HomeMy WebLinkAboutContract 40906•
CITY SECRETARY
COIiTRACT NO.
PROFESSIONAL SERVICES AGREERVIENT
This PROFESSIONAL SERVICES AGREEMENT ("Agreement") is made and entered into by.
and between the CITY OF FORT WORTH (the "City"), a Texas home rule municipal corporation acting
by and through Tom Higgins, its duly authorized Assistant City Manager, and THE NELROD COMPANY
dba FOX ENERGY SPECIALISTS ("Consultant"), a Texas Corporation and acting by and through
Nelson Rodriguez, its duly authorized President. The term Consultant shall include employees, directors,
officers, agents or representatives.
1. SCOPE OF SERVICES.
Consultant hereby agrees to provide the City with professional consulting services for
performing Energy Audits and Inspections in support of the Weatherization Assistance Program —
American Recovery and Reinvestment Act. Attached hereto and incorporated for all purposes incident
to this Agreement is Exhibit "A," Statement of Work, Exhibit "C," Work Order, Exhibit "D," Work
Order Pricing, Exhibit "E," Pre -Assessment Form, and Exhibit "F," Building Weatherization Report
more specifically describing the services to be provided hereunder.
2. TERM.
This Agreement shall commence upon October 1, 2010 ("Effective Date") and shall expire on
August 31, 2011, unless terminated earlier in accordance with the provisions of this Agreement
("Expiration Date")
3. COMPENSATION.
The City shall pay Consultant an amount not to exceed FORTY-FIVE THOUSAND DOLLARS
AND NO CENTS $45 000. ( 00) in accordance with the provisions of this Agreement and the Payment
Schedule attached as Exhibit "B," which is incorporated for all purposes herein. Consultant shall not
perform any additional services for the City not specified by this Agreement unless the City requests and
approves in writing the additional costs for such services. The City shall not be liable for any additional
expenses of Consultant not specified by this Agreement unless the City first approves such expenses in
writing.
4. TERMINATION.
4.1. Written Notice.
The City or Consultant may terminate this Agreement at any time and for any reason by
providing the other party with 30 days written notice of termination:
4.2 Non -appropriation of Funds.
In the event no funds or insufficient funds are appropriated by the City in any fiscal period
for any payments due hereunder, City will notify Consultant of such occurrence and this
Agreement shall terminate on the last day of the fiscal period for which appropriations were
received without penalty or expense to the City of any kind whatsoever, except as to the portions
of the payments herein agreed upon for which funds shall have been appropriated,
4.3 Duties and Obligations of the Parties.
In the event that this Agreement is terminated prior to the Expiration Date, the City •shall
pay Consultant for services actually rendered up to the effective date of termination and
Consultant shall continue to provide the City with services requested by the C
Form Services Agreement
The Neirod Company dba Fox Energy Specialists
Page 1 of 7
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It�����C�'AI.. RECORD
CITY SECRETARY
FT. WORTH, TX
1 0-07-1 0 A 'I 1: 24* •.
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accordance with this Agreement up to the effective date of termination.
5. DISCLOSURE OF CONFLICTS AND CONFIDENTIAL INFORMATION.
Consultant hereby warrants to the City that Consultant has made full disclosure in writing of any
existing or potential conflicts of interest related to Consultant's services under this Agreement In the
event that any conflicts of interest arise after the Effective Date of this Agreement, Consultant hereby
agrees immediately to make full disclosure to the City in writing. Consultant, for itself and its officers,
agents and employees, further agrees that it shall treat all information provided to it by the City as
confidential and shall not disclose any such information to a third party without the prior written approval
of the City. Consultant shall store and maintain City Information in a secure manner and shall not allow
unauthorized users to access, modify, delete or otherwise corrupt City Information in any way.
Consultant shall notify the City immediately if the security or integrity of any City information has been
compromised or is believed to have been compromised.
6. RIGHT TO AUDIT.
Consultant agrees that the City shall, until the expiration of three (3) years after final payment
under this contract, have access to and the right to examine at reasonable times any directly pertinent
books, documents, papers and records of the consultant involving transactions relating to this Contract
at no additional cost to the City.. Consultant agrees that the City shall have access during normal
working hours to all necessary Consultant facilities and shall be provided adequate and appropriate work
space in order to conduct audits in compliance with the provisions of this section. The City shall give
Consultant reasonable advance notice of intended audits.
Consultant further agrees to include in all its subcontractor agreements hereunder a provision to
the effect that the subcontractor agrees that the City shall, until expiration of three (3) years after final
payment of the subcontract, have access to and the right to examine at reasonable times any directly
pertinent books, documents, papers and records of such subcontractor involving transactions related to
the subcontract, and further that City shall have access during normal working hours to all subcontractor
facilities and shall be provided adequate and appropriate work space in order to conduct audits in
compliance with the provisions of this paragraph. City shall give subcontractor reasonable notice of
intended audits
INDEPENDENT CONTRACTOR.
It is expressly understood and agreed that Consultant shall operate as an independent
contractor as to all rights and privileges granted herein, and not as agent representative or employee of
the City. Subject to and in accordance with the conditions and provisions of this Agreement, Consultant
shall have the exclusive right to control the details of its operations and activities and be solely
responsible for the acts and omissions of its officers, agents, servants, employees, contractors and
subcontractors. Consultant acknowledges that the doctrine of respondeat superior shall not apply as
between the City, its officers agents, servants and employees, and Consultant, its officers, agents,
employees, servants, contractors and subcontractors. Consultant further agrees that nothing herein
shall be construed as the creation of a partnership or joint enterprise between City and Consultant.
LIABILITY AND INDEMNIFICATION.
CONSULTANT SHALL BE LIABLE AND RESPONSIBLE FOR ANY AND ALL PROPERTY
LOSS, PROPERTY DAMAGE ANDIOR PERSONAL INJURY, INCLUDING DEATH, TO ANY AND ALL
PERSONS, OF ANY KIND OR CHARACTER, WHETHER REAL OR ASSERTED, TO THE EXTENT
CAUSED BY THE NEGLIGENT ACT(S) OR OMISSION(S), MALFEASANCE OR INTENTIONAL
MISCONDUCT OF CONSULTANT, ITS OFFICERS, AGENTS, SERVANTS OR EMPLOYEES.
Form Services Agreement
The Nelrod Company dba Fox Energy Specialists
Page 2 of 7
CONSULTANT COVENANTS AND AGREES TO, AND DOES HEREBY, INDEMNIFY, HOLD
HARMLESS AND DEFEND THE CITY ITS OFFICERS, AGENTS, SERVANTS AND EMPLOYEES,
FROM AND AGAINST ANY AND ALL CLAIMS OR LAWSUITS FOR EITHER PROPERTY DAMAGE
OR LOSS (INCLUDING ALLEGED DAMAGE OR LOSS TO CONSULTANT'S BUSINESS AND ANY
RESULTING LOST PROFITS) ANDIOR PERSONAL INJURY, INCLUDING DEATH,TO ANY AND
ALL PERSONS, OF ANY KIND OR CHARACTER, WHETHER REAL OR ASSERTED, ARISING OUT
OF OR IN CONNECTION .WITH THIS AGREEMENT, TO THE EXTENT CAUSED BY THE
NEGLIGENT ACTS OR OMISSIONS OR MALFEASANCE OF CONSULTANT, ITS OFFICERS,
AGENTS, SERVANTS OR EMPLOYEES.
9. ASSIGNMENT AND SUBCONTRACTING.
Consultant shall not assign or subcontract any of its duties, obligations or rights under this
Agreement without the prior written consent of the City. If the City grants consent to an assignment, the
assignee shall execute a written agreement with the City and the Consultant under which the assignee
agrees to be bound by the duties and obligations of Consultant under this Agreement. The Consultant
and Assignee shall be jointly liable for all obligations under this Agreement prior to the assignment. If the
City grants consent to a subcontract, the subcontractor shall execute a written agreement with the
Consultant referencing this Agreement under which the subcontractor shall agree to be bound. by the
duties and obligations of the Consultant under this Agreement as such duties and obligations may apply.
The Consultant shall provide the City with a fully executed copy of any such subcontract.
