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HomeMy WebLinkAboutContract 50124-FP1 FORTWORTH. CSC No.50124-FP1 2019 TRANSPORTATION AND PUBLIC WORKS ''- NOTICE OF PROJECT COMPLETION City Project Ne: 02694 Regarding contract 5017A for 2014 CIP YEAR 3 CONTRACT 5 as required by the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by City Council on 12/05/2017 through M&C C-28497 the director of the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT upon the recommendation of the Assistant Director of the Transportation&Public Works Department has accepted the project as complete. Original Contract Prices: $4,690,917.42 Amount of Approved Change Orders: $83,919.40 Ns 1 Revised Contract Amount: $4,774,836.82 Total Cost Work Completed: $4,116,878.18 Less Deductions: Liquidated Damages: Days @$210.00/Day Pavement Deficiencies: Total Deduction Amount: $0.00 Total Cost Work Completed: $4,116,878.18 Less Previous Payments: $3,911,034.27 Final Payment Due $205,843.91 �iiretL Prceur Lauren Prieur(Dec17,2019) Dec 17,2019 Recommended for Acceptance Date Asst. Director, TPW - Infrastructure Design and Construction w;,,;am,o, on`(Dec7,zo17 Dec 17,2019 Accepted Date -Asst.Director, TRANSPORTATION AND PUBLIC WORKS DEPARTMENT i9ana B r h o Dana Burghdoff(Cec17,2019) Dec 17,2019 Asst. City Manager Date Comments: OFFICIAL MOM'! MOM CITY SECRETARY FT. WORTH,TX 4� F� , W TPW Construction Invoice Contract: C550124 P.O.# 18-102786:781 Payment Date: 11/1/2019 TO:]LB Contracting,LLC INV.# C S50124-17 FINAL Estimate No. 17 DOE: P O Box 2413I ProjManager Mary Hanna Fort Worth TX 76124 FOR: 2014 C1P Year 3,Contract 5 Contract Amount: $4,774,836.82 Completed Ret Pen Adi Pav Total to Date: $4,116,878.18 S0.01 $0.00 $0.00 $4,116,878.17 Previous Estimate: $4.1 16,878.18 $205,843.92 $0.00 $0.00 $3,91 1,034,26 Earned to Date: $0.00 {$205,843.91) $0.00 $0.00 $205,843.91 Payments: 3401 4-02004 3 1-5 74 00 1 0-0O2694-0O2483-9999-14010199 $1,747,986.19 CO#1:$83,919.40 34014--2060000--C 02694-C RE'I'AN- Total to Date: $1,619,941.37 $0.00 $0.00 $0.00 $1,619,941.37 Previous Estimate: $1,619,941.37 $80,997.07 $0.00 $0.00 $1,538,944.30 Earned to Date: $0.00 ($80,99T07) $0.00 $U0 $80,997.07 39412-0200431-5740010-0O2694-0O2483 $200,000,00 39412--2060000--0O2694-CRETAN-- Total to Date: $194,766,55 $0.0] $0.00 $0.00 $194,766,54 Previous Estimate: $194,766.55 $9,738.33 $0.00 $0.00 $185,028,22 Earned to Date: $0.00 ($9,738.32) $0.00 $0.00 $9,738.32 59607-0700430-5740010-0O2694-001788 $967,037.88 5 960 7--2 0600 00--C 02694-C RE TAN-- Total to Date: $851.534.75 $0.00 $0.00 $0.00 S851,534.75 Previous Estimate: $851,534.75 $42,576.74 $0.00 $0.00 $808,958.01 Earned to Date: $0.00 ($42,576.74) $0.00 $0.00 $42,576,74 Wednesday,December 11,2019 Page l of 2 Contract: CS50124 P.O.# 18-102786,781 Payment Date: 11/1/2019 TO:JLB Contracting,LLC 1NV•# C S50124-17 FINAL Estimate No. 17 DOE: P D Box 24131 ProjManager Mary Hanna Fort Worth TX 76124 FOR: 2014 C1P Year 3,Contract 5 Contract Amount: $4,774,936,82 Com letcd Ret Pen Ad' Pa Total to Date: $4,116,878.18 $0.01 $0.00 $0,00 $4,116,878.17 Previous Estimate: $4,116.878.18 $205,843.92 $0.00 $0.00 $3,911,034.26 Earned to Date: $0.00 ($205,843.91) $0.00 $0.00 $205,843.91 Payments: 5960 1-06 004 3 0-57400 1 0-0O2694-001788 $1,859,812,75 59601--2060000--0O2694-CRETAN-- Total to Date: $1,450,635,51 $0.00 $0.00 10,00 $1,450,635.51 Previous Estimate: $1A50,635.51 $72,531.78 $0.00 $0.00 $1,378.103.73 