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Contract 50857-FP1
FORT WORTH. C(TY SECRETARY CONTRACT NO. TRANSPORTATION AND PUBLIC WORKS NOTICE OF PROJECT COMPLETION City Project Nd: 101287 Regarding contract 50857 for CONCRETE JOINT SEALING 2018 as required by the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by City Council on 06/05/201R tlu:ough M&C C-28703 die director of the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT upon die recommendation of the Assistant Director of die Transportation&Public Works Departmen t has accepted die project as complete. Original Contract Prices: $349,080.00 Amount of Approved Change Orders: NO 1 Revised Contract Amount: $349,080.00 Total Cost Work Completed: $349,079.01 Less Deductions: Liquidated Damages: Days®$210.00/Day Pavement Deficiencies: Total Deduction Amount: $0.00 Total Cost Work Completed: $349,079.01 Less Previous Payments: $331,625.06 Final Paym nt Due $17,453.95 li / Recomme de for Acc tance Date Director, TRANSP RT 0 N PUBLIC WORKS DEPARTMENT Accepted Date Asst. Director, TRANSPORTATION AND PUBLIC WORKS DEPARTMENT n I � Asst. City anager Date Comments: OFFICIAL RECORD CITY SECRETARY FT. WORTH,TX TPW Construction Invoice Contract: CS50857 P.O.# 18-104863 Payment Date: 6/12/2019 TO:Macias Specialty Contracting LLC INV.# CS50857-9-FINAL Estimate No. 9 DOE: 602 Orchard green Dr ProjManager Juan De La Cruz Euless TX 76040 FOR: Concrete Paving Joint Sealant 2018 at Various Locations Contract Amount: $349,080.00 Completed Ret Pen Ad' Pa Total to Date: $349,079.01 $0.00 $0.00 $0.00 $349,079.01 Previous Estimate: $349,079.01 $0.00 $0.00 $0.00 $331,625.06 Earned to Date: $0.00 ($17,453.95) $0.00 $0.00 $17,453.95 Payments: 30100-0200431-5740010-101287-003380-9999 $349,080.00 3 0 1 00-206 000 0-1 0 1 287-RETAIN=$17,453.92 3 0 1 0 0-2060 00 0-1 0 1287-RETAIN=$0.03 Total to Date: $349,079.01 $0.00 $0.00 $0.00 $349,079.01 Previous Estimate: $349,079.01 $17,453.95 $0.00 $0.00 $331,625.06 Earned to Date: $0.00 ($17,453.95) $0.00 $0.00 $17,453.95 Thursday,September 26,2019 Page I of I FORT WORTH. Account Inquiry-Multi Ledger Fiscal Year: 2019 YTD as of 09/30/2019 Period: 17 General Ledger ACTUALS Run Time: 09/26/2019 12:56 PM Report ID: GL0319 Exportedger Data Export Journal Data Furid Account Description is 30100 2060000 Retainage Payable 101287 RETAIN ($17 453-921 30100 2060000 Retainage Payable 0200431 101287 RETAIN {S 0 03 Parameter Value Report Id GL0319 Account Inquiry-Multi Ledger Fiscal Year 2019 Accounting Period 17 Ledger ACTUALS Fund Code 10100,13001,13002,19100,19907,19908,19909,19910,20101,20102,20103,20104,20105,20106,21001,21002,21003,23001,23002,25001,25002,25003,25004,25005,25006,25007,25008,25010,25011,25012,26001,26002,26003.260 04,26005,26006,27001,28001,28002,28003,28004,28005,28006,28007,28008,28009,28010,28011,28501,28502,28503,28504,28505,28506,28507,28508,28510,28511,28512,28514,28515,28516,28517,28518,28519,28520,28603, 28604,28606,28607,28608,28609,28610,28612,28613,28614,28615,28710,28721,28722,28730,28770,28790,29001,29002,29500,30100,30101,30102,30103,30104,30105,30106,30107,30108,30109,30110,30111,30112,30113,3011 4,30200,30205,30206,30285,30286,31001,31002,31003,33001,33002,33003,33004,33005,34009,34010,34011,34012,34013,34014,34016,34017,34018,34019,34020,35005,36001,36002,36003,36004,36005,36006,39001,39002,3 