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Contract 45007-FP1
F0RT WORTH � . � , �� . Received By Business Support Group Brandy Crane DEC 2 3 2019 TRANSPORTATION AND PUBLIC WORKS NOTICE OF PROJECT COMPLETION D.O.E. Ns: 7019 Regarding contract 45007 for BRIDGE REPAIR&REHABILITATION @ 25 LOCATIONS (2012-25) as required by the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by City Council on 12/11/2012 through M&C C-25997 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: $241,666.52 Amount of Approved Change Orders: T(o 1 Revised Contract Amount: $241,666.52f Total Cost Work Completed: $241,371.62' Less Deductions: Liquidated Damages: Days @$210.00/Day Pavement Deficiencies: Total Deduction Amount: $0.00 Total Cost Work Completed: $241,371.62 Less Previous Payments: $238,957.90 i Final Payment Due $2,413.72 12 Recommended for Acceptance Date Asst. Director, TPW - Infrastructure Design and Construction )u, Accepted Date C Director, TRANSPORTATION AND PUBLIC WORKS DEPARTMENT Asst, City Manager Date ii Comments: FUND ACCT: GG01-5391590-0202 003 �I RK VVORTH9 TX =`?- TPW Construction Invoice Contract: CS45007 P.O # PO-15 86954,PO 14 80588,PO Payment Date: 11/10/2015 TO:Bone Construction Solutions LLCCS5007- TMA t,# Estimate No. 21 DOE 7019 5217 Davis BLVD Ste D ProjManager Tariqul Islam NRichlandHills TX 76248 ACH- ContractFOR: 2012-25 Bridge Repair and Rehabilitation at 25 Bridges Amount: $241,666.52 Completed Ret Ad-j Pay FINAL PAY Total to Date: $241,371.62 $0.00 $0.00 $241,371.62 Previous Estimate: $241,371.62 $2,413.72 $0.00 $238,957.90 Earned to Date: $0.00' ($2,413:72) $0.00 52;413.72 Payments: GG01-539590-0202003 $241,666.52 10100-0202003-5430104- Total to Date: $241,371.62 $0.00 $0.00 $241,371.62 Previous Estimate: $241,371.62 $2,413.72 $0.00 $238,957.90 Earned to Date: $0.00 ($2,413.72) $0.00 $2,413.72 Transportation&Public Works BUSMESS SUPPORT GROUP Contact Person-BRANDY CRANE-Ext.2852 DePartmen=provSignatKARENSTRIKEgAA DEPARTME T CHECK PICK-UP YES ❑ Monday,January 25,2016 Page I of 1 City Project Numbers DOE Number 7019 Contract Name BRIDGE REPAIR&REHABILITATION Q 25 LOCATIONS(2012-25) Estimate Number 21 Contract Limits Payment Number 21 Project Type BRIDGE REPAIR For Period Ending 11/10/2015 Project Funding Project Manager Islam City Secretary Contract Number 45007 Inspectors RODGERS / SALAZAR Contract Date 12/11/2012 Contractor BONE CONSTRUCTION SOLUTIONS,LLC Contract Time 120 CD P O BOX 823043 Days Charged to Date 85 CD NORTH RICHLAND , TX 76182 Contract is .000000 Complete HILLS CITY OF FORT WORTH SUMMARY OF CHARGES Line Fund Account Center Amount Gross Retainage Net Funded ---------------------------------------- Total Cost of Work Completed $241,371.62 Less %Retained $0.00 Coot f gr�aalo"" Net Earned $241,371.62 Earned This Period $2,413.72 - Y'Ca + l Retainage This Period $0.00 management . n d $rot erton Less Liquidated Damages ' V6gerin FScalaned n 0 Days @ $0.00 /Day $0.00 Wt >l�allle leve he�P Contacted concerping the retlp LessPavement Deficiency $0.00 $tlSil ieI �,t € tS,oSgdt;itil� tph,pnywen>& Less Penalty $0.00 Less Previous Payment $238,957.90 � 1t1ot& ' Plus Material on Hand Less 15% $0.00 Balance Due This Payment $2,413.72 Tuesday,November 10,2015 Page 4 of 4 FORT WORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name BRIDGE REPAIR&REHABILITATION @ 25 LOCATIONS(2012-25) Contract Limits Project Type BRIDGE REPAIR City Project Numbers DOE Number 7019 Estimate Number 21 Payment Number 21 For Period Ending 11/10/2015 CD City Secretary Contract Number 45007 Contract Time 12(ED Contract Date 12/11/2012 Days Charged to Date 85 Project Manager Islam Contract is 100.00 Complete Contractor BONE CONSTRUCTION SOLUTIONS,LLC P O BOX 823043 NORTH RICHLAND , TX 76182 HILLS Inspectors RODGERS / SALAZAR Tuesday,November 10,2015 Page 1 of 4 City Project Numbers DOE Number 7019 Contract Name BRIDGE REPAIR&REHABILITATION @ 25 LOCATIONS(2012-25) Estimate Number 21 Contract Limits Payment Number 21 Project Type BRIDGE REPAID For Period Ending 11/10/2015 Project Funding BRIDGE REPAIR Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total --------------------------------------- I ------- ----------- — ------ I REMOVE CON(OTHER)-TXDOT SPEC ITEM 2 CY $1,635.79 $3,271.58 1.2 $1,962.95 104 2 FLOWABLE BACKFILL-TOOT SPEC ITEM 401 24 CY $523.38 $12,561.12 12 $6,280.56 3 CNC STR REP HORIZONTAL TXDOT SPEC 130 SF $88.97 $11,566.10 53.55 $4,764.34 ITEM 429 4 CNC STR REPAIR VERTICAL OR OVERHEAD 460 SF $114.04 $52,458.40 425 $48,467.00 TXDOT SPEC ITEM 429 5 CNC STR REP BRIDGE DECK PARTIAL DEPTH 750 SF $51.37 $38,527.50 830.75 $42,675.63 TXDOT SPEC ITEM 429 6 RIPRAP CONCRETE 5 IN TOOT SPEC ITEM 432 2 CY $1,433.61 $2,867.22 1.79 $2,566.16 7 CLEAN AND SEAL JOINTS AND CRACKS 5140 LF $14.92 $76,688.80 6273.9 $93,606.59 TXDOT SPEC ITEM 438 8 TREE REMOVAL 4"-12"DIA TOOT SPEC ITEM 31 EA $1,013.00 $31,403.00 34 $34,442.00 752 9 EPDXY INJECTION TY IX TEXDOT SPEC ITEM 180 LF $68.46 $12,322.80 96.5 $6,606.39 780 ---------------------------------------- Sub-Total of Previous Unit $241,666.52 $241,371.62 ------------------------------------- i i Tuesday,November 10,2015 Page 2 of City Project Numbers DOE Number 7019 Contract Name BRIDGE REPAIR&REHABILITATION @ 25 LOCATIONS(2012-25) Estimate Number 21 Contract Limits Payment Number 21 Project Type BRIDGE REPAIR For Period Ending 11/10/2015 Project Funding Contract Information Summary Original Contract Amount $241,666.52 Chamw Orders Total Contract Price $241,666.52 ,JIO"�72/1-11, , Date Total Cost of Work Completed $241,371.62 r ctor Less %Retained $0.00 Net Earned $241,371.62 Date Earned This Period $2,413.72 Inspection Supervisor Retainage