10. INSURANCE.
Consultant shall provide the City with certificate(s) of insurance documenting policies of the
following minimum coverage limits that are to be in effect prior to commencement of any work pursuant
to this Agreement:
10.1 Coverage and Limits
(a) Commercial General Liability
$1,000,000 Each Occurrence
$2,000,000 Aggregate
(b)
(c)
Automobile Liability
$1, 000, 000
$250,000
$500,000
$100,000.
Each accident on a combined single limit basis or
Bodily injury per person
Bodily injury per occurrence
Property damage
Coverage shall be on any vehicle used by the Consultant, its employees, agents,
representatives in the course of providingservices under this Agreement. "Any
vehicle" shall be any vehicle owned, hired and non -owned
Worker's Compensation
Statutory limits
Employer's liability
$100,000 Each accident/occurrence
$100,000 Disease - per each employee
$500,000 :Disease - policy limit
Form Services Agreement
The Nelrod Company'dba Fox Energy Specialists
Page 3 of 7
This coverage may be written as follows:
Workers' Compensation and Employers' Liability coverage with limits consistent with
statutory benefits outlined in the Texas workers' Compensation Act (Art. 8308 — 1 01 et
seq. Tex Rev. Civ. Stat.) and minimum policy limits for Employers' Liability of $100,000
each accident/occurrence, $500,000 bodily injury disease policy limit and $100,000 per
disease per employee
(d) Errors & Omissions (Professional Liability):
$1,000,000 Each Claim Limit
$2,000,000 Aggregate Limit
If coverage is written on a claims -made basis, the retroactive date shall be
coincident with or prior to the date to the contractual agreement. The certificate of
insurance shall state that the coverage is claims -made and include the retroactive
date. The insurance shall be maintained for the duration of the contractual
agreement and for five (5) years following completion of the services provided
under the contractual agreement or for the warranty period, which ever is longer.
An annual certificate of insurance submitted to the City shall evidence coverage.
10.2 Certificates.
Certificates of Insurance evidencing that the Consultant hasobtained all required
insurance shall be delivered to the City prior to Consultant proceeding with any work
pursuant to this Agreement. All applicable policies shall be endorsed to name the City as
an additional insured thereon, as its interests may appear. The term City shall include its
employees, officers, officials, agent, and volunteers in respect to the contracted services.
All policies except Professional Liability shall provide a Waiver of Subrogation in favor of
the City. Any failure on the part of the City to request required insurance documentation
shall not constitute a waiver of the insurance requirement. The City reserves the right to
make reasonable requests or revisions pertaining to the types and limits of that
coverage. A minimum of thirty (30) days notice of cancellation or reduction in limits of
coverage shall beprovided to the City. Ten (10) days notice. shall be acceptable in the
event of non-payment of premium. Such terms shallbe endorsed onto Consultant's
insurance policies. Notice shall be sent to the Risk Manager, City of Fort Worth, 1000
Throckmorton, Fort Worth, Texas 76102, with copies to .the City Attorney at the same
address.
11. COMPLIANCE WITH LAWS, ORDINANCES, RULES AND REGULATIONS.
Consultant agrees to comply with all applicable federal, state and local laws, ordinances, rules
and regulations. If the City notifies Consultant of any violation of such laws, ordinances, rules or
regulations, Consultant shall immediately desist from and correct the violation.
Form Services Agreement
The Nelrod Company.dba Fox Energy Specialists
Page4of7
12. NON-DISCRIMINATION COVENANT.
Consultant, for itself, its personal representatives, assigns, subcontractors and successors in
interest, as part of the consideration herein, agrees that in the performance of Consultant's duties and
obligations hereunder, it shall not discriminate in the treatment or employment of any individual or group of
individuals on any basis prohibited by law If any claim arises from an alleged violation of this non-
discrimination covenant by Consultant, its personal representatives, assigns, subcontractors or
successors in interest, Consultant agrees to assume such liability and to indemnify and defend. the City
and hold the City harmless from such claim
13. NOTICES.
Notices required pursuant to the provisions of this Agreement shall be conclusively determined
to have been delivered when (1) hand -delivered to the other party, its agents, employees, servants or
representatives, (2) delivered by facsimile with electronic confirmation of the transmission, or (3)
received by the other party by United States Mail, registered, return receipt requested, addressed as
follows:
To The CITY:
City of Fort Worth
Housing and Economic Development Department
Attn: Blake Kornegay
1000 Throckmorton
Fort Worth TX 76102-6311
Facsimile (817) 392-7369
To CONSULTANT:
3109 Lubbock Avenue
Fort Worth, TX 76109
1-866-448-0961 ext. 111
Facsimile: (817) 546 0161
14. SOLICITATION OF EMPLOYEES.
Neither the City nor Consultant shall, during the term of this agreement and additionally for a
period of one year after its termination, solicit for employment or employ, whether as employee or
independent contractor, any person who is or has been employed by the other during the term of this
agreement, without the prior written consent of the person's employer.
15. GOVERNMENTAL POWERS.
It is understood .and agreed that by execution of this Agreement, the City does not waive or
surrender any of its governmental powers.
16. NO WAIVER.
The failure of the City or Consultant to insist upon the performance of any term or provision of
this Agreement or to exercise any right granted herein shall not constitute a waiver of. the City's or
Consultant's respective right to insist upon appropriate performance or to assert any such right on any
future occasion.
17. GOVERNING LAW / VENUE.
This Agreementshall be construed in accordance with the internal laws of the State of Texas. If
any action, whether real or asserted, at law or in equity, is brought on the basis of this Agreement, venue
for such action shall Ile in state courts located in Tarrant County, Texas or the United States District Court
for the Northern District of Texas, Fort Worth Division.
Form Services Agreement
The t4elrod Company dba Fox Energy Specialists
Page 5of7
18. SEVERABILITY.
If any provision of this Agreement is held to be invalid, illegal or unenforceable, the validity,
legality and enforceability of the remaining provisions shall not in any way be affected or impaired.
19. FORCE MAJEURE.
The City and Consultant shall exercise their best efforts to meet their respective duties and
obligations as set forth in this Agreement, but shall not be heldliable for any delay or omission in
performance due to force majeure or other causes beyond their reasonable control (force majeure),
including, but not limited to, compliance with any government law, ordinance or regulation, acts of God,
acts of the public enemy, fires, strikes, lockouts, natural disasters, wars, riots, material or labor
restrictions by any governmental authority, transportation problems and/or any other similar causes.
20. HEADINGS NOT CONTROLLING.
Headings and titles used in this Agreement are for reference purposes only and shall not be
deemed a part of this Agreement.
21. REVIEW OF COUNSEL.
The parties acknowledge that each party and its counsel have reviewed and revised this
Agreement and that the normal rules of construction to the effect that any ambiguities are to be resolved
against the drafting party shall not be employed in the interpretation of this Agreement or exhibits hereto.
22. AMENDMENTS / MODIFICATIONS / EXTENSTIONS.
No extension, modification or amendment of this Agreement shall be binding upon a party hereto.
unless such extension, modification, or amendment is set forth in a written instrument, which is executed
by an authorized representative and delivered on behalf of such party.
23. ENTIRETY OF AGREEMENT.
This Agreement, including the schedule of exhibits attached hereto and any documents
incorporated herein by reference, contains the entire understanding and agreement between the City
and Consultant, their assigns and .successors in interest, as to the matters contained herein. Any prior or
contemporaneous oral or written agreement is hereby declared null and void to the extent in conflict with
any provision of this Agreement.
24. SIGNATURE AUTHORITY.
The person signing this agreement hereby warrants that he/she has .the legal authority to execute
this agreement on behalf of the respective party, and that such binding authority has been granted by
proper order, resolution, ordinance or other authorization of the entity. The other party is fully entitled to
rely on this warranty and representation in entering into this Agreement.
[SIGNATURE PAGE FOLLOWS]
Form Services Agreement
The Nelrod Company dba Fax Energy Specialists
Page. 6 of 7
IN WITNESS WHEREOF, the parties hereto have executed this Agreement.
CITY OF FORT WORTH:
By:
ATT
By:
Assistant City We 4er yc
City Secret
APPROVED AS TO FORM AND LT
By:
The Nelrod Company dba.
