HomeMy WebLinkAboutContract 49225-A1 CITY SECRETARY> I �,
AMENDMENT No.1 CONTRACT N0. `7tb
TO CITY SECRETARY CONTRACT No. 49225
WHEREAS, the City of Fort Worth (CITY) and Carrillo Engineering, LLC,
(ENGINEER) made and entered into City Secretary Contract No. 49225, (the
CONTRACT) which was authorized by M&C C-28288 on the 20t" day of June,
2017 in the amount of $400, 000; and
WHEREAS, the CONTRACT involves engineering services for the
following project:
Hulen Street at Granbury Road Intersection Improvements; and
WHEREAS, it has become necessary to execute Amendment No. 1 to the
CONTRACT to include an increased scope of work and revised fee.
NOW THEREFORE, CITY and ENGINEER, acting herein by and through their
duly authorized representatives, enter into the following agreement, which
amends the CONTRACT:
1.
Article I of the CONTRACT is amended to include33�the additional
engineering services specified in a proposal dated J� ?il, 2018, a copy
of which is attached hereto and incorporated herein. The cost to City for
the additional design services to be performed by Engineer totals
$ 230, 000 (See Attached Funding Breakdown Sheet, Page -3-)
2 .
Article II of the CONTRACT is amended to provide for an increase in
the fee to be paid to Engineer for all work and services performed under
the Contract, as amended, so that the total fee paid by the City for all
work and services shall be an amount of $ 630, 000 .
3.
All other provisions of the Contract, which are not expressly amended
herein, shall remain in full force and effect.
EXECUTED and EFFECTIVE as of the date last written by a signatory,
below.
City of Fort Worth
Professional Services Agreement Amendment Template
CFW Official Release 9/19/2017
Page 1 of 4
OFFICIAL RECORD
CITY SECRETARY
�9` FT.WORM,TX
APPROVED:
City of Fort Worth Carrillo lEngineering, LLC
Sus n anis Anna C. Blackwell, P.E.
Assistant City Manager Managing Member
DATE: DATE: Z e
APPR VAL RECOMMENDED:
Douglas 0. Wiersig, P.
Director, Department of Transportation and
Public Works
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 .
4J��1E. Lopez, P.E.
Project Manager
City of Fort Worth
Professional Services Agreement Amendment Template
CFW Official Release 9/19/2017
Page 2 of 4
APPROVED AS TO FORM AND LEGALITY: M&C: C-28764
Date: /June 26, 2018
Douglas W. Black
5A Assistant City Attorney
ATTEST:
Ary' J. Ka erg O �
City Secretary
§#-
City of Fort Worth
Professional Services Agreement Amendment Template
CFW Official Release 9/19/2017
Page 3 of 4
FUNDING BREAKDOWN SHEET
City Secretary No. 49225
Amendment No. 1
Department Fund-Account-Center Amount
TPW 34018-0200431-5330500-101017-003930-9999 $230, 000 . 00
Total :
City of Fort Worth
Professional Services Agreement Amendment Template
CFW Official Release 9/19/2017
Page 4 of 4
301 Commerce Street,Ste. 1410
Ca -Carrillo Engineering Fort Worth,Tx 76102
Carrillo Engineering,LLC 817-697-4996
July 3, 2018
Mr. Raul E. Lopez, P.E.
Transportation and Public Works Department
City of Fort Worth
200 Texas Street
Fort Worth, Texas 76102
Re: Hulen Street at Granbury Road Intersection Improvements
City Project No. 101017—Amendment No. 1
Dear Mr. Lopez,
Please find attached Amendment No. 1 for the Hulen Street at Granbury Road Intersection
Improvements for an hourly amount not-to-exceed plus expenses of $230,000. A detailed scope of
services can be found in Attachment A and a Level of Effort chart has also been provided.
We appreciate the opportunity to provide professional services for the City of Fort Worth. If additional
information or clarification is needed, please give me a call at 817-697-4996.
