HomeMy WebLinkAboutContract 47575-FP2 Departm t o P &W Cons Services
CPN# r,. , Date
Project Manager / �S
Risk Management C adv
D.O.E. Brotherton RTWORTH, CITY er i4RY Z ►
CFA Westerman/Scanned L 1*1 CONTRACT NO.
Esteban Perez/Scanned
The Proceeding people have bee C nta ted
concerning the request for final payment& have CATION AND PUBLIC WORKS
released this project for such payment. )F PROJECT COMPLETION
Clearance Conducted By �� `% Developer Projects) lyppG�73��
C&/ytA1'tV:9 ( City JVs?:s: 02517
' e Sze/y-7s�J
Regarding contract 117396 for SEVEN OAKS ADDITION,PHASE ONE as required by the
TRANSPORTATION&PUBLIC WORKS as approved by City Council on N/A through M&C N/A die director
of the TRANSPORTATION&PUBLIC WORKS upon the recommendation of the Assistant Director of the
Transportation&Public Works Department has accepted the project as complete.
Original Contract Price: $820,358.50
Amount of Approved Change Orders: $61,418.50 Ns 1
Revised Contract Amount: $881,777.00
Total Cost Work Completed: $881,777.00
1
kftotk
Recommended for Acceptance Date
Asst, Director, TPW - Infrastructure Design and Construction j
L'
Accepted Date
® Director, TRANSPORTATION & PUBLIC WORKS
�I
Asst. City Manager Date
Comments: BM,&MBD
i
I
JAN 3 0 ZOV OFFICIAL RECORD
CITY SECRETARY
Initial:- FT.WORTH,TX
Rev.9/22/16
FORT WORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name SEVEN OAKS ADDITION,PHASE ONE
Contract Limits
Project Type DRAINAGE,PAVING&ST LIGHT
City Project Numbers 02517
DOE Number 7396
Estimate Number 1 Payment Number I For Period Ending 11/28/2016
CD
City Secretary Contract Number 117396 Contract Time 24aD
Contract Date Days Charged to Date 240
Project Manager Jaafari Contract is 100.00 Complete
Contractor JACKSON CONSTRUCTION LTD
5112 SUN VALLEY DRIVE
FORT WORTH, TX 76119
Inspectors DICKINSON / DUARTE
Monday,November 28,2016 Page 1 of 5
City Project Numbers 02517 DOE Number 7396
Contract Name SEVEN OAKS ADDITION,PHASE ONE Estimate Number I
Contract Limits Payment Number I
Project Type DRAINAGE,PAVING&ST LIGHT For Period Ending 11/28/2016
Project Funding
DRAINAGE
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
1 18"RCP CLASS II1 95 LF $49.00 $4,655.00 95 $4,655.00
2 21"RCP CLASS III 196 LF $55.00 $10,780.00 196 $10,780.00
3 30"RCP CLASS III 280 LF $85.00 $23,800.00 280 $23,800.00
4 36"RCP CLASS III 272 LF $107.00 $29,104.00 272 $29,104.00
5 4'STORM JUNCTION BOX 2 EA $2,300.00 $4,600.00 2 $4,600.00
6 10'CURB INLET 2 EA $3,700.00 $7,400.00 2 $7,400.00
7 20'CURB INLET 2 EA $5,900.00 $11,800.00 2 $11,800.00
8 SLOPING CONCRETE HEADWALL 2 EA $5,300.00 $10,600.00 2 $10,600.00
9 SLOPING CONCRETE HEADWALL IN OAK 2 EA $1,200.00 $2,400.00 2 $2,400.00
GROVE
10 TRENCH SAFETY co#1 843 LF $1.00 $843.00 843 $843.00
Sub-Total of Previous Unit $105,982.00 $105,982.00
PAVING
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
1 UNCLASSIFIED EXCAVATION BY PLAN 13000 CY
2 SWPPP>1 ACRE 1 LS $1,000.00 $1,000.00 1 $1,000.00
3 HYDRATED LIME 230 TN $167.00 $38,410.00 230 $38,410.00
4 6"LIME TREATMENT 14000 SY $3.00 $42,000.00 14000 $42,000.00
5 2"HMAC SURFACE 960 SY $17.00 $16,320.00 960 $16,320.00
