HomeMy WebLinkAboutContract 44743-CO12 CITY SECRETARY CONTRACT NO.44743-CO12
TEXAS DEPARTMENT OF TRANSPORTATION
CONSTRUCTION CONTRACT CHANGE ORDER NUMBER: 12
Third Party Funding Notification Sheet
This form is used when the subject change order involves funding by a source other than TxDOT/U.S.DOT,and involves third
parties who are providing funding under an Advance Funding Agreement or Donation Agreement.
1. Outside funding provided by:
CCSJ: 0902-48-539
City of Fort Worth
(Outside Entity's Legal Name) Project: BR 2006(132)
2.Type of outside funding agreement for this change: Highway: Precinct Line
F11 Existing nn Amended Flew County: Tarrant
[Chick one]
District: Fort Worth
3. Indicate the type and amount of funding:
Contract
❑Fixed Price(Lump Sum) (Estimated Amount ) Number: 08133013
Actual Cost
J
(a) Contract Items(Bid Items): $70,000.00 Use as needed:
I hereby acknowledge notification of the modifications
(b) E&C*: (a)X = $0.00 covered by this Change Order.
enter%
(c) Indirect Cost**: (a+ b)x = $0.00
enter% Date 6/20/16
TOTAL $70,000.00
By i
CITY OF FORT WORTH
APPROVAL RECOMMEN� Typed/Printed Name Jesus J.Chapa
Typed/Printed Title Assistant City Manager
Joh 1C—armafi
Did ctor,Water Department
*The percentage(%)for E&C(Engineering and Contingencies)charges varies from project to project
depending on the contract amount of the project. Projects with higher contract amount will have the lower rate
of E&C charge. For a specific project,E&C rate(%)can be derived from the cost of"Engineering and Contingencies"in
the"Estimated Cost"of the project.
**Use the statewide district rate as established by Finance Division each year. This line 3(c)is for Service Project only,
unless otherwise specified in the Advance Funding Agreement. See Stand Alone Manual Notice 98-2 for instructions.
Funding for this Change Order has been arranged:
TxDOT Representative Date
Typed/Printed Name:
TXDOT Form 2146-AFA(Rev.07/13)Page 1 of 1
APPROVED AS TO FORM AND LEGALITY
^ Doug as W. Black CIAL
Assistant City Attorney CITY SECR '
ary J se Secretary FT. WORTH,TX
Texas
Department
at Transportation
MEMO
May 23, 2016
To: Mr.Tracy Cain, P.E.
Director - Construction Division
Through: Mr.Jay Tarwater
Transportation Specialist- Construction Division
From: Mr. Michael Bostic, P.E. ">
Director - Fort Worth District Construction
Subject Change Order 12
Project: BR 2006(132)
Control: 0902-48-839
Highway: CS
County: Tarrant
Enclosed is one copy of Change Order Number 12 on the above captioned project approved by the Fort
Worth District Engineer.This is a SLOA project. Project plans were prepared by Consultant.
This change order is necessary to revise project's estimate on quantity of Item 2158-2011"24" CASING BY
OPEN CUT(1/2 IN THICKNESS)".This work was requested by the City of Fort Worth Water Department to
extend the casing in order to span the gabion improvements.The revision will overrun the estimated plan
quantity for this item by 100 LF,the Contractor agreed to be paid by the existing unit price.
The work is performed by Haydon Building Corp.
The final quantity placed in the field has been verified by the State personnel and supported by the invoices
submitted by the Contractor.
The City of Fort Worth will be responsible for 100%of the change order costs.
Attached is one copy of the Area Engineer's memo,supporting the revised and added item(s).
The cost in Control 0902-48-539 will increase by$70,000.00.
The equipment rates used in calculating the cost of this change order have been checked against the Blue
Book Rates.
Your review and further handling will be appreciated.
OUR VALUES: People -Accountability• Trust -Honesty
OUR MISSION: Through collaboration and leadership,we deliver a safe,reliable,and Integrated transportation system that enables the movement of people and
goods.
An Ennnl onnonunity Emnimer
If you should have any questions concerning this matter, please contact Mr. Greg Gorecki at(817) 370-
6517.
CAM
Attachments
CC® Mr. M.Tran, P.E.
Area Engineer
Mr.Tracy Cain,P.E. 2 May 23,2016
Texas
Do 'a 'ment
,AJof 7ransportatlon
MEMO
March 11, 2016
To: Michael Bostic, P.E.