Fox Energy Specialists:
By:
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Name: Nelson Rodriguez
Title: President
Date: O9s3OaW(D
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Form Services Agreement
The Nelrod Company dba Fax Energy Specialists
Page 7 of 7
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RONALD R. TERRY
Notary Public, State of Texas
My Commission F <pires
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OFFICIAL RECORD.
CITY SECRETARY
FT. WORTH, TX
T WORTH
FOR
Attachment A..
Scope of Work
Energy. Inspection Services
July 30, 2010
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GENERALLY
a, The City of Fort Worth, is requesting fixed costs for Weatherization
Inspections for houses or units within a multifamily complex,
(hereafter both are .referred to as a "Unif) located in Tarrant
County, in support of a Pilot Program These inspections shall be
conducted with the guidelines as established for a "Whole House"
inspection approach and/or method. The Consultant shall be an
accredited Energy Audit Inspector qualified and trained to perform
the Initial and Final Weatherization Inspections. The Inspector shall
provide documentation of these Inspector credentials.
This Pilot Program will evaluate the efficiencies and benefits of
outsourcing these tasks for the City's Weatherization Programs. If
the City of Fort Worth determines this outsourcing is a benefit, a
competitive sealed bid procurement progress will be conducted.
Based on a "Best Value' evaluation by the City of Fort Worth a new
contract may be awarded.
The City of Fort Worth reserves the right to award or not award a
contract for these services and Pilot Program. By an evaluation, the
City shall determine if it is in their best interest to award none, one
or multiple contracts for these services. If multiple contracts are
awarded the services shall be split to the Consultants as
determined by the City's evaluation, An award, if made shall be
made to the Consultant or Consultants providing the Best Value as
determined by the City of Fort Worth.
b. Consultant shall provide a total, firm, fixed unit cost for each task
identified in Attachment B The proposed fee for these services
shall include all labor, material equipment and any other items
required to satisfactorily and professionally complete the task.
Consultant shall perform .prompt and efficient professional
inspection services or other services as required, after receiving a
written, approved Work. Order from the City's Housing and
Economic Development Department, (hereafter referred to as the
'City"). An example of these Work Orders are included.. as
"Attachment C and Attachment D":
i, Attachment C is created internally by the City based on the
"Priority List. This release is generally used for Multifamily
Units
ii. Attachment D is generated by .a NEAT Audit. This release is
generally used for Single Family Homes.
2ofb
I1. BASIC SERVICES
a. AUTHORIZING WORK ORDER
The City will issue the Consultant a Work Order identifying
the services authorized and the Unit's address. Consultant
shall within two (2) working days of receiving this Work
Order, contact the citizen or appropriate authorized person,
(Le. Apartment Manager) associated with that Unit and
schedule a mutually agreed upon time to .start the required
services.
b. PERFORM AN. INITIAL WEATHERIZATION INSPECTION
i. Consultant shall perform the Initial or Post -Inspection for
each Unit authorized, including completing the City's 'Pre -
Assessment Form" This form is included as "Attachment
EA. The Consultant shall perform all required inspections,
test, observations, sketches, color pictures and all other
tasks required to complete the entire Pre -Assessment Form,
including to but not limited to a
ii.. Pre -Renovation Lead Form and delivery, if required the City
supplied "Lead Pamphlet"
Hi. Perform Carbon Monoxide Test if applicable
iv. Sketch
v. Blower Door Test
vi. Visual Inspection
vu. Consultant shall complete the Initial. Inspection including. the
Pre -Assessment Form and/or NEAT Audit on each Unit
within ten, (10) working days of receiving a Work Order.
vili. ENVIRONMENTAL REVIEW
ix. Consultant shall complete the City's Environmental Review
for each unit. Generally this Request Form is only needed
on Single. Family Units Consultant shall including color
photographs as. required. These photographs include at a
minimum a picture of the Front across the street and the
Right and Left Sides of the Uit. This form is included as part
of "Attachment E" for review.
3 of6
x. Consultant shall submit the completed form and color
photographs within ten (10) working days of the authorizing
Work Order
xi. Consultant can provide these documents to the City as a
paper original or an agreed to electronic format
c. FINAL INSPECTION
Consultant shall perform the Final Inspection for each Unit if or
when authorization is provided by the City. The Consultantshall
review the Pre -Assessment Form and/or NEAT audit, City's Work
Order and City's Contractors Invoice verifying all required
Weatherization improvements identified and in these documents
are, satisfactorily completed, installed correctly and within
established industry guidelines and workmanship.
I. Consultant shall thoroughly conduct a Final Inspection for
each authorized Unit. The consultant conducting the Final
Inspection will be responsible for ensuring that all
weatherzation improvements identified are either on the
Priority List or the NEAT Audit. The consultant shall verify
that these identified weatherization measures /improvements
are installed and working properly ensuring no more or less
of these measures were installed.
ii. Consultant will inspect the outside and inside of the Unit for
proper installation of the weatherization measures This
includes ensuring that the required materials were installed,
the materials were installed correctly and that no safety
hazards exist related to the installation of the weatherization
approved, required measures/improvements.
iii. Consultant shall document any deficiencies identified in this
Final Inspection. All observed problems shall be
documented in a detailed manner. This documentation shall
clearly .identify the problem and include a minimum of the
below information;
1. Unit Address
2. Location at the Unit where the identified problem(s) is
located
3. Detailed description of the problem and if
required/needed a picture or pictures
4. Date of Inspection
5. Inspector names
4 of6
6. Contractors name
7. Contractor's Representative present at the Inspection.
d. Final Re -Inspection
Consultant, if required shall conduct additional Final Inspections to
verify ail weatherization problems identified by the first Final
Inspection are now correct and functioning properly This re -
inspection Consultant shall document all weatherization measures
and improvements as identified for the Unit are installed correctly,
functioning properly and are within established Industry Guidelines
and Workmanship. Consultant shall also verify that no safety
hazards exist relating to the installation of the weatherization
measures or improvements.
e. FINAL OR POST BLOWER DOOR TEST
When all weatherization measures/improvements are inspected
and satisfactorily installed and functioning properly the consultant
shall perform the Final or Post Blower Door Test and complete and
verify the 'Building Weatherization Report', (BWR). The BWR is
included as 'Attachment F".
i. Consultant shall compare the results of the Final Blower
Door Test to the Initial Assessment Blower Door Test to
determine the effectiveness of the installed weatherization
measures/improvements.
H. Consultant shall document these results as required and
also provide the City labeled pictures as supporting
documentation
f. WEEKLY REPORTING REQUIREMENTS
i. Consultant shall provide the City with a weekly written Status
Report of all Units that cannot be scheduled for an
Inspection Appointment within two, (2) ..working Days of
receiving the authonzing Work Order. The Format and
schedule for this Report shall be mutually agreed to.
IJ. Consultant shall also provide weekly a report identifying the
Units that are scheduled for services. The Format and
schedule for this Report shall be mutuallyagreed to.
iii. Consultant shall provide the City with a weekly written Status
Report of all Units that cannot have the Inspection and/or
5 of 6
g.
NEAT Audit completed within ten (10) Working Days of
receiving the Work Order. This report shall also include a
detailed Recovery Plan and revised inspection completion
date. The Format and schedule for this Report shall be
mutually agreed to.
Consultant shall provide the City with a weekly written report
of all activities concerning the Environmental Request Tasks.
The Format and schedule for this Report shall be mutually
agreed to
v. Consultant shall provide the City a weekly written Status
Report of all other activities scheduled, not scheduled,
completed or Units with issues/problems. The Format and
schedule for this Report shall be mutually agreed to
vi. The Format and schedule for these Reports shall be
mutually agreed to.
CUSTOMER SURVEY
i The Consultant will be responsible for providing and
conducting a written survey to each Unit to ensure that there
is complete satisfaction with the Weatherization Program.
The Consultant will also be responsible for reporting whether
the Units occupants are not satisfied. The results of this
survey will be summarized and a written report presented
monthly for the City's review. The Format and schedule for
this Report shall be mutually agreed to.
h. ADDITIONAL SERVICES
Consultant shall modify the required services, adding to or reducing
the scope related to these inspection services as requested by the
City in writing at a mutual agreed to price adjustment, if needed.
