Either party may change its Project Manager or Project Director upon written notice to the other party. - Notices required to be given in writing by the Supplier under this Contract shall be sent to: State of California Department of Water Resources Attention: Program Manager Safe Drinking Water Program 1416 9th Street, Room 338 P. 0. Box 942836 Sacramento, CA 94236-0001 Notices required to be given in writing by the State under this Contract shall be sent to: Honorable Mayor Citv of Lodi Post Office Box 3006 Lodi, California 95241-1910 E54(11-16-89) -4- r A change of address for delivery of notice may be made by either party by written notice of such change of address to the ocher party. All such notices shall be enclosed in a properly addressed, post- age prepaid envelope and deposited in a United States Post Office for delivery by registered or certified mail. __.. IN.WITNESS_WHEREOF,.the parties hereto have -executed this Contract on AN 2 = tg92 Approved as to Legal_Form__._. STATE OF CALIFORNIA and Sufficiency: DEPARTMENT OF WATER RESOURCES B By C!: e- Chief Counsel Chief Department of Water Resources Division of Fiscal Services P. 0. Box 942836 Sacramento, CA 94236-0001 Citv of Lodi Sup l' Signature Thomas A. Peterson City Manager Print Name e Post Office Box 3006 Address Lodi, California 95241-1910 Attest: Alice M. Rei he City Clerk Approved as to form Bob McNatt E54(11-16-89) -5- City Attorney Date: X% -Al herein and made a part of this Contract. The Supplier accepts and agrees to comply with all terms, provisions, conditions, and commitments of this Contract, including all incorporated documents, and to fulfill all assur- ances, declarations, representations., and statements made by the Supplier in the application, documents,.amendments, and communications filed in support of its request for Safe Drinking Water financing. SECTION 3. ESTIMATE OF PROJECT COST The reasonable cost of the Project is,estimated to be $4,758.000 SECTION 4. LOAN AMOUNT Pursuant to the California Safe Drinking Water Bond Law of 1988, its applicable rules and regulations, and subject to the availability of funds, the State will lend to the Supplier in accordance with the terms of this Contract and amount not to exceed $4,758.000 A five percent administrative fee will be added to the amount of loan funds disbursed as part of the Loan Principal to be repaid by.the Supplier. SECTION 5. SUPPLIER'S COST The Supplier agrees to fund the difference between the estimate of the project cost (Section 3) and the loan amount (Section 4). Such Supplier's cost in the amount of $ -0- shall be expended prior to the expenditure of State loan funds. SECTION 6. REQUIREMENTS FOR DISBURSEMENT By February 29. 1992 . the Supplier shall meet all conditions precedent to the disbursement of money under this Contract, including Basic Conditions Precedent under Article A-3 of the Standard Conditions. Failure by Supplier to comply with this date may, at the option of the State, result in termination of the Contract under Article A-6 of the Standard Conditions. SECTION 7. RATE OF INTEREST The rate of interest to be paid by the Supplier shall be 3.41 percent per annum of--tife unpaid balance of the loan. SECTION 8. WATER CONSERVATION For a period of 20 years, which is the reasonably expected life of the Project, Supplier shall undertake all reasonable efforts to conserve water in a cost effective manner. E54(11-16-89) -2- �� EXHIBIT A STATE OF CALIFORNIA _.... _. THE RESOURCES AGENCY. DEPARTMENT OF WATER RESOURCES LOAN CONTRACT STANDARD CONDITIONS ARTICLE A-1. DEFINITIONS Whenever in this Contract the following terms are used, their meaning shall be as follows unless the context clearly requires otherwise: .__ State Department -of Health Services --The State of California Department of Health Services or the local health agency that has jurisdiction to issue the necessary water permit under the provisions of Chapter 7 (commencing with Section 4010) of Part 1 of Division 5 of the Health and Safety Code. Contract --The Contract to which these Loan Contract Standard Conditions are appended, which shall be considered a promissory note for the purpose of meeting the Loan Security Requirements of Exhibit B. Daps --Calendar days unless otherwise expressly indicated. Month --Calendar months unless otherwise expressly indicated. Year --Calendar year unless otherwise expressly indicated. Project -'All work, -not incldding construction equipment, for the construction, improvement, or rehabilitation of the domestic water system, including water supply, treatment, works, storage facilities, and all or part of a water distribution system proposed by the Supplier pursuant to the plans and specifications that describe the plan of the Project approved by the State Department of Health Services and all addenda and changes to the foregoing documents approved by the State Department of Health Services. Supplier --Any person, partnership, corporation, association, or other -entity or political subdivision of the state which owns or operates a domestic water system. System --All facilities owned, under control of or operated by the Supplier for the provision of piped water to the public for human consumption, which may include any water supply, treatment, storage, or distribution facilities. Eligible Project --A project for the construction, improvement, or rehabilitation of a domestic water system determined to be eligible under the California Safe Drinking Water Bond Law. E54(11-16-89) -Al- Eligible Project Costs --Reasonable costs associated with an eligible project including the engineering, legal, and administrative fees associated with the Project, and also including those reasonable costs incurred by the applicant to prepare the application and to establish eligibility prior to or after the effective date of this Contract. Eligible Project costs do not include: (a) Operation and maintenance costs. (b) Cost of providing water for industrial or agricultural use. (c) Costs for purchase of equipment. (d) Payment of principal or interest of existing indebtedness or any interest payment unless: (1) The debt is incurred after the issuance of a letter of commitment of funds by the State; and (2) The State agrees in writing to the eligibility of the costs for reimbursement before the debt is incurred; and (3) The purposes for which the debt is incurred are otherwise Eligible Project Costs. (e) Establishment of a reserve fund. Treatment Works --Any devices or systems used in the treatment of water supplies, including necessary lands, that render such supplies pure, wholesome, and potable water for domestic purposes. Loan Commitment --The maximum sum of money that the State agrees to lend to the supplier under this Contract, not to exceed $5,000,000 plus any administration fee. Principal Amount of the Loan --The total amount disbursed to the Supplier under the Contract, plus an administrative fee not to exceed five percent, less any amount of such total amount disbursed that may have been repaid or remitted to the State by the Supplier. Term of Loan --The period of time between the date of first disbursement of money to the Supplier and the date the Principal Amount of the Loan is repaid in full". Repayment Term --The period of time between the date of final disbursement of money to the Supplier and the date the Principal Amount of the Loan is repaid in full. Fiscal Agent --A bank,-iTavings and loan, or any other financial institution approved by the State, to which funds for the repayment of this loan are deposited, or are under the control of, for the purpose of disbursing repayments of the loan to the State according to the repayment schedule referred to in Article A-9 of Exhibit A. ARTICLE A-2. TERM OF CONTRACT Subject to the provisions of Article A-3, this Contract shall become effective on the date of its execution and shall remain in effect until the Principal Amount of the Loan, all interest thereon, and any other sums of money due to the State have been paid in full_ E54(11-16-89) -A2- ARTICLE A-3....BASIC CONDITIONS.. PRECEDENT The State shall have no obligation to disburse money under this Contract unless and until: (a) The Supplier provides a copy of a resolution passed by its governing body accepting the loan, and designating a representative to execute this Contract and to sign requests for disbursement of State funds. (b) The Supplier demonstrates to the State's satisfaction the proposed Project has the support of a majority of the affected community by holding an election; or by holding a widely publicized public meeting pur- suant to direction by the State; or by any other suitable, lawful method of determining community support, at which public comments and questions are received and answered. If Supplier determines that an election is not required by law prior to Supplier's execution of this Safe Drinking Water Bond Law loan contract, it shall transmit to the State a written opinion from Supplier's counsel stating that no election is required and stating the legal basis for Supplier's determination. (c) The Supplier demonstrates the availability of sufficient funds to complete the Project. (d) All other sources of funds for the Project have been utilized. (e) The Supplier has satisfied the security provisions of Article A-12. (f) The Supplier has engaged the services of a Fiscal Agent under an agreement approved by the State. (g) The Supplier submits an initial budget of Eligible Project Costs approved by the State Department of Health Services on a form provided by the Department of Water Resources. The Supplier shall thereafter submit to the State in writing any substantial changes in the budget. The Supplier shall obtain written approval of changes from the State Department of Health Services and the State before the changes are made. (h) The Supplier demonstrates to the State's satisfaction that the Supplier has and. -will contEAULr-to have sufficient water available at all times and a right to use the water required to operate the Project through- out the repayment period of the loan. (i) The Supplier obtains all necessary permits required by other State, federal and/or local agencies, including an Amended Water Permit from the State or County agency which issucs your permit to operate a water system. _ ARTICLE A-4. COMPLIANCE WITH LAWS, REGULATIONS, PERMIT REQUIREMENTS The Supplier shall at all times comply with, and require its subcontractors to comply with, all applicable federal and state laws, rules and regulations, permits, and all applicable local ordinances, specifically including, but not limited to, environmental, procurement and safety laws, rules, regulations, permits, and ordinances. E54(11-16-89) -A3- ARTICLE A-5. LOAN DISBURSEMENTS BY STATE (a) Cost Statements After the Basic Conditions Precedent in Articles A-3 and A-4 are met, the State will disburse the whole or portions of the loan commitment to the .Supplier.following: receipt ,..from the Supplier of a statement or statements of incurred Eligible Project Costs on forms provided by the State. Requests for State funds shall be filed monthly or for such longer period as the State and Supplier may mutually agree and the Supplier shall provide the following information: (1) A statement of the incurred Eligible Project Costs for work performed in constructing the Project during ,the period identified in the particular statement. (2) A statement of other incurred Eligible Project Costs that have been incurred for the Project during the period identified in the particular statement, including, but not limited to, legal, engineering, and administrative fees associated with the Project and reasonable costs of the Supplier to prepare the application and establish eligibility. After the State gives notice to the Supplier that the State has determined that the Project has been completed or terminated, the Supplier shall furnish a final statement of incurred Eligible Project Costs. (b) Disbursement Following the review by the State of each statement of costs, the State will disburse to the Supplier the amount approved, subject to the availability of funds. Any and all money disbursed to the Supplier under this Contract and any and all interest earned by the Supplier on such money shall be used solely to pay Eligible Project Costs. (c) Withholding of Loan Disbursement by Supplier The Supplier shall withhold not less than five percent (5.0%) from any loan disbursement or the combination of loan disbursements until the Project is determined to be completed pursuant to Article A-7. ARTICLE A-6. WITHHOLDING OF LOAN --DISBURSEMENTS BY STATE (a) Conditions for Withholding If the State determines that the Project is not being carried out substantially in accordance with the provisions of this Contract, or if the State determines that the Supplier has failed in any other respect to substantially comply with the provisions of this Contract, and if the Supplier does not remedy any such failure to the State's satisfaction, the State may withhold from the Supplier all or any portion of the loan commitment and take any other action that it deems necessary to protect its interests. (b) Withholding Entire Loan Commitment If the State notifies the Supplier that it has decided to with - E54(11 -16-89) -A4- hold all of the loan commitment from -the Supplier pursuant to Subdivision (a) of this Article, this Contract shall terminate upon receipt of such notice by the Supplier and shall no longer be binding on either party hereto. (c).Withholding Balance of Loan Commitment Where_ a. portion of the loan commitment has been disbursed to the Supplier and the State notifies the Supplier that it has decided to withhold the balance..of.the..loan commitment -from the, Supp 1ier-pursuant. to Subdivision (a) of this Article, the portion that has been disbursed shall thereafter be repaid forthwith to the State with interest as directed by the State. Refusal of the Supplier to so repay may, at the option of the State, be considered a material. breach. of contract and may be treated as default under Article B-5 of Exhibit B. ARTICLE A-7. TIMING OF PROJECT (a) Project Completion Date The Supplier shall cause the project to be completed not later than January 31. 1993 . provided that said date for completion may be extended upon written approval of the State. (b) Project Pursuant to Project Plans and Specifications The Project shall be constructed in accordance with the final plans and specifications approved by the State Department of Health Services, together with any revisions thereof approved by the State Department of Health Services. (c) Determination of Project Completion For the purposes of this Contract, the Project shall be considered to be completed or terminated when so determined by the State. (d) Competitive Bidding Any contract let for the construction of the Project, or any part thereof, which is in excess of $10,000, or which is in excess of any smaller amount for which bids are required under the enabling authority of the Supplier, shall be -.let by competitive bid procedures which assure award of the Contract to the lowest responsible bidder, except as may be otherwise authorized in writing by the State. Requests for approval of competitive bidding, for award of a contract to other than the low bidder, or for a supplier to proceed on the basis of force account or day labor, or for any other procedure which deviates from the principle of competitive bidding shall be submitted in writing to the State before the procedure is implemented. State's prior written approval of the procedure will be based on compliance with applicable laws and policies. The State expressly reserves the right to approve or disapprove of such requests. (e) Sign Referring to Safe Drinking Water Bond Law Financing During construction of the Project, the Supplier shall cause a sign to be installed at a prominent location which shall include a statement that the Project is financed under the California Safe Drinking Water Bond E54(11-16-89) -AS- Law.Program administered by the State of California, Department of Water Resources, and the State Department of Health Services. (f) Audit Requirement Pursuant to Government Code Section 10532, the contracting parties shall .be subject to the examination. -and audit of the State and the State Auditor General for a period of three years after final payment under this.,Contract-with respect.to-all matters connected- with- .the. performance of this Contract, including, but not limited to, the cost of administering this Contract. All records of the Supplier or subcontractors shall be preserved for this purpose for at least three years after completion of the Project. ARTICLE A-8. STATEMENT OF PRINCIPAL AMOUNT OF LOAN (a) Remittance of Unexpended Funds The Supplier, within a period of thirty (30) days from the final disbursement from the State to the Supplier of loan funds, shall remit to the State any unexpended funds that were disbursed to the Supplier under this Contract and were not needed to pay Project Costs incurred. Unexpended funds remitted to the State under this subdivision shall not be considered to be.a repayment of any part of the loan, but shall be deemed to be a return to the State of part of the funds disbursed and a reduction in the total amount loaned to the Supplier pursuant to this Contract. (b) Transmission of Statement to Supplier Within sixty (60) days after final disbursement of money, the State shall transmit to the Supplier a written statement setting forth the Principal Amount of the Loan consisting of all disbursements plus an administrative fee not to exceed five percent to be repaid by the Supplier to the State pursuant to Article A-9 thereof. ARTICLE A-9. REPAYMENT OF PRINCIPAL AMOUNT OF LOAN (a) Re�avment Terms The. Supplier shall -make semiannual payments to the State for a period not to exceed 20 years as set forth in the following repayment schedule, entitled "Estimated Schedule of Loan Repayment", until the Principal Amount of the Loan is repaid in full, provided that in any event the final semiannual payment shall be in an amount equal to the then unpaid portion of the Principal Amount of the Loan. The first amount of the semiannual payment shall be due and payable on October 1. 