HomeMy WebLinkAboutContract 49027-FP1 FORTWORTH. CITYSEM�
CBCTNO. �� z
TRANSPORTATION AND PUBLIC WORKS
NOTICE OF PROJECT COMPLETION
(Developer Projects)
C�t� 7 / City Project NQ: 100009
(16
Regarding contract 100009 for �
7TH AVE AND WEST PULASKI ST PAVING&DRAINAGE IMPROVEMENTS 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 Price: Ste°, $1,004,986.85
Amount of Approved Change Orders: g
N L q ' $22,279.91 Ns 1
h
Revised Contract Amount: \ 0,0 $1,027,266.76
Cl a
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Total Cost Work Completed: c M a $1,027,266.76
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Recomme Acceptance Date
Asst. Direct PW - Development Services
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Accepted Date
As Dir or,
TRANSPORTATION AND PUBLIC WORKS DEPARTMENT
W `
Ass City Panager Date
Comments:
OFFICIAL RECORD
CITY d®CRI TARP
FT.VI offol YX
---- - L47 •�,1
Rev.9/22/16
FORT WORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name 7TH AVE AND WEST PULASKI ST PAVING AND DRAINAGE MMPROVE
Contract Limits
Project Type DRAINGE&PAVING
City Project Numbers 100009
DOE Number 1009
Estimate Number I Payment Number I For Period Ending 5/16/2018
CD
City Secretary Contract Number 1100009 Contract Time 23(ED
Contract Date 2/14!2017 Days Charged to Date 345
Project Manager NA Contract is 100.00 Complete
Contractor PORT WORTH CIVIL
1675-B SOUTH MAIN STREEET
KELLER, TX 76248
Inspectors DICKINSON / RUIZ
r
Thursday;May 24,2018 Page I of 5
A�
City Project Numbers 100009 DOE Number 1009
Contract Name 7TH AVE AND WEST PULASKI ST PAVING AND DRAINAGE I1WPROV Estimate Number 1
Contract Limits Payment Number 1
Project Type DRAINGE&PAVING For Period Ending 5/16/1018
Project Funding
UNIT I:DRAINAGE IMPROVEMENTS
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Qaanity Total Qaanity Total
————————————————————————————— -
1 REMOVE 10'CURB INLET 2 EA $1,550.00 $3,100.00 2 $3,100.00
2 REMOVE 20'CURB INLET 1 EA $2,530.00 $2,530.00 1 $2,530.00
3 REMOVE 18"STORM LINE 24 LF $75.00 $1,800.00 24 51,800.00
4 REMOVE 21"STORM LINE 29 LF $80.00 $2,320.00 29 $2,320.00
5 REMOVE STORM DRAIN MANHOLE 1 EA $2,340.00 $2,340.00 1 52,340.00
6 21"RCP CLASS 1I1 46 LF $230.00 $10,580.00 46 $10,580.00
7 24"RCP CLASS 111 29 LF $243.00 $7,047.00 29 $7,047.00
8 10'CURB INLET 3 EA $7,800.00 $23,400.00 3 $23,400.00
9 20 CURB INLET 1 EA 513,500.00 $13,500.00 I $13,500.00
10 INLET SILT PROTECTION DEVICE 4 EA $210.00 $840.00 4 $840.00
--------------------------------------
Sub-Total of Previous Unit $67,457.00 $67,457.00
UNIT II:PAVING IMPROVEMENTS
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Qaanity Total Qaanity Total
----------------------._.—.__----------------
1 REMOVE SIDEWALK 7786 SF $3.00 $23,358.00 7786 $23,358.00
2 REMOVE STEP 20 SF $145.00 $2,900.00 20 $2,900.00
3 REMOVE ADA RAMP 12 EA $1,165.00 $13,980.00 12 $13,980.00
4 REMOVE CONCRETE DRIVE 3268 SF $6.30 $20,588.40 3268 $20,588.40
5 REMOVE ASPHALT PVMT(CO#1) 2505 SY $28.95 $72,519.75 2505 572,519.75
6 REMOVE CONC CURB&GUTTER 1624 LF $12.25 $19,894.00 1624 $19,894.00
7 BARRIER FREE RAMP TYPE R-1(CO#1) 5 EA $4,885.00 $24,425.00 5 $24,425.00
8 BARRIER FREE RAMP TYPE P-1 5 EA $3,840.00 $19,200.00 5 $19,200.00
