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Contract 47060-FP1
irtRaent of TPW Const. Services # r J c . Date ect Manager rirlx- .-ZZ-19 Management Sood E. Brotherton -1 ITWORTH. CrtY SECRETARY er V. Gutzier . CONTRACT N0. . Janie Morales/Scanned � .T7--t Ir weeding people have been Contacted concerning the request I ON AND PUBLIC WORKS iI payment&have released this project for such payment OJECT COMPLETION •ance Conducted By Etta Bac City Project Ns: 02520 Regarding contract 47060 for STREET REHABILITATION(HMAC-2015-2)as required by the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by City Council on 09/01)'2015 through M&C C-27442 the director otthe TRANSPORTATION AND PUBLIC WORKS DEPART T upon the recommendation of the Assistant Director of the Transportation&Public Works Department has accepted the project as complete. Original Contract Prices: $1,644,944.14 Amount of Approved Change Orders: $402,990.38 Na 1-V Revised Contract Amount: $2,047,934.52 Total Cost Work Completed: $2,047,934.51 I Less Deductions: Liquidated Damages: Days®$210.00/ ay Pavement Deficiencies: �� � Total Deduction Amount: '� tel, ��<;�`.' $0.00 �4 4CJ i Total Cost Work Completed: $2,047,934.51 Less Previous Payments: S1,940,967.03 Final Payment Due $106, 67.48 . c i��_ Recommended for Acceptance Date Asst. Director, TPW - Infrastructure Design and Construction f - Accepted' Date 4M Director, TRANSP,011TATION AND PUBLIC WORKS DEPARTMENT Asst. City)Manager Date Comments: 3140 8 r 10(00000 -- C 0,2S xC0 - e e-T k rnl -*S 1 t 0+9-09 5u00l -- x.0(00000 - - CGLS2o - CQFTAtf $ ,5110+3- 0 11 3G409-0Z00431 - 54HO010 -CV7SZ0 ;A.O(PZ.83 $ -lci 1 ,�Pi'—,& 3G409-020043i - 5 4 �ypOiU - COZSZO _c. �--• +q5&43 w6lvh tjn CO-44 OFFICIALR�CQRD QrLd r reC+,Wf)s +0 CI� vHTYp� C V FL ®FtrX ecc ep veil 0 c4 kc,�13 o j j-- momTPW Construction Invoice Contract: CS47060 P.O.# PO-16-90370 Payment Date: 7/13/2017 TO:Peachtree Construction LTD INV.# CS47060-29 V N R 0 Estimate No. 29 DOE: 5801 Park Vista Cir ProjManager Kristian Sugrim Keller TX 76248 FOR: 2015-2 HNIAC ST REHABILITATION Contract Amount: $2,047,934.52 Completed Ret Pen Ad' Pa Total to Date: $2,047,934.51 $0.00 $0.00 $0.00 $2,047,934.51 Previous Estimate: $2,043,123.20 $0.00 $0.00 $0.00 $1,940,967.04 Earned to Date: 54,811.31. ($102,156.16) $0.00 $0.00 $106,967.4$ Payments: 39408-0200431-5740010--CO2520-C06283--9999 $1,094,372.52 CO#2-$267,445.25 Comments:CO#2-$267,445.25 CO#4:$4,455.13 Total to Date: $1,024,019.53 $0.00 $0.00 $0.00 $1,024,019.53 Previous Estimate: $1,021,561.60 $51,078.08 $0.00 $0.00 $970,483.52 Earned to Date: $2,457.93 ($51,078.08) $0.00 $0.00 $53,536.01 56007-0600430-5740010--CO2520-CO1783-2015-..„=-F _ _.r $476,781.00 CO#I-$5,000.00,CO#2-$60,545.00 Comments:CO#1-$5,000.00 Comments:CO#2-$60,545.00 Total to Date: $511,957.49 $0.00 $0.00 $0.00 $511,957.49 Previous Estimate: $510,780.80 $25,539.04 $0.00 $0.00 $485,241.76 Earned to Date: $1,176.69 ($25,539.04) $0.00 $0.00 $26,715.73 56007-0700430-5740010--CO2520-C01783-2015- $476,781.00 CO#1-$5,000.00,CO#2-$60,545.00 Comments:CO#1-$5,000.00 Comments:CO#2-$60,545.00 Total to Date: $511,957.49 $0.00 $0.00 $0.00 $511,957.49 Previous Estimate: $510,780.80 $25,539.04 $0.00 $0.00 $485,241.76 Earned to Date: $1,176.69 ($25,539.04) $0.00 $0.00 $26,715.73 EDe HASE ORDER MUST PEAR ON INVOICE Transportation&Public Works Tuesday,October 30,2018 BUSINESS SUPPORT GROUP Page 1 of 1 son/Phone Number AGUpER XrovalS86g27 p KC�VIC X►8648�` ` w ti g 12- oCD QCD N O o o 0 0 , 0 N � OD O O 0 � 0 d � N H c a N y 7 d Z Z Q Q H H W W K K U U � o O J N N co c CDN � U c F) Q c � C, d y � • C V � J V � Q � d d 0 v m � M � M v 0 r 0 0 v 0 o coo � 0 0 V (O O N N m m C co N YO R O C' m C o O ^1 a c a•�� J 0 m N O O o o - o O r o 00 o Y c c .0 U N w w N v a o m n m O m o m W N NO d' LL Q J LL Q d O LL d BuySpeed Online Page 1 of 1 MMMNNPP—BUyspsed Online Acc unte Payable Dep.,Innnent Access NIGP Code Browse I My Acoount I Customer Service I About Current Organization:CITY OF FORT WORTH Lll, October 30,2018 5:00:26 PM CDT Y a 0 x Home Documents R-1 Almaguer Invoice#:CS47060-29 FINAL'Vendor#:0000007231 Vendor Group#:01 St ms:41R Readyf,,App al General nems Subcontractors Accounts Routing Attachments Notes Reminder Change Order Summary Back to PO Header Information Invoice Number: CS47060-29 FINAL' Invoice Status: 41R-Ready for Approval Invoice Type: 3way matching Invoice Description: CS47060-29 FINAL-2015-2 HMAC ST REHABILITATION Invoice Date: %/1372017 Effect Date: I oma2o18 Payment Amount: $106.967.46 Handling Code: Payment Date: 08707/2017 Payment Terms: Payment Term Day: 0 Payment Discount: 0.0% Paid-Bank/Check: Alternate ld: Entered By: Itzel Almaguer Entered Date: 10/30/2018 Updated By: I1zeI Almaguer Updated Date: 10r302018 Received Date: 06730201704:55:00 PM - Attachments Agency Files: Agency Forms: Vendor Files: Vendor Forms: Purchase Order Information Purchase order Number: PO-16-00090370 PO Description C547060 CO2520 PO Amount: $2,647,934.52 Remaining To Invoice: $000 Buyer: Karen Stnker PoVendor Information Vendor: 0000007231-PEACHTREE CONSTRUCTION LTD Address Grp: 01 Vendor Remit-to Address: Coned 5801 PARK VISTA CIR KELLER,Tx 76248 USA Fed ID: '^•^45x0 Remit Text: Email:JBCtARK@PEACHTREECON.COM Phone:(ODO)O00-0000 Id:32396(EFT Enabled) Misc&Freight Invoice Account - Event Type Fiecal Year Account Code T2nsact.n Amount Mac 18 56007-2060000-002520-CRETAN- $5107808 Misc 18 39408-2060000-602520-CRETAN- E5107808 '. Total: $102,156.16 '.. Item Information Invoice hem#/PO Item#:6 C082-$267,445.25-2015-2 HMAC ST REHABILITATION 39408-0200431-5740010-CO2520C08283-I C293541200-202620252083 CS47060 M&CC-28034 DATE 121316 PD Perron Inv Discount% Original Final Item Status TO Pay Amount Pay Amount Pay 3PCR-Complete Receipt $0.00 $356.19 0.0% $0,00 Vea MAKE: ASSET MODEL: ASSET MANUF: ASSET_SERIAL: ASSET NN: ASSET TAG: Event Type Racal Year Account Code Transaction Amount Ex P. 18 39408-02004315740010-002520-CO6283- $356.19 �V Enc. 16 39408-0200431-57411010--CO2520-C06283- -$356.19 t Invoice Item ill Item#:9 Collie.$4,455.13-2015-2 HMAC ST REHABILITATION 39408-02004315740010-CO2520-066263 CS4706D-004 M&C C-28034 DATE 121316 PO Parma Invoice Dlaeourd% Origirul Final Item statue To Pay Amount Pay Amount Pay 3PCR-Complete Receipt $0.00 $4,455.13 0.0% E0.00 I Yes MAKE: ASSET MODEL: ASSET_MANUF: ASSET_SERIAL: ASSET_VIN: ASSET TAG: Event Type Fiscal Year Account Code Transa lion Amount E.P. 18 39408-OM0431-5740010-CO2520-COB263- $4,455.13 Enc. 18 39408-0200431-5740010-002520-006283- -$4,455.13 Approval Path: Delete Approver Order Approval level Approver Date Date Approvedlniaa ad7Canceled Comment Sequence Path Type Requealed ApprovedlDisapprov<NDanctlad byfeV Yew D Add New V � Pdmery Add/Delete Approver Copyright 02018 Pedal Holdings,Inc.-All Rights Reserved.default I https:/ibso.fortworthtexas.gov/bso/purchaseorder/invoice/invoiceSummary.sdo?vendorld... 10/30/2018 moo o o m m0 0 0 0 h CLcc o ds "� c sv us vi bs sus rsi n rn v3 v3 oo a �., 0 x F' d 8 •a .c an d A a, �' o •p A ca o p, m U 01 Q v� a, A m e m i C p 3 z v m a a rn ami w A a s o C7 + u axi -o •nVi ai w W H O d o n q N— � aIn 0 (a � FSI oV� F. o a d O aM Oa. q w O �EjOU en W U X k a Wj d W m rn e I�-� a ° o O W CW7 10 a W > Q qo U o c ryi z o U U z F W' z U U C a c � a � a 60 ooz e z o@ a o c a c O z U a < a d m U U c 00 N M 7 VI lC 1: W O; N (d O x a @ tJ aqi v ..y E ami C3 E A 0 U z J's 8 2 °� �q F ^jOaU ° ° Av6 � (D N C ° w a s oo & 0.u E � L P U Nv�C 5Y'C0 N NL Q O CFI0 z b.d to 0 w U q CD U > 0 0 U M ° 30a 0m Ev O ar w U y °U `°° �' °a' ti , 0 m ^r a = 3 Y v C C°C C 0 {� pj pp N C ed p y aqi N ryj 0 v 0 E,° T E c 00 0 M w 10 a, o 0 w 0 ° aq a o � °r,° v o'o aa c. c r o -4a 4-4 r•-I `c h 0 y o to ~ p a " W a 0 0 m ° c v U o b F W WWp " 0 ° o U p °.j.E 2 Uz O O a w x3� n°.5 > w w .F>..0 O O � U � F � v � �•`�.E � v b P ° > m U v U 0 U o .i. 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VE c0 N U) I �e» LL s i-° d C4 �+ f J U t 3 L6 L6 �O o0 00 oo O c N N N N i N N O O M co Cl) M M co co jM ch co m 00 00 `y aO 00 cc) i �d ao Wm '� Crr i IVNrr w U U U U o i0 0 0 0 B j d U U U m aD000 a' 000 a.o00 cNNN aNNN �CNNN @ LO to LO R LO c0 LO 1 cp CN c0 c0 I p^ L N N N ,= N N N ( 1 i p ¢ c U O O O N N N z U U U UUUU UUUU 7 O O O ,• O_ O_O_ � i O__O O_ L L O O O i O O O O O O i [o O O O O O O O O O U LiLI? L9 LO L9 I?M M O Cl)O O O O O O I O O O ( O O O i O O O O O N c0 I� p r I N (oo co I� O r-(Dr- 999 r 0 0 0 0 0 0 0 0 0 0 0 0 999 0 0 U aoti � aorr 1C.11-0- �0 0 0 0 0 0 0 0 mornrnrM InOOO O�O M ifl c0 cn In O O OO O O lO0 O O O O O O ._. I r ! r O c I i y l � Q W z n. IT 44 (t3 o a ; EN M Q N d O O U £ a+ O I LL 0 d L6 L6 L6 6 d U I O i N N , N N' N N C O O MMM rco MM co (MMM a 'U a00000 oro � ooww `yO0000 0000co G = 0 0 0 0 0 0 0 0 o U U U 0 is0 o 0 0 0 0 0 0 0 a C N N N C N N " I ;C N N N a C N N N I L N N N !.t N N N Z ¢ c Q. VUUU V U U U V U U U 000 000 000 LL 000 000 000 c O o o ... O O O o o o '... 0 L�) L�) L? L? L9 � LI?o o o o I o 0 v v v v v v v v v 000 cn m co CD m m 000 c) ol0000l 00000 00000 Ni r� c) for Nco rcor o�o 0 0 0 0 0 0 0 0 0 0 0 0 0 U 0Drr � � co "- "- a0rr � � 00000 C, oc3 00000 I�oo T�o�o (D ( � ooIDoI I i mCDcoma) m to to to 10 -- - - - - co Lo Lo to m 0 0 0 0 0 0 M Ln Lo uo u 0 0 0 0 0 0 Contractor Final Estimate Approval Final-l-Estimate Page 2 of 3 FORTWORTH, Contractor Final Estimate Approval Date Started: 9/11/2 18 11 Date Due: 9/25/2018 Invoiced Amount: (Amount from $ 106,967.48 Request No.: Final-l-Estimate Line 8 of C-620) Project Name: 02520 - HMAC 2015 - 2 Street Rehabilitation Project Number: 02520 Invoice No.: Reference: Contractor: Brendan Taylor Discussion: (Limit 5000) Approval Status: https://projeetpoint.buzzsaw.com/ bz_web/Forms/FormPrint.aspx?Siteld=51500&ProcessI... 