1993 The remaining amounts shall be made semiannually thereafter commencing on April 1, 1994 until the Principal Amount of the Loan is -repaid in full; provided, however, as to the foregoing that the Supplier shall only be required to make such payments from any funds which accrue in the special fond �elititled SafeOD i king, itey,Fffd, established by Resolution No. adopted o' into which are deposited the collected assessments or user charges defined in Article B-2 of Exhibit B. Supplier shall not be obligated to make such payments from any other source of funds, including the Supplier's General Fund. E54(11-16-89) -A6- s Estimated schedule of Repayment of the Loan City of Lodi E54402 -A7- Loan Amount: 54,758,000 5% Administrative Fee: 1237,900 _ Principal: 54,995,900 Interest: 3.4100% Term: 20 Years Repayment Schedule' - - - Principal Payment Semiannual Interest Principal Principal Reduction No. Payment Balance Factor ------- -------------- --------------------------------------------- -------------------- S4,995,900.00 1 $173,313.37 585,180.10 $88,133.27 54,907,766.73 1.764112% 2 5173,313.37 583,677.42 589,635.95 54,818,130.78 1.794190% 3 5173,313.37 582,149.13- $91,164.24 54,726,966.54 1.824781% 4 $173,313.37 $80,594.78 $92,718.59 54,634,247.95 1.855894% 5 $173,313.37 579,013.93 $94,299.44 $4,539,948.51 1.887536% 6 1173,313.37 577,406.12 595,907.25 54,444,041.26 1.919719% 7 $173,313.37 575,770.90 $97,542.47 54,346,498.79 1.952451% 8 $173,313.37 $74,107.80 599,205.57 $4,247,293.22 1.985739% 9 $173,313.37 572,416.35 5100,897.02 54,146,396.20 2.019597% 10 5173,313.37 570,696.06 $102,617.31 54,043,778.89 2.054030% 11 5173,313.37 568,946.43 $104,366.94 53,939,411.95 2.089052% 12 5173,313.37 567,166.97 5106,146.40 $3,833,265.55 2.124670% 13 $173,313.37 $65,357.18 5107,956.19 53,725,309.36 2.160896% 14 5173,313.37 563,516.52 5109,796.85 $3,615,512.51 2.197739% 15 5173,313.37 $61,644.49 5111,668.88 $3,503,843.63 2.235210% 16 $173,313.37 559,740.53 5113,572.84 53,390,270.79 2.273321% 17 $173,313.37 $57,804.12 5115,509.25 53,274,761.54 2.312081% 18 5173,313.37 $55,834.68 5117,478.69 53,157,282.85 2.351502% 19 5173;313.37 553,831.67 $119,481.70 53,037,801.15 2.391595% 20 $173,313.37 $51,794.51 $121,518.86 52,916,282.29 2.432371% 21 $173,313.37 149,722.61 5123,590.76 $2,792,691.53 2.473844% 22 $173,313.37 $47,615.39 $125,697.98 $2,666,993.55 2.516023% 23 1173,313.37 $45,472.24 1127,841.13 $2,539,152.42 2.558920% 24 $173,313.37 -$43,292.55 $130,020.82 12,409,131.60 2.602551% 25 1173,313.37 -$41,075.69 ..5132,237.68 52,276,893.92 2.646924% 26 $173,313.37 $38,821.04 5134,492.33 12,142,401.59 2.692054% 27 1173,313.37 $36,527.95 1136,785.42 $2,005,616.17 2.737953% 28 1173,313.37 $34,195.76 1139,117.61 11,866,498.56 2.784636% 29 1173,313.37 $31,823.80 $141,489.57 11,725,008.99 2.832113% 30 $173,313.37 $29,411.40 5143,901.97 $1,581,107.02 2.880401% 31 $173,313.37 $26,.957.87 $146,355.50 $1,434,751.52 2.929512% 32 $173,313.37 124,462.51 1148,850.86 $1,285,900.66 2.979461% 33 $173,313.37 121,924.61 --4131,388.76 11,134,511.90 3.030260% 34 $173,313.37 $19,343.43 1153,969.94 1980,541.96 3.081926% 35 $173,313.37 $16,718-24 5156,595.13 1823,946.83 3-134472% 36 $173,313.37 $14,048.29 5159,265.08 $664,681.75 3.187916% 37 $173,313.37 $11,332.62 5161,980.55 $502,701.20 3.242269% 38 $173,313.37 $8,571.06 1164,742.31 $337,958.89 3.297550% 39 $173,313.37 15,762.20 $167,551.17 $170,407.72 3.353774% 40 $173,313.17 $2,905.45 $170,407.72 $0.00 3.410955% -A7- (b) Advance Payment Option The Supplier shall have the option of paying in advance on any semiannual payment due date all or any part of the unpaid portion of the Principal Amount of the Loan, provided that any interest accrued hereunder shall be paid at the same time, and, provided further, that any such payment shall not relieve the Supplier of its obligations to make payments in the amount and at the time specified in Subdivision (a) of this Article until the Principal Amount of the Loan_is_repaid.in full. ARTICLE A-10. INTEREST PAYMENTS The Supplier shall pay interest to the State at the rate specified in Section 7 of Contract Special Provisions on the unpaid balance of the loan. Interest on the principal shall not be deferred. The Department will invoice the Supplier semiannually for interest accrued during the Project construction period. The interest amount of each disbursement shall be calculated as the fraction x/182.5 times the interest rate, where x is the number of calendar days remaining in the semiannual period from the date on which the disbursement was made. Interest accrued during the construction period iss due and payable within 30 days of the date of the invoice. . Upon completion of the Project, interest and principal shall be due and payable semiannually until the Principal Amount of the Loan is repaid in full. ARTICLE A-11. DELINQUENCY IN INTEREST PAYMENT Upon_ every amount of interest money required to be paid by the Supplier to the State pursuant to Article A-10 of this Contract which remains unpaid after it -becomes due and payable, interest shall accrue at the rate of one percent (1.0%) per month of the amount of such delinquent payment from and after the due date until it is paid, and the Supplier hereby agrees to pay such interest, provided that no such interest shall be charged to or be payable by the Supplier under this article unless such delinquency continues for more than thirty (30)..days. Delinquency for a period of one year may, at the discretion of the State, be considered a material breach of contract and may be treated as default under Article B-5 of Exhibit B. ARTICLE A-12. SECURITY REQUIREMENTS The Supplier shall meet the security requirements provisions set forth in Exhibit B, "Loan Contract Security Requirements", to adequately protect the interest of the State during the term of the loan. ARTICLE A-13. PAYMENT CAPACITY IMPAIRMENTS (a) Transfer of Water Outside Service Area No sale or other transfer of water made available by the constructed project shall be made outside the Supplier's existing service area which, in the judgement of the State, would materially impair the Supplier's capacity to make payments to the State as provided for in this Contract. The Supplier shall notify the State as promptly as feasible of all E54(11-16-89) -A8- proposed sales or_other.transfers of Project water outside the Supplier's service area. (b) Changes in Supplier's Organization The Supplier shall notify the State as promptly as feasible of any proposed change in the Supplier's organization or service area. While this Contract is in effect, no changes shall be made in the organization of the Supplier without permission of the State. The Supplier shall take no action which may materially impair the Supplier's capacity to make payments to the State. ARTICLE A-14. ACCOUNTING AND DEPOSIT OF LOAN DISBURSEMENTS (a) Separate Accounting of Loan Disbursements and Interest; Records The Supplier shall account for the money disbursed pursuant to this Contract separately from all other Supplier's funds. The Supplier shall maintain audit and accounting procedures that are in accordance with generally accepted accounting principles and practices, consistently applied. The Supplier shall keep complete and accurate records of all receipts, disbursements, and interest earned on expenditures of such funds. The Supplier shall require its contractors or subcontractors to maintain books, records, and other documents pertinent to their work in accordance with generally accepted accounting principles and practices. Records are subject to inspection by the State at any and all reasonable times. (b) Disposition of Money Disbursed All money disbursed pursuant to this Contract shall be deposited, administered, and accounted for pursuant to the provisions of law applicable to the Supplier. (c) Interim and Final Audits The State reserves the right to conduct an audit at any time between the execution of this Contract and the completion of the Project. After completion of the Project, the State may require the Supplier to conduct a final audit, at the Supplier's expense, such audit to be conducted by and a report prepared by an-in89pbndent Certified Public Accountant. Failure or refusal by Supplier to comply with this provision shall be considered a substantial failure to comply with this Contract, and the State may elect to pursue any remedies provided in Article A-7 or take any other action it deems necessary to protect its interests. ARTICLE A-15. REPORTS ON EXPENDITURE AND PROJECT CONSTRUCTION During the planning and construction phases, the Supplier agrees to provide to the State an annual summary of the information required by Articles A-5 and A-14. E54(11-16-89) -A9- 0-1 ARTICLE A-16. INSPECTIONS OF PROJECT BY STATE AND STATE DEPARTMENT OF HEALTH SERVICES The State and -State Department of Health Services shall have the right to inspect the work being performed at any and all reasonable times during the term of the Contract. This right shall extend to any subcon- tracts -,...and Supplier shall include.provisions ensuring such access in all its contracts or subcontracts entered into pursuant to its Contract with the State.. --_ Supplier shall notify the State and the State Department of Health Services of the final inspection of the Project or any component by the Supplier at least ten (10) days prior to the date set for the inspection. ARTICLE A-17. PROHIBITION AGAINST DISPOSAL OF PROJECT WITHOUT STATE PERMISSION The Supplier shall not sell, abandon, lease, transfer, exchange, mortgage, hypothecate, or encumber in any manner whatsoever all or any portion of any real -or other property necessarily connected or used in conjunction with the Project, or with the Supplier's service of domestic water, without prior permission of the State. Supplier shall not take any action, including but -not limited to actions relating to user fees, charges and assessments, that could adversely affect the ability of the Supplier to make timely payments or to otherwise meet its obligations under this Contract, without prior written permission of the State. The State may require that the proceeds from the disposition of any real or personal property be remitted to the State to be applied to Supplier's indebtedness under this Contract. ARTICLE A-18. NONDISCRIMINATION CLAUSE During the performance of this contract, the supplier, its contractor and subcontractors shall not deny the Contract's benefits to any person on the basis of religion, color, ethnic group identification, sex, age, physical or mental disability, nor shall they discriminate unlawfully against any employee or applicant for employment because of race, religion, color, national origin, ancestry, physical handicap, mental disability, medical condition, marital status,.age, or sex. Supplier shall insure that the evaluation and treatment of employees and applicants for employment are free of such discrimination. Supplier, its contractors and subcontractors shall comply with the provisions of the Fair Employment and Housing Act (Government Code, Section 12900 et seq.), the regulations promulgated thereunder (California Code of Regulations, Title 2, -Section 7285.0 et seq.), the provisions of Article 9.5, Chapter 1, Part 1, Division 3, Title 2 of the Government Code (Government Code, Sections 11135-11139.5) and the regulations or standards adopted by the awarding State Agency to implement such article. Supplier, its contractors and subcontractors shall give written notice of their obligations under this clause to labor organizations with which they have a collective bargaining or other agreement. Supplier shall include the nondiscrimination and compliance provisions of this clause in all subcontracts to perform work under the contract. E54(11-16-89) -A10- The Supplier's signature on this Contract shall constitute a certification under the penalty of perjury under the laws of the State of California that the Supplier has, unless exempted, complied with the nondiscrimination program requirements of Government Code, Section 12990, and Title 2, California Code of Regulations, Section 8103. ARTICLE A-19. WORKERS' COMPENSATION CLAUSE Supplier affirms that it is aware of the provisions of Section 3700 of the California Labor Code, which requires every employer to be insuredagainst liability for workers' compensation or to undertake self- insurance in accordance with the provisions of that code, and Supplier affirms that it will comply with such provisions before commencing the performance of the work under this Contract and will make its contractors and subcontractors aware of this provision. ARTICLE A-20. SUCCESSORS AND ASSIGNS This Contract and all of its provisions shall apply to an bind the successors and assigns of the parties hereto. No assignment or transfer of this Contract or any part hereof, rights hereunder, or interest herein by the Supplier shall be valid unless and until it is approved by the State and made subject to such reasonable terms and conditions as the State may impose. ARTICLE A-21'. STATE TO BE HELD HARMLESS The Supplier agrees to indemnify the State of California, Department of Water Resources and the State Department of Health Services, and their officers, agents, and employees against and to hold the same free and harmless from any and all claims, demands, damages, losses, costs, expenses, or liability due or incident to, either in whole or in part, and whether directly or indirectly, the Project. ARTICLE A-22. REMEDIES NOT EXCLUSIVE The use by either party of any remedy specified herein for the enforcement of this Contract is not exclusive and shall not deprive the party using such remedy of, or limits.the application of, any other remedy provided by law. ARTICLE A-23. AMENDMENTS This Contract may be amended at any time by mutual agreement of the parties, except insofar as any proposed amendments are in any way contrary to applicable law. Requests by the Supplier for amendments must be in writing stating the amendment request and tha reason for the request. ARTICLE A-24. OPINIONS AND DETERMINATIONS Where the terms of this Contract provide for action to be based upon opinion, judgement, approval, review, or determination of either party hereto, such terms are not intended to be and shall never be construed as permitting such opinion, judgement, approval, review, or determination to'be arbitrary, capricious, or unreasonable. E54(11-16-89) -All- ARTICLE A-25. CONTRACTING OFFICER OF THE STATE The contracting officer of the State shall be the Director of the Department of Water Resources of the State of California and his successors, .or .the.ir. duly. authorized. representatives . The -contracting officer shall be responsible for all discretionary acts, opinions, judgements, approvals, reviews, and determinations required by the State under the terms of this Contract. ARTICLE A-26. WAIVER OF RIGHTS It is the intention of the parties hereto that from time to time either party may waive any of its rights under this Contract unless contrary to law. Any waiver by either party hereto of rights arising in connection with this Contract shall not be deemed to be a waiver with respect to any other rights or•matters. ARTICLE A-27. NOTICES All notices that are required either expressly or by implications to be given by one party to the other under this Contract shall be signed for the State by its contracting officer and for the Supplier by such officers, as from -time to time, it may authorize in writing to so act. All such notices shall be deemed to have been given if delivered personally or if enclosed in a properly addressed postage -prepaid envelope and deposited in a United States Post Office for delivery by registered or certified mail. ARTICLE A-28. INSPECTION OF -BOOKS, RECORDS, AND REPORTS During regular office hours, each of the parties hereto and their duly authorized representatives shall have the right to inspect and to make copies of any books, records, or reports of either party pertaining to this Contract or matters related hereto. Each of the parties hereto shall maintain and shall make available at all times for such inspection accurate records of all its costs, disbursements, and receipts with respect to its activities under this Contract. Failure or refusal by Supplier to comply with this provision shall be considered a substantial failure to comply with this -Contract, and the State may withhold disbursements to the Supplier or take any other action it deems necessary to protect its interests. - ARTICLE A-29. SUIT ON CONTRACT` Each of the parties hereto may sue and be sued with respect to this Contract. ARTICLE A-30. CLAIMS DISPUTE.CLAUSE Any claim that Supplier may have regarding the performance of this agreement including, but not limited to, claims for additional compensation or extension of time, shall be submitted to the Director, Department of Water Resources, within thirty days of its accrual. State and Supplier shall then attempt to negotiate a resolution of such claim and process an amendment to this agreement to implement the terms of any such resolution. E54(11-16-89) -Al2- f EXHIBIT B LOAN CONTRACT SECURITY REQUIREMENTS ARTICLE -B-1. NO PRIORITY FOR -ADDITIONAL LOANS The Supplier agrees to.incur no additional indebtedness having any priority in payment of principal or interest or pledge of revenues or facilities or equipment in existence at the date of this Contract or to be constructed or obtained under terms of this Contract without obtaining prior written consent of the State. ARTICLE B-2. RATES AND CHARGES The Supplier agrees that it will levy and collect assessments or user charges as may -be necessary to operate and to maintain the Project and to meet the payments of the loan when the same becomes due and if, for any reason, gross revenues prove insufficient to service the loan contract, Supplier agrees to raise sufficient funds through increased user charges or assessments or any other legal means available to it to meet loan payments and to operate and to maintain the Project. ARTICLE B-3. PERFORMANCE AND ASSURANCES Supplier agrees to faithfully and expeditiously perform or cause to be performed all Project work as described in'the final plans and specifications as submitted or as later amended and approved by the State Department of Health Services under this Contract and to apply State funds received only to Eligible Project Costs and to operate and maintain the Project in accordance with applicable provisions of the law. In the event the State finds it necessary to enforce this provision or any right of power under this Contract in the manner provided by law, Supplier agrees to pay all costs incurred by the State including, but not limited to, reasonable attorneys' fees, legal expenses, and costs. ARTICLE B-4. SECURITY INTEREST The Supplier agrees to grant to the State a security interest in both real and personal property as the State determines is reasonably necessary to secure payment of Supplier's obligations. The Supplier shall execute any and all documents feq-aired by the State to create such a security interest, including any amendments, notifications, or new documents as may be reasonably necessary to maintain, preserve, and protect the State's interest in the property. ARTICLE B-5. DEFAULT PROVISIONS Supplier will be in default under this agreement -if any of the following occur: (1) Failure to pay any installment when due, or the entire indebtedness to the State when due at the designated due date, on accelerated maturity, or otherwise; (2) Failure to make any remittances required by this Contract; (3) Substantial