HomeMy WebLinkAboutContract 47572-FP2 Depart f T,�&W Const. Services
CPN# Date
Project anager d"
Risk Management Canad CI i!Y SECRETARY / —
IT WORTH,
D.O.E. BrothertonMontacted
���T�e��� _� � Zi
CFA Westerman/Scannedl
Esteban Perez/Scanned
The Proceeding people have bee
concerning the request for final payment& have kTION AND PUBLIC WORKS
released this project for such payment. F PROJECT COMPLETION
Clearance Conducted By
)eveloper Projects) Z)pE 75-/-2
�anr� e�Z�
City Project Ns: 02658
0-FA ���� cs
# y 7
Regardu1g contract 117512 for PALMILLA SPRINGS PHASE 3,s required by the
TRANSPORTATION& PUBLIC WORKS as approved by City Council on N/A through M&C N/A the director
of the TRANSPORTATION&PUBLIC WORKS upon the recommendation of the Assistant Director of the
Transportation&Public Works Department has accepted the project as complete.
Original Contract Price: $226,722.00
Amount of Approved Cliange Orders: $2,812.10 Ns 1
Revised Contract Amount: $229,534.10
Total Cost Work Completed: $229,534.10 ''\\
'&
Recommende or Acceptance Date
Asst Director, PW - Infrastructure Design and Construction
Accepted / Date
ow Director, TRANSPORTATIO & PUBLIC WORKS
Asst. City Manager l Date
Comments:
NOV 14 2016
Initial: el OFF�-
RD
I
ICAL RECO- _ CITY�ECREAR
TP
Rev.9/22/16 -�a�
FORTWORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name PALMILLA SPRINGS PHASE 3
Contract Limits
Project Type STORM DRAIN
City Project Numbers 02658
DOE Number 7512
Estimate Number 1 Payment Number l For Period Ending 10/20/2016
CD
City Secretary Contract Number 117512 Contract Time 12(VD
Contract Date Days Charged to Date 221
Project Manager Sahu Contract is 100.00 Complete
Contractor C.W.YOUNG CONSTRUCTION
210 S.SIXTH STREET
MANSFIELD, TX 76063
Inspectors LAYER/ ROBERTS
Thursday,October 20,2016 Page I of 4
�J
City Project Numbers 02658 DOE Number 7512
Contract Name PALMILLA SPRINGS PHASE 3 Estimate Number I
Contract Limits Payment Number 1
Project Type STORM DRAIN For Period Ending 10/20/2016
Project Funding
STORM DRAIN
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quauity Total Quanity Total
I 5'X2'BOX CULVERT 200 LF $210.70 $42,140.00 200 $42,140.00
2 36"RCP CLASS III 230 LF $99.15 $22,804.50 230 $22,804.50
3 30"RCP CLASS III 475 LF $77.06 $36,603.50 475 $36,603.50
4 24"RCP CLASS I1I 480 LF $60.65 $29,112.00 480 $29,112.00
5 21"RCP CLASS III COY 78 LF $53.20 $4,149.60 78 $4,149.60
6 20'CURB INLET COM 1 1 EA $4,750.00 $4,750.00 1 $4,750.00 j
I
7 15'CURB INLET COY 4 EA $4,300.00 $17,200.00 4 $17,200.00
8 10'CURB INLET COY 4 EA $3,400.00 $13,600.00 4 $13,600.00
9 STORM JUNCTION STRUCTURE 1 EA $8,875.00 $8,875.00 1 $8,875.00
10 4'STORM JUNCTION BOX 1 EA $3,525.00 $3,525.00 1 $3,525.00
11 HEADWALL BOX CULVERT 1 EA $6,000.00 $6,000.00 1 $6,000.00
12 30"FLARED HEADWALL 1 EA $1,850.00 $1,850.00 1 $1,850.00
13 6"CONCRETE FLUME W/6"CURBS 1275 SF $9.85 $12,558.75 1275 $12,558.75
14 MEDIUM STONE RIPRAP COM 1 520 SY $50.00 $26,000.00 520 $26,000.00
15 TRENCH SAFETY COY 1 ——— 1463 LF —— $0.25 — $365.75 1463 — $365.75 f
