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HomeMy WebLinkAboutContract 51361-FP1 CITY SECRETARY FORTWORTH. - ^1!TRACT NO. A� 9 TRANSPORTATION AND PUBLIC WORKS NOTICE OF PROJECT COMPLETION City Project Ns: 101603 Regarding contract 51361 for CONCRETE RESTORATION 2019-2 as required by the TRANSPORTATION& PUBLIC WORKS as approved by City Council on 9/11/2018 through M&C C-28827 the director of the TRANSPORTATION&PUBLIC WORKS upon the recommendation of the Assistant Director of the Transportation&Public Works Department has accepted the project as complete. Original Contract Prices: $605,790.00 Amount of Approved Change Orders: Ns Revised Contract Amount: Total Cost Work Completed: $554,648.67 Less Deductions: Liquidated Damages: Days @$210.00/Day Pavement Deficiencies: Total Deduction Amount: Total Cost Work Completed: $554,648.67 Less Previous Payments: $526,916.24 Final Payment Du i $27,732.43 Recomm n d for Acceptance Date Director Tr n o ation and Publ' Works Department _ Accep Date Asst, irect r, RA RTATION & PUBLIC WORKS MV4'� Asst. City Manager Date Comments: OFFICIAL RECORD CITY SECRETARY FT.WORTH,TX Department of TP &W Const. Services CPN# _ Date Project Manager 5,V--aAn rywun, Risk Management Canad D.O.E. Brotherton CFA Morales/Scanned NIlPr _ Gutzler/Scanned la The Proceeding people have been Contacted concerning the request for final payment& have released this project for such payment. Clearance Conducted By OAwna4a i TPW Construction Invoice Contract: CS51361 P.O.# 19-00105772-1;1498 Payment Date: 7/11/2019 TO:Urban hifraconstruction INV.# C S51361-8 FINAL Estimate No. 8 DOE: 2512 GRAVEL DRIVE ProjManager Shanuni Rahman FORT WORTH TX 76118 FOR: Concrete Restoration(2019-2)at Various Locations Contract Amount: $605,790.00 Completed Ret Pen Adi Pay Total to Date: $554,648.67 $0.00 $0.00 $0.00 $554,648.67 Previous Estimate: $554,648.67 $0.00 $0.00 $0.00 $526,916.24 Earned to Date: $0.00 ($27,732.43) $0.00 $0.00 $27,732.43 Payments: 30100-0200431-5740010-101603-E03380-9999 $605,790.00 30100--2060000--101603-RETAIN-- Total to Date: $554,648.67 $0.00 $0.00 $0.00 $554,648.67 Previous Estimate: $554,648.67 $27,732.43 $0.00 $0.00 $526,916.24 Earned to Date: $0.00 ($27,732.43) $0.00 $0.00 $27,732.43 Thursday,October 24,2019 Page 1 of 1 C-620 Signature Page Contractor's Application for Payment Invoice No. 8—�rlAcr To(Owner) City of Fort Worth Invoicing Period(From-To): Invoice Date: 6/1/2019-6/3 0/2019 7/1 1/2019 P.G- FW020-0000000232 1498 From(Contractor): Remit to(If Not Automatic Deposit): Number: URBAN INFRACONSTRUCTION.LLC Project: 101603 Contractor's CFW Vendor No.: 0000039969 City Secretary Contract 51361 Contract CONCRETE RESTORATION 2019-2 Number. Name: Application For Payment Change Order Summary Approved Change Orders 1. ORIGINAL CONTRACT PRICE........................................................... $ $6 05,7)0.00 _ Number Additions Deletions 2. Net change by Change Orders................................................................. $ 1 3. Current Contract Price(Line 1 t 2)........................................................ $ $605,790.00 _ 4. TOTAL COMPLETED AND STORED TO DATE 3 (Progress Estimate,Construction Allowance and Change Orders)....... $ $554,648.67 4 5. RETAINAGE: 5 a. X S554.64967 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)............................. $ $554,648.67 TOTALS 7. LESS PREVIOUS PAYMENTS(Line 6 from prior Application)......... $ $526,916.24 NET CHANGE BY S. AMOUNT DUE THIS APPLICATION................................................. $ S27,732.43 CHANGE ORDERS 9.BALANCE TO FINISH,PLUS RETAINAGE (Column G on Progress Estimate+CA+COs+Line 5 above)............... $ $51,141.33 Contractor's Certification 10. CONTRACT TIME: The Contractor certifies