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Contract 47843-FP1
CITY SECREv CITY OF FORT WORTH C©kQ �,s,,..."� W13�1 - pl NOTICE OF PROJECT COMPLETION ApR 1,4 a Regarding Contract No. 47843. or Concrete Paving Joint Sealant 2016, CPN 100058 which was requested by the Transportation and Public Works Department and approved by the City Council on April 19, 2016 through M&C C-27682 the Director of the Transportation and Public Works Department, upon the recommendation of the Assistant Director of the Transportation and Public Works Department, has accepted the project as complete. Contractor: Scodeller Construction,Inc. Original Contract Price: $ 411,900.00 Amount of Approved Change Orders: $ 0.00 Revised Contract Amount: $ 411,900.00 Total Cost Work Complete: $ _409,223.55 Less Liquidated Damages: $ 0.00 Days__ @$ Less Penalty: $ 0.00 Total Contract Cost: $ 409,223.55 Less Previous Payments: $ 388,762.37 Final Payment Due: $ 20.461.18 Recommended for Accep6tnce Date Assistant Director, Transportation and Public Works Accepted J Date Director,Transportation and Public Works City Manager Date EMAZL,ED MAY 2 2 17 OFFICIAL.REC®Ra CITY SECRETARY hattial: - FT.WORTH,TX 7= TPS Construction Invoice Contract: CS47843 P.O.# PO-16-94767 Payment Date: 2/28/2017 TO:SCODELLER CONSTRUCTION INC INV.# CS47843-4 Estimate No. 4 DOE: 51722 GRAND RIVER AVE ProjManager TARIQUL ISLAM WIXOM MI 48393 FOR: CONCRETE PAVING JOINT SEALANT 2016 AT VARIOUS LOCATIONS Contract Amount: $411,900.00 Completed Ret Pen Adj Pay Total to Date: $409,223.55 $20,461.18 $0.00 $0.00 $388,762.37 Previous Estimate: $409,223.55 $40,922.36 $0.00 $0.00 $368,301.19 Earned to Date: $0.00 ($20,461.18) $0.00 $0.00 $20,461.18 Payments: 30100-0200431-5740010--100058-003380-2016- $411,900.00 Total to Date: $409,223.55 $0.00 $0.00 $0.00 $409,223.55 Previous Estimate: $409,223.55 $20,461.18 $0.00 $0.00 $388,762.37 Earned to Date: $0.00 ($20,461.18) $0.00 $0.00 $20,461.18 ACH FINAL PAY Transportation &Public Works SUSINIESS SUPPORT GROUP Contac)Pe on BRANDY CRANE- .2852 Departm to rovalStgr.at, L:ur S DEPARTMENT CHECK PICK-UP YES iJ Friday,May 19,2017 Page i of 1 co 17 o 0 N N O z bq EA N � 0 N W N kn O O '0I �I CD V z o sNv N U � O � O � O r � ON N O N O p ^N` O W U ° I a o � _ E NN EA N ti N 1 H � I Q I cr n i Ey ami r�i c�+i I !E o 0 Vl 10 V. 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M 0 H o o. s H 9 o d `v m CC � � O p �� 5np•a.cp a �/ • y O U N 0 0 u: w E 3 w° O N Contractor Final Estimate Approval Final-I-Estimate Page 1 of 2 Routing Assigned To: Brandy Crane Due Date: 4/2/2017 Assigned By: Eamonn Dwyer Due Time: 3:30 PM Links 1 fortworthgov/Infrastructure Projects/100058 - Joint Seal 2016/Contractor/Submitted Invoices/Estimate 004/Copy of Ft Worth Estinate No 004.x1sm Attachments(0) No Attachments have been added to this form. https://projectpoint.buzzsaw.com/ bz web/Forms/FormPrint.aspx?Siteld=51500&Processl... 5/17/2017 Contractor Final Estimate Approval Final-I-Estimate Page 2 of 2 FORT WORT h, Cor trd-lc '�Or HnM F_sUmate A pprovM Date Started: 2/28/2017 i Date Due: 3/14/2017 Invoiced Amount: (Amount from $ 20,461.18 Request No.: Final-1-Estimate Line 8 of C-620) Project Name: 100058 - Joint Seal 2016 Project Number: 100058 Invoice No.: 4 Final Reference: Contractor: Eamonn Dwyer Discussion: Release of retainage (Limit 5000) Approval Status: Approved: Yes Comments: User: Tariqul Islam Date: 2017-03-27 4:31 PM Approved: Yes Comments: User: Eamonn Dwyer Date: 2017-03-28 1:06 PM Approved: Yes Comments: User: Kim Arnold Date: 2017-03-28 8:49 AM Approved: Yes Comments: User: Doug Wiersig Date: 2017-03-28 3:30 PM https://projectpoint.buzzsaw.com/ bz_web/Forms/FormPrint.aspx?Siteld=51500&ProcessI... 