HomeMy WebLinkAboutContract 46690-FP2 Depart t of PW Const. Services
DOE#,' . Date CITY SECRETAW.
Prosect Manager�, CONTRACT NO.
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Risk Management S. Canday ITWORTH.
D.O.E. Brotherton i
CFA Westerman/Scanned ❑
The Proceeding people have been Contacted concerning the requestATION AND PUBLIC WORKS
110r final payment&have released this project for such payment. IF PROJECT COMPLETION
Clearance Conducted By Etta Bacy D.O.E.Ns: 7376
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Regarding contract 117376 for WATER/SANITARY SEWER& STREET LIGHTING HSC INDUSTRIAL as
required by the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by City Council on
N/A through M&C N/A the director of the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT
upon the recommendation of the Assistant Director of the Transportation&Public Works Department has accepted
the project as complete.
Original Contract Prices: $24,640.00
Amount of Approved Change Orders: N2 1
Revised Contract Amount: $24,640.00
Total Cost Work Completed: $23,935.00
Less Deductions:
Liquidated Damages: Days Q$210.00/Day
Pavement Deficiencies:
Total Deduction Amount: $0.00
Total Cost Work Completed: $23,935.00
Less Previous Payments:
Final Payment Due $23,935.00
;z•out• Zeal 4.,
Recommended for Acceptance Date
Asst. Director, TPW - Infrastructure Design and Construction
may tj -- ----2,/�-Xg
Accepted A Date
Directo ,
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TRANSPORTATION AND PUBLIC WORKS DEPARTMENT
Asst. City Manager Date j
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Comments: FUND ACCT:C205-2023202435
E�rA.aLE.�► I
FEB 1 1 2016
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FORT NORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name WATER,SANITARY SEWER&STREET LIGHTING HSC INDUSTRIAL B
Contract Limits
Project Type STREET LIGHTING
City Project Numbers 02435
DOE Number 7376
Estimate Number I Payment Number 1 For Period Ending 10/26/2015
CD
City Secretory Contract Number 117376 Contract Time 120;D
Contract Date 4/9/2015 Days Charged to Date 113
Project Manager Ehia Contract is 97.000 Complete
Contractor TRI DAL EXCAVATION&UTILITIES INC
540 COMMERCE ST
SOUTHLAKE, TX 76092
Inspectors RODGERS / SALINAS
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City Project Numbers 02435 DOE Number 7376
Contract Name WATER,SANITARY SEWER&STREET LIGHTING HSC INDUSTRIAL Estimate Number 1
Contract Limits Payment Number 1
Project Type STREET LIGHTING For Period Ending 10/26/2015
Project Funding
UNIT IR:STREET LIGHTING IMPROVEMENTS
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
---------------------- --------------------
1 2"SCH 80 PVC CONDUIT 645 LF $9.00 $5,805.00 600 $5,400.00
2 1#12 G 645 LF $3.00 $1,935.00 250 $750.00
3 1 ALUMINUM QUAD 2224#6 645 LF $2.00 $1,290.00 600 $1,200.00
4 PULL BOX 1 EA $975.00 $975.00 2 $1,950.00
5 INSTALL PAD MOUNTED CONTRACTOR WITH 1 FA $6,125.00 $6,125.00 1 $6,125.00
METER
6 NEW STREET LIGHT TYPE 18 WITH 33A ARMS 2 EA $4,255.00 $8,510.00 2 $8,510.00
Sub-Total of Previous Unit $24,640.00 $23,935.00
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Wednesday,November 04,2015 Page 2 of 4
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City Project Numbers 02435 DOE Number 7376
Contract Name WATER,SANITARY SEWER&STREET LIGHTING HSC INDUSTRIAL Estimate Number 1
Contract Limits Payment Number I
Project Type STREET LIGHTING For Period Ending 10/26/2015
Project Funding
Contract Information Summary
Original Contract Amount $24,640.00
Chanize Orders
Total Contract Price $24,640.00
Jewjwel�_
D t �/ �z% Total Cost of Work Completed $23,935.00
Mont actor Less %Retained $0.00
Date I Net Earned $23,935.00