breach of this agreement, or any supplement or amendment to it, or any other agreement between Supplier and the State E54(11-16-89) -B1- evidencing or securing Supplier's obligations; (4) Making any false warranty, representation, or statement with respect to this Contract; (5) Loss, theft, or damages to any collateral; (6) Seizure of, or levy on any collateral; and/or (7) Dissolution or cessation of operations by Supplier, termina- tion of Supplier's existence, insolvency of Supplier, or from filing of a voluntary of involuntary bankruptcy petition by or on behalf of Supplier. When an event of default occurs, the State may do any or all of the following: (1) Declare the Supplier's obligations immediately due and payable, with demand or notice to Supplier, which Supplier expressly waives; (2) Terminate any obligation to make future payments to Supplier; (3) Exercise all rights and remedies available to a secured creditor after default, including, but not limited to, the rights and remedies of secured creditors under the California Uniform Commercial Code; (4) Perform any of Supplier's obligations under this Contract for Supplier's account; (5) Take over all of Supplier's property and operate the Supplier's water system at its discretion; and (6) Take any other action which it deems necessary to protect its interests. Supplier agrees that any remedy provided in this Contract is in addition to and not in derogation of any other legal or equitable remedy available to the State as a result of a breach of contract by the Supplier, whether such breach occurs before or after completion of the project. No waiver by the State of any breach or default will be a waiver of any breach or default occurellfg"later. A waiver will be voluntary if signed by the State or its authorized agent. ARTICLE B-6. RESERVE FUND The Supplier agrees to provide for the accumulation of necessary reser—es in accordance with Section 11 of this Contract to assure that funds will be available to make the semiannual payments when due. A reserve of two semiannual payments will be required to be accumulated during the first ten- year period for all repayment methods except those based on the quantity of water used, for which a reserve of four semiannual payments shall be accumulated during the first ten years. This reserve shall be maintained at this level thereafter with the withdrawals being replaced at the same original rates until the reserve is returned to the maximum amount. The reserve fund shall be maintained and administered by the Fiscal Agent. E54(11-16-89) -B2- JAN 2 1 1992 Mr. Thomas A. Peterson, City Manager City of Lodi Post office Box 3006 Lodi, California 95241-1910 Mr. Homer Vaughn, Acting District Engineer Stockton District Office of Drinking Water Department of Health Services 31 E. Channel Street State Building, Room 270 Stockton, California 95202 f STATE OF CALIFORNIA—THE RESOURCES AGENG. PETE WILSON, Governor DEPARTMENT OF WATER RESOURCES 1416 NINTH STREET, P.O. BOX 942836 SACRAMENTO, CA 94236.0001 (916) 445-9248 To: Loan and Grant Contractors Safe Drinking Water Bond Law Program Under the Safe Drinking Water Bond Law Program you have signed a contract for a loan or grant with the State of California, Department of Water Resources. Your DWR contract reflects your estimated total project or study costs, the amount of State funding, and critical dates for your completion of contract requirements and of the project or study. The study or project elements eligible for State funding have been defined to DWR by the Department of Health Services in a written certification. Unanticipated circumstances and events may impact the scope and terms of your DWR contract, and may require that you request a contract amendment. You should maintain a suspense file for critical dates and other variables within your DWR contract so that you can request consideration of an amendment to the contract with sufficient lead time for review and approval by both DWR and DHS. At the earliest indication that there may be a need for a contract amendment you must contact by phone DWR staff in Sacramento, and follow up with a written request to DWR. Your request must identify the contract terms which may need amendment and include full justification. You must indicate whether any elements of your approved project are expected to change. Discuss alternative measures you have considered. Please follow the euidelines on the reverse. After receipt of your written request for a contract amendment, DWR will ask for the DHS District Engineer's comments and recommendation. The contract amendment will be issued by DWR, then executed by your organization and DWR for attachment to your executed contract. If you are requesting an increase in State funding, you must indicate the source of r:payment of the additional loan. The bond law requires the State to make a loan to the extent an applicant is able to repay a loan. Grants may be awarded to public agencies only, after loan capacity has been exhausted, up to the limits of the bond law. If there are questions call your DWR contact person in the Bond Financing and Administration Office at (916) 653-9497. BFA 612 (9-11-91) State of California GENERAL OBLIGATION LOAN/GRANT Proposition Name of Public Agency/Water Co. Contact Person: Periodic Estimate No.: for Period DEPARTMENT OF WATER RESOURCES BUDGET AND EXPENDITURE SUMMARY 19 , to Do to DWR Contract No.: Telephone: , 19 The Resources Agency Page-of- Do ageof LINE ITEM ALLOTMENT TITLE ALLOTMENT AMOUNT TOTAL PRIOR CLAIMS CURRENT CHARGES TOTAL CHARGES TO DATE ALLOTMENT BALANCE INITIAL SUBMISSION ONLY: Reviewed by Registered Civil Engineer RCE No. Date SUBMIT: One Copy to Department of Water Resources, Bond Financing and Administration P. 0. Box 942836, Sacramento, CA 94236-0001 State of California GENERAL OBLIGATION LOAN/GRANT Proposition Name of Public Agency/Water Co.: Contact Person: Periodic Estimate No.: for Period DEPARTMENT OF WATER RESOURCES BUDGET AND EXPENDITURE SUMMARY , 19 , to Do to . DWR Contract No.: _Telephone:_ , 19 The Resources Agency Page of LINE ITEM ALLOTMENT TITLE ALLOTMENT AMOUNT TOTAL PRIOR CLAIMS CURRENT CHARGES TOTAL CHARGES TO DATE ALLOTMENT BALANCE +Yr, SUB TOTAL THIS PAGE SUB TOTAL PAGE SUB TOTAL PAGE TOTAL INITIAL SUBMISSION ONLY: Reviewed by Registered Civil Engineer RCE No. Date SUBMIT: One Copy to Department of Water Resources, Bond Financing and Administration P. 0. Box 942836, Sacramento, CA 94236-0001 Stote of California GENERAL OBLIGATION LOAN/GRANT Proposition Name of Public Agency/Water Co.: Contact Person: Periodic Estimate No.: for Period DEPARTMENT OF WATER RESOURCES BUDGET AND EXPENDITURE SUMMARY 19 , to Do to , DWR Contract No.: Telephone:, , 19 The Resources Agency Page of LINE ITEM ALLOTMENT TITLE ALLOTMENT AMOUNT TOTAL PRIOR CLAIMS CURRENT CHARGES TOTAL CHARGES TO DATE ALLOTMENT BALANCE 1 SUB TOTAL THIS PAGE SUB TOTAL PAGE SUB TOTAL PAGE TOTAL INITIAL SUBMISSION ONLY: Reviewed by Registered Civil Engineer RCE No. Date SUBMIT: One Copy to Department of Water Resources, Bond Financing and Administration P. 0. Box 942836, Sacramento, CA 94236-0001 State of California GENERAL OBLIGATION LOAN/GRANT Proposition Name of Public Agency/Water Co.:_ Contact Person: DEPARTMENT OF WATER RESOURCES BUDGET AND EXPENDITURE SUMMARY Periodic Estimate No.: for Period , 19 , to Date. DWR Contract No.: —Telephone:— , elephone:_, 19 The Resources Agency Page of LINE ITEM ALLOTMENT TITLE ALLOTMENT AMOUNT TOTAL PRIOR CLAIMS CURRENT CHARGES TOTAL CHARGES TO DATE ALLOTMENT BALANCE 4 INITIAL SUBMISSION ONLY: Reviewed 6y Registered Civil Engineer SUBMIT: One Copy to Department of Water Resources, Bond Financing and Administration P. 0. Box 942836, Sacramento, CA 94236-0001 RCE No. Date State of California GENERAL OBLIGATION LOAN/GRANT Proposition Name of Public Agency/Water Co.: Contact Person: Periodic Estimate No.: for Period DEPARTMENT OF WATER RESOURCES BUDGET AND EXPENDITURE SUMMARY 19 , to Do to DWR Contract No.: Telephone: _ , 19 The Resources Agency Poge of LINE ITEM ALLOTMENT TITLE ALLOTMENT AMOUNT TOTAL PRIOR CLAIMS CURRENT CHARGES TOTAL CHARGES TO DATE ALLOTMENT BALANCE w� SUB TOTAL THIS PAGE SUB TOTAL PAGE SUB TOTAL PAGE TOTAL INITIAL SUBMISSION ONLY: Reviewed by Registered Civil Engineer RCE No. Date SUBMIT: One Copy to Department of Water Resources, Bond Financing and Administration P. 0. Box 942836, Sacramento, CA 94236.0001 INSTRUCTIONS FOR DWR 4133 A (To be filled out by the Public Agency for periodic payment) PART A: Public Agency: The name should be identical to the name used in the contract with the Department of Water Resources. Address and Telephone Number: Self-explanatory. DWR Contract Number: The number is on the contract. Periodic Estimate: Submit no more than one estimate per month. PART B: Expenditure Summary Budget Line Item Number: Corresponding to DWR 4135, Budget and Expenditure Summary. Attachment Number: Numerically identify each attachment, corresponding to DWR 4133 C. Description: Identify the material, labor or item being billed. Indicate vendor's name. Project Expenditure: The total dollar amount of the partial payment being requested by the contractor or vendor. State Funds Requested: The dollar amount of the project expenditure being requested this estimate. PART C: Totals 1. Total expenditures and State funds requested from the columns in Part B. 2. Total all prior periodic estimates — DO NOT INCLUDE THIS ESTIMATE. (See Item on previous estimate.) 3. Total of Items 1 and 2. 4. Total retention this estimate. 5. Total retention from all prior periodic estimates — DO NOT INCLUDE THIS ESTIMATE. (See Item 6 on previous estimate.) 6. Total of Items 4 and 5. 7. Loan amount from the contract NOT including the administrative fee. 8. Total of Items 3 and 6. 9. Funds still available — Item 7 minus Item 8. This amount MUST be equal to or greater than zero. DO NOT WRITE IN THE BLOCKS MARKED "FOR DWR USE". If additic)IIA space is required. USS a Second 1 AVIV 4 1:55 :1 and identify it in the upper right hand Curn(T.' oUll ( N I.1' the last ll11'R 41:15 A. INSTRUCTIONS FOR PAR'T'IAL PAYMENT ESTIMATE, DWR 1135 C PART A: Self-explanatory. PART B: Contract Item: Unit: Identify each item by its basic description (each, square foot, linear foot, project, etc.). Quantity: The number of units contracted. Unit Price: The price per unit. This Period: Quantity: Number of contracted units this period. Amount: Number of contracted units this period X Unit Price. Total to Date: Quantity: Total units billed including this partial payment. Amount: Total quantity X Unit Price. PART C: 1. Amount earned: Total of "This Period" and "Total to Date" columns in Part B. 2. Amount retained: Self-explanatory. 3. Previous payments: Self-explanatory. 4. .Amount Due: 1 minus 2 and 3. Estimated Percentage and Progress Schedule: Self-explanatory and required on all contractor items. PART D: Part D, 1, 2. and :3 must be signed. Part D. 2 i, always signed by a registered civil engineer unless otherwise approved in writing by DW l{. Part D, ,3 is ahvnys signed by the Public Agency. All signatures on original set of the estimate must be original signatures. Additional copies mai• f.e made from this set. Please submit the original and four copies of the entire estimate package to the Department of Water Resource,, Bond Financing and Administration, 11. 0. Box 942836, Sacramento, CA 9.1236.0001. DWR 413:A i,Backi ;New 6/87) State of California C DEPARTMENT OF WATER RESOURCES Proposition PERIODIC ESTIMATE FOR PARTIAL PAYMENT GENERAL OBLIGATION LOAN/GRANT PART A (See Instructions on Reverse Side) Name of Public Agency Address: Telephone No.: Periodic Estimate No. PART B — Expenditure Summary for Period DWR Contract No.: , 19_, to The Resources Agenc,. Page of M BUDGET ATTACH- PROJECT STATE LINE TEM NO. MENTNO DESCRIPTION EXPENDITURES FUNDS REQUESTED PART C — Totals Total this 1 periodic estimate Total all prior 2 periodic estimates 3 Total periodic ezpendi- tures to date (rOR DWR USE ONLY) (I . 2 above Total retention this Amount of thisS Patna; Payment 4 periodic estimate PAYMENT APPROVED: Total retention oil prior 5 periodic estimates 6 Total retention to date (4 AUTHORIZED SIGNATURE OEPARTMENT OF WATER RESOURCES + S obove) Work Order N o . 7 DWR Contract Amount Dare Paid Total Funds obligated'" 8 (3 + 6 above) Claim No. 9 Funds still available" - (7 - 8 above)FOR DWR 'JSE S'J RN AM= - DWR a135.A JUbh11 I : Uriginal and tour copies to the Department of Water Resources. .� _� 6''371 INSTRUCTIONS FOR DWR 4135 A (To be filled out by the Public Agency for periodic payment) PART A: Public Agency: The name should be identical to the name used in the contract with the Department of Water Resources. Address and Telephone Number: Self-explanatory. DWR Contract Number: The number is on the contract. Periodic Estimate: Submit no more than one estimate per month. PART B: Expenditure Summary Budget Line Item Number: Corresponding to DWR 4133, Budget and Expenditure Summary. Attachment Number: Numerically identify each attachment, corresponding to DWR 4135 C. Description: Identify the material, labor or item being billed. Indicate vendor's name. Project Expenditure: The total dollar amount of the partial payment being requested by the contractor or vendor. State Funds Requested: The dollar amount of the project expenditure being requested this estimate. PART C: Totals 1. Total expenditures and State funds requested from the columns in Part B. 2. Total all prior periodic estimates — DO NOT INCLUDE THIS ESTIMATE. (See Item on previous estimate.) 3. Total of Items 1 and 2. 4. Total retention this estimate. 5. Total retention from all prior periodic estimates — DO NOT INCLUDE THIS ESTIMATE. (See Item 6 on previous estimate.) 6. Total of Items 4 and 5. 7. Loan amount from the contract NOT including the administrative fee. 8. Total of Items 3 and 6. 9. Funds still available — Item 7 minus Item 8. This amount MUST be equal to or greater than zero. DO NOT WRITE IN THE BLOCKS MARKED "FOR DWR USE". If aclditiollal .pace i, re(Juired. use a second I )WR 4 t:t.i e\ and identify it Ill the upper rig lit hand cUrnel'. I'utal 0N[N the last DWR .41:35 A. INSTRUCTIONS FOR PARTIAL PAYMENT ESTIMATE, DWR 4135 C PART A: Self-explanatory. PART B: Contract Item: Unit: Identify each item by its basic description (each, square foot, linear foot, project, etc.). Quantity: The number of units contracted. Unit Price: The price per unit. This Period: Quantity: Number of contracted units this period. Amount: Number of contracted units this period X Unit Price. Total to Date: Quantity: Total units billed including this partial payment. Amount: Total quantity X Unit Price. PART C: 1. Amount earned: Total of "This Period" and "Total to Date" columns in Part B. 2. Amount retained: Self-explanatory. 3. Previous payments: Self-explanatory. 4. Amount Due: 1 minus 2 and 3. Estimated Percentage and Progress Schedule: Self-explanatory and required on all contractor items. PART D: Part 1), 1, 2, and :3 must lie signed. Part 1). 2 is always signed by a registered civil engineer unless otherwise approved in writing by DWR. Part D,:3 is ahvays signed by the Public Ag;encc. All signatures on original set of the estimate must be original signatures. Additional copies may I,e inade from this set. Please submit the original and four copies of the entire estimate package to the Department of Water Resources, Bond Financing; and :Administration, P. 0. Box 942836, Sacramento, CA 91236-(H)0I. GWR 4135A .Back) (Ne- 6 871 State of California Proposition_ PART A Name of Public Agency Address: DEPARTMENT OF WATER RESOURCES PERIODIC ESTIMATE FOR PARTIAL PAYMENT GENERAL OBLIGATION LOAN/GRANT (See Instructions on Reverse Side) Telephone No.: Periodic Estimate No. for Period PART B — Expenditure Summary DWR Contract No.: , 19_, to The Resources Agenc Page _ of — 19 BUDGET LINE TEM NO. ATTACH- ENT NO DESCRIPTION PROJECT EXPENDITURES STATE FUNDS REQUESTED PART C — Totals Total this 1 periodic estimate 2 Total all prior periodic estimates 3 Total tures to date expendi- 1 + 2 above !FOR DWR USE ONLY) 4 Total retention this periodic estimate - Amount of this5 Po,I,al Payment PAYMENT APPROVED: 5 Total retention all prior periodic estimates 1 V Total retention to date (4 - S above) AUTHORIZED SIGNATURE DEPARTMENT OF WATER RESOURCES O,de, No. DWR Contract Amount Dare Pa,dobligatedecev„. g Total funds (3 + b above) <,gc,:�r•.: a.a. = 9 Funds still ovailable (7 - 8 above) Claim No. ,OR DWR USE SU RN A'A E: :)'NR 4135A ;New 627; JUbMi I : Urlginal and tour copies to the Department of Water Resources. INSTRUCTIONS FOR DWR 4135 A (To be filled out by the Public Agency for periodic payment) PART A: Public Agency: The name should be identical to the name used in the contract with the Department of Water Resources. Address and Telephone Number: Self-explanatory. DWR Contract Number: The number is on the contract. Periodic Estimate: Submit no more than one estimate per month. PART B: Expenditure Summary Budget Line Item Number: Corresponding to DWR 4135, Budget and Expenditure Summary. Attachment Number: Numerically identify each attachment, corresponding to DWR 4135 C. Description: Identify the material, labor or item being billed. Indicate vendor's name. Project Expenditure: The total dollar amount of the partial payment being requested by the contractor or vendor. State Funds Requested: The dollar amount of the project expenditure being requested this estimate. PART C: Totals 1. Total expenditures and State funds requested from the columns in Part B. 2. Total all prior periodic estimates — DO NOT INCLUDE THIS ESTIMATE. (See Item on previous estimate.) 3. Total of Items 1 and 2. 4. Total retention this estimate. 5. Total retention from all prior periodic estimates — DO NOT INCLUDE THIS ESTIMATE. (See Item 6 on previous estimate.) 6. Total of Items 4 and 5. 7. Loan amount from the contract NOT including the administrative fee. 8. Total of Items 3 and 6. 9. Funds still available — Item 7 minus Item 8. This amount MUST be equal to or greater than zero. DO NOT WRITE. IN THE BLOCKS MARKED "FOR DWR USE". If additional space is rr(yuircd, Lis,—.1. Iecontl 1)11'li 4 V5 A and identit'v it in the upper right hand corner. Total ONLY' the last DWR 4135 A. INSTRUCTIONS FOR PARTIAL PAYMENT ESTIMATE, DWR 4135 C PART A: Self-explanatory. PART B: Contract Item: Unit: Identify each item by its basic description (each, square foot, linear foot, project, etc.). Quantity: The number of units contracted. Unit Price: The price per unit. This Period: Quantity: Number of contracted units this period. Amount: Number of contracted units this period X Unit Price. Total to Date: Quantity: Total units billed including this partial payment. Amount: Total quantity X Unit Price. PART C: 1. Amount earned: Total of "This Period" and "Total to Date" columns in Part B. 2. Amount retained: Self-explanatory. 3. Previous payments: Self-explanatory. 