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HomeMy WebLinkAboutContract 46999-FP1 FORT WORTH® CITY SECRETARY . . CONTRACT NO. TRANSPORTATION AND PUBLIC WORKS NOTICE OF PROJECT COMPLETION City Project Ns: 2586 Regarding contract 46999 for CONCRETE STREET RESTORATION 2015-10 as required by the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by City Council on 07/21/2015 ' through M&C C-27362 the director of die 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: $651,960.00 Amount of Approved Change Orders: $162,308.00'Ns 1 Revised Contract Amount: $814,268.00 Total Cost Work Completed: $813,375.94' Less Deductions: Liquidated Damages: Days @$210.00/Day Pavement Deficiencies: Total Deduction Amount: $0.00 Total Cost Work Completed: $813,375.94 Less Previous Payments: $761,891.82 Final Payment Due $51,484.12 jRecomme ded fo Acceptance Date As, t. Director, TPW - Infrastructure Design and Construction Accepted Date Director, TRANSPORTATION AND PUBLIC WORKS DEPARTMENT Asst. City Manager Date Comments: 3gg0J o-tooq l - s330Y,)I C o2s86 - Co33�3 - - OFFICIAL RECORD C.on.S'tr��iar1 ,�-rc. CITY SECRETARY JAN 5 2017T.WVORTH,TX - = 11 nit" TPW Construction Invoice Contract: CS46999 P.O.# PO-15-89773 Payment Date: 9/13/2016 TO:WESTML CONSTRUCTION INC 1Nv.# CS46999-' r�jVA4L Estimate No. 19 DOE: PO BOX 2016 ProjManager TARIQUL ISLAM CLEBURNE TX 76031 FOR: CONCRETE RESTORATION 2015-10 Contract Amount: $814268.00 Completed Ret Ad_j Pay Total to Date: $813,375.94 $0.00 $0.00 $813,375.94 Previous Estimate: $801,991.39 $40,099.57 $0.00 $761,891.82 Earned to Date: $11,384.55 (540,099.57) $0.00 $51,484.12 Payments: C293-537110-203330258683 $814,268.00 -CO#1-$162,308.00 Total to Date: $813,375.94 $0.00 $0.00 $813,375.94 Previous Estimate: $801,991.39 $40,099.57 $0.00 $761,891.82 Earned to Date: $I1,384.55 ($40,099.57) $0.00 $51,484.12 FINAL PAY ACH Transportation&Public Works BUSINESS SUPPORT GROUP Contact Person-BRANDY CRANE.-Ext.2852 Department Ap r ig for: KAREN STRIKER DEPARTMENT CHECK PICK-UP YES ❑ Monday,November 14,2016 Page 1 of 1 City of Fort Worth Summary of Charges City Secretary Contract 46999 Concrete Street Restoration at Six Locations P,0. Num: Number: Project Number: Q25S6 Application Period: 09/01/2016-09/13/2016 Application Number: 19/FINAL Application Date: 9/13/2016 Funding Identification Numbers TotalCompleted Amt Remaining Gross Retainage Net Change Order 8 - 39408-0200431-5330401--CO2586-CO3383-- _ 0 --- -_-.�_ -- �- ------- --- --- 0 -- ----- -- — 0 --- - 0 - I -------- 0 ------0 - - _Totals 39408-0200431-5330401--C02586-CO3383-- ' $813,375.94 ----I - -$1-2,27661 $11,384.55 -�$40-,0-99.57 -- --I - --- _ - $51,484.12 0 ------- - ___ 0 __ ------ �� 0 --- ---- & ----- 0 ----- - 0 --- - -- — Department ofPW Const. Services CPN#�,Zp Date Project Manager 11,%I Risk Management S. Canady D.O.E. Brotherton Water Dept. Esteban Per z CFA Westerman/Scanned The Proceeding people have been Contacted concerning the request for final payment&have released this project for such payment. j Clearance Conducted By Etta Bacy Cit of Fort Worth Summary of Charges City Secretary Contract P.p. Num: 46999 Concrete Street Restoration at Six Locations Number: Project Number: 02586 Application Period: 09/01/2016-09/13/2016 Application Number: 19/FINAL Application Date: 9/13/2016 Funding Identification Numbers Total Completed li Amt Remaining Gross Retainage Net _. Original Contract _39408-0200431-5330401--CO2586-C03383-- $651,959.99 $0.01 $32,597.99 $32,597.99 0 0 0 __ _.._ _. --_------------ Change ._- _ _Change Order 1 _ 39408-0200431 5330401--CO2586-CO3383-- � — $161,415.94 — $12,276.61 $11,384.55 — � ($7,501.58 $18,886.13 0 0 0 ' 0 - Change Order 2 39408-0200431-5330401--0O2586-CO3383-- Change Order.3 39408-0200431-5330401--CO2586-CO3383-- 0 0 A '0 City of Fort Worth Summary of Charges City secretary Contract 46999 Concrete Street Restoration at Six Locations P.0' 02586 Num: Number: Project Number: Application Period: 09/01/2016-09/13/2016 Application Ntunber: 19/FINAL Application Date: 9/13/2016 Funding Identification Numbers Total Completed Amt Remaining Gross Retainage Net Change Order 4 39408-0200431-5330401--CO2586-C03383-- Change Order 5 39408-0200431-5330401--002586-C03383-- 0 0 ,0 0 0 I0 _- Change Order-6 39408-0200431-5330401--CO2586-CO3383-- 0 0 0 0 0 Change Order? 39408-0200431-5330401--CO2586-C03383-- 0 _...._ _ �._ __..----__. C-620 Signature Page Contractor's Application for Payment Invoice No. 19/FINAL To(Owner) Invoicing Period(From-To): Invoice Date: City Of Fort worth 09101/2016-09113/2016 9/13/2016 P.O. From(Contractor): Remit to(If Not Automatic Deposit}: Number: Westhill Construction,Inc Project: 0286 Contractors CFW Vendor No.: City secretaryContractNumber: 46999 cNamontraet Concrete Street Restoration at Six Locations Number: Name: Application For Payment Change Order Summary Approved Cbane Orders 1. ORIGINAL CONTRACT PRICE........................................................... $ 5651,960.00 Number Additions Deletions 2. Net change by Change Orders.................................................................. $ $162,308.00 1 $162,308.00 3. Current Contract Price(Line 1 f 2)......................................................... $ $814,268.00 2 4. TOTAL COMPLETED AND STORED TO DATE 3 (Progress Estimate,Construction Allowance and Change Orders)....... $ $813,375.94 4 5. RETAINAGE: 5 a. X $813,375.94 Work Completed......... $ 6 b. x Not Used $ 7 c. Total Retainage(Line 5a+Line 5b)................................. $ 8 6. AMOUNT ELIGIBLE TO DATE(Line 4-Line 5c).............................. $ $813,375.94 TOTALS $162,308.00 7. LESS PREVIOUS PAYMENTS(Line 6 from prior Application)......... $ $761,891.82 NET CHANGE BY $162,308.00 8. AMOUNT DUE THIS APPLICATION.................................................. $ $51,484.12 CHANGE ORDERS 9.BALANCE TO FINISH,PLUS RETAINAGE (Column G on Progress Estimate+CA+COs+Line 5 above)............... $ $892.06 Contractor's Certification 10. CONTRACT TIME: The Contractor certifies with the submittal of this document and associated Payment Request Submittal a. Days Awarded 150 on the City of Fort Worth Buzzsaw system that to the best of their knowledge:(1)all previous progress b, Days Added by CO 60 payments received from Owner on account of Work done under the Contract have been applied on account to discharge Contractor's legitimate obligations incurred in connection with Work covered by c. Total Days 210 prior Applications for Payment;(2)title of all Work,materials and equipment incorporated in said Work or otherwise listed in or covered by this Application for Payment will pass to Owner at time of d Days Charged payment free and clear of all Liens,security interests and encumbrances(except such as are covered by a Bond acceptable to Owner indemnifying Owner against any such Liens,security interest or e. Days Remaining 210 encumbrances);and(3)all Work covered by this Application for Payment is in accordance with the Contract Documents and is not defective. This document has been modified from its original form