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AG 17-027RETURN TO: PW ADMIN EXT: 2700 ID# p CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM 1. ORIGINATING DEPT/Div: PUBLIC WORKS/ ? A --' 2. ORIGINATING STAFF PERSON: IJ L-'jc^\`' " _ EXT: Z, \ -S 3. DATE REQ. BY: Z � I, I I-7 4. TYPE OF DOCUMENT (CHECK ONE): ❑ CONTRACTOR SELECTION DOCUMENT (E.G., RFB, RFP, RFQ) ❑ PUBLIC WORKS CONTRACT ❑ SMALL OR LIMITED PUBLIC WORKS CONTRACT ❑ PROFESSIONAL SERVICE AGREEMENT ❑ MAINTENANCE AGREEMENT ❑ GOODS AND SERVICE AGREEMENT ❑ HUMAN SERVICES / CDBG ❑ REAL ESTATE DOCUMENT ❑ SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS) ❑ ORDINANCE ❑ RESOLUTION ❑ CONTRACT AMENDMENT (AG##): ❑ INTERLOCAL 0G, OTHER 1 C CCG C.S G \ s 2f t (;e c-: \z +y Acjs t.e M t A', 5. PROJECT NAME: �2e lz� or Y"; ^0,- kc t s t- Gvcn A- c_entiel 6. NAME OF CONTRACTOR: V y e,�,+c SQjr\cX �, n e c% IA ADDRESS: 170 l ow °JTO.54 Tic \ \cyvt wh 4lboOa E -MA I I .: SIGNATURE NAME: l3[]h ' C4• \oC TELEPHONE: ao 0 - -S %Z - 14 � 2 FAX: TITLE;. C_iorh+htrc.:e\ S�rJ�ti C, 7. EXHIBITS AND ATTACHMENTS: 1>6 SCOPE, WORK OR SERVICES ❑ COMPENSATION ❑ INSURANCE REQUIREMENTS /CERTIFICATE ❑ ALL OTHER REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT /AMENDMENTS CFW LICENSE # BL, EXP. 12/31/_ UBI# , EXP. 8. TERM: COMMENCEMENT DATE: 31 1 I \ COMPLETION DATE: 6 ( I 1 \, 9. TOTAL COMPENSATION: $ \-. , \',I\ (INCLUDE EXPENSES AND SALES TAX, IF ANY) (IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES) REIMBURSABLE EXPENSE: ❑ YES �bNO IF YES, MAXIMUM DOLLAR AMOUNT: $ IS SALES TAX OWED: ❑ YES %NO IF YES, $ PAID BY: ❑ CONTRACTOR ❑ CITY CA PURCHASING: PLEASE CHARGE TO 10. DOCUMENT/ CONTRACT REVIEW ❑ PROJECT MANAGER ❑ DIVISION MANAGER c� DEPUTY DIRECTOR DIRECTOR ❑ RISK MANAGEMENT (IF APPLICABLE) FL LAW DEPT 11. COUNCIL APPROVAL (IF APPLICABLE) INITIAL / DATE REVIEWED COMMITTEE APPROVAL DATE: INITIAL / DATE APPROVED COUNCIL APPROVAL DATE: 12. CONTRACT SIGNATURE ROUTING ❑ SENT TO VENDOR/CONTRACTOR DATE SENT: DATE REC'D: ❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS ❑ CREATED ELECTRONIC REMINDER/NOTIFICATION FOR I MONTH PRIOR TO EXPIRATION DATE (INCLUDE DEPT. SUPPORT STAFF IF NECESSARY) ❑ LAW DEPT > SIGNATORY (MAYOR o DI `'C'O ❑ CITY CLERK ASSIGNED AG # SIGNED COPY RvrURNED ❑ Ri:'FURN ONE ORIGINAL INITIAL / DATE SIGNED , nt V1 I AG# DATE SENT: 02 -11 - 11 COMMENTS: "ORIGINALS �tc, yf\c�\ i 5 Q \tctcon;� \j.a �\S� r 1ZaccQ �v�����s �ih4ec9 a��C( gic.n��JrC� . 2/17 DocuSign Envelope ID: 71428540- 44F8- 4B55- A909- 4FD8517ADE94 • PUGET SOUND ENERGY Paget Sol:nd Energy P.O. Box 97034 Bellevue, WA 98009 -9734 PSE.com 1111 /i211#116 City of Federal Way 33325 8th Ave S Federal Way WA 98003 RE: Gas Altered Facility Agreement PSE Order No. 109099868 Dear Edward Walsh Thank you for the opportunity to assist you with Replacing your gas service for your business at 31510 Pete Von Reichbauer Way S, Federal Way I have completed the site visit and cost estimate for your project. The estimated customer contribution for your project is$14,437 . The estimate for your project is based upon CREW RECONNECTING 2" COMMERCIAL SERVICE FROM PREVIOUS CUT AND CAP. CUSTOMER TO SUPPLY TRENCHING, SAND, AND BACKFILL. In order to proceed with your project we will need to get an agreement from you for the charges associated with your project. You will be receiving an email from DocuSign letting you know that you have a document requiring your signature. After you receive the email notice from DocuSign, please refer to the steps below to complete the agreement: 1. Review the agreement to ensure accuracy and verify information captured during our phone conversation and site meeting regarding your natural gas relocation. 2. Sign where a signature is indicated on the agreement. 3. Once you "confirm signing" on the document, we will receive your agreement electronically for processing. Please save a copy of the electronic document for your records. Upon signing your agreement in DocuSign, you will be billed by PSE for the amount indicated on the Gas Altered Facility Agreement. This payment needs to be received prior to scheduling your project. Please note that if there are significant changes to scope, you will be provided with a new estimate of costs based upon changes in scope. If the scope change results in a change of your initial payment, Puget Sound Energy will bill or refund you the difference, as appropriate. Below are the typical steps you can expect once we