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HomeMy WebLinkAboutContract 47744-FP3 Depart t f W Const.Services CPN#CJJ Da Project Manager '� ' �Jq— Risk Mana ement S.Canadv tT WO RT H o CITY SECRETARY -rD2, D.O.E. Brotherton CONTRACT NO. Water V. Gutzier CFA Jai orales/Scanned ❑ TION AND PUBLIC WORKS The Proceedinj people have been Contacted concerning the'.request PROJECT COMPLETION ✓ r T''� l for final payment&have released this project for such payvleot eveloper Projects) City Project Ns: 02683 Clearance Conducted BI Etta Bag Regarding contract 02683 for PRIMROSE CROSSING-W RISINGER RD as required by the WATER DEPARTMENT as approved by City Council on N/A through M&C N/A the director of the WATER DEPARTMENT upon the recommen -""`"""#-tFiessis" or of the Transportation&Public Works Department has accepted the project as complete.# 3 ' 'r a L� t�f;`� 1.1{ sI ,' JUN2 9 2017 :'U; Original Contract Price: r $375,611.54 Amount of Approved Change Orders: N� Revised Contract Amount: Total Cost Work Completed: $375,611.54 Recommended for Acceptance Date Asst. Director,TPW - Infrastructure Design and Construction /,-)e .CL 6/??fes Accepted Date Asst. Director, WATER DEPARTMENT - -� - /7 Asst. City Manager Date OFFICIAL RECORD Comments: CITY SECRETARY FT.WORTH,TX Rev.9/22/16 "a JUN 27 2017 ✓°,P �5-q 6 Ol-- c o a (0 3 City Project Numbers 02683 - -m _ DOE Number7541 Contract Name PRIMROSE CROSSING-W RISINGER RD Estimate Number I Contract Limits Payment Number I Project Type WATER&SEWER For Period Ending 5/2/2017 Project Funding Project Manager Ehia City Secretary Contract Number 117541 Inspectors DICKINSON / CROWLEY Contract Date Contractor KODIAK TRENCHING 7 BORING,LLC Contract Time 160 CD P 0 BOX 93929 Days Charged to Date 281 CD SOUTHLAKE, TX 76092 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 $375,611.54 Less %Retained $0.00 Net Earned $375,611.54 Earned This Period $375,611.54 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 $0.00 Plus Material on Hand Less 15% $0.00 Balance Due This Payment S375,611.54 Tuesday,May 2,2017 Pas.-e 4 of 4 FORT WORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name PRIMROSE CROSSING-W RISINGER RD Contract Limits Project Type WATER&SEWER City Project Numbers 02683 DOE Number 7541 Estimate Number 1 Payment Number 1 For Period Ending 5/2/2017 CD City Secretary Contract Number 117541 Contract Time 16(ED Contract Date Days Charged to Date 281 Project Manager Ehia Contract is 100.00 Complete Contractor KODIAK TRENCHING 7 BORING,LLC P 0 BOX 93929 SOUTHLAKE, TX 76092 Inspectors DICKINSON / CROWLEY Tuesday,May 2,2017 Page 1 of 4 City Project Numbers 02683 DOE Number 7541 Contract Name PRIMROSE CROSSING-W RISINGER RD Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER&SEWER For Period Ending 5/2/2017 Project Funding WATER Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total 1 TRENCH SAFETY FOR WATER 4797 LF $0.30 $1,439.10 4797 $1,439.10 2 DUCTILE IRON WATER FITTINGS 3.62 TN $10,654.00 $38,567.48 3.62 $38,567.48 W/RESTRAINT 3 8"PVC WATER PIPE 681 LF $22.90 $15,594.90 681 $15,594.90 4 12"PVC WATER PIPE 4101 LF $38.00 $155,838.00 4101 $155,838.00 5 12"PVC WATER PIPE CSS BACKFILL 15 LF $53.85 $807.75 15 $807.75 6 CONCRETE ENCASEMENT FOR UTILITY PIPES 6.8 CY $165.00 $1,122.00 6.8 $1,122.00 7 FIRE HYDRANT 7 EA $4,126.00 $28,882.00 7 $28,882.00 8 CONNECTION TO EXISTING 4"-12"WATER 1 EA $666.31 $666.31 1 $666.31 MAIN 9 8"GATE VALVE 11 EA $1,325.00 $14,575.00 11 $14,575.00 10 12"GATE VALVE 12 EA $2,643.00 $31,716.00 12 $31,716.00 11 12"X12"TAPPING SLEEVE&VALVE 1 EA $4,552.00 $4,552.00 1 $4,552.00 Sub-Total of Previous Unit $293,760.54 $293,760.54 SEWER Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total --_—_—_---- - Quanity Total 1 POST CCTV INSPECTION 1263 LF $1.25 $1,578.75 1263 $1,578.75 2 MANHOLE VACUUM TESTING 8 EA $167.00 $1,336.00 8 $1,336.00 3 TRENCH SAFETY 1263 LF $0.30 $378.90 1263 $378.90 4 8"SEWER PIPE 1079 EA $30.45 $32,855.55 1079 $32,855.55 5 8"SEWER PIPE CSS BACKFILL 110 LF $46.40 $5,104.00 110 $5,104.00 6 15"SEWER PIPE 52 LF $44.65 $2,321.80 52 $2,321.80 7 15"SEWER PIPE CSS BACKFILL 22 LF $63.50 $1,397.00 22 $1,397.00 8 CONCRETE ENCASE SEWER PIPE 4.8 CY $155.00 $744.00 4.8 $744.00 9 4'MANHOLE 8 EA $3,466.25 $27,730.00 8 $27,730.00 10 4'EXTRA DEPTH MANHOLE 41 VF $205.00 $8,405.00 41 $8,405.00 Sub-Total of Previous Unit $81,851.00 $81,851.00 Tuesday,May 2,2017 Page 2 of 4 City Project Numbers 02683 DOE Number 7541 Contract Name PRIMROSE CROSSING-W RISINGER RD Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER&SEWER For Period Ending 5/2/2017 Project Funding Contract Information Summary Original Contract Amount $375,611.54 Chante Orders Total Contract Price $375,611.54 J Date + Total Cost of Work Completed 375 611 4 l? $ .5 Contractor Less %Retained $0.00 Net Earned $375,611.54 _ at Inspection Supe sEarned This Period $375,611.54 or / wcc'/ Date C-(7 Retainage This Period $0.00 P ject Manager Less Liquidated Damages o Days @ /Day $0.00 G� Dat (� LessPavement Deficiency $0.00 Asst.D'reecctor/TPIN-IgErastructure Designrand Construction Less Penalty $0.00 Date v/ Less Previous Payment $0.00 Director/Contracting Department Plus Material on Hand Less 15% $0.00 Balance Due This Payment $375,611.54 Friday,June 16,2017 Page 3 of 4 A PIPE & SUPPLY Esta6Czsh d 1976 January 13,2017 The Hanover Insurance Co. VIA CMRRR NO.7016 2140 0000 4562 4798 440 Lincoln Street Worcester,MA 01653 MMCAD, LLC VIA CMRRR NO.7016 2140 0000 4562 4781 1800 Valley View Lane,Suite 300 Farmers Branch,Texas 75234 City of Fort Worth VIA CMRRR NO.7016 2140 0000 4562 4774 1000 Throckmorton Street Fort Worth,Texas 76102 Re: Project: Primrose Crossing Claimant: ACT Pipe&Supply,Inc. ("ACT Pipe&Supply") Amount of Claim: $6,490.00 Dear Sir/Madame: THIS NOTICE IS SERVED TO COMPLY WITH THE TEXAS GOVERNMENT CODE;IT IS NOT INTENDED AS A REFLECTION ON THE CREDIT WORTHINESS OF ANY PARTY/INDIVIDUAL IN THE ABOVE REFERENCED PROJECT. ACT Pipe&Supply, Inc.has a claim of$6,490.00 for materials provided to the above-referenced Project during the month(s)of October 2016 through December 20I6.The materials provided are generally described as Pipe,Valves,and Fittings.Such materials were provided to Kodiak Trenching&Boring LLC for its work on the above-referenced Project. The amount claimed is just and correct and all just and lawful offsets,payments,and credits known to ACT Pipe&Supply,Inc.have been allowed.A copy of ACT Pipe&Supply Inc.'s Sworn Statement of Account is enclosed. increly, Rh i�d 'Wils n, A Senior Credit Manager CC: Kodiak Trenching& Boring LLC VIA CMRRR NO.7016 2140 0000 4562 4767 611 South Main Street,Suite 700 Grapevine,Texas 76092 ,950 West Sam Houston Pkwy.N. Houston,Texas 77041 + (713) 937-0600+ FAX(713) 937-0690+ (800)231-9808 "Proudly Serving the Fire Protection, Waterworks &Plufnhing Supply Industries" A„t—;-e T ara.in a Ft Wnrth + Miecinn + r..n11Pan Ctatinn+ Temnle t PIPE & SUPPLY E5ta6Czshed 1976 SWORN STATEMENT OF ACCOUNT STATE OF TEXAS COUNTY OF HARRIS BEFORE ME,the undelsigped authority on this day personally appeared,Rhonda Wilson who,after being by me duly sworn did depose and say: I. "My name is Rhonda Wilson. I am Senior Credit Manager of ACT Pipe&Supply,Inc.,I am over the age of 18,and authorized to make this affidavit and the statement contained herein. 