Earned to Date: $0,00 ($72,531.78) $0.00 $0.00 $72,531.78 Wednesday,December l 1,2019 Page 2 of m a m m c ) 6 �_ O >, O_ P b od T a c� oe oe rl Lli N H N N r N H H Vi VI H H H H H 49 Yi' � •Y � � a C tl❑ e 3 z w o .4 e O a v W + x C Q A r x + cg d C d Q eaU U � u, gf ❑ U � F ❑ W a E F" a A c C CW7 d 3 W 7 e Cj c o V U z Z Z V dU S a U [e 3 0 w $ a o O LU c r�nJ O O F E' C d a d m V U 2 W a N 11 Y Y %d fz cd cz �3 �Cyv € d G7 � � z � ❑r o a° " � am o. _ a E U v - giac ° ri � a � a s U CA 2 O Q 2 wi o o v o a E ri U O� m u cvi= v`�' c m v E E imm T° v H s u �'a'� m 7 - � E = ° � u�� ,� �-- .moo CL v a c+ w E� o E � N ui 3 yolH ooc�o.p via -cc y 0 rl 1f7 e ¢ ao 0o p a '�n�6 w e =o � E ar 4 a y m'eu- .¢ A- 4r H 3 c v mQ F ry er, v u� a r ao U e�n N5 v °cc `da� � r s ko R.RS89 R888 �QR28s» �B88 8 88 �8888Si%SS8�Si8853 85sR5t$ r �� s o$ISM Mau § s i : u � ssa. s.$ s � ng $ fir Rom. 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M1N Martin 1Nigg Nov 1,4:22 PM cmwigg@jlbcontracting.com Submitted to Reviewer 1 Reviewer 1 Initial Review 1 n DR Daniel Roy Nov 5,7:34 AM -daniel.roy@fortworthtexas.gov> Submitted to Reviewer 2 Reviewer 2 Initial Review 2 n M H Mary Hanna Nov 6,8:07 AM �mary,hanna @fortworthtexas.gov Submitted to Reviewer 3 Reviewer 3 Initial Review 3 n LZ Lane zarate Nov 11,9:45 AM 4lane.za rate@fortworthtexas.gov� Submitted to Reviewer 4 Approved Reviewer 4 Initial Review 4 n LP Lauren Prieur Nov 13,5:13 PM l a u ren.p rie u r@ fo rtwo rthtexa s.g ov Submitted to Approver No comments Approver Final Review n Tpw Bsap Recon Team Send email notification https:Hdoes.b360.autodesk.coni/projects/51200374-4155-47dO-9c3e-fal k6g5d%51revie... 12/11/2019 N � G 0 It C . n N J j N V. 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O Is is a a y'o a rr L1 � L v N ¢ w ¢ 3 u 3 m Q LL a 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 Sam Davis, President of JLB 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; 2014 CIP, Year 3 Contract 5 BY -- Sam Davis President JLB Contracting, LLC Subscribed and sworn before me on this day ofr , 2019. `t�rtiy pfI/ JAMIE GREENWAY � NOWY Public.Stai&of Texas -omm. Expires 03-25-2020 ' = ;;' Notary ID 1211645-e NOT P BLIC N AND F R TH ST E OF TEXAS - My commission expires er CONSENT OF OWNER ❑ SURETY COMPANY OCCTOR ❑ TO FINAL PAYMENT STY ❑ OTHER (SIMILAR TO AIA DOCUMENT G707) Bond No. 8368035 PROJECT: 2014 CIP Year 3 - Contract 5, City Project No. 02694 (name,address)Fort Worth, Texas TO (Owner) ARCHITECTS PROJECT NO: City of Fort Worth CONTRACT FOR: Above Project 200 Texas Street Fort Worth, Texas 76102 CONTRACT DATE: December 5, 2017 CONTRACT GR: JLB Contracting, LLC In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above,the(here iriwn name and address of Surety Company) Westfield Insurance Company 555 Republic Drive, Suite 450 PIano, Texas 75074 ,SURETY COMPANY, on bond of(here insert name and address of Contractor) .1LB Contracting, LLC P.O. Box 24131 ,CONTRACTOR, Fort Worth,Texas 76124 hereby approves of the final payment to the Contractor, and agrees that the 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 200 Texas Street Fort Worth. Texas 76102 'OAR' as set forth in the said Surety Company's bond. IN WITNESS WHEREOF, The Surety Company has hereunto set its hand this 5th day of November 2019 WESTFIELD MURANCE COMPANY Surety Comp B n� Signature—of Authorize Representative Attest: (Seal): Kyle W. Sween_ey Attorney—in--Fact Title