HomeMy WebLinkAboutContract 47386-FP1 i FORTWORTH. ,�
RECEIVED CITY SECRET
NOV 16 2018 CONTRACT N0.
r,RY OF FORT WORTH
a
EC ARY TRANSPORTATION AND PUBLIC WORKS
NOTICE OF PROJECT COMPLETION
City Project Ns: 02369
Regarding contract 47386 for 2014 CIP YEAR 2 CONTRACT 1 as required by the
TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by City Council on 12/15/2015
through M&C C-27568 the director of the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT upon
the recommendation of the Assistant Director of the Transportation&Public Works Department has accepted the
project as complete.
Original Contract Prices: $3,414,296.90
Amount of Approved Change Orders: ($2.54) Ns 1 ✓
Revised Contract Amount: $3,414,294.36
Total Cost Work Completed: $3,371,462.22
Less Deductions:
Liquidated Damages: Days @$210.00/Day
�i Pavement Deficiencies:
Total Deduction Amount: $0.00
Total Cost Work Completed: $3,371,462.22
Less Previous Payments: $3,202,889.11 ✓
Final Payme Due $168,573.11
r
Recomme ceptance Date `
Asst. Dire t PW - Infrastructure Design and Construction
Accepted Date
Director,
TRANSPORTATION AND PUBLIC WORKS DEPARTMENT
wl
Asst. City Manager DatE
Comments: ECORDiw- 34014 20(00000 Ca Z3Cv q-C FETA N ��50,12U•1p@.. ETARY5q(o01-- Zo o0000-- (-02-3(oct- METAO $LIU,0(o0• (� k,TX
5qUOI -- W00000-- CO Z3(oct - C e5 TA IJ $y-1 V-64
Depart en o PW(,onst. Services
CPN# Date
Project Manager
Risk Management S. Ga wood
D.O. E. Brotherton f��
Water V. Gutzier
CFA Janie Mor es/Scanned ❑
requ
The
final payment&have released this e have been tacted project for such payment est
for
Clearance Conducted By Etta Bacy
y)-0
gecejved L�i-k-' MOI)S
�
,.�.� TPW Construction Invoice
Contract: CS47386 P.O.# 18-00101210 Payment Date: 924/2018
TO:JLB Contracting,LLC INV•# CS47386-36 FINAL Estimate No. 36 DOE:
P O Box 24131 ProjManager KRISTIAN SUGRIM
Fort Worth TX 76124
FOR: CONTRACT 1 -2014 CIP YEAR 2
Contract Amount: $3,414,296.90 /
Completed Ret Pen Adj Pay
Total to Date: $3,371,462.22 $0.00 $0.00 $0.00 $3,371,462.22
Previous Estimate: $3,371,462.22 $0.00 $0.00 $0.00 $3,202,889.11
Earned to Date: $0.00 ($168,573.11) $0.00 $0.00 $168,573.11
Payments:
34014-0200431-5740010--CO2369-CO2483-2016-14010199 $1,560,315.50
Total to Date: $1,517,480.82 $0.00 $0.00 $4,250.56 $1,521,731.38
Previous Estimate: $1,517,480.82 $75,874.04 $0.00 $8,501.12 $1,441,606.78
Earned to Date: $0.00 ($75,874.04) $0.00 $4,250.56 $80,124.60
59601-0600430-5740010--CO2369-C01783-- $1,679,997.15
Total to Date: $1,679,997.15 $0.00 $0.00 ($37,939.69) $1,642,057.46
Previous Estimate: $1,679,997.15 $83,999.86 $0.00 ($75,879.38) $1,595,997.29
Earned to Date: $0.00 ($83,999.86) $0.00 ($37,939.69) $46,060.17
59607-0700430-5740010--CO2369-C01783-- $173,984.25
Total to Date: $173,984.25 $0.00 $0.00 $33,689.13 $207,673.38
Previous Estimate: $173,984.25 $8,699.21 $0.00 $67,378.26 $165,285.04
Earned to Date: $0.00 ($8,699.21) $0.00 $33,689.13 $42,388.34
PURCHASE ORDER MUST
APPEAR ON INVOICE
Tuesday,November 13,2018 cans rtatfon"uWi Wor
BUSINESS SUPPORT GROUP Page 1 0£1