2. ACT Pipe&Supply,Inc.has an outstanding and unpaid claim in the amount of S 6,490.00 for :materials provided during the month(s)October 2016 through December 2016 to Kodiak Trenching&Boring LLC. 3. The amount of ACT Pipe&Supply,Inc.'s unpaid account from which this claim is filled is just and correct and all just and lawful offsets,payments,and credit known to ACT Pipe&Supply, Inc.have been allowed. 4. Attached hereto are true and correct copies of the statement of account itemizing the invoices which the above-described project is based. AC. P J.sip ly,I n By,. r (/ Rhonda Wilson,CBA Senior Credit Manager STATE OF TEXAS COUNTY OF HARRIS This instrument was SUBSCRIBED AND SWORN TO before me on"Sc-1 u2�,2017,by Rhonda Wilson,Senior Credit Manager of ACT Pipe&Supply,Inc.a Texas corporation,on behalf of said corporation,to certify which witness my hand and seal of office. ' DEIDRA ANN WEISS `�o��pY PLeLtr ,Notary Public,State of Texas Comm.Expires 10-22-2017 Notary ID 12960238fi Printed Name of Notary o .,,M�"".�•"� --- Commission Expires: v FJF 6950 West Sam Houston Pkwy.N. Houston,Texas 77041 + (713)937-0600• FAX(713)937-0690• (800)231-9808 "Proudly Serving the Fire Protection, Waterworks &Plumbing Supply Industries" -. .. .... „ n__ A..i__.._ 7---.3- - '01 AIT. 44, • ILA:nn:nn ♦ ('nlIorrP Cfnflnn ♦ TPMnl P. ACTPIPE & SUPPLY CORPORATE OFFICE-HOUSTON,TEXAS STATEMENT PAGE: 1 (713)937-0600 (800)231-9808 P.O.BOX 301282 DATE: 01/12/17 DALLAS TX 75303-1282 TO: 33461 KODIAK TRENCHING & BORING LLC 611 SOUTH MAIN STREET SUITE 700 GRAPEVINE, TX 76092 DATE INVOICE SHIP DT AMOUNT CUSTOMER PO#/PAYMNTS TP BALANCE Ship-to PRIM PRIMROSE CROSSING GC n9 J�7 98411& 2969i:7 9:273 4 i9i7_QP no !� n� 2gi866 09/0 i892 . 09 �-�-� x-31$6 �L�61 n 7r�.-e-9 0 n® /tenor/ _98/ g 6-90� nnnoov4v°vr 3:76--99 n9 !v�-4 223612 09 12 135-09 irr-90 2336ig 99�i2/i6 399.90 45999948 399-99 n n l �21�9:6 n o/9 3 g !Tl r& n o I� Imo- -6983 144- 00 10/07/16 243490 10/04/16 36.00 4500004881 36. 00 10/10/16 243972 10/07/16 324.00 17360 324. 00 10/18/16 247426 10/17/16 118.00 4500004881 118.00 10/18/16 247427 10/17/16 668.00 4500004881 668.00 10/20/16 248255 10/12/16 3184. 00 . 3184. 00 10/21/16 249171 , 10/18/16 2160.00 4500004881 2160.00 lI 14 16 257959 11/11/16 330.00 4500004881 330.00 11/22/16 261151 11/17/16 3950.00 PRIM 6 ® 3950.00 12/15/16 268850 12/13/16 2600.00 4500004881 $ ,490 2600.00 12/20/16 270597 12/19/16 2200.00 4500004881 2200.00 Please Remit Payments To: P.O.BOX 301282 DALLAS TX 75303-1282 CURRENT 1-30 31-60 61-90 OVER 90 TOTAL DUE 4800 .00 4280. 00 6130.00 738.00 6908. 00 22856 .00 i CONSENT OF OWNER X❑ SURETY COMPANY ARCHITECT ❑ TO FINAL PAYMENT CONTRACTOR ❑ SURETY ❑ AIA DOCUMENT G707 OTHER PROJECT: Primrose Crossing-W. Risinger Road (name, address) TO (Owner) ARCHITECT'S PROJECT NO: MMCAD, LLC & City of Fort Worth 1221 1-35 CONTRACT FOR: $1,569,356.80 Carrollton, TX 75006 CONTRACT DATE: March 23, 2016 BOND NO: 1045804 CONTRACTOR: Kodiak Trenching & Boring, LLC 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 as it appears in the bond). The Hanover Insurance Company , SURETY COMPANY, on bond of(here insert name and address of Contractor as it appears in the bond), Kodiak Trenching & Boring, LLC , 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(here insert name and address of Owner) MMCAD, LLC & City of Fort Worth OWNER as set forth in