5/17/2017 5/19/2017 BuySpeed Online --� Department Access NIGP Code Browse I My Account I Customer Service I About Current Organization:CITY OF FORT WORTH Tj May 19,2017 7:37:29 AM CDT H' Q 6 ..:r... IJGGUII.e lll:> I Brandy Crane Invoice#t: CS47 -._'_) R.'iAl.Vr-n or i-:00000-MIE 7 �,�enido'GI CtLl,#:01 Status:41K-Ready for Approval d General Items Subcontractors Accounts Routing Attachments Notes Reminder Change Order P,u1ii olY Back to PO Header Information Invoice Number: CS47843-FINAL Invoice Status: 41R-Ready for Invoice Type: 3 way Approval matching Invoice Description: CS47843-FINAL CONCRETE PAVING JOINT SEALANT 2016 AT VARIOUS Invoice Date: 02128/2017 Effect Date: 0511912017 LOCATIONS Payment Amount: $20,461.18 Handling Code: Payment Date: 03/25/2017 Payment Terms: ACH(DIRECT DEPOSIT) Payment Term 0 Payment 0.0 Pa Y Day: Discount: Paid-Bank/Check: Alternate Id: Entered By: Brandy Crane Entered Date: 05/19/2017 Updated By: Brandy crane Updated Date: 0 5/191201 7 Received Date: 02/28/2017 07:34:00 AM Agency Files: Agency Forms: Vendor Files: Vendor Forms: I > Information Purchase order DRPA-17-00003201 PO Description CS47843-FINAL Number: 100058 PO Amount: $2o,as1.1a Remaining To $0.00 Buyer: BranCrane Invoice: `�r ti7t'=Nf!-��v . `7tl tl nEi 011 Vendor: 0000040087-SCODELLER CONSTRUCTION INC Address Grp: 01 Vendor Remit-to ACH REMIT Address: 51722 GRAND RIVER AVE WIXOM,MI 48393 USA Fed ID: """5522 Remit Text: Email:TOM@SCODELLERCONSTRUCTION.COM Phone:(248)374-1102 Id:128086 (EFT Enabled) Invoice Item#/PO Item#:1 RETAINAGE$20,461.18-CONCRETE PAVING JOINT SEALANT 2016 AT VARIOUS LOCATIONS 30100-0200431-5740010--100058-003380- 2016-CS47843 M&C C-27682 DATE 041916 PO Permit Invoice Discount% Original Final Item Status To Pay Amount Pay Amount Pay 3PCR-Complete Receipt $0.00 $20,461.18 0.0% $0.00 Yes MAKE: ASSET MODEL: ASSET MANUF: ASSET SERIAL: ASSET VIN: ASSET TAG: Event Type Fiscal Year Account Code Transaction Amount Exp. 17 30100--2060000--100058-RETAIN-- $20,461.18 Enc. 17 30100--2060000--100058-RETAIN-- -$20,461.18 ,val Path: Delete I Approver Order Approval Level Approver Date Date Approved/Disapproved/Canceled Comment https://bso.fortworthtexas.gov/bso/purchaseorderA nvoi ce/invoiceSum m ary.sdo?vendorld=0000040087&docld=D R PA-17-00003201&releaseN br=0&docType=1&... 1/2 5/19/2017 BuySpeed Online Sequence Path I Type Requested I Approved/Di s approve d/Ca nceled by View ID Add IF Primary New Add/Delete Approver Print Copyright©2017 Periscope Holdings,Inc.-All Rights Reserved. https://bso.fortworthtexas.govfbso/purchaseorder/invoice/i nvoiceSum mary.sdo?vendorld=0000040087&docld=D RPA-17-00003201&releaseN br=0&docType=1&... 2/2 I,- N `z r - - . ---. - c T Q c co 00 It ao N co T p N J O O 1- L6 O T O N T_ E f0 O ++ O V C CL LL d , Z Z Z Q Q Q W W W 2 ry LO co LO ' Cl O O • O O O • V � r •� p 0 O O O �y O O O CD 0 •1••� p • CO 0 O Q M O O O L Q. O O O • O O O r U T T T Q CO O O co CY) m J U) U) O o , o p ch a a U Q Q CO CO . � T �- O O O N N N in a0 • p m m � mO m_ O O O @ N O O O O O O o Q �+ 11.���•s1 • d a a F o U Diel U Q Q -__ • O N Q O 3 • O • L N Q , O N (O N O O O O a d O N N N . w ii a J Li SWORN STATEMENT State of Michigan County of OAKLAND Eamonn Dwyer being duly sworn,deposes and says: That he/she makes this Sworn Statement on behalf of Scodeller Construction who is the contractor for an improvement to the following described real property situated in Tarrant Counter Texas and described as follows: City of Fort Worth,TX Concrete Paving Joint Sealant 2016 at Various Locations That the following is a statement of each subcontractor and supplier and laborer, for which laborer the payment of wages or fringe benefits and withholdings is due but unpaid,with whom the (contractor) (subcontractor)has(contracted) (subcontracted) for