085-21 - Public Works Board - Contract Amendment 1DocuSign Envelope ID: 86AE4E80-1B26-48A2-8FDA-A7F69B77F2E4
AMENDMENT FACE SHEET
Contract Number: PE22-96103-000
PROJECT COMPLETION AMENDMENT - X
PUBLIC WORKS BOARD
EMERGENCY CONSTRUCTION LOANS
1. Contractor
2. Contractor Doing Business As (optional)
City of Port Orchard
N/A
214 Prospect St
Port Orchard, WA 98366
3. Contractor Representative
4. Public Works Board Representative
N/A
N/A
5. Original Contract Amount
6. De -Obligation
7. Final Contract Amount
$500,000.00
$246,847.50
$253,152.50
8. Amendment Funding Source
9. Amendment Start Date
10. Amendment End Date
Federal: ❑ State: 0 Other: ❑
Amendment Execution
June 1, 2041
N/A: ❑
Date
11. Federal Funds (as
12. Federal Agency
13. CFDA
applicable):
N/A
N/A
N/A
14. Contract Purpose
The purpose of this amendment is to certify the project completion for this Public Works Board Loan.
The Board, defined as the Washington State Public Works Board and Borrower/Contractor acknowledge and
accept the terms of this Agreement/Contract As Amended and attachments and have executed this
Agreement/Contract Amendment on the date below to start as of the date and year referenced above. The
rights and obligations of both parties to this Agreement/Contract As Amended are governed by this
Agreement/Contract Amendment and the following other documents incorporated by reference: Amendment
Terms and Conditions, including Attachment I: Certified Project Completion Report. A copy of this
Agreement/Contract Amendment shall be attached to and made a part of the original Agreement/Contract
between the Board and the Borrower/Contractor. Any reference in the original Agreement/Contract to the
"Agreement" or the "Contract" shall mean the "Agreement As Amended" or "Contract As Amended,"
respectively.
FOR THE CONTRACTOR
FOR PUBLIC WORKS BOARD
��p�`DocuSigned by:
[DOCUSIgned by:
F69E8885DOE74EF...
7245D4026B7D42E...
Signature
Kathryn A. Gardow, Public Works Board Chair
Robert Putaansuu
7/25/2022 1 5:59 PM PDT
Print Name
Date
Mayor
APPROVED AS TO FORM ONLY
This 22nd Day of March, 2013
Title 7/25/2022 1 9:28 AM PDT
Bob Ferguson
Attorney General
Date
Signature on File
Kathryn Wyatt
Assistant Attorney General
DocuSign Envelope ID: 86AE4E80-1B26-48A2-8FDA-A7F69B77F2E4
AMENDMENT DECLARATIONS
Amendment Title
Amendment Number
CLIENT INFORMATION
Legal Name
Loan Number
Completion Amendment
Amendment X
City of Port Orchard
PE22-96103-000
PROJECT INFORMATION
Title Pottery Lift Station Repairs
Project City Port Orchard
Project State Washington
Project Zip 98366
LOAN TERMS and CONDITIONS
Loan Amount
De -obligation
Final Loan Amount
Loan Term -Original
Loan Term -Revised
Current Interest Rate
Final Interest Rate
Loan Reimbursement
Start Date
Payment Month
$500,000.00
$246,847.50
$253,152.50
20 Years
20 Years
.94%
.94%
9/20/21
June 1
SPECIAL TERMS AND CONDITIONS GOVERNING THIS LOAN AGREEMENT
LOAN SECURITY CONDITION GOVERNING THIS LOAN AGREEMENT
Revenue Obligation: This loan is a revenue obligation of the CONTRACTOR payable solely from the net
revenue of the Sanitary Sewer (Wastewater) system. Payments shall be made from the net revenue of
the utility after the payment of the principal and interest on any revenue bonds, notes, warrants or other
obligations of the utility having a lien on that net revenue. As used here, "net revenue" means gross
revenue minus expenses of maintenance and operations. The BOARD grants the CONTRACTOR the
right to issue future bonds and notes that constitute a lien and charge on net revenue superior to the lien
and charge of this loan agreement.