the said Surety's bond. IN WITNESS WHEREOF , the Surety has hereunto set its hand this 22nd day of May 2017 The Hanover Insurance CompqAy Surety 4 y Signature of Authorized Representative Attest: / Douglas Moore,Attorney-in-Fact (Seal): Title AIA DOCUMENT G707•CgOSENT OF SURETY TO FINAL PAYMENT.APRIL 1970 ONE PAGE EDITION.AIA 0•©1970•THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVE., NW,WASHINGTON,D.C.20006 THE HANOVER INSURANCE COMPANY MASSACHUSETTS BAY INSURANCE COMPANY CITIZENS INSURANCE COMPANY OF AMERICA POWERS OF ATTORNEY CERTIFIED COPY KNOW ALL MEN BY THESE PRESENTS: That THE HANOVER INSURANCE COMPANY and MASSACHUSETTS BAY INSURANCE COMPANY,both being corporations organized and existing under the laws of the State of New Hampshire,and CITIZENS INSURANCE COMPANY OF AMERICA,a corporation organized and existing under the laws of the State of Michigan,do hereby constitute and appoint John R.Ward,Douglas Moore,Emily Mikeska and/or Eva O.Limmer of Ward&Moore Insurance Services LP of Gatesville,TX and each is a true and lawful Attorney(s)-in-fact to sign,execute,seal,acknowledge and deliver for,and on its behalf,and as its act and deed any place within the United States,or,if the following line be filled in,only within the area therein designated any and all bonds,recognizances,undertakings,contracts of indemnity or other writings obligatory in the nature thereof,as follows: Any such obligations in the United States,not to exceed Thirty Five Million and No/100($35,000,000)in any single instance and said companies hereby ratify and confirm all and whatsoever said Attorney(s)-in-fact may lawfully do in the premises by virtue of these presents. These appointments are made under and by authority of the following Resolution passed by the Board of Directors of said Companies which resolutions are still in effect: "RESOLVED,That the President or any Vice President,in conjunction with any Vice President,be and they are hereby authorized and empowered to appoint Attorneys-in-fact of the Company,in its name and as its acts,to execute and acknowledge for and on its behalf as Surety any and all bonds,recognizances, contracts of indemnity,waivers of citation and all otherwritings obligatory in the nature thereof,with powerto attach thereto the seal of the Company.Anysuch writings so executed by such Attorneys-in-fact shall be as binding upon the Company as if they had been duly executed and acknowledged by the regularly elected officers of the Company in their own proper persons."(Adopted October 7,1981 -The Hanover Insurance Company;Adopted April 14,1982- Massachusetts Bay Insurance Company;Adopted September 7,2001-Citizens Insurance Company of America) IN WITNESS WHEREOF, THE HANOVER INSURANCE COMPANY, MASSACHUSETTS BAY INSURANCE COMPANY and CITIZENS INSURANCE COMPANY OF AMERICA have caused these presents to be sealed with their respective corporate seals,duly attested by two Vice Presidents, this 22nd day of May 2014. u, THE HANOVER INSURANCE COMPANY A� * MASSACHUSETTS BAY INSURANCE COMPANY on}— CITIZENSSURANCE OMPANY OF AMERICA 4 g 3SitSd 19Q4 BEAD 1 1974 + — Rotyert Thomas.Vice President THE COMMONWEALTH OF MASSACHUSETTS ) �- "��" (' ` • -- –�– ' COUNTY OF WORCESTER )ss. Joe Arenstrom.V0 Pres idem On this 22nd day of May 2014 before me came the above named Vice Presidents of The Hanover Insurance Company,Massachusetts Bay Insurance Company and Citizens Insurance Company of America,to me personally known to be the individuals and officers described herein,and acknowledged thatthe seals affixed to the preceding instrument are the corporate seals of The Hanover Insurance Company,Massachusetts Bay Insurance Company and Citizens Insurance Company of America, respectively,and that the said corporate seals and their signatures as officers were duly affixed and subscribed to said instrument by the authority and direction of said Corporations. BARBARA A.GARLICK Notary Public CommarmeattM of Massachusetts ���ri� i5 `�7 1�r � � ComRssicn Ex,Mr,s Sept.2t,2418 %' -^-�.