HomeMy WebLinkAboutContract 45746-FP1 `, ` =' ' u► ` CITY SECRETARY
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CONTRACT NO. I
1. FEB s 2 2018
CITY OF FORT WORTH c�
NOTICE OF PROJECT COMPLETION 59(D U — ozoo l
CS y�y�
Regarding City Secretary Contract 45746 & 45746-AI for the Village Creek Water
Reclamation Facility Peak Flow Management Facilities which was requested by the
Water Department and approved by City Council on March 4. 2014 through M&C C-
26693 and on December 15. 2015 through M&C C-18625, the Director of the Water
Department, upon the recommendation of the Construction Manager. CDM Smith Inc..
has accepted the project as complete. Final Payment(Estimate#28)
Original Contract Price: $26,459,406.00
Amount of Approved Change Orders: (41,094,431.00) Number: 30
Revised Contract Amount: $25,364,975.00
Total Cost Work Completed: $25,364,975.00
Less Liquidated Damages: 0.00 (@$ /Day)
Less Pavement Penalty: 0.00
Total Contract Cost: $25,364,975.00
Less Previous Payments: $24,351,372.33
Final Payment Due: $1,013,602.67
01/19/2018
Recomm nded for Acceptance Date
Construction Manager,
,_
Accepted Date
A sit. Director, Water Department
('- -b Char a b �$
45 City Manager Date OFFICIAL.RECORD
CITY SECRETARY
FT./NORTH,TX
RECEIVED FEB 16
D to of Final completion Date of Estimate
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CDM-
Smith
801 Cherry Street,Unit 33,Suite 1820
Fort Worth,Texas 76102
tel:817 332-8727
January 19, 2018
Dena Johnson,P.E.
Fort Worth Water Department
1000 Throckmorton Street
Fort Worth,Texas 76102
Subject: Village Creek Peak Flow Management Facilities
Project Final Completion
City Project No. 02009
City Secretary No.45746
Dear Dena:
CDM Smith received McCarthy's request for final project completion for the Village Creek Water
Reclamation Facility(VCWRF) Peak Flow Management Facilities Project.All requirements for final
inspection and project closeout listed in Specification Section 0177 19 - Closeout Requirements
have been satisfied and the project has been completed in accordance with the plans and
specifications.Attached is the Notice of Project Completion (Green Sheet) and McCarthy's final
payment application.CDM Smith recommends the City accept the final completion of the project
and process the final payment application.
Please let me know if you have any questions.
Sincerely,
a4-�b"&7"J
Amy Robinson,P.E.,BCEE
Senior Project Manager
CDM Smith Inc.
cc: David Townsend,FWWD
Ryan Wilhelm,McCarthy Building Companies,Inc.
�J
WATER+ENVIRONMENT+TRANSPORTATION+ENERGY+FACILITIES
1 ),
12001 N.Central Expressway,Suite 400, Dallas,Texas 75243
P 972-991-5500 1 F 972-991-9249
mccarthy.com
December 21,2017
Amy Robinson
801 Cherry Street, Unit 33, Suite 1820
Fort Worth, TX 76102
Request for Notice of Project Completion
Dear Mrs. Robinson,
Per Specification Section 01 7719, Closeout Requirements, McCarthy Building Companies, Inc. is
respectfully requesting the Notice of Project Completion be issued for the Village Creek WRF Peak Flow
Management Facilities Project. As of 12/21/2017, McCarthy considers all work to be complete, in
accordance with contract documents, and has been fully accepted by the City of Fort Worth. In addition,
the following project closeout documentation required to be supplied by McCarthy is attached:
1) Copy of the Final Payment Request
2) Statement of Contract Time
3) Affidavit of Payment and Release of Liens
The Consent of Surety will be provided following the execution of the Change Order#30- Final Project
Contract Value Reconciliation Change Order.
If you have any questions or require additional information, please feel free to contact me at(903)467-
2150.
Sincerely,
Ryan Wilhelm
Project Manager
A McCarthy Holdings,Inc.company
FORTWORTH
i
44
' listen.think.deliver.
Application for Payment
Project: Village Creek Water Reclamation Facility Peak Flow Management Facilities
Project Type: Waste Water
City Project Number: 02009
City Secretary Contract Number: 45746
Application No: 028 Period To: 12/21/2017
Owner: City of Fort Worth
Engineer: CDM Smith
Contractor: McCarthy Building Companies, Inc.
Address: 4500 Wilma Lane,Arlington,Texas 76012
Cost Breakdown
Item No. Item Description Cost
0 Total Project Budget: $ 26,459,406.00
1 GMP1 Contract Sum: $ 4,859,016.00
1a GMP2 Contract Sum. $ 21,600,390.00
2 Net Change by Change Orders: $ (1,094,431.00)
3 Contract Sum to Date: $ 25,364,975.00
4 Total Completed&Stored to Date: $ 25,364,975.00
5a Retainage-Completed Work: $ -
5b Retainage-Stored Material: $ _
6 Total Earned Less Retainage $ 25,364,975.00
7 Less Previous Certificates for Payment $ 24,351,372.33
8 Current Payment Due $ 1,013,602.67
9 Balance to Finish,Including Retainage $ _
By: V Date: 1.2 1162
Cont o
By: �Z., ! Date:
City Project Man er
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TWDB-1106-A
Revised: 3/25/2015
Monthly American Iron and Steel Certificate
Compliance Submittal by Owner (Sub-Recipient)
TWDB Project No. 73699
Loan/Grant No. 1000345
This executed certificate must be submitted with each Outlay report for iron and steel
projects included within construction contracts.
Amy Robinson Senior Project Manager
I, of
(Name) (Title)
CDM Smith Inc. hereby certify that all iron and steel
products and/or materials incorporated into the construction, alteration,
maintenance, or repair of the subject project are in full compliance with the
American Iron and Steel requirements of Section 608 of the Federal Water
Pollution Control Act for the Clean Water State Revolving Fund or P.L. 113-
235, Consolidated and Further Continuing Appropriations Act 2015, for the
Drinking Water State Revolving Fund, or comply with waivers granted by the
U.S. Environmental Protection Agency.
I understand that a false statement herein may subject me to penalties under federal and
state laws relating to filing false statements and other relevant statutes.
01/19/2018
Signature Date
DB-0154
Revised 3/11/2013
MONTHLY DAVIS BACON ACT CERTIFICATE of COMPLIANCE
Submittal by Recipient
TWDB Project No. 73699
Loan/Grant No. 1 1000345
This executed certificate must be submitted with each Outlay report for labor included
within construction contracts. This Certificate applies only for LOANS CLOSED AFTER
10/30/2009.
I, Amy Robinson Senior Project Manager of
(Name) (Title)
CDM Smith Inc. hereby certify that interviews, periodic reviews of a
(Name of entity)
representative sample of the weekly payroll data, and contractor weekly payroll
certifications such as OMB No. 1215-0149, have been performed to verify that contractors
and subcontractors are paying the appropriate wage rate for compliance with the DAVIS
BACON ACT, 40 U.S.C. §§3141 et seq. as amended and in conformance with the U.S.
Department of Labor regulations at 29 CFR Part 5, (Labor Standards Provisions
Applicable to Contracts Covering Federally Financed and Assisted Construction) and 29
CFR Part 3 (Contractors and Subcontractors on Public Work Financed in Whole or in
Part by Loans or Grants from the United States).