performance under the contract with the owner or lessee thereof,and that the amounts due to the persons as of the date thereof are correctly and fully set forth opposite their names, as follows: Amount of Laborer Fringe Name of Type of Balance to Amount of Labor Benefits and Subcontractor, Improvement Total Contract Amount Amount Complete Wages Due but Withholding Due Supplier,or Laborer Furnished Price Already Paid Currently Owing (Optional) Unpaid but Unpaid All payroll and related taxes have been paid in full. All Fully Paid In-House Materials Used That the contractor has not procured material from, or subcontracted with, any person other than those set forth above and owes no money for the improvement. Deponent further says that he or she makes the forgoing statement as the contractor or as of the(contractor)(subcontractor)for the purpose of representing to the owner or lessee of the above-described premises and his or her agents that the above-described property is free from claims of construction liens,or the possibility of construction liens,except as specifically set forth above and except for claims of construction liens by laborers which may be provided pursuant to section 109 of the construction lien act,Act No.497 of the Public Acts of 1980, as amended,being section 570.1109 of the Michigan Complied Laws. WARNING TO OWNER: AN OWNER OR LESSEE OF THE ABOVE-DESCRIBED PROPERTY MAY NOT RELY ON THIS SWORN STATEMENT TO AVOID THE CLAIM OF A SUBCONTRACTOR, SUPPLIER, OR LABORER WHO HAS PROVIDED A NOTICE OF FURNISHING OR A LABORER WHO MAY PROVIDE A NOTICE OF FURNISHING PURSUANT TO SECTION 109 OF THE CONSTRUCTIO- LIEN ACT TO THE DESIGNEE OR THE OWNER OR LESSEE IF THE DESIGNEE IS NOT NAMED OR HAS D. 9 Dep vent WARNING TO DEPONENT: A PERSON WHO WITH INTENT TO DEFRAUD,GIVES A FALSE SWORN STATEMENT I�SUBJECT TO CRIMINAL PENALTIES AS PROVIDED IN SECTION 110 OF THE CONSTRUCTION LIEN ACT,ACT NO.497 OF THE PUBLIC ACTS OF 1980,AS AMENDED, BEING SECTION 570.2220 OF THE MICHIGAN COMPLIED LAWS. Subscribed and sworn to before me this ',�n 7ACtIng IFER FULLER >n day of Y► `4,rc.� o rl Public•Michigan gston County Myn Expires Feb 25,2021 ounty of CN Not ubli Oakland County,Michigan My commission expires: FULL CONDITIONAL WAIVER I /We have a contract with City of Fort Worth, TX to provide WORK PER CONTRACT for the improvement of the property described as: City of Fort Worth, TX Conrete Paving Joint Sealant 2016 At Various Locations Scodeller Job# 16-901 Has been fully paid and satisified. By signing this waiver, all my/our construction lien rights against such property are waived and released. This waiver is conditioned on actual payment of: $ 20,461.18 If the Owner or Lessee of the property or the Owner's or Lessee's designee has received a notice o furnishing from us or if we are not required to provide one, and the Owner, Lessee, or designee ha; received this waiver directly from us, the Owner, Lessee or designee may not rely upon it without contacting us, either in writing, by telephone, or personally, to verify that it is authentic. 12" 20 Signature of lien claimant Date signed Scodeller Construction, Inc. 51722 Grand River Ave. Wixom, MI 48393 Phone: 248-374-1102 Fax: 248-374-1109 DO NOT SIGN BLANK OR INCOMPLETE FORMS RETAIN A COPY. D o tu im oin n T"I Bond No. 58727421 PROJECT:(Nadine and add es s) ARCHITECT'S PROJECT INlUMBEP: 100058 OYANER IS] Concrete Paving Joint Sealant 2016 at Various Locations COMTR.ACT FOR: Concrete Paving ARCHITECT ❑ Joint Sealant 2016 at Various CONTRACTOR❑ l isiLocations Aril 19th, 2016 TO Ostt _P,:fAamej andaddress) CON T BRACT DATED: p SURETY ❑ City of Fort Worth 1000 Throckmorton Street OTHER ❑ Fort Worth, TX 76102 In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the (Insert name and address ofStlretr.) Western Surety Company 101 S. Reid St. , 4300 Sioux Falls, SD 57103-7046 ,SURETY, on bond of (Insert name and address of Contractor'.) Scodeller Construction, Inc. 51722 Grand River Avenue Wixom, MI 48393 ,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 r.adnle cmd address UfOwner.) City of Fort Worth 1000 Throckmorton Street Fort Worth, TX 76102 OWNER, as set forth in said Surety's bond. IN WITNESS W1-IEREOF,the Surety has hereunto set its hand on this date: March 2nd, 2017 (Insert h-It 'd1101g,the Pe oath 1611owed(nl'the numeric date and year.) Western Surety mpany jSur-�t�'I - -- -- - ----- - n (Stgncnldrre O)Ql1 rdUl'1=Ec1'repe-esentat1Yc) ,Attest: Kathy Susan Zack - - -- --- - - (Sea/) (Printed/dtlme and lilac) CAUTION:You should sign an original AIA Contract Document,on which this text appears in RED.An original assures that char. nl r,,l'r, r`,. ger'. AIA Document 37'='—1994.Copyright @ 1970 and 1994 by The American Institute of Architects.All rights reserved.WARNING:This AIA" Document is pi- -(-tad by U.S.Copyright Law and international Treaties.Unauthorized reproduction or distribution of this AJAe Document,or any portion of it,may result in savere civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law. Purchasers are not permitted to reproduce this document.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel.copyright@aia.org Vmern Surety Company POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT Know All Men By These Presents,That WESTERN SURETY COMPANY,a South Dakota corporation,is a duly organized and existing corporation having its principal office in the City of Sioux Falls,and State of South Dakota,and that it does by virtue of the signature and seal herein affixed hereby make,constitute and appoint Kathy Susan Zack,Heidi D Pattenaude, Individually of Southfield,MI,its true and lawful Attorneys)-in-Fact with full power and authority hereby conferred to sign,seal and execute for and on its behalf bonds, undertakings and other obligatory instruments of similar nature - In Unlimited Amounts - and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said Attorney,pursuant to the authority hereby given,are hereby ratified and confirmed. This Power of Attorney is made and executed pursuant to and by authority of the By-Law printed on the reverse hereof,duly adopted,as indicated,by the shareholders of the corporation. In Witness Whereof, WESTERN SURETY COMPANY has caused these presents to be signed by its Vice President and its corporate seal to be hereto affixed on this 15th day of March,2016. ,, WESTERN SURETY COMPANY �a5�a["...... �`v; �W 4 {�•DS S _ ��SEpbv 11.1111110�e aul T.Bruflat,Vice President State of South Dakota ss County of Minnehaha On this 15th day of March,2016,before me personally came Paul T.Bruflat,to me known,who,being by me duly sworn,did depose and say: that he resides in the City of Sioux Falls,State of South Dakota;that he is the Vice President of WESTERN SURETY COMPANY described in and which executed the above instrument; that he knows the seal of said corporation;that the seal affixed to the said instrument is such corporate seal; that it was so affixed pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority,and acknowledges same to be the act and deed of said corporation. My commission expires J.MOHR HOTAavFuauc� ��/ June 23,2021 arm SOUTH DAKOTA sEA� J.Mohr,Notary Public CERTIFICATE I,L. Nelson, Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in force,and further certify that the By-Law of the corporation printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said corporation this 2nd day of March 2017 WESTERN SURETY COMPANY �m4%'pPOR '°g y ... L.Nelson,Assistant Secretary Form F4280-7-2012