HomeMy WebLinkAboutContract 46320-FP1 Depa e t f W Const.Services
DOE# ,. Dat C1T1(SECRETARY
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Project Manager �k�` �L�Jj J �•
Risk Management S.Canadv 1A tT WO RT H c
D.O.E. Brotherton L-1 YL
CFA Westerman/Scanned ❑
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The Proceediog people have been Contacted eoaenuhng the request ATION AND PUBLIC WORKS
for final payment&have released this project for such payment F PROJECT COMPLETION
Clearance Conducted By Etta Bacy D.O.E.Ns: 7149
1 c5#44 3
regarding contract 117149 for SENDERA RANCH PHASE 3 SECTION 3D as required by the
WATER DEPARTMENT as approved by City Council on N/A through M&C N/A the director of the
WATER DEPARTMENT upon the recommendation of the Assistant Director of the Transportation&Public Works
Department has accepted the project iggTp eCe. I
@ �,
Original Contract Prices: .� S392,010.00
Amount of Approved Change Orde JAN 2 0 2016 53,000.00 N4 1
Revised Contract Amount: 5395,010.00
Total Cost Work Completed: 5395,010.00
Less Deductions:
Liquidated Damages: Days®$210.00/Day
Pavement Deficiencies: OFFICIAL RECORD
gry SECRE"fARY
Wo
Total Deduction Amount: R,�,a ll $0.00
VT.
Total Cost Work Completed: $395,010.00
Less Previous Payments: $0.00
Final Payment Due $395,010.00
• ®4•tai
Recommended for Acceptance Date
Asst. Director,TPW - Infrastructure Design and Construction
cce ted Date
P
Asst. Director, WATER D ARTMENT
bl�.� 0. ti / z�
Asst. City W46iger Date
Comments: FUND ACCT:WATER P265-607150220383/SEWER P275-707130220383
BACAMM-D
`P �G5-d2aQ3
JAN 2016
init at-
JAN 2 0 2016 5-q (,p�_ C o a a03
City Project Numbers 02203 �Lw DOE Number 7149
Contract Name SENDFRA RANCH PHASE 3 SECTION 31) Estimate Number I
Contract Limits Payment Number I
Project Type WATER&SEWER For Period Ending 12/15/1015
Project Funding
Project Manager Jaafwi City Secretary Contract Number 117149
Inspectors GREGORY / COLLIER Contract Date 12/9/2014
Contractor RKM U AM SERVICES,INC. Contract Time 85 CD
1604 BLUEBANK ROAD Days Charged to Date 297 CD
DALLAS, TX 75229-3102 Contract is •000000 Complete
CITY OF FORT WORTH
SUMMARY OF CHARGES
Line Fund Account Center Amount Gross Retainage Net
-- Funded __ --------------------
Total Cost of Work Completed $395,010.00
Less %Retained $0.00
Net Earned $395,010.00
Earned This Period 5395,010.00
Retainage This Period $0.00
Less Liquidated Damages
0 Days Q $0.00 /Day $0.00
LessPavement DeBcieaty $0.00
Less Penalty $0.00
Less Previous Payment $0.00
Plus Material on Hand Less 15% $0.00
Balance Due The Payment $395,010.00
Wedo Wq.December 16,2015 Page 4 of4
1) 2co:!�-02 Q03
FORT WORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name SENDERA RANCH PHASE 3 SECTION 3D
Contract Limits
Project Type WATER&SEWER
City Project Numbers 02203
DOE Number 7149
Estimate Number I Payment Number I For Period Ending 12/15/2015
CD
City Secretary Contract Number 117149 Contract Time BCD
Contract Date 12/9/2014 Days Charged to Date 297
Project Manager Jaah i Contract is 100.00 Complete
Contractor RKM UTILITY SERVICES.INC.