receive your completed agreement: 1. Once we receive your Gas Altered Facility Agreement, the process will be initiated to prepare your job for construction. There are many possible steps involved (site inspection, traffic control plan and permitting design with the local jurisdiction, obtaining easement, and obtaining underground locates prior to the installation and schedule availability). On average, this process can take 10 to 12 weeks to complete. Page 1 of 2 DocuSign Envelope ID: 71428540 -44F8- 4855- A909- 4FD8517ADE94 2. If a permit for work in the right of way is required, we will submit your project to the proper municipality for a permit and contact you to schedule your natural gas service installation once we have received the permit. Our crew schedule is typically 1 -2 weeks to commence construction once we have all steps completed. 3. If your project includes the relocation, or upgrade of your gas meter, you will need to provide all associated fuel line work to connect to the meter. Our crew is required to lock the gas meter upon completion of our work but I will assist you with the coordination and timing for having your mechanical contractor make connection to the outlet of the Gas meter. You will need to call the PSE Customer Service at 1- 888 - CALLPSE to schedule a meter turn -on. If you need assistance with finding a mechanical contractor, PSE can assist you through our Contractor Alliance Network. Our Energy Advisors are available at 1- 800 - 562 -1482 to assist you. Thank you in advance for submitting your natural gas service agreement, you will soon be enjoying the many benefits of natural gas. We look forward to the opportunity to serve you. Should you have any questions along the way I am here to assist you. Sincerely, BOB TAYLOR Page 2 of 2 DocuSign Envelope ID: 71428540- 44F8- 4B55- A909- 4FD8517ADE94 Date 2/9/17 " GAS ALTERED FACILITY AGREEMENT Agreement is subject to revision A after 90 days Customer (Owner) Name Co -Owner Name (if applicable) CITY OF FEDERAL WAY Service Address City Zip Code 31510 PETE VON REICHBAUER WAYS EDERAL WAY '98003 Mailing Address (if different from above) City State Zip Code 33325 8TH AVE S FEDERAL IWA 98003 Primary Phone Alternate Phone Email Address (for line extension communication only) 253 - 835 -2730 253- 835 -2700 Ef3'hFl AR'- WAL-CH@EiT'fflFFEQERAt Y:C_&M Type of Service Beding Altered EDWARD .WALSH @CITYOFFEDERALWAY.COM © Residential ® Commercial Your Natural Gas Usage Plans Additional lob Details Which gas appliances do you plan to install and use within 12 months of PSE installing Please describe any additional job details below. your natural gas meter (not counting any existing appliances) EXISTING METER AND SERVICE HAD 2960 CFH. IF YOU CHANGE YOUR APPLIANCE SELECTION, PLEASE NOTIFY YOUR PSE REPRESENTATIVE NEW LOADS ARE 980 CFH AND 800 CFH FUTURE Appliances New Qty Existing Qty BTU /Hr WITH A TOTAL CONNECTED LOAD OF 1780 CFH. ❑ Furnace /Heat Rated Fireplace ❑ Water Heater (Standard Tank Type) CUSTOMER TO SUPPLY TRENCHING, SAND, AND ❑ On- Demand Water Heater (Tankless) BACK FILL FOR CREW. ❑ Clothes Dryer ❑ Range /Oven Decorative ❑ Fireplace Natural Gas ❑ Generator El Other:TOTAL BTU 980 2960 El Other: FUTURE 800 ❑Other: Customer agrees to supply all piping from PSE's gas meter to Heated living square footage 46000 their gas appliances. Desired Delivery Pressure at Meter 0 6" W.C. (standard delivery) ®psi Initial: PaVM ellt Op ti 011 S Following payments app I : Charge Amount Customer Advance: Pay 12,131 prior to scheduling construction. This amount is potentially refundable upon review. Please see the Review of Contribution and Refund statement on back of form. Total Charges prior to Construction TOTAL $12,131 Customer Acceptance By signing this agreement you are authorizing PSE to continue with all the needed elements to complete your project. Please do not send payment with this agreement. Upon receipt of a signed agreement, PSE will bill you for the amount indicated at the mailing address shown on the agreement. PSE requires payment prior to firming up a construction date; delaying payment may result in a construction delay. Changes in the scope of the project requested by you may result in either additional charges or refunds to the amount billed on this agreement. IT IS AGREED AND DECLARED THAT THE TERMS AND CONDITIONS SET FORTH HEREIN AND ON THE REVERSE HEREOF ARE PART OF THIS AGREEMENT AND BINDING UPON THE PARTIES