HomeMy WebLinkAboutContract 47795-FP1 FORTWORTH, CITY SECRUARY
CONTRACT No. � S"
45, TRANSPORTATION AND PUBLIC WORKS
� NOTICE OF PROJECT COMPLETION
City Ptpject NO: 100122
Regarding contract 47795 for BRIDGE REHABILITATION AT TEN LOCATIONS 2016-1 as required by the
TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by City Council on 44/19/2016
through M&C C-27681 the director of the TRANSPORTATION AND PUBLIC:WORKS DEPARTMENT upon
the recommendation of the Assistant Director of the Transportation&Public Works Department has a4cepted the
project as complete.
Original Contract Prices: S443,255.501-
Amount
443255.501-
Amount of Approved Change Orders: $103,427.13-ke 1,2
Revised Contract Amount: $546,682.63✓�
Total Cost Work Completed: $546,682.63
Less Deductions:
Liquidated Damages: Days @$210.00/Day
Pavement Deficiencies:
Total Deduction Amount: $0.00
Total Cost Work Completed: $546,682.63'
Less Previous Paym is $519,348.50
Final Payment Du $27,334.
Recommends for-Acc4tance Dat
Asst. Director, TPW - Infrastructure Design and Construction
Accepted Date
jW Director,
TRANSPORTATION AND PUBLIC WORKS DEPARTMENT
Q'�" ai&"J-- C () E �'
Asst. i Manager Date
Comments:
LCIALC'MSECRERI
'00f�D415 Le
epartmen�t toff TI'W Const. Services
CPN4:1 �
Project Manager
Management
Risk Manag S. Gatewo D.O.E. Brotherton I
Water V. Gutzier
CFA Janie M rales/Scanned a �;
The Iroceeding+peoPle have been Contacted concerning the request
for final payment&have released this project for such payment.
Clearance Conducted By Etta Ba-ey
i?,s
X16
k l Iff
Construction Invoice
Contract: CS47795 P.O.# PO-17-97145 Payment Date: 8/13/2018
TO:Gibson&Associates Inc. INV.# CS47795-8 —� Estimate No. 8 DOE:
11210 Ryliecrest �D 0 U U T 7� D ^ I ProjManager Tariqul Islam
Balch Springs TX 75180 K tI (�! ��' n
FOR: 2016-1 BRIDGE REHABILITATION AT TEN LOCATIONS
Contract Amount: $554,161.50
Completed Ret Pen Adj Pay
Total to Date: $546,682.63 $0.00 $0.00 $0.00 $546,682.63
Previous Estimate: $546,682.63 $0.00 $0.00 $0.00 $519,348.50
Earned to Date: $0.00 ($27,334.13) $0.00 $0.00 $27,334.13
Payments:
30100-0200431-5740010--100122-002680-2016- $542,095.50
Comments:CO#1 -$98,840.00
Total to Date: $534,616.63 $0.00 $0.00 $0.00 $534,616.63
Previous Estimate: $534,616.63 $26,730.83 $0.00 $0.00 $507,885.80
Earned to Date: $0.00 ($26,730.83) $0.00 $0.00 $26,730.83
30100-0200431-5740010-100122-002680 $12,066.00
CO#2:$12,066.00
Total to Date: $12,066.00 $0.00 $0.00 $0.00 $12,066.00
Previous Estimate: $12,066.00 $603.30 $0.00 $0.00 $11,462.70
Earned to Date: $0.00 ($603.30) $0.00 $0.00 $603.30
PURCHASE ORDER MUST
APPEAR ON INVOICE
Transportation if Public Works
BUSINESS SUPPORT GROUP
Contact Person/Phone Number
DANA GUTHEIL X 8972
Department Approval Signature(Printed)
CAROL BUKOVIC X 8648
ttmentApproval Sig 4Qatez
( 0 n l�
11
Tuesday,October 16,2018 Page 1 of 1
BRIDGE REHABILITATION AT TEN LOCATIONS (2016-1), CPN 100122
BRIDGE OVER MAP DISTRICT
Spur 347/Belknap Street (East Bound) Railroad 63W 9
Spur 347/Belknap Street (West Bound) Railroad 63W 9
East Northside Drive Samuels Avenue 62R 2
East Northside Drive Railroad 63J 9
East Northside Drive Trinity River 62R 2
Brennan Avenue Tributary of Trinity River 62H 2
Basswood Boulevard White Branch 36U 4