as an EJCDC document and the user did not highlight the modifications.You are encouraged to read the document carefully and consult Legal Counsel prior to its execution. C-620 Unit Price Progress Estimate Progress Estimate City Secretary 46999 Contractor's Application Contract Num: For(contra`°' Concrete Street Restoration at Six Locations Appli`ation Number' 19/1FINAL Appli-tion Period: 09/01/2016-09/13/2016 Application Date, 9/13/2016 A B C D E F G Item Tata]Complemd % Balance to Finish Estimated Quan6Ty Prettio Val Installed Materials Praxmtly $peeification Unit of Bid Quantity Unit Prioe Bid Value Value Value?his Period and Stored de Date (F) (B-F) Sid Item No. Description Section No. M-,- Stored Value Stared(not m C) (D�E) 1 0135.0201 Remobilization _ 017000 ,. EA 1 $50000 _ $500.00 _ $500.00 2 9999.0001 Remove and Replace 6'Concrete Driveway 0241 11/32 13 SF 200 $700 $1,40000 261.00000000 $1,827.00 $1,827.00 $1,827.00 130.5% S427.00 3 9999.0002 Remove Concrete and Replace with 7'Concrete Pavement -0241 15/32 13 SY 9500 $59 90 _$569,050.00 _9598.45000000 $574,94716 $574,947.16 $574,947.16 101.0% $5,897.16 ,_. 4 3123.0101.Unclassified Excavation 312316 CY _. 150 $1000 $1,500.00 _ $1,500.00 5 3211 0122 Flex Base,Type A GR-2 - 32 11 23 CY 650 $30.()a S19,500.00 952.12433300 $28,563.73 $28,563.73 $28,563,73 146.5% -$9,063.73 6 3213 0208 Concrete HES(extra depth) 32 13 13 CY 150 $125.00 S18,750.00 128.45000000 $16,056.25 $16,056.25 $16,056.25 85.6% _ $2,693.75 7 3292.0100 Block Sod Placement - 329213 SY 400 $400 $1,600.00 24.44000000 $9776 ;:$97.76 $97.75 6.1% $1,50224 ... 8 32130700 Joint Sealant - _...,. 321373 LF ._2000 $100 $2,000.00. . .. $2,000.00 9 3305.0108 Miscellaneous Adjustment(Utilales) _. - 330514 LS 1 $4,000.00 $4,000.00 $4,000.00 10 99990003 Geogrid Tenser(TRIAX 140-475) 999900 SY 2000 $500 $10,000.00 5705.62000000 $2852810 $29,278.10 $750.00 _ $28,528.10 285.3% -$18,528.10 11 3217 2001 Raised Marker TY W 32 1723 EA 2000 $4.00 $8,000.00 200.00000000 _ V800.00 $800.00 $800._00 10.0% $7,200.00 12 3217 2002 Raised Marker TY Y 32 17 23 EA 2000 $4.00 $8,000.00 $8,000.00 _.. 13 3217.2101REFL Raised Marker TY l-A 32 17 23 _ EA _.. 100 $4.00 $400.00 $400.00 14 3217.2102 REFL RaisedMarkerTY l-C _32 1723 EA 100 $4.00 $400.00 $400.00 15 3217.2103 REFLRaised Marker TY II-A-A _ _. 321723 . .EA 100 $4.00 $40000 $400.00 16 3217 2104 REFL Raised Marker TY II-C-R 32 1723 EA 100 $4.00 _ $400.00 $400.00 17 3441 1301 Loop Detector Cable Sawcut 3441 10 LF _ 500 $4.00 $2,000.00 $2,000.00 18 3441.1302 14 AWG Loop Detect Cable_ _. 344110 LF 500 $4.00 $2,000.00 . . $2,000.00 19 3217.0305 Stop Bars Pavement Markings 321723 _ LF 200 $5.00 $1,000.00 $1,000.00 _ __._. 20 99990004 Remove and Replace Sidewalk _ 02 41 13132 13 SF 200 $5.00 $1,000.00 228.00000000 $1,140.00 $390.00 $750.00 $1,140.00 114.0% 5140.00 21 321T5001 Curb Address Painting -32 1725 EA 6 $10.00 $60.00 $60.00 Totals $651960.00 $651959.99 $651959.99 $681989.99 100.0% $0.01 This document has been modified from its original form as an E3CDC document and the usor did not higlilight the nsdifieations.You are encouraged to read Otc document carefully and consult Legal Counsel prior to its eseeution. Contractor Final Estimate Approval Final-l-Estimate Page 1 of 3 Routing Assigned To: Brandy Crane Due Date: 11/14/2016 Assigned By: Katie Newby Due Time: 2:09 PM Links 1 fortworthaov/Infrastructure Proiects/02586 - Concrete Restoration (2015-10)/Contractor/Submitted Invoices/Final Estimate/Copy of 02586 - 2015-10 Invoice Final.xlsm Attachments(0) No Attachments have been added to this form. r https://projeetpoint.buzzsaw.com/ bz web/Forms/FormPrint.aspx?Siteld=51500&Proces... 