HomeMy WebLinkAboutContract 46789-FP1 DOE# r _ ..,.._t
Project M e
Risk Managem CITY SECRETARY,
D.O.E. ZTWORTH� CONTRACT
NO,
CFA W e
The Proceeding people have been Contacted concerning / �/
the request for final payment&have released this 'ATION AND PUBLIC WORKS 5'(0 00 ( ��
project for such payment
T PROJECT COMPLETION C 5 Z4(o� 8
Clearance Conducted By Shameka Kennedy D.O.E.Ns: 7453
Regarding contract 46789 for CULTURAL DISTRICT-HARLEY&MONTGOMERY PH 4 as required by the
WATER DEPARTMENT as approved by City Council on 6/16/2015 through M&C C-27350 the director of the
WATER DEPARTMENT upon the recommendation of the Assistant Director of the'Transportation&Public Works
Department has accepted the proje Tete.
Original Contract Prices: `�' it �(� $1,645,417.20
Amount of Approved Change Ord ,, ,215 $80,900.48 NO 1&2 20
Revised Contract Amount: ` r $1,726,317.68
Total Cost Work Completed: _ $1,726,317.68
Less Deductions:
Liquidated Damages: Das 44 S21t1.p01 Da
Pavement Deficiencies:
Total Deduction Amount:
Total Cost Work Completed: $1,726,317.68
Less Previous Payments: $1,694,743.06
Final P t e $31,574.62
Recomme ded or Acceptance Date
Asst. Dire or, PW - Infrastructure Design and Construction
-��+. .�- 6-2S-1b
Accepted Date
Asst. Director, WATER DEPARTMENT
-lam
Asst. City Manager Date
i
Comments: P266-541200-707170146883
OFFICIAL RECORD
CITY SECRETARY
,� 52016
���RT�lT�I�
'TOT I
. 6S
' JUN 2 8 2016 ;� `"` 6 VO-7" c 014169
City Project Numbers 01468 �� -..._...j DOE Number 7453
Contract Name CULTURAL.DISTRICT-HARLEY&MONTGOMERY PH 4 Estimate Number 13
Contract Limits Payment Number 13
Project Type SEWER For Period Ending 527/2016
Project Funding
Project Manager Kasavich City Secretary Contract Number 46789
Inspectors DICKINSON / WATSON Contract Date
Contractor S.J.LOUIS CONSTRUC ON OF TEXAS,LTD Contract Time 171 CD
Days Charged to Date 177 CD
Contract is .000000 Complete
hog-N
CITY OF FORT WORTH' #,..�.,.__.—.. 'C.
SUMMARY OF CHARCOIC;E #._ �
Line Fund Account Center Amount Gross Retainage Net
Funded
---------—————————————————————————————
2 7'(',[j�'SS 1�G�15jNl7Zo i�wiL.UU •f !7.11g�ln2 "�i. 557�.Po7
Total Cost of Work Completed $1,726,317.68
WATER DEPARTMENT Less %Retained $0.00
ENGR ERWG AND FISCAL. VICES Net Earned $1,726,317.68
coma l Earned This Period $31,574.62
Retaivage This Period $0.00
Less Liquidated Damages
OEPAA7mENT CHEER ACK-UP YES® 0 Days 8 $0.00 /Day $0.00
LessPavement Deficiency $0.00
Less Penalty $0.00
Less Previous Payment $1,694,743.06
Plus Material on Hand Less 15% $0.00
Balance Due This Payment $31,574.62
Tuesday,June 14,2016 Page 5 of 5
P ato(o- a)u 8
FORT WORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name CULTURAL DISTRICT-HARLEY&MONTGOMERY PH 4
Contract Limits
Project Type SEWER