Cantrell Sansom Road Little Fossil Creek 49A 2
East Vickery Boulevard Sycamore Creek 78J 8
East 4th Street Trinity River 63U 8
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Contractor Final Estimate Approval Final-9-Estimate Page 2 of 3
FORTWORTH, Contractor Final Estimate Approval
Date Started: 8/22/2018Date Due: 9/5/201819
Invoiced Amount:
(Amount from $ 27,334.13 Request No.: Final-9-Estimate
Line 8 of C-620)
Project Name: Bridge Rehabilitation (2016-1)
Project Number: 100122
Invoice No.: 8 & Final
Reference:
Contractor: Joe Montgomery
Discussion: Final Payment for Retainage - Green Sheet
(Limit 5000)
Approval Status:
https://projectpoint.buzzsaw.com/ bz_web/Forms/FormPrint.aspx?Siteld=51500&Proces... 10/17/2018
Contractor Final Estimate Approval Final-9-Estimate Page 3 of 3
Approved: Yes
Comments:
User: Tommy McKinnon
Date: 2018-08-22 9:18 AM
Approved: Yes
Comments:
User: Etta Bacy
Date: 2018-08-22 11:00 AM
Approved: Yes
Comments:
User: Joe Montgomery
Date: 2018-08-22 11:11 AM
Approved: Yes
Comments:
User: Ron Cordova
Date: 2018-08-27 7:51 AM
Approved: Yes
Comments:
User: Tariqul Islam
Date: 2018-09-05 4:14 PM
Approved: Yes
Comments:
User: Riad Nusrallah
Date: 2018-09-10 8:32 AM
Approved: Yes
Comments:
User: Lauren Prieur
Date: 2018-09-11 9:41 PM
Approved: Yes
Comments:
User: Dana Gutheil
Date: 2018-10-16 12:34 PM
Approved: Yes
Comments:
User: Carol Bukovic
Date: 2018-10-17 8:10 AM
https:Hprojectpoint.buzzsaw.com/ bz_web/Forms/FormPrint.aspx?Siteld=51500&Proces... 10/17/2018
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CRY SECRETARY ,
FORT ORTH.: City of Fort Worth CONTRACT NO
Change Order Request Breakdown
Project Name Bridge Rehabilitation at Ten Locations City Sec# 477795
Client Project#(s) 100122
Change Order Submittal# I__ J Date 11/3012016
Dept TPW Contract Time
Totals CC?
Original Contract Amount $443,255,50 $443,255.50 150
Extras to Date
Credits to Date
Pending Change Orders(in M&C Process)
Contract Cost to Date $443,255.50 $443,255,50 150
Amount of Proposed Change Order $98,840.00 $98,840,00 20
Revised Contract Amount $542,095.50 $542,095.50 170
Original Funds Available for Change Orders $0.00
Remaining Funds Available for this CO $0.00
Additional Funding(if necessary) $98,840.00 $98,840.00
CHANGE ORDERS to DATE(INCLUDING THIS ONE)AS%OF ORIGINAL CONTRACT 22.3006
MAX ALLOWABLE CONTRACT AMOUNT(ORIGINAL CONTRACT COST+25%) $554,069:38
y USTt9#'TM�
The City of Fort Worth has increased the limits of the approach slabs to be removed due to severity of damage at Belknap/Weatherford Street
Locations. Upon removal of the asphalt overlay at E.4th Street Bridge over Trinity River it was discovered that the deck had deteriorated more
than originally thought and as such 920 SF of partial depth deck repair quantity is added to the contract,
'
Maded�p
gal,KISeemiary
L
N ...........
OMI �A ..
FORT WORTH City of Fort Worth
---v---- Change Order Additions
Project Name I Bridge Rehabilitation at Tete locations City Sec# 471795
Client Project# T Pt22
Change Order Submittal# i i Date 11/30/2016
ADDITIONS
IT M TSCRiPTION DEPT Qty unit n ost Total
Remove Conc.(Approach Slab)
Class S Concrete Approac la 1.
Concrete Structure Repair(Rapid Deck Repair Partial epth, 5 .