Inspection Supe ►s f - Earned This Period $23,935.00
�CC /� /2 / t r Retainage This Period $0.00
--C," Date
i� Less Liquidated Damages
Project Manager
Drays Q /Day $0,00
D to ?'Gtr'• /(P LessPaventent Deficiency $0.00
ctorlfPW/infrastructure Design and Construction Less Penalty $0.00
Less Previous Payment $0.00
Director/C tracting Department Plus Material on Land Less 15% $0.00
Balance Due This Payment $23,935.00
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Wednesday,November 04,2015 P*ge3 o1`4
City Project Numbers 02435 DOE Number 7376
Contract Name WATER,SANITARY SEWER&STREET LIGHTING HSC INDUSTRIAL Estimate Number I
Contract Limits Payment Number I
Project Type STREET LIGHTING For Period Ending 10/26/2015
Project Funding
Project Manager Ehia City Secretary Contract Number 117376
Inspectors RODGERS / SALINAS Contract Date 4/9/2015
Contractor TRI DAL EXCAVATION&UTILITIES INC Contract Time 120 CD
540 COMMERCE ST Days Charged to Date 113 CD
SOUTHLAKE, TX 76092 Contract is .000000 Complete
CITY OF FORT WORTH
SUMMARY OF CHARGES
Line Fund Account Center Amount Gross Retainage Net
Funded
i
Total Cost of Work Completed $23,935.00
Less %Retained $0.00
Net Earned $23,935.00
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Earned This Period $23,935.00
Retainage This Period $0.00
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Less Liquidated Damages
0 Days @ $0.00 /Day $0.00
LessPavement Deficiency $0.00
Less Penalty $0.00
Less Previous Payment $0.00
Plus Material on Hand Less 15% $0,00
Balance Due This Payment $23,935.00
Wednesday,November 04,2015 Page 4 of
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540 Commerce ,M. UTILITIES Metro (817)481-2886- -
Southlake; TX 76092 Fax {817) 410-8024
AFFIDAVIT
STATE OF TEXAS
COUNTY OF TARRANT
Before me,the undersigned authority a Notaq Public: n the state and cowity
aforesaid, ori this day personally appeared ScDttLangham,PioiOct Manager of Tri Dal,
Ltd,known tome to be a credible jrcrson,who being`by me duly sworn,upou,his oath
deposed and said;
That all person,ffrnis,associations, corporations or other organizations furnishing
labor and/or materials have.been paid hi Rill;
That the wage scale established by the City Council in the City of Fort Worth has
been paid;and
That there are no ch inns pend ing_for persolial injury and/or property c{��rinages;
Oji C'Ohftac.-t described aS;.
IISC Industrial Buf1din
DOE'#:Z37b;Ciiy.Pigiect#: 02435
i
ujaterProject# P26S:b02I50243.5= 0
SarufarY Setiver=# P275 702130243500 -
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Scat-Ungham
tbselil ed _sero 11 t efore°rne on t
.11-s 28th;cia5r o;.'July,2.6 3
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CONSENT OF OWNER ❑
ARCHITECT ❑
SURETY COMPANY CONTRACTOR ❑
,TO FINAL PAYMENT SURETY
OTHER
AIA DOCUMENT C70-7
PROJECT: HSC Industrial Building
(name, address) Fort Worth, TX
TO (Owner)
FCity of Fort Worth CFA No.- 2014-051
100 Throckmorton Street
CONTRACT FOR: Water, Sanitary and Street
Fort Worth, TX 76102 Lighting
CONTRACT DATE: April 9, 2015
CONTRACTOR:
TRI DAL UTILITIES, LTD.
In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the
(here insert name and address of Surety Company)
TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA
ONE TOWER SQUARE., HARTFORD, CT 06183 SURETY COMPANY,
on bond Of(here insert name or Contractor)
TRI DAL UTILITIES, LTD.-
540
TD.540 COMMERCE ST., SOUTHLAKE, TX 76092 CONTRACTOR,
hereby approves of 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 to (here insert name and address of Owner)
CITY OF FORT WORTH
100 THROCKMORTON STREET, FORT WORTH, TX 76102 OWNER,
as set forth in the said Surety Company's bond, Bond No. 106229771
IN WITNESS WHEREOF,
the Surety Company has hereunto set its hand this 28th day of July, 2015.