Sincerely,
Carrillo Engineering, LLC
Anna C. Blackwell, P.E.
Managing Member
Attachment:
Amendment No. 1
Attachments A—D
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ATTACHMENT "A"
Scope for Engineering Design Related Services for Hulen Street at Granbury Road Intersection
Improvements
The scope set forth herein defines the work to be performed by the ENGINEER in completing
the project. Both the CITY and ENGINEER have attempted to clearly define the work to be
performed and address the needs of the Project.
OBJECTIVE
Complete final construction plans and specifications for the intersection of Hulen Street and
Granbury Road. The project includes the reconstruction of approximately 500 linear feet in all
directions from the intersection. The project involves the realignment of traffic lanes, widening
at the intersection, reconfiguration of the tum lanes to increase capacity at the intersection, and
traffic signal design. The typical cross section will be in accordance with the current MTP.
The scope forAmendment No. 1 includes, but is not limited to, project management, data
collection for record drawings, topographic survey, SUE, right-of-way documentation, TDLR and
railroad permitting, utility relocation and final design plans, specifications and opinion of
probable construction costs, bidding and construction phase services, and additional task orders
as necessary.
WORK TO BE PERFORMED
ENGINEER hereby agrees to provide design services as requested by the CITY during the term
of this AGREEMENT. Work under this agreement will be performed on a Task Order basis. The
CITY will request services for each Task Order. The ENGINEER shall prepare scope, fee and
schedule as necessary to perform the services requested for each Task Order within 10 working
days of the CITY's request.
Each Task Order shall include scope for services as Attachment"A". This scope will outline
tasks required to complete the Task Order. For each task the scope shall include a detailed
description of the task, outline any assumptions and list the required deliverables.
Each Task Order shall include Attachment"B" detailing the compensation for the Work
Authorization. Compensation will be based upon hours agreed to by the CITY and the
ENGINEER for each Work Authorization. Compensation will be based on the Schedule of Rates
in Attachment "B"of this agreement. The fee will include an estimate of reimbursable and sub-
consultant cost for each Task Order. Compensation for each Task Order shall be based upon
agreed upon not-to-exceed fee and paid via invoiced amount.
If the Task Order requires a schedule it shall be attached as Attachment"D".
City of Fort Worth,Texas
Attachment A
PMO Release Date:07.23.2012
Page 1 of 1
ATTACHMENT B
COMPENSATION
Intersection Improvements at Hulen Street and Granbury Road
Time and Materials with Rate Schedule Project
I. Compensation
A. The ENGINEER shall be compensated in an hourly amount not-to-exceed
$230,000 for personnel time, non-labor expenses, and subcontract expenses in
performing services enumerated in Attachment A as follows:
i. Personnel Time. Personnel time shall be compensated based upon hours
worked directly in performing the PROJECT multiplied by the appropriate Labor
Catgg-ory Rate for the ENGINEER's team member performing the work.
Labor Category Rate as presented in the rate schedule table below is the rate for
each labor category performing the work and includes all direct salaries,
overhead, and profit.
Labor Category Rate
($/hour)
Project Director $200
Sr. Project Engineer $175
Project Engineer/ Professional $150
EIT $120
Designer $120
CADD $90
Administrative $75
ii. Non-Labor Expenses. Non-labor expenses shall be reimbursed as Direct
Expenses at invoice or internal office cost.
Direct Expenses (non-labor) include, but are not limited to, mileage, travel and
lodging expenses, mail, supplies, printing and reproduction services, other direct
expenses associated with delivery of the work; plus applicable sales, use, value
added, business transfer, gross receipts, or other similar taxes.
iii. Subcontract Expenses. Subcontract expenses and outside services shall
be reimbursed at cost to ENGINEER plus a markup of ten percent (10%).
iv. Budgets. ENGINEER will make reasonable efforts to complete the work
within the budget and will keep the City informed of progress toward that end so
that the budget or work effort can be adjusted if found necessary.