This Period $0.00 Date Less Liquidated Damages Project M Days @ /Day $0.00 Date Z C�'�.i LessPavement Deficiency $0.00 1 ASst irector/T` rPW-Infrastructure Design and Construction Less Penalty $0.00 W, Date Z Ir 5� Less Previous Payment $238,957.90 Director ontractingDepartm t Plus Material on Hand Less 15% $0.00 Balance Due This Payment $2,413.72 Tuesday,November 10,2015 Page 3 of 2/7/2016 BuySpeed Online -1 T- Y., Bu Online Accounts Payable Basic Purchasing Department Access NIGP Code Browse I My Account I Customer Service I About Current Organization:CITY OF FORT WORTH FO February 7,2016 10:29:06 AM CST Nome Documents Brandy Crane Invoice#:CS45007-FINAL*Vendor#:0000035957 Vendor Group#:01 Status:41R-Ready for Approval General Items Credits Subcontractors Accounts Routing Attachments Notes Reminder Change Order Summary Back to PO Header Information Invoice Number: CS45007-FINW Invoice Status: 41R-Ready for 3 way Approval Invoice Type: matching Invoice Description- CS45007-FINAL Bridge Repair and Rehabilitation at Twenty Five Invoice Date: 11/10/2015 Effect Date: 0210712016 Bridges 2012-25 Payment Amount: $2,413.72 Handling Code: ACH(DIRECT Payment Date: 12105/2015 DEPOSIT) Payment Terms., ACH(DIRECT DEPOSIT) Payment Term Day: o Payment Discount; 0.0% Paid-Bank/Check: Alternate Id: Entered By: Brandy Crane Entered Date. 0210712016 CredltAmount: $0.00 Updated By: Brandy Crane Updated Date: 02/0712016 Received Date: 11110/201510:25:00 AM Attachments i Agency Files: Agency Forms: Vendor Files: Vendor Forms: Purchase Order Information Purchase order Number: DRPA-16.00078059 PO Description CS45007-FINAL PAY PO Amount: $2,413.72 Remaining To $0.00 Buyer- Brandy Invoice: Crane PoVendor Information Vendor: 0000035957-BONE CONSTRUCTION SOLUTIONS LLC Address Grp: 01 Vendor Remit-to Tolissa Townsend Address: 6217 DAVIS BLVD STE D N RICHLAND HILLS,TX 76248 USA Fed ID: -6057 Remit Text: Email:johnbonebcs@oudook.com Phone:(817)718-1095 Id:119306 (EFT Enabled) Item Information Invoice Item#1130 Item#:1 2012-25 Bridge Repair&Rehabilitation at 25 Bridges 10100--2060000----- PO 0100--2060000----- PO Permit Invoice Discount% 0r Iginal Fin Item Status To Pay Amount Pay Amount Pay 1 3PCR-Complete Receipt $0.00 $2,413.72 0.0% $0.00 Yes MAKE: ASSET MODEL: ASSET_MANUF: ASSET SERIAL: ASSET VIN: ASSET TAG: r Event Type Fiscal Year Account Code Transaction Amount Exp. 16 10100--2060000----- $2,413,72 Eric. 16 10100--2060000----- -$2,413.72 Approval Path: h".Ilbso.fbrtworthtexas.gov/bsolpurchaseorderfinvoicelinvoiceSummary.sdo?vendorld=0000035957&docld=DRPA-16-00078059&releaseNbr=O&doeType=l... 1/2 2!7/2016 BuySpeed Online Delete Approver Order Approval Level Approver Date Date Approved/DlsapprovedlCanceled Comment Sequence Path Typo Requested ApprovedfDlsapproved/Canceled by View ID Add ♦ New Primary Addfl)elete Approver Print j Copyright©2016 Periscope Holdings,Inc.-All Rights Reserved.default https://bso fortworthtexas.gov/bso/purchaseorderfinvoicefinvoiceSummary.sdo?vendorld=0000035957&docld=DRPA-16-00078059&releaseNbr=O&docType=1... 212 10100 2060000 -48227.050 CEN ACCOUN TRANSAM EFFECTIV FUND TERI TID OUNT EDATE DESC1 DESC2 DESC3 D GG01 0 205000 $(6,001.16) 11/25/2013 CS45007-15 BSAP 35957 403604 GG01 0 205000 $(4,050.10) 12/11/2013 CS45007-16 BSAP 35957 403604 GG01 0 205000 $(4,429.03) 12/30/2013 CS45007-17 BSAP 35957 403604 GG01 0 205000 $(4,502.11) 1/13/2014 CS45007-18 BSAP 35957 403604 GG01 0 205000 $(3,100.10) 1/29/2014 CS45007-19 BSAP 35957 403604 GG01 0 205000 $19,668.78 2/12/2014 CS45007-20 BSAP 35957 403604 $(2,413.72) TO ALL WHOM IT MAY CONCERN WHEREAS, Cowtown Traffic Control, Inc.has been paid by BONE CONSTRUCTION SOLUTIONS, LLC.To furnish materials,supplies and/or equipment,for real property construction project located at VARIOUS BRIDGES, FORT WORTH,TEXAS and known as the Bridge Repair and Rehabilitation at Six Locations (2012-25)—(GG01-539590-0202003)project. NOW,THEREFORE,This 18th day of March 2014 for and in consideration of the sum of$1,436.05 paid simultaneously herewith,the receipt which is hereby acknowledged by the undersigned, (Cowtown Traffic Control, Inc.)does hereby waive and release any lien rights to,or claim of lien with respect to and on said above-described premises,and the improvements thereon,for the monies or other consideration due or to become due materials,supplies and/or equipment billed on Invoice(s) THROUGH January 31,2014 job by virtue of said contract on account of materials,supplies and/or equipment furnished by the undersigned to BONE CONSTRUCTION SOLUTIONS, LLC.for the use on the above-described premises. THIS FINAL R OF LIEN IS CONDITIONED UPON THE CLEARANCE WITH COLLECTED FUNDS OF THE HE V �� NECTION WITH THIS FINAL WAIVER. r _ It's a c u is presentative Co Tr , Inc. ignatur G,: o (printed name) Title: SUBS D SWORN TOB ORE ME this Qa / day of minted name) NOTA PUBLIC, in and for the State of Texans DEBRA K.STEWART My Commission Expires: 6 Y AG y C)O4 *® NOTARY PUBLIC STATE OF TEXAS OF4c My Comm.Exp.04-04-2016 112 W.Jessamine Street Fort Worth,Texas 76110 • Phone:817-9244524 • Fax:817-926-2725 Ai I TO ALL WHOM IT MAY CONCERN WHEREAS,SUNBELT RENTALS has been paid by BONE CONSTRUCTION SOLUTIONS, LLC.To furnish materials, supplies and/or equipment,for real property construction project located at VARIOUS BRIDGES, FORT WORTH,TEXAS and known as the Bridge Repair and Rehabilitation at Six Locations (2012-25)–(GG01-539590-0202003) project. NOW,THEREFORE,This 18th day of March 2014 for and in consideration of the sum of$°d paid simuitaneousiy herewith, the receipt which is hereby acknowledged by the undersigned, (Sunbelt Rentals) does hereby waive and release any lien rights to, or claim of lien with respect to and on said above-described premises,and the improvements thereon, for the monies or other consideration,due or to become due materials, supplies and/or equipment billed on Invoice(s)THROUGH January 31,2014 job by virtue of said contract on account of materials,supplies and/or equipment furnished by the undersigned to BONE CONSTRUCTION SOLUTIONS, LLC.for the use on the above-described premises. THIS FINAL WAIVER OF LIEN IS CONDITIONED UPON THE CLEARANCE WITH COLLECTED FUNDS OF THE CHECK GIVEN IN CONNECTION WITH THIS FINAL WAIVER. By: It's accounts representative Sunbelt entals nn By: , (signature) (printed name) Title:. .tom ac.