20240903IPC to Staff 21(c) Supplemental - Attachment 1 - RFP - T902 Construction - 8 Annex A ECP027.pdf

Independent Contractors Request for 0""IDA O
Unescorted Physical or Electronic Access �An,DPOOIVERV
Independent Contractor's em pioyees w Il not be perm itted unescorted access to Idaho Pow Er Com pany w thout the successful
passing in the previous 6 m cnths of crim inal background check,identity verification,drug test,and applicable training.Return
com pleted form to ICProgram @ idahopow a-.com or fax to [phone].
CONTRACT WORKER INFORMATION
Date: Independent Contractor Com piny Nam e
Contract Worker: F irst Name M iddle Initial L ast Nam e
Contract Worker has: Date Successfully Passed:
❑ Successfully Passed Drug Test using criteria listed below
❑ Successfully Passed Seven Year Crim hal Background Check using criteria listed below
❑Successfully Passed Identity Verification using criteria listed below
By signing below Independent Contractor hereby w a-rants that all statements contained herein are true and correct.
Independent Contractor also hereby w arrants that its em ployee has successfully passed a drug test, seven-year criminal
background check, and identity verification, utilizing provided criteria below or hereby requests an exception in the space
above. Independent Contractor agrees to update each request for access at least every six and a half years after the initial
request,for cause, or at the request of Idaho Pow a•. Further, Independent Contractor agrees to indem r>ify and hold harm less
Idaho Pow Er from and against any claim of dam ages and/or im position of fines resulting from Independent Contractor's
negligent and/or w Ilful provision of false or inaccurate inform ation on,or in relation to,this request.Independent Contractor
agrees to permit Idaho Pow Er (w th reasonable prior notice to Independent Contractor) to audit Independent Contractor's
records and processes that support this certification.
Signature of Authorized Representative of Independent Contractor D ate
Printed Nam eand Title of Authorized Representative of Independent Contractor
M INIM UM SCREENING CRITERIA—M ust have been corn{feted within the previous 6 m cnths:
If Independent Contractor is requesting an exception to the Drug Test,Identify Verification,or the Crim hal Background Check,please note reason for requested
exception.Exceptions m u;t be requested for identified felony or m Wem mnor convictions involving:(a)violence to persons/property,(b)theft or fraud,(c)
drug/alcohol,or(d)traffic/other.Independent Contractor shall not allow persons who have not m Et Idaho Power's criteria to perform work,unless Independent
Contractor has received assent,in writing,from Idaho Power.
Drug Test Criteria:
• Drug test shall be a five(5)Panel Drug Test,which should be recognizable at testing labs as a"Sam FSA5 panel at SONG—THC cut-off."
Identity Verification:
• Verify that the nam Q gender,birth date,and social security num ber all m atch up to each other.
Seven Year Crim hal Background Check Criteria:
• Gounty Crim hal—A search in all provided and developed(from SSN Trace)counties of residence,em iloym ant,and school attendance for previous 7 years
using all nam es provided and developed(from SSN Trace).
• National Crim inal Record Locator—Used to identify jurisdictions in which an applicant m a/have a crim ha[record or is a registered sex offender.This is a
search of a proprietary crim hal database containing m cre than 400 m Ilion records.The records com p-ising the database are obtained from county,state,
and federal entities as well as incarceration and law enforcem Ent records.In addition,the database includes OFAC lists,FBI M ost Wanted,Fugitive Lists from
ten federal agencies(such as US M ershals,US Secret Service,US DEA),and fugitive lists from num aous state and local law enforcem eit agencies.This search
is a"locator"device designed to identify jurisdictions in which an applicant potentially has a crim hal record or is a registered sexual offender.As employm Ent
decisions should not be m ade based on this database inform ation,a search will autom atically be conducted in the originating jurisdiction if one or m cre
possible records are found.This locator searches records from the past 7 years using the applicant's first nam q last nam q and date of birth.
CSF026(5/16/2016) [ECP 027,Annex A,2/6/2018] IPC

IPC KIT No.: Change Order # P""111111141QAW
`_POUVER
-- --- --- An IDACORP company
Effective Date of this Change Order Title Work Order Num her
Change Order
Agreem Ent Title
Agreem Ent Date C ontractor
The Parties Agree To The Follow hg:
DESCRIPTION OF CHANGE AL
MODIFIED EXHIBITS
No Modified Exhibits
M odified Exhibits attached and hereby incorporated in Order inc
ADJUSTM ENT TO CONTRACT PRICE A DJ ENT TC19VNTRACT TIM E
Adjustm ant to the Contract Price for this Change der is as djustm Ent to the Approved Schedule for this Change Order is
❑ No adjustment to the Contract Price. Option 1) ccordance with General Conditions section GC-8,"Tim e
❑ By unit prices pursuant to General Con s GC-1 he unit and Order of Com detion"and is as follows:
quantities are described in"Descr. do ove. T tal Unit ❑The Approved Schedule rem ans unchanged(no change to
Estim ate is$ The new tot it Price Esti m a/not Contract Tim e,Guaranteed Substantial Com pletion Date,
exceeded by Contractor without rior writte proval The new and/or Final Com Oetion,phased or interim com Oetion
Unit Price a:e inclu ' this e Order i Option 2) dates).
❑ By fix sum purs onditions a fixed lum p ❑The Approved Schedule,Contract Tim q M iestone Dates,
su adjustm Ent to the $ ew lum psum Phased Com Oetion,Guaranteed Substantial Com Oetion
am cluding this Change Order i Option 3) Date,and/or Final Com Oetion Date is adjusted as follows:
Updated t ontr a(this am t inclu this Change Order
and all other ed Change Or ):$
Except as provided inNtnge Or erm sand conditions of the Contract Docum ants,as am ended from tim eto tim q rem an unchanged.
Prepared By: Approved by IPAR
Accepted By: Contractor Approved by IPC
Contractor's Signature Idaho Power Com pany Signature
Title Title
IPC Change Order LGL 034(6/05/18)
Page 1 of 1