with the submittal of this document and associated Payment Request Submittal a. Days Awarded 150 on the City of Fort Worth Buzzsaw system that to the best of their knowledge:(1)all previous progress b, Days Added by CO ')I 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 C. Total Days 171 prior Applications for Payment;(2)title of all Work,materials and equipment incorporated in said Work or otherwise listed in or covered by this Application for Payment will pass to Owner at time of payment cl Days Charged 17p free and clear of all Liens,security interests and encumbrances(except such as are covered by a Bond acceptable to Owner T��indemnifying Owne ag inst any such Liens,security interest or encumbrances); e, Days Remaining and(3)all Work covered this Applicat nor any is in accordance with the Contract Documents and is not defective. This document has been modified from its original form as an EJCDC document and the user did not highlightthe modifications.You are encouraged to read the document carefully and consult Legal Counsel priorto its execution. City of Fort Worth Summary of Charges City Secretary Contract Num: 51361 CONCRETE RESTORATION 2019-2 P.0.: FW020-0000000232 Project Number: 101603 Application Period: 6/1/2019-6/30/2019 Application 8 Application Date: 7/11/2019 Number: Funding Identification(FID) Total Completed Amt Remaining Gross Retainage Net Totals 30100 0200431 5740010 101603 E03380 9999 $554,648.67 $51,141.33 $0.00 $0.00 0 0 0 0 0 0 0 0 0 0 Grand Total $554,648.67 $51,141.33 $0.00 ($27,732.43) $27,732.43 C-620 Unit Pries Progress Estimate Progress Estimate Din,See- 51361 Contractor's Application C...Neal: CONCRETE RESTORATION2019-2 AVpfiwfiaer4am�. 9 AMIiewm Perin,!: 6/1/2019-6130/2019 Applimli.Will: 7111/2019 A ➢ C D E F O been ve Betnneelo Final Lnimntad Qlanily Mmeneb.Pnnvntly Tobl Cempleled Specifimtion Bid Qnonlily knit l'nm ➢id Vnlua Vvins PnNiouxly lmmlled Vnlue Value Thiv Pena) and Storcdlo Dole (P) (➢-F) Bid been No. Dexanplion Section Na. Unit ofMeavurc hmelled Stonvl(n°I in C) (D+E) B 1 0135.0201 REMOBILIZATION_ _ 0170W _EA 1.W0000 $500.00 _ $500.00 $500.00 9999.0000 REMOVE AND REPLACE S'CONCRETE DRIVEWAY .2.13/32 2 1320 SF__ _ 1400.000ODO $8.00 E11,2W.00 681.20000000 $5,45024-_ _ $6.450,24 _ $5,460.24 48.7% $5,749.76 9999.0000 REMOVE CONCRETE AND REPLACE?'CONCRETE .24113132 3 PAVEMENT HES 1.113 SY_ 62W.000000 $77.00 $477.400.00 5848.51000W0 $450.33527 $4W.335.27 $450.335.27 94.3% $27.064.73 4 32I.0107_UNCLASSIFIED E.TYPE YE A.GRA2ION _ _. 321123 CY 1W.W= _$30.01) 33,W0.00 _ - __- __- 53,000.00 5 3211.0122 FLEX BASE.TYPEA.GR-2 _321123 CY 605.000000 E80.00 E36.300.00 922.35000000 355,341.OD E55,341.00 _ __$55,341.001525% _ 319.041.00 6 3213.0208_CONCRETE HES IEXTRA DEPTHI._ _ _ 321313 CY 50.11OW00_ _ __E7$6.00 S7,75000 189.71000000 _ $$1290.05.__ E$1M05 3$1.290.00_33 0% 5$1.710)D 05 7 329201W BLOCK SOD PLACEMENT 329213 -S`f _.. SW.WWW $B.W E3,000AO 2I5.00000000 $1.290.00 _ E7290.00 51,290.00 43.0% E7.710.W 9999.0000 REMOVE AND REPLACE ADA RAMP U411.33213 8 _20 EA 2000000_ $SW.00_ ES.000.00 _ _ ____ __ $5.000.00 9 3213.0700 JOINTSEALANT 321373 LF 500A00000 S200 $1.000.01) $1.0DO.01) 10 3305.0108 MISCELGEOGRLANEOUS NSER(T INX 140 75)O(UTILITIES) 330500 LS 1.WOW0 $B4OW.W $6,OW.W _ _ _ 46,OW.W 9999.WW GEOGRID TENSER(7RU1X 140<75)OR APPROVED EOUAL 9999 atl 11 SY 3500.0D0000 $3.50 $12250.00 ll 82.0322000D $14.637.11 $14.637.11 $0.00_ S1_4.63711 119.5% -$2.387.11 12 3217.2301 RAISED MARKER TY W 321723 EA 100.000000 E6.00 S600.W 165.00000000 $99000 3990.00 $960.00 165.0% 3390W 13 3441.1301 14LOOP AWGDETECTOR TECTC CABLE 344110 LF 2W.000000 $5.00 $1,200.00 f1,2W.W 14 _3441.1302 STOP BARS DETECT CABLE _3441 10217D LF _ 2W.000000 $B.W $3.450.00 _ _ _ $,450.00 15 3217.OW5 STOP BARS PAVEMENT MARKINGS 321]23 __LF 150.WOOW $23,W _$3.450.W __ _ _ _ _ _ _ _ __ __ _ $3,450,W 16 3217.0W7 a SOLID THERMOPLASTIC(HAS)LANE LINE 321723 LF 3020.000000 $2.00 $6.040.00 E5,040.00 9999.0000 REMOVE AND REPLACE 4"SIDEWALK 02 41 13 3213 17 _20 _SF_ 200.00W00 $11.00 _$2200.00 _ _ _ _ $2,200M0 18 32775W1 CURB ADDRESS PAINTING _321123 _EA 4,000000 $100.00 $400.00__3.00000000 $300.00 S300.00 __. $30040 75.0% _ _. _$100.00 3217.0501 24"SOLID WHITE THERMOPLASTIC(HAE)CROSSWALK 321723 19 LINES LF -_ 100.000000 S23.00.