4. Amount Due: 1 minus 2 and 3. Estimated Percentage and Progress Schedule: Self-explanatory and required on all contractor items. PART D: Part D, 1, 2, and:3 must lie signed. Part D. 2 is always signed by a registered civil engineer unless otherwise approved in writing by DWR. fart D, 3 is nlivays signed by the Public agency. All signatures on original set of the estimate must lie original signatures. Additional copies may he made from this set. Please submit the original and four copies of the entire estimate package to the Department of Witter Resources, Bond Financing and Administration, P. O. Box 942836, Sacramento, CA 94236-0001. DWR 4135A .Back; :New 6%87) State of California Proposition PART A Name of Public Agency Address: Telephone No.: Periodic Estimate No. PART B — Expenditure Summary r DEPARTMENT OF WATER RESOURCES PERIODIC ESTIMATE FOR PARTIAL PAYMENT GENERAL OBLIGATION LOAN/GRANT (See Instructions on Reverse Side) for Period DWR Contract No.: , 19_, to The Resources Agenr Page_ of M SUOGET LIME ATTACH. PROJECT STATE TEM NO. MENTNO DESCRIPTION EXPENDITURES FUNDS REQUESTED PART'C — Totals Total this periodic estimate Total oil prior periodic estimates 3 l periodic expendi- tures to date (FOR DWR USE ONLY) 1 . 2 above retention this - Amount of this STotal Partial Payment 4 periodic estimate PAYMENT APPROVED: Total retention all prior S periodic estimates 6 Total retention to date AF EO SIGNATURE DEPARTMENT OOF WATER RESOURCES (4 + CJ above) Wor4 Order No. l DWR Contract Amount Date Paid Total funds obligated $ Q 5 above) 4 _ 9 Funds still available (7 - S above) Claim No. FOR 0-R USE sU 9N A•,._ DWR '35A New 6 d7) JUbMI I : Uriginal and four copies to the Department of Water Resources. :: INSTRUCTIONS FOR DWR 4135 A (To be filled out by the Public Agency for periodic payment) PART A: Public Agency: The name should be identical to the name used in the contract with the Department of 'Vater Resources. Address and Telephone Number: Self-explanatory. DWR Contract Number: The number is on the contract. Periodic Estimate: Submit no more than one estimate per month. PART B: Expenditure Summary Budget Line Item Number: Corresponding to DWR 4135, Budget and Expenditure Summary. Attachment Number: Numerically identify each attachment, corresponding to DWR 4135 C. Description: Identify the material, labor or item being billed. Indicate vendor's name. Project Expenditure: The total dollar amount of the partial payment being requested by the contractor or vendor. State Funds Requested: The dollar amount of the project expenditure being requested this estimate. PART C: Totals 1. Total expenditures and State funds requested from the columns in Part B. 2. Total all prior periodic estimates — DO NOT INCLUDE THIS ESTIMATE. (See Item on previous estimate.) 3. Total of Items 1 and 2. 4. Total retention this estimate. 5. Total retention from all prior periodic estimates — DO NOT INCLUDE THIS ESTIMATE. (See Item 6 on previous estimate.) 6. Total of Items 4 and 5. 7. Loan amount from the contract NOT including the administrative fee. 8. Total of Items 3 and 6. 9. Funds still available — Item 7 minus Item 8. This amount MUST be equal to or greater than zero. DO NOT WRITE IN THE BLOCKS MARKED "FOR DWR USE". If addilimlid space is rc-quired. usu a .second 1 AVR 41:;5 A unci identify it in the upper right huncl corner. Total ONLY the last I)WR 41:3: A. INSTRUCTIONS FOR PARTIAL PAYMENT ESTIMATE, DWR 4135 C PART A: Self-explanatory. PART B: Contract Item: Unit: Identify each item by its basic description (each, square foot, linear foot, project, etc.). Quantity: The number of units contracted. Unit Price: The price per unit. This Period: Quantity: Number of contracted units this period. Amount: Number of contracted units this period X Unit Piice. Total to Date: Quantity: Total units billed including this partial payment. Amount: Total quantity X Unit Price. PART C: 1. Amount earned: Total of "This Period" and "Total to Date" columns in Part B. 2. Amount retained: Self-explanatory. 3. Previous payments: Self-explanatory. 4. Amount Due: 1 minus 2 and 3. Estimated Percentage and Progress Schedule: Self-explanatory and required on all contractor items. PART D: - Part D, 1, 2, and :.3 must be signed. Part I). 2 is always signed by a registered civil engineer unless otherwise approved in writing by DWR. Part D,:3 is always signed by :he Public Agency. All signatures on original set of the estimate must be original signatures. Additional copies may lie made from this set. Please submit the original and four copies of the entire estimate package to the Department of Water Resources, Bond Financing and Administration, 1'. 0. Box.942836, Sacramento, CA 9423(i-0001. DWR 4135A BacKi ;New 6/37) Stare of California DEPARTMENT OF WATER RESOURCES The Resources Agenc Proposition PERIODIC ESTIMATE FOR PARTIAL PAYMENT Page_ of _ GENERAL OBLIGATION LOAN/GRANT PART A (See Instructions on Reverse Side) Name of Public Agency Address: DWR Telephone No.: Contract No.: Periodic Estimate No. for Period 19_, to 19 PART B — Expenditure Summary BUDGET ATTACH. PROJECT STATE LINE :TEM NO. MEN TNO] DESCRIPTION EXPENDITURES FUNDS REQUESTED PART C — Totals Total this 1 periodic estimate Total all prior 2 periodic estimates 3 Total periodic expendi- FOR DWR USE ONLY) 1 . 2 abovel Total retention this Amz,unr of this 5 Partial Poyment 4 periodic estimate PAYMENT APPROVED: Total retention oil prior 5 periodic estimates L Total retention to date AUTHORIZED SIGNATURE DEPARTMENT OF WATER RESOURCES v (A + S obove) 'Nark Order No. DWR Contract Amount ft .. 1 Dcte Paid Total funds obligated,"" $ (3 6 above) 9 Funds still ovoiloble.�Y' `.r r Claim No. (7 -8 above) Q. •:x FOR O. R t_.SE SJ RN A,:r_; J\.VR 4135:1 :Ne- 6�87) JUbMI I : Uriginal Grid four copies to the Department of Water Resources. C C INSTRUCTIONS FOR DWR 4135 A (To be filled out by the Public Agency for periodic payment) PART A: Public Agency: The name should be identical to the name used in the contract with the Department of Water Resources. Address and Telephone Number: Self-explanatory. DWR Contract Number: The number is on the contract. Periodic Estimate: Submit no more than one estimate per month. PART B: Expenditure Summary Budget Line Item Number: Corresponding to DWR 4135, Budget and Expenditure Summary. Attachment Number: Numerically identify each attachment, corresponding to DWR 4135 C. Description: Identify the material, labor or item being billed. Indicate vendor's name. Project Expenditure: The total dollar amount of the partial payment being requested by the contractor or vendor. State Funds Requested: The dollar amount of the project expenditure being requested this estimate. PART C: Totals 1. Total expenditures and State funds requested from the columns in Part B. 2. Total all prior periodic estimates — DO NOT INCLUDE THIS ESTIMATE. (See Item on previous estimate.) 3. Total of Items 1 and 2. 4. Total retention this estimate. 5. Total retention from all prior periodic estimates — DO NOT INCLUDE THIS ESTIMATE. (See Item 6 on previous estimate.) 6. Total of Items 4 and 5. 7. Loan amount from the contract NOT including the administrative fee. 8. Total of Items 3 and 6. 9. Funds stili available — Item 7 minus Item 8. This amount MUST be equal to or greater than zero. DO NOT WRITE IN THE BLOCKS MARKED "FOR DWR L?SE". If additionitl space is rcquired. uav a scc•ond DWR a L::5 A and identify it in the upper tight halal corner. Total ONLY the last DWR 41:15 A. INSTRUCTIONS FOR PARTIAL PAYMENT ESTIMATE, DWR 4135 C PART A: Self-explanatory. PART B: Contract Item: Unit: Identify each item by its basic description (each, square foot, linear foot, project, etc.). Quantity: The number of units contracted. Unit Price: The price per unit. This Period: Quantity: Number of contracted units this period. Amount: Number of contracted units this period X Unit Price. Total to Date: Quantity: Total units billed including this partial payment. Amount: Total quantity X Unit Price. PART C. 1. Amount earned: Total of "This Period" and "Total to Date" columns in Part B. 2. Amount retained: Self-explanatory. 3. Previous payments: Self-explanatory. 4. Amount Due: 1 minus 2 and 3. Estimated Percentage and Progress Schedule: Self-explanatory and required on all contractor items. PART D: Part I), 1, 2, and :3 must he signed. Part I). 2 is always signed by a registered civil engineer unless otherwise approved in writing by DWR. Vart D, a is ahvnys signed by the Public Agency. All signatures on original set of the estimate must be original signatures. Additional copie-s may be o.nade from this set. Please submit the original and four copies of the entire estimate package to the Department of Water Resources, Bond Financing and Administration, I'. 0. Box 9428:36, Sacramento, CA 9.1236-0001. D:^NR 4135A :Back) (New 6.87) State of California Proposition PART A Name of Public Agency Address: Telephone No.: Periodic Estimate No. PART B – Expenditure Summary DEPARTMENT OF WATER RESOURCES PERIODIC ESTIMATE FOR PARTIAL PAYMENT GENERAL OBLIGATION LOAN/GRANT (See Instructions on Reverse Side) for Period DWR Contract No.: r 19_, to The Resources Agenc Page— of M BUDGET LINE ATTACH. PROJECT STATE TEM NO. ,MENTNO DESCRIPTION EXPENDITURES FUNDS REQUESTED PART C — Totals Total this 1 periodic estimate Total all prior 2 periodic estimates 3 Total periodic expendi- tures to date (FOR DWR USE ONLY) 1 . 2 above Amount of this 5 Total retention this ' Partial Payment 4 periodic estimate PAYMENT APPROVED: Total retention all prior 5 periodic estimates 6 Total retention to date AUTHORIZED SIGN 4TURE DEPARTMENT OF WATER RESOURCES (d + 5 obove) Nor'. Order No. DWR Contract Amount Vii:% -: :i..4... _ Date Pald Total funds obligated $ (3 . 6 above) Claim No.Funds 9 still ovailable (7 - 8 above) r� • �� a �� i3OR p'NR •_SSE SJ R.., Am V`N� 4131-54 .New 0:87} SUbMI I : Uriginal and lour copies to the Department of Water Resources. PART C M PART D 1. Certification of Contractor According to the best of my knowledge and belief, I certify that all items and amounts shown on the foregoing Periodic Estimate for Partial Payment are correct; that all work has been performed and/or material supplied in full accordance with the requirements of the referenced Contract, and/or duly authorized deviations, substitutions, alterations, and/or additions; that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate; that no part of the "Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with the nondiscrimination provisions of the Loan/Grant Contract with the Department of Water Resources. By (Signature of Au[hor<zrd Repreaenlal+vel 19 Title 2. Certification of Engineer I certify that I have checked and verified the foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge and belief it is a true and correct statement of work performed and/or material included in this Periodic Estimate has been inspected by me and/or by my duly authorized representative or assistants and that it has been performed and/or supplied in full accordance with requirements of the referenced contract; and that partial payment claimed and requested by the contractor is correctly computed on the basis of work performed and./or material supplied to date. Signed 'Er.4-eer) Date: 3. Request for Payment by Public Agency or Water Company !Rego:rauon .\'n rrebrA Tho construction .,f the project is progressing satisfactorily, and to the best of my knowledge the amounts contained in the t.>re nine Periodic f:stirnate for Partial Payment are true and correct statements of actual costs incurred for work performed, and I hereby request payment of funds under the Bond Law provisions of the Water Code in the amount ''f.s _ for reimbursement of eligible project costs estimated above. ,A,!hor::ed. 0-4—trd 'g—turel DWR 4135C i3cck) New 61871 THIS PERIOD TOTAL TO DATE Amount Earned g $ Amount Retained S $ Previous Payments S XXXXXXXXXXXXXXXXXXX $ Amount Due $ $ Estimated Percentage of Job Completed 74 Is Contractor's Construction Progress on Schedule? ❑ Yes ❑ No* *Explain: PART D 1. Certification of Contractor According to the best of my knowledge and belief, I certify that all items and amounts shown on the foregoing Periodic Estimate for Partial Payment are correct; that all work has been performed and/or material supplied in full accordance with the requirements of the referenced Contract, and/or duly authorized deviations, substitutions, alterations, and/or additions; that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate; that no part of the "Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with the nondiscrimination provisions of the Loan/Grant Contract with the Department of Water Resources. By (Signature of Au[hor<zrd Repreaenlal+vel 19 Title 2. Certification of Engineer I certify that I have checked and verified the foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge and belief it is a true and correct statement of work performed and/or material included in this Periodic Estimate has been inspected by me and/or by my duly authorized representative or assistants and that it has been performed and/or supplied in full accordance with requirements of the referenced contract; and that partial payment claimed and requested by the contractor is correctly computed on the basis of work performed and./or material supplied to date. Signed 'Er.4-eer) Date: 3. Request for Payment by Public Agency or Water Company !Rego:rauon .\'n rrebrA Tho construction .,f the project is progressing satisfactorily, and to the best of my knowledge the amounts contained in the t.>re nine Periodic f:stirnate for Partial Payment are true and correct statements of actual costs incurred for work performed, and I hereby request payment of funds under the Bond Law provisions of the Water Code in the amount ''f.s _ for reimbursement of eligible project costs estimated above. ,A,!hor::ed. 0-4—trd 'g—turel DWR 4135C i3cck) New 61871 State of California PART A NAME OF CONTRACTOR: NAME OF PUBLIC AGENCY,WATER CO. PARTMENT OF WATER RESOURCES GENERAL OBLIGATION LOAN/GRANT PARTIAL PAYMENT ESTIMATE TELEPHONE NO. The Resources Agency Attachment No. OF Periodic Estimate No. DWR Contract No. Proposition DATE OF COMPLETION: AMOUNT OF CONTRACT: DATES OF ESTIMATE: Original Original S From Revised Revised $ To n ESCRIPTION OF JOB: P aR3 B 'Show Originul ltems and Change Orders Separately. CONTRACT ITEMS THIS PERIOD TOTAL TO DATE ITEM'" UNIT QUANTITY UNIT PRICE QUANTITY AMOUNT QUANTITY AMOUNT i 'Show Originul ltems and Change Orders Separately. PART C C PART D 1. Certification of Contractor According to the best of my knowledge and belief, I certify that all items and amounts shown on the foregoing Periodic Estimate for Partial Payment are correct; that all work has been performed and/or material supplied in full accordance with the requirements of the referenced Contract, and/or duly authorized deviations, substitutions, alterations, and/or additions; that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate; that no part of the "Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with the nondiscrimination provisions of the Loan/Grant Contract with the Department of Water Resources. Con vartor) By )Signature of Authoraed Representative) , 19 Title 2. Certification of Engineer I certify that I have checked and verified the foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge and belief it is a true and correct statement of work performed and/or material included in this Periodic Estimate has been inspected by me and/or by my duly authorized representative or assistants and that it has been performed and/or supplied in full accordance with requirements of the referenced contract; and that partial payment claimed and requested by the contractor is correctly computed on the basis of work performed and/or material supplied to date. Signed ,EnFuuery Date: 3. Request for Payment by Public Agency or Water Company (Reg'strat,on Numb-) Tho (onstrurtii)rn ,)i rh), prv,jt?ct is progressing satisfactorily, and to the bestof my knowledge the amounts contained in the forl,r Hing Pen(�dic Estimate for Partial Payment are true and correct statements of actual costs incurred for work Pk•rf(-rmed. anti i hereby request payment of funds under the Bond Law provisions of the Water Code in the amount for reimbursement of eligible project costs estimated above. 1..rn,,,e_.d. pvaegnated tiq[natu rvl DWR 4135. ,3cci; New 6:87} THIS PERIOD TOTAL TO DATE Amount Earned S $ Amount Retained $ $ Previous Payments S XXXXXXXXXXXXXXXXXXX $ Amount Cue $ $ Estimated Percentage of Job Completed c Is Contractor's Construction Progress on Schedule? 1:1 Yes ❑ No *Explain: PART D 1. Certification of Contractor According to the best of my knowledge and belief, I certify that all items and amounts shown on the foregoing Periodic Estimate for Partial Payment are correct; that all work has been performed and/or material supplied in full accordance with the requirements of the referenced Contract, and/or duly authorized deviations, substitutions, alterations, and/or additions; that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate; that no part of the "Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with the nondiscrimination provisions of the Loan/Grant Contract with the Department of Water Resources. Con vartor) By )Signature of Authoraed Representative) , 19 Title 2. Certification of Engineer I certify that I have checked and verified the foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge and belief it is a true and correct statement of work performed and/or material included in this Periodic Estimate has been inspected by me and/or by my duly authorized representative or assistants and that it has been performed and/or supplied in full accordance with requirements of the referenced contract; and that partial payment claimed and requested by the contractor is correctly computed on the basis of work performed and/or material supplied to date. Signed ,EnFuuery Date: 3. Request for Payment by Public Agency or Water Company (Reg'strat,on Numb-) Tho (onstrurtii)rn ,)i rh), prv,jt?ct is progressing satisfactorily, and to the bestof my knowledge the amounts contained in the forl,r Hing Pen(�dic Estimate for Partial Payment are true and correct statements of actual costs incurred for work Pk•rf(-rmed. anti i hereby request payment of funds under the Bond Law provisions of the Water Code in the amount for reimbursement of eligible project costs estimated above. 