HomeMy WebLinkAboutContract 44743-CO28 CITY SECRETARY CONTRACT NO.44743-CO28
TEXAS DEPARTMENT OF TRANSPORTATION
CONSTRUCTION CONTRACT CHANGE ORDER NUMBER: 28
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
P]Existingnn Amended Flew County: Tarrant
[Cuck one]
District: Fort Worth
3. Indicate the type and amount of funding:
Contract
❑Fixed Price(Lump Sum) (Estimated Amount ) Number: 08133013
P-1 Actual Cost
(a) Contract Items(Bid Items): $3,890.72 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 10/26/16
TOTAL $3,890.72
CITY OF FORT WORTH
APP V L RECOMMENDED: Typed/Printed Name Jesus J.Chapa
� Typed/Printed Title Assistant City Manager
Doug Wierstg
,�,/yt Director,Transpotation/Public Works 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
k'195-0q� vJ &W n
Douglas W. Black
Assistant City Attorney
,Ar Texas Department of Transportation
2501 SW LOOP 820 1 FORT WORTH,TEXAS 761332300 1 (817)370-6500 1 WWW.TXDOT,GOV
September 23, 2016
Precinct Line Road Project
CSJ: 0902-48-539/0902-48-680/0902-48-793
Tarrant County
Jesus J. Chapa
Assistant City Manager
City of Fort Worth
1000 Throckmorton Street
Fort Worth,TX 76102
Dear Mr. Chapa:
During construction of this project, it has become necessary to execute the Change Order#28 to introduce
the new TCP plan sheets 18B and 42A. The changes would enhance safety measures and reduce the
durations of the impacts to the businesses by providing an opportunity for the Contractor to accelerate
construction activities.The cost of the change order is$3,890.72.
The following documents are attached:
1. Third Party Funding Notification Sheet.
2. Change Order package.
We request that you sign the Third Party Funding Notification Sheets in the highlighted areas and return to:
Texas Department of Transportation
Attn: Rose Rodriguez - Transportation Planning& Development
2501 S.W. Loop 820
Fort Worth,Texas 76133
If you should have any questions concerning this matter, please contact Rose Rodriguez at
(817) 370-6997.
Mo h ld Al-t-if► P•E
Mohammad A Al Hweil, P.E.
Advance Transportation Planning Director
Fort Worth District
Enclosures
cc: Minh Tran, P.E., North Tarrant County Area Engineer
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 Equal opportunity Employer
TEXAS DEPARTMENT OF TRANSPORTATION
CONSTRUCTION CONTRACT CHANGE ORDER NUMBER: 28
Third Party Funding Notification Sheet
This form is used when the subject change order involves funding by a source other than TxDOT/US.DOT,and involves third
parties who are providing funding under an Advance Funding Agreement or Donation Agreement.
1.Outside funding provided by:
CCSJ: 090248-539
City of Fort Worth
(Outside Entity's legal Namel Project: OR 2006(132)
2.Type of outside funding agreement for this change: Highway:CS
® Existing ❑Amended ❑ New County:Tarrant
[Check one l 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(Bad Items): 3,890.72 Use as needed:
I hereby acknowledge notification of the modifications
(b) E&C•: (a)X a 0.00 covered bythis Change Order.
ROW—
(c)
O W—
(c) Indirect Cost": (a+b)x a 0.00
Date
TOTAL. 3,890.72
By
Typed/Printed Name
Typed/Printed Title
•The percentage(%}for E&C(Engineering and Contingencies}charges varies from project to project
depending on the contract amount of the project.Projects with a higher contract amount will have a tower rate
of E&C charge. For a spedfic project,E&C rate(%)can be derived from the cost of'Engineering and Contingendes"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 Praject 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:
TX DOT Form 2146-AFA(Rev 07/131 Page 1 of 1
fJ�D1?P8rftMnt
aruporiatlon
MEMO
September 9, 2016
To: Mr.Tracy Cain, P.E.
Director-- Construction Division
Through: Mr.Jay Tarwater
Transportation Specialist-Construction Division
Franc Mr. Michael Bostic,P.E. 41P,-F)
Director- Fort Worth District Construction
Subject: Change Order 28
Project: BR 2006(132)
Control: 0902-48-539
Highway: CS
County. Tarrant
Enclosed is one copy of Change Order Number 28 on the above captioned project approved by the Fort
Worth District Engineer.This Is a NONPARTICIPATING project.Project pians were prepared by Consultant.
This Change Order is necessary to introduce new TCP plan sheets 18B and 42A.The Contractor submitted
RFI #101, proposing a TCP change that would enhance safety measures and reduce the durations of the
Impacts to the businesses by providing an opportunity for the Contractor to accelerate construction activities
in the area Identified.The Contractor provided a revised TCP from Aguirre&Fields(P.S.188 and 42A).