__ S2.300.00 _ _ _ _ _,____ _ ___ _E2,300,00 20 9999.0096 PAVING CONSTRUCTION ALLOWANCE FA.-_ 1.000000 $25.000.00 $25,000.00 _ _ 525,000.00 TUtals $605790.00 $554,648.671 55546" 0.00 564646.67 91.8% 111M1.R Thixdnmmmi l�vx I-modified l}am iU onBi.I f ex nee UCDC dun end the n did ma hipJliou 9. modifiemi..V.,me encoum0ed to rmd We dome-uercihlly vnd--h L 1pl Caemcl prior I.i0 Gammon City of Fort Worth Summary of Charges City Secretary Contract Num: 51361 CONCRETE RESTORATION 2019-2 P.C.: FW020-0000000232 project Number. 101603 Application Period: 6/1/2019-6/30/2019 Application 8 Application Date: 7/11/2019 Number: Funding Identification(FID) Total Completed Amt Remaining Gross Retainage Net Original Contract 30100 0200431 5740010 101603 E03380 9999 $554,648.67 $51,141.33 $0.00 $0.00 0 0 0 0 0 0 0 0 0 0 ...--------- Change Order 1 - - -- - - - --- -------— — 30100 0200431 5740010 101603 E03380 9999 0 0 0 0 0 0 0 0 0 0 Change Order 2 - - --- - -- ----- ---- - -- --- i 30100 0200431 5740010101603 E03380 9999 0 0 0 0 0 0 0 0 0 0 City of Fort Worth Summary of Charges City Secretary Contract Num: 51361 CONCRETE RESTORATION 2019-2 P.0.: FW020-0000000232 project Number. 101603 Application Period: 6/1/2019-6/30/2019 Application 8 Application Date: 7/11/2019 Number: Funding Identification(FID) Total Completed Amt Remaining Gross Retainage I Net Change Order 3 I 1 30100 0200431 5740010101603 E03380 9999 0 0 I 0 0 0 0 0 0 0 0 - Change Order 4 ----- -- ----- — --------------- --- -- — 30100 0200431 5740010 101603 E03380 9999 0 0 0 0 0 0 0 0 0 0 Change Order 5 30100 0200431 5740010101603 E03380 9999 0 0 0 0 0 0 0 0 0 0 City of Fort Worth Summary of Charges City Secretary Contract Num: 51361 CONCRETE RESTORATION 2019-2 P.0.: FW020-0000000232 Project Number: 101603 Application Period: 6/1/2019-6/30/2019 Application 8 Application Date: 7/11/2019 Number. Funding Identification(FID) Total Completed Amt Remaining Gross., Retains a Net i Change Order 6 I 30100 0200431 5740010 101603 E03380 9999 0 0 0 0 0 0 0 0 0 0 _- - - -_ - - Change Order 7 30100 0200431 5740010101603 E03380 9999 0 'D 0 '0 0 0 '0 ,0 0 0 Change Order 8 30100 0200431 5740010101603 E03380 9999 0 0 I 0 0 0 0 0 0 I 0 0 i 1 RT WORTH. Account Inquiry Fiscal Year: 2019 YTD as of 09/30/2019 Period: 17 General Ledger ACTUALS Run Time: 10/24/2019 01:34 PM Report ID: GL0070 Export Ledger Data Export Journal Data 2060000 Retainage Payable 30100 101603 RETAIN $0.00 ($27.732.43) Parameter Value Report ID GL0070 Fiscal Year 2019 Accounting Period 17 Ledger ACTUALS Fund Code 30100 Account 2060000 Project ID 101603 FSCM 92 Production Page 1 of 2 FORTWORTH rev 03/05/07 TRANSPORTATION & PUBLIC WORKS FINAL STATEMENT OF CONTRACT TIME FINAL STATEMENT NO.:8 NAME OF PROJECT: Concrete Restoration 2019-2 PROJECT NO.: 101603 CONTRACTOR: Urban Infraconcstruction DOE NO.: PERIOD FROM:11/12/18 TO: 05/13/19 FINAL INSPECTION DATE: 13-May-19 WORK ORDER EFFECTIVE: CONTRACT TIME: 170 -"O D DAY OF DAYS REASON FOR DAYS DAY OF DAYS REASON FOR DAYS MONTH CHARGED CREDITED MONTH CHARGED CREDITED DURING DURING 1. 16. 2. 17. 3. 18. 4. 19. 5. 20. 6. 21. 7. 22. 8. 23. 9. 24. 10. 25. 11. 26. 12. 27. 13. 28. 14. 29. 15. 30. 