SCOPE OF WORK
Repairs associated with the Pottery Lift Station. Construction includes 100% piping replacement and wet
well lining with air dispersion systems for both the Pottery Lift Station and the Sedgwick Lift Station, which
has been found to be the major contributor to the high concentrations of hydrogen sulfide gas.
The project costs may include but are not limited to: engineering, cultural and historical resources,
environmental documentation, review, permits, public involvement, bid documents and construction. The
project needs to meet all applicable Local, State, and/or Federal standards.
DocuSign Envelope ID: 86AE4E80-1B26-48A2-8FDA-A7F69B77F2E4
AMENDMENT TERMS AND CONDITIONS
Contract Number: PE22-96103-000
PUBLIC WORKS BOARD
PROJECT COMPLETION AMENDMENT
CONSTRUCTION CONTRACTS
The purpose of this amendment is to acknowledge the project has been certified complete and the final contract amount,
interest rate, and local share on the above referenced contract have been adjusted, if necessary, as reflected below.
The Public Works Board, (or its successor) a department of the state of Washington and the Contractor agree to amend
the above referenced contract as described below.
The amount of the loan shall be the Final Loan Amount as identified on the Declarations Page. The interest rate shall be
the Final Interest Rate as identified on the Declarations Page, per annum on the outstanding balance.
Page 1
7/6/2022
DocuSign Envelope ID: 86AE4E80-1B26-48A2-8FDA-A7F69B77F2E4
ATTACHMENT I: CERTIFIED PROJECT COMPLETION REPORT
PUBLIC WORKS BOARD -EMERGENCY CONSTRUCTION LOANS
Loan Number: PE22-96103-002 Contractor: City of Port Orchard
Project Name: Pottery Lift Station Repairs Address: 214 Prospect St
Port Orchard, WA 98366
Original or Extended Project Completion Date: 9/20/22
Chief Executive Officer Certification
The Chief Executive Officer of the Borrower/Contractor certifies that:
• To the best of his/her knowledge, the financial information and data provided in this report is true and
correct as of the signature date indicated below, and no project costs listed in this report incurred more
than twelve (12) months before agreement/contract execution or after the date of the project completion;
• Records supporting the information provided in this report are on file and will be made available by the
Borrower/Contractor upon request; and
E�DocuSigned by:
leo(�c,v%
F69E8885DOE74EF...
Signature of Chief Executive Officer
Robert Putaansuu
Print Name
Title
Mayor
7/25/2022 1 9:28 AM PDT
Date of Signature
Project Engineer or Consultant Certification
The Project Engineer or Consultant of the Borrower/Contractor certifies that:
• To the best of his/her knowledge, the data provided in this report is true and correct as of the signature
date indicated below;
• The project was completed in accordance with the Loan Agreement/Contract's Scope of Work; and
• The loan is 20 years, if performance incentive has been choose to extend the term; the engineer agrees
the life of the asset 20 years. 2/25/2022
• The project was completed on
(Actual Date of Project Completion)
EDocuSigned by: �L
�� C. C1 AVIALY
A08425EC455B474...
Signature of Project Engineer or Consultant
Kenneth C. Hammer
Print Name
Title
Interim Public works Director
7/25/2022 1 7:38 AM PDT
Date of Signature
7/6/2022
DocuSign
Certificate Of Completion
Envelope Id: 86AE4E801B2648A28FDAA7F69B77F2E4
Subject: Please DocuSign: PWB Emergency Construction Completion Amd-X.doc
Division:
Local Government
Program: Public Works Board
ContractNumber: PE22-96103-000
DocumentType:
Contract Amendment
Source Envelope:
Document Pages: 4 Signatures: 4
Certificate Pages: 5 Initials: 0
AutoNav: Enabled
Envelopeld Stamping: Enabled
Time Zone: (UTC-08:00) Pacific Time (US & Canada)
Record Tracking
Status: Original
7/6/2022 11:52:45 AM
Security Appliance Status: Connected
Storage Appliance Status: Connected
Signer Events
Kenneth C. Hammer
kchammer@cityofportorchard.us
Interim Public Works Director
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 7/25/2022 7:32:55 AM
ID:c097Obc3-ac66-4de9-bO22-5d727ad98eO6
Robert Putaansuu
rputaansuu@cityofportorchard.us
Mayor
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 7/25/2022 9:27:57 AM
ID:920a6586-e484-4687-a47a-fladO8564578
Kathryn Gardow
pwbgardowk@gmail.com
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 7/25/2022 5:58:50 PM
ID:1c792228-f3c1-4a22-8f08-704855a2eefa
Holder: Mark Rentfrow
mark. rentfrow@commerce.wa.gov
Pool: StateLocal
Pool: Washington State Department of Commerce
Signature
DocuSig�neld by:
E
d wVul� RAAMmtr
n08425Ec455B474...