1604 BLUEBANK ROAD
DALLAS, TX 75229-3102
inspectors GREGORY / COLLIER
Wedusday,Dwcmber 16.2015 Page 1 of 4
City Project Numbers 02203 DOE Number 7149
Contract Name SENDERA RANCH PHASE 3 SECTION 3D Estimate Number 1
Contract Limits Payment Number I
Project Type WATER&SEWER For Period Ending 12/15/2015
Project Funding
UNIT I:WATER 11"ROVEMENfS
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
1 8"WATER PIPE 3242 LF $27.00 $87,534.00 3242 $87,534.00
2 8"GATE VALVE 11 EA $1,350.00 $14,850.00 11 $14,850.00
3 FIRE HYDRANT 5 EA $4,000.00 $20,000.00 5 $20,000.00
4 DUCTILE WATER FITTINGS W/RESTRAINT 2.5 TN $2,500.00 $6,250.00 2.5 $6,250.00
5 CONCRETE BLOCKING 5.9 SY $250.00 $1,475.00 5.9 $1,475.00
6 BORE AND ENCASE 8"WATER LINE 54 LF $340.00 $18,360.00 54 $18,360.00
7 1"WATER SERVICE 70 EA $700.00 $49,000.00 70 $49,000.00
8 CONNECTION TO EXISTING 4"-12"WATER 2 EA $3,000.00 $6,000.00 2 $6,000.00
MAIN
9 REMOVE SIDEWALK 76 LF $6.00 $456.00 76 $456.00
10 TRENCH SAFETY 3242 LF $0.50 $1,621.00 3242 $1,621.00
11 TESTING 3242 LF $0.50 $1,621.00 3242 $1,621.00
Sub-Total of Previous Unit $207,167-00 $207,167.00
UNIT E:SANITAYR SEWER IMPROVEMENTS
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
— —
- --------- ———— -- — ------ --- -
1 18"SEWER PIPE 322 LF $70.00 $22,540.00 322 $22,540.00
2 8"SEWER PIPE 2640 LF $24.00 $63,360.00 2640 $63,360.00
3 4'MANHOLE 21 EA $3,000.00 $63,000.00 21 $63,000.00
4 CORROSION PROTECTION 21 VF $300.00 $6,300.00 21 $6,300.00
5 4"SEWER SERVICE 68 EA $400.00 $27,200.00 68 $27,200.00
6 CONNECTION TO EXISTING 18"SANITARY 1 EA $1,000.00 $1,000-00 1 $1,000.00
SEWER LINR
7 TRENCH SAFETY 2962 LF $0.50 $1,481.00 2962 $1,481.00
8 POST-CCTV INSPECTION 2962 LF $1.00 $2,962.00 2962 $2,962.00
Sub-Total of Previous Unit $187,843.00 $187,843-00
---------------------------------------
Wednesday,December 16,2015 Page 2 of 4
City Project Numbers 02203 DOE Number 7149
Contract Name SENDERA RANCH PHASE 3 SECTION 3D Estimate Number I
Contract Limits Payment Number 1
Project Type WATER&SEWER For Period Ending 12/15/2015
Project Funding
Contract Information Summary
Original Contract Amount Sj92,010.00
Change Orders
Change Order Number 1 $3,000.00
Total Contract Price $395,010.00
Date Total Cost of Work Completed $395,010.00
r ,/ Less %Retained $0.00
J /'1 Date/ Net Earned $393,010,00
Inspection Supemsor Earned This Period $395,010.00
tZV,0, t(i Retainage This Period $0.00
Date Less Liquidated Damages
Project Man
60 / Days Q /Day $0,00
ate Ot•l9•ZDI�! LessPavement Deficiency $0,00
Asst ' r nurture sign and Construction Less Penalty 50,00
DateLess Previous Payment 30,00
Director I Contracting DepaRm ' Plas Material on Hand Less 15% 50.00
Balance Due This Payment 5395,010,00
Wedonsday,December 16,2015 Pale 3 of 4
DEVEL OPER-AWARDED-PROJECT CHANGE ORDER
PROJECT NAME: Sendera Ranch Phase 3 Section 3D CHANGE
