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Home My WebLink AboutContract 44406-FP1 CITY SECRETAW L+ b F 1 FORTWORTH. TRACT NO }� ?6 3- b I Z40 C5 �liO(o TRANSPORTATION AND PUBLIC WORKS NOTICE OF PROJECT COMPLETION D.O.E. Ns: 6565 WSM-A Regarding contract 44406 for WATER AND SANITARY SEWER REPLACEMENT CONTRACT 2009-w^as required by the WATER DEPARTMENT as approved by City Council on 03/05/2013 through M&C C-26142 the director of the WATER DEPARTMENT upon the recommendation of the Assistant Director of the Transportation& Public Works Department has accepted the project as complete. Original Contract Prices: �� 1EE 1 $1,638,475.30 Amount of Approved Change Orders: AP �� $68,033.65 Ns 1,2 i Revised Contract Amount: 1� $1,706,508.95 Total Cost Work Completed: $1,666,415.70 Less Deductions: Liquidated Damages: Days @$210.00/Day Pavement Deficiencies: Total Deduction Amount: $0.00 Total Cost Work Completed: $1,666,415.70 Less Previous Payments: $1,644,156.96 Final Payment Due $22,258.74 Recommended for Acceptance Date Asst. Director, TPW - Infrastructure Design and Construction Accepted Date erector, WATER DEPARTMENT City Manager Date m Comments: FUND P253-608170144483 /P258-708170144483 M M M OFFICIAL RECORD 0 M CITY SECRETARY FT.WORTH, TX {{ APR 3 0 2015 / C S 14�4 44 No City Project Numbers 01444 !?: DOE Number 6565 Contract Name WATER AND SANITARY SEWER REPLACEMENT CONTRACT 2009 Estimate Number 23 Contract Limits Payment Number 23 Project Type WATER&SEWER For Period Ending 228/2015 Project Funding Project Manager Ch-bey City Secretary Contract Number 44406 Inspectors RODGERS / SAI AZAR Contract Date 3/5/2013 Contractor JACKSON CONSTRUCTION LTD Contract Time 200 CD 5112 SUN VALLEY DRIVE Days Charged to Date 299 CD FORT WORTH, TX 76119 Contract is 000000 Complete CITY OF FORT WORTH i\�}y!O i� - >> SUMMARY OF CHARGES - " Line Fund Account Center Amount Gross Retainage Net Funded -------------------------------------- Total Cost of Work Completed $1,666,415.70 _ Less %Retained $0.00 Ep,DEr<.RI'Y!EAiT Net Earned $1,666,415.70 E IGINEERiNG k ND FISCAL SER` !CES ��rcr n o_ 8429Earned This Period $22,258.74 Coria B�* ena i_os- ;t:.. De pF o-_l Si naLu—for' Retainage This Period $0.00 Less Liquidated Damages DEPARTMENT CHECK PICK-l YES ❑ 0 Days @ $0.00 /Day $0.00 LessPavement Deficiency $0.00 Less Penalty $0.00 Less Previous Payment $1,644,156.96 Plus Material on Hand Less 15% $0.00 Balance Due This Payment $22,258.74 Friday,Much 06,2015 Page 6 of 6 FORT WORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name WATER AND SAMTARY SEWER REPLACEMENT CONTRACT 2009 WS M—A Contract Limits Project Type WATER&SEWER City Project Numbers 01444 DOE Number 6565 Estimate Number 23 Payment Number 23 For Period Ending 2/28/2015 CD City Secretary Contract Number 44406 Contract Time 20CD 79 9 C D4ee WJE Contract Date 3/5/2013 Days Charged to Date 299 Project Manager Chaubey Contract is 98.000 Complete Contractor JACKSON CONSTRUCTION LTD 5112 SUN VALLEY DRIVE FORT WORTH, TX 76119 Inspectors RODGERS / SALAZAR Friday,March 06,2015 Page 1 of 6 City Project Numbers 01444 DOE Number 6565 Contract Name WATER AND SANITARY SEWER REPLACEMENT CONTRACT 2009 Estimate Number 23 Contract Limits Payment Number 23 Project Type WATER&SEWER For Period Ending 2/28/2015 Project