HomeMy WebLinkAboutItem 06.mJune 27, 2013 Item No
RESOLUTION ACCEPTING BIDS AND AWARDING CONTRACT
FOR THE KENRICK AVENUE TRAIL AND 195 STREET TRAIL CONSTRUCTION
PROJECT, IMPROVEMENT PROJECT 06 -23
Proposed Action
Staff recommends adoption of the following motion: Move to approve resolution accepting
bids and awarding contract for the Kenrick Avenue Trail and 195 Street West Trail
Construction Project, Improvement Project 06 -23. Approval of the motion will result in
accepting bids and awarding contract to Rosti Construction of MN, Inc. for the construction of
the Kenrick Avenue and 195 Street Trail project.
Overview
The construction of the Kenrick Avenue Trail (also known as the Lake Marion Loop), has been
in the planning stages for many years dating back to a Feasibility Study that was completed
for the project in 2007. The trail is proposed to be constructed along the east side of Kenrick
Avenue from the Park & Ride to 205th Street and alongside the south side of 195th Street from
Kenrick Avenue to Casperson Park. This trail would complete a significant trail segment to the
City's existing trail system that would provide pedestrian and bike safety, be constructed with
a significant contribution from a Federal Grant ($826,400.00) and meet the desires and wishes
of many Lakeville residents.
On June 3, 2013 four bids were received for the project with Rosti Construction of MN, Inc.
submitting the low bid of $1,874,210.40. Funding for the project will be financed from a
Federal Grant ($826,400.00), Dakota County Grant ($22,000.00), Lake Marion HOA ($2,000.00)
and the Park Dedication Fund ($1,360,875.00) for a total project cost of $2,211,275.00.
Primary Issues to Consider (see attachment)
• Historical Background
• Financial Historical Perspective
• Financing Recommendation
• Staff Recommendation
Supporting Information
• Project Bid Abstract
• Memorandum dated June 18, 2013 from WSB & Associates on project
• Contract for Construction between the City of Lakeville and Rosti Construction of MN, Inc.
Brett Altergott
Parks & Recreation it ctor
Financial Impact: $ 2,211,275.00 Budgeted: Y/N Y Source: Federal Grant, Dakota
County Grant, Lake Marion HOA and Park Dedication Fund
Related Documents (CIP, ERP, etc.):
Notes:
Primary Issues to Consider
HISTORICAL BACKGROUND
A Feasibility Study was completed for the project in 2007. In 2009, the City was successful in
securing a $1 million Federal Grant for the project. This project included the construction of a
trail on the bluffs of Lake Marion on property owned by the Bury family. An agreement with
the Bury family could not be reached so staff proceeded to work with MnDOT and the
Metropolitan Council to complete a Scope of Change on project which entailed relocating the
trail from the bluffs to the south side of 195th Street from Casperson Park to Kenrick Avenue.
The Scope of Change and Federal Grant were approved equaling $826,400.
Construction and financing of the trail on Kenrick Avenue, from the Park & Ride to 205th Street
and alongside the south side of 195th Street from Kenrick Avenue to Casperson Park, was
presented to the City Council at a Work Session in March of 2012. After the Work Session,
WSB was authorized to proceed with the preparation of plans and specifications.
Ten bids were received for the project on September 18, 2012. The engineer's estimate for
the project was $1,190,559.20. The low bid was submitted by Rosti Construction of Minnesota,
Inc. with a bid of $1,333,333.00 which was 12% higher than the engineer's estimate.
On October 1, 2012 the Council rejected the bids and re -bid the project in early 2013 with the
expectation of receiving more favorable bids.
Prior to rebidding, staff and WSB reviewed different design options in the attempt to lower
costs such as the elimination of some or all of the over 700' of boardwalk that was designed as
part of the original bid package. The attached memo from WSB explains the steps that were
taken and the complexity of the project.
After the redesign of the trail, bids were opened again on June 3, 2013. Four bids were
received for the project with Rosti Construction of Minnesota, Inc. submitting the low bid of
$1,874,210.40 which is 13% higher than the engineer's estimate of $1,657,349.
