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City Project Numbers m"
02305 .���. . DOE Number T259
Contract Name SEWER MPROV,RESERVE AT lid:"AUS°l F ti to Number I
Contract Limits Payment Number I
Project Type A IY SEWER For Period Ending 9124n.015
Project Funding
4
i
Project Manager Imxg City Secretary Contract Number 117219
Inspectors LAYER t DEN Contract Date
Contractor KWA Contract Time 365 CD
16800 WE'ST(IROVEDRIVE SUITE 300 Days Charged to Date 250 Cab
I)ISON, U. 75001 Contract is Complete f
CITY OF FORT womi
SUMMARY OF CHARGES
I
i
Line Fund Account Center Amount Gross Retainage Net
...... ......
Funded
Total Cost of Work Completed $1.35,263.20
Less %Retained $0.00
Net Earned $135,26120
Earned is Period $135,26,3.20
Retainage This Period S0M
Less Liquidated Damages
0 Days @ 50.00 /Day $0.00
LessPavement Deficiency $0,
Less Penalty $0.00
s Previous Payment $0.00
Plus Material on an 15% $0.
Balance Due This Payment $1356320
Thunday,ScpJzwnbm,24,20l5 Page 4 of 4
FORT WORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name SEWER IMPROV.RESERVE NI'MCAJASUR
Contract Limits
Project Type WATER&SEWER
City Project Numbers 02308
DOE Number 7259
Estimate Number I Payment Number I For Period Ending 9/24/2015
CD
City Secretary Contract Number 117259 Contract Time 36ED
Contract Date Days Charged to Date 250
Project Manager 10W Contract is 100.00 Complete
Contractor KWA
16800 WESTGROVE DRrVE SUnT 300
ADDISON, TX 75001
Inspectors LAYER / ODEN
'Mursday,Sepimber 24,2015 Pop 1 of 4
City Project Numbers 02308 DOE Number 7259
Contract Name SEWER IMPROV.RESERVE AT MCAL1S7`ER Estimate Number I
Contract Limits Payment Number I
Project Type WATER&SEWER For Period Ending 9/24/2015
Project Funding
WATER
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
1 6"PVC WATER PIPE 3 LF $25.00 $75.00 3 $75.00
2 8"PVC WATER PIPE 779 LF $27.00 $21,033.00 779 $21,033.00
3 CONNECTION TO EXISTING 8"WATER MAIN I EA $2,800.00 $2,800.00 1 $2,800.00
4 4"WATER METER AND VAULT I EA $19,200.00 $19,200.00 1 $19,200.00
5 DUCTILF IRON WATER FITTINGS 1.1 TN $7,200.00 $7,920.00 1.1 $7,920.00
6 FIRE HYDRANT I EA $3,400.00 $3,400.00 1 $3,400.00
7 6"GATE VALVE I EA $1,150.00 $1,150.00 1 $1,150.00
8 8"GATE VALVE 3 EA $1,350.00 $4,050.00 3 $4,050.00
9 TRENCH SAFETY 782 LF $1.00 $782.00 782 $782.00
Sub-Total of Previous Unit $60,410.00 $60,410.00
SEWER
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
1 8"SEWER PIPE 1135 LF $29.00 $32,915-00 1135 $32,915.00
2 8"SEWER CARRIER PIPE 103 LF $29.00 $2,987.00 103 $2,987.00
3 8"SEWER PIPE,CSS BACKFILL 40 LF $4100 $1,640.00 40 $1,640.00