ENGINEER is not obligated to incur costs beyond the indicated budgets, as may
be adjusted, nor is the City obligated to pay ENGINEER beyond these limits.
City of Fort Worth,Texas
Attachment B
PMO Official Release Date:8.09.2012
Page 1 of 4
B-1
ATTACHMENT B
COMPENSATION
If ENGINEER projects, in the course of providing the necessary services that the
PROJECT cost presented in Article 2 of this Agreement will be exceeded, whether
by change in scope of the project, increased costs or other conditions, the
ENGINEER shall immediately report such fact to the City and, if so instructed by
the City, shall suspend all work hereunder.
When any budget has been increased, ENGINEER's excess costs expended prior
to such increase will be allowable to the same extent as if such costs had been
incurred after the approved increase.
B. The ENGINEER shall be paid monthly payments as described in Section II -
Method of Payment.
II. Method of Payment
A. The ENGINEER shall be paid by the City based upon an invoice created on the
basis of statements prepared from the books and records of account of the
ENGINEER, based on the actual hours and costs expended by the ENGINEER
in performing the work.
B. Each invoice shall be verified as to its accuracy and compliance with the terms of
this Agreement by an officer of the ENGINEER.
C. ENGINEER shall prepare and submit invoices in the format and including content
as presented in Exhibit B-1.
D. Payment of invoices will be subject to certification by the City that such work has
been performed.
III. Progress Reports
A. The ENGINEER shall prepare and submit to the designated representative of the
Transportation and Public Works Department monthly progress reports and
schedules in the format required by the City.
City of Fort Worth,Texas
Attachment B
PMO Official Release Date:8.09.2012
Page 2 of 4
B-2
ATTACHMENT B
COMPENSATION
IV. Summary of Total Project Fees
Firm Primary Responsibility Fee Amount %
Prime Consultant
Carrillo Engineering, Civil Engineering Services $173,500 75.4%
LLC
Proposed MBE/SBE Sub-Consultants
The Rios Group Level A SUE and test holes $4,000 1.7%
Gorrondona & As-built Survey $12,500 5.4%
Associates, Inc.
Non-MBE/SBE Consultants
Kimley-Horn and Traffic Services and Project $40,000 17.5%
Associates, Inc. Support
TOTAL $230,000 100.00/0
Project Number& Name Total Fee MBE/SBE Fee MBE/SBE
CPN 101017— Hulen Street at
Granbury Road Intersection $230,000 $16,500 7.2%
Improvements
City MBE/SBE Goal = 8.0% Consultant Committed Goal*= 8.4%
"Based on effective amount,excluding contingency
City of Fort Worth,Texas
Attachment B
PMO Official Release Date:8.09.2012
Page 3 of 4
B-3
EXHIBIT "B-1"
ENGINEER INVOICE
(Supplement to Attachment B)
To be included with each Work Authorization.
City of Fort Worth,Texas
Attachment B
PMO Official Release Date:8.09.2012
Page 4 of 4
B-4
ATTACHMENT "C"
CHANGES AND AMENDMENTS TO STANDARD AGREEMENT
Design Services for
Intersection Improvements at Hulen Street at Granbury Road
City Project No. 101017
No changes to the Standard Agreement are proposed.
City of Fort Worth,Texas
Attachment C
PMO Release Date:05.19.2010
Page I of 1
Consulting Contract Schedule Specifications FORT WO RT H
City of Fort Worth Capital Improvement Program
Attachment D-Project Schedule
This PROTECT requires a Tier 3 schedule as defined herein and in the City's Schedule Guidance
Document.
