HomeMy WebLinkAboutContract 47524-FP1 DepartmentP &W Const.Services
CRN# (),'MM- Date
Project Manager l 0-1- CITY SECRETARY
Risk Management CanadvQ -2-1IT WO RT H CONTRACT No-� . E�-1-LLL
D.O.E. Brotherton _ to
CFA Westerman/Scanned
Esteban Perez/Scanned
The Proceeding people have been Contacted yc (pQ)
concerning the request for final payment& have ATION AND PUBLIC WORKS
released this project for such payment. ►F PROJECT COMPLETION
Clearance Conducted By PAIM4G� City Project Ns: 02682
-
Regarding contract 117537 for WEST FORK RANCH PHASE 5A as required by the WATER DEPARTMENT as
approved by City Council on N/A through M&C N/A the director of the WATER DEPARTMENT upon the
recommendation of the Assistant Director.of the,,TrY p§portation&Public Works Department has accepted the project
as complete.
Original Contract Prices: OCT 3 2016 sJ; $290,890.60
Amount of Approved Change Orders: j No
''Y.
Revised Contract Amount:
Total Cost Work Completed: $290,890.60
Less Deductions:
Liquidated Damages: Days @$210.00/Day
Pavement Deficiencies:
Total Deduction Amount:
Total Cost Work Completed: $290,890.60
Less Previous Payments: $0.00
Final Payment Du $290,890.60
L -
&-W. k
Recommen ed or Acceptance Date
Asst. Direc r, PW - Infrastructure Design and Construction
/1)-31-/6
Accepted / Date
Asst. Director, WATER DEPARTMENT A�/.��
C `T�
Asst. City Manager Date
Comments:
(011
Jc.
i
FT.WORTH9 TX T r?, COS- 0 G2
it f�i
City Project Numbers 02682 O C T 31 2016 t�t
DOE Number 7537
Contract Name WEST FORK RANCH PHASE 54, Estimate Number 1
Contract Limits Payment Payment Number 1
Project Type WATER&SEWER For Period Ending 9/21/2016
Project Funding
Project Manager Long City Secretary Contract Number 117537
Inspectors LAYER/ SLATEN Contract Date
Contractor BURNSCO CONSTRUCTION,INC. Contract Time 180 CD
6331 SOUTHWEST BLVD Days Charged to Date 206 CD
FORT WORTH, TX 76132 Contract is .000000 Complete
CITY OF FORT WORTH
SUMMARY OF CHARGES
Line Fund Account Center Amount Gross Retainage Net
Funded
Total Cost of Work Completed $290,890.60
Less %Retained $0.00
Net Earned $290,890.60
Earned This Period $290,890.60
Retainage This Period $0.00
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 $290,890.60
Wednesday,September 21,2016 Page 4 of 4
1�a60 - 0 ab8�
FORTWORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name WEST FORK RANCH PHASE SA
Contract Limits
Project Type WATER&SEWER
City Project Numbers 02682
DOE Number 7537
Estimate Number 1 Payment Number 1 For Period Ending 9/21/2016
CD
City Secretary Contract Number 117537 Contract Time 180:D
Contract Date Days Charged to Date 206
Project Manager Long Contract is 100.00 Complete
Contractor BURNSCO CONSTRUCTION,INC.
