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Home My WebLink AboutContract 51572-FP1 City Secretary 51572 -FP1 Contract No. N0 1 FORT WORTHO) Date Received Nov 11,2019 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: ALLIANCE MEDICAL PARK City Project No.: 101599 Improvement Type(s): Water N Sewer N Original Contract Price: $94,766.80 Amount of Approved Change Order(s): Revised Contract Amount: Total Cost of Work Complete: $94,766.80 20 � lv z 01120Nov 5 2019 (Nov 5,2019) f Contractor Date Vice President Title Structures and Interiors,Incorporated Company Name K.�Ck""i's- Nov 5,2019 Kevin Chambers(Nov 5,2019) Project Inspp�ct Date Victor V.Tornero Jr(Nov 6,2019) Nov 6,2019 Project Manager Date �7a�/2 fG�2tt/LIO�Gl�2t Janie Scarlett Morales(Nov 7,2019) Nov 7,2019 CFA Manager Date Dana Burghdofl(It6v 7,20145f Nov 7,2019 Asst. City Manager Date ----- OFFICIAL RECORD CITY SECRETARY Page 1 of 2 FT WORTH,TX Notice of Project Completion Project Name:ALLIANCE MEDICAL PARK City Project No.: 101599 City's Attachments Final Pay Estimate 0 Change Order(s): ❑ Yes 0 N/A Pipe Report: 0 Yes ❑ N/A Contractor's Attachments Affidavit of Bills Paid Consent of Surety Statement of Contract Time Contract Time: 70 CD Days Charged: 284 Work Start Date: 1/7/2019 Work Complete Date: 10/17/2019 Page 2 of 2 FORTWORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name ALLIANCE MEDICAL PARK Contract Limits Project Type WATER&SEWER City Project Numbers 101599 DOE Number 1599 Estimate Number 1 Payment Number 1 For Period Ending 11/1/2019 CD City Secretary Contract Number Contract Time 7aD Contract Date Days Charged to Date 284 Project Manager NA Contract is 100.00 Complete Contractor STRUCTURES AND INTERIORS,INC 1594 HART ST SOUTHLAKE, TX 76092 Inspectors DICKINSON / CHAMBERS Friday,November 1,2019 Page 1 of 4 City Project Numbers 101599 DOE Number 1599 Contract Name ALLIANCE MEDICAL PARK Estimate Number I Contract Limits Payment Number 1 Project Type WATER&SEWER For Period Ending 11/1/2019 Project Funding WATER Item Description of Items Unit Unit Cost Estimated Estimated Completed Completed No. Quanity Total Quanity Total ---------------------------------------- 1 DUCTILE IRON WATER FITTINGS 0.2 TN $1,889.00 $377.80 0.2 $377.80 W/RESTRAINT 2 6"DIP WATER 6 LF $73.00 $438.00 6 $438.00 3 8"PVC WATER PIPE 10 LF $48.00 $480.00 10 $480.00 4 CONNECTION TO EXISTING 4"-12"WATER 3 EA $550.00 $1,650.00 3 $1,650.00 5 2"WATER SERVICE 1 EA $2,760.00 $2,760.00 1 $2,760.00 6 3"WATER METER AND VAULT 1 EA $16,816.00 $16,816.00 1 $16,816.00 7 12"X 6"TAPPING SLEEVE&VALVE 1 EA $3,623.00 $3,623.00 1 $3,623.00 8 12"X 8"TAPPING SLEEVE&VALVE 2 EA $4,186.00 $8,372.00 2 $8,372.00 ------------------- ------------------- Sub-Total of Previous Unit $34,516.80 $34,516.80 SEWER Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total I POST CCTV INSPECTION 803 LF $1.00 $803.00 803 $803.00 2 MANHOLE VACUUM TESTING 4 EA $110.00 $440.00 4 $440.00 3 TRENCH SAFETY 803 LF $1.00 $803.00 803 $803.00 4 8"SEWER SERVICE 1 EA $1,160.00 $1,160.00 1 $1,160.00 5 8"SEWER PIPE 763 LF $35.00 $26,705.00 763 $26,705.00 6 8"SEWER PIPE CSS BACKFILL 40 LF $103.00 $4,120.00 40 $4,120.00 7 4'MANHOLE 4 EA $2,977.00 $11,908.00 4 $11,908.00 8 T EXTRA DEPTH MANHOLE 14.2 VF $860.00 $12,212.00 14.2 $12,212.00 9 CONNECT TO EXISTING 8"SEWER MAIN I EA $2,099.00 $2,099.00 1 $2,099.00 ----------------- --------------------- Sub-Total of Previous Unit $60,250.00 $60,250.00 -------------------------------------- Friday,November 