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Contract 46272-FP1
Department Qf TP&W Const. Services DOE# Date Project anager�� s Risk Management J. Page -tz'; fir RT WORTH. CiTY S1- J D.O.E. Brotherton CoI CT W. CFA Westerman/Scanned V The Proceeding people have been C ted concerning the request for final payment&have released this project for such payment. rATION AND PUBLIC WORKS Clearance Conducted By Shameka Kennedy )F PROJECT COMPLETION D.O.E.NQ: 7263 Regarding contract 317263 for DYNATEN ADDITION-ST LIGHT as required by the 69,q q�z7z. TRANSPORTATION&PUBLIC WORKS as approved by City Council on N/A through M&C N/A the director of the TRANSPORTATION&PUBLIC WORKS upon the recommendation of the Assistant Director of the Transportation&Public Works Department has accepted the project as complete. Original Contract Prices: $18,703.56 Amount of Approved Change Orders: NQ Revised Contract Amount: Total Cost Work Completed: $18,703.56 Less Deductions: Liquidated Damages: Days @$210.00/Day Pavement Deficiencies: Total Deduction Amount: Total Cost Work Completed: $18,70356 Less Previous Payments: $0.00 Final Payment Due $18,703.56 Recotr�nended for Acceptance Date Asst. Director, TPW - Infrastructure Design and Construction Accepted Date Director, TRANSPORTATIO $� PUBLIC WORKS f «'/l Asst. City Manager Date Comments: C205-541200-205320231283 FEB 2016 '�A R��OR® FORT WORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name DYNATEN ADDITION Contract Limits Project Type STREET LIGHT City Project Numbers 02312 DOC Number 7263 Estimate Number I Payment Number I For Period Ending 10/8/2015 CD City Secretary Contract Number 317263 Contract Time 36CD Contract Date Days Charged to Date 85 Project Manager Long Contract is 100.00 Complete Contractor MELS ELECTRIC 6305 SIH45 WICHER, TX 75172 Inspectors LAYER / HOUSTON .- a Thursday,Octoba 08 2015 Page 1 of 4 City Project Numbers 02312 DOE Number 7263 Contract Name DYNATEN ADDITION Estimate Number I Contract Limits Payment Number I Project Type STREET LIGHT For Period Ending 10/8/2015 Project Funding ST LIGHT Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total --------------------------------------- 1 RDWY ILLUM FOUNDATION I EA $984.84 $984.84 1 $984.84 2 2"CONDT PVC SCH 80 350 LF $11.50 $4,025.00 350 $4,025.00 3 GROUND BOX TYPE B I EA $517.63 $517.63 1 $517.63 4 RDWY ILLUM ASSMBLY TY 8 1 EA $1,626.09 $1,626.09 1 $1,626.09 5 6-6-6 TRIPLEX ALUM ELEC CONDUCTOR 1050 LF $11.00 $11,550.00 1050 $11,550.00 -------------------------------------- Sub-Total of Previous Unit $18,703.56 $18,703.56 i r I i s i i i i Thursday,October 08,2015 Page of i @i@ 6 4 f� f City Project Numbers 02312 DOG Number 7263 Contract Name DYNATEN ADDITION Estimate Number I Contract Limits Payment Number 1 Project Type STREET LIGHT For Period Ending 10/8/2015 Project Funding Contract Information Summary Original Contract Amount $18,703.56 Change Orders Total Contract Price $18,703.56 DaL.LJa 1.1 Total Cost of Work Completed $18,703,56 Coe re Less %Retained $0.00 /., Date Net Earned $18,703.56 �" Inspection 3 r Earned This Period $18,703,56 C Retainnge This Period $0.00 t a7 Less Liquidated Damages Project ganager ( Days @ /Day $OAO t' Date �'� �y LessPavement Deficiency $0,00 Ass, 1,ctortrP -Infrastructure Design and Construction Less Penalty $0.00 pate �� �'« Less Previous Payment $0.00 Director Contracting Departin Plus Material on Hand Less 15% $0,00 e ��✓ Balance Due This Payment $18,703.56 /G I a Thinsday,October 08,2015 Page 3 of4 I City Project Numbers 02312 DOE Number 7263 Contract Name DYNATEN ADDITION Estimate Number I Contract Limits Payment Number I Project Type STREET LIGHT For Period Ending 10/8/2015 Project Funding Project Manager Long City Secretary Contract Number 317263 Inspectors LAYER / HOUSTON Contract Date Contractor MELS ELECTRIC Contract Time 365 CD 6305 SIH45 