HomeMy WebLinkAboutContract 50559-FP1 CaYSE
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FORT WORT H o
57001y -/00$,?4
WATER DEPARTMENT sz
ENGINEERING AND FISCAL SERVICES ✓•�
NOTICE OF PROJECT COMPLETION
Regarding Contract No.50599 for the Repair and Repainting of Seminary Hill and Willow Spines
Elevated Tanks,(City Proiect#100886)as required by the Water Department as approve by City
Council on 02/20/2018 through M&C C-28588 the Director of the Water Department upon the
recommendation/approval of the Consultant/City Project Manager has accepted the project as
complete.Final Payment(Payment Application#10)will be issued in accordance with Administrative
Regulation Cfi.
Original Contract Prices: $1,490,200.00
Amount of Approved Change Orders: $ 0.00
Revised Contract Amount: $1,490,200.00
Total Cost Work Completed: $1,400,125.00
See Notes on Final Payment Breakdown
Less Deductions:
Liquidated Damages: 0 Days @$210.00/Day
Other Deductions(see comments):
Total Deduction Amount: $0.00
Total Cost Work Completed: $1,400,125.00
Less Previous Payments: $1,184,69750
Final Payment Due: $215,42750
4u 7 �
r
mended for Acceptance Date
Seater,P.E.
m Engineering,Inc.
71il
Approved, ena Johnson,P.E. Date
,yrojectManner,Water Department OFFICIAL RECORD
RECFNSD CITY SECRETARY
A� 16 FT.WORTH,TX
�ypFFORT�R�
CRYS
40 i4d _Z19
Accepted,Chris Harder T- S Date
Director,Water Department
IA
)'��Iji 0��
Dana Burghdo Date
Acting Assists ity Manager
Date of Final Completion Date of Warranty Start
6/10/2019 6/10/2019
sqa
LS 5 6S 1
PAYMENT REQUEST'
PROJEC7. PROJECT NUMBER
OWNER:
CONTRACTOR-
ENGINEER:
Pz-`,Y UIENT PERIOD FROM: TO 22
SUMMARY OF PAYMENT ESTIMATE VALUES FROM.ATTACHED TABULATIONS
Original Contract Amount 1,490,200.00
Approved Change Orders _
Current Contract Amount a 1,490,200.00
Total Value of Original Contract Performed n 1,400,125.00
(Attachment"A"consisting of 8 pages)
Extra Work on Approved Change Orders $ _
(Attachment"B"consisting of 1 page)
Materials on Hand _
(Attachment"C"consisting of_pages)
Total Value of Work to Date $ 1,400,125.00
Less Amount Retained at 5 % $ _
Net Amount Earned on Contract $ 1,400,125.00
Less Amount of Previous Payments $ 1,184,697.50
BALANCE DUE THIS STATEMENT 2i
Percentage of Contract Paid to Date 93.96%
The undersigned Contractor certifies that all work,including materials on hand,covered by this Periodical Payment
has been completed and delivered and stored in accordance with the Contract Documents,that all amounts have
been paid by him for work,materials,and equipment for which previous Periodical Payments were issued and
received from the Owner,and that the current payment shown herein is now due.
Contractor: By
i . -
Date:
Subscribed and swam to be e this 019
Notary Public: •_ W&Notary lD#12 1T7912
My Commission expires: Expires January 30,2021
Recommended for Payment by
= d�der35G�remit
I A&M Construction and
Utilities INC
BY' . �- Z� _ ��j�JyG 4950 Grisham Dr.