- 9-, SUBSCRIBED AND SWORN TO BEFORE ME this.--d—day of (printed name) NOTA PUBLIC, in and for the State ofTe#s � My Commission Expires: (IJ•.2�•l 7 .� O � /',JENNIFER L EDWARDS NOTARY PUBLIC w: :;TATE OF OHIO '0011'm. xpir'et. a June 23, 2014 ";11T t o f O \\�� TO ALL WHOM IT MAY CONCERN WHEREAS,RAM TOOL has been paid by BONE CONSTRUCTION SOLUTIONS, LLC.To furnish materials, supplies and/or equipment,for real property construction project located at VARIOUS BRIDGES, FORT WORTH,TEXAS and known as the Bridge Repair and Rehabilitation at Six Locations (2012-25)— (GG01- 539590-0202003) project. NOW,THEREFORE,This 20th day of March 2014 for and in consideration of the sum of total $)31����a4aid herewith,which is hereby acknowledged by the undersigned,(Ram Tool) does hereby waive and release any lien rights to, or claim of lien with.respect to and on said above-described premises, and the improvements thereon,for the monies or other consideration due or to become due materials,supplies and/or equipment billed on Invoice(s)THROUGH January 31, 2014 job by virtue of said contract on account of materials,supplies and/or equipment furnished by the undersigned to BONE CONSTRUCTION SOLUTIONS, LLC..for the use on the above-described premises. THIS FINAL WAIVER OF LIEN IS CONDITIONED UPON THE CLEARANCE WITH COLLECTED FUNDS OF THE CHECK GIVEN IN CONNECTION WITH THIS FINAL WAIVER, By: 02,ZA ° It's accounts representative r Ram Tool By: aJ2'� � (signature) e re 50 (printed name) Title: SUBSCRIBED AND SWORN TO BEFORE ME this /1/ day of A' `Aec-k (printed name) \111111111111/ WQdan(A �� �N,N WYp�q� ►'� ��\��' lr��'�Ia!� �YOT P LIC,.in and r the State of r ;. =* NOTARY V*_ My Commission Expires: PUBLIC z llllilllll CONSENT OF SURETY OWNER ° TO FINAL PAYMENT ARCHITIRCT �► CONTRACTOR [� AIA I.aCj42t Tent G707 SURM Y �7 Bond No. 712251P OTHM TO OWNML- ARCHITECT'S PROJECT NT O.:N/A (Nmneeurdadcbr.�j City of Fort Worth Bridge Repair and Rehabilitation at Six 1000 Throckmorton CONTRAC`f Fait-Locations(2012-25),GG01-539590-0202003 Fort Worth, TX 76102 I',ROJECT CONTTtt1,CTDATED.December 11,2012 (fflv))wandrtdd w*0 Bridge Repair and Rehabilitation at Six Locations(2012-25), GG01-539590-0202003 In accordance with Tile provisions ofthe contract between the Owner and the Contractor as indjuted above,the ffilw xnattrrtnrdadd,vnrofsurc t) Developers Surety and Indemnity Company P. O. Box 19725 Irvine, CA 92623 SUR M. , on bond of {Insert namectndaddrrssgf�ontrizuar9 Bone Construction Solutions, LLC P.O. Box 823043 North Richland Hills, TX 76182 COMPACTOR, hereby approves of the final payment to the Contractor,and agrees that final payment to the Contractor shall not relieve the Surety of any of Its obligadons to (!r>_wrrrruuneandadtlr+easaf4u•rrc,j � City of Fort Worth 1000 Throckmorton Fort Worth,TX 76102 OWNER, as set forth in said Surety s bond. IN WITNESS WHEREOF,the Surety has hereunto set its hand on this date; April 7, 2014 (lraan9In4vitingThe rrrambfollouv�,dhvtherrta,rerfedatea,rdrm ) ANA Developers Surety and Indemnity Company wetpRPOR -Ito gT,may:, rtYj r b OCT. fi B ?yT 10 rnL y' So 1938 oc ='jd''•, r a,,: (SYgratrrm t11ba,Y rr nt tirrj Attest'. � " •,�� ., Brady K. Cox A orney-in-Fact N (Seal). Mariss Allen tl',intrrl uameaud tldpl CQ707-7994 POWER OF ATTORNEY FOR DEVELOPERS SURETY AND INDEMNITY COMPANY PO Box 19725,IRVINE,CA 92623 (949)263-3300 KNOW ALL BY THESE PRESENTS that except as expressly limited,DEVELOPERS SURETY AND INDEMNITY COMPANY,does hereby make,constitute and appoint: """Brent Baldwin,Brock Baldwin,William D,Baldwin, Michael B. Hill,Brady K,Cox,Blaine Allen,Monica Campos,jointly or severally'"` as its true and lawful Attomey(s)-in-Fact,to make,execute,deliver and acknowledge,for and on behalf of said corporation,as surely,bonds,undertakings and contracts of suretyship giving and granting unto said Attomey(s)-in-Fad full power and authority to do and to perform every act necessary,requisite or proper to be done in connection therewith as each of said corporation could do,but reserving to each of said corporation full power of substitution and revocation,and all of the acts of said Attorney(s)-in-Fact,pursuant to these presents,are hereby ratified and confirmed. This Power of Attomey is granted and is signed by facsimile under and by authority of the following resolution adopted by the Board of Directors of DEVELOPERS SURETY AND INDEMNITY COMPANY,effective as of January 1st,2008. RESOLVED,that a combination of any two of the Chairman of the Board,the President,any Executive Vice-President,Senior Vice-President or Vice-President of the corporation be,and that each of them hereby is,authorized to execute this Power of Attorney,qualifying the atiorney(s)named in the Power of Attomey to execute,on behalf of the corporation,bonds,undertakings and contracts of suretyship;and that the Secretary or any Assistant Secretary of the corporation be,and each of them hereby is,authorized to attest the execution of any such Power of Attomey; I RESOLVED,FURTHER,that the signatures of such officers may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile,and any such Power of Attomey or certificate bearing such facsimile signatures shall be valid and binding upon the corporation when so affixed and in the future with respect to any bond,undertaking or contract of suretyship to which it is attached. IN WITNESS WHEREOF,DEVELOPERS SURETY AND INDEMNITY COMPANY has caused these presents to be signed by its officers and attested by its Secretary or Assistant Secretary this May 23.2013. f 8y:__' MD +`�y A7H •a Daniel Young,Senior Vice-President fWi O;L =meq BY: " r` xot 1936 ?b Gregg N.0 ice-President /Qy1...