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Contract 44743-CO27
CITY SECRETARY CONTRACT NO.44743-CO27 TEXAS DEPARTMENT OF TRANSPORTATION CONSTRUCTION CONTRACT CHANGE ORDER NUMBER: 27 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 Existingnn Amended Blew County: Tarrant [Cuck one] 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): $491,237.85 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 912/16 TOTAL $491,237.85 By � / _ / CITY OF FORT WORTH AP VAL RECOMMENDED: Typed/Printed Name Jesus J.Chapa 0Typed/Printed Title Assistant City Manager Doug ie ig Director,Transpotation/Public Xks 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(rJ4.1 >%' 0-O'oppOoOn-��'� APPROVED AS TO FORM AND LEGALITY QAr ok_ui' Douglas W. Blackav i� k 2,49f o° ° �` Assistant City Attorney o° M&y L �r, ity acre f �� , ZTexeS HYMN Or 1�}B�ttS�110/i MEMO August 4, 2016 TO: Mr.Tracy Cain,P.E. Director- Construction Division Through: Mr.Jay Tarwater Transportation Specialist- Coonnstruction Division From: Mr.Michael Bostic, P.E.0 Director- Fort Worth District Construction Subject Change Order 27 -Time Extension 4 Project: BR 2006(132) Control: 0902-48-539 Highway: CS County: Tarrant Enclosed is one copy of Change Order Number 27 an the above captioned project approved by the District Engineer.This is a NON-PARTICIPATING project.Project plans were prepared by consultant. The project encountered the following issues after the commencement of the work: *ROW not clear of existing fence relocation,this impacted the water service relocation; *The relocation of the existing Water Service,as required by the plans; *Oncor franchise utility relocation; *AT&T franchise utility distribution line relocation; *Atmos franchise utility gas line relocation; The above listed issues impacted the critical path of work on the project schedule.The work activities impacted Include:traffic control,embankment,subgrade treatment and roadway pavement.The work activities were rescheduled to minimize the delay on the project completion.TxDOT and Contractor mutually agreed to continue the work activities on the project.However,the progress of the project has been negatively impacted. OUR VALUES: People•Accountability• Trust•Honesty OUR MISSION: Through collaboration and leadership,we deriver a sale,reliable,and integrated transportation system that enables the movement ofpeowe and goods. M EMIAI OFMM MV(Mrd0rtf The Contractor has provided a Time Impact Analysis with documentation describing the impacted time and cost. Following the review of the submitted documents and negotiation,TxDOT and Contractor mutually agreed the following project settlement. 175 working days to be added to Contract:155 compensable days and 20 non-compensable days due to the impact from the above issues. $309,635.75= Project overhead for the 155 compensable days using 6%formula stated in the Special Provisions Item 004-017 Article 4.4.A.1b. $173,727.10=Inefficiency cost incurred by the Contractor due on concrete material escalation,rebar material escalation, and standby equipment,) $7,875.00= Barricade maintenance during the impacted duration. $491,237.85-Total Settlement for the impacts. With the execution of this change order,TxDOT and Contractor mutually agreed that this Change Order resolved all outstanding project issues and disputes encountered to June 25th,2015.No further additional compensation or time will be considered as the result of this Change Order. 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 item(s). The cost in Control 0902-48-539 will be increased by$491,237.85. Time Extension Number 4 will add 175 days to the contract. 