1,2019 Page 2 of 4 City Project Numbers 101599 DOE Number 1599 Contract Name ALLIANCE MEDICAL PARK Estimate Number I Contract Limits Payment Number I Project Type WATER&SEWER For Period Ending 11/1/2019 Project Funding Contract Information Summary Original Contract Amount $94,766.80 Change Orders Total Contract Price $94,766.80 Total Cost of Work Completed $94,766.80 Less %Retained $0.00 Net Earned $94,766.80 Earned This Period $94,766.80 Retainage This Period $0.00 Less Liquidated Damages Days @ /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 $94,766.80 Friday,November 1,2019 Page 3 of 4 City Project Numbers 101599 DOE Number 1599 Contract Name ALLIANCE MEDICAL PARK Estimate Number I Contract Limits Payment Number 1 Project Type WATER&SEWER For Period Ending 11/1/2019 Project Funding Project Manager NA City Secretary Contract Number Inspectors DICKINSON / CHAMBERS Contract Date Contractor STRUCTURES AND INTERIORS,INC Contract Time 70 CD 1594 HART ST Days Charged to Date 284 CD SOUTHLAKE, TX 76092 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 $94,766.80 Less %Retained $0.00 Net Earned $94,766.80 Earned This Period $94,766.80 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 $94,766.80 Friday,November 1,2019 Page 4 of 4 FO,-RlTWO RT H TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PROJECT NAME: Alliance Medical Park PROJECT NUMBER: 101599 DOE NUMBER: NA WATER PIPE LAID SIZE TYPE OF PIPE LF 8"PVC 8" PVC 10' FIRE HYDRANTS: NA VALVES(16" OR LARGER) NA PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: Yes NEW SERVICES: 2" Copper 6' SEWER PIPE LAID SIZE TYPE OF PIPE LF 8"PVC 8" PVC 763' PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: Yes NEW SERVICES: 1 8"PVC 8' TRANSPORTATION AND PUBLIC WORKS Es` The City of Fort Worth•1000 Throckmorton Street•Fort Worth,TX 76012-6311 (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 Michael H. Lease, President Of Structures and Interiors, Incorporated, 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; Alliance Medical Park CPN#101599 P BY ` Michael H. Lease President Structures and Interiors, Incorporated Subscribed and sworn before me on this date 5 of November, 2019. .Ski Notary Public ti Tarrant, Texas re or �� _4) CONSENT OF OWNER ❑ SURETY COMPANY ARCHITECT ❑ CONTRACTOR ❑ TO FINAL PAYMENT SURETY ❑ Conforms with the American Institute of OTHER Architects,AIA Document G707 Bond No PBO1604000076 PROJECT: (name, addreSs)Alliance Medical Park Ft.Worth,TX TO (Owner) City Project No. [MOB ALLIANCE PARTNERS,LLC&THE CITY OF ARCHITECT'S PROJECT NO: 101599 FORT WORTH CONTRACT FOR: 1000 Throckmorton St. Water,Sanitary Sewer,Paving,and Street Lighting Improvements for Alliance Medical Park Fort Worth TX 76102 CONTRACT DATE: CONTRACTOR: STRUCTURES AND INTERIORS, 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) PHILADELPHIA INDEMNITY INSURANCE COMPANY One Bala Plaza, Suite 100 Bala Cynwyd PA 19004-1403 , SURETY COMPANY on bond of (here insert name and address of Contractor) STRUCTURES AND INTERIORS, INC. 1594 Hart St. Southlake TX 76092 , 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) MOB ALLIANCE PARTNERS, LLC&THE CITY OF FORT WORTH 1000 Throckmorton St. Fort Worth TX 76102 , OWNER, as set forth in the said Surety Company's bond. IN WITNESS,WHEREOF, the Surety Company has hereunto set its hand this 4th day of November, 2019 PHILADELPHIA INDEMNITY INSURANCE COMPANY Surety Company Nh Attest: (Seal): Signature of Authorized Representative