1..rn,,,e_.d. pvaegnated tiq[natu rvl DWR 4135. ,3cci; New 6:87} State of California OF WATER RESOURCES The Resources Agency Attachment No. of GENERAL OBLIGATION LOAN/GRANT Periodic Estimate No. PARTIAL PAYMENT ESTIMATE DWR Contract No. Proposition PART A NAME OF CONTRACTOR: NAME OF PUBLIC AGENCY!WATER CO. TELEPHONE NO. DATE OF COMPLETION: AMOUNT OF CONTRACT: OATES OF ESTIMATE: Original Original $ From Revised Revised $ To DESCRIPTION OF JOB: PA^i 8 ' Show Original Items and Change Orders Separately. CONTRACT ITEMS THIS PERIOD TOTAL TO DATE ITEM* UNIT QUANTITY UNIT PRICE QUANTITY AMOUNT QUANTITY AMOUNT ' Show Original Items and Change Orders Separately. PART C PART D 1. Certification of Contractor According to the best of my knowledge and belief, I certify that all items and amounts shown on the foregoing Periodic Estimate for Partial Payment are correct; that all work has been performed and/or material supplied in full accordance with the requirements of the referenced Contract, and/or duly authorized deviations, substitutions, alterations, and/or additions; that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate; that no part of the "Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with the nondiscrimination provisions of the Loan/Grant Contract with the Department of Water Resources. By • C'ontracmn (Stgnamre of ufhorrzed RepraaerttattL' el , 19 Title 2. Certification of Engineer I certify that I have checked and verified the foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge and belief it is a true and correct statement of work performed and/or material included in this Periodic Estimate has been inspected by me and/or by my duly authorized representative or assistants and that it has been performed and/or supplied in full accordance with requirements of the referenced contract; and that partial payment claimed and requested by the contractor is correctly computed on the basis of work performed and/or material supplied to date. Signed ,Engmrert Date: 3. Request for Payment by Public Agency or Water Company t Regtatrahort .Vumberl The construction oC the project is progressing satisfactorily, and to the bestof my knowledge the amounts contained in the f� reu,ning Pernndie F,timate for Partial Payment are true and correct statements of actual costs incurred for work perf-rmed, and i hereby request payment of funds under the Bond Law provisions of the ;Vater Code in the amount -:E 3 — _ for reimbursement of eligible project costs estimated above. • 1ut ^. �•:,:;f. il—gnatrd ,i.Knaturr/ GWR 4135C .Back) :New 6/871 THIS PERIOD TOTAL TO DATE Amount Earned $ $ Amount Retained $ $ Previous Payments $ XXXXXXXXXXXXXXXXXXX $ Amount Due $ $ Estimated Percentage of Job Completed s .c Is Contractor's Construction Progress on Schedule? ❑ Yes a No* *Explain: PART D 1. Certification of Contractor According to the best of my knowledge and belief, I certify that all items and amounts shown on the foregoing Periodic Estimate for Partial Payment are correct; that all work has been performed and/or material supplied in full accordance with the requirements of the referenced Contract, and/or duly authorized deviations, substitutions, alterations, and/or additions; that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate; that no part of the "Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with the nondiscrimination provisions of the Loan/Grant Contract with the Department of Water Resources. By • C'ontracmn (Stgnamre of ufhorrzed RepraaerttattL' el , 19 Title 2. Certification of Engineer I certify that I have checked and verified the foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge and belief it is a true and correct statement of work performed and/or material included in this Periodic Estimate has been inspected by me and/or by my duly authorized representative or assistants and that it has been performed and/or supplied in full accordance with requirements of the referenced contract; and that partial payment claimed and requested by the contractor is correctly computed on the basis of work performed and/or material supplied to date. Signed ,Engmrert Date: 3. Request for Payment by Public Agency or Water Company t Regtatrahort .Vumberl The construction oC the project is progressing satisfactorily, and to the bestof my knowledge the amounts contained in the f� reu,ning Pernndie F,timate for Partial Payment are true and correct statements of actual costs incurred for work perf-rmed, and i hereby request payment of funds under the Bond Law provisions of the ;Vater Code in the amount -:E 3 — _ for reimbursement of eligible project costs estimated above. • 1ut ^. �•:,:;f. il—gnatrd ,i.Knaturr/ GWR 4135C .Back) :New 6/871 State of California PART,MENT OF WATER RESOURCES GENERAL OBLIGATION LOAN/GRANT PARTIAL PAYMENT ESTIMATE PART A NAME OF CONTRACTOR: YAMF_ OF PUBLIC AGENCYIWATER CO. TELEPHONE NO. The Resources Agency Attachment No. of Periodic Estimate No. DWR Contract No. Proposition DATE OF COMPLETION: AMOUNT OF CONTRACT: DATES OF ESTIMATE: Original Original $ From Revised Revised $ To ",E5(7RIPTION OF JOB: PART U *'Show Original Items and Change Orders Separately. J's:.' 4135C ,N.-, 6.87 CONTRACT ITEMS THIS PERIOD TOTAL TO DATE ITEM* UNIT QUANTITY UNIT PRICE QUANTITY AMOUNT QUANTITY AMOUNT *'Show Original Items and Change Orders Separately. J's:.' 4135C ,N.-, 6.87 PART C C PART D 1. Certification of Contractor According to the best of my knowledge and belief, I certify that all items and amounts shown on the foregoing Periodic Estimate for Partial Payment are correct; that all work has been performed and/or material supplied in full accordance with the requirements of the referenced Contract, and/or duly authorized deviations, substitutions, alterations, and/or additions; that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate; that no part of the "Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with the nondiscrimination provisions of the Loan/Grant Contract with the Department of Water Resources. By trnrtorl !Signature o! Authorised Rep--ral—) , 19 Title 2. Certification of Engineer I certify that I have checked and verified the foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge and belief it is a true and correct statement of work performed and/or material included in this Periodic Estimate has been inspected by me and/or by my duly authorized representative or assistants and that it has been performed and/or supplied in full accordance with requirements of the referenced contract; and that partial payment claimed and requested by the contractor is correctly computed on the basis of work performed and/or material supplied to date. Sinned ,£agineen Date: 3. Request for Pavment by Public Agency or Water Company /Reg,atra hon .VumOer/ 1' he construction �ei ,he project is progressing satisfactorily, and to the bestofmy knowledge the amounts contained in the Ior( ;;oinV Pervxiic E,uniate for Partial Payment are true and correct statements of actual costs incurred for wart pe!•,iirmed, anci l hereby request payment of funds under the Bond Law provisions of the Nater Code in the amount ^d --- for reimbursement of eiigible project costa estimated above. Ur gv ated S,g—turee OWR 4135C 13act1 tNew 6/57, THIS PERIOD TOTAL TO DATE Amount Earned g $ Amount Retained 5 $ Previous Payments $ XXXXXXXXXXXXXXXXXXX $ Amount Due g $ Estimated Percentage of job Completed T Is Contractor's Construction Progress on Schedule? ❑ Yes ❑ No* *Explain: PART D 1. Certification of Contractor According to the best of my knowledge and belief, I certify that all items and amounts shown on the foregoing Periodic Estimate for Partial Payment are correct; that all work has been performed and/or material supplied in full accordance with the requirements of the referenced Contract, and/or duly authorized deviations, substitutions, alterations, and/or additions; that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate; that no part of the "Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with the nondiscrimination provisions of the Loan/Grant Contract with the Department of Water Resources. By trnrtorl !Signature o! Authorised Rep--ral—) , 19 Title 2. Certification of Engineer I certify that I have checked and verified the foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge and belief it is a true and correct statement of work performed and/or material included in this Periodic Estimate has been inspected by me and/or by my duly authorized representative or assistants and that it has been performed and/or supplied in full accordance with requirements of the referenced contract; and that partial payment claimed and requested by the contractor is correctly computed on the basis of work performed and/or material supplied to date. Sinned ,£agineen Date: 3. Request for Pavment by Public Agency or Water Company /Reg,atra hon .VumOer/ 1' he construction �ei ,he project is progressing satisfactorily, and to the bestofmy knowledge the amounts contained in the Ior( ;;oinV Pervxiic E,uniate for Partial Payment are true and correct statements of actual costs incurred for wart pe!•,iirmed, anci l hereby request payment of funds under the Bond Law provisions of the Nater Code in the amount ^d --- for reimbursement of eiigible project costa estimated above. Ur gv ated S,g—turee OWR 4135C 13act1 tNew 6/57, State of California --PARTMENT OF WATER RESOURCES 4 - GENERAL OBLIGATION LOAN/GRANT PARTIAL PAYMENT ESTIMATE PART A NAME OF CONTRACTOR: ::AME OF PUBLIC AGENCY!WATER CO. TELEPHONE NO. The Resources Agency Attachment No. of Periodic Estimate No. DWR Contract No. Proposition UArE OF COMPLETION: AMOUNT OF CONTRACT: DATES OF ESTIMATE: Original __ Original $ From Revised Revised $ To i)_ -Sr RIPTION OF JOB: FART 3 "Show Original Items and Change Orders Separately. DWR 4135C New 6/871 CONTRACT ITEMS THIS PERIOD TOTAL TO DATE IT`M UNIT QUANTITY UNIT PRICE QUANTITY AMOUNT QUANTITY AMOUNT 1 "Show Original Items and Change Orders Separately. DWR 4135C New 6/871 PART C r PART D 1. Certification of Contractor According to the best of my knowledge and belief, I certify that all items and amounts shown on the foregoing Periodic Estimate for Partial Payment are correct; that all work has been performed and/or material supplied in full accordance with the requirements of the referenced Contract, and/or duly authorized deviations, substitutions, alterations, and/or additions; that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate; that no part of the "Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with the nondiscrimination provisions of the Loan/Grant Contract with the Department of dater Resources. X-11—tort By (Signature of Authorized Repreae wiuo , 19 Title 2. Certification of Engineer I certify that I have checked and verified the foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge and belief it is a true and correct statement of work performed and/or material included in this Periodic Estimate has been inspected by me and/or by my duly authorized representative or assistants and that it has been performed and/or supplied in full accordance with requirements of the referenced contract; and that partial payment claimed and requested by the contractor is correctly computed on the basis of work performed and/or material supplied to date. Signed 'Engineer) Date: 3. Request for Payment by Public Agency or Water Company )Rex<atra[,un Num6erl rher-lratrcctiuiifthel)roject is progressing satisfactorily, and to the best of my k now ledge the am, Junts con tained ill the rf" oin r Penodic Estirnate for Partial Payment are true and correct statements of cctual costs incurred for work pert(irmeti. and I hereby request payment of funds under the Bond Law provisions of the Nater Code in the amount ot, S --_ _ for reimbursement of eligible project costs estimated above. {,thw—d. 0.-Ae—frd S�geaturel DWR 41350 3acK) New 6/27) THIS PERIOD TOTAL TO DATE Amount Earned $ $ Amount Retained $ $ Previous Payments $ XXXXXXXXXXXXXXXXXXX $ Amount Due $ $ Estimated Percentage of Job Completed a Is Contractor's Construction Progress on Schedule? 11 Yes F-1 No* *Explain: PART D 1. Certification of Contractor According to the best of my knowledge and belief, I certify that all items and amounts shown on the foregoing Periodic Estimate for Partial Payment are correct; that all work has been performed and/or material supplied in full accordance with the requirements of the referenced Contract, and/or duly authorized deviations, substitutions, alterations, and/or additions; that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate; that no part of the "Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with the nondiscrimination provisions of the Loan/Grant Contract with the Department of dater Resources. X-11—tort By (Signature of Authorized Repreae wiuo , 19 Title 2. Certification of Engineer I certify that I have checked and verified the foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge and belief it is a true and correct statement of work performed and/or material included in this Periodic Estimate has been inspected by me and/or by my duly authorized representative or assistants and that it has been performed and/or supplied in full accordance with requirements of the referenced contract; and that partial payment claimed and requested by the contractor is correctly computed on the basis of work performed and/or material supplied to date. Signed 'Engineer) Date: 3. Request for Payment by Public Agency or Water Company )Rex<atra[,un Num6erl rher-lratrcctiuiifthel)roject is progressing satisfactorily, and to the best of my k now ledge the am, Junts con tained ill the rf" oin r Penodic Estirnate for Partial Payment are true and correct statements of cctual costs incurred for work pert(irmeti. and I hereby request payment of funds under the Bond Law provisions of the Nater Code in the amount ot, S --_ _ for reimbursement of eligible project costs estimated above. {,thw—d. 0.-Ae—frd S�geaturel DWR 41350 3acK) New 6/27) State of California PART A PARTMENT OF WATER RESOURCES GENERAL OBLIGATION LOAN/GRANT PARTIAL PAYMENT ESTIMATE NAME OF CONTRACTOR: :.AME OF PUBLIC AGENCY/WATER CO. TELEPHONE NO. The Resources Agency Attachment No. of Periodic Estimate No. DWR Contract No. Proposition DATE OF COMPLETION: AMOUNT OF CONTRACT: DATES OF ESTIMATE! Original Original $ From Revised Revised $ To ,L-:; RIPTION OF JOB: PART S *Show Original Items and Change Orders Separately. D A,'R 41.35C . - 6 ?T CONTRACT ITEMS THIS PERIOD TOTAL TO DATE IT`M� UNIT QUANTITY UNIT PRICE QUANTITY AMOUNT QUANTITY AMOUNT I I I *Show Original Items and Change Orders Separately. D A,'R 41.35C . - 6 ?T T PART C PART D 1. Certification of Contractor According to the best of my knowledge and belief, I certify that all items and amounts shown on the foregoing Periodic Estimate for Partial Payment are correct; that all work has been performed and/or material supplied in full accordance with the requirements of the referenced Contract, and/or duly authorized deviations, substitutions, alterations, and/or additions; that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate; that no part of the "Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with the nondiscrimination provisions of the Loan/Grant Contract with the Department of Water Resources. By 'Contractor) (Signature of Authorized Representative) , 19 Title 2. Certification of Engineer 1 certify that I have checked and verified the foregoing Periodic Estimate for Partial Payment; that to the beat of my knowledge and belief it is a true and correct statement of work performed and/or material inciuded in this Periodic Estimate has been inspected by me and/or by my duly authorized representative or assistants and that it has been performed and/or supplied in full accordance with requirements of the referenced contract; and that partial payment claimed and requested by the contractor is correctly computed on the basis of work performed and/or material supplied to date. Signed ,Engineer) (ReRmi'atton Number) Date: 3. Request for Payment by Public Agency or Water Company "rhe construction of the project is progressing satisfactorily, and to the bestofmy knowledge the amounts contained in the ti)regoing Periodic Estimate for Partial Payment are true and correct statements of actual cots incurred for work prr:.)rmed. and I hereby request payment of funds under the Bond Law provisions of the Water- 'ode in the amount for reimbursement of eligible project costa estimated above. .-1 u!hornted. Des)gnated S+Rnaturel ,Date) CWR 4135C 9ccki !New 6/27) THIS PERIOD TOTAL TO DATE Amount Earned $ $ Amount Retained $ $ Previous Payments $ XXXXXXXXXXXXXXXXXXX $ Amount Due $ $ Estimated Percentage of Job Completed o- ;c Is Contractor's Construction Progress on Schedule? ❑ Yes ❑ No* *Explain: PART D 1. Certification of Contractor According to the best of my knowledge and belief, I certify that all items and amounts shown on the foregoing Periodic Estimate for Partial Payment are correct; that all work has been performed and/or material supplied in full accordance with the requirements of the referenced Contract, and/or duly authorized deviations, substitutions, alterations, and/or additions; that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate; that no part of the "Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with the nondiscrimination provisions of the Loan/Grant Contract with the Department of Water Resources. By 'Contractor) (Signature of Authorized Representative) , 19 Title 2. Certification of Engineer 1 certify that I have checked and verified the foregoing Periodic Estimate for Partial Payment; that to the beat of my knowledge and belief it is a true and correct statement of work performed and/or material inciuded in this Periodic Estimate has been inspected by me and/or by my duly authorized representative or assistants and that it has been performed and/or supplied in full accordance with requirements of the referenced contract; and that partial payment claimed and requested by the contractor is correctly computed on the basis of work performed and/or material supplied to date. Signed ,Engineer) (ReRmi'atton Number) Date: 3. Request for Payment by Public Agency or Water Company "rhe construction of the project is progressing satisfactorily, and to the bestofmy knowledge the amounts contained in the ti)regoing Periodic Estimate for Partial Payment are true and correct statements of actual cots incurred for work prr:.)rmed. and I hereby request payment of funds under the Bond Law provisions of the Water- 'ode in the amount for reimbursement of eligible project costa estimated above. .