31. SAT, SUN, RAIN,TOO WET, UTILITIES DAYS TOTAL &HOLIDAYS &TOO COLD RELOCATIONS OTHERS CHARGED DAYS THIS 170 PERIOD PREVIOUS 170 PERIOD TOTALS 170 TO DATE *REMARKS: 1jq CONT DATE INSPECTOR DATE ✓ ENGINEERING DEP ARTXIENT s' The City of Fort Worth• 1000 Throckmorton Street•Fort North,TX 76012-6311 Q (817) 392-7941 •Fax: (817)392-7845 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 Anup Tamrakar, CEO Of Urban Infraconstruction 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; CPN 101603 Concrete Restoration 2019-2 BY IV up Tamrakar, CEO Subscribe d sworn before in ate 24th of July, 2019. SUBHHATA PIMA -2'`"••""•e�;%Notary Public,State ofTexas M— EXPOS 06 11 2021 Comm. P Notary Ib 131125450 Notary Public Tarrant County, TX CONSENT OF OWNER SURETY COMPANY ARCHITECT' TO FINAL PAYMENT CONTRACTOR SURETY AIA DOCUMENT G707 OTHER Bond No. 2276427 PROJECT: Concrete Restoration (2019-2) at Various Locations (name,address) TO(Owner) [ City of Fort Worth ] ARCHITECT'S PROJECT NO: 1000 Throckmorton Street Fort Worth,TX 76102-6312 CONTRACT FOR: [ ] CONTRACT DATE: 9/11/2018 CONTRACTOR: Urban Infraconstruction,LLC 2512 Gravel Drive Fort Worth,TX 76118 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) North American Specialty Insurance Company 1200 Main Street, Suite 800 Kansas City,MO 64105 , SURETY COMPANY, on bond of(here insert name and address of Contractor) Urban Infraconstruction,LLC 2512 Gravel Drive Fort Worth,TX 76118 , CONTRACTOR, hereby approves of the final payment to the Contractors, 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) City of Fort Worth 1000 Throckmorton Street Fort Worth,TX 76102-6312 ,OWNER, as set forth in the said Surety Company's bond. IN WITNESS WHEREOF, the Surety Company has hereunto set its hand this 23rd day of July 2g19 North American Specialty Insurance Company Surety Company 0.AAyu,- ignature of Authorized Representative Attest- (Seal): Andrea Rose Crawford 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 AIA DOCUMENT G707 CONSENT OF SURETY COMPANY TO FINAL PAYMENT APRIL 1970 EDITION AIA ONE PAGE 1970 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 New York Ave.,NW,WASHINGTON,D.C. 20006 SWISS RE CORPORATE SOLUTIONS NORTH AMERICAN SPECIALTY INSURANCE COMPANY WASHINGTON INTERNATIONAL INSURANCE COMPANY WESTPORT INSURANCE CORPORATION GENERAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS,THAT North American Specialty Insurance Company,a corporation duly organized and existing under laws of the State of New Hampshire,and having its principal office in the City of Overland Park,Kansas and Washington International Insurance Company a corporation organized and existing under the laws of the State of New Hampshire and having its principal office in the City of Overland Park,Kansas,and Westport Insurance Corporation,organized under the laws of the State of Missouri,and having its principal office in the City of Overland Park,Kansas each does hereby make,constitute and appoint: SAMMY JOE MULLIS,JR.,JOHN WILLIAM NEWBY,CHERI LYNN IRBY,WILBERT RAYMOND WATSON,MICHAEL L.TULLIS,SANDRA LEE RONEY,DEBRA LEE MOON, ANDREA ROSE CRAWFORD,MARY JO ZAKRZEWSKI,JAMES B.ROGERS,JR„TROY RUSSELL KEY,LINDA MICHELLE STALDER AND CHRISTOPHER CARL SUNDBERG JOINTLY OR SEVERALLY Its true and lawful Attorney(s)-in-Fact,to make,execute,seal and deliver,for and on its behalf and as its act and deed,bonds or other writings obligatory in the nature of a bond on behalf of each of said Companies,as surety,on contracts of suretyship as are or may be required or permitted by law,regulation,contract or otherwise,provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the amount of: ONE HUNDRED TWENTY FIVE MILLION($125,000,000.00)DOLLARS This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held on March 24,2000 and Westport Insurance Corporation by written consent of