Contact Person/Phone Number
ITZEL ALMAGUER X 8627
Department Approval Signature(Printed)
CAROL BUKO pIC X 8648
Dep nt Ap ov I tura/D
p-ece�ved L�i-k. 81301)8
D RLP} I?ct inG( t
41
`. TPW Construction Invoice
Contract: CS47386 P.O.# 18-00101210 Payment Date: 9/24/2018
TO:JLB Contracting,LLC INV.# CS47386-36 FINAL Estimate No. 36 DOE:
P O Box 24131 ProjManager KRISTIAN SUGRIM
Fort Worth TX 76124
FOR: CONTRACT 1-2014 CIP YEAR 2
Contract Amount: $3,414,296.90
Completed Ret Pen Adj Pay
Total to Date: $3,371,462.22 $0.00 $0.00, $0.00 $3,371,462.22
Previous Estimate: $3,371,462.22 $0.00 $0.00 $0.00 $3,202,889.11
Earned to Date: $0.00 ($168,573.11) $0.00 $0.00 $168,573.11
Payments:
34014-0200431-5740010--CO2369-CO2483-2016-14010199 $1,560,315.50
Total to Date: $1,517,480.82 $0.00 $0.00 $4,250.56 $1,521,731.38
Previous Estimate: $1,517,480.82 $75,874.04 $0.00 $8,501.12 $1,441,606.78
Earned to Date: $0.00 ($75,874.04) $0.00 $4,250.56 $80,124.60
59601-0600430-5740010--CO2369-C01783-- $1,679,997.15
Total to Date: $1,679,997.15 $0.00 $0.00 ($37,939.69) $1,642,057.46
Previous Estimate: $1,679,997.15 $83,999.86 $0.00 ($75,879.38) $1,595,997.29
Earned to Date: $0.00 ($83,999.86) $0.00 ($37,939.69) $46,060.17
59607-0700430-5740010--CO2369-C01783-- $173,984.25
Total to Date: $173,984.25 $0.00 $0.00 $33,689.13 $207,673.38
Previous Estimate: $173,984.25 $8,699.21 $0.00 $67,378.26 $165,285.04
Earned to Date: $0.00 ($8,699.21) $0.00 $33,689.13 $42,388.34
PURCHASE ORDER MUST
APPEAR ON INVOICE
Tuesday,November 13,2018 Tran5bn-&Publ6-Wor
ks
BUST ESS SUPPORT GROUP Page 1 of 1
Contact Person/Phone Number
ITZEL ALMAGUER X 8627
Department Approval Signature(Printed)
CAROL BUKOVIC X 8648
Department Approval Signature/Date:
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Contractor Final Estimate Approval Final- 1 - Submit Page 2 of 4
FORT WORTH. Contractor Final Estimate Approval
Date Started: 19/24/2 18jM Date Due: 110/8/2018
Invoiced Amount:
(Amount from $ 168,_573.11 i Request No.: Final - 1 - Submi
Line 8 of C-620)
Project Name: 2014 CIP Year, 2 - Contract 1
Project Number: 02369
Invoice No.: 136
Reference:
Contractor: Isam Davis 1
Discussion:
(Limit 5000) j
i
N
R
Approval Status:
https://projectpoint.buzzsaw.com/ bz web/Forms/FormPrint.aspx?SiteId=51500&ProcessI... 11/9/2018
Contractor Final Estimate Approval Final- 1 - Submit Page 3 of 4
Approved: Yes
Comments:
User: Gary Deyon f
Date: 2018-09-26 10:21 AM
i
i
Approved: Yes
Comments:
User: Etta Bacy
Date: 2018-09-26 10:26 AM
i
Approved: Yes
Comments:
User: Sam Davis
Date: 2018-09-26 12:13 PM
r
i
i
;Approved: Yes I
(Comments:
User: Ariel Duarte
Date: 2018-09-26 2:51 PM j
I
Approved: Yes
!Comments:
!User: John Kasavich
Date: 2018-09-28 5:26 PM
I
Approved: Yes
!Comments:
User: Gary Deyon
Date: 2018-10-17 8:55 AM
,
i
I
!Approved: Yes
!Comments:
;User: Etta Bacy
Date: 2018-10-17 10:09 AM i
I
Approved: Yes
Comments:
User: Sam Davis
Date: 2018-10-17 12:40 PM
Approved: Yes
Comments:
User: Ariel Duarte
Date: 2018-10-18 3:14 PM
i
Approved: Yes
(Comments:
https://projeetpoint.buzzsaw.com/ bz web/Forms/FormPrint.aspx?SiteId=51500&Processl... 11/9/2018
Contractor Final Estimate Approval Final - 1 - Submit Page 4 of 4
User: John Kasavich
Date: 2018-10-25 3:05 PM f
Approved: Yes /
Comments: / e
User: Kristian Sugrim v j
(Date: 2018-10-25 3:58 PM i
I
Approved: Yes
Comments: J
User: Lane Zarate
,Date: 2018-11-08 4:21 PM
i
j
;Approved: Yes
jcomments:
;User: Ricardo Matute
!Date: 2018-11-08 10:40 AM
• I
r
https://projectpoint.buzzsaw.com/ bz web/Forms/FormPrint.aspx?SiteId=51500&ProcessI... 11/9/2018
FORTWORTH.
TRANSPORTATION AND PUBLIC WORKS
NOTICE OF PROJECT COMPLETION
City Project Ns: 02369
Regarding contract 47386 for 2014 CIP YEAR 2 CONTRACT 1 as required by the
TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by City Council on 12/15/2015
through M&C C-27568 the director of the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT upon
the recommendation of the Assistant Director of the Transportation&Public Works Department has accepted the
project as complete.
Original Contract Prices: $3,414,296.90
Amount of Approved Change Orders: ($2.54) Ns 1
Revised Contract Amount: y $3,414,294.36 ✓
Total Cost Work Completed: $3,371,462.22
4 °w
Less Deductions: o
13 c d
t ...
Liquidated Damages: o 0 U w Days @$210.00/Day
Pavement Deficiencies: I a pq Q
EVl >
Total Deduction Amount: `o`� p °., o $0.00
Total Cost Work Completed: 'q U $3,371,462.22
u a q
Less Previous Payments: Z •�„x W +r 2 i° $3,202,889.11 ✓
CL o v
t=
Final i ASU i~w
Final Paye Due _ $168,573.11 /
I (�
Recomme ceptance Date
Asst. Dire t PW - Infrastructure Design and Construction
Accepted Date
Ift Director,
TRANSPORTATION AND PUBLIC WORKS DEPARTMENT
11011slis
Asst.C"
ity anager Dat
Comments:
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FORTWORTHREV:8/20/16
TRANSPORTATION AND PUBLIC WORKS
PERFORMANCE EVALUATION OF CONTRACTOR
I) CONTRACTOR&PROJECT DATA
Name of Contractor Project Name
JLB Contracting,LLC 2014 CIP Year 2 Contract 1
Inspector City Project Number
Gary Deyon 2369
Canstniclion Czomponenis Project Manager
Q Water Q Waste Water[:] Storm Drainage0 Pavement Kristian Sugrim
Initial Contract Amount ProjectDculty
$3,414,296.90 0 Simple Q Routine 0 Complex
Final Contract Amount Date
$3,414,296.90 IFebruary 13,2018
I1)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 4 20 20
3 Plans on Site 5 Y 4 20 20
4 Field Supervision 15 Y 3 60 45
5 Work Performed 15 Y 3 60 45
6 Finished Product 15 Y 3 60 45
7 Job Site Safety 15 Y 3 60 45
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 3 20 15
11 Property Restoration 5 Y 3 20 15
12 After Hours Response 5 Y 4 20 20
13 Project Completion 5 Y 3 20 15
TOTAL ELEMENT SCORE(A) 351
BONUS POINTS(25 Maximum)(B)
TOTAL SCORE(TS) 351
VIII)CONTRACTOR'S RATING
Maximum Score(MS)=448 or sum of applicable element score maximums which= 448
Rating([TS/MS] *100%) 351 / 448 = 78%
Performance Category Good
<20%=Inadequate 20%to<40%=Deficient 40%to<60%=Standard 60%to<80%=Good >80%=Excellent
Inspector's Comments(INCLUDING EXPLANATION OF BONUS POINTS AWARDED)