FINANCIAL HISTORICAL PERSPECTIVE
The current Kenrick Avenue Trail plan location was established in March of 2012 with a
budget based on engineer's estimate as $1.30 million. The project budget was revised as
$1.797 million in September 2012 after bids were opened.
The project costs have increased to $2.211 million based on recent June bids which includes a
$93,710 contingency which is 5% of the construction costs. The 5% contingency was
recommended by WSB and is consistent with contingency used for street construction
projects. Staff is recommending the City share of project costs ($1.36 million) be financed
from the Park Dedication Fund.
Estimate
March 2012
Estimate
Sept 2012
Estimate
June 2013
Revenues
970,360
674,315
73,759
Federal Grant
826,400
826,400
826,400
Dakota County Grant
22,000
13,980
22,000
Lake Marion Assoc.
127,677
(105,704)
2,000
Park Dedication Fund
451,600
957,121
1,360,875
(262,246
(200,196)
Total Revenues $
1,300,000
$ 1,797,501
$ 2,2 11,275
(125,283)
Expenditures
Construction Contract
1,033,000
1,603,333
1,874,210
Engineering (estimate)
160,932
164,000
205,000
Other (incl contingency)
106,068
30,168
132,065
Total Project Cost $ 1, $ 1,7 $ 2,211,27
FINANCING RECOMMENDATION
Park Dedication Fund
The 2012 Park Dedication fund balance was $971,193 more than anticipated as a result of the
resurgence in single family development activities and as a result of not pursuing the Bury
property acquisitions at this time.
Revenues
Park Development Fees
Other
Total Revenues
Expenditures
Bury Property Acqusitions
Developer Credits
Other
Total Expenditures
Increase / (decrease)
Fund Balance, January 1
Fund Balance, December 31
2012
Budget
Actual Variance
296,045
970,360
674,315
73,759
108,391
34,632
$ 369,804 $
1,078,751 $
708,947
300,000
-
300,000
21,973
127,677
(105,704)
248,027
180,077
67,950
$ 570,000 $
307,754 $
(262,246
(200,196)
770,997
971,193
751,325
626,042
(125,283)
$ 551,129 $ 1,397,039 $ 845,910
In 2013, Park Dedication fees have already exceeded budget estimates by $194,079 and
developer credits are $102,477 less than budget. The 2012 increase in fund balance
combined with the 2013 development activity exceeding budget, provide adequate and
sufficient financing for the Kenrick Avenue Trail project.
2013
Revenues
Park Development Fees
Other
Total Revenues
Expenditures
Kenrick Avenue Trail
Dodd Blvd Trai I
Developer Credits
Other
Total Expenditures
Increase / (decrease)
Fund Balance, January 1
Fund Balance, December 31
Budget Estimated Variance
525,448
719,527
194,079
100,945
105,646
4,701
$ 626,393
$ 825,173
$ 198,780
957,121
1,360,875
(403,754)
146,700
146,700
-
149,000
46,523
102,477
67.000
67,000
-
S 1.319.821
$ 1,621,098
S (301.277)
(693,428)
(795,925)
(102,497)
1,397,039
1,397,039
-
$ 703,611
$ 601,114
$ (102,497)
STAFF RECOMMENDATION
The Kenrick Avenue Trail project has become much more complex and expensive than
originally anticipated. While the project costs have substantially exceeded the original
estimate in 2012, the project is feasible and it can be reasonably assumed that the project will
not become less expensive.
Federal funding for the project is currently available but will be lost if the City does not
proceed this year. Local funding can be accomplished with Park Dedication funds due to
greater than anticipated platting in the City. The additional funding will not jeopardize other
projects. However, in the 2013 -2017 Parks & Recreation CIP $138,500 is budgeted in 2015 for
paving of parking lots at Meadows, Foxburough, and Dodd Trail Parks which could be
deferred if necessary. Staff recommends the City Council discuss the CIP priorities during the
budget process.
The project will provide substantial benefits for the community and enjoys community
support.
Staff is recommending the City Council proceed with the project and the City share of the
Kenrick Avenue trail project be financed from the Park Dedication Fund.