4 6"SEWER SERVICE 23 LF $26.00 $598.00 23 $598.00
5 4'MANHOLE 7 EA $3,050.00 $21,350.00 7 $21,350.00
6 16"STEEL CASING 100 LF $90.00 $9,000-00 100 $9,000.00
7 WATER STOPS 4 EA $10.00 $40.00 4 $40.00
8 TRENCH SAFETY 1261 LF $1.60 $2,017.60 1261 $2,017.60
9 POST CCTV INSPECTION 1261 LF $1.60 $2,017.60 1261 $2,017.60
10 MANHOLE VACUUM TESTING 7 EA $150.00 $1,050.00 7 $1,050.00
11 UTILITY MARKERS 1238 LF $1.00 $1,238.00 1238 $1,238.00
Sub-Total of Previous Unit $74,853.20 $74,853.20
Thursday,September 24,2015 Page 2 of 4
CityProjectNumbers 02308 DOE Number 7259
iI
Contract Name SEWER IMPROV.RESERVE AT M(,ALIS'ff-.,R Estimate Number I
Contract Limits Payment Number I
Project Type WATER&SEWER For Period Ending 9f2412015
Project Funding
Contract Information Summary
Original Contract Amount $135,7A3,20
Chanze Orders
Total Contract Price $135,2,63.20
Date lbfljp—I�L�, Total Cost of Work Completed $135,263.20
cont Less %Retained $0.00
Date Net Earned $135,263.20
Inspection is Earned This Period 5135,26120
Retainage This Period $0.00
Date Less Liquidated Damages
Cvlana
Days I Day 50.00
Date
_ZZLI LessPavement Deficiency $0,00
sign and C h Less Penalty $0,00
A,r Directm1TP)1A?-TiA-stmctu t
Less Previous Payment $0.00
7%Date
Dimctor I Contacting Iepar en Plus Material on Hand Less 15% $0.00
Balance Due This Payment $13526120
Thunday,SWember 24„2015 Page 3 of 4
FoRTWORTH wv 03/05107
1,000 N
TRANSPORTATION&PUBLIC WORKS
FINAL STATEMENT OF CONTRACT TIME
FINAL STATEMENT NO.:I
NAME OF PROJECT:
I C
PROJECT NO.: 'OIL- IOWA Qmstmaion a.
I275041.302303 1b10.: 7259
PERIODFROM10 7/ s2-15
WORK ORDER EFFECTIVE: 365 0
DAY OF DAYS REASON FOR DAYS DAY OF DAYS REASON FOR DAYS
0
CH OED
MONTH Cj CREDITED MONTH CHARGED CREDITE D
D�UiR�ING DURING
1. 16.
2. 17.
3. 1&
® 19.
® 20.
6. 21.
7. 21
9. 24.
10. 25.
11. X
12. 27.
13. X
14. 29.
is. 30.
31.
SAT,SUN, RAIN,TOO WET, UTILITIES OTHERS* DAYS TOTAL
&HOLIDAYS &TOO RELOCATIONS CHARGED DAYS
THIS 0 0 0 0 331 331
PERIOD
PREVIOUS
0 0 10 10 10 10
PERIOD
TOTALS
TO DATE 0 0 0 0 a 331
*REMARKS.
�Alxll V1 14-A
c614T dfa. DATE INSPEM, )R DATE
EINGINEMUNG DETARTMENT
The City of F art Worth1000 Mrockinorton Street-Fort Wo.rth,TX. 760F2-6,3( 1 392-7941 *Fax-(817)392-7845 OFFICIAL REC011tD
MIN SECRETARY
Fll"',,WORTH qTX
I
t'ORTWORTH
TRANSPORTATION AND PUBLIC,WORKS
PIPE -PORT
PROJECT Reserve&McAlister
PROJECT CT'N1t1MBER: P265-606150230883_'P275-7 a 1302030883
DOE NUMBER: 7259
WATER
PIPE LAID SIZE TYPE OF PIPE L
water stn PVC,-SDR:-14 779
WATER PVC—SD!—14 3
FIRE r
1
: I VALVES QI601 OR LARGER,)
PIPE ABANDONED SIZE TYPE OF PIPE LF
DENSITIES:
NEW SIER.VI . : "A
SEWER.