10/8/2018 Contractor Final Estimate Approval Final-l-Estimate Page 3 of 3 Approved: Yes Comments: User: Emanuel Nieto Date: 2018-09-11 10:30 AM Approved: Yes Comments: User: Etta Bacy Date: 2018-09-11 10:36 AM Approved: Yes Comments: User: Brendan Taylor Date: 2018-09-11 10:37 AM Approved: Yes Comments: User: Emanuel Nieto Date: 2018-09-11 10:52 AM Approved: Yes Comments: User: Kristian Sugrim Date: 2018-09-11 4:50 PM Approved: Yes Comments: User: Lane Zarate Date: 2018-09-18 4:36 PM w Approved: Yes Comments: n User: Ricardo Matute Date: 2018-10-02 11:26 AM https://projectpoint.buzzsaw.com/ bz_web/Forms/FormPrint.aspx?Siteld=51500&Processl... 10/8/2018 Contractor Final Estimate Approval Final-l-Estimate Page 1 of 3 Routing Assigned To: TPW AP Reconciliation Due Date: 10/7/2018 Assigned By: Brendan Taylor Due Time: 11:26 AM Links 1 fortworthgov/Infrastructure Projects/02520 - Street Rehabilitation (HMAC 2015-2)/Contractor/Submitted Invoices/Estimate 29 FINAL/Estimate 29.xlsm Attachments t0) No Attachments have been added to this form. https://projeetpoint.buzzsaw.com/ bz web/Forms/ForrnPrint.aspx?SiteId=51500&ProcessI... 10/8/2018 FORTWORTHREV:8/20/16 TRANSPORTATION AND PUBLIC WORKS PERFORMANCE EVALUATION OF CONTRACTOR I) CONTRACTOR&PROJECT DATA Name of Contractor Project Name Peach Tree Construction 20HMAC Street Rehab 2015-2 Inspector City Project Number Roy Scharfenberg 2520 Construction Components Project Manager Water ❑ Waste Water 0 Storm Drainage ® Pavement Kristian Surgrim Initial Contract Amount Project Difficulty $1,644,944.14 3 Simple O Routine O Complex Final Contract Amount Date $2,047,934.51 4.30.18 II)PERFORMANCE EVALUATION 0-Inadequate 1-Deficient 2-Standard 3-Good 4-Excellent ELEMENT WEIGHT(x) APPLICABLE(Y/N) RATING(0-4) MAX SCORE SCORE 1 Submission of Documents 2 Y 3 8 6 2 Public Notifications 5 Y 3 20 15 3 Plans on Site 5 Y 3 20 15 4 Field Supervision 15 Y 4 60 60 5 Work Performed 15 Y 3 60 45 6 Finished Product 15 Y 3 60 45 7 Job Site Safety 15 Y 4 60 60 8 Traffic Control Maintenance 15 Y 3 60 45 9 Daily Clean Up 5 Y 3 20 15 10 Citizen's Complaint Resolution 5 Y 1 3 20 15 11 Property Restoration 5 Y 3 20 15 12 After Hours Response 5 Y 3 20 15 13 Project Completion 5 Y 3 20 15 TOTAL ELEMENT SCORE(A) 366 BONUS POINTS(25 Maximum)(B) TOTAL SCORE(TS) 366 III)CONTRACTOR'S RATING Maximum Score(MS)=448 or sum of applicable element score maximums which= 448 Rating(ITS/MS] * 100%) 366 / 448 = 82% Performance Category Excellent <20%=Inadequate 20%to<40%=Deficient 40%to<60%=Standard 60%to<80%=Good >80%=Excellent Inspector's Comments(INCLUDING EXPLANATI OF BONUS POINTS AWARDED) Inspector Signature Contract Signature 2 .o Inspector's Supervisor Signature CONTRACTOR'S COMMENTS TRANSPORTATION AND PUBLIC WORKS The City of Fort Worth• 8851 Camp Bowie West Blvd.•Fort Worth,TX 76116• (817)392-8306 FORTWORTHREV:02'22'0' TRANSPORTATION AND PUBLIC WORKS CONTRACTOR'S EVALUATION OF CITY I)PROJECT INFORMATION Date: 14.30.2018 Name of Contractor Project Name Peachtree Construction LTD 20HMAC Street Rehab 2015-2 DOE Inspector Project Manager Roy Scharfenberg Kristian Surgrim DOE Number Project Difficulty Type of Contract 2520 P Simple ® Routine o Complex ❑ Water ❑ Waste Water ❑ Storm Drainage o Pavement Initial Contract Amount Final Contract Amount $1,644,944.14 $2,047,934.51 II)PERFORMANCE EVALUATION 0-Inadequate 1 -Deficient 2 -Standard 3 -Good 4-Excellent RATING ELEMENT RATING ELEMENT (0-4) (0-4) INSPECTION EVALUATION PLANS&SPECIFICATIONS 1 Availability of Inspector 1 Accuracy of Plans to Existing Conditions 2 Knowledge of Inspector 2 Clarity& Sufficiency of Details r( 3 Accuracy of Measured Quantities 3 Applicability of Specifications 4 Display Of Professionalism 4 Accuracy of Plan Quantities 5 Citizen Complaint Resolution PROJECT MANAGER EVALUATION 6 Performance-Setting up Valve Crews,Labs 44 1 Knowledge And/Or Problem Resolution ADMINISTRATION 2 Availability of Project Manager 1 Change Order Processing Time 3 Communication 2 Timliness of Contractor Payments 4 Resolution of Utility Conflicts 3 3 Bid Opening to Pre-Con Meeting Timeframe 3 III)COMMENTS&SIGNATURES COMMENTS Signature Contractor Signature DOE Inspector Signature DOE Inspector's Supervisor Q INSPECTOR'S COMMENTS TRANSPORTATION AND PUBLIC WORKS The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TX 76012-6311 (817)392-7941 •Fax: (817) 392-7845 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 Brendan Taylor(name),Project Manager (title), of Peachtree Construction, Ltd.,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 City of Fort Worth has been paid; and That there are no claims pending for personal injury and/or property damages; On Contract described as; HMAC Surface Overlay (2015-2),City Project 002520 By Subscribed and sworn before me on this l-7 day of—A4 4- ,20 18 CHERYL JEROME � PYPpp zo�P BLc Notary Public,state of Texas -'O Comm.Expires 08-02-2020 Ootar/ftiy in ant County, Texas Notary ID 616044-1 nma CONSENT OF OWNER ❑ SURETY COMPANY ARCHITECT ❑ TO FINAL PAYMENT CONTRACTOR ❑ SURETY X OTHER ❑ AIA DOCUMENT G707 Bond No. 106298835 PROJECT: Street Rehabilitation (HMAC 2015-2), 02520 (name, address) TO(Owner) F ARCHITECT'S PROJECT NO: City of Fort Worth 1000 Throckmorton Street CONTRACT FOR: Construction Fort Worth,TX 76102 L CONTRACT DATE: September 1, 2015 CONTRACTOR: Peachtree Construction, Ltd. 5801 Park Vista Circle, Keller,TX 76244 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) Travelers Casualty and Surety Company of America 9601 McAllister Freeway, Suite 900, San Antonio,TX 78216 SURETY COMPANY, on bond of(here insert name and address of Contractor) Peachtree Construction, Ltd. 5810 Park Vista Circle, Keller,TX 76244 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 OWNERS, as set forth in the said Surety Company's bond. IN WITNESS WHEREOF, the Surety Company has hereunto set its hand this 17th day of April 2018 Travelers Casualty and Surety Company of America Surety C mpany / \�, Q lr .-� Signature of Authorized Representative Attest: (Seal): Lorrie Scott, Secretary Linda K Edwards Attorney-In-Fact _ Title NOTE: This form;s to be used as a companion document to AIA DOCUMENT G706,CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS,Current Edition AIA DOCUMENT G707•CONSENT OF SURETY COMPANY TO FINAL PAYMENT•APRIL 1970 EDITION•AIA® ONE PAGE ©1970•THE AMERICAN INSTITUTE OF ARCHITECTS.1735 NEW YORK AVE.,NW,WASHINGTON,D.C.20006 Travelers Casualty and Surety Company of America .tA. Travelers Casualty and Surety Company TRAVELERS J St. Paul Fire and Marine Insurance Company POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS:That Travelers Casualty and Surety Company of America,Travelers Casualty and Surety Company,and St. Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the "Companies"),and that the Companies do hereby make,constitute and appoint Linda K.Edwards,of Fort Worth,Texas,their true and lawful Attorney-in-Fact to sign, execute,seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF,the Companies have caused this instrument to be signed,and their corporate seals to be hereto affixed,this 3rd day of February, 2017. O V6�li.N \Y Ah°co". oSIX ,), State of Connecticut City of Hartford ss. Robert L.Raney,Se or Vice President On this the 3rd day of February,2017,before me personally appeared Robert L.Raney,who acknowledged himself to be the Senior Vice President of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, and that he,as such,being authorized so to do,executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. In Witness Whereof,I hereunto set my hand and official seal. o.ttr My Commission expires the 30th day of June,2021 * *gyp ♦ Marie C.Tetreault,Notary Public This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Travelers Casualty and Surety Company of America,Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company,which resolutions are now in full force and effect,reading as follows: RESOLVED, that the Chairman,the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice President,the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond,recognizance,or conditional undertaking,and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her;and it is FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company,provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary;and it is FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when(a)signed by the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or(b)duly executed(under seal, if required)by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority;and it is FURTHER RESOLVED,that the signature of each of the following officers:President,any Executive Vice President,any Senior Vice President,any Vice President,any Assistant Vice President,any Secretary,any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents,Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof,and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I, Kevin E. Hughes, the undersigned, Assistant Secretary of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company,and St. Paul Fire and Marine Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies,which remains in full force and effect. Dated this t ith day of April 2018 Ww 491 CONN. 417 Kevin E.Hughes,Assl tant Secretary To verify the authenticity of this Power of Attorney,please call us at 1-800-421-3880. Please refer to the above-named Attorney-in-Fact and the details of the bond to which the power is attached. FORTWORTH, TRANSPORTATION AND PUBLIC WORKS STATEMENT OF CONTRACT TIME STATEMENT# FINAL STATEMENT# 29 CPN 2520 NAME OF PROJECT: Street Rehabilitation HMAC 2015-2 Contractor I PeachTree Const YEAR: 2018 PROJECT NO.: FINAL INSPECTION DATE 11/29/2017 25201 WD CD CONTRACT TIME 484 1 X PERIOD FROM: 1 5/1/2018 TO: 1 5/15/2018 1 BEG - Month DEVELOPMEN (N'/N; N WORK ORDER EFFECTIVE: 10/19/2015 BEG Y MID /n 100.0% DAY OF MONTH DAYS REASON FOR DAY OF MONTH DAYS REASON FOR CHARGED DAYS CREDITED CHARGED DAYS CREDITED 1 Tue 0 OTH 16 2 Wed 0 OTH 17 3 Thu 0 OTH 18 4 Fri 0 OTH 19 5 Sat 0 OTH 20 6 Sun 0 OTH 21 7 Mon 0 OTH 22 8 Tue 0 OTH 23 9 Wed 0 OTH 24 