-1 u!hornted. Des)gnated S+Rnaturel ,Date) CWR 4135C 9ccki !New 6/27) State of California PART A NAME OF CONTRACTOR: yAME OF PUaLIC AGENCY!WATER CO. �ARTMENTOFWATER RESOURCES f GENERAL OBLIGATION LOAN/GRANT PARTIAL PAYMENT ESTIMATE TELEPHONE NO. The Resources Agency Attachment No. of Periodic Estimate No. DWR Contract No. Proposition DATE OF COMPLETION: AMOUNT OF CONTRACT: DATES OF ESTIMATE: Original Original S From Revised Revised S To ^ESCRIPTION OF JOB-. PART B `Show Original Items and Change Orders Separately. —''VR 4135C .. w 6 .47' CONTRACT ITEMS THIS PERIOD TOTAL TO DATE IT "-,V1* UNIT QUANTITY UNIT PRICE QUANTITY AMOUNT QUANTITY AMOUNT `Show Original Items and Change Orders Separately. —''VR 4135C .. w 6 .47' PART C e� PART D 1. Certification of Contractor According to the best of my knowledge and belief, I certify that all items and amounts shown on the foregoing Periodic Estimate for Partial Payment are correct; that all work has been performed and/or material supplied in full accordance with the requirements of the referenced Contract, and/or duly authorized deviations, substitutions, alterations, and/or additions; that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate; that no part of the"Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with the nondiscrimination provisions of the Loan/Grant Contract with the Department of Nater Resources. Contrartort 2. Certification of Engineer By (Signature of Authonied Representative) , 19 Title I certifv that I have checked and verified the foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge and belief it is a true and correct statement of work performed and/or material included in this Periodic Estimate has been inspected by me and/or by my duly -authorized representative or assistants and that it has been performed and/or supplied in full accordance with requirements of the referenced contract; and that partial payment claimed and requested by the contractor is correctly computed on the basis of work performed and/or material supplied to date. Signed tEngtnean Date: 3. Request for Payment by Public Agency or Water Company rHeq<etr¢non Va.nber/ The construction 11f the project is progressing satisfactorily, and to the bestof my knowledge the amounts contained in the furegming Periodic I -:;timate fur Partial Payment are true and correct statements of actual costs incurred for work ;)erformed, and I hereby request payment of funds under the Bond Law provisions of the Water Code in the amount ""S — for reimbursement of eligible project costs estimated above. :l utnr, r,,vd. Uv..rKnated .i�Kna[urri DWR 41355C .;?ack) ;New 6187) THIS PERIOD TOTAL TO DATE Amount Earned $ $ Amount Retained S $ Previous Payments $ XXXXXXXXXXXXXXXXXXX $ Amount Due $ $ Estimated Percentage of Job Completed c Is Contractor's Construction Progress on Schedule? ❑ Yes ❑ No* *Explain: PART D 1. Certification of Contractor According to the best of my knowledge and belief, I certify that all items and amounts shown on the foregoing Periodic Estimate for Partial Payment are correct; that all work has been performed and/or material supplied in full accordance with the requirements of the referenced Contract, and/or duly authorized deviations, substitutions, alterations, and/or additions; that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate; that no part of the"Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with the nondiscrimination provisions of the Loan/Grant Contract with the Department of Nater Resources. Contrartort 2. Certification of Engineer By (Signature of Authonied Representative) , 19 Title I certifv that I have checked and verified the foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge and belief it is a true and correct statement of work performed and/or material included in this Periodic Estimate has been inspected by me and/or by my duly -authorized representative or assistants and that it has been performed and/or supplied in full accordance with requirements of the referenced contract; and that partial payment claimed and requested by the contractor is correctly computed on the basis of work performed and/or material supplied to date. Signed tEngtnean Date: 3. Request for Payment by Public Agency or Water Company rHeq<etr¢non Va.nber/ The construction 11f the project is progressing satisfactorily, and to the bestof my knowledge the amounts contained in the furegming Periodic I -:;timate fur Partial Payment are true and correct statements of actual costs incurred for work ;)erformed, and I hereby request payment of funds under the Bond Law provisions of the Water Code in the amount ""S — for reimbursement of eligible project costs estimated above. :l utnr, r,,vd. Uv..rKnated .i�Kna[urri DWR 41355C .;?ack) ;New 6187) State of California PART A -PARTMENT OF WATER RESOURCES GENERAL OBLIGATION LOAN/GRANT PARTIAL PAYMENT ESTIMATE NAME OF CONTRACTOR: NAME_ OF PUBLIC AGENCY: WATER CO. TELEPHONE NO. The Resources Agency Attachment No. of Periodic Estimate No. DWR Contract No. Proposition DATE OF- COMPLETION: AMOUNT OF CONTRACT: DATES OF ESTIMATE: Original Original $ From Revised Revised $ To r ._SCRIPTION OF JOB: FART B 'Show Original Items and Change Orders Separately. DWR 4135C "Jew 6.871 CONTRACT ITEMS THIS PERIOD TOTAL TO DATE ITEM* UNIT QUANTITY UNIT PRICE QUANTITY AMOUNT QUANTITY AMOUNT 1 I 'Show Original Items and Change Orders Separately. DWR 4135C "Jew 6.871 .e - PART C PART D 1. Certification of Contractor According to the best of my knowledge and belief, I certify that all items and amounts shown on the foregoing Periodic Estimate for Partial Payment are correct; that all work has been performed and/or material supplied in full accordance with the requirements of the referenced Contract, and/or duly authorized deviations, substitutions, alterations, and/or additions; that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate; that no part of the "Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with the nondiscrimination provisions of the Loan/Grant Contract with the Department of Nater Resources. 1Cuntracton By /Jignature u/ Authorised Representglivel 19 Title 2. Certi kation of Engineer I certify that I have checked and verified the foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge and belief it is a true and correct statement of work performed and/or material included in this Periodic Estimate has been inspected by me and/or by my duly authorized representative or assistants and that it has been performed and/or supplied in full accordance with requirements of the referenced contract, and that partial payment claimed and requested by the contractor is correctly computed on the basis of work performed and/or material supplied to date. Signed l Eaguteeo Date: 3. Request for Payment by Public Agency or Water Company trat,nn Number) The construction of the project is progressing satisfactorily, and to the best of my knowledge the amounts contained in the forf•,oing Purtodic F:,tirnate for Partial Payment are true and correct statements of actual costs incurred for work pt -t 6trmrd, and I hereby request payment of funds under the Bond Law provisions of the Water Code in the amount "t* •-s —. for reimbursement of eligible project costs estimated above. trd S,Knatu o Dater DWR 4135C .Back; (New 6137) THIS THIS PERIOD TOTAL TO DATE Amount Earned $ $ Amount Retained $ $ Previous Payments $ XXXXXXXXXXXXXXXXXXX $ Amount Cue $ $ Estimated Percentage of Job Completed Is Contractor's Construction Progress on Schedule? ❑ Yes ❑ No* a> e *Explain: PART D 1. Certification of Contractor According to the best of my knowledge and belief, I certify that all items and amounts shown on the foregoing Periodic Estimate for Partial Payment are correct; that all work has been performed and/or material supplied in full accordance with the requirements of the referenced Contract, and/or duly authorized deviations, substitutions, alterations, and/or additions; that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate; that no part of the "Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with the nondiscrimination provisions of the Loan/Grant Contract with the Department of Nater Resources. 1Cuntracton By /Jignature u/ Authorised Representglivel 19 Title 2. Certi kation of Engineer I certify that I have checked and verified the foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge and belief it is a true and correct statement of work performed and/or material included in this Periodic Estimate has been inspected by me and/or by my duly authorized representative or assistants and that it has been performed and/or supplied in full accordance with requirements of the referenced contract, and that partial payment claimed and requested by the contractor is correctly computed on the basis of work performed and/or material supplied to date. Signed l Eaguteeo Date: 3. Request for Payment by Public Agency or Water Company trat,nn Number) The construction of the project is progressing satisfactorily, and to the best of my knowledge the amounts contained in the forf•,oing Purtodic F:,tirnate for Partial Payment are true and correct statements of actual costs incurred for work pt -t 6trmrd, and I hereby request payment of funds under the Bond Law provisions of the Water Code in the amount "t* •-s —. for reimbursement of eligible project costs estimated above. trd S,Knatu o Dater DWR 4135C .Back; (New 6137) >r State of California OARTMENT OF WATER RESOURCES GENERAL OBLIGATION LOAN/GRANT PARTIAL PAYMENT ESTIMATE PART A NAME OF CONTRACTOR: .:4MF_ OF PUBLIC AGENCY.'WATER CO. TELEPHONE NO. The Resources Agency Attachment No. of Periodic Estimate No. DWR Contract No. Proposition GATE OF COMPLETION: AMOUNT OF CONTRACT: DATES OF ESTIMATE: Original Original $ From Revised _ Revised $ To n ESCPIPTION OF JOB: PA R 3 'Show Original Items and Change Orders Separately. DwR 4135C Mew 5:'87` CONTRACT ITEMS THIS PERIOD TOTAL TO DATE ;TEM* UNIT QUANTITY UNIT PRICE QUANTITY AMOUNT QUANTITY AMOUNT i i 'Show Original Items and Change Orders Separately. DwR 4135C Mew 5:'87` PART C PART D 1. Certification of Contractor According to the best of my knowledge and belief, I certify that all items and amounts shown on the foregoing Periodic Estimate for Partial Payment are correct; that all work has been performed and/or material supplied in full accordance with the requirements of the referenced Contract, and/or duly authorized deviations, substitutions, alterations, and/or additions; that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate; that no part of the "Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with the nondiscrimination provisions of the Loan/Grant Contract with the Department of Nater Resources. By — (Signature of Authorized Repreeentalicel 19 Title 2. Certification of Engineer I certify that I have checked and verified the foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge and belief it is a true and correct statement of work performed and/or material included in this Periodic Estimate has been inspected by me and/or by my duly authorized representative or assistants and that it has been performed and/or supplied in full accordance with requirements of the referenced contract; and that partial payment claimed and requested by the contractor is correctly computed on the basis of work performed and/or material supplied to date. Signed tEngtnerrt Date: 3. Request for Payment by Public Agency or Water Company !Regtatratron Numb,» The construction of the prniect is progressing satisfactorily, and to the bestof my knowiedge the amounts contained in the Core<, going Periodic H:.timute 61r Partial Payment are true and correct statements of actual costs incurred for work perC:)rmed, and I hereby request payment of funds under the Bond Law provisions of the Nater (.;ode in the amount "r, 1� ---- for reimbursement of eligible project costs estimated above. .a u N:on;.-d. Drs�gnatrd .i�Xna:urn CWR 41_5C Back) (New 6/87) THIS PERIOD TOTAL TO DATE Amount Earned $ $ Amount Retained $ $ Previous Payments $ XXXXXXXXXXXXXXXXXXX $ Amount Due $ $ Estimated Percentage of Job Completed a Is Contractor's Construction Progress on Schedule? ❑ Yes a No* *Explain: PART D 1. Certification of Contractor According to the best of my knowledge and belief, I certify that all items and amounts shown on the foregoing Periodic Estimate for Partial Payment are correct; that all work has been performed and/or material supplied in full accordance with the requirements of the referenced Contract, and/or duly authorized deviations, substitutions, alterations, and/or additions; that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate; that no part of the "Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with the nondiscrimination provisions of the Loan/Grant Contract with the Department of Nater Resources. By — (Signature of Authorized Repreeentalicel 19 Title 2. Certification of Engineer I certify that I have checked and verified the foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge and belief it is a true and correct statement of work performed and/or material included in this Periodic Estimate has been inspected by me and/or by my duly authorized representative or assistants and that it has been performed and/or supplied in full accordance with requirements of the referenced contract; and that partial payment claimed and requested by the contractor is correctly computed on the basis of work performed and/or material supplied to date. Signed tEngtnerrt Date: 3. Request for Payment by Public Agency or Water Company !Regtatratron Numb,» The construction of the prniect is progressing satisfactorily, and to the bestof my knowiedge the amounts contained in the Core<, going Periodic H:.timute 61r Partial Payment are true and correct statements of actual costs incurred for work perC:)rmed, and I hereby request payment of funds under the Bond Law provisions of the Nater (.;ode in the amount "r, 1� ---- for reimbursement of eligible project costs estimated above. .a u N:on;.-d. Drs�gnatrd .i�Xna:urn CWR 41_5C Back) (New 6/87) State of California ARTMENT OF WATER RESOURCES GENERAL OBLIGATION LOAN/GRANT PARTIAL PAYMENT ESTIMATE PART A NAME OF CONTRACTOR: NAME OF PUBLIC AGENCY!WATER CO. TELEPHONE NO. The Resources Agency Attachment No. of Periodic Estimate No. DWR Contract No. Proposition DATE OF COMPLETION: AMOUNT OF CONTRACT: DATES OF ESTIMATE: Original Original S From Revised Revised $ To i =SCRIP TION OF JOB: PART 8 "Show Original Items and Change Orders Separately. NR 4'1 35C 1` _- 6 87. CONTRACT ITEMS THIS PERIOD TOTAL TO DATE IT UNIT QUANTITY UNIT PRICE QUANTITY AMOUNT QUANTITY AMOUNT I "Show Original Items and Change Orders Separately. NR 4'1 35C 1` _- 6 87. PART C PART D 1. Certification of Contractor According to the best of my knowledge and belief, I certify that all items and amounts shown on the foregoing Periodic Estimate for Partial Payment are correct; that all work has been performed and/or material supplied in full accordance with the requirements of the referenced Contract, and/or duly authorized deviations, substitutions, alterations, and/or additions; that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate; that no part of the "Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with the nondiscrimination provisions of the Loan/Grant Contract with the Department of Water Resources. By !Signature of Authorised Repreaentativer , 19 Title 2. Certification of Engineer I certify that I have checked and verified the foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge and belief it is a true and correct statement of work performed and/or material included in this Periodic Estimate has been inspected by me and/or by my duly authorized representative or assistants and that it has been performed and/or supplied in full accordance with requirements of the referenced contract; and that partial payment claimed and requested by the contractor is correctly computed on the basis of work performed and/or material supplied to date. Signed !Engineer) Date: 3. Request for Payment by Public Agency or Water Company (ReRatrathon Nurnher) The construction -4 the project is progressing satisfactorily, and to the best of my knowledge the amounts contained in the ,rt �nin� Periodic lEstimate for Partial Payment are true and correct statements of actual costs incurred for work per(iirmed, and I hereby request payment of funds under the Bond Law provisions of the Water Code in the amount �d 7 for reimbursement of eligible project costs estimated above. a�th��r, rva_ flv.r�gnatrd �i,tnatlrvt DWR 4135C :Back) (New 6/871, THIS PERIOD TOTAL TO DATE Amount Earned j $ Amount Retained S $ Previous Payments S XXXXXXXXXXXXXXXXXXX $ Amount Due $ 1 $ Estimated Percentage of Job Completed r ,c Is Contractor's Construction Progress on Schedule? ❑ Yes ❑ No "Explain: PART D 1. Certification of Contractor According to the best of my knowledge and belief, I certify that all items and amounts shown on the foregoing Periodic Estimate for Partial Payment are correct; that all work has been performed and/or material supplied in full accordance with the requirements of the referenced Contract, and/or duly authorized deviations, substitutions, alterations, and/or additions; that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate; that no part of the "Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with the nondiscrimination provisions of the Loan/Grant Contract with the Department of Water Resources. By !Signature of Authorised Repreaentativer , 19 Title 2. Certification of Engineer I certify that I have checked and verified the foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge and belief it is a true and correct statement of work performed and/or material included in this Periodic Estimate has been inspected by me and/or by my duly authorized representative or assistants and that it has been performed and/or supplied in full accordance with requirements of the referenced contract; and that partial payment claimed and requested by the contractor is correctly computed on the basis of work performed and/or material supplied to date. Signed !Engineer) Date: 3. Request for Payment by Public Agency or Water Company (ReRatrathon Nurnher) The construction -4 the project is progressing satisfactorily, and to the best of my knowledge the amounts contained in the ,rt �nin� Periodic lEstimate for Partial Payment are true and correct statements of actual costs incurred for work per(iirmed, and I hereby request payment of funds under the Bond Law provisions of the Water Code in the amount �d 7 for reimbursement of eligible project costs estimated above. a�th��r, rva_ flv.r�gnatrd �i,tnatlrvt DWR 4135C :Back) (New 6/871, State of California PARTMENT OF WATER RESOURCES GENERAL OBLIGATION LOAN/GRANT PARTIAL PAYMENT ESTIMATE PART A NAME OF CONTRACTOR: NAME OF PUBLIC AGENCY/WATER CO. TELEPHONE NO. The Resources Agency Attachment No. of Periodic Estimate No. DWR Contract No. Proposition BATE OF COMPLETION: AMOUNT OF CONTRACT: OATES OF ESTIMATE: Original Original $ From Revised Revised $ To ,. E:Sr_'RIPTION OF JOB: PART B 'Show Original Items and Change Orders Separately. D'r/R 41350 New 6-$71 CONTRACT ITEMS THIS PERIOD TOTAL TO DATE !TEM* UNIT QUANTITY UNIT PRICE QUANTITY AMOUNT QUANTITY AMOUNT I 'Show Original Items and Change Orders Separately. D'r/R 41350 New 6-$71 t State of California GENERAL OBLIGATION LOAN/GRANT Proposition Name of Public Agency/Water Co.:— Contact Person: John Doe DEPARTMENT OF WATER RESOURCES SAMPLE BUDGET AND EXPENDITURE SUMMARY XYZ WaLer Company Periodic Estimate No.: 2 for Period January 1 19 86 to January 31 The Resource% Agency Page 1 of 1 Date 2/1/86 E5XXXX DWR Contract No.: __Telephone: (415) 123-4567 r 19 86 LINE ITEM ALLOTMENT TITLE ALLOTMENT AMOUNT TOTAL PRIOR CLAIMS CURRENT CHARGES TOTAL CHARGES TO DATE ALLOTMENT BALANCE 1 En in ering 90,000.00 25,694.77 3,130.43 28,825.20 61,17'4.80 2 Legal Services 1(),000.00 315.00 160.00 475.00 9,525.00 3 Miscellaneous Materials: 100,000.00 3,284.23 96,715.77 Water Conservation Kits 428.00 Pump 2,856.23 4 Construction Work: 640,000.00 215,004.97 424,995.03 Pipeline 1.31,443.97 Reservoir 83,561.00 Administration 60,000.00 60,000.00 Retention to Date: Pi.pelAne 14,604.89 ( 14,604.89) I'eservoi.r 8,356.10 (8,356.10) SUB TOTAL THIS PAGE 900,000,00 109,570.77 1'38 018.63 270 550.39 629,449.61 SUB TOTAL PAGE SUB TOTAL PAGE TOTAL 900,000.00 109 570.77 138 018.63 270.5.50.39 629,44 .61 INITIAL SUBMISSION ONLY: Reviewed by Registered Civil Engineer SUBMIT: One Copy to Deportment of Water Resources, Bond Financing and Administration P. 0. Box 942836, Sacramento, CA 94236-0001 DWR 4135 (New 6/87) RCE No. Date r INSTRUCTIONS FOR DWR 4135 B (To be filled out by the Water Co. for periodic payment) PART A: Water Co.: The name should be identical to the name used in the contract with the Department of Water Resources. Address and Telephone_ Number. Self-explanatory. DWR Contract Number. The number is on the contract. Periodic Estimate: Submit no more than one estimate per month. PART B: Expenditure Summary Budget Line Item Number: Corresponding to DWR 4135, Budget and Expenditure Summary. Attachment Number. Numerically identify each attachment, corresponding to DWR 4135 C. Description: Identify the material, labor or item being billed. Indicate vendor's name. Project Expenditure: The total dollar amount of the partial payment being requested by the contractor or vendor. State Funds Requested: The dollar amount of the project expenditure being requested this estimate. PART C: Totals 1. Total expenditures and State funds requested from the columns in Part B. 2. Total all prior periodic estimates — DO NOT INCLUDE THIS ESTIMATE. (See Item on previous estimate.) 