HomeMy WebLinkAboutContract 45595-A2 CITY SECRETARY, _
AMENDMENT No.02 CONTRACT NO. I
TO CITY SECRETARY CONTRACT No. 45595
WHEREAS, the City of Fort Worth (CITY) and Carollo Engineers, Inc. ,
(ENGINEER) made and entered into City Secretary Contract No. 45595 , (the
CONTRACT) which was authorized by M&C C-26779 on the 22nd day of April ,
2014 in the amount of $ 149,000 . 00 ; and
WHEREAS, the CONTRACT was subsequently revised by Amendment No. 01
in the amount of $700 ,000 .00 authorized by M&C C-28171 ; and
WHEREAS, the CONTRACT involves engineering services for the follow-
ing project:
Enclosure of Gaseous Chlorine and Sulfur Dioxide Storage Facilities
Project at Village Creek Water Reclamation Facility
WHEREAS, it has become necessary to execute Amendment No. 02 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 agree-
ment, which amends the CONTRACT:
1 .
Article I of the CONTRACT is amended to include the additional
engineering services specified in Attachment A - Scope of Services dated
August 1, 2018 , attached hereto and incorporated herein. The cost to
City for the additional engineering services during construction to be
performed by Engineer totals $780 ,000 . 00 .
1629
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 $1, 629,000 . 00 .
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,
Jt
ED
any City of Fort Worth,Professional Services Agreement Amendment Template OFFICIAL RiMCGRE)
0/1,qOfficial Release 9/19/2017 �x Lw Page 1 of 3
! 07yS�S q�pAry CITY SEC�`s:�"i�?�b.1
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APPROVED: ENGINEER:
City of Fort Worth Carollo Engineers, Inc.
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Jesus J. Chapa l Hish "Hutch Musallam, P.E.
Assistant City Manager Vice President
/1
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Scott Hoff, E.
Senior Vice President
DATE: AV /V Z8 DATE: 2-7
APPROVAL RECOMMENDED:
r"e �-(C.
Christopher P. Harder, PE M&C: C-28837
Director, Water Department Date: 9/11/2018
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APPROVED AS TO FORM AND LEGALITY:
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Douglas W. Black
Assistant City Attorney
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ATTEST: OR�O. ,GfjO
U,
M ry J.6 s
City Sec etary
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
requi ents.
Seiavash Mir
Project Manager
City of Fort Worth,Professional Services Agreement Amendment Template
CFW Official Release 9/19/2017 Page 2 of 3
FUNDING BREAKDOWN SHEET
City Secretary No. 45595
Amendment No. 2
Department Fund-Account-Center Amount
Total :
City of Fort Worth,Professional Services Agreement Amendment Template
CFW Official Release 9/19/2017 Page 3 of 3
August 1,2018
ATTACHMENT A
SCOPE OF SERVICES
CITY OF FORT WORTH
VILLAGE CREEK WATER RECLAMATION FACILITY
ENCLOSURE OF GASEOUS CHLORINE & SULFUR DIOXIDE STORAGE FACILITIES
The scope of work presented herein represents the Office Services portion of the Engineering services
During Construction for the Village Creek Wastewater Treatment Plant Enclosure of Gaseous Chlorine&
Sulfur Dioxide Storage Facilities.The design contract documents refer to this project as"Enclosure of
Gaseous Chlorine and Miscellaneous Improvements Project".
ENGINEER will support the construction phase of the project. For this project ENGINEER refers to Carollo
Engineers, Inc.and its subconsultants including JQ Infrastructure(JQI),Gupta and Associates, Inc. (GAI)
and Azcarate and Associates Consulting Engineers(AACE).
ENGINEER will provide the services of a part time Resident Project Representative(RPR).CITY will
provide the services of a qualified inspector who will work with ENGINEER's personnel. ENGINEER will
endeavor to protect CITY in providing these services however,it is understood that ENGINEER does not
guarantee the CONTRACTOR's performance, nor is ENGINEER responsible for supervision of the
CONTRACTOR's operation and employees. ENGINEER is not responsible for the means,methods,
techniques,sequences,or procedures of construction selected by the CONTRACTOR,or any safety
precautions and programs relating in any way to the condition of the premises,the work of the
CONTRACTOR or any SUBCONTRACTOR. ENGINEER is not responsible for the acts or omissions of any
person(except its own employees or agents)at the project site or otherwise performing any of the work
of the Project.