J Seiter, PEI Date j da'oarrdeti, TRr 75088
Pro.pproved for Payment by
sty of Fort Worth
By
Date
��v� ��p+• (23r,2
- vU.�.1u—--_ _
------
Schedule of Values
Seminary Hill&Willow Springs Elevated Tank
Dry. Ory, Tohl Doll" Dollars Total Volue
Bid TM1Ie PreWous pry, ? Thla PraWousy Of Wbrk Of Work
Item Description qty Unit Unit$ ! Total$ Prod! Eetlmet¢a Complete j Pod¢d B01ad Camplatatl completed
"BASE UNIT PRICES" I I TOTAL WORK COMPLETE TO DATE
1 Subtotal for Bid kem al $..aa
.KEPI
SH4 Seminary Hill Contractor Mobilamlon 1 LS 30,000.00 $30000.00 O.aa 1.00 1.00 30.00 3]a.000.00 3M.0c..00 t00%
5H2 Com late Semina .H ra air items 1 LS 100000.00 $100000.00 C.a0 1.aa t.aa 30.Da s100,0a0.00 sloo,a00,a0 100%
SX] Remove and Ra lace existin Semina HIII TEC 2000 valve 1 LS 12400.00 $12,000.00 00 o.ao t.00 512,0oa,00 $0.00 $12,W0.00 t00%
1.
SX4 Cam Iete Semina HIIIRe air of IisB der Corrosion damage 1 LS 204000400 $20.000.00 t.0o 0.00 14400! 520,Oo04M EO.Oo $20,OOO.o0 100%
Repair by welding pits,holes and prior eonoelon damage up to 6?
Diameter,for Seminary Hill,per Project Specification,as directed by the
.mgin...PARTIALLY USED.YIELOED REDUCED TOTAL CONTRACT
SNS AMOUNT 300 EA 75.00 $22500.00 37.00 0.00 37.001 $24775.00 0.00 $2.775.00 121
Provide and Install TNEMEC Series 215 Pit Fillarfor Seminary Hill par
SH3 ra'oc[S ecmcations end a.dlroclad b en Inear. 1 GAL 300.00 5300.00 1.00 a.00__ 1.Oa s300.0a s0.a0 330..00 100%
Pressure wash interior of Seminary Hill tank to remove soluble Galt content
SH7 a needed erI roectS ec!lwtiens and as directed b the an inner. 1 LS SA00.00 $5,000.00 0.00 1400 1.00 =00 55.000,00 SS,000Ao t00%
Provide and operate dehumidification equipment to maintain less than 5094
relative humltliry during ell Seminary HIII Interior blasting,coating,and cud
SH9 operations,per Prefect S eciflcatlans 1 LS 60000.00 $60000.00 am 1A0 1.00, 304M Sa0,000.00 se0,o00.00 100%
Replace Seminary Hip Interior Wat Area Ceating System with specified
SH9 Tnemee Zinela a /e o eaatin s tam. 1 LS 240000.00 $240000400 om 1.0. 1.001 $a.oa 324o,00a.ao g2da,a00.00 10o%
Provide and install SSPC Class 3A containment for Seminary Hill capable
being apamted In winds up to 25 mph,as described in the Project
SH10 S ecilcatian. 1 LS 50.000.00 $50000.00 a.0a 1400 1.00i $0.00 350,000.00 $50.000Aa 10a%
Replace Seminary HIII Exterior coating system with specified TNEMEC
SH41 zin4e o lurethane7fiuoro of mercmtin s tam. 1 LS 405000.00 $4055.000.00_ 0.20 O.Sa 1.00j S81,000A0 M24,000.00 $405,000.00 100%
Seminary HIII Disinfection S Cleanup.Disinfection to be performed by City
5H12 via chlorine Wadi- 1 LS 5,000.00 55,000.00 1.00 1
.00 1.001 35,000.00 30.00 $5.000.00 10a%
SX4] Semina Hill Contractor De-moblliiation, 1 LS 20,000.00 $20,000.00 1.00 0.00 1400 520,000.00 $0.00 $20.000.00 1.0%
W51 Will-Springs Contraetor mobilization 1 LS 20,000.00 $20,000.00 0.00 1,Oo 1.00{ 3a,00__ 320,000.00 __ E20.000.00 f0a%
W52 Cam late WIIowS rin sre air Hama 1 LS 30.000.00 550.000.00 0.00 1.00 1.001 s0.00 $WDo..00 $50.000.0c 100%
cos] Pefortn vacuum box test at Willaw S rin s Der AVvWA D107 1 LS 10.000.00 $10,000.00 0,00 1,00 1.00 Sa.Oa slo.ao0.oa 51a..cc._ 100%
Removeand replace eAsting W llow Springs TIED 2000 Valve Actuator With
W56 new actuator of similar make. 1 LS 12,000400 512,000.00_ 1.00 D,00 1.00 E12,000.00_ 30.00 E12.000.00 fee.
