HomeMy WebLinkAboutContract 44743-CO23 CITY SECRETARY CONTRACT NO.44743-CO23
TEXAS DEPARTMENT OF TRANSPORTATION
CONSTRUCTION CONTRACT CHANGE ORDER NUMBER: 23
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
0 Existing nn Amended Jew County: Tarrant
[Chick one j
District: Fort Worth
3. Indicate the type and amount of funding:
Contract
❑Fixed Price(Lump Sum) (Estimated Amount ) Number: 08133013
❑Actual Cost
(a) Contract Items(Bid Items): $5,623.80 Use as needed:
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 8/8/16
TOTAL $5,623.80
By
�
CITY OF FORT WORTH
APP]RqMAL RECOMMENDED: Typed/Printed Name Jesus J. Chapa
1 1
Q41 C-i. Typed/Printed Title Assistant City Manager
Doug Wie s g
Director,Transpotation/Public Wor s 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
AEPROVEJD AS TO FORM AND LEGALITY
c
Doug as .Black
Assistant City Attorney
Texas
Department
of 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.09?'
Director - Fort Worth District Construction
Subject Change Order 23
Project: BR 2006(132
Control: 0902-48-539
Highway: CS
County: Tarrant
Enclosed is one copy of Change Order Number 23 on the above captioned project which has been approved
by the Area Engineer.This is a SLOA project. Project plans were prepared by consultant.
This change order is necessary to compensate the Contractor for changeable message signs used for traffic
switch/detours.The signs were used to increase public awareness and safety of the Contractor and TxDOT
employees.
This change order is to add Item 6834 2001"PORTABLE CHANGEABLE MESSAGE SIGN"to the project.
The City of Fort Worth may be responsible for up to 100%of the change order costs.The final amount of
participation will be determined following the completion and approval of the Statement of Cost.
Additionally, this Change Order adds Special Provision 000249"Certificate of Interested Parties(Form
1295)"to the project. This modification is required by House Bill 1295,Section 2252.908 passed by the
Texas Legislature in 2015.A copy SP 000-249 and TxDOT memo regarding this subject is attached to
Change Order.
Attached is one copy of the Area Engineer's memo,supporting the added item(s).
The cost in Control 0902-48-539 will increase by$5,623.80.
Your review and further handling will be appreciated.
OUR VALUES: People•Accountability• Trust - Honesty
OUR MISSION: Through collaboration and leadership,we deliver a sate,reliable,and integrated transportation system that enables the movement of people and
goods.
An Enu"I Onnnrtunity EmNnvm
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
Department
of Transportation
MEMO
April 11, 2016
To: Michael Bostic, P.E.
Director of Construction, FM
From: Minh Tran, P.E.
Area Engineer, NTAO
Subject Change Order#23
Project: BR 2006(132)
CCSJ: 0902-48-539
Highway: CS
County:Tarrant
GENERAL INFORMATION
Contract Amount: $ 10,498,196.74
Previous Changes: $ 387,118.26
Proposed Changes: $ 5,623.80
TOTAL CHANGES: $ 10,890,938.80
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
r Description of Contract: Bridge replacement
r Describe the reasons and recommendations being made for this Change Order:
This change order is necessary to compensate the Contractor for changeable message signs used
for traffic switch/detours.The signs were used to increase public awareness and safety of the
Contractor and TxDOT employees.
This change order is to add Item 6834 2001"PORTABLE CHANGEABLE MESSAGE SIGN"to the
project.
The City of Fort Worth may be responsible for up to 100%of the change order costs.The final
amount of participation will be determined following the completion and approval of the Statement
of Cost.
OUR GOALS
MAINTAIN A SAFE SYSTEM • ADDRESS CONGESTION • CONNECT TEXAS COMMUNITIES • BEST IN CLASS STATE AGENCY
An Equal Opportunity Employer
Additionally,this Change Order adds Special Provision 000-249 "Certificate of Interested Parties
(Form 1295)'to the project. This modification is required by House Bill 1295,Section 2252.908
passed by the Texas Legislature in 2015.A copy SP 000-249 and TxDOT memo regarding this
subject is attached to Change Order.