6 4"HMAC BASE 960 SY $35.00 $33,600.00 960 $33,600.00
7 6"CONCRETE PAVEMENT 13828 SY $35.00 $483,980.00 13828 $483,980.00
8 4"CONCRETE SIDEWALK 4423 EA $5.25 $23,220.75 4423 $23,220.75
9 BARRIER FREE RAMP 21 EA $1,350.00 $28,350.00 21 $28,350.00
10 4"SLD PVMT MARKING HAS 30 LF $14.25 $427.50 30 $427.50
11 MANHOLE ADJUSTMENT MINOR 17 EA $500.00 $8,500.00 17 $8,500.00
12 VALVE BOX ADJUSTMENT 22 EA $100.00 $2,200.00 22 $2,200.00
13 TRAFFIC CONTROL 6 MO $1,465.00 $8,790.00 6 $8,790.00
14 END OF ROAD BARRICADE 84 LF $28.00 $2,352.00 84 $2,352.00
15 FURNISH/INSTALL ALUM SIGN EX POLE 7 EA $250.00 $1,750.00 7 $1,750.00
MOUNT
Monday,November 28,2016 Page 2 of 5
City Project Numbers 02517 DOE Number 7396
Contract Name SEVEN OAKS ADDITION,PHASE ONE Estimate Number I
Contract Limits Payment Number 1
Project Type DRAINAGE,PAVING&ST LIGHT For Period Ending 11/28/2016
Project Funding
16 TYPE II-A-A-4"RAISED PAVEMENT MARKER 8 EA $28.00 $224.00 8 $224.00
17 4"SLD PVMT MARKING HAS CO#1 3 LF $14.25 $42.75 3 $42.75
Sub-Total of Previous Unit $691,167.00 $691,167.00
STREET LIGHTING
ItemDescription of Items Unit Unit Cost
Estimated Estimated Completed Completed
No. Quanity Total Quanity Total
1 NO 4 TRIPLEX OHINSULATED ELECT CONDR 50 LF $2.50 $125.00 50 $125.00
2 GROUND BOX TYPE B 4 EA $740.00 $2,960.00 4 $2,960.00
3 RDWY ILLUM ASSEMBLY CO#1 16 EA $1,900.00 $30,400.00 16 $30,400.00
4 FURNISWINSTALL 8'WOOD LIGHT POLE ARM 3 EA $1,550.00 $4,650.00 3 $4,650.00
CO#1
5 ROADWAY ILLUM FOUNDATION CO#1 16 EA $1,200.00 $19,200.00 16 $19,200.00
6 6-6-6 TRIPLEX ALUM ELEC CONDUCTOR 2228 LF $2.25 $5,013.00 2228 $5,013.00
7 2"SCHEDULE 80 CONDUIT 2228 LF $10.00 $22,280.00 2228 $22,280.00
Sub-Total of Previous Unit $84,628.00 $84,628.00
Monday,November 28,2016 Page 3 of 5
City Project Numbers 02517 DOE Number 7396
Contract Name SEVEN OAKS ADDITION,PHASE ONE Estimate Number I
Contract Limits Payment Number I
Project Type DRAINAGE,PAVING&ST LIGHT For Period Ending 11/28/2016
Project Funding
Contract Information Summary
Original Contract Amount $820,358.50
Chante Orders
Change Order Number 1 $61,418.50
Total Contract Price $881,777.00
Total Cost of Work Completed $881,777.00
Contractor Less %Retained $0.00
ij►� ��'2�, ,t/ Net Earned $881,777.00
li(�f Date ��SQ
Inspection Supervisor Earned This Period $881,777.00
Retainage This Period $0.00
E�-h¢�(1 �a G�✓� Date l 1
Less Liquidated Damages
Project Man
,{ �] Days @ /Day $0.00
/l�l�
� C' ba- _ Date ` !! LessPavement Deficiency $0.00
U
/T'P!W-Infrastructure Design and Construction Less Penalty $0.00
w. Date Z- Less Previous Payment $0.00
Director ontracting Departme Plus Material on Hand Less 15% $0.00
Balance Due This Payment $881,777.00
Monday,November 28,2016 Page 4 of 5
City Project Numbers 02517 DOE Number 7396
Contract Name SEVEN OAKS ADDITION,PHASE ONE Estimate Number I
Contract Limits Payment Number 1
Project Type DRAINAGE,PAVING&ST LIGHT For Period Ending 11/28/2016
Project Funding
Project Manager Jaafari City Secretary Contract Number 117396
Inspectors DICKINSON / DUARTE Contract Date
Contractor JACKSON CONSTRUCTION LTD Contract Time 240 CD