CONTRACT: Water.Sanitary Sewer,and Storm Drain Improvernerft ORDER No:
CFA# 2014-070 CITY PARTICIPATION: NO
CITY PROJECT# 2203
DOE# 7149 1
WATER PROJECT# P265-607150220383
SEWER PROJECT_ # P275-707130220383
FILE# W-2291
INSPECTOR: Mike Collier Phone No: 817-223-2273
PROJECT MANAGER: Khat Jaafari Phone No: 817-392-7872
CONTRACT UNIT
WATER SEWER PAVING DRAINAGE STREET LIGHTS CONTRACT
Developer `i Developer � _ _ __, Developer Developer
_ DAYS
Cost Cost Cost Cost +greet Cost Caalt
ORIGINAL CONTRACT $207,167.00 $184,843.00 $41$104.50 $81,890.50 -- 80
EXTRAS TO DATE
CREDITS TO DATE �'
CONTRACT TO DATE $207,187.00 SMOR $184,843.00 $412,104.50 881 590.60 ma 80.00 ®0
AMOUNT OF PROP.CHANGE ORDER $ 3,000.00
REVISED CONTRACT AMOUNT $207,167.00 $187,843.00 _ $412,104.10 831 5011101 $0.00 80
TOTAL REVISED CONTRACT AMOUNT
PER UNIT $207 167.00 $187 843.00 $41 104.50 881 .60 $0.00
REVISED COST SHARE Dev.Cost: $338,706.00
TOTAL REVISED CONTRACT $863,706.00
Revised:10-12-2011 Pape 1
You are directed to make the following hancies in the contract documents:
PAY ITEM#
(All in Contract Section G) QUANTITY UNIT ITEM DESCRIPTION UNIT PRICE TOTAL
3339.1003 1 EA Manhole-Std.4'Dia. $ 3,000.00 $ 3,000,00
$
$ 3,000.00
REASONS FOR CHANGE ORDER Sanitary sewer added near connection to existing 18'sewer to deflect alignment to match approved plans-SS-1 Sta, 0+13.83
Revised: 10-12-2011 Page 2
RECOMMENDED: APPROVED: APPROVED:
Peloton land Solutions.Inc Centunon Acqusifim,LP RKM Utility Services,Inc
By: By. By: ,�_1
Name: Jay Reisslg,P.E. Name: Cl-lr i S { ,c7f1 Name: be.*m w+f
'-T
Title: Project Manager Title Title: �.
Revised:10-12-2011 Page a
FORTWORTH
TRANSPORTATION AND PUBLIC WORKS
PIPE REPORT FOR:
PROJECT NAME: Sendera Ranch Phase 3 Section 3D
PROJECT NUMBER: 2203
DOE NUMBER: 7149
WATER
PIPE LAID SIZE TYPE OF PIPE LF
8" PVC 3242
FIRE HYDRANTS: 5 VALVES(16"OR LARGER)
PIPE ABANDONED SIZE TYPE OF PIPE LF
DENSITIES: Yes
NEW SERVICES: 1" copper 1610
SEWER
PIPE LAID SIZE TYPE OF PIPE LF
18" PVC 322
8" PVC 2640
PIPE ABANDONED SIZE TYPE OF PIPE LF
DENSITIES: Yes
NEW SERVICES: 4" PVC 3400
TRANSPORTATION AND PUBLIC WORKS
The City of Fort Worth•1000 Throckmorton Street•Fort North,TX 76012-6311
(817)392-7941 •Fax: (817)392-7845
CENTURION ACQUISITIONS, L.P.
1800 Valley View Lane, Suite 300
Farmers Branch,TX 75234
Office:469-892-7200
Fax:469-892-7201
December 191,2015
VIA EMAIL DELIVERY
City of Fort Worth
Attn:Ron Cordova
8851 Camp Bowie West
Fort Worth,Texas 76116
Re: Subdivision known as Sendera 3-313, (the"Development")
Please accept this letter as our formal acknowledgement to the City of Fort
Worth that Centurion Acquisitions, L.P.the owners of the above mentioned
Development, will not pursue liquidated damages against Independent Utility
Construction Inc, our street light contractor for Senders 3-31).
f
If you need any further information in regards to this matter feel free to contact
me.