WSS Complete Willow Springs Re air of pits 5 Prior Corrosion damage 1 LS 20,000.00 $20.000.00 0.00 1.00 1.00� 30.00 $20.000.00 _ _520.000.00 t00%
Repair by welding pits,holes and prior corrosion damage up to 5'In
Diameter,for Willow SlOnnga,per Prol¢ct Specification,as directed by the i
enginceer.PARTIALLY USEQYIELOEO REDUCED TOTAL CONTRACT
W59 AMOUNT 300 EA 50.00 $15000.00 a.pp 5.00 S250A1) 32M.00 2%
ProWde and install TNEMEC Sodas 215 pit
Filler for W11low Spring.par in,
Project Specllcatlens old as directed by the eng-sIPARTIALLY USED.
W57 YIELDED REDUCED TOTAL CONTRACT AMOUNT 3GAL 300.00 $900.00 oA0 1.00 1,00 50.00 E300.00 Q00.00 ]3%
Pressure wash interior of W111ow Springs tankto remove eolubie salt cone
WSa a needed er the Project S eeflcatian,and za directed b the en i 1 LS 5,000.00 $5,000.00 0.00 1.00 1.00i 30.00 35,a00.00 SS.a00.00 100%
ProWde and operate dehumidification equipment to m ilrOun less than 50-
relative humidity during all tallow Springs interior blasting,coating,and
W59 cu n arollon¢,per
Pro'eiaS eciflostions 1 LS 50000.00 $50,f%10.00 0.00 1.00 1.001. 30,W _ $5ap00.00 S5a,000.00 100%
Replace WIlow Springs Interior Wet Mee Coating System with specified
W510 TNEMEC uncle a lee coatln s stem, t LS 262,500.00 $262500.0o O.Da 1.00 t.aai 30.00 $261,500.00 s25z.Wo.oa 100%
Pepper-Lawson Page 1 7262019
Schedule of Values
Seminary Hill&Willow Springs Elevated Tank
on. cry. Tebl Dallas We. Tutel Value %
Bid This Prevl.u. Cy. i Thla Pleli-y OrMk Of Work
t
Rem Description l city Unit Unit$ Total$ wded Eatlnmtaa Complate Paned WIW I Complamd Ca.ml-d
Willow Springs Disinfection&Cleanup.Dlsimeal to be performed by Cit
W511 via chlorine in'ectian. 1 LS 5,000.00 $5,000.00 0,00 0.00 0,00 $0.00 g0.00 0%
WS12 Wllows do sControctor De•mohilcation. 1 LS 20,000.00 $20,000.00 0.00 1.00 1.00, $O.oa 5]a.0ao.00 E2a,000.o0 100%
Alternate Bid Items -r-- -"
Add or deduct from the Base Bid to install Alternate Coating System l '�-
manufaaured by Induron or Sherwin-Willlams,per Section 13 02 00 of the
Alt.t reject$eciflopp n.Pdcin NOT re ulred. OILS SO.00 0.00 0.00 OOOi _ 50.00 30.0a 3--Oa a%
10me account allowance to be used for eddihonal Is repair and
modifcalion Inane amount of$50,000.00.NOT USED-YIELDED I
Alt] REDUCED TOTAL CONTRACT AMOUNT 1 LS 50,000.00 $50000.00 0.00 0.00 0.00 50.oa__ 30,00 E0.00 0%
LS $0.00 0.00 0.00 0.00�• $0.00 $0.00 $0.00 0%
LS $0.00 o.po o.00 O.oOi $0.00 $0.00 $0.00 a%
LS $0.00 0.00 0.00 O-i so.0a $0.00 30.00 .'ALS 50.00 0.00 0.00 0.00i 30.00 E0.00 $0.00 0%
o%
TOTAL BID PRICE 1,490,200.00 $153,075.00 $1,247,050.00 $1,400,12S.00 0.94
Contract Summary; Total Complete to Date $1.400,125.00
Total Unit Price Work- 0.00 Work Completed This Period $153.075.00
Total Cash Allowances 0.00 Leas 5%ReWlnage $70.006.25
Subtotal 1 $1,330.118.75
Plus Materials On Hand $0.00
Original Contract Amount. 1,490,200.00 Lees 5%Retainage $o,p0
