HomeMy WebLinkAboutContract 45838-FP2 Departof TPW Const. Services
DOE# 7 Date -_
Project Manager� Lnad
�� �( l,;
Risk Managementt S. "' , 0' ,day v�MAW
D.O.E. Brotherton J t
T WORTH, �� a 2
CFA Westerman/Scanned ❑
The Proceeding people have been Contacted concerning the request .ATION AND PUBLIC WORKS
for final payment&have released this project for such payment.
DF PROJECT COMPLETION
Clearance Conducted By Etta Bacy D.O.E. Ns: 7201
M1 ScaA
Regarding contract 217201 for'TRAILS OF FOSSIL CREEK PHASE IV as required by the
TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by City Council on N/A through
M&C N/A the director of the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT upon the
recommendation of the Assistant Director of the Transportation&Public Works Department has accepted the project
as complete.
Original Contract Prices: $767,606.60
Amount of Approved Change Orders: N� 1
Revised Contract Amount: $767,606.60
Total Cost Work Completed: $767,606.60
Less Deductions:
Liquidated Damages: _ - Days @$210.00/Day
Pavement Deficiencies:
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Total Deduction Amount: $0.00
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Total Cost Work Completed: $767,606.60
Less Previous Payments: j
Final Payment Due $767,606.60 I
°& 2•lS • Zo[ (o
Recommended for Acceptance Date
Asst. Director, TPW - Infrastructure Design and Construction
Accepted w 2-11 Z o(�
Date
AM Director,
TRANSPORTATION AND PUBLIC WORKS DEPARTMENT
Asst. City Manager Date
Comments. FUND: C205-475220-207760?9-51
VMA 11.,E;"
FEB 2 2016
lnitlal: U
FORT WORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name TRAILS OF FOSSIL CREEK PHASE IV WATER,SEWER AND DRAINAGE
Contract Limits
Project Type DRAINAGE&BOND
City Project Numbers 02251
DOE Number 7201
Estimate Number 1 Payment Number I For Period Ending 1/31/2016
W
City Secretary Contract Number 217201 Contract Time 180v
Contract Date Days Charged to Date 469
Project Manager Long Contract is 100.00 Complete
Contractor BURNSCO CONSTRUCTION,INC.
6331 SOUTHWEST BLVD
FORT WORTH, Ta 76132
Inspectors RODGFRS / DEYON
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City Project Numbers 02251 DOE Number 7201
Contract Name TRAILS OF FOSSIL CREEK PHASE IV WATER,SEWER AND DRAINA Estimate Number I
Contract Limits Payment Number 1
Project Type DRAINAGE&BOND For Period Ending 1/31/2016
Project Funding
UNIT III:DRAINAGE IMPROVEMENTS
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
----------------------------------------
1 — ------- -----------------------
1 21"RCP CLASS III 143 LF $85.50 $12,226.50 143 $12,226.50
2 24"RCP CLASS 111 195 LF $88.50 $17,257.50 195 $17,257.50
3 27"RCP CLASS I11 137 LF $94.50 $12,946.50 137 $12,946.50
4 30"RCP CLASS 111 324 LF $100.50 $32,562.00 324 $32,562.00
5 36"RCP CLASS III 250 LF $118.50 $29,625.00 250 $29,625.00
6 5X4 BOX CULVERT 745 LF $242.50 $180,662.50 745 $180,662.50
7 7X4 BOX CULVERT 249 LF $331.50 $82,543.50 249 $82,543.50
8 8X4 BOX CULVERT' 609 LF $353.50 $215,281.50 609 $215,281.50
9 TRENCH SAFETY 2652 LF $0.50 $1,326.00 2652 $1,326.00
10 TYPE 1 JUNCTION BOX(9'X9') 1 EA $10,500.00 $10,500.00 1 $10,500.00
I t TYPE 2 JUNCTION BOX(9'X7) I EA $10,000.00 $Io,000.00 1 $10,000.00
12 4'STORM JUNCTION BOX 1 EA $3,200.00 $3,200.00 1 $3,200.00
13 10'CURB INLET 14 EA $3,200.00 $44,800.00 14 $44,800.00
14 4'DDROP INLET(3'X3'INTERIO DIMENSIONS) I EA $3,300.00 $3,300.00 1 $3,300.00
15 CONCRETE COLLAR I 1 EA $400.00 $4,400.00 11 $4,400.00
16 Y ROUND MANHOLE RISER 2 EA $1,600.00 $3,200.00 2 $3,200.00
17 4"CONCRETE FLUME WITH 6"CURB 207 SY $72.00 $14,904.00 207 $14,904.00
18 CONCRETE BOX STRUCTURE FOR FLUME I EA $3,800.00 $3,800.00 1 $3,800.00
19 TYPE PW-2 WINGWALL 15 LF $160.00 $2,400.00 15 $2,400.00
