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Contract 47552-FP1
Depar-1 ent f TPW Const. Services c,,�� � DOE# Date , PICT No. Project Manager , — CON Risk Management J. Barksdale •L kT 0 RT H D.O.E. Brotherton CFA Westerman/Scanned ❑ 1, The Proceeding people have been Contacted concerning the request ATION AND PUBLIC WORKS for final payment&have released this project for such payment. F PROJECT COMPLETION s �SS2 Clearance Conducted By Etta Bacy City Project Ne: 2444 Regarding contract 47552 for W&SS REPLACEMENT CONTRACT 2015 WSM-D PART 2 as required by the WATER DEPARTMENT as approved by City Council on 01/12/2016 through M&C C-27601 the director of the WATER DEPARTMENT upon the recommendation o sistant Director of the Transportation&Public Works Department has accepted the project D11 �J t SSP 0� Original Contract Prices: 201 $1,026,022.00 � Amount of Approved Change Orders: $10,400.00 Ns 1 Revised Contract Amount: $1,036,422.00 Total Cost Work Completed: $961,984.00 Less Deductions: Liquidated Damages: Days @$210.00/Day Pavement Deficiencies: Total Deduction Amount: $0.00 Total Cost Work Completed: $961,984.00 Less Previous Payments: $913,884.80 Final Payment Due $48,099.20 77 •G-l� Reco me ded for Acceptance Date Asst. irec r, _fPW - Infrastructure Design and Construction Accepted !. Date Asst. Director, WATER DEPARTMENT Asst. 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Sy2223y3q�� � AFFIDAVIT STATE OF TEXAS COUNTY OF TARRANT Before me, the undersigned authority, a Notary Public in the state and county aforesaid, on this day personally �appeared C�..J- , of (Name) (Title) VI$ &NI—S , 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 furnishing 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; and That there are no claims pending for personal injury and/or property damages; On Contract described as; BY Subscribed and sworn before me on this 1 L/ day of Xk(6tzs 20 SHELLI HAZELWOOD `--No—aty-Piib"lic in Tarrant " *=Nota Public State of Texas Notary County, Texas - •-� Fa,,' My Commission#126538540 �' °F My Comm.Exp.June 4,2020 CONSENT OF OWNER ❑ SURETY COMPANY ARCHITECT ❑ TO FINAL PAYMENT CONTRACTOR ❑ SURETY ❑ OTHER ❑ AIA DOCUMENT G707 Bond#1009009476 PROJECT: 2015 WSM-D Part 2 (name, address) Fort Worth, TX TO (Owner) FiMii y of Fort Worth ARCHITECT'S PROJECT NO:2444 1000 Throckmorton Fort Worth,TX 76102 CONTRACT FOR: Water&Sanitary Sewer Replacement L I CONTRACT DATE: January12,2016 CONTRACTOR: R&D Burns Brothers, 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) U.S. Specialty Insurance Company 5601 Granite Parkway Ste. 1100, Plano,TX 75024 SURETY COMPANY, on bond of(here insert name and address of Contractor) R&D Burns Brothers, Inc. P.O. Box 786, Burleson,TX 76097 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 St., 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 4th day of August,2016. U.S. Malty Insurance Company Su ety\C�impany Signature of Authorized Representative Attest: (Seal): Tracy L Miller,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 AIA DOCUMENT G707•CONSENT OF SURETY COMPANY TO FINAL PAYMENT•APRIL 1970 EDITION•AIA® ONE PAGE ©1970•THE AMERICAN INSTITUTE OF ARCHITECTS.1735 NEW YORK AVE.,NW,WASHINGTON,D.C.20006 f' POWER