HomeMy WebLinkAboutContract 47914-FP2 Department of TP&W Const. Services
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Project anager — T
Risk Management Canal �T Wo 1 i l
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D.O.E. Brotherton �,-2'?- '"l CITY SECRE7'AR�9
Gutzler/Scanned
CFA Morales/Scanned � �- - ' CONj'RgCTNO (,. �llil��� ;L
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The Proceeding people have been Contacted
concerning the request for final payment& have NTION AND PUBLIC WORKS
released this project for such payment. F PROJECT COMPLETION
eveloper Projects)
Clearance Conducted By PA'wnofZ_�i ern City Project Ns: 100123
Regarding contract 100123 for WILLOW RIDGE ESTATES PHASE 3A as required by the 79/
TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by City Council on N/A through
M&C N/A the director of the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT upon the
recommendation of the Assistant Director of the Transportation&Public Works Department has accepted the project
as complete.
Original Contract Price: $2,570,113.40
Amount of Approved Change Orders: Ne 1
Revised Contract Amount: $2,570,113.40
Total Cost Work Completed: $2,570,113.40
7
j Cpcd-cy.
Recom ended for Acceptance D e
Asst. Director, TPW - Infrastructure Design and Construction
aL 0. t j 3/3///7
Accepted 0 6 Date
® Director, /
TRANSPORTATION AND PUBLIC WORKS DEPARTMENT 31z �
3 7
Asst. City Manager Date
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Comments: ZMAIM.En OFFICOAL�''i2co
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CITY pllpf_�M TA PV
MAR 0 5 2017
ianttiai•
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Rev.9/22/16
FORT WORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name WILLOW RIDGE ESTATES PHASE 3A
Contract Limits
Project Type STORM DRAIN&PAVING
City Project Numbers 100123
DOE Number 0123
Estimate Number I Payment Number I For Period Ending 3/20/2017
CD
City Secretary Contract Nurnber Contract Time 24ED
Contract Date Days Charged to Date 268
Contract is 100.00 Complete
Project Manager NA
Contractor GILCO CONTRACTING,INC.
6331 SOUTHWEST BLVD.
BENBROOK, TX 76132-1063
Inspectors LAYER / SLATEN
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Thursday,March 23,2017 Page I of 5
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City Project Numbers 100123 DOE Number 0123
Contract Name WILLOW RIDGE ESTATES PHASE 3A Estimate Number 1
Contract Limits Payment Number I
Project Type STORM DRAIN&PAVING For Period Ending 3/20/2017
Project Funding
STORM DRAIN
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
1 REMOVE RIPRAP 1072 SF $1.00 $1,072.00 1072 $1,072.00
2 REMOVE FW-O HEADWALL 1 EA $750.00 $750.00 1 $750.00
3 MEDIUM STONE RIPRAP 1271 SY $50.00 $63,550.00 1271 $63,550.00
4 CONCRETE COLLAR 3 EA $500.00 $1,500.00 3 $1,500.00
5 21"RCP 180 LF $45.00 $8,100.00 180 $8,100.00
6 24"RCP 1238 LF $52.00 $64,376.00 1238 $64,376.00
7 30"RCP 71 LF $68.00 $4,828.00 71 $4,828.00
8 33"RCP 30 LF $81.00 $2,430.00 30 $2,430.00
9 36"RCP 385 LF $86.00 $33,110.00 385 $33,110.00
10 48"RCP 140 LF $172.00 $24,080.00 140 $24,080.00