Funding WATER IMPROVEMENTS ItemEstimated Estimated Completed Completed Description of Items Unit Unit Cost No. Quanity Total Quanity Total 1 24"PVC C905 WATER PIPE(CO#2) 2013 LF $108.00 $217,404.00 2013 $217,404.00 2 12"WATER PIPE(CO 92) 1115 LF $46.00 $51,290.00 1115 $51,290.00 3 8"WATER PIPE(CO#2) 8634.4 LF $27.00 6233,128.80 8634.4 $233,128.80 4 6"PVC WATER PIPE(CO#2) 85 LF $27-00 $2,295.00 85 $2,295.00 5 24"GATE VALVE W/VAULT 3 EA $28,000.00 $84,000.00 2 $56,000.00 6 12"GATE VALVE 5 EA $2,000.00 $10,000.00 5 $10,000.00 7 8"GATE VALVE(CO#2) 18 EA $1,100-00 $19,800.00 18 $19,800.00 8 6"GATE VALVE 13 EA $775.00 $10,075.00 13 $10,075.00 9 SALVAGE 3/4"WATER METER 264 EA $15.00 $3,960.00 244 $3,660.00 10 SALVAGE FIRE HYDRANT(CO#2) 11 EA $500.00 $5,500.00 11 $5,500.00 11 REMOVE 6"WATER VALVE 13 EA $50.00 $650.00 13 $650.00 12 SALVAGE 24"WATER VALVE 3 EA $175.00 $525.00 2 $350.00 13 4'WIDE ASPHALT PVMT REPAIR,RESD(CO#2) 11872.68 LF $30-00 6356,180.40 11872.68 $356,180-40 14 TEMPORARY ASPHALT PAVING REPAIR 6505 LF $11.50 $74,807.50 6505 $74,807.50 (RYAN AVE)(CO#2) 15 6"CONC PVMT REPAIR(CO 42) 386 SY $87.00 $33,582.00 386 $33,582.00 16 4"CONC SIDEWALK(CO#2) 866.64 SF $8.00 $6,933.12 866.64 $6,933.12 17 4'BARRIER FREE RAMP,TYPE A(CO#2) 6 EA $900.00 $5,400.00 6 $5,400.00 18 7"CONC CURB AND GUTTER1815(CO 42) 635 LF $33.00 $20,955.00 635 $20,955.00 19 7"CONC VALLEY GUTTER(CO 42) 32 SY $89.00 $2,848.00 32 $2,848.00 I 20 TEMPORARY WATER SERVICES I LS $80,000.00 $80,000.00 1 $80,000.00 21 TRENCH SAFETY(CO#2) 3128 LF $0.10 $312.80 3128 $312.80 22 CONCRETE COLLAR(CO#2) 6 EA $415.00 $2,490.00 6 $2,490.00 23 DUCTILE IRON WATER FITTING W/ 4.04 TN $8,800.00 $35,552.00 4.04 $35,552.00 RESTRAINT(CO#2) 24 I"WATER SERVICE(CO#2) 255 EA $530.00 3135,150.00 255 $135,150.00 25 1 1/2"WATER SERVICE 10 EA $13435.00 $14,350.00 10 $14,350.00 26 2"WATER SERVICE(CO#2) 4 EA $1,990.00 $7,960.00 4 $7,960-00 27 1"WATER SERVICE METER RELOCATION(CO 255 EA $230.00 $58,650.00 255 $58,650.00 #2) 28 1 1/2"WATER SERVICE METER RELOCATION 10 EA $275.00 $2,750.00 10 $2,750.00 29 2"WATER SERVICE METER RELOCATION(CO 3 EA $300-00 $900.00 3 $900.00 #2) Friday,March 06,2015 Page 2 of 6 II City Project Numbers 01444 DOE Number 6565 Contract Name WATER AND SANI'T'ARY SEWER REPLACEMENT CONTRACP 2009 Estimate Number 23 Contract Limits Payment Number 23 Project Type WATER&SEWER For Period Ending 228/2015 Project Funding 30 CONNECTION TO EXISTING 24"WATER MAIN 2 EA $8,000.00 $16,000.00 2 $16,000.00 31 CONNECTION TO EXISTING 12"WATER MAIN 4 EA $1,000.00 $4,000.00 4 $4,000.00 32 CONNECTION TO EXISTING 8"WATER MAIN 10 EA $1,000.00 $10,000.00 10 $10,000.00 (CO#2) 33 CONNECTION TO EXISTING 6"WATER MAIN 10 EA $1,000.00 $10,000.00 10 $10,000.00 36 FIRE HYDRANT(CO#2) 11 EA $2,400.00 $26,400.00 11 $26,400.00 37 2"WATER AIR RELEASE VALVE VAULT 1 EA $12,000.00 $12,000.00 1 $12,000.00 38 TRAFFIC CONTROL 6 MO $1,250.00 $7,500.00 6 $7,500.00 39 SWPPP>1 ACRE 1 LS $3,200.00 $3,200.00 1 $3,200.00 40 WATER LINE GROUTING(FLOWABLE FILL) 72 CY $140.00 $10,080.00 72 $10,080.00 (CO#2) 41 9"CONCRETE PAVEMENT REPAIR HIGH 226 SY $114.00 $25,764.00 226 $25,764.00 EARLY STRENGTH(CO#1) 42 ADDITIONAL SIGNAGE&BARRICADES FOR 1 LS $13,014.83 $13,014.83 1 $13,014.83 BERRY/RYAN INTERSECTION(CO#1) Sub-Total of Previous Unit $1,615,407.45 $1,586,932.45 SEWER IMPROVEMENTS Item Estimated Estimated Completed Completed Description of Items Unit Unit Cost No. Quanity Total Quanity Total 1 8"DIP SEWR PIPE 52 LF $200.00 $10,400.00 52 $10,400.00 2 8"SEWER PIPE 645 LF $34.00 $21,930.00 645 $21,930.00 3 REMOVE 4'SEWER MANHOLE 4 EA $400.00 $1,600.00 4 $1,600.00 I i 4 T WIDE ASPHALT PVMT REPAIR, 760 LF $39.00 $29,640.00 353.25 $13.776.75 j RESIDENTIAL 5 TEMPORARY ASPHALT PAVING REPAIR 52 LF $14.00 $728.00 39I $5,474.00 6 TRENCH SAFETY 744 LF $1.00 $744.00 697 $697.00 7 PRE-CCTV INSPECTION 697 LF $2.00 $1,394.00 8 POST-CCTV INSPECTION 697 LF $1.50 $1,045.50 697 $1,045.50 9 CLAY DAMS 1 EA $150.00 $150.00 1 $150.00 10 4"SEWER SERVICE,2-WAY CLEANOUT 2 EA $780.00 $1,560.00 2 $1,560.00 11 T MANHOLE 6 EA $2,500.00 $15,000.00 6 $15,000.00 12 MANHOLE VACUUM TESTING 6 EA $150.00 $900.00 4 $600.00 13 CONCRETE COLLAR 4 EA $415.00 $1,660.00 14 T EXTRA DEPTH MANHOLE 7 VF $300.00 $2,100.00 15 BLOCK SOD PLACEMENT 125 SY $8.00 $1,000.00 750 $6,000.00 Friday,March 06,2015 Page 3 of 6 City Project Numbers 01444 DOE Number 6565 Contract Name WATER AND SANITARY SEWER REPLACEMENT CONTRACT 2009 Estimate Number 23 Contract Limits Payment Number 23 Project Type WATER&SEWER For Period Ending 2/28/2015 Project Funding 16 TRAFFIC CONTROL I MO $1,250.00 $1,250.00 1 $1,250.00 17 MANHOLE VACUUM TESTING 6 EA t Sub-Total of Previous Unit $9I,101.50 $79,483.25 ——--- ---------——— i I I i it I, i ii i I I I i i Friday,March 06,2015 Page 4 of 6 City Project Numbers 01444 DOE Number 6565 Contract Name WATER AND SANITARY SEWER REPLACEMENT CONTRACT 2009 Estimate Number 23 Contract Limits Payment Number 23 Project Type WATER&SEWER For Period Ending 2/28/2015 Project Funding Contract Information Summary Original Contract Amount $1,638,475.30 Change Orders Change Order Number 1 $36,428.83 Change Order Number 2 $31,604.82 Total Contract Price $1,706,508.95 j� !- l ` +G t li- � �Date Total Cost of Work Completed $1,666,415.70 C Inactor Less %Retained $0.00 lao L Net Earned $1,666,415.70 Date J Earned This Period $22,258.74 Inspection Supervisor Retainage This Period $0.00 Date 2� Less Liquidated Damages Pr 'ect M r 1 Days @ /Day $0.00 Date LessPavement Deficiency $0.00 Asst.Director/TPW-Infrastruc a Design and Construction Less Penalty $0.00 Date C" Less Previous Payment $1.644,156.96 /45jo-Director/Contracting Depa e t Plus Material on Hand Less 15% $0.00 Balance Due This Payment $22,258.74 Friday,March 06,2015 Page 5 of 6 FORT woRTH City of Fort Worth CITY Si:C OAW 444,00 2- . Change Order Request COMMCT NO. Project Name Water&Sanitary Saw Replacement Contract 2009,WSM-A City Sec No. 44406 Project No.(s)P253-6061701444831 P2%708170144483 DOE No. 6565 City Pro.No. 01444 Water and Sanitary Sewer Main Replacemant on 5th Avenue,6th Avenue,Ryan Avenue,Ryan Place Drive,Stadium Drive, mon Avondale Avenue,Lowden Street and Frazer Avenue Convactorl Jackson Construction,Ltd. Change Order# 0 Date: 11113015 City Project Mgr. Rakesh Chaubey City Inspector I Richard Salazar Phone Number; 817-392-6051 Phone Number: 817-223-2261 Dept. Water Sewer Totals Contrail Time (Calendar Days) Original Contract Amount $1,547,373.80 $91,101.50 $1,638,475.30 200 Extras to Date $36,428.83 $36,428.83 15 Credits to Date Pending Change Orders(in M&C Process) Contract