Director of Construction, FTW
From: Minh Tran, P.E.
Area Engineer, NTAO
Subject Change Order#12
Project: BR 2006(132)
CCSJ: 0902-48-539
Highway:CS
County:Tarrant
GENERAL INFORMATION
Contract Amount: $ 10,498,196.74
Previous Changes: $ 283,321.04
Proposed Changes: $ 70,000.00
TOTAL CHANGES: $ 10,851,517.78
Contractor: HAYDON BUILDING CORP.
Plans were prepared by: Freese&Nichols,Aguirre & Fields
Work on this change order is: In Progress
Third Party Participation:City of Fort Worth
REVIEW INFORMATION
Description of Contract:Bridge replacement
v Describe the reasons and recommendations being made for this Change Order:
This change order is necessary to revise project's estimate on quantity of Item 2158-2011"24"
CASING BY OPEN CUT(1/2 IN THICKNESS)".This work was requested by the City of Fort Worth Water
Department to extend the casing in order to span the gabion improvements.The revision will overrun
the estimated plan quantity for this item by 100 LF,the Contractor agreed to be paid by the existing
unit price.
The work is performed by Haydon Building Corp.
The final quantity placed in the field has been verified by the State personnel and supported by the
invoices submitted by the Contractor.
OUR GOALS
MAINTAIN A SAFE SYSTEM • ADDRESS CONGESTION • CONNECT TEXAS COMMUNITIES • BEST IN CLASS STATE AGENCY
An Equal Opportunity Employer
The City of Fort Worth will be responsible for 100%of the change order costs.
NEW AND/OR REVISED PLAN SHEET(S):
Revision (4):317;
➢ Added Items: NA
Added Days: NA
If you should need additional information please contact Chuck Putnam at(817)399-4303.
Michael Bostic,P.E. 2 March 11,2016
Q E
C7 J
V 97.0
Cl
m v ❑ aim
N U,73
11 U d
❑❑❑❑
tij
G J
OE 2 r
coO_ z
p c o D O x rzt
d LQ [] F 0
LU ° Ex y s E o O z —
LL N O r U,
U.
E � ¢ ❑ `o
Q Q Q N co
>. O O E U
ui � � z co
z m c m w z a v
F= m V Q 9 d
fL N U W U G E
C14 M U O I¢- O N m C _N y
_ O yy
U r Q1 m
U
N
C G
O CO¢ y'c m
rn
2 � w z z W �
s
z >-
m = v y n
a ccx o z �- v
a V w z IL z G w ? e m aCL
CL_
v a c
C7 C4 ' Q
x o o Ix (A w acro
Q a aci = ro c a
U = m c s
V E O
y m y N 00
W N O O m D
M
U C q lE b
Q< W r `p co m
S IV N a m U
z O P` S O G A
t
O
m �
a = ¢ ,-
corm o
o
W
O yO C C
U Q G st C> LL. O� ? o
Z O cl
O di uNi J U m p
r N 4 c m
a ti ti tt O W -. m —Ca m
N 1n t0 h Q H z w C T O .q
i f�jI U CFj
O C! 4R 47 LU
1n o J 0O Q CC ` LL m C LU LU
n 0 .- c c Q m C m_ n = O
U) LLI
N N f7 Q Q r cc F Q G F- O S 17 '�.— �O i` N� 0
k°') maw ooa4 Q o ¢ o � snc= � a m g w
o m o in invsw T v c~n v> O a 0 �Uw to W
` z e.c ~ 3 m v ❑ O
O -� � ati s L z
�4 z a cr 0) W a o co
5 W
W'` f> > Q H a 1 x 4 Q c' m C m si ¢
p U 0. O h ¢ u! !- co F- m a m a 0
�� c�jFt�i � � � � v � w W ZG. wa o `o ❑ � O
Lin
iq a v ¢ V O C q ui x � m m m 2 c
oll � � z -% � aa �a CL v FNUYE C7 <y q
' .? Oa0 wduzi O 0a p q 3 ayi r hL- IL- z
aanaa. ¢ a. c+ Uu
15
• w , uj E
,
M
{]
\ CID
V3 m@
\)
72
\
) 4.
$
[� k
g § §
cE e 2
ƒk § g '
\\ } S
§ LU
§ I
k � 91. )
E
E B o U.
B-
kE
cm
3 i
[
�/ o - � -
) �
CID
!
