HomeMy WebLinkAboutContract 50305-FP3 City Secretary 50305 -FP3
Contract No.
RECEIVED
FEB 122019 FO RT WO RT H Date Received Feb 6,2019
CIV o�Fo�Ywoa� l00(c Co.S
U ECRETAFtY
NOTICE OF PROJECT COMPLETION
(Developer Projects)
The Transportation and Public Works Department upon the recommendation of the Project
Manager has accepted the following project as complete:
Project Name: Summer Creek Ranch Section XIII Phase C
City Project No.: 100665
Improvement Type(s): ❑ Paving ® Drainage ❑ Street Lights ❑ Traffic Signals
Original Contract Price: $5,100.00
Amount of Approved Change Order(s):
Revised Contract Amount: $5,100.00
Total Cost of Work Complete: $5,100.00
JJ
Feb 4,2019
Contractor Date
Contract Manager
Title
Burnsco Construction, Inc.
Company Flame
Feb 4,2019
Project Inspector Date
Feb 5,2019
Project Manager Date
7a�rie�54V-4&illwiaCer Feb 5 2019
CFA Manager Date
`'" Feb 5,2019
Asst. City Manager Date
w
OFI<=UAL RECJ
CITY SECRETAage 1 of 2
FT. WORTH,
Notice of Project Completion
Project Name: Summer Creek Ranch Section XIII Phase C
City Project No.: 100665
City's Attachments
Final Pay Estimate
Change Order(s): ❑ Yes 0 NIA
Contractor's Attachments
Affidavit of Bills Paid
Consent of Surety
Statement of Contract Time
Contract Time: 40 CD Days Charged: 193
Work Start Date: 7/16/2018 Work Complete Date: 01/24/2019
Page 2 of 2
City Project Numbers 100665 DOC Number 6650
Contract Name SUMMER CREEK RANCH SECTION X111 PHASE C Estimate Number I
Contract Limits Payment Number 1
Project Type STORM For Period Ending 1/24/2019
Project Funding
Project Manager NA City Secretary Contract Number 100665
Inspectors CORDOVA / CAIN Contract Date 6/12/2018
Contractor BURNSCO CONSTRUCTION,INC. Contract Time 40 CD
6331 SOUTHWEST BLVD Days Charged to Date 193 CD
FORT WORTH, TX 76132 Contract is .000000 Complete
CITY OF FORT WORTH
SUMMARY OF CHARGES
Line Fund Account Center Amount Gross Retainage Net
Funded
Total Cost of Work Completed $5,100.00
Less %Retained $0.00
Net Earned $5,100.00
Earned This Period $5,100.00
Retainage This Period $0.00
Less Liquidated Damages
0 Days @ $0.00 /Day $0.00
LessPavement Deficiency $0.00
Less Penalty $0.00
Less Previous Payment $0.00
Plus Material on Hand Less 15% $0.00
Balance Due This Payment $5,100.00
Thursday,January 31,2019 Page 4 of
FORT WORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name SUMMER CREEK RANCH SECTION XIII PHASE C
Contract Limits
Project Type STORM
City Project Numbers 100665
DOE Number 6650
Estimate Number 1 Payment Number 1 For Period Ending 1/24/2019
CD
City Secretary Contract Number 100665 Contract Time 4(FD
Contract Date 6/12/2018 Days Charged to Date 193
Project Manager NA Contract is 100.00 Complete
Conti-actor BURNSCO CONSTRUCTION,INC.
6331 SOUTHWEST BLVD
FORT WORTH, TX 76132
Inspectors CORDOVA / CAIN
Thursday,January 31,2019 Page I of 4
l
City Project Numbers 100665 DOE Number 6650
Contract Name SUMMER CREEK RANCH SECTION XIII PHASE C Estimate Number I
Contract Limits Payment Number I
Project Type STORM For Period Ending 1/24/2019
Project Funding
UNIT III:STORM IMPROVEMENTS
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
T
I REMOVE HEADWALL/SET _ 1 EA $1,100.00 $1,100.00 1 $1,100.00
2 Y DROP INLET 1 EA $4,000.00 $4,000.00 1 $4,000.00
Sub-Total of Previous Unit $5,100.00 $5,100.00
---------------------------------------
Thursday,January 31,2019 Page 2 of
City Project Numbers 100665 DOE Number 6650
Contract Name SUMMER CREEK RANCH SECTION XIII PHASE C Estimate Number I
Contract Limits Payment Number I
Project Type STORM For Period Ending 1/24/2019
Project Funding
Contract Information Summary
Original Contract Amount $5,100.00
Chance Orders
Total Contract Price $5,100.00
Total Cost of Work Completed $5,100.00
Less %Retained $0.00
Net Earned $5,100.00
Earned This Period $5,100.00
Retainage This Period $0.00
Less Liquidated Damages
Days a /Day $0.00
LessPavement Deficiency $0.00
Less Penalty $0.00
Less Previous Payment $0.00
Plus Material on Hand Less 15% $0.00
Balance Due This Payment $5,100.00
Thursday,January 31,2019 Page 3 of 4
AFFIDAVIT
STATE OF TEXAS
COUNTY OF TARRANT
Before me, the undersigned authority, a notary public in the state
and county aforesaid, on this day personally appeared Ab Grantges,
Contract Mgr, Of Burnsco Construction, known to me to be a credible
person, who being by me duly sworn, upon his oath deposed and said;
That all persons, firms, associations, corporations, or other
organizations furnishing labor and/or materials have been paid in full;
That the wage scale established by the City Council in the City of
Fort Worth has been paid in full;
That there are no claims pending for personal injury and/or
property damages;
On Contract described as;
Summer Creek Ranch VIII C -Water, Sanitary Sewer and Storm Drain
BY
Ab Gran ge ontract Manager
Subscribed and sworn before me on this date 4th of February, 2019.
^ OW
CESILIA CANALES
Notary ID#131652996
Notary Public My Commission Expires
Tarrant County,Texas July 24, 2022
CONSENT OF OWNER ❑
SURETY COMPANY ARCHITECT ❑
CONTRACTOR ❑
TO FINAL PAYMENT SURETY ❑
Conforms with the American Institute of OTHER
Architects, AIA Document G707
Bond No 022220206
PROJECT:
(name, address)Summer Creek Ranch Section XIII Phase C-Water,Sanitary Sewer and Storm Drain Improvements
Fort Worth TX
TO (Owner)
FORESTAR(USA)REAL ESTATE GROUP, INC.AND ARCHITECT'S PROJECT NO:
CITY OF FORT WORTH
CONTRACT FOR:
14755 Preston Road,Suite 130 Summer Creek Ranch Section XIII Phase C-Water,Sanitary Sewer
and Storm Drain Improvements
Dallas TX 75254 CONTRACT DATE:
CONTRACTOR: BURNSCO CONSTRUCTION, INC.
In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above,the
(here insert name and address of Surety Company)
LIBERTY MUTUAL INSURANCE COMPANY
175 Berkeley Street
Boston MA 02116 , SURETY COMPANY
on bond of (here insert name and address of Contractor)
BURNSCO CONSTRUCTION, INC.
6331 Southwest Boulevard
Benbrook TX 76132 , CONTRACTOR,
hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve
the Surety Company of any of its obligations to (here insert name and address of Owner)
FORESTAR (USA) REAL ESTATE GROUP, INC.AND CITY OF FORT WORTH
14755 Preston Road, Suite 130
Dallas TX 75254 , OWNER,
as set forth in the said Surety Company's bond.
IN WITNESS,WHEREOF,
the Surety Company has hereunto set its hand this 1st day of February,2019
LIBERTY MUTUAL INSURANCE COMPANY
Sure Company
Attest:Tina McEwan —6vg�- 4"
(Seal): Signa re of Authorized Representative
Soohinie Hunter Attorney-in-Fact
Title
NOTE: This form is to be used as a companion document to AIA DOCUMENT G706, CONTRACTOR's AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS,
Current Edition
ONE PAGE
This Power of Attorney limits the acts of those named herein,and they have no authority to
bind the Company except in the manner and to the extent herein stated.
.fey Liberty Mutual Insurance Company
utua _ The Ohio Casualty Insurance Company Certificate No: 8200274
SURETY West American Insurance Company
POWER OF ATTORNEY
KNOWN ALL PERSONS BY THESE PRESENTS:That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire,that
Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts,and West American Insurance Company is a corporation duly organized
under the laws of the State of Indiana(herein collectively called the"Companies"),pursuant to and by authority herein set forth,does hereby name,constitute and appoint,
Robbi Morales.Don E.Cornell,Sophinic blunter,Tina McFxvan,Ricardo J.Reyna.Joshua Saunders Kclly A.Westbrook
all of the city of Dallas state of fx each individually if there be more than one named,its true and lawful attorney-in-fact to make,
execute,seal,acknowledge and deliver,for and on its behalf as surety and as its act and deed,any and all undertakings,bonds,recognizances and other surety obligations,in pursuance
of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper
persons.
IN WITNESS WHEREOF,this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed
thereto this 1 I th day of January , 2019
Liberty Mutual Insurance Company
P� k SU.*7 Pmt`( lNs& � 1NSUnq The Ohio Casualty Insurance Company
ti� 5J �oRpORa,11, \OP�oRPORgT tic West American Insurance Company >
a Fo ca Q 3 Fon 3 Fo c� c)
y ; 1912y on ov 1919 0 1991
1k C.13 C„U`��•r a3 yO�LHAMPs�,aa� �,j, �A'b1ANP .da3 fl / jam C
c David M.Carey,Assistant Secretary
- State of PENNSYLVANIA
County of MONTGOMERY ss
L
a) On this 1 I th day of January , 2019 before me personally appeared David M,Carey,who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance o
o 76 Company,The Ohio Casualty Company,and West American Insurance Company,and that he,as such,being authorized so to do,execute the foregoing instrument for the purposes=E'
v > therein contained by signing on behalf of the corporations by himself as a duly authorized officer. LU
a
IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at fling of Prussia,Pennsylvania,on the day and year first above written. a) a
C:)
O N f 4w�r i,'.t p�C COMMONWEALTH OF PENNSYLVANIA Q'I:
LO Notarial Seal /! O
� ( GF leresa Paslelia,Notary Public
t3
p� � ! Upper tuterionTwp.,Montgomery Cbunty By:
a
F. My Commission Expires M19a ch 2S,2021 3 E
Teresa Pastella,Notary Public o Co
N �0.
0) ti{R! ,rt,,,; Member,Pennsylvania Assoclatian of Notaries a
Co N _..._....- O
C a) This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company,Liberty Mutual
o.i= Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows: 5 m
E 6 ARTICLE IV-OFFICERS:Section 12.Power of Attorney. w
o 2 Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President,and subject to such limitation as the Chairman or the C
>, President may prescribe,shall appoint such attorneys-in4act,as may be necessary to act in behalf of the Corporation to make,execute,seal,acknowledge and deliver as surety >o
M c any and all undertakings,bonds,recognizances and other surety obligations,Such attorneys-in-fact,subject to the limitations set forth in their respective powers of attorney,shall N
have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation.When so executed,such" CO
Zinstruments shall be as binding as if signed by the President and attested to by the Secretary.Any power or authority granted to any representative or attorney-in-fact under the Cl)N
provisions of this article may be revoked at any time by the Board,the Chairman,the President or by the officer or officers granting such power or authority. o 0
ARTICLE XIII-Execution of Contracts:Section 5.Surety Bonds and Undertakings. "_
Any officer of the Company authorized for that purpose in writing by the chairman or the president,and subject to such limitations as the chairman or the president may prescribe,F--•
shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,
bonds,recognizances and other surety obligations.Such attorneys-in-fact subject to the limitations set forth in their respective powers of attorney,shall have full power to bind the
Company by their signature and execution of any such instruments and to attach thereto the seal of the Company.When so executed such instruments shall be as binding as if
signed by the president and attested by the secretary.