6331 SOUTHWEST BLVD
FORT WORTH, TX 76132
Inspectors LAYER / SLATEN
Wednesday,September 21,2016 Page 1 of 4
City Project Numbers 02682 DOE Number 7537
Contract Name WEST FORK RANCH PHASE 5A Estimate Number I
Contract Limits Payment Number 1
Project Type WATER&SEWER For Period Ending 9/21/2016
Project Funding
WATER
Item Completed
No. Description of Items Estimated Estimated Completed Com P Unit Unit Cost P p
Quanity Total Quanity Total
-------------------------------------- -
1
-------------
--------------- -
1 8"PVC WATER PIPE 2434 LF $20.00 $48,680.00 2434 $48,680.00
2 8"GATE VALVE 5 EA $1,240.00 $6,200.00 5 $6,200.00
3 FIRE HYDRANT 3 EA $3,400.00 $10,200.00 3 $10,200.00
4 DUCTILE IRON WATER FITTINGS 2 TN $4,900.00 $9,800.00 2 $9,800.00
W/RESTRAINT
5 1"WATER SERVICE 91 EA $720.00 $65,520.00 91 $65,520.00
6 1 1/2"WATER SERVICE 1 EA $1,200.00 $1,200.00 1 $1,200.00
7 CONNECTION TO EXISTING 4"-12"WATER 6 EA $850.00 $5,100.00 6 $5,100.00
MAIN
8 TRENCH SAFETY 2434 LF $0.10 $243.40 2434 $243.40
9 CONCRETE BLOCKING TYPE B 5 CY $150.00 $750.00 5 $750.00
10 PAYMENT,PERFORMANCE&MAINTENANCE 1 LS $4,000.00 $4,000.00 1 $4,000.00
BONDS
--------------------------------- -----
Sub-Total of Previous Unit $151,693.40 $151,693.40
SEWER
Item Description of Items Estimated Estimated Completed Com
No. P Unit Completed
Unit Cost Total Quanity Total
P p
————— Quanity
1 8"SEWER PIPE 2093 LF
$26.00 $54,418.00 2093 $54,418.00
2 8"SEWER PIPE CSS BACKFILL 40 LF $38.00 $1,520.00 40 $1,520.00
3 4'MANHOLE 9 EA $2,250.00 $20,250.00 9 $20,250.00
4 4'EXTRA SEPTH MANHOLE 12 VF $100.00 $1,200.00 12 $1,200.00
5 MANHOLE VACUUM TESTING 9 EA $110.00 $990.00 9 $990.00
6 4"SEWER SERVICE 85 EA $580.00 $49,300.00 85 $49,300.00
7 POST CCTV INSPECTION 2133 LF $1.40 $2,986.20 2133 $2,986.20
8 TRENCH SAFETY 2133 LF $1.00 $2,133.00 2133 $2,133.00
9 EPDXY MANHOLE LINER 9 EA $200.00 $1,800.00 9 $1,800.00
10 CONNECT TO EX.8"SANITARY SEWER 3 EA $200.00 $600.00 3 $600.00
11 PAYMENT,PERFORMANCE&MAINTENANCE 1 LS $4,000.00 $4,000.00 1 $4,000.00
BONDS
--------------------- -----------------
Sub-Total of Previous Unit $139,197.20 $139,197.20
------- --------------- ---
Wednesday,September 21,2016 Page 2 of 4
City Project Numbers 02682 DOE Number 7537
Contract Name WEST FORK RANCH PHASE 5A Estimate Number 1
Contract Limits Payment Number 1
Project Type WATER&SEWER For Period Ending 9/21/2016
Project Funding
Contract Information Summary
Original Contract Amount $290,890.60
Chan6e Orders
Total Contract Price $290,890.60
A Date Total Cost of Work Completed $290,890.60
Contra Less %Retained $0.00
Date l'o/S//rGC Net Earned $290,890.60
Inspection Su a 'so Earned This Period $290,890.60
Retainage This Period $0.00
Date /6?