OF ATTORNEY AMERICAN CONTRACTORS INDEMNITY COMPANY TEXAS BONDING COMPANY UNITED STATES SURETY COMPANY U.S.SPECIALTY INSURANCE COMPANY J. KNOW ALL MEN BY THESES TS&Tat_me_ can Contractors 'Idd'' 7 ' lCom any a Californi eor�czrafton�Texas Bonding Company, an assumed name �rr€ertcan�htractors IndemnityiConppor",,�6,nzted States Surety Co*asy 11 wry nd=_ corporation and U.S. Specialty Insurance Company,a Texas corporation(collectively,the"Companies"),do by these presents Mace -- constitute and appoint: Tracy L.Miller,William Mitchell Jennings,William Blanchard or Alicia Grumbles of Fort Worth,Texas s ue_nfila it gttomey(s)-in-fact,a bli m f)ietr l Oparate capacity if more lap-0neli above,with full power and authority ii �'I -ti er �onfe res s tts name,place;arld�st. d,tg exerout�,acknowledge and deo i_an a a fonds,recognizances,undertakings r of er instruments or contracts otosuretyship to include riders, amen_ments�, and consents of surety, providing the bond penalty does not exceed ********************Ten Million******************** Dollars ($_ **10,000,000.00** ), This Power of Attorney shall expire without further action on December 20,2017. This Power of Attorney is granted under and by authority of the following resolutions adopted by the Boards of Directors of the Companies: Be it Resolver,that the President,any ViftPresf ea an��4ssistantM-President,any Secre or'an Ass' ant Secretary shall be andjshereby-pese t�#uo power and authority to appoint any one or more�aitalale person s ttomey(s)-in-Fact to repres at anis act ffor and 'Ai behalf of the Compan u�ect3©the Ilai provisions: _ —riga_ _ — 11 - �i Attorney-in-Fact may be given full power and authority for and in the name of and on behalf of the Company,to execute,acknowledge and deliver,any and all bonds, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings, including any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts,and any and all notices and documents canceling or terminating the Company's liability thereunder,and any such instruments so executed by any such Attomey-in-Fact shall be binding upon the Company as if signed by the President and sealed and effected _by,tht�ome W— i :. - - feuResso�ve�c _ - t t�at=31}e=stgnature of any a?hor ed off' i�jq s,alb of} ;Company heretof_o`re oa ereafte ffi ed ola ower of attorney or any certificate relating ereio b acsun many power of attorney or gextificaXe b,e inng facsi rile signature or fa irmlaeal slM 6>�tialr �binding upon the Company with respect to any bones—or underta�g to which it is attached i IN WITNESS WHEREOF,The Companies have caused this instrument to be signed and their corporate seals to be hereto affixed,this 1 st day of December,2014. AMERICAN CONTRACTOW NDEMNITY COMPANY TEXAS BONDING COMPANY Corporate Seals UNTTEiYTSUI�F COMRANY U.S.SPE fCIA LT Y INSCIRANCE COMPANY — — :rmuwa,, `q:Punwarnn nn� � - r - om'mar„ l 1 r a�' 1 �.atHAcioq, ., a`o4cs„5Uj? ��0�_L c�,'. - a`N�nswa�:,,, I r -- -- 2p.;•' •'"...!9Q�% `tiP+'.',� qf� '.0�,,, =V NWRIOMim iy= -0• r3'= =x' lY= -q' •�= B Lam. -� SEIT.35,1'H0 3 �We b_ =W: 2= �N �/� = J .t 3 c :'o'S % ?? s•. y` " ///s\VV Daniel P.Aguilar,Vice Preside t SLI Fd�P.. 3,�q'`•....._..r P�� .r - A star ub7t ZqM officer completing