9 BARRIER FREE RAMP TYPE M-2 1 EA $4,655.00 $4,655.00 1 $4,655.00
10 4"CONC SIDEWALK 11152 SF $11.15 $124,344.80 11152 $114,344.80
11 F24"SID PVMT MARKING RAE(W) 112 LF $16.35 $1,831.20 112 $1,831.20
12 FURNISHANSTALL ALUM SIGN EX POLE I EA $685.00 $685.00 1 $685.00
MOUNT
13 FURNISIVINSTALL ALULM SIGN GROUND 7 EA $775.00 $5,425.00 7 $5,425.00
MOUNT CITY STD(CO#1)
14 REMOVE AND REINSTALL SIGN PANEL AND 11 EA $300.00 $3,300.00 11 $3,300.00
POST(CO#I)
Thursday,May 24,2018 Page 2 of 5
City Project Numbers 100009 DOE Number 1009
Contract Name 7TH AVE AND WEST PULASKI ST PAVING AND DRAINAGE IMPROV Estimate Number I
Contract Limits Payment Number I
Project Type DRAINAGE&PAVING For Period Ending 5/16/2018
Project Funding
15 8-LIME TREATMENT(CO#1) 3270 SY S17.95 558,369.50 3270 $58,369.50
16 71/2"CONCPVMT(CO#1) 2738 SY S137.75 $377,159.50 2738 5377,159.50
19 SWPPP DEVICES(SWPPP PLAN BY OTHERS) 1 LS S8,500.00 $8,500.00 1 $8,500.00
20 HMAC'TRANSITION 20 TN 5205.00 $4,100.00 20 S4,100.00
21 REMOVE STREET LIGHTS(8 EACH) I EA S6,320.00 $6,320.00 1 56,320.00
22 BARRIER FREE RAMP TYPE P-2 3 EA S3,840.00 $11,520.00 3 $11,520.00
23 BARRICADES AND TRAFFIC CONTROL 4 EA S5,125.00 S20,500.00 4 $20,500.00
3A REMOVE ADA RAMP(CO#1) 1 EA $2,340.00 52,340.00 1 $2,340.00
6A REMOVE CONCRETE CURBS/GUTTER(CO#1) 116 LF S25.65 $2,975.40 116 $2,975.40
11A 24"SLD PVMT MARKING HAE(W)(CO#1) 108 SY $38.55 $4,163.40 108 $4,163.40
25 6-CURB&GUTTER(CO#1) 173 LF 557.75 $9,990.75 173 $9,990.75
26 12-CURB&GUTTER(CO#1) 78 LF $67.45 $5,261.10 78 $5,261.10
27 REMOVE RIP RAP(CO#]) 156 SF $7.85 $1,224.60 156 $1,224.60
28 BARRIER FREE RAMP M-3(CO#1) 2 EA $5,665.00 $11,330.00 2 $11,330.00
29 INSTALL ALUM SIGN EX POLE 1 EA $488.00 $488.00 I $488.00
30 REMOVE SIDEWALK(TERRELL)(CO#1) 3089 SF $5.90 $18,225.10 3089 $18,225.10
31 4-CON.SIDEWALK(TERE1,L)(CO#1) 4407 SF 516.18 $71,305.26 4407 $71,305.26
32 BARRICADES TRAFFIC CONTROL(CO#1) 1 MO 57,876.00 $7,876.00 1 $7,876.00
33 REMOVE HANDRAIL(CO#1) 20 LF $29.00 $580.00 20 $580.00
34 SWPPP DEVICES(CO 01) 1 LS $475.00 $475.00 1 $475.00
--------------------------------------
Sub-Total
------------------
Sub-Total of Previous Unit $959,809.76 $959,809.76
nws*,May 24,2018 Page 3 of 5
City Project Numbers 100009 DOE Number 1009
Contract Name 7TH AVE AND WEST PULASKI ST PAVING AND DRAINAGE IMPROV Estimate Number 1
Contract Limits Payment Number 1
Project Type DRAINAGE&PAVING For Period Ending 5/16/2018
Project Funding
Contract Information Sunnmary
Original Contract Amount 51,004,986.85
Chanee Orders
Change Order Number 1 $22,279.91
Total Contract Price 51,027,266.76
DataTotal Cost of Work Completed $1,027,266.76
C ctor Less %Retained $0.00
c.r Date
06 1 3 zu/6 Net Earned $1,027,266.76
iln tion Supervisor Earned This Period $1,027,266.76
l fj Retainage This Period $0.00
Date v ` w Less Liquidated Damages
P et anager
Days® /Day 50.00
i
Date a& 3 t�i t LessPavement Deficiency $0.00
A
s.Di Infrastructure Design and Construction Less Penalty $0.00
Date J (1 Less Previous Payment $0.00
'� Dire cting Department �1 Plus Material on Hand Less 15% $0.00
Balance Due This Payment $1,027,266.76
Thursday,May 24,2018 Page 4 of 5
City Project Numbers 100009 DOE Number 1009