Task 450—Additional Services during Design Phase
Subtask 415—Additional Effort during Design
ENGINEER furnished additional services during the design phase as summarized below.This effort has
already been spent and will be reallocated to this subtask.
1. Provided a memorandum evaluating the suitability using the existing chlorine storage area to
house the new scrubbers.
2. Conducted a site visit and include a written evaluation of the abandoned chlorine tanks at the
Holly WTP.
3. Evaluated options for housing the new evaporators and locating the evaporator building.A site
plan and facility layout was prepared with several options.
4. Designed the leak detection system in the existing chlorine evaporator building to make it
consistent and tie all together
5. Designed access platform, piping,and appurtenances,including additional instrumentation and
controls at the sulfur dioxide storage facility.
Page 1 of 4
Task 500—General Administration
Subtask 510—Project Administration& Coordination
ENGINEER will furnish general administrative services to remain current on the project status and to
provide organized execution of work and retrieval of information during the anticipated project duration
of up to 18 months. ENGINEER will coordinate work of subconsultants and communicate with CITY staff.
ENGINEER will provide the necessary M/WBE or SBE submittal and progress report required by CITY.
ENGINEER will provide CITY with monthly progress reports on services performed.Monthly progress
reports will include information such as cumulative percentage of the overall budget expended,a brief
description of work performed during the reporting period,and such other information as may be
appropriate.
Subtask 520—Filing of Project Documents
ENGINEER will utilize the CITY'S BUZZSAW electronic filing system and file project documents for the
duration of the project,assumed at 18 months.
Subtask 530—Pre-Construction Conference
ENGINEER will conduct a pre-construction conference to establish communication procedures between
the CITY,CONTRACTOR,and ENGINEER;to review schedule,submittal requirements,shut-down and
operational constraints;and other construction issues. Engineer will provide a proposed agenda and a
summary of the discussions.
Task 600—Engineering Services during Construction
The ENGINEER subconsultants will provide engineering services during construction as described below.
Services in excess to what is described below are considered additional services.Services are based on a
construction time not exceeding 18 months in accordance with the construction contract documents.
Subtask 610—Monthly Progress Meetings and Site Visits
ENGINEER will visit the project site on a monthly basis and attend monthly progress meetings. Engineer
will also conduct a site visit at the day of the monthly progress meeting.The purpose of the monthly
visits is to consult with OWNER the CONTRACTOR regarding project issues.This task allows for total of
up to eighteen(18)monthly visits. Engineer will provide a proposed agenda and summary of the
discussions.
Subtask 620—Weekly Coordination Conference Calls
ENGINEER will participate in weekly conference calls with CITY,CONTRACTOR,and CITY's Resident
Inspector as required.The intent of these conference calls is communicate with CITY's Resident
Inspector the intent of contract documents,discuss design details,stay current on project progress,and
assist in resolving situations that may arise during the construction.Action Items and decision logs will
be documented.
August 1,2018 Page 2 of 4
Subtask 630—Additional Site Visits
The ENGINEER will conduct additional site visits to observe certain construction tasks, review or verify
field conditions, as needed or requested by CITY for a total of thirty two(32)one-person visit through-
out the construction period as follows. It is assumed that each visit will take approximately 4 hours
including travel time and documentation.These visits are in addition to the services of the part time
resident project representative(RPR).A brief summary of the purpose of the trip,general observations,
action Items and decision logs will be documented.
A. Structural. Up to ten (10)one person visits.
B. Process Mechanical &Piping. Up to (6)visits
C. Electrical/I&C. Up to ten (10)visits.
D. HVAC: Up to six(6)visits.
Subtask 635—Part Time Resident Project Representative
ENGINEER will provide the services of a part-time Resident Project Representative to conduct on-site
observation services on as needed basis and to support the efforts of the CITY's Inspector. 1250 hours
are assumed for this effort.This effort includes coordination, construction observation,and travel time.