Total Change Orders- 0.00 Subtotal 2 $0.00
Total Work Change Directives 0.00 Less Previous Payments $1,184,697.50
Revised Contract Amount•Inclusive of WCD's 1,490,200.00 Total Due This Period $14S,421.25
0
Peppe,Lawson Page 2 7/26/2019
j30ND#: PBO1692800250
CONSENT OF SURETY OWNER
TO FINAL PAYMENT ARCHITECT ❑
AIA Document G707 CONTRACTOR ❑
(Instructions on reverse side) SURETY ❑OTHER ❑
TO OWNER ARCHITECT'S PROJECT NO.:
(Name and address)
City of Fort Worth
CONTRACT FOR
PROJECT: CONTRACT DATED:
(Name and=&d )
Repair and Repainting of Seminary Hill and Willow Springs Elevated
Project No. 100886
In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above,the
(Insert name and address of Surety)
Philadelphia Indemnity Insurance Company
One Bala Plaza,Suite 100
Bala,Cynwyd,PA 19004
SURETY,
on bond of
(Insert name and address ofCantractor)
A&M Construction and Utilities,Inc.
4950 Grisham Dr.
Rowlett,TX 75088
,CONTRACrOR,
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
(Insert mmne and adar-=of Owner)
City of Fort Worth
as set forth in said Surety's bond, OWNER,
IN WITNESS WHEREOF,the Surety has hereunto set its hand on this date:July 22 2019
(Insert in writing the month followed by the mtmeric date and year)
Philadelphia Indemnity Insurance Company
rs�tervl
� Ignatare Ihorized represemotrs•. -+—
Attest:
Brent M.Blonigan, Attorney-in-fact
(Primed name and tide)
CAUTION: You should sign an original AIA document that has this caution printed in red,An
original assures that changes will not be obscured as may occur when documents are reproduced.
See instruction Sheet for Limited License for Reproduction of this document.
AIA DOCUMENT G707-CONSENT OF SURETY TO FINAL.PAYMENT-1994 EDITION-AIA Page 1 of 2
1994-THE AMMCAN 1NSTnV1E OF ARCHITECTS,1735 NEW YORK AVENUE,NW,WASH.
INGTON,D.C.20006-5292-WARNING:Unlicensed photocopying vlolattts U.S.copy_ G7O7-�994
right laws and will subject the violator to legal prosecution.
INSTRUCTION SHEET
FOR AIA DOCUMENT G707,CONSENT OF SURETY TO FINAL PAYMENT
A.GENERAL INFORMATION
9.Purpose
This document is intended for use as a companion to AIA Document G706,Contractor's Affidavit of Payment of Debts and
Claims,on construction projects where the Contractor is required to furnish a bond. By obtaining the Surety's approval of final
payment to the Contractor and its agreement that final payment will not relieve the Surety of any of its obligations,the Owner
may preserve its rights under the bond.
2.Related Documents
This document may be used with most of the AIA's Owner-Contractor agreements and general conditions,such as A201 and its
related family of documents.As noted above,this is a companion document to AIA Document G706.
3.Use of Current Documents
Prior to using any AIA document,the user should consult the AIA,an AIA component chapter or a current AIA Documents List to
determine the current edition of each document.