Contract Name 7TH AVE AND WEST PULASKI ST PAVING AND DRAINAGE IMPROV Estimate Number I
Contract Limits Payment Number I
Project Type DRAINAGE&PAVING For Period Ending 5/16/2019
Project Funding
Project Manager NA City Secretary Contract Number 1100009
Inspectors DICKINSON / RUIZ Contract Date 2/14/2017
Contractor FORT WORTH CIVIL Contract Time 230 CD
1675-B SOUTH MAIN STREEET Days Charged to Date 345 CD
KELLER, TX 7624E 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 $1,027,266.76
Less %Retained $0.00
Net Earned $1,027,266.76
Earned This Period $1,027,266.76
RataiRage 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 $1,027,266.76
Thursday,May 24,2019 Page 5 of 5
DEVELOPER-AWARDED-PROJECT QH"GE ORDER
PROJECT NAME: 7th Avenue and W.Putaald Street CHANGE
CONTRACT: A Drainage. B P"nq ORDER No:
CFA# 2016=001 CITY PARTICIPATION: NO
CITY PROJECT# 100009
DOE# NVA
B1
WATER PROJECT 111, 59601-5310350-OW0430.100000.001SW
SEWER PROJECT# 59007-5310350-0700430.1OOD09-0013W -
FILE# K•2M14
INSPECTOR: James Ruiz Phone No: 817-6757574
PROJECT MANAGER: Aaron LON,P.E. Phone No: 817-392-7818
CONTRACT UNIT
WATER 6EVYER PAVWO DRAINAGE sTREETLIO11T6 CONTRACT
0—lop. wiops+ OOvsiepsr DOvMopsr Dsvuopu DAYS
Cost a Cop Cost Cost
ORIGINAL CONTRACT S97T,529A$ 667,457.00
EXTRAS TO DATE
CREDITS TO DATE
CONTRACT TO DATE 50.00 30.00 $937,529.65 467,457.00 $0.00
AMOUNT OF PROP.CHANGE ORDER f221T6.91
REVISED CONTRACT AMOUNT $0.00 $see $6s9,909.re $6x,457.00 $0.00
TOTAL REVISED CONTRACT AMOUNT
PER UK R 30.00 f0.00 $959 606.76 507.467.00 $0.00
REVISED COST SHARE Dev.Cost: $1.027,26:6.76
L TOTAL REVISED CONTRACT _ $1,027,266.76
Revised:10.12.2011 Page 1
You are directed to make the foll-int Ulan es v1 the contract documents:
CITY BID REM
PAY ITEM 1 a QUANTITY QNI1 ITEM OESCNPTIOM UNIT PRICE TOTAL
3mA 0241.0300 1 EA Remove ADA Ram $2.340.00 $2.340.00
5 0241.1100 1276 SY Remove Asphalt Pvmt $28.95 $7,990.20
6-A 0241.1300 116 LF Remove Cone Cur63Guiter $25.65 $2.975.40
7 3213.0501 1 EA Barrier Free Ramp.Type R-1 51.885.00 54.885.00
11-A 3217.0501 10B SY 24"SLD Pvml M HAE 538.55 54.163.40
13 3441.4003 4 EA FumishAnstell Alum Sign Ground Mount City Std. $77500 53,100.00
14 3441.4110 7 EA Remove and Reinstait SIV Panel and Post 5300.00 $2,100.00
15 3211.0502 110 SY 8Ume Treatment $17.65 1 4SI.963.50)
15 9998 0001 264 SV _ 7 112'Cone Pvml $137.75 $36.366.00
17 9988.0002 2EA SY Concrete Crosswalk Paving t Peach- $28380 S71 882.00
18 9998.0003 270 SY Concrete Crosewldk Border Paving'Light Blue" $291.W 578.570.001
25' 3218.0101 173 LF B'Curb and Gutter 557.75 %9,9W.75--
25* 9989.0006 78 LF 12 Curb and Gutter $67.45 $5.261.10
27' 0241.0800 150 SF Remove RiA Ran $7.85 51.224.60
28' 3213.0505 2 EA Bwdsr Free Ramp.Type M-3 55.885.00 511.33080
29' 3441.4007 1 EA Instal Akan Sign Ex Pole Mount S48B.00 $488.00
30' 0241.0100 3069 SF I Remove SWewMk W.Terrell) 55.90 $15.225.10
31• 3213.0301 4407 SF 4"Cone Sidewalk Torres $16.10 1 $71305.26
32' 3471.0002 1 MO Sartlades end Tra010 Coned ON.T $7.076.00 57.076.00
33' 9999.0007 20 LF Remove Handrail 529.00 5580.00
34' 9899.0004 1 LS SWPPP Devices @ Terns 5475.00 5475.00
TOTAL $22,279.91
NOTE:""DENOTES A NEW PAY REM
REASONS FOR CHANGE ORDER
l:Intersection or 7M Avenue and West Terrek Avenin changed to mnmin e+fsfing.