11/11/2016 Contractor Final Estimate Approval Final-l-Estimate Page 2 of 3 FORT WORTH. Contractor Final Estimate Approval Date Started: 9/14/2016 Date Due: 9/28/2016 Invoiced Amount: (Amount from $ 51,484.12 Request No.: Final-l-Estimate Line 8 of C-620) Project Name: Concrete Restoration (2015-10) Project Number: 02586 Invoice No.: FINAL Reference: Contractor: Katie Newby Discussion: (Limit 5000) Approval Status: https://projectpoint.buzzsaw.com/ bz_web/Forms/FormPrint.aspx?SiteId=51500&Proces... 11/11/2016 Contractor Final Estimate Approval Final-l-Estimate Page 3 of 3 Approved: Yes Comments: User: Ali Motamed Date: 2016-09-19 8:08 AM Approved: Yes Comments: User: Dennis Rodgers Date: 2016-11-08 10:43 AM Approved: Yes Comments: User: Roy Teal Date: 2016-11-08 12:35 PM Approved: Yes Comments: User: Dennis Rodgers Date: 2016-11-08 12:38 PM Approved: Yes Comments: User: Riad Nusrallah Date: 2016-11-08 7:50 PM Approved: Yes Comments: User: Todd Blomstrom Date: 2016-11-08 8:01 PM Approved: Yes Comments: User: Doug Wiersig Date: 2016-11-11 2:07 PM https://projeetpoint.buzzsaw.com/ bz web/Forms/Fon Print.aspx?SiteId=51500&Proces... 11/11/2016 ?aline Basic Purchasing Department Access NIGP Code Browse I My Account I Customer Service I About Current Organization:CM OF FORT WORTH November 74,2016 3:48:39 PM CST A �/ Home G:u_u�:e;�ts Brandy Crane f,�: r-S46999-FINAL Vendor#:0006407251 Vendor Group#:01 Status:41R•Ready for Approval General Items Subcontractors Accounts Routing Attachments Notes Reminder Change Order Back to PO General Validation Warnings You are going to final pay the following partially paid po items [21. Header information Invoice Number: CS46999-FINAL Invoice Status: 41R-Ready for Approval Invoice Type: 3 way matching Invoice Description: CS46999-FINAL CONCRETE RESTORATION 2015-10 Invoice Date: 09/1312016 Effect Date: 11114/2016 Payment Amount: $51,484.12 Handling Code: ACH(DIRECT DEPOSIT) Payment Date: 10/08/2016 Payment Terms: Payment Term Day: 0 Payment Discount: 0.0% Paid-Bank/Check: Alternate Id: Entered By: Brandy Crane Entered Date: 11/1412016 Updated By: Brandy Crane Updated Date: 11/14/2016 Received Date: 02/17/2016 03:44:00 PM Agency Files: Agency Forms: Vendor Files: Vendor Forms: torch ,s,�n,der Informaticr* Purchase order Number: PO-15-00089773 PO Description C846999 PO Amount: $814,268.00 Remaining To Invoice: $892.06 Buyer: Brandy Crane 'PoVendor Information Vendor: 0000007251-WESTHILL CONSTRUCTION INC Address Grp: 01 Vendor Remit-to Address: ANGIE REYNOLDS PO BOX 2016 CLEBURNE,TX 76031 USA Fed ID: -4557 Remit Text: Email:WESTHILLCONST@AOL.COM Phone:(817)558-2504 Id:115084 (EFT Enabled) I'llisc�E=eEs--:Ia rivoiee f�._�:, . Event Type Fiscal Year Account Code Transaction Amount Misc 17 39408--2060000--CO2586-CRETAN-- $38,757.68 Misc 17 39408-0200431-5330401--CO2586-C03383-- $1,341.89 Total: $40,099.57 Invoice Item WPO Item#:2 CO#1-$162,308.00-CONCRETE RESTORATION 2015-10 39408-0200431-5330401--CO2586-CO3383--CS46999 M&C C-27744 DATE 060716 PO Permit Invoice Discount% Original Final Item Status To Pay Amount Pay Amount Pay 3PPR-Partial Receipt $0.00 $11,384.55 0.0% $0.00 Yes MAKE: ASSET MODEL: ASSET MANUF: ASSET SERIAL: ASSET VIN: ASSET TAG: Event Type Fiscal Year Account Code Transaction Amount Exp. 17 39408-0200431-5330401--CO2586-C03383-- $11,384.55 Enc. 17 39406-0200431-5330401--CO2586-C03383-- -$11,384.55 Delete Approver Order Approval Levet Approver Date Date Approved/Disapproved/Canceled Comment Sequence Path Type Requested Approved/Disapproved/Canceled by View ID Add __._ _.. .. .., New Primary Add/Delete Approver Print Copyright©2016 Periscope Holdings,Inc.