its Executive Committee dated July 18,2011. "RESOLVED,that any two of the President,any Senior Vice President,any Vice President,any Assistant Vice President, the Secretary or any Assistant Secretary be,and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named in the given Power of Attorney to execute on behalf of the Company bonds,undertakings and all contracts of surety,and that each or any of them hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is FURTHER RESOLVED,that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile,and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be binding upon the Company when so affixed and in the future with regard to any bond,undertaking or contract of surety to which it is attached." `�\\\1\111nILITY////j4� a���ya�ap't(IONq�"� i d......... N MNCE o`Q�•..........•'Itr�% e�'K`K,bRPoRq' so By .... Gj,GAP R.�� ' 36=. 4 T.• Steven Anderson,Senior VicePresidento as m ton International Insurance Company4 >' F; SEAL - I Z E f SEAL .n= t. ,p g &Senior•Vice President of North American Specialty Insurance Company e Ity1 2 1973 4t tmj y; iO &Senior Vice President of Westport Insurance Corporation By W111,&ONE i 1N�N`,\� 1'1 Ntp�� �g Mikee A.Ito,Senior Vice President of Washington International Insurance Company &Senior Vice President of North American Specialty Insurance Company larulr• &Senior Vice President of Westport Insurance Corporation IN WITNESS WHEREOF,North American Specialty Insurance Company,Washington International Insurance Company and Westport Insurance Corporation have caused their official seals to be hereunto affixed,and these presents to be signed by their authorized officers this this 20th day of August ,20 18 North American Specialty Insurance Company Washington International Insurance Company State of Illinois Westport Insurance Corporation County of Cook Ss: On this 20th day of August 201 before me,a Notary Public personally appeared Steven P.Anderson ,Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and Senior Vice President of Westport Insurance Corporation and Michael A.Ito Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and Senior Vice President of Westport Insurance Corporation,personally known to me,who being by me duly sworn,acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the voluntary act and deed of their respective companies. OFFICIAL SEAL M.KENNY � \'� �' r Notary Public-State of lllinols hfyC.1210412oi 'fi"i M.Kenny,Notary Public } I, Jeffrey Goldberg , the duly elected Vice President and Assistant Secretary of North American Specialty Insurance Company,Washington International Insurance Company and Westport Insurance Corporation do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney given by said North American Specialty Insurance Company,Washington International Insurance Company and Westport Insurance Corporation which is still in full force and effect. IN WITNESS WHEREOF,I have set my hand and affixed the seals of the Companies this 23rd day of July Z0 19 Jeffrey Goldberg,Vice President&Assistant Secretary of Washington International Insurance Company& North American Specialty Insurance Company&Vice President&Assistant Secretary of Westport Insurance Corporation North American'Specialty Insurance Company Washington International Insurance Company Westport Insurance Corporation TEXAS CLAIMS INFORMATION IMPORTANT NOTICE ADVISO IMPORTANTE In order to obtain information or make a complaint: Para obtener informacion o para someter un queja: You may contact Jeffrey Goldberg,Vice President Puede comunicarse con Jeffrey Goldberg,Vice — Claims at 1-800-338-0753 President— Claims,al 1-800-338-0753 You may call Washington International Insurance Usted puede Ilamr al numero de telefono gratis de Company and/or North American