2. Cwb torrid at NE interseclion o/71h Avenue and PiMM Street modiTled to aecolnerodate ad3 ing fiber We vault
3:Crou"A s(InlersecWris changed Iran colored concmle pavemel 10 regWar concrete pavement,Added sMated crosswalk to Termg Avanua and Royiudale SL
Added Pedestrian Cros"slgra of All Street crossings,
3:Sidewalk added and wkW*d Shap Hast Terrell Avenue. A8'd 9lbck ramps added to crosswalk across West Tanotl Avenue. Curb rmnp added to southwest
ksorsteaion of T~Avenue and 61h Avenue.
APPROVED:; APPROVED:
IConat+"En9f-) fDet+►'9+e7 ( � ti ��f�1L/C�'- 1" 'S
Revised:10-12-2011 {,kJ 1 � Page 2
\)J\ 3y..() Name:
Na+nw },,
Tilt:DtSL.4'AfTwo; TWm:
Redssd:10.12-2011 Page 3
CONSENT OF OWNER
SURETY COMPANY ARCHITECT
TO FINAL PAYMENT CONTRACTOR
SURETY
AIA DOCUMENT G707 OTHER
Bond Na. 22?30"
PROJECT: 7th Avenue&W.Pulaski Street
(name,address)
TO(Owner) [ City of Fort Worth ] ARCHITECTS PROJECT NO:
1000 Throckmorton Street
Fort Worth,TX 76102 CONTRACT FOR: Construction
[ ] CONTRACT DATE:
CONTRACTOR: Fort Worth Civil Constructors,LLC
P.O.Box 164513
Fart Worth,TX 76161
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)
North American Specialty Insurance Company
5200 Metcalf OPN111
Overland Park,KS 66202 , SURETY COMPANY,
on bond of(here insert name and address of Contractor)
Fort Worth Civil Constructors,LLC
P.O.Box 164513
Fort Worth,TX 76161 , CONTRACTOR,
hereby approves of the final payment to the Contractors,and agrees that final payment to the Contractor shall not relieve
the Surety Company of any of its obligations to(here insert name and address of Owner)
City of Fort Worth
1000 Throckmorton Street
Fort Worth,TX 76102 ,OWNER,
as set forth in the said Surety Company's bond.
IN WITNESS WHEREOF,
the Surety Company has hereunto set its hand this 30th day of May , 2018
North American Specialty Insurance Company
Surety Company
Signature of Authorized Representative
(Seal): Andrea Rose Crawford Attorney-In-Fact
Title
NOTE: This form is to be used as a companion document to AIA DOCUMENT G706,CONTRACTORS AFFTDAVIT OF PAYMENT OF DEM AND CLAIMS,
Current Edition
AIA DOCUMENT G707 CONSENT OF SURETY COMPANY TO FINAL PAYMENT APRIL.1970 EDITION ATA ONE PAGE
1970 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 New York Ave.,NW,WASHINGTON,D.C. 20006
SWISS RE CORPORATE SOLUTIONS
NORTH AMERICAN SPECIALTY INSURANCE COMPANY
WASHINGTON INTERNATIONAL INSURANCE COMPANY
WESTPORT INSURANCE CORPORATION
GENERAL POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS,TI•IAT North American Specialty Insurance Company,a corporation duly organized and existing under
laws of the State of New Hampshire,and having its principal office in the City of Overland Park,Kansas and Washington International Insurance
Company a corporation organized and existing under the laws of the State of New Hampshire and having its principal office in the City of Overland
Park,Kansas,and Westport Insurance Corporation,organized under the laws of the State of Missouri,and having its principal office in the City of
Overland Park,Kansas each does hereby make,constitute and appoint:
SAMMY JOE MUL LIS,JR.,JOHN WILLIAM NEWBY,CHERI LYNN IRBY,WILBERT RAYMOND WATSON,MICHAEL L.TULLIS.SANDRA LEST RONEY.D 9BRA LES MOON,
ANDREA ROSS CRAWFORD,MARY JO ZAKRZBW3KI,JAMES B.ROOBR3,JR.,TROY RUSSELL KEY AND LINDA MICHELLE STALDSR JOINTLY OR SEVERALLY
Its true and lawful Attorney(s)-in-Fact,to make,execute,seal and deliver,for and on its behalf and as its act and deed,bonds or other writings
obligatory in the nature of a bond on behalf of each of said Companies,as suety,on contracts of suretyship as are or may be required or permitted by
law,regulation,contract or otherwise,provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the
amount of ONE HUNDRED TWENTY FIVE MILLION($125,000,000.00)DOLLARS
This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of
Directors of North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held
on March 24,2000 and Westport Insurance Corporation by written consent of its Executive Committee dated July 18,2011.