10 Thu 0 OTH 25 11 Fri 0 OTH 26 12 Sat 0 OTH 27 13 Sun 0 OTH 28 14 Mon 0 OTH 29 15 Tue 0 OTH 30 31 & Oth Not Applicable SAT,SUN,and WEATHER UTILITIES OTHERS DAYS TOTAL DAYS HOLIDAYS RELOCATE CHARGED THIS PERIOD 0 0 0 0 0 PREVIOUS PERIOD 0 484 484 TOTAL TO DATE 0 0 0 0 484 484 REVIARKS: Signature: Signature: (Print Name) Roy Scharfenberg Ar CONTRACTOR DATE INSPECTOR DATE 5/9/2018 FORT WORTH. City of Fort Worth CITY SECRETARY Change Order Request Breakdown CONTR.ACTNO' Project Namel Street Rehabilitation(HMAC 2015-2) City Sec# 1 47060 Client Project#(s)l 02520 Contractor Peachtree Construction PM Kristian Surgrim Inspector Roy Scharfenberg Change Order Submittal# ® Date 7/3/2018 t Time Dept. TPW Water Fund Sewer Fund Totals Contract Original Contract Amount $822,472.14 $411,236.00 $411,236.00 $1,644,944.14 190 Extras to Date $269,934.45 $122,334.60 $1,244.60 $393,513.65 194 Credits to Date Pending Change Orders(in M&C Process) Contract Cost to Date $1,092,406 58; $533,570;60 , $412,480 60_ $2,038,457.79 384 Amount of Proposed Change Order $9,476._73 $U00_ $0 00 $9,476.73 150 Revised Contract Amount $1,=101 883 32: $533,570:_60 $412,'480 60 $2,047,934.52 534 Original Funds Available for Change Orders $0.00 Remaining Funds Available for this CO 00 Additional Funding(if necessary) $9,476 73 $9,476.73 CHANGE ORDERS to DATE(INCLUDING THIS ONE)AS%OF ORIGINAL CONTRACT MAX ALLOWABLE CONTRACT AMOUNT(ORIGINAL CONTRACT COST+2501o) $2 056,18018: This change order request is being submitted to provide revisions and clarification on Change Orders#1,#2,and#3.. Change Order(#4)is to identify items that are to be constructed previously funded in Change Orders#2 and#3 with the exception of the last item for the amount of $9,476.73 which was not previously funded. P - -.1D GCt�(S�CFtc�AB`t . ' FORTWORTH City of Fort Worth IT-- Change Order Additions Project Name I Street Rehabilitation(HMAC 2015-2) City Sec# 47060 Client Project# 1 02520 Contractorl Peachtree Construction PMJ Kristian Surgrim Inspectof Roy Scharfenberg Change Order Submittal# ® Date 713/2018 ADDITIONS ITEM DESCRIPTION DEPT ryUnit — nit Cost Total 6'HMAC BaseRepair-Oakmont 7. 401 akmontStone Work 1.0000 00 1,150.00 ,5. MAC Base Repair-shell 2.03000000 355.00------T7=5 Raised Pavement Markers 224.00000000 5.00 Extra MOB Tt ping Crew 1.00000000 $550.00 $550.00 Extra MOB-Concrete Crew 1.00000000 1,600.00 $1,500.00 Cold Mix Used on City Hall Streets 1.00000000 $1,468.2 Barricades and Traffic Handling for City Hall Streets 1.00000000 11,667.0 7. Towing-City Hall Streets 1.00000000 104.54 .5 2"Surface Milling-City Hall Streets 5, 6.54000000 5.00 77, .7 econd Towing City Hall treat 1.00000000 104.54 .5 342.62 2"HMAC Typ"D"PG 64-22 Oveday-City Hall treats 8,5 .39750000 2.25 5, 368.7 32 .0302 2"Asphalt Pavement Type D 20,176.41510000 8.89 7, 6""HMAC Repair-Oakmont TPW 26.69500000 Cy $355.00 $9,476.73 TPW $9,476.73 Water Fund Sewer Fund Sub Total Additions 9,476.73 Change Order Additions Page 1 of 1 M/SBE Breakdown for this Change Order M/SBE Sub Type of Service Amount for this CO NA Total $0.00 Previous Change Orders co# DATE AMOUNT Total $0:00 CFW Change Order Approval St-COApp06 Page 1 of 4 Routing Assigned To: Due Date: Assigned By: Due Time: Links 1 fortworthgov/Infrastructure Proiects/02520 - Street Rehabilitation (HMAC 2015-2)/Contractor/Change Orders/Change Order 4 2015-2 02025.x1s Attachments(0} No Attachments have been added to this form. https://projeetpoint.buzzsaw.com/ bz web/Forms/FormPrint.aspx?SiteId=51500&ProcessI... 8/21/2018 CFW Change Order Approval St-COApp06 Page 2 of 4 FORTWORTH. City of Fort Worth Change Order Request Approval (Change Order Breakdown Available in Links) For Change Order Submittal No.: ;4 Change Order No.: St-COApp06 Date Started: 2018-08-06 City Sec. No.: 47060 Date Due: '2018-09-25 Project Name: 02520 - HMAC 2015 - 2 Street Rehabilitation 02520 DOE Numbers: Project Numbers: - -DOE No. . ...... ._. Project Remove and replace nonfunctional curb & gutter, driveways and Description: sidewalks, followed by the pulverization and stabilization of the existing pavement and a 3" HMAC overlay. Project Manager: Kristian Sugrim City Inspector: Roy Scharfenberg Contractor: Peachtree Construction, Ltd. COUNCIL ACTION (If Required): M&C Log Name: M&C Number: M&C Date: COST AND DAYS SUMMARY: Requested Department: Cost($) Fund Account Center: Days: TPW $ 9,476.73 39408-0200431-5740010-CO2520-C 150 Total Cost: $ 9,476.73 Total Requested Days: 150 Approval Status: https://projeetpoint.buzzsaw.com/ bz web/Forms/FormPrint.aspx?Site1d=51500&ProcessI... 8/21/2018 CFW Change Order Approval St-COApp06 Page 3 of 4 :Approved: Yes !Comments: User: Brendan Taylor 'Date: 2018-08-07 7:27 AM Approved: Yes !Comments: .User: Kristian Sugrim 'Date: 2018-08-07 9:50 AM �FOR'r Approved: Yes Comments: User: Brendan Taylor U Date: 2018-08-10 11:35 AM ' AUNWd by: Approved: Yes 7P� Comments: yf sL q ,'� User: Kristian Sugrim Date: 2018-08-10 11:56 AM OVI Approved: Yes 1295.