DATE: 8/30/2023
PROJECT DESCRIPTION:
PROJECT NO: CIP 13-03 PURCHASE ORDER NO: 04396
CONTRACTOR:
DESCRIPTION OF CHANGES AND/OR EXTRA WORK:
The Contractor is hereby directed to make the herein described changes from the plans and specifications and/or perform the following described work not included in the Plans and Specifications for this project.
ITEM DESCRIPTION U/M QUANTITY UNIT PRICE TOTAL 1 FA 1 $4,928.04 $4,928.04
2 FA 1 $2,130.68 $2,130.68
3 FA 1 $9,766.22 $9,766.22
TOTAL ESTIMATED PRICE FOR THIS CHANGE ORDER: $16,824.94 JUSTIFICATION: (Be specific on each item. Attach supporting documents as necessary)
Excavate abutment #4 around existing utilities. Work performed on 2/21/2023 and 2/22/2023.
Extra Work Bills (EWB) #9 and #10 total
This document shall become an amendment to the Contract and all provisions of the Contract will apply hereto. This Change Order constitutes a complete and final resolution of all claims of the Contract for additional time or additional compensation relat ed to or affected by work that is the subject of this Change Order. Quantities of items other than Lump Sum are not to exceed the amounts indicated.
Excavate abutment #4 footing to expose existing utilities in conflict (SCE, Spectrum and Frontier). Work performed on 3/2/2023.
EWB #15 total
Remove, relocate and add new fire hydrants and gate valves.
Work performed on 5/18/2023, 5/19/2023, 5/30/2023, 5/31/2023, 6/12/2023, 6/13/2023 and 6/16 2023.
EWBs #25, #26, #32, #33, #36, #37 and #38 total
2. The Contractor excavated abutment #4 footing to expose existing utilities that are not shown on the plans. These utilities are consideredburried manmade objects.
3. The plans show fire hydrants to be removed/relocated on the east side of Holland Rd. However, there is no contract bid item or method of payment provided for performing this work.
Holland Road Overcrossing at Interstate 215
The additional work will be compensated at force account Riverside Construction Company
CONTRACT CHANGE ORDER NO. 05
CITY OF MENIFEE
DEPARTMENT OF PUBLIC WORKS
The labor rates were verified against the certified payrolls and the equipment rental rates are per the latest Caltrans Labor Surcharge and Equipment Rental Rates publication.
1. The Contractor excavated abutment #4 around existing utilities that are not shown on the plans. These utilities are consideredburried manmade objects.
C:\Users\phann\OneDrive - Southstar Engineering & Consulting, Inc\Desktop\CCO 05 DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 CONTRACT CHANGE ORDER NO. 05
CITY OF MENIFEE
DEPARTMENT OF PUBLIC WORKS
CONTRACT VARIANCE SUMMARY
CCO # Amount %
01 $20,537.39 0.08%
02 $49,000.00 0.19%
03 ($9,000.00) -0.03%
04 $0.00 0.00%
05 $16,824.94 0.07%
Totals $77,362.33 0.28%
$25,848,403.85 January 10, 2023
$60,537.39 March 28, 2024
$16,824.94 0
$25,925,766.18 March 28, 2024
AUTHORIZATION BY CITY:
Recommended for approval by:
Date: __________ Date: __________
Approved by:
Date: __________ Date: ___________
ACCEPTANCE BY CONTRACTOR:
We, the undersigned Contractor, have given careful consideration to the above described changes and/or extra work and hereby agree that said work is a supplement to the contract and all provisions will apply hereto.
Accepted by: _____________________________________________________ Date: ____________________________ Signature
_____________________________________________________
Please print name and title
Revised Completion Date:
0 Date Started:
Original Completion Date:
Additional Time (Working Days)
Description Date Approved
4/17/2023
5/15/2023
5/31/2023
Irrigation Modifications Plan IP-5
0 0
Additional Time
Director of Public Works/Engineering
________________________________________________________________________________ __________________________________________________________________________ Original Contract Amount:
0 7/27/2023 Increased Girder Flare Thickness
Exc. Abut. #4/Fire Hydrant extra work
0 0
City Manager
Nicolas Fidler
Amr Abuelhassan, Southstar Construction Manager Carlos E. Geronimo, City Project Manager Armando G. Villa
Previous Change Order Amounts:
Current Change Order Amount:
Revised Contract Amount:
12" C900 DR 14 Fusible Pipe
Extra Work for miscellaneous items
C:\Users\phann\OneDrive - Southstar Engineering & Consulting, Inc\Desktop\CCO 05 DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 8/31/2023
Ryan Camp
DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 8/31/2023
8/31/2023
9/5/2023
9/5/2023
Holland Rd Overcrossing at 1-215 Project
cco #05
Report #9 $ 2,951.47
Report #10 $ 1,976.57
Report #15 $ 2,130.68
Report #25 $ 377.01
Report #26 $ 377.01
Report #32 $ 435.55
Report #33 $ 421.29
Report #36 $ 3,150.41
Report #37 $ 2,471.39
Report #38 $ 2,533.56
Total $ 16,824.94
DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 CCo .:tt.S-
STATE OF CALIFORNIA - DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL-TITLE PAGE
CEM-4902A (NEW 7/94) CT# 7541-3496-7
Date Performed
2/21/23
Date of Report
3/02/23
Con. Job No
22014
1 Cont. Rpt. No. g_O
02 I Work Performed By
Riverside Construction Company, Inc.
Description of Work
EX ABUT 4 AROUND EXISTING
For Resident Engineer's Use Only
Date Received
□ NewBill 0 Approved for Payment
0 Resubmittal 0 Returned for Correction
Date of Action
Contract No.
CASEWB
CCO No.
220141 902
Report No. Page
E.W. A._Q.
+ - I FA I LS I UP l_FA L LS I UP I BR
+IX
Attached to This Bill Are:
0 Labor Charges CEM-49028
0 Equipment Charges CEM-4902C
0 Material Charges CEM-4902D
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� % Standard Mark-up
Total Equipment & Materials (A) + (B) + Standard Mark-up otal Regular Labor (C)
� % Regular Labor Surcharge
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� % Premium Labor Surcharge
Subtotal Regular & Premium (C+D)
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Signature (Resident Engineer)
FM 941992 M
771.16]
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771.16]
77.12]
848.28]
1,470.76]
147.08]
0.00]
0.00]
1,470.76]
1,617.84]
0.00]
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Total Other Expenses (F)
Subtotal (C) + (D) + Regular Surcharge+ Premium Surcharge+ (E) + (F) � % Standard Markup
Total Labor (C) + (D) + Surcharge + (E) + (F) + Markup
Total Equipment & Materials
Total Equipment & Materials+ Labor
� % of Mark-up on Subcontracted Work (Only)
Grand Total
Name
/
In Case of Question:
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1,617.84]
485.35]
2,103.19]
848.28]
2,951.47]
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DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5
STATE OF CALIFORNIA- DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL (SHORT FORM)
Date Performed I Date of Report I Cost Job No
220 i 4
Cont. Rpt. No.
01 2/2i/23 3/02/23
02 Work Performed By • • •
R1vers1de Construction Company, Inc.
03 Description of Work
EX ABUT 4 AROUND EXISTING
9.0 I
Contract No.
CASEWB
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CCO No.
22014 902 [
Report No.
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Equip ID Number Equipment Description Regular Overtime For Resident Engineers Only Class Make Code Attach Hours Hours 04 4i79 TRUCK T&TT i2-20 8.00 □ NewBill D Approved for
Payment
05 1156 LDRRT CAT 1869E 4.00
06 D Resubmittal D
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25 Invoice Description I Units
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Labor Charges $2,103.19
Labor Name Labor Reoular Hours Overtime Hours Subsistence Craft ID Int Last Hrs Rate Hrs Rate Units Rate 34 LBR DG GUTIERREZ 8.0 69.840 91.780
35 TMS L ROMERO 8.0 70.260 89.120
36 OE DC KIMBERLING 4.0 87.490 i i5.830
37 38
39 40
Signature (Resident Engineer) In Case of Question Contact:
(Resident Engineer's Use Only)
Signature (Prime Contractor's Representative)
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FM 942020 M White • Data Entry Canary • Resident Engineer Pink • Contractor (After Approval) Goldenrod - Contractor EWBi/1s.com DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 STATE OF CALIFORNIA· DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL - EQUIPMENT CHARGES
Equip ID Number Class Make
04 4179 TRUCK T&TT
05 1156 LDRRT CAT
06 07
08 09
10 11
12 13
14 15
16 17
18 19
20 21
22 23
Signature of Resident Engineer
Contract No. CCONo.