•1•JD State of California County of Orange On May 23 2013 before me, Gina L Gamer Notary Public Date Here Insert Name and Title of the Officer personalty appeared Daniel Young and Gregg N.Okura Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s)whose name(s)istare subscribed to the within instrument and acknowledged to me that helshe/they executed the same in hislharitheir authorized capacity(tes),and that by hisihatitheir signatures)on the instrument the person(s),or the entity upon behalf of LINA L.GARNER which the person(s)acted,executed the instrument. COMM,#2021213 NOTARY PUBLIC C.AUFOF kA I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is ORAS COUNtyf true and correct. y� NIoomm. 18.2017 as � WITNESS my hand and official seal. '- -— Place Notary Seal Above Signature Gina L.Gamer,Notary Public CERTIFICATE The undersigned,as Secretary orAssislant Secretary of DEVELOPERS SURETYAND INDEMNITY COMPANY does hereby certify that the foregoing Power ofAltorney remains in full force and has not been revoked and,furthermore,that the provisions of the resolution of the Board of Directors of said corporation set forth in the Power of Attomey are in farce as of the date of this Certificate. This Certificate is executed in the City of Irvine,California,this 7th day of April,2014 , Mark J.Lansdon,Assistant Secretary ID-1438(Rev.05113) FORTWORTH REV:02/20/07 TRANSPORTATION AND PUBLIC WORKS PERFORMANCE EVALUATION OF CONTRACTOR CONTRACTOR&PROJECT DATA Name of Contractor Project Name Bone Construction Solutions,LLC Bridge Repair and Rehabilitation at Tm Five Locations(2 DOEInspector DOENumber Richard Salazar 7019 DOEInspector Project Manager ❑ Water❑ Waste Water❑ Storm Drainage❑ Pavement Na'ib Fares Initial ContractAmount Project Difficulty $241,666.52 O Simple O Routine O Complex Final Contract Amount Date $241 4 -= 1Z 11/12/2015 II)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 4 20 20 3 Plans on Site 5 Y 4 20 20 4 Field Supervision 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 3 20 15 10 Citizen's Complaint Resolution 5 Y 3 20 15 11 Property Restoration 5 Y 4 20 20 12 After Hours Response 5 Y 4 20 20 13 Project Completion 5 Y 4 20 20 TOTAL ELEMENT SCORE(A) 436 BONUS POINTS(25 Maximum)(B) TOTAL SCORE(TS) 436 III)CONTRACTOR'S RATING Maximum Score(MS)=448 or sum of applicable element score maximums which= 448 Rating(ITS/MS]*100%) 436 / 448 = 97% 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 Throckmorton Street•Fort Worth,TX 76012-6311 (817)392-7941 •Fax:(817)392-7845 FORTWORTH 02'22'0' TRANSPORTATION AND PUBLIC WORKS CONTRACTOR'S EVALUATION OF CITY I)PROJECT INFORMATION Date: 11/12/2015 Name of Contractor Project Name Bone Construction Solutions,LLC Bridge Repair and Rehabilitation at Twenty Five Bridges(201 DOE Inspector Project Manager Richard Salazar Tari ul Islam DOENumber ProjectDelcult), TjpeofContract 7019 10 Simple O Routine O Complex ❑ Water❑ Waste Water❑ Storm Drainage0 Pavement Initial Contract Amount Final Contract Amount $241,666.52 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 Ins ector 2 Clarity&Sufficiency of Details f` 3 Accuracy of Measured Quantities 13 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 Change Order Processing Time 3 Communication 2 Timliness of Contractor Payrnents 14 Resolution of Utility Conflicts 3 Bid Opening to Pre-Con Meeting Timeframe III)COMMENTS&SIGNATURES COMMENTS Signature Contractor Signature DOE Inspector Signature DOE Inspector's Supervisor INSPECTOR'S COMMENTS TRANSPORTATION AND PUBLIC WORKS The City of Fort Worth•1000 Throckmorton Street•Fort Worth,TX 76012-6311 (817)392-7941 •Fax:(817)392-7845 IOWAI I {� 3j i f t 1 1 f�'xdi 1 1 1 fUlnie i��611 �tA u � �L1 adaJn r : ? oAe nF i 1N�cSo' �i Yi•f.�� ty`s"' �sL.r!t�i�i�'tr: '�}`�•�'�`�� �iS�j� s c� o�;f'� Zt'F�oT(o�o�>f"�o � yds � ?'�` L•�`, ��� i "� �� 1 • 1 1 1 • ' / 1 1 I 1 1 '� 1 1 • ' i 1 • 1 i ' 1 1 1 1 Tv }�lilei.�iz� {L6-1 its 2. ©' [pit 0�t' 4 t � iyy hi}1�� 3s L t (' 1t;I''� fi•1*''[E`rh�e 4 Y `? k`�° + t; Xa.4titz�r� 1 M 1 1 �Yu'Y'£' x i f�;ii ;S1 S'x_''5�..1 i..k1�� K €t?�d'a`t 46,t:5R�Fsi�(yt s;,ti, r�-4{ iaf3 Nti..G/z ' ,(J_.k�!O o- y 11 NO Ell 11 }ren}Katinl' /{Ilj j/Y011(� eI1Fl�t��rE 1//1�a1/ l�i� i�r BP(r�n j�l( rrY G el Cho! Ia�t Ie�k s I R 3 ..tib # t fi s 1 _3f� ,.,r,.e. 2 44 s s i 3, ..��_�1"�4•�7�1t,� t �1 ,z3}.3�z--.,z. s2.3 '��.Y.. - r_ .i `,x�t ���' _ .�-4• +c z �T tS{ rxy _. s: r'�; ��,�" ts'u�'a`� `' f�3�G£'i�' �•? �{i'isS?F S 5s���t 'v Cc +fit— '�-�'F As,� i—� i. K [} .i{yrG , (,UL31 i:..__s"5.s •,:i>xuF•�?,3� L,�YCS+nieL,s"c.i. 5,� +..�N_L�L'a���i�b?,,i-d�gUUs3a',91.`.`_`�'3u'��������rl c._�aa.��4'�'FC:.�.t..rs.r „lam t�S?.c:�.)i.�.ci�S_S�� le 4u•_��...