PIPE LAID SIZE TYPE OF PIPE LF
Sewer gin PVC-SDR.-26 1135
PIPE AB NED SIZE TYPE OF PIPE LF
DTEN'SIT
NEW SER R : 61n PVC-SDR-26 3
e City of Fort Worth•A 000rhirockmorton Street®lwt Wo "I".' 7601L 2-6311
(81-7)392- x"941 -Fax (81 7)392,..784
FORTWORTH
TR. SPORTAiTION AND PUBLIC WORKS
PERFORMANCE EVALUATION OF CONTRACTOR
CONTRACTOR&PROJECT DATA
Name of Contractor Project Naz4ae
KWA Construction Reserve a),Mcalister
DOE 144vctor DOENumber
WeyTnan Oden 7259
144wctor Project Manager
ED water 2 waste water S l Pavernert Aaron Lon
Initial Contract Amount ProjectI)triculty
$135,263.20 0 Simple Routine Complex
Final Contract Amount Date
$1.35,263.20 9/30/2015
I1)PERFORMANCE EVALUATION
0-Inadequate 1-Deficient 2-Standard 3-Good 4-Excellent
ELEMENT WEIGHT(x) APPLIC:AIILE(Y/N) 1 LTING(0-4) MAX SCORE E SC O
I Submission of Documents 2 Y 4 8 8
2 Public Notifications 5 Y 4 20 20
3 Plus on Site 5 Y 4 20 20
4 Field Supervision 15 Y 4 60 60
5 Work Performed 15 Y 4 60 60
6 Finished Product 15 Y 3 60 45
7 :lob Site Safety 15 Y 3 _ 60 45
Tniffic Control Maintenan 15 Y 3 60 45
9 Daily Clean Up 5 Y 4 20 20
10 Citizen's Com hint R iroatiott 5 Y 4 20 20
11 Property Restoration 5 Y 4 20 20
12 5 Y 4 20 E20
13 Project Completion 5 Y 4 20
TO7FAL ELEMENT S (A) 4013
BONUS POINTS(25 kv1 "mmn)(II)
TOTAL )
U1)CONTRACTOR'S RATING
Maximum Score(MS)=:448 gl sum of applicable elcment scom maximums which 448
Rating(ITS/MSI*100%) 403 t 448 90
Performance Category E° t+t
20%-Inadequate .20'06 to<40%:-Lkfirient 4l) ta=ro X60%—5'laand and %to<810 — oath" 2t80*16--,Excellent
inspectoes Comments(INCLUDING EXPLANATION OF BONUS POINTS AW ED)
Signature DOE hispector c .. c. � 1 Si a�ttu�re onir.actor w....f
Signature DOE Inspec oes Supervisor
CONTRACTOR'S C
'nLANSPORTATION AND 1'I~1` U WOIUCS
The City of Dort Worth•1000 Tla.roc:irznaatt m Street-Fort.Worth, 7'601.2-631.1
(817)392,..7941 •Fax:(817)392...7845
i
��mow j 4i��Ntoi�"w���,aauni�num�r
9349 VWaterStane Blvd
Ita 200
Uncinnfaim Ohio 45249
„ w ( 5131"14-8400
513 •6165 Fox
C. r v I'fopi,.rieint
J
J
i
City of Fort Worth
1000 Throckmorton St
Fort Worth,TX 712
Re: Liquidated Damages
To Whom It May Concern,
Reserve at McAlister,LLC hereby states that no liquidated damages II be assessed against the general
contractor for e work perfoffned under the C.
Please t hesitate to contact me with any questions that you my have regarding this matter at
(513)589-2694.