TxDOT and the City of Fort Worth reviewed and accepted the TCP revision.
This change order will use existing items to create a lump sum payment(UC019608-2017)for the proposed
work, by decreasing Item 0260 2016"LIME(HYD,COM,OR QK(SLURRY))",and Item 060 2027 `LIME TRT
(EXTMATL)(8")"and increasing Item 3268 2008"D-GR HMA TY-5 PG64.22". Below is a detailed analysis:
An alternative analysis was done to compare the cost of the original 8"lime treated subgrade versus the
proposed deep hot mix asphalt(HMAC)
Original 8" Lime Treatment:
Item 260 201.6 003 X 6.356 tons @$128.000%ton =$813.50
Item 260 2027 003 X 381.33 SY @$3.500/SY=$1,334.66
Total treatment cost-$2,148,16
OUR VALUES: People•A=untablllty•Trow•Honesty
OUR MtSStON; Through collaborroUan and leadership,we deilver a safe,retlable,and Integrated transportation system that enables the movement orp&"and
Imo.
Yn w CkMn1KAV fmMavcr
4" HMA base In lieu of 8" Lime Treatment:
- Item 3268 2008 @$69.O0O/TOM X 87.52 tons=$6,O38.88
The additional cost incurred to the City for using 4" HMA base in lieu of 8"Lime Treatment Is:
Delta is$6,038.8&$2,148.16 = $3,890.72(LS).
The work will be performed by Haydon and their subcontractors,and then inspected by TOOT field
personnel.
The City of Fort Worth will be responsible for 1O0%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$3,890.72.
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(817)370-
6517.
CAM
Attachments
W. Mr. M.Tran, P.E.
Area Engineer
Mr.Tracy Cain,P.E. 2 September 9,2016
Texas
t7epariment
o17YansportafIon
MEMO
07/27/2016
To: Michael Bostic, P.E.
FTW Director of Construction
From: Minh Tran, P.E. h'l
NTAO Area Engineer
Subject Change Order#28
Project: BR 2006(132)
CSJ: 0902-48.539
Highway: CS
County: Tarrant
��RAt. I�IFARMATION
Contract Amount: $ 10,498,196.74
Previous Changes: $ 939,494.10
Proposed Changes: $ 3,890.72
TOTAL CHANGES: $ 11,441,581.56
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
r Description of Contract:Bridge replacement
r Describe the reasons and recommendations being made for this Change Order:
This Change Order is necessary to introduce new TCP pian sheets 18B and 42A.The Contractor
submitted RFi#101, proposing a TCP change that would enhance safety measures and reduce the
durations of the impacts to the businesses by providing an opportunity for the Contractor to
accelerate construction activities in the area identified.The Contractor provided a revised TCP from
Aguirre&Fields(P.S. 186 and 42A).TxDOT and the City of Fort Worth reviewed and accepted the
TCP revision.
This change order will use existing items to create a lump sum payment(UC019608-2017)for the
proposed work,by decreasing Item 0260 2016"LIME(HYD,COM,OR QK(SLURRY))",and Item 060
2027 "LIME TRT(EXTMATL)(8")"and Increasing Item 3268 2008"D-GR HMA TY-13 PG64-22 4.Below
Is a detailed analysis:
OUR VALUES. People•Accountability• Trust• Honesty
OUR MISSION Through collaboration and leadership,we deriver a safe,rettabie.and Integrated transportation system that enables the movement of people and goods.
ur EmIV Opponuniq e,nautc+
An alternative analysis was done to compare the cost of the original 8" lime treated subgrade versus
the proposed deep hot mix asphalt(HMAC)
Original 8"Lime Treatment:
Item 260 2016 003 X 6.356 tons Q$128.000/tan = $813.50
Item 260 2027 003 X 381,33 SY @$3,500/SY d$1,334.66
Total treatment cost=$2,148.16
4"HMA base In lieu of 8" Lime Treatment:
Item 3268 2008 @$69.000/TON X 87.52 tons= $6,038.88
The additional cost incurred to the City for using 4" NMA base In lieu of 8"Lime Treatment is:
Delta is$6,038.8&$2,148.16= $3,890.72 (LS).
The work will be performed by Haydon and their subcontractors,and then inspected by TxDOT field
personnel.
The City of Fort Worth will be responsible for 100'-.'[)of the change order costs.
NEW AND/OR REVISED PLAN SHEET(S):
Revision(0): 18B, 42A;
r Added Items:
o 96082017 UNIQUE CHANGE ORDER ITEM 17: Phase 4 TCP Revision/Material Change
Added Days: NA
If you should need addlUonal informatlon please contact Chuck Putnam at(817) 399-4303.