11 4X4 BOX CULVERT 60 LF $242.00 $14,520.00 60 $14,520.00
12 5X5 BOX CULVERT 220 LF $282.00 $62,040.00 220 $62,040.00
13 6X4 BOX CULVERT 30 LF $346.00 $10,380.00 30 $10,380.00
14 7X4 BOX CULVERT 821 LF $354.00 $290,634.00 821 $290,634.00
15 7X5 BOX CULVERT 693 LF $360.00 $249,480.00 693 $249,480.00
16 8X5 BOX CULVERT 394 LF $382.00 $150,508.00 394 $150,508.00
17 9X7 BOX CULVERT 479 LF $610.00 $292,190.00 479 $292,190.00
18 4'STORM JUNCTION BOX 1 EA $4,000.00 $4,000.00 1 $4,000.00
19 4'MANHOLE RISER 5 EA $2,800.00 $14,000.00 5 $14,000.00
20 10'CURB INLET 11 EA $3,400.00 $37,400.00 11 $37,400.00
21 10'RECESSED INLET 3 EA $3,500.00 $10,500.00 3 $10,500.00
22 4'X4'DROP INLET I EA $4,000.00 $4,000.00 1 $4,000.00
23 5'X5'DROP INLET I EA $4,500.00 $4,500.00 1 $4,500.00
24 PW-1 HEADWALL AT 9X7 RCB 1 EA $99,000.00 $99,000.00 1 $99,000.00
25 PW-1 30 SKEWED HEADWALL AT 7X4 RCB 1 EA $50,000.00 $50,000.00 1 $50,000.00
26 FW-0 HEADWALL,AT 5X5 RCB 1 EA $20,000.00 $20,000.00 1 $20,000.00
27 FW-0 HEADWALL,AT 7X5 RCB 2 EA $19,000.00 $38,000.00 2 $38,000.00
28 SETP-CD HEADWALL,AT 24"RCP 1 EA $2,100.00 $2,100.00 1 $2,100.00
29 SETP-CD HEADWALL,AT 4X4 BOX CULVERT 2 EA $7,400.00 $14,800.00 2 $14,800.00
30 CONCRETE PILOT CHANNEL 1086 LF $51.00 $55,386.00 1086 $55,386.00
31 TRENCH SAFETY 4741 LF $0.50 $2,370.50 4741 $2,370.50
Thursday,March 23,2017 Page 2 of 5
City Project Numbers 100123 DOE Number 0123
Contract Name WILLOW RIDGE ESTATES PHASE 3A Estimate Number I
Contract Limits Payment Number I
Project Type STORM DRAIN&PAVING For Period Ending 3/20/2017
Project Funding
Sub-Total of Previous Unit $1,629,604.50 $1,629,604.50
PAVING
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
1 MEDIUM STONE RIPRAP 270 SY $50.00 $13,500.00 270 $13,500.00
2 HYDRATED LIME 131.56 TN $150.00 $19,734.00 131.56 $19,734.00
3 HYDRATED LIME 197.15 TN $150.00 $29,572.50 197.15 $29,572.50
4 6"LIME TREATMENT 8771 SY $2.60 $22,804.60 8771 $22,804.60
5 8"LIME TREATMENT 13144 SY $2.70 $35,488.80 13144 $35,488.80
6 6"CONC PVMT 8121 SY $32.20 $261,496.20 8121 $261,496.20
7 7.5"CONC PVMT 8202 SY $36.45 $298,962.90 8202 $298,962.90
8 10"CONC PVMT 3968 SY $45.50 $180,544.00 3968 $180,544.00
9 4"CONC SIDEWALK 5434 SF $4.35 $23,637.90 5434 $23,637.90
10 5"CONCRETE DRIVEWAY 345 SF $5.00 $1,725.00 345 $1,725.00
I 1 BARRIER FREE RAMP 13 EA $1,975.00 $25,675.00 13 $25,675.00
12 BARRIER FREE RAMP 2 EA $1,900.00 $3,800.00 2 $3,800.00
13 BARRIER FREE RAMP 4 EA $1,700.00 $6,800.00 4 $6,800.00
14 4"SLD PVMT MARKING HAS 171 LF $4.00 $684.00 171 $684.00
15 8"SLD PVMT MARKING HAS 35 LF $8.00 $280.00 35 $280.00
16 TRAFFIC CONTROL I LS $1,500.00 $1,500.00 1 $1,500.00
17 CONNECT TO EXISTING PAVEMENT 128 LF $8.00 $1,024.00 128 $1,024.00
18 TYPE III BARRICADES 227 LF $50.00 $11,350.00 227 $11,350.00
19 CONCRETE HEADER 193 LF $10.00 $1,930.00 193 $1,930.00
Sub-Total of Previous Unit $940,508.90 $940,508.90
Thursday,March 23,2017 Page 3 of 5
City Project Numbers 100123 DOE Number 0123
Contract Name WILLOW RIDGE ESTATES PHASE 3A Estimate Number I
Contract Limits Payment Number I
