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Contract 50567-AR1
_ Cit of Fort Worth CIN SECRETARY FORT WORTH Y CONTRACT NO. 5©Sko7 A k 1 Construction Allowance Request Breakdown Construction CA# 0 Date 7/16/2018 City Sec# 1 50567 Client Project#(s)l 101265 FAC#(s) Project Name HMAC 2017-5 Street Rehabilitation at Various Locations Description Contractorl JLB Contracting, LLC City Inspector Martina Salinas Funding TPW Select Day Type Allocation Account Totals Original Contract Amount $1,945,950.00 $1,945,950.00 210 Extras to Date Credits to Date Current Contract Amount $1,945,950.00 $1,945,950.00 210 Amount of Proposed Allocation $7,720.00 $7,720.00 Original Allowance Available for Allocation $95,785.00 $95,785.00 Allowance Funds Previously Allocated Remaining Funds Available for this Allocation $95,785.00 $95,785.00 JUSTIFICATION SUMMARY Construction Allowance funds are requested for the installation of concrete steps and 2:27 base repair for utility cuts repair on 8th.Avenue as well as for trees pruning for the installation of combination sidewalk on Travis Ave. It is understood and agreed that the acceptance of this Construction Allowance Request by the contractor constitutes an accord and satisfaction and represents payment in full for all costs arising out of,or incidental to,the above Construction Allowance Request.Contract Time will be adjusted on the basis of the time shown on this Construction Allowance Request by a later Change Order,if necessary. J OFFICIAL RECORD r ' CITY SECRETARY FT.WORTH,T( ��� gS � �ZIV Mu - - 0 ti cD 0 `" CD 0 0 0 C6CD 0 Ln o C m O Lo m O r C::,�$ m U Cd co -tf _T m U � U U) -i _o UCD O O O O OO O CL Cl) CD CO O c > co O 3 Z_- LO O U N Y Qo L M W 00 }1 O (6 u) (ND : d N O Ln C o Z � � o F- - F- LL O v U o a`, O ?� m O _ O -j uo U Q � M = s � O > U V o L — Df i� c0 N - C U O J J L C � Cd O ` N C N U o MSI _ Q m Y O U) c � O O O � ~ *k *k a p o � N Q Z U C O vOi ca N ¢O 'p u- ami 0 3 c N LL a_ OU Co U '. C � E E 0ON _ 0 N U 1- rt � U 0 () 04 M d' CD 0 0 0 0 0 N N ti ti r-- ~ N O 0 Q H O N O N a bD (O CL C O Y Q Q) Q) bD c (O U 0 o � m c 0 coo U Q)co -tf ZD C C _T cu U � c `o U N Q ❑ C W 3 O LU cC W L m O m � � 4-j ! t C:) ro 7 cB W fa- d O W o � U O v Q v LL _ o J ' ° o m Q ° U Q - z bio O o U cu V +-' o fn _ z 0cu p a U) LLJ 04 0 U a> � � c o ��..��..II coo U W N QH L U o m O in v E o c o k *k m _Q cu QLL- E.,y Qa� m U O� a o C C d r_ 2 U Eiy 0 U 0 0 0 0 c 0 � D a 76 H 0 co 0 N W ticd C O ..'Z 4J W i 4J 0 W h0 C L U MIWBE Breakdown for this Construction Allowance Request MWBE Sub Type of Service Amount for this FOA Total $0.00 Previous Construction Allowance Requests CO# DATE AMOUNT Total $0.00 CFW Construction Allowance Request Approval CAAppr-02 Page 1 of 3 Routing Assigned To: Due Date: Assigned By: Due Time: Links 1 fortworthgov/Infrastructure Projects/101265 - HMAC (2017-5)/Contractor/Change Orders/Copy of allowance 1 - steps base repair combo sw trees approved.xlsm Attachments(0) No Attachments have been added to this form. https:Hprojectpoint.buzzsaw.com/ bz_web/Forms/ForrnPrint.aspx?Siteld=51500&Processl... 8/16/2018 CFW Construction Allowance Request Approval CAAppr-02 Page 2 of 3 FORT WORTH. city of Fort Worth Construction Allowance Request Approval (Construction Allowance Breakdown Available in Links) For Construction Allowance Submittal No.: 1 Construction Allowance Request Approval No.: CAAppr-02 Date Started: 2018-07-25 Date Due: 2018-09-13 City Sec. No.: 50567 Project Name: HMAC (2017-5) 101265 DOE Numbers: Project Numbers: Project Removal and replacement of nonfunctional driveways, curb & Description: gutter and sidewalks; followed by the pulverization and stabilization of the existing pavement and a 2" HMAC overlay. Project/Contract Compliance Kristian Sugrim City Inspector: Martina Salinas Manager: Contractor: JLB Contracting, LLC. COST AND DAYS SUMMARY: Requested Department: Cost($) Fund Account Center: Days: TPW $ 7,720.00 30100-0200431-5740010-101265-0 Total Cost: $ 7,720.00 Total Requested Days: 0 Approval Status: https://projeetpoint.buzzsaw.com/ bz_web/Forms/FormPrint.aspx?Siteld=51500&ProcessI... 8/16/2018 Lr w Lonstruction Allowance xequest Approval LAAppr-U2 rage s of s Approved: Yes Comments: User: Lane Zarate Date: 2018-07-25 10:02 PM M&C. Approved: Yes 1295. 'j I `� Comments: User: Ricardo Matute Date: 2018-07-30 2:59 PM Approved: Yes Comments: User: Doug Wiersig Date: 2018-07-30 4:49 PM Approved: Yes Comments: User: Doug Black Date: 2018-08-01 6:19 PM Att81 y. Approved: Yes Comments: Mary J. ity S User: Susan Alanis �( a Date: 2018-08-15 8:27 PM Action Required: IEXP� OFFICIAL RECORD CITY SECRETARY FT.WORTH,TX i i https://projeetpoint.buzzsaw.com/ bz_web/Forms/ForrnPrint.aspx?SiteId=51500&ProcessI... 8/16/2018 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. Kristian Sugrim. Name of Employee/Signature Project Manager Title This form is N/A as No City Funds are associated with this Contract Kristian Sugrim v. . Printed Name Signature OFFICIAL RECORD CITY SECRETARY FT.WORTH,TX G