FORT
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Attachment B
Fee Schedule
Energy Inspection Services
July 30, 2010
Additional Information
Attachment - B
Fee Schedule
Energy Inspection Services
Fox Energy Specialists
Single
Family
Unit
Task
Cost
per
Unit
Cost
per
Unit
Total
Electric
with
Gas/Other
Initial
Weatherization
Inspection
$350.00
$375.00
Environmental
Review
Request
$50.00
$50.00
Final
Inspection
including
Blower
Door
Test
$200.00
$235
00
Final
Re -Inspection
$70.00
$70.00
Customer
Survey
$20100
$20.00
.t:
Unit
Multifamily
within a
Complex
Cost
Unit
Task
per
Cost
per
Unit
Total
Electric
with
Gas/Other
Initial
Weatherization
Inspection
$250.00
$275.00
Final
Inspection
including
Blower
Door
Test
$150.00
$170.00
Final
Re -Inspection
$55.00
$55.00
Customer
Survey
$20.00
$20.00
FaRT WORTH
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Attachment C
WORK ORDER by
City of Fort Worth
Energy. Inspection Services
July 30, 2010
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Work Order
Home Improvement and Construction Division
WORK ORDER INFORMATION
Work Order Name: WO/Job No 111/1
Work Order Type: Weatherization
Audit Name. Job No 111
CLIENT INFORMATION
Client Name:
Client ID: Job No 111
Alt. Client ID: Jerry 5stes
AGENCY INFORMATION
Agency: City of Fort Worth Housing and Economic
Development
Address: 1000 Throckmorton
Fort Worth, TX 76102
Agency Contact: Wells, Chris
Company Name & License Number:
Contractor's Signature:
COMMENT
Address: 1420 Nelson Place
Fort Worth, TX 76028
Agency Phone: (817) 392-7554
Fax: (817) 392-2013
Entail Address;
Work Phone: (817) 392-8814
Cell Phone: (817) 992-9033
Email Address:
•
Client Name:
Client ID: Job No 111
Alt. Client ID: Jerry Estes
Work Order
Work Order Name: WO/Job No 111/1
Report Run On: 7/28/2010
DOE Weatherization Assistant
Version 8.6.0
Page 1 of 3
Attachment D
Work Order
Pricing Document
Energy Inspection Services
July 30, 2010
FORT WORTH
Work Order.
nous=.nam acoNotenc otvffiLo1'MEN2
1000 Thmckmorlozat *Fee Woith, TX 76102.
Client: Apartment Unoccupied
Address: 7448 Candleridge CItz #1602
Fort Worth, TX 76132
Job Number: DOE ARRA #985
Initial BDR: 1626 @ 50pa
Target Blower Door Readings must not fall below 760 cfms ®50pa
Telephone: Not available
Assessor: Chris Wells
Contact Person Name and No.:
QTY.
vireo atuum)
PRICE
Labor
PRICE
Material
TOTAL
Labor
TOTAL
Material
SUB
TOTAL
Item #
DESCRIPTION
75mi
Dual Gasket rigid door (Misc. Infiltration)
1
15.00
22.00
$ 15.00
$ 22.00
$ 37.00
158mi
General Caulking (Mist, infiliratdon)
5
3.50
5.20
$ 17.50
$ 26.00
$ 43.50
29
Duct Seal Services with mastic, flat fee per duct
5
0.00
33.00
$ -
$ 165.00
$ 165.00
'172
CFL- Minimum Light Output,1,600 lumens
15
3.00
5.00
$ 45.00
$ 75.00
$ 120.00
273a
7-Day Programmable Thermostat (only), each
1
0.00
161.00
$ -
$ 161.00
$ 161.00
289b
2 TON: Heat Pump
1
700.00
1,637.00
$ 700.00
$ 1,637.00
$ 2,337.00
216b
Evaporator/Cooling coil
1
384.00
577.00
$ 384.00
$ 577.00
$ 961.00
npl2
Retrofit Thermostat Wiring
1
162.00
38.00
$ 162.00
$ 38.00
$ 200.00
0.00
0.00
$ -
$ -
$ -
0.00
0.00
$ -
$ -
$ -
0.00
0.00
$ -
$ -
$ -
0.00
0.00
$ -
$ -
$ -
0.00
0.00
$ -
$ -
$ ------
0.00
0.00
$ -
$ -
$ '-
0.00
0.00
$ -
$ -
$ -
0.00
0.00
$ -
$ -
$ -
0.00
0.00
$ -
$ -
$ -
0.00
0.00
$ -
$ -
$ -
0.00
0.00
$ -
$ -
$ -
0.00
0.00
$ -
$ -
$ -
0.00
0.00
$
$ -
$ -
0.00i
0.00
$ -
$ -
$ -
0.00
0.00
$ -
$ -
$ -
TOTAL
$1,323.50
$2,701.00
$4,024.50
FORT WORTH
Attachment E
Pre -Assessment &
Environmental Review Request
Form
Energy Inspection services
nous=AND ECONOMIC DEVEGOEA E lT
1000.T)uoalomrton St. t Fort Worth, TX 76102
•
THE WEATHERIZATION ASSISTANCE PROGRAM
CITY OF FORT WORTH
HOUSING AND ECONOMIC DEVELOPMENT DEPARTMENT
PRE -ASSESSMENT FORM
CUSTOMER
NAME:
Apartment
Unoccupied
ADDRESS:
5612
Miles
Dr
#1802,
Fort Worth,
TX
76132
PRONE:
JOB
NUMBER:
1186
_
TYPE
OF
DWELLING:
Site
Built
MH
I
OTHER
DATE
INSPECTED
INSPECTOR
(S)
PRIORITY LIST SUMMARY:
1. ' Air Sealing / Infiltration Measures
2. Seal and Insulate Ducts
3. Attie Insulation
4. Compact Fluorescent Lights
5. Smart Thermostat
6. SidewallInsullation
7.• Refrigerator
8. Floor I/Foundation Insulation
9. Heat Pump Replacement (HVAC)
10. Miscellaneous Repairs
Initials
Occupant / Owner Acknowledgement
CLIENT EDUCATION
I have received client education materials form the City's Weatherization Program including the
ENERGY SAVERS TIPS BOOKLET..
ATTIC INSULATION
I accept decline the insulation to be installed in my attic. I have been informed by
Agency staff of the energy savings which can result from this material being installed.
WALL INSULATION
I accept decline the wall insulation to be installed in my home. I have been informed by
Agency staff of the energy savings which can result from this material being installed,
SMART THERMOSTAT
I agree to allow the installation of a Smart Thermostat in my home, I have been informed by
Agency staff of the energy saving which can result from this type of unit being installed.
Date Signature of Apartment Unoccupied
Weatherization Assistance Program Priority List Pre -assessment Form July 20! 0 1
friftelimarkera
PRE -RENOVATION FORM
Occupant Confirmation
Pamphlet Receipt
E3 I have received a copy of the lead hazard information pamphlet informing me of the potential risk of the
lead hazard exposure from renovation activity to be performed in my dwelling unit. I received this
pamphlet before the work began.
Owner -occupant Opt -out Acknowledgment
❑ (A) I confirm that 1 own and live in this property, that no child under the age of 6 resides here, that no
pregnant woman resides here, and that this property is not a child -occupied facility.
Note: A child resides in the primary residence of his or her custodial parents, legal guardians, foster
parents, or informal caretaker if the child lives and sleeps most of the time at the caretaker's residence.
Note: A child -occupied facility is a pre-1978 building visited regularly by the same child, under 6 years
of age, on at least two different days within any week, for at least 3 hours each day, provided that the
visits total at least 60 hours annually.
if Box A is checked, check either Box B or Box C, but not both.
(8) 1 request that the renovation firm use the lead -safe work practices required by EPA's Renovation,
Repair, and .Painting Rule; or
(C) i understand that the firm performing the renovation will not be required to use the
lead -safe work practices required by EPA s Renovation, Repair, and Painting Rule
Apartment Unoccupied
Printed Name of Owner -occupant
■
Signature of Owner -occupant Signature Date
Renovator's Self Certification Option (for tenant occupied dwellings only)
Instructions to Renovator If the lead hazard information pamphlet was delivered
but a tenant signature was not obtainable, you may check the appropriate box below.