HERETO. CUSTOMER GRANTS PERMISSION FOR COMPANY TO ACCESS CREDIT INFORMATION WHEN NECESSARY. THIS AGREEMENT IS NOT VALID UNTIL ACCEPTED BY PSE. CUSTOMER ACKNOWLEDGES THE RECEIPT OF A COPY OF THIS AGREEMENT Customer Signature / �`�"'� _ Print Name o `—k^c Date �'1` \71 IMPORTANT NOTE: IN ADDITION TOTH tfNISTeLATION CHARGES ABOVE, VDU WILL RECEIVE A BILL FROM PSE FOR MONTHLY BASIC CHARGES AS SOON AS THE METER IS INSTALLED. Notification Number 50359224$ DocuSign Envelope ID: 71428540 -44F8- 4855- A909- 4FD8517ADE94 TERMS OF AGREEMENT GENERAL This Agreement represents the entire understanding and Agreement between the Customer ( "Customer") and Puget Sound Energy ( "PSE" or "Company') and supersedes any and all prior agreements, whether written or oral, that may exist between the parties. In all matters not specifically agreed to or identified herein including but not limited to the proposed extension of distribution facilities, and natural gas consumption, the W ashington Administrative Code ( "WAC ") and the tariffs for PSE on file with the Washington Utilities and Transportation Commission ( "W UTC ") shall govem this Agreement, as such tariffs may be revised from time to time upon approval of the W UTC Any conflict in terms between this Agreement and the Company's tariffs shall be resolved in favor of such tariff. Provided, however, that any price quoted will be honored forthree (3) months and this Agreement is otherwise effective for twelve (12) months FACILITY EXTENSION PSE agrees to install for Customerthe natural gas facility extension described on the front of this Agreement This facility extension at all times will remain the property of PSE. Customer in turn agrees to (a) pay the amount, if any, due for the extension; (b) make the payments to PSE as required by this Agreement, if applicable and (c) abide by terms and conditions stated herein. ECONOMIC TEST All applications to extend distribution facilities to new Customers are subject to a Facilities Investment Analysis ( "FIA ") to determine economic viability. The FIA is used to determine if an extension or modification is justified without additional contribution and will determine the level of additional contribution, if required. Annual consumption and construction costs for each new Customer will be determined by PSE, using Schedule 7 Facility Extension Standards. RESULTS OF CONTRIBUTION AND REFUND Ifthe FIA results meet or exceed the Companys target rate of return, the extension will be made without Customer payment, otherthan the Qualification Payment and Kittitas New Customer Rate, except as noted in the "Extensions from Extensions" section below. Ifthe FIA results are below the Company's target rate of return, the facilities extension may proceed upon the Customer's Agreement to pay: (1) a Customer advance over and above the Qualification Payment, and/or (2) a Kittitas New Customer Rate. EXTRAORDINARYCOSTS Charges shown on the front of this agreement are based on standard construction costs as identified in Schedule 7 of PSE's tariff and extraordinary costs, if any. Standard construction costs include the cost of obtaining a basic street use permit from the appropriate agency and basic restoration in the easement or right -of -way Basic restoration includes patching existing hard surface to cover required excavation. Any additional requirements imposed by local government authorities are not included in the basic installation cost in Schedule 7, but are considered extraordinary costs and are included as extraordinary costs in the FIA. PSE or its contractor also reservesthe right to revise the actual cost to the Customer shown on the front of this agreement if costs otherthan standard construction costs are imposed by any outside agency afterthis agreement is signed. Extraordinary cost(s) caused by a customer request becomes the direct responsibility ofthe Customer. PSE or its contractorwill make a reasonable effort to identify these extraordinary costs prior to the signing ofthis agreement. REVIEW OF CONTRIBUTION AND REFUND Facility extensions requiring a Customer advance will be reviewed afterfive years from completion of construction, or sooner upon request. Refunds, if applicable, will be paid at that time. No additional reviews will be performed after the fifth year. In cases where review ofthe facilities extension indicates refunds are due, interest will be paid on Customer Advances subsequently refunded at the rate established for