——————————————— ———————
Sub-Total of Previous Unit $229,534.10 $229,534.10
-------------------------------------- I
1
i
i
i
I
i
i
i
t
tt
Thursday,October 20,2016 Page 2 of 4
City Project Numbers 02658 DOE Number 7512
Contract Name PALMILLA SPRINGS PHASE 3 Estimate Number I
Contract Limits Payment Number I
Project Type STORM DRAIN For Period Ending 10/20/2016
Project Funding
Contract Information Summary
Original Contract Amount $226,722.00
Chanize Orders
Change Order Number 1 $2,812.10
Total Contract Price $229,534.10
•
Total Cost of Work Completed $229,534.10
OngLess %Retained $0.00
Net Earned $229,534.10
Date G�
Inspect' n S e r Earned This Period $229,534.10
�/9/fir Retainage This Period $0.00
--- Date Less Liquidated Damages
roject Manager
c Days a /Day $0.00
Date �'0 LessPavementDeticiency $0.00
A ire or/TPW-Infrastructure Design and Construction Less Penalty $0.00
i, (,J. Date I 0 �� Less Previous Payment $0.00
Direct Contracting Departm t Plus Material on Hand Less 15% $0.00
Balance Due This Payment $229,534.10
Thursday,October 20,2016 Page 3 of
City Project Numbers 02658 DOE Number 7512
Contract Name PALMILLA SPRINGS PHASE 3 Estimate Number 1
Contract Limits Payment Number I
Project Type STORM DRAIN For Period Ending 10/20/2016
Project Funding
Project Manager Sahu City Secretary Contract Number 117512
Inspectors LAYER / ROBERTS Contract Date
Contractor C.W.YOUNG CONSTRUCTION Contract Time 120 CD
210 S.SIXTH STREET Days Charged to Date 221 CD
MANSFIELD, TX 76063 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 $229,534.10
Less %Retained $0.00
Net Earned $229,534.10
Earned This Period $229,534.10
Retainage This Period $0.00
Less Liquidated Damages
0 Days rJ $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 $229,534.10
Thursday,October 20,2016 Page 4 of 4
DEVELOPER-AWARDED-PROJECT CHANGE ORDER
PROJECT NAME: Palmilla Springs.Phase 3 CHANGE
CONTRACT[ Water.Sewer.Paving.Drain a&Street Light ORDER NO:
CFA# 2015.108 CITY PARTICIPATION:1 NO
CITY PROJECT# 2658
DOE# 7512 q
WATER PROJECT# P265-603150265683
SEWERPROJECT# P275-703130265B83
FILE# K-2417
INSPECTOR: David Beardsley Phone No: 713-493-4442
PROJECT MANAGER: Gopal Sahu Phone No: 817-392-7949
CONTRACTUNIT
WATER SEWER PAVING DRAINAGE STREETLIGHTS CONTRACT
DAYS
ocvcloperco t �C C FXM 0-10per Cost ,y Yd�Da"10p•r Cost Develop►r Cost witCWjC; od i Developu Cost yCiljC $
ORIGINALCONTRACT $218.80"at��l:"`'tt,�„` St1a,9�8.10 �'l, v ,,, 5559.Ot0A5 �``i ,y +.y,�.'u 5226XM-00 .�+F .�+ ,1�iT+. 577,210 a0 .Y'�'�S M4X'-K•.
EXTRAS TO DATE
CREDITS TO DATE `�. 1,319-r,i,,. `•�ti..:x+,`�cck �W'"•�.t+Mi1 r ,.I�+uryiaJ.: }ai_' �a s a:' .,"'L`F.S=cT-ICY<
CONTRACT TO DATE 52la306S0 -RSO ErY' I,� 5418.91a.10 ryT , lr}1,4' rrdr a 9�,y•`u�.sm`rz µ.c'rca:�� ! D
,,�y .•.,,i� 5559A10A5 .c+�.X150.00;v�� 5226,72200
MOUNT OF PROP.CHANGE ORDER 4-:-' ,ra'�li9f4Ei t�Sa' 535,!X736 '-i.-'`t3C*.'lit;-
RWSEO CONTRACT AMOUNT S24a,a06AD ;^ '. 5151,13S.a6 yFr'iS0A0,t�.t^<'s` SS59,010A5 ,95i�.S0A0��"t� 5229.551,10 V iw 'SD90 -7:+ 577,210,W JSQ 00,•t!: R .