Project Manager Less Liquidated Damages
117 AG�� Days @ /Day $0.00
Date LessPavement Deficiency $0.00
JDictW-Infrastructure Design and ConstructionLess Penalty $0.00
� Date �°-3 t` ' Less Previous Payment $0.00
Director/Contracting Department Plus Material on Hand Less 15% $0.00
/1 °�✓ Balance Due This Payment $290,890.60
Wednesday,September 21,2016 Page 3 of 4
FoRTWORTH rev 03/05/07
TRANSPORTATION&PUBLIC WORKS
FINAL STATEMENT OF CONTRACT TIME
FINAL STATEMENT NO. 1
NAME OF PROJECT: West Fork Ranch Phase 5A
PROJECT NO.: 02682 CONTRACTOR: Burnsco
DOE NO., 7537
PERIOD FROM 03/02/16 TO: 09/23/16 FINAL INSPECTION DATE: 23-Sep-16
WORK ORDER EFFECTIVE 3/2/2016 CONTRACT TIME 180 O WD OO CD
DAY OF DAYS REASON FOR DAYS DAY OF DAYS REASON FOR DAYS
MONTH DURING CREDITED MONTH CHARGED CREDITED
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 DAYS TOTAL
&HOLIDAYS &TOO COLD RELOCATIONS OTHERS* CHARGED DAYS
THIS
PERIOD 206
PREVIOUS
PERIOD
TOTALS
TO DATE 1206
*REMARKS:
CONTRACTOIC DATE INSPECTOR` DATE
ENGINEERING DEPARTMENT
g The City of Fort Worth•1000 Throckmorton Street•Fort Worth,TX 76012-6311
(817)392-7941 •Fax:(817)392-7845
*PulteGroup
September 20th,2016
Mr.John Burns
Burnsco Construction, Inc.
6331 Southwest Blvd.
Benbrook,Texas 76132
Re: Contract for West Fork Ranch Phase 5A—Water,Sanitary Sewer&Storm Improvements
CoFW Project No.02682
CoFW File No. K-2432
CoFW DOE No.02682
Dear John Burns:
This letter will document that Pulte Homes of Texas,L.P.confirms that Burnsco Construction, Inc. has
completed the Work associated with the above-referenced contract in an appropriate time frame,
subject to completion of any warranty or maintenance work as identified and required by the City of
Fort Worth,and that no liquidated damages will be assessed by Pulte Homes in connection with the
Work.
Pulte Homes of TX,L.P.
By:
Curt M. Millward
Land Development Project Manager
Cc: City of Fort Worth
FORTWORTH
TRANSPORTATION AND PUBLIC WORKS
PIPE REPORT FOR:
PROJECT NAME: West Fork Ranch Phase 5A
PROJECT NUMBER: 02682
DOE NUMBER: 7537
WATER
PIPE LAID SIZE TYPE OF PIPE LF
yes 8" PVC 2434
FIRE HYDRANTS: 3 VALVES(16" OR LARGER) n/a
PIPE ABANDONED SIZE TYPE OF PIPE LF
no
DENSITIES: yes
NEW SERVICES: 1" Copper 2275
Copper 25
SEWER
PIPE LAID SIZE TYPE OF PIPE LF
yes 8" PVC 2093
PIPE ABANDONED SIZE TYPE OF PIPE LF
no
DENSITIES: yes
NEW SERVICES: 4" PVC 2125
TRANSPORTATION AND PUBLIC WORKS
The City of Fort Worth•1000 Throckmorton Street•Fort North,TX 76012-6311
(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
Burnsco West Fork Ranch Phase 5A
DOE Inspector DOE Number
Connor Slaten 7537
DOEInspector Project Manager
21 Water Q Waste WaterO Stone Drainageo Pavement Aaron Long
Initial Contract Amount ProjectDculty
$290,890.60 Q Simple QQ Routine Q Complex
Final Contract Amount Date
$290,890.60 9/19/2016
Ill PERFORMANCE EVALUATION
0-Inadequate I-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 3 20 15
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 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) 443
BONUS POINTS(25 Maximum)(B)
TOTAL SCORE(TS) 443
III)CONTRACTOR'S RATING
Maximum Score(MS)=448 or sum of applicable element score maximums which= 448
Rating(f TS/MS] * 100%) 443 / 448 = 99%
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 -l1— Signature Contractor
Signature DOE Inspector's SupervisorI��l�`^-� _
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
CONSENT OF OWNER ❑
SURETY COMPANY ARCHITECT ❑
CONTRACTOR ❑
TO FINAL PAYMENT SURETY ❑
Conforms with the American Institute of OTHER
Architects,AIA Document G707
Bond No 022053039
PROJECT: West Fork Ranch Phase 5A-Water and Sanitary Sewer Improvements
(name, address) Fort Worth TX
TO (Owner)
PULTE HOMES OF TEXAS,L.P.AND CITY OF FORT ARCHITECT'S PROJECT NO:
WORTH CONTRACT FOR:
4800 Regent Blvd. Suite 100 West Fork Ranch Phase 5A-Water and Sanitary Sewer
Improvements
Irving TX 75os3 --J CONTRACT DATE:
CONTRACTOR:BURNSCO CONSTRUCTION, 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)
LIBERTY MUTUAL INSURANCE COMPANY
175 Berkeley.Street
Boston MA 02116 , SURETY COMPANY
on bond of (here insert name and address of Contractor)
BURNSCO CONSTRUCTION, INC.