22014 902
Equipment Description Regular Overtime Reg
Code Attach Hours Hours Rate
12-20 8.00 49.31
1869E 4.00 94.17
In Case of Question Contact:
(Resident Engineer's Use Only)
Signature of Prime Contractor's Representative
Cin><f
Name
FM 941987M White • Data Entry
"7�/IZ3'
Canary� - Resiclent Engineer Pink - Contractor (After Approval) Goldenrod - Contractor CASEWB 9.0
Report No. I Pag
3 OF 3
OT Extended
Rate Amount
394.48
376.68
Total (A) 771.16
Business Phone
EWBills.com
DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5
IVERSIDE
CONSTRUCTION
COMPANY, INC.
.aENcY: {7.11}1 o JJ/tj'I// He
PROJECT: j/oL ,ti, 1> 6C.
JOB NO.: z ZQ!L/
COST CODE: 9'i 2- goo
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8 8
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8 DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 -Ceo #.5
STATE OF CALIFORNIA· DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL-TITLE PAGE
CEM-4902A (NEW 7/94) CT# 7541-3496-7
Date Performed Date of Report Con. Job No. Cont. Rpt. No. 2/22/23 3/02/23 22014 10.0
Work Performed By
Riverside Construction Company, Inc.
03 I Description of Work
EX ABUT 4 AROUND EXISTING UTILITIES
For Resident Engineer's Use Only
Date Received
D NewBill D Approved for Payment
D Resubmittal D Returned for Correction
Date of Action
Contract No.
CASEWB
CCONo.
220141 902
Report No. Page
E.W. A.G.
+ - I FA I LS I UP J_FA )_LS I UP I BR
+IX
Attached to This Bill Are:
D Labor Charges CEM-49028
D Equipment Charges CEM-4902C
D Material Charges CEM-4902D
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Total Cost Summary, Standard Mark-Ups & Subcontractor Mark-Up otal Equipment (A)
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� % Standard Mark-up
Total Equipment & Materials (A) + (B) + Standard Mark-up otal Regular Labor (C)
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FM 941992 M
840.75]
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840.75]
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924.83]
735.48]
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0.00]
Pink - Contractor (After Approval)
Total Other Expenses (F)
Subtotal (C) + (D) + Regular Surcharge+ Premium Surcharge + (E) + (F) � % Standard Markup
Total Labor (C) + (D) + Surcharge+ (E) + (F) + Markup
Total Equipment & Materials
Total Equipment & Materials+ Labor
� % of Mark-up on Subcontracted Work (Only)
Grand Total
In Case of Question:
(Resident Engineer's Use Only)
0.00]
809.03]
242.71]
1,051.74]
924.83]
1,976.57]
0.00]
1,976.57]
DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5
STATE OF CALIFORNIA- DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL (SHORT FORM)
Date Performed Cont. Rpt. No. I E.W. I A.G.
I Contract No.
CASEWB
I CCONo.
22014 902 I
Report No.
I BR I 50% I Sub R/W I Partnering I Labor I WCI Class I WCI Rate
10.0 01 2/22/23
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02 03
04 05
06 07
08 09
10 Work Performed By • •
R1vers1de Construction Company, Inc.
Description of Work
EX ABUT 4 AROUND EXISTING UTILITIES
Equipment Charges
Equip ID Number Equipment Description
Class Make Code Attach
4179 TRUCK T&TT 12-20
4188 TRUCK T&TT 06-12
1169 HCECL CAT 335
$1,976.57
$924.83
Regular Overtime For Resident Engineers Only Hours Hours
3.00 □ New Bill D Approved for
Payment
3.00 3.00 D Resubmittal D
Returned for
Correction
Date Received Date of Action
Material and/or Work Done by Specialist or Lump Sum or Unit Price Payments Vendor Name
24 Invoice Description
Vendor Name
25 Invoice Description
Craft ID Int
Labor Name
Last
34 LBR DG GUTIERREZ
35 OE J MORQUECHO
36 OE JS LINSMEIER
37 38
39 40
Signature (Resident Engineer)
Signature (Prime Contractor's Representative) () � �/
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I
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Labor Charges $1,051.74
Labor Regular Hours Overtime Hours Subsistence
Hrs Rate Hrs Rate Units Rate
3.0 69.840 91.780
3.0 87.600 115.995
3.0 87.720 116.175
In Case of Question Contact:
(Resident Engineer's Use Only)
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Name
I
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DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5
IVERSIDE
CONSTRUCTION
COMPANY, INC .
. a ENCY: U7'-/ o P /lft i1lir�
PROJECT: #OLLl i)
JOB NO.: 2 Z OIL/
. COST CODE: 9:0.2 - 9 () Q
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DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 CCD #)
STATE OF CALIFORNIA - DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL-TITLE PAGE
CEM-4902A (NEW 7/94) CT# 7541-3496-7
01 Date Performed Date of Report Con. Job No.
3/02/23 4/06/23 22014
Work Performed By
Riverside Construction Company, Inc.
Description of Work
Cont. Rpt. No.
15.0 Contract No. CCONo.
220141 902
Report No.
E.W. A.G.
+ - I FA I LS J UP I FA I LS I UP I BR
+IX
CASEWB
Page
15.0 Partnering
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N
EXCAVATE ABUT 4 FOOTING TO EXPOSE UTILITIES IN CONFLICT For Resident Engineer's Use Only
□ NewBill
D Resubmittal
otal Equipment (A)
otal Materials (B)
D Approved for Payment
D Returned for Correction
Subtotal Equipment & Materials (A) + (B)
� % Standard Mark-up
Total Equipment & Materials (A)+ (B) + Standard Mark-up otal Regular Labor (C)
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� % Premium Labor Surcharge
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Subtotal (C) + (D) + Regular Surcharge+ Premium Surcharge otal Subsistence (E)
�ignafure (Resident Engineer)
Signature (Prime Contractor's Re1
Date Received
Date of Action
Attached to This Bill Are:
□ Labor Charges CEM-4902B
D Equipment Charges CEM-4902C
D Material Charges CEM-4902D
Total Cost Summary, Standard Mark-Ups & Subcontractor Mark-Up 890.06]
0.00]
890.06]
89.01]
979.07]
805.32]
80.53]
0.00]
0.00]
805.32]
885.85]
0.00]
-Z/31/z3
Total Other Expenses (F) o.oo]
Subtotal (C) + (D) + Regular Surcharge + Premium Surcharge+ (E) + (F) 885.85] � % Standard Markup
Total Labor (C) + (D) + Surcharge + (E) + (F) + Markup
Total Equipment & Materials
Total Equipment & Materials+ Labor
� % of Mark-up on Subcontracted Work (Only)
Grand Total
rt\.r A-b\AA..\'
In Case of Question:
(Resident Engineer's Use Only)
265.76]
1,151.61]
979.07]
2,130.68]
0.00]
2,130.68]
-U2--
FM 941992M White - Data Entry Canary - Resident Engineer Pink - Contractor {After Approval) Goldenrod - Contractor DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 STATE OF CALIFORNIA· DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL (SHORT FORM)
Date Performed I Dat
4/Q6/23
I Cost Job No
22014 01 3/02/23
Cont. Rpt. No.
15.0 I E.W. I A.G.
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15.0 02 Work Performed By • • •
R1vers1de Construction Company, Inc. $2,130.68
03 04
05 06
07 08
09 10
Description ofWork
EXCAVATE ABUT 4 FOOTING TO EXPOSE UTILITIES IN CONFLICT Equipment Charges
Equip ID Number Equipment Description Regular
Class Make Code Attach Hours
4179 TRUCK T&TT 12-20 4.00
4188 TRUCK T&TT 06-12 3.00
1169 HCECL CAT 335 3.00
$979.07
Overtime For Resident Engineers Only Hours
D NewBill D Approved for
Payment
D Resubmittal D Returned for
Correction
Date Received Date of Action
Material and/or Work Done by Specialist or Lump Sum or Unit Price Payments Vendor Name
I
Invoice Number
J
Mo/Day/Yr
24 Invoice Description I Units I Unit Cost or Net Pay
Vendor Name
I
Invoice Number
I
Mo/Day/Yr
25 Invoice Description
I
Units
I
Unit Cost or Net Pay
Labor Charges
Labor Name Labor Reaular Hours Overtime Hours Subsistence Craft ID Int Last Hrs Rate Hrs Rate Units 34 OE J MORQUECHO 3.0 87.600 115.995
35 OE JS LINSMEIER 3.0 87.720 116.175 ..
36 LBR DG GUTIERREZ 4.0 69.840 91.780
37 38
39 40
Signature (Resident Engineer) In Case of Question Contact:
(Resident Engineer's Use Only}
Signature (Prime Contractor's Representative) a_d � 1/31 lzs Name
I
Business Phone
FM 942020 M White - Data Entry Canary - Resident Engineer Pink - Contractor (After Approval) Goldenrod - Contractor $1,151.61
Rate
EWBills.com
DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5
STATE OF CALIFORNIA- DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL· EQUIPMENT CHARGES
Equip ID Number Class Make
04 4179 TRUCK T&TT
05 4188 TRUCK T&TT
06 1169 HCECL CAT
07 08
09 10
11 12
13 14
15 16
17 18
19 20
21 22
23 Signature of Resident Engineer
Signature of Prime Contractor's Representative
11�,>1?