4.Limited License for Reproduction
AIA Document G707 is a copyrighted work and may not be reproduced or excerpted from in substantial part without the express
written permission of the AIA. The G707 document is intended to be used as a consumable-that is,the original document pur-
chased by the user is intended to be consumed in the course of being used. There is no implied permission to reproduce this
document,nor does membership in The American Institute of Architects confer any further rights to reproduce G707.
A cautionary notice is printed in red on the original of this document. This notice distinguishes an original AIA document from
copies and counterfeits. To ensure accuracy and uniformity of language,purchasers should use only an original AIA document or
one that has been reproduced from an original under a special limited license from the AIA.
A limited license is hereby granted to retail purchasers to reproduce a maximum of ten copies of a completed or executed G707,but
only for use in connection with a particular project. Further reproductions are prohibited without the express permission of the AIA.
B.CHANGES FROM THE PREVIOUS EDITION
Changes in the location of various items of information were made,without revision to the substance of the document.
C.COMPLETING THE G707 FORM
GENERAL: The bond form is the usual source of required information such as the contract date and the names and addresses of the
Surety,Owner,Contractor and Project.
ARCHITECT'S PROJECT NO.: this information is typically supplied by the Architect and entered on the form by the Contractor.
CONTRACT FOR: This refers to the scope of the contract,such as"General Construction"or"Mechanical Work".
D.EXECUTION OF THE DOCUMENT
The G707 form requires both the Surety's seal and the signature of the Surety's authorized representative.
4/94
INSTRUCTION SHEET FOR AIA DOCUMENT G707;-!CONSENT OF SURETY TO FINAL PAYMENT t_'1994 Page 2 of 2
EDITIONi1AIASATHE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVENUE,N.W,
WASFIINGTON,D.C.20006-5292 G707-1994
2310
PHILADELPHIA INDEMNITY INSURANCE COMPANY
One Bala Plaza,Suite 100
Bala Cynwyd,PA 19004-0950
Power of Attorney
KNOW ALL PERSONS BY THESE PRESENTS That PHILADELPHIA INDEMNITY INSURANCE COMPANY(the Company),a corporation organized and
existing under the laws of the Commonwealth of Pennsylvania,does hereby constitute and appoint Debbie Palmer, Kara Pierce, Marci Luse and/or Brent M.
Blonigan of Grayliawk Insurance Associates its true and lawful Attorney-in-fact with full authority to execute on its behalf bonds.undertakings,recognizances and
other contracts of indemnity and writings obligatory in the nature thereof, issued in the course of its business and to bind the Company thereby,in an amount not to
exceed$50.000,000
This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of
PHILADELPHIA INDEMNITY INSURANCE COMPANY on the 14'i'of November.2016
RESOLVED: That the Board of Directors hereby authorizes the President or any Vice President of the
Company (1) Appoint Attorney(s) in Fact and authorize the Attorney(s) in Fact to
execute on behalf of the Company bonds and undertakings-contracts of indemnity and
other writings obligatory in the nature thereof and to attach the seal of the Company
thereto; and (2) to remove, at any time. any such Attorney-in-Fact and revoke the
authority given And.be it
FURTHER
RESOLVED: That the signatures of such officers and the seal of the Company may be affixed to any
such Power of Attorney or certificate relating thereto by facsimile,and any such Power of
Attorney so executed and certified by facsimile signatures and facsimile seal shall be
valid and binding upon the Company in the future with respect to any bond or
undertaking to which it is attached
IN TESTIMONY WHEREOF. PHILADELPHIA INDEMNITY INSURANCE COMPANY HAS CAUSED THIS INSTRUMENT TO BE SIGNED AND ITS
CORPORATE SEALTO BE AFFIXED BY ITS AUTHORIZED OFFICE THIS 27"'DAY OF OCTOBER.2017
\�QFtJ'tIrY4�Ys;V.
