IDENTIFICATION OF PROPOSER AND EQUITY MEMBERS—Form B-1 NAME OF ENTITY AND CONTACT INFORMATION (address, representative, phone, fax, e-mail) ROLE IN ORGANIZATION Contractor License and License Limit (if applicable) Description of Work/Services To Be Performed By Entity (if applicable) The above information is true, correct and accurate. [Insert the Proposer’s name] By: Name:
FORM M-2 PRICE BREAKDOWN SH 360 PROJECT TEXAS DEPARTMENT OF TRANSPORTATION ITEM / LINE NO. DESCRIPTION ITEM TOTAL (US Dollars, Nominal) BASE SCOPE OPTION 1 OPTION 2 OPTION 3 OPTION 3A (Camp Wisdom Road/Sublett Road) OPTION 3B (Webb Lynn/Lynn Creek Parkway) OPTION 3C (New York Avenue) OPTION 3D (Debbie Lane/Ragland Road) OPTION 3E (Holland Road) OPTION 3F (Broad Street) OPTION 3G (Heritage Parkway) OPTION 3H (Lone Star Road ) OPTION 3I (Matlock Road ) OPTION 3 (Total 3A – 3I) A Professional Services 1 Professional Services Development Management & Community Outreach 2 Development Design, Design Survey, & Landscape Design 3 Environmental Permitting Activities 4 Utility Locates, Utility Survey, and Utility Adjustment Design 5 Design Quality Assurance, Construction Quality Acceptance Firm, and Environmental Compliance Team 6 Right-of-Way Acquisition Service and ROW Survey/Mapping 7 Miscellaneous Professional Services not covered by Lines 1-6 8 Subtotal Professional Services (Sum Lines 1 through 7) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 B Construction 9 Construction Development Management
Form M-4.2 atc cost adjustments ATC Adjustment for Additional Impact to Associated with Approved ATCs Relating to Proposer’s Option 1 SH 360 Project – option 1 Texas Department of Transportation Approved ATC # DESCRIPTION of APPROVED ATC COSTS to TxDOT (US Dollars, Nominal) TOTAL $0.00
Form M-4.4.4 atc cost adjustments ATC Adjustment for Additional Impact to TxDOT Associated with Approved ATCs Relating to Proposer’s Option 3D SH 360 Project – option 3D Texas Department of Transportation Approved ATC # DESCRIPTION of APPROVED ATC COSTS to TxDOT (US Dollars, Nominal) TOTAL1 $0.00 Note: 1. is Option 3D ATC Adjustments to Form M-4.4.
FORM m-5.1 DB CONTRACTOR CASH FLOW ADJUSTMENT MAXIMUM PAYMENT SCHEDULE SH 360 Project – base Texas Department of Transportation Months after NTP Anticipated Draw (A) DB Contractor's Cumulative Draw (B) Discount Factor (C) PV of Anticipated Draw (A x C) 1 $0.00 $0.00 0.9963 $0.00 2 $0.00 $0.00 0.9927 $0.00 3 $0.00 $0.00 0.9891 $0.00 4 $0.00 $0.00 0.9854 $0.00 5 $0.00 $0.00 0.9818 $0.00 6 $0.00 $0.00 0.9782 $0.00 7 $0.00 $0.00 0.9747 $0.00 8 $0.00 $0.00 0.9711 $0.00 9 $0.00 $0.00 0.9675 $0.00 10 $0.00 $0.00 0.964 $0.00 11 $0.00 $0.00 0.9605 $0.00 12 $0.00 $0.00 0.9569 $0.00 13 $0.00 $0.00 0.9534 $0.00 14 $0.00 $0.00 0.9499 $0.00 15 $0.00 $0.00 0.9465 $0.00 16 $0.00 $0.00 0.943 $0.00 17 $0.00 $0.00 0.9395 $0.00 18 $0.00 $0.00 0.9361 $0.00 19 $0.00 $0.00 0.9327 $0.00 20 $0.00 $0.00 0.9293 $0.00 21 $0.00 $0.00 0.9259 $0.00
21 $0.00 $0.00 0.9259 $0.00 22 $0.00 $0.00 0.9225 $0.00 23 $0.00 $0.00 0.9191 $0.00 24 $0.00 $0.00 0.9157 $0.00 25 $0.00 $0.00 0.9124 $0.00 26 $0.00 $0.00 0.909 $0.00 27 $0.00 $0.00 0.9057 $0.00 28 $0.00 $0.00 0.9024 $0.00 29 $0.00 $0.00 0.8991 $0.00 30 $0.00 $0.00 0.8958 $0.00 31 $0.00 $0.00 0.8925 $0.00 32 $0.00 $0.00 0.8892 $0.00 33 $0.00 $0.00 0.886 $0.00 34 $0.00 $0.00 0.8827 $0.00 35 $0.00 $0.00 0.8795 $0.00 36 $0.00 $0.00 0.8763 $0.00 37 $0.00 $0.00 0.8731 $0.00 38 $0.00 $0.00 0.8699 $0.00 TOTAL 11 $0.00 22 $0.00 Notes: 1. 1 is the nominal Option 1 Price from Form M-1. 2. TOTAL 2 is the PV of Anticipated Draw from Form M-1 and for use in calculation of Price Amount in Section 5.4.1.