this oiiifigtelven�ies`only the identit f t ivtdua htr igned the document to heel is certificate is attactie�,4and nottfi truthfulness,accuracy,o sah3it f to dnsume —State of California — County of Los Angeles SS: On this 1st day of December,2014, before me,Maria G.Rodriguez-Wong,a notary public, personally appeared Dan P.Aguilar,Vice President of American Contractors Indemnity Company,Texas Bonding n-Compailr Wd States Surety Company and til S $pecialtiy;Insurance Company wh"roved to me on_ _ the basis of satisfactory evidence to bethe peifoi>-whose memejs suMcribed to the withintmstimifibtit afi&acknowledged to me thatlft�execufei#tfieaamlmii his authorized capacity,and that by his srraerson,or the entity upoiubenalf ofwhicn t �person acted execite ,�e�n�amens I certify under PENALTY OF PERJURY user the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. MARIA G.RODRIGUEZ-Wo Signature — ' .-. Commission*2049771 s I i(Sea44l} _y-_� otar titlwoWfornia — oapeles county l ! ? Commix Tre_ 20,2017 I,Michael Chalekson,Assistant Secretary of American Contractors Indemnity Company,Texas Bonding Company,United States Surety Company and U.S.Specialty Insurance Company,do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney,executed by said Companies,which is still in full force and effect;furthermore,the resolutions of the Boards of Directors,set out in the Power of Attorney are in full force and effect In Witn s Whereof I have ner Mitts hAffil ced the seals of Corm antesi'at os A"geles,California�Er Md of Corporate Seals �� s„unnrj;; o uuq, npoua........ - pAcTo a� - qsu LADIN :i " sw %. `.^`gt,.......RS _ . `E,. ...Fj:., ��0,... C''; ..•``�N�n 4� _ •U'i'� :p�>. .x`00 ”`•..O m yr�i2ia:w w �AviT]�( - _1Vtchael Chalekson Assistant Secreta BDI3dI0. — m 4}, r y�l r: c :� c , Secretary g�nC c>r 8757 'q:4 u,iVg_ r `;yet t l ' �=j �"q "77- 1 — '\ y iF7Ca f �OF't :na/r�r� �1 '�r(nu �& �+: uugr FORTWORTHV:02/22/07 TRANSPORTATION AND PUBLIC WORKS CONTRACTOR'S EVALUATION OF CITY 1)PROJECT INFORMATION Date: 8/4/2016 Name of Contractor Project Name R&D BurnsBrothers Inc. Water and Sanitary Sewer Replacement WSM-D PT 2 DOE Inspector Project Manager Kim Brenz (Rakesh Chaubey DOE Number Project Difficulty Type of Contract 7456 Q Simple Q Routine Q Complex ❑✓ Water E Waste Water ❑Storm Drainage ❑ Pavement Initial Contract Amount Final Contract Amount $1,026,022.00 $961,984.00 II)PERFORMANCE EVALUATION 0-Inadequate 1 -Deficient 2-Standard 3-Good 4-Excellent LELEMENT RATING ELEMENT RATING (0-M �p_4) PECTION EVALUATION PLANS&SPECIFICATIONS Availability of Ins ector 4 1 Accuracy of Plans to Existing Conditions 4 Knowledge of Inspector 14 2 Clarity&Sufficiency of Details 4 3 Accuracy of Measured Quantities 4 3 Ap licability of Specifications 4 4 Display Of Professionalism 4 4 Accuracy of Plan Quantities 3 5 Citizen Complaint Resolution 4 PROJECT MANAGER EVALUATION 6 Performance-Setting up Valve Crews,Labs 4 1 Knowledge And/Or Problem Resolution 3 ADMINISTRATION 2 Availability of Project Manager 2 1 Change Order Processing Time 4 3 Communication 2 2 Timliness of Contractor Payments 4 4 Resolution of Utility Conflicts 3 3 Bid Opening to Pre-Con Meeting Timeframe 2 III)COMMENTS&SIGNATURES COMMENTS Signature