I understand that a false statement herein may subject me to penalties under federal and
state laws relating to filing false statements and other relevant statutes.
01/19/2018
Signature Date
TWDB-0551 Revised 2014/2/18 Page 18
Standard
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LAST NMA13 SUPERVISORS NAME '7,57
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4 IF— YVAUR:KATE
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ACTION CHECK ELO
Do You mmrk over a hours per dap Yes NO
Do you work over 40 hours Per meek?
Are you paid at least time and a half far o Ortjme hours?
Yv
Are You receiving any cash Payments for fringe benefits required by the posted wage deterrnin3tion decision?
v44AT DEDUCTtOidS OTHER TiiANguf.;,ALZ;zr-URrrY ARE N%DE FROM YOUR PAY7
HflW MANY HOURS 01D YOU WORKON YOUR LAST WORK DAY BEFORE Tn—
YOU USE
0 r-� �Z/
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DATE OF LASTLUORKQA�t,GEEFOI�EINTERUfEW(]'S6fiSfDD)
DATE YOU BEGAN WOR
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—EMP CORRZCTTOTHE ES OF ILTY KN ........---------
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NTERVIEVVER RTUREED on PR� PIAME DATE
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V2 YES NO
PZ ROPERLY CLASSIFIE C),PZ
AND POSTERS DISPLAYED?
FOR USE 8 PAYROLL CHECKER
INFORM INAGREEMENT
YES NO
Tum—m—ans
E FIF;kNAME
MMA 9 d M14
ATE
STANDARD FORM I
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DB-0156 3/10/2016
Page 12
Standard Form 1445—Labor Standards Interview
LABOR STANDARDS INTERVIEW
CONTRACT NUleBER
EMPLOYEE INFORMATION
LASTNA1tAE FlRS �E ,wl
NAP,lEOFPRlh9EC�OJyT$A�TOR
NAME OF
CA 2TI-1 STREET A,lDRF2RES5
FhtiPLOy P-$F' r1 9 ;1 74"x`
a-UREWSOR'SNAME - — STATE ZIP D
LAS7 _E FSfiST 9Eh71 � � r
CLASSIFICATICN WALE RATE t3 0
ACTION CHECK BELOW
Do you work over 8 hours per
NO
r day? ,.
too you work over 40 hours per week?
Are You Paid at least time and a half for over itre hours?
Are YOU receiving any cash payments for fringe benefits required by the posted Wage determination derision?
VYHAT DEDU(5;SONS OTHER THAN TAXES AtJD SOCIAL SECURITY AR£MADE FROM YOUR PAY7
f &d
HOW MANY HOVRS U'U YOU V—Ori?YOUR LAST WORK DAY BEFORE
THIS iNTERvletw TOOL5 YOV VSE
DATE OF LAST WDRK DAYS^OR INTERVMW fYYiWZp)
17/0
DATE YOU BEGArdVYORiC OH T IS PR0IECT{YYh7tLFLF�Di�},
. � 114"AJE
THEA$OVE IS CORRECT YO THE BEST OF MY KNOVIrL.EDGE
EtAPLOYEt:i SFGNATU w � f ti
•�+TM '� ��ti^�.'�il r'i t✓I t1ATE PYYA3FrfDDD
IPdIEKVLEtArcR RE' TYPED OR PRINTED AME DATE 4YYhfIMpD)
1tiTERVfEWER'S ' +f,
WORK EMPLOYEE WAS DOING V#'H EN INTERVIINTERVIEWEDCOARPNEdTS
ACTION {r£exPlaselianlsnsaCM rrocarr aectlan) YES NO
EP I LOYEEPROPERLY CLASSIFIEDAND PAID7
ARE WAGE RATESAND POSTERS DISPLAYED?
L ABOVE LNFORR9ATK il,I If�J AGREE@11ENT:U11 PAYROLL DATOA7R PRYRDLL CHECKEf?
S No
�olcM c,+aTS
LASTh CHECKER
rIIW NAME M1
SIGNATU
JO ITLE
DPTs (YvaaastxD)
AUTH ED FOR EPROOVCTION
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by GSA_P iR .l2AR[dBCFR)53.222jg)
D"156 3/7.0/2016
Page 12
Standard Form 1445–Labor Standards Interview
LABOR STANDARDS INTERVIEW
CONTRACTNUM5ER
LAST EkIPLOYSE INFORMATION
FIRST NAPAE MI
NAME OF Pftrkili C_qNTRACTOR KE� � ;z L- I
-K C LA STREMA—DDRESS
NAME OF E&IPLOYER c 7 —1 A
STATE IZIP CODE
SUPERVISOR*SNPAIE L – —1-1 1 1z
(ASTNNA6 FIRSTNAME MI VJOR�CLASSIFICATION WAGE RATE
14
ACTION CHECK BELOW
YES NO
Do you work over 8 hours per day?
00 You MIR over 40 hours per week?
Are you paid at least time and 2 half for overtime hours?
Are you receiving any cash payments for fringe benefits required by the posted wage determination decision?
MAT DEDUCTIONS OTHER THAN TAXES AND SOCIAL SEC—URFrY ARE MAGE FROI4 YOUR PAY? I
t
HOWMANY HOURS DID YOU WORKON YOUR LAST WORK BAY BEFORE
THIS INTERVIEW? TOOLS YOU USE
DATE OF LAST DAY BE )RE INTERVIEW(),YxMDD)
j - 1 - 2L-A (-el
DATE YOU BEGAN WORK ON THIS PROJECT(YYMfAoD)
Q L�,
THEABOI IS CORRECT TO THE BEST OF fify KNOWLEDGE
EMPLOYEES SIGNATURE GATE—jYYfflMDD)
tt
INTERVIEWER S RE i' TYPEDORPRINTEDN E DATE jYYAfffDDj
L INTIERVi=vvI:21C,5 COMMENTS
WORK EMPLOYEE WAS WING V%1H EN INTERVIEWED III Zip I 1:11111:1''I Is rip :,Usd
corrimnit xfttbo) YES NO
ISEMPLOYEE PROPERLY CLASSIFISDANDPAID?
ARE WAGE RATES AND POSTERS DISPLAYED?
19 ABOVE INF-nfflP%I Mi IN AGREEMENT WITH PAYROLL--FOR USEBYPAYROLL CHECKER
AYES
CHECKER
E Flrlr NAME MI J08 LE
SfGNATU IPR P�'j a-r M I VI
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L REPRMUCTION )L 80
STANISA—Rt)FoRM-144
Pic-alad by OSA-FAR(4e CFR)s3.222(g)
DB-0156 3/10/2016
Page 12
Standard Form 1445—Labor Standards Interview
LABOR STANDARDS INTERvIEW
CONTRACT,NUMBER
IZCC� EMPLOYEE INFORMATION
LASTJIAME FIRSLNAME IMI
NAME Or PRAIE CONTRACTOR
J
AFT
STATE I
SUPMVISOR'SNAME 7�5
Z/4L-
LAST
NAME IFIRSTVME
MI WORKCrASSiFKATION WAGE-RATE
ACTION CHECK BELOW
YES NO
Do you%vork over 8 hours per day?
Do you work over 40 hours per week?
Are you paid at least time and a half for overtime hours?
Are you receiving any cash payments for fringe benefits required by the posted wage deternination decision?
