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Contract 47873-FP1
Re FORTWORTHusingsW�uor`a Gr0t piayYt . M;AY 202017, CITYSECRETARY CONTRACT NO. TRANSPORTATION AND PUBLIC WORKS NOTICE OF PROJECT COMPLETION City Project Ns: 100124 Regarding contract 47873 for HMAC 2016-6 CDBG STREET REHABILITATION as required by the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by City Council on 05/17/2016 through M&C C-27721 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 Prices: $985,718.25 Amount of Approved Change Orders: $26,607.05 fNs 1 r Revised Contract Amount: $1,012,325.30 Total Cost Work Completed: $1,011,542.98 Less Deductions: Liquidated Damages: Days @$210.00/Day Pavement Deficiencies: Total Deduction Amount: $0.00 Total Cost Work Completed: $1,011,542.98 Less Previous Payments: $955,046.39 1 Payment Due $56,496. 9 C � z � Recommended for Acceptance Date Asst. Dire tor, TPW - Infrastructure Design and Construction l GJ. �/'Z f/r Accepted yDate ® Director, TRANSPORTATION AND PUBLIC WORKS DEPARTMENT �-J (ruw 25 7V City Man ger)"SAl D e Comments: FUND ACCT:21001-0200431-5740010-G00259-9 Z MAILEID OFFICIAL.RECORD CITY SECRETARY "11! lUN 2017 FT.WORTH,TX Initiah-- ,r.,r.." ��f 2-3o -IL TP S Construction Invoice cl Contract: CS47873 P.O.# PO-16-94415 Payment Date: 12/30/2016 TO:Advanced Paving Acquisition,LTD INV.# CS47873= F.-A14L Estimate No. 9 DOE: DBA Advanced Paving Company 2257 ProjManager KRISTIAN SUGRIM Dallas TX 75229 ACH FOR: 2016-6 CDBG HMAC SURFACE OVERLAY AT 11 LOCATIONS ����� PAY Contract Amount: $1,012,325.30 Completed Ret Pen Adi Pay Total to Date: $1,005,311.98 $50,265.60 $0.00 $0.00 $955,046.38 Previous Estimate: $999,080.98 $100,531.20 $0.00 $0.00 $898,549.78 Earned to Date: $6,231.00 (550,265.60) $0.00 $0.00 $56,496.60 Payments: 21001-0200431-5740010--G00057-991912-- $689,160.77 Total to Date: $689,160.77 $0.00 $0.00 $0.00 $689,160.77 Previous Estimate: $689,1%77 $34,458.04 $0.00 $0.00 $654,702.73 Earned to Date: $0.00 ($34,458.04) $0.00 $0.00 $34,458.04 21001-0200431-5740010--G00259-991912-- $323,164.53 Comments:CO#1-$26,607.05 Total to Date: $322,382.21 $0.00 $0.00 $0.00 $322,382.21 Previous Estimate: $316,151.21 $15,807.56 $0.00 $0.00 $300,343.65 Earned to Date: $6,231.00 ($15,807.56) $0.00 $0.00 $22,038.56 Transportation &Public Works BUSINESS SUPPORT GROUP Contact Person-BRAND)'CR1NF- 282 Dcpartme A royal Sign- - :or: KAREN STRI K F. DEPARTMENT CHECK PICK-UP YES Q Thursday,May 25,2017 Page 1 of 1 5/25/2017 BuySpeed Online Buy' ,_,li' - nTfr Online Department Access NIGP Code Browse I My Account I Customer Service I About Current Organization:CITY OF FORT WORTH May 25,2017 1:02:34 PM CDT r x iHome Documents I Brandy Crane Invoice#: CS478)73=FfNAJ—V:;ndoi#:00000232391(- 'si!]; ,;`'O'I Status:41R-Ready for Approval General Items Subcontractors Accounts Routing Attachments Notes Reminder Change Order Back to PO General Validation Warnings You are going to final pay the following partially paid po items:[3]. Invoice Number: CS47873-FINAL Invoice Status: 41R-Ready for Invoice Type: 3 way Approval matching Invoice Description: CS47873-FINAL 2016-6 CDBG HMAC SURFACE OVERLAY AT 11 Invoice Date: 12/30/2016 Effect Date: 05/25/2017 LOCATIONS Payment Amount: $56,496.60 Handling Code: Payment Date: 01/24/2017 Payment Terms: Payment Term Day: o Payment 0.0/ Discount: Paid-Bank/Check: Alternate id: Entered By: Brandy Crane Entered Date: 05/25/2017 Updated By: Brandy Crane Updated Date: 05/25/2017 Received Date: 12/30/2016 