Equipment Description
Code Attach
12-20
06-12
335
7131/z..3
CASEWB 15.0
Contract No. CCONo. Report No. I Pag:3 22014 902 OF 3
Regular Overtime Reg OT Ex1ended
Hours Hours Rate Rate Amount
4.00 49.31 197.24
3.00 38.20 114.60
3.00 192.74 578.22
In Case of Question Contact:
890.06 (Resident Engineer's Use Only) Total (A)
Name Business Phone
DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5
IVERSIDE
CONSTRUCTION
COMPANY, INC.
-A n!,) !J l ';,! e:
DAILY EXTRA WORK DIARY
/J✓.;-/1,/lk& ,GENCY: ---==-----�--'----------=
PROJEC��--�_L_�_1_Y�_C> __ Q_._�---
DATE WORK PERFORMED: _3_____,/2_2-+/2_£.c_--:;_3 ______ , I JOB N0.: __ 2_2_u�/_i-/_· ____ _
SUBCONTRACTOR: _____________ _
. COSTCODE: _�_{)_/_-_CJ_'rJ_O ____ _
LABOR:
EQUIPME NT:
EQUIP
NUMBER
MATERIALS:
QUANTITY U/M
REMARKS:
/]I
(IF NOT PRIME)
CLASSIFICATION HOURS
R ular Overtime
3 3
DESCRIPTION HOURS
3 3
DESCRIPTION
SIGNATURE BE LOW AGREE S CONTRACTOR or SUBCONTRACTOR WORKED ON,ffEM OF. WORK.
IL fo�K -"----'-"_#. -���L'-='-'--'-'',,(W/r-"--'-/✓ __ _ CONTRACTOR'S REPRESENTATIVE A_l3ENC)'",.,S REPRESENTATIVE DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5
STATE OF CALIFORNIA - DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL-TITLE PAGE
CCo:jt 5
CASEWB 25.0
CEM-4902A (NEW 7/94) CT# 7541-3496-7
Date Performed Date ot Report Con. Job No. Cont. Rpt. No. 5/18/23 7/21/23 22014 25.0
Work Performed By
Riverside Construction Company, Inc.
Description of Work ,r-H> ..vi.a.� #VI c.;J
REMOVE CONCRETE - FIRE HYDRANT RELOGATE
For Resident Engineer's Use Only
Date Received
□ NewBill D Approved for Payment
D Resubmittal 0 Retumed.forCorrection
Date of Action
Contract.NO:- - =-=-:-:-TccoNo.
2gQIB 908
Report No. Page
E.W. I A.C.
±_- J FA_lLS l UP LfA I gi_l_U_e_l_BR
+IX
Attached to This Bill Are:
0 Labor Charges CEM-49028
D Equipment Charges .CEM-4902C
D Material Charges CEM-4902D
Partnering
Swilch
N
Total Cost Summary, Standard Mark-Ups & Subcontractor Mark-Up [T'otal Equipment (A) 0.00
Total Materials (BJ
Subtotal Equipment & Materials (A) + (8)
1 0 % Standard Mark-up
Total Equipment & Materials (A)+ (B) + Standard Mark-up Total Regular Labor .(C)
9 % Regular Labor Surcharge
[T'ol2l Premium Labor (DJ
I
9 % Premium Labor Surcharge
Subtotal Regular & Premium (C+D)
Subtotal (C) + (DJ + Regular-Surcharge + Premium Surcharge irotal Subsistence (E)
'-signature. (Resident Engineer)
-
Signatifre (Prime Contractor's Repre.
0.001
-- 0.00'
0.00 ------�
-- -o.{f61
r---266.06
23�95
0.00 0.00
-- 266.06
290'.01
tsd,z..3
0.00 - ----
FM941992M White -. Data Entry Canary - Resident Engineer Pink • Contractor (Atrer Approval) Total Other Expenses (F)
Subtotal (C) + (DJ + Regular Surcharge + Premium Surcharge+ (E ) + (F) 30 % Standard Markup
Total Labor (C) + (DJ +Surcharge+ (El+ (F) + Markup
Total Equipment & Materials
Total Equipment & Materials+ Labor
10 1 %·of Mark-up on Subcontracted Work (Only)
Grand Total
In Case of Question:
(Resident Engineer's Use Only)
0.001
290.01 ---
87.00 377.01 ---
0.001
--- 377.oT 1...---•-·--··--
0.00 377.01 ._______ ---
N� -----
\ \ •
I Business-Phone
__ _ __ _ _ .. r7v--0r&� ��� �dl--� 2.-7t6B
Goldenrod -Contractor EWBills.com
DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL - LABOR CHARGES
Name Craft 10 Int last
34 LBR R REYES
35 LBR D ENCINAS
36 37
38 39
40 41
42 43
44 45
46 47
48 49
50 51
52 53
OTHER EXPENSES SUBJECT TO LABOR MARKUP
54 Signature (Resident Engineer)
Signature (Prime Conrractor's Represenf;Jf/ve)
--- -- -- -- --- - - -
Description
{,tSZ\ -- -.;_ .... -
] Cohtract No.
22014
Regular Hours
Hrs Ra1e
2.0 67.840
2.0 65.190
Total (Cl
.,,,?,, l-i-3-·. - ...
Total
135.68
130.38
266.06
- - ..
CASEWB 25.0
CCONo. Report No. 1 Labor su
9 charge \ WCI Class I WCI Rate I Pag
2908 OF 2
Premium Hours Subsistence
Hrs Rale Total UnllS Rate Total
88.780
84.805
Total(D) Total (E)
Amount
Travel Expense Extended Total (F)
Units Rate
In Case of Question:
(Resident Engineer's Use Only)
Name
I Business Phone
- -
DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5
RIVERSIDE CONSTRUCTION COMPANY DAILY EXTRA WORK DIARY
AGENCY: r,..-rt/ bv V\t �' fi:,Q'f'."
QRoJECT: \±ct- ;e,.� '\2-b cc...
DATE WORK PERFORM ED : __,._----,-_5_,{i-'t-"g:"-'/'---z..�3"--------==--=======:i
SUBCONTRACTOR
JOB NO.: :2,"ZD\ \:;/ (IF NOT PRIME)
cosT coDE: 90S /goo
ft�
Description of work performed and location : _}2f::.,..,;c�-=-f\�!_J �O�L�l�s:_�0�0�N>������\--J__:·___:t:";�1�1t-:!f-'::__:\.+IT.'t'i'U�';).!i' -�f\-1-.JT��!__._!;jb,::s;;;,;!2:- ��foi;���-•- LABOR:
EMPLOYEE
NAME
EQUIPMENT:
EQUIP
NUMBER
II r I
DESCRIPTION
■ I,
I - -
CLASSIFICATION HOURS
Regular overtime
z.
2-
HOURS
r • ■
DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 STATE OF CALIFORNIA· DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL-TITLE PAGE
CEM-4902A (NEW 7/94) CT# 7541-3496•7
01 Date Performed Date of Report Con.Job No.
CC0#-5.
Cont Rpt No.
contractiilo. CCONo.
22014 908 ----··-
E_W.
... FA LS UP FA
CASEWB 26.0
I Report No. �, Page
1 of 2
AC. Sub R/W Pannenng
LS UP BR Work Delav Switch
5/19/23 7/21/23 22014 26.0 + X N N N
f02TWork Performed By
'--l Riverside Construction Company, Inc.
03 I Description olWork fTI/Je>\M_c,101111'{w
REMOVE CONCRETE · FIRE HYDRANT REl::GGATIO�
For Resident Engineer's Use Only
0 NewBill 0 Approved for Payment
0 Resubmittal 0 Returned fer Correctlon
I-
Total Equipment (A)
�otal Materials (BJ
Subtotal Equipment & Materials (A) + (B)
I 10 % Standard Mark-up
Total Equipment & Materials (A) + (BJ + Standard Mark-up ifotal Regular Labor (CJ
, 91 % Regular Labor Surcbarge
Total Premium Labor (D)
9 I % Premium Labor Surcharge
Subtotal Regular & Premium (C+OJ
Subtotal {C) + (D) + Regular Surcharge + Premium Surcharge rotal Subsistence (E)
Signature (Prime-Con-·
FM 941992 M White • Data Entry
Date Received
Date of Action
Attached to This Bill Are:
� Labor Charges CEM-4902B
D Equipment Charges CEM-49020
□ Material Charges CEM-4902D
Total Cost Summary, Standard Mark-Ups & Subcontractor Mark-Up o.oo·
0.00 0.00
0.00,
0.001
266.06]
23.95]
·--·--·•-·-- 0.001
1---·- -0:001
266.06
290.01
0.001
Total Other Expenses (F)
Subtotal (C) + (DJ+ Regular Surcharge + Premium Surcharge.+ (E) + (F) 30 % Standard Mar1<up
Total Labor (C) + (DJ + Surcharge + (El + (F) + Markup
Total Equipment & Materials
Total Equipment & Materials + Labor
0.001
290.011
87.00!