5112 SUN VALLEY DRIVE Days Charged to Date 240 CD
FORT WORTH, TX 76119 Contract is .000000 Complete
CITY OF FORT WORTH
SUMMARY OF CHARGES
Line Fund Account Center Amount Gross Retainage Net
Funded
Total Cost of Work Completed $881,777.00
Less %Retained $0.00
Net Earned $881,777.00
Earned This Period $881,777.00
Retainage This Period $0.00
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 $881,777.00
Monday,November 28,2016 Page 5 of 5
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You are directed to make the following chap es in the contract documents
NE
UNIT
CITY BID IN
PAY ITEM N ITEM N QUANTITY UNIT ITEM DESCRIPTION PRICE TOTAL
7 r 70 1 Ea i"Water Service $ 590.001 $ 590.00
13 rr 130 235 SY 4'Wide Asphalt Pavement Repair $ 78.00 $ 18 330.00
TOTAL WATER S 18 920.00
8"PVC Sewer Pie $ 25.00 $ 10 525.00
210 421 LF33 282 15.9 VF E ox Manhole Liner S 197.00 $ 3 132.30
TOTAL SANITARY SEWER $ 13 657.30
34 / 385 95 LF Trench Safety $ 1.00 $ 95.00
TOTAL DRAINAGE $ 95.00
49 440 319 SY 2"HMAC Surface(Type D $ 17.00 $ 5,423.00
50 450 319 Sy 4"HMAC Surface(Type B $ 35.00 $ 11 165.00
51 460 978 Sy 6"36000 Concrete Pvmnt wfcurb $ 35.00 $ 34 230.00
52 470 2023 SF 4"Concrete Sidewalk $ 5.25 $ 10,620.75
54 490 3 LF 4"SLD Pvml Markin HAS White $ 14.25 $ 42.75
56 530 14 LF End o1 Road Barricade $ 28.00 $ 392.00
59 540 4 Ea Furnish/install Alum Sign Ex.Pole Mount $ 250.00 $ 1,000.00
TOTAL PAVING $ 62 873.50
63 590 1 Ea Rd Illum Assembly T 11 w17ow LED Luminare $1,900.00 $ (1,900.00)
Lai 64 600 1 Ea R81 8'Arm w/138W LEO Luminaire on Exist Pole $i 550.00 $ 1,550.00
65 610 1 Ea Roadwa Ilium Found T 4 also includin conduit Si 200.00 $ 1,200.00)
TOTAL STREET LIGHTS $ (1,650.00)
TOTAL $ 93 996.80
REASONS FOR CHANGE 1 The Change Order is submitted to revised contra to reflect actual completed
DEVELOPER IS RESPONSIBLE FOR 100%OF THE CHANGE ORDER COST AND NO
REIMBURSEMENT FROM THE CITY WILL BE SOUGHT BY THE DEVELOPER FOR CHANGE ORDER.
RECOMMENDED: APPROVED: APPRO D:
S t nc Seve ks.FW,Ltd�,p, Jac on nstruction.Ltd
By BY B
Name William L Boomer P E _ Name Ronald B.Foran e. Carmen Este
Title President _ Title President Title Office Manager
PaOa 2
Reglad 10.122011
C)
FORTWORTHO
N
r
TRANSPORTATION AND PUBLIC WORKS
STATEMENT OF CONTRACT TIME
STATEMENT#
FINAL STATEMENT# 1 DOE 7396
NAME OF PROJECT: Seven Oaks Addition Phase One Contractor Jackson
YEAR:j 2016
PROJECT NO.: FINAL INSPECTION DATE 10/18/2016
2517WD CD
CONTRACT TPa 240 1 X
PERIOD FROM: 1 11/16/2016 TO: 111/30120161 MID - Month DEVELOPMENT (Y/N)I Y
WORK ORDER EFFECTIVE: 112 512 0 1 6 BEG(v/n) MID(y/n) Y_
DAY OF MONTH DAYS REASON FOR DAY OF MONTH DAYS REASON FOR
CHARGED DAYS CREDITED CHARGED DAYS CREDITED
1 Wed 16 Wed 0 OTH
2 Thu 17 Thu 0 OTH
3 Fri 18 Fri 0 —OTH-
4
TH4 Sat 19 Sat 0 OTH
5 Sun 20 Sun 0 OTH
6 Mon 21 Mon 0 OTH
7 Tue 22 Tue 0 OTH
8 Wed 23 Wed 0 OTH
9 Thu 24 Thu 0 OTH
10 Fri 25 Fri 0 OTH
11 Sat 26 Sat 0 OTH
12 Sun 27 Sun 0 OTH
13 Mon 28 Mon 0 OTH
14 Tue 29 Tue 0 OTH
15 Wed 30 Wed 0 OTH
31 Thu
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 15 0 15
PREVIOUS PERIOD 9 240 249
TOTAL TO DATE 1 0 0 0 24 240 264
REMARKS:
6TH:Job Completed
A P
