HomeMy WebLinkAboutContract 47926-CO1 CITY SECRETARY r
FORT WORTH. City of Fort Worth CONTRACT NO.
Change Order Request Breakdown
Project Namel Micro Surfacing 2016 City Sec# 1 47926
Client Project#(s)l 100066
Contractor Intermountain Slurry Seal, Inc. PM Tariqul Islam Inspector William(Bill)Mason
Change Order Submittal# 0 Date 3/1/2017
Contract Time
Dept. T/PW Totals CD
Original Contract Amount $764,181.47 $764,181.47 90
Extras to Date
Credits to Date
Pending Change Orders(in M&C Process)
Contract Cost to Date $764,181.47 $764,181.47 90
Amount of Proposed Change Order $109,328.57 $109,328.57 21
Revised Contract Amount $873,510.04 $873,510.04 111
Original Funds Available for Change Orders $0.00
Remaining Funds Available for this CO $0.00
Additional Funding(if necessary) $109,328.57 $109,328.57
CHANGE ORDERS to DATE(INCLUDING THIS ONE)AS%OF ORIGINAL CONTRACT 14.31%
MAX ALLOWABLE CONTRACT AMOUNT(ORIGINAL CONTRACT COST+25%) $955,226.84
JUSTIFICATION (REASONS) FOR CHANGE ORDER
This Change Order is to request additional time for the following reason:21 days delay in City crews crack sealing roads prior to the Seal Coat.
Overruns on the street resurfacing was due to additional level up material required. The City agreed to pay half of a second coat of micro seal
that was required on a section of Sycamore School Rd. due to scarring from traffic and a rough texture.
A by
Maty J. k � ,` i ecretary
-ko�- FORTS
�XAS
OFFICIAL RECORD
cv �� CITY SECRETARY
co F
T.MORTH9 TX
A I
016$ L
FORT WORTH City of Fort Worth
Change Order Additions
Project Name Micro Surfacing 2016 City Sec# 47926
Client Project# 100066
Contractor Intermountain Slurry Seal,Inc. PM Tadqui Islam Inspector William(Bill)Mason
Change Order Submittal# 0 Date 3!112017
ADDITIONS
I FEM DESCRIPTION DEPT Qty Unit Unit Cost Total
2 POLYMER MODIFIED MICRO SURFA ING 7=
4 HMAC PAVEMENT LEVELLIP T/PW 84.00000000 TON 650.00
T/PW $109,328.57
Sub Total Additions 109,328.57
Change Order Additions Page 1 of 1
FORT WORTH City of Fort Worth
Change Order Deletions
Project Name I Micro Surfacing 2016 CitySec# 47926
Client Project# 100066
Contractor Intermountain Slurry Seal,Inc. PM Tariqul Islam Inspector William(Bill)Mason
Change Order Submittal# 0 Date 3/1/2017
DELETIONS
ITEM MESCRIPTION DEPT- Unit UnitCost ota
T/PW $0.00
Sub Total Deletions
Change Order Deletions Page 1 of 1
MISBE Breakdown for this Change Order
M/SBE Sub Type of Service Amount for this CO
Pannell Industries Street Sweeping $16,898.20
Perkins Construction HMAC Pavement Level Up $31,814.19
Total $48,712.39
Previous Change Orders
CO# DATE AMOUNT
Total $0.00
CFW Change Order Approval St-COApp01 Page 1 of 5
Routing
Assigned To: Due Date:
Assigned By: Due Time:
Links 2
fortworthgov/Infrastructure Projects/100066 - Micro-Surfacing 2016/Contractor/Change Orders/Change Order 1
Breakdown.xls
fortworthgov/Infrastructure Projects/100066 - Micro-Surfacing 2016/Contractor/Change Orders/M&C Approval Change
Orderl Micro Surfacing 2016.1)df
Attachments(0)
No Attachments have been added to this form.
https://projeetpoint.buzzsaw.com/ bz web/Forms/FormPrint.aspx?SiteId=51500&ProcessId... 6/5/2017
CFW Change Order Approval St-COApp01 Page 2 of 5
City of Fort Worth
�' Change Order Request Approval
(Change Order Breakdown Available in Links)
...............................................................
For Change Order Submittal No.:
...............................................................