� ��..11�'1��].f /{�I�•;� FORTWORTH. TRANSPORTATION AND PUBLIC WORKS NOTICE OF PROJECT COMPLETION D.O.E. Ns: 7316 Regarding contract 45808 for CONCRETE RESTORATION(2014-10)AT VARIOUS LOCATIONS as required by the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by City Council on 06/03/2014'-rough M&C C-26813'&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. ss9, yVt.?2 � Original Contract Prices: Amount of Approved Change Orders: $0.00 N9 1 559,YY)-72 a� Revised Contract Amount: $56r„�rL Total Cost Work Completed: $462,261.36 Less Deductions: Liquidated Damages: 40 Days @$650.00/Day Pavement Deficiencies: Total Deduction Amount: $26,000.00' C Total Cost Work Completed: $436,261.36 i Less Previous Payments: $386,253.7 ' FinaIPaymenta $50,007.611 i Ak b - 717 �l / ecomm ded r Acceptance Date Asst. Dir tor, TPW - Infrastructure Design and Construction r Accepted Date Director, TRANSPORTATION AND PUBLIC WORKS DEPARTMENT Asst. City Manager Date Comments: FUND ACCT: GG01-537110-0202006 =f t TPW Construction Invoice Contract: CS45808 P.O.# PO-15-86924,PO-14-84154 Payment Date: X0/15/2015 TO:Nissi Development Group INV.I/ CS45808-25 Estimate No. 25 DOE: 7316 11498 Luna Rd Ste 104 ProjManager Tariqul Islam Dallas TX 75234 FOR: 2014-10 CONCRETE RESTORATION AT VARIOUS LOCATIONS Contract Amount: $559,441.72 ACH Completed Ret Adj Pay Total to Date: $462,261.36 $0.00 ($26,000.00) $462,261.36 Previous Estimate: $406,582.89 $20,329.14 $0.00 $412,253.75 Earned to Date: 5555678.47 ($20,329.14) (S16,000.00); $50,007.61 Payments: C301-537110-200000100115 $559,441.72 30100- -5330401-C100115-C10000- Total to Date: $462,261.36 $0.00 ($26,000.00) $436,261.36 Previous Estimate: $406,582.89 $20,329.14 $0.00 $386,253.75 Earned to Date: $55,678.47 ($20,329.14) ($26,000.00) $50,007.61 Transportation&Public Works BUSINESS SUPPORT GROUP Contact Person-BRANDY CRANE-Ext.2852 i Department Approva "� ature torr KAREN > STRIKER DEPARTMENT CHECK PICK-UP YES ❑� Wednesday,March 02,2016 Page 1 of 1 City Project Numbers DOE Number 7316 Contract Name CONCRETE RESTORATION(2014-10)AT VARIOUS LOCATIONS Estimate Number 25 Contract Limits Payment Number 25 Project Type PAVING For Period Ending 10/15/2015 Project Funding Project Manager Islam City Secretary Contract Number 45808 Inspectors RODGERS / WOLFF Contract Date 6/3/2014 Contractor NISSI DEVELOPMENT GROUP,INC Contract Time 244 CD 11498 LUNA RD SUITE 104 Days Charged to Date 284 CD DALLAS, TX 75234 Contract is .000000 Complete CITY OF FORT WORTH SUMMARY OF CHARGES Line Fund Account Center Amount Gross Retainage Net Funded Q Ct1<Ii�$tr +PeB Total Cost of Work Completed j $462,261.36 _ Less %Retained $0.00 i�stt IYlanager l _ Net Earned $462,261.35 Ianaglement'S. Canady Earned This Period $76,007.61 Brothe>rton A Westerman/Scanned ❑. Retainage This Period $650.00 Less Liquidated Damages lffwTl 8pceedaig people have been Contacted.conceraing the requ.of 40 Days @ $650.00 /Day $26,000.00 I*fth#1 payment&have released this project for such payment LessPavement Deficiency $0.00 0 �1taa CondactO'gy UfAg Aaey Less Penalty $0.00 Less Previous Payment $386,253.74 Plus Material on Hand Less 15% $0.00 Balance Due This Payment $50,007.61 Tuesday,October 20,2015 Page 4 of 4 FORTWORT CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name CONCRETE RESTORATION(2014-10)AT VARIOUS LOCATIONS Contract Limits Project Type PAVING City Project Numbers DOE Number 7316 Estimate Number 25 Payment Number 25 For Period Ending 10/15/2015 CD City Secretary Contract Number 45808 Contract Time 24CD Contract Date 6/3/2014 Days Charged to Date 284 Project Manager Islam Contract is 82.000 Complete Contractor NISSI DEVELOPMENT GROUP,INC 11498 LUNA RD SUITE 104 DALLAS, TX 75234 Inspectors RODGERS / WOLFF Tuesday,October 20,2015 Page I of 4 v �\ City Project Numbers DOE Number 7316 Contract Name CONCRETE RESTORATION(2014-10)AT VARIOUS LOCATIONS Estimate Number 25 Contract Limits Payment Number 25 Project Type PAVING For Period Ending 10/15/2015 Project Funding PAVING Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total --------------------------------------- I REMOBILIZATION 1 EA $900.00 $900.00 2 REMOVE CONCRETE DRIVEWAY 380 SF $1.79 $680.20 480.5 $860.10 3 6"CONCRETE DRIVEWAY 380 SF $4.55 $1,729.00 480.5 $2,186.28 4 REMOVE CONCRETE PAVEMENT 9600 SY $5.73 $55,008.00 8620 $49,392.60 5 7"CONCRETE PAVEMENT HES 9600 SY $38.08 $365,568.00 8620 $328,249.60 6 UNCLASSIFIED EXCAVATION 200 CY $48.00 $9,600.00 110 $5,280.00 7 FLEX BASE,TYPE A GR-2 800 CY $23.00 $18,400.00 489 $11,247.00 8 CONCRETE HESS(EXTRA DEPTH) 200 CY $127.00 $25,400.00 4 $508.00 9 BLOCK SOD PLACEMENT 268 SY $4.39 $1,176.52 10 JOINT SEALANT 7000 LF $2.80 $19,600.00 11 MISCELLANEOUS ADJUSTMENT(UTILITIES) 1 LS $5,800.00 $5,800.00 1.082116 $6,276.27 12 MISCELLANEOUS STRUCTURE ADJUSTMENT 1 EA $4,700.00 $4,700.00 (10'STORM DRAIN INLET TOP) 13 RAISED MARKER TY W 1000 EA $4.25 $4,250.00 381 $1,619.25 14 RAISED MARKER TY Y 1000 EA $4.25 $4,250.00 149 $633.25 15 REFL RAISED MARKER TY I-A 50 EA $4.95 $247.50 32 $158.40 16 REFL RAISED MARKER TY I-C 50 EA $4.95 $247.50 78 $386.10 17 REFL RAISED MARKER TY 11-A-A 50 EA $4.95 $247.50 36 $178.20 18 REFL RAISED MARKER TY 11-C-R 50 EA $4.95 $247.50 10 $49.50 19 LOOP DETECTOR CABLE SAWCUT 1000 LF $22.00 $22,000.00 1194 $26,268.00 20 14 AWG LOOP DETECT CABLE 1000 LF $13.00 $13,000.00 1194 $15,522.00 21 CURB ADDRESS PAINTING 4 EA $30.00 $120.00 22 REMOVE/REPLACE SIDEWALK 200 SF $7.50 $1,500.00 972 $7,290.00 23 REMOVE/REPLACE EXISTING RAMP WITH 8 EA $375.00 $3,000.00 4 $1,500.00 STANDARD ADA RAMP 24 GEOGRID TEXAS(TRIAX 140475) 1000 SY $3.97 $3,970.00 1173 $4,656.81 --------------------------------------- Sub-Total of Previous Unit $561,641.72 $462,261.35 -------------------------------------- Tuesday,October 20,2015 Page 2 of 4 City Project Numbers DOE Number 7316 Contract Name CONCRETE RESTORATION(2014-10)AT VARIOUS LOCATIONS Estimate Number 25 Contract Limits Payment Number 25 Project Type PAVING For Period Ending 10/15/2015 Project Funding Contract