VMAT DEDUCTIONS OTHER THAN TAXES AND SOCIAL SECURITY ARE MAGE FROM YOUR FAY? ^
HOWMANY HOURS—03531OUVER—KON YOUR LAST�VMRK DAY BEFORE
THIS INTER%nEW TOOLS YOX USE
LLQ'
DATE OF LAST VMVK p4'lr MF'bfE INTERVIEW(YMOD)
DATE YOU BEGAN ftRK On THIS Paci.;ECr jyyAFAfDDj
EXAFLOYEE"SSKMTURE TRGA9OVE IS CORRECT To THE BEST OF
4�— UTE—IVYMMDD)
INTER%nEVVER MATURE
YP DATE rAWNDO)
INTARVI; COMMENTS
1=
VMRKEMPLOYEEVASOOINGVMEN—MTERMEYIED ACTION
11;1&1 1:11,1,111 1 101!�Jiliid mocanig7wft
YES NO
IS EMPLOYEE PROPERLY CLASSIFIEDAND PJUD?
k1
ARE WAGE RATESAN@POSTERS DISPLAYED7
FOR USE BY PAYROLL CHECREW
YES NO ENT WITH PAYROLL DATA?
U67, 1I-hK A,�
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LAST NAME CHECKER
FIR rLWE
AG
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AUTHOR-2ED FOR H I i�p
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PtavwvsedAionnctns
STANDARD FORM I (RW.1228)
Pmsaibad Ixy GSA-FAR(49 CPR)s3.222tq)
DB-0156 3/10/2016
Page 12
Standard Form 1445—Labor Standards Interview
LABOR STANDARDS INTERVIEW
CONTRACTNUMBER EMPLOYEE INFORMATION
,2 C-C)12) - NARIS FIRST If
NAME OF PRM*E CONTRACTOR
�-3
STR ETADDRESS
NAME OF fK]PLOYM 7, 1 Tr L—T—c JQ T�,
SUPERVISOR'SNAMIE TV-1,1070! 1-7
LAST VOFRRC SS'IFICAT159 p +1 1,LL
GE RATE
ACTION I CHECK BELOW
YES NO
Do you vvork over a hours per day? V--
Do you work over 40 hours per week?
Are you Paid at leasttirne and a Wf for overtime hours?
Are you receiving any cash Payments for fringe benefits required by the Posted wage determination decision?
)KHAT DEDUC7IQNS OTHER THAN TAXESANDSO SECURITY----E rKiJM TUUH PAY?
HOWMANY HUUK5 DID YOU WYORK ON YOUR AST VMR�DAY
�BEFQRE H
THIS INTERVIEW? TOOLS f( i—USE
I t — ; - I
DATE OF L4M Mm DAY BEFORE NFERVIEW—fyyAWDO) -, --
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71
J
DATE YOU BEGAN PROJECT lyYMADO)
LOYEeSMSUATURE THEABOVE IS CORRECT
DATE—IYYMMDD)
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BATE MAIM00)
VVORXEMPLOY WAS DOING WHEN INTERVIEWED INTE EWurs COMMENTS
ACTION IjhwpanaHon&nand arecorrtmlrMa,—Mbnj YES NO
tsempLOYMPROPERLYCIASSIFfEDANDPAU37 NO
ARE WAGE RATESAND POSTERS U)SPLAYED7
FOR FW USE BY PAYtS ABOVE INFORt ViTK3N IN AGREEMENT WITH ROLL CHECKER
PAYROLL DATA?
CHECKER
VMA D
DATE I D)
AUTHORIZED FOR L CAL RRE.PQ0o—rU-CT'ON
STANDARD FORM 11445 (REV.%Z99,
Pmibad by GSA-PAR(4a CPR)53,M9)
DB-0156 3/10/2016
Page 12
Standard.Form 1445—Labor Standards Interview
QZdOLABOR STANDARDS INTERVIEW
CC NTRACTNUMBER
PLOY€E INFORMATION
NAME y FIRST NAME All
NAfitEO}�FPRAIECONTRACTOR ��r�s°�,-"r'-' ^
S l R '•-��=��� "'� STF(EETADORESS
Wa1EOP�3SPLOYER _
`P � LkI
"` STATE ZIP CO
SUPERVtSORSNAME �.4 ;b; DE
LAST NAME FIRST,pL4151E MI WORK CIASSIFICATK)N WAGE RATE _ 1
ACTION CHECK BELOW
Qa you vwrk over 8 hoots per day? YES NO
c�
Do you work over 40 hours per week?
Are you paid at least time and a half for overtime hours?
Are you receiving any Cash payments for fringe benefits required by the posted vrege determination decision?
V44AT DEDUCTIONS OTHER THAN TAXESANDSOCtAL SECURITY ARE&FADE FROM YOUR PAY?
HOW MANY HOURS OID YO(-MRK ON rwR LAST WORK DAY BEFORE r- �
THIS INTERVIEW? TOOLS YOU USE
11
DATEflF LILST WORK 0AY BEFOREINTERVIEW f)rydf4fpD)
—TE YOU BEGAN WORK ON r mS PROSECT)YY1N4f0D)
THEABOVE IS CORRECTTO THE BEST OFMY KNOWLEDGE
EMPLOYEESSKiNATURE
OAT-(VMMOD)
E'INTERVIEWER RE ' TYPED OR PRINTED NA/pE' `..
"? ?'/_�$ DATE IYMUDD)
`�cc gam' ✓T G" c r 7)Z I.�? r-
V7 j'd� ��— i }-,.—o C
VIORKEMPLOY ASOOINGWHEN3NTERVIEWED INT RVIEWER'$COMMENTS
ACTION(1fnPranatlon)antedard asecammar>)asscfiopy YES NO
13 EMPLOYEE PROPERLY CLASSIFIED AND PAID?
AREWAGE RATES ANG POSTERS DISPLAYEOT
FOR USE BY PAYROLL CHECKER
iSASOVE INFORMATION IN AGREEMENT WITH PAYROLLOATA?
YES 1 NO
COMMENTS
LAST"NAME CHECKER
FIR NAME h71p JOf,{�ITLE ,q A � n n
sISNAyD8--1JQ � fes- j}}Jlf{Ofj� E T A hJ d' (W--
DAT (YYhlALDD)
AUTHORIZED FOR R6PRODtiC'{2DN )
Z 1L
Pravlouacdi3mnot ncaAte STANDARD FORM-J440
(REV.52.98)
PM—Rmd by GSA-FAR(48 CFR)SS.2=,)
DB-0156 3/1012016
Page 12
Standard Form 1445—Labor Standards Interview
0200 LABOR STANDARDS INTERVIEW
CONTRACTNUMBER
EMPLOYEE INFORMATION
LAST E FIRy*,T NAME MI
NA lq£ICFPKU61hWNTRAC OR ' �
STREETAuD�R/ESS �;
NAME OFEIt1PlOYER 22
> f 7 ,a ,t c ,�.».._-'T- � 1. � `z;;5
C! CODE
SUPERVISOR'SNAME "�'- ...:. "C ,)rel i •. Z x= 1 L:
LAST,NAME FIRS !E 671 WO }{CLASS{FK:ATION
7.,+":.� WAGE RATE Gam:
ACTION CHECK BELOW
YES NO
Do you work over 8 hours per day?
Do you work over 40 hours per week?