-All Rights Reserved. i CF Prom pts ACTUALS 39408 2060000 CO2586 CRETAN $ (38,757.68) 39408-0200431-5330401--CO2586-CO3383-- CS46999-1 $ (1,341.89) $ (40,099.57) AFFIDAVIT STATE OF TEXAS COUNTY OF JOHNSON Before me, the undersigned authority, a notary public in the state and county aforesaid, on this day personally appeared Angela Reynolds, Secretary Of Westhill 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; Concrete Restoration 2015-10 City Secretary# 46999 BY Angela Reyno s/Secretary Subscribed and sworn before me on this date 19 of September, 2016. Notary Public Johnson, Texas F.Ay 1 MARILYN K.NEWBY Notary ID 1191569-9 b My Commis"Expires Mny 19,2020 SURETEC INSURANCE COMPANY OWNER ❑ ARCHITECT ❑ CONSENT OF SURETY CONTRACTOR ❑ TO FINAL PAYMENT SURETY [] OTHER ❑ BOND NO.: 5197481 TO OBLIGEE: (Name and address) CONTRACT FOR: City of Fort Worth 1000 Throckmorton Fort Worth,TX 76102 PROJECT: CONTRACT DATED: (Name and Address) Concrete Restoration (2015-10)at Various Locations PRINCIPAL,; Westhill Construction, Inc, P.O.Box 2016 Cleburne,TX 76031 At the request of the Obligee and the Principal indicated above,(hrsert natne and address ofSuretp) SureTec Insurance Company 1330 Post Oak Blvd.,Suite l 100 Houston,TX 77056 SURETY, on bond of (Insert name and address of Contractor) Westhill Construction,Inc. P.O. Box 2016 Cleburne,TX 76031 CONTRACTOR, and conditioned on the representation by Obligee that all Contract provisions relating to the payment of final payment under the Contract have been satisfied by Principal as of the date of final payment,and that no claims by Obligee or any third party are known or believed by Obligee or its representatives to exist as of the date of final payment, representations as to the truth and accuracy of the foregoing conditions being deemed to have been made by Obligee in connection with this request for Consent of Surety, hereby approves of the final payment to the Principal,and agrees that final payment in accordance with the terms hereof shall not relieve the Surety of its obligations to (Insert name and address of Obligee) City of Fort Worth 1000 Throckmorton Fort Worth,TX 76102 ,OBLIGEE, as set forth in said Surety's bond. IN WITNESS WHEREOF,the Surety has hereunto set its hand on this date: September 21,2016 (Insert in writing the month followed hp the numeric date and rear) Sure'Cec Insurance Company (Signawre of'authorized representative) Attest: Teresa Godsey Attorney-in-Fact (Seal): (Printed name and line) SURETEC CONSENT TO FNAL PAYMENT REV. 1.1.2004 SureTec Insurance Company THIS BOND RIDER CONTAINS IMPORTANT COVERAGE INFORMATION Statutory Complaint Notice/Filing of Claims Tvobtain information ormake ucomplaint:You may call the Surety's m|| free.telephone number-for information o,mmake u complaint vrfi|euclaim at: \-V66'73Z'0O99. You muyalso write mthe Surety at: SureTecInsurance Company 8737Great Hills Trail, Suite 320 4ustin. Tx 78759 You may contact the Texas Department ofInsurance mobtain(nfonnxhnnuncompanies,coverage,t-ighmmcomplaints u/ |'X00-2.52- 3439.You may write the Texas Department o[Insurance m 110 Box |49|04 Austin,TX?8?