- Iej �
ol
0! /�\ 3}A)
' a o
�, .
cm rA
r &, g .
� ) � ��K./ A ��
. R
£ B �
)\ d
2 k k k k § \
e &o u
Z ] $ / z z §
a z Q6 ) §
/} § S d d a «
\k\ / % § 1D. k k
M o o c
x
O ow o g
m �
m
CL
1- o
} Q
z Q
N
H
iZ
O O
W o
Q H o Q
m o
� o
a
O
W
O
z
a
x
> Y o U
= C o0
CL
+ W
t7 a
N �
m
z
m
W F a o
0
0 z d o
O c
LU
O
Z
Q �
T
v z �
N
N
W
2
Y
U
z
r-
N
h
U
2
W
0.
O
Q m
a ?
d' N
N U
w
O N
a ix
m o
O1 O wz
h 07
LO
cc m
v 07
4 O
O O
Q
� n m
LU O m
_ V N
N
O N W12 ul
o
LUQ
C1
z z O a
0 0 a u z o
0
v
m
c
m
IL
N
r
O
O
O
C3 p
z
LLID
a
d
17J
L7
z
a
z
c
0
E
Q
0
m
m
U
Y
O
C,
A
LO
m
N 'J
M U
o p
w E
a
0 0
IL`
z_ Y
z
0
i
33.3H3nmokidraum miam,uvm3YJNtzl OVOW 3NI1 nNI:)3dd
h Z3 to
Rj5Z
11.V „
I - d lid C.3 N WW z
r
I �ia`E n �s fF �f rRa i 8 3 d zi'
R f
I p aE h; vlac 6� ' F 0. v zr z�
sx pC V Vl
! epp� rgyC7• yE€ E ' z � ( 3 e
1i i�v
ij
t i
I I ` I li � i Irll � ;
�I I
i
W - `47 tg=; MATCHLINE';
• :� �p �x �:� .,.s I v 1 1 a a0 I: � P I I I d I I I I I I Z , u
g MATCHLINE 18+00 "+ RrrS:` +tY,
- x gib,: � � �
- .:.�^.i-.- , , JNJM1 NYN � • ��t•� R�{�TiSY{}e+Y}._�Y.k. ! + I I
-il, I = s - u'�sW l � • --w-'s-.%-+ I �t•�• '`FV j�T'i.'r y31.�oo'n• aa•f
46
y1 0. 1 ooror.
� __ � � I �I . 1 I I �•oa. .
„y"�u a •�ls �• . 4 r .„ J el.� i �
/ � 1 Iry �J �' 'I.� �+ �. 16 ]4 �t J ,-'� 1 I I • � 7M�9Y7 13:
ar.
�I
I 1.I M
two .✓tu {�-.KTr-1 ' 1
.: X
P \ •� „I 1 2 1 rl 1
-.2,(r„ix
s ''7 ?�`�- �._ ,Y u�:�'..b�•l`« IL. � I .. _ I _1_{-I I }l,IYIA i 3[! ti'OQ<i 'ig
i ! ,., f -Yum'°^ :+ , ' t T-�r�f u��ll•ii� rr•roc•-�rn�
,/IYTA 1O13If )
It07. [S
I` -
- -I I a3Ii7A 0�]:1
Al �� j I I' e?•r6t .•1,3ry
L- --- mea o r s3'rl I Q
w2z! 7.
e a
i
Form 2146
Change Order Checklist (Rev ag/,o)
Page 1 of)
Change Order Number; 12 Contractor: Haydon Building Corp.
CSJ: 0902-48539 Project: BR 2006(132)
Highway: CS County: Tarrant
Area Engineer: Minh Tran,P.E. CO Amount: $70,000.00
Is the change order for an Interim adjustment? ❑Yes ❑x No
Is the change order ❑x State oversight? ❑Federal oversight? ❑x Participating? ❑ Non-Participating?
If Federal oversight,is the change order Z Major? ❑or Minor?
Is the Reason Code correct? ❑x Yes ❑No
Is the proposed work within project limits? ❑x Yes ❑No
Does the change order affect the DBE commitment? [-]Yes ❑x No
Has time been addressed? ❑Yes ❑X No
Yes No NA Signatures
❑x ❑ ❑ Has the change order been signed by the Contractor?
❑x ❑ Is change order signed by AE?
❑x ❑ ❑ Is DE signature included?(If required)
❑ ❑x Is AED-DO signature required?(if so,see"Administrative Approval'below.)