- /,j A :Comments: User: Lane Zarate Date: 2018-08-14 10:16 PM .Approved: Yes Comments: User: Ricardo Matute Date: 2018-08-17 9:42 AM Approved: Yes Comments: User: Doug Wiersig Date: 2018-08-17 11:39 AM Approved: Yes Comments: User: Doug Black Date: 2018-08-17 8:58 PM ;Approved: Yes 'Comments: (User: Susan Alanis Date: 2018-08-20 10:09 AM https://projeetpoint.buzzsaw.com/ bz web/Forms/FonnPrint.aspx?Sitcld=51500&ProcessI... 8/21/2018 CFW Change Order Approval St-COApp06 Page 4 of 4 Action Required: https://projectpoint.buzzsaw.com/ bz web/Forms/FormPrint.aspx?SiteId=51500&ProcessI... 8/21/2018 TRANSPORTATION & PUBLIC WORKS Routing Slip ]Date: August 21, 2018 To: Department Initials Date Allison Tidwell/Mary Kayser City Sectary Office Action _File Note&Return y Approval _For Clearance _Per Conversation As Requested _For Correction _Prepare Reply _Circulate _For Your Information _ See Me Comment _Investigate _ Signature Coordination _Justify _Other Remarks: CONTRACT FOR CITY PROJECT NO. 2 Copies Return To: TPWContracts@FortWorthTexas.gov x7233 i t � k ,F. V oRr ARy t31kZ-ZS4vz1 FORTWORTH. City of Fort Worth Change Order Request Breakdown Project Namel Street Rehabilitation(HMAC 2015-2) City Sec# 1 47060 Client Project#(s)l 02520 Contractor Peachtree Construction PM Kristian Surgrim Inspector Roy Scharfenberg Change Order Submittal# ® Date 7/3/2018 Dept. TPW Water Fund Sewer Fund Contract Time Totals CD Original Contract Amount $822,472: $411,236.00 $411,236.00 $1,644,944.00 190 Extras to Date $269,934.45 $122,334.60 $1,244.60 $393,513.65 194 Credits to Date Pending Change Orders(in M&C Process) Contract Cost to Date $1,092,406:45 $533,570.60 $412,480.60 $2,0381451.65 384 Amount of Proposed Change Order $9,476.73 $0.00 $0.00 $9,476.73,, 150 Revised Contract Amount $1,101,883.18 $533,570.60 $412,480.60 $2,047,934.38 534 Original Funds Available for Change Orders $0.00 Remaining Funds Available for this CO $0.00 $0.00 $0.00 Additional Funding(if necessary) $9,476.73 $9,476.73 CHANGE ORDERS to DATE(INCLUDING THIS ONE)AS%OF ORIGINAL CONTRACT 24.50% MAX ALLOWABLE CONTRACT AMOUNT(ORIGINAL CONTRACT COST+25%) $2,056,180.00 This change order request is being submitted to provide revisions and clarifications on Change Orders#1,#2,and#3.. Change Order(#4)is to identify items that are to be constructed, previously funded in Change Orders#2 and#3 with the exception of the last item for the amount of $9,476.73 which was not previously funded. FORT WORTH City of Fort Worth Change Order Request Breakdown Project Namel Street Rehabilitation(HMAC 2015-2) City Sec# 1 47060 Client Project#(s)l 02520 Contractor Peachtree ConstructionPM Kristian Surgrim Inspector Roy Scharfenberg Change Order Submittal# ® Date 7/3/2018 Dept. TPW Water Fund Sewer Fund Contract Time Totals CD Original Contract Amount $822,472.00 $411,236.00 $411,236.00 $1,644,944.00 of 190 Extras to Date $269,934.45 v $122,334.60 $1,244.60 v $393,513.65 �{ Credits to Date 2 Pending Change Orders(in M&C Process) Ja 00 Contract Cost to Date $1109 ,4051 $a33,S0 602 4 $2,038,457.65 3 �, Amount of Proposed Change Order MR Revised Contract Amount $1,092,406.45 $533,570.60 $412,480.60 $2,038,457.65 ' 534 Original Funds Available for Change Orders Remaining Funds Available for this CO $0.00 $0.00 $0.00 Additional Funding(if necessary) CHANGE ORDERS to DATE(INCLUDING THIS ONE)AS%OF ORIGINAL CONTRACT 23.92%' MAX ALLOWABLE CONTRACT AMOUNT(ORIGINAL CONTRACT COST+25%) $2,056,180.00 a This change order request is being submitted to provide revsions and clarifucaton on Change Orders#1,#2,and#3.. Change Order(#4)is to identify items that are to be constructed previously funded in Change Orders#2 and#3. II If\) l/W I � Ldp, �h� Cuckp cw��N Fox_ T�H City of Fort worth Change Order Additions Project Name Street Rehabilitation(HMAC 2015-2) City Sec# 47060 Client Project# 02520 Contractor Peachtree Construction PMJ Kristian Surgrim Inspector Roy Scharfenberg Change Order Submittal# ® Date 7/3/2018 ADDITIONS ITEM DESCRIPTION JEPT ty Unit Unit Cost Total (1 �g ase epau- a mont ---r--7777,i 7=m=----77— $355.00 �b 1 OakmontStone Work 1.00000000 1,15 .00 $1,1bum HMAC Base Repair-Isbell 2.030 000 355.007 . 5 Raised Pavement Markers 24. 0 5.00 Extra MOB-Striping Crew 1.00 00000 550.00 5 Extra MOB-Concrete Crew 1.00000000 P,500.00 ,5 . Cold Mix Used on City Hall Streets 1.00000000 1,468.26 Barricades and Traffic Handling for City Hall Streets 1.00000000 $11,667.01 $11,667.01 Towing-City Hall Streets 1.0 104.54 .5 2"Surface Milling-City Hall Streets 15,456.54000000 5.00 77, Second Towing City Hall Street 1.00000000 1 .5 .5 2"HMAC Typ"D"P 2 Oveday-City Hall Streets 8,599.39750000 12.25 5, 3212.0302 2'Asphalt Pavement Type D 2 176.41510 8.89 7, er Arry TPW $0.00 Water Fund $0.00 Sewer Fund $0.00 Sub Total Additions $0.00 Change Order Additions Page 2 of 2 } CITY SECRETARY 4-7 FORT WORTH. City of Fort Worth CONTRACT NO. � Change Order Request Breakdown ProjectNamel Street