Inspector Signature Contractor Signature
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
FORTWORTH
TRANSPORTATION AND PUBLIC WORKS
PIPE REPORT FOR:
PROJECT NAME: 2014 CIP Year 2 Contract 1
PROJECT NUMBER: 2369
DOE NUMBER:
WATER
PIPE LAID SIZE TYPE OF PIPE LF
10" PVC 660
8" PVC 9021
6" PVC 6
1" Copper 785
FIRE HYDRANTS: 9 VALVES(16" OR LARGER)
PIPE ABANDONED SIZE TYPE OF PIPE LF
DENSITIES: Yes/Pass
NEW SERVICES:
SEWER
PIPE LAID SIZE TYPE OF PIPE LF
8" SD-26 1017
PIPE ABANDONED SIZE TYPE OF PIPE LF
6" PVC 419
DENSITIES: Yes/Pass
NEW SERVICES:
TRANSPORTATION AND PUBLIC WORKS
E The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TX 76012-6311
(817)392-7941 •Fax: (817)392-7845
FORTWORTHREV:02122107
TRANSPORTATION AND PUBLIC WORKS
CONTRACTOR'S EVALUATION OF CITY
I)PROJECT INFORMATION Date: February 13,2018
Name of Contractor Project Name
JLB Contracting,LLC 2014 CIP Year 2 Contract 1
DOE Inspector Project Manager
Gary Deyon Kristian Sugrim
DOE Number ProjectDifficulty Type of Contract
2369 O Simple QQ Routine Q Complex Q✓ water0 Waste water Storm Drainagr Pavement
Initial Contract Amount Final Contract Amount
$3,414,296.90 $3,414,296.90
II)PERFORMANCE EVALUATION
0-Inadequate 1 -Deficient 2-Standard 3 -Good 4-Excellent
ELEMENT RATING ELEMENT RATING
(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
3 Accuracy of Measured Quantities 3 Applicability of Specifications
4 Display Of Professionalism 4 Accuracy of Plan Quantities 2_
5 Citizen Complaint Resolution 3 PROJECT MANAGER EVALUATION
6 Performance-Setting up Valve Crews,Labs 1 Knowledge And/Or Problem Resolution Z-
ADMINISTRATION 2 Availability of Project Manager z
1 Change Order Processing Time O 3 Communication y
2 Timliness of Contractor Payments 4 Resolution of Utility Conflicts
3 Bid Opening to Pre-Con Meeting Timeframe
III)COMMENTS&SIGNATURES
COMMENTS WAJ i r—,/Z 7 trP r :../A S VHF'-Y
-r?44,112 1 515 v g s e.el, a Q TI,-( 79e-t,i -eg'D—11-e pp-O-J&vr�'-
e'
Signature Contractor
Signature DOE Inspector
Signature DOE Inspector's Supervisor
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
CONSENT OF OWNER ❑
SURETY COMPANY ARCHITECT ❑
CONTRACTOR ❑
TO FINAL PAYMENT SURETY
❑
OTHER
(SIMILAR TO AIA DOCUMENT G707)
Bond No. 4075946
PROJECT: 2014 CIP Year 2 - Contract 1,Unit 1, 2, and 3, City Project No. 02369
(name,address)Fort Worth, Texas
TO (Owner)
ARCHITECT'S PROJECT NO:
F—City of Fort Worth, Texas CONTRACT FOR: Above Project
200 Texas Street
Fort Worth, Texas 76102
CONTRACT DATE:
CONTRACTOR: JLB Contracting, LLC
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) Westfield Insurance Company
555 Republic Drive, Suite 450
Plano, Texas 75074 ,SURETY COMPANY,
on bond of(here insert name and address of Contractor)
JLB Contracting,LLC
P.O. Box 24131 ,CONTRACTOR,
Fort Worth, Texas 76124
hereby approves of the final payment to the Contractor, and agrees that the 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
200 Texas Street
Fort Worth, Texas 76102 ,OWNER,
as set forth in the said Surety Company's bond.