—✓✓ ! Barbara A.Garlick,Notary Public My Commission Expires September 21,2018 I,the undersigned Vice President of The Hanover Insurance Company,Massachusetts Bay Insurance Company and Citizens Insurance Company of America, hereby certify that the above and foregoing is a full,true and correct copy of the Original Power of Attorney issued by said Companies,and do hereby further certify that the said Powers of Attorney are still in force and effect. This Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America. "RESOLVED,That any and all Powers of Attorney and Certified Copies of such Powers of Attorney and certification in respect thereto,granted and executed by the President or any Vice President in conjunction with any Vice President of the Company,shall be binding on the Company to the same extent as if all signatures therein were manually affixed,even though one or more of any such signatures thereon may be facsimile." (Adopted October 7,1981-The Hanover Insurance Company;Adopted April 14,1982-Massachusetts Bay Insurance Company;Adopted September 7,2001-Citizens Insurance Company of America) GIVEN under my hand and the seals of said Companies,at Worcester,Massachusetts,this 22nd day of May 2017. THE HANOVER INSURANCE COMPANY MASSA HUSETT BAY I RA CE COMPANY OJT EN 1 SUR CE OF AMERICA J. h I ete,Vice es ent H2,ijq E'r Insurance GxouP_ Texas Complaint Notice Commercial Lines IMPORTANT NOTICE AVISO IMPORTANTE To obtain information or make a complaint: Para obtener informacion o para someter una queja: You may call The Hanover Insurance Company/ Usted puede Ilamar al numero de telefono gratis de Citizens Insurance Company of America's toll-free The Hanover Insurance Company/Citizens Insurance telephone number for information or to make a Company of America's para informacion o para complaint at: someter una queja al: 1-800-608-8141 1-800-608-8141 You may also write to The Hanover Insurance Company/ Listed tambien puede escribir a The Hanover Insurance Citizens Insurance Company of America at: Company/Citizens Insurance Company of America al: 440 Lincoln Street 440 Lincoln Street Worcester, MA 01615 Worcester, MA 01615 You may contact the Texas Department of Insurance Puede comunicarse con el Departamento de Seguros to obtain information on companies, coverages, de Texas para obtener informacion acerca de rights or complaints at: companias, coberturas, derechos o quejas al: 1-800-252-3439 1-800-252-3439 You may 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: (512)475-1771 Fax: (512) 475-1771 Web: http://www.tdi.texas.gov Web: http://www.tdi.texas.gov E-mail: ConsumerProtection@tdi.texas.gov E-mail: Con sumerProtection@tdi.texas.gov PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS O RECLAMOS: Should you have a dispute concerning your premium Si tiene una disputa concerniente a su prima o a un or about a claim you should contact the agent or the reclamo, debe comunicarse con el agente o la com- company first. If the dispute is not resolved,you may pania primero. Si no se resuelve la disputa, puede contact the Texas Department of Insurance. entonces