City Project Numbers 01468
DOE Number 7453
Estimate Number 13 Payment Number 13 For Period Ending 5/27/2016
CD
City Secretary Contract Number 46789 Contract Time 17CD
Contract Date Days Charged to Date 177
Project Manager Kasavich Contract is 100.00 Complete
Contractor S.J.LOUIS CONSTRUCTION OF TEXAS,LTD
Inspectors DICKINSON / WATSON
Tuesday,June 14,2016 Page I of 5
City Project Numbers 01468 DOE Number 7453
Contract Name CULTURAL DISTRICT-HARLEY&MONTGOMERY PH 4 Estimate Number 13
Contract Limits Payment Number 13
Project Type SEWER For Period Ending 5/27/20I6
Project Funding
SEWER
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
--------- ------ ---------------- -- --------
1 36"CASING BY OTHER THAN OPEN CUT 850 LF
2 48"TUNNEL LINER PLATE BY OTHER THAN 857 LF $1,009.00 $864,713.00 857 $864,713.00
OPEN CUT CO#2
3 24"SEWER CARRIER PIPE cc#1 C092 833 LF $360.00 5299,880.00 833 $299,880.00
4 24"FIBERGLASS SEWER PIPE cog C092 307 LF $466.00 $143,062.00 307 $143,062.00
5 18"SEWER PIPE CSS BACKFILL cog 36 LF $392.00 $14,112.00 36 $14,112.00
6 12"SEWER PIPE CSS BACKFILL cc#1 CO#2 25 LF $163.00 $4,075.00 25 $4,075.00
7 6"SEWER PIPE CSS BACKFILL 100 LF $128.00 $12,800.00 100 $12,800.00
8 6"SEWER ABANDONMENT PLUG 6 EA $100.00 $600.00 6 $600.00
9 REMOVE 4'SEWER MANHOLE 7 EA $1,400.00 $9,800.00 7 $9,800.00
10 4"CONC SIDEWALK CO#2 49 SF $6.00 $294.00 49 $294.00
11 6"CONCRETE DRIVEWAY C092 77 SF $10.00 $770.00 77 $770.00
12 HES CONC PVMT REPAIR W/ASPHALT 809 SY $93.00 $75,237.00 809 $75,237.00
OVERLAY co#I CO#2
13 6"CONC CURB&GUTTER 25 LF $30.00 $750.00 25 $750.00
14 4"SLD PVMT MARKING HAS CO#2 2916 LF $1.50 $4,374.00 2916 $4,374.00
15 4"BRK PVMT MARKING HAS C042 150 LF $1.50 $225.00 150 $225.00
17 REFL RAISED MARKER CO#2 15 EA S4.00 $60.00 15 560.00
18 SEEDING HYDROMULCH C092 14 SY $1.00 $14.00
19 PRE CCTV INSPECTION CO#2 2750 LF $2.50 $6,875.00 2750 $6,875.00
20 POST CCTV INSPECTION CO#2 1158 LF $1.00 $1,158.00 1158 $1,158.00
21 MANHOLE VACUUM TESTING 8 EA $100.00 $800.00 8 $800.00
22 TRENCH SAFETY C092 468 LF $0.01 $4.68 468 $4.68
23 UTILITY MARKERS 1 LS 5500.00 $500.00 1 $500.00
24 CONCRETE COLLAR CO#2 8 EA $600.00 $4,800.00 8 $4,800.00
25 EPDXY MANHOLE LINER cc#1 104 VF $167.00 $17,368.00 104 $17,368.00
26 4'MANHOLE cc#1 2 EA $4,500.00 $9,000.00 2 $9,000.00
27 5'MANHOLE 2 EA $5,800.00 $11,600.00 2 $11,600.00
29 5'EXTRA DEPTH MANHOLE CO#2 9 VF $144.00 $1,296.00 9 $1,296.00
30 6'DROP MANHOLE W/INTERIOR STA3+04 1 EA $30,600.00 $30,600.00 I $30,600.00
31 6'DROP MANHOLE W/INTERIOR DROP I EA $28,700.00 $28,700.00 1 $28,700.00
STA5+85
Tuesday,June 14,2016 Page 2 of 5
City Project Numbers 01468 DOE Number 7453
Contract Name CULTURAL DISTRICT-HARLEY&MONTGOMERY PH 4 Estimate Number 13
Contract Limits Payment Number 13