9003,39004,39005,39006,39007,39008,39009,39100,39101,39102,39201,39209,39301,39302,39303,39304,39402,39403,39405,39406,39407,39408,39409,39410,39411,39412,39501,39801,39802,40100,40101,40102,40103,401D 4,52001,52002,52003,52004,52005,52006,53001,53002,53003,53004,53005,54001,54002,54003,54501,54502,54503,54504,55001,55002,55003,55004,55005,55006,56001,56002,56003,56004,56005,56006,56007,56008,56009,5 6010,56011,56012,56013,56014,56015,56016,56017,56501,56502,57002,57003,57004,57005,57006,58001,59101,59302,59304,59401,59451,59501,59502,59601,59602,59603,59604,59605,59607,59608,59651,59652,59653,5990 0,59901,60101,60102,60103,60104,60105,60106,60107,60108,60109,60110,60111,60201,60202,69106,69900,69901,69902,69903,71010,71050,71060,90000 Account 2060000 Project ID 101287 FSCM 92 Production Page 1 of 3 C-620 Signature Page Contractor's Application for Payment Invoice No. Final Estimate To(Owner) City of Fort Worth Invoicing Period(From-To): Invoice Date: 12/17/2018-12/31/2018 6/12/2019 P.0. PO-18-00104863 From(Contractor): Remit to(If Not Automatic Deposit): Number: MACIAS SPECIALTY CONTRACTING LLC Project: 101287 Contractor's CFW Vendor No.: 38657 802 S Carrier Pkwy Grand Prairie TX 75053 City secretary Contract 50857 contract Number: Name: CONCRETE PAVING JOINT SEALANT 2018 Application For Payment Change Order Summary Approved Change Orders 1. ORIGINAL CONTRACT PRICE........................................................... $ $349,0 81111 Number Additions Deletions 2. Net change by Change Orders................................................................. $ _ + 1 3. Current Contract Price(Line 1 t 2)........................................................ $ $349,080.00 _ 2 4. TOTAL COMPLETED AND STORED TO DATE 3 (Progress Estimate,Construction Allowance and Change Orders)...... $ $349,079.01 4 5. RETAINAGE: 5 a. X $349.079.01 Work Completed.......... $ 6 b. X Not Used $ 7 c.Total Retainage(Line 5a+Line 5b)............................... $ 8 6. AMOUNT ELIGIBLE TO DATE(Line 4-Line 5c).............................. $ $3 49,0790 1 TOTALS 7. LESS PREVIOUS PAYMENTS(Line 6 from prior Application)........, $ $331,625.06 NET CHANGE BY 8. AMOUNT DUE THIS APPLICATION.................................................. $ $17,453.95 CHANGE ORDERS 1 9.BALANCE TO FINISH,PLUS RETAINAGE (Column G on Progress Estimate+CA+COs+Line 5 above).............. $ $0.99 Contractor's Certification 10. CONTRACTTIME: The Contractor certifies with the submittal of this document and associated Payment Request Submittal q a. Days Awarded 120 on the City of Fort Worth Buzzsaw system that to the best of their knowledge:(1)all previous progress b Days Added by CO 2q payments received from Owner on account of Work done under the Contract have been applied on account to discharge Contractor's legitimate obligations incurred in connection with Work covered by 1 C. Total Days 144 prior Applications fbr Payment;(2)title of all Work,materials and equipment incorporated in said Work Pai CCT Uangye r or otherwise listed in or covered by this Application fbr Payment will pass to Owner at time of payment d Days Charged 125 free and clear of all Liens,security interests and encumbrances(except such as are covered by a Bond acceptable to Owner indemnifying Owner against any such Liens,security interest or encumbrances); e, Days Remaining 19 