TOTALREVISED CONTRACTAIAOUNT
PER UNIT S213,a0650 5151,135.” 5559,01 OAS 5229534:10' S77.2'f0.40
REVISED COST SHARE Dev.Cost: S1,538,696.81 iCik�C`tls7'C
eaa .N:
TOTAL REVISED CONTRACT 51,538,696.81
Revised:10-12-2011 Page 1
You are dltacted to make the followinq than es In the contract documents:
PAY ITEM 0 CITY 810 ITEM* QUANTITY UNIT ITEM DESCRIPTION UNiTPR10E TOTAL
A-1'.1 3331.4115 29,00 LF B'SEWER PIPE 53959 S1 148.11
A-12 3331.4116 40.00 LF 8"SEWER PIPE.CSS BACKFILL SX09 52.963.60
A-12 5999.9999 50.00 LF 8"SEWER PIPE METHOD OTHER THAN-OPEN CUT S343.10 717.155.00
A-1.4 9999.9999 40.00 LF 12"PVCSLEEVE S81.06 5324240
Ar1.8 3339.1003 1.00 EA 4!DROP MANHOLE 55022.35 $5.02235
A-1,10 3339.0001 20.00 VF EPDXY MANHOLELINER $200.00 S4,000,00
A-1,12 3301.0002 69.00 LF POST=TV INSPECTION 51:10 $75.80
A-1.13 3301.0101 1.0D I EA MANHOLEVACUUM TESTING 580.00 SB0.0D
C01.1. 1 9999.9999 1 2.001 EA I ADDITIONAL BASESTHATHAD TO BE RESUILTTO ACCOUNT $750.00. $1,500.00
SEWER TOTAL 535187 36
8-15• 3341.0201 1 18.00 1 LF I 21'RCP,CLASS III 55320- SSS780
8-1.6 1 33495003 1 0.001 EA 1 20'CURB'INLET f 54115.0- 0D-
8-1.7 3349.5002' lu 2.00 EA 15'CURS JNLET 54.300.00 S8 D0.00
B-18 33495001 -L, 9.00 EA 101 CURB INLET S3,40D.00 43.400.00
B-1.14 3137.01D4 t 28.00 1 SY MEDIUM STONE,RIPRAP,DRY S50.00 S1.400.00
B-1.15 3305,0109- 18.00 LF TRENCH SAFETY 5025 $4.50
STORM GRAIN TOTAL SZ 81210
REASONS FOR CHANGE ORDER Due le con111ctS t57aS eN/311nggaS 11neS.offsite San118ry-Te vrerdesfpmmcWfrcafrons were made.Mare twe some mlhor errofs In rhe original wnLactgbanbllesfor storm dram.
NO CITY FUNDS INVOLVED IN THIS CONTRACT,DEVELOPER IS RESPONSIBLE FOR I 00%OF THE CHANGE ORDER COSTAND NO
REIMBURSEMENT FROM THE CITY{NILL BE SOUGHT BY THE DvELOPER,
RECOMMENDED: APPROVED: APPROVED:
TEAGUE NA_LL,.-&PPr=RKINS JASEZ C 40PM C:VJ.YOUNG CONSTRUCTION.RUCTION.
By; �'�-zt By: By:
Name: Jonathan Banplart P.E. Name, A cwted Name:
Tale: Sr.ProleetManager Tido: Title: r
Revised:10-12-2011 Page 2
FORTWORTH rev 03/05/07
TRANSPORTATION& PUBLIC WORKS
FINAL STATEMENT OF CONTRACT TIME
FINAL STATEMENT NO.:-1
NAME OF PROJECT: Palmilla Springs Ph.3
PROJECT NO.: 02658 CONTRACTOR: C.W.Young Construction
DOE NO.: 7512
PERIOD FROM:10/01/16 TO: 10/18/16 FINAL INSPECTION DATE: 18-Oct-16
WORK ORDER EFFECTIVE:2/22/2016 CONTRACT TIME: 120 O Wfl* CD
DAY OF DAYS REASON FOR DAYS DAY OF DAYS REASON FOR DAYS
MONTH CHARGED CREDITED MONTH CHARGED CREDITED
DURING DURING
1. 0 16. 0
2. 0 17. 0
3. 0 18. 0 Held Final
4. 0 19.
5. 0 20.
6. 0 21.
7. 0 22.
8. 0 23.
9. 0 24.
10. 0 25.
11. 0 26•
12. 0 27.
13. 0 28.
14. 0 29•
15. 0 30.
31.