Project Type SEWER For Period Ending 5/27/2016
Project Funding
32 6'DROP MANHOLE W/INTERIOR DROP 1 EA $29,900.00 $29,900.00 1 $29,900.00
STA9+43
33 TRAFFIC CONTROL 5 MO $1.00 $5.00 5 $5.00
34 CONTAMINATED MATERIAL HANDLING CO#2 109 LF $1.00 $109.00 109 $109.00
35 CONTAMINATED MATERIAL LOADING, 50 CY $52.00 $2,600.00 50 $2,600.00
TRANSPORTING&DISPOSAL co#1 CO#2
37 16'DIA SHAFT FOR ADDED MANHOLE AT STA 26 VF $2,000.00 $52,000.00 26 $52,000.00
7+27 CO#1
38 8'MANHOLE BASE W/5'RISER CO#I 1 LS $53,000.00 553,000.00 1 $53,000.00
39 CLSM/CSS/SPOIL TRUCKING FOR MANHOLE 1 LS $13,000.00 $13,000.00 1 $13,000.00
CO#1
40 ABANDON AND GRANT 20'OF INSTALLED I LS $5,000.00 $5,000.00 1 $5,000.00
TUNNEL CO#1
41 REDO 5"DIA MANHOLE BASE CO#2 1 LS $1,250.00 $1,250.00 1 $1,250.00
42 4"BORED SEWER SERVICE UNDER BOX 1 LS $17,500.00 $17,500.00 1 $17,500.00
CULVERT W/CLEANOUT CO#2
43 18"PLUG FOR SLUBOUTCO#2 1 LS $1,000.00 $1,000.00 1 $1,000.00
44 ADDITIONAL 4"SEWER SERVICES ON LINE A- 1 LS $7,500.00 $7,500.00 1 $7,500.00
3 CO#1
Sub-Total of Previous Unit $1,726,331.68 $1,726,317.68
Tuesday,June 14,2016 Page 3 of 5
City Project Numbers 01468 DOE Number 7453
Contract Name CULTURAL DISTRX r-HARLEY&MONTGOMERY PH 4 Estimate Number 13
Contract Limits Payment Number 13
Project Type SEWER For Period Ending 5/27/2016
Project Funding
Contract Information Summary
Original Contract Amount $1,645,41720
Change Orders
Change Order Number 1 S49.330.00
Change Order Number 2 $31,570.48
Total Contract Price $1,726,331.68
Date ` d Total Cost of Work Completed $1,726,317.68
C�on�r- `� Less %Retained $0.00
lyC� ate Net Earned $1,726,317.68
on Supervise Earned This Period $31,574.62
Inspecti /- Retainage This Period $0.00
ncager
a�Date �i ��� Less Liquidated Damages
r- q Days @ /Day $0.00
Aet Date �! �`�-� LessPavement Deficiency $0.00
Asst. wractwe Design and Construction Less Penalty $0.00
Date if 1./L Less Previous Payment $1,694,743.06
Director/ tracting Department Plus Material on Hand Less 15% $0.00
Balance Due This Payment $31,574.62
Tuesday,June 14,2016 Page 4 of 5
FORT WORTH Rv 03/05/07
TRANSPORTATION & PUBLIC WORKS
FINAL STATEMENT OF CONTRACT TIME
FINAL STATEMENT NO.:13
NAME OF PROJECT: Cuhural Distric/Will Rogers Sanitary Sewer Improv P-(4)
PROJECT NO.: 1468 CONTRACTOR: SJ Louis of Texas,LTD
DOE NO.: 7453
PERIOD FROM:05/11/16 TO: 05/20/16 FINAL INSPECTION DATE: 14-Dec-15
WORK ORDER EFFECTIVE:74/2015 CONTRACT TIME: 177 0 RE CD
DAY OF DAYS REASON FOR DAYS DAY OF DAYS REASON FOR DAYS
MONTH CHARGED CREDITED MONTH CHARGED CREDITED
DURING DURING
1. 16. M Other
2. 17. T Other
3. 18. W Other
4. 19. Th Other
5. 20. F Other
6. 21.
7. 22.
8. 23.
9. 24.
10. 25.
11. W Other 26.
12. Th Other 27.
13. F Other 28.
14. S Other 29.
15. - Su Other 30.
31.
