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Contract 50446-FP1
Department of TPW Const. Services CPN#�� Date Project Manager .E J37 IT WORT Risk Management S. Gatewood 6• 1 ® CITY SECRETARY D.O.E. Brotherton If4AW CONTRACT N0. S044 — W Water V. Gutzier CFA Janie—Morales/Scanned n 'ATION AND PUBLIC WORKS —10 ►F PROJECT COMPLETION MQ ^ The Pr ceedi people have been Contacted concerning the request for final payment&have released this project for such payment. Developer Projects) City Project X2: 101352 Clearance Conducted By Etta Bacy eS ik5oq4/ly Regarding contract 101352 for CHAMPIONS CENTER PAD 8 RETAIL DEVELOPMENT as required by the WATER DEPARTMENT as approved by City Council.on N/A through M&C N/A the director of the WATER DEPARTMENT upon the recommendation of the Assistant Director of the Transportation&Public Works Department has accepted the project as comp�e"tsi i Via L l � �� Original Contract Price: NOV 06 2018} $45,600.00 Amount of Approved Change Orders: 1 y""": --------- $0.00 Ns 1 Revised Contract Amount: $45,600.00 l Total Cost Work Completed: $45,600.00 74JK Recomm fo Acceptance Date Asst. Dir r, TPW - Development Services Accepte Date Asst. Director, WATER DEPARTMENT Asst. Cky, Manager Date Comments: kO OFFICIAL RECORD t�0g' e CITY SECRETARY "r's� t FT. WORTH,TX Rev.9/22/16 L. � LL NOV n S 2018 R� 06'Y- � 0 City Project Numbers 101352 DOE Number 1352 Contract Name CHAMPIONS CENTER PAD 8 RETAIL DEVELOPMENT Estimate Number I Contract Limits Payment Number 1 Project Type WATER&WASTEWATER For Period Ending 5/31/2018 Project Funding Project Manager NA City Secretary Contract Number Inspectors MILLER,W / FLUTE Contract Date 1/19/2018 Contractor EMJ CORPORATION Contract Time 120 CD 5525 N.MACARTHUR BLVD.,#400 Days Charged to Date 30 CD IRVING, TX 75038-2604 Contract is .000000 Complete CITY OF FORT WORTH SUMMARY OF CHARGES Line Fund Account Center Amount Gross Retainage Net Funded Total Cost of Work Completed $45,600.00 Less %Retained $0.00 Net Earned $45,600.00 Earned This Period $45,600.00 Retainage This Period $0.00 Less Liquidated Damages 0 Days @ $0.00 /Day $0.00 LessPavement Deficiency $0.00 Less Penalty $0.00 Less Previous Payment $0.00 Plus Material on Hand Less 15% $0.00 Balance Due This Payment $45,600.00 Thursday,May 31,2018 Page 4 of 4 FORTWORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name CHAMPIONS CENTER PAD 8 RETAIL DEVELOPMENT Contract Limits Project Type WATER&WASTEWATER City Project Numbers 101352 DOE Number 1352 Estimate Number 1 Payment Number I For Period Ending 5/31/2018 CD City Secretary Contract Number Contract Time 12CD Contract Date 1/19/2018 Days Charged to Date 30 Project Manager NA Contract is 100.00 Complete Contractor EMJ CORPORATION 5525 N.MACARTHUR BLVD.,#400 IRVING, TX 75038-2604 Inspectors MILLER,W / FLUTE Thursday,May 31,2018 Page 1 of 4 City Project Numbers 101352 DOE Number 1352 Contract Name CHAMPIONS CENTER PAD 8 RETAIL DEVELOPMENT Estimate Number I Contract Limits Payment Number 1 Project Type WATER&WASTEWATER For Period Ending 5/31/2018 Project Funding UNIT I:WATER IMPROVEMENTS Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total --------------------------------------- I ---------------- ------------------- 1 FITTINGS,TEES,AND CROSSINGS 1 LS $20,410.00 $20,410.00 1 $20,410.00 2 12"PVC WATER LINE 137 LF $60.00 $8,220.00 137 $8,220.00 3 12"GATE VALVE&BOX 1 EA $3,500.00 $3,500.00 1 $3,500.00 4 CONNECT TO EX. 12"WATER LINE 2 EA $1,250.00 $2,500.00 2 $2,500.00 5 TRENCH SAFETY 137 LF $10.00 $1,370.00 137 $1,370.00 - ------------------------------------- Sub-Total of Previous Unit $36,000.00 $36,000.00 r-- UNIT II:WASTEWATER IMPROVEMENTS Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total ----------------------- - ---------------- 1 8"PVC PIPE(10'-12'DEEP) 73 LF $70.00 $5,110.00 73 $5,110.00 2 CONNECT TO EXIST.S.S.STUB 1 EA $2,200.00 $2,200.00 1 $2,200.00 3 TRENCH SAFETY 73 LF $20.00 $1,460.00 73 $1,460.00 4 8"SEWER PLUG 1 EA $150.00 $150.00 1 $150.00 5 POST-CCTV INSPECTION 1 LS $680.00 $680.00 1 $680.00 ---------------------- ---------------- Sub-Total ------ --------Sub-Total of Previous Unit $9,600.00 $9,600.00 ---- -------------------- ---------------- Thursday,May 31,2018 Pa.