Cost to Date $1,583,802.63 $91,101.50 $1,674,904.13 215 Amount of Proposed Change Order 5,354.82 4$3 750.00 31,604.82 084 Revised Contract Amount $1,619,157.45 $87,351.50 $1,706,508.95 299 Original Funds Available for Change Orders $46,421.00 $4,555.00 $50,976.00 Remaining Funds Available for this CO $9,992.17 $4,555.00 $14,547.17 Additional Funding(if necessary) $25,362.65 $25,362.65 CHANGE ORDERS to DATE(INCLUDING THIS ONE)AS%OF ORIGINAL CONTRACT 4.16% MAX ALLOWABLE CONTRACT AMOUNT(ORIGINAL CONTRACT COST+25%) $2,048,094.13 The change order will provide for the following: • Increased pay item quantities of temporary asphalt,permanent asphalt and concrete pavement repair that are necessary on the project. • Additional 8-inch gate valves that are necessary on the project. M 0 The deletion of pay item quantities that are no longer needed on the project. C-) m_ c Staff concurs with the contractor's request for 84 additional calendar days on the project for the 0 order. e 0 R� $:r d t' 00UU�'QO Mgry J. ser, City S20076rx It is understood and agreed that the acceptance of this Change Order by the contractor constitutes an accord and satisfaction and repres in full(both time and money)for all costs arising out of,or incidental to,the above Change Ord* J J- Jackson Construction,Ltd. Steve Haberstroh Iiia_ z4 �S M&C Number Id1A M&C Date Approved NIA FORT WORTH' City of Fort Worth —�%"'"V'+' - Change Order Additions Project Name lWater 8Sewer Reiplaoernent Contract 2009,WSM-A City Sec No. Project No.(s) P253.MI70144483!P258-708170144483 DOE No.= City Pro.No. 01444 Project Water and Sanitary Sewer Main Replacement on 5th Avenue,6th Avenue,Ryan Avenue,Ryan Place Drive,Stadium Drive, Description Avondale Avenue,Lowden Street and Frazier Avenue Contractor I Jadworn Construction,Ltd. Change Order# = Date: 1h312015 City Project Mgr. I Rakesh City Inspector I Richard Salazar ADDITIONS ITEM LIMCMM DEPT MYunit Unit G TOW 3 84nch Water Pipe Water 33.40 LF $27.00 $901.80 7 8'Gate Valve Water 10.00 EA $1,100.00 $11,000.00 13 4'Wide Asphalt PVMT Repair Residential Water ;1487.68 LF $30.00 $44,630.40 14 Temporary Asphalt Paving Repair Water 1750.00 LF $11.50 $20,125.00 15 6'Conc PVMT Repair Water 1206.00 SY $87.00 $17,922.00 16 4"Conc Sidewalk Water 846.64 SF $8.00 $6,773.12 17 4"Barrier Free Ramp,Type A Water 4.00 EA $900.00 $3,600.00 19 7"Conc Valley Gutter Water 7.00 Lf $89.00 $623.00 24 1'Water Service Water 1.00 EA $530.00 $530.00 27 1'Water Service Relocation Water 1.00 EA $230.00 $230.00 32 Connection to EAsting 8"Water Main Water 1.00 EA $1,000.00 $1,000.00 i Water $107,335.32 Sewer Page 2 of 4 lAddiflons Sub Total 1 $107,335.32 i Fk> r Wild wr tII City of Fort Worth -'—`"404�� Change Order Deletions Project Name lWater 8 Sanitary Sewer Replacement Contract 2009,WSM-A City Sec No. Project No.