12:59:00 PM Attachments Agency Files: Agency Forms: Vendor Files: Vendor Forms: Purchase Order Information Purchase order PO-16-00094415 PO Description CS47873 G00057 Number: G00259 PO Amount: $1,012,325.30 Remaining To $782.32 Buyer: Brandy Invoice: Crane aoVendor Information Vendor: 0000023239-ADVANCED PAVING COMPANY Address Grp: 01 Vendor Remit-to Becky Garrett Address: ADVANCED PAVING COMPANY 2311 JOE FIELD RD DALLAS,TX 75229 Fed ID: ---9367 Remit Text: USA Email:bgarrett@advancedpavingeo.com Phone:(972)245-0000 Id:115863 (EFT Enabled) N(lisc r? Freight Invoice r'ccuuni Event Type Fiscal Year Account Code Transaction Amount Misc 17 21001--2060000--G00057-GRETAN-- $34,458.04 Misc 17 21001--2060000--G00259-GRETAN-- $15,807.56 Total: $50,265.60 Item information Invoice Item WPO Item#:3 COM1-$26,607.05-2016-6 CDBG HMAC SURFACE OVERLAY AT 11 LOCATIONS 21001-0200431-5740010--G00259-991912--CS47873 PO Permit Invoice Discount% Original Final Item Status To Pay Amount Pay Amount Pay 3PPR-Partial Receipt $0.00 $6,231.00 0.0% $0.00 Yes MAKE: ASSET MODEL: ASSET MANUF: ASSET SERIAL: https:/Ibso.fortworthtexas.gov/bso/purchaseorderA nvoicefinvoiceSum mary.sdo?vendorld=0000023239&docld=PO-16-00094415&releaseN br=0&docType=I&ma.. 1/2 5/25/2017 BuySpeed Online ASSET VIN: ASSET TAG: Event Type Fiscal Year Account Code Transaction Amount Exp. 17 21001-0200431-5740010--G00259-991912-- $6,231.00 Enc. 17 21001-0200431-5740010--G00259-991912-- -$6,231.00 Approval Path: Delete Approver Order Approval Level Approver Date Date Approved/DisapprovedlCanceled Comment Sequence Path Type Requested ApprovedlDlsapproved/Canceled by View ID Add — — Primary New Add/Delete Approver I Print Copyright©2017 Periscope Holdings,Inc.-All Rights Reserved. 's hUps://bso.fortworthtexas.gov/bso/purchaseorderAnvoiceriinvoiceSummary.sdo?vendorld=0000023239&docld=PO-16-00094415&releaseNbr=0&docType=I&mo.. 2/2 .- o r d c o 0 N g) L LO LO J N 0 r M M ti Efl d3 r O N LO N N • r-+ E OO ++ O V •L c a ii a ■ Z Q H W LO O O • O ■ U' ■ Rf L ti V r C Cl N LL -W • O 0 MC CD d N L V E • Q. 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Q Ur N N Q N O .O N O N M 00 "- O H f 0 0 rn n U MN N N N . 4) J �i LL. d City Project Numbers 100124 DOE Number 0000 Contract Name HMAC 2016-6 CDBG STREET REHABILITATION Estimate Number 9 Contract Limits Payment Number 9 Project Type PAVING For Period Ending 12/30/2016 Project Funding Project Manager NA City Secretary Contract Number 47873 Inspectors RODGERS / DEYON Contract Date 5/17/2016 Contractor ADVANCED PAVING ACQUISITION,LTD. Contract Time 80 CD 2311 JOE FIELD RD. Days Charged to Date 146 CD DALLAS, TX 75229 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 $1,011,542.98 Less %Retained $0.00 Net Earned $1,011,542.99 Earned This Period $56,496.60 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 $955,046.39 Plus Material on Hand Less 15% $0.00 Balance Due This Payment $56,496.60 Tuesday,May 16,2017 Page 4 of 4 FORT WORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name HMAC 2016-6 CDBG STREET REHABILITATION Contract Limits Project Type PAVING City Project Numbers 100124 DOE Number 0000 Estimate Number 9 Payment Number 9 For Period Ending 12/30/2016 CD City Secretary Contract Number 47873 Contract Time 8(rD Contract Date 5/17/2016 Days Charged to Date 146 Contract is 100.00 Complete Project Manager NA Contractor ADVANCED PAVING ACQUISITION,LTD. 2311 JOE FIELD RD. DALLAS, TX 75229 Inspectors RODGERS / DEYON Tuesday,May 16,2017 Page 1 of 4 