Customer deposits in Rule No. 5. Refunds, excluding interest, will not be greaterthan the amount of the original Customer Advance The refund shall be refundable to the original contributor(s). EXTENSIONS FROM EXTENSIONS Extensions from existing facilities that require a Customer advance under the terms and conditions of Rule 7A ofthe Company's tariffs may be subject to an FIA, combining the existing and subsequent facilities extensions. The purpose ofthe new analysis is to determine whether any Customer advance previously paid must be revised and if so, to determine by how much. The combined FIA will be performed only when the subsequent extension: (a) was constructed within the five year review period for the existing facilities extensions; and (b) required no Customer advance. Ifthe subsequent facilities extension requires a Customer advance, the options under Results of Test and Customer Advances apply (Section 5 of Rule 7A). Ifthe combined FIA eliminates the Customer advance, any customer advance previously paid will be refunded to the original contributors. ESTIMATED GAS USAGE REVIEW In addition to requesting gas service, Customer has committed to installing the gas appliances listed on the front side of this document. PSE monitors expected Customer gas consumption verses actual usage as related to this commitment. Lowerthan expected gas usage may result in a verification of appliances actually installed. If Customer fails to install all appliances listed on the front of this agreement, Customer agrees to pay possible additional facility extension charges as determined by a new FIA. UNUSED FACILITIES EXTENSIONS Ifthe Company provides a facilities extension and the Customerfails to commence gas usage within six months from the date of installation, the Company may bill the Customerfor costs and expenses. Ifthe Customer subsequently commences gas usage within two years of installation, such costs paid by the Customer shall be refunded without interest subject to the results of an FIA. RIGHTS OF WAY If PSE determines that is it necessary to obtain operating rights to perform any work, it shall be the Customer's responsibility to obtain such rights in a form acceptable to PSE prior to construction If PSE chooses to obtain such rights, all costs associated with said acquisition shall be the responsibility ofthe Customer. Ifthe cost to obtain adequate rights exceeds or is less than the estimate forthat purpose in the original FIA, the Company reserves the right to perform a new FIA and adjust the charges due from the Customer. Ifthe necessary rights to construct the facility extension cannot be obtained, PSE may declare this agreement null and void. DEFAULT Time is ofthe essence and the occurrence of either ofthe following shall constitute and be defined as a Default: (1) any failure by Customerto pay when due any payment required by this Agreement; or (2) any failure by Customer to perform any provision or Agreement required by this Agreement or bylaw Whenever a Default shall occur, the Company or assigns may, at its option, at anytime thereafter and without notice, as allowed bylaw, accelerate payment of the unpaid balance and demand and be entitled to immediately receive from Customer the unpaid balance plus any earned interest and late charges Customer agrees to pay on demand the amount of all expenses reasonably incurred by Company or assigns in an effort to collect the balance due hereunder and to minimize Company's loss. In the event that this Agreement is referred to an attorney for protecting, collecting or defending Companys interest, Customer agrees to pay Company's reasonable attorney fees and legal expenses. PAYMENTSCHEDULE Customer's payment period will be the same as the gas account, or a period equivalent to the calendar month if no gas account is established. LATE CHARGES If payment is not received by the due date, a late charge may be assessed accordance with the Company's tariff METER PROTECTION It is the Customers responsibility to provide adequate protection for the gas meter(s) per PSE specifications EXTENSIONS FOR LARGE COMMERCIAL /INDUSTRIAL LOADS An FIA will be performed to determine if an additional Customer advance is required for large commercial /industrial Customers, defined as having a total connected load in excess of 1100 cubic feet per hour If a shortfall is determined, the Customer will pay a refundable Customer advance. Review and refund procedures are reflected