TM $98,840.00
Sub Total Additions 40.00
Change Order Additions Page 1 of 1
Fe�itr 4Vt1tz►H City of Fart worth
Change Order Deletions
ProjectName Bridge Rehabilitation at Ten Locations City sec# 417795
Client Project# 100922
Change tattler Submittal# L J Date 1113012015
DELETIONS
DEMIRRUN DEPT City unit Unitos ota
TP ti.Qa
tiota e e ons'
Change Order Deletions Page I of 1
WSBE Breakdown for this Change Order
M/SBE Sub Type of Service Amount for this CO
Reyes Group Class S Concrete(Approach Slab) $28,075.50
Total $28,075.50
Previous Change Orders
co# DATE AMOUNT
N/A
Total $0.00
CFW Change Order Approval St-COApp02 Page 1 of 3
Routing
Assigned To: Due Date:
Assigned By: Due Time:
Links 1
fortworthoov/Infrastructure Projects/100122- Bridge Rehabilitation (2016-1)/Contractor/Chancre Orders/CO #1
Breakdown Rev. 1 12.6.16.xis
Attachments(0)
No Attachments have been added to this form.
https:/iprojectpoint.buzzsaw.com/ bz web/Forms/FormPrint.aspx?Site.Id=51500&ProcessI... 4/14/2017
CFW Change Order Approval St-COAppO2 Page 2 of 3
FORT WORTH,,., City of Fort Worth
Change Order Request Approval
(Change Order Breakdown Available in Links)
For Change Order Submittal No.: St-COSub02
Change Order No.: St-COAppO2 Date Started: 2017-03-24
City Sec. No.: 477795 Date Due: 2017-04-07
Project Name: Bridge Rehabilitation (2016-1)
100122 DOE Numbers:
Project Numbers:
Project Bridge Rehabilitation at Ten Locations
Description:
Project Manager: Tariqul Islam City Inspector: Tommy Mckinnon
Contractor: Gibson & Associates
COUNCIL ACTION (If Required):
M&C Log Name:
M&C Number: M&C Date:
COST AND DAYS SUMMARY:
Requested
Department: Cost($) Fund Account Center: Days:
$ 98,840.00 30100-0200431-5740010-- 20
100122-002680----
Total Cost: $ 98,840.00 Total Requested Days: 20
Approval Status:
httt)s:/,It)roiectr)oint.bu7z,saw.cora/ bz web/Forms/Foii-nPj,-int.aspx?Siteld=51500&ProcessI... 4/14/2017
. CFW Change Order Approval St-COApp02 Page 3 of 3
Approved: Yes
Comments:
User: Joe Montgomery
Date: 2017-03-28 10:16 AM
Approved: Yes
Comments:
User: Tariqul Islam
Date: 2017-03-28 12:19 PM
Approved: Yes
Comments:
User: Riad Nusrailah
Date: 2017-03-29 9:30 PM
Approved Yes
Comments:
User: Richard Martinez
Date: 2017-04-13 10:14 AM
Approved: Yes
Comments:
User: Doug Wiersig
Date: 2017-04-13 8:39 PM
Approved: Yes
Comments:
User: Doug Black
Date: 2017-04-14 10:44 AM
Approved: Yes
Comments:
User: Jay Chapa
Date: 2017-04-14 11:44 AM
Action Required:
https://projeetpoint.buzzsaw.conv`_bz_web/Forms/Fo1inPriiit.aspx?S teld=51500&Processl... 4/1412017
Contract Compliance Manager:
By signing I acknowledge that l am the person responsible
for the monitoring and administration of this contract, including
ensuring all performance and reporting requirements.