Regards,
Chris Hodgson
Project Manager
Centurion American
(972)824-6334
CONSENT OF SURETY OWNER E1
TO FINAL PAYMENT A1%CI-IITF:CT D
ALA.Docw?tent G707 CONTRACTOR ❑
SURETY
Bond No. PB00317400136 OTHER L7
TO OWNER: ARCHITECT'S PROJECT NO.;
(Amne cunt adehrz)
City of Fort Worth
1000 Throckmorton St. COiNTR,�CT FOR: Construction
Fort Worth, TX 76102
PROJECT: CONTRACT DATED;
(Name and addhr,o
Water, Sanitary Sewer, Storm Drain and Paving Improvements to Serve Sendera Phase 3 Section 3D
In accordance vATh the provisions of the Contract between the Owner and the Contractor as indicated above,the
Owen nam,and addit=ofSmr)q
Philadelphia Indemnity Insurance Company
One Bala Plaza, Suite 100
Bala Cynwyd, PA 19004-1403
5'URFTY,
on bond of
{insert rtanre and addme,gfConiractor)
RKM Utility Services, Inc.
1805 Royal Lane Suite 107
Dallas, TX 75229
CONTRACTOR,
hereby approves of the final payment to the Contimctor,and agrees that final payment to the Contractor shall not relieve the Surety of
any of its obligations to
(Invert rtante and addra+a of Ocrrrer)
City of Fort Worth
1000 Throckmorton St.
Fort Worth, TX 76102
OWNER,
as set forth in said Surety's boric-l.
1N WITNESS WHEREOF,the Surety has hereunto set its hand on this date.. November 25, 2015
(Amyl fn wtit6g the wontbfolAwed b.p dx rnanetie dareand,mar.1
Philadelphia Inde nsurance Company
OS M'y,Y)
(SYg1ofatdhorYzrd7YfJ1YR1Ila ]e)
Tab Reedy Attorney-a- act
(Seal)- i Lo itn s
fr'tiruad rratua and rtrkp
G707-1994
1455
PHILADELPHIA INDEMNITY INSURANCE COMPA-DIY
231 St.Asaph's Rd.,Suite 100
Bala Cynwyd,PA 19004-0950
Power of Attorney
KNOW ALL PERSONS BY THESE PRESENTS:That PHILADELPHIA INDEVLNITV INSURANCE COMPANY(the Company),a corporation organized and
existing under the laws of the Commonwealth of Pennsylvania,does hereby constitute and appoint,,Edward G.Britt,Jr.,David G.VIlclette,David T.Miciette,
Barry K.McCord,Robert C.Davis,Krista Lovett,Ashley Britt Russell,Joni Bowen,Heather Notes,Brett A.Tisdale,Tabitha Reedy and Rita G.Gu&o of
Bowen,Nficlette&Britt Insurance Agency,LLC of Houston,Texas
Its true and lawful Attorney-in-fact with full authority to execute on its behalf bonds,undertakings,recogaizances 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$25.000,000.00.
This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adapted by the Board of Directors of
PHILADELPHIA INDENINITY INSURANCE COMPANY at a meeting duly called the I'day of July,2011.
RESOLVED: That the Board of Directors hereby authorizes the President or any Vice President of the
Company to: (1) Appoint Attomey(s) ir1 Fact and authorize the Attomey(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 Attomey-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 the respect to any bond or
undertaking to which it is attached.
IN TESTIMONY WHEREOF,PHILADELPHIA INDEMNPFY INSURANCE COMPANY HAS CAUSED THIS INSTRUMENT TO BE SIGNED AND
ITS CORPORATE SEALTO BE AFFDOED BY ITS AUTHORIZED OFFICE THIS l OTH DAY OF JUNE 2013.
1927 -
(Seal)
Robert D.O'Leary Jr.,President&CEO
Philadelphia Indemnity Insurance Company
On this 10'a day of lune 2013,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.