3. Total of Items 1 and 2. 4. Total retention this estimate. 5. Total retention from all prior periodic estimates — DO NOT INCLUDE THIS ESTIMATE. (See Item 6 on previous estimate.) 6. Total of Items 4 and 5. 7. Loan amount from the contract NOT including the administrative fee. 8. Total of Items 3 and 6. 9. Funds still available — Item 7 minus Item 8. This amount MUST be equal to or greater than zero. DO NOT WRITE IN THE BLOCKS MARKED "FOR DWR USE". If additional space is required, use a second DWR 4135 B and identify it in the upper right hand corner. Total ONLY the last DWR 4135 B. INSTRUCTIONS FOR PARTIAL PAYMENT ESTIMATE, DWR 4135 C PART A: Self-explanatory. PART B: Contract Item: Unit: Identifv each item by its basic description (each, square foot, linear foot, project, etc.). Quantity: The number of units contracted. Unit Price: The price per unit. This Period: Quantity: Number of contracted units this period. Amount: Number of contracted units this period X Unit Price. Total to Date: Quantity: Total units billed including this partial payment. Amount: Total quantity X Unit Price. PART C: 1. Amount earned: Total of "This Period" and "Total to Date" columns in Part B. 2. Amount retained: Self-explanatory. 3. Previous payments: Self-explanatory. 4. Amount Due: 1 minus 2 and 3. Estimated Percentage and Progress Schedule: Self-explanatory and required on all contractor items. PART D: Part D, 1, 2, and 3 must be signed. Part D, 2 is always signed by a registered civil engineer unless otherwise approved in writing by DWR. Part D, 3 is always signed by by the Water Co. All signatures on origianl set of the estimate must be original signatures. Additional copies may be made from this set. Please submit the original and four copies of the entire estimate package to the Department of Water Resources, Bond Financing and Administration, P. O. Box 942836, Sacramento, CA 94236-0001. DWR 41359 (Bock) (New 5187) Stare of California Total this DEPARTMENT OE WATER RESOURCES ST''LF The Resources Agency Proposition PL JDIC ESTIMATE FOR PARTIAL PAYME: Page 1 of 1 Total all prior 109,570.77 GENERAL OBLIGATION LOAN Periodic estimates PART A (see Instructions on Reverse Side) tures to date 247, 589.40 247,589.40 XYZ Water Company (PRIVATE) Name of Water Company: Total retention this 14,604.89 14,604.89 periodic estimate Special j Name of Bank: Bank of Unites! States Checking Account No.: 567123-4 Address of Bank: 1234 Any Street, Anywhere, CA 95801 Total retention to date 22,960.89 22,960.89 DWR Telephone No. of Bank: (415) 123-4567 Contract No.: E5XXXX 8 Periodic Estimate No. 2 for Period January 1 19—.a6 to .Tanttary 31 '19 qA PART B — Expenditure Summary 270,550.39 9 BUDGET IN ITEM NO_ ATTACH- ENT NO DESCRIPTION PROJECT EXPENDITURES 3,130.43 STATE FUNDS REQUESTED 1 1 ABC Engineering Consultants 3,130.43 2 2 DEF Law Office 160.00 160.00 3 3 GEH Enterprises 428.00 428.00 3 + JKL, Inc. 2,856.23 2,856.23 4 5 LINO Pipeline, Inc. 131,443.97 131,443.97 (FOR DWR USE ONLY) Amount of this S Partial Payment PAYMENT APPROVED: AUTHORIZED SIGNATURE DEPARTMENT OF WATER RESOURCES Work Order No. Date Pa,d [loim No. POR :WR t1SE SURNAMEI DWR 41358 iNew 6/87) PART C — Totals SUBMIT: Original and four copies to the Department.of Water Resources. Total this 138,018.63 138,018.63 1 Periodic estimate 2 Total all prior 109,570.77 109,570.77 Periodic estimates 3 tures to date 247, 589.40 247,589.40 1 . 2 above 4 Total retention this 14,604.89 14,604.89 periodic estimate j Total retention all prior 8,356.10 8,356.10 periodic estimates 6 Total retention to date 22,960.89 22,960.89 (4 . 5 above) 7 DWR Contract Amount 900.000.00 8 Total funds obligated (3 + 6 above) 270,550.39 9 Funds still available (7 - ft above) 629 449.61 SUBMIT: Original and four copies to the Department.of Water Resources. PART C or PART D 1. Certification of Contractor According to the best of my knowledge and belief, I certify that all items and amounts shown on the foregoing Periodic Estimate for Partial Payment are correct; that all work has been performed and/or material supplied in full accordance with the requirements of the referenced Contract, and/or duly authorized deviations, substitutions, alterations, and/or additions; that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate; that no part of the"Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with the nondiscrimination provisions of the Loan/Grant Contract with the Department of Water Resources. ,Controctari By rSsgnct.,e of Authorized Representatn•ei 2/1 , 19 86 Title 2. Certification of Engineer I certify that I have checked and verified the foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge and belief it is a true and correct statement of work performed and/or material included in this Periodic Estimate has been inspected by me and/or by my duly authorized representative or assistants and that it has been performed and/or supplied in full accordance with requirements of the referenced contract; and that partial payment claimed and requested by the contractor is correctly computed on the basis of work performed and/or material supplied to date. Signed �Eng�neen 2/1/86 Date: 3. Request for Payment by Public Agency or Water Company ' Regi I t ra t'...Ya m he r i The construction of the project is progressing satisfactorily, and to the best of my knowledge the amounts contained in the foregoing Periodic Estimate for Partial Payment are true and correct statements of actual costs incurred for work performed, and I hereby request payment of funds under the Bond Law provisions of the Water Code in the amount of S 3,130.43 for reimbursement of eligible project costs estimated above. •Authunred. Designated Sig—t—, 2/1/86 Mate, DwR 4135C i8ack) jNew 6/87) THIS PERIOD TOTAL TO DATE Amount Earned S 3,130.43 S 28,825.20 Amount Retained $ NA S NA Previous Payments S XXXXXXXXXXXXXXXXXXX $ 25 694.77 Amount Due $ 3 13;=.43 $ 130.43 Estimated Percentage of Job Completed Is Contractor's Construction Progress on Schedule? F-1 Yes F� No* *Explain: 10 N/A PART D 1. Certification of Contractor According to the best of my knowledge and belief, I certify that all items and amounts shown on the foregoing Periodic Estimate for Partial Payment are correct; that all work has been performed and/or material supplied in full accordance with the requirements of the referenced Contract, and/or duly authorized deviations, substitutions, alterations, and/or additions; that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate; that no part of the"Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with the nondiscrimination provisions of the Loan/Grant Contract with the Department of Water Resources. ,Controctari By rSsgnct.,e of Authorized Representatn•ei 2/1 , 19 86 Title 2. Certification of Engineer I certify that I have checked and verified the foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge and belief it is a true and correct statement of work performed and/or material included in this Periodic Estimate has been inspected by me and/or by my duly authorized representative or assistants and that it has been performed and/or supplied in full accordance with requirements of the referenced contract; and that partial payment claimed and requested by the contractor is correctly computed on the basis of work performed and/or material supplied to date. Signed �Eng�neen 2/1/86 Date: 3. Request for Payment by Public Agency or Water Company ' Regi I t ra t'...Ya m he r i The construction of the project is progressing satisfactorily, and to the best of my knowledge the amounts contained in the foregoing Periodic Estimate for Partial Payment are true and correct statements of actual costs incurred for work performed, and I hereby request payment of funds under the Bond Law provisions of the Water Code in the amount of S 3,130.43 for reimbursement of eligible project costs estimated above. •Authunred. Designated Sig—t—, 2/1/86 Mate, DwR 4135C i8ack) jNew 6/87) DLII LL State of California DEPARTMENT OF WATER RESOURCES^ GENERAL OBLIGATION LOAN/GRANT PARTIAL PAYMENT ESTIMATE PART A NAME OF CONTRACTOR: ABC Engineering Consultants The Resources Agency Attachment No. 1 of 5 Periodic Estimate No. 2 DWR Contract No. Proposition NAME OF PUBLIC AGENCY/WATER CO. TELEPHONE NO. ,XYZ Water Company DATE OF COMPLETION: AMOUNT OF CONTRACT: DATES OF ESTIMATE: Original Original S NSA From 1/1/86 Revised Revised S To 1/31/86 DESCRIPTION OF JOB: Water System Improvement Design and Surveying preparatory to and during construction; Contra Administration, Engineering Coordination and Supervision during construction; Preparation of PART B Grade Sheets, Constructing Staking, etc. *5how Original Items and Change Orders Separately. DWR 4135C (New 6/87) CONTRACT ITEMS THIS PERIOD TOTAL TO DATE ITEM* UNIT QUANTITY UNIT PRICE QUANTITY AMOUNT QUANTITY AMOUNT State Loan Design Project Our W.O. 106-35 See Attachel Summary of Invoices ani Copy of Invoices $3,130.43 S28,825.20 *5how Original Items and Change Orders Separately. DWR 4135C (New 6/87) S A M P L E ABC ENGINEERING CONSULTANTS February 1, 1986 SUMMARY: STATE LOAN DESIGN PROJECT 106-35.1 Invoice Date: Invoice Number: Engineering Fees: Incidental Expenses: TOTAL: 1/10/86 3221 $ 2,090.00 $ 279.97 $ 2,369.97 1/10/86 3222 255.00 9.27 264.27 1/10/86 3223 278.00 .52 278.52 1/10/86 3224 209.00 8.67 217.67 TOTAL: $ 2,832.00 $ 290.43 $ 3,130.43 ABC ENGINEERING CONSULTANTS (714) 684-6900 S A M P L E Invoice NO. 3221 Date February 1, 1986 BILLING PERIOD: From 1/1/86 to 1/31/86 Account 106-35.2 DDf1TWIM. _ _ STAIR T flnTL_.IIFSTC9d . DDCI7FCT. C_RAiF.D�i.... TTRMR . ('f1DRRCDf1NT1RNf`R .. - . General Design; Specification * Preparation, and Related Work. Services - Office -- *X Hours 3 $ Y; - *X Hours a $ Y ** 374.00 *X Hours 3 $ Y ** 672.00 $ 2,090.00 $ 2,090.00 Incidental Expenses Prints $ 159.15 Covers, Binders, Dividers - 30.60 UPS 30.46 The Sun -Telegram 59.76 $ 279.97 $ 279.97 TOTAL DUE $ 2,369.97 X --number of hours _ ** Y=hourly rate ABC ENGINEERING -CONSULTANTS (714) 684-6900 S A M P L E Invoice NO. 3222 Date February 1, 1986 BILLING PERIOD: From 1/1/86 to 1/31/86 Account 106-35.3 PROJECT: PANORAMA TIE -LINE Design and.Drafting;.Drafting Specification Exhibit for Project Sign. Services - Office *X Hours @ $ Y ** *X Hours @ $ Y ** Incidental Expenses Telephone Prints TOTAL DUE * X --number of hours ** Y=hourly rate $ 46.00 209.00 $ -255.00 $ .60 8.67 $ 255.00 $ 9.27 $ 9.27 $ 264.27 ABC ENGINEERING CONSULTANTS (714) 684-6900 S A M P L E Invoice NO. 3223 Date February 1, 1986 BILLING PERIOD: From 1/1/86 to 1/31/86 Account 106-35.4 PROJECT: STATE LOAN DESIGN PROJECT - PANORAMA PRESSURE REDUCERS & HYDROPNEUMATIC TANK Drafting and Design. Services - Office *X Hours @ $ Y ** $ 18.00 *X Hours a $ Y ** 253.00 *X Hours a $ Y ** 7.00 $ 278.00 $ 278.00 Incidental Expenses Telephone $ _..12 Prints .40 $ .52 $ .52 TOTAL DUE $ 278.52 * X=number of hours _ ** Y=hourly rate ABC ENGINEERING CONSULTANTS (714) 684-6900 S A M P L E Invoice NO. 3224 Date February 1, 1986 BILLING PERIOD: From 1/1/86 to 1/31/86 Account 106-35.5 PROTECT: STATE LOAN PROJECT - TERRACE TIE -LINE Drafting and Design. Services - Office *X Hours @ $ Y ** $ 209.00 $ 209.00 Incidental Expenses - Prints 8.67 $ 8.67 TOTAL.DUE $ 217.67 * X --number of hours - ** Y=:hourly rate PART C PART D 1. Certification of Contractor According to the best of my knowledge and belief, I certify that all items and amounts shown on the foregoing Periodic Estimate for Partial Payment are correct; that all work has been performed and/or material supplied in full accordance with the requirements of the referenced Contract, and/or duly authorized deviations, substitutions, alterations, and/or additions; that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate; that no part of the "Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with the nondiscrimination provisions of the Loan/Grant Contract with the Department of Water Resources. 'Cuntrar[oq By tStgnat.re of Authorized Reprexrtfatn't[ 2/1 .19 86 Title 2. Certification of Engineer I certify that I have checked and verified the foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge and belief it is a true and correct statement of work performed and/or material included in this Periodic Estimate has been inspected by me and/or by my duly authorized representative or assistants and that it has been performed and/or supplied in full accordance with requirements of the referenced contract; and that partial payment claimed and requested by the contractor is correctly computed on the basis of work performed and/or material supplied to date. Signed Date: 2/1/86 ,Engineer) rRegat•atwn N—b,,, 3. Request for Payment by Public Agency or Water Company The construction of the project is progressing satisfactorily, and to the best of my knowledge the amounts contained in the foregoing Periodic Estimate for Partial Payment are true and correct statements of actual costs incurred for work performed, and I hereby request payment of funds under the Bond Law provisions of the Water Code in the amount of S 1 fin - nn for reimbursement of eligible project costs estimated above. .{.!hunted, hes,mrtoted Slpnat.,e, 2/1/86 ,Dater DWR 4135C ,Back; (New 6/87) THIS PERIOD TOTAL TO DATE Amount Earned $ $ 160.00 475.00 Amount Retained S $ Previous Payments S XXXXXXXXXXXXXXXXXXX S 315.00 Amount Due $ 160.00 $ 160.00 Estimated Percentage of Job Completed Is Contractor's Construction Progress on Schedule? ❑ Yes ❑ No* *Explain: N/A PART D 1. Certification of Contractor According to the best of my knowledge and belief, I certify that all items and amounts shown on the foregoing Periodic Estimate for Partial Payment are correct; that all work has been performed and/or material supplied in full accordance with the requirements of the referenced Contract, and/or duly authorized deviations, substitutions, alterations, and/or additions; that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate; that no part of the "Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with the nondiscrimination provisions of the Loan/Grant Contract with the Department of Water Resources. 'Cuntrar[oq By tStgnat.re of Authorized Reprexrtfatn't[ 2/1 .19 86 Title 2. Certification of Engineer I certify that I have checked and verified the foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge and belief it is a true and correct statement of work performed and/or material included in this Periodic Estimate has been inspected by me and/or by my duly authorized representative or assistants and that it has been performed and/or supplied in full accordance with requirements of the referenced contract; and that partial payment claimed and requested by the contractor is correctly computed on the basis of work performed and/or material supplied to date. Signed Date: 2/1/86 ,Engineer) rRegat•atwn N—b,,, 3. Request for Payment by Public Agency or Water Company The construction of the project is progressing satisfactorily, and to the best of my knowledge the amounts contained in the foregoing Periodic Estimate for Partial Payment are true and correct statements of actual costs incurred for work performed, and I hereby request payment of funds under the Bond Law provisions of the Water Code in the amount of S 1 fin - nn for reimbursement of eligible project costs estimated above. .