Rehabilitation(HMAC 2015-2) City Sec# e 47060 Client Proiect#(s) 02520 —71 Contractorl Peachtree Construction PMJ Kristian Surgrim Inspector[ Roy Scharfenberg Change Order Submittal# L� jPnte 8/7/2017 t Dept. TPW Water Fund Sewer Fund Contract Time Totals CD Original Contract Amount $822,472(00 $411,236.00 $411,236,00 $1,644,944.00 190 Extras to Date $267,445.25 $126,090.00 $5,000.00 $398,535.25 194 Credits to Date Pending Change Orders(in M&C Process) Contract Cost to Date $1,089,917.25 $53732600 $416,236.00 $2,043,479.25 384 Amount of Proposed Chan2e Order $2,489.20 $1,244.60 $9,244.60 $4,978.40 150 Revised Contract Amount $9,092,406.45 $538,570.60 $417,480.60 $2,048,457.65 534 Original Funds Available for Change Orders $0.00 Remaining Funds Available for this CO $0.00 $0.00 $0,00 Additional Funding(if necessary) $2,489.20 $1,244.60 $1,244.60 $4,978.40 CHANGE ORDERS to DATE(INCLUDING THIS ONE)AS%OF ORIGINAL CONTRACT 24.53% MAX ALLOWABLE CONTRACT AMOUNT(ORIGINAL CONTRACT COST+25%) $2,056,180.00 This change order request is being submitted to provide additional funding to the contract due to overrun quantities on paving assets.Also, 150 calendar days will be added to the contract to compensate for water conflicts,replacement of 11 lead services on Englewood Ln;stormwater delays on Oakmont Ln,and gas conflict on Locke Ave.(60 Days);additional milling and overlay of City Nall Streets,pricing negotiations, community planning and multidepartment meetings to coordinate the work around City Hall(90 days). ro, 1O 1 x X CV t;0t0"rfoal\%lo"T1 Gt7`IS��ftEC�A�` ,�n4tr 01 t OFFICIAL RECtM TX T. C SEC , . Page 1 of 2 P.O.DATE: 10/22/2015 4ORT WORTH CITY OF FORT WORTH r•~ Purchase Order Number Purchase Order PO-16-00090370 SHOW THIS NUMBER ON ALL PACKAGES, INVOICES AND SHIPPING PAPERS. V Vendor Number:0000007231 TRANSPORTATION&PUBLIC WORKS E PEACHTREE CONSTRUCTION LTD S 200 Texas Street,2nd Floor N P O BOX 821198 H FORT WORTH,TX 76102 D FORT WORTH,TX 76182-1198 P O T Phone: (817)392-8198 R O MAIL INVOICE IN DUPLICATE TO: NVOICES: Direct invoices in DUPLICATE to the address shown. B TRANSPORTATION&PUBLIC WORKS STANDARD PURCHASING TERMS AND CONDITIONS set forth in the 1 200 Texas Street,2nd Floor .ity of Fort Worth's Bid or Quotation, are incorporated herein by L FORT WORTH,TX 76102 eference and become a part of this order. L T O Phone: (817)392-8198 \ccount Code:39408-0200431-5740010--CO2520-CO6283-- Payment Terms: Shipping Terms: aid No.: Delivery Calendar Day(s)A.R.O.: 0 Item Class-Item Requisition Quantity Unit Unit Price Total # Class-Item 913-50 1 2015-2 HMAC ST REHABILITATION 39408-0200431-5740010--CO2520-C06283- 1 EA $822,472.14 $822,472.14 -/C293-541200-202620252083 CS47060 M&C C-27442 DATE 090115 LN/FY/Account Code Dollar Amount 1/1200431-5740010-- $822,472.14 CO2520-CO6283-- Class-Item 913-50 2 2015-2 HMAC ST REHABILITATION 56007-0600430-5740010--CO2520-C01783- 1 EA $411,236.00 $411,236.00 2015-/P266-541200-602170252083 CS47060 M&C C-27442 DATE 090115 LN/FY/Account Code Dollar Amount 2/18/56007-0600430-5740010-- $411,236.00 CO2520-001783-2015- Class-Item 913-50 3 2015-2 HMAC ST REHABILITATION 56007-0700430-5740010--CO2520-C01783- 1 EA $411,236.00 $411,236.00 2015-/P266-541200-702170252083 CS47060 M&C C-27442 DATE 090115 LN/FY/Account Code Dollar Amount 3/18/56007-0700430-5740010-- $411,236.00 CO2520-001783-2015- Class-Item 913-50 4 CO#1 -$5,000.00-2015-2 HMAC ST REHABILITATION 56007-0600430-5740010- 1 EA $5,000.00 $5,000.00 -CO2520-CO1783-2015-CS47060 LN/FY/Account Code Dollar Amount 4/18/56007-0600430-5740010-- $5,000.00 CO2520-001783-2015- Class-Item 913-50 5 CO#1 -$5,000.00-2015-2 HMAC ST REHABILITATION 56007-0700430-5740010- 1 EA $5,000.00 $5,000.00 -CO2520-CO1783-2015-CS47060 % Page 2 of 2 LN/FY/Account Code Dollar Amount 5/18/56007-0700430-5740010-- $5,000.00 CO2520-001783-2015- Class-Item 913-50 6 CO#2-$267,445.25-2015-2 HMAC ST REHABILITATION 408-0200431- 1 EA $267,445.25 $267,445.25 574001 0--0O2520-CO6283--/C293-541200-202620252083 tS47060 M&C C- 28034 DATE 121316 LN/FY/Account Code Dollar Amount 6/18/39408-0200431-5740010-- $267,445.25 CO2520-C06283-- Class-Item 913-50 7 CO#2-$60,545.00-2015-2 HMAC ST REHABILITATION 56007-0600430- 1 EA $60,545.00 $60,545.00 5740010--CO2520-C01783-2015-/P266-541200-602170252083 CS47060 M&C C- 28034 DATE 121316 LN/FY/Account Code Dollar Amount 7/18/56007-0600430-5740010-- $60,545.00 CO2520-001783-2015- Class-Item 913-50 8 CO#2-$60,545.00-2015-2 HMAC ST REHABILITATION 56007-0700430- 1 EA $60,545.00 $60,545.00 5740010--CO2520-C01783-2015-/P266-541200-702170252083 CS47060 M&C C- 28034 DATE 121316 LN/FY/Account Code Dollar Amount 8/18/56007-0700430-5740010-- $60,545.00 CO2520-001783-2015- TOTAL: $2,043,479.39 APPROVED: Rev.20091027 By: Karen Striker Phone#: (817) 392-6265 BUYER FORT WORTH; City of Fort Worth CITY SECRETARRY 4r7o(oo- Cy q Change Order Request Breakdown CONTRACT NO. Project Namel Street Rehabilitation(HMAC 2015-2) City Sec# 1 47060 Client Project#(s)l 02520 