City Project Numbers 100124 DOE Number 0000 Contract Name HMAC 2016-6 CDBG STREET REHABILITATION Estimate Number 9 Contract Limits Payment Number 9 Project Type PAVING For Period Ending 12/30/2016 Project Funding PAVING Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total ----------------------- ---------------- 1 3305.0108 Miscellaneous Adjustments(Utilities) 0.81 LS $6,000.00 $4,860.00 0.81 $4,860.00 (CO#1) 2 0241.1300 Remove Concrete Curb&Gutter(CO#1) 4777.51 LF $3.85 $18,393.41 4762.51 $18,335.66 3 3216.0102 7"Concrete Curb&Gutter(CO#1) 7279.2 LF $25.30 $184,163.76 7279.2 $184,163.76 4 241.0401 Remove Concrete Driveway(CO#1) 10769.8 SF $2.75 $29,616.95 10769.8 $29,616.95 5 3213.04016"Concrete Driveway(CO#1) 11103.8 SF $5.78 $64,179.96 11103.8 $64,179.96 7 0241.0100 Remove Sidewalk(CO#1) 10711.9 SF $1.38 $14,782.42 10711.9 $14,782.42 8 32123.03114"Concrete Sidewalk(CO#1) 13038.9 SF $7.15 $93,228.14 13038.9 $93,228.14 10 0241.1400 Remove Concrete Valley Gutter(CO#1) 7.4 SY $25.30 $187.22 7.4 $187.22 11 3216.0302 7"Concrete Valley Gutter(CO#1) 7.4 SY $82.50 $610.50 7.4 $610.50 12 0241.0300 Remove ADA Ramp(CO#1) 28 EA $110.00 $3,080.00 28 $3,080.00 13 9999.0000 ADA Ramp(CO#1) 39 EA $1,485.00 $57,915.00 39 $57,915.00 16 0241.1700 8"Pavement Pulverization(CO#1) 28963.33 SY $5.97 $172,911.08 28963.33 $172,911.08 17 3211.0600 Cement Modification. 13 lbs/sy(CO#1) 188.18 TN $131.00 $24,651.58 188.18 $24,651.58 18 9999.0000 Roadbond ENI (CO#1) 225 GA $120.00 $27,000.00 225 $27,000.00 19 3212.0302 2"Asphalt Pavement,Type D(CO#1) 28963.33 SY $9.90 $286,736.97 28963.33 $286,736.97 24 3441.1301 Traffic Loop Detector Cable Swa-Cut(CO 223.44 LF $24.00 $5,362.56 193 $4,632.00 #1) 25 3441.1302 AWG Loop Dector Cable(CO#1) 192.5 LF $12.00 $2,310.00 193 $2,316.00 26 3305.0112 Water Valve-Box Adjustment(with 10 EA $265.00 $2,650.00 10 $2,650.00 Concrete Collar)(CO#1) 27 3305.0112 Manhole Adjustment(with Concrete 17 EA $465.00 $7,905.00 17 $7,905.00 Collar)(CO#1) 28 3217.0100 Curb Address Painting(CO#1) 69 EA $13.00 $897.00 69 $897.00 29 3292.0100 Block Sod Replacement(CO#1) 1475 SY $7.15 $10,546.25 1475 $10,546.25 30 3232.0100 Concrete Retaining Wall with Sidewalk, 13.5 SF $25.00 $337.50 13.5 $337.50 Facc(CO#1) Sub-Total of Previous Unit $1,012,325.30 $1,011,542.99 -- ----------------- - --- ---------------- Tuesday,May 16,2017 Page 2 of 4 City Project Numbers 100124 DOE Number 0000 Contract Name HMAC 2016-6 CDBG STREET REHABILITATION Estimate Number 9 Contract Limits Payment Number 9 Project Type PAVING For Period Ending 12/30/2016 Project Funding Contract Information Summary Original Contract Amount $985,718.25 ChanEe Orders Change Order Number 1 $26,607.05 Total Contract Price $1,012,325.29 �A A I A' Is Date ✓ ` 17 Total Cost of Work Completed $1,011,542.98 Contr cto II Less %Retained $0.00 Net Earned $1,011,542.99 Vlo�� Date Earned This Period $56,496.60 Inspection Supervisor Retainage This Period $0.00 L�—, Date7 �l Less Liquidated Damages oject Manager � ( 1 IIS 4 \) Days @ /Day $0.00 Date LessPavement Deficiency $0.00 Asst Di cctr/TPW-Infrastructure Design and onnstruction Less Penalty $0.00 Date J G� 7 Less Previous Payment $955,046.39 Director Contracting Departm t Plus Material on Hand Less 15% $0.00 Balance Due This Payment $56,496.60 Tuesday,May 16,2017 Page 3 of 4 HMAC 2016-6 CDBG Day Number: 135 Chargeable Day?: No Date: 11/16/2016 Day of the Week: Wednesday Weather Conditions: CONTRACTOR Forman Operator Pipe LayerO PERSONNEL: Laborers Truck