Days Charged to Date 85 CD WICHER, TX 75172 Contract is .000000 Complete CITY OF FORT WORTH SUMMARY OF CHARGES Line Fund Account Center Amount Gross Retainage Net Funded i i i i i Total Cost of Work Completed $18,703.56 ; Less %Retained $0.00 Net Earned $18,703.56 1 Earned This Period $18,703.56 Retainage This Period $0.00 Less Liquidated Damages 0 Days @ $0.00 /Day $0.00 LessPavement Deficiency $0.00 r Less Penalty $0.00 Less Previous Payment $0.00 1 Plus Material on Hand Less 15% $0.00 Balance Due This Payment $18,703.56 i jt 3 Thursday,October 08,2015 Page d of 4 1 f a e f I E FORTWORTH rev 03/05/07 TRANSPORTATION&PUBLIC WORKS FINAL STATEMENT OF CONTRACT TIME FINAL STATEMENT NO. 1 NAME OF PROJECT: Dynaten Addition PROJECT NO.: 2312 CONTRACTOR: Mel's Electric DOE NO. 7263 PERIOD FROM 07/06/15 TO: 09/25/15 FINAL INSPECTION DATE: 28-Sep-15 WORK ORDER EFFECTIVE 7/6/2015 CONTRACT TIME 365 O WD OO CD DAY OF DAYS REASON FOR DAYS DAY OF DAYS REASON FOR DAYS MONTH CHARGED CREDITED MONTH CHARGED CREDITED DURING DURING 1. 16. 2. 17. 3. 18. 4. 19. 5. 20. 6. 21. 7. 22. 8. 23. 9. 24. 10. 25. 11. 26. 12. 27. 13. 28. 14. 29. 15. 30. 31. SAT,SUN, RAIN,TOO WET, UTILITIES OTHERS* DAYS TOTAL &HOLIDAYS &TOO COLD RELOCATIONS CHARGED DAYS THIS 0 0 0 0 85 85 PERIOD PREVIOUS 0 0 0 0 © 0 PERIOD TOTALS 0 0 0 0 85 85 TO DATE *RF-MARKS; 00"- I C5 -.7- CPNTRACOR DATE INSPE DATE _ ENGINEERING DEPAR"T,%f a%I' The Cit_-of FortWorth-1000 Throckmorton Street-Fort Wortk TX 76012-6311 (817)392-7971-F=(817)392-7845 1�/ FORT WO RT H REV:02/22/07 TRANSPORTATION AND PUBLIC WORKS CONTRACTOR'S EVALUATION OF CITY I)PROJECT INFORMATION Date: 10/7/2015 Name of Contractor Project Name Mel's Electric Dynaten Addition DOEInspector Project Manager - - Garey Houston Aaron Long DOENmuber T}pe of Contract 7263 JProjectDiffict-111), O Simple O Routine O Complex ❑Water ❑Waste Water ❑Storm Drainage ❑Pavement Initial ContractAmount Final ContractAmo►mt $18,703.56 $18,703.56 I1)PERFORMANCE EVALUATION 0-Inadequate 1 -Deficient 2-Standard 3-Good 4-Excellent r LENIENT RATING ELEMENT RATING 0-4 _(0-4) INSPECTION EVALUATION PLANS&SPECIFICATIONS 1 Availability of Inspector 4,1 1 Accurac of Plans to Existing Conditions 2 Knowledge of Inspector 2 Clari &Sufficienc of Details 3 Accurac of Measured Quantities 3 !kpplicability of Specifications _ 4 Dis la Of Professionalism 4 Accuracy of Plan Quantities 5 Citizen Complaint Resolution PROJECT MANAGER EVALUATION 6 Performance-Setting up Valve Crews,Labs 411 Knowledge And/Or Problem Resolution ADMIlVISTRATION 2 Availability of Proect Manager 1 Change Order Processing Time 3 Comniuuieation 2 Timliness of Contractor Payments 14 Resolution of Utili Conflicts 3 Did 2pen*g to Pre-Con Meeting Timefiaame - HO COMMENTS&SIGNATURES COMMENTS Signature Contractor Signature DOE Inspector i Signature DOE Inspectors Supervisor INSPECTOR'S COMMENTS I i i I t i ' _ TRANSPORTATION AND PUBLIC WORKS I The City of Fort Worth-1000 Throckmorton Street•Fort Worth,TX 76012-6311 (817)392-7941•Fsw(817)392-7845 FORTWORTH REV:02/20/07 TRANSPORTATION AND PUBLIC WORKS PERFORMANCE EVALUATION OF CONTRACTOR D CONTRACTOR&PROJECT DATA Name oJContractor Project Nanne Mel's Electric D naten Addition DOE,lnspector DOENumber Garey Houston 7263 DOE Inspector Project Manager ❑Water ❑Waste Water ❑Storm Drainage ❑Pavement Aaron Lon Initial Conh•act Amount Project Difficulfy $18,703.56 O Simple OO Routine O Complex Final Contract Amount Date $18,703.56 10/7/2015 ID PERFORMANCE EVALUATION 0-Linde uate 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 4 8 8 2 Public Notifications 5 Y 4 20 20 3 Plans on Site 5 Y 4 20 20 4 Field Su erviston 15 Y 4 60 60 5 Work Performed 15 Y 4 60 60 6 Finished Product 15 Y 4 60 60 7 Job Site Safety 15 Y 4 60 60 8 Traffic Control Maintenance 15 Y 4 60 60 9 Daily Clean Up 5 Y 4 20 20 10 Citizen's Complaint Resolution 5 Y 4 20 