IN WITNESS WHEREOF,
The Surety Company has hereunto set its hand this 20th day of August 2018
WESTFIELD IN RAN E COMPANY
Surety Company
By .r/
Signature of thorized Representative
Attest:
(Seal): Kyle W. Sweeney Attorney-in-Fact
Title
Note:This form is intended tp be vjed�as companion document to the Contractor's Affidavit of Payment of Debts and Claims,Current Edition
THIS POWER OF ATTORNEY SUPERCEDES ANY PREVIOUS POWER BEARINU 1111:5 SAMt
POWER#AND ISSUED PRIOR-TO 04/20/11, FOR ANY PERSON OR PERSONS NAMED BELOW.
POWER NO. 4220052 06
General
Power Westfield Insurance Co.
`
of Attorney Westfield National Insurance Co.
Ohio Farmers Insurance Co.
CERTIFIED COPY Westfield Center, Ohio
Know All Men by These Presents, That WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO
FARMERS INSURANCE COMPANY, corporations, hereinafter referred to individually as a "Company" and collectively as -Companies," duly
organized and existing under the laws of the State of Ohio, and having its principal office in Westfield Center, Medina County, Ohio, do by these
presents make, constitute and appoint
CHARLES D. SWEENEY, MICHAEL A. SWEENEY, KYLE W.SWEENEY, ELIZABETH GRAY,JOINTLY OR SEVERALLY
of FORT WORTH and State of TX its true and lawful Attorney(s)-in-Fact,with full power and authority hereby conferred in its name,
place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings, or other instruments or contracts of
suretyship- - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - -
LIMITATION: THIS POWER OF ATTORNEY CANNOT BE USED TO EXECUTE NOTE GUARANTEE, MORTGAGE DEFICIENCY, MORTGAGE
GUARANTEE, OR BANK DEPOSITORY BONDS.
and to bind any of the Companies thereby as fully and to the same extent-as if such bonds were signed by the President,sealed with the corporate
seal of the applicable Company and duly attested by its Secretary, hereby ratifying and confirming all that the said Attorney(s)-in-Fact may do in
the premises. Said appointment is made under and by authority of the following resolution adopted by the Board of Directors of each of the
WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY:
"Be It Resolved,that the President, any Senior Executive, any Secretary or any Fidelity& Surety Operations Executive or other Executive shall
be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and act for
and on behalf of the Company subject to the following provisions:
The Attorney-in-Fact. may be given full power and authority for and in the name of and on behalf of the Company,to execute,acknowledge and
deliver, any and all bonds, recognizances, contracts, agreements of indemnity and other conditional or obligatory undertakings and any and all
notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such
Attorney-in-Fact shall be as binding upon the Company as if signed by the President and sealed and attested by the Corporate Secretary.-
'Be it Further Resolved,that the signature of any such designated person and the seal of the Company heretofore or hereafter affixed to any
power of attorney or any certificate relating thereto by facsimile,and any power of attorney or certificate bearing facsimile signatures or facsimile
seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached.' (Each adopted at a meeting
held on February 8,2000).
In Witness Whereof, WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE
COMPANY have caused these presents to be signed by their Senior Executive and their corporate seals to be hereto affixed this 20th day of
APRIL A.D.,2011
,...u.w.,,,y - ,,... ,
Corporate �•�SUR�( ONAL...nuuu".,,,, • "��S(/....
WESTFIELD INSURANCE COMPANY
Seals �rQ�a.•......!CF;� aP .• ' ••.!s�G ....,•" 5 . • "',yc.�, WESTFIELD NATIONAL INSURANCE COMPANY
Affixed,�.oe .at+ :LQ ;=o: ••,p; ,;��'�• '•e^ OHIO FARMERS INSURANCE COMPANY
"' SEAL .90_ t '•gKARTE14�p;�
3,�j.' .ay. ��_� =`''' •O t 1848 :q
'� ••~'•• ""�� � -"may•. .. ..• ' ••••..�',,•r� I -
By:
State of Ohio
�""'"•""'"`"' •••.*1...•'''. """"•" "" Richard L. Kinnaird, Jr., National Surety Leader and
County of Medina ss.: Senior Executive
On this 2011h day of APRIL A.D.,2011 , before me personally came Richard L. Kinnaird, Jr. to me known, who, being by me duly
sworn, did depose and say,that he resides-in. Medina, Ohio;that he is Senior Exectitive of WESTFIELD INSURANCE COMPANY,WESTFIELD
NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, the companies described in and which executed the above
instrument;that he knows the seals of said Companies;that the seals affixed to said instrument are such corporate seals;that they were so affixed
by order of the Boards of Directors of said Companies;and that he signed his name thereto by like order.