Signature: Signature:
(Print Name) — > t'[.t'- Ariel Duarte
CONTRACTOR �- DATE JG� iMPECTOR Q DATE 11/28/2016
9"',
FORTWORTHREV:8/20/16
TRANSPORTATION AND PUBLIC WORKS
PERFORMANCE EVALUATION OF CONTRACTOR
I) CONTRACTOR&PROJECT DATA
Name of Contractor Project Name
Jackson Construction Seven Oaks Addition,Phase One
Inspector City Project Number
Ariel Duarte 2517
Construction Components Project Manager
❑ Water❑ Waste Water 2 Storm Drainage2l Pavement Khal Jaafari
Initial Contract Amount ProjectDculty
$820,358.50 O Simple OO Routine O Complex
Final Contract Amount Date
$881,777.00 .11/29/2016
II)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 4 60 60
8 Traffic Control Maintenance 15 Y 4 60 60
9 Daily Clean Up 5 Y 3 20 15
10 Citizen's Complaint Resolution 5 Y 4 20 20
11 Property Restoration 5 Y 4 20 20
12 After Hours Response 5 Y 4 20 20
13 Project Completion 5 Y 3 20 15
TOTAL ELEMENT SCORE(A) 399
BONUS POINTS(25 Maximum)(B)
TOTAL SCORE(TS) 399
III)CONTRACTOR'S RATING
Maximum Score(MS)=448 or sum of applicable element score maximums which= 448
Rating( [TS/MS] x 100%) 399 / 448 = 89%
Performance Category Excellent
<20%=Inadequate 20%to<40%=Deficient 40%to<60%=Standard 60%to<80%=Good >_80%=Excellent
Lnspector's Comments(INCLUDI G EXPLANATION OF BONUS POINTS AWARDED)
i.
Inspector Signature Contractor Signa
p
Inspector's Supervisor Signature
CONTRACTOR'S COMMENTS
TRANSPORTATION AND PUBLIC WORKS
The Cite of Fort Worth• 8851 Camp Bowie West Blvd. •Fort Worth,TX 76116• (817) 392-8306
CCONSTRUCTION LTD.
5112 SUN VALLEY DRIVE
FORT WORTH,TX 76119
TEL:817-572-3303
FAX:817-478-0443
November 16, 2016
City of Fort Worth
CFA Administration
1000 Throckmorton St.
Fort Worth,TX 76102
RE: Seven Oaks Addition, PH 1
DOE# 7396 City Project#02517
The purpose of this letter is to acknowledge that we have been paid in full by Seven Oaks
—FW Ltd for the public improvements constructed to serve Seven Oaks Addition, PH 1
in Fort Worth, Texas. As a result, we hereby waive,release and relinquish all rights to
assert any claim or demand for lien in connection with this project.
Please feel free to contact me with any questions you may have.
Sincerely,
Troy L. Jackson
Vice President
eCONSTRUCTION LTE)-
5 1
TD_51 12 SUN VALLEY DRIVE
FORT WORTH,TX 76119
TEL:8 17-57Z-3303
FAX: 817-478-0443
Affidavit of All Bills Paid
STATE OF TEXAS
KNOW ALL MEN BY THESE PRESENTS:
COUNTY OF TARRANT
I, Troy L. Jackson, of the undersigned principal hereby certify that all
obligations, claims and debts due laborers, materialmen, subcontractors,
suppliers, and others incurred in or contingent to the performance of the
work on the project known as Seven Oaks Addition, PH 1 in the City of Fort
Worth, Texas have been fully paid.
This affidavit is made for the purpose of obtaining payment from the
City of Fort Worth on above construction work.
Subscribed and sworn to before me this Jackson Construction, Ltd.
Principal
16th y of November, 2016
By:
Notary Signature Troy L. Jackson, Vice resident
Commission Expires: 04/06/2020
'w'I'l"lo, CARMEN L. ESTEP
YA�PNotary Public,State of Texas
Comm.Expires 04-06-2020
Notary ID 2910611
eCONSTRUCTION LTD.