SAT,SUN, RAIN,TOO WET, UTILITIES DAYS TOTAL
E
&HOLIDAYS &TOO COLD RLOCATIONS OTHERS* CHARGED DAYS
THIS 0 0
PERIOD
PREVIOUS 221 221
PERIOD
TOTALS 221 221
TO DATE
*REMARKS:
CO TRACTOR 1DATtINS
ENGINEERING DEPARTMENT
d The City of Fort Worth•1000 Throclunorton Street•Fort Worth,Thi 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
Mane of Contractor Project Marne
C W Young Construction,L.P. Pahrtilla Springs Phase 3
DOE Inspector DOE Number
David Beardsley 7512
DDE Inspector Project Manager
❑Water ❑Waste Water o Storm Drainage ❑ Pavement Gopal Sahu
Initial Contract Amount Project Difficulty
$226,722.00 D Simple ® Routine O Complex
Final Contract Amount Date
$229,534.10 10/19/2016
Il)PERFORMANCE EVALUATION
0-Inadequate I-Deficient 2-Standard 3-Good 4-Excellent
ELEMENT WEIGHT(x) APPLICABLE(Y/N) RATING(0-4) MAX SCORE SCORE
I 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 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
III)CONTRACTOR'S RATING
Maximum Score(MS)=448 or sum of applicable element score maximums which= 448
Rating([TS/MSj *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)
Signature DOE Inspector Signature Contractor
Signature DOE Inspector's upernsor
CONTRACTOR'S COMMENTS
TRANSPORTATION AND PUBLIC WORKS
The City of Fort Worth•1000 Throckmorton Street•Fort Worth,TY 76012-6311
(817)392-7941 •Fax:(817)392-7845
BOND NUMBER 022052532
OWNER El
CONSENT OF SURETY ARCHITECT
TO FINAL PAYMENT CONTRACTOR
Conforms with the American Institute of SURETY
Architects,AIA Document G707 OTHER
TO OWNER: Jabez Development,L.P.and the City ARCHITECT'S PROJECT NO.:
(Name and address) of Fort Worth
CONTRACT FOR: Water,Sewer and Storm Improvements
PROJECT: Palmilla Springs,Phase 3 CONTRACT DATED: �OVt r 30' t Z61'
(Nante and address)
In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above,the
(Insert name and address ofSureo}
Liberty Mutual Insurance Company
175 Berkeley Street,Boston,Massachusetts 02116
SURETY,
on bond of
(Insert name and address of Contractor)
C.W.Young Construction,L.P.
210 S.Sixth Street,Mansfield,Texas 76063
,CONTRACTOR,
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 obligations to
(Insert name and address ofOtrnet)
Jabez Development,L.P.and the City of Fort Worth,Tx
OWNER,
as set forth in said Surety's bond.
IN WITNESS WHEREOF,the Surety has hereunto set its hand on this date: October,19,2016
(Insert in writing the month followed by the numeric date and year.)
Libe utual Insurance Compan
4natur
Attest: f authorized represerttatire)
Sonia Lara,Attorney-in-Fact
(Printed name and title)
THIS-POWER 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.7114493
American Fire and Casualty Company Liberty Mutual Insurance Company
The Ohio Casualty Insurance Company West American Insurance Company.
POWER Of ATTORNEY
KNOWNALL PERSONS BY THESE PRESENTS: ThatAmedcan 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 WestAmerican Insurance Company
is a corporation duly organized under-theaaws of the State of.lridiana.(herein collectivel�-calleflhe"Companies"-),.pursuahtto and by;4uthorily herein set forth,does hereby name,constitute
and appoint, Tom!J Pope 1`41--W-Bower Bill eallinger RtchaYd wlaxw=Candace Reynpjds Bnan-, Smlih:Andre�y P Clark,Kevin Clatiorn,Hilaria
Tijerina Rachel Duncan Melissa lfaire DavidW.:Morgan `Cliaria ire"rez,:Cofir3fE.Coniy;Matk Rozewlcz;LaGasha:Grl rtes;Sonia Lara,Bryant Ahmed,
Zia Reeves;Teresa Skertchly,Todd Tschantz;AlCstra Weis
all the city of Dallas state of 7X; s=.:eac}aandjvidually if there be more[fia atone nafnetl,its trupondlawful attorney-iti_fact`fo make,execute,seal,acknowledge
and deliver,for and on its behalf as surety and,as=its acfand deed,ani and all undertakings,hopdslrgcogn;-- es and otE-6 surety obligations,jri_pursuance of these.presents and shall
be as binding upon the Companies as if thej-6:v peen&&'signed byahspresident and attested3iythe secrefaryof the.136 ipanles in their own-ptoper persons.