The RPR will act as directed by ENGINEER and in coordination with CITY, in order to assist ENGINEER in
inspecting performance of the work of the Contractor when RPR is on the project site. It is understood
that for the limited RPR engagement,CITY will provide its own qualified inspector at the project site who
will act as the primary inspector of the work.
Through on-site inspections of the work in progress and field checks of materials and equipment by the
RPR and the CITY's inspector, ENGINEER will endeavor to identify defects and deficiencies in the work of
the Contractor, but the furnishing of such resident project representation will not make ENGINEER
responsible for construction means, methods,techniques,sequences or procedures, or for safety
precautions or programs,or for the Contractor's failure to perform their work in accordance with the
Contract Documents. RPR's dealings in matters pertaining to the on-site work will in general be with
ENGINEER,CITY's inspector and Contractor, keeping CITY and project team advised as necessary. RPR's
dealings with Subcontractors will only be through or with full knowledge and approval of Contractor.
RPR will communicate with the CITY's Resident Inspector,with the knowledge of and under the direction
of ENGINEER.
CITY and ENGINEER will review the job progress on a quarterly basis in accordance with the construction
schedule,to verify the assumed effort required to complete job tasks as defined in the Scope of
Services.
General observations,action Items and decision logs will be documented when Engineer's RPR services
are furnished.
Subtask 640—Submittals
ENGINEER will review Shop Drawings, Pay Applications, Record Data, Operation and Maintenance
Manuals,and other submittals for conformance with the intent of the Contract Documents.This task
assumes a maximum of three hundred (300)submittals and re-submittals. ENGINEER will provide status
update of the submittals during the scheduled monthly progress meetings.Additional submittals or
excessive reviews will be considered as additional service. ENGINEER will track the budget expended for
submittal review beyond (2) two re-submittal for reimbursement by CONTRACTOR through CITY.
August 1,2018 Page 3 of 4
Submittals will generally be reviewed and returned within the timeframe allotted per the Construction
Documents.
Subtask 650—Responses to Requests for Information
CONTRACTORS issue Requests for Information (RFIs) periodically during the course of a construction
project to clarify details associated with the design project.The ENGINEER will prepare responses to
substantive RFIs. It is assumed that up to fifty(50) RFI responses will be prepared throughout the
duration of the project.
Subtask 660—Change Orders
Review and provide the CITY with recommendations on CONTRACTOR'S CHANGE ORDER(CO) requests.
A total of three(3)change orders are assumed for this task.Change orders that are assumed for this
task are for elements that do not require additional design or extensive engineering effort.
Subtask 670—Start-up assistance
ENGINEER will assist the City in the start-up of the facilities.A total of up to three(3)start-up assistance
visits are included in this task. Each start-up visit will include approximately three(3) ENGINEERING
Personnel, 1 day per person inclusive of travel.
Subtask 680—Project Closeout
ENGINEER will assist in project completion activities at the conclusion of the construction. Including
observation of completed construction for general conformance with the design concept and
preparation of a list of deficiencies to be corrected by the CONTRACTOR before final payment can be
recommended.Services include preparing a preliminary list of deficiencies;a follow-up review of project
after the punch list has been completed by the CONTRACTOR,and a final walk through with the CITY
staff.
Subtask 690—Record Drawings
Using information obtained from CONTRACTOR's record drawings and the field set of contract
documents maintained by CITY, ENGINEER will revise the Contract Documents at the end of the project
to record drawing status.The drawings will be issued in draft form for review and comment by the CITY.
A final set will be prepared based on comments received. It is assumed that CONTRACTOR will provide a
detailed set of drawings showing changes made throughout the construction.
Deliverables:
Five(5) reduced size sets(11"x 17")and 1 full size set of record drawings will be submitted to the CITY
along with a CD of the electronic drawings and pdf format.
August 1,2018 Page 4 of 4
ATTACHMENT B
COMPENSATION
Engineering Services during Construction
Enclosure of Chlorine and Sulfur Dioxide Facilities Project
City Project No. 02273
Time and Materials with Multiplier Project
I. Compensation
A. The ENGINEER shall be compensated 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 Direct Salaries
multiplied by a factor of 3.35.
Direct Salaries are the amount of wages or salaries paid ENGINEER's
employees for work directly performed on the PROJECT, exclusive of all payroll-
related taxes, payments, premiums, and benefits.