SAT,SUN, RAIN,TOO WET, UTILITIES DAYS TOTAL
&HOLIDAYS &TOO COLD RELOCATIONS OTHERS* CHARGED DAYS
THIS 0 0 0 10 0 10
PERIOD
PREVIOUS 0 0 0 131 177 308
PERIOD
TOTALS 0 0 0 141 177 318
TO DATE
*REMARKS:
CONTRACT DAlt INSPECTOR DATE
ENGINEERING DEPARTMENT
yF The City of Fort Worth- 1000 Throckmorton Street-Fort Worth,TX 76012-6311
(817)392-7941 -Fax:(817)392-7845
FORTWORTH
TRANSPORTATION AND PUBLIC WORKS
PIPE REPORT FOR:
PROJECT NAME: Cultural D61=1 District-Harley&Montgomery PH 4
PROJECT NUMBER: 1468
DOE NUMBER: 7453
WATER
PIPE LAID SIZE TYPE OF PIPE LF
FIRE HYDRANTS: VALVES(16"OR LARGER)
PIPE ABANDONED SIZE TYPE OF PIPE LF
DENSITIES:
NEW SERVICES:
SEWER
PIPE LAID SIZE TYPE OF PIPE LF
SEWER 18" CSS 307
SEWER 12" CSS 36
SEWER 6" CSS 25
PIPE ABANDONED SIZE TYPE OF PIPE LF
DENSITIES:
NEW SERVICES:
TRANSPORTATION AND PUBLIC WORDS
The City of Fort Worth•1000 Throckmorton Street•Fort Worth,TX 76012-6311
(817)392-7941 •Fax:(817)392-7845
FORTWORTH REV:
E:02/20/07
TRANSPORTATION AND PUBLIC WORKS
PERFORMANCE EVALUATION OF CONTRACTOR
CONTRACTOR&PROJECT DATA
Name of Contractor Project Name
S.J.Louis Construction Cultural District-Harley&Montgomery PH4
DOE Inspector DOE Number
Donald Watson 7453
ELtspeetar Project Manager
❑ water Waste water[:] Storm Drainage❑ Pavement John Kasavich
Initial Contract Amount Project Difficulty
$1,645,417.20 0 Simple OQ Routine 0 Complex
Final Contract Amount Date
$1,711,861.88 6/2/2016
H)PERFORMANCE EVALUATION
0-Inadequate 1-Deficient 2-Standard 3-Good 4-Excellent
ELEMENT WEIGHT(x) APPLICABLE(Y/N) RATING(0-4) MAX SCORE SCORE
1 Submission of Documents 2 Y 2 8 4
2 Public Notifications 5 Y 3 20 15
3 Plans on Site 5 Y 4 20 20
4 Field Supervision 15 Y 4 60 60
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 3 60 45
9 Daily Clean Up 5 Y 2 20 10
10 Citizen's Complaint Resolution 5 Y 4 20 20
11 Pro erty Restoration 5 Y 4 20 20
12 After Hours Response 5 Y 3 20 15
13 Project Completion 5 Y 3 20 15
TOTAL ELEMENT SCORE(A) 359
BONUS POINTS(25 Maximum)(B)
TOTAL SCORE(TS) 399
III)CONTRACTOR'S RATING
Maximum Score(MS)=448 pr sum of applicable element score maximums which- 448
Rating([TS/MS]•100%) 359 / 448 IM
Performance Category Excellent
<20%-Inadequate 20%to<40%-Deficient 40%to<60%-Standard 60%to<80•/-Good >_80%-Excellent
Inspector's Comments(INCLUDING EXPLANATION OF BONUS POINTS AWARDED)
Signature DOE Inspector v �l�- --�_ Signature Contractor
� P� >�
Signature DOE Inspector's Supervisor
0, - ;�ae4
CONTRACTOR'S COMMENTS
TRANSPORTATION AND PUBLIC WORKS
The City of Fort Worth-1000 Throckmorton Street-Fort Worth,TX 76012-6311
(2) (817)392-7941 -Fax:(817)392-7845
FORT NORTH CONTRACTOR'S AFFIDAVIT OF
PAYMENT OF DEBTS AND CLAIMS
City of Fort Worth,TX
PROJECT: ULTURALDISTRICT/WILL ROGERSSANITARY SEWER PROJECT NUMBER:
IMPROVEMENTS,PART 4-MONTGOMERY ST.