Note:This form is intended to b:uscd as a companion document to the Contractor's Affidavit of Payment of Debts and Claims,Current Edition THIS POWER OF ATTORNEY SUPERCEDES ANY PREVIOUS POWER BEARINU I Hla SAnAt POWER#AND ISSUED PRIOR TO 04120111,FOR ANY PERSON OR PERSONS NAMED BELOW- POWER NO_ 4220052 06 Genera!Power Westfield Insurance Co. of Attorney Westfield National Insurance Co. Ohio Farmers Insurance Co. CERTIFIED COPY Westfield Cenler, Ohio Know Aft Men by These Presents, That WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, corporations, hereinafter referred to individually as a -Company" and collectively as "Companies," duly organized and existing under the laws of the State of Ohio, and having its princclpal office in Westfield Center, Medina County, Ohio,d❑ by these presents make,constitute and appoint CHARLES❑. SWEENEY, MICHAEL A. SWEENEY, KYLE W.SWEENEY, ELIZABETH GRAY, JOINTLY OR SEVERALLY of FORT WORTH and State of TX its true and lawful Attorneys)-in-Fact,with full power and authority hereby conferred in its name, place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings, or other instruments or contracts of suretyship- - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - -- - - - -- LIMITATION; THIS POWER OF ATTORNEY CANNOT BE USED To EXECUTE NOTE GUARANTEE, MORTGAGE DEFICIENCY, MORTGAGE GUARANTEE,OR BANK DEPOSITORY BONDS. and to bind any of the Companies thereby as fully and to the same extent as it such bonds were signed by the President,sealed with the corporate seal of the applicable Company and duly attested by its Secretary, hereby ratifying and confirming all that the said Attorneys)-m-Fact may do in the premises. Said appointment is made under and by authority of the following resolution adopted by the Board of Directors of each of the WEST F€ELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OH I❑FARMERS INSURANCE COMPANY: 'Be it Resolved,that the President,any Senior Executive,any Secretary or any Fidehty& Surety Operations Executive or other Executive shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorneys)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: The Attorney-in-Fact. may be given full power and authority for and in the name of and on behalf of the Company,to execute,acknowledge and deliver,any and all bonds, recognizances, contracts, agreements of indemnity and other conditional or obligatory undertakings and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney-in-Fact shall be as binding upon the Company as if signed by the President and sealed and attested by the Corporate Secretary,' -Be it Further Resolved,that the signature of any such designated person and the seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile,and any power of attorney or certificate bearing facsimile signatures or facsimile seal shaft be valid and binding upon the Company with respect to any bond or undertaking to which it is attached.- (Each adopted at a meeting held on February 8,2000). In Witness Whereof,WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY have caused these presents to be signed by their Senior Executive and their corporate seats to be hereto affixed this 20th day of APRIL A.D.,2011 . Corporate XA%vR� ay �,."��pN�'�•. SIj6�,ti� WESTFIELD INSURANCE COMPANY Seats ON .«..ti+C F .........N Aft ,cam ta. WESTFIELD NATIONAL INSURANCE COMPANY o :'P 'QM =� OHIO FARMERS INSURANCE COMPANY �' � SEt7L� 3�V roe+ Yrrp; k%'. 