Project Type STORM DRAIN&PAVING For Period Ending 3/20/2017
Project Funding
Contract Information Summary
Original Contract Amount $2,570,113.40
Chante Orders
Total Contract Price $2,570,113.40
2 1 — Total Cost of Work Com leted
Date p $2,570,113.40
o tra Less %Retained $0.00
1� Net Earned $2,570,113.40
Date A- t Earned This Period $2,570,113.40
Inspection Sue r
/ Retainage This Period $0.00
/ (�C Date Less Liquidated Damages
rankr Days @ /Day $0.00
Date 0 1 LessPavement Deficiency $0.00
A . irector/TPW-Infrastructure Design and Construction Less Penalty $0.00
0.0'.' Date 7 Less Previous Payment $0.00
Directo /Contracting Depart nt Plus Material on Hand Less 15% $0.00
Balance Due This Payment $2,570,113.40
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IIS
Thursday,March 23,2017 Page 4 of 5
City Project Numbers 100123 DOE Number 0123
Contract Name WILLOW RIDGE ESTATES PHASE 3A Estimate Number I
Contract Limits Payment Number i
Project Type STORM DRAIN&PAVING For Period Ending 3/20/2017
Project Funding
Project Manager NA City Secretary Contract Number
Inspectors LAYER / SLATEN Conti-act Date
Contractor GILCO CONTRACTING,INC. Contract Time 240 CD
6331 SOUTHWEST BLVD. Days Charged to Date 268 CD
BENBROOK, TX 76132-1063 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 $2,570,113.40
Less %Retained $0.00
Net Earned $2,570,113.40
Earned This Period $2,570,113.40
Retainage This Period $0.00
Less Liquidated Damages
0 Days n $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 $2,570,113.40
Thursday,March 23,2017 Page 5 of 5
FORT WORTH rev 03/05/07
TRANSPORTATION & PUBLIC WORKS
FINAL STATEMENT OF CONTRACT TIME
FINAL STATEMENT NO.:1
NAME OF PROJECT: Willow Ridge Estates PH 3A
PROJECT NO.: 100123 CONTRACTOR: Gilco Contracting,Inc.
DOE NO.: N/A
PERIOD FROM,06/27/17 TO: 03/21/17 FINAL INSPECTION DATE: 21-Mar-17
WORK ORDER EFFECTIVE:6/27/2016 CONTRACT TIME: 240 0 WB* CD
DAY OF DAYS REASON FOR DAYS DAY OF DAYS REASON FOR DAYS
MONTH CHARGED CREDITED MONTH CHARGED CREDITED
DURING DURING
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 268
PERIOD
PREVIOUS 0
PERIOD
TOTALS 268
TO DATE
*REMARKS:
CO RACTOR' DATE PECTOR DATE
ENGINEERING DEPARTMENT
The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TX 76012-6311
d
(817)392-7941 •Fax: (817)392-7845
FoRTWORTHREV:02/20/07
TRANSPORTATION AND PUBLIC WORKS
PERFORMANCE EVALUATION OF CONTRACTOR
n CONTRACTOR&PROJECT DATA
Name of Contractor Project Name
Gilco Contracting,Inc. Willow Ridge Estates PH 3A
DOE Inspector DOENumber
Connor Slaten 100123
DOE Inspector Project Manager
❑Water ❑Waste Water 0 Storm Drainage R] Pavement Fred Ehia
Initial Contract Amount Project Difficulty
$2,570,113.40 O Simple OO Routine O Complex
Final Contract Amount Date
$2,570,113.40 3/21/2017
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 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([TS/MS1* 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 i ture Contractor
Signature DOE Inspector's Supervisor
CONTRACTOR'S COMMENTS
TRANSPORTATION AND PUBLIC WORKS
i' The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TX 76012-6311