OWNER: of Fort worth Tx e
CONTRACTOR: .J.Louis Construction of Texas.Ltd. 21510
ENGINEER: mle -Hom and Associates
The Contractor,in accordance with the Contract Documents,hereby certifies that, except as listed below,all
obligations for all materials and equipment furnished,for all work labor, and services performed,and for all known
indebtedness and claims against the Contractor for damages arising in any manner in connection with the
performance of the Contract referenced above for which the Owner or his property might in any way be held
responsible have been paid in full or have otherwise been satisfied in full.
EXCEPTIONS: (If none,write"NONE". The Contractor shall fumish a bond,acceptable to the Owner,
for each exception.)
CONTRACTOR S.J. Louis Construction of Texas, Ltd.
BY 4L AdjM H, Lunsford
TITLE Viae Presklwt
Subscribed and sworn to before me this 1st day of_June , 2016
Notary Publi Lisa J. Ra 1�,
�"YP�j�� LISA J.RAY
IL
Notary Public,State of Texas
My Commission Ex ares: 04/08/2 0Comm.Expires 04-05-202Q
P : oFs;o°�` Notary ID 126489174
M.
FORT NORTH
CONTRACTOR'S AFFIDAV/T
OF RELEASE OF LIENS
The City of Fort Worth
PROJECT: ULTURALDISTRICT/WILL ROGERSSANITARY SEWER PROJECT NUMBER:
MPROVEMENTS,PART 4-MONTGOMERY Sr.
OWNER: my of Fort Worth,Texas 01468
CONTRACTOR: 3.1 Louis Construction of Texas,Ltd. 21510
ENGINEER: imle -Nam and Associates
The Contractor,in accordance with the Contract Documents,and in consideration for the full and final payment to
the Contractor for all services In connection with the project;does hereby waive and release any and all liens,or
any and all claims to liens which the Contractor may have on or affecting the project as a result of its contract(s)
for the Project or for performing labor andlor fumishing materials in any way ccnnected with the construction of
any aspect of the project The Contractor further certifies and warrants that all subcontractors of labor and/or
materials for the Project,except as listed below,have been paid in full for all labor and/or materials supplied to, for,
through or at the direct or indirect request of the C.oniractor prior to, through and including the date of this affidavit.
EXCEPTIONS: (If none,write"NONE". The Contractor shall furnish a bond,acceptable to the Owner,for
each exception.)
CONTRACTOR S.J. Louis Construction of Texas. Ltd.
By VAI t;hk— Adam H. Lunsford
Title Vice President
Subscribed and Pwom to before me this 'Est day of June .20 16
Notary Publio,�, �bn Lisa J. Ra
My Commission Expires: 04/08/2020
�4'pY P�Oa ISA J. RAY
?,4; �f%Notary Public,State of Texas
? Comm.Expires 04-06-2020
Notary ID 126489174
FORT WORTH Bond Number: 190034032
CONSENT OF SURETY COMPANY
TO FINAL PAYMENT
City of Fort Worth,TX
PROJECT: ULTURAL DISTRICTMILL ROGERS SANITARY SEWER PROJECT NUMBER:
IMPROVEMENTS,PART 4-MONTGOMERY ST.
OWNER: i of Fort Worth Texas
CONTRACTOR: J. Louis Construction of Texas,Ltd. 21510
ENGINEER: mie -Horn and Associates
The Surety Company,on bond of the Contractor listed above for the referenced project in accordance with the
Contract Documents,hereby approves final payment to the Contractor,and agrees that final payment to the
Contractor shall not relieve the Surety Company of any of its obligations to the Owner under the terms of the
Contract and as set forth in said Surety Company's bond.
In witness whereof,the Surety Company has hereunto set its hand this 31st day of Mgy 201(L_.
Libedy Mutual Insurance Company
Surety Company
gy
] � i)�b
Authorized Representative
Title V. DeLene Marshall, Attomey-In-Fact
Address:
175 Berkeley Street, Boston, MA 02116
Attach Power of Attorney
C:tUsersWH=bethWeskhDpXCONSENT OF SURETY COMPANY TO FINAL PAYMENT.DOC
LIMITED PARTNERSHIP ACKNOWLEDGMENT
State of Texas
ss.