Declined — 1 certify that I have made a good faith effort to deriver the lead hazard information pamphlet to
the rental dwelling unit listed below at the date and time indicated and that the occupant declined to
sign the confirmation of receipt. I further certify that I have left a copy of the pamphlet at the unit with
the occupant.
Unavailable for signature— l certify that 1 have made a good faith effort to deliver the lead hazard
information pamphlet to the rental dwelling unit listed below and that the occupant was unavailable to
sign the confirmation of receipt. I further certify that I have left a copy of the pamphlet at the unit by
sliding it under the door or by (fill in
how pamphlet was left).
■
Printed Name of Person Certifying Delivery Attempted Delivery Date
Signature of Person Certifying Lead Pamphlet Delivery
5612 Miles Dr #1802, Fort Worth, TX 76132
Unit Address
Note Regarding Mailing Option — As an alternative to delivery in person, you may mail the lead hazard Information
pamphlet to the owner andtor tenant. Pamphlet roust be mailed at least seven days before renovation Marling must be
documented by a certificate of mailing from the post office.
Note: This form Is effective as of April 2010.
Weatherization Assistance Program Priority List Pre -assessment Form July 2010 2
}- -achmenie&
PRIORITY LIST # 1- MR SEALING/INFILTRATION REDUCTION
AIR SEALING MEASURES
Infiltration
Measures
Minor
Repairs
to Walls
and
Ceilings
Caulking
Y N
No. of
Tubes
Sheetrock
Repairs
Y
N
Lo cationJNotes:
Location/Notes:
Location/Notes:
Y
N
Weather-strip
Location/Notes:
DOORS
L
Location
Doors Size
Notes:
A
$
—
C
D
E
Initial Evaluation for Health & Safety
f Household Health
I Are there any household occupants health issues that wilt effect performing blower door testing:
Weatherfrafion Assistance Program Priority list Pre -assessment Form July 2010
Y
3
COMiTBUS'1111LE FUEL STOVE REPLACEMENT
(Charge to Health and Safety)
Kitchen Stove/Gas Range
Is Unit Electric?
Y
N
Stove deteriorated, Condition Warrants Replacement:
Carbon Monoxide Readings
Y
N
Comments:
I N/A
PRIORITY LIST # 2 DUCT SEALING/INSULATE/REPAIRS
Location
of
Ducts:
or Crawl
■
Unconditioned
Space
Space
❑Attic
Space
❑Conditioned
Duct
Insulation
or
Repairs
needed
to ducts
supply/return
lines or
plenum?
Y N
Notes:
No, of
Registers
Any
to
Replace?
Y
N
Filter
size
Replace
Y
N
Instruct
Client
how to
replace
filter
Y
N
Notes:
Duct
Blaster
Test Y
N
Notes:
FYI.-
Heating = 400 cfin per25,000 Btu output Cooling = 400 cfin per
12,000 Btu
(ton)
Weatherization Assistance Program Priority List Pre -assessment Form July 2010
A-iGeh rmen+
PRIORITY LIST # 3- ATTIC INSULATION
L
Location
Area
to
be
insulated
Existing
Insulation
Type
Existing
Thickness
M
Main
Attic
sq.ft.
Inches-
R-
Secondary
Attic
sq.ft,
Inches-
R
Add
(if
Yes
Insulation
have
client
sign
to R-38
front
Y N
page)
Inches?
How
many
Comments:
_
Is
There
an Attic
Access: Y N
I
Location
:
Does it need
insulation:
Y N
Does it need weather-stripping:
Y
N
Does
Comments:
it
need
to
be repaired:
Y
N
TYPE
of
hoof: Gable
HIP
FLAT
Any Roof
Leaks: Y
N
Comments:
Knob
&
Tube
Wiring:
Y
N
Comments:
1 of
Existing
Roof Vents:
Gable-
Soffit-
Turbine-
Dormer- Gravity-
Ridge
Other
-
Vents
Needed:
Gable-
Soffit-
Turbine-
Dormer- Gravity-
Ridge
Other-
Type:
weathsrizufion Assistance Program Priority List Pr.assessment Form July2010
Y-ttarhmer+
PRIORITY LIST # 4 — COMPACT FLOURESCENT LAMPS (CFLs)
Bedrooms-1 2 3 4
Number of Bulbs to Replace
Fixture Repairs Needed
Location of Replacement
Living Room
Bathroom
Kitchen
Other
Replacement Chart:
Notes:
Incandescent
CFLs
40 watts
9-13 watts
60 watts
1345 watts
75 watts
18-25 watts
100 watts
23-30- watts
Out door post light
14 watts
PRIORITY LIST # 5- SMART THERMOSTAT
Already exists: Y N
Comments
Functions: Y N
Recommend Installing:
(lf res have client sign front page)
Y N
Wee therization Assistance Program Priority List Pre -assessment Form July 2010
6
PRIORITY LIST # 6- WALL INSULATION
When
wall
completing
cavity
is
already
the
wall
exposed
insulation
or
if
If
inspection
an
Wall
infrared
Insulation
camera
process,
is
some
used
have
of
during
the
the
some
the
client
of
inspection.
sign
the
the
questions
{rant
may
page
not
be applicable
unless
a
is needed,
WALLS/SIDE
WALLS
Wall
# 1
Wall
# 2
Wall
# 3
Wall # 4
Existing
Insulation
Y N
Y
N
Y
N
Y N
Type
of
Existing
Insulation
and
R-Value
Repairs
to
Needed
Y
N
Y N
Y
N
Y
N
Walls
Can the
sustain
the
insulation
Y
N
Y
N
Y
N
Y
N
walls
surface
Exterior
wall
area*
surface
Total
area
sq.ft.
less windows
and
doors
Comments:
Exterior Wall
Composition
(Type
of
Siding)
Wood
Masonite
Vinyl
Aluminum
Other
Comments:
Weatherization Assistance Program Priority List Pre -assessment Flom July 20I0
7
ftffachrneri4-E
PRIORITY LIST # 7 — REFRIGERATOR REPLACEMENT/ASSESSMENT
Brand Name:
Model/Serial No.:
Manufactured Date:
D'sage KWHY (metering for 2 hours)
Door Hinges: Right Left
Replace unit: Y N
Comments:
PRIORITY LIST # 8 - FLOOR INSULATION
Floor Insulation
Crawl Space Height:
Install Insulation: Y N Sq,t,
Is there existing Insulation Y N
Are there any foundations vents Y N
Any to Install
Y N Type No.
PRIORITY LIST #10 - MISCELLANEOUS REPAIRS
NIMINNENNIMIMMIONIMik
Comments:
Weatherization Assistance Program Priority List Pro -assessment Form July 2010
f - Hach m,en+ E
n
WINDOW Type:.
Vinyl Wood Aluminum
Other:
Size
Work
Needed
Size:
Work
Needed
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
6
9
9
10
10
Weatherization Assistance Program Priority List Pre -assessment Form July 2010
411achmi+ E
PRIORITY LIST # 9 HEATING AND COOLING SYSTEMS
Air Conditioning Units
WU
Unit
CSCentral
System
EvarEvaporative
Cooler
Window
Location
Type
Manufacturer
Model
#
Year
BTUs
EER
Amps
Volts
CEM
1. Does the filter need cleaning or replacement? Y N 2. Do the coils need cleaning? Y N
Recommendations:
Heating Units
VSR=Vented Space Heater lUVSkliamUnvented Space Heater VWF=Vented Wall Furnace
FF=Floor Furnace CH=Central Heater WS= Wood Stove CST=Cook Stove
Location
Manufacturer
Model
#
Electric
Gas
co
Level
BTUs
Efficiency
Amps
H&S
Type
I. Are the burners in good condition? Y N
Recommendations:
2.Reason for H&S.
Water Heaters
Location
Manufacturer
Model #
Gas
Electric
CO Level
Efficiency
Gallons
WAS
I .Are the burners in good condition? Y N
Recommendations:
2.Reason for H&S.