Tariqul Islam
A ,c d -N-4 R-q e—&-
Title
„
CITY SECRETARY � n
FORT WORTH City of Fort Worth CONTRACT NO,
Change Order Request Breakdown
Project Namel Bridge Rehab10 Location 2016-1 1 City Sec# 47795
Client Project#(s) CPN 100122
Contractor Gibson&Associates,Inc PM Tariqul Islam Inspector Tommy McKinnon
Change Order Submittal# Date 1/9/2018
Dept. TIPW Water Sewer Contract Time
Totals CD
Original Contract Amount $443,255.50 $443,255.50 150
Extras to Date $98,840.00 $98,840.00 20
Credits to Date
Pending Change Orders(in M&C Process)
Contract Cost to Date $542,095.50 $542,095.50 170
Amount of Proposed Change Order $4,587,13 $0.00 $4,587.13 200
Revised Contract Amount $546,682.63 $546,682.63 370
Original Funds Available for Change Orders $0.00
Remaining Funds Available for this CO $0.00
Additional Funding(if necessary) $4,587.13 1 $4,587.13
CHANGE ORDERS to DATE(INCLUDING THIS ONE)AS%OF ORIGINAL CONTRACT 2333%
MAX ALLOWABLE CONTRACT AMOUNT(ORIGINAL CONTRACT COST+2551.) $554,069.38
This Change Order is to reconcile contract pay items.Time also ran over contract due to delays for Belknap Weatherford bridge approach slab and pavement repair by other
contractor.Delayed mostly due to TxDOT project on Belknap at same location.To consider Downtown traffic during pick season this project need to be delayed for few
months.
C\C`l
CO SSC
4 +4
City of Fort Worth
Change Order Additions
Project Name Bridge Rehab10 Location 2016-1 City Sec# 47795
Client Project# CPN 100122
Contractor Gibson&Associates,Inc PM Tanqul Islam inspector'
Tommy McKinnon
Change Order Submittal# Date 1/9/2018
ADDITIONS
ry Unit Unit Cost Total
1CONC STR REPAIR(RAPID DECK REP)(PRT DPTF— 95.00000000 F 54.
11 CNC STIR REP NERTI AL R OVERHEAD) T/PW 32.40000000 F $140.00
T/PW $12,066.00
Water $0.00
Sewer $0.00
Sub Total Additions $12,066.00
Change Order Additions Page 1 of 1
FORT WOxrx City of Fort Worth
—�vl— Change Order Deletions
Project Name Bridge Rehab10 Location 2016-1 City Sec# 47795
Client Project# CPN 100122
Contractor Gibson&Associates,Inc PMJ Tariq ul Islam Inspector Tommy McKinnon
Change Order Submittal# F2 Date 1/9/2018
DELETIONS
ITEM DESCRIPTION JEH I ty Unit mt ost ota
--77—CNC CRCK REPAIR(DISCRETE)(ROUT AND SEAL) T17w- 30.000000005. =,5 .
21 BRID EC NSTRUCTION ALLOWANCE T/PW 0.59788700 EA 10,000.0 5=, 7
T/PW $7,478.87
Water $0.00
Sewer $0.00
Sub Total Deletions 7,78.87
Change Order Deletions Page 1 of 1
M/SBE Breakdown for this Change Order
M/SBE Sub Type of Service Amount for this CO
Total $0.00
Previous Change Orders
co# DATE AMOUNT
Total $0.00
City of Fort Worth, Texas
Mayor and Council Communication
SIM �
COUNCIL ACTION: Approved on 6/5/2018
DATE: Tuesday, June 5, 2018 REFERENCE NO.: **C-28702
LOG NAME: 20BRIDGE REHABILITATION 2016-1 CHANGE ORDER 2
SUBJECT:
Authorize Execution of Change Order No. 2 to City Secretary Contract No. 47795 with Gibson &
Associates, Inc., in the Amount of$4,587.13 and the Addition of 200 Days to Reconcile Contract Pay Items
for a Revised Contract Amount of$546,682.63 (COUNCIL DISTRICTS 2, 4, 8, and 9)
RECOMMENDATION:
It is recommended that the City Council authorize execution of Change Order No. 2 to City Secretary
Contract No. 47795 with Gibson &Associates, Inc., in the amount of$4,587.13 and the addition of 200
days to reconcile contract pay items and add an additional 200 days for a revised contract amount of
$546,682.63 (City Project No. 100122).
DISCUSSION:
On April 19, 2016, (M&C C-27681) the City Council awarded City Secretary Contract No. 47795 in the
amount of$443,255.50 to Gibson &Associates, Inc., for Bridge Rehabilitation at ten locations as
illustrated in the attached map.
Change Order No. 1 was approved administratively on April 14, 2017 in an amount of$98,840.00 to add
128 square yards of approach slab and 920 square feet of bridge deck repair for E. 4th Street bridge to
this contract.
Change Order No. 2 will reconcile contract pay items based on actual work completed at all locations and
add days to the contract time for delays not caused by the contractor. The major items added to this
change order are 95 square feet of bridge deck repair and 32 square feet of overhead structural repair.