TRAVELERS CASUALTY AND SURETY
COMPANY OF AMERICA
Stl?e y Company
Signature of Authorized Representative
A tt.est: /�--
0eal): Toni Petranek, Witness Trena-e Donovan
Title Attorney-In-Fact
NOTE:.This form is to used as a companion document to AIA--DOCUMENT G706, CONTRACTORS AFFIDAVIT OF PAYM-ENT ANTTDEBTB AND
CLAIMS, Current Edition — —
AIA DOCUMENT 0707 - CONSENT OF SURETY COMPANY TO FINAL PAYMENT APRIL-1970 EDITION 'AIA® ONE PAGE
t3 1970 - THE AMERICAN INSTITUTE OF ARCHTTECTS, 1735 NEW YORK-AVE., NW,WASHINGTON, D.C. 20006 —
f
I K WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER
!! e POWER OF ATTORNEY
L�AVE>L�RJ Farmington Casualty Company St.Paul Mercury Insurance Company
Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company
Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company of America
St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company
St.Paul Guardian,Insurance Company
Attorney-In Fact No. 229569 Certificate No, 006-399'528
KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company,St, Paul Fire and Marine Insurance Company,St, Paul Guardian Insurance
Company,St.Paul Mercury Insurance Companyi Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States
Fidelity and Guaranty Company are corporations duly organized under the laws of the State of Connecticut,that Fidelity and Guaranty Insurance Company is a
corporation duly organized under the laws of the State of Iowa,and that Fidelity and Guaranty Insurance Underwriters,Inc„is a corporation duly organized under the
laws of the State of Wisconsin(herein collectively called the"Companies"),and that the Companies do hereby make,constitute and appoint
Clem F.Lesch.Steven W.I-ewis.Eric Lesch,lZoecr Bules,Jennifer Picchi.Trenuc Donovan,and Tonic Petranck
of the City of Irving State of Texas their true and lawful Attorneys)-in-Fact,
each in their separate capacity if more than one is named above,to sign,execute,seal and acknowledge any and all bonds,recognizances,conditional undertakings and
other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons,guaranteeing the performance of
contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law.
1N:WPT14F 8S`AYHEREOF,the Companies have caused this instrument to be signed and their corporate seals to be hereto affixed,this 24th
d5y ofJmt�: 2015
Farmington Casualty Company St.Paul Mercury Insurance Company
Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company
Fidelity and Guaranty Insurance'lnderwrlters,Inc. Travelers Casualty and Surety Company of America
St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company
St,Paul Guardian Insurance Company
pASV,{r � �•4tFE6 �*µ.,rNsa {1N9Vq ftY AH° W°� .51�Y�
� Zb^O � RyyYb..,.._ Y <��OAPo•Aa>�2 P: `^ F;'t� tT '' � � � t
1977 c' � `�im iJ.°0 0l � twtnonn. < tt_
State of Connecticut By:
City of Hartford ss. Robert L.Raney, enior Vice President
On this the 24th day of June 2015 before me personally appeared Robert L.Raney,who acknowledged himself to
be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul
Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers
Casualty ru d_Surety Company of America,and United States Fidelity and Guaranty Company,and,that he,as such,being authorized so to do,executed the foregoing
instrument for the-purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer.
0.1ET ,
In Witness Whereof,I hereunto set my hand and official seal.
My Commission expires the 30th day of June,2016. Or
�UbUG Marie C.Teircauli,Notary Public
- l
58440-8-12 Printed in U.S.A.
WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER j
WARNING:THIS POWER OFATTORNEY IS INVALID WITHOUT THE RED BORDER
This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company,Ffdeli1
and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,-Inc.,St.Paul Fire and Marine Insurance Company,St. Paul Guardian Insurance
Company,St_Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty mid Surety Company of America,and United States
Fidelity and Guaranty Company,which resolutions are now in full force and effect,reading as follows:
RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President,any Vice President,any Second Vice
President,the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary may appoint Attorneys-jn-Fact and Agents to act for and on.behalf
of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the
Company's seal bonds,recognizances,contracts of indemnity,and other writings obligatory in the nature of a bond,recognizance,or conditional undertaking,and any
of said officers or the Board of Directors at any time may remove any such appointee and revoke the power-given-him or her;and it is
FURTHER RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Viee-President,any Senior Vice President or any Vice President may
delegate all or any part of the foregoing authority to one or more officers or employees of this Company,provided that each such delegation is in writing and a copy
thereof is filed in the office of the Secretary;and it is
FURTHER RESOLVED,that any bond,recognizance,contract of indemnity,or writing obligatory in the nature ofd bond,recognizance,or conditional undertaking
shall be valid and binding upon the Company when(a)signed by the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice
President,any Second Vice President,the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the
Company's seal by a Secretary or Assistant Secretary,-or(b)duly executed(under seal,if required)by one or more Attorneys-in-Fact and Agents pursuant to the power
prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is
FURTHER RESOLVED,that the signature of each of the following officers:President,any Executive Vice President,any Senior Vice President,any Vice President,
any Assistant Vice President,any Secretary,any Assistant Secretary,and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any
certificate relating thereto appointing Resident Vice Presidents,Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds '
and undertakings and other writings obligatory in the nature thereof,and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal
shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on
the Company in the future with respect to any bond or understanding to which it is attached.