Weatherization Assistance Program Priority List Pre -assessment Form July 2010 10
4
• I-
•
1. Client
AckM Uie 6
TEXAS DEPARTMENT OF HOUSING AND COMMUNITY AFFAIRS
BLOWER DOOR DATA SJT'ET (May 2009)
Apartment Unoccupied
2. Square Footage of Unit
3. Determine N Factor
N=
N factor
Ceiling Height of Unit
lob # 1186
Total Volume of Unit
Table 1: N Factor by height and shielding for Texas dwellings
Number of Stories
Shielded (closely surrounded by other buildings) 22.2
Normal (surrounded by trees or other buildings)
18.5
Exposed (dwelling is not surrounded by any objects) 16.7
4. Calculate the Building Tightness Limit by using the following formula: BTL = (.35 x VOLUME x N) / 60
.35x( )x( )
60
5, Initial CFM Reading
=
Building Tightness Limit (measured in CFM)
@ 50
Pascal
One One & Half Two
20
16.7
15.0
17.8
14,8
13.3
Units, whose initial CFM reading (before any weatherization work is performed) is below the BTL, shall not receive any air tightening
measures. However, energy efficiency measures such as attic insulation, wall insulation, HVAC repairs etc. may be performed.
6. Determine the Target Reduction Percentage by using the following table
Reduction %
CFM
CFM Reduction:
7. Second CFM reading (optional)
8. Final CFM Reading
9. Is the umt's final CFM reading above the BTL? ❑ Yes
No Air
Sealing
0-1250
Optional Air
Sealing
1251-2750
30%
2751-4250
40%
4251-5500
■
No
If the unit is below the BTL, mechameal ventilation must be installed.
I certify that the above referenced information is true and accurate.
Initial Test
Interim Test
Final Test
Sub -recipient Representative
Sub -recipient Representative
Sub -recipient Representative
Date
Date
Date
Wealherization Assistance Program Priority List Pre -assessment Form My 2010
Pascal
Pascal
45% 1 50%
5501-7500 >7501
11
Compliance Inspection Report
Note: Reports of Final and Repair Compliance Inspections
left at site always require reviewer's signature to be Chide!.
Consult mortgagee for officiai reports.
U.S. Department of Housing
and Urban Development
Office of Housing
Federal Housing Commissioner
OMB No.2502-0189
(exp, 10731/2004
Bender's Name and Address
WAP\CFW
4201 N. Main St., Fort Worth) TX 76106
Mortgagee's Name and Address
Apartment Unoccupied
5612 Miles Dr #1802
Fort Worth,TX 76132
a.® Report not left at site.
b.❑ Report not official without
reviewer's signature.
FHA Case Number
Date of Inspection (mm/dd/yyyy)
Property Address
5612 Miles Dr#1802
Fort Worth, TX 76132
1. Inspection of On -Site improvements Reveals
1. Construction ■ was, ❑ was not begun prior to the date of mortgage
insurance approval shown on the commitment, statement of appraised
value or "Early Start" letter. (Applies to the Initial report on new
construction)
2.0 Builder other than named In application
3,0 Unable to make inspection.(Explaln below)
4 ❑ Accepted construction exhibits not available at site
5.0 Individual Sewage disposal system•❑ Individual Water supply system
No noncompliance. ■Correction essential as explained below
Submit Health Department letter
■
9.0 No noncompliance observed
10.0 Acceptable vadadons as described below (Request for Change, form
HUD-92577, may be submitted).
11.■ Extensive noncompliance as explained below (sea iV.A below)
12. ■ On•site improvements acceptably completed subject to receipt of
cer(ficabon that mortgagee's Inspection reveals satisfactory comple-
tion of all items listed below.
13 ■ On -site Improvements acceptably completed except Hems listed be-
low,cempietion of which Is delayed by conditions beyond control of the
e.❑
Correction recede by rprt, dated not acceptably completed builder
(see IV,B below),
7.
■
Repairs required by form HUD-92800.5E not acceptably
completed
14,❑
On spa
Improvemerks
acceptably completed
15.❑
Off -site Improvements
8.
Correction essential
as explained below
❑
a Correction/Completion essential as explained below
pa
Will examine at next Inspection
❑
b Completion assured by escrow agreement or
❑b
Do not conceal until reinspected governing authority
El c. Acceptably
completed
Ii.
Exp
anation
of statements
checked
In
Parts
I and
lit
inspection
Number
X
Inspection
C
Initial
Framing 1 nip
Inspection
❑
Final
inspection
❑
Other (explain) ❑
Repair inspection
No.
Performed
initial
inspection
and
appears
to
be a
good
candidate
for WAP
services.
I will
complete
the
pre -assessment
tool
and
create
a work
order.
Certification: I certify that
ds fth
I
have carefully inspected
this
property
on this date. I have no personal interest,
present or prospective,
In the
property,
applicant,
or procee o e mortgage. To the bolt cf my knumsage i nave reponee au noncompliance, work requiring correction, and unacceptable work
Warning: HUD will prosecute false claims and statements. Coevlctlon ma result to criminal and/or civil penalties. (1e U.S,C. 1001, 1010, 1012; 31 U.S.0 3729, 3802)
Signature Dale (mm/ddlyyyy)
❑ Fee Inspector El Appraiser ID Number
❑ DE Staff Inspector ■ HUD Inspector
III. Specific Conditions Required by the HUD-92800.5B, Not Requiring Field Inspection
16. U Submit items or resubmit incomplete
Hems as noted above.
Approved Signature
r as modified
by me
■
17. Acceptable Compliance with all specific 18. ■ Submit Termite Sop
corxtitions not requinng field inspection. Treatment Guarantee.
Date 0 Direct Endorsement Underwriter
(mrnktd/yyyy)
Chief Architect ❑ Deputy
N. To Mortgagee: When signed below, refer to the statement on the track corresponding to the designation checked
❑ A. Noncompliance
❑ (a) Variations from exhibits.
(b) Unacceptable construction.
(a) Premature construction,
■
■
B Compliance - incomplete Items, "Mortgagee's Assurance
of Completion", HUD-92300, may be submitted.
for completion
$ not later than;(nvnfdd/yyyy)
Signature Date (mm/ddlyyyy)
°,; / bg•li ri " 01grfilltsiVii
Previous editions are obsolete,
Retain this record for 30 years or the lice of the We Submit an Original and four copies
❑ None
ID Number
C. Final Acceptance, Closing papers
may be submitted provided
mortgage credit analysis is
acceptable
U Direct Endorsement Underwriter
❑ Director of Housln Development Q De.
•
• :hi R •.1:f? .i .r._r;= : i .arat; _!Et •.i.'DfA::Lre;rkrlr;q.._ : :;e, . "-
=,.
s `
IfLS. �, it :
ID Number
form U • _ 2051 (7187)
ref, Handbooks 4000, 4115.3, 4i 45, 4165, 4190, & 4240.4
Weathcrizntion Assistance Program Pnorfty List. Pre -assessment Form July 2010
12
4i£ "Y.i`.Fi, �'•.
1;21 W, tyFogg St. �F$uf1\VOdIL. Ts 76110 t Soytti�� w
yy;-.�z+d�',+S M�1'`���aa`••A ;.M•A►Tl�a� 6w� a'YY"�{t•^Ai�;�� 3+�y''Sy'�.:•��t
M.w • r '!'b...r. + Al'Sr, r d )t:-11
1321 W. Fogg Si Fort Worth -Tx 76110 (West)
321 W. Fo; St. Fori Word. Tx 76110 (1+ierl1f)
eLmr rooflealtinTfflley on front of house
�Addk 19 blen 1iberglassin nlaLion to the attic
•
ok
_.1321 W_ Fogg $t Fort Worth, Ts. 76110 (Bail)
i:nrtAF�'rFNfir t
dti
1321 W. Fo
1321 W. Fa
:
St. Fort North Tx 76110 to the ri¢11,1)
St. Fort W orth- Ts 76110 (to tIfe left)
- A A 1 Sftli�4 X IA?M�Ms� "1w131
t 1321 W •F M•'SC Farf worth. Tx 76110 (across the
s
�' .f •f r•1'. al, e
•
Afliwhrven1- E
•
•
CITY OF FORT WORTH HOUSING and ECONOMIC DEVELOPMENT
DEPARTMENT
ENVIRONMENTAL REVIEW REQUEST FORM
PROJECT DATA
•
Program/Activity Name: Weatherization Assistance Program/ American
Recovery Reinvestment ACT 2009 (WAP/ARRA)
Project/Activity Location: 5400 Oak Grove Road W Fort Worth, Tx 76134
(Add a separate document if multrpte locations are Included)
Point Person or Contact for Project: Joe Cordova
Contact Information: Sherry Johnson
(City staff will provide information)
Eundrng Source: WAF/ARFCA "`
Funding Amount or Estimate: $6,500.00
Grant Number:
(City staff will provide information)
Date: March 22, 2010
•
ENVIRONMENTAL REVIEW DATA
Provide the following information for this request.