W t3 y
"'• 1927�'m=
sw
(Seal)
Robert D O'Leary Jr,President&CEO
Philadelphia Indemnity Insurance Company
On this 2r day of October,2017,before me came the individual who executed the preceding instrument,to me personally known,and being by me duly sworn said
that he is the therein described and authorized officer of the PHILADELPHIA INDEMNITY INSURANCE COMPANY;that the seal affixed to said instrument is
the Corporate seal of said Company,that the said Corporate Seal and his signature were duly affixed
OF V �
NOiMLLL7EAt
a..,�w°,e'�"°—Wyc Notary Public:
+e �am+�ru�dr
N[oaMrlm[anYn:I.otil.ffit
•na
residing at Bala Cvmwd.PA
(Notary Seal)
My commission expires September 25,2021
I,Edward Sayago,Corporate Secretary of PHILADELPHIA INDEMNITY INSURANCE COMPANY,do hereby certify that the foregoing resolution of the Board of
Directors and this Power of Attorney issued pursuant thereto on this 27'day of October,2017 are true and correct and are still in full force and effect I do further
certify that Robert D O'Leary Jr.,who executed the Power of Attorney as President.was on the date of execution of the attache7pof Attorney the duly elected
President of PHILADELPHIA INDEMNITY INSURANCE COMPANY,
In Testimony Whereof]hatle subscribed my name and affixed the facsimile seal of each Company ihi�✓� {� /
day o 2
7 Edward Sayago,Corporate Secretary
PHILADELPHIA INDEMNITY INSURANCE COMPANY
IMPORTANT NOTICE AQVISO IMPORTANTE
To obtain information or make a complaint: You may Para obener informacion o para someter una queja:
call the Surety's toll free telephone number for Usted puede liamar al numero de telefono gratis de
information or to make a complaint at: para information o para someter una ue q ja al:
1-877-438-7459 1-877-438-7459
You may also write Philadelphia Indemnity Insurance Usted tanbien puede escribir a Philadelphia
Company at: Indemnity Insurance Company:
One Baia Plaza,Suite 100 One Bala Plaza, Suite 100
Bala Cynwyd, PA 19004 Bala Cynwyd, PA 19004
Attention: Senior Vice President and
Director of Surety Attention: Senior Vice President and
Director of Surety
You may contact the Texas Department of Insurance Puede comunicarse con el Departamento de
to obtain information on companies. coverage, rights Seguros de Texas para abtener information acerca
or complaints at: de companias, coberturas, derechos o quejas aL
1-800-252-3439 1-800-252-3439
You may write the Texas Department of Insurance Puede escribir al D�
at. partmenta 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: httP:/1'oivAv.tdi.state.tx.us Web: httP://www.tdi.state.tx.us
Email: ConsumerProtectionCatdi.state.tx,us Email: ConsumerProtection`tdi.state.tx.us
PREMIUM OR CLAIM DISPUTES: Should you have DISPUTAS SOBRE PRiMAS O RECLAMOS: Si
a dispute concerning your premium or about a claim, tiene una disputa concerniente a su prima o a un
you should contact the Surety first. If the dispute is reclamo, debe comunicarse con el Surety primero. Si
not resolved you may contact the Texas Department no se resuelve la disputa; puede entonces
of Insurance.
comunicarrse con el departamento (TDI).
ATTACH THIS NOTICE TO YOUR BOND This UNA ESTE AVISO A SU FIANZA DE GARANTIA:
notice is for information only and does not become a Este aviso es solo para proposito de information y
part or condition of the attached document. no se convierte en parte o condition del documento
adjunto.
CONDITIONAL WAIVER AND RELEASE ON FINAL PAYMENT
Project: Repair and Repainting of Seminary Hill and Willow Springs Elevated Tanks
Job No.City Proiect#100886
On receipt by the signer of this document of a check from City of Fort Worth (maker of
check) in the sum of$215,427.50 payable to A&M Construction&Utilities. Inc. (payee or
payees of check)and when the check has been property endorsed and has been paid by the
bank on which it is drawn,this document becomes effective to release any mechanic's lien right,
any right arising from a payment bond that complies with a state or federal statute,any common
law payment bond right,any claim for payment, and any rights under any similar ordinance, rule,
or statute related to claim or payment rights for persons in the signer's position that the signer
has on the property of City of Fort Worth (owner)located at Stephens Park, Fort Worth, Texas
(location)to the following extent:Repair and Repainting of Seminary Hill and Willow Springs
Elevated Tanks(job description).