County of T=Vkt
On this 1st day of June ,2016,before me personally appeared
Adan H. lunsford to me known who being by me duly sworn,
that he/she is the Vice President of the SJ.Louis Construction of Texas,Ltd.the Limited
Partnership described in and which executed the foregoing instrument,and that he/she signed his/her name thereto by order of the
Board of Governors of said Limited Partnership.
""'°"„• LISA J. RAY
1�Y 140•G
Go:Notary Public,State of Texas
Comm.Expires 04-08-2020 otiry Public Tarrant J County, Texas
,,,,,,,�.• Notary ID 126489174 My commission expires 04/08/20M
ACKNOWLEDGMENT OF CORPORATE SURETY
State of Tet(”
ss.
County of DaUes
On this 316t day of May .2016,before me appeared V.DeLene Marshall
to me personally known who being by me duly sworn,did say that(s)he is the Attorney-in-Fact of Liberty Mutual Irmurance
Companya corporation,that the seal affixed to the foregoing instrument is the corporate seal of said corporation and that said instrument
was executed in behalf of said corporation by authority of its Board of Directors;and that said V.DeLene Marshall acknowledged
said instrument to be the free act and deed of said corporation.
��Y►vi S.HUNTER (> i
Notary Public Notary Public DaIM County, T
My CornmtExp res 03512.2017 My commission expires 03/12f1017
THfS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND.
This Power of Attorney limits the ads of those named herein,and they have no authority to bind On Company except in the manner and to the extent herein stated.
Certificate No.rrl""
American Fire and Casualty Company Lferty,Mutual Insurance Company
The Ohio Casualty Insurance Company West American Insurance Company
POWER OF ATTORNEY
KNOWN ALL PERSONS BY THESE PRESENTS. That American Fre✓i Casually Company and The Ohio Casualty Insurance Company are corporations duly oxganiced under the laws of
the Slade of New Hampshire,that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts,sunt WestAmerican hueaance Company
Is a corporation duly organized under the laws of the Sista of hdiarha(herein collectively caned the l pursuant Io and by authority herein ant forSh,does hereby name,constfluta
and appolitrl Don E.Comet;Keay A.Westbrook:Ricardo J.Reyna.Robbs Morales:Sophlnie Hunter:V.DeLene Maistfail �
i
an of the city of Dallas .State of TX each badiNdually,Item be more than one named,its true ad law U at1omnya1nW to make,execute,sed,acknowledge �
and delver,for and on Its behalf a surely and as its act and dead,any and d undertakings,bonds,recognmrces and other surely obligations,in p mjanoe of nese presents and dual j
be as blinding upon the Corrperafes a t they have been duly signed by Che president and attested byte secsetauy of Che Companies in their own proper persaraa.
IN WITNESS WHEREOF,to Power of Aftney has been subscribed by an authorized officer or ofrlaal of the Campanies and the corporate seals of the Companies have been affixed
lheraio Chis 2,rah day of February 2016
D C.tS �j-4 INSU `�NSUq INSU,} Aum erican Fire and Casualty Company �
Qy►�' o,( syr r + � The Ohio Casualty Insurance Company n
< a Uberty Mutual Insurance Company
R 1906 0 0 1919 n x912 1991< Cc
0 y = West dean Insurance Company
o
ey _
t >
David M.Ca ,Assistant Secretary C
STATE OF PENNSYLVANIA ss to.
ox COLNITY OF MONTGOMERY C
01. W On yule 25th day of February 2016.before me prnmaaly appeared David M.Carey,who ardmowiedged himself lo be the Assistant Secretary of American Fes art 01-
O
v rix Casualty Company,Liberty Mutual Insurance Company The Ohio Casusity Insurance Company,and Wast Amenc:an Intrurarlce Campsny,and that he,a such,being authorized so to do,
Oexecute Che far%ptng instrument for the purposes therein contained by signing on behalf of the corporation by hintsrtf a a duly authorized oltfiaer.