Purpose of the Project:
To carry out Weatherization Assistance Program actives using American
Recovery Reinvestment Act of 2009 funding. These funds will be used to
assist income eligible homeowners with weatherization improvements to
their homes.
Site Specific Project Activity Description: Many of the homes in this program
are older and it is impossible to know all the work that is needed until a project
commences. Therefore, all exempt activities listed in Appendix A (see list below)
will be cleared as possible activities for each property. All in -kind materials will be
used when making repairs, replacements, or upgrades. Repairs replacements
or upgrading will not require alterations to the exterior of the building
Revised 03/02/2007
•
nmf�
CITY OF FORT WORTH HOUSING and ECONOMIC DEVELOPMENT
DEPARTMENT
ENVIRONMENTAL REVIEW REQUEST FORM
•
S ite Specific Work. Installation of attic and wall insulation, seal HVAC
ductwork, install CFL lamps, caulk around all plumbing penetrations,
electrical repairs, replace gas furnace, replace kitchen gas range.
N OTE:
o Each submittal shall include a work order form for the work
performed.
o if additional work is needed and is listed in Appendix A, that work
may continue without the ER being resubmitted for Sec. 106 review.
Files must be documented according to the change.
o Work cannot be performed for non Appendix A items until SHPO has
__ _ reviewed and approved such_ activities. if additional work i.5,needed,_.,,____.
and is not listed in Appendix A, Housing and Economic Development
staff must resubmit the project new activities with its updated work
order for SHPO review,
Activities Exempt from Section 106 Review (Appendix A of Interagency Agreement
between TDHCA and Texas SHPO)
Interiors
o Work not visible from exterior of building; no structural alterations; no
interior demolition; no drop ceiling added; and no walls leveled or moved.
o Repair or upgrading of electrical or plumbing systems with no effect to
exterior.
o Replace existing appliances, water heaters, CFL light bulbs.
o Install fire, smoke or carbon monoxide detectors.
o Install mechanical equipment with no effect to exterior.
o Repair mechanical equipment provided that new equipment is installed in
location of existing equipment and no physical alteration of building exterior.
o Insulation in accordance with Preservation Brief #3. No spray foam
insulation; Holes shall not be drilled through exterior siding or interior
decorative plastenvork for installation of exterior blown in insulation.
Rooting
o In -kind replacement of existing roofing material.
o Installation of reflective roof coating where not visible from ROW or with
materials that closely match historic materials and form, restore the feature,
and does not alter the roofline.
o InstaIIation of covered ridge vents and other vents not visible from ROW.
Revised 03/02/2007
dritryien4 2
CITY OF FORT WORTH HOUSING and ECONOMIC DEVELOPMENT
DEPARTMENT
ENVIRONMENTAL REVIEW REQUEST FORM
Exterior Painting- In accordance with Preservation Brief #37 and with no
destructive surface prep methods (i.e. Water or sand blasting, chemical removal)
Masonry- In accordance with Preservation Brief # 1 & # 2
Windows and Doors
o Air infiltration control measures that do not obscure historic windows or trim.
o Interior storm windows and doors or exterior doors that do not harm or obscure
historic windows and trim.
o Removable, transparent film an windows, solar screens, or window louvers that
do not harm or obscure historic windows or trim. -
foundations _ _
o Underpinning and ventilating crawl space, provided that materials are set at
least two inches behind outer face of piers on front facade.
o Installation of foundation vents, painted or finished to match existing materials.
Other Exterior
o In -kind repair of minor roof and wall Ieaks prior to insulating attic walls.
Site Work- Repair of hardscape or plumbing infrastructure that does not disturb
historic
Please attach the following documents only if it applies to the Project/Activity,
1) At least 2 color photographs of the protect/activity area:
(Clearly mark the home that will receive the WAP/ARRA assistance.)
2) Lead Letter/Risk Assessment:
(For all dwelling structures built prior to 1978)
3) Site Specific Work Order
(Attach site -specific work order detailingthe work to be competed)
•
Revised 03/02/2007
•
•
mchni en+ £
CITY OF FORT WORTH HOUSING and ECONOMIC DEVELOPMENT
DEPARTMENT
ENVIRONMENTAL REVIEW REQUEST FORM
Submitted by: Chris Wells
Date: March 22, 2010
.01016
Revised 03/02/2007
The Weatherization Assistance Program
Work Order
Client: J L Cooper
Job No.: DOE A ] A # 122 !
Address: 5400 Oak Grove Rd. W Fort Worth, Tx 767.34
Target Blower Door Readings: optiondl airsealing
Telephone: 817-568-6848
Assessor: Chris Wells
'
QTY. _
PRICE
PRICE I
TOTAL
TOTAL
SUI3
DESCRIPTION
Labor
MaterialI
Labor
Material
TOTAL
Caulking around all plumbing penetrations,
10
$ 5.20
$ 3.50
$ 52.00
$ 35.00
$ 87.00
i`oam tape around furnace closet door
1
$ 10.00
$ 8.00
$ 10.00
$ 8.00
$ 18.00
MS doors A,B,C, and attic access
4
$ 14.00
$ 10.00
$ 56.00
$ 40.00
$ 96.00
Seal all ducts wl mastic
9
$ 33.00
$. - !
$ 297.00
$ -
$ 297.00
Seal plenum
1
$ 50.00
$ - i
$ 50.00
$ -
$ 50.00
Seal return
1
$ 60.00
$ - I.
$ 60.00
$ -
$ 60.00
Duct Blaster Test
1
$ 157.00
$ - i
$ 157.00
$ -
$ 157.00
CFL Lamps
15
$ 5.00
$ 3.00
$ 75.00
$ 45.00
$ 120.00
R-11 blown in cellulose wall insulation
1176
$ 0.60
$ 0.40
$ 705.60
$ 470.40
' $ 1,176.00
R-19 blown in fiberglass attic insulation
1500
$ 0.42
$ 0.27
$ 630.00
$ 405.00
$ 1,035.00
Gaskets for electrical outlets
30
$ 1.20
$ 0.80
$ 36.00
$ 24.00
$ 60.00
$ -I
$ -
$ -
$ -
75K BTU central gas furnace (H&S)
1
$ 1,630.00
$ 1,085.00
$ 1,630.00
$ 1,085.00
$ 2,715.00
30" Gas kitchen range (H&S)
1
$ 420.00
$ 60.0.0
$ 420.00
$ 60.00
$ 480.00
$ -
$ -
$ - •
$ -
$ -
$ • -
$ -!
$ -
$ -
$ -
$ -
$ -
$• -
$ -
$ -
$ -
$ - f
$ -
$ -
$ -
I
$ -
$ -
$ -
TOTAL i
4,178.60
2,172.40' $ 6,351.00
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540Oak Grove Rd. W Fort Worth, Tx 76134 across the streetL
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400 Oak Grove Rd. W -Fort Worth., Tx 76134 (to the left)
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dnmout g
.
•
Information
as actually
Appraised
" A
"'Rounded
reference
TAD's
Owner
Taxing
Property
Legal
e
o
Description:
Number:
is
re
Appraisal
03/10/2010
e:
026
099
220
224
225
904
to
J
of
It
Grove
L
Grove
Addition
Worth
Rd
Rd
Hospital
College
W,
W
District
Fort
Worth
Dist
Dist
'
Tarrant
Account
database.