FORM m-5.3 DB CONTRACTOR CASH FLOW ADJUSTMENT MAXIMUM PAYMENT SCHEDULE SH 360 Project – option 2 Texas Department of Transportation Months after NTP Anticipated Draw (A) DB Contractor's Cumulative Draw (B) Discount Factor (C) PV of Anticipated Draw (A x C) 1 $0.00 $0.00 0.9963 $0.00 2 $0.00 $0.00 0.9927 $0.00 3 $0.00 $0.00 0.9891 $0.00 4 $0.00 $0.00 0.9854 $0.00 5 $0.00 $0.00 0.9818 $0.00 6 $0.00 $0.00 0.9782 $0.00 7 $0.00 $0.00 0.9747 $0.00 8 $0.00 $0.00 0.9711 $0.00 9 $0.00 $0.00 0.9675 $0.00 10 $0.00 $0.00 0.964 $0.00 11 $0.00 $0.00 0.9605 $0.00 12 $0.00 $0.00 0.9569 $0.00 13 $0.00 $0.00 0.9534 $0.00 14 $0.00 $0.00 0.9499 $0.00 15 $0.00 $0.00 0.9465 $0.00 16 $0.00 $0.00 0.943 $0.00 17 $0.00 $0.00 0.9395 $0.00 18 $0.00 $0.00 0.9361 $0.00 19 $0.00 $0.00 0.9327 $0.00 20 $0.00 $0.00 0.9293 $0.00
21 $0.00 $0.00 0.9259 $0.00 22 $0.00 $0.00 0.9225 $0.00 23 $0.00 $0.00 0.9191 $0.00 24 $0.00 $0.00 0.9157 $0.00 25 $0.00 $0.00 0.9124 $0.00 26 $0.00 $0.00 0.909 $0.00 27 $0.00 $0.00 0.9057 $0.00 28 $0.00 $0.00 0.9024 $0.00 29 $0.00 $0.00 0.8991 $0.00 30 $0.00 $0.00 0.8958 $0.00 31 $0.00 $0.00 0.8925 $0.00 32 $0.00 $0.00 0.8892 $0.00 33 $0.00 $0.00 0.886 $0.00 34 $0.00 $0.00 0.8827 $0.00 35 $0.00 $0.00 0.8795 $0.00 36 $0.00 $0.00 0.8763 $0.00 37 $0.00 $0.00 0.8731 $0.00 38 $0.00 $0.00 0.8699 $0.00 11 $0.00 TOTAL 22 $0.00 Notes: 1. TOTAL 1 is the nominal Option 2 Price from Form M-1. 2. TOTAL 2 is PV of Anticipated Draw from Form M-1 and for use in calculation of Price Amount in Section 5.4.1.
FORM N-3 OPERATIONS AND MAINTENANCE SCHEDULE FOR option 1 SH 360 Project – OPTION 1 Texas Department of Transportation Full Year of Operation (from Substantial Completion) Routine Maintenance Renewal Work Escalated Total Annual Maintenance Payment (E) = (A× B)+(C× D) Discount Factor (F) Factored Maintenance Amount (G)=(E × F) Annual Routine Maintenance Price in 2015 U.S. Dollars1 (A) Routine Maintenance Price Escalation Factor (B) Annual Renewal – Other Price in 2015 U.S. Dollars2 (C) Renewal Work Price Escalation Factor (D) 1 1.0770 1.0928 0.8762 2 1.1039 1.1256 0.8384 3 1.1314 1.1593 0.8024 4 1.1598 1.1942 0.7678 5 1.1888 1.2300 0.7347 6 1.2185 1.2669 0.7031 7 1.2489 1.3048 0.6729 8 1.2802 1.3441 0.6438 9 1.3122 1.3844 0.6161 10 1.3450 1.4259 0.5896 11 1.3785 1.4686 0.5643 12 1.4131 1.5127 0.5399 13 1.4484 1.5581 0.5166 14 1.4846 1.6049 0.4944 15 1.5216 1.6529 0.4732 TOTAL3 $0.00 1. Annual Routine Maintenance from Form N-3.1 2. Annual Renewal – Other Price from Form N-3.2 3. Adjusted Maintenance Value for Option 1 to Form N-1
FORM N-4.1 ROUTINE MAINTENANCE SCHEDULE FOR option 3 SUB-OPTIONS SH 360 Project – OPTION 3 Texas Department of Transportation Full Year of Operation (from Substantial Completion) Annual Routine Maintenance Price in 2015 U.S. Dollars Option 3A Option 3B Option 3C Option 3D Option 3E Option 3F Option 3G Option 3H Option 3I TOTAL1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Notes: 1. Annual Routine Maintenance Prices to Form N-4.
SUBSTANTIAL COMPLETION COMMITMENT—Form O Description Substantial Completion Date Proposal Commitment Date for Substantial Completion of the Base Scope NTP1 plus __________ calendar days Proposal Commitment for Option 1 Schedule Adjustment __________ additional calendar days to complete Option 1 Work Proposal Commitment for Option 2 Schedule Adjustment __________ additional calendar days to complete Option 2 Work Proposal Commitment for Substantial Completion of Base Scope, Option 1 and Option 2 __________ calendar days to complete Base Scope, Option 1 and Option 2 Work (must equal the sum of the days in the preceding rows)