IN WITNESS WHEREOF this PowerbfAttorne":has lieen subscribed;6"ars authorized offl-cen'or,official ofih - ompanies_aijdthe.cor orate s`ea(s of the Companies have been affixed-
'thereto this 16th day of September 2015cc
No CA s w irvs� �,t1saR- N,Nsuq~ ` American Fire and Casualty Company
F.Poazoryr G9 JP�orwo2: �9 The Ohio Casualty Insurance Company. d+
a 1906 0 o V 1914 n o ° Liberty Mutual lnsurance Company d
o * 1912 3 1991 West merican Insurance Company
(11 �fYb'Nae�esN T�'� dy`�•kxu�aya Aij�sstclh��_ ' ^;out+F �- �
a(Di * * * * By: >,
David M.Carey'-Assistant Secretary C
STATE OF PENNSYLVANIA ss to
COUNTY OF MONTGOMERY .
v :On this 16th day of September 2015,before me personally appeared David M. Carey,who acknowledged himself to be the Assistant Secretary of American Fire.and v F-
ui:Casualty Company,Liberty Mutual Insurance Company,The Ohio Casualty Insurance Company,and West American Insurance Company,and that he,as such,being authorized so to do,
�. Itt
� ,.execute the foregoing instrument for the purposes therein contained by signing on-behalf of-the corporations by himself as a duly authorized-officer. E.
y > 1N WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting,Pennsylvania,on the day and year firstabove written. TO CL
y - 9P PAsr COMMONWEALTH OF PENNSYLVANIA - Q M
Q �Q oa-NgrtwFq�Flt Notarial Seal �' �" ?^' O
- y y Teresa Pastella,Notary Public gy;
a y _ of Plymouth Twp,,Montgomery County Teresa Pastelia;Notary Public �' ;
7 z \P My Cornmissfon Expites March 29,2017
3.
so - - 2 LVPayG Member,Pennsyivania Association of Notaries
7-4+ - -
This Power ofAttorney is made and executed pursuant to and by authority of the following By-laws and Authorizations ofAmerican Fire and Casualty Company,The Ohio Casualty:Insurance .y c
Company,D. _ P y,Liberty Mutual Insurance Company,and WestArnerican-Insurance Company which resolutions are now in frill force and effect reading as follows: s c
M.tn _- rn
u d 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..d
to such limitatfon as the Chairman or the President may prescribe,shall appoinfsuch attomeys-in-fact,as may be necessary to act in behalf of the Corporation to(hake,execute,seal,. i>,,a)-
5.S .acknowledge and deliver as surety any and all undertakings,bonds;recognisances and other surety obligations. Such aftorneys-in-fact,subject to the limitations set forth in their respective -a
powers of attorney,shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation When so
j 9 Y Y Y yP yg Y P Y Q
executed,such instruments shall be as binding as-if si ned b the President and attested to b the Secretor.An ower or aufhorit roofed to an re resentative br atfome-in-Tact under
z. the prodisions of this article may be revoked at any time by the Board,the Chairman,the Presidentorby the officer or officers granting such power or authority.
"o C'ARTICLE XIII-Exeeution.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, o0
:and sub ect to"such limitations as the chairman or the resident may rescribe,shall appoint such attorne s in-fact,as ma be:necessa to act(n behalf of the Com an to make,execute,. N
�. ._. j P_ yp PP Y Y ry Company, - M
-_seal,acknowledge and deliver as surety any and all undertakings;bonds;recognizances and other surety obligations. Such atforneys-in-fact subject to the limitations set forth in their C 0
v =respective powers of attorney,L 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 o
:executed such instmments shall be asbrndtng as if signed by the presidentand aftested by the secretary. - -_ _ _ p
Certificate of Designation-The Presiderif of the Company,'_achng pursuanYto the BylawsAfifte C.rnpmi aeihorizes aVtd fvi;`Carey;Rssistarif:Secretary to appoint such attorneys,in- T
fact as may be necessary to act on befiaif-0f the Company7o make execune,seal,acknowledge and-deltyel assuretj_a: and all undertakings bonds,recognizances and other surety
obligations: _
Authorization-By unanimous consentof l�e'Gompanys Board of Cre'ctors,the Company consents that facsimile or mechaflically reproducedf§ig6afure of any assistant secretary of the
Company,wherever appearing upon a certifi&!tdppy o'anyspowerofatfori}ey issued by the CoritLSaiiy in conrractron wit# sGtety bonds;shall be alidand binding upon the Company with-
the same force and effect as though manualiy:affixd;
.I Gregory W.Davenport,the undersigned,AsslstanFSecreta ,ofAmeitcaiil=i"re.apd CAsualJj Company,Tlie Ot io Casually fi rance.Coitipagy;;.l iberty Mutual insurance Company,and
11.rY P 9 ry,
West American Insurance Company do hereby Cattily flat the original ppwer oPattameyofvyhrch tfie foregoing is a full;(Fye. d correcCcoliy:of the Power of Attorney executed by said
Companies,is in full force and effect and has not:bdenievoked.