Certificate of Designation-The President of the Company,acting pursuant to the Bylaws of the Company,authorizes David M.Carey,Assistant Secretary to appoint such attomeys-in-
fact as may be necessary to act on behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety
obligations.
Authorization-By unanimous consent of the Company's Board of Directors,the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the
Company,wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds,shall be valid and binding upon the Company with
the same force and effect as though manually affixed.
I,Renee C.Llewellyn,the undersigned,Assistant Secretary,The Ohio Casualty Insurance Company,Liberty Mutual Insurance Company,and West American Insurance Company do
hereby certify that the original power of attorney of which the foregoing is a full,true and correct copy of the Power of Attorney executed by said Companies,is in full force and effect and
has not been revoked.
IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this I st day of February 2019
P� 1NSU"? Pv-Y INS&,p N %NSURq
J:40 010 quo�m �"'Y VIORgr'9y `GP oanPORgy,yC
1912 0 1919° J =1991 G '` `-
0 0
��9ssac„OS`� saw y°Z 'iAhtPS�paa�o �s NOIANP �a By Renee C.Llewellyn,Assistant Secretary
LMS-12873 LMIC OCIC WAIC Multi Co 062018
Liberty
mutuil;
SURETY
TEXAS TEXAS
IMPORTANT NOTICE AVISO IMPORTANTE
To obtain information or make a complaint: Para obtener informacion o para someter una
queja:
You may call toll-free for information or to Usted puede llamar al numero de telefono gratis
make a complaint at para informacion o para someter una queja al
1-877-751-2640 1-877-751-2640
You may also write to: Usted tambien puede escribir a:
2200 Renaissance Blvd., Ste. 400 2200 Renaissance Blvd., Ste. 400
King of Prussia, PA 19406-2755 King of Prussia, PA 19406-2755
You may contact the Texas Department of Puede comunicarse con el Departamento de
Insurance to obtain information on companies, Seguros de Texas para obtener informacion
coverages,rights or complaints at acerca de companias, coberturas, derechos o
1-800-252-3439 quejas al
1-800-252-3439
You may write the Texas Department of Insurance Puede escribir al Departamento de Seguros
Consumer Protection (111-1 A) de Texas Consumer Protection (11 I-1 A)
P. O. Box 149091 P. O. Box 149091
Austin, TX 78714-9091 Austin,TX 78714-9091
FAX: (512) 490-1007 FAX# (512) 490-1007
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PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS O RECLAMOS:
Should you have a dispute concerning your Si tiena una disputa concerniente a su prima o a
premium or about a claim you should first un reclamo, debe comunicarse con el agente o
contact the agent or call 1-800-843-6446. primero. Si no se resuelve la disputa, puede
If the dispute is not resolved, you may contact the entonces comunicarse con el departamento (TDI)
Texas Department of Insurance.
ATTACH THIS NOTICE TO YOUR UNA ESTE AVISO A SU POLIZA:
POLICY:
This notice is for information only and does not Este aviso es solo para proposito de informacion
become a part or condition of the attached y no se convierte en parte o condicion del
document. documento adjunto.
NP 70 68 09 01
LMS-1529210/15
Green Sheet CPN 100665
Summer Creek Ranch Section
XIII Phase C - Drainage
-- ---- Adobe Sign Document History 02/07/2019
--- Created: 02/01/2019
L By: Etta Bacy(etta.bacy@fortworthtexas.gov)
Status: Signed
Transaction ID: CBJCHBCAABAA9tzXmGdDW7twsREdX15zfD8Ydo5U-73t
"Green Sheet CPN 100665 Summer Creek Ranch Section XIII P
Kase C - Drainage" History
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