Change Order No.: St-COApp01 Date Started: 2017-05-18
City Sec. No.: 47926 Date Due: 2017-05-26
Project Name: 100066 - Micro-Surfacing 2016
100066 DOE Numbers:
Project Numbers:
Project Application of micro surfacing overlay at various locations
Description:
Project Manager: Tariqul Islam City Inspector: William Mason
Contractor: Intermountain Slurry Seal
COUNCIL ACTION (If Required):
M&C Log Name: 20 MICRO SURFACING 2016—CHANGE ORDER 1
M&C Number: C-28239 M&C Date: 2017-05-16
COST AND DAYS SUMMARY:
Requested
Department: Cost($) Fund Account Center: Days:
TPW $ 109,328.57 39412 0200431 5740010 21
100066 006280
Total Cost: $ 109,328.57 Total Requested Days: 21
Approval Status:
https://projectpoint.buzzsaw.com/ bz web/Forms/FonnPrint.aspx?SiteId=51500&ProcessId... 6/5/2017
CFW Change Order Approval St-COApp01 Page 3 of 5
https://projectpoint.buzzsaw.com/ bz web/Forms/FonnPrint.aspx?SiteId=51500&ProcessId... 6/5/2017
CFW Change Order Approval St-COApp01 Page 4 of 5
Approved: Yes
Comments:
User: Josh Bowen
Date: 2017-05-18 7:07 PM
Approved: Yes
Comments:
User: Tariqul Islam
Date: 2017-05-18 2:14 PM
Approved: Yes
Comments:
User: Josh Bowen
Date: 2017-05-18 8:27 PM
Approved: Yes
Comments:
User: Josh Bowen
Date: 2017-05-19 6:08 PM
Approved: Yes
Comments:
User: Tariqul Islam
Date: 2017-05-19 1:14 PM
Approved: Yes
Comments:
User: Tariqul Islam
Date: 2017-05-19 2:47 PM
Approved: Yes
Comments:
User: Riad Nusrallah
Date: 2017-05-22 11:43 AM
Approved: Yes
Comments:
User: Richard Martinez
Date: 2017-05-25 10:00 AM
Approved: Yes
Comments:
User: Doug Wiersig
Date: 2017-05-30 11:22 AM
Approved: Yes
Comments:
https://projectpoint.buzzsaw.com/ bz web/Forms/FormPrint.aspx?SiteId=51500&ProcessId... 6/5/2017
CFW Change Order Approval St-COApp01 Page 5 of 5
User: Doug Black
Date: 2017-06-01 1:21 PM
Approved: Yes
Comments:
User: Jay Chapa
Date: 2017-06-05 11:22 AM
Action Required:
https://projectpoint.buzzsaw.com/ bz_web/Forms/FormPrint.aspx?SiteId=51500&ProcessId... 6/5/2017
City of Fort Worth, Texas
Mayor and Council Communication
COUNCIL ACTION: Approved on 5/16/2017
DATE: Tuesday, May 16, 2017 REFERENCE NO.: **C-28239
LOG NAME: 20MICRO SURFACING 2016 CHANGE ORDER 1
SUBJECT:
Authorize Execution of Change Order No. 1 to City Secretary Contract No. 47926 with Intermountain Slurry
Seal, Inc., in the Amount of$109,328.57 for Additional Level Up Materials Required on Various Street
Segments and Additional Coat of Micro Surfacing Required on a Section of Sycamore School Road for a
Revised Contract Amount of$873,510.04 and Provide for Project Management Costs in the Amount of
$87,000.00 for a Revised Project Amount of$960,510.04 (COUNCIL DISTRICTS 2, 6, 8 and 9)
RECOMMENDATION:
It is recommended that the City Council authorize the execution of Change Order No. 1 to City Secretary
Contract No. 47926 with Intermountain Slurry Seal, Inc., in the amount of$109,328.57 for additional level
up materials required on various street segments and additional coat of micro surfacing required on a
section of Sycamore School Road, as well as project management costs in the amount of$87,000.00 for a
revised Contract amount of$960,510.04 (City Project No. 100066).
DISCUSSION:
On June 7, 2016, (M&C C-27747) the City Council awarded City Secretary Contract No. 47926 in the
amount of$764,181.47 to Intermountain Slurry Seal, Inc., for Micro Surfacing at various locations.