20 5.5'X5'3/8"TFUCK GALVANIZED STEEL PLATE 3 EA $900.00 $2,700.00 3 $2,700.00 {
WITH DIAMON PATTERN
21 C PAINTED EXTRUDED ALUMINUM FENCE 260 LF $44.00 $11,440.00 260 $11,440.00
22 GALVANIZED HANDRAIL 30 LF $110.00 $3,300.00 30 $3,300.00
23 6'GATESTEEL I EA $1,500.00 $1,500.00 1 $1,500.00
24 REMOVE CONC CURB&GUTTER 22 LF $4.80 $105.60 22 $105.60
25 LARGE STONE RIPRAP,GROUTED 9 SY $76.00 $684.00 9 $684.00 1
26 36"CMP(SEDIMENTATION POND) 217 LF $78.00 $16,926.00 217 $16,926.00
27 48"CMP PERFORATED RISER 15 LF $84.00 $1,260.00 15 $1,260.00
(SEDIMENTATION POND)
28 TRENCH SAFETY(SEDIMENTATION POND) 232 LF $0.50 $116.00 232 $116.00
29 INSTALLATION OF 72"X21"ANTI-VORTEX TOP 3 EA $2,800.00 $8,400.00 3 $8,400.00
(SEDIMENTATION POND)
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City Project Numbers 02251 DOE Number 7201
Contract Name TRAILS OF FOSSIL CREEK PHASE IV WATER,SEWER AND DRAINA Estimate Number I
Contract Limits Payment Number 1
Project Type DRAINAGE&BOND For Period Ending 1/31/2016
Project Funding
30 1.25 CY ANTI FLOAT BLOCK 3 EA $800.00 $2,400.00 3 $2,400.00
(SEDIMENTATION POND)
31 ANTI-SEEP COLLAR(SEDIMENTATION POND) 6 EA $1,600.00 $9,600.00 6 $9,600.00
32 1.5"FILTER STONE(SEDIMENTATION POND) 10 CY $24.00 $240.00 10 $240.00
---- ------------------------------ ----
Sub-Total of Previous Unit $743,606.60 $743,606.60
UNIT IV:BONDS
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total
Quanity Total
---------------------------------------____
1 PAYMENT,PERFORMANCE,&MAINTENANCE I LS $24,000.00 $24,000.00 1 $24,000.00
BOND
----------------------------------------
Sub-Total of Previous Unit $24,000.00 $24,000.00
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City Project Numbers 02251 DOE Number 7201
Contract Name TRAILS OF FOSSIL CREEK PHASE IV WATER,SEWER AND DRAINA Estimate Number I
Contract Limits Payment Number 1
Project Type DRAINAGE&BOND For Period Ending 1/31/2016
Project Funding
Contract Information Summary
Original Contract Amount $767,606.60
Chanme Orders
'total Contract Price $767,606.60
Date �— /l> Total Cost of Work Completed $767,606.60
C tra Less %Retained $0.00
D to `-f
2C( Net Earned $767,606.60/
ervisor Earned This Period $767,606.60
i spection Sup
Retainage This Period $0.00
Date
Less Liquidated Damages
Project Manager
Days @ /Day $0.00
LessPavement Deficiency $0.00
director PW-Infrastructure Design and Construction Less Penalty $0.00
Date 5� 1 Jia Less Previous Payment $0.00
Direc /Contracting Departm Vvt Plus Material on Hand Less 15% $0.00
Balance Due This Payment $767,606.60
Friday,January 29,2016 Page 4 of 5
City Project Numbers 02251 DOE Number 7201
Contract Name TRAILS OF FOSSIL CREEK PHASE IV WATER,SEWER AND DRAINA Estimate Number 1
Contract Limits Payment Number 1
Project Type DRAINAGE&BOND For Period Ending 1/31/2016
Project Funding
Project Manager Long City Secretary Contract Number 217201
Inspectors RODGERS / DEYON Contract Date
Contractor BURNSCO CONSTRUCTION,INC. Contract Time 180 W
6331 SOUTHWEST BLVD Days Charged to Date 469 W
FORT WORTH, TX 76132 Contract is .000000 Complete
CITY OF FORT WORTH
SUMMARY OF CHARGES
Line Fund Account Center Amount Gross Retainage Net
Funded
F
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Total Cost of Work Completed $767,606.60
Less %Retained $0.00
Net Earned $767,606.60
Earned This Period $767,606.60
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Retainage This Period $0.00 k
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Less Liquidated Damages
0 Days @ $0.00 /Day $0.00
LessPavement Deficiency $0.00
Less Penalty $0.00
Less Previous Payment $0.00
Plus Material on Hand Less 15% $0.00
Balance Due This Payment $767,606.60