D1. CONSULTING SERVICES SCHEDULE DEVELOPMENT: The CONSULTANT shall
prepare schedules for consulting services that meet the requirements described in this
specification, showing by Critical Path Method (CPM) the planned sequence and timing of
the Work associated with the Agreement. All submittals shall be submitted in PDF format,
and schedule files shall also be submitted in native file format (i.e. file formats associated
with the scheduling software). The approved scheduling software systems for creating the
schedule files are:
- Primavera (Version 6.1 or later or approved by CITY)
- Primavera Contractor(Version 6.1 or later or approved by CITY)
- Microsoft Project(Version 2003/2007 or later or approved by CITY)(PHASING OUT)
D2. BASELINE CONSULTING SERVICES SCHEDULE: Following notice-to-proceed, the
CONSULTANT shall develop, submit and review the draft detailed baseline consulting
services schedule with the CITY to demonstrate the CONSULTANT's understanding of the
Agreement requirements and approach for performing the work. The CONSULTANT will
prepare the final detailed baseline consulting services schedule based on CITY comments,if
any,and submit to the CITY no later than the submittal of the first project invoice.
The following guidelines shall be adhered to in preparing the baseline schedule, and as
described in further detail in the CITY's Schedule Guidance Document.
a. The scope shall be subdivided by work breakdown structure (WBS)representing the
tasks,subtasks,and activities associated with delivering the work.
b. The schedule shall accurately describe the major work activities,key milestones, and
dependencies/relationships as appropriate to the work.
c. The schedule should include appropriate meetings, review periods, critical decision
points,including third party utility dependencies and reviewing agencies.
D3. PROGRESS CONSULTING SERVICES SCHEDULE: The CONSULTANT shall prepare
and submit monthly to the CITY for approval the updated schedule in accordance with D1
and D2 and the CFJ Y's Schedule Guidance Document inclusive. As the Work progresses,
the CONSULTANT shall enter into the schedule and record actual progress as described in
the CITY's Schedule Guidance Document.
The updated schedule submittal shall also include a concise schedule narrative that
highlights the following,if appropriate and applicable:
• Changes in the critical path,
• Expected schedule changes,
• Potential delays,
• Opportunities to expedite the schedule,
• Coordination issues the CITY should be aware of or can assist with,
City of Fort Worth,Texas
Attachment D
PMO Release Date:02.15.2011
Page 1 of 2
• Other schedule-related issues that the CONSULTANT wishes to communicate to the
CITY.
D4. PERFORMANCE AND CONSULTING SERVICES SCHEDULE: If the work
accomplished falls behind that scheduled due to factors within the CONSULTANT's
control, the CONSULTANT shall take such action as necessary to improve the progress of
the Work. In addition, the CITY may require the CONSULTANT to submit a revised
schedule demonstrating the proposed plan to make up the delay in schedule progress and
to ensure completion of the Work within the allotted Agreement time.
D5. SCHEDULE TIERS SPECIAL INSTRUCTIONS:
The requirements for the schedule are determined based on the nature and needs of the
project. The schedule tier for this project is stated at the top of this document.
CONSULTANT shall submit each schedule relying on the CITY's current Schedule
Guidance Document.
D6. SCHEDULE SUBMITTAL AND PAYMENT:
As stated in III.A.(1). of the Agreement, CONSULTANT shall provide the information
required by Attachment D. CONSULTANT's monthly invoices will not be accepted and
processed for payment without monthly schedule updates that are submitted in the time
and manner required by Attachment D and the CITY's current Schedule Guidance
Document.