Are you paid at feast time and a half for overtime hours? r
Are you receiving any cash payments for fringe benefits required by the posted wage determination decision?
W,IAT DEDUCTIONS 0^1E THAN TAXES AND SOCIAL SECURITY ARE MADE FROM YOUR PAY? � (
HOW MANY HOURSDIDYOU WORK ON YOUR LAST WORK DAY BEFORE =`ye
THIS INTERVIEW/ TOOLS YOU USE
DATE OF?AST WORK DAY BEFORE INTERir)tWW(YYM UM)
OATEYOU KWPT%0RKON��TgFg115PROJECT lYs7HIdDD)
@4PLOYEE'SSKlNATU THEABOVE--nnECT TO THE SE5T OFMY KNOWLEDGE
D 1A1TE f Y_YUMDD) {{
N RE
1NTERVIEYV`cR J TYPED OR PRINTEDN E OATS {YY%MiDO)
s'f
IN EWERS COMMENTS
WORKEMPLOYEEWASDOINGVVHENwTERVIEWEO ACTION)JJmrpb=lbnkneodeAuseeammerdsseclan) YES NO
13 EMPLOYEEPROPERLYCIASSIFIEDANOPAID?
Aft WAGE RATES AND POSTERS DISPiAYED7
IS ABOVE INFORMATION AGREEMENT WITH PAYROLLOgOR USE BY PAYROLL CHECKER
1_.l YES NO
//COMMENTS I
L_i STS 6 0. ;—)A\10 As ;L Pi-.
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LASY NAM CHECKER
O rV
PzU fj FIRSA.(I�rry?E MI JO8T1 �,ttY /' ;qy
SIGNATURE ^J G CJT / 1
DATE {yYMAIDD)
AUTHOF"M FOR LOCAL REPRODUCTION
Pravioua edli nnot uaabto STANDARD FORM 9445 lREV.t2a8)
Pr -4-d try GSA.-PAR(48 CFA)53,222(8)
D8 0156 3/10/2016
Page 12
Standard Form 1445—Labor Standards Interview
LABOR STANDARDS INTERVIEW
CONTRACCNUMBER
0 EMPLOYEE INFORMATION
CAST NAME FIRSMj NAME
NAMEOFPRVAECONTRAGTOR
c '-A STREETADDRESS
NAME OF EMPLOYERI
"'T-''A ci ATE JZUSC40
SUPERVISOR'SNAME r
FISTrAS ^
LAxE p
ATK)14
WAGE RATE
ACTION CHECK BELOW
YES NO
Do you work over 8 hours per day? YE,
DD you York over 40 hours per week?
Are you paid at least time and a half for overtime hours?
1
Are you receiving any cash payments for fringe benefits required by the posted wage determination decision? t,f
VWAT DEDUCTMUS OTHER THAN TAXES AND SOCIALSECURI7YARE MADE-- M YOUR PAY? _
c v' 66
HOW MANY HOURS DID YOU WORKON YOUR CAST WORK DAY BEFORE
THIS INTERVIEW? ;DOLS YOU USE
DATE OF IAS I WWRK DAY BEFORE INTERVIEW IYYMkfDD)
- OATEYOU BEIGAN WORK ON PROJECT "'`�'(� "n
7� lYY1NMD0}
r" a 75ti. E - 1 C, ri�
PLOY, SIG RE
THEA8OVE LS CORRECTTOTHE BEST CFMy KNOWLEDGE
EME.£S
DATE tYYAWDD)
GNATURE It -f cl
INTERVONER -"''° TYPED OR PRINTED £ DATE (YY41N&V)
-e%v3%�ea' r✓:..ns^w�. ...°....•�"' _.. I,c— `J
IA TERVIEWER'S COMMENTS G �7
V181RKE7siPCOYEEWASDOINGWNENiN;ERVIEWEp ACTION ir/mrpbwhbnianaaday,euotaavnafllsaettian) YES NO
f p.
IS EMPLOYEE PROPERLY CLASSIFIEDAND PAID?
ARE WAGE RATES AND POSTERS DISPLAYED?
AEOVEINFORMATKLN kNAGREEMENTWIMPAYROLLOATOA7�u SE BYPA,YRLA1.,f,C'f'IECKER
YES I1 NO
ENTS
LASTM—ME CHECKER
�� F7R$7't� MI JOB iTLE
SIGNATtr E T)It A N ftc
DATE TYYINxfOD)
AUTHORMEO LOCAL EPROOLIGTION�
Prowwssecdhone usable STANDARD FORM 4445 (REV.12-98)
Pmzaibad by GSA-FAR(48 CFR)63222{8)
DB-0156 3/10/2016
Page 12
Standard Form 1445—Labor Standards Interview
LABOR STANDARDS INTERVIEW
cONTRACTNUMBER EMPLOYEE INFORMATION
LASI�QMFE— FIRST7
-NA)AE — -1
NAME OFPRGLIE 7
/-A�-1 L;9'� P� I C I?i-�!�A A--
STREETADDRESS
NAME OF EMPLOY—ER -4 1'Z C�-,�-U�,n,
Kc CITY IP t:
SUPERVISORSNAME
LASTWME FIRSTNAME hit WDR LASSIFICA710N WAGE RATE
Lu i Z
ACTION CKE—CKBELOW
YES NO
Do you work over 8 hours per day 7
Oo you mcTk over 40 hours per week?
Are you paid at least time and a half for overtime hours?
Are you receiving any cash payments for fringe benefits required by the posted wage deterininalion dacjsjon-?
VO4AT DEDUCTIONS OTHER TIUN rAXrzS AND SOCIAL SEC :um TUWJiVAT7
"'OWNUMMY OURS DID YOU MRK ON YOUR LAST WORK DAY BEFORE
THIS INTERVIEW? T LS YOU USE
DATE OF LAST VMRK DAY BEFORE NTERIAOM—fM*W)
DATE YOU Btlim VVURK ON THIS PROJECT
EMPLOYEE73SIGNATURE THEAROVE ISCORRECTTOTHE BEST OFMY KNOWLEDGE
TATE—(YYMWDj
INNTERVI R TYPEOOR PRWTEDN"E I j
FATE—(YYZffD0j
RKEMPLi -RVIEWED INT VIEWER'S COMMENTS
ACTION 11,1111,jjj:rp11,I *djIg We ii7�406a4 YES NO
IS GM PLOYEE PROPERLY CtASSIFIEDAN D PAID?
ARE WAGE RATESAND POSTERS I)ISptAyE0?
IS BOVEINFORMATK)N Mft—--
ROLL CKE—CKER
I I I'M PAYROLL DATA?usEsy pAy
YES NO
NAM FIRST Nimme CHECKER JOB TITLE
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DATE D)
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Page 12
Standard Form 1445—Labor Standards Interview
LABOR STANDARDS INTERVIEW
CONTMCTNUMBER
EMPLOYEE JNF0rwAT=
NAME OF FRIME—CONTRACTOR
TAME FIRST WIE All
NAME OF EP .:ET A
isa',
SUF'k:R,V(SOR'S NAME ST E I
LASTNA14E FIRST-1 N E PAi
-�7
74ORK CLASNFCATION
iz� AGE RATE
0
ACTION CHECK BELOW
Do you vmrk over 8 hours per day? Yes NO
Do You Work over 40 hours per week?
Are you paid at least time and a half for overtime hours?