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. If you should have any questions concerning this matter,please contact Mr.Greg Gorecki at(81.7)370- 6517. CAM Attachments CC: Mr. M.Tran,P.E. Area Engineer Mr.Tracy Cain,P.E. 2 August 4,2016 TC7C8S 1}epartlt?Mt of Transportation MEMO 07/15/2016 To: Michael Bostic,P.E. FTW Director of Construction From: Minh Tran, P.E. NTAO Area Engineer Subject Change Order#27 Project: BR 2006(132) CSJ: 0902-48-539 Highway: CS County: Tarrant GENERAL INFORMATION Contract Amount: $ 10,498,196.74 Previous Changes: $ 422,697.11 Proposed Changes: $ 491,237.85 TOTAL CHANGES: $ 11,412,131.70 Contractor: HAYDON BUILDING CORP. Plans were prepared by: Freese&Nichols,Aguirre&Fields Work on this change order is:Complete Third Party Participation:City of Fort Worth REVIEW INFORMATION > Description of Contract:Bridge replacement Describe the reasons and regommendations being made for this Change Order: The project encountered the following issues after the commencement of the work: * ROW not clear of existing fence relocation,this Impacted the water service relocation; *The relocation of the existing Water Service,as required by the plans; * Oncor franchise utility relocation; *AT&T franchise utility distribution line relocation; *Atmos franchise utility gas line relocation; The above listed issues impacted the critical path of work on the project schedule.The work activities impacted include:traffic control,embankment,subgrade treatment and roadway pavement-The work activities were rescheduled to minimize the delay on the project completion. OUR VALUES: People-Accountability•Trust•Honesty OUR MISSION: Through collaboration and leadership,we deliver sate,reliable,and Integrated transportation system that enables 0t movement of people and goods. M Epuat oopO*"employer TxDOT and Contractor mutually agreed to continue the work activities on the project. However,the progress of the project has been negatively impacted. The Contractor has provided a Time Impact Analysis with documentation describing the impacted time and cost Following the review of the submitted documents and negotiation,TxDOT and Contractor mutually agreed the following project settlement. 175 working days to be added to Contract:155 compensable days and 20 non-compensable days due to the impact from the above issues. $309,635.75= Project overhead for the 155 compensable days using 6%formula stated in the Special Provisions Item 004-017 Article 4.4A.1b. $3.73,727.10=Inefficiency cost incurred by the Contractor due an concrete material escalation, rebar material escalation,and standby equipment.) $7,875.00-Barricade maintenance during the impacted duration. $491,237.85=Total Settlement for the Impacts. With the execution of this change order,TxDOT and Contractor mutually agreed that this Change Order resolved all outstanding project issues and disputes encountered to June 25th,2015.No further additional compensation or time will be considered as the result of this Change Order. The City of Fort Worth will be responsible for 1001,of the change order costs.. > NEW AND/OR REVISED PIAN SHEETS: None r Added Items: 0 05022001 BARRICADES,SiGNS AND TRAFFIC HANDLING 0 96082016 UNIQUE CHANGE ORDER ITEM 16: Dispute Resolution ➢ Added Days: o Extension#4 o Adding 175 days If you should need additional information please contact Chuck Putnam at(817)3994303. Michael Bostic, P.E. 2 07/15/2016 M* Change 2146 Change Order Checklist (AOv 02110) Aga: Page 1 of i Change Order Number. 27 Contractor. Haydon Building Corp. CSJ: 090248.539 Project: BR 2006(132) Highway: CS County: Tarrant Area Engineer. Minh Tram,P.E. CO Amount: $491,237.85 Is the change order for an Interim adjustment? ❑Yes ®No Is the change order x❑State oversight? ❑Federal oversight? ®Participating? ❑Non-Participating? If Federal oversight,Is the change orderx❑Major? []or Minor? Is the Reason Code correct? ❑x Yes ❑No Is the proposed work within project limits? ®Yes ❑No Does the change order affect the DBE commitment? [:]Yes ❑x No Has time been addressed? [EYes ❑No Yes No NA Signatures ® ❑ ® Has the change order been signed by the ContracWr7 ❑x ❑ Is change order signed by AE7 ❑x ❑ ❑ is DE signature included?(If required) ❑ ® Is AED-DO signature required?