CITY OF LAKEVILLE
RESOLUTION NO.
RESOLUTION ACCEPTING BIDS AND AWARDING CONTRACT
FOR THE KENRICK AVENUE TRAIL AND 195 STREET TRAIL CONSTRUCTION PROJECT,
IMPROVEMENT PROJECT 06 -23
WHEREAS, notices to bidders for the acceptance of sealed bids for the Kenrick Avenue
Trail and 195 Street West Trail Construction Project was officially published on May 3, 2013,
and
WHEREAS, sealed bids were opened at 10:00 AM on June 3, 2013, and
WHEREAS, four bids were received on the project and the bid amounts ranged from
$1,874,210.40 to $4,840,400.35, and
WHEREAS, the lowest responsible bidder for the Kenrick Avenue and 195 Street West
Trail project was Rosti Construction of MN, Inc. for the total bid amount of $1,874,210.40.
NOW, THEREFORE, BE IT RESOLVED, that the bids are accepted for the project and
the contract is awarded to Rosti Construction of MN, Inc. pending approval of their DBE
requirements from the Civil Rights Office.
APPROVED this 1 ST day of July 2013 by the City Council of the City of Lakeville.
CITY OF LAKEVILLE
Matt Little, Mayor
ATTEST:
Charlene Friedges, City Clerk
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engineering-planning- environmental- construction 701 Xenia Avenue south
Suite 300
Minneapolis, MN 55416
Tel 763- 541.4600
Fax 763,541 -1700
Memorandum
To: Mr. Brett Altergotl, Parks & Recreation Director
From: Monica Heil, WSB & Associates, Inc,
Date: June 18, 2013
Re. Lake .Marion Trail Extension Project
WSB Project No. 1715 -840
Background
The Lake Marion Trail Extension project was originally bid on September 18, 2012. At that
time, the design of the project included Mn/DOT approved modular block retaining walls and
pedestrian boardwalks to facilitate the construction of the Lake Marion Trail Extension over and
across Lake Marion and the adjacent wetlands, where Lake Marion crosses beneath Interstate -
35. The bids received for the project, with the lowest bid totaling $1,333,333,00, which was
12 % higher than the original engineer's estimate for the project. At the time, many contractors
cited an increase on construction activity and limited resources to complete the project due to
other scheduling constraints. The City made the decision to reject the bids received on October
1, 2012, and to modify some of the original design components in an effort to reduce
construction costs and re -bid the project at a time when contractor resources were less
constrained.
In the decision to re-bid the Lake Marion Trail Extension Project, City Staff was seeking
opportunities to reduce the overall length of the proposed boardwalk to reduce on going
operations and maintenance costs associated with such a boardwalk. In lieu of the boardwalk
that was proposed to be constructed over portions of the wetlands adjacent to Lake Marion, the
possibility of installing modular block retaining walls, as were previously approved by MnfDOT,
was investigated. Based on the average bid prices received with the September 18, 2012 bid
opening for this project, it was estimated that up to $140,000 in savings could be realized by
increasing the modular block retaining walls fol the project, and reducing the overall length of
the proposed boardwalks. The City moved forward with the redesign of the project to
incorporate the aforementioned changes and re- subrnitted plans to Mn/DOT for review on
January 25, 2013,
Following Mn/DOT's review of the re- submittal, WSB & Associates, Inc. received commentss .
stating that Mh/Dors most recent prefabricated modular block retaining wall specification no
longer allows the use of modular block retaining walls in areas where the groundwater table is
above the leveling pad of the walls. This modular block retaining wall specification change had
St Cloud • Minneapolis • St. Paul
Equal Opporivntty Employer
vabeng.00m
9.^017IH4hA oinWo 18I ;IDMM.Mery Joey
Mr. "Brett Altergott
June 18, 2013
Page 2
been communicated internally at Mn/DOT, but had not been published or made available to the
public. Mn/DOT now requires sheet pile retaining walls be installed in such applications; the
modular block retaining walls approved for the project by Mn/DOT in 2012 are no longer
permitted. Sheet pile retaining walls are more expensive than modular block retaining walls, and
so the following possibilities were also examined:
Was additional federal funding available to mitigate some of the increased .costs
associated with the sheet pile retaining walls? WSB & Associates did contact MxVDOT
in March, 2013 to investigate this alternative.
o Unfortunately, no additional funding was available for this project.