This change order will close out the contract and complete the bridge rehabilitation at the10 locations. This
contract was delayed slightly to avoid other construction activity by TxDOT on the IH-35 project and travel
lane availability on Belknap Street in Downtown. As such, contract time has been extended by 200
calendar days.
Funding for this project is as follows:
Original Contract _ $443,255.50_
'Change Order No. 1 — administrative approval _C$ 98,840.00_ _
Change Order No. 2 —this M&C 1$ 4,587.13
Notal Change Order Amount $103,427.13
Revised Contract Amount ,$546,682.63
The project is located in COUNCIL DISTRICTS 2, 4, 8, and 9.
FISCAL INFORMATION /CERTIFICATION:
nATl TT1 -T? TVT'TT A T1TT TT A'PTrINT l)nI L 1 f�TT A NTI— (\T)TNUT�
The Director of Finance certifies that funds are available in the General Capital Project funds as previously
appropriated.
FUND IDENTIFIERS (FIDs):
TO
Fund Department ccoun Project Program ctivity Budget Reference # Amoun
ID ID Year Chartfield 2
FROM
Fund Department Accoun Project Program ctivity Budget Reference # moun
ID ID Year Chartfield 2
CERTIFICATIONS:
Submitted for City Manager's Office by: Susan Alanis (8180)
Originating Department Head: Douglas Wiersig (7801)
Additional Information Contact: Tariqul Islam (2486)
ATTACHMENTS
1. Bridqe Rehab CO 2.pdf (CFW Internal)
2. FID Bridge Rehab CO 2.pdf (CFW Internal)
3. Form 1295 CO Gibson Associates.pdf (Public)
4. Map Bridge Rehabilitation 2016-1.pdf (Public)
nn Tl TT-W-17 n TTT A DTT TT A T1 f-)N F 7/11 4 1 OT-J A\Tl,R (11?Yw1? 1) Pa ap ? of 7
CFW Change Order Approval 02 Page 1 of 3
Routinci
Assigned To: Due Date:
Assigned By: Due Time:
Links 2
fortworthgov/Infrastructure Proiects/100122 - Bridge Rehabilitation (2016-1)/Contractor/Change Orders/Change Order 2
Breakdown CPN100122.xlsx
fortworthgov/Infrastructure Proiects/100122 - Bridge Rehabilitation (2016-1)/Contractor/Change Orders/M&C Copy of
Chage Order2 Bridge Repair 2016-1.pdf
Attachments(0)
No Attachments have been added to this form. -----�
CFW Change Order Approval 02 Page 2 of 3
FORT WORTH. city of Fort Worth
Change Order Request Approval
(Change Order Breakdown Available in Links)
For Change Order Submittal No.: St-COSub02
Change Order No.: 02 Date Started: 2018-06-08
City Sec. No.: 47795 Date Due: 2018-06-23
Project Name: Bridge Rehabilitation (2016-1)
100122 DOE Numbers:
Project Numbers:
Project Bridge rehabilitation at 10 locations.
Description:
Project Manager: Tariqul Islam City Inspector: Tommy McKinnon
Contractor: Gibson &Associates, Inc
COUNCIL ACTION (If Required):
M&C Log Name: 20BRIDGE REHABILITATION 2016-1 CHANGE ORDER 2
M&C Number: C-28702 M&C Date: 2018-06-05
COST AND DAYS SUMMARY:
Requested
Department: Cost($) Fund Account Center: Days:
TPW $ 4,587.13 30100 0200431 5740010 200
100122 002680
Total Cost: $ 4,587.13 Total Requested Days: 200
Approval Status:
CFW Change Order Approval 02 Page 3 of 3
Approved: Yes
Comments:
User: Joe Montgomery
Date: 2018-06-08 1:26 PM
Approved: Yes
Comments:
User: Tariqul Islam
Date: 2018-06-08 4:53 PM
Approved: Yes
Comments:
User: Riad Nusrallah
Date: 2018-06-11 8:19 AM IVI��o I
4r5i�$
Approved: Yes 1 95:
Comments:
User: Richard Martinez
Date: 2018-06-18 5:54 PM
Approved: Yes � �' ,+
Comments:
User: Doug Wiersig
Date: 2018-06-21 3:28 PM
Approved: Yes A
Comments:
User: Doug Black
Date: 2018-06-26 4:34 PM nald P. Gonzales: • Ck Secretafy
Approved: Yes
Comments:
User: Susan Alanis
Date: 2018-06-28 8:09 PM
Action Required:
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.