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CONSENT OF OWNER ❑
SURETY COMPANY ARCHITECT ❑
TO FINAL PAYMENT CONTRACTOR F-1
SURETY ❑
Conforms with the American Institute of OTHER
Architects, AIA Document G707
Bond No 022048353
PROJECT: Trails of Fossil Creek Phase IV
(name, address) Fort Worth, TX
TO (Owner)
FOSSIL CREEK A2A DEVELOPMENT LLC AND CITY ARCHITECT'S PROJECT NO:
OF FORT WORTH
CONTRACT FOR:
548 Silicon Drive Suite 100 Trails of Fossil Creek Phase IV-Water,Sewer and Drainage
SoImprovements
uthlake Tx 7sosa -J CONTRACT DATE:
CONTRACTOR:BURNSCO CONSTRUCTION, INC.
In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the
(here insert name and address of Surety Company)
LIBERTY MUTUAL INSURANCE COMPANY
175 Berkeley Street
Boston MA 02116 , SURETY COMPANY
On bond of (here insert name and address of Contractor)
BURNSCO CONSTRUCTION, INC.
6331 Southwest Boulevard
Benbrook TX 76132
, CONTRACTOR,
hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve it
the Surety Company of any of its obligations to (here insert name and address of Owner)
FOSSIL CREEK A2A DEVELOPMENT LLC AND CITY OF FORT WORTH j
548 Silicon Drive Suite 100
Southlake TX 76092 j
OWNER,
as set forth in the said Surety Company's bond,
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IN WITNESS,WHEREOF,
the Surety Company has hereunto set its hand this 22nd day of December,2015
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LIBERTY MUTUAL INSURANCE COMPANY
/ Surety Company
Attest;Robb!-Mora16s-
(Seal):
Signature of Authorized Representative
f
Sophinie Hunter Attorney-in-Fact
Title
NOTE; This form is to be used as a companion document to AIA DOCUMENT G706, CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS,
Currant Edition
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ONE PAGE I
d
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AFFIDAVIT
STATE OF TEXAS
COUNTY OF TARRANT
Before rne, the undersigned authority, a notary public in the state
and county aforesaid, on this day personally appeared John Burns,
President Of Burnsco construction, Inc.,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;
Trails of Fossil Creek IV-Water, Sewer, Drainage Improvements
BY
John Burns, President
Subscribed and sworn before me on this date 29th of December, 2015.
Notary Public
Tarrant County,Texas
i
°n P� MARY PANNELL
YJNotary Public Stat i ley s
My Cornrnlsslon Expires g
October 19, 2018 eF3
anu
THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND,
i his Power of Attorney limits the acts of those named herein,and they have no authority to bind the Company except in the manner and to the extent herein stated.
American Fire and Casualty Company Liberty Mutual Insurance Company Certificate No. 7111477
The Ohio Casualty Insurance Company West American Insurance Company
POWER OF ATTORNEY
KNOWN ALL PERSONS BY THESE PRESENTS; That American Fire&Casualty Company and The Ohio Casualty Insurance Company are corporations duly organized under the laws of
the State of New Hampshire,that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts,and West American Insurance Company
is a corporation duly organized under the laws of the State of Indiana(herein collectively called the`Companies"),pursuant to and by authority herein set forth,does hereby name,constitute
and appoint, Don E.Cornell-Kelly A.Westbrook;Ricardo J.Reyna;Robbi Morales;So hinie Hunter;V.Del-ene Marshall
all of the city of Dallas
--�_,Slate of TX each
ne named,
s true and
and deliver,for and on its behalf as surely antl as it ed,anyand all lundy it ertakiere ngs,bondse more ,eeognizancestand other surety obligations,incpursuancemake,execute,seal,acknowledge
of these presents and shall
be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons.