1,Kevin E.Hughes,the undersigned,Assistant Secretary,of Farmington Casualty Company,Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance
Underwriters,Inc.;St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury insurance Company,Travelers Casualty and
Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company do hereby certify that the above and"foregoing
is a true and correct copy of the Power of Attorney executed by said Companies,which is in full force and effect and has not been revoked. - -
IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this'81h day of
f
Kevin E.Hughes,Assistant Sect9tary
GA6LAl �11RC Q �i�1�S0 �INSLq �JT,Wpr
-
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19 S 2 0 � 1977 �+ m j x i n HNrIFOPD, � �7 tiL'itPJnA� <
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's a o o SB1i1;•.e W S
To verify the authenticity of this Power of Attorney,call 1-800-421-3880 or contact us at www.tmvelersbond.com.Please refer to the Attorney-In-Fact number,the
above-named individuals and the details of the bond to which the power is attached.
I
WARNING:THIS POWER OF ATTORNEY IS INVALID WrfHOUTTHE RED-BORDER
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540 Commerce UTILITIES Metro (817) 481-2886
Southlake,-TX 76092 Fax (817) 410-8024
AFFIDAVIT
STATE OF TEXAS
COUNTY OF`1"ARRANT
Before me, the tindersigned authority a Notary Public in the shite lud county
aforesaid,.on this city Personally appeared Scott Langham,Project Manager of Tri Dal,
Ltd;known to the to he a credible person,who being by me duly sworn, tlpon his oath.
deposed and said;
That all person,finlls; associations, corporations or other organizations f irnishing
labor`and/or materials have been Haid 111 Rill;
That the wage-scale establislied by the City Council in the City of Fort Worth has
been paid; and
That there are no claims pending for personal injury and/or property daniages;
On Contract described as;
HSC Industrial Buildint
DOE#: 7376 City Project#: 02435
Water Proicet#:P265-6021502435-00
Sanitary Sewer#: P275-7021302435-00
BY:
i
Scot all lam
Subscribed and sNvoln before me ori this 12th day of November, 2015
- BY: rtiC �, J Wit' "�� ;{t:
� >
4' = JI�NIME e�slia�o h Janine DeSlia a C1
_' � Noteiy EublIG,Slate of iafc
-IV GOMM'tsston Exptaes Notary Public in Taii•ant
July 0 , 2019
` County,Texas
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A o ,rte R H REV:02/22107
TRANSPORTATION AND PUBLIC WORKS'
CONTRACTOR'S EVALUATION OF,CITY
1)PROJECT INFORMATION Date: F11/10/2015
Name gfcorr/raclor r Pr( ecl,i'arpe
Tri-Dal Utilities I.1SC Industrial
DOF.hispsctor' Projecl,I tare i-ei'
Martina Salinas — Red Elea
110E r1'uumer Projecl Df j%ictthy 7}pe ojC.'onlract
7376_ O Simple OO Routine 0 Complex ❑Water i]Waste Water ❑Storm Drainage L Pavement
Irrilial Contract Aniaunl - Final contract Amount
$2,460.00 $23,935.00
11)PERFORMANCE EVALUA'T'ION
0-Inadequate I -Deficient 2-Standard 3-Good 4-Excellent _
FLF\1FNT RATING FI,FNIE'Nl RMING
INSPECTION EVALVATION PLANS Sz SPECIFICATIONS
---- _ _
I Availability of Inspector F l Accuracy of Plans to Existing Conditions j
- r --
nspttor
3 Ac Knowledge
-�21__ 3 Applicabili[3 otfSpocifieltions[s
4 Display Of Professionalism �4 Accuracy of Plan.Quantities
S Citizen Complaint Resolution �C PROJECT MANAGE,R EVALUATION
6 Performance-setting ith Valve Crews,Labs -1 KtiotiN,ledge Aii(VOr Problem Resolution