Information Summary Original Contract Amount $561,641.72 Change Orders Change Order Number 1 $0.00 Total Contract Price $561,641.72 +' \ � Date Z t}' � Total Cost of Work Completed $462,261.36 C tr or Less %Retained $0.00 41 0-1 Net Earned $462,261.35 Date Inspection Supervisor Earned This Period $76,007.61 Z"e Retainage This Period $650.00 Date r Less Liquidated Damages Projec Manag yr 40 Days @ $650.00 /Day $26,000.00 Date LessPavement Deficiency $0.00 Ass. irec /TPW- frastructure Design and Construction Less Penalty $0.00 AU Date �� 1 Less Previous Payment $386,253.74 Director Contracting Deparhne Plus Material on Hand Less 15% $0.00 Balance Due This Payment $50,007.61 Tuesday,October 20,2015 Page 3 of 4 3/212016 BuySpeed Online Online Accounts Payable Basic Purchasing Department Access NXGP Code Browse I My Account I Customer Service I About Current Organization:CITY OF FORT WORTH March 2,2016 11:52:02 AM CST Home Documents I Brandy Crane ------------------- ------ Invoice#: CS45808-FINAL Vendor#:0000036466 Vendor Group#:01 Status:41R-Ready for Approval General Items Credits Subcontractors Accounts Routing Attachments Notes Reminder Changs Order Summary Back to P Header Information Invoice Number; CS45808-FINAL Invoice Status: 41R-Ready for Approval Invoice Type: 3 way matching Invoice Description: CS45808-FINAL 2014-10 Concrete Street Restoration Invoice Date: 10/15/2015 Effect Date: 0310212016 Payment Amount: $50,007.61 Handling Code: ACH(DIRECT DEPOSIT) Payment Date- 11/0912015 Payment Terms- Payment Term Day: 0 Payment Discount: 0.0% Paid-Bank/Check: Altemate Id: Entered By: Brandy Crane Entered Date: 0310212016 Credit Amount: $0.00 Updated By: Brandy Crane Updated Date: 0310=016 Received Date- 10/15/201511:49:00 AM -Attachments Agency Files: Agency Forms: Vendor Files: Vendor Forms: Purchase Order Information Purchase order Number: PO-15-00086924 PO Description CS45808 PO Amount: $284.677.40 Remaining To Invoice: $97,180.36 Buyer: Brandy Crane PoVendor Information Vendor: 0000036466-NISSI DEVELOPMENT GROUP INC Address Grp: 01 Vendor Remit-to Address- JIWON JEON 11498 LUNA RD STE 104 DALLAS,TX 75234 USA Fed ID- -0372 Remit Text: Email:J eon@nisslgroup.com Phone:(469)420-9898 Id:119468 (EFT Enabled) Misc 8,Freight Invoice Account Event Type Fiscal Year Account Code Transaction Amount Mise 16 30100-2060000--=001-CRETAN-- $20,329.14 Miso 16 30100-020E410-5330401--CIO201-CCAPEX-2015- -$26.000.00 Total: -$5,670.86 Item information Invoice Item#1P0 Item#:I Concrete Street Restoration 201410 C301-537110-200000100115 CS45808 M&C:C-26813 Date:060314 Original PO-14-84154 PO Permit Invoice Discount% Original Final P Item Status To Pay Amount Pay Amount ay 3PPR-Partial Receipt $0.00 $55,678.47 0.0% $0.00 No MAKE: ASSET—MODEL: ASSET MANUF: ASSET SERIAL: ASSET VIN: ASSET TAG: Event Type Fiscal Year Account Coda Transaction Amount Exp. 15 30100-020E410-5330401--C10201-CCAPEX-2015- $55,678.47 Enc. 15 30100-020E410-5330401--CIO201-CCAPEX-2015- -$55,678.47 https./fto.fortvvorthtexas.gov/bso/purchaseorderfinvoiceTinvoiceSummary.sdo?vendorld=0000036466&doctd=PO-15-00086924&releaseNbr=O&doGType=[&m... 1/2 312/2016 BuySpeed Online Approval Path: Delete Approver Order Approval Level Approver Date Date Approved/Disapproved/Canceled Comment Sequence Path Type Requested Approved/Disapproved/Canceled by View ID Add New ♦ Primary -Fruit i Copyright(D2016 Periscope Holdings,Inc.-AM Rights Reserved.default hftps://bso,fortworthtexas.gov/bso/purchaseorderfinvoicefinvoiceSummary.sdo?vendorld=0000036466&docld=PO-15-00086924&releaseNbr=O&doGType=l&m... 212 FUND ACCOU CENTER TRANSAMO EFFECTIVE DESC1 DESC2 DESC3 NTID ID UNT DATE GG01 205000 0 $ (1,143.22) 10/14/2014 CS45808-2 BSAP 36466 9/30/2014 GG01 205000 0 $ (1,298.27) 10/27/2014 CS45808-3 BSAP 36466 10/15/2014 GG01 205000 0 $ (1,192.40) 11/13/2014 CS45808-4 BSAP 36466 10/31/2014 GG01 205000 0 $ (1,265.62) 11/25/2014 CS45808-5 BSAP- 36466 11/15/2014 GG01 205000 0 $ (1,955.41) 12/22/2014 CS45808-6 BSAP 36466 11/30/2014 GG01 205000 0 $ (3,511.52) 12/26/2014 CS45808-7 BSAP 36466 12/15/2014 GG01 205000 0 $ (473.82) 1/15/2015 CS45808-8 BSAP 36466 12/31/2014 GG01 205000 0 $ (2,098.84) 1/29/2015 CS45808-9 BSAP 36466 1/15/2015 GG01 205000 0 $ (804.12) 2/12/2015 CS45808-10 BSAP 36466 1/31/2015 C301 205000 100100 $ (532.34) 3/4/2015 CS45808-11 BSAP 36466 1/31/2015 C301 205000 100100 $ (702.57) 3/12/2015 CS45808-12 BSAP 36466 2/28/2015 C301 205000 100100 $ (5,351.01) 7/13/2015 CS45808-20 BSAP 36466 6/30/2015 $ (20,329.14) i AFFIDAVIT OF BILLS PAID STATE OF TEXAS § § KNOW ALL MEN BY THESE PRESENTS: COUNTY OF TARRANT § Personally, before me the undersigned authority, on this day appeared Jiwon Jeon, who being duly sworn on oath, says that he is a legal representative of Nissi Development Group,Inc. and that the contract for the construction of the project, designated as: Concrete Restoration(2014-10)at Various Location has been satisfactorily completed and that all bills for materials, apparatus, fixtures, machinery, labor, and equipment used in connection with the construction of this project have been fully paid. i I gnature Title Sworn to and subscribed before me this, the 8th day of December,2015. ar"vie•. JEFF CHgl * Notary Public � STATE OF TEXAS Nota P,u n d for of e My Comm.Exp,July 7,2019 County, Texas Instructions: If the developer or contractor is an individual, he/she shall sign the affidavit. If the developer or contractor is a partnership, any partner may sign the affidavit. If the developer or contractor is a corporation, a person authorized by the by-laws of by the Board of Directors shall sign the affidavit and a corporate resolution must accompany the affidavit