6331 Southwest Boulevard
Benbrook TX 76132 , 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)
PULTE HOMES OF TEXAS, L.P.AND CITY OF FORT WORTH
4800 Regent Blvd. Suite 100
Irving TX 75063
OWNER,
as set forth in the said Surety Company's bond.
IN WITNESS,WHEREOF,
the Surety Company has hereunto set its hand this 23rd day of September,2016
LIBERTY MUTUAL INSURANCE COMPANY
Sure Company
Attest;AeRly .Westbrook1.
(Seal): Signatufe of Authorized Representative
Soohinie Hunter 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
PHIS Pt7WER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND.
This Power of Attorney limits the acts of those named herein,and they have no authority to bind the Company except in the manner and to the extent herein stated.
Certificate No.7443913
American Fire and Casualty Company Liberty Mutual Insurance Company
The Ohio Casualty Insurance Company West American Insurance Company
POWER OF ATTORNEY
KNOWN ALL PERSONS BY THESE PRESENTS: That American Fire&Casualty Company and The Ohio Casualty Insurance Company are corporations duly organized under the laws of
the State of New Hampshire,that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts,and West American Insurance Company
is a corporation duly organized under the laws of the State of Indiana(herein collectively called the"Companies',pursuant to and by authority herein set forth,does hereby name,constitute
and appoint, Don E.Cornell;Kelly A.Westbrook;Ricardo J.Reyna;Robbi Morales;Sophinie Hunter;Tina McEwan•V. DeLene Marshall
i
all of the city of Dallas state of TX each individually if there be more than one named,its true and lawful attomey-in-fact to make,execute,seal,acknowledge
and deliver,for and on its behalf as surety and as its act and deed,any and all undertakings,bonds,recognizances and other surety obligations,in pursuance of these presents and shall
be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons.
IN WITNESS WHEREOF,this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed
thereto this 5th day of August 2016
a
Pp10 CA �'i INS& \-\NSUq� hwsUR. American Fire and Casually Company a
C`�,roaac.vE 9� JP°ev°2;�g9 1JP ar°�9,;'Y�, rn eerottn,,9"•�
The Ohio Casualty Insurance Company N
< 1906 0 0 1919 1912 ° 1991 o Liberty Mutual Insurance Company 0)
° West merican Insurance Company
N yy,,"•',cin+n"'r� dy`r•Hnratsr��, 9i�'SrncMf �f2 l �•;oiuta Y
3
y * 1 * * By: rti fll
STATE OF PENNSYLVANIA ss David M.Care ,Assistant Secretary m
M COUNTY OF MONTGOMERY
a) 0On this 5th day of August , 2016, before me personally appeared David M. Carey,who acknowledged himself to be the Assistant Secretary of American Fire and O
wa) Casualty Company,Liberty Mutual Insurance Company,The Ohio Casualty Insurance Company,and WestAmerican Insurance Company,and that he,as such,being authorized so to do, AW
p 2 execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. L
E
a)> IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting,Pennsylvania,on the day and year first above written. O
�
pq T COMMONWEALTH OF PENNSYLVANIA /IQ/� ++p
�
P Notarial Seal
Teresa Pastella,Notary Public By: O�!