IPC KIT#: ����
IPC Asset Suite No.: PMR
An IDACDRP company
CO MITIO NAL WAIVER AND RELEASE UPO NPRO G JESS PAYMENT
Upon receipt by the undersigned of paym ent (either in the form of a check, w re transfer, ACH deposit or
other tender,i.e., "Progress Paym Ent") from Idaho Pow er Com pany in the sum of$ and made
(Am cunt Paid)
payable to ('Contractor ), and upon acceptance
(Contractor Nam e
of the Progress Paym ant by Contractor, eit er upon completion of the wre transfer or ACH deposit or
w h=n the check has been properly endorsed and has been paid by the bank upon w lich it is draw n this
docum ent shall becom eeffective to release and Contractor shall be deem ed to wave and release any notice
of any m echanic's lien, m aterialm an's lien, construction lien, design professional's lien, or sim iar lien, any
stop notice or bonded stop notice, or any bond right or claim the undersigned has on the job of Idaho
Pow Er Com pany located at:
(Project Description and Location)
to the extent described in this docum ent. This release covers the final paym ent for labor, services,
equipm ent, or m aterials furnished by Contractor to the job of Idaho Pow a• Com pany referenced above
through only and does not cover any retention retained before or after the release date;
extras furnished before the release date for w lich payment has not been received; extras or items
furnished after the release date. Rights based upon w crk perform ed or item s furnished under a w itten
change order w hch has been fully executed by the parties prior to the release date are covered by this
release unless specifically reserved by the claim ant in this release. This release of any m echanic's,
m aterialm an's, construction, design professional's, or sim iar lien, stop notice or bonded stop notice, or
bond right or claim shall not otherw se affect the contract rights, including rights betw een parties to the
contract based upon a rescission,abandonm ent,or breach of the contract, or the right of the undersigned to
recover compensation for furnished labor, services, equipm ent or m aterial that w as not com pensated by
the Progress Payment. Before any recipient of this document relies on it, said party should verify evidence
of paym ent to the undersigned.
Dated this day of ,20_.
CONTRACTOR
By
IPC Conditional waiver&Release Upon Progress Paym Ent LGL 125(3/9/16)
[ECP 027,Annex A,2/6/2018] Page 1 of 1

RM
Certificate of Substantial Com Oetion �POR®
An IDACORP company
Work Order: Project Description:
Project Leader: Construction M anager:
Engineer/Designer: Inspector:
Contractor: Contractor Forem an:
1. This Certificate of Substantial Com detion ("Certificate") applies to:
❑ All Work
OR
❑ The following M iestones:
2. Idaho Power Com pany (IPC) and Contractor inspected the Work subject to this Certificate (as stated in Section 1
above) and IPC confirm sthat Contractor achieved Substantial Com FJetion on:
3. Aprelim hary list of item sto be com Oeted or corrected by Contractor prior to the Final Com Oetion Date is attached
hereto a nd i ncorporated b y t his r eference ( "Punch L ist"). The P unch L ist m a/ n of b e
all-inclusive, and the failure to include an item does not alter the responsibility of Contractor to com Oete all the
Work in accordance with the Contract Docum ants.
4. In accordance with the Special Conditions (Exhibit C to the Agreem Ent):
❑ As-Built Docum entation reflecting all deviations from the original docum entation was subm tted on:
OR
❑ As-Built Docum antation reflecting all deviations from the original docum antation shall be provided upon Final
Com Oetion of the Work.
This Certificate does not constitute an acceptance of Work not in accordance with the Contract Docum ants nor is it a waiver
of any of Contractor's obligations as set forth in the Contract Docum ents.
Contractor certifies Substantial Com Oetion:
Contractor's Authorized Representative Signatf&re y(Print Nam Date Certified
Idaho Pow Er Corn pany accepts this Certificate of Substantial Com Oetion:
IPAR Signature D By(Print Nam ate Accepted
CID#54326 Certificate of Substantial Com Oetion LGL 153(2/5/18)
Page 1 of 1
White—Contract File Yellow—Project Leader Pink—Contractor