Driver EQUIPMENT: Backhoe Loader Haul TruckO Misc.Equipment: Progress: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: General Remarks: (Use All+Enter for Line Breaks) HMAC 2016-6 CDBG Day Number: 136 Chargeable Day?: No Date: 11/17/2016 Day of the Week: Thursday Weather Conditions: CONTRACTOR Forman Driver Operator Pipe LayerO PERSONNEL: Laborers Truck ver EQUIPMENT: Backhoe Loader Haul Truck Misc.Equipment: Progress: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: Desi nation: From: To: General Remarks: (Use Alt+Enter for Line Breaks) HMAC 2016-6 CDBG Day Number: 137 Chargeable Day?: No Date: 11118/2016 Day of the Week: Friday Weather Conditions: CONTRACTOR Forman Operator Pipe LayerO PERSONNEL: Laborers Truck Driver EQUIPMENT: Backhoe 0 Loader Haul TruckO Misc.Equipment: Progress: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: General Remarks: (Use Alt-Enter for Line Breaks) HMAC 2016-6 CDBG Day Number: 138 Chargeable Day?: No Date: 11/19/2016 Day of the Week: Saturday Weather Conditions: CONTRACTOR Forman Operator Pipe Layer PERSONNEL: Laborers Truck Driver EQUIPMENT: Backhoe 0 Loader 0 Haul TruckO Misc.Equipment: Progress: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: General Remarks: No Work (Use Alt-Enter for Line Breaks) HMAC 2016-6 CDBG Day Number: 139 Chargeable Day?: No Date: 11/20/2016 Day of the Week: Sunday Weather Conditions: CONTRACTOR Forman Operator Pipe Layer PERSONNEL: Laborers Truck Driver EQUIPMENT: Backhoe Loader Haul TruckO Misc.Equipment: Progress: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: General Remarks: No Work (Use All+Enter for Line Breaks) HMAC 2016-6 CDBG Day Number: 140 Chargeable Day?: No Date: 11/2112016 Day of the Week: Monday Weather Conditions: CONTRACTOR Forman Operator Pipe Layer PERSONNEL: Laborers 3 Truck Driver EQUIPMENT: Backhoe LoaderHaul TruckO Misc.Equipment: Progress: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To Designation: From: To: Designation: From: To: General Remarks: Springleaf-Removed ramps on Springleaf and McCart (Use Alt-Enter for Line Breaks) HMAC 2016-6 CDBG Day Number: 141 Chargeable Day?: No Date: 11/22/2016 Day of the Week: Tuesday Weather Conditions: CONTRACTOR Forman Operator Pipe LayerO PERSONNEL: Laborers 2 Truck Driver EQUIPMENT: Backhoe Loader 0l Haul Truck Misc.Equipment: Progress: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: General Remarks: Working on Wheelchair ramps(Forming)@ Springleaf (Use Alt+Enter for Line Breaks) HMAC 2016-6 CDBG Day Number: 142 Chargeable Day?: No Date: 11/23/2016 Day of the Week: Wednesday Weather Conditions: CONTRACTOR Forman Operator Pipe Layer PERSONNEL: Laborers 6 Truck Driver EQUIPMENT: Backhoe Loader Haul Truck Misc.Equipment: Progress: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: Desi nation: From: To: General Remarks: Springleaf-Completed Wheelchair ramps at the corner of Springleaf and McCart.POL street and compacted,explained to contractor (Use Alt-Enter for Line that he's responsible for maintaning the street Hit Traffic Loop at intersection of McCart and Springleaf Breaks) HMAC 2016-6 CDBG Day Number: 143 Chargeable Day?: No Date: 11/2412016 Day of the Week: Thursday Weather Conditions: CONTRACTOR Forman Operator Pipe Layer PERSONNEL: Laborers Truck Driver EQUIPMENT: Backhoe 0 Loader 0 Haul TruckO Misc.Equipment: Progress: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: General Remarks: City Holiday No Work (Use Alt+Enter for Line Breaks) HMAC 2016-6 CDBG Day