377.011
0.00]
377.01 I
; 1 O I % of Mark-up on Subcontracted Woll< (Only) I O. OOI Grand Total I 377.01 I
-·-..,,.-·-·- r- ----· ----
In Case of Questlon:
ngineer
I (Res/denr Engineer's Use Only)
-, rad--z.3_ --- ---------�� � &k_uo. \�:
u
��;
h
:2{, 2 -,ca 58
Pink • Contractor (Alter Approval) Goldenrod · Contraior ll EWBills.com DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 STATE OF CALIFORNIA· DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL - LABOR CHARGES
.Craft ID Im
Name
Last
34 LBR C SORIANO II
35 LBR D ENCINAS
36 37
38 39
40 41
42 43
44 45
46 47
48 49
50 51
52 53
OTHER EXPENSES SUBJECT TO LABOR MARKUP
I Oesalp�on
541
Signature (Resident Engineer)
Signature (Prime Contractors Representative/
- -----. -- ...... - fJ.ufA - - - -
I Contract No.
22014
Regular Hours.
Hrs Rate
2.0 67.840
2.0 65.190
Total(C)
•r-=M f--z�.. - .. -
Total
135.68
130.38
266.06
. - ..
CASEWB 26.0
I
CCONo.
908
Report No. I Labor su
9 harge I WCI Class I WCI Rate I Pag
2 OF 2
Premium Hours Subsistence
Hrs Rate Total Units Rate Total
88.780
84.805
Tolal (D) Total (E)
Amount
Travel Expense Extended Total (F)
Units Rate
In Case of Question:
(Resident Engineers Use Only/
Name
I
Business Phone
-
DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 RIVERSl'DE CONSTRUCTION COMPANY
AGENCY:------"=C�'---'------'----""'-'---'--=:..__��---'--''t,"�0=--'-\��-=----=-------"-;=1 DROJECT�:__,_\-b�,�\--==�-DL..e-_1/4:,��\I\.D=-�'()�C. __ JOB NO.: ,2..2.LJ) l/
COST CODE: 9o<l> /CJoo
Description of work performed and location :
LABOR:
EQUIPMENT:
EQUIP
1NUMBER
MATERIALS:
QUANTITY
DESCRIPTION
REMARKS:
c,,,,, /, I
■ -
,I .,.
■ ■
- .
SUBCONTRACTOR
(IF NOT PRIME)
CLASSIFICATION
DAILY EXTRA WORK DIARY
HOURS
Regular Overtime
-z...
2 HOURS
■ t.. ■
■ ■
DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5
STATE OF CALIFORNIA- DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL-TITLE PAGE
CCO=ft 5
CASEWB
CEM-4902A{NEW 7/94) CT# 7541-3496-7
Date Performed Date of Report Con . .Job No. Cont Rpt No. 5/30/23 7/21/23 22014
Woik Performed By
Riverside Construction Company, Inc.
Description of Work
RELOCATE FIRE HYDRANT A-bo�J..(;'tl � e..J-
For Resident Engineer's Use Only
Date Received
0 NewBill 0 Approved-for Payment
0 Resubmittal 0 Rewrned for Correction Date of· Action
32.0 Contract No. Page 1 cco No. I Report No.
22014 �' 9_0_9�
E.',11__,______l_ P..C.
+· I FA-I LSl_UJ>.lJ'AJ LS I_UPl�B
+ I X
Attached to This Bill Are:
� Labor Charges CEM-49028
0 Equipment Charges CEM-4902C
0 Material Charges CEM-4902D
32.0 Partnering
Switch
N
Total Cost Summary, standard Mark-Ups & Subcontractor Mark-Up jf otal Equipment (A)
Total Materials (B)
Subtotal Equipment·& Materials (A) + (B)
-:ro, % Standard Mark-up
1-- Total Equipment & Materials (A) + (B) + Standard Mark-up r
otal Regular labor (C)
! 9 .! % Regular Labor Surcharge
Total Premium Labor (0)
--9-1 % Premium Labor Surcharge
Subtotal Regular & Premium (C+D)
Subtotal (Cl + (D) + Regular Surcharge + Premium Surcharge otal Subsistence (E)
.. t:�·-•-----•- I I Signa,ure (Resident Engineer)
c=
0.001
57.42]
57.42]
5.74]
63.161
262.80
23.651
0.00]
O.OOj
262.80]
286.451
0.001
L
�
,,
Signature (Prlme·Comracio?s- :crese�rarive/
-��(, \;z.·,·--�--
FM941992M Whlte • Data Entry canary - Resident Engineer Pink - Contractor (Alter Approval/ Total Other Expenses (F)
Subtotal (Cl + (D) + Regular Surcharge+ Premium Surcharge + (E} + (F) � % Standard Markup
Total Labor (C) + (0) + Surcharge + (E) + (F) + Markup
Total Equipment &- Materials
Total Equipment &.Materials+ Labor
10] % of Mark-up on Subcontracted Work (Only)
Grand Total
In Case of Question:
(Resident Engineer's Use Only)
Name -- - -----
0.00!
286.451
85.94]
372.391
63.16 435.55]
0.00]
435.55
f-j �
Business Phone
Goldenrod • Contractor t/YV - · - _5£c:::;:.v--.. '1 t]�'-2. bL -7ClJ 5 E,---· - c-,-,-�_:::::.
EWBills.com
DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5
STATE OF CALIFORNIA- DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL· LABOR CHARGES
Craft ID Int
Name
Last
34 OE R RIGGS
35 36
37 38'
39 40
41 42
43 44
45 46
47 48
49 50
51 52
53 OTHER EXPENSES SUBJECT TO LABOR MARKUP
I Description
54 I
Signature (Residenr-Engineer)
I Contract No.
22014
Regular Hours
Hrs· Rau,
3.0 87.600
Total (C)
Signature (Prime Contra,:ror's Representative)
O.,� �{, l-i.-1
CASEWB 32.0
CCONo. Report No.
I
Labor su
9 harge I WCI Class I WCI Rate I Pag
2909 OF 3
Premium 1-iours. Subslstence
Total Hrs Rate Total Units Rate Total
262.80 115.995
262.80 Total (D) Total (E)
Amount
Travel Expense Extended Total ( F)
Units Rate
In Case or Question:
(Resident Engineer's Use Only)
Name
I
Business Phone
FM 941991 M White • Data Entry canary - Resident Engineer Pink • Contractor(AfterApprovat/ Goldenrod • Contractor EWBills.ccm DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL - MATERIAL CHARGES
DC-CEM-4902D (NEW 7/94) CT# 7541-3499-3
Vendor Name
SUMMIT EQUIPMENT RENTAL
MATERIAL and/or WORK done by specialis
or LUMP SUM_QLUNIT PRICE PAYMENJS
Contract No.
22Q14
Invoice Number
CASEWB 32.0
Report� Page
I 3 OF 3_
Mo/OayNr
75956-1 24 I-' __________________________ _____________ ...._ Invoice Description Unit, Un� Cost or Net Pay EXtended Total 5/30/23
Vendor Name
3 HRS. RENTAL EXCAVATOR 1.000 57.42
I 25 I
lnvclce.Number
c;u=nded-Total lnvolce·Descriptlon Unit! Unit Cost or Net Pay �-- I
Vendor Name Invoice Number
26 Invoice Description Unit! Unit Cost or. Net Pay
Vendor Name I Invoice Number
21 1-
I
------------------------,------------.---'-· -----
Invoice Descript
i
on J Unit, J Unit Cost or Ne
t
Pay
Vendor Name ··�;;;;Number
28 Invoice Description
I
Unit! Unit Cost or Net Pay
VendcrName Invoice Number
Extended Total
!__
Extended Total
-
Extended Total
29 Invoice Descr!pticn Unit! I Unit Cost or Net Pay -t:.xtenaediotal -·
Vendor Name Invoice Number
30 --------------------------------�------------ ------------------- Invoice Description I Unit, Unit Cost or Net Pay
Vendor Name
31 , Invoice Description I Unit!
Vendor Name
� ! -
Invoice Description Unit!