NEW AND/OR REVISED PLAN SHEET(S):
None
Added Items:
o 68342001 PORTABLE CHANGEABLE MESSAGE SIGN
s Added Days: NA
If you should need additional information please contact Chuck Putnam at(817) 399-4303.
Michael Bostic,P.E. 2 April 11,2016
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CERTIFICATE OF INTERESTED PARTIES FORM 1295
loll
Complete Nos,1-4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos,1,2,3,5,and 6 if there are no interested parties. CER-1-IFICATION OF FILING
1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business, 2016-34402
Haydon Building Corp
Irving,TX United States Date Filed:
2 Name of governmental entity or swte agency that is a pam to the contract for which the form is 0410412016
being filed.
Public Safety,Texas Department of Date Acknowledged:
g Provide the identification:number used by the governmental entity or state agency to trnck or identify the contract,and provide a
description of the goods or services to be provided under the contract,
0902-48-539
Bridge&Roadway Construction-Precinct Line-Walker Branch
4 Nature of interest(check applicable)
Name of Interested Party City,state,Cour�u'y(place of business)
Controlling Intermediary
Jones,Scott Irving,TX United States X
5 Check only if there is NO Interested Party.
6 AFFIDAVIT t swear,or affirm,under penalty of perjury,that the above d sclosure is true and correct
NOEMI TOVAR MARTINEZ
Notary Public.State of Texas 0j+
My Commission Expires Si nature of authorized agent of contractingbusiness entity
February 14,20i 7
AF IX'M5 A AMP SEAL. ABpVE 1 }
Swom to and subscribed before me.by the said?ro` l f N this the day of Ajoyl I
20if P ,to certify whi ,witness my hand and seal of office,
C IN I6L t� rILD
Signature of officer administerin Printed name of officer administering oath Title of officer administering oath
Forms provided by Texas Ethics Commission www,ethics,state.lY.us Version V1.0.312
M* Form Z 146
Change Order Checklist (Rev 09110)
ZPage 1 of 1
Change Order Number: 23 Contractor: Haydon Building Corp.
CSJ: 0902-48-539 Project: BR 2006(132)
Highway: CS County: Tarrant
Area Engineer: Minh Tran,P.E. CO Amount: $5,623.80
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 ❑x 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 Q 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)
❑ 0 Is AED-DO signature required?(If so,see"Administrative Approval"below.)
Yes No NA 3rd Party Funding
E] ❑ Is 3rd party funding Involved In this project? (If no, move to next section)
❑ 0 ❑ If yes, has the funding been requested and received?
0 ❑ 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?
❑ Q ❑ 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
Q ❑ Is the work within the scope of the original environmental assessments and reviews?
❑ ❑x Does this change order Impact pedestrian elements previously reviewed by TDLR or Increase the cost of
pedestrian elements to$50,000 or more?If yes,answer next question.
❑ ❑ Q Has TDLR reviewed the impact to pedestrian elements associated with this change order?
❑ ❑x Does work performed in the change order affect any current environmental commitments?
❑ ❑ n Have the necessary environmental clearances or permits been obtained to address the affect?
❑ a 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?
❑ ❑ Q Have the necessary clearances or permits been obtained to address the increased Impact?
❑ ❑ 0 If the change order work causes the soil disturbance area to exceed the t acre and 5 acre thresholds,has
a CSN or N01 been processed?
Yes No NA Stockpiled Materials
❑ ❑ 0 Are materials being received through this change order that will be placed in stock?
❑ ❑ Q If yes,have the materials been set up In MSMS?
Yes No NA Area Office and District Approval
0 ❑ 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)
❑ ❑ 0 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 CST7
❑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?
Cl ❑ 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