City of Fort Worth,Texas
Attachment D
PMO Release Date:02.15.2011
Page 2 of 2
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Official site of the City of Fort Worth,Texas
CITY COUNCIL AGENDA FoR�I-I
COUNCIL ACTION: Approved on 6/26/2018
DATE: 6/26/2018 REFERENCE C-28764 LOG NAME: 202018 BOND PROGRAM
NO.: PROPOSITION A
CODE: C TYPE: NOW PUBLIC NO
CONSENT HEARING:
SUBJECT: Authorize Execution of New or Amendments to Existing Engineering Services Agreements
for Design and Construction Management Services for 22 Major Thoroughfare, Arterial and
Intersection Projects Identified in the 2018 Bond Program (COUNCIL DISTRICTS 2, 3, 4,
6, 7, 8, and 9)
RECOMMENDATION:
It is recommended that the City Council authorize execution of the following engineering contracts or
amendments to current engineering contracts for design and construction management services for major
thoroughfare, arterial and intersection improvement projects identified in the 2018 Bond Program as
indicated below:
Contract Amendments:
1.Amendment No.1, in an amount not to exceed $425,000.00 to City Secretary Contract(CSC)49226, an
Engineering Agreement with Kimley-Horn and Associates, Inc., for design of transportation improvements
along Bonds Ranch Road from Hawks Landing Road to Blue Mound Road/FM 156 (101009),for a revised
contract amount not to exceed $1,295,000.00;
2. Amendment No. 1, in an amount not to exceed $90,000.00 to City Secretary Contract(CSC)49227, an
Engineering Agreement with Halff Associates, Inc., for design of transportation improvements along
Westport Parkway, from Alta Vista Parkway to Beach Street(101019), for a revised contract amount not to
exceed $565,000.00;
3.Amendment No. 1, in an amount not to exceed $843,000.00 to City Secretary Contract(CSC)49555, an
Engineering Agreement with HDR Engineering, Inc., for design of transportation improvements along
Avondale Haslet Road, from Willow Creek Drive to Haslet County Line Road/FM 156 (101014), for a
revised contract amount not to exceed $1,243,000.00;
4.Amendment No. 1, in an amount not to exceed $595,000.00 to City Secretary Contract(CSC)49024;an
Engineering Agreement with Kimley-Horn and Associates, Inc., for design of transportation improvements
along Harmon Road, from Golden Triangle Boulevard to US HWY 287 (100459), for a revised contract
amount not to exceed $2,395,000.00;
5. Amendment No. 1, in an amount not to exceed $750,000.00 to City Secretary Contract(CSC)49229, an
Engineering Agreement with Pacheco Koch Consulting Engineers, Inc., for design of transportation
improvements at the intersection of Kroger Drive at State Highway 377 and Basswood Boulevard at State
Highway 377 (101015), for a revised contract amount not to exceed $1,150,000.00;
6.Amendment No. 1, in an amount not to exceed $1,500,000.00 to City Secretary Contract(CSC)49556,
an Engineering Agreement with Burns & McDonnell Engineering Company, Inc., for design of transportation
improvements along Cromwell Marine Creek from Boat Club Road to Old Decatur Road (101012), for a
revised contract amount not to exceed $1,900,000.00;
�Y.Amendment No. 1, in an amount not to exceed $230,000.00 to City Secretary Contract(CSC)49225, an
Engineering Agreement with Carrillo Engineering, LLC, for design of intersection improvements at S. Hulen
Street and Granbury Road (101017)for a revised contract amount not to exceed $630,000.00;
8.Amendment No. 1, in an amount not to exceed $360,000.00 to City Secretary Contract(CSC)49228, an
Engineering Agreement with Lee Engineering, LLC, for design of intersection improvements at Park Vista
http://apps.cfwnet.org/council_packet/mc review.asp?ID=26022&counciidate=6/26/2018 7/11/2018
1V1M%_1 l.cvicw Page 2 of 4
Boulevard and Keller Haslet Road (101020) for a revised contract amount not to exceed $760,000.00;
New Contracts:
9. An Engineering Agreement with Wier&Associates, Inc., for design of intersection improvements at
Golden Triangle Boulevard and Harmon Road (101013), in an amount not to exceed $250,000.00;
10. An Engineering Agreement with HDR Engineering, Inc., for design of transportation improvements
along W. 7th Street from University Drive to the Trinity River(101555) in an amount not to exceed
$750,000.00;
11. An Engineering Agreement with Schrickel, Rollins and Associates, Inc., for design of transportation
improvements along Riverside Drive from Golden Triangle to Keller Hicks in an amount not to exceed
$700,000.00;
12. An Engineering Agreement with Cobb Fendley &Associates, Inc:., for design of transportation
improvements along the University Drive Corridor from Trail Drive to Park Hill (101588), in an amount not to
exceed $900,000.00;
13. An Engineering Agreement with AECOM, Inc., for design of intersection improvements at Crowley Road
and N. Crowley Cleburne Road (101578) and Alta Mesa Boulevard and Crowley Road (101579) in an
amount not to exceed $594,580.00;
14. An Engineering Agreement with Multatech Engineering, Inc., for design of intersection improvements at
E. Seminary Road and Mansfield Highway (101590) and McCart Avenue and Altamesa Boulevard
(10 1572) in an amount not to exceed $690,778.00;
15. An Engineering Agreement with Pape—Dawson Engineering, Inc., for design of intersection
improvements at Beach Street and Basswood Boulevard (101582) in an amount not to exceed
$398,195.00;