Number: 144 Chargeable Day?: No Date: 11/2512016 Day of the Week: Friday Weather Conditions: CONTRACTOR Forman Operator Pipe LayerO PERSONNEL: Laborers Truck Driver EQUIPMENT: Backhoe 0 Loader 0 Haul TruckO Misc.Equipment: Progress: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: General Remarks: City Holiday No Work (Use All+Enter for Line Breaks) HMAC 2016.6 CDBG Day Number: 145 Chargeable Day?: No Date: 11/26/2016 Day of the Week: Saturday Weather Conditions: CONTRACTOR Forman Operator Pipe Layer PERSONNEL: Laborers Truck Driver EQUIPMENT: Backhoe Loader Haul TruckO Misc.Equipment: Progress: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: Desi nation: From: To: General Remarks: No WORK (Use Alt+Enter for Line Breaks) HMAC 2016-6 CDBG Day Number: 146 Chargeable Day?: No Date: 11/27/2016 Day of the Week: Sunday Weather Conditions: 169 CONTRACTOR Forman Operator Pipe Layer PERSONNEL: Laborers Truck Driver EQUIPMENT: Backhoe Loader Haul TruckO Misc.Equipment: Progress: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: Desi nation: From: To: General Remarks: No Work (Use Alt+Enter for Line Breaks) HMAC 2016-6 CDBG Day Number: 147 Chargeable Day?: No Date: 11/28/2016 Day of the Week: Monday Weather Conditions: 72 CONTRACTOR Forman Operator Pipe LayerO PERSONNEL: Laborers 4 Truck Driver EQUIPMENT: Backhoe Loader 0 Haul Truck Misc.Equipment: Pulzerizin Machine Progress: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: General Remarks: Springleaf-POL (Use Alt-Enter for Line Breaks) HMAC 2016-6 CDBG Day Number: 14B Chargeable Day?: No Date: 11/29/2016 Day of the Week: Tuesday Weather Conditions: 172 CONTRACTOR Forman Operator Pipe LayerO PERSONNEL: Laborers 2 Truck Driver EQUIPMENT: Backhoe 0 Loader Haul TruckO Misc.Equipment: Progress: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: General Remarks: Springleaf-putting in cement today and will be paving the street on Friday.Waiting to repair Traffic Loop (Use All+Enter for Line Breaks) HMAC 2016-6 CDBG Day Number: 149 Chargeable Day?: No Date: 11/30/2016 Day of the Week: Wednesday Weather Conditions: 60 CONTRACTOR Forman Operator Pipe LayerO PERSONNEL: Laborers 4 Truck Driver EQUIPMENT: Backhoe 0 Loader Haul Truck Misc.Equipment: Progress: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: General Remarks: Springleaf-Scheduled to pave tomorrow,Bean electric repairing traffic loop (Use Alt+Enter for Line Breaks) HMAC 2016-6 CDBG Day Number: 150 Chargeable Day?: No Date: 12/1/2016 Day of the Week: Thursday Weather Conditions: 165 CONTRACTOR Forman Operator Pipe Layer PERSONNEL: Laborers Truck Driver EQUIPMENT: Backhoe Loader 0 Haul TruckO Misc.Equipment: Progress: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: Designation: From: To: General Remarks: Springleaf-Completed paving 2"asph (Use Alt-Enter for Line Breaks) AFFIDAVIT STATE OF Texas COUNTY OF Dallas Before me,the undersigned authority, a notary public in the state and county aforesaid, on this day personally appeared Sam L. Garrett, Owner Of Advanced Paving Company, 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; HMAC 2016-6 CDBG Street Rehabilitation BY Sam L. Garrett Subscribed and sworn before me on this date 17th of May , 2017. P- - BECKY GARREn Am .