Are you receiving any cash payments for fringe benefits required by the posted mage defernination decision?
VMATE)EDUCTMS OTHER THAN TAXES O SOCIAL SECURIT'rARE MADE FROM YOUR PAY7
HOWMANY HOURS VJU YOU VWUHK 0
Ttirs P4TERVTEW7 ON Y(0yUR LAST VMVDRK DAY BEFORE TOOLSYOUUSE
ICU— L
yyWCq
oA-rr o;r LksT'VUBR '11::11!1��!:FCREIN'rERVIEw I
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DATE YOU BEGAN VWURK ON THISMD
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EUPLOYE OWLEUGE
DATE fY-Y—AfMDDj
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YES NO
YES
7--f 4' IS EUPLOYEr PROPERLY CLASSIFIED AND PA-107
ED
ARE WAGE RATES AND POSTERS GISpLo-iYED?
FOR USE BY PAYROLL CHECKER
75�*N IN L"rl=I`;�
IS Aoo�--INFORMATION IN�AGIREEMENT�VWWTH PAYROLL.Q
[ I YES I I NO
COMMENTS
LAST NAME CHECKER
YI KST XAM r: MI JOB T1ILr:
SIGNATURE
DATE IYYMAIDD)
AUT)4OR2rI);—:0R LOCAL REPRODUCTION
PmViour ocibm n=Utawa STANDARD FORMT�(jtsv�12M
Plmsrn'6®d try GSA.FAR j48 CFR)x3,222{9)
DB-0156
Rev 04/17 Page 12 of 33
Standard Form 1445—Labor Standards Interview
LABOR STANDARDS INTERVIEW
CONTRACT NUMBER
EMPLOYEE INFORMATION
L-6—ST NAME F :ST NAFAE
NAME Or PiFIV E—CONTRACTOR STREET.
c
I_
STREETA'DDRESS
NAME OF EMPLOYER _Z
�Z4- 4-Z- 0
STATEIFCODE
SUPERVISOR'S,W,TEJ
LAST NA-- 1 7;-" 4--, 2 1
FIRST NAM
r "I WORK rt,-SSIFjfWrZl—t VYAU--RATE
ACTION CHECK ELOW
Do You work over 8 hours par day? YES NO
V--T
Do You work over 40 hours per week?
Are YOU Paid at least time and a half for Overtime hours?
Are YOU receiving any cash PDyMents for fringe benefits required by the posted mage determination decision?
-
MATOEQU TPMS OTHER THAN TAXES ANO—AL S!f.;
: UH11Y ARE MADE FROM YOUR 7
AL
140wh"tVAMNY HOURSONO YOU INORK ON YaUR LAST VUOFKQAY
THIS INTERVIEW? TOOLS YOU USE
QA7r OF LAS,Y"RK DAY BEFORE INTERVIEW I YYMMOD)
C z
DATE YOU BEGAI'l—WORK ON THIS PROJFr-
ffyAlMM)
THE AROVEISCOR CT TO THE PEST OF MY KNO14N&EDGE
GMKOY FSSIGNATURE -r A BATE
SIG RE
tKTERVIEt-rtR PRINTF NAME '9TE—tVYMMDD)
INTE VIEWER'S
WORK FAIPLvy cr vvA,i UVFKG WHEN INTERVIEVWCED lif n4604a M—dd.
C
Jf IS EMPLOYEE PROPERLY CLASSIFIED AND PAID?
1---:7L EF)L--- AREWAGE RATES AFJU POSTERS DISPLAYED?
iS ABOVE INFORMATION IN AGREEM"IT VWTH PAYROLL C.FOR Y I'AYMOLL CHECKER
YES NO
col'I'VIENTs
LAW NAME
CHECKER
M, 308 TITLE
DATE
--]
DATE—(YYAWl&f(1Dj
AUTHORIZED FOR LOCAL REPRODUCTION
Previou-adibon not usablo STANDARD FORM 1445
Pm—Rmd by C-1A-FAR(48 CFR)53,='w
DB-0156'
Rev 04/17 Page 12 of 33
Standard For 1445—Labor Standards Interview
CONT LABOR STANDARDS INTERVIEW
ON
LAST NAME FLR"dAE
c: f J
NAME OF 9-1PLOYER ET ADDRESS
SUPERVISORSNAbBE
STATEIP co
AME V�T, Wz��- 1-�4
KC
MMATION
I
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ACTION CHECK BELOW
Do You work Over 8 hours per day? YES NO
Do You work over 40 hours per week?
Are You paid at least time and a half for overtime hours?
Are You receiving any cash payments for fringe benefits requited by the Posted wage determination deci
VSiAT DEDUCTIONS OTHER THAN TAXES AND$OCTAL TYAREMADEFROM.--..._HOW&LSr1Y HOURS DID YDU WORK ON YOUR[AST _ *Session?
VIJURK DAY BEFORE
THIS NTER%nEW? TOOLS You USE�
DATE Or LAST VMRK DAY BEFOjtE INTERVIEW
-DATE—YOU B=GWORK ON THIS PROJECT(YYAfFMO)
EM GYE-2SSn--NATUK THEAW1 -r-T TO THE urzT OF MY KNOWLEpGE
DATE IYYMMM)
INTERVIEWERTyl:"E[ 1! 1114 DNAME DATE rlyffMoot
INT EWUVS C��A-i
WORKEP14 YEE WAS=ING A14EN WMTERVI ACTION gferp3anationianmdar, YES NO
IS EMPLOYEE PROPERLY CLASSIFE;O AND PAID?
V3-A C V- Y IL.)
ARE WAGE RATESANo POSTERS DISPLAYED?
MA ;y-e�u4p:,RIWATI0,41FOR USE BY PAYROLL CHECKER
OVE WFORIWATIC,14 IN Azaeemaxr vW'i PAYROLL 0,
N AGREEAUM VWH PAYROLL UAW
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LAST NAME CHECKER
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SIGJdATURE
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STANDARD FORM 1445 (Rrzv.i2.W
P.—1-a by 09A.-PAR(4 8 CFR)53-"a 7(9)
DB-0156
Rev 04117 Page 12 of 33
' DATE YOU BEGAN_
ty \
, Fopz r Wco ikT14 City of Fort WorthCO'NACT NO. E 4
ar� , Change Order Request
-� Proje&V6a e: Vll'age Creek Water Redamaton Facility Peak Flow Management Facilities City Sec No.: 45746
Project No.(ss):/56006-CO2009 DOE No. N/A CityProj.No.:1 02009
Prom cfIescnptiort' Construction of VCWRF Peak Flow Management Facilities(CMAR)
Contractor. McCarthy Building Companies,Inc. Change Order# 1 Date: 12/21/2017
City Project Mgr. Dena Johnson City Inspector. CDM Smith Inc.
Phone Number. 817-392-7866 —� Phone Number: 817-332-8727
Dept. Water Sewer Totals Contract Time
Calender days)
Original Contract Amount $26,459,406.00 ?�-;, See Note 2
Extras to Date(See Note 1) w�S -r 7 .