16. An Engineering Agreement with JT Engineering, Inc., for design of intersection improvements at E.
Northside Drive and Cold Springs Road (101584) in an amount not to exceed $442,886.80;
17. An Engineering Agreement with Bridgefarmer&Associates Inc., for design of intersection
improvements at W. Long Avenue and Angle Avenue (101583) in an amount not to exceed $455,985.00;
18. An Engineering Agreement with Hayden Consultants, Inc., for design of intersection improvements at S.
Normandale Street and Las Vegas Trail (101591) in an amount not to exceed $528,013.00;
19. An Engineering Agreement with Kimley-Horn and Associates, Inc., for design of intersection
improvements at NW Loop 820 and Marine Creek Parkway (101585) in an amount not to exceed
$432,000.00.
DISCUSSION:
In preparation for the 2018 Bond Program and to advance delivery of projects, engineering contracts were
executed on 13 potential Jump Start Projects (Mayor and Council Communication (M&C) C-28288 June 20,
2017) to further define individual project cost and identify possible risks that would impact costs and
delivery schedules. Funding for these Jump Start Projects(*) was authorized on May 16, 2017 in the
amount of$10M (M&C G-19009). The following summarizes the contract awards for the 2018 Bond
Program 11 Major Thoroughfare and Arterial projects, and 11 Intersection Improvement projects:
2018 Bond Program Major Thoroughfare and Arterial
Project Name Engineering Consultant NTE Contract
Amendment
*Bonds Ranch Road- Hawks Landing to Kimley-Horn &Associates, Inc. $425,000.00
Blue Mound Road/ FM 156 - CD 7
*Westport Parkway-Alta Vista Parkway to Halff Associates, Inc. $90,000.00
Beach Street- CD 7
*Avondale Haslet Road-Willow Creek HDR Engineering, Inc $843,000.00
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Drive to Haslet County Line Road -CD 7
*Harmon Road-Golden Triangle Kimley-Horn &Associates, Inc. $595,000.00
Boulevard to US 287 -CD 7
* US 377 at Basswood Boulevard and Pacheco Koch Consulting $750,000.00
Kroger Drive- CD 4 Engineers, Inc.
*Cromwell Marine Creek- Boat Club Road Burns & McDonnell $1,500,000.00
to Old Decatur Road -CD 2 Engineering Company, Inc.
*Golden Triangle Boulevard and Harmon Wier&Associates Inc. $250,000.00
Road (New Contract) -CD 7
University Drive -Trail Drive to Park Hill Cobb Fendley&Associates, $900,000.00
(New Contract) - CD 9 Inc.
Riverside Drive - Golden Triangle Schrickel, Rollins &Associates, $700,000.00
Boulevard to Keller Hicks Road (New Inc.
Contract) - CD 7
West 7th Street- University Drive to Trinity HDR Engineering, Inc. $750,000.00
River (New Contract) -CD 9
2018 Bond Program Intersection Improvements
Project Name Engineering NTE
Consultant Contract/Amendment
Amount
*S. Hulen Street and Granbury Road - CD Carrillo Engineering, $230,000.00
6 LLC
*Park Vista Boulevard and Keller Haslet Lee Engineering, LLC $360,000.00
Road -CD 7
Crowley Road and N. Crowley Road AECOM, Inc $306,375.00
Cleburne Road -CD 6
Alta Mesa Boulevard and Crowley Road - AECOM Inc. $288,205.00
CD8
E. Seminary Road and Mansfield Multatech Engineering, $350,900.00
Highway -CD 8 Inc.