(817)392-7941 •Fax:(817)392-7845
FoRT WORT H REV:02/22/07
TRANSPORTATION AND PUBLIC WORKS
CONTRACTOR'S EVALUATION OF CITY
I)PROJECT INFORMATION Date: 8/8/2016 _
Name of Contractor Project Name
Gilco Contracting,Inc. Willow Ridge Estates PH 3A
DOEInspector Project Manager
Connor Slaten Fred Ehia
DOENumber Project Difficulty I T}Te of Contract
100123 O Simple Routine O Complex ❑Water ❑Waste Water Q Storm Drainage 1] Pavement
Initial Contract Amount Final Contract Amount
$2,570,113.40 1$2,570,113.40
II)PERFORMANCE EVALUATION
0-Inadequate 1 -Deficient 2-Standard 3 -Good 4-Excellent
ELEMENT RATING ELEMENT RATING
_
(0-4) (0-4)
INSPECTION EVALUATION I PLANS&SPECIFICATIONS
1 Availability of Inspector T 1 Accuracy of Plans to Existing Conditions
2 Knowledge of Inspector 12 Clarity&Sufficiency of Details
3 Accuracy of Measured Quantities 13 Applicability of Specifications
4 Display Of Professionalism 14 Accuracy of Plan Quantities
5 Citizen Complaint Resolution PROJECT MANAGER EVALUATION
6 Performance-Setting up Valve Crews,Labs j 1 Knowledge And/Or Problem Resolution
ADMINISTRATION 12 Availability of Project Manager
1 Change Order Processing Time 13 Communication
2 Tinniness of Contactor Payments 4 Resolution of Utility Conflicts
3 Bid Opening to Pre-Con Meeting Timeframe
III)COMMENTS&SIGNATURES
COMMENTS
Signature Contactor
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
CONSENT OF OWNER ❑
SURETY COMPANY ARCHITECT ❑
CONTRACTOR ❑
TO FINAL PAYMENT SURETY ❑
Conforms with the American Institute of OTHER
Architects, AIA Document G707
Bond No 022054658
PROJECT:
(name, addreSS)Willow Ridge Estates Phase 3A
Fort Worth Texas
TO (Owner)
PULTE HOMES OF TEXAS,L.P.AND CITY OF FORT? ARCHITECT'S PROJECT NO:
WORTH CONTRACT FOR:
4800 Regent Blvd.,Suite 100 Willow Ridge Estates Phase 3A,City Project No. 100123
Irving TX 75063 CONTRACT DATE:
CONTRACTOR:GILCO CONTRACTING, 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)
GILCO CONTRACTING, 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 9th day of March,2017
LIBERTY MUTUAL INSURANCE COMPANY
Sur6y Company
Attes"Kell Westbrook '
(Seal): Signature of Authorized Representative
Sophinie Hunter Attorney-in-Fact
Title
NOTE; This form i:, to be used as a companion document to AIA DOCUMENT G706, CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS,
Current Edition
ONE PAGE
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.7555760
Liberty Mutual Insurance Company
The Ohio Casualty Insurance Company West American Insurance Company
POWER OF ATTORNEY
KNOWN ALL PERSONS BY THESE PRESENTS:That The Ohio Casualty Insurance Company is a corporation 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
all of the city of Dallas state of TX each individually if there be more than one named,its true and lawful attorney-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 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 30th day of November 2016
Z
If INS tNSU NINSUq
JP�ovs°�yli'Qq R� � T z�F The Ohio Casualty Insurance Company
Liberty Mutual Insurance Company d
O 1919 n > 1912 3 1991 e O
y West merican Insurance Company
t t * By.