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.
A flat PECE charge rate of $ 11.70 per hour of staff member will be invoiced to
cover project equipment and communication expenses.
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.
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.
City of Fort Worth,Texas
Attachment B
PMO Official Release Date:8.09.2012
Page 1 of 4
B-1
ATTACHMENT B
COMPENSATION
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
Water 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
Carollo Engineers, Inc. Project oversight, coordination, $ 603,888.00 77.4%
construction observation,
engineering services during
construction etc.
Proposed MBE/SBE Sub-Consultants
Gupta &Associates, Engineering services during $ 106,453.00 13.6%
Inc. (GAI) construction associated with
electrical instrumentation and
control.
JQ Infrastructure, LLC Engineering services during $ 31,000.00 4%
(JQI) construction associated
structural.
Azcarate and Engineering services during $ 38,659.00 5%
Associates Consulting construction associated
Engineers, LLC (AACE) heating, scrubbers, ventilation,
and air conditioning.
Non-MBE/SBE Consultants
TOTAL $ 780.000.00 100%
Project Number& Name Total Fee MBE/SBE Fee MBE/SBE
780 000.00 176 112.00 22.6%
City MBE/SBE Goal = 19% Consultant Committed Goal = 22 %
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)
Insert required invoice format following this page, including negotiated total budget and
allocations of budgets across work types and work phases.
City of Fort Worth,Texas
Attachment B
PMO Official Release Date:8.09.2012
Page 4 of 4
B-4
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City of Fort Worth, Texas
Mayor and Council Communication
COUNCIL ACTION: Approved on 9/11/2018 - Ordinance No. 23368-09-2018 & Resolution
No. 4973-09-2018
DATE: Tuesday, September 11, 2018 REFERENCE NO.: **C-28837
LOG NAME: 60CHLORINE AND SULFUR DIOXIDE
SUBJECT:
Authorize Execution of a Construction Contract with Crescent Constructors, Inc., in the Amount of
$8,573,000.00, Authorize Execution of Amendment No. 2 to City Secretary Contract No. 45595, in the
Amount of$780,000.00, an Engineering Agreement with Carollo Engineers, Inc., for Additional
Construction Services and Management each for the Construction of the Enclosure of the Gaseous
Chlorine and Sulfur Dioxide Storage Facilities Project, Adopt Resolution Expressing Official Intent to
Reimburse Expenditures with Proceeds of Future Debt, Provide for Project Staff Costs and Contingencies
and Adopt Appropriation Ordinance (COUNCIL DISTRICT 5)
RECOMMENDATION:
It is recommended that the City Council:
1. Adopt the attach Resolution expressing Official Intent to Reimburse expenditures with proceeds
from future debt for the construction of the Enclosure of Gaseous Chlorine and Sulfur Dioxide
Storage Facilities Project;
2. Adopt the attached Appropriation Ordinance increasing appropriations in the Commercial Paper
Fund in amount of$9,870,000.00 for construction of the Enclosure of Gaseous Chlorine and Sulfur
Dioxide Storage Facilities Project;
3. Authorize the execution of a construction contract with Crescent Constructors, Inc., in the amount of
$8,573,000.00 for Construction of the Enclosure of Gaseous Chlorine and Sulfur Dioxide Storage
Facilities Project and provide for project staff costs and contingencies;
4. Authorize Amendment No. 2 to City Secretary Contract No. 45595, in the Amount of$780,000.00,
an Engineering Agreement with Carollo Engineers, Inc., for additional construction services and
construction management for the construction of Enclosure of Gaseous Chlorine and Sulfur Dioxide
Storage Facilities Project (City Project No. 02273).
DISCUSSION:
The Village Creek Water Reclamation Facility uses gaseous chlorine and sulfur dioxide in the chlorination
and dechlorination treatment process. The aging equipment associated with this treatment process is in
need of replacement and upgrades and the facilities need to be updated and improved to reduce the risk
of leaks, increase the functionality and reliability of the systems and reduce maintenance costs. This
Project consists of modifications, additions, and/or replacements of the chlorine and sulfur dioxide storage
tanks in order to improve safety and reduce risk.