Are there other opportunities to eliminate some of the proposed retaining walls and
increase wetland impacts as a result?
o This was discussed with the DNR. However, as previous submittals bad already
demonstrated that wetland impacts could be limited through a combination of
retaining walls and boardwalks, the DNR will not allow for additional wetland
impacts for the sole purposes of reducing project construction costs.
Having investigated the aforementioned alternatives, and realizing that there was still a benefit to
re- bidding the project using a combination of sheet -pile retaining walls and boardwalks (The
total boardwalk length has been reduced by 320 feet since the September, 2012 bidding of the
project. Long -term reductions in the operation and maintenance costs associated with the
boardwalk system will be realized for many years to come), Staff decided to move forward with
re- bidding the project, with the first advertisement for bid running on May 3, 2013. The
engineer's estimate for the revised design was $1,657,349.20. The low bidder at the June 3, 2013
bid opening was Rosti Construction, in the amount of $1,874,210.10. The difference between
the engineer's estimate and the bid prices received was largely due to the "Foundation
Preparation" associated with the bridge component of the project ($191,000). The bid price
received for this same item from Rosti Construction in September, 2012 was $6,000. After
numerous requests, Rosti has not provided an explanation for the increased bid price for this
work.
WSB and Staff have researched possible design alternatives that would reduce the project costs
without altering the scope of the project. For example, the City could opt not to resurface the
parking lot adjacent to the fishing pier as a pait of this project in an effort to reduce the project
costs. Moving forward, the field representative working on the project will closely monitor
construction conditions to determine if there are additional design alternatives to reduce the
project construction costs, without altering the scope of the project.
K701715441AAn"),..16 If 13RAIWtakmm d=
CONTRACT FOR CONSTRUCTION
THIS AGREEMENT, made and entered into as of the 26th day of June, 2013, by and between the City of
Lake ` ,,a un I corporation under the laws of the State of Minnesota, hereinafter called the "Owner".
and K!'�Tl 1�S`il'taC�t"I trY1 ,hereinafter called the "Contractor".
WITNESSETH:
That in consideration of their mutual covenants and agreements as hereinafter set forth, the Owner for
itself and the Contractor for itself, its successors, and assigns, covenants and agrees as follows, to wit:
1. The Contractor agrees to furnish all the necessary materials, labor, use of tools, equipment, plant
and every other thing necessary to perform the work designated and referred to in this Contract,
including all Contractor's superintendence, and to furnish everything necessary for the completion
of the improvement which is the subject of this Contract (except such things as the Owner has
specifically agreed to provide, according to the Contract Documents); and agrees under penalty of
a public contractor's corporate surety bond in the amount of One Million Eight Hundred Seventy -
Four Thousand Two Hundred Ten and 40/100 Dollars ($1,874,210.40) to perform and complete
the work shown in the plans and drawings, entitled "Kenrick Avenue Trail and 195"' Street W. Trail
Construction," prepared by WSB & Associates, Inc. and dated March 22, 2013, and to conform in
all respects with the provisions and requirements of the General Conditions, Supplementary
General Conditions and Specifications for said improvement, which is entitled "Kenrick Avenue
Trail and 195"' Street W. Trail Construction," for the Owner prepared by WSB & Associates, Inc.,
dated March 22, 2013.
2. The Contractor agrees that performance shall be in accordance with the terms, requirements and
conditions of this instrument, and laws of the State of Minnesota, and the following documents.
ADVERTISEMENT FOR BIDS for said Kenrick Avenue Trail and 195 Street W. Trail
Construction for the Owner.
PROPOSAL by the Contractor, presented to the Council of the Owner on June 24th, 2013, and
accepted by the Owner on July 1, 2013.