Sincerely,
B ' 14.McGeady
Partner,President MV Affordable Housing Development
MV Residential Development
EM m me
Consent of Surety OWNER El
to Final Payment ARCHITECT
CONTRACTOR
SURETY
AIA DOCUMENT G707 OTHER
Bond No.46BCSGS8988
TO OWNER ARCHITECT'S PROJECT NO.:
(Va"and address)
Reserve at McAlister Senior Living, LLC CONTRACT FOR: Paving, Drainage, Street Lights, Water
9349 WaterStone Blvd. & Sanitary Sewer Improvements
Cincinnati, OH 45249
PROJECT: CFA for Reserve at McAlister
(News and address)
CONTRACT DATED: September 24, 2014
In accordance with the provisions of the Contract between the Owner and the Contractor as included above, the
Hartford Fire Insurance Company
One Hartford Plaza, Hartford, CT 06155-0001
(Insert nerne end address of Surety)
SURETY, on bond of KWA Construction, L.P. ----------
(Insert nacre and adeiress of contractor)
16800 Westgrove Drive,Suite 300, Addison, TX 75001 CONTRACTOR,
hereby approves of the final payment to the Contractor, and agrees that Final payment to the Contractor shall not relieve the
Surety of any of its obligations to Reserve at McAlister Senior Living, LLC _
(Insert nanv and address of Owner)
9349 WaterStone Blvd., Cincinnati, OH 45249
OWNER,
as set forth in the said Surety's bond.
IN WITNESS WHEREOF,the Surety has hereunto set its hand on this date:4Cjob9L5-20-t-5------
(Insert in wrting the rimah foikwed by the numerk date and year.)
Hartford Fire Insurance Company
ty)
Attest
'�z
(3.164 "11)
(�Ygngure of authorized repre wt*%-,)
Amber Jones, Attorney-in-Fact
(Printed name and title
Printed in cooperation with the American Institute of Architects(AIA)
The language in this document conforms exactly to the language used in AIA Document G707-Consent of Surety Compet-4 lio Final Payment-
1994 Edition.
IMPORTANT NOTICE AVISO IMPORTANTE
To obtain information or make a complaint: Para obtener information o para someter una
queja.
You may contact your agent.
Puede comunicarse con su agents.
You may call Hartford Insurance Group at the
toil free telephone number for information or to Usted puede Ilamar al nume-ro de telefono
make a complaint at: gratis de The Hartford Insurance Group para
indormacion o para someter una queja al
1-800-392-7805 1-800-392-7805
I
You may also write to The Hartford:
Usted tambien puede escribir a The Hartford.
The Hartford The Hartford
Hartford Financial Products
2 Park Avenue, 51" Floor Hartford Financial Products
New York, New York 10016 2 Park Avenue, 5t" Floor
1-212-277-0400 New York, New York 10016
1-212-277-0400
You may contact the Texas Department of Puede comunicarse con el Departamento de
Insurance to obtain information on companies,
coverages, rights or complaints at: Seguros de Texas para obtener information
acerca de companies, coberturas, derechos o
quejas al:
1-800-252-3439 1-800-252-3439
You may write the Texas Department of Puede escribir al Departamento de Seguros de
Insurance Texas
P.O. Box 149104 P.O. Box 149104
Austin, TX 78714-9104 Austin, TX 78714-9104
Fax Number (512) 475-1771 Fax Number(512) 475-1771
Web: http://www.tdi.state.tx.us Web: http://www.tdi.state.tx.us
E-mail: ConsumerProtection @tdi.state.tx.us E-mail: ConsumerProtection @tdi.state.tx.us
PREMIUM OR CLAIMS DISPUTES: Should DISPUTAS SOBRE PRIMAS O ECLA OS;.
you have a dispute concerning your Si tiene una disputa concerniente a su
premium or about a claim you should prima o a un reclamo, debe comunicarse
contact the agent first. If the dispute is not con su agente primero. Si no se resuelve la
resolved, you may contact the Texas disputa, puede entonces comunicarse con
Department of Insurance. el departamento (TDI).
ATTACH THIS NOTICE TO YOUR POLICY: UA ESTE AVISO A SU POLIZA: Este aviso
This notice is for your information only and es solo para proposito de information y no
does not become a part or condition of the se convierte en pae o condition del
attached document. documento adjunto.