20 11 Property Restoration 5 Y 4 1 20 20 12 After Hours Response 5 Y 4 20 20 13 Pro'cct Completion 5 Y 4 20 20 TOTAL ELEMENT SCORE(A) 448 BONUS POINTS(25 Maximum)(B) TOTAL SCORE(TS) 448 IID CONTRACTOR'S RATING Maximum Score(MS)=448 or sum of applicable element score maximums which= 448 Rating((TS/MS]*100%) 448 1448 = 100% Perlbrmance Category Excellent <20%=Inadequate 20%to<40%=Deficient 40%to<60%=Standard 60%to<80%=Good >_80%=&vellent Inspector's Comments(INCLUDING EXPLANATION OF BONUS FOU41S AWARDED) Signature DOE Inspector Signature COntTACiOP Signature DOE Inspector's Supervisor CONTRACTORS COMMENTS s i IRANSPORTATION AND PUBLIC WORKS The City of Fort Worth-1000 Throckmorton Street•Fort Worth,TX 76012-6311 0 (817)392-7941•Fax;(817)392-7845 CONSENT OF OWNER ❑ SURETY COMPANY ARCHITECT ❑ TO FINAL PAYMENT CONTRACTOR ❑ SURETY ❑ AIA.DOCUMENT G707 OTHER ❑ Bond No. 1039724 PROJECT: Remove,relocate and replace a light pole-Dynaten Addition—Project CFA Number 2014-072 (name,address) TO(Owner) Dynaten Corporation and City of Fort Worth Architect's Project No.: Contract For: Remove,relocate and replace a light pole Dynaten Addition—Project CFA Number 2014-072 Contract Date: May 7,2015 Contractor: Mels Electric,LP,6305 S Interstate Highway 45, Wilmer,TX 75172 In accordance with the provision of the Contract between the Owner and the Contractor as indicated above,the The Hanover Insurance Company,SURETY COMPANY,on bond of Mels Electric,LP,CONTRACTOR,hereby approves the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve the Surety Company of any of its obligations Dynaten Corporation and City of tort Worth,OWNER,as set forth in the said Surety Company'bond. IN WITNESS WHEREOF, the Surety Company has hereunto set is hand this 30th Day of October, 2015. The Hanover Insurance Company Surety Company I i Signature 611AWhort'A Representative Peggy Hogan Attorney-In-Fact Attest: (Seal): i i Nobe: This form is to be used as a companion document to AIA DOCUMENT G706,CONIRACTOWS AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS,Current Edition AIA DOCUMENT G707•CONSENT OF SURETY COMPANY TO FINAL PAYMENT s April 1970 Edition •AIA® One Page Of 970 a THF AMERICAN INSTITUTE OF ARCHITECTS,1735 New York Ave_,NW,Washington,D.C.20006 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 MASSACHUSETTS 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 Lott,Steve Rickenbacher,David Oxford,Peggy Hogan and/or Sherrei Breazeale of Southwest Assurance Group,Inc.of Dallas,TX and each is a true and lawful Attorneys)-in-fact to sign,execute,seal,knowledge 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 Million and No/100($30,000,000)in any single instance and said companies hereby ratify and confirm all and whatsoever said Attorney(s)-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,Thatthe 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 bonds,recognizances, contracts of indemnity,waivers of citation and all otherwritings obligatory in the nature thereof,with powerto attach thereto the seal of the Company.Any such writings so executed by such Attorneys-in-fact shall be as binding upon the Company as if they had been duty 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) IN WITNESS WHEREOF,THE HANOVER INSURANCE COMPANY, MASSACHUSETTS BAY INSURANCE COMPANY and CITIZENS INSURANCE COMPANY OF AMERICA have caused these presents to be sealed with their respective corporate seals,duly attested by two Vice Presidents, this 10th day of November 2014. THE HANOVER INSURANCE COMPANY Y `, `� MASSACHUSETTS SAY INSURANCE COMPANY ti CITIZENS $URANCE OMAANY OF AMERICA 7loti'II g 1484 1074 �' Robert Thomas,Vioe Ptcsldent THE COMMONWEALTH OF MASSACHUSETTS ) COUNTY OF WORCESTER )ss, Joc Arenstrom,Vic`4 President On this 10th day of November 2014 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 seals and their signatures