Invoice Number
Unit Cost or Net Pay
Invoice Number
�t Cost or Net Pay
----------------------------------------------------------- Vendor Name Invoice Number
Extended Total
Extended Total
Extended Total
57.42I
I
Mo/OayNr
I Mo/DayNr
l
=-1 Mo/Day/Yr
1 t<l.o/Day/Yr
I
t<l.o/Oay/Yr
I
Mo/DayNr
I
Mo/Day/Yr
! Mo/DayNr
-
33 Invoice D
escr
i
p
t
i
�
n
-----------------~ _ -�
nl
� ,-----,-,,.�-__
U
:
lCost•Or Net Pay
-� Signature o
T
Reslaent Engineer Signature of Pnme Contractors Representative � g /, J Z,3
FM941986M White - Data Entry Canary - Resident Engineer Pink - Contractor (Alter Approval) Goldenrod • Contractor t:.xteMed Total
--
Invoice
57.42 Total (8)
E:WBllls.ccm
DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 Invoice#: 75956 RIVERSIDE CONSTRUCTION COMPANY INC
908-900 I 19378
5-5055 1-22014
Mini Excavator 5 Hrs.
$95.70
909--900
5-5055
Mini Excavator 11 Hrs.
$210.54
Current On Account
TRANS 601
ENT
06.30.2023
"A 3% credit card fee will be added to all credit card payments". Please Note:
No credits will be Issued after 30 days, from invoice date.
Rental and Sales:
$2,965.70
Total Amount: $3,062.74
851•248-3313 Phone
Mon- Frf 7:00- 4:00 Closed Sot-Sun
P,tnltd On Thu 611&2023 t0:12:"'4PM
ENV:
$96.60
Total Paid
Any Damages To Be Billed On Separate Invoice.
WWW.SUMMITRENTALS.NET
Goftwar• by Polnt,o.f.Rtl'llal SORwm www.polnt-of,tonUJ.com $0.00
Menifee= 8.75%:
$0.44
Total Duo: $3,082.74
951·382-3500 Fox
Modmcauon fl.7
Conltt1d-P1nJm1.1IOLlfll (10)
DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 Pogo1 of3
RomltTo:
SUMMIT EQUIPMENT RENTAL
26105 SHERMAN ROAD
MENIFEE, CA 92585
Invoice
WWW.SUMMITRENTALS.NET
Cuatomor#: 6168
RIVERSIDE CONSTRUCTION COMPANY INC
PO BOX 1146
Riverside, CA 92502
Ordered By: CARL
Closed
Thu 6/15/2023
Job □••er: MENIFEE. ANTELOPE RD
Date Out Fri 5/12/2023
Terms
NET30
Sales Representative: Mario Martinez 951-60-6-1594 [email protected] Delivery Fri 5/12/2023 7:00AM
CARL SHORT 909-772-8140
ANTELOPE RD - HOLLAND RD
ANTELOPE RD
MENIFEE
Right next to freeway
Antelo.e,e rd and Holland rd
Qty Koy !tome Str#
Pickup Tue 6/13/2023
CARL SHORT 909-772-8140
ANTELOPE RD • HOLLAND RD
ANTELOPE RD
MENIFEE
Slatut RetumltdDalo
1 07481130 EXCAVATOR MINI· 10,000II YMRZ4mEHAJ00831 Ratumed Man 6/12/2023 4:00PM GEHL
Meter Out 1482.4 Mater In: 1488.1 Toto! hot1ra on maier: 5.7 1doy $320.00 1week $960.00 4wceks $2,400.00
Called Off#142897 on 61612023 for 619/2023
AfN EQUIPMENT DAMAGES TO BE BILLED ON SEPARATE INVOICE
1 PROPTAX CA. PROPERTY TAX REIMBURSEMENT FEE
1 88382218 36" 245 EXCAVATOR BUCKET 257080.7-1
caned Off 0.142897 on 818/2023 for 6/tl/2023
ANY EQUIPMENT OAMAGES TO BE BILI.ED ON SEPARATE INVOICE 1 PROPTAX CA. PROPERTY TAX REIMBURSEMENT FEE
1 88181840 18" ZAS EXCAVATOR BUCKET
1day$40.00 1wock$120.00 4We<>ks$380.00
Called Off #142897 on 61612023 for 81912023
ANY EQUIPMENT DAMAGES TO BE BILLED ON SEPARATE INVOICE
1 PROPTAX CA. PROPERTY TAX REIMBURSEMENT FEE
1 !RETURN FEE RIV. RETURN FEE RIVERSIDE
1 NON RETURNED KEY NON RETURNEO KEY
Man - Frl 7:00 • ◄:OO Clo,,od Sat-Sun
Printed On Thu llf15J202310:t2:44PM SoltW.,.t,yPoW-of,Rltl(IISolt-lrlre www.po1rt,of-11nlllc:cm Puffod
Rarumed Man 6/1212023 4:00PM
Putted
Ro:tumed Mon 6/12/2023 4:00PM
PuRctl
SOid
PuUod
Invoice#
75956-1
Aging Date
Thu 6/15/2023
Prfco
$2,400.00
$18.00
$0.00
$0.00
$360.00
$2.70
$180.00
$S.00
ModlficaUon #7
can1,�ci-P .. m1.SOL,pl(I0)
DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 Invoice#: 75956 RIVERSIDE CONSTRUCTION COMPANY INC
lf:fl}L'I .UHtr:tDTOl_:\:TUl�CO!'/Tlt,\C'T
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Modification #7
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DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5
RIVERSIDE CONSTRUCTION COMPANY DAILY EXTRA WORK DIARY
AGENCY: � tT �, o � \'v\£'t,-.)I (?. t:3=:
OROJECT: IJv< I A:-t-...-0 T2vM D<....
JOB NO.: 2-ZolY
C0STC0DE: 4Jo9 /qoo I
Description of work performed and location :
LABOR:
EMPLOYEE
NAME
DESCRIPTION
MATERIALS:
QUANTITY
REMARKS:
A-do
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DATE WORK PERFORMED :___,=---_5_�_3_lJ�/2_z_��----
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HOURS
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DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 STATE OF CALIFORNIA· DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL-TITLE PAGE
CCCJ#S
CEM-4902A (NEW 7194) CT# 7541-3496-7
Date Performed
5/31/23
Work Performed By
Date of Report
7/21/23
Con. Job No. I Cont. RpL No.
·22014 33.0
Riverside Construction Company, Inc.
['iiil Description of Work
I\ ., J L 7 REtJ/EOK F£RE HYDRANT 1-'t�evt�-
For Resident Engineer's Use Only
Date Received
□ NewBill D ApprovedforPayment
D Resubmittal D Returned for Correction Date of Action
[ Contract No.
CASEWB
22014
1 cc909 I Report No. f Page
E.W. I A.C.
+· I FA I LS I UP I FA I LS_LU�LBR
+IX
Attached to This Bill Are:
0 Labor Charges CEM-49028
0 Equipment Charges CEM-4902C
D Material Charges CEM-49020
33.0 Partnering
SWitch
N
Total Cost Summary, Standard Mark-Ups & Subcontractor Mark-Up rota! Equipment (A)
r otal Materials (B)
Subtotal Equipment & Materials (A) + (6)
I 10. %Standard"Mark-up
1--- Total Equipment &· Materials (A) + (B) + Standard Mar.k-up jrotal Regular Labor (C)
9 I % Regular Labor Surcharge
Total Premium Labor (D)
,---, I �I % Premium Labor Surcharge
Subtotal Regular & Premium (C+D)
Subtotal (C) + (D) + Regular Surcharge + Premium Surcharge � otal Subsistence (E}
157.30]
0.001
157.30.
15.73!
173.03]
175.20!
15.77 0.001
0.00]
175.20
190.97]
0.00]
Total Other Expenses (F)
Subtotal (C) + (D) + Regular Surcharge + Premium Surcharge + (El + (F) 1:30-1 % Standard Markup
Total Labor (C) + (D) +Surcharge+ (E) + (F) + Markup
Total Equipment & Materials
Total Equipment & Mateiials + Labor
1 _ 10 I % of Mark-up on Subaintracted Work (Only)
Grand Total
----- ··-------·�- - -·- -
In Case of Question:
(Resident Engineer's Use Only)
0.00]
190.97]
57.29]
248�
173.03
421.29J
0.00]
421.2�
Signature (Prime Con
--�'dn ______ ___ .A�, vt_b��� 1 ?.;:;��2i_?._� 7fjst3
FM 941992M ry - Resident Engineer Pink - Contractor (Alter Approval) Goldenrod • Coniractor EWB//1s.com DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL - LABOR CHARGES
CASEWB 33.0
I Contract No. CCONo. Report No. I Labor su
9 harge I WCI Class I WCI Rate I Pag
222014 909 OF 3
Name Regular Hours Premium Hours Craft ID Int Last Hrs Rate Total Hrs Rate 34 OE R RIGGS 2.0 87.600 175.20 115.995
35 36
37 38
39 40
41 42
43 44
45 46
47 48
49 50
51 52
53 Total (C) 175.20 Total (D)
OTHER EXPENSES SUBJECT TO LABOR MARKUP
I
54 I
Signature (Resident Engineer)
Signature (Prime Contractor's Representative)
FM941991 M White - Data Entry
Desaiption
(h� 8 l, l1-s
Name
Canary - Resident Engineer Pink • Contractor (Afrer Approval) Goldenrod - Contractor Subsistence
Total Units Rate Total
Total (E)
Amount
Travel Expense Extended Total (F)
Units Rate
In Case of Question:
(Resident Engineer's Use Only}
I
Business Phone
EWB/1/s.com
DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL - EQUIPMENT CHARGES
Equip ID Number Class
04 1147 LDRRT
05 06
07 08
09 10
11 12
13 14
15 16
17 18
19 20
21 22
23 Signature-of Resident Engineer
Signature ct Prime Contractors· Representative
.. _ .. ---- ... . ........ - . - . -
Make
CAT
(Ji�
-✓ - ·-• . -
Equipment Descriptlcn
Code
1865E
'8(, J 2,3 -··-• - .