F-4275-1,JTX4275-1
HR 42 H006 00 0807
Producer Compensation Notice ffiiTFORD
|
�
You can review and obtain information On The HarUord's �
producer compensation practices ed wvvw.thehertford.cmnn |
or at 1-800-592-5717
HR 00 H093 00 02D7 2007, The Hartford Page 1 of 1
_
Direct MquiriesIC)aian;to
THE HARTFORD
Bond T-4
POWER OF ATTORNEY One Hartford Plaza
Hanford,Connecticut 06155
call.888-266-3486 or onus 860-757-5835)
KNOW ALL PERSONS BY THESE PRESENTS THAT: I—cy Code:46-50889 4
.....] Hartford Fire imsurance Company,a crirpwa�ion duh organized under ffic la%%s ot the State<A'Conneeficul
Hartford Casualty lnsurance Cc"pany,a cmporarwn&0%ai ganiiztd under ifie,Li%�oi:r1re Sralk!"fin&1na
Hartford Accident and Indemnity Company,a corporaxam duh orgymbed undcr d3uc r la%%a of the Swe iii'Onmectitur
Hartford Lhictermiters Irmurance Company-i voqwmfion dwy orgauuzed under rhe iai%s offt Slate of ConnecvRrut
gp Twin City Five insurance Company,as cmpowwiorr du orean?ed undier uhe hwh,s M'die'Ame oi1ndiana
Hartford Insurance Company of Illinois,as corpora6on d0y("ganized under the h ,:u ofilic S' ate of'Iflinois
Hartford Insurance Company of the Midwest,a coijimadou di&',,or'eanized under dw,Uaos of ft:Swic ofindUana
Hartford lnsurance Company of the Southeast,a ceirporHtUon duly organrierd under the hn%s rifilic Maw ofi-1wida
having their borne office in Hartford, Connecticut(hereinafter collectively referred to as the"Companies") do hereby;make, constitute and appoint,
up to the amount of UnI Jzd,ted ,
Julie BaLlfflberger, Amber Jones, April Punta., Da.rrin J. Weber of DAI¢IA-.S,
Texas
iliv*i true arKJ iawful Alkxuwy(s)in Fact,each to their separate,capacity if more than one is narned above,to sign its, name as su;ety(ws) orrife as defimatpri
above by Q,and to exectAe,seat and a(ArnovAedge any and ail bonds,undertakings,contracts and othra w6 ten Iristrurnents in ffie naftHeftieFeaf,on behalf
of the Companies in their business of gwiranteeing tree fidelity of persons,t uaranteelng the performance of contrarl's and exectarrig or guavanieeing bonds
and underlakiMs required or peandled In any adiors or proceedings allowed lby law-
In Witness Sher f,and as authofized by a Resdution of Ox,,Board of[Aectors of Ice Conpank--t m ALQtArt 1, 2009, the Canpanies have
caused these pre sents to tm signed by its Vrce President and Hs cailpaiate seals to be hereto affixed, rft0y attested by his Assistant Secretary. Further,
pirrsuant to Reschifian of the Board of[Arectors of the Cornpar6es, the Conrpwiies Ilhennatty unwrnbiguousiy affirm that trv,.�y are and WH be bound by army
me&wrricafly apiched sifpiawres applied to Uqs IFaower of Aftorney,
Ail,
197
John Gray,Assistant SecTratary M Ross Fisher, Vice President
STATE OF CONNECTICUT Hartford
COUNTY OF HARTFORD
On this 12Ui day of,iity,2012,before me pe.morwfly came M. Ross Rsher,to me ktwwn,who bisiM, by n-w.dully swom,chd depose and say'.that
he resides In the Courity of t lartford,Slate of Connecficul;hat he,is the Vice President of Ov,Companies,the corporations described in aryJ which executed
the above instrurrient,that he knr.wj the seats of the said mrpoiatifam"that the seals affixed to the sald instrument are such corporate seats;that Hwy were
so affixed by&Ahority of the Boards of Directors of said corporations ar"O that he signed his riairne thereto by like authority.