Specialty Insurance Washington International Insurance Company and/or Company's and/or Westport Insurance Corporation North American Specialty Insurance Company's and/or toll-free number for information or to make a Westport Insurance Corporation para informacion o complaint at: para someter una queja al: 1-800-338-0753 1-800-338-0753 You may also write to Washington International Usted tambien puede escribir a Washington Insurance Company and/or North American Specialty International Insurance Company and/or North Insurance Company and/or Westport Insurance American Specialty Insurance Company and/or Corporation at the following address: Westport Insurance Corporation al: 1450 American Lane 1450 American Lane Suite 1100 Suite 1100 Schaumburg,IL 60173 Schaumburg,IL 60173 You may contact the Texas Department of Insurance Puede escribir al Departmento de Seguros de Texas to obtain information on companies, coverages, para obtener informacion acerca de companias, rights or complaints at: coberturas, derechos o quejas al: 1-800-252-3439 1-800-252-3439 You may write the Texas Department of Insurance: Puede escribir al Departmento de Seguros de Texas: P.O. Box 149104 P.O. Box 149104 Austin,TX 78714-9104 Austin,TX 78714-9104 Fax: (512)475-1771 Fax: (512)475-1771 Web: hftpi//­www.tdo.state.tx.us Web: http://www.tdi.state.tx.us Email:ConsumerProtection@tdi.state.tx.us Email:ConsumerProtection@tdi.state.tx.us PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS 0 RECLAMOS: Should you have a dispute concerning your premium Si tiene una disputa concerniente a su prima o a un or about a claim you should first contact the reclamo, debe comunicarse con el Washington Washington International Insurance Company and/or International Insurance Company and/or North North American Specialty Insurance Company and/or American Specialty Insurance Company and/or Westport Insurance Corporation. If the dispute is not Westport Insurance Corporation primero. Si no se resolved,you may contact the Texas Department of resuelve la disputa, puede entonces comunicarse Insurance. con el Departmento de Seguros de Texas. ATTACH THIS NOTICE TO YOUR POLICY: UNA ESTE AVISO A SU POLIZA This notice is for information only and does not Este aviso es solo para proposito de infromacion y no become a part or condition of the attached se converte en parte o condicion del documento document. adjunto. BIM 360 Document Management Page 1 of 2 AUTODESK BIM 360 fortworthgov>101603-Concrete Restoration 2019-2- a MG Document Management FOLDERS REVIEWS TRANSMITTALS ISSUES Reviews > Reviewdetail OPEN #12- Final Review © Duedate:Sep30 Contractor Final Estimate Submittal Work flow Start review Void entire review J Export Report Name- Description Version Markr PROGRESS gI. 2019-2 Pay app S Final.xlsm -- V5 0 Initiator Initial Review n pay app S.pdf -- V1 0 NP Nilima Poudel Sep 6,4:12 PM <nili ma @urba niconstruct.com> Submitted to Reviewer 1 Reviewer 1 Initial Review 1 n BM Brian Mcgill Sep 9,737 AM <bria n.mcgi ll@fortworthtexas.gov> Submitted to Reviewer Reviewer2 Initial Review2 n SR Shammi Rahman Sep 9,11:33 AM <sha mmi.rah ma n@fortworthtexas.gov> Submitted to Reviewer Reviewer3 Initial Review3 n RN Had nusrallah Sep 16,1:45 PM <riad.n usra lla h @fortworthtexas.gov> Submitted to Reviewer 4 approved Reviewer4 Initial Review 4 n JP Jeffrey Perrigo Sep 16,3:06 PM <j effrey.pe rri go @fo rtworth texas.gov> Submitted to Reviewers Reviewer5 Initial Reviews n MH Monty Hall Sep 27,12:55 PM <mon ty.h a l l @fortworth texa s.g ov> Submitted to Approver Approved Approver Final Review n Tpw Bsap Recon Team,Karen Striker Send email notification https://does.b360.autodesk.com/projects/ce838aI 1-9540-4b5c-ba84-c2285551992b/reviews/704edc 14-0402-4bb4-aaed-5... 10/24/2019