Michael Bostic, P.E. 2 07/27/2016
--
Farm 2146
r Chavia Ovideb, CSGI)eddhs� (Rev u9/1a)
IfPage 1ofI
Change Order Number: 28 Contrador: Haydon Building Corp.
CSJ: 0902-48-539 Project: 9R 2006(132)
Highway: CS County: Tarrant
Area Engineer. Minh Tran,KE, CO Amount: 53,890.72
Is the change order for an interim adjustment? ❑Yes ®No
Is the change order ®State oversight? ®Federal oversight? ®Participating? ® Non-Participating?
If Federal oversight,Is the change order ❑x Major? ❑or Minor?
Is the Reason Code correct? ®Yes ❑ No
Is the proposed work within project limits? ®Yes ❑No
Does the change order affect the DBE.commitment? ❑Yes ®No
Has time been addressed? ®Yes ❑No
Yes No NA Signatures
® ❑ ❑ Has the change order been signed by the Contractor?
® ❑ Is change order signed by AEP
❑ ❑ ® Is DE signature Included?(if required)
❑ ® 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?
® ❑ Does this change order Impact 3rd party funding?
❑ ® ❑ Will this Impact require a new or revised funding agreement?
❑ ® ® If an amendment or new agreement is required, has OGC-CSS reviewed the agreement?
❑ ® ❑ Has a Third Party Funding Notification Sheet(Form 2146-AFAI been sent and signed by the 3rd party?
Yes No NA Permitting:Envloonmental,Historical,etc
0 ❑ Is the work within the scope of the original environmental assessments and reviews?
❑ ❑x Does this change order impact pedestrian elements previously reviewed byTDLR or increase the cost of
pedestrian elements to 550,000 or more7 If yes,answer next question.
❑ ❑ ® Has TDLR reviewed the impact to pedestrian elements associated with this change order?
® ® 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?
❑ ® 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?
❑ ❑ 9 Have the necessary clearances or permits been obtained to address the Increased impact?
❑ ❑ If the change order work causes the soil disturbance area to exceed the I acre and 5 acre thresholds,has
a CSN or N01 been processed?
Yes No NA Stockpiled Materials
❑ ❑ ® Are materials being received through this change order that will be placed In stock?
❑ ❑ ❑x If yes,have the materials been set up In MSMS?
Yes No NA Area Office and District Approval
❑x ❑ Does the AE's memo Include an explanation/description of the change order work?
❑x ❑ ❑ Is price Justification information Included?(per District procedures)
® ❑ ❑ Are plan sheets attached?(per District procedures)
❑ ❑ ® If a Ume 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 CSV
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 CSTattached 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
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CERTIFICATE OF INTERESTED PARTIES FORM 12955
Complete Nos,l-4 and 6 It there are interested paries OFFICE USE ONLY
Complete Nos.1,2.3 5,and 6 H thein are no interested penies. CERTIFICATION OF FILING
1 Name of business entity filing form,and the city,state and country of the business entity's place CartNicate Number:
of business. 2016.89662
Hayden Building Copr
Phoenix,AZ United States nate Filed:
2 Name of governmental entity or state agency that 13 a party to the contract for which the lomn is 07125l2G1G
being filed.
Texas Department at Transportation Datef2-7
cknawledged:
/ILI It:
3 Provide the identilicadon number used by the govemmental entity or state agency to track or identity the c6tract,and provide a
descrlplion of fire services,goods,or other property to be provided under the contract.
090248539
CO 28
Nature of interest
4 Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling Intermediary
Keeble,Les PhoeniX.AZ United States X
Behrhorst,Ftitz Phoenix,AZ United States X
Pulice,James A,Jr Phoen x,AZ United States X
Eklund,Mark Phoenix,AZ United States X
Haydon,Gary Phoenix,AZ United States X
S Chcck only It there is Na interested Party. ❑
tt AFFIDAVIT I swear,or affirm,under penalty of pe;Iury,that the above disclosure is true and correct,
OFFICIAL SEAL
DEBBIE O'CONNER DlgltatlyrlgnsdbyNurkoVd.d
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Notay Pubc.�dArtmn [oe rmkl baydnnbc.cwc
US
MAMC)PACOUNiY Mark D Eklund Date:
701a07.25 MAIM
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MY Comm F,piresMeeh t 2018
Signature of autltonzed agent of contracting business entity
AFFIX NOTARY STAMP 1 SEAL ABOVE
Sworn to and subscribed before me,by the said 4, Unis the ..�- _day at
20�� to certify which,witness my hand and seal of ul(tee
signature of writer at nunittrrina oath Printed name of o ircr administering oath Title If+acr atkninistenny oadn
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version Vl.D,277
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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