McCart Avenue and Alta Mesa Boulevard Multatech Engineering, $339,878.00
-CD 6 Inc.
Beach Street and Basswood Boulevard - Pape-Dawson $398,195.00
CD 4 En ineerin , Inc.
E. Northside Drive and Cold Springs JT Engineering, Inc. $442,866.80
Road - CD 2
W. Long Avenue and Angle Avenue - CD Bridgefarmer $455,985.00
2 Associates, Inc.
S. Normandale Street and Las Vegas Hayden Consultants, $528,013.00
Trail -CD 3 Inc.
NW Loop 820 and Marine Creek Kimley-Horn & $432,000.00
Parkway - CD 2 Associates, Inc.
Available resources within the General Fund will be used to provide interim financing for expenditures
incurred on projects within the 2018 Bond Program until debt is issued. Once debt associated with these
projects is sold, bond proceeds will reimburse the General Fund, in accordance with the statement
expressing official Intent to Reimburse that was adopted as part of the ordinance approving the bond election
and authorizing the appropriation of funds.
M/WBE OFFICE —All firms being awarded new engineering contracts/amendments are in compliance with
the City's BDE Ordinance.
These projects are located in COUNCIL DISTRICTS 2, 3, 4, 6, 7, 8, and 9.
http://apps.cfwnet.org/council_packet/mc_review.asp?ID=26022&councildate=6/26/2018 7/11/2018
M&C Review Page 4 of 4
FISCAL INFORMATION/CERTIFICATION:
The Director of Finance certifies that upon approval of the above recommendations, funds are available in
the current capital budget as appropriated, of the 2018 Bond Program Fund. Prior to an expenditure being
incurred, the participating department has the responsibility to validate the availability of funds.
TO
Fund Department Account Project Program Activity Budget Reference# Amount
ID ID Year (Chartfield 2)
FROM
Fund Department Account Project Program Activity Budget Reference# Amount
ID ID Year ChartField 2
Submitted for City Manager's Office b : Susan Alanis (8180)
Originating Department Head: Douglas Wiersig (7801)
Additional Information Contact: Kim Arnold (2552)
ATTACHMENTS
All 1295 Forms.pdf
Maps 2018 Borid Prog Proposition A.pdf
http://apps.cfwnet.org/council_packet/mc review.asp?ID=26022&councildate=6/26/2018 7/11/2018
0- �� - q .
CERTIFICATE OF INTERESTED PARTIES FORM 12$5
loll
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. 2017-209954
Carrillo Engineering,LLC
Fort Worth,TX United States Date Filed:
2 Name of governmental entity or state agency that is a parry to the contract for which the form is 05/18/2017
being filed.
City of Fort Worth Date kn ledged:
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.
101017
Civil engineering services for infrastructure improvements at the intersection of Hulen Street and Gran bury Road in Fort Worth,
Texas.
4 Nature of interest
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling I Intermediary
Blackwell,Anna Fort Worth,TX United States X
5 Check only if there is NO Interested Party. ❑
6 AFFIDAVIT I swear,or affirm,under penalty of pejury,that the above disclosure is true and correct.
rA'nr" e1 ANGIE LANINGHAM
fy �} My Notary ID p 129285995
0-
y Expires Jimmy 30,2021A— 8
9 SS�gnaunir of authwlxed agent of contracting business ergty
AFFIX NOTARY STAMP/SEAL ABOVE (� (�
Sw to and subscribed before me,by the said t"- rf.'f UtU�-`1�F�{ this the _day of r ,
20�,to certify which,witness my hand and seal of office.
ftmworimokm
ature officer ad tistering 611 Printed ame of officer admini ring oath Title of officer administering oath
Farms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.883