comunicarse con el departamento (TDI). ATTACH THIS NOTICE TO YOUR POLICY:This UNA ESTE AVISO A SU POLIZA: Este aviso es solo notice is for information only and does not become para proposito de informacion y no se convierte en a part or condition of the attached document. parte o condicion del documento adjunto. The Hanover Insurance Company 1440 Lincoln Street,Worcester,MA 01653 181.1457(12(13)Pg.1 of 1 Citizens Insurance Company of America 1808 North Highlander Way,Howell,MI 48843 hanover.com Exhibit B Unconditional Waiver and Release of Lien on Progress Payment Project Primrose Crossing Job No. The signer of this document has been paid and has received a progress payment in the sum of $ 6,490.00_for all labor,services, equipment,or materials furnished to the property or to Kodiak Trenching&Boring,LLC. (person with whom signer contracted)on the property of MMCAD,LLC (owner) located at Crowley,Tx (location)to the following extent: Primrose Crossing Utilities (job description). The signer therefore waives and releases any mechanic's lien right, any right arising from a payment bond that complies with a state or federal statute,any common law payment bond right, any claim for payment,and any rights under any similar ordinance,rule,or statute related to claim or payment rights for persons in the signer's position that the signer has on the above rel'erenced project to the following extent: This release covers a progress payment for all labor,services,equipment, or materials furnished to the property or to Kodlak Trenching&Boring,LLC. (person with whom signer contracted)as indicated in the attached statement(s) or progress payment request(s),except for unpaid retention,pending modifications and changes,or other items furnished. The signer warrants that the signer has already paid or will use the funds received from this progress payment to promptly pay in full all of the signer's laborers,subcontractors, materialmen, and suppliers for all work,materials,equipment,or services provided for or to the above referenced project in regard to the attached statement(s) or progress payment request(s). Date ACT PiM&Supply (Company naive) By, (� C (Signature) ` �: Dx /'1�ZG3� (Title) Before me, a Notary Public, on this day personally appeared known to me to be the . person whose name is subscribed to the forgoing instrument and acknowledged to me that he executed the same for the purpose and consideration therein expressed. Give under my hand and seal of office this Gday of A.D.20,xt / (Ngtary] r!rVYI [Notary Number] \\�\\\►uuuNl�h���i My commission expires thel day of ,20� �v •' OF FORTWORTH TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PROJECT NAME: Primrose Crossing-Risinger Road PROJECT NUMBER: 2683 DOE NUMBER: WATER PIPE LAID SIZE TYPE OF PIPE LF C900 8" PVC 681 C900 12" PVC 4116 FIRE HYDRANTS: 7 VALVES(16" OR LARGER) PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: NEW SERVICES: SEWER PIPE LAID SIZE TYPE OF PIPE LF SDR-26 8" PVC 1189 SDR-26 15" PVC 74 PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: NEW SERVICES: TRANSPORTATION AND PUBLIC WORKS iF The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TX 76012-6311 (817)392-7941 •Fax: (817)392-7845 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 Matthew Mahone, Managing Director Of Kodiak Trenching and Boring,LLC,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; W. Risinger Road D.O.E NO. 7541 BY Matthew Mahone Subscribed and sworn before me on this date 26 of May,2017. (I I I I�� � )awt,8� o ary Public irant,Texas JEJOIFEP.I+IAVARRO