"RESOLVED,that any two of the President,any Senior Vice President,any Vice President,any Assistant Vice President,
the Secretary or any Assistant Secretary be,and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named
in the given Power of Attorney to execute on behalf of the Company bonds,undertakings and all contracts of surety,and that each or any of them
hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is
FURTHER RESOLVED,that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any
certificate relating thereto by facsimile,and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be
binding upon the Company when so affixed and in the future with regard to any bond,undertaking or contract of surety to which it is attached."
\�\\\1\IIIUTVtllqu a r"
�``\OQ�-6p0 / `G'� "'tiaPtii /'ts Ey `
J Cs�^ �r.,yy G rye''•. 3leven rsur, wen a rY grain erser ons Company ~f•
Z +; '.Z c o SEAL •n &Seeder Vice PraWetp efNwth Awericw Specialty Lsurruree Cewpwq• L h�EPtL _
Us SEAL :qoa p'; r^' •arrriwvJw►re"rrt4rrrw�er-i�rwrreCwpwurawl u
Tl, 913 �rr0.� '� f+
..........
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IN WITNESS WHEREOF,North American Specialty Insurance Company,Washington International Insurance Company and Westport
Insurance Corporation have caused their official scats to be hereunto affixed,and these presents to be signed by their authorized officers this
this 12 day of January ,20 18 .
North American Specialty Insurance Company
Washington International Insurance Company
State of Illinois Westport Insurance Corporation
County of Cook ss:
On this 12 day of January .20 18,before me,a Notary Public personally appeared Steven P.Anderson ,Senior Vice President of
Washington International Insurance Company and Senior Vice President of North American Specialty insurance Company and Senior Via President of
Westport Insurance Corporation and Michael A.Ito Senior Vice President of Washington International Insure=Company and Senior Via President
of North American Specialty Insurance Company and Senior Vice President of Westport Insurance Corporation,personally known to me,who
being by me duly sworn,acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the
voluntary act and deed of their respective companies.
[ KIAL SAL � `1
M KENNY
No"P&A)k-State of 0ltruti'
My Cww2"2021 rt>'nw M.Kuarasy.NoWy Fvblic
t
I, Jeffrey Goldberg , the duly elected Vice President and Assistant Secretary of North American Specialty Insurance Company,Washington
International Insurance Company and Westport Insurance Corporation do hereby certify that the above and foregoing is a true and correct copy of a
Power of Attorney given by said North American Specialty Insurance Company,Washington International Insurance Company and Westport lnswaaee
Corporation which is still in full force and effect.
IN WITNESS WHEREOF,I have set my hand and affixed the seals of the Companies this 30th day of A&W .20 18 .