Signature Adoption: Pre -selected Style
Using IP Address: 152.44.129.230
by:
ED—Sign1d
6bu� Naaln SUU
F69E88B5DOE74EF...
Signature Adoption: Pre -selected Style
Using IP Address: 152.44.129.230
Signed using mobile
[DocuSigned by:
7245 D4026B7D
Signature Adoption: Drawn on Device
Using IP Address: 107.122.81.87
Signed using mobile
Status: Completed
Envelope Originator:
Mark Rentfrow
1011 Plum Street SE
MS 42525
Olympia, WA 98504-2525
mark.rentfrow@commerce.wa.gov
IP Address: 147.55.134.112
Location: DocuSign
Location: DocuSign
Timestamp
Sent: 7/6/2022 11:59:44 AM
Viewed: 7/25/2022 7:32:55 AM
Signed: 7/25/2022 7:38:38 AM
Sent: 7/25/2022 7:38:39 AM
Viewed: 7/25/2022 9:27:57 AM
Signed: 7/25/2022 9:28:21 AM
Sent: 7/25/2022 9:28:22 AM
Viewed: 7/25/2022 5:58:50 PM
Signed: 7/25/2022 5:59:08 PM
In Person Signer Events
Signature
Timestamp
Editor Delivery Events
Status
Timestamp
Agent Delivery Events
Status
Timestamp
Intermediary Delivery Events
Status
Timestamp
Certified Delivery Events
Status
Timestamp
Carbon Copy Events
Status
Timestamp
Witness Events
Signature
Timestamp
Notary Events
Signature
Timestamp
Envelope Summary Events
Status
Timestamps
Envelope Sent
Hashed/Encrypted
7/6/2022 11:59:45 AM
Certified Delivered
Security Checked
7/25/2022 5:58:50 PM
Signing Complete
Security Checked
7/25/2022 5:59:08 PM
Completed
Security Checked
7/25/2022 5:59:08 PM
Payment Events
Status
Timestamps
Electronic Record and Signature Disclosure
Electronic Record and Signature Disclosure created on: 8/11/2020 4:44:12 PM
Parties agreed to: Kenneth C. Hammer, Robert Putaansuu, Kathryn Gardow
ELECTRONIC RECORD AND SIGNATURE DISCLOSURE
From time to time, Washington State Department of Commerce (we, us or Company) may be
required by law to provide to you certain written notices or disclosures. Described below are the
terms and conditions for providing to you such notices and disclosures electronically through the
DocuSign system. Please read the information below carefully and thoroughly, and if you can
access this information electronically to your satisfaction and agree to this Electronic Record and
Signature Disclosure (ERSD), please confirm your agreement by selecting the check -box next to
`I agree to use electronic records and signatures' before clicking `CONTINUE' within the
DocuSign system.
Getting paper copies
At any time, you may request from us a paper copy of any record provided or made available
electronically to you by us. You will have the ability to download and print documents we send
to you through the DocuSign system during and immediately after the signing session and, if you
elect to create a DocuSign account, you may access the documents for a limited period of time
(usually 30 days) after such documents are first sent to you. After such time, if you wish for us to
send you paper copies of any such documents from our office to you, you will be charged a
$0.15 per -page fee. You may request delivery of such paper copies from us by following the
procedure described below.