aY NU otary Public.State of exas H� m.Expires 04-28-2020 Com b PIotary ID 1�OG406A FORTWORTHREV:02/20/07 TRANSPORTATION AND PUBLIC WORKS PERFORMANCE EVALUATION OF CONTRACTOR 1) CONTRACTOR&PROJECT DATA Name of Contractor Project Name Kodiak Trenching and Boring,LLC Primrose Crossing-Risinger Rd DOE Inspector DOE Number John Crowley CPN#02683 DOE Inspector Project Manager E water[] waste Water❑ storm Drainage[] Pavement Fred Ehia Initial Contract Amount Project Difficulty $375,611.54 O Simple ) Routine O Complex Final Contract Amountf6/9/2017 te $375,611.54 II)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 1 8 2 2 Public Notifications 5 Y 3 20 15 3 Plans on Site 5 Y 3 20 15 4 Field Supervision 15 Y 3 60 45 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 2 60 30 9 Daily Clean Up 5 Y 2 20 10 10 Citizen's Complaint Resolution 5 Y 3 20 15 11 Properly Restoration 5 Y 3 20 15 12 After Hours Response 5 Y 3 20 15 13 Project Completion 5 Y 2 20 10 TOTAL ELEMENT SCORE(A) 307 BONUS POINTS(25 Maximum)(B) III)CONTRACTOR'S RATING TOTAL SCORE(TS) 307 Maximum Score(MS)=448 or sum of applicable element score maximums which= 448 Rating( ITS/MS] K 100%) 307 / 448 = 69% 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) Signature DOE Inspector Signature Contractor Signature DOE Inspector's Supervisor re4 CONTRACTOR'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 FORTWORTHREV:02'22/07 TRANSPORTATION AND PUBLIC WORKS CONTRACTOR'S EVALUATION OF CITY I PROJECT INFORMATION Date: 6/9/2017 Name of Contractor Project Name Kodiak Trenching and Borin ,LLC Primrose Crossing-Risinger Rd DOE Inspector Project Manager John Crowley Fred Ehia DOE Number Project Difficulty Tvpe of Contract CPN# 02683 O Simple QQ Routine Q Complex ❑� water0 Wastewater Storm Drainage[] Pavement Initial Contract Amount Final Contract Amount $375,611.54 $375,611.54 II)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 q 1 Accuracy of Plans to Existing Conditions 2 Knowledge of Inspector 4 2 Clarity& Sufficiency of Details 4 3 Accuracy of Measured Quantities 4 13 Applicability of S ecifications 4 Display Of Professionalism `+ 4 Accuracy of Plan Quantities y 5 Citizen Complaint Resolution 4 PROJECT MANAGER EVALUATION 6 Perfonnance-Setting up Valve Crews,Labs 1 Knowledge And/Or Problem Resolution ADMINISTRATION 2 Availability of Project Manager 1 Change Order Processing Time 3 Communication � 2 Timliness of Contractor Payments 14 Resolution of Utility Conflicts 3 Bid Opening to Pre-Con Meeting Timeframe t III)COMMENTS&SIGNATURES COMMENTS Signature Contractor Signature DOE Inspector Signature DOE Inspector's Supervisor v INSPECTOR'S COMMENTS TRANSPORTATION AND PUBLIC WORKS 10 The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TX 76012-6311 (817) 392-7941 •Fat: (817) 392-7845 FORTWORTH. TRANSPORTATION AND PUBLIC WORKS STATEMENT OF CONTRACT TIME STATEMENT# FINAL STATEMENT# Final CPN 2683 NAME OF PROJECT: Primrose Crossing-Risinger Road Contractor Kodiak YEAR:1 2017 PROJECT NO.:02683 FINAL INSPECTION DATE WD CD CONTRACT TIME 160 g PERIOD FROM: 4/16/2017 TO: 1 4/30/2017 MID - Month IDEVELOPMENT WORK ORDER EFFECTIVE: 6/27/2016 BEG /n n MID (n DAY OF MONTH DAYS REASON FOR DAY OF MONTH DAYS REASON FOR CHARGED DAYS CREDITED CHARGED DAYS CREDITED 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 INA 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 0 281 281 TOTAL TO DATE 0 0 0 1 0 1 281 1 281 REMARKS: Project Time was stopped on 4/3/2017 r Signature: �.�,�.� Signature: (Print Name) John Cr4 ley CONTRACTOR DATE INSPECTOR DATE 4/29/2017