IN WITNESS WHEREOF,this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed
thereto this 11th dayof_ September 2015
NO Cq�eA Zl INS�PnwlsOg� JAbnrgcR U9q ilA 1ltsukq t NlrtsuR American Fire and Casualty Company
C O < h�t G 2 •�_(pPFnRgr„y(` \(' pC: �f.(.
S The Ohio Casualty Insurance Company
d 1906 1979 a F 1912
1991 Liberty Mutual Insurance Company
� # ,( * f,C J ncr+us• F l;.o,A„p \, West merican Insurance Company
STATE OF PENNSYLVANIA
m ey; t1
,A
cu COUNTY OF MONTGOMERY ss David M.Care ssistant Secretary
On ih(s 11th dayof September _ 2015 before me personally appeared David M. Carey,who acknowledged himself to be the Assistant Secretary of American Fire and
a) Casualty Company,Liberty Mutual Insurance Company,The Ohio Casualty Insurance Company,and West American Insurance Company,and that he,as such,being authorized$
o to do, j
execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer,
_ IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting,Pennsylvania,on the day and year first above written. p
it
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0 SSP PAsT� COMMONWEALTH OF PENNSYLVANIA �f
` Iry co:r '�t�!y Notarfai Seal Q c
Teresa Pastella,Notary Public y.”
tit
p
OF Plymouth Twp.,Montgomery County By: o
0 P Teresa Pastella,Nota P
p �� My Commission Expires March 28,2017 ry ublic �-'t
� yCT,9�pVgb��' Member,Pennsylvania Association of Notaries 3 r
a This PowerofAttorney is made and executed pursuant to an by authority of the following By-laws and Authorizations ofAmerican Fire and Casually Company,The Ohio Casualty Insurance 0 C
Company,Liberty Mutual Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows: o.
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ARTICLE IV-OFFICERS-Section 12,Power of Attorney.Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President,and subject o >:
to such limitation as the Chairman or the President may prescribe,shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Corporation to make,execute,seal, > c
e acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surely obligations. Such attorneys-in-fact,subject to the limitations set forth in their respective a
powers of attorney,shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so '�
lCortificate
executed,such instruments shall be as binding as if signed by the President and attested to by the Secretary,Any power or authority granted to any representative or attorney-in-fact under >•al
0
the provisions of this article may be revoked at any time by the Board,the Chairman,the President or by the officer or offrcers granting such power or authority. m
o
ARTICLE XIII-Execution of Contracts-SECTION 5.Surety Bonds and Undertakings.Any officer of the Company authorized for that purpose in writing by the chairman or the president, ,
and subject to such limitations as the chairman or the president may prescribe,shall appoint such attorneys-in-fact,as may be necessary to act in behalfofthe Company to make,execute, Eseal,acknowledge and deliver as surety any and ail undertakings,bonds,recognizances and ocher surety obilgations. Such attorneys-in-fact subject to the Irmitations set forth in their Cao
respective powers of attorney,shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so 0 o
executed such instruments shall be as binding as if signed by the president and attested by the secretary.of Designation-The President of the Company,acting pursuant to the Bylaws of the Company,authorizes David M.Carey,Assistant Secretary to appoint such attorneys-in- l'
fact as may be necessary to act on behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety
obligations.
Authorization-By unanimous consent of the Company's Board of Directors,the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the
Company,wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds,shall be valid and binding upon the Company with
the same force and effect as though manually affixed.
I,Gregory W.Davenport,the undersigned,Assistant Secretary,of American Fire and Casually Company,The Ohio Casualty Insurance Company,Liberty Mutual Insurance Company,and
West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full,true and correct copy of the Power of Attorney executed by said !
Companies,is in full force and effect and has not been revoked.
0 CA
t til
IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this C�{'}, day of t
\yF.Pouvatrr,9� JA os.,�SU9 A�1NSUirq NINSUq
2 n L;
n
19ob -0 1919 0 1912 1991 °
•.rrar:.^:.H�`��D � = By,
* t yd t�' J r4*r>ti aanp Gregory W.Davenport,Assistant Secretary
i
MS 12873 122013 -�249 of 500
Liert),
tual,
V sURETY
Important Notice
TO OBTAIN INFORMATION OR TO MAKE A COMPLAINT:
You may write to Liberty Mutual Surety at.