AllM.INISTRATION 2 Availability of'.Project Manager f`
l Change Order Processing Time _ - 3 Comtnunlcattolt _
2 Timliness,of Contractor Paymenise 4 Resohttion o_f Utilitjt Conflicts —
3 Bid Opening to Pre-Con Meeting Titnefi•attte
III)COMMENTS&SIGNATURES
COMAJENTS
T�
Signature Contractor '� s
Signature DOE Inspector A
i
Signature DOE Inspector's Supervisor
t
Imspm,roTt'5 COMI ENTS
a
'iRANTSPDXIWrION'A-NND PUBLIC 1CTORKS
j. The City of Fort\North 1000'Throckinorton Street•Fort ZNortli, ,06012-63`11
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(817)392-7941 Fqx:(317)392-7845
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FORT WORTHV:0z,2o,0'
TRANSPORTATION AND PUBLIC WORKS
PERFORMANCE EVALUATION OF CONTRACTOR
I) CONTRACTOR&PROJECT DATA
iVame of Contractor Project Name
Tri-Dal Utilities HSC Indush•ial Building
DOL Inspeclor DOE Number
Martina Salinas 7376
DOE Ltspeclor Project Manager
❑ water El Waste Water❑ Storm DrainageD Pavement Fred Ehia
Inittal Contract Amount Project Diffilculty
$2,460.00 0 Simple Q Routine 0 Complex
Final Contract Amount Dale
$23,935.00 11/10/2015
II)PERFORMANCE EVALUATION
0-Inadequate I-Deficient 2-Standard 3-Good 4-Excellent
ELEMENT IWEIGHT(x) APPLICABLE(Y/N) RATING(0-4) 1 MAX SCORE ISCORE
I 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 3 60 45
6 Finished Product 15 Y 4 60 60
7 Job Site Safety 15 Y 4 60 60
8 Traffic Control Maintenance l5 Y 4 60 60
9 Daily Clean Up 5 Y 3 20 15
10 Citizen's Complaint Resolution 5 N
II Property Restoration 5 Y 4 20 20
12 After Hours Response 5 N
13 Project Completion 5 Y 2 20 10
TOTAL ELEMENT SCORE(A) 356
BONUS POINTS(25 Maximum)(B)
III)CONTRACTOR'S RATING TOTAL SCORE(TS) 356
Maximum Score(NIS)=448 or sum of applicable element score maximums whiclt= 408
Rating(ITS/MSI a 100%) 356 1 408 = 87%
Performance Category Excellent
<20%=Inadequate 20%to<40%=Deficient 40%to<60 o=Standard 60'�b to<80%=Good ?S(1%=Excellent
Inspector's Comments(INCLUDING EXPLANATION OF BONUS POINTS ANVVARDED)
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Signature DOE Inspector Signature Contractor
"--Q
Signature DOE Inspector's Supervisor
CONTRACTORS col+*AEIVTs
TR-A-Nt SPORTATIO'd AND PUBLIC FORKS
' The City of Fort Worth•1000 Throckmorton Street•Fort Word,T-X-76012-6311
(817)392-7941•Fat-(817)392-7845
FORT WORTH ,
TRANSPORTATION AND PUBLIC WORKS
STATEMENT OF CONTRACT TIME
STATEMENT# 1
FINAL STATEMENTH Final DOE 7376
NAME OF PROJECT: HSC Industrial Building Conn actor ;. .. A
YEAR:j 2015
PROJECT NO.: FINAL INSPECTION DATE 181-21)E;
#/02435 1 WD D
CONTRACTTIME 1 120 1 x
PERIOD FROM: 9/16/2015 TO: 1 9/21/2016 1 MID Month IDEVELOPNIM11(Y/N y
WORK ORDER EFFECTIVE: 6/1/2015 BEG !n n MID /n
DAY OF MONTH DAYS REASON FOR DAY OF MONTH DAYS REASON FOR
CIIARCED DAYS CREDITED CHARGED DAYS CREDITED
1 Tue 16 Tue 1
2 Wed 17 Wed 1
3 Thu 18Thu 1
4 Fri _19 Fri
6_ Sat 20 Sat 1
6 ---_Sun21 Sun 1
-7 Mon 22 Mon 1
8 Tue_ 23 Tue 1
9 Wed __ 24 Wed_ 1
10 Thu _ _ _ 26 Thu 1
11 Fri 26_ Fri 1
12 Sat 27 Sat 1
13 Sun 28 Sun 1 i
14 Mon 29
15 Tue 30
31
NA Wkn&Hol Wea utl Oth
Not Applicable SAT,SUN,and WEATHER UTILITIES OTHERS DAYS TOTAL DAYS
HOLIDAYS RELOCATE CHARGED
THIS PERIOD 0 0 0 0 13 13
PREVIOUS PERIOD 0 100 100
TOTAL TO DATE 0 0 0 0 113 113
REMARRS:
_/ sa
Signature: `; Signature:
'yl
(Print Name) (Print Name) Martina Salinas
CONTRACTOR "!'i j ft's- DATE INSPECTOR
nAzs 7 0/2712015 }
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