* z�. ��= A4y Notary ID#3802638 Notary ublic y Explr" Ober 11,2020 Dallas, Texas CONSENT OF OWNER ❑ SURETY COMPANY ARCHITECT ❑ CONTRACTOR ❑ TO FINAL PAYMENT SURETY ❑ Conforms with the American Institute of OTHER Architects, AIA Document G707 Bond No SSB408290 PROJECT: (name, address)HMAC 2016-6 CDBG Street Rehabilitation Fort Worth TX TO (Owner) ARCHITECT'S PROJECT NO: CITY OF FORT WORTH CONTRACT FOR: 1000 Throckmorton Street HMAC 2016-6 CDBG Street Rehabilitation City Project No. 100124 Fort Worth TX 76102 CONTRACT DATE: CONTRACTOR:ADVANCED PAVING CO. In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above,the there insert name and address of Surety Company) RLI INSURANCE COMPANY 9025 North Lindbergh Drive Peoria IL 61615 , SURETY COMPANY on bond of (here insert name and address of Contractor) ADVANCED PAVING CO. 2311 Joe Field Rd. Dallas TX 75229-3326 , 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 Street 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 17th day of May, 2017 RLI INSURANCE COMPANY Surety Company Attest:Robbi Morales (Seal), Signa re of Authorized Representative Sophinie 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 ® RLI Surety POWER OF ATTORNEY RL 9025 N.Lindbergh Dr.I Peoria,IL 61615 Phone:(800)645-24021 Fax:(309)689-2036 RLI Rnsulrance Company www.rlicorp.com Know All Men by These Presents: That this Power of Attorney is not valid or in effect unless attached to the bond which it authorizes executed, but may be detached by the approving officer if desired. That RLI Insurance Company,an Illinois corporation,does hereby make,constitute and appoint: Don E Cornell Ricardo J Reyna V DeLene Marshall Sophinie Hunter Robbi Morales Kelly A Westbrook.Tina McEwan,jointly or severally in the City of Dallas State of Texas its true and lawful Agent and Attorney in Fact,with full power and authority hereby conferred, to sign, execute, acknowledge and deliver for and on its behalf as Surety, the following described bond. Any and all bonds provided the bond penalty does not exceed Twenty Five Million Dollars($25,000,000.00). The acknowledgment and execution of such bond by the said Attorney in Fact shall be as binding upon this Company as if such bond had been executed and acknowledged by the regularly elected officers of this Company. The RLI Insurance Company further certifies that the following is a true and exact copy of the Resolution adopted by the Board of Directors of RLI Insurance Company,and now in force to-wit: "All bonds,policies,undertakings,Powers of Attorney or other obligations of the corporation shall be executed in the corporate name of the Company by the President,Secretary,any Assistant Secretary,Treasurer,or any Vice President,or by such other officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys in Fact or Agents who shall have authority to issue bonds,policies or undertakings in the name of the Company. The corporate seal is not necessary for the validity of any bonds,policies,undertakings,Powers of Attorney or other obligations of the corporation. The signature of any such officer and the corporate seal may be printed by facsimile." IN WITNESS WHEREOF, the RLI Insurance Company has caused these presents to be executed by its Vice President with its corporate seal affixed this 2nd day of December 2016 11 f'C"N,�, RLI Insurance Company C,OpvonnI-, ' SEAL . = By: Barton W.Davis Vice President State of Illinois l ,�I'INIIO\ } SS Countyof Peoria JJJ CERTIFICATE On this 2nd day of December 2016 before me, a Notary I, the undersigned officer of RLI Insurance Company, a stock Public, personally appeared Barton W. Davis who being by me duly corporation of the State of Illinois,do hereby certify that the attached sworn, acknowledged that