Liberty Mutual Surety
Interchange Corporate Center
450 Plymouth Road, Suite 400
Plymouth Meeting, PA 19462-8284
You may contact the Texas Department of Insurance to obtain information on
companies, coverages, rights or complaints at:
1-800-252-3439
You may write the Texas Department of Insurance:
P. O. Box 149104
Austin, TX 78714-9104
Fax: (512) 475-1771
Web: http://www.tdi.state.tx.us
E-mail: ConsumerProtection tdi state tx us
Premium or Claim Disputes
Should you have a dispute concerning a premium, you should contact the agent first. If you
have a dispute concerning a claim, you should contact the company first. If the dispute is not
resolved, you may contact the Texas Department of Insurance.
Attach This Notice To Your Policy:
This notice is for information only and does not become a part or condition of the
attached document.
LMIC-3500
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SERFI ►r 110MFS
January 22, 2016
Mr. John Burns
Burnsco construction, Inc.
6331 Southwest Blvd.
Benbrook, Texas 76132
RE: Trails of Fossil Creek Phase IV—Water, Sanitary Sewer and Storm Drain
Improvements
CoFW Project No. 02251
CoFW File No. W-2310
CoFW DOE No. 7201
Mr. Burns,
This letter will document that Fossil Creek A2A Development LLC confirms that Burnsco
Construction, Inc. has completed the Work associated with the above referenced
contract in an appropriate timeframe, subject to completion of any warranty or
maintenance work as identified and required by the City of Fort Worth, and that no
liquidated damages will be assessed by Fossil Creek A2A Development LLC in i
connection with the Work.
Fossil Creek A2A Development LLC i
By:
64
Ron Ramirez, P.E.
Executive Vice-President
Engineering
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serene Development. UC
;.tat 4riirot! Dvive strife io)u sounaokc- ix 7607 " USA
let_ 1 682 333 0101 Fox_ 1 €i; 778 8505
:ti.vti:.serenehor�es..=orn t
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FORTWORTHREV:02/20/07
TRANSPORTATION AND PUBLIC WORKS
PERFORMANCE EVALUATION OF CONTRACTOR
I) CONTRACTOR&PROJECT DATA
Name of Contractor Project Name
Burnsco Construction Trails Of Fossil Creek Phase IV
DOE Lvspeclor DOE Number
Gat De on 7201
DOEInspector Project Manager
❑ Water❑ Waste Water O Storm Drainage❑ Pavement Aaron Long
Mitial Contract Amount Project Difftrrlty
$767,606.60 O Simple O Routine O Complex
Final Conlract Amount Date
$767,606.60 1/22/2016
II)PERFORMANCE EVALUATION
0-Inadequate I-Deficient 2-Standard 3-Good 4-Excellent
ELEMENT WEIGHT(- APPLICABLE Y/N RATING 0-4 MAX SCORE SCORE
I Submission of Documents 2 Y 4 g g
2 Public Notifications 5 Y 4 20 20
3 Plans on Site 5 Y 4 20 20
4 Field Supervision 15 Y 3 60 45
5 Work Performed 15 Y 3 60 45
6 Finished Product 15 Y 3 60 45
7 Job Site Safety 15 Y 3 60 45
8 Traffic Control Maintenance 15 Y 2 60 30
9 Daily Clean Up 5 Y 2 20 10
10 Citizen's Complaint Resolution 5 Y 4 1 20 20
11 Pro er Restoration 5 Y 4 20 20
12 After Hours Response 5 Y 4 20 20
13 Pro'cct Completion 5 Y 4 20 20
TOTAL ELEMENT SCORE(A) 348
BONUS POINTS(25 Maximum)(B)
III)CONTRACTOR'S RATING TO'T'AL SCORE('TS) 348
Maximum Score(MS)=448 or sum of applicable element score maximums which= 448
Rating(ITS/MS]*100%) 348 / 448 = 78%
Performance Category Good
<20%=Inadequate 20%to<40%=Deficient 40%to<60%=Standard 60%to<80%=Good _>80%=&cellent
Inspector's Comments(INCLUDING EXPLANATION OF BONUS POINTS AMIARDED)
Signature DOE Inspector Signature Contractor
Signature DOE Inspector'sSupetvisor
CONTRACTOR'S COMMENTS
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TRANSPORTATION AND PUBLIC V)'ORI<S
The City of Fort Worth•1000 Throckmorwn Street•Fort Worth,TX 76012-6311
(817)392-7941 •Fay(817)392-7845
FORTWORTH REV:02/22/07
TRANSPORTATION AND PUBLIC WORKS
CONTRACTOR'S EVALUATION OF CITY
1)PROJECT INFORM_A_TION Date: 1/22/2016
Name of Contractor Project Name �~
Burnsco Construction Trails Of Fossil Creek Phase IV
DOE Inspector Project Manager
Gail De on Aaron Long _
DOE Number ProjeclDglcalh, Tipeo—ontract y
7201 10 Simple OO Routine O Complex ❑ Water❑ Waste Waters] Storm Drainage❑ Pavement
Initial Contraci Amount Final Contract Amount — ---i- -- -
$767,606.60 $767,606.60
Il)PERFORMANCE EVALUATION
0-Inadequate I -Deficient 2-Standard 3 -Good 4-Excellent
ELEMENT RATING ELEMENT k.-- RATING
.....