> IN WITNESS WHEREOF,I have hereunto subscribed name and afixed my notarial seal at Plymouth Meeting.Pennsylvania,on the day and year first above written. ACL
S� pgsT
COMMONWEALTH OF PENNSYLVANIA a
Q�yoNw << Notarial Seal w
C M v rs r Tereaa Pameaa,Notary Publie gy �� O
Q m °fur My Comm4sion � b 7 TaraMi fsaatMb Notary Public _
ZI
16-
0
'gym
C 0 �Fi. +�' Member.PanrIsOver a AnoWaon of NoWim OE
re
C E This Power o7Attomey is made and exachied pursuant to and by authority of the following By-laws and Autarizations ofAmerican Fire and Casualty Company,The Ohio Casualty Insurance to 0
0�.. Company,LBerty Mutual Insurance Company,and West American Insurance Company which resolutions are now in nil force and affect reading as b b&, E c
Qi
m 0 ARTICLE N-OFFICERS-Section 12 Power of Homey.Arty elitrxr or otter official of the Corporation a dhorized for that purpose in writing by the Chairman or the Praident,and subject O C
to such imitation as the Chairman or the President may proscribe,shall appoint such attomeys4n-bc t,as may be necessary to ad in behalf of the Corporation to make,execute,sal.
O c acknowledge and claim as arrety any and all uhdartaldngs,bonds,reeognbances and otter surety obligations. Such athomeys gad,subjed tDChe lhmr ftu set forth to their respective ;p
E ® Powers of attorney,shall have full power to bind the Corporation by their signature and execration of shy such im numents and to attach Croreto the sat of the C mcxatart. When so --i 0
p R executed,such instruments shall be a binding a 0 signed by the President and&tested to by the Secretary.Any power or authority granted lo any representative or attaney4n-W oder >J2
O the providom of this ante may be revoked at any lime by the Bard,the Chairman,the President or by the officer or offxas granting such Power or authority, ro 0
ARTICLE%III-Execution of Contracts-SECTION S.Suety Bonds and LI dertskirtgs.Any officer of the Company authorized for that purpose in writing by the dtafnnan or the president, E T
> 0 and subjad to such fm itatolns as the chairman or the presidennt may prescribe,shall appdrd such adornoys4 n-fact,a may be nese isary to and in b&W of the Company b make,execubit, C4
O 3 seal,acknowledge and deliver a surely any and all undertakings,bonds,reagnaanc�as and other surety,obligations. Such d subject to the limitations set forth in their E 0?
Z V respective Powers of attorney,shall have full pourer to bind the Comptny by their signature and execution tat any such instrumat t and to attach thereto the seat of the Company.When so 00
hearted surcih iadhrrtterts shall be a binding a K signed by the president and attested by Ca secretary.
Certificate of Designation-The President of the Company,actingpusuent ID the Bylaws of the Company,autnaizes David M.Carel;Assistant Secretary to appoint such atomeys•in•
fad as may be necessary to ad on balms of the Company to make,execute,seal,acknowledge and claim a suety any and al undertakings,bonds,recognizonces and other surety
�.
Authorintion-By unanimous ocrosent of the Company&Board of Directors,the Company consents that facsimile or machardmily reproduced signature of any assistant secretary of the
Company,wherever appea%upon a certified copy of arry power of atlomey issued by the Company in connection with surety bonds,stall be valid and binning upon the Company with
the same force and a ted as#a*manually atTsued.