(I)MMONWEALTH OF PENNMVAMA
NapHd Seal �+'
KhbeRq A Ka IM4 Notary NN,
WverNvbnTwp.X11 C-14}N mC#reS 13c It,2016
"eroa,x»s"AWAsocwilmCF10u Notary Public:
residing at: Bala Cvnwvd,PA
(Notary Seal)
My commission expires: December 18,2016
I,Edward Sayago,Corporate Secretary of PHILADELPHIA INDEMNITY INSURANCE COMPANY,do herby certify that the foregoing resolution of the Board of
Directors and this Power of Attorney issued pursuant thereto are true and correct and are still in full force and effect.1 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 attached Power of Attorney the duly elected President of PHILADELPHIA
INDEMNITY INSURANCE COMPANY,
Q�j Q',�tz�� r`�
In Testimony Whereof I have subscribed my name and affixed the facsimile seal of each Company thisL0day of Me r16w. Z�V
92
Edward Sayago,Corporate Secretary
r,- PHILADELPHIA INDEMNITY INSURANCE COMPANY
i
AFFIDAVIT
STATE OF Texas
COUNTY OF Dallas
Before me,the undersigned authority, a notary public in the state
and county aforesaid, on this day personally appeared Ryan Dowdy,
President Of RKM Utility Services, Inc.,known to me to be a credible
person,who being by me duly sworn, upon his oath deposed and said;
That all persons, firms,associations, corporations, or other
organizations fiirnishing labor and/or materials have been paid in full;
That the wage scale established by the City Council in the City of
Fort Worth has been paid in full;
That there are no claims pending for personal injury and/or
property damages;
On Contract described as;
Sendera Ranch Phase 3D
I
BY _
Ryan Dowdy-Presdient I
1
Subscribed and sworn before me on this date 24 of November, 2015.
I
STEVEN SCOTT SALSBURY
�= Notary Public,State of Texas
My Commission Expires
/✓< /,� .%� -- �rF of t�.`� September?R 2016 ail
LDalla sTX c.._._._
i
i
r
i
FORTWORTHIE":00/07
TRANSPORTATION AND PUBLIC WORKS
PERFORMANCE EVALUATION OF CONTRACTOR
1) CONTRACTOR&PROJECT DATA
fame o(Contractor Project Name
RKM Utility Services,Inc. Sendera Ranch Phase 3 Section 3D
0E Inspector DOE Number
Michael Collier 7149
LK1£Inspector Project Manager
[] waterEl Waste Water❑ Storm Drainage❑ Pavement Kahl Jaafari
Initial Contract Amount Project Difficulty
$392.010.00 0 Simple Oo Routine 0 Complex
Final Contract Amount Date
$395,010.00 12/16/2015
II) PERFORMANCE EVALUATION
o-Inadequate I-Deficient 2-Stwidard 3-Good 4-Excellent
I:I.6MENT WEIGHT(x) APPLICABLE(Y I N) RATING(0-4) MAX SCORE SCORE
I Submission of Documents 2 Y 4 8 8
2 Public Notifications 5 Y 3 20 15
3 Plans on Site 5 Y 4 20 20
4 Field Supervision 15 Y 4 60 60
Work Performed 15 Y 4 60 60
t, Finished Product 15 Y 4 60 60
7 .lob Site Safety 15 Y 3 60 45
S Traffic Control Maintenance 15 Y 3 60 45 I
ki Dail•Clean Up 5 Y 3 20 IS
10 Citizen's Complaint Resolution 5 Y 3 20 1 15
11 Property Restoration 5 Y 4 20 20
12 Alter flours Response 5 Y 4 20 20
13 Proicet Completion 5 Y 4 20 20
TOTAL ELEMENT SCORE(A) 403
BONUS POINTS(25 Maximum)(B)
TOTAL SCORE(TS) 403
111)CONTRACTOR'S RATING
Maximum Score(MS)=448 gr sum of applicable element score maximums which= 443