Tariqul Islam
Title
❑ This form is N/A as No City Funds are associated with this Contract
Printed Name Signature
AFFIDAVIT
STATE OF TEXAS
COUNTY OF TARRANT
Before me, the undersigned authority, a notary public in the state
and county aforesaid, on this day personally appeared Alan C. Meador,III,
Vice President Of Gibson&Associates, Inc.,known to me to be a credible
person,who being by me duly sworn,upon his oath deposed and said;
That all persons, firms, associations, corporations, or other
organizations furnishing labor and/or materials have been paid in full;
That the wage scale established by the City Council in the City of
Fort Worth has been paid in full;
That there are no claims pending for personal injury and/or
property damages;
On Contract described as;
Bridge Rehabilitation at Ten Locations (2016-1)
BY
Alan C. Meador, III
Subscribed and sworn before me on this date 13th of August, 2018.
���--- til• ���
Notary Public
Dallas,Texas
PAM N DAVIS
PGe�%Notary Public,State of Texas
= Comm.Expires 03-30-2021
F `� Notar ID 283117-2
rrmp� Y
a
CONSENT OF OWNER ❑
SURETY COMPANY ARCHITECT ❑
CONTRACTOR ❑
TO FINAL PAYMENT SURETY ❑
Conforms with the American Institute of OTHER
Architects,AIA Document G707
Bond No 82443247
PROJECT:
(name, address)Bridge Rehabilitation at Ten Locations(2016-1)
Fort Worth,TX
TO (Owner)
City Project No.
ARCHITECT'S PROJECT N0: 100122
CITY OF FORT WORTH CONTRACT FOR:
1000 Throckmorton Street Bridge Rehabilitation at Ten Locations(2016-1)
Fort Worth Tx 76102 _f CONTRACT DATE: 4/19/2016
CONTRACTOR: GIBSON &ASSOCIATES, 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)
FEDERAL INSURANCE COMPANY
15 Mountain View Road
Warren NJ 07059 , SURETY COMPANY
on bond of (here insert name and address of Contractor)
GIBSON &ASSOCIATES, INC.
P.O. Box 800579
Balch Springs TX 75180-0579 , CONTRACTOR,
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
1000 Throckmorton Street
Fort Worth TX 76102 , OWNER,
as set forth in the said Surety Company's bond.
IN WITNESS, WHEREOF,
the Surety Company has hereunto set its hand this 13th day of August, 2018
FEDERAL INSURANCE COMPANY
Surety Company
Attest: 06>-
(Seal): Signature of Authorized Representative
Robbi Morales 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
5 CHUBBQ
Power of Attorney
Federal Insurance Company I 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 Don E. Cornell, Sophinie Hunter, V. DeLene Marshall, Tina McEwan,
Robbi Morales,Ricardo J.Reyna,Joshua Saunders and Kelly A.Westbrook of Dallas,Texas;Steven Dwain Brockinton of Little Rock,Arkansas------------------------
each as their true and lawful 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 W1tDess 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 90 day of August,201&
f 1:Iv;n �1 1:hl r .:\sWuant Stxrelary Stcphetl M.Haney.Vice Pm ident
' a wF" M.�►' 'a wog+'
STATE OF NEW JERSEY
County of Hunterdon ss.
On this 9th day of August,2018,before me,a Notary Public of New Jersey,personally came Dawn M.Chloros,to me known 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 knows 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 J.ADELAAR
CI )
NOTARY PUBLIC OF NEW JERSEY
No.2318885
CaroB1ISM0aExPM July 16,2018
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,of bonds,undertakings,recognizances,contracts and other written commitments of the Company
entered into in the ordinary course of business(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 seal 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 behalf of the Company,to appoint in writing any person the attorney-
in-fact of the Company with full power and authority to execute,for and on behalf of the Company,under the seal of the Company or otherwise,such Written Commitments of the
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 of the Company as are specified in such
written delegation,which specification may be by general type or class of Written Commitments or by specification of one 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 of the 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 be an exclusive statement of the powers and authority of officers,employees and other pei sons 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."
