Exhibit 3-4
PS PRE-APPROVAL
CONTROL SHEET
January 1, 2015
Contract No.
Base Contract
or Amendment/Task Order No.
The following information must be provided with every professional services base contract,
amendment, task order and extra work order letter (EWOL).
I. CMS INPUT INFORMATION
Contract Title: (see CMS)
Amendment/Task Order Title:
Contract No.:
Amendment/Task Order No.:
Work Order No.:
Dollar Value of this Action:
Time Extension:
days
Duration:
days
Consultant Name:
Grant No.
SCOPE OF WORK: (short synopsis)
PMM Manual Exhibit 3-4 2015-06-01
Page 1
Contract No.
Base Contract
or Amendment/Task Order No.
ACTION TYPE:
AMENDMENT (a - i)
EXTRA WORK ORDER LETTER (EWOL) (c, d, e, i)
NEW CONTRACT (a - i)
CLAIM
TASK ORDER (a - i)
TIME (e)
TRANSFER OF FUNDS AMENDMENT (a - i)
ATTACHMENTS:
(a) Extra Work Order Letter (EWOL (if applicable) (A&F to provide)
(b) Fixed Fee Matrix
(c) Independent Cost Estimate (ICE)
(d) CMS Report(s): CMS-PS-008, CMS-PS-009, CMS-PS-020 (A&F to provide)
(e) Consultant Cover Letter (REQUIRED)
(f) Consultant Cost Proposal (Exhibit A)
(g) Consultant Hour Matrices
(h) Consultant Scope of Work
(i) Design Change Log
AUTHORIZATION LEVEL:
DIRECTOR
$0 - ≤ $100,000
SENIOR DIRECTOR
>$100,000 - ≤ $250,000
CHIEF ENGINEER OF D&C
>$100,000 - ≤$250,000
ASSISTANT GM FOR D&C
>$250,000 - ≤ $500,000
GENERAL MANAGER
>$500,000 - ≤$5,000,000
SECRETARY OF TRANSPORTATION
>$5,000,000 - ≤$15,000,000
BOARD OF DIRECTORS
>$15,000,000
ASSISTANT GM FOR D&C
Time Extension
PMM Manual Exhibit 3-4 2015-06-01
Page 2
Contract No.
Base Contract
II.
or Amendment/Task Order No. ______
CONTRACT OVERVIEW
0.0%
Percentage of DBE Participation this action
0.0%
Percentage of DBE Commitment to date
0.0%
DBE Contract Goal
0.0%
Percentage of work completed
Percentage is to be entered as a
decimal instead of a whole #,
(e.g., 10% must be entered as .10
Base contract dollar value
Total authorized/pending to date, including this action
III. EFFECTIVE DATE/EWOL INFORMATION
This information is used to determine if the effective date of this action occurred prior to full
authorization of this action. If a consultant starts work prior to the Notice to Proceed (NTP)
as a result of an extra work order (EWOL), the effective date must be stated here to enable
the consultant to bill for work performed prior to NTP. No work may be performed without
proper authorization and no payment made for work performed prior to the effective date.
There has been no prior work performed on this amendment or task order.
If prior work has been performed, how did the consultant receive direction to proceed:
Submission of an Extra Work Order Letter dated
Executed Change Order/Amendment
Verbally
Email dated
Effective Date of this Action:
If directed verbally, please state who gave verbal direction to start this work and on what
date for the following reason(s):
Verbal Direction given by:
Reason for EWOL:
PMM Manual Exhibit 3-4 2015-06-01
Page 3
Contract No.
Base Contract
or Amendment/Task Order No. _____
IV. RECORD OF NEGOTIATIONS
CONSULTANT ESTIMATE: $
SPECIFIC COST OR WORK ELEMENTS QUESTIONED BY THE PROJECT:
(Personnel classifications for complexity of work; Hour per tasks listed in hour matrices;
Duration for the scope of work; Deliverables listed in scope of work.)
CONSULTANT’S RESPONSE TO MBTA’S QUESTIONS:
FINAL RESOLUTION:
THIS CONTRACT HAS BEEN REVIEWED WITH THE CONSULTANT, AND THE COST
HAS BEEN NEGOTIATED TO $
FROM $
.
If you require additional space, please attach a separate sheet.
PMM Manual Exhibit 3-4 2015-06-01
Page 4
Contract No.