Rating(ITS I MSS+100%) 403 I 448 - 90%
Performance Category Excellent
20%-!»adequate 20%to<40%-Defteient 40%to<60%-Standard 60%to<80%-Good a80%=Excellent
Inspector's Comments(INCLUDING EXPLANATION OF BONUS POINTS AWARDED)
Signature DOE Inspector -Signature Contractor
Ji
Signature DOE Inspector's Supervisor / fid
C'ONTRACTOR'S COMMENTS
TRANSPORT ATIO,N AND PUBLIC WORKS
The City of Fort Worth-1000 Tbmckmortoo Street-Fort Worth,TY 76012-6311
a
(817)392-7941 -Fax:(817)392-7845
FORTWORTHREV:0222/07
TRANSPORTATION AND PUBLIC WORKS
CONTRACTOR'S EVALUATION OF CITY
1)PROJECT INFORMATION Date: 12/17/2015
`Aame ofContractor Project Name
RKM Utility Services Inc. Sendera Ranch Phase 3 Section 3-D
DOE Inspector Project Manager
Michael Collier Kahl Jaafari
DOE:Number Project Difficulty Type of Contract
47149 O Simple Q Routine Q Complex 2✓ water 21 wastewater[-] Storm Drainage Pavement
Initial Contract Amount Final Contract Amount
;$392.010.00 $395,010.00
II)PERFORMANCE EVALUATION
0- Inadequate 1 -Deficient 2-Standard 3-Good 4-Excellent
fiLFTgENT RATING ELEMENT TRATING
(0-4) (0-4)
INSPECTION EVALUATION PLANS&SPECIFICATIONS
I Availability of Inspector I Accuracy of Plans to Existing Conditions 3
2 TKnowle� _die of Inspector 2 Clarity&Sufficiency of Details 4
3 Accuracy of Measured Quantities 13 Applicability of Specifications
4 Display Of Professionalism4 Accuracy of Plan Quantities
1-7
5 Citizen Complaint Resolution I{ PROJECT MANAGER EVALUATION
b Performance-Setting up Valve Crews Labs I Knowled a And/Or Problem Resolution
ADMINISTRATION 2 Availability of Pro'ect Manger
l Chan a Order Processing Time 3 Communication '
'2 Timliness of Contractor Payments 4 Resolution of Utili Conflicts
3 Bid 0en_'ng to Pre-Con Meeting Timeframe
III)COMMENTS&SIGNATURES
COMMENTS
Sid==nature Contractor oo�
Snature DOE Inspector
Si;nature DOE Inspector's Supervisor G s
INSPECTOR'S COMMENTS
_ TR_ANSPORTXTION:I,ND PUBLIC WORKS
The City of Fort Worth•1000 Throckmortm Street•Fort Worth,TY 76012-6311
(817)392-7941 •Fax(817)392-7845
FORTWORTH rev 03/05/07
TRANSPORTATION&PUBLIC WORKS
FINAL STATEMENT OF CONTRACT TIME
FINAL STATEMENT NO.:l
NAME OF PROJECT: Sendera Ranch Phase3 Section 3D
PROJECT NO.: 2203 CONTRACTOR: RKM Utility Services,Inc.
DOE NO.:
ITW-
PERIOD FROM:02/17/15 TO: 12/10/15 FINAL INSPECTION DATE: 10-Dec-15
WORK ORDER EFFECTIVE:2/17/2015 CONTRACT TIME: 85 0 WE* CD
DAY OF DAYS REASON FOR DAYS DAY OF DAYS REASON FOR DAYS
MONTH CHARGED CREDITED MONTH CHARGED CREDITED
DURING DURING
1. Tue 1 16.
2. Wed 1 17.
3. Thu 1 18.
4. Fri 1 19.
5. Sat 1 20.
6. Sun 1 21.
7. Mon 1 22.
S. Tue 1 23.
9. Wed 1 24.
10. Thu Final 25.
11. 26.
12. 27.
13. 28.
14. 29.
15. 30.
31.
SAT,SUN, RAIN,TOO WET, UTILITIES OTHERS* DAYS TOTAL
& HOLIDAYS &TOO COLD RELOCATIONS CHARGED DAYS
THIS
PERIOD 297 297
PREVIOUS
0 0
PERIOD
TOTALS 297 297
TO DATE
-REMARKS:
CONTRA TOR DATE INSPECTOR DATE
ENGINEERING DEPART7IEN''T
The City of Fort Worth•1000 Throdanorton Street•Fort Worth,T176012-6311
(817)392-7931•Fas(817)392-7845