CONTRACT DOCUMENTS for said Kenrick Avenue Trail and 19e Street W. Trail Construction
dated March 22, 2013, referred to in the preceding paragraph of this Agreement and made a part
of the aforementioned proposal.
PLANS AND DRAWINGS for said 2013 Kenrick Avenue Trail and 195� Street W. Trail
Construction as identified in a preceding paragraph of this Contract and which are dated March
22, 2013.
ANY ADDENDA to the plans, drawings, general conditions and specifications for said Kenrick
Avenue Trail and 195"' Street W. Trail Construction which addenda were prepared by WSB &
Associates, Inc.
PUBLIC CONTRACTOR'S SURETY BOND in the principal sum of the amount bid.
Each and all of the aforementioned Contract Documents are hereby incorporated into this
Contract by specific reference and the terms and provisions thereof are and constitute a part of
this Contract as though attached hereto or fully set forth herein.
The Owner agrees to pay the Contractor for the performance of this Contract and the Contractor
agrees to accept in full compensation therefor, the sums set forth within the aforementioned
proposal of the Contractor for each unit and each type of unit of work to be performed. It is
understood and agreed that the said proposal is for the construction of said Kenrick Avenue Trail
and 195 Street W. Trail Construction on a unit price basis in accordance with the said proposal,
KENRICK AVENUE TRAIL AND 19e STREET W. TRAIL
CFC
CONSTRUCTION
S.P. 108-118-004
CITY OF LAKEVILLE, DAKOTA COUNTY, MN
WSB PROJECT NO. 1715-M
and that sum of $1,874,210,40 as set out in said proposal, is the sum of the unit prices, multiplied
by the estimated quantities of the respective units of work listed therein.
IN WMMS WHEREOF, the parties hereto have hereunto set their hands and seals as of the day and
year first above wditn.
CONTRACTOR
CITY OF LAKEVILLE, MN
Mayor
Clerk
(city l)
By
Authorized Official
KF.M=AVENUE TRAIL AND 186'" STREET W. TRAl4
CFC
CONSTRUCTION
S.P. 1684184"
CITY OF LAKEVILLE, DAKOTA COUNTY, MN
wSB PROJECT NO. 1716 -i8
Minnesota Pollution Notice of Termination/
Control Agency
.s2ot.afayem Road North Permit Modification Form
St. Paul. NW 55555 -4194
NpDES Construction Stormwater Permit programs
Transfer or terminate your National Pollutant Discharge Elimination System (NPDES) Construction Stormwater Permit. Allowable
changes are permit termination and permit transfer for all or a portion of the site. This form replaces the Notice of Termination
(NOT); Permit Transfer, Permit Modification, and Subdivision Registration forms used under the former permit.
Instructions for this form are located on the Internet at http: / /www.pca. state. mn. us /publicationslwq- strm2- 60i.pdf.
Form will be invalid and returned to sender unless the checkbox associated with the applicable actions is checked and the
corresponding signature is provided in section A -1, A -2, A-3, and or A-4.
Please submit to: Construction Stormwater Permit Program
Minnesota Pollution Control Agency
520 Lafayette Load North
St. Paul, Minnesota 55155 -4194
Existing Permit Identification
a. Current permit ID: C000 3 4 1 5 ® or SUB00
b. Project name: Kenrick Avenue Trail
Project location: Kenrick Avenue from 185th to 205th street _
Briefly describe where the coneftwtion activity occurs (for example, Intersection of 461h St. and Irving Ave.). include address if available.
Select Option 1, 2, or 3
1. Notice of Termination (NOT) for entire site by existing owner
Select this option when a project has achieved final stabilization with existing owner / contractor and no part of the site is
being transferred to a new owner and all construction activity is complete.
c. ❑ Notice of Termination for entire existing permitted s!te or a subdivided site. (Current owner and contractor must sign under
the'Currenr Owner and `Current` Contractor sections respectively).
Check above box and sign section A-1 and A -2 an page 2.
3. Transfer of entire stto to new owner or contractor (TransferlModification)
Select this option if the entire site (represented by the ID above) has either a new owner andlor new general contractor.