showing such authority. If the developer or contractor is a joint-venture of partnerships, or of individuals and partnerships, the affidavit may be signed by the individual or any partner of the partnership accompanied by proof of authority. If the developer is or contractor is a joint-venture in which a corporation is a party, separate affidavits must be executed in the name of the joint-venture: one by each corporation and one by each individual or partnership accompanied by proof of authority. CONSENT OF OWNER SURETY COMPANY ARCHITECT ❑ CONTRACTOR ❑ TO FINAL PAYMENT SURETY ❑ Conforms with the American Institute of OTHER Architects,AIA Document G707 Bond No SU1128698 PROJECT: (name, address)CONCRETE RESTORATION (2014-10) Fort Worth. TX 76102 TO (Owner) F ARCHITECT'S PROJECT NO: CITY OF FORT WORTH CONTRACT FOR: 1000 Throckmorton Street CONCRETE RESTORATION(2014-10) Fort Worth TX 76102 �f CONTRACT DATE: CONTRACTOR:NISSI GROUP INC. 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) ARCH INSURANCE COMPANY 300 Plaza Three Jersey City NJ 07311-1107 , SURETY COMPANY on bond of (here insert name and address of contractor) NISSI DEVELOPMENT GROUP INCdba NISSI GROUP 1500 Midway Ct.Suite W12 Elk Grove IL 60007 , 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 1000 Throckmorton Street Fort Worth TX 76102 , OWNER, as set forth in the said Surety Company's bond, IN WITNESS,WHEREOF, the Surety Company has hereunto set its hand this 9th day of December,2015 ARCH INSURANCE COMPANY TSC_o parry Attest:Robbi Morales ,, 4 (Seal): gignature ofWuthorized Representative V. DeLene Marshall Attorney-in-Fact Title NOTE; this form is to be used as a companion document to AIA DOCUMENT G706, CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS, Current Edition ONE::PAGE _ 01, r(' - - - — �, li64111fitil - - — ff '�N�I3 ' tr — i AIC 0000165478 EWS POWER OFATW /- 3W- MID UNLESS ITrlSi� iTE 'BACKGROUNQ This�owWd Attorney limits thus se�ramed herein,and they vel Ihi61 oil It b i y t bind the Compa exon We— manner and to the extent herein stated. Not valid for Mortgage, Note, Loan, Letter of Credit, Bank Deposit, Currency Rate, Interest Rate or Residential Value Guarantees. All OF ATI = Know All Persons By These Presents: That the Arch Insurance Company, a corporation organized and existing under the laws of the State of Missouri, having its principal administrattyaa�- in Jersey City, Ne%Jersey awirfiffrer=referred to as they C i' %q'1qJTsj,.1a e yappoint:� Co nil ilyA.Westbrook r ' y ,1 i Morales,Soph ir I r teone Marshall of DE ' E F _ its true and lawful Attorney(s)In-Fact,to make,execute,seal,and deliver from the date of issuance of this power for and on its behalf as surety,and asits-act and deed: a alWo�ndertakin is,reg Rib � �o���p rety obligation�r i ernWs �eeding N ne Ilion�Ilars 90 000 000.0 iN '"Tt This authority does not permit the same obligation to be split into two or more bonds In order to bring each such bond within the dollar limit of authority as set forth herein. _ -WI ecmaf�rch bonds, unfit _, _�j�z�c�and other su q l� � �ti, � I R s ice of these p a tes=_ brr�li- u said Company a I all intents and me had been up acknowledged by its regularly elected officers at its principal administrative o tern Jersey City,New Jersey. This Power of Attorney is executed by authority of resolutions adopted by unanimous consent of the Board of Directors of the Company -on-Saptembe 2011, true and ace4irp�t rQ piq,, ,o�+ j i h are hereinafter set forth ander by certified to by the undersi _ rem fn full force and ff�Q.tl ——_= _— 11"111 u 11,11 " " -')1-ImP VOI D,That the Chairman of the Bd rd, tf1e President, or the Executive VW Pre ent, or any Senior Vice Presrd f, cTgHWSu e y Business Division, or their appointees designated in writing and filed with the Secretary, or the Secretary shall have the power and authority to appoint agents and attorneys-in-fact, and to authorize them subject to the limitations set forth in their respective powers of attorney,to execute on behalf of the Company, and attach the seal of the Company thereto, , rr ttr bods,I undertakings, recogn izan—ces and_ �t�rur� gns obligatortW tt any such offi rsJ t5W, appoint agen foma camy1 Ap ii Ila This Power of Attorney is signed, sealed and certified by facsimile under and by authority of the following resolution adopted by the unanimous consent of the Board of Directors of the Company on September 15,2011: =IQT€D Tha§ffftg nature of the Cha o#nth p0 1 fie President,or the€xe utiue _ dent,or any Senior�ic�sident� 1huyqess Divisiopn' r �j tp � � nated in Dwrit e�r�t1 retar y P nd t siat�r_fe AIC 0000165478 In Testimony Whereof,the Company has caused this instrument to be signed and its corporate seal to be affixed by their authorized officers,this 15`h day of September,2015. Attested and Certified Arch Insurance Company 01 f,Xf)(f47K,tTE ��` Patrick K. Nails,Secretary David M. in a stein,Executive Vice President STATE OF PENNSYLVANIA SSS COUNTY OF PHILADELPHIA SS I, Helen Szafran, a Notary Public, do hereby certify that Patrick K. Nails and David M. Finkelstein personally known to me to be the same persons whose names are respectively as Secretary and Executive Vice President of the Arch Insurance Company, a Corporation organized and existing under the laws of the State of Missouri,subscribed to the foregoing instrument,appeared before me this day in person and severally acknowledged that they being thereunto duly authorized signed, sealed with the corporate seal and delivered the said instrument as the free and voluntary act of said corporation and as their own free and voluntary acts for the uses and purposes therein set forth. ntn�ortsv�u: rx�iNar�.v to NOTARK SEAL HELEN S7AF1MX NWq Public City of Pb9adiiIphIte,Pb#a,Nutt oiy �rf rb#QGtpbst 2fJi7 elen Szafran,N tary Publi My commission expires 10/03/2017 CERTIFICATION I, Patrick K. Nails, Secretary of the Arch Insurance Company, do hereby certify that the attached Power of Attorney dated September 15. 