Contractor Peachtree Construction PM Kristian Surgrim Inspector Roy Scharfenberg Change Order Submittal# ® Date 7/3/2018 Dept. TPW Water Fund Sewer Fund Contract Time Totals CD Original Contract Amount $822,472.14 $411,236.00 $411,236.00 $1,644,944.14 190 Extras to Date $269,934.45 $122,334.60 $1,244.60 $393,513.65 194 Credits to Date Pending Change Orders(in M&C Process) Contract Cost to Date $1,092,406.59 $533,570.60 $412,480.60 $2,038,457.79 384 Amount of Proposed Change Order $9,476.73 $0.00 $0.00 $9,476.73 150 Revised Contract Amount $1,101,883.32 $533,570.60 $412,480.60 $2,047,934.52 534 Original Funds Available for Change Orders $0.00 Remaining Funds Available for this CO $0.00 $0.00 $0.00 Additional Funding(if necessary) $9,476.73 $9,476.73 CHANGE ORDERS to DATE(INCLUDING THIS ONE)AS%OF ORIGINAL CONTRACT 24.500/. MAX ALLOWABLE CONTRACT AMOUNT(ORIGINAL CONTRACT COST+25%) $2,056,180.18 IN This change order request is being submitted to provide revisions and clarification on Change Orders#1,#2,and#3.. Change Order(#4)is to identify items that are to be constructed previously funded in Change Orders#2 and#3 with the exception of the last item for the amount of $9,476.73 which was not previously funded. l R�C��vEd QUG 2� 201 C1 C��ECR�PRYH Fox_ r _H City of Fort Worth Change Order Additions Project Name Street Rehabilitation(HMAC 2015-2) City Sec# 47060 Client Project# 02520 contractorl Peachtree Construction PMJ Kristian Surgrim Inspector Roy Scharfenberg Change Order Submittal# ® Date 713/2018 ADDITIONS ty Unit Unit Cost Total 6'HMAC Base Repair-Oakmont akmont tone Work 1.0000000050.0 HMAC Base Repair-Isbell 2.0300000055. Raised Pavement Markers 24. 0 000 05. Extra MOB-Striping rew 1.00000000 55. Extra MOB-Concrete Crew __F7577 Cold Mix Used on City Hall Streets 1.00000000 Barricades and Traffic Handling for City Hall Streets 7. Towing-City Hall Streets 5 2"Surface Milling-City Hall Streets --f5—,456.540000005. Second Towing City Hall Street 5 HMAC Typ"D"P Overlay-City Hall Streets 8,599.39750000 ---5T2-F5 3212.0302 Asp alt Pavement Type D 0, 76. 15 0 0 .89 HMAC Base Repair-Oakmont TPW 26.69500000 55. k TPW $9,476.73 Water Fund $0.00 Sewer Fund $0.00 Sub Total Additions 9,476.7 Change Order Additions Page 1 of 1 .. .• • .- �• . � �.� i i . ' �Itit`i7�i11 � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� � ����� ,��� .��� ��� . �•• � -. . .- - M/SBE Breakdown for this Change Order M/SBE Sub Type of Service Amount for this CO NA Total $0.00 Previous Change Orders co# DATE AMOUNT Total $0.00 ,CFW Change Order Approval St-COApp06 Page 1 of 4 Routing Assigned To: Due Date: Assigned By: Due Time: Links 1 fortworthgov/Infrastructure Projects/02520 - Street Rehabilitation (HMAC 2015-2)/Contractor/Change Orders/Change Order 4 2015-2 02025.x1s Attachments(0) No Attachments have been added to this form. https://projeetpoint.buzzsaw.com/ bz web/Forms/FonnPrint.aspx?Siteld=51500&Processl... 8/21/2018 .CFW Change Order Approval St-COApp06 Page 2 of 4 FORTWORTH. C'ty of Fort Worth - - ,r�••.a.. Change Order Request Approval (Change Order Breakdown Available in Links) For Change Order Submittal No.: 4 Change Order No.: St-COApp06 Date Started: 2018-08-06 City Sec. No.: 47060 Date Due: 2018-09-25 Project Name: 02520 - HMAC 2015 - 2 Street Rehabilitation 02520 DOE Numbers: Project Numbers: DOE No. Project Remove and replace nonfunctional curb & gutter, driveways and Description: sidewalks, followed by the pulverization and stabilization of the existing pavement and a 3" HMAC overlay. Project Manager: Kristian Sugrim City Inspector: Roy Scharfenberg Contractor: Peachtree Construction, Ltd. COUNCIL ACTION (If Required): M&C Log Name: M&C Number: M&C Date: COST AND DAYS SUMMARY: Requested Department: Cost($) Fund Account Center: Days: TPW $ 9,476.73 39408-0200431-5740010-CO2520-C 150 Total Cost: $ 9,476.73 Total Requested Days: 150 Approval Status: https://projectpoint.buzzsaw.com/ bz web/Forms/FormPrint.aspx?Siteld=51500&ProcessI... 8/21/2018 CFW Change Order Approval St-COApp06 Page 3 of 4 Approved: Yes Comments: User: Brendan Taylor Date: 2018-08-07 7:27 AM Approved: Yes Comments: User: Kristian Sugrim Date: 2018-08-07 9:50 AM ®�FSR... Approved: Yes Comments: - User: Brendan Taylor U _ Date: 2018-08-10 11:35 AM IT �7FXPc' Approved: Yes Comments: Mary User: Kristian Sugrim Date: 2018-08-10 11:56 AM M&C: Approved: Yes 1295: Comments: User: Lane Zarate Date: 2018-08-14 10:16 PM Approved: Yes Comments: User: Ricardo Matute Date: 2018-08-17 9:42 AM Approved: Yes Comments: User: Doug Wiersig Date: 2018-08-17 11:39 AM Approved: Yes Comments: User: Doug Black Date: 2018-08-17 8:58 PM Approved: Yes Comments: User: Susan Alanis Date: 2018-08-20 10:09 AM https:Hprojectpoint.buzzsaw.com/ bz_web/Forms/FormPrint.aspx?Siteld=51500&ProcessI... 8/21/2018 CFW Change Order Approval St-COApp06 Page 4 of 4 k' f I, Action Required: https://projectpoint.buzzsaw.com/ bz web/Forms/FonnPrint.aspx?Siteld=51500&Processl... 8/21/2018