CERTIFICATE
y Covunks�oo E�pvn.f JuN 3 L M 6 M
i,,tie urviersIgned,Vice President of the Comparges,00 11EREBY CSR -flFY that the above and foreg6vig is a true and correct copy®of the Power
of Affoaw-.1 exew,.,,uted by said Cofq)an0s,which is still In full force effective as of octobe r 5, 2 015
Signed and seated at Me City of Hartford,
/ZOM
197-/
Kevin Hedlunarr,Assistant Vme Piresdent
POA 20 P
AFFIDAVIT
STATE OF Texas
COUNTY OF Dallas
Before me,the undersigned authority,a notary public in the state
and county aforesaid,on this day personally appeared Keller Webster,
Presiden Of KWA Construction,LP,known to me to be a credible person,
who being by me duly sworn,upon his oath deposed and said;
That all persons, firms,associations, corporations,or other
organizations furnishing labor and/or materials have been paid in full;
That the wage scale established by the City Council in the City of
Fort Worth has been paid in full;
That there are no claims pending for personal injury and/or
property damages;
On Contract described as;
Paving,Drainage, Street Lights,Water& Sanitary Sewer Improvements to
serve Reserve at McAlister Lots 1 &2,Block 6,Highpoint Hill; City
Project No. 02308
BY
Keller Webster-President
Subscribed and sworn before me on this date 22nd of September, 2015.
Notary Public
Dallas,Texas
TASHA KEENE
My Commission Expires
February 18,2019
lip Www
I
tORTWORTHREV:02/22/07
i
TRANSPORTATION AND PUBLIC WORKS
CONTRACTOR'S EVALUATION OF CITY
i
I PROJECT INFORMATION Date: 9/30/2015
Name of Contractor Project Name
KWA Construction Reserve a7 McAlister __..
DOE Inspector Project Manager
W a en Aaron.Pan.
DOE Alumb=7 _
ojectDirkulty T°y ofContract
7259 Simple ®` Routine_.__ .mmm .._...._..w_..a__. _..__... ._ B water er waste
._Va....t_er[] .w.:_.. ina Pavement
_ .. . �.
Initial Contract Amount Final Contract Amount
$135,263.20 $135,263,20
I PERFORMANCE EVALUATION
0-Inadequate [ m Deficient 2 w Standard 3 m Good 4-Excellent
ELEMENT =(0'74) ELEMENT SY,dn�f'ING
(0-4)
INSPECTION EVALUATION PLANS&SPECIFICATIONS
1. Availability of Ins ector l Accurac of Plans to ExistLn Conditions
2 Knowledge of Inspector 2 Mari &SufFucienc of Details
3 Accurac of'1Vleasured entities 3 :ill' l K of S ecif cations
4 Dis Ia Of Professionalism 4 Accuracy of Plan Quantities
5 Citizen Corn laint Resolution PROJECT MANAGER EVALUATION
6 Performalttin u Valve Crews,Labs 1 Knowledge And/Or Problem Resolution
ADMINISTRATION 2 Availabilit oEProlect.Mana er
I Charl Orden Processing Time 3 Communication
2 Tunliness of Con r Pa ants ,- 4 Resolution of Ut li Confaicts
3 Bid Opening to P're-Con Ivl�etin Tiunefraune
COMMENTS&SIGNATURES
COMMENTS
W
Signature Contractor
Signature E Inspector
Signi DOE'Inspector's Supervisor
INSPECTOR'S COMMENTS
ANSPOItT IION AND PUBLIC WORK'.S
Ile City. of Fort Worth•1000 I'lssoa kmor ton Street•Fort as 76012-0311
`817)392...7941 •F G81" 392..7845