Attach
�A,&. __ "---- --" --•-•- -
CASEWB 33.0
Contract No.
22014
I CCO No. I Report No.
I
Page
909 3 OF 3
Regular Over1lm• Reg OT Extended
Hours Hours Rale Rate Amount
2.00 78.65 157.30
In Case ofQues1ion Contact:
157.30 (Resident Engineer's Use Only) Total(A)
Name Business Phone
-···-···
DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5
RIVERSIDE CONSTRUCTION COMPANY DAILY EXTRA WORK DIARY
AGENCY: C1::c:i ,,-c ,tu�,�
OROJECT : 1-:}b l \ P-.-f\.O jto-AO tJJ c..
JOB NO.: ,Z,.1--0\ \.f
COST CODE: 'Jo9 /9 D d
DATE WORK PERFORMED : ___ S_,_/�3u/-1-,l .... z�?,..!.✓'--------'===
SUBCONTRACTOR
(IF NOT PRIME)
Description of work performed and location: �� bf¼: /-t 1/bt2.-4-1Jr . &r-r:::or-1� LABOR:
EMPLOYEE
NAME
EQUIPMENT:
EQUIP
NUMBER
MATERIALS:
QUANTITY
REMARKS:
DESCRIPTION
CLASSIFICATION
�ow AGREES CONTRACTOR or SUBCONTRACTOR WORKED ON ITEM , F WORK:; / - .,,{/
CONTRAC'Fe>F(S REPRESENTATIVE
■ ■
•■ ....
.ii t- .. 1 ■-(.■ ■
•■ ■ �� /;.-.A.::r-1�
Ai� �RESENTATIVE
II ■ ■ ■
■
..... ■••■· 1•
■
HOURS
Regular Overtime
:z...
HOURS
z.
■
DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5
STATE OF CALIFORNIA- DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL-TITLE PAGE
cco:#5 CASEWB 36.0
CEM-4902A (NEW 7/94) CT# 7541-3496-7
Date Performed Date of Report Con. Job No. Cont Apt. No. 6/12/23 7/21/23
Work Performed By
Riverside Construction Company, Inc.
�
D
R��00�0
;1RE HYDRANT
For Resident Engineer's Use Only
0 NewBill 0 Approved for Payment
0 Resubmiual 0 Returned for Correction
22014 36.0
Date Received
Date of Action
Contract No. I Page I CCO No. I Report No.
22014 1 909_ 1
E.W. I A.r;;,
+ • I FA I !.SLU��J LS I UP I BR
·
_
so% I Sub
Fl_ao W_o_rk
+IX N I N
Attached to This Bill Are:
0 Labor Charges CEM-49028
0 Equipment Charges CEM-4902C
0 Material Charges CEM-4902D
Pannerlng
Switch
N
Total Cost Summary, Standard Mark-Ups & Subcontractor Mark-Up [Total Equipment (Al
!rota! Materials (Bl
Subtotal Equipment & Materials (Al + (Bl
L __ 1 0 ¾ Standard Mark-up
Total Equipment &· Materials (A) + (Bl + Standard Mark-up rotal Regular Labor (Cl
I•
9 i ¾ Regular Labor Surcharge
lrotal Premium Labor (Ol
9 , ¾ Premium Labor Surcharge
Subtotal Regular & Premium (C+Dl
Subtotal (C) + (0) + Regular Surcharge+ Premium Surcharge Total Subsistence (El
254.34]
153.14i
407.481
40.74]
448.22]
1,906.981
171.63]
0.0Q)
0.00]
1,906.98]
2,078.61\
0.001
Total Other Expenses (F)
Subtotal (C) + (Dl + Regular Surcharge + Premium Surcharge + (E) + (F) J 30 I ¾ Standard Markup
Total Labor (C) + (0) +Surcharge+ (E) + (F) + Markup
Total Equipment & Materials
Total Equipment & Materials + Labor
I 1 0 j % of Mark-up on Subcontracted Work (Only)
Grand Total
0.001
2,078.61 1
623.58:
2,702.19
448.221
3,150.411
�I
3,150.41
Signature (Resident
Eiigi'T} __ _
--------------------·-· -----·- ·------ -------· --- -· ------- Signature (Prime Con�.-
Sf ' ----' -Z-3
FM 941992 M --White - Data Entry anary - Resident-Engineer Pink • Contractor (After Approval} In Case of Question:
(Residenr Engfneer's Use Onfy)
l Name
.LlL---�-- I
Business Phone ---- -
_____ D. m_., ODl.Uli _ �� �oq -2=_b_2. -1�5 B
Goldenrod - Ccntrabor EWBills.com
DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5
STATE OF CALIFORNIA- DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL - LABOR CHARGES
CASEWB 36.0
I �2011°·
CCONo. Report No. I Labor su
9 harge I WCI Class I WCI Rate I Pag
2 909 OF 4
Name Regular Hours Premium Hours
Craft ID· Int Last Hrs. Rate Total Hrs Rate
34 LBR M GONZALEZ 6.0 65.190 391.14 84.805
35 LBR C SORlANO II 6.0 67.840 407.04 88.780
36 OE JS LINSMEIER 8.0 87.720 701.76 116.175
37 LBR R REYES 6.0 67.840 407.04 88.780
38 39
40 41
42 43
44 45
46 47
48 49
50 51
52 53
Total (C) 1,906.98 Total (DJ
OTHER EXPENSES SUBJECT TO LABOR MARKUP
I Description
54 1
Signature (Residenr Engineer)
Signature (Prime Contrar:1or.'s Representative)
fA1 }A' 8(, /-z-3
Name
FM 941991 M White· - Data Entry Canary - Resident Engineer Pink - Contractor (Attor Approval) Goldenrod - Contractor Subsistence
Total Units Rate Total
I
Total (E)
Amount
Travel Expense Extended Total '(F)
Unlls Rate
In Case of Question:
(Resir!enr Engineer's Use Only)
I
Business Phone
EWBills.com
DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 STATE OF CALIFORNIA· DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL - EQUIPMENT CHARGES
Equip ID Number Class Mal<e
04 4223 TRUCK T&TT
05 06
07 08
09 10
11 12
13 14
15 16
17 18
19 20
21 22
23 Signab.Jre of Resident Engineer
Signature of Prime Contractofs Representative
/J�,c;q_'- -- - -- --- .. - - ' - - . -
Equipment DescrlpUon
Cooe
06-12
81J/z:3 -· . - ,,.,..__ a ..
Al!:,ch
- .. -
CASEWB 36.0
Contract No.
22014
\ CCO No. \ Report No. \ Page
909 3 OF 4
Regular Overtime Reg OT Extended
Hours Hours Rate Rate Amount
6.00 42.39 254.34
In Case of Question Contact:
254.34 (Residont Engineer"s Use Only) Total (A)
Name Business Phone
··-···
DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 STATE OF CALIFORNIA- DEPARTMENT OF TRANSPORTATION CASEWB 36.0 EXTRA WORK BILL - MATERIAL .CHARGES
DC-CEM-4902D (NEW 7/94) CT# 7541-3499-3 MA TERI AL and/or WORK done by specialis Contract No. CCC No. Report No. -Page or LUMP �..!)Mor UNIT PRICE PAYMENTS 2�Q14 909 4 OF 4
Vendor Name
SUMMIT EQUIPMENT RENTAL
24 lnvo� Cescrlption J Unit:
8 HRS. RENTAL EXCAVATOR
Vendor Name
1.000
Invoice Number
75956-1
Unit Cost or Net Pay Extended Total
1 s3.14 l
!