(s) P253.608170144483/P258-708170144483 DOE No. 6565 City Pro.No.Project 01444 Description Water and Sanitary Sewer Main Replacement on 5th Avenue,6th Avenue,Ryan Avenue,Ryan Place Drive,Stadium Drive,Avondale Avenue,Lowden Street and Fraser Avenue Contractor Jacitson Constriction,Ltd. Change Order#0.2 Date 1113!2015 City Project Mgr. Rakesh Chaubey City Inspector iGa Salazar DELETIONS ITEM DESCRIPnON DEPT Qty Unit Unit Cost r 1 24"PVC C95 Water Pipe Water 5.00 LF $108.00 $540.00 2 17 Water Pipe Water 20.00 LF $4600 $920.004 6"PVC Water Pipe Water .45.00 LF $27.00 $1,215.00 10 Salvage Fire Hydrant Water 1.00 EA $500.00 $500.00 18 T Conc Curb 8 Gutter Water -1180.0011-F $33.00 $38,940.00 21 Trench Safety Water 25.00 LF $0.10 $2.50 22 Concrete Collar Water 7.00 EA $415.00 $2,905.00 23 Ductile Iron Water Fitting with Restraint Water '0.21 TN $8,800.00 $1,848.00 26 T Water Service Water ,-1.00 EA $1,990.00 $1,990.00 29 2'Water Service Metier Reloction Water -2.00 EA $300.00 $600.0 34 2"x8°Tapping Sleeve 8 Valve Water 1.00 EA $3,300.00 $3,300.00 36 Fire Hydrant Water /2.00 EA $2,400.00 $4,800.00 40 Water Une Grouting(Flowable Fill) Water !103.00 CY $140.00 $14,420.00 43 Extra Width Asphalt Pavement Repair Sewer 30.00 TN $125.00 $3,750.00 Water $71,980.50 Sewer $3,750.00 Page 3 of 4 IDelefions Sub Total $75,730.50 MfWBE Breakdown for this Change Order Total Previous Change Orders I III WRIN.,MR M, Total I I-mm mm",MW I-.ONSENT OF SURETY OWNER TO FINAL PAYMENT ��TRCT cONnT ACTOR D?Gt7t2ertt G707SURETY1 Bond No. BCD1009407 CFTHF.R TO OWNFa- ARCI 1 FCT'S PRO,TECI' NO_: ;Warne urrd ad&nm,1 City of Fort Worth, Texas CONTRACT FOR_ Water& Sewer Replacements TX PROTECT: CON'S RACi DA-1"ED: i:Ntane and ad&vKfl Contract 2009/WSM-A DOE 6565/Water Sewer Replacements =ort Worth, TX in teetweer;the Owner anti the Cantractor as indicated albava,the (/tuerr name alit(adrfe�3s ct5rrrwyJ The Hanover insurance Company 440 Lincoln Street Worcester MA 01653 SUET-TY, on bond of tinter name and addrem o{Canrraaar) Jackson Construction, Ltd. 5112 Sun Valley Drive Fort Worth TX 76119 CONTRACTOR, hereby apptrnes of the n^.al payment to the Contractor,and agrees that final payment to the Contractor shall not relieve the Surety or any of its obligations to (l,zwrt natneand addren o,f caner) City of Fort Worth, Texas TX OW?ZER, as set forth in said 5ureys bond LN WITNESS WHEREOF,the Surety has hereunto set iLs hand ors This date: March 10, 2015 (lnrrl in uv idrg,t&-month folloxtd 4-sire munerk dssr and.swar.) The Hanover Insurance Company {Srrrr'ry) 1 CS{gnaturcofw r�iuQrrpresen+atiser) Attest; �',;��J� . y Jack M. Crowley Attorney-in-Fact thime$name and 1111e) Surety Phone No. 508-853-7200 x-4476 G707--1994 THE HANOVER INSURANCE COMPANY MASSACHUSETTS BAY INSURANCE COMPANY CITIZENS INSURANCE COMPANY OF AMERICA POWERS OF ATTORNEY CERTIFIED COPY KNOW ALL MEN BY THESE PRESENTS: That THE HANOVER INSURANCE COMPANY and MASSACHUSET 1 S BAY INSURANCE COMPANY,both;being corporations organized and existing under the laws of the State of New Hampshire and CITIZENS INSURANCE COMPANY OF AMERICA,a corporation organized and existing under the laws of the State of Michigan,do hereby constitute and appoint Steven R.Foster,Jack M.Crowley;Patricia A.Smith and/or Marie Perryman of Dallas,TX and each is a true and lawful Attorney(s)-in-fact to sign,execute,seal,acknowledge and deliver for,and on its behalf,and as its act and deed any place within the United States,or,if the following line be filled in only within the area therein designated any and all bonds,recognizances:undertakings, contracts of indemnity or other writings obligatory in the nature thereof,as follows: Any such obligations in the United States,not to exceed Thirty Five Million and