and(3)all Work covered by this Application fbr Payment is in accordance with the Contract Documents and is not defective. � IVl This document has been modified from its original form as an EJCDC document and the user did not highlight the modifications.You are encouraged to read the document carefully and consult Legal Counsel prior to its execution. AI-A Document G707TIA Consent of Surety to Final Payment Bond No. 015-202-178 PROJECT:(Name and address) ARCHITECT'S PROJECT NUMBER: City Project#101287 OWNER❑ Concrete Paving Joint Sealant 2018 at Various Locations CONTRACT FOR: Construction ARCHITECT ❑ CONTRACTOR❑ TO OWNER:(Naive and a(kress) CONTRACT DATED: June 5, 2018 SURETY ❑ City of Fort Worth 200 Texas Street Fort Worth, TX 76102 OTHER❑ In accordance will)the provisions of the Contract hetween the(honer and the Conlractor as indicated shove,the (hiserl roams•and address oJ',Surety) The Ohio Casualty Insurance Company 1200 MacArthur Boulevard 3rd Floor Mahwah, NJ 07430 SURE'l'1', on bond of (Inset'l mane and address of Conlrac•tor) Macias Specialty Contracting, LLC 410 NW 11th Street #106 Grand Prairie, TX 75050 CONTRACTOR, hereby approves of the final payment to the I'onlraclor,and agrees that final payment to the Contractor shall not relieve the Surety of any of its obligations to (hiserl name and address of Owner) City of Fort Worth 200 Texas Street Fort Worth, TX 76102 OWNER, as set forth in said Surety's hond. IN WITNESS WHEREOF,the Surely has hereunto set its hand on this dale: (Insert in writing the month followed by the numeric dare and Fear.) February 12, 2019 The Ohio Casualty Insurance Company (Sirrel)') - A (Siti�nattwe aJ urlhoril-er!rcpnesenlallle) Attest: Cheryl R. Coleman,Attorney-In-Fact (Seri j: Ra-- ;3 rley,As Surety (Printed name and title) CAUTION:You should sign an original AIA Contract Document,on 01114ch this text 11ppe11rs In RFD An original assures Ihat changes will not be obscured. AIA Document G707TM—1994.Copyright©1970 and 1994 by The American Institute of Architects.All rights reserved. ;;ARNING:This AW Do°urrOnt P ProtKlad by U-$•CG7pyrlQht Low and InlamdtlOnel Treaties Ur f thv. r lr-u.,.,um•nt or any parlloal of It.mRy rMault In awrrrr civil and c6minrl panafllea.and will Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e- mail The American Institute of Architects'legal counsel,copyright@aia.org. 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, Liberty Liberty Mutual Insurance Company Mutual. The Ohio Casualty Insurance Company Certificate No:8200288-969516 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, Marc J. Michalewsky;Sandra A.Pace;Thomas M.True;Lisa A.Anderson;Kemal Brkanovic;Cheryl R.Coleman;Mary J.D'Amato;Rachael Hurley all of the city of Westfield state of NJ 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 14th day of January 1 2019 . Liberty Mutual Insurance Company P�INSU� P�ZY INS& d \NSUgq The Ohio Casualty Insurance Company JrooRPOj+4To'yn� �yJ2°ONPORsro9yn �P20NPORaro�n� West American Insurance Company Y ; 1912yo 021919� � 1991 0 o s vNi N ����88ACHs �a yahAMPshdb� Y� �AOIpN* �a� r c By: y C: David M.Carey,Assistant Secretary T State ofPENNSYLVANIA > i5 cc County of MONTGOMERY ss C m � C 0 aD On this 14th 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 @ 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 � > therein contained