2011-32 Florida Department of Transportation
RICK SCOTT 719 S. Woodland Blvd. ANANTH PRASAD, P.E
GOVERNOR DeLand, FL 32720 SECRETARY
May 4, 2010
Preston Davis
Public Works Director
P.O. Box 120219
Clermont, Florida 34712
Re: State Highway Lighting, Maintenance, and Compensation Agreement Work Order (FY
10/11)
Financial Project ID: 413615-1 -78 -01
Contract Number: AM -436
FEID No.: VF- 596000290 -001
Work Order for Fiscal Year 10/11
Resolution No.: City Council Minutes: July 23, 2002
Dear Mr. Davis:
You are hereby authorized to perform maintenance of the State Highway Lighting Systems within your
jurisdiction in accordance with the terms and conditions of the State Highway Lighting, Maintenance, and
Compensation Agreement.
The total compensation for Fiscal Year 10/11 paid under this Work Order is $13481.44. This amount
reflects a 3% increase per unit cost from the previous year. The compensation period for this work order
will begin from July 1, 2010, and expire June 30, 2011.
Please execute and/or return the following documents directly to this office in the enclosed self -
addressed envelope. In order to guarantee availability of funds. these documents must be returned
to this office no later than June 7. 2010.
o Sign this original work order confirming receipt and agreement of the compensation terms
listed above and return.
o Sign and have notarized, the enclosed State Highway Lighting, Maintenance, and
Compensation Agreement Certification and return.
o If the Resolution referenced above is no longer current, return a copy of your current
Resolution.
www.dot.state.fl.us
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Page Two
State Highway Lighting, Maintenance and Compensation Agreement Work Order (FY 10/11)
Contract Number: AM -436
If you wish to receive payment for the Fiscal Year 09/10 Work Order, please submit an invoice to this
office anytime after May 19, 2010. Invoices for Fiscal Year 09/10 must be received no later than December 27,
2010. Per the State Highway Lighting, Maintenance, and Compensation Agreement paragraph 2.c, which states
"Invoices may be submitted anytime after May 19 of the fiscal year in which the services were provided, but no
later than 180 days after the end of the fiscal year. Payment shall be made in one lump sum as provided in
paragraph 4 hereof,"
A sample invoice is attached for your information. Please verify that all information contained on the sample
invoice is included on your invoice.
If you have any questions, please contact: Barbara McCabe at (352) 326 -7722.
Attachments: State Highway Lighting, Maintenance, and Compensation Agreement Certification
Sample Invoice
FLORIDA DEPARTMENT
OF TRANSPORTATION MAINTAINING AGENCY
n/ D, G ArRind
f a P.B. Concurrence By: (1/0
. Engineer
Typed Name 57 ,vd Z9viS
IG.� • � ��..,,,,
Title: iL. C '���rce
Phone: (36) 39 8 350
Date: 5 / / /1
STATE HIGHWAY LIGHTING QUANTITY
•
VERIFICATION
Clermont , agrees that
(Local Maintolning Agency)
�3 C>
!embalms, is the low lined on the attached
(Total Number of Lmaiesh+es)
page(s), have been identified for p.ymm►t through the state Highway Lighting,
Maintenance, and Compensation Agreement. This agreement wan reached via:
Id Phone 0 Mfg
❑ Email (see 0 Letter (see attached)
FDOT REPRESENTATIVE CONTACT INFORMATION
i'�era m reL Cenitrar x 1 .n :eAMr
(Name) friths)
352- 31S -2ioo 3 10
(Phone Number) O
LOCAL AGEN CONTACT INFORMATION
Ore a ' ?ubl;c Slarvtas Dire dtor
(Name) j 410 (Title)
352- 394- 33fin 3 3 1 . 1 0 ______
(Phone Number) (Dee)
51
Page 1 of 2
STATE HIGHWAY LIGHTING QUANTITY
C C movir VERIFICATION
State Road: R So
Section Number: 11 (In 06
Limits: jaw__
From MP: 11, ginl
To MP: 13, 68S
Quantity: St)
State Road: R SO
Section Nmnber: 1 I t'17 00C:11
From MP:
To MP: I s tar
Quantity IS
State Road:
Section Number:
Limits: Pett
From MP:
• To MP:
• Quantity: I 5
• State Road:
Section Number:
Limits:
From MP:
To MP:
Quantity:
State Road:
Section Nmnber:
Limits:
From MP:
To MP:
Quatnity:
State Road:
Section Number:
Limits:
From MP:
To MP:
Quantity:
Page 2 of 2
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 375-040-68
E- VERIFY PROCUREMENT
Contract No: AM-436
Financial Project No(s): 413615- 1 -78 -01
Project Description: Highway Lighting Maintenance Agreement
Vendor /Consultant acknowledges and agrees to the following:
Vendor /Consultant shall utilize the U.S. Department of Homeland Security's E -Verify
system, in accordance with the terms governing use of the system, to confirm the
employment eligibility of;
1. all persons employed by the Vendor /Consultant during the term of the
Contract to perform employment duties within Florida; and
2. all persons, including subcontractors, assigned by the Vendor /Consultant to
perform work pursuant to the contract with the Department.
Company /Firm: City of if Authorized Signature: 4 _ A __
Title: Director of Public Services
Date: May 13. 2011