No/100($35,000,000)in any single instance and said companies hereby ratify and confirm all and whatsoever said Attomey(sl-in-fact may lawfully do in the premises by virtue of these presents. These appointments are made under and by authority of the following Resolution passed by the Board of Directors of said Companies which resolutions are still in effect: "RESOLVED.That the President or any Vice President,in conjunction with any Vice President.be and they are hereby authorized and empowered to appoint Attomeys-in-fact of the Company,in its name and as its acts.to execute and acknowledge for and on its behalf as Surety any and all bongs.recognizances, contracts of indemnity,waivers of citation anc all other writings obligatory in the nature thereof,with power to atach thereto the seal of the Company.Any such writings so executed by such Attomeys-in-fact shall be as binding upon the Company as if they had been duly executed and acknowledged by the regularly elected officers of the Company in their own proper persons` (Adopted October 7 1981 -The Hanover Insurance Company,Adopted April 14. 1982- Massachusetts Bay Insurance Company,Adopted September 7.2001-Citizens Insurance Company of America) W WITNESS WHEREOF, THE HANOVER INSURANCE COMPANY, MASSACHUSETTS BAY INSURANCE COMPANY and CITIZENS INSURANCE COMPANY OF AME-RICA have caused these presents to be sealed with their respective corporate seals,duly attested by two Vice Presidents, this 5th day of December 2011. THE}iANCFVER INSURANCE COMPANY MASSACHUSETTS BAY INSURANCE COMPANY CITIZENSII SURANCE:POMPANY OF AMERICA 4 r / ftclk.rr Thomas. Vice Prpsitient THE COMMONWEALTH OF MASSACHUSETTS COUNTY OF WORCESTER ss. Ire BTenstrorn. Vicc' ?resilient On this 5th day of December 2011 before me came the above named Vice Presidents of The Hanover Insurance Company,Massachusetts Bay Insurance Company and Citizens Insurance Company of America,to me personally known to be the individuals and officers described herein;and acknowledged that the seals affixed to the preceding instrument are the corporate seals of The Hanover Insurance Company,Massachusetts Bay Insurance Company and Citizens insurance Company of America, respectively, and that the said corporate seats and their signatures as officers were duly affixed and subscribed to said instrument by the authority and direction of said Corporations. �5'�wr� oAPB.ARkA,vARt.ti,Y, � ttdtary Public �� _ y/'/ 1 :�mfr10'7�'E3�t1��1�Li5aL1t115Ch51,./�,t ) pr�f flf_4/ L�Lh�t�>sMnza'�x55eF. - Barbara A.Garlick, Notary Public My Commission Expires September 21,2018 I.the undersigned Vice President of The Hanover Insurance Company Massachusetts Bay insurance Company and Citizens Insurance Company of America, hereby certify that the above and foregoing is a full,true and correct copy of the Original Power of Attorney issued by said Companies,and do hereby further certify that the said Powers of Attorney are still in force and effect. This Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America. "RESOLVED,That any and all Powers of Attorney and Certified Copies of such Powers of Attomey and certification in respect thereto,granted and executed by the President or any Vice President in conjunction with any Vice President of the Company,shall be binding on the Company to the same extent as if all signatures therein were manually affixed,even though one or more of any such signatures thereon may be facsimile.