Robbi Morales 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 1017 PHILADELPHIA INDEMNITY INSURANCE COMPANY One Bala Plaza,Suite 100 Bala Cynwyd,PA 19004-0950 Power of Attorney KNOW ALL PERSONS BY THESE PRESENTS:That PHILADELPHIA INDEMNITY INSURANCE COMPANY(the Company),a corporation organized and existing under the laws of the Commonwealth of Pennsylvania,does hereby constitute and appoint Don Cornell,Kelly A.Westbrook,Tina McEwan,Ricardo Jose Reyna,Robbi Morales,Tonie Petranek,Joshua Saunders and/or Sophinie Hunter at Aon Risk Services Southwest,Inc.,its true and lawful Attomey-in-fact with full authority to execute on its behalf bonds,undertakings,recognizances and other contracts of indemnity and writings obligatory in the nature thereof,issued in the course of its business and to bind the Company thereby,in an amount not to exceed$50,000,000. This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of PHILADELPHIA INDEMNITY INSURANCE COMPANY on the 141h of November,2016. RESOLVED: That the Board of Directors hereby authorizes the President or any Vice President of the Company: (1) Appoint Attomey(s) in Fact and authorize the Attorney(s) in Fact to execute on behalf of the Company bonds and undertakings,contracts of indemnity and other writings obligatory in the nature thereof and to attach the seal of the Company thereto; and (2) to remove, at any time, any such Attorney-in-Fact and revoke the authority given. And,be it FURTHER RESOLVED: That the signatures of such officers and the seal of the Company may be affixed to any such Power of Attorney or certificate relating thereto by facsimile,and any such Power of Attorney so executed and certified by facsimile signatures and facsimile seal shall be valid and binding upon the Company in the future with respect to any bond or undertaking to which it is attached. IN TESTIMONY WHEREOF, PHILADELPHIA INDEMNITY INSURANCE COMPANY HAS CAUSED THIS INSTRUMENT TO BE SIGNED AND ITS CORPORATE SEALTO BE AFFIXED BY ITS AUTHORIZED OFFICE THIS 27T''DAY OF OCTOBER,2017. r K ' ... .. (Seal) n.„�.�,1Ai�Y°�h ly Robert D.O'Leary Jr.,President&CEO Philadelphia Indemnity Insurance Company On this 27'h day of October,2017,before me came the individual who executed the preceding instrument,to me personally known,and being by me duly sworn said that he is the therein described and authorized officer of the PHILADELPHIA INDEMNITY INSURANCE COMPANY;that the seal affixed to said instrument is the Corporate seal of said Company;that the said Corporate Seal and his signature were duly affixed. rOWONWEALr4 Of bF NOThFfAt 5LrtL +ao.a•n K�wv.N.—Pk Notary Public: iawe�waaaoxwa..uv:ga+u+wrountr J6rN x+srtx ,.. residing at: Bala Cynwyd.PA (Notary Seal) My commission expires: September 25.2021 1,Edward Sayago,Corporate Secretary of PHILADELPHIA INDEMNITY INSURANCE COMPANY,do hereby certify that the foregoing resolution of the Board of Directors and this Power of Attorney issued pursuant thereto on this 271h day of October,2017 are true and correct and are still in full force and effect. I do further certify that Robert D.O'Leary Jr.,who executed the Power of Attorney as President,was on the date of execution of the attached Power of Attorney the duly elected President of PHILADELPHIA INDEMNITY INSURANCE COMPANY, In Testimony Whereof I have subscribed my name and affixed the facsimile seal of each Company this 4 th day of November_20 19 Edward Sayago,Corporate Secretary `' PHILADELPHIA INDEMNITY INSURANCE COMPANY