0-4) 0-4
INSPECTION EVALUATION PLANS&SPECIFICATIONS
I Availabili of Inspector 1 Accuracy of Plans to Existing Conditions
2 Knowledge of Ins ector _ 2 Clarity&Sufficiency of Details
3 Accurate of Measured 2uantities M. 3 A licabili of Specifications
4 Display Of Professionalism 4 Accuracy of Plan 2uantities _--_-.-
5 _Citizen Complaint Resolution u- PROJECT MANAGER EVALUATION
6 Perfor;nance-Setting up Valve Crews,Labs I Knowledge And/Or Problem Resolution
ADMINISTRATION - 2 Availability of Project Manager m
1 Change Order Processing Time 3 Communication__
2 Timliness of Contractor Payments . t ---
=r, 4 .Resolution of lJtility Conflicts
3 Bid 0 ening to Pre-Con MeetinTituefiame
III)COMMENTS&SIGNATURES
COMMENTS
Signature Contractor '41�12,
Signature DOE Inspector
Signature DOE Inspector's Supervisor
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INSPECTOR'S COMMENTS
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TRANSPORTATION AND PUBLIC WORDS
The City of Fort Words•1000 Throckmorton Street•Fort Worth,'IX 76012-6311
(817)392-7941 •Fax.(817)392-7845
FORT WORTH
TRANSPORTATION AND PUBLIC WORKS
STATEMENT OF CONTRACT TIME
STATE,WNO.:
FINAL 1
NAME of Fossil Creek Phase IV Water,Sewer,Storm,Paving DOG 7201
YEAR: g Contractor Surnsco
PROJE
2251 FINAL INSPECTION DATE
S'I'D CD
C.'ONTRACT"I'IIbTE 180X
PERIOD FRONT: 1/16/2016 TO: 1/31/2016 13EG Month DrvE1 ornlrsNl Y/N N
WORK ORllER EFFECTING: 8/2012014 BEG /n
DAY OF MONTH DAYS REASON FOR DAYS REASON FOR
CHARGED DAYS CREDITED DAY OF MONTH
1 Sat p na 16 CHARGED DAYS CRCDITGD
2 Sun 0 na 17
3 Mon 0 na 18
4 Tue 0 no 19
5 Wed p na 20 -
6 Thu ---
na- -- 21
-7 Fr( 0 na 22
8 Sat _ 0 na 23
9 Sun 0 na 24
10 Mon 0 na Y5
11 Tue 0 na 26
12 Wed 0 na 27
13 Thu 0 na 28
14 Fri 0 na 29
15 Sat 0 na 30
NA Wkn&Hol L Wea utl Oth
Not Applicable Mi SUN,and WEATHER UTILITIES OTHERS DAYS
HOLIDAYS TOTAL DAYS
THIS PERIOD RELOCATE CHARGED
0 p 0 0 0 0
PRB'1'IOUS PERIOD
0 469 469
TOTAL TO DATE 0 0 0 0 469 469
REMARKS:
Completed and Final on 12/9/2015
Signature: /
�— Signature:
(Print a (Print Name) Gary Deyon
C0ITRACrOn CIOR -
INSPECTOR DATE