as officers were duly affixed and subscribed to said Instrument by the authority and direction of said Corporations. i V BARBARA A.GARLICK Notary Public CanvimmvoAathosAtafeBchaO"e '' ' IAyCorm+�SiionErpt�Sayi.2L201B y _ 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 ofAttomeyand Certified Copies of such Powers ofAttorney 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." (Adopted October 7,1981-The Hanover Insurance Company;Adopted April 14,1982-Massachusetts Bay Insurance Company;Adopted September7,2001-Citizens Insurance Company of America) GIVEN under my hand and the seals of said Companies,at Worcester,Massachusetts,this 30th day of October 2015. r THE HANOVER INSURANCE COMPANY IMAASA HUSETT BAY I CE COMPANY EN I SUR CE OF AMERICA h I ete,Vice s ent 1 c v Texas Complaint Notice Commercial Lines IMPORTANT NOTICE AVISO IMPORTANTE To obtain information or make a complaint: Para obtener informacion o para someter una queja: You may call The Hanover Insurance Company/ Usted puede llamar al humero de telefono gratis de Citizens Insurance Company of America's toll-free The Hanover Insurance Company/Citizens Insurance telephon6 number for information or to make a Company of America's para informacion o para complaint at: someter una queja al; 1-800-343-6044 1-800-343-6044 You may also write to The Hanover Insurance Company/ Usted tambien puede escribir a The Hanover Insurance Citizens Insurance Company of America at: Company/Citizens Insurance Company of America al: 440 Lincoln Street 440 Lincoln Street Worcester,MA 01653 Worcester,MA 01653 You may contact the Texas Department of Insurance Puede comunicarse con el Departamento de Seguros to obtain information on companies,coverages, de Texas para obtener informacion acerca de rights or complaints at: companias,coberturas,derechos o quejas al: 1-800-252-3439 1-800-252-3439 You may write the Texas Department of Insurance: Puede escribir al Departamento de Seguros de Texas: P.0.Box 149104 P.O.Box 149104 Austin,TX 78714-9104 Austin,TX 78714-9104 Fax:(512)475-1771 Fax:(512)475-1771 Web:http://www.tdi.texas.gov Web:http://www.tdi.texas.gov E-mail:ConsumerProtection@tdi.texas.gov E-mail:ConsumerProtection@tdi.texas.gov 1 PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS 0 RECLAMOS: Should you have a dispute concerning your premium Si tiene una disputa concerniente a su prima o a un or about a claim you should contact the agent or the reclamo,debe comunicarse con el agente o la com- company first,If the dispute is not resolved,you may pania primero.Si no se resueive la disputa,puede contact the Texas Department of Insurance. entonces comunicarse con el departamento(TDI), ATTACH THIS NOTICE TO YOUR POLICY: This UNA ESTE AVISO A SU POLIZA: Este aviso es solo notice is for information only and does not become para proposito de informacion y no se convierte en a part or condition of the attached document, parte o condicion del documento adjunto. I : I f i I iS 3 E 3 I { MELS ELECTRIC, L.P. AFFIDAVIT OF BILLS PAID STATE OF TEXAS § § KNOW ALL MEN BY THESE PRESENTS: COUNTY OF DALLAS § Personally, before me the undersigned authority,on this day appeared Timothy Keierleber,who being duly sworn on oath, says that he is a legal representative of Mels Electric, L. P. and that the contract for the construction of the project, designated as: DYNATEN BUILDING 3935 Tarrant Main St. Fort Worth,TX 76040 SUBCONTRACT NO.: 2014019.166 has been satisfactorily completed and that all bills for materials,apparatus,fixtures, machinery, labor and equipment used in connection with the construc Wer, c have been fully paid. Tlmot Kelesi have Sworn to and subscribed before me this,the 29th day of October, 2015 Susan J.Hensley . �TexasPublic Notary Public in-and for Dallas Cou STATE OF TEXAS op CoM.Exp.1012=17 i I 1 i 635 SourH I.H. 45 P.O. Box 40 WILMER. TEXAS 75172