On April 22, 2014 (M&C C-26779), the City Council authorized an engineering agreement with Carollo
Engineers, Inc., to evaluate options to reduce risk and replace aging equipment at the chlorine and sulfur
dioxide facilities. On April 4, 2017 (M&C C-28171), the City Council authorized Amendment No. 1 to the
engineering agreement for the preparation of plans and specifications to make the recommended
modifications to the chlorine and sulfur dioxide storage facilities.
http://apps.cfwnet.org/ecouncil/printmc.asp?id=26077&print=true&DocType=Print 10/2/2018
As part of Amendment No. 2, the Engineer will perform construction phase services, including project and
construction management, shop drawing reviews, and special inspections.
This Project was advertised on May 24, 2018 and May 31, 2018 in the Fort Worth Star-Telegram. On
June 28, 2018, the following bids were received.
BIDDER BID AMOUNT Fontract
Crescent Constructors, Inc. 11$8,573,000.00 11480 Calendar Days
Archer Western Construction $8,638,000.00
Felix Construction Company $8,812,798.00
lGaracon Construction, Inc. $9,336,389.00
In addition to the contract cost$260,000.00 is required for staff project management and inspection and
$257,000.00 for project change orders and contingency for a total construction cost of$9,090,000.00.
This project is anticipated to be included in a future revenue bond issue for the Water and Sewer Fund.
Available cash within the Water and Sewer portfolio and the City's portfolio along with the appropriation
authority authorized under the Callable Commercial Paper Program (CP)will be used to provide interim
financing for this project until debt is issued. To the extent resources other than the Water and Sewer
portfolio are used to provide interim financing, the Water and Sewer Fund will be charged interest that is
equivalent to the overall rate of return being earned by the City portfolio (currently approximately one-
percent annually). Should the City's portfolio not support the liquidity needed to provide an interim short-
term financing source, another funding source will be required, which could mean issuance of securities
under the CP Program or earlier issuance of Water and Sewer revenue bonds than is currently planned.
Once debt associated with this project is sold, bond proceeds will be used to reimburse the Water and
Sewer portfolio and the City's portfolio in accordance with the attached Reimbursement Resolution.
The City Council adopted the Water Department's Fiscal Year 2018-2022 Five Year Capital Improvement
Plan on September 26, 2017. This City Council adopted plan includes this specific project, with funding
identified through the CP program to be reimbursed with future revenue bonds. In accordance with the
provisions of the Financial Management Policy Statement, Staff anticipates presenting revenue-supported
debt issuances to the City Council for consideration within the next three years. This debt must be issued
within approximately three years to provide reimbursement for these expenses. If that does not occur, the
costs will no longer be reimbursable by issuing tax-exempt debt and the funding source will have to be
made whole through budgetary methods. Adoption of this resolution does not obligate the City to sell
bonds, but preserves the ability to reimburse the City from tax-exempt bond proceeds.
Construction is anticipated to commence in November 2018, with a contract time of 480 calendar
days. The construction is estimated to be completed by end of April 2020.
M/WBE OFFICE: Crescent Constructors, Inc., is in compliance with the City's DBE Ordinance by
committing to seven percent MBE participation and documenting good faith effort. Crescent Constructors,
Inc. identified several subcontracting and supplier opportunities. However, the firms contacted in the areas
identified did not respond or did not submit the lowest bids. The City's MBE goal on this project is 25
percent.
MWBE OFFICE: Carollo Engineers, Inc. is in compliance with the City's BDE Ordinance by committing to
43 percent SBE participation on this Amendment No. 2. The City's goal on this Amendment is 19 percent.
Additionally, Carollo Engineers is a certified M/WBE firm.
http://apps.cfwnet.org/ecouncil/printmc.asp?id=26077&print--true&DocType=Print 10/2/2018
This project will have no impact on the Water Department's annual operating budget when completed.
This project is located in COUNCIL DISTRICT 5, the Village Creek Water Reclamation Facility serves ALL
COUNCIL DISTRICTS, Mapsco 68.