Check all the boxes below that apply.
d ❑ New Owner for entire existing permitted site. f. ❑ Current Owner for entire existing permitted site.
e. ® New Contractor for entire existing permitted site. g. ❑ Current Contractor far entire existing permitted site.
Check above box(es) and sign section A -3 end A-4 page 3 and or check above box(es) and sign section A -1 and A -2 page 2
Both 'Current" and `New" Parties . roust sigr: this form (preferred), however, separate forms are acceptable.
3. Trans( of a portion of a site to a new owner or contractor (Subdivision)
Select this ciption K a portton of a site ( penmitted under the ID above) has eltf-er a new owner and /or new general
contractor. Check the boxes below that apply.
h. Describe tha portion of the site being transferred: Lot Block
Project location /address:
City, State, and Tip: _
Example: SiN quadrant of 45th Street and ln4ng Avenue or tots 1 -17 of block 20. include fist of addresses if available or include a .nap
L ❑ New Owner for portion of existing site. k. ❑ Currant Owner of the portion to be transferred.
New Contractor for portion of existing site. I. ❑ Current Contractor of the portion to be transferred.
Check above box(es) and sign section A -3 and A-4 page 3 and or check above boxes) and sign section A -1 and A• -2 pape 2
Both 'Currenr and New' Parties roust sign this form (preferred), however, separate forms are acceptable.
www.pca.stwte.mn.us • 651 - 296 -6300 800. 657 -3864 - M 651 -282 -5332 or 800- 657.3864 • Available in alternative formats
wq- strm2 -60 • 7120109 Page r of 3
Current owner Authorized Signature (A -1)
Business/Firm name: C1ty of Lakevill _
Last name: Petree First name: Chris —_ Title:
E -mail address: _pc et 'clakevillemn.gov Telephone: 952 985 -2700 Ext.
Mailin address: 1 fl400 2va a A _
City: Lak eville
Altemate contact:
Last name:
E-mail address.
State: _ MN Zip code: _ 55044
First name: Title:
Telephone: ( ) Ext. —
1 certify under penalty of law that this doeurwid and all attachments were prepared under my direction or supervision In accordance
with a system designed to assure that qualified personnel properly Rather and evaluate the information submitted. Based on my
Inquiry of the person or persons who manage this system, or the persons directly responsible for gathering the information, the
information is, to the best of my knowledge and belief, true, accurate and complete. l am aware that there are significant penalties
for submitting false information, including the possibility of fine and imprisonment for knowing violations.
I also certify under penalty of law that I have read, understood, and accepted all terms and conditions of the National Pollutant
Discharge Elimination System (NPDES)/State Disposal System (SDS) General Stormwater Permit Construction Activity (MN
R100001) that authorizes stormwater discharges associated with the construction site identified on this form.
Authorized signature: _
Date:
This Application must be signed by: Corporation.* a principal executive officer of at least the level of vice - president or the duly
authorized representative or agent of the executive officer if the representative or agent is responsible for the overal! operation of
the facility that is the subject cf the permit application. Partnership or We Proprietorship: a general partner or the proprietor.
Municipality, State, Federal or &Mar Public Agency. principal executive officer or ranking elected official.
Current Contractor Authorized Signature (A -2)
Business/Firm name: City of Lakeville
Last name: Petree _ First name: Chris Title: _
E-mail address: cpetree0lakevillernn.9ov Telephone: (9 585 - 2700 Ext.
Mailin address: 18 400 I Lava Avenue _
City: Lakeville State: mn
Alternate contract:
Last name:
First name:
Zip code: 55094
Tale:
E-mail address: __ Telephone: (_ ) _ Ext.
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that qualiied personnel properly gather and evaluate the information submitted. Based on my
inquiry of the person or persons who manage this system, or the persons directly responsible for gathering the intormation, the
Information is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties
for submitting false information, including the possibility of fine and Imprisonment for knowing violations.
I also certify under penalty of law that I have read, understood, and aucepied all terms and conditions of the National Pollutant
Discharge Elimination System (NPDESYState Disposal System (SOS) General Stormwater Permit Construction Activity (MN
R100001) that authorizes storm ischarges 13ted a construction site identified on th form.