Change Order No. 1 will provide funding for additional level up materials required on various street
segments under contract to address minor failures and pot holes. This change order also includes an
additional coat of micro surfacing on Sycamore School Road from South Freeway to West Everman
Parkway to provide better riding quality due to rough texture of street.
Project budget is as follows:
jOriginal Contract $764,181.47
Change Order No. 1 $109,328.57
(Revised Contract $873,510.04
Project Management, Inspection, Material Testing and Contingencies f $87,_000.00
Pro-ject
87,000.00
Project Appropriations $960,510.04
The estimated completion date will be extended to June 2017 as a result of the additional work capacity
added by this change order.
MIWBE OFFICE- Intermountain Slurry Seal, Inc., agrees to maintain its initial MBE commitment of 14
percent that it made on the original contract and extend and maintain that same MBE commitment of 14
percent to this first change order. Therefore, Intermountain Slurry Seal, Inc., remains in compliance with
Logname: 20MICRO SURFACING 2016 CHANGE ORDER 1 Page I of 2
the City's BDE Ordinance and attests to its commitment by its signature on the Acceptance of Previous
MBE Commitment form executed by an authorized representative of its company.
The project is located in COUNCIL DISTRICTS 2, 6, 8 and 9, Mapsco 62L, 77V, 78E, 89R, 90B, 928,
92P, 103H and 103K.
FISCAL INFORMATION I CERTIFICATION:
The Director of Finance certifies that funds are available in the current capital budget, as appropriated, of
the General Capital Projects Fund. Prior to an expenditure being incurred, the participating department
has the responsibility to validate the availability of funds.
FUND IDENTIFIERS (FIDs):
TO
Fund Department ccoun Project Program ctivity Budget Reference # moun
ID ID Year Chartfield 2
FROM
Fund Department ccoun Project Program ctivity Budget Reference # moun
ID ID Year Chartfield 2
CERTIFICATIONS:
Submitted for City Manager's Office by: Jay Chapa (5804)
Originating Department Head: Douglas Wiersig (7801)
Additional Information Contact: Tariqul Islam (2486)
ATTACHMENTS
1. 100629 - Micro Surfacing CO#1.xlsx (CFW Internal)
2. Form 1295 C01 Intermountain Slurry Seal Inc.pdf (Public)
3. Map 01 Microsurfacing 2016.pdf (Public)
4. Map 02 Microsurfacing 2016.1)df (Public)
5. Map 03 Microsurfacing 2016.pdf (Public)
6. Map 04 Microsurfacing 2016.pdf (Public)
7. Map 05 Microsurfacing 2016.pdf (Public)
8. Map 06 Microsurfacing 2016.pdf (Public)
9. MBE Commitment Form Proiect 100066.13df (CFW Internal)
Logname: 20MICRO SURFACING 2016 CHANGE ORDER 1 Page 2 of 2
Contract Compliance Manager:
By signing I acknowledge that I am the person responsible
for the monitoring and administration of this contract, including
ensuring all performance and reporting requirements.
Tariqul Islam
Title
❑ This form is N/A as No City Funds are associated with this Contract
Printed Name Signature
C-28239 C
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
lofl
Complete Nos.1-4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos.1,2,3,5,and 6 if there are no interested parties. CERTIFICATION OF FILING
1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business. 2017-192715
Intermountain Slurry Seal, Inc.
Lewisville,TX United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 04/14/2017
being filed.
City of Fort Worth Date yEkngCvyledrd*,
3 Provide the identification number used by the governmental entity or state agency to track or identify the contract,and provide a
description of the services,goods,or other property to be provided under the contract.
100066,Change Order 1
HMAC Pavement Level Up, Microsurfacing
4 Nature of interest
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling I Intermediary
5 Check only if there is NO Interested Party.
X
6 AFFIDAVIT I swear,or affirm,under penalty of perjury,that the above disclosure is true and correct.
qua.r�
° TRACEE L LASUZZO
My Commission Expires
February 27,2018
Signature of horized agent of contracting business entity
AFFIX NOTARY STAMP/SEAL ABOVE tt
Sworn to and subscribed before me,by the said ���J n Q� this the day of 1
20 to certify which,witness my hand and seal of office.
Signature of officer a ministering oath Printed name of officer administering oath Title of officer ad i aster g oath '
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.883