he signed the above Power of Attorney as the Power of Attorney is in full force and effect and is irrevocable; and aforesaid officer of the RLI Insurance Company and acknowledged said furthermore, that the Resolution of the Company as set forth in the instrument to be the voluntary act and deed of said corporation. Power of Attorney, is now in force. In testimony whereof, I have hereset my hand td the seal of the RLI Insurance Company un this day of (� �2D 1`Z• By: Jacque ' e M.Bockler Notary Public RLI Insurance Company _ i "OFFICIAL SEAL" NOTA"V B PUBLIC ICF JACQUELINE M.BOCKLER �5 y' ILLINOIS COMMISSION EXPIRES 01/14/18 Barton W.Davis Vice President 4171584010112 A0058514 LIRLI Insurance Company Texas Policyholder NoticeP.O.Box 3967 Peoria,IL 61612-3967 RPhone:309-692-1000 Fax:309-683-1610 IMPORTANT NOTICE AVISO IMPORTANTE To obtain information or make a complaint: Para obtener infonnacion o para someter una queja: You may call RLI Insurance Company's toll free telephone Usted puede Ilamar al numero de telefono gratis de RLI number for information or to make a complaint at Insurance Company's para informacion o para someter una 800-645-2401 queja al 800-645-2402. You may also write to RLI Insurance Company at: Usted tambien puede escribir a RLI Insurance Company: 9025 N. Lindbergh Drive 9025 N.Lindbergh Drive Peoria,IL 61615 Peoria,IL 61615 FAX# 309-683-1610 FAX# 309-683-1610 You may contact the Texas Department of Insurance to obtain Puede comunicarse coil el Departamento de Seguros de Texas information on companies,coverages,rights or complaints at para obtener informacion acerca de companias,coberturas, 1-800-252-3439 derechos o quejas al I-800-252-3439 You may also write the Texas Department of Insurance: Puede escribir al Departamento de Seguros de Texas: P.O. Box 149104 P.O.Box 149104 Austin,TX 78714-9104 Austin,TX 78714-9104 Fax Number: (5 12)475-1771 Fax Number: (512)475-1771 Web: http://www.tdi.texas.gov Web: http://www.tdi.texas.j4ov E-mail: ConsumerProtection a tdi.texas.gov E-mail: Con sumerProtectionna,tdi.texas.gov PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS O RECLAMOS: Should you have a dispute concerning your premium or about a Si tiene una disputa concerniente a su prima o a un reclamo,debe claim,you should contact the agent first. If the dispute is not comunicarse con el agente primero. Si no se resuelve la disputa, resolved, you may contact the Texas Department of Insurance. puede entonces comunicarse con el departamento(TDI). ATTACH THIS NOTICE TO YOUR POLICY: UNA ESTE AVISO A SU POLIZA: This notice is for information only and does not become a part or Este aviso es solo para proposito de informacion y no se convierte condition of the attached document, en parte o condicion del documento adjunto. M4201413 UW 1042ML(04/13) FORTWORTH REV:8/20/16 TRANSPORTATION AND PUBLIC WORKS PERFORMANCE EVALUATION OF CONTRACTOR n CONTRACTOR&PROJECT DATA Name of Contractor Project Nante Advanced Paving HMAC 2016-6 CDBG Street Inspector City Project Number Gary De on 100124 Construction Components Project Manager ❑ Water❑ Waste Water❑ Storm Drainage[Z Pavement Kristian Su inn Initial Contract Amount Project Difficulty $985,718.25 0 Simple Routine 0 Complex Final Contract Amount Date $1,012,325.30 5/17/2017 In PERFORMANCE EVALUATION 0-Inadequate 1-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 3 8 6 2 Public Notifications 5 Y 3 20 15 3 Plans on Site 5 Y 2 20 10 4 Field Supervision 15 Y 4 60 60 5 Work Performed 15 Y 3 