` (Adapted October 7, 1981-The Hanover Insurance Company,Adopted April 14,1982-Massachusetts Bay Insurance Company,Adopted September 7,2001-Citizens Insurance Company of America) GIVEN under my hand and the seals of said Companies,at Worcester,Massachusetts,this 10th day of March 2015. THE HANOVER INSURANCE COMPANY MASSACHUSETTS BAY INSURANCE COMPANY CITIZENS INSURANCE COMPANY OF AMERICA (:�teitn Margosian,Vice President &I JACKS Q50 C=ONSTRUCTION LTD. 51 12 SUN VALLEY DRIVE FORT WORTH,TX 76119 TEL 817-572-3303 FAX 817-478-0443 Affidavit of All Bills Paid STATE OF TEXAS KNOW ALL MEN BY THESE PRESENTS: COUNTY OF TARRANT I, Troy L. Jackson, of the undersigned principal hereby certify that all obligations, claims and debts due laborers, materialmen, subcontractors, suppliers, and others incurred in or contingent to the performance of the work on the project known as Water and Sanitary Sewer Replacement Contract 2009 WSM-A in the City of Fort Worth, Texas have been fully paid. This affidavit is made for the purpose of obtaining payment from the City of Fort Worth on above construction work. Subscribed and sworn to before me this Jackson Construction, Ltd. Principal 10th Day of March, 2015 By. to Signature Troy L. Jac on,Vice resident Commission Expires: 04/06/2016 `4pRV yUBCARMEN L. ESTEP Notory Public,Stote of Texos e€ My commission Expires April 06, 2016 FORTWORTH TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PROJECT NAME: Water and Sanitary Sewer Replacement Contract 2009 PROJECT NUMBER: 1444 DOE NUMBER: 6565 WATER PIPE LAID SIZE TYPE OF PIPE LF 24" PVC 2013 12" PVC 1115 8" PVC 8634.4 6" PVC 85 FIRE HYDRANTS: I I VALVES(161"OR LARGER) 2 PIPE ABANDONED SIZE TYPE OF PIPE LF 24" PVC 2013 12" PVC 1115 8" PVC 8634 6" PVC 85 DENSITIES: Yes NEW SERVICES: (255) 1- (10) 255) 1"(10) 1 1/2" (5)_2' SEWER PIPE LAID SIZE TYPE OF PIPE LF 8" DIP 52 8" PVC 645 PIPE ABANDONED SIZE TYPE OF PIPE LF 8" PVC 697 DENSITIES: Yes NEW SERVICES: (2)4" PVC TRANSPORTATION AND PUBLIC WORKS The City of Fort Worth•1000 Throckmorton Street•Fort Worth,TX 76012-6311 la (817)392-7941 •Fax:(817)392-7845 FORTWORTHREV:02/20/07 TRANSPORTATION AND PUBLIC WORKS PERFORMANCE EVALUATION OF CONTRACTOR CONTRACTOR&PROJECT DATA Name of Contractor Project Name Jackson Construction Water and Sanitary Sewer Replacement Contract 2009 DOE Inspector DOE Number Richard Salazar 6565 DOE Inspector Project Manager Q WaterO Waste Water❑ Storm Drainage0 Pavement Rakesh Chaube Initial Contract Amount Project Difficulty $1,638,475.30 0 Simple Q Routine 0 Complex Final Contract Amount s Date V,ft670 S 3/9/2015 In PERFORMANCE EVALUATION 0-Inadequate 1-Deficient 2-Standard 3-Good 4-Excellent ELEMENT WEIGHT(x) APPLICABLE(Y/N) RATING(0-4) MAX SCORE SCORE 1 Submission of Documents 2 Y 3 8 6 2 Public Notifications 5 Y 3 20 15 3 Plans on Site 5 Y 4 20 20 4 Field Supervision 15 Y 3 60 45 5 Work Performed 15 Y 4 60 60 6 Finished Product 15 Y 4 60 60 7 Job Site Safety 15 Y 3 60 45 8 Traffic Control Maintenance 15 Y 3 60 45 9 Daily Clean Up 5 Y 3 20 1 15 10 Citizen's Complaint Resolution 5 Y 3 20 15 11 Property Restoration 5 Y 3 20 15 12 After Hours Response 5 Y 3 20 15 13 