-e 2 of 4 City Project Numbers 101352 DOE Number 1352 Contract Name CHAMPIONS CENTER PAD 8 RETAIL DEVELOPMENT Estimate Number I Contract Limits Payment Number 1 Project Type WATER&WASTEWATER For Period Ending 5/31/2018 Project Funding Contract Information Summary Original Contract Amount $45,600.00 Change Orders Total Contract Price $45,600.00 to K—S-14 Total Cost of Work Completed $45,600.00 Contractor /O.►�Q�f� Less %Retained $0.00 ��, //_ •`� Net Earned $45,600.00 to C9 Inspec ion Sup4-1 orr� Earned This Period $45,600.00 � (— Retainage This Period $0.00 C Date Less Liquidated Damages Prod c anager ` Days @ /Day $0.00 Date /I LessPavement Deficiency $0.00 AsJ&, -Infrastructure Design and ConstLtion Less Penalty $0.00 � Date 0 t Cdb b Less Previous Payment $0.00 Director/Contracting Department Plus Material on Hand Less 15% $0.00 Balance Due This Payment $45,600.00 Thursday,May 31,2018 Page 3 of 4 FORT WORTH TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PROJECT NAME: Water and Wastewater Improvementsto serve Champion Centrer Pad*Retail Development PROJECT NUMBER: 101352 DOE NUMBER: NA WATER PIPE LAID SIZE TYPE OF PIPE LF 137 LF 12" C-900 Slip Joint 137 FIRE HYDRANTS: VALVES(16" OR LARGER) PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: NEW SERVICES: SEWER PIPE LAID SIZE TYPE OF PIPE LF 73 LF 8" SDR-26 Slip Joint 73 PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: NEW SERVICES: TRANSPORTATION AND PUBLIC WORKS s' The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TX 76012-6311 (817)392-7941 •Fax: (817)392-7845 AIA Document G707rM - 1994 Consent Of Surety to Final Payment PROJECT:(Nance and address) ARCHITECT'S PROJECT NUMBER: OWNER: Water and Wastewater Improvements to Serve Champions Center Pad 8 Retail ARCHITECT:❑ Development CONTRACTOR: CONTRACT FOR:General Construction TO OWNER:(Name and address) CONTRACT DATED: SURETY: LRIC Champions Center,LP and the OTHER:❑ City of Fort Worth,Texas In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above.the (Insert name and address of Stu•etr) Continental Casualty Company on bond of SURETY, (Insert name and address of Contractor) EMJ Corporation 5525 N.MacArthur Blvd, Suite 400 Irving TX 75038 , hereby approves of the final payment to the Contractor,and agrees that final payment to the Contractor shall CONTRACTOR, not relieve the Surety of any of its obligations to (Insert name and address of Owners) LRIC Champions Center,LP and the City of Fort Worth,Texas as set forth in said Surety's bond. OWNER, IN WITNESS WHEREOF,the Surety has hereunto set its hand on this date:June 5,2018 (Insert in writing the month followed by the nunteric date and rear.) Continental Casualty Company (Surety) 4ignature of authorized re r,,,ntati,�,) Attest: i Patricia S.Kleehammer,Attorney-in-fact (Seal): \ (Printed name and title) AIA Document G707——1994.Copyright©1982 and 1994 by The American Institute of Architects.All rights reserved. This document was produced by AIA software at 13:58:01 on 06/05/2018 under Order No.1286863630 which expires on 04/04/2019,and is not for resale. User Notes: (389ADA3E) Western Surety Company POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT Know All Men By These Presents,That WESTERN SURETY COMPANY,a South Dakota corporation,is a duly organized and existing corporation having its principal office in the City of Sioux Falls,and State of South Dakota,and that it does by virtue of the signature and seal herein affixed hereby make,constitute and appoint Mark R Brock, Patricia S Kleehammer, Emily K Fant, Tucker H Compton, Mark Ramsey Brock Jr, John D Brock, Cecil Ray Vaughan III, T Michael Langley, Dana Keith Davis, Individually of Rossville,GA,its true and lawful Attomey(s)-in-Fact with full power and authority hereby conferred to sign•seal and execute for and on its behalfbonds. undertakings and other obligatory instruments of similar nature - In Unlimited Amounts - and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said Attorney.pursuant to the authority hereby given,are hereby ratified and confirmed` This Power of Attorney is made and executed pursuant to and by authority of the By-Law printed on the reverse hereof,duly adopted,as indicated,by the shareholders of the corporation. In Witness Whereof• WESTERN SURETY COMPANY has caused these presents to be signed by its Vice President and its corporate seal to be hereto affixed on this 25th day of April,2018. rcMS�ReryM, WESTERN SURETY COMPANY "`Q�rr•""."