Yes No NA 3rd Party Funding
❑ Is 3rd party funding Involved In this project? (If no, move to next section)
❑ ❑ If yes, has the funding been requested and received?
x❑ ❑ Does this change order Impact 3rd party funding?
❑ ❑x ❑ Will this Impact require a new or revised funding agreement?
❑ ❑ ❑x if an amendment or new agreement is required, has OGC-CSS reviewed the agreement?
❑ ❑x ❑ Has a Third Party Funding Notification Sheet(Form 2146-AFA)been sent and signed by the 3rd party?
Yes No NA Permitting:Environmental,Historical,etc
❑x ❑ Is the work within the scope of the original environmental assessments and reviews?
❑ r Does this change order impact pedestrian elements previously reviewed byTDLR or increase the cost of
pedestrian elements to$50,000 or more?If yes,answer next question.
❑ ❑ Z Has TDLR reviewed the impact to pedestrian elements associated with this change order?
❑ M Does work performed In the change order affect any current environmental commitments?
❑ ❑ x❑ Have the necessary environmental clearances or permits been obtained to address the affect?
❑ Z Does work performed In the change order Increase the impact to wetlands;waters of the U.S.;
archeological,historical or social Issues;endangered species;or any other regulated areas?
❑ ❑ 0 Have the necessary clearances or permits been obtained to address the increased Impact?
❑ ❑ 9 If the change order work causes the soil disturbance area to exceed the 1 acre and 5 acre thresholds,has
a CSN or N01 been processed?
Yes No NA Stockpiled Materials
❑ ❑ x❑ Are materials being received through this change order that will be placed In stock?
❑ ❑ Fx� If yes,have the materials been set up In MSMS?
Yes No NA Area Office and District Approval
M ❑ Does the AE's memo include an explanation/description of the change order work?
x❑ ❑ ❑ Is price justification information included?(per District procedures)
x❑ ❑ ❑ Are plan sheets attached?(per District procedures)
❑ ❑ x❑ if a time extension Is being granted,has It been justified?(per District procedures)
Yes No NA Administrative Approval
❑x ❑ Is a copy of the AE memo included in the transmittal to C5T7
❑x ❑ Does the transmittal Indicate who prepared the plans?(TxDOT or Consultant)
❑x ❑ ❑ If consultant prepared,is the consultant name provided?
❑x ❑ Is the status of the change order work Indicated?(awaiting CO approval,active,complete)
❑ ❑x Does the transmittal indicate if environmental clearance for extra work has been addressed?
❑ ❑ Has the bank balance category for funding been Identified?
❑ ❑ Is the transmittal memo from the District to CST attached and signed?
❑ ❑ Is all required documentation attached?(Ex:Plan Sheets,Form 2146,Price Justification,Force Account Backup Data)
❑ ❑ Has prior verbal approval of the change order work been given by Administration?
Comments
FORTWORTH
MEMORANDUM TO THE RECORD
TO: CONTRACT FILE NO. 44743
DATE: January 3, 2019
FROM: Vania Soto, Administrative Assistant
City Secretary's Office
SUBJECT: REQUEST TO FILE MULTIPLE CHANGE ORDERS TO CITY SECRETARY
CONTRACT NO. 44743
BACKGROUND
On January 2, 2019,the City Secretary's Office received Change Order Nos. 38, 43 and 45-51 to City
Secretary Contract No. 44743. During routine research before filing, it was discovered that previous
change orders had never been filed with the City Secretary's Office. The Administrative Assistant
requested originals of these documents from Transportation and Public Works for attesting and
recording, but was informed that Change Order No. 1, 7, 29 and 33 did not have any documentation
and were not received at the City Secretary's Office. Change Order No. 2, 3, 11, 21, 25, 30, 31, 37,
40 and 44 were not required by TXDOT to be signed by the City. All other Change Orders not
mentioned have signatures and do not require a memo to record. Therefore, it was requested by
Transportation/Public Works that a copy of the change orders or this memo be made the original in
order to facilitate the processing of subsequent Change Orders. Correspondence related to the
location of the original and the request for filing has been included in the contract file.
AUTHORIZATION FOR CONTRACT NUMBER
Per the direction of Mary Kayser, City Secretary, the City Secretary's Office has been requested to
issue a contract number,and place in the City of Fort Worth's official contract files the Change Orders
that were missing.
This request has been approve
City Secretary's Office