District
03267733
44650-5-8
5400
Cooper,
5400
Fort
View
BIk5Lot8
Proposed
G
Jurisdictions:
refe
Prior
and
Location:
Estate
Worth
Park
Oak
Oak
76134-2328
Water
ISD
Rea[
c
City
Regional
Tarrant
Tarrant
Tarrant
Everman
Owners
subject
n
Values
only
Information:
3
Tx
Fort
may
County
County
County
Thls
account
is
zero
intended
carried
for
in
change.
for
not accurately
Year
2010
reffect
the complete
status
ofe
Tax
'
Land
Impr
2010
Total**
Market
Value
$O
SO
SO
(Appraised
I{
Approximate
Value*
SO
SO
SO
Size***
1,500
Land
Acres
0-t)000
!Land
SgFt
0
value
value
may
Indicates
be
that
than market
property
5-Year
value
record
due
has
Value
to
not yet
sta
History
e-mandated
been
completed
limitations
for
on value
the indicated
increases
tax year
lass
the
Tax Year
XMPT
Appraised
Land
Appraised
Impr
I Appraised
i
Total
Market
Land
Market
Impr
Market
Total
2009
050
$6,000
$33,700
$39,700
$6,000
$33,700
S39,700
2008
050
$6,000
S56,800,
S62,800
$6,000
$56,800
$62,800
2007
050
$6,000
552,4601
$58,460
S6,000
$56,800
$62,800
2006
050
661000
S47,1461
S53,146
$6,000
$56,800
$62,800
2005
050
S6,000
$42,3151
$48,315
S6,000
$70.200
$76,200
Pot
Deed
Deed
Year
Deed
Complete:
TAD
MAPSCO:
Data
Dtsabled
Page:
10/02/1996
012540
1684
100
2054
091U
None
Person
380
General
Homestead
Protest
Deadline:
State
Garage
Central
Central
Class:
Code:
Bays:
Heat:
Pool:
Air:
006
Al
00
Y
Y
N
Single
Family
Exemptions;
Property
Date:
Built:1959
Map:
Vol:
Agent:
Fo?T WORT
MkeAdimen4- E
floUs ito4ab rcorioMienevaonffiit
loon 77uaabmnanst. • rod Wank; riiisio2
Project Pictures
Pictures c.
Home to the Left
Home Across Street
Pictures of Neighborhood
Home to the Right
•
Home Across Street
FoRT WORTH
'-'uswfri*"ter
Attachment F
Building Weatherization Report
Energy Inspection Services
July 30, 2010
Additional Information
fi011Crtt"u:ue-t4ONosgcsbarCoD linti
Dag huoeihni+cut sr > 2e41 Worh-1X741gt
BIDING WEATFIERIZATION REPORT
Agency City Of Fort Worth H.E.D. Vendor:
Contract #:
County
TARRANT
DOE ARRA WAP # 16090000664 'Audit#: Job No
blame Address
Priority List Estimated Cost: $5,000.00
Final Blower Door Reading:
Heating Equipment
Location RPR RPL
Cooling Equipment
Location RM. RPL
Work Start Date: Work End Date:
Phone#:
Total square footage of conditioned space: sq. fk
Type Fuel Efficiency Monoxor
Pre Post Pre Post
I II
Type
Fuel.
Weatherization Materials Installed - (List in SIR Order)
Total Cost of Weatherization Materials
COP
Pre Post.
1
SIR!
H&S
SIR/
H&S
Heater Types
VSH
UVSI•I
VWF
FF
CH
WS
COOKSTOVE
A/C Types
WU
EVAP
CS
Quantity COST--DOE/ARRA
Labor Material
1
Compliance Inspection -Report
Note: Reports of Final and Repair Compliance Inspections
(eft et site always require reviewer's signature to be Official,
Consult morlgagee for official reports.
Builder's Name and Address
CFWIWAP
4201 N. Main St, Fort Worth, TX 76106
hn carnckatuome
'Mortgagee's Name and Addmss
Erasmo Cabello
1321 W. Fogg St.
Fort Worth, Tx, 76110
I. lnspsctIon of On -Silo Improvements Reveals
U.S. Oepartmenfof Housing
and Urban Development
Ofiice of housing
Federal Housing Commissioner
a. ❑ Report not left at site,
b.❑ Report not official without
reviewer's signature.
Property Address
1321 W. Fogg St.
Fort Worth, Tx. 76110
•
OMB No. 2502-0189
(ex).10/31/2004
FHA Case Number
Date of Inspection (mmidd/yyyy)
7128/10
1. Construction Ili was, C0 was not begun prior to the date of mortgage
insurance approval shown on the commitment, statement of appraised
value or "Early Start" letter. (Applies to the initial report on new
construction)
2.0 Builder other than named in applicatfon
3. ■ Unable to make inspection,(Explafn below)
4411 Accepted construction exhibits not available at site
5.111 Individual Sewage dispose( systenv0 Individual Water supply system
No noncompliance. ['Correction essential as explained below.
0 Submit Health Department letter
6.C] Correction req'd. by rprt, dated not acceptably completed
7.0 Repairs required by form HUD-92600.55 not acceptably completed
8.9 Correction essential as explained below
0a Will examine at next inspection
[lb Do not conceal until reinspected
II, Erxp anation of statements checked in Parts i and 111
P—1 What Inspection III Framing inspection
■
Re
•
•
Final Inspection
9. 0 No noncompliante observed
10. ■ Acceptable variations as described below (Request for Change, form
HUD•92577, may be submitted),
11.0 Extensive noncompliance as explained below (see IV.A below)
12.0 On -site improvements acceptably completed subject to receipt of
certification that mortgagee's inspection reveals satisfactory comple-
tion of ail items listed below. •
13. ■ On -site Improvements acceptably completed except items listed be-
low,completion of which is delayed by condklons beyond control of the
binder (see iV.B below).
14.111 On -site Improvements acceptably completed
15.0 Off -site improvements
❑ a Correction/Completion essential as explained below
❑ b. Completion assured by escrow agreement or governing authority •
a Acceptably completed
Inspection Number
Other (explain) ❑ Repair Inspection
r
Final Inspection, Additional work was performed to bring blower door to an acceptable reading Doors seated and
Weather stripped. Contractor worked for several hours sealing and locating air Infitfration. Installed new cook stove.
Installed new wall furnace. Installed bath tub surround. Work complete ower excited.
•
•
Certification: 1 certify that 1 have carefully inspected this property on this date. I have no personal interest, meant or prospective, in the property, applicant,
or proceeds of the mortgage, To the best of my knowledge 1 have reported all noncompliance, work requiring correction, and unacceptable work.
. arning: HUD.will prosecute false datms and statements. Conviction may result in criminal and/or civil penalties. (1a U.S.C, 1001, 1010, 1012; 31 U.S.C..3729, 3802)
ature A / Date (mm/ddfyyyy)
0 Fee inspector . 0 Appraiser ID Number
7/28i10
ill. 'sec 'c Conditions Require by the HUD-92800.6B, Not Requiring Field Mapes -eon
16. t aebmif sterns or
kers as noted a
Approved
as modified
by me
V, To.Mortgagee: When s
] A Noncompliant
(a) Variatio
❑ (b) Una
❑ (c) Pre
111
Signs ure Date
(mm/dd/y )
For HUDOnly for concurrence of Direct Endorsement Processing of.
this Compilanceinspectlon Report.Ifsigned, thisftnal report fs considered
processed by HUD and,•thereby, cdnvert(b(e to the Veterans Administration.
Previous edfions we obsolete.
Retain this record for 30 years or the fife of the file Submit en Original end four copies
Sfg
❑ DE Staff inspector ❑ HUD inspector
Incomplete 17, 0 Acceptable Compliance with all specific
conditions not re wan field inspection,
❑ Direct Endorsement Underwriter
Date--
7128/10f10
ned below, refer to the statement on the back corresponding to the designation checked.
18. ❑ SubmitTermfte Soli IIII None
Treatment Guarantee.
from exhibits,
able construction,
ure construction.
Chief Architect
B. compliance e Incomplete Items. "Mortgagee's Assurance
of Completion", HUD-92300, may be submitted.
for completion
S riot later than:(mmfddwyyyy)
❑ e.
0 Direct Endorsement Underwriter
0 Director of Housing Development
•
Deputy
[ D Number
Final Acceptance. Closing papers
may be submitted provided
mortgage credit analysis is
acceptable
ID Number
0 Deputy .
.SIgnalure of Hen Aulbonmd Agent nato
- .• . (ttirordct+jyyy)
•
formHU0.9206 ( l
rat Handbooks 4noe, 41 tb.3 44451 4165, 4180, & 4240.4
l