in the "Results of Contribution and Refund" section above. However, subsequent incremental load will be included in the review process. CANCELLATION POLICY The Customer will have three working days to cancel this agreement from the date of Customer's signing. The Customer may cancel the agreement after that time but the Company may choose to bill the Customer for any costs incurred up to that point. DocuSign Envelope ID: 71428540 -44F8- 4855- A909- 4FD8517ADE94 PUGET SOUND ENERGY PSE GAS FACILITIES EXCAVATION REQUIREMENTS & FINAL GRADE CERTIFICATION PURPOSE This document is an agreement between Puget Sound Energy (PSE) and the Owner /Developer (Developer) who is providing excavation for the installation of PSE's facilities. This document does not provide an easement for operating rights. If PSE determines that a recordable easement on the Developer's property or other property is necessary, it shall be the Developer's responsibility to obtain such easements in a form acceptable to PSE prior to construction. EXCAVATION REQUIREMENTS The requirements and conditions outlined below apply when you provide the excavation for PSE's gas facilities as a condition of receiving gas service for your project. If you need additional information, please call the PSE contact person listed below. 1 • Developer is responsible for acquiring utility locates by calling One -Call, 1- 800 - 424 -5555 at least 48 hours (two full working week days) prior to digging. The excavation must meet the requirements of the Washington Administrative Code and Safety Standards. 2. Developer shall call the PSE contact person noted below for trench and route approval prior to starting excavation. 3. The gas main trench shall be excavated to provide a minimum of 36 inches of facility coverage, to a maximum trench depth of 48 inches. 4• The single family and multifamily residential gas service trench shall be excavated to provide a minimum of 18 inches of facility coverage, to a maximum trench depth of 36 inches. For all Commercial /Industrial gas services throughout PSE's service territory and ALL service in Cie Elum, west of Cie Elum and within upper Kittitas county, shall be excavated to provide a minimum of 24 inches of facility coverage, to a maximum trench depth of 36 inches. A 12 inch horizontal separation is required between PSE gas facilities and other utilities within a joint trench. 5. Use soil backfill that is free from construction debris, sharp rocks, glass, frozen clods, and rocks larger than 10 inches in diameter. Developer shall provide and install sand (per PSE specifications) bedding and shading for gas facility protection as directed by PSE's contact person. Developer is responsible for any damages caused by improper backfill or compaction. 6• Developer agrees to maintain a minimum of 2 feet of horizontal clearance between PSE conduit, pipe or conductors and any foundation on Developer's property. 7• Developer shall allow 45 days prior notice to PSE to access gas mains if installing pavement or curbs. 8. Developer shall provide the excavation for PSE gas facilities within the designed location. Developer shall identify and provide final grade, property lines, and utility easements prior to installation of PSE's gas facilities. 9• Developer will be financially liable for the relocation of PSE's facilities which are inadequately covered, located outside the area where PSE has adequate operating rights, improperly graded inhibiting standard access and /or any damages resulting from dig -ins due to changes or variations in grade that are made after the installation of PSE's facilities. FINAL GRADE CERTIFICATION By my signing below, I certify that the gas facilities work area shall be at final grade prior to excavation. I assume full responsibility for my excavation work and the resulting location of these facilities. I also agree to indemnify, defend, and hold harmless Puget Sound Energy from all liability arising out of, or in connection with my work, including but not limited to all claims, losses, damages, and expenses, including reasonable attorney's fees, which result from my failure to excavate within easement areas or rights -of -way, or from digging without adequate rights on adjoining properties. Date: Z- \\1\ \'1 CITY OF FEDERAL WAY Owner or Developer: Signature: - PLEASE PRINT 31510 PETE VON REICHBAUER WAY S, FEDERAL WAY Project Address: BOB TAYLOR PSE Contact person. 2807 12/10 109099868 PSE Work Order: