HomeMy WebLinkAboutContract 44743-CO41 CITY SECRETARY CONTRACT NO.44743-CO41
TEXAS DEPARTMENT OF TRANSPORTATION
CITY CHANGE ORDER NUMBER: 41
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: CS
F�] Existing ❑ Amended ❑ New County. Tarrant
[Check one]
District: 02-Fort Worth
3. Indicate the type and amount of funding:
Contract
F/I Fixed Price(Lump Sum) (Estimated Amount ) Number: 08133013
F/I Actual Cost
(a) Contract Items(Bid Items): $5,180.08 Use as needed.
I hereby acknowledge notification of the modifications
(b) E&C*: (a)X = $0.00 covered by this Change Order.
(c) Indirect Cost**: (a+b)x = $0.00
enter% Date 1/18/17
TOTAL $5,180.08 "I
By �/�--
CITY OF FORT WORTH
AP OVAL RECOMMENDED: Typed/Printed Name Jay Chapa
eL). v Typed/Printed Title Assistant City Manager
Douglas .Wiersig, P.E.
Director,0f ransportation/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.09/2010)Page 1 of 1 Contract Compliance Manager:
By signing I acknowledge that I am the person responsible
APPROVED AS TO FORM AND LEGALITY for the monitoring and administration of this contract,including
ensuring all performance and reporting requirements.
- aa�
D G /�
Do glas W. Black ;
Assistant City Attorney Michael Weiss,P.E.
Sr.Professional Engineer
Title
TEXAS DEPARTMENT OF TRANSPORTATION
CITY CHANGE ORDER NUMBER: 41
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. CS
Fj] Existing ❑ Amended ❑ New County. Tarrant
[Check one]
District: 02-Fort Worth
3. Indicate the type and amount of funding:
Contract
P1 Fixed Price (Lump Sum) (Estimated Amount ) Number. 08133013
Q Actual Cost
(a) Contract Items(Bid Items): $5,180.08 Use as needed.
I hereby acknowledge notification of the modifications
(b) E&C*: (a)x = $0.00 covered by this Change Order.
(c) Indirect Cost**: (a+ b)x = $0.00
enter% Date 1/18/17
TOTAL $5,180.08
By
CITY OF FORT WORTH
AP OVAL RECOMMENDED: Typed/Printed Name Jay Chapa
/C (J, L) Typed/Printed Title Assistant City Manager
Douglas Yy.Wiersig,P.E.
Director, ransportation/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.09/2010)Page 1 of 1 Contract Compliance Manager:
By signing I acknowledge that I am the person responsible
APPROVED AS TO FORM AND LEGALITY for the monitoring and administration of this contract,including
ensuring all performance and reporting requirements.
No MiLwi
Do glas W. Black
Assistant City Attorney Michael Weiss,P.E.
Sr.Professional Engineer
Title
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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