2015 on behalf of the person(s)as listed above is a true and correct copy and that the same has been in full force and effect since the date thereof and is in full force and effect on the date of this certificate; and I do further certify that the said David M. Finkelstein, who executed the Power of Attorney as Executive Vice President,was on the date of execution of the attached Power of Attorney the duly elected Executive Vice President of the Arch Insurance Company. IN TE�IMONY WHEREOF, I have hereunto subscribed my name and affixed the corporate seal of the Arch Insurance Company on this day of 't)cV,.)"20 _. i Patrick K.Nails,Secretary This Power of Attorney limits the acts of those named therein to the bonds and undertakings specifically named therein and they have no authority to bind the Company except in the manner and to the extent herein stated. PLEASE SEND ALL CLAIM INQUIRIES RELATING TO THIS BOND TO THE FOLLOWING ADDRESS: Arch Insurance—Surety Division 3 Parkway,Suite 1500 gid ' Philadelphia,PA 19102 icy cukromTf -art spu ��3lr09f� OOMLOO 13 00 03 03 Page 2 of 2 Printed in U.S.A. ARCH Insurance Company ARCH Surety TEXAS CONSUMER NOTICE IMPORTANT NOTICE To obtain information or make a complaint: You may contact your agent at the telephone number provided on the Declarations page of your policy. You may contact William J. Misero, Surety, Arch Insurance Company, at the toll-free telephone number or address provided below: Arch Insurance Company Attention: William J. Misero 3 Parkway Suite 1500 Philadelphia PA 19102 1-866-472-8845 You may contact the Texas Department of Insurance to obtain information on companies' coverages, rights or complaints at: 1-800-252-3439 You may write the Texas Department of Insurance: P.O, Box 149091 Austin, TX. 78714-9091 FAX# (512) 475-1771 PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should contact the agent or the company first. If the dispute is not resolved, you may" contact the Texas Department of Insurance. ATTACH THIS NOTICE TO YOUR POLICY: This notice is for information only and does not become a part or condition of the attached document. (Ed. 4112) Printed in U.S.A. REV:02/22/07 FORTWORTH TRANSPORTATION AND PUBLIC WORKS CONTRACTOR'S EVALUATION OF CITY I)PROJECT INFORMATION Date: 12/14/2015 Name of Contractor Project Name Nissi Group Concrete Restoration(2014-10)At Various Locations DOEInspector T Project Manager Candace Klenk Tari ul Islam DOE Number Project Difficult)) Type of Contract 7316 O Simple Q Routine O Complex ❑ Water[] WasteWater[] Storm Drainage Pavement Initial Contract Amount Final Contract Amount $561,532.12 $561,532.12 11)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 Change Order Processing Time 3 Communication 2 Timliness of Contractor Payrnents CK 14 Resolution ofUtility Conflicts 3 Bid Opening to Pre-Con Meeting Timeframe IID COMMENTS&SIGNATURES COMMENTS Signature Contractor Signature DOE Inspector Signature DOE Inspector's Supervisor INSPECTOR'S COMMENTS _ TRANSPORTATION AND PUBLIC WORKS The City of Fort Worth•1000 Throckmorton Street•Fort Worth,TX 76012-6311 (817)392-7941 •Fax:(817)392-7845 FORTWORTHREV:02/20/07 TRANSPORTATION AND PUBLIC WORKS PERFORMANCE EVALUATION OF CONTRACTOR I) CONTRACTOR&PROJECT DATA Maine of Contractor Project Name Nissi Group Concrete Restoration(2014-10) DOE Inspector DOE Number Candace Klenk 7316 DOEInspector Project Manager ❑ Water❑ Waste Water❑ Storm DrainageD Pavement Tari ul Islam Initial ContractAmount Project Difficulty $561,541.72 O Simple Q Routine Q Complex Final Contract Amount Date $561,641.72 112/14/2015 II)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 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 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 3 20 15 10 Citizen's Complaint Resolution 5 Y 4 20 20 11 Property Restoration 5 Y 3 20 15 12 After Hours Response 5 Y 4 20 20 13 Project Completion 5 Y 3 20 15 TOTAL ELEMENT SCORE(A) 428 BONUS POINTS(25 Maximum)(B) TOTAL SCORE(TS) 428 III)CONTRACTOR'S RATING Maximum Score(MS)=448 or sum of applicable element score maximums which= 448 Rating([TS/MS] * 100%) 428 / 448 = 96% 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) n— "Signature DOE Inspector Signature Contractor t\ Signature DOE Inspector's Supervisor CONTRACTOR'S COMMENTS _ 'TRANSPORTATION AND PUBLIC WORKS The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TX 76012-6311 (817)392-7941 •Fax:(817)392-7845 1 � (- l� p�,•�}�,�.����y � 1. .}moi';�;� "' _ ' 1 � � ° � �C•`!t��J{�Ca 1n�'FhkF"�"-.'+i. 1 1 °� � .�� o L as���i`,,,,4 ` r r �A�!• �:� '}� rTfi. PROM CT . w, s 1 ry4\.S s .rti �.�'z�•�]:F is �' ..�n. i:F:tJ,. 4.,. d"' . 1 1}f'k 1 Ur.. �fi��.q���: AYS M�—CIIARGED1l�ii7r ; 1 , • 1 1 ! 11 1 1 ' 8 1 , , 1 Not Applicable SATSUNand HOLIDAYS THIS ® a K�Y =Ki.,,�4�� - FIT T Yom• -:I�i��`��;r PERIOD 1 1 �_����_ t S PERIOD . 1 as I�T ;a .tA1T:lelr{Y?;�;'4�°� -}'�.AA�.i�'FrIIRJ. c Br- o o •e AQ'. �' fS.; f1Sj =/�' 7C �°Y'�Ir�11v'-r' 5 7 Cyd illy}� y r g tyt <zPYC r s }5 6,LH�L.-��i+�7,.11=,�Ct�s�.Z(a���A1�4(�},� �r�lc��.;t.�-.A'�;0.i� Si� q'� °• �j�X°�lt��h=�L°.��h�le-Lt�l� Y j. '"4.,� t� -s S,. r {•S^a � tf4 'S1 t.�Zf-V�' 3��i.. �2 ys'Y - ;' �F ( i r 5''{ �:;i °�r�" .�r�4 s a�{s"- �t f x".1 '£ r _453��✓a;;�'}'i�,t��"`�'.4-,•� �s5 t r-.. f. ,i' ,>. �,.. .. �- i , i CC.s-�-y— -c�5yfiq `T;"n }- - �AF1§Lli{' r { af 4; a*w� 4 YEb'1 i' xr�ar