JeRcey Goldktg.Vice President&Assistau Secretary of W ashielpoa lmenis6ow lnswanceCompwy&
North Awerican Specialty Inswatce Company&Vice President A Assistant Secretary of Westport Insumree Corporation
North American Specialty Insurance Company
Washington International Insurance Company
Westport Insurance Corporation
TEXAS CLAIMS INFORMATION
IMPORTANT NOTICE ADVISO IMPORTANTE
In order to obtain information or make a complaint: Para obtener informacion o para someter un queja:
You may contact Jeffrey Goldberg,Vice President Puede comunicarse con Jeffrey Goldberg,Vice
— Claims at 1-800-338-0753 President—Claims,al 1-800-338-0753
You may call Washington International Insurance Usted puede Ilamr al numero de teiefono gratis de
Company and/or North American Specialty Insurance Washington International Insurance Company and/or
Company's and/or Westport Insurance Corporation North American Specialty Insurance Company's and/or
toll-free number for information or to make a Westport Insurance Corporation para informacion o
complaint at: para someter una queja al:
1-800-338-0753 1-800-338-0753
You may also write to Washington International Usted tambien puede escribir a Washington
Insurance Company and/or North American Specialty International Insurance Company and/or North
Insurance Company and/or Westport Insurance American Specialty Insurance Company and/or
Corporation at the following address: Westport Insurance Corporation al:
1450 American Lane 1450 American Lane
Suite 1100 Suite 1100
Schaumburg,IL 60173 Schaumburg,IL 60173
You may contact the Texas Department of Insurance Puede escribir al Departmento de Seguros de Texas
to obtain information on companies,coverages, para obtener informacion acerca de companies,
rights or complaints at: coberturas,derechos o quejas al:
1-800-252-3439 1-800-252-3439
You may write the Texas Department of Insurance: Puede escribir al Departmento de Seguros de Texas:
P.O.Box 149104 P.O. Box 149104
Austin,TX 78714-9104 Austin,TX 78714-9104
Fax: (512)475-1771 Fax: (512)475-1771
Web: hfn_//www_tdi.statA.tx_tis Web: httn://wvuw.tdi.stata.tx.us
Email:ConsumerProtection@tdi.state.tx-us Email:ConsumerProtection@tdi.state.tx.us
PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS O RECLAMOS:
Should you have a dispute concerning your premium Si tiene una disputa concerniente a su prima o a un
or about a claim you should first contact the reclamo,debe comunicarse con el Washington
Washington International Insurance Company and/or International Insurance Company and/or North
North American Specialty Insurance Company and/or American Specialty Insurance Company and/or
Westport Insurance Corporation. If the dispute is not Westport Insurance Corporation primero. Si no se
resolved,you may contact the Texas Department of resueive la disputa,puede entonces comunicarse
Insurance. con el Departmento de Seguros de Texas.
ATTACH THIS NOTICE TO YOUR POLICY: UNA ESTE AVISO A SU POLIZA
This notice is for information only and does not Este aviso as solo para proposito de infromacion y no
become a part or condition of the attached se convene an parte o condicion del documento
document. adjunto.
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 Austin Alumbaugh,
President Of Fort Worth Civil Constructors, LLC,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;
Cook Children's- South Campus Improvements-71h St&Pulaski St
02316-S-0237
Austin Alai ba gh
Subscribed and sworn before me on this date 30th of May,2018.
JANE RATLIFF
lJatary Puoic,state of Texas
Comm.Expires 08.11.2019
N tary Public %: a�`�'' Notary ID 6126060
a ant Co, "Texas
FORTWORTH.
TRANSPORTATION AND PUBLIC WORKS
INSPECTION PUNCH LIST
1. Steps need to be attached to inlets(2)
2. Storm Drain Inlet with one manhole needs to be replaced and two manhole's
added.
Co rac r
I ector
FORTWORTH rev 03/05/07
r� -7
TRANSPORTATION&PUBLIC WORKS
FINAL STATEMENT OF CONTRACT TIME
FINAL STATEMENT NO.:1
NAME OF PROJECT: 7th Ave&Pulsaki St Improvements
PROJECT NO.: 100009 CONTRACTOR: Fort Worth Civil Contracto
DOE NO.: N/ Al
PERIOD FROM:06/06/17 TO: 05/16/18 FINAL INSPECTION DATE: 26-Mar-18
WORK ORDER EFFECTIVE:6/6/2017 CONTRACT TIME: 345 CD
DAY OF DAYS REASON FOR DAYS DAY OF DAYS REASO DAYS
MONTH CHARGED CREDITED MONTH CHARGED CREDITED
DURING DURING
1. 16.
2. 17.
3. 18.
4. 19.
5. 20.
6. 21.
7. 22.
8. 23.
9. 24.
10. 25.
11. 26.
12. 27.
13. 28.
14. 29.
15. 30.
31.
SAT,SUN, RAIN,TOO WET UTILITIES DAYS TOTAL
&HOLIDAYS &TOO COLD RELOCATIONS OTHERS* CHARGED DAYS
THIS 0 0 0 0 345 345
PERIOD
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