Credits to Date(See Note 1) -
Pending Change Orders(in M&C Process)
Contract Cost to Date ., 4426 4EJ
y
x�r
Amount of Proposed Change Order y �_{.�. :441 V r s
Revised Contract Amount ] ¢, � sx �
Original Funds Available for Change Orders
Remaining Funds Available for this CO x �,,
Additional Funding(if necessary) e}w� ,sz N�� ,~ ;s,���
CHANGE ORDERS to DATE(INCLUDING THIS ONE)AS%OF ORIGINAL CONTRACT
MAXALLOWABLE CONTRACT AMOUNT(ORIGINAL CONTRACT COST+25%) s �
The project was completed with unspent budget.All unspent cost and contingency bud split 5
�a
with CMAR per contract.This change order is to credit the City for the savings related t t 31 e 4t
budget savings.
Final Contract Cost Ci Sa s'• r
Estimated Cost at Completion $23,568,056
CMAR Fee (3.5%) $824,882 X��
Unspent Cost Budget(50%Split) $362,776 $362,776 `
Unspent Contingency Budget $309,261 $309,261 ^\\
Unspent Owner's Allowance Budget $383,335
CMAR Shared Savings of Contingency from CO 21 $300,000
Unspent CMAR Feed
$39,059
Total Final Contract Amount $25,364,975 $1,094,431
It is understood and agreed that the acceptance of this Change Order by the contractor constitutes an accord and satisfaction 6Q repres
payment in full(both time and money)for all costs arising out of,or incidental to,the above Change Order.
McCarthyBuilding Companies,Inc.
12/5/2017 /
Ut
M&C Number N/A M&C Date Approved
i
F0- a r -WO RT H City of Fort Worth
W 00— Change Order Deletions
Project Name FVIllage Creek Water Reclamation Facility Peak Flow Management Facilities City Sec No.: 45746
Project No.(s): 56006-CO2009 DOE No. N/A City Proj. No.: 02009
Project Description Construction of VCWRF Peak Flow Management Facilities(CMAR)
Contractor McCarthy Building Companies, Inc. Change Order: EEI Date 12/5/2017
City Project Mgr. Dena Johnson City Inspector: CDM Smith Inc.
DELETIONS
ITEM DESCRIPTION DEPT Qty; Unit Unit Cost Total
Water
Sewer
Page 3 of 4 1 Deletions Sub Total
'C?RT +QRTI City of Fort Worth
Change Order Additions
Project Name Village Creek Water Reclamation Facility Peak Flow Management Facilities City Sec No.: 45746
Project No.(s): 56006-CO2009 DOE No. N/A City Proj.No.: 02009
Project
Description Construction of VCWRF Peak Flow Management Facilities(CMAR)
Contractor McCarthy Building Companies,Inc. Change Order:0 Date: 12/5/2017
City Project Mgr. Dena Johnson City Inspector CDM Smith Inc.
ADDITIONS
ITEM DESCRIPTION DEPT Qty Unit Unit Cost Total
Water
Sewer
Page 2 of 4 Additions Sub Total
MIWBE Breakdown for this Change Order
MWBE Sub ;Type of Service Amount for this CO
Total $0.00
Previous Change Orders
Co# DATE AMOUNT
Total $0.00
Page 4 of 4
Attachment 1 to Change Order#1
Village Creek Water Reclamation Facility Peak Flow Management Facilities
City Proiect Number 02009•City Secretary Contract Number 45746
The project was completed with unspent budget. Per the executed CMAR contract, all unspent
cost and contingency budget is split 50%with CMAR per contract.This change order is to credit
the City for the savings related to the unspent budget savings. Additional information and
explanation are provided.
Final Contract Cost City Savings
Cost of Work at Completion $23,568,056 $0
CMAR Fee(3.5%)(See Note 3A) $824,882 $0
Unspent Cost Budget(50%Split)(see Note 3B) $362,776 $362,776
Unspent Contingency Budget(see Note 3C) $309,261 $309,261
Shared Savings of Contingency from CO#21(see Note 3D) $300,000 $0
Unspent Owner's Allowance Budget(See Note 4) $0 $383,335
Unspent CMAR Fee(see Note 5) $0 $39,059
Total Final Contract Amount $25,364,975 $1,094,431
(Note 6)
NOTES:
General Note: Project was completed by CMAR (Construction Manager at Risk)
Note 1: Customer Change Orders 1-29 were used to transfer funds from project internal
allowances and contingencies to work activities with no change in Total Cost of Work/Total Cost
of Contract. Customer Change Order 30 is the basis for this formal Change Order#1.
Note 2: Contract did not have designated length of Contract or Contract Time.The adopted GMP
2 (Amendment #2) provided a schedule with projected completion date of approximately 19
months after Notice to Proceed. Change Order #21 added three months to the projected
completion date.
Note 3: All the Notes Refer to specific sections of the executed CMAR agreement (City Secretary
Contract#45746) approved by City Council on March 4, 2014 (M&C C-26693)
Note 3A: Section 2 of Article 2 (Compensation) of the this contract states that "The City
shall compensate the CMAR for providing Construction Phase Services for the
construction fee of 3.5%of the contract work.
Note 36. Section 5 of Article 2 (Compensation) of this contract states that "50%of the
Savings will be paid the CMAR."
Note 3C. Section 4 of Article 2 (Compensation) of this contract states that "Any unspent
Contingency Funds to be shared a 50/50 basis between CMAR and the City".
Note 3D. Per Change Order#21,$600,000 of the Contingency Funds where split by mutual
agreement per Section 4 of Article 2 (Compensation) of this contract. The $300,000 for
the City was placed in the Owner's Allowance and was allocated for additional work
requested by City Plant Staff.
Note 4. The contract had an Owner's Allowance for additional work as requested by the City in
the amount of$963,114 plus an additional$300,000 from the split of Contingency Funds as listed
above. At the end of the project$383,335 remained unspent.
Note 5. As the Final Cost of Work was $830,257 less than the Cost of Work in GMP1 & GMP 2
(contracted Cost of Work) a credit is provided. Actual fee(Note 3A)was less than the budgeted fee
Note 6.Total amount to be earned the CMAR (Contractor)for the Contract.
FORTWORTH rev 03/05/07
WATER ENGINEERING &FISCAL SERVICES
FINAL STATEMENT OF CONTRACT TIME
FINAL STATEMENT NO.:N/A
NAME OF PROJECT: Village Creek Water Reclamation Facility Peak Flow Management Facilities
PROJECT NO.: 56006-CO2009 CONTRACTOR: McCarthy Building Companic
CITY PROJECT 56006-002009
PERIOD FROM:07/09/14 TO: FINAL INSPECTION DATE: 7/20/2017
WORK ORDER EFFECTIVE:N/A CONTRACT TIME: N/A Q WD QQ 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
PERIOD
PREVIOUS
PERIOD
TOTALS
TO DATE
'REMARKS: Contract did not have a designated length of Contract or Contract Time
//7 _ Q""�2�°�^ 02/07/2018
ONTRACTOR DATE INSPECTOR DATE
WATER ENGINEERING&FISC�LL SERVICES
The City of Fort North• 1000 Throckmorton Strect•Fort Worth,TZ 76012-6311
(817)392-4477•Fax: (817)392-8460
CONSENT OF OWNER ❑
SURETY COMPANY ARCHITECT ❑
CONTRACTOR ❑
TO FINAL PAYMENT SURETY ❑
Conforms with the American institute of OTHER
Architects,AIA Document G707
Bond No 1 0641 21 30,82397862
PROJECT:
(name, address)Peak Flow Management Facility
TO (Owner) , Fort Worth,TX,
F ARCHITECT'S PROJECT NO:
CONTRACT FOR:
CITY OF FORT WORTH Village Creek Peak Flow Management Facilities
1000 Throckmorton Street I
Fort Worth,Tx,76102 J CONTRACT DATE:7/9/2014
CONTRACTOR:MCCARTHY BUILDING COMPANIES, 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)
TRAVELERS CASUALTY AND SURETY FEDERAL INSURANCE COMPANY
COMPANY 202B Hall's Mill Road
One Tower Square Whitehouse Station NJ 08889
Hartford,CT 06183 , SURETY COMPANY
on bond of (here insert name and address of Contractor)
MCCARTHY BUILDING COMPANIES, INC.