(if so,see"Administrative Approval"below.) Yes No NA 3rd party Funding ❑x ❑ is 3rd party funding Involved In this project? (If no, move to next section) ❑ ® ❑ It yes, has the funding been requested and received? ❑x ® Does this change order impact 3rd party funding? ❑ 0 ❑ 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 patty? Yes No NA Permitting:Environmental,Historical,etc ® ❑ is the work within the scope of the original environmental assessments and reviews? ❑ x❑ Does this change order impact pedestrian elements previously reviewed by MLR or increase the cost of pedestrian elements to$50,000 or morel tf yes,answer next question. ❑ ❑ 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? ❑ ❑ ® Have the necessary environmental clearances or permits been obtained to address the affect? ❑ ❑x Does work performed In the change order Increase the impact to wetlands;waters of the U.S4 archeological,historical or social issues;endangered species;or any other regulated areas? ❑ ❑ 9 Have the necessary clearances or permits been obtained to address the Increased impact? ❑ ❑ ®x If the change order work causes the soli disturbance area to exceed the 1 acre and 5 acre thresholds,has a CSN or N01 been processed7 Yes No NA Stockpiled Materials [] ❑ ❑x Are materials being received through this change order that will be placed in stock? ❑ ❑ a If yes,have the materials been set up In MSMS7 Yes No NA Area Office and District Approval ® ❑ Does the AE's memo include an explanation/description of the change order work? ® ❑ ❑ Is price justification information Included?(per District procedures) ❑ ❑ ® Are plan sheets attached?(per District procedures) ® ❑ ❑ 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 CST? ❑x Does the transmittal indicate who prepared the plans?(TxDOT or Consultant) ❑ ❑ 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 CSTattached and signed? Is all required documentation attached?iEx;Plan Sheets,Form 2146,Price Justification,Force Account Backup Data) Has prior verbal approval of the change order work been given by Administration? 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G 7 U7 F e w c `m co.� a .Ym2 c0 a 4 c t {� o ^r CC m 3 a � g;uj Lij CL (a r- U � � tiF- 0 a w W �OQ ¢ c a, d ti .mc` ti c 8 m W o � D 2 Z F u N N r �s a � o o� d ti Uzi_ Z a c w LL E o 0 o w 8 k m rri LA •V•O� ai Q } w Ll ® x $ to, z 19 LLIw a w C13 r ° g x co e � w a � � v v dO O d z z a a A � v m J 3 V Si u w C v z ul W W U R d W aa V N a m ® m d 03 M cn N z go a O � s s H G 4 cc a ee u °m O a Ln 0 M m N x w d O W C7 V .i C a 4 w U �c CJ' O N W E I L N ,S d }C Q � } U LL �= CERTIFICATE OF INTERESTED PARTIES FORM 1.295 loft Complete Nos.I-4 and 6 it there are Interested patties, OFFICE USE ONLY Complete Nos.1,2,3 5,and 6 if there are no interested parties. CERTIFICATION OF F1UNG I Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number: of business. 2016.85038 Haydon Build ng Corp Phoenix,AZ United States Date Filed, 2 Name of governmental entity or state agency that Is a pasty to the contract for which the terms 07/14/2016 being filed. Texas Department of Transportation Dateckn wledged; it a I(-- 3 Provide the Identification number used by the govemmental entity or state agency to track or identify the Aontrah and provide a description of the services,goods,or other property to be provided under the contract. 090248539 CO 27 Nature of Interest 4 Name of Intetesred Parry City,state,Country(place of business) (check applicable) controlling Inlermediery Behrhorst,Fritz Phoenix,AZ United States X Keebel,Les Phoenix,AZ United States X Pullce,Jim Phoenlx,AZ United Staters X Haydon,Gary Phoenix,AZ United States X Eklund,Mark Phoenix,AZ United States X 5 Check only if there is NO Interested Pany. a 6 AFFIDAVIT I swear,or affirm,under pcnaity of pegury,that the above disdosure Is true and::trees. Wg1U1 J slq,xd gr Al+rl,n ttivnd WICIAL SM tu+cn-WA o ENwd.a.Hnrocn eu.an c DEBBIE A.O'CONNER Mark D Ek and Cnq►,oµaaui-nvttu,d.,�gda�bctnn,,C.�: F1a�ry PuM-SIO ol Artem aur.29r607 14 13)7.43-UPW MARICOPA COUNTY Signature of authorized agent of eontfanng business entity my comm.Enk"Match 1.201 a AFFIX NOTARY STAMP I SEAL ABOVE l ZSwom to and subscribed before me,by the said / this the day of 20_/JJ—,to cavity which,witness my hand and seal of office. a6Z- 4Y Sipnalure at alficer adm1ni51e+ing oath Printed name of otr=r administering cath TRIe of gificer administer np oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0,277 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