-_.,COQ•. ..�.:• POR •:3: 3 P awt.. aul T.�RmffljaLVice President State of South Dakota County of Minnehaha ss On this 25th day of April,2018,before me personally came Paul T.Bruflat,to me known,who,being by me duly sworn,did depose and say: that:he resides in the City of Sioux Falls,State of South Dakota:that he is the Vice President of WESTERN SURETY COMPANY described in and which executed the above instrument;that he knows the seal of said corporation.that the seal affixed to the said instrument is such corporate seal:that it was so affixed pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority and acknowledges same to be the act and deed of said corporation. vIy commission expires J.MOHR 2uC June 23.2021 NOTARY PUSOUTH DAKOTA CERTIFICATE J.Mohr.Notary Public I,L. Nelson, Assistant Secretary of WE§TERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in xce.and further certify that the By-Law of the corporation printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed ty name and affixed the seal of the said corporation this day of uREryn, Q��" ` :ted= WESTERN SURETY COMPANY W 40aP0#4 N, 3Ni arm F4280-7-2012 L.Nelson.Assistant Secretary D to www.cnasurety.com>Owner/Obligee Services>Validate Bond Coverage,if you want to verify bond authenticity. EMJ CONSTRUCTION AFFIDAVIT STATE OF Texas COUNTY OF Dallas Before me, the undersigned authority, a notary public in the state and county aforesaid, on this day personally appeared Chris Palmore, Project Manager Of EMJ Corporation, 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; Champions Circle Phase 1 B BY A� Le�ns Palmore, Project Manager Subscribed and sworn before me on this date 9th Day of October, 2018. Q'rSUZANNA TRENT of Public ary Notary Public,State of Texas Dallas, Texas 9 }Q Comm. Expires 03-24-2021 of Notary Notary ID 131057390 5525 N MacArthur Blvd Suite 400 Irving, TX 75038 972.580.1210 WWW,EMJCORP.COM BEAR CR EES CONSTRUCTION AFFIDAVIT SITE UTILITIES & DEVELOPMENT STATE OF Texas COUNTY OF Dallas Before me, the undersigned authority, a notary public in the state and county aforesaid, on this day personally appeared Brian K. Holdgate, Member of General Partner Of Bear Creek Site Utilities & 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 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; Champions Circle Phase 1 B BY 6c Brian K. Holdgate, Me r of General Partner Subscribed and sworn before me on this date 4th of October, 2018. 'y " EVAN J FELDMAN µY PU�i�� Notary Public, state of Texas Nom: 'Q= Comm. Expires 01-28-2019 Notary ID 1147578-0 4950 Hanson Drive Irving,Texas 75038 81*0 P 972.957.1700 F 972.957.1707 x;000 ► State of Texas HUB#: 1752788768500 w� NCTRCA Minority Certified Texas Fire Registration#:SCRU-1751788 Texas RME License#:RME-U-1745895 Notary Public Dallas County, State of Texas a c e 4950 Hanson Drive Irving,Texas 75038 0�O a o P 972.957.1700 F 972.957.1707 00 000 5-!a�e a�7exas HUB#: 1752788768500 Q NCTRCA Minority#:WFWB41339NO610 Texas Fore RegustraVcn #:SCEP-�020-U Texas RME License#:RME-1270-U FORTWORTH rev 03/05/07 TRANSPORTATION & PUBLIC WORKS FINAL STATEMENT OF CONTRACT TIME FINAL STATEMENT NO.: 1 NAME OF PROJECT: Water and Wastewater Improvements to Serve Champions Center Pad 8 Retail Development PROJECT NO.: 101352 CONTRACTOR: EMJ Construction DOE NO.: NA PERIOD FROM:05/16/18 TO: 05/31/18 FINAL INSPECTION DATE: 23-May-18 WORK ORDER EFFECTIVE:4/23/2018 CONTRACT TIME: 120 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 30 30 PERIOD PREVIOUS 0 PERIOD TOTALS 30 30 TO DATE *REMARKS: CONTRACTOR DATE I P CTOR TE ENGINEERING DEPARTMENT The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TZ 76012-6311 A (817) 392-7941 •Fax: (817) 392-7845