|4-9/04 Pux#: 5|2-490-l007 Web: Bmu |:ConyunndPrnteuino(�Dub,omao.gov PREMIUM 0DCLAIM I)fSPUTF'S: Should you have a dispute concerning your premium or about a clairn,you should contact the Surety first. lfthe dispute isnot resolved,you may contact the Texas Department nfInsurance. ---_-------------------------—--------_------------------------------------------------------------------------------ ------ � Texas Rider oon��o�� 1 xmo � | FORTWORTHREV:02122107 TRANSPORTATION AND PUBLIC WORKS CONTRACTOR'S EVALUATION OF CITY PROJECT INFORMATION Date: 3/20/2016 Name of Contractor Project Name Westhill Concrete Resotrution contract 2015-10 DOE Inspector Project Manager Ali Motamed Tarig Islam DOE Number Project Difijzculty Type of Contract 2586 0 Simple Q Routine 0 Complex [—] Water❑ wastewater[] Storm Drainages Pavement Initial Contract Amount Final Contract Amount $651,960.00 $813,375.94 I1)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 4 Accuracy of Plan Quantities 5 Citizen Complaint Resolution 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 Pa ents 4 Resolution of Utility Conflicts 3 Bid Opening to Pre-Con Meeting Timeframe 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 Throckmorton Street•Fort Worth,TX 76012-6311 (817)392-7941 •Fax: (817)392-7845 FORTWORTHREV:02/20/07 TRANSPORTATION AND PUBLIC WORKS PERFORMANCE EVALUATION OF CONTRACTOR I) CONTRACTOR&PROJECT DATA Name of Contractor Project Name Westhill Construction Concrete Resotrution Contract 2015-10 DOE Inspector DOE Number Ali Motamed 2586 DOE Inspector Project Manager ❑ Water❑ Waste Water[] Storm Drainage0 Pavement Tariq Islam Initial Contract Amount ProjectDculty $651,960.00 0 Simple Routine O Complex Final Contract Amount Date $813,375.94 9/20/2016 In 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 3 8 6 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 4 60 60 6 Finished Product 15 Y 4 60 60 7 Job Site Safety 15 Y 3 60 45 8 Traffic Control Maintenance 15 Y 3 60 45 9 Daily Clean Up 5 Y 3 20 15 10 Citizen's Complaint Resolution 5 Y 4 20 20 11 Property Restoration 5 Y 3 20 15 12 After Hours Response 5 Y 3 20 15 13 Project Completion 5 Y 4 20 20 TOTAL ELEMENT SCORE(A) 396 BONUS POINTS(25 Maximum)(B) TOTAL SCORE(TS) 396 II1)CONTRACTOR'S RATING Maximum Score(MS)=448 or sum of applicable element score maximums which= 448 Rating([TS/MS] * 100%) 396 / 448 = 88% 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 Signature Contractor Signature DOE Inspector's Supervisor CONTRACTOR'S COMMENTS TRANSPORTATION AND PUBLIC WORKS The City of Fort Worth•1000 Throckmorton Street•Fort Worth,TX 76012-6311 (817)392-7941 •Fax:(817)392-7845 FORT WORTH,, TRANSPORTATION AND PUBLIC WORKS STATEMENT OF CONTRACT TIME STATEMENT# FINAL STATEMENT# &19 DOE I NA NAME OF PROJECT: Concrete Resotrution 2015-10 Contractor Westhill YEAR: 2016 PROJECT NO.: FINAL INSPECTION DATE 2/17/2016 2586 1 WD CD CONTRACT TIME 210 1 N PERIOD FROM: 9/16/2016 TO: 1 9/20/2016 1 MID - Month I DEVELOPMENT (1'/N) N WORK ORDER EFFECTIVE: 1. 10/12/2015 BEG y In) N MID /n) Y 100.0% LIP YR(y 1 n) Y DAY OF MONTH DAYS REASON FOR DAY OF MONTH DAYS REASON FOR CHARGED DAYS CREDITED CHARGED DAYS CREDITED 1 16 Fri 0 NA 2 17 Sat 0 NA 3 18 Sun 0 NA 4 19 Mon 0 NA 5 20 Tue 0 NA g 21 Wed 0 NA 7 22 Thu 0 NA g 23 Fri 0 NA 9 24 Sat 0 NA 10 25 Sun 0 NA 11 26 Mon 0 NA 12 27 Tue 0 NA 13 28 Wed 0 NA 14 29 0 NA 15 30 0 NA 31 0 NA NA Wkn&Hol Wea utl Oth Not Applicable SAT,SUN,and WEATHER UTILITIES OTHERS DAYS TOTAL DAYS HOLIDAYS RELOCATE CHARGED THIS PERIOD 0 0 0 0 0 0 PREVIOUS PERIOD 0 210 210 t TOTAL TO DATE 0 0 0 0 210 210 REMARKS: A .4 ,/ Signature:` ;l Signature: - (Print Name) Ali Motamed CONTRACTOR Jam! y(� DATE INSPECTOR DATE 1 9/20/2016