Withdrawing your consent
If you decide to receive notices and disclosures from us electronically, you may at any time
change your mind and tell us that thereafter you want to receive required notices and disclosures
only in paper format. How you must inform us of your decision to receive future notices and
disclosure in paper format and withdraw your consent to receive notices and disclosures
electronically is described below.
Consequences of changing your mind
If you elect to receive required notices and disclosures only in paper format, it will slow the
speed at which we can complete certain steps in transactions with you and delivering services to
you because we will need first to send the required notices or disclosures to you in paper format,
and then wait until we receive back from you your acknowledgment of your receipt of such
paper notices or disclosures. Further, you will no longer be able to use the DocuSign system to
receive required notices and consents electronically from us or to sign electronically documents
from us.
All notices and disclosures will be sent to you electronically
Unless you tell us otherwise in accordance with the procedures described herein, we will provide
electronically to you through the DocuSign system all required notices, disclosures,
authorizations, acknowledgements, and other documents that are required to be provided or made
available to you during the course of our relationship with you. To reduce the chance of you
inadvertently not receiving any notice or disclosure, we prefer to provide all of the required
notices and disclosures to you by the same method and to the same address that you have given
us. Thus, you can receive all the disclosures and notices electronically or in paper format through
the paper mail delivery system. If you do not agree with this process, please let us know as
described below. Please also see the paragraph immediately above that describes the
consequences of your electing not to receive delivery of the notices and disclosures
electronically from us.
How to contact Washington State Department of Commerce:
You may contact us to let us know of your changes as to how we may contact you electronically,
to request paper copies of certain information from us, and to withdraw your prior consent to
receive notices and disclosures electronically as follows:
To contact us by email send messages to: docusign@commerce.wa.gov
To advise Washington State Department of Commerce of your new email address
To let us know of a change in your email address where we should send notices and disclosures
electronically to you, you must send an email message to us at docusign@commerce.wa.gov and
in the body of such request you must state: your previous email address, your new email
address. We do not require any other information from you to change your email address.
If you created a DocuSign account, you may update it with your new email address through your
account preferences.
To request paper copies from Washington State Department of Commerce
To request delivery from us of paper copies of the notices and disclosures previously provided
by us to you electronically, you must send us an email to docusign@commerce.wa.gov and in
the body of such request you must state your email address, full name, mailing address, and
telephone number. We will bill you for any fees at that time, if any.
To withdraw your consent with Washington State Department of Commerce
To inform us that you no longer wish to receive future notices and disclosures in electronic
format you may:
i. decline to sign a document from within your signing session, and on the subsequent page,
select the check -box indicating you wish to withdraw your consent, or you may;
ii. send us an email to docusign@commerce.wa.gov and in the body of such request you must
state your email, full name, mailing address, and telephone number. We do not need any other
information from you to withdraw consent.. The consequences of your withdrawing consent for
online documents will be that transactions may take a longer time to process..
Required hardware and software
The minimum system requirements for using the DocuSign system may change over time. The
current system requirements are found here: hops://support.docusi n�guides/signer--uide-
signing-system-requirements.
Acknowledging your access and consent to receive and sign documents electronically
To confirm to us that you can access this information electronically, which will be similar to
other electronic notices and disclosures that we will provide to you, please confirm that you have
read this ERSD, and (i) that you are able to print on paper or electronically save this ERSD for
your future reference and access; or (ii) that you are able to email this ERSD to an email address
where you will be able to print on paper or save it for your future reference and access. Further,
if you consent to receiving notices and disclosures exclusively in electronic format as described
herein, then select the check -box next to `I agree to use electronic records and signatures' before
clicking `CONTINUE' within the DocuSign system.
By selecting the check -box next to `I agree to use electronic records and signatures', you confirm
that:
You can access and read this Electronic Record and Signature Disclosure; and
You can print on paper this Electronic Record and Signature Disclosure, or save or send
this Electronic Record and Disclosure to a location where you can print it, for future
reference and access; and
Until or unless you notify Washington State Department of Commerce as described
above, you consent to receive exclusively through electronic means all notices,
disclosures, authorizations, acknowledgements, and other documents that are required to
be provided or made available to you by Washington State Department of Commerce
during the course of your relationship with Washington State Department of Commerce.