Authorized signature: Date: �"
This Application must be signed b poration: a principal executive officer of at least the Ov l of v ce -president or the duly
authorized representative or agent of the executive officer if the representative or agent is responsible for the overall operation of
the facility that is the subject of the permit application. Partnership or Sole Proprietorship: a general partner or the proprietor.
Municipality, State, Federal or Other Public Agency: principal executive officer or ranking elected offrciat.
www.pca.state.mn.us • 651 -'196 -6300 • 800. 657 -3864 651.282.5332 or 800- 657.3864 • Available in alternative formats
wq- stom2 -60 . 7120109 Hoge 2 of 3
"New" Owner Authorized Signature (A-3)
Business/Firm name:
Last name:
First name: Title:
E-mail address: Telephone: ( ) Ext.
Mailin address:
City:
Alternate contact:
Last name:
State:
Zip core:
First name: Tide:
E -mail address: Telephone: ( ) Ext.
I certify under penalty of law that this document and all alladtfrients were prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel proporly gather and evaluate the information submitted. Based on my
inquiry of the person or persons who matisge this system, or the persuns directly responsible for gathering the information, the
information is, to the best of my knowledge and belief, true, accurate and complete. t am aware that there are significant penalties
tar submitting false Information, including the possibility of fine and imprisonment for knowing violations.
I also certify under penalty of law that I have read, understood, and accepted all terms and conditions of the National Pollutant
Discharge Elimination System (NPDES) / Stata Disposal System (SDS) General Stormwater Permit Construction Activity (iVIN
8100001) that authorizes stormwater discharges associated with the construction site identified on this form.
Authorized signature:
9
This Application must be signed by. Corporation: a principal executive officer of at least the level of vita- president or the duly
authorized representative or agent of the executive officer if the representative or agent is responsible for the overall operation of
the facility that is the subject of the permit application. Partnwship or Sole Proprietorship: a general partner or the proprietor.
Municipality, State, ,Federal or Othei Public Agency: princlpal executive officer or ranking elected official.
"New" Contractor Authorized Signature (A-4)
BusinesslFirm name:
Last name:
E -mail address: _
Mailing address: � ��
City:
State: A4 N Zip code s�
Alternate contact:
Last name: ,S First . naam ' e:_�� �1 _ Title: V C� l��Gi
E-mail address: ° IQ/0 ICU S r! Gr?Y15 "i r to t tl r LC? '►°i Telephone: S -Zi Ext.
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel property gather and evaluate the information submitted. Based on my
inquiry of the person or persons who manage this system, or the persons directly responsible for gathering the information, the
information is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties
for submitting false information, including the possibility of fine and imprisonment for knowing violations.
I also certify under penalty of law that I have read, understood, and accepted all terms and conditions of the National Pollutant
Discharge Elimination System (NPDES) /State Disposal System (SDS) General Stormwater Permit Construction Activity (MN
8100001) that authorizes sto orate ischa es associated with the construction site identified or thi form.
Authorized signature: Date:
This Application must be signed by: Corporation: a principal executive officer of at least the levet of vice- presiaent or the duly
authorized representative or agent of the executive officer if the representative or agent Is responsible for the overall operation of
the facility that is the subject of the permit application. Partnership or Sole Proprietorship: it general partner or the proprietor
hfunicipality, State, Federal or Other Public Agency: princlpal executive officer or ranking elected ofcial,
If you have questions about the administrative details of the permit process go to: http inn.us/publications4cl-
swyi2-60+.rpdf cl-
strni7- 60 +.rpd° or call the Minnesota Pollution Control Agency at 654.2W - 6300 or 800 - 657 - 3MK and ask for 'Construction
Stormwater. ' If you have technical questions, ask for the 'Stormwater Policy and Technical Assistance Unit.'
(952 -)i7 - 5
www.pca.state.rm.us • 651 - 296.6300 • 800 - 657.3864 TTY 651 -282 -5332 or 800 - 657.3864 • Avaitabte in alternative formats
wq - 5trrrr2 -60 . 7120109 Page 3 of 3