Oi of Plymouth Twp.,Montgomery County Teresa Pastella,Notary Public y
P My Commission Expires March 28,2017 3 cc
d O 2��SYt•N �G Member,Pennsylvania Association of Notaries O E
SOY RYP d 16
C co This Power ofAttomey is made and executed pursuant to and by authority of the following By-laws and Authorizations of American Fire and Casualty Company,The Ohio Casualty Insurance .N e
NCompany,Liberty Mutual Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows:
to0 ARTICLE IV—OFFICERS—Section 12.Power of Attorney.Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President,and subject O =
ta; to such limitation as the Chairman or the President may prescribe,shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Corporation to make,execute,seal, >y
O acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Such attomeys-in-fact,subject to the limitations set forth in their respective r
E r powers of attorney,shall have full power to bind the Corporation by their signature and execution of any such instruments and to allach thereto the seal of the Corporation. When so m
O R executed,such instruments shall be as binding as if signed by the President and attested to by the Secretary.Any power or authority granted to any representative or attorney-in-fact under >
Athe provisions of this article may be revoked at any time by the Board,the Chairman,the President or by the officer or officers granting such power or authority. Q
co C ARTICLE XIII—Execution of Contracts—SECTION 5.Surety Bonds and Undertakings.Any officer of the Company authorized for that purpose in writing by the chairman or the president, oo
y i and subject to such limitations as the chairman or the president may prescribe,shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Company to make,execute, L-M
Z U seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Such attorneys-in-fact subject to the limitations set forth in their O o
respective powers of attomey,shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so v 0
executed such instruments shall be as binding as if signed by the president and attested by the secretary. O ca
Certificate of Designation—The President of the Company,acting pursuant to the Bylaws of the Company,authorizes David M.Carey,Assistant Secretary to appoint such attorneys-in- ~
fact as may be necessary to act on behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety
obligations. -7
Authorization—By unanimous consent of the Company's Board of Directors,the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the
Company,wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds,shall be valid and binding upon the Company with
the same force and effect as though manually affixed.
I,Gregory W.Davenport,the undersigned,Assistant Secretary,of American Fire and Casualty Company,The Ohio Casualty Insurance Company,Liberty Mutual Insurance Company,and
West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full,true and correct copy of the Power ofAttomey executed by said
Companies,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 '�3 day of ,�lJi E/f?UGC 20 1 r.
SND CASO �ZY INSrj �,1NSUq \NSUq
�yyowoFA��••v�� C�On.ovvoagr���
a 1906 no 0 1919 1912 ° 1991 o BY:
o a c �� = Gregory W.Davenport,Assistant Secretary
72 of 300
LMS 12873 122013
Liberty
ut-Ltil'
SURETY
TEXAS TEXAS
IMPORTANT NOTICE AVISO IMPORTANTE
To obtain information or make a complaint: Para obtener informacion o para someter una
queja:
You may call toll-free for information or to Usted puede hamar al numero de telefono gratis
make a complaint at para informacion o para someter una queja al
1-877-751-2640 1-877-751-2640
You may also write to: Usted tambien puede escribir a:
Interchange Corporate Center Interchange Corporate Center
450 Plymouth Road, Suite 400 450 Plymouth Road, Suite 400
Plymouth Meeting, PA 19462-1644 Plymouth Meeting, PA 19462-1644
You may contact the Texas Department of Puede comunicarse con el Departamento de
Insurance to obtain information on companies, Seguros de Texas para obtener informacion
coverages, rights or complaints at acerca de companias, coberturas, derechos o
1-800-252-3439 quejas al
1-800-252-3439
You may write the Texas Department of Insurance Puede escribir al Departamento de Seguros
Consumer Protection (111-1A) de Texas Consumer Protection (1 I 1-1A)
P. O. Box 149091 P. O.Box 149091
Austin,TX 78714-9091 Austin, TX 78714-9091
FAX: (512)490-1007 FAX#(512)490-1007
Web: http://www.tdi.texas.gov Web:htW://www.tdi.texas.gov
E-mail: ConsumerProtectionntdi.texas.gov E-mail: ConsumerProtectiongtdi.texas.gov
PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS O RECLAMOS:
Should you have a dispute concerning your Si tiena una disputa concerniente a su prima o a
premium or about a claim you should first un reclamo, debe comunicarse con el agente o
contact the agent or call 1-800-843-6446. primero. Si no se resuelve la disputa, puede
If the dispute is not resolved,you may contact the entonces comunicarse con el departamento (TDI)
Texas Department of Insurance.