Project Completion 5 Y 3 20 15 TOTAL ELEMENT SCORE(A) 371 BONUS POIN'T'S(25 Maximum)(B) TOTAL SCORE(PS) 371 III)CONTRACTOR'S RATING Maximum Score(MS)=448 or sum of applicable element score maximums which= 448 Rating([TS/NLS]* 100%) 371 / 448 — 83% Performance Category Excellent <20%=Inadequate 20%to<40%=Deficient 40%to<60%=Standard 60%to<80%=Good _>80%=Excellent Inspector's Comments(INCLUDING EXPLANATION OF BONUS POINTS AWARDED) Signature DOE Inspector Signature Contractor Signature DOE Inspector's Supervisor CONTRACTOR'S COMMENTS TRANSPORTATION AND PUBLIC WORKS The City of Fort Worth•1000 Throdanorton Street•Fort Worth„TX 76012-6311 (817)392-7941 •Fax:(817)392-7845 FORTWORTHREV:02/22/07 TRANSPORTATION AND PUBLIC WORKS CONTRACTOR'S EVALUATION OF CITY PROJECT INFORMATION Date: 3/9/2015 Name of Contractor Project Name Jackson Construction,LTD Water and Sanitary Sewer Replacement Contract 2009 DOE inspector Project Manager Richard Salazar Rakesh Chaube DOE Number Project Difficulty Type of Contract 6565 0 Simple OQ Routine 0 Complex 2 waterRI Waste water Storm Drainage0 Pavement Initial Contract Amount Final Contract Amount $ 1,638,475.30 )Ob S— II) i / II)PERFORMANCE EVALUATION 0-Inadequate 1 -Deficient 2-Standard 3 -Good 4-Excellent ELEMENT RATING ELEMENT RATING (0-4) (0-4) INSPECTION EVALUATION PLANS&SPECIFICATIONS 1 Availability of Inspector 1 Accuracy of Plans to Existing Conditions 2 Knowledge of Inspector 2 Clarity&Sufficiency of Details 3 Accuracy of Measured Quantities 3 Applicability of Specifications 4 Display Of Professionalism 4 Accuracy of Plan Quantities 5 Citizen Complaint Resolution PROJECT MANAGER EVALUATION 6 Performance-Setting up Valve Crews,Labs 1 Knowledge And/Or Problem Resolution ADMINISTRATION 2 Availability of Project Manager 1 Chane Order Processing Time Y 3 Communication 3 2 Timliness of Contractor Pa ents 1 4 Resolution of Utility Conflicts 3 Bid Opening to Pre-Con Meeting Timeframe IIT)COMMENTS&SIGNATURES COMMENTS Signature Contractor Signature DOE Inspector Signature DOE Inspector's Supervisor INSPECTOR'S COMMENTS TRANSPORTATION A!-ID PUBLIC WORKS ID The City,of Fort Worth-1000 Throckmorton Street-Fort Worth,TX 76012-6311 (817)392-7941 -Fax:(817)392-7845 FORT WORTH, TRANSPORTATION AND PUBLIC WORKS STATEMENT OF CONTRACT TIME STATEMENT# FINAL STATEMENT# 22 DOE NAME OF PROJECT: Wator and Sattilary Sowor Pj*boottwdConboft4#06 Contractor • icer:COASL YEAR:j 2015 PROJECT NO.: FINAL INSPECTION DATE W9W14 WD CD CONTRACT TIME 200 1 X PERIOD FROM: TO: 1,2118r1d1KMID - Month j1DEVFL0Pmmf4(Y/N N WORK ORDER EFFECTIVE: ": BEG /n ARID /n DAY OF MONTH DAYS REASON FOR DAY OF MONTH DAYS REASON FOR CHARGED DAYS CREDITED CHARGED DAYS CREDITED 1 16 Mon 0 2 0 WA 17 Tue 0 3 0 ISA 18 Wed 0 4 0 NIA 19 Thu 0 5 0 [ 20 Fri 0 f 6 0 21 Sat 0 $tom ft 7 0 22 Sun 0 Slate kitfl6 8 0 23 Mon 0 Stop tariafl 9 0 24 Tue 0 stop 17cTFB! 10 0 WR 25 Wed 0 stop of 11 0 NfA 26 Thu 0 mwft 12 0 IVIG 27 1 Fri 0 ftR AMR 13 0 28 Sat 0 §Ng lift 14 0 Int 29 0 -ft 15 0 30 0 W 31 0 Btor fits! �Idol d� Not Applicable SAT,SUN,and WEATHER UTILITIES OTHERS DAYS TOTAL DAYS HOLIDAYS RELOCATE CHARGED THIS PERIOD 0 0 0 0 0 0 PREVIOUS PERIOD ( 2" 299 TOTAL TO DATE 1 0 0 0 0 299 299 REMARKS: Stop time on 8/0112010 Sigmrtures Signature: Eft � Yt3 d Richard Salazar DATE DATE i s