{.!hunted, hes,mrtoted Slpnat.,e, 2/1/86 ,Dater DWR 4135C ,Back; (New 6/87) State of California DEPARTMENT OF 'NATER RESOURCES J t''lrl'L GENERAL OBLIGATION LOAN/GRANT PARTIAL PAYMENT ESTIMATE PART A NAME OF CONTRACTOR: DEF Law Offices NAME OF PUBLIC AGENCY/WATER CO. TELEPHONE NO. XYZ Water Company The Resources Agency Attachment No. 2 of 5 Periodic Estimate No. 2 DWR Contract No. Proposition DATE OF COMPLETION: AMOUNT OF CONTRACT: DATES OF ESTIMATE: Original Original $ NIA From 1/1 /RFi Revised Revised $ To 1/31/86 DESCRIPTION OF JOB: Legal Services PART B *Show Original Items and Change Orders Separately. JWR A135C (New 6/87) CONTRACT ITEMS THIS PERIOD TOTAL TO DATE ITEM* UNIT QUANTITY UNIT PRICE QUANTITY AMOUNT QUANTITY AMOUNT See Attach ad Invoice N/A 160.00 N/A 475.00 *Show Original Items and Change Orders Separately. JWR A135C (New 6/87) S A M P L E DEF Law Offices February 1, 1986 PROFESSIONAL SERVICES AS FOLLOWS: 1/10/86 Preparation of four letters (certified mail) requesting Easement for new Domestic Water Line. $80.00 1/29/86 Preparation of four letters (certified mail) re proposed Right of Way Easement in the vicinity of "S" Road. $80.00 PART C TH15 PERIOD T T TO DATE PART D 1. Certification of Contractor According to the best of my knowledge and belief, I certify that all items and amounts shown on the foregoing Periodic Estimate for Partial Payment are correct, that all work has been performed and/or material supplied in full accordance with the requirements of the referenced Contract, and/or duly authorized deviations, substitutions, alterations, and/or additions; that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate; that no part of the "Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with the nondiscrimination provisions of the Loan/Grant Contract with the Department of Water Resources. ,Cantr6e1ar/ By (Signature of Authorized Representattrr, 2/1 , 19 86 Title 2. Certification of Engineer I certify that I have checked and verified the foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge and belief it is a true and correct statement of work performed and/or material included in this Periodic Estimate has been inspected by me and/or by my duly authorized representative or assistants and that it has been performed and/or supplied in full accordance with requirements of the referenced contract; and that partial payment claimed and requested by the contractor is correctly computed on the basis of work performed and/or material supplied to date. Signed ,Enginerrl ,Reg,stranon Number, Date: 2/1/86 3. Request for Payment by Public Agency or Water Company The construction of the project is progressing satisfactorily, and to the best of my knowledge the amounts contained in the foregoing Periodic Estimate for Partial Payment are true and correct statements of actual costs incurred for work perfor" � I hereby request payment of funds under the Bond Law provisions of the Water Code in the amount of 5 for reimbursement of eligible project costs estimated above. il-9—tea S,Rnarure, 2/1/86 Date, DWR 4135C (Bock) (New 6%87) 0 Ai- LAmount AmountEarned S 428.00 S 428.00 Amount Retained $ None $ None Previous Payments $ XXXXXXXXXXXXXXXXXXX $ Amount Due $ 428.00 $ 428.00 Estimated Percentage of Job Completed Is Contractor's Construction Progress on Schedule? ❑ Yes F� No* *Explain: °i N/A PART D 1. Certification of Contractor According to the best of my knowledge and belief, I certify that all items and amounts shown on the foregoing Periodic Estimate for Partial Payment are correct, that all work has been performed and/or material supplied in full accordance with the requirements of the referenced Contract, and/or duly authorized deviations, substitutions, alterations, and/or additions; that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate; that no part of the "Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with the nondiscrimination provisions of the Loan/Grant Contract with the Department of Water Resources. ,Cantr6e1ar/ By (Signature of Authorized Representattrr, 2/1 , 19 86 Title 2. Certification of Engineer I certify that I have checked and verified the foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge and belief it is a true and correct statement of work performed and/or material included in this Periodic Estimate has been inspected by me and/or by my duly authorized representative or assistants and that it has been performed and/or supplied in full accordance with requirements of the referenced contract; and that partial payment claimed and requested by the contractor is correctly computed on the basis of work performed and/or material supplied to date. Signed ,Enginerrl ,Reg,stranon Number, Date: 2/1/86 3. Request for Payment by Public Agency or Water Company The construction of the project is progressing satisfactorily, and to the best of my knowledge the amounts contained in the foregoing Periodic Estimate for Partial Payment are true and correct statements of actual costs incurred for work perfor" � I hereby request payment of funds under the Bond Law provisions of the Water Code in the amount of 5 for reimbursement of eligible project costs estimated above. il-9—tea S,Rnarure, 2/1/86 Date, DWR 4135C (Bock) (New 6%87) State of California DEPARTMENT OF WATER RESOURCES SAMPLE The Resources Agency Attachment No. _ 3 of 5_ GENERAL OBLIGATION LOAN/GRANT Periodic Estimate No. 2 PARTIAL PAYMENT ESTIMATE DWR Contract No. Proposition PART A NAME OF CONTRACTOR: GHI Enterprises NAME OF PUBLIC AGENCY/WATER CO. TELEPHONE NO. XYZ Water Company DATE OF COMPLETION: AMOUNT OF CONTRACT: DATES OF ESTIMATE= Original Original $ N/A From 1/1/86 Revised Revised S To 1/31/86 DESCRIPTION OF JOB: Water Conservation Kits PART B 't Show Original Items and Change Orders Separately. DWR 4135C INe- 6/87) CONTRACT ITEMS THIS PERIOD TOTAL TO DATE ITEM* UNIT QUANTITY UNIT PRICE QUANTITY AMOUNT QUANTITY AMOUNT Kit - See Each 200 2.14 200 $428.0 200 $428.00 Invoice 't Show Original Items and Change Orders Separately. DWR 4135C INe- 6/87) GHI Enterprises PROJECT: S A M P L E Invoice NO. 1287 Date February 1, 1986 BILLING PERIOD: From To Account CUSTOMER PO NO ORDER DATE DATE SHIPPED SALESMAN ROUTING per verbal 3 Jan 86 7 Jan 86 SS Shipped UPS Quantity Quantity Remaining Unit Ordered Shipped on Order Price Unit Amount COMPLETE WATER GUARD CONSERVATION KIT (2 Toilet Tank Inserts, 2 Shower Flow Restrictors, 2 Leak Detectors) TER,"!S : 30 days NET 200 ea 200 ea -0- $2.14 each $428.00 INVOICE TOTAL - $428.00 PART C Tulc oC DI(1r1 PART D 1. Certification of Contractor According to the best of my knowledge and belief, I certify that all items and amounts shown on the foregoing Periodic Estimate for Partial Payment are correct; that all work has been performed and/or material supplied in full accordance with the requirements of the referenced Contract, and/or duly authorized deviations, substitutions, alterations, and/or additions; that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate; that no part of the "Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with the nondiscrimination provisions of the Loan/Grant Contract with the Department of Water Resources. By (Signature of Authorized Repeesentatu e. 2/1 , 19 _ 86.— Title 2. Certification of Engineer I certify that I have checked and verified the foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge and belief it is a true and correct statement of work performed and/or material included in this Periodic Estimate has been inspected by me and/or by my duly authorized representative or assistants and that it has been performed and/or supplied in full accordance with requirements of the referenced contract; and that partial payment claimed and requested by the contractor is correctly computed on the basis of work performed and/or material supplied to date. Signed •Entnneeo Date: 21/11/86 3. Request for Payment by Public Agency or Water Company tReglateauon Numhen The construction of the project is progressing satisfactorily, and to the best of my knowledge the amounts contained in the foregoing Periodic Estimate for Partial Payment are true and correct statements of actual costs incurred for work performed, and I hereby request payment of funds under the Bond Law provisions of the Water Code in the amount of j 2,956.23 for reimbursement of eligible project costs estimated above. D-im—ted S,gnatmw 2/1/86 DwR 4135C j8cc'lm "New 6;87) I VIMI I V V..� Amount Earned 5 2,856.23 $ 2,856.23 Amount Retained $ Kone $ None Previous Payments 5 XXXXXXXXXXXXXXXXXXX S Amount DueS 2,856.23 5 2,856.23 Estimated Percentage of Job Completed Is Contractor's Construction Progress on Schedule? ® Yes No* *Explain: 100 a PART D 1. Certification of Contractor According to the best of my knowledge and belief, I certify that all items and amounts shown on the foregoing Periodic Estimate for Partial Payment are correct; that all work has been performed and/or material supplied in full accordance with the requirements of the referenced Contract, and/or duly authorized deviations, substitutions, alterations, and/or additions; that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate; that no part of the "Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with the nondiscrimination provisions of the Loan/Grant Contract with the Department of Water Resources. By (Signature of Authorized Repeesentatu e. 2/1 , 19 _ 86.— Title 2. Certification of Engineer I certify that I have checked and verified the foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge and belief it is a true and correct statement of work performed and/or material included in this Periodic Estimate has been inspected by me and/or by my duly authorized representative or assistants and that it has been performed and/or supplied in full accordance with requirements of the referenced contract; and that partial payment claimed and requested by the contractor is correctly computed on the basis of work performed and/or material supplied to date. Signed •Entnneeo Date: 21/11/86 3. Request for Payment by Public Agency or Water Company tReglateauon Numhen The construction of the project is progressing satisfactorily, and to the best of my knowledge the amounts contained in the foregoing Periodic Estimate for Partial Payment are true and correct statements of actual costs incurred for work performed, and I hereby request payment of funds under the Bond Law provisions of the Water Code in the amount of j 2,956.23 for reimbursement of eligible project costs estimated above. D-im—ted S,gnatmw 2/1/86 DwR 4135C j8cc'lm "New 6;87) State of California _DEPARTMENT OF WATER RESOURCES J L'tYLG The Resources Agency Attachment No. 4 of 5 GENERAL OBLIGATION LOAN/GRANT Periodic Estimate No. 2 PARTIAL PAYMENT ESTIMATE DWR Contract No. Proposition PART A NAME OF CONTRACTOR: JKL, Inc. NAME OF PUBLIC AGENCY/WATER CO. TELEPHONE NO. XYZ Water Company DATE OF COMPLETION= AMOUNT OF CONTRACT: DATES OF ESTIMATE: Original Original $ 2,856_21 From 1/1/86 Revised Revised $ To 1/31/86 DESCRIPTION OF JOB: Material only, purchase of 20 H.P. Submersible Pumping Unit for Panorama Heights Well PART B *Show Original items and Change Orders Separately. DWR AI35C (New 6/87) CONTRACT ITEMS THIS PERIOD TOTAL TO DATE ITEM* UNIT QUANTITY UNIT PRICE QUANTITY AMOUNT OUANTITY AMOUNT Pump 1 each 1 each L.S. Complete $2,856.23 Complete $2,856.23 (See attached quotati n sheet) *Show Original items and Change Orders Separately. DWR AI35C (New 6/87) S A M P L E JILL, INC. PQR Pumps December 1, 1985 ABC Engineering Consultants 123 MainStreet Any Town, CA Attention: RE: Quotation on 20 HP Submersible Pump Gentlemen: Per your request we are pleased to submit for your consideration the following quotation. Accordingly, we offer: 1 Model 20 HP Submersible Pump and Motor 100 GPM at 485' TDH $2,354.40 250' #8-3 Cable 165.00 1 12" x 3" x 4" Well Seal 104.40 $2,623.80 6% Sales Tax 157.43 Freight 75.00 TOTAL $2,856.23 Labor to install assuming we have to use the existing pump is $650.00. Delivery can be made within 15 working days. The bowl assembly quoted is a 10 stage with bronze impellers, stainless steel shaft and cast iron bowls. Thank you for the opportunity of submitting this quotation. Very truly yours, JKL, INC. By JKL, INC. PQR Pumps PROJECT: S A M P L E Invoice NO. 4505 Date February lr 1986 BILLING PERIOD: From To Account Customer Order No. Order Date Shipped Via Date Shipped Terms 2249 1/6/86 System 99 1/15/86 Net 30 Days 1 Submersible Pump and Motor 250 #8-3 Cable 1 12" Well Seal 1 Delivery 1 Sales Tax TOTAL $2,856.23 THANK YOU Job # 78-274 PART C PART D 1. Certification of Contractor According to the best of my knowledge and belief, I certify that all items and amounts shown on the foregoing Periodic Estimate for Partial Payment are correct; that all work has been performed and/or material supplied in full accordance with the requirements of the referenced Contract, and/or duly authorized deviations, substitutions, alterations, and/or additions; that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate; that no part of the"Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with the nondiscrimination provisions of the Loan/Grant Contract with the Department of Water Resources. ivIN0 Pipelines, Inc. B (Contractor' y 'Signature of Authort:ed Representaheet 2/1 2. Certification of Engineer 19 86 Title President I certify that I have checked and verified the foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge and belief it is a true and correct statement of work performed and/or material included in this Periodic Estimate has been inspected by me and/or by my duly,authorized representative or assistants and that it has been performed and/or supplied in full accordance with requirements of the referenced contract; and that partial payment claimed and requested by the contractor is correctly computed on the basis of work performed and/or material supplied to date. Signed 'Engineer Date: 2/1/86 3. Request for Payment by Public Agency or Water Company 1Regv1ra1,an N -6f" The construction of the project is progressing satisfactorily, and to the best of my knowledge the amounts contained in the foregoing Periodic Estimate for Partial Payment are true and correct statements of actual costs incurred for work performed anc� I he �,by request payment of funds under the Bond Law provisions of the Water Code in the amount of S 131 X43 �� for reimbursement of eligible project costs estimated above. Author' -a. Designated Signature, 2/1/86 'Date, OWR 4135C i8ack) (New 6/87) THIS PERIOD TOTAL TO DATE Amount Earned $ 146,048.86 $ 146,048,86 Amount Retained S 14,604.89 $ 14,604.89 Previous Payments $ XXXXXXXXXXXXXXXXXXX S —0— Amount Due $ 131,443.97 S 131,443.97 Estimated Percentage of Job Completed Is Contractor's Construction Progress on Schedule? El Yes a No* *Explain: 87 ar �c PART D 1. Certification of Contractor According to the best of my knowledge and belief, I certify that all items and amounts shown on the foregoing Periodic Estimate for Partial Payment are correct; that all work has been performed and/or material supplied in full accordance with the requirements of the referenced Contract, and/or duly authorized deviations, substitutions, alterations, and/or additions; that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate; that no part of the"Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with the nondiscrimination provisions of the Loan/Grant Contract with the Department of Water Resources. ivIN0 Pipelines, Inc. B (Contractor' y 'Signature of Authort:ed Representaheet 2/1 2. Certification of Engineer 19 86 Title President I certify that I have checked and verified the foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge and belief it is a true and correct statement of work performed and/or material included in this Periodic Estimate has been inspected by me and/or by my duly,authorized representative or assistants and that it has been performed and/or supplied in full accordance with requirements of the referenced contract; and that partial payment claimed and requested by the contractor is correctly computed on the basis of work performed and/or material supplied to date. Signed 'Engineer Date: 2/1/86 3. Request for Payment by Public Agency or Water Company 1Regv1ra1,an N -6f" The construction of the project is progressing satisfactorily, and to the best of my knowledge the amounts contained in the foregoing Periodic Estimate for Partial Payment are true and correct statements of actual costs incurred for work performed anc� I he �,by request payment of funds under the Bond Law provisions of the Water Code in the amount of S 131 X43 �� for reimbursement of eligible project costs estimated above. Author' -a. Designated Signature, 2/1/86 'Date, OWR 4135C i8ack) (New 6/87) State at California nEPARTMENT OF WATER RESOURCES `'AMPLE The Resources Agency Attachment No. 5 of 5 GENERAL OBLIGATION LOAN/GRANT Periodic Estimate No. 2 PARTIAL PAYMENT ESTIMATE DWR Contract No. Proposition PART A NAME OF CONTRACTOR: MNO Pipeline Incorporated NAME OF PUBLIC AGENCY/WATER CO• TELEPHONE NO. XYZ Water Company DATE OF COMPLETION: AMOUNT OF CONTRACT: DATES OF ESTIMATE: Original Original S 166.990.40 From 1 /1 186 Revised Revised $ To �f�6 DESCRIPTION OF JOB: Construction Contract PART B 'Show Original Items and Change Orders Separately. DWR 4135C .;Ne- 6/87) CONTRACT ITEMS THIS PERIOD TOTAL TO DATE ITEM* UNIT QUANTITY UNIT PRICE QUANTITY AMOUNT QUANTITY AMOUNT See Attachel Contract Partial Payment Request $131,443.97 $131,443.97 'Show Original Items and Change Orders Separately. DWR 4135C .;Ne- 6/87) 0 S A M P L L•' DATE 2/1/86 Page 1 of 3 CONTRACT DOCUMENTS FOR FURNISH AND CONSTRUCT TERRACE TIE LINE & APPURTENANCES AND PANORAMA MNO Pipeline Inc. HEIGHTS TIE LINE, PRESSURE TANK & PRESSURE REDUCER INSTALLATIONS WITH FENCING & APPURTENANCES PARTIAL PAYMENT REQUEST NO. 1 Bid Item No. or Sub -Item Contract Percent Amount Bid Item or Change Change Order No. No. Description Amount Completed Completed Order Total 101 101.1 6" AC Pipe 36,889.66 95% 35,045.17 101 101.2 6" Gate Valve 1,680.00 95% 1,596.00 101 101.3 6" Fire Hydrant 950.00 100% 950.00 101 101.4 Conn. to exist 200.00 100% 200.00 101 101.5 Conn. to exist 200.00 100% 200.00 101 101.6 Slope Trench 100.00 100% 100.00 202 202.1 12" A.C. Pipe 10,222.60 95% 9,711.47 202 202.2 8" A.C. Pipe 80,567.50 95% 76,539.12 202 202.3 6" A.C. Pipe 4,719.12 95% 4,483.16 7btal Completed = 128,824.92 Engineer's Statement We have examined this Payment Request and approve it for payment Less 10% Retention = subject to the noted changes and/or corrections. Balance = By Less Previous Payments = DATE 2/1/86 Page 2 of 3 CONTRACT DOCUMENTS FOR FURNISH AND CONSTRUCT TERRACE TIE LINE & APPURTENANCES AND PANORAMA MNO Pipeline Inc. HEIGHTS TIE LINE,'PRESSURE:TANK & PRESSURE REDUCER INSTALLATIONS WITH FENCING & APPURTENANCES PARTIAL PAYMENT REQUEST NO.• 1 Bid Item No. or Sub -Item Contract Percent Amount Bid Item or Change Change Order No. No. Description Amount Completed Completed Order Total 202 202.4 6" AC Pipe 6,351.52 95% 6,033.94. 202 202.5 6" Gate Valve 2,040.00 100% 2,040.00 202 202.6 6" Gate Valve 1,200.00 100% 1,200.00 202 202.7 6" Fire Hydrant 4,750.00 100% 4,750.00 202 202.8 6" Fire Hydrant 1,000.00 100% 11000.00 202 202.9 Conn. to exist 200.00 100% 200.00 202 202.10 Conn. to exist 200.00 0 a 202 202.11 1" Air Valve 200.UO 0 Total Completed = Engineer's Statement We have examined this Payment Request and approve it for payment Less 10% Retention = subject to the noted changes and/or corrections. Balance = By Less Previous Payments = TOTAL DUE SAMPIX MNO Pipeline Inc. Bid Item No. or Change Order No. Sch II 201 Sch II 202 Sch II 203 Sch II 203 Sch II 209 Sch II 204 Sch II 204 Sch II 204 i CONTRACT DOCUMENTS FOR. FURNISH AND CONSTRUCT TERRACE TIE .LINE & APPURTENANCES.AND PANORAMA HEIGHTS TIE LINE, PRESSURE TANK & PRESSURE REDUCER INSTALLATIONS WITH FENCING & APPURTENANCES PARTIAL PAYMENT REQUEST NO. 1 Sub --Item Contract Percent No. Description Amount Completed Pressure Red Sta. 5,000.00 0 Pressure Tank 5,000.00 408 203.1 Fencing 1,290.00 0 203.2 12" Gates 400.00 0 203.3 30" Gates 170.00 0 204.1 Fencing 1,830.00 0 204.2 16" Gate 500.00 0 204.3 30" Gate 170.00 0 Engineer's Statement We have examined this Payment Request and approve it for payment subject to the noted changes and/or corrections. By DATE 2/1/86 Page 3 of 3 Amount Completed Total Completed = Less 10% Retention Balance = Less Previous Payments = TOTAL DUE Bid Item'.or Change Order Total 2,000.00 146,048.86 14,604.89 131,443.97