IRM
Notice of Final Com pletion �POR®
An IDACORP company
KIT# Project Description:
Idaho Power Authorized Representative:
Contractor:
Pursuant to Section 21 of the General Conditions for Construction Services, Contractor certifies to IPC as follows:
Required
❑ Substantial Com Fletion has occurred; and
❑ All Punch List Item 5 site clean-up, and Restoration have been com Meted; and
❑ All applicable Record Docum ants have been provided to, and to Contractor's knowledge accepted by, IPC; and
❑ Contractor has delivered to IPC a final certificate of occupancy and all other governm antal approvals necessary for
IPC to occupy or utilize the Work or designated portion thereof for its intended purpose; and
If Applicable
❑ Contractor has provided IPC with four copies of Operations and M aintenance m aivals
❑ Contactor has returned to IPC all IPC property(including, but not lim ted to, keys and access badges/cards); and
❑ Contractor has com FJeted all Work and other actions set forth in Change Orders.
❑ As-Built Docum citation reflecting all deviations from the original docum Entation.
The date upon which Contractor com FJeted all Work was:
Authorized Contractor Signature By(PRINT NAME) Date Certified
❑ Idaho Power Com pany accepts this Notice of Final Com Fletion
❑ Idaho Power Com pany does NOT accept this Notice of Final Com FJetion
N oted
Deficiencies:
Upon resolution of the deficiencies noted above, Contractor shall resubm t the Notice of Final Completion.
Authorized IPC Signature By(PRINT NAME) Date
(DATE OF FINAL COMPLETION)
CID#56230 Notice of Final Com Oetion LGL 160(2/5/18)
White—Contract File Yellow—Project Leader Pink—Contractor

IPC KIT#: ����
IPC Asset Suite No.: PMR
An DAC.Rl company
CONDITIONAL WAIVER AND RELEASE UPON FINAL PAYM ENT
Upon receipt by the undersigned of paym eat (either in the form of a check, wre transfer, ACH deposit or
other tender,i.e., "Final Paym eat") from Idaho Pow a-Com pany in the sum of$ and made payable
(Am cunt Paid)
to ("Contractor"), and upon acceptance of the Final
(Contractor Nam e)
Paym eft by Contractor, either upon com pletion of the w re transfer or ACH deposit or w len the check has
been properly endorsed and has been paid by the bank upon w hch it is draw n this docum eat shall becom e
effective to release and the undersigned shall be deem ed to wave and release any notice of any m echanic's
lien, m aterialm an's lien, construction lien, design professional's lien, or sim>1ar lien, any stop notice or
bonded stop notice, or any bond right or claim the undersigned has on the job of Idaho Pow ar Com pany
located at:
(Project Description and Location)
to the extent described in this document. This release covers the Final Payment for labor, services,
equipm eat,or m aterials furnished by Contractor to the job of Idaho Pow a- Com pany referenced above and
does not cover Disputed Claim slisted below,if any. Rights based upon w crk perform ei or items furnished
under a w ritten change order w lich has been fully executed by the parties prior to the release date are
covered by this release unless specifically reserved by the claim ant in this release. This release of any
m echanic's, m aterialm an's, construction, design professional's, or sim lar lien, stop notice or bonded stop
notice, or bond right or claim shall not otherwse affect the contract rights,including rights between parties
to the contract based upon a rescission, abandonment, or breach of the contract. Before any recipient of
this document relies on it, the recipient should verify evidence of payment to the undersigned. Contractor
represents and covenants, and w it take all actions necessary to terminate any claim of a lien filed at any
county recorder's office elsew lure, that it has already paid or w it use the m oney received from the Final
Paym Ent promptly to pay in full all laborers, subcontractors, m aterialm en, and suppliers for all w crk,
services,m aterials, or equipm Ent that are the subject of this w aver and release.
DISPUTED CLAIMS The follow i g invoices, applications for payment, retention, or change orders are
reserved by Idaho Pow E"Com pany from this Final Paym e t(be specific):
Dated this day of ,20_.
CONTRACTOR
By
IPC Conditional waiver&Release Upon Final Paym Ent LGL 036(3/9/2016)
[ECP 027,Annex A,2/6/20181 Page 1 of 1

Annex A - Form of Incident Investigation Report
Em doyee Full Nam e(First,M I Last): 0 ccupation/Job Title: Y ears in Job Title:
WHO was Em doyee Full Nam e(First,M[Last): O ccupation/Job Title: Y ears in Job Title:
Involved?
Em doyee Full Nam e(First,M[Last): 0 ccupation/Job Title: Y ears in Job Title:
Provide a factual,chonological description of the incident:
W HAT
happened?
Job Nam e L ocation of job where incident occurred:
WHERE did it
happen? Job Address: C ity: S tate,Zip:
Date of Incident: T im eof Incident:
WHEN did it
happen? TirrheReported to IPC: W om did you contact at IPC:
Explain actions you have taken or plan to take to prevent sim lar incidents(include the date actions were taken or will be taken):
Corrective
Action Taken
List any injuries and/or dam zges resulting from the incident:
Injury/Damage
Supervisor: 0 ccupation/Job Title: D ate:
ProjectMaiager: 0 ccupation/Job Title: D ate:
Signatures
Safety M anager: O ccupation/Job Title: D ate:
[ECP 027,Annex A,2/6/2018]