J
INTESTIMONYWHEREOF,I_have hereunto set my hand and affixed the seals of said Companies this . day of `-' 2�rO
PNP-CA-r6. - Pyr'(.INSpj p�W sURR _ si#1CI5✓R,I - -
�4.``wwo2
Z1906 a o 1919 n 1912 3 r 1991 By: y.
Gregory W.Davenport,Assistant Secretary
59 of 500
LMS 12873 122013
LibertX
utual.
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 llamar al numero de telefono gratis
make a complaint at para informacion o para someter una queja al
1-877-751-2641 1-877-751-2641
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 79462-8284 Plymouth Meeting,PA 79462-8284
You may contact the Texas Department of Puede comunicarse con el Departamento de
Insurance to obtain information on companies, Seguros de Texas para obtener information
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(111-1A)
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:bM2://www.tdi.texas.gov Web: http://www.tdi.texas.gov
E-mail: ConsumerProteotion@tdi.texas.gov E-mail: ConsumerProtection@tdi.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
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 Joe Winchester,
Proj. Manager Of CW Young Construction,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;
Palmilla Springs,Ph. 3 -DOE#7512 - City Project# 02658
r
BY .�
Joe Winchester- Project Manager
Subscribed and sworn before e on t s date 19th of October,2016.
r
'Z&Z�
Notary Public
Tarrant, TX
�Y`. f1tERETT-W STEWAOT III
My Ommission Wires
March l2,2019.
210 S. Sixth Ave.
Mansfield, TX 76063
(817) 477-1414
L kfSF�l
NDF6 LR- - fax: (817) 473-6077
10/19/2016
City of Fort Worth
CFA Administration
1000 Throckmorton St.
Fort Worth,TX 76102
RE: Palmilla Springs,Ph. 3
DOE#7512 City Project#02658
The purpose of this letter is to acknowledge that we have been paid in full by Jabez Development, L.P. for
the public improvements constructed to serve Palmilla Springs,Ph. 3 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,
4Joerinchester
Young Construction,L.P
C.W. Young Construction, L.P. -- 210 S. Sixth Ave. -- Mansfield, TX 76063
FORTWORTHREV:02/22/07
TRANSPORTATION AND PUBLIC WORKS
CONTRACTOR'S EVALUATION OF CITY
I)PROJECT INFORMATION Date: 10/19/2016
Name of Contractor Project Name
C W Young Palmilla Springs,Phase 3
DOEInspeclor Project Manager
David Beardsley Gopal Sahu
DOENmuber ProjectDtfcully T}pe of Contract
7512 10 Simple ® Routine o Complex ❑Water ❑Waste Water o Storm Drainage ❑ Pavement
Initial Contract Amount Final Contract Amount
$226,722.00 $229,534.10
I1)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 t-` 1 Accuracy of Plans to Existing Conditions
2 Knowledge of Inspector G 2 Clarity&Sufficiency of Details 14
3 Accuracy of Measured Quantities 0 13 Applicability of Specifications [
4 Display Of Professionalism 4 Accuracy of Plan Quantities C
5 Citizen Complaint Resolution PROJECT MANAGER EVALUATION
6 Performance-Setting up Valve Crews,Labs L( 1 Knowledge And/Or Problem Resolution
ADMINISTRATION 2 Availability of Project Manager
I Change Order Processing Time 3 Communication /
2 Timliness of Contractor Payments 4 Resolution of Utility Conflicts
3 Bid Opening to Pre-Con Meeting Timeframe L
III)COMMENTS&SIGNATURES f
COMMENTS f�� ri�►�.ir lr �til.T r '�-c �J / ��
Signature Contractor
Signature DOE Inspector
Signature DOE Inspector's Super iso 0 G0.eL
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