= STATE OF PENNSYLVANIA ss David M.Care ,Assistant Secretary
COUNTY OF MONTGOMERY _ C
L a1 On this 30th day of November 2016 before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance v F
Company,The Ohio Casualty Company,and West American Insurance Company,and that he,as such, being authorized so to do,execute the foregoing instrument for the purposes >W
0.2 therein contained by signing on behalf of the corporations by himself as a duly authorized officer. L
N > IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at King of Prussia,Pennsylvania,on the day and year first above written. O 0
r P PAST COMMONWEALTH OF PENNSYLVANIA
Qty�onwp� Notarial Seal ���' "�"� �'�'��/ �' 4-4
C t,�� 4�2 y Teresa Pastella,Notary Public By; O.a
M of upper Marion Twp.,Montgomery County Teresa Pastella,Notary Public 4)
O i q, ,Q My Commission Expires March 28,2017 3 tb
r0 'yp)gR PFJ Member,Pennsylvania Association of Notaries a M
r- d
MThis Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual V)p
6�, Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows: W .
01
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 Ir
r 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,
O c 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 respective =p
rpowers 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 df
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 >
,a the 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.
�
M 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, E oQ
> L 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
O 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 C 00
Z v respective powers of attorney,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 instruments shall be as binding as if signed by the president and attested by the secretary. p
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.
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, Renee C. Llewellyn, the undersigned, Assistant Secretary, 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 of Attorney 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 day of / u 20 M
-�Y INSU \,A SU N%Nsu _
- SJP�e�°�riRg2 .SJP
0 1919 0 1912 a 1991 By:
yo J ab y = Renee C.LlewNyff5ssistant secretary
�y�YY-AMPSt�F�-aD �i)'SgACNUS��\= �NDtAi:P
243 of 300
LMS 12873 082016
Liberty
Mutual
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:
2200 Renaissance Blvd., Ste. 400 2200 Renaissance Blvd., Ste. 400
King of Prussia, PA 19406-2755 King of Prussia, PA 19406-2755
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-IA) 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: http://www.tdi.texas. Web: hLtp://www.tdi.texas.g
E-mail: ConsumerProtection(a tdi.texas.gov E-mail: ConsumerProtection@a 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 condition del
document. documento adjunto.
NP 70 68 09 01
LMS-15292 10/15
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 Rob Taylor, Project
Coordinator of Gilco Contracting, 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;
Paving Improvements to serve:
Willow Ridge Estates Phase 3A
BY Rob Taylor
Subscribed and sworn before me on this 10th of March_, 2017.
MARY PANNELL
'Notary Public,state of Texas
'N••• f"eComm. Expires 10-19-2018 Notary P blic
�t9fe OP ?
Notary ID 5144234 Tarrant County, TX
•
March 10, 2017
City of Fort Worth
CFA Administration
1000 Throckmorton St.
Fort Worth, TX 76102
RE: Final Waiver of Lien; Water, Sanitary Sewer, Storm, Paving & Street Lights
Improvements to serve Willow Ridge Estates,Phase 3A
City Project#100123
File No. W-2382
CoFW Water Project No. 59601-5310350-0600430-100123-001580
CoFW Sanitary Sewer Project No. 59607-5310350-0700430-100123-001380
CoFW"X"No. 23500
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 Willow Ridge Estates, Phase 3A 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,
Rob Taylor
Project Coordinator
6331 Southwest Blvd.
Denbrook, Texas 76132
Office: 817.735.1600
Fax: 817.735.1613
Pulte
March 3, 2017
Mr. Dale Gilreath
Gilco Contracting, Inc.
6331 Southwest Blvd.
Benbrook,Texas 76132
Re: Contract for Willow Ridge Phase 3A—Water, Sanitary Sewer,Storm, Paving &Street Lighting
Improvements
CoFW Project No. 100123
CoFW File No.W-2382
CoFW Water Project No.59601-5310350-0600430-100123-001580
CoFW Sanitary Sewer Project No. 59607-5310350-0700430-100123-001380
CoFW"X" No. 23500
Dear Dale Gilreath:
This letter will document that Pulte Homes of Texas, L.P. confirms that Gilco Contracting, 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