by signing on behalf of the corporations by himself as a duly authorized officer. w CU IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at King of Prussia,Pennsylvania,on the day and year first above written. n �o M to $F'R°NryF r$e COMMONWEALTH OF PENNSYLVANIA Q O ���tit� 7ls , Notarial Sealy O C ❑F Teresa Pastella,Notar Public Co p 0) Upper MerionTwp.,Montgomery County By: W C �g My Commission Expires March 28,2021 � E I�4N� \� eresa Pastella,Notary Public O ca q �. Member,Pennsylvania Assocladon of Notaries a C:) N - _ NO �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 4;rn o 9 Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows: o a)a) " 0) ARTICLE IV-OFFICERS:Section 12.Power ofAttomey. o 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 U -0 > President may prescribe,shall appoint such attomeys-in-fact,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"-0? z � instruments 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 M LP 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. 0'— CD 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, � 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 attorneys-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 Powerof Attorney executed by said Companies,is in full force and effect and has notbeen revoked. IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this 12th day of February 2019 . v \NSU '11 INS& 0\NSUR 7`p'�°pPo�ra9yC+ 10 s: 1912 0 0 1919 1991 3n : - ,rye o YdJ1�/`SACHUS�.dD y0�hA MPg�`�L rs �NOtpNP ,da By Renee C.Llewellyn,Assistant Secretary LMS-12873 LMIC OCIC WAIC Multi Co 062018 THE OHIO CASUALTY INSURANCE COMPANY Mlltll�ll• FINANCIAL STATEMENT—DECEMBER 31,2017 SURETY Assets Liabilities Cash and Bank Deposits......................................... $22,398,732 Unearned Premiums................................................ $1,200,504,734 *Bonds—U.S Government..................................... 501,755,079 Reserve for Claims and Claims Expense................ 3,145,397,036 *Other Bonds............................................................ 3,842,445,321 Funds Held Under Reinsurance Treaties................. 0 Reserve for Dividends to Policyholders.................. 154,803 *Stocks..................................................................... 161,029,164 Additional Statutory Reserve.................................. 0 Real Estate.............................................................. 24,027,802 Reserve for Commissions,Taxes and Agents'Balances or Uncollected Premiums........... 717,524,715 Other Liabilities................................................ 107,937,270 Accrued Interest and Rents..................................... 30,875,608 Total............................................................. $4,453,993,843 Other Admitted Assets............................................ 847,561,563 Special Surplus Funds................. $ 28,196,932 Capital Stock............................... 4,500,000 Paid in Surplus............................ 738,183,897 Unassigned Surplus..................... 922,743,312 Total Admitted Assets.................................... 6.147.617.98 Surplus to Policyholders............................... 1,693,624,141 Total Liabilities and Surplus................................ S6.147.bU-M P�sv Ivsv yJ �GFFORq�'Y(` Bonds are stated at amortized or investment value;Stocks at Association Market Values. 0 1919 0The foregoing financial information is taken from The Ohio Casualty Insurance Company's financial Syr Ry�MQ���= statement filed with the state of Ohio Department of Insurance. 1,TIM MIKOLAJEWSKI, Assistant Secretary of The Ohio Casualty Insurance Company,do hereby certify that the foregoing is a true, and correct statement of the Assets and Liabilities of said Corporation,as of December 31,2017,to the best of my knowledge and belief. IN WITNESS WHEREOF,I have hereunto set my hand and affixed the seal of said Corporation at Seattle, Washington, this 1011 day of March,2018. Assistant Secretary S•12620CIC/a 3/18 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 Abraham Jackson, President Of Macias Specialty Contracting LLC, 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; Concrete Paving Joint Sealant 2018 at Various Locations, City Project Number 101287 By Abraha ack n, P esid nt Subscribed and sworn before me on this date 8th of February, 2019. LINA JACKSON sNotery Public,State of Texe� Comm. Expires 05-10-2021 ,, ' otary fKublic _ ''���,°O Notary ID 1 3 1 1 2408-C, County, State "� - �- FORTWORTH. TRANSPORTATION AND PUBLIC WORKS STATEMENT OF CONTRACT TIME STATEMENT# FINAL STATEMEN`1`# 9 FINAL. CPN#1 101287 NAME OF PROJECT: iconcrete Paving Joint Seal 2018 Contractor Macias Specialty YEAR:1 2019 PROJECT NO.: FINAL INSPECTION DATE 112812019 n/a I CD CONTRACT TIME 144 1 X PERIOD FROM: 1 411/2019 TO: 1 4/30/2019 1 Month I DEVELOPMENT Beg of Month End of Month WORK ORDER EFFECTIVE: 713012018 BEG n/a MID(y) n/a 100.0% LIP YR I n DAY OF MONTH DAYS REASON FOR DAY OF MONTH DAYS REASON FOR CHARGED DAYS CREDITED CHARGED DAYS CREDITED 1 Mon 1 16 Tue 1 2 Tue 1 17 Wed 0 na 3 Wed 1 18 Thu 0 na 4 Thu 1 19 Fri 0 na 5 Fri 1 20 Sat 0 na 6 Sat 1 21 Sun 0 na 7 Sun 1 22 Mon 0 r 8 Mon 1 23 Tue 0 9 Tue 1 24 Wed 0 10 Wed 1 25 Thu 0 11 Thu 1 26 Fri 0 12 Fri 1 27 Sat 0 13 Sat 1 28 Sun 0 14 Sun 1 29 Mon 0 15 Mon 1 30 Tue 0 31 NA Wkn&Hol Wea Utl Oth a=add Not Applicable SAT,SUN,and WEATHER UTILITIES OTHERS DAYS TOTAL DAYS HOLIDAYS RELOCATE CHARGED THIS PERIOD 0 0 0 0 16 16 PREVI,OUS PERIOD 0 128 128 TOTAL TO DATE 1 0 0 0 0 144 144 REMARKS: COOKS LANE:Complete. McCART AVENUE: Complete. S. HULEN STREET(SB): Complete. SYCAMORE SCHOOL ROAD:Complete. Fianal Inspection Held 1/28/19, Punch List items were completed 4/16/19. Stop time at 144 days project substantially complete. Time used 100.0% Signatur : Signature: (Print Name) b ra t�G Sd� INSPECTOR(Type Name)Matt Cain CONTRACTOR C I C, S S Q G,C,11hl Cis„ ,L a` DATE ZL INSPECTOR 10— u) I DATE C-620 Unit Price Progress Estimate Progress Estimate City Secretary Contract Num: 50857 Contractor's Application For(contract): CONCRETE PAVING JOINT SEALANT 2018 Application Number: Final Estimate l Application Period: 12/17/2018- 12/31/2018 f Application Date: 6/12/2019 A B C D I E F I I G Item f + Total Completed % Balance to Finish Estimated Quantity Materials Presently Bid Item No. Description Specification Unit of Measure Bid Quantity Unit Price Bid Value Installed Value Previously Installed Value Value This Period Stored(not in C) and Stored to Date (F) (B-F) Section No. (D+E) B 9999.0000 Clean and Silicon Seal Existing Concrete Pavement Joint(up tp 1 1/2"wide 32 13 73 LF 42000.000000 _ $1.17 $48�930.00 11612.00000000 $13,527.98 _ $13 527.98 $13,527.98 27.6% $35,402.02 9999.0000 Clean and Silicon Seal Existing Concrete Pavement Joint(1/2"to 2 2"wide 32 13 73 LF 90000 000000 $3.34 $300,150.00 _ 100615.00000000 _ `$335,551.03 $335,551.03 _$335,551.03 111.8% -$35,401.03 I I This document has been modified finm its original form as an EJCDC document and the user did not highlight the modifications.You are encouraged to read the document carefidly and consult Legal Counsel prior to its execution. C-620 Unit Price Progress Estimate Progress Estimate City Secretary 50857 Contractor's Application Contract Num: For(contract): CONCRETE PAVING JOINT SEALANT 2018 IApplication Number Final Estimate Application Period: 12/17/2018- 12/31/2018 Application Date: 6/12/2019 A B C D E F G Item Balance to Finish Estimated Quantity Materials Presently Total Completed Specification Bid Quantity Unit Price Bid Value Value Previously Installed Value Value This Period and Stored to Date (F) (B-F) Bid Item No. Description Section No. Unit of Measure Installed Stored(not in C) (D+E) B Totals $349,080.001 $349,079.011 $349,079.011 1 $349,079.01 100.0% 1 $0.99 This document has been modified fiom its original form as an EJCDC document and the user did not highlight the modifications.You are encouraged to read the document caret fly and consult Legal Counsel prior to its execution. City of Fort Worth Summary of Charges City Secretary Contract Num: 50857 CONCRETE PAVING JOINT SEALANT 2018 P.0.: PO-18-00104863 Project Number: 101287 Application Period: 12/17/2018-12/31/2018 Application Final Estimate Application Date: 6/12/2019 Number: Funding Identification(FID) Total Completed Amt Remaining Gross Retainage Net Original Contract 30100-0200431-5740010-101287-003380-9999 $349,079.01 $0.99 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.0' $0.00 0 $0.00 $0.00 $0.00 $0.0 $0.00 0 $0.00 1 $0.00 $0.00 $0.0 $0.00 0 $0.00 $0.00 $0.00 $0.0 $0.00 0 $0.00 $0.00 $0.00 $0.0 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.r $0.00 $0.00 Change Order 1 30100-0200431-5740010-101287-003380-9999 J0 $0.00 0 .00 0 $0.00 0 .00 0 $0.00 0 00 0 $0.00 0 .00 0 $0.00 0 .00 1) $0.00 0 00 $0.00 0 00 $0.00 0 .00 $0.00 0 10 $0.00 0 $0.00 Change Order 2 30100-0200431-5740010-101287-003380-9999 0 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 1 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 J $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 City of Fort Worth Summary of Charges City Secretary Contract Num: 50857 CONCRETE PAVING JOINT SEALANT 2018 P.0.: PO-18-00104863 Project Number: 101287 Application Period: 12/17/2018-12/31/2018 Application Final Estimate Application Date: 6/12/2019 Number: Funding Identification(FID) Total Completed Am Remaining Gross Retainage Net Change Order 3 30100-0200431-5740010-101287-003380-9999 $0.00 $0.00 $0.00 $O.i $0.00 0 $0.00 $0.00 $0.00 $0.0 $0.00 0 $0.00 $0.00 $0.00 $0.0 $0.00 0 $0.00 $0.00 $0.00 $0.0 $0.00 0 $0.00 $0.00 $0.00 $0.0 $0.00 0 $0.00 1 $0.00 $0.00 1 $0.0 $0.00 0 $0.00 $0.00 $0.00 $0.0 $0.00 0 $0.00 $0.00 $0.00 $0.0 $0.00 0 $0.00 $0.00 $0.00 $0.01 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 Change Order 4 30100-0200431-5740010-101287-003380-9999 $0.00 0 $0.00 0 DO $0.00 0 DO $0.00 0 DO $0.00 0 DO 1 $0.00 0 DO $0.00 0 DO $0.00 0 DO $0.00 0 DO 0 $0.00 0 ^ i $0.00 Change Order 5 30100-0200431-5740010-101287-003380-9999 $0.00 $0.00 0 $0.00 ) $0.00 0 $0.00 $0.00 0 $0.00 J $0.00 0 $0.00 $0.00 0 $0.00 $0.00 0 $0.00 $0.00 0 $0.00 $0.00 0 $0.00 $0.00 0 $0.00 .00 0 $0.00 0 $0.00 $0.00 0 $0.00 City of Fort Worth Summary of Charges City Secretary Contract Num: 50857 CONCRETE PAVING JOINT SEALANT 2018 P.0.: PO-18-00104863 Project Number: 101287 Application Period: 12/17/2018-12/31/2018 Application Final Estimate Application Date: 6/12/2019 Number: Funding Identification(FID) Total Completed Am Remaining Gross Retainage Net Change Order 6 30100-0200431-5740010-101287-003380-9999 $0.00 $0.00 $0.00 $O.i $0.00 0 $0.00 $0.00 $0.00 $0.0 $0.00 0 $0.00 $0.00 $0.00 $0.0 $0.00 0 $0.00 $0.00 $0.00 $0.0 $0.00 0 $0.00 $0.00 $0.00 $0.0 $0.00 0 $0.00 1 $0.00 $0.00 1 $0.0 $0.00 0 $0.00 $0.00 $0.00 $0.0 $0.00 0 $0.00 $0.00 $0.00 $0.0 $0.00 0 $0.00 $0.00 $0.00 $0.01 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 Change Order 7 30100-0200431-5740010-101287-003380-9999 $0.00 0 $0.00 0 DO $0.00 0 DO $0.00 0 DO $0.00 0 DO 1 $0.00 0 DO $0.00 0 DO $0.00 0 DO $0.00 0 DO 0 $0.00 0 ^ i $0.00 Change Order 8 30100-0200431-5740010-101287-003380-9999 $0.00 $0.00 0 $0.00 ) $0.00 0 $0.00 $0.00 0 $0.00 J $0.00 0 $0.00 $0.00 0 $0.00 $0.00 0 $0.00 $0.00 0 $0.00 $0.00 0 $0.00 $0.00 0 $0.00 .00 0 $0.00 0 $0.00 $0.00 0 $0.00 City of Fort Worth Summary of Charges City Secretary Contract Num: 50857 CONCRETE PAVING JOINT SEALANT 2018 P.0.: PO-18-00104863 Project Number: 101287 Application Period: 12/17/2018-12/31/2018 Application Final Estimate Application Date: 6/12/2019 Number: Funding Identification(FID) Total Completed Amt Remaining Gross Retainage Net Totals 30100-0200431-5740010-101287-003380-9999 $349,079.01 $0.99 $0.00 $O.i $0.00 0 $0.00 $0.00 $0.00 $0.0 $0.00 0 $0.00 $0.00 $0.00 $0.0 $0.00 0 $0.00 $0.00 $0.00 $0.0 $0.00 0 $0.00 $0.00 $0.00 $0.0 $0.00 0 $0.00 1 0.00 1 $0.00 $0.0 $0.00 0 $0.00 $0.00 $0.00 $0.0 $0.00 0 $0.00 $0.00 $0.00 $0.0 $0.00 0 $0.00 $0.00 1 $0.00 $0.0 $0.00 0 $0.00 $0.00 $0.00 $0.0 $0.00 0 $0.00 $0.00 $0.00 $0.0 Grand Total $349,079.01 $0.99 $0.00 1 ($17,453.95)1 1 $17,453.95 Release Retainage: $17,453.95 fortworthg ov 101287-J oint Sea l 2018 SC Document Management FOLDERS REVIEWS TRANSMITTALS ISSUES Reviews Review detail OPEN #1-Fina(Review Time left 2da ys Contractor Final Estimate Workflow Start review Void entire review Export Report Name Description Version PROGRESS C-620 Contractors Unit Price Application for Payment Final Estimate.pdf -- V1 Initiator Initial Review C-620 Contractor-s Unit Price Application for Payment FInal Estimate.xlsm -- V1 AJ Abraham Jackson Jun 12,10-42 AM <aj @m acia sspecia lty.com> Submitted to Reviewer 1 Reviewerl Initial Review I MC Matt Cain Aug 2,8:20 AM <mcain @m ultatech.com> Submitted to Reviewer 2 Approved 8-2-19 Reviewer2 Initial Review2 IC Juan Pablo De La Cr... Aug 7,9:18AM <jua n.delacruz@fortworthtexas.gov, Submitted to Reviewer 3 Reviewer3 Initial Review 3 RN Had nusrallah Aug 29,9:49 AM <niad.nus ra llah @fortworthtexas.g ov> Submitted to Reviewer 4 J Reviewer4 Initial Review4 JP Jeffrey Perrigo Sep 26,11:35 AM <jeffrey.perrigo@fortworthtexas.gov> Submitted to Reviewers Reviewers Initial Reviews MH Monty Hall Sep 26,121 PM <m onty.ha If @fortworthtexas.gov> Submitted to Approver Approved... Approver Final Review Tpw Bsap Recon Team Send email notification I