Base Contract
or Amendment/Task Order No. ______
V. FULL DISCUSSION and DBE INFORMATION
MBTA Contract No.
was awarded to the design firm of
A Notice to Proceed was issued for the Base Contract work on
BRIEF PROJECT DESCRIPTION:
that has a total project budget of: (see Budget Analyst)
Design
Construction
Real Estate
Force Account
Materials/Procurement
Project Administration/Inspection
TOTAL PROJECT BUDGET
$ 0.00
The Disadvantaged Business Enterprise (DBE) participation goal on MBTA
including all amendment/task orders thereto is
%.
Contract No.
This amendment/task order contains a DBE participation of
% as follows:
TOTAL
PMM Manual Exhibit 3-4 2015-06-01
$ 0.00
Page 5
Contract No.
Base Contract
or Amendment/Task Order No.______
The contract value authorized/pending to date including this amendment/task order is
$
The DBE commitment to date including this amendment/task order is $ 0.00
(
%) the breakdown is as follows:
Subconsultant
DBE Contract
Value
Work Type
$ 0.00
TOTAL
For GM/BOD staff summary only. The DBE participation to date paid through last as of
payment no.
is
%
with the breakdown as follows: (Please print the
subcontractor payment screen for all actions going to the GM/BOD for inclusion into the Staff
Summary). Please use the "Contract Value (adjusted)" in CMS when calculating the paid through last %.
(see attached example)
DBE Contract
Subconsultant
Work Type
Value
$
$
$
$
$
$
$
$
TOTAL
$
0.00
Therefore, it is recommended that the Director
approve Amendment/Task
Order No.
to this contract for an estimated sum not to exceed $
including a fixed fee of $
(if necessary)
PMM Manual Exhibit 3-4 2015-06-01
and a contract completion date of
weeks from the Notice to Proceed be approved.
Page 6
AMENDMENT/TASK ORDER NO.
Contract No.
DESIGN CHANGE LOG #
VI. DESIGN CHANGE REQUEST FORM [instructions are found in the MBTA Project Controls
Policy Manual (Section VIII)]
PROJECT NAME
AMENDMENT/TASK ORDER TITLE
CONTRACT NO.
AMENDMENT/TASK ORDER NO.
DESIGN CHANGE LOG #
WBS #
DATE
EFFECTIVE DATE
1. DESCRIPTION OF PROPOSED CHANGE:
2. BASIS OF ORIGINAL DESIGN:
3. WHY WAS CHANGE NOT ANTICIPATED?
4. JUSTIFICATION OF PROPOSED CHANGE:
PMM Manual Exhibit 3-4 2015-06-01
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AMENDMENT/TASK ORDER NO.
Contract No.
DESIGN CHANGE LOG #
5. TECHNICAL/OPERATIONS IMPACT:
6. IMPACT IF CHANGE REQUEST NOT APPROVED:
7. SCHEDULE IMPACT:
a) DESIGN: (Indentify current schedule data date. List current design milestone(s) and end dates.
Describe how this action will affect current design milestone(s))
b) CONSTRUCTION: (List anticipated construction advertising date and milestone. How will this action
impact the anticipated advertising and milestone date?)
PMM Manual Exhibit 3-4 2015-06-01
Page 8
AMENDMENT/TASK ORDER NO.
Contract No.
DESIGN CHANGE LOG #
8. COST IMPACT:
a) DESIGN: (How will this action affect current design budget?)
b) CONSTRUCTION: (How will this action affect construction budget?)
DATE
SUBMITTED BY:
MBTA Project Manager
(type name)
SIGNATURE:
COMMENTS:
PMM Manual Exhibit 3-4 2015-06-01
Page 9
AMENDMENT/TASK ORDER NO.
Contract No.
DESIGN CHANGE LOG #
Concur
Not Concur
Approved
Not Approved
Approved
Not Approved
Approved
Not Approved
SIGNATURE:
DIRECTOR OF
PROJECT CONTROLS
DATE
COMMENTS:
SIGNATURE:
AREA DIRECTOR
DATE
COMMENTS:
SIGNATURE:
CHIEF ENGINEER OF
DESIGN & CONSTRUCTION
(if applicable)
DATE
COMMENTS:
SIGNATURE:
AGM OF DESIGN
& CONSTRUCTION
(if applicable)
DATE
COMMENTS:
PMM Manual Exhibit 3-4 2015-06-01
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CMS (example) report to be used when calculating DBE participation to
date [using the Contract Value (adjusted)] the paid through last as of
payment %