Invoice Number
I 25 Invoice Description Unlu Unit Cost or Net Pay Extended Total Vendor Name Invoice Number
Ma/Oay/Yr
6/12/23
153.141
Mc/Day/Yr
Mo/Day/Yr
I 2s 1 Invoice DQSCtfption I Unlu Unit Cost or Net Pay Extended Total I Vendor Name
27 Invoice Description
l---. Vendor Namo
28 I Invoice Description
Vendor Name
Uniu
-------------�---- -------------�-----
Unit,
! Invoice Number
Unit Cost or Net Pay Extended Total
Jnvol�umber
Unit Cost or Not Pay Extended Total
Invoice Number
·29 Invoice Descrll)llon I Unltt Unit Cost or Net Pay Exlended Total J Ma/Oay/Yr
�·Mcioay/Yr--·
I Mc/Day/Yr
Vendor Name
� 1�
I
Invoice Number �-��. �-
;
Ma/Day,:;;---
- I
Unit Cost or Net Pay I Extended Total --------1 Invoice ,Descripfion I
Vendor Name Invoice Number Mo/Oay/Yr
31 Invoice Description Unit!
-·-L--------------------------,
Unit Cost or Net Pay Extended Total
,--.�------------------------------Vendor Name
32 --------------
Invoice Description
,----l-------· --------
vendor Name
I 33
I Invoice Descrlpllon
·---
----------------- --
Unll!
Unit,.
I Invoice Number
Unit Cost or Net Pay Extended T 0121
j Invoice Number
Unit Cost or Net Pay Extended Total
I
rs1gnature of ResidenfE:ngineer !
Signature o(Prlme·c·oritraclors'Represeritative--
"?/ I Invoice
Mo/Oay/Yr
Mo/Day/Yr
I
1s3.14 l
========--===========, =-=-===========l��-1:'.;::-__:'{! b,'J,___ Total (8)
- Resident Engineer -Pink - Contractor (Atr�r Approval) -
EWBi/ls.com FM941986M White - Data Entry Canary
DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 Invoice II: 75956 RIVERSIDE CONSTRUCTION COMPANY INC
908-900
5-5055
Mini Excavator 5 Hrs.
$95.70
909--900
5-5055
Mini Excavator 11 Hrs.
$210.54
19378
1-22014
Current On Account
TRANS 601
ENT
06.30.2023
"A. 3% credit card fee will be added to all credit card payments". Please Note:
No credits will be issued after 30 da}'_s, from invoice date.
Rental and Sales:
$2,965.70
Total Amount: $3,062.74
951-246-3313 Phone
Mon. Fri 7:00-4:00 Closed Sat.Sun
PMlitd011TtluMGfl023 fG:12:«PM
ENV:
$96.60
Total Paid
Any Damages To Be Billed On Separate Invoice.
WWW.SUMMITRENTALS.NET
Software byPolnt,cr.Ranllll SOflWlrt WWW,po!nl•Clt•Mnhll,C(lm $0.00
Menifee= 8.75%:
$0.44
Total Duo: $3,062.74
951-382-3500 Fax
Modlficallon #7
COl\ltoct,Par1:mt..SOL.(fl1(10)
DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 Peoo 1 of3
RnmltTo:
SUMMIT EQUIPMENT RENTAL
26105 SHERMAN ROAD
MENIFEE, CA 92585
WWW.SUMMITRENTALS.NET
Customer#: 5168
RIVERSIDE CONSTRUCTION COMPANY INC
PO BOX 1146
Riverside. CA 92502
Ordered By: CARL
Invoice
Closed I Invoice#
Thu 6/1512023 75956-1
Job Descr. MENIFEE· ANTELOPE RD
Date Out Fri 5112/2023
Terms Aging Date
NET30 Thu 6/1512023
Sales Representative: Marto Martinez 951-60-6-1594 [email protected] Delivery Fri 5/12/2023 7:00AM
CARL SHORT 909-772-8140
ANTELOPE RD· HOLLAND RD
ANTELOPE RD
MENIFEE
Right next to freeway
!elope rd and Holland rd
Qty Koy ttomc Sor#
Pickup Tue 6/13/2023
CARL SHORT 909-n2-8140
ANTELOPE RD· HOLLAND RD
ANTELOPE RD
MENIFEE
Statua Ratumod Dato
1 87481130 EXCAVATOR MINI· 10.000/l YMRZ45Y6EHAJ00831 Returned Mon 611212023 4:00PM GEHL
Motor Out 14B2.4 Meter In: 14Bfl.1 Total hours on meter: 5.7 1day$320,0O 1weekS960.00 4waoksS2,4OO.00
CaRad on #142897 on 6/6/2023 tor 819/2023
ANY EQUIPMENT DAMAGES TO BE BILLED ON SEPARATE INVOICE
1 PROPTAX CA, PROPERTY TAX REIMBURSEMENT FEE Puffod
1 88362218 36" ZA5 EXCAVATOR BUCKET 257080-7-1 Rotumod Mon 6/1212023 4:00PM Ca Red on #142697 on 618/2023 for 819/2023
ANY EQUIPMENT DAMAGES TO BE BILLED ON SEPARATE INVOICE
1 PROPTAX CA. PROPERTY TAX REIMBURSEMENT FEE Pulled
1 88181840 18"ZAS EXCAVATOR BUCKET Rclumed Mon 6112/2023 4:00PM tday $40,00 1waok $120.00 4wecko $360,00
Called Off #142897 on 6/S/2023 ror 819/2023
ANY EQUIPMENT DAMAGES TO BE BILLED ON SEPARATE INVOICE
1 PROPTAX CA. PROPERTY TAX REIMBURSEMENT FEE Pulled
1 !RETURN FEE RIV. RETURN FEE RIVERSIDE Sold
1 NON RETURNED KEY NON RETURNED KEY Pulled
Price
$2,400.00
$18.00
S0.00
$0.00
$360.00
$2.70
$180.00
$5.00
Mon� Fri 7:00-4:00 Cfouod Sat-Sun
PrtnlGd on Ttw611"'2023 11);1.2" .. <tPM Sortw11:re t,yPclnt-of-RcnlA! Sortwiant www,palM-or,rent&!,com Modlficatlon #7
CcnttflCl•Params.5CUJ)t {10)
DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 .., Q M
0 DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 ■■ ■ ■-
RIVERSIDE CONSTRUCTION COMPANY
AGENCY: C,-n, or M� I�
PROJECT : \.tb.Lt kt---=� � CC.
JOB NO.: 2,.7P I Lf
COST CODE: 9o9) j on
Description of work performed and location :
LABOR:
DESCRIPTION
REMARKS:
A-wo t�,,,,.f.vl ,i ... <
SUBCONTRACTOR :
(IF NOT PRIME)
CLASSIFICATION
- fl:£:l. Tt""O .
t\
iv-, pw,.,
SIGNAT OW AGREES CONTRACTOR or SUBCONTRACTOR WORKED ON ITE, ic>F W°.3lK. -■
r
■
■ ■
PRESENTATIVE
"■• ■• ,I
r�!II-,.
■ r ■'j-
■ ■
l!I .!I
" .1■ u· lr ii ·
■ ■ ■ •
■
•
■
■
DAILY EXTRA WORK DIARY
•
■
.J
■
■ J
DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5
STATE OF CALIFORNIA- DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL-TITLE PAGE CCo-#S CASEWB 37.0
CEM-4902A (NEW 7/94) CT# 7541-3496-7 I Contract No . j CCONo. �2014. 909
j Report-No. -- Page
I 1 3
Date Performed
6/13/23
Date of Report
7/21/23
Con.Job-N
22014
1 ContRpt.No
:3?.Q
FA
+IX
Work Performed By
Riverside Construction Company, Inc.
03 Descriptlon of Work
REMOVE FIRE HYDRANT
For Resident Engineer's Use Only
Date Rec eived
□ Ne wBill D Approved for Payment
D Resubmittal D Returned for Correction
Date ol Action
Total Cost Summary, Standard Mark-Ups & Subcontractor Mark-Up E.W.