Notarial `„�.01004,,, '
Seat a1 A I-
S
Affixed
William J. Kahelin,A rney at Law, Notary Public
State of Ohio N d. x'40 My Commission Does Not Expire(Sec. 147.03 Ohio Revised Code)
County of Medina ss.: y �o•t+�•
1, Frank A.Carrino, Secretary of WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS
INSURANCE COMPANY, do hereby.certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said
Companies, which is still in full force and effect;and furthermore,the resolutions of the Boards of Directors, set out in the Power of Attorney are
in full force and effect. , ;;1;� (,
In Witness Whereof, I have hereunto.set my,hand 6''nd affixed the seals of said Companies at Westfield Center, Ohio, this 20th day of
Aug ust A.D., 2018
,�•`asUR•tk�,
N tlnitA(, r, P lNSU ''4,
SGS- :� ., ...R•Iyc�
v. •.ca.•''% P Or � •. �•-
$N SUL
SEAL .m_ -�1 :as Secretary
., � �� �: .,o• ?%•,1E348Aie
; = Frank A. Carrino,-Secretary
�Y -^441t1.1.�` .111 .1��•' l
BPOAC2 (combined) (06-02)
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 Sam Davis, President of JLB Contracting, LLC,
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;
2014 CIP Year 2 Contract 1, Unit 1,2 and 3
City of Fort Worth Project No. 02369
Bl(-
Sam
YSam Davis
President
JLB Contracting, LLC
Subscribed and sworn before me on this Jq1—(, of 2018.
NOT PUB IC IN AND F
T T COUNTY, TEXAS
My commission expiresla.Zr a
v � JAMIE GREENWAY
°: z Notary Public,State of Texas
Comm. Expires 09-25-2020
Notary ID 1211545 4
FORTWORTH rev 03/05/07
TRANSPORTATION & PUBLIC WORKS
FINAL STATEMENT OF CONTRACT TIME
FINAL STATEMENT NO.:35
NAME OF PROJECT: 2014 CIP YEAR 2 CONTRACT
PROJECT NO.: 2369 CONTRACTOR: JLB Contracting
DOE NO.:
PERIOD FROM:10/16/17 TO: 10/30/17 FINAL INSPECTION DATE: June 19,2018
WORK ORDER EFFECTIVE:2/15/2016 CONTRACT TIME: 300 Q WO* CD
DAY OF DAYS REASON FOR DAYS DAY OF DAYS REASON FOR DAYS
MONTH CHARGED CREDITED MONTH CHARGED CREDITED
DURING DURING
1. 16. Mon 1
2, 17. Tues 1
3. 18. Wed 1
4, 19. Thur 1
5. 20. Fri 1
6. 21. Sat 1
7, 22. Sun 1
8, 23. Mon 1
9, 24. Tue 1
10. 25. Wed 1
11. 26. Thu 1
12, 27. Fri 1
13. 28. Sat 1
14. 29. Sun 1
15. 30. Mon 1
31.
SAT,SUN, RAIN,TOO WET, UTILITIES DAYS TOTAL
&HOLIDAYS &TOO COLD RELOCATIONS OTHERS CHARGED DAYS
THIS 15 15
PERIOD
PREVIOUS 609 609
PERIOD
TOTALS 624 624
TO DATE
*REMARKS:
9 L711 .9
CONTRACTOR DATE O DATE
_ ENGINEERING DEPARTMENT
i The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TX 76012-6311
(817)392-7941 •Fax: (817)392-7845
i