Contractor n Signature DOE Inspector Signature DOE Inspector's Supervisor INSPECTOR'S COMMENTS TRAiNSPORTATION AND PUBLIC WORKS cr The City of Fort Worth•1000 Throckmorton Street•Fort Worth,TX 76012-6311 a (817)392-7941 •Fax: (817)392-7845 FORTWORTHREV:02/20/07 TRANSPORTATION AND PUBLIC WORKS PERFORMANCE EVALUATION OF CONTRACTOR 1) CONTRACTOR&PROJECT DATA Name of Contractor Project Name R&D Brothers Brothers 2015 wsm-d part 2 DOE Inspector DOE Number Kim Brenz 7456 DDE Inspector Project Manager 0 Water Q Waste Water[—] Storm Drainage[] Pavement Rakesh Chaubey Initial Contract Amount Project Difficulty $1,026,022.00 Q Simple QQ Routine O Complex Final Contract Amount Date $1,036,422.00 8/19/2016 In PERFORMANCE EVALUATION 0-Inadequate 1-Deficient 2-Standard 3-Good 4-Excellent ELEMENT WEIGHT(x) APPLICABLE(YIN) 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 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 4 20 20 10 Citizen's Complaint Resolution 5 Y 1 4 20 20 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) 448 BONUS POINTS(25 Maximum)(B) TOTAL SCORE(TS) 448 111)CONTRACTOR'S RATING Maximum Score(MS)=448 or sum of applicable element score maximums which= 448 Rating([TS/MS]x 100%) 448 / 448 = 100% 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) GOOD JOB Signature DOE Inspector &, �,gnature Contractor Signature DOE Inspector's Supervisor CONTRACTOR'S COMMENTS TRANSPORTATION AND PUBLIC WORKS r The City of Fort Worth•1000 Throckmorton Street•Fort Worth,TX 76012-6311 (817)392-7941 •Fax_(817)392-7845 FORT NORTH TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PROJECT NAME: 2015 WSM-D,Part 2 PROJECT NUMBER: 2444 DOE NUMBER: 7456 WATER PIPE LAID SIZE TYPE OF PIPE LF yes 16" pvc 268.00' yes 8" pvc 4345.00' FIRE HYDRANTS: 8 ea VALVES(16"OR LARGER) 1 ea 16"with valt PIPE ABANDONED SIZE TYPE OF PIPE LF yes 6" cast 4355.00' yes 16' cast 268.00' DENSITIES: yes NEW SERVICES: SEWER PIPE LAID SIZE TYPE OF PIPE LF yes 8" pvc 3995.00' yes 4" pvc 107.00' PIPE ABANDONED SIZE TYPE OF PIPE LF yes 8" cast 3995.00' yes 4" cast 107.00' DENSITIES: yes NEW SERVICES: TRANSPORTATION AND PUBLIC WORKS The City of Fort Worth•1000 Throckmorton Street•Fort Worth,TX 76012-6311 (817)392-7941 •Fax:(817)392-7845 FORT WORTH TRANSPORTATION AND PUBLIC WORKS STATEMENT OF CONTRACT TIME STATEMENT# FINAL STATEMENT# 1 DOE 7456 NAME OF PROJECT: Water and Sanitary Sewer Replacement Contract 2015 WSM-D Part 2Contractor R.D.Bums YEAR. - ,'G PROJECT NO.: FINAL INSPECTION DATE 8/17/2016 #02444 WD CD CONTRACT TIME 150 X PERIOD FROM: 8/16/2016 TO: 1 8/31/2016 MID - Month nEVELOPntEN N WORK ORDER EFFECTIVE: 4!25/2016 BEG n MID '- ! E4.70! DAY OF MONTH DAYS REASON FOR DAY OF MONTH DAYS REASON FOR CHARGED DAYS CREDITED CHARGED DAYS CREDITED 1 16 Tue 1 2 17 Wed 1 Final Insp. 3 18 Thu 0 NA 4 19 Fri 0 NA 5 20 Sat 0 NA 6 21 Sun 0 NA 7 22 Mon 0 NA 8 23 Tue 0 NA 9 24 Wed 0 1 NA 10 25 Thu 0 NA 11 26 Fri 0 NA 12 27 Sat 0 NA 13 28 Sun 0 NA 14 1 29 15 30 31 Lrykn&1-101 UVe, 0 Not Applicable SAT,SUN,and WEATHER UTILITIES OTHERS DAYS TOTAL DAYS HOLIDAYS RELOCATE CHARGED THIS PERIOD 0 0 0 0 2 2 PREVIOUS PERIOD 0 95 95 TOTAL TO DATE 1 0 0 0 0 97 97 REMARKS: Signature: Signature: (Print Name) (Print Name) CONTRACTOR DATE INSPECTOR DATE