I,Dawn M.Chloros,Assistant Secretary of FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY(t a"Companies')do hereby
certify that
(i) the foregoing Resolutions adopted by the Board of Directors of the Companies are true,correct and in full force and effect,
(ll) the foregoing Power of Attorney is true,correct and in full force and effect.
Given under my hand and seals of said Companies at Whitehouse Station,NJ,this August 13, 2018
Ikiw'n yi.ChlxJrts.AsSistantScrnKary
i N THE EVENT YOU WISH TO VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY US OF ANY OTHER MATTER,PLEASE CONTACT US AT:
Tele hone(908)903-3493 Fax(908)903-3656 e-mail:surety@chubb.com
li
FED-VIG-PI(rev.08-18)
FORTWORTH rev 03/05/07
TRANSPORTATION & PUBLIC WORKS
FINAL STATEMENT OF CONTRACT TIME
FINAL STATEMENT NO.:1
NAME OF PROJECT: Bridge Repair and Rehabilitation at 10 Locations
PROJECT NO.: CPN#100122 CONTRACTOR: Gibson and Associates
DOE NO.: N/A
PERIOD FROM:09/06/17 TO: 12/20/17 FINAL INSPECTION DATE: December 20th 2017
WORK ORDER EFFECTIVE:9/6/2017 CONTRACT TIME: 370 O WD* 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
370
PREVIOUS
PERIOD 370
TOTALS
TO DATE i370
*REMARKS:
CO CTOR DATE SPECTOR DATE
_ ENGINEERIN ' EPART�NT
��° The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TX 76012-6311
(817)392-7941 •Fax: (817) 392-7845
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BuySpeed Online Page 1 of 1
peed Onl Accounts Payable Department Ac
NIGP Code Browse I My Account I Customer Service I About Current Organization:CITY OF FORT WORTH October 16,2018 12:27:15 PM CDT Pb Ci d
Home DocumentsDaa naa Gu
Status:
Invoice #: CS47795-8 FINAL Vendor #:0000009564 Vendor Group #:01 Ready
Approval
General Items Subcontractors Accounts Routing Attachments Notes Reminder Change Order Summary Back to PO
Header Information
Invoice Number: CS47795-8 FINAL Invoice Status: 41R-Ready for Approval Invoice Type: away matching
Invoice Description: Auto-generated RPA Invoice Invoice Date: 08/13/2018 Effect Date: 09/28/2018
Payment Amount: $27,334.13 Handling Code: Payment Date: 09/07/2018
Payment Terms: ACH(DIRECT DEPOSIT) Payment Term Day: 0 Payment Discount: 0.0%
Paid-Bank/Check: Alternate Id:
Entered By: Dana Gutheil Entered Date: 10/16/2018
Updated By: Dana Gutheil Updated Date: 10/16/2018
Received Date: 07/31/2018 12:25:00 PM
Attachments
Agency Files:
Agency Forms:
Vendor Files:
Vendor Forms:
Purchase Order Information
Purchase order Number: DRPA-19-00009156 PO Description 100122-2016-1 Bridge Rehab 10
Locs
PO Amount: $27,334.13 Remaining To Invoice: $0.00 Buyer: Karen Striker
PoVendor Information
Vendor: 0000009564-GIBSON&ASSOCIATES INC Address Grp: 01
Vendor Remit-to Address: BRAD MILAM
11210 RYLIECREST
BALCH SPRINGS,TX 75180
USA Fed ID: ......7660 Remit Text:
Email:bradm@gibsonassoc.net
Phone:(972)557-1199
Id:115362(EFT Enabled)
Item Information
Invoice Item#/PO Item#:1 100122-2016-1 Bridge Rehab at 10 Locations-Refunding retainage 30100-20600000-100122-RETAIN$27,334.13
PO Permit Invoice Discount k Original Final
Item Status To Pay Amount Pay Amount Pay
3PCR-Complete Receipt $0.00 $27,334.13 0.0% $0.00 Yes
MAKE:
ASSET MODEL:
ASSET MANUF:
ASSET SERIAL:
ASSET VIN:
ASSET TAG:
Event Type Fiscal Year Account Code Transaction Amount
Exp. 18 30100-2060000-100122-RETAIN— $27,334.13
Enc. 18 30100-2060000-100122-RETAIN— -$27,334.13
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