LS
of
A.C. "50o/, Sub A/W
UP FA LS UP BR Fla Work Oeta.v
I N N N
Attached to This Bill Are:
0 Labor Charges CEM-49028
0 Equipment Charges CEM-4902C
D Material Charges CEM-4902D
Partnering
Swtteh
N
----·--------·--------------------- -------,
[Total Equipment (A) 993.16] Total Other Expenses (F) o.ool Total Materials (B)
Subtotal Equipment & Materials (A) + (Bl
1 0 % Standard Mark-up
__J
Total Equipment.& Materials (A) + (BJ + Standard Mark-up !Total Regular Labor (Cl
I_
9 % Regular Labor Surcharge
Total Premium Labor (D)
I- 91 % Premium Labor Surcharge
Sub total Regular & Premi um (C+D)
Subtotal (C J+ (D) + Regular Surcharge+ Premium Surcharge Total Subsistence (EJ
0.001
993.16
99.32]
1,092.481
973.12
87.58]
0.001
0.00 973.121
1,oso:75\
0.001
Sub total (C) + (D) +Regular.Surcharge+ Premium Surcharge+ (E) + (F) � % Standard Markup
Total Labor (C ) + (D) +Surcharge+ (EJ + (F) + Markup
Total Equipment & Materials
Total Equipment·& Materials+ Labor
f' 10 % of Mark-up on Subcontract ed Work·(Only)
Grand Total
1,060.70]
318.211
1,378.91
1,092.48]
2,471.391
o.oo\ \
2,471.39'--
Slgnatiire-(R_e_skl_en-1 -�,)--- --
-
--- -- ----- -- --- u,�- ---�=-.. -��
T--·--- �-. --Tnc;;�f Q�estion:
-- - -------· '
I
(Resident Engineers Use Only)
-Signature (Primet5ontracta?s:ep-
__
--=_(l_(_�
S(l I Z.3_ ... - __ --=--=-�-=G
e
m���� ! 9:;:�L�.}�5�
FM 941992 M White • Data Entry Canary - Resident Engineer Pink • Contractor (Mer Approval) Gold enrod -Contractor � EWBills.com DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 STATE OF CALIFORNIA- DEPARTMENT OF TRANSPORTATION CASEWB 37.0
EXTRA WORK BILL - LABOR CHARGES
\ Contract No. CCONo. Report No. \ Labor su
9 harge I WCI Class I WCI Rate \ Pag
222014 909 OF 3
Name Regular Hours Premium Hours
Craft ID Im Last Hrs I Rate Total Hrs Rate
34 LBR C SORIANO II 4.0 67.840 271.36 88.780
35 OE JS LINSMEIER 8.0 87.720 701.76 116.175
36 37
38 39
40 41
42 43
44 45
46 47
48 49
50 51
52 53
Total(C) 973.12 Total (D)
OTHER EXPENSES SUBJECT TO LABOR MARKUP
I OesCflption
541
Signature (Resident Engine&r)
-
Signature (Prime Ccntractor's Representative)
(Ju� sf, /7.,..,_
Name
FM941991 M White - Data Entry canary - Resident Engineer Pink • Contractor (Alter Approval) Goldenrod • Contractor Subsl�nee
Total Units Rate Total
Total(E)
Amount
Travel Expense Extended Total (F)
Units Rate
In Case of Questton:
(Resident Engineer's Use Only)
I
Business Phone
EWBi/1s.com
DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL - EQUIJ>MENT CHARGES
Equip ID Number Cl= Make
04 4223 TRUCK T&TT
05 1156 LDRRT CAT
06 07
08 09
10 11
12 13
14 15
16 17
18 19
20 21
22 23
Signature of Resident Engineer
Signature of Prime Contracto�s Representative
�g .. - _...,... -
Equipment Description
Code
06-12
1869E
-- . Bl, I� -
CASEWB 37.0
Contract No.
I csoog' I Report No. Page
22014 3 OF 3
Regular Dvertlme Reg OT Extenoed
Attach Hours Hours Rate Rate Amount
4.00 42.39 169.56
8.00 102.95 823.60
In Case of Question Contact:
993.16 (Resident Engineer's Use Only) Total (A)
Name Business Phone
.... .. - .. - ...
DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 RIVE:RSIDE CONSTRUCTION COMPANY
AGEN cv : C n l,f o r M�, Ee::tr
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JOB NO. : 't-1. 0 \ '-{
COST CODE: � cA I cwo
Description of work performed and location :
LABOR:
EMPLOYEE
NAME
EQUIPMENT:
EQUIP
NUMBER
l/'217
QUANTITY
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SUBCONTRACTOR :
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CLASSIFICATION
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DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 STATE OF CALIFORNIA· DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL-TITLE PAGE
CEM-4902A (NEW 7/94) CT#7541-3496-7
CL0=#- 5
Contract No.
220141
cc90�·-·-Report No.
E.W. I A.C.
CASEWB 38.0
Date Performed
6/16/23
Date of Report
7/21/23
eon. Job
1\1220141
Cont. Apt. No
3S
.O +• I FA I LS_l_Ul>j__EA � I UP I BR
+ I X
Pannerlng
Switch
N
Work Performed By
Riverside Construction Company, Inc.
Description of Work
REMOVE FIRE HYDRANT
For Resident Engineer's Use Only
□ NewBIII
D Resubmittal
1 1 otal Equipment (A)
rotal Materials (B)
D Approved for Payment
D Returned for Correction
Subtotal Equipment & Materials (Al + (Bl
-----:;-o1 % Standard Mark-up
Total Equipment & Materials (A)+ _(B) + Standard Mark-up r��gular Labor (C)
� % Regular Labor Surcharge
otal Premium Labor (0)
1 9 !
% Premium Labor Surcharge
I
Subtotal Regular & Premium (C+O)
Subtotal (C) + (0) + Regular Surcharge + Premium Surcharge rrotal Subsistence (E)
Date Received
Date of Action
Attached to This Bill Are:
0 Labor Charges CEM-4902B
0 Equipment Charges CEM-4902C
0 Material Charges CEM-4902D
Total Cost Summary, Standard Mark-Ups & Subcontractor Mark-Up 1,390.091
0.001
1,390.091
139.011
1,529.101
708.861
63.801
0.001 -
0.001 --
708.86
772.66
r 0.00
Total Other Expenses (F)
Subtotal (C) + (D) + Regular Surcharge + Premium Surcharge + (E) + (F) � % Standard Markup
L____J
Total Labor (C) + (D) + Surcharge + (E) + (F) + Markup
Total Equipment & Materials
Total Equipment & Materials + Labor
Q�J % of Mark-up on Subcontracted Work {Only)
Grand Total
---r-- - ----· . --- ·--· -- ----
In Case of Question:
(Resldenr E.n9/neer's Use Only)
0.00]
772.661
231 :so1
1,004.461
1,529.10]
2,533.56]
0.00]
2,533.561
Signature(Prime Contract,r's
White • Data Entry
8 fi
· �ame --- I Business Phone ___ 'b
� ----�_,lz..3_ _ ____ l�rY'1ftk��� _tt�=u2_-l.__��- - Pink • Contractor (Airer Approval) Goldenrod • Contractor EWBills.com FM941992M DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 STATE OF CALIFORNIA· DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL - LABOR CHARGES
Cralt ID Int
Name
L2st
34 OE DC KIMBERUNG
35 TMS M HARDY
36 37
38 39
40 41
42 43
44 45
46 47
48 49
50 51
52 53
OTHER EXPENSES SUBJECT TO LABOR MARKUP
I Description
54 I
Signature (Resident Engineer)
Signature (Prime Conrractol's Representative)
fJuW
illary g
I Contract No.
22014
Regular Hours
Hrs Rate
4.0 87.490
5.0 71.780
Total (C)
Bf J/,z.3
CASEWB 38.0
CCONo. Report No. I Labor su
9 ai:ge I WCI Class \ WCI Rate \ Pag
2 909 OF 3
Premlum Kours. Subsistence
Total Hrs Rate Total Units Rate Total
349.96 115.830
358.90 91.400
708.86 Total (D) Tolal (E)
Amount
Travel Expense Extended Total (F)
Units Rate
I I
In Case ol Quesijon:
(Resident E:ngineet's Use Only}
Name I Business Phone
DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL - EQUIPMENT CHARGES
Equip ID Number Class Make
04 2045 TRUCK T&TT
05 6033 TRUCK T&TT
06 1146 LDRRT CAT
07 08
09 10
11 12
13 14
15 16
17 1B
19 20
21 22
23 Signature of Resident Engineer
Contract No. CCONo.
22014 909
EqulpmentDesalption Regular Overtime Reg
Code Attach Hours Hours Rate
60 5.00 105.34
12-20 5.00 54.71
2310 4.00 147.46
In Case of Question Contact:
(Residenr cngineer's Use Only)
Signature· of Prime Contractor's Representative·
(�) '8 { I /'7.,,j
Name
FM9419B7M White - Data Entry Canary - Resident Engineer Pink - Contractor (After Approval) Goldenrod - Contractor CASEWB 38.0
Report No. [ Pag
3 OF 3
OT Extended
Rate Amount
526.70
273.55
589.84
Total (A) 1,390.09
Business Phone
EWB/1/s.com
DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5 ■
RIVERS(DE CONSTRUCTION COMPANY
f n '1 0 r:: N\A..J \ f:-ff
ROJECT: \±bLL � � 6G
JOB NO. : 1,,1.-o \\.I (IF NOT PRIME)
SUBCONTRACTOR
COST CODE: 9o'1 (qo?:>
Description of work performed and location : _1/-1,,\,�,£fl)l'.:_!_�O'.!.lL<I f:"t'.._-'--�"__lf_._(2.,{'::::.i:. _ _.l�___.:__:.Lfl?j--=�!.2....'.-=---�=--=-----=-===-----=====-=== LABOR:
EMPLOYEE
NAME
EQUIPMENT:
EQUIP DESCRIPTION
·NUMBER
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OSIGNATURE BEL
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CLASSIFICATION HOURS
Regular Overtime
5 HOURS
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■
DocuSign Envelope ID: 0DB8D525-D878-45F6-96DF-D35DB84C9830 DocuSign Envelope ID: E4519B4F-D699-47A3-8D43-CE8B98CFA2A5