This release covers final payment for all labor, services,equipment, or materials furnished to
the property or to City of Fort Worth(person with whom signer contracted)as indicated in the
attached statement(s)or final payment request(s).
Before any recipient of this document relies on this document,the recipient should verify
evidence of payment to the signer.
The signer warrants that the signer has already paid or will use the funds received from this
progress payment to promptly pay in full all of the signer's laborers,subcontractors, materialmen,
and suppliers for all work, materials,equipment,or services provided for or to the above
referenced project in regard to the attached statement(s)or final payment request(s).
Date Ajh
A&M Construction&Utilities.Inc.(Company name)
By ; / (Signature)
SUBSCRIBED AND SW9Rbl TO BEFORE ME,the undersigned, a Notary Public on
this $1 day of 2�to certify which witness by hand and
seal of office.
=n3 JAMES THO
* ;y My Nptary 10 5 I77912
Expires J uary 202
Notarf Public, State of Texas
CONTRACTOR'S AFFIDAVIT OF FINAL PAYMENT
THE STATE OF TEXAS If
} KNOW ALL MEN BY THESE PRESENTS:
COUNTY OF TARRANT }
BEFORE ME,the undersigned authority,on this day personally appeared
Antonio Banda
("Affidavit"), who, after being by me duly swom,deposes, and says that it is A & M Construction &
Utilities, Inc., a Texas Corporation (the "Contractor"), which said Contractor was awarded the contract
dated the _day of 20_,forthe constructionof Repair and RepaintiniZ of Seminary
Hill and Willow Springs Elevated Tanks. (City Proiect #100886) (the"Work"), for a total
consideration of One Million, Four Hundred Thousand One Hundred Twenty Five Dollars and
Zero Cents($1,400.125.00)to be paid to the said Contractor(the"Contract"), and that Affidant has full
power of authority to make this affidavit.
That the City of Fort Worth,a State of Texas Municipal Corporation(the "Owner")has approved
the final estimate on said Work,and that the said Contractor has fully satisfied and paid any and all claims
that may be covered by Texas Government Code,Chapter 2253,as amended or any other applicable
statutes or charter provisions,and that all just bills for labor and materials have been paid and discharged by
said Contractor insofar as they pertain to the work in question.
That in addition to any funds which may have been previously paid by the Owner,the Contractor
hereby accepts the amount of Two Hundred Fifteen Thousand,Four Hundred Twenty Seven Dollars
and Fifty Cents ($215,427.50) as FULL AND FINAL PAYMENT under the aforementioned Contract,
and hereby waives and releases any right Affdant and/or the Contractor may have to pursue claims of any
nature against the Owner arising out of or in any manner connected with the performance of the Work and/or
the Contract,including but not limited to claims of third parties that supplied material and/or labor for the
Work for or through the Contractor("Subcontractors"),as well as claims for delay,additional compensation
or for recovery of liquidated damages which may have been withheld by the Owner.The Contractor shall
defend,hold harmless and indemnify the Owner from any such claims of such Subcontractors.The Contractor
further releases the Owner from any claim or liability arising from any act or neglect of the Owner related to
or connected with the Contract. This affidavit is given pursuant to the final payment provisions of the
Contract,and shall not be deemed to alter or modify the terms and provisions of said Contract.
A&M Construction&Utilities.Inc_
l (Affidavit)
(Prin ed Name and Title)
SUBSCRIBED AND SWORN TO BEFORE ME,this the Sid f A.D.20�.
Pam' (N Public in and for the State of Texas)
S JAMES 11i0RN
[Notary Seal] +yB,,, My Notary ID#126177912
Expires January 30,2021 Name ofNotary)
My commission expires I J3 2,1 7