5112 SUN VALLEY DRIVE
FORT WORTH,TX 76119
TEL:817-572-3303
FAX:817-478-0443
AFFIDAVIT
STATE OF TEXAS
COUNTY OF TARRANT
Before me,the undersigned authority, a notary public in the state
and county aforesaid, on this day personally appeared Troy L. Jackson,
Vice President Of Jackson Construction, Ltd,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;
Seven Oaks Addition, Ph 1
BY
Troy L. ackson, Vice President
Subscribed and sworn before me on this date 16th of November, 2016.
Notary lic
Tarrant, Texas
It, CARMEN C. ESTEP
Notary Public,State of Texas
Comm.Expires 04-06-2020
Notary ID 2910611
CONSENT OF SURETY OWNIFR o
TO FINAL PAYMENT AI;CIT L7
CONTTRACRACTOR ❑
.A:=1.Document G707 SURETY )0
Bon(No. BCD1032155 OTHFR
TO aVNER ARCHITECT'S PROJECT NO.:
(Name w-faddrev)
Sev�ti Oaks-FW, Ltd
Sev- W I-20, Suited CONTRACTFOR-- Water, Sewer,Paving and Drainage
Arlington, TX 76017
PROJEC 1": CONTRACT DAT'ED-
(tlNante and addmo
Seven Oaks Addition/Phase One
Fort Worth, TX
In accordance vAth Tile provisions of the Contract between die Owner and the Contractor as indimted above,the
(Insr:tY narnrarrd addr�ef Sumr�g
The Hanover Insurance Company
440 Lincoln Street
Worcester, MA 01653
SURETY,
on bond of
(linen name and addrresO'Contractor)
Jackson Construction, Ltd.
5112 Sun Valley Drive
Fort Worth, TX 76119
CONTRAC'T'OR,
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
(lawrl nameand addrec.ofOwrer)
Seven Oaks-FW, Ltd
6031 W 1-20, Suite 226
Arlington, TX 76017
OWNER,
as set for€b in said Surety's bund..
IN WITNESS WHEREOF,the Surety has hereunto set its hand on this date: October 21, 2016
(limn in u9 Srontbfolfox ec(hY tix raunarrc dcr2 and)earl
The Hanover Insurance Company
(S-Xx
By:
(S�qn aJuutbo:szrsf r nfata�J
Attest; / Jack M. Crowley Attorney-in-Fact
(Printed name and fide)
Surety Phone No. 508-853-7200 x-4476
G707-1994
THE HANOVER INSURANCE COMPANY
MASSACHUSETTS BAY INSURANCE COMPANY
CITI'*L'ENS INSURANCE COMPANY OF AMERICA
POWERS OF ATTORNEY
CERTIFIED COPY
KNOW ALL MEN BY THESE PRESENTS: That THE HANOVER INSURANCE COMPANY and MASSACHUSETTS BAY INSURANCE COMPANY,both being
corporations organized and existing under the laws of the State of New Hampshire,and CITIZENS INSURANCE COMPANY OF AMERICA,a corporation
organized and existing under the laws of the State of Michigan,do hereby constitute and appoint
Steven R.Foster,Jack M.Crowley,Patricia A.Smith and/or Marie Perryman
of Dallas,TX and each is a true and lawful Attorneys)-in-fact to sign,execute,seal,acknowledge and deliver for,and on its behalf,and as its act and deed
any place within the United States,or,if the following line be filled in,only within the area therein designated any and all bonds,recognizances,undertakings,
contracts of indemnity or other writings obligatory in the nature thereof,as follows:
Any such obligations in the United States,not to exceed Thirty Five Million and No/100($35,000,000)in any single instance
and said companies hereby ratify and confirm call and whatsoever said Attorney(s)-in-fact may lawfully do in the premises by virtue of these presents.