60 45 6 Finished Product 15 Y 3 60 45 7 Job Site Safety 15 Y 3 60 45 8 Traffic Control Maintenance 15 Y 3 60 45 9 Daily Clean Up 5 Y 2 20 10 10 Citizen's Complaint Resolution 5 Y 4 20 20 11 Property Restoration 5 Y 3 20 15 12 After Hours Response 5 Y 4 20 20 13 Project Completion 5 Y 3 20 15 TOTAL ELEMENT SCORE(A) 351 BONUS POINTS(25 Maximum)(B) TOTAL SCORE(TS) 351 III)CONTRACTOR'S RATING Maximum Score(MS)=448 or sum of applicable element score maximums which= 448 Rating(ITS/MS] * 100%) 351 / 448 = 78% Performance Category Good <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) Inspector Signature Contractor Signature if I AJ Inspector's Supervisor Signature CONTRACTOR'S COMMENTS TRANSPORTATION AND PUBLIC WORKS The City of Fort Worth•8851 Camp Bowie West Blvd. •Fort Worth,TX 76116 • (817)392-8306 FORTWORTHREV:02/22/0' TRANSPORTATION AND PUBLIC WORKS CONTRACTOR'S EVALUATION OF CITY n PROJECT INFORMATION Date: 5/17/2017 Nance of Contractor Project Name Advanced Paving Acquisition,LTD HMAC 2016-6 CDBG Street Rehabilitation DOE Inspector Project Manager Gary De on Kristian Su rim DOE Number Project Difficuhh, T}pe of Contract 100124 O Simple Q Routine O Complex ❑ Water❑ Waste Water[] Storm Drainage❑✓ Pavement Initial Contract Amount Final Contract Amount $985,718.25 1$1,012,325.30 II)PERFORMANCE EVALUATION 0 -Inadequate 1 -Deficient 2- Standard 3 -Good 4-Excellent ELEMENT —7 TOT ING ELEMENT RATING 4) (0-4) INSPECTION EVALUATION PLANS& SPECIFICATIONS 1 Availability of Inspector I Accuracy of Plans to Existing Conditions 2 Knowled e of Inspector _ q 2 Clari & Sufficiency of Details 3 Accuracy of Measured Quantities 4 3 Applicability of Specifications 4 Display Of Professionalism +- 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 ADMINISTRATION 2 Availability of Project Manager 1 Change Order Processing Time Ll 3 Communication 2 Timliness of Contractor Payments 4 Resolution of Utility Conflicts 3 Bid O enin to Pre-Con Meeting Timefi-ame L! III)COMMENTS&SIGNATURES t COMM�NTS V 729gv Signature Contractor ` Signature DOE Inspector Signature DOE Inspector's Supervisor INSPECTOR'S COMMENTS TRANSPORTATION AND PUBLIC WORKS d The City of Fort Worth•1000 Throckmorton Street•Fort Worth,TX 76012-6311 a (817)392-7941 •Fax: (817)392-7845 FORTWORTH. TRANSPORTATION AND PUBLIC WORKS STATEMENT OF CONTRACT TIME STATEMENT# FINAL STATEMENT# 9 DOE 1 100124 NAME OF PROJECT: HMAC 2016.6 CDBG Contractor Advanced YEAR: 2016 PROJECT NO.: FINAL INSPECTION DATE 100124 1 WD CD CONTRACT TIME 801 a PERIOD FROM: 1 12/1/2016 TO: 112/15/20161 BEG - Month I I DEVELOPMEN (Y/N)I N WORK ORDER EFFECTIVE: 1 7/5/2016 EEG(y/n) y MID /n n 182.5% LIP YR /n) DAY OF MONTH DAYS REASON FOR DAY OF MONTH DAYS REASON FOR CHARGED DAYS CREDITED CHARGED DAYS CREDITED 1 Thu 0 NA 16 2 Fri 0 NA 17 3 Sat 0 NA 18 4 Sun 0 NA 19 5 Mon 0 NA 20 6 Tue 0 NA 21 7 Wed 0 NA 22 8 Thu 0 NA 23 9 Fri 0 NA 24 10 Sat 0 NA 25 11 Sun 0 NA 26 12 Mon 0 NA 27 13 Tue 0 NA 28 14 Wed 0 NA 29 15 Thu 0 NA 30 31 NA Wkn&Hol Wea utl Oth Not Applicable SAT,SUN,and WEATHER UTILITIES OTHERS DAYS TOTAL DAYS HOLIDAYS RELOCATE CHARGED THIS PERIOD 0 0 0 0 0 0 PREVIOUS PERIOD 0 146 146 TOTAL TO DATE 0 0 0 0 146 146 REM ARITS Completed Flatwork on Roberts Cut Off 8/12 Completed Flatwork on Stuart 7/20 Stop Time 10/15..... 102 wd ....Started time back on 11/15 Spring leaf...Received CO#1 5/8/17 1 , Signature: �/� it ti��i A <i;` �i' Signatul�:� g !`�� � I (Print Name) / (Print Nade) Gary Deyon DATE CONTRACTOR DATE INSPECTOR 5/15/2017