12001 N.Central Expressway,Suite 400 , CONTRACTOR,
Dallas,TX,75243
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 , OWNER,
1000 Throckmorton Street
Fort Worth,TX,76102
as set forth in the said Surety Company's bond.
IN WITNESS,WHEREOF,
the Surety Company has hereunto set its hand this 20th day of December,2017
TRAVELERS CASUALTY AND SURETY COMPANY
FEDERAL INSURANCE COMPANY
`�-- Surety Colliparry
Attest: ,(eawTorres
(Seal): Signature of Authorized Representative
Susan A.Welsh 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
ACKNOWLEDGEMENT BY SURETY
STATE OF ILLINOIS
COUNTY OF WILL
On this 20th day of December 2017, before me, Aaron D. Griffin, a Notary
Public, within and for said County and State, personally appeared Susan A.
Welsh to me personally known to be the Attorney-in-Fact of and for
Travelers Casualty and Surety Company and Federal Insurance Company
acknowledged that she executed the said instrument as the free act and deed
of said Company.
IN WITNESS WFIEREOF, I have hereunto set my hand and affixed my
official seal, at my office in the aforesaid County, the day and year in this
certificate first above written.
OFFICIAL
ASEAL
ARON!D GRIFFIN
Notary Public in the State of Illinois LNOTARY PEJBLoe,STATE of ILLINOIS
County of Will MISSION EMPIRES 11/02/2019
WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER
TRAVELERS,I POWER OF ATTORNEY
Farmington Casualty Company St.Paul Mercury Insurance Company
Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company
Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company of America
St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company
St.Paul Guardian Insurance Company
a
i
I,
Attorney-In Fact No. 230983 Certificate No. 007359306
l
KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance
Company,St.Paul Mercury Insurance Company,Travelers Casualty.and Surety Company,Travelers Casualty and Surety Company of America,and United States
Fidelity and Guaranty Company are corporations duly organized under the laws of the State of Connecticut,that Fidelity and Guaranty Insurance Company is a
corporation duly organized under the laws of the State of Iowa,and that Fidelity and Guaranty Insurance Underwriters,Inc.,is a corporation duly organized under the
laws of the State of Wisconsin(herein collectively called the"Companies"),and that the Companies do hereby make,constitute and appoint
Debra J.Doyle,Diane M.O'Leary,James B.McTaggart,Jennifer L.Jakaitis,Judith A.Lucky-Eftimov,Sandra M.Winsted,Sandra M.Nowak,
Susan A.Welsh,Christina L.Sandoval,Linh Eck,and Jessica B.Dempsey
of the City of Chicago State of IlhnoiS their true and lawful Attomey(s)-in-Fact,
1' each in their separate capacity if more than one is named above,to sign,execute,seal and acknowledge any and all bonds,recoggnizances,conditional undertakings and
other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons,guaranteeing the performance of
contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law.
IN WITNESS WiIEREGF,the Companies have caused this instrument to be signed and their corporate seals to be hereto affixed,this 28th
day of_ August' _2017
Farmington Casualty Company St.Paul Mercury Insurance Company
Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company
Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company of America
St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company
('. St.Paul Guardian Insurance Company
,...+�+I t7s L1,.' \.TY Ary Yw�py
Ry`4
�' • '�` O�i Z �4vy. P Q'RPO 1 14 '.;Z s, 4 `fL � �yC \OYY "VJ
ms`stT�' a r 2 1.9.51 g J:, :n; a�; --' :o; w HARTFORD, t FYIRCFORq <
SEA.L:'a: CONN. n e� CQNM. .2 N 1896 -.
�y >• ��d T� � W;/fix n N�r��� ''`��b 1.......JSA J v.'... :`ds F �6 a` �iy�•..-.•'$ 0�'1 ��
' `.....�'N'� �5�.,•.,.,...""'� e'� �a1 �:vc�aa° SII AtN
State of Connecticut By:
City of Hartford ss. Robert L.Raney,Senior Vic President
On this the 28th day of August 2017 before me personally appeared Robert L.Raney,who acknowledged himself to
be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul
Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers
Casualty and Surety Company of America,and United States Fidelity and Guaranty Company,and that he,as such,being authorized so to do,executed the foregoing
instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer.
i
�,;Er
In Witness Whereof,I hereunto set my hand and official seal. TAP?
My Commission expires the 30th day of June,2021. �1/e�to Marie C.Tetreault,Notary Public
58440-5-16 Printed in U.S.A.
WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER
IHLiP:R F=;.'
Power of Attorney
Federal Insurance Company ( Vigilant Insurance Company I Pacific Indemnity Company
Know All by These Presents,That FEDERAL INSURANCE COMPANY,an Indiana corporation,VIGILANT INSURANCE COMPANY,a New York corporation,and PACIFIC
INDEMNITY COMPANY,a Wisconsin corporation,do each hereby constitute and appoint Marcia K.Cesafsky, Debra J. Doyle,Derek J. Elston,Jennifer L.Jakaitis,
Judi Lucky-Eftimov,James B.McTaggart,Linda M.Napolillo,Sandra M.Nowak,Diane M.O'Leary,Christina L.Sandoval,Christopher P.Troha,Susan
A.Welsh and Sandra M.Winsted of Chicago,Illinois--------------
each as their true and lawfiil Attorney-in-Fact to execute under such designation in their names and to affix their corporate seals to and deliver for and on their behalf as surety
thereon or otherwise,bonds and undertakings and other writings obligatory in the nature thereof(other than bail bonds)given or executed in the course of business,and any
instruments amending or altering the same,and consents to the modification or alteration of any instrument referred to in said bonds or obligations.
In Witness Whereof,said FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY have each executed and attested these
presents and affixed their corporate seals on this 1711 day of February,2017.
1}uv:n M.Chloroc.:lssistant Secretary Stephen M.Ilancy.Vicc President
Q
STATE OF NEW JERSEY
CountyofHunterdon ss.
On this 17"day of February,2017 before me,a Notary Public of New Jersey,personally came Daum M.Chloros,to me lmoum to be Assistant Secretary of FEDERAL INSURANCE
COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY,the companies which executed the foregoing Power of Attorney,and the said Dawn M.
Chloros,being by me duly sworn,did depose and say that she is Assistant Secretary of FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC
INDEMNITY COMPANY and knows the corporate seals thereof,that the seals affixed to the foregoing Power of Attorney are such corporate seals and were thereto affixed by
authority of said Companies;and that she signed said Power of Attorney as Assistant Secretary of said Companies by like authority;and that she is acquainted with Stephen M.