These appointments are made under and by authority of the following Resolution passed by the Board of Directors of said Companies which resolutions
are still in effect:
"RESOLVED,That the President or any Vice President,in conjunction with any Vice President,be and they are hereby authorized and empowered to appoint
Attorneys-in-fact of the Company.in its name and as its acts,to execute and acknowledge for and on its behalf as Surety any and all bonds,recognizances,
contracts of indemnity,waivers of citation and all other writings obligatory in the nature thereof,with power to attach thereto the seal of the Company.Any such
writings so executed by suc:i Attomeys-in-fact shall be as binding upon the Company as if they had been duly executed and acknowledged by the regularly
elected officers of the Company in their own proper persons."(Adopted October 7, 1981 -The Hanover Insurance Company;Adopted April 14, 1982-
Massachusetts Bay Insurance Company;Adopted September 7,2001-Citizens Insurance Company of America)
IN WITNESS WHEREOF, THE HANOVER INSURANCE COMPANY, MASSACHUSETTS BAY INSURANCE COMPANY and CITIZENS INSURANCE
COMPANY OF AMERICA have caused these presents to be sealed with their respective corporate seals,duly attested by two Vice Presidents,
this 5th day of December 2011.
THE HANOVER INSURANCE COMPANY
MASSACHUSETTS SAY INSURANCE COMPANY
CMZENS',JJ4SURANCE OMPANY OF AMERICA
Robert"Fhornas,Vice f rt!ddent
THE COMMONWEALTH OF MASSACHUSETTS ) Jfl�l�reftstio—�rCe PresidentCOUNTY OF WORCESTER )ss.
On this 5th day of December 2011 before me came the above named Vice Presidents of The Hanover Insurance Company,Massachusetts Bay Insurance
Company and Citizens Insurance Company of America,to me personally known to be the individuals and officers described herein,and acknowledged that the
seals affixed to the preceding instrument are the corporate seals of The Hanover Insurance Company,Massachusetts Bay Insurance Company and Citizens
Insurance Company of America, respectively, and that the said corporate seals and their signatures as officers were duly affixed and subscribed to said
instrument by the authority and direction of said Corporations.
6ARBARAA.GAIIIICK
d Natary Public
* / Oerrm�nr ealth ok tAassadsuseas /, }
J
�' ' R1}i;Hoof=sscrEapr�£aF"•.21.29f8 "� —'f
Barbara A.Garlick,Notary Public
My Commission Expires September 21,2018
I,the undersigned Vice President of The Hanover Insurance Company,Massachusetts Bay Insurance Company and Citizens Insurance Company of America,
hereby certify that the above and foregoing is a full,true and correct copy of the Original Power of Attorney issued by said Companies,and do hereby further
certify that the said Powers of Attorney are still in force and effect.
This Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of The Hanover Insurance Company,
Massachusetts Bay Insurance Company and Citizens Insurance Company of America.
"RESOLVED,That any and all Powers of Attorney and Certified Copies of such Powers of Attorney and certification in respect thereto,granted and executed
by the President or any Vice President in conjunction with any Vice President of the Company,shall be binding on the Company to the same extent as if all
signatures therein were manually affixed,even though one or more of any such signatures thereon may be facsimile." (Adopted October 7,1981 -The
Hanover Insurance Company;Adopted April 14,1982-Massachusetts Bay Insurance Company;Adopted September 7,2001-Citizens Insurance Company of
America)
GIVEN under my hand and the seals of said Companies,at Worcester, Massachusetts,this 21st day of October 2016.
THE HANOVER INSURANCE COMPANY
MASSACHUSETTS BAY INSURANCE COMPANY
CITIZENS INSURANCE COMPANY OF AMERICA
J ' W—
/ f
n Margosian,Vice President
FORTWORTHREV:02'22/07
TRANSPORTATION AND PUBLIC WORKS
CONTRACTOR'S EVALUATION OF CITY
I)PROJECT INFORMATION Date: 11/29/2016
Name of Contractor Project Name
Jackson Construction Seven Oaks Addition,Phase One
DOE Inspector Project Manager
Ariel Duarte Khal Jaafari
DOE Number Prgied DcrJtj Tjpe of Contract
7396 CPN 02517 10 Simple OO Routine O Complex ❑ Water❑ Waste Water E Storm DrainageRl Pavement
Initial Contract Amount Final Contract Amount
$820,358.50 $881,777.00
II)PERFORMANCE EVALUATION
0-Inadequate I -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 Payments 14 Resolution of Utility Conflicts
3 Bid Opening to Pre-Con Meeting Timeframe
III)COMMENTS&SIGNATURES
COMMENTS
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Signature Contractor
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Signature DOE Inspector
Signature DOE Inspector's Supervisor ezz=
INSPECTOR'S COMMENTS
TRANSPORTATION AND PUBLIC WORKS
F The City of Fort Worth•1000 Throckmorton Street•Fort Worth,TX 76012-6311
(817)392-7941 •Fax: (817)392-7845