HomeMy WebLinkAboutContract 50567-AR2 FORT WORTH® City of Fort worth CITY SECRETARY
Construction Allowance Request BreakdownnNCTNO..
Construction CA# 0 Date 9/6/2018 City Sec# 1 50567
Client Project#(s)J 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 $48,067.00 $48,067.00 15
Original Allowance Available for Allocation $95,785.00 $95,785.00
Allowance Funds Previously Allocated $7,720.00 $7,720.00
Remaining Funds Available for this Allocation $88,065.00 $88,065.00
JUSTIFICATION SUMMARY'
Construction Allowance funds are requested for the installation of a ribbon curb on True Avenue and traffic signal loops on Overton Park Drive
East
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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.
OFFICIAL RECORD
CITY SECRETARY
FT.WORTH,TX
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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 $0.00
CFW Construction Allowance Request Approval CAAppr-03 Page 1 of 3
Routing
Assigned To: Due Date:
Assigned By: Due Time:
Links 1
fortworthgov/Infrastructure Projects/101265 - HMAC (2017-5)/Contractor/Change Orders/allowance request 2/allowance
2 - ribbon curb& l000s.xlsm
Attachments 101
No Attachments have been added to this form.
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CFW Construction Allowance Request Approval CAAppr-03 Page 2 of 3
FORTWORTH.,' City of Fort Worth
fir•..-� Construction Allowance Request Approval
(Construction Allowance Breakdown Available in Links)
For Construction Allowance Submittal No.: 2
Construction Allowance Request Approval No.: CAAppr-03
Date Started: 2018-09-20 Date Due: 2018-11-09
City Sec. No.: 50567
Project Name: HMAC (2017-5)
101265 DOE Numbers:
Project Numbers:
Project Removal and replacement of nonfunctional curb and gutter,
Description: driveways and sidewalks, followed by the pulverization and
stabilization of the existing pavement and a 2" HMAC overlay.
Project/Contract
Compliance Kristian Sugrim City Inspector: Martina Salinas
Manager:
Contractor: ]LB Contracting, LLC.
COST AND DAYS SUMMARY:
Requested
Department: Cost($) Fund Account Center: Days:
TPW $ 48,067.00 30100-0200431-5740010-101265-0 15
Total Cost: $ 48,067.00 Total Requested Days: 15
Approval Status:
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CFW Construction Allowance Request Approval CAAppr-03 Page 3 of 3
Approved: Yes
Comments:
User: Lane Zarate
Date: 2018-09-21 4:50 PM
Approved: Yes
Comments: OR
User: Doug Wiersig :,..•
Date: 2018-09-21 1:19 PM .�, %0
PP 1�1tpSt d: y'
A roved: Yes *'• :'*
Comments:
User: Doug Black
Date: 2018-09-24 3:32 PM aryS. C
Approved: Yes
Comments:
User: Susan Alanis 1��IA1
Date: 2018-09-29 10:49 AM M&C: 1
1295:. , ..
Action Required:
F
RECORD
RETARY
H, TX
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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 Su rim w---•
Printed Name Sign ure
K
ECORD1=TARYH,TX