Haney,and]mows him to be Vice President of said Companies;and that the signature of Stephen M.Haney,subscribed to said Power of Attorney is in the genuine handwriting of
Stephen M.Haney,and was thereto subscribed by authority of said Companies and in deponent's presence.
Notarial Seal KATHERINE RY PUBLIC J.O NEINJ,R
NeTMY y, NCTARY PUBLIC OF NEW,IERSEY
No.2316585
PUBLt Ctunm1561an Expire[July 16,2019 Noun'Puboe
JEA`�
CERTIFICATION
Resolutions adopted by the Boards of Directors of FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY on August 30,2016:
"RESOLVED,that the following authorizations relate to the execution,for and on behalf of the Company,ofbonds,undertakings.recognizances,contracts and other written commitments ofthe Company
entered into in the ordinary course ofbusiness(each a"Written Commitment"):
(1) Each of the.Chairman,the President and the vice Presidents of the Company is hereby authorized to execute any Written Commitment for and on behalf of the Company,under the
seal of the Company or otherwise.
(2) Each duly appointed attorney-in-fact of the Company is hereby authorized to execute any Written Commitment for and on behalf of the Company,under the sea]of the Company or
otherwise,to the extent that such action is authorized by the grant of powers provided for in such person's written appointment as such attorney-in-fact
(3) Each of the Chairman,the President and the vice Presidents of the Company is hereby authorized,for and on behalfoftbe Company,to appoint in writing any person the attomer
in-fact of the Company with full power and authority to execute,for and on behalfof the Company,under the seal of the Company or otherwise.such Written Commitments ofthe
Company as may be specified in such written appointment which specification may be by general type or class of Written-Commitments or by specification of one or more particular
written Commitments.
(4) Each of the Chairman.the President and the Vice Presidents of the Company is hereby authorized,for and on behalf of the Company,to delegate in writing to any other officer of the
Company the authority to execute,for and on behalf of the Company,under the Company's seal or otherwise,such Written Commitments ofthe Company as are specified in such
written delegation,which specification may be by general type or class of Written Commitments or by specification crone or more particular Written Commitments.
(5) The signature of any officer or other person executing any Written Commitment or appointment or delegation pursuant to this Resolution,and the seal ofthe Company,may be affixed by
facsimile on such Written Commitment or written appointment or delegation. .
FURTHER RESOLVED, that the foregoing Resolution shall not be deemed to bean exclusive statement of the powers and authority of officers,employees and other persons to act for and on behalf of
the Company,and such Resolution shall not limit or otherwise affect the exercise of any such power or authority otherwise validly granted or vested"
L Dawn M.Chloros,Assistant Secretary of FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY(the"Companies")do hereby
certify that
(i) the foregoing Resolutions adopted by the Board of Directors ofthe Companies are true,correct and in full force and effect,
(ii) the Companies are duly licensed and authorized to transact surety business in all 50 of the United States of America and the District of Columbia and are
authorized by the U.S.Treasury Department;further,Federal and Vigilant are licensed in the U.S.Virgin Islands,and Federal is licensed in Guam,Puerto Rico,
and each ofthe Provinces of Canada except Prince Edward Island;and
(iii) the foregoing Power of Attorney is true,correct and in full force and effect I
Given under my hand and seals ofsaid Companies at Whitehouse Station,NJ,this � � I � ✓
0
D,rv:n M.Chlora...W� ictMu Secrctat a
IN THE EVENT YOU IRISH TO NOTIFY US OF A CLAIM,VERIFY THE ALTHENTICrrl'OF THIS BOND OR NOTIFY CIS OF ANY OTHER MATTER,PLEASE CONTACT US AT:
Telephone(908)903-3493 Fax(908)903-3656 e-mail:surecy@chubb.com
Form 15-10-0225B-U GEN CONSENT(rev.12-16)
FIIVAL WAIVER OF LIEN
Whereas McCARTHY has been employed by_ The City of Fort Worth _ to
perform construction services as provided under the Contract dated 7/9/2014 for
the premises known as the Village Creek Water Reclamation Facility
For and in consideration of One Million Thirteen Thousand Six Hundred and Two Dollars and
Sixty-Seven cents Dollars ($ 1,013,602.67), which amount represents full and final payment
of the Total Contract Amount of Twenty-Five Million Three Hundred and Sixty Fou>
Thousand, Nine Hundred and Seventy-Five Dollars ($_25,364,975.00 ), and other good and
valuable considerations including, but not limited to, the release of McCARTHY by the Owner,
as evidenced by final payment to McCARTHY, from all claims relating to the Project, except for
latent defective work and warranty obligations as provided under the Contract, the receipt
whereof is hereby acknowledged, McCARTHY does hereby waive and release, except for
unresolved claims McCARTHY may have, any and all lien or claim or right of lien under the
applicable statutes, relating to Mechanic's liens, on the above described premises and
improvements thereon, and on the monies or other considerations due or to become due from the
Owner, on account of labor or services, material, fixtures or apparatus furnished by the
undersigned for the above described premises.
McCARTHY
B
y ig
Title
Authorized Representative
STATE OF _ 1
ss.
COUNTY OF 1
Subscribed and sworn to before me this 6 day of
NotamLiblic
My Com /ission Expires:
O'A�� ! y4Y-Pu\, Mada L Escobedo
+ My Commission Expires
01/16!2020
Avol.doe-091211 R
AFFIDAVIT OF BILLS PAID
STATE OF Texas §
COUNTY OF Dallas §
Before me, the undersigned authority, personally appeared
(name), the Pru;o,T (title) of_McCarthy Building Tompanies, Inc
(Company), who upon his/her oath deposed and said:
On City of Fort Worth Contract described as:
Village Creek Peak Flow Management Facilities Project, (Contract Description)
All persons, firms, associations, corporations, or other organizations furnishing
labor and/or materials have been paid in full all amounts due and owing as of this date
except for those noted on the attached schedule. Any unpaid future obligations will be
paid and satisfied directly out of funds paid in reliance on this affidavit; and
The wage scale established by the City Council in the City of Fort Worth has been
paid in full; and
There are no claims pending for personal injury and/or property damages.
All of the provisions of this release shall bind the McCarthy Building Companies
Inc. (Company) and its legal representatives, successors and assigns and shall inure to
the benefit of the City.
The person signing this document represents that he/she is duly authorized to do
so on behalf of McCarty Building Companies, Inc (Compa ).
By-
Title:
yTitle: P,-,
SUBSCRIBED, WORN TO AND ACKNOWLEDGED BEFORE ME by
306 F-R.ZIkv on this the M day of 6�.��tc�vu , 20_Lb to certify
which witness m hand and official seal of office. ki
Notary Public to of Texas My commission expires:
KIMBERLY DAWN GIBBONS
.�ITKY LB ii
°' `^y Notary Public,State of Texas
lam. My Commission Expires
November 07, 2019
SCHEDULE OF UNPAID AMOUNTS
ContractorNendor Name: Amount Paid Amount Owed Percentage Owed
C Green Sca in LP $ 636,199.32 $ 33,484.18 5 %
Facility Solutions Group $ 2,351,707.52 $ 215,246.58 9.2 %
Fluid Dynamics Inc. $_ 70,315.20 $_22,204.80 24 %
Pump Solutions Inc. $ 49,937.41 $30,257.59 37.73 %
If all contractors/vendors have been paid in full and there are no pending or known
claims, write NONE on the first line.
i
i