FISCAL INFORMATION /CERTIFICATION:
The Director of Finance certifies that upon approval of the above recommendations and adoption of the
attached appropriation ordinance, funds will be available in Water& Sewer Commercial Paper Fund for
the of Enclosure of Gaseous Chlorine and Sulfur Dioxide Storage Facilities Project. The Water and Sewer
Commercial Paper Fund includes authority of$150,000,000.00 for the purpose of providing interim
funding for Water and Sewer Capital Project. After this transfer, the balance will be $116,890,765.00 for
future capital projects. Funding will be as depicted in the table below for the Enclosure of Gaseous
Chlorine and Sulfur Dioxide Storage Facilities Project.
FUND Existing Additional project Total*
Appropriations Appropriations
F
2017A Water&
Sewer Bond Fund $795,000.00 $0.00 $795,000.00
56011
Water & Sewer
Commercial Paper $0.00 $9,870,000.00 $9,870,000.00
Fund 56016
Sewer Capital
Fund- Legacy $212,000.00 $0.00 $212,000.00
59607
Project Total $1,007,000.00 $9,870,000.00 $10,877,000.00
Numbers rounded for presentation purposes.
FUND IDENTIFIERS (FIDs):
TO
Fund Departmentccoun Project JProgram ctivity Budget Reference# moun
ID 1A ID Year Chartfield 2
FROM
Fund Department�Accounj Project Program ctivity Budget Reference# moun
ID ID Year (Chartfield 2)
CERTIFICATIONS:
Submitted for City Manager's Office by: Jay Chapa (5804)
Originating Department Head: Chris Harder (5020)
Additional Information Contact: Seiavash Mir (8404)
ATTACHMENTS
1. 60CHLORINE AND SULFUR DIOXIDE 56016 A018.docx (Public)
2. 60CHLORINE AND SULFUR DIOXIDE Crescent Constr MWBE.pdf (CFW Internal)
3. 60CHLORINE AND SULFUR DIOXIDE FID Table.pdf (CFW Internal)
4. 60CHLORINE SULFUR DIOXIDE REIMB RESOLUTION.docx (Public)
5. Carolla Engineers Form 1295.pdf (Public)
6. Carollo Engineers Sam Form.pdf (CFW Internal)
7. Carollo MWBE Compliance Memo.pdf (CFW Internal)
8. Crescent Construction Form 1295 Chlorine.pdf (Public)
9. LOCATION MAP.pdf (Public)
http://apps.cfwnet.org/ecouncil/printmc.asp?id=26077&print=true&DocType=Print 10/2/2018
10. SAM Crescent Constructors..pdf (CFW Internal)
http://apps.cfwnet.org/ecouncil/printmc.asp?id=26077&print—hve&DocType=Print 10/2/2018
CERTIFICATE OF INTERESTED PARTIES FORM 1295
l of l
Complete Nos.l-a and 6 it there are interested parties. OFFICE USE ONLY
Complete Nos.1,2,3,5,and 6 if there are no interested parties. CERTIFICATION OF FILING
I Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business. 12018-379186
Carollo Engineers,Inc.
Dallas,TX United States Date Filed:
2 Name of governmental entity or state agency that is a party tot the contract for which the form is 07/12/2018
being filed.
City of Fort Worth Date Ac7 ,:,wledged:
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
02273
Engineering services for the Village Creek WRF Enclosure of Gaseous Chlorine&Miscellaneous Improvements Project
4 Nature of interest
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling Intermediary
Hart,Vincent Broomfield,CO United States X
Wachter,Russell Phoenix,AZ United States X
Wason,Ash Costa Mesa,CA United States X
Carella,Louis Walnut Creek,CA United States X
Hagstrom,James Walnut Creek,CA United States X
Narayanan,Balakrishnan Walnut Creek,CA United States X
Bames,Michael Walnut Creek,CA United States X
5 Check only if there is NO Interested Party. ❑
6 UNSWORN DECLARATION v
My name is_ / r and my date of birth is — W .
My address is v` L�/,n �/wSt�` �h I � OZ
(street) (city) (state) (zip code) (country)
I declare under pertalty of perjury that the foregoing is true and correct. d
7 0
Executed in �`�Gh County, State of �0<413 ,on the I(�day of 20
(mo (year)
CHRISTINE THOMPSON
NoUry ID•190018112 Signature of a rized agent of compat ng business entity
My Commission Expires (Declarant)
Forms pro a Ethic www.ethics.state.tx.us Version V1.0.6711