1.Gregory W.Davenport,the utde*ned,Assistant Secretary,of American Fre and Casualty Company,The Oita Casualty klstaance Company,Liberty Mutual Insurance Company,and
Wast American Insurance Cornpany do hereby catity Ott the original power of attorney of which the t reg ft is s full,true and correct copy of to Powe of Attorney executed by said
Compania,is in full force and effect and has not been revoked. it
IN TESTMONY WHEREOF,I have hereunto set my hard and affoted to seals of said Companies Cite I I a day of
D C.1S& Jr�tY INSU 4Jr�,tNSUR,�C 1gt tNSUR�_
z 1906 0 0 1919 1912 ° ` 1991 s By: �
_� �' W_ ' Gregory W.Davenport,Assistant Secretary
.'ray`,•Nx�Ea'?, D y +'Ab
Y
232 of 500
LMS 12873 122013
Liberty
Mutual
SURETY
TEXAS TEXAS
IMPORTANT NOTICE AVISO IMPORTANTE
To obtain information or make a complaint: Para obtener informacion o para someter una
queja:
You may call toll-free for information or to Usted puede llamar al numero de telefono gratis
make a complaint at para informacion o para someter una queja at
1-877-751-2640 1-877-751-2640
You may also write to: Usted tambien puede escribir a:
Interchange Corporate Center Interchange Corporate Center
450 Plymouth Road, Suite 400 450 Plymouth Road, Suite 400
Plymouth Meeting, PA 19462-1644 Plymouth Meeting, PA 19462-1644
You may contact the Texas Department of Puede comunicarse con el Departamento de
Insurance to obtain information on companies, Seguros de Texas para obtener informacion
coverages, rights or complaints at acerca de companias, coberturas, derechos o
1-800-252-3439 quejas al
1-800-252-3439
You may write the Texas Department of Insurance Puede escribir al Departamento de Seguros
Consumer Protection (111-1A) de Texas Consumer Protection (111-1A)
P. O. Box 149091 P. O. Box 149091
Austin, TX 78714-9091 Austin, TX 78714-9091
FAX: (512)490-1007 FAX 9 (512)490-1007
Web: http://www.tdi.texas.gov Web: http://www.tdi.texas.gov
E-mail: ConsumerProtection@tdi.texas.gov E-mail: ConsumerProtection@tdi.texas.gov
PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS O RECLAMOS:
Should you have a dispute concerning your Si tiena una disputa concerniente a su prima o a
premium or about a claim you should first un reclamo, debe comunicarse con el agente o
contact the agent or call I-800-843-6446. primero. Si no se resuelve la disputa, puede
If the dispute is not resolved, you may contact the entonces comunicarse con el departamento (TDI)
Texas Department of Insurance.
ATTACH THIS NOTICE TO YOUR UNA ESTE AVISO A SU POLIZA:
POLICY:
This notice is for information only and does not Este aviso es solo para proposito de informacion
become a part or condition of the attached y no se convierte en parte o condicion del
document. documento adjunto.
NP 70 68 09 01
FORTWORTHRE":02/22107
TRANSPORTATION AND PUBLIC WORKS
CONTRACTOR'S EVALUATION OF CITY
PROJECT INFORMATION Date: 16=016
Name of Contractor Project Name
S.J.Louis Construction Cultural District-Harley&Montgomery PH4
DOE inspector Project Manager
Donald Watson John Kasavich
DOE Number 1projectDoculty Type of Contract
7453 10 simple ) RouUne 0 Complex rSi-,711,861.68
water 21 waste water[:] StormDainage❑ Pavement
Initial Contract Amount al Contract Amount
51,645,417.20
II)PERFORMANCE EVALUATION
0-Inadequate 1 -Deficient 2-Standard 3-Good 4-Excellent
ELEMENT RATING ELEMENT RATING
(0-4) (0-4)
INSPECTION EVALUATION PLANS&SPECIFICATIONS
1 Availability of Inspector 1 Accuracy of Plans to Existing Conditions
2 Knowledge of Inspector 2 Clarity&Sufficiency of Details
3 Accuracy of Measured Quantities 3 Applicability of Specifications
4 Display Of Professionalism y 4 Accuracy of Plan Quantities
5 Citizen Com laint Resolution It PROJECT MANAGER EVALUATION
6 Performance-Setting up Valve Crews,Labs 1 Knowledge And/Or Problem Resolution
ADMINISTRATION 2 Availability of Project Manager
1 Change Order Processing Time 3 Communication
2 Timliness of Contractor Payments 4 Resolution of Utility Conflicts
3 Bid Opening to Pre-Con Meeting Timeframe V
III)COMMENTS&SIGNATURES
COMMENTS
Signature Contractor
Signature DOE Inspector
Signature DOE Inspector's Supervisor
INSPECTOR'S COMMENTS
TRANSPORTATION AND PUBLIC WORKS
The City of Fort Worth.•1000 Thmckmorton Street•Fort Worth,TX 76012-6311
(817)392-7941 •Fam(817)392-7845