ATTACH THIS NOTICE TO YOUR UNA ESTE AVISO A SU POLIZA:
POLICY:
This notice is for information only and does not Este aviso es solo para proposito de informacion
become a part or condition of the attached y no se convierte en parte o condicion del
document. documento adjunto.
NP 70 68 09 01
September 26, 2016
City of Fort Worth
CFA Administration
1000 Throckmorton St.
Fort Worth_ TX 76102
RE: Final Waiver of Lien;Water, Sanitary Sewer&Drainage Improvements to serve
West Fork Ranch 5A: DOE# 7537 City Project 402682
The purpose of this letter is to acknowledge that we have been paid in full by Pulte Group
for the public improvements constructed to serve West Fork Ranch 5A, in Fort Worth,
Texas. As a result, we hereby waive, release and relinquish all rights to assert any claim
or demand for lien in connection with this project.
Please feel free to contact me with any questions you may have.
Sincerely,
Ab Granges`tel
Contract Manager
6331 Southwest Blvd
Benbrook, Texas 76132
Office: 817-738-3200
Fax: 817-738-3435
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 Ab Grantges,
Contract Mgr, Of Burnsco construction, Inc., known to me to be a credible
person, who being by me duly sworn,upon his oath deposed and said;
That all persons, firms, associations, corporations, or other
organizations 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 in full;
That there are no claims pending for personal injury and/or
property damages;
On Contract described as;
West Fork Ranch Ph. 5A Water, Sanitary Sewer and Storm Drain
BY
Ab Grantges, act Manager
Subscribed and sworn before me on this date 26th of September,2016.
d,,,t4�11
Notary Public
Tarrant County, Texas EIA MCQUIEN
aY"� t Texas
Notary Public,Slate o
N comm,Expires 06 26.2018
�
%'F
,jiltNotary ID 125446481
FORTWORTHREV:02/22/07
TRANSPORTATION AND PUBLIC WORKS
CONTRACTOR'S EVALUATION OF CITY
n PROJECT INFORMATION Date: 9/9/2016
Name of Contractor Project Name
Bumsco West Fork Ranch Phase 5A
DOE Inspector Project Manager
Connor Slaten Aaron Long
DOE Number Profect D cuht, Tvpe of Contract
7537 Q Simple (j) Routine Q Complex 0 WaterO WasteWaterO Storm Drainage0 Pavement
Initial Contract.4mount Final Contract Amount
$290,890.60 $290,890.60
It)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 LJ 1 Accuracy of Plans to Existing Conditions
2 Knowledge of Inspector y 2 Clarity&Sufficiency of Details
3 Accuracy of Measured Quantities LJ 3 Applicability of Specifications
4 Display Of Professionalism 1 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 L
ADMINISTRATION 2 Availability of Project Manager
1 Change Order Processing Time 3 Communication
2 Timliness of Contractor Payments L 4 Resolution of Utility Conflicts L
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
s The City of Fort Worth•1000 Throckmorton Street•Fort Worth,Thi 76012-6311
(817)392-7941 •Fax:(817)392-7845