1848 ;-W ti BY State of Ohio' r .........k r+,���•"''•"""'��•` Richard L. Kinnaird, Jr.,National Surety Leader and County of Medina ss.: Senior Executive On this 20th day of APRIL A.D., 2011 , before me personally came Richard L. Kinnaird, Jr. to me known, who, being by me duly sworn, did depose and say,that he resides-in Medina, Ohio;that he is Senior Executive of WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, the companies described in and which executed the above Instrument;that he knows the seals of said Companies;that the seals affixed to said instrument are such corporate seals;that they were so affixed by order of the Boards of Directors of said Companies;and that he signed his name thereto by like order. Notarial ,.». L Seal RI A Z4 4zas Affixed 0:�, I%v - r William J. Kahelin,A ney at Law,Notary Public State of Ohio W My Commission Does Not Expire(Sec.147.03 Ohio Revised Code) County of Medina ss.: q .I y T E. O>✓r O i 1,Frank A.Carrino,Secretary of WESTFIELD INSURANCE;COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OH€O FARMERS INSURANCE COMPANY, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said Companies,which is still in full force and effect; and furthermore,the resolutions of the Boards of Directors,set out in the Power or Attorney are In full force and effect. In Witness Whereof, I have hereunto set my hand and affixed the seals of said Companies at Westfield Center, Ohio, this nth day of Ncwemb� n�'% 2019 SEAL _RAA '� :a= �-+�q Secretary 1848 Frank A. Currino,Secretary �� �Wl � •f .l.l y F F- BPOAC2 (combined) (06-02) FORTWORTH TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PROJECT NAME: 204 CIP Year 3 - Contract 5 PROD ECT N UM BER: 2694 DOE NUMBER: NIA WATER PIPE LAID SIZE TYPE OF PIPE LF C-900 DR-14 12" PVC Slip joint 1540 C-900 DR-14 8" PVC Slip joint 5781 C-900 ❑R-14 6" PVC Slip joint 104 FIRE HYDRANTS: 6 VALVES(16" OR LARGER) PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: NEW SERVICES: 1" Copper 173 SEWER PIPE LAID SIZE TYPE OF PIPE LF C-900 SDR-26 8" PVC Slip joint 2134 DIP 8" ❑IP slip joint 1081 CIPP 6" CIPP 300 PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: NEW SERVICES: 4" PVC slip joint 100 TRANSPCRTA-nON AND PUBLIC WORKS The City of Fort Worth• 1000 Throckmorton Street•fort Worth,TX 76012-6311 (817)392-7941 ■Fax: (817)392-7845 M&C Review Page 1 of 3 Official site of the City of Fort Worth, Texas CITYCOUNCIL AGENDA °�1°r COUNCIL ACTION: Approved on 12/5/2017 -Ordinance Nos. 23031-12-2017 & 23032-12-2017 DATE: 12/5/2017 REFERENCE C-28497 LOG NAME: 202014 CIP YEAR 3 NO.: CONTRACT 5-JLB CODE: C TYPE: NOW PUBLIC CONSENT HEARING: NO SUBJECT: Authorize Execution of Contract with JLB Contracting, LLC, in the Amount of $4,690,917.42 for 2014 CIP Year Three Contract No. 5, Combined Street Paving Improvements and Water and Sanitary Sewer Main Replacements and Adopt Appropriation Ordinances (COUNCIL DISTRICT 2) RECOMMENDATION: It is recommended that the City Council: 1. Adopt the attached appropriation ordinances increasing estimated receipts and appropriations in the Water Capital Fund in the amount of$2,172,495.00 from available funds and in the Sewer Capital Fund-- Legacy in the amount of$1,129,621.00 from available funds; and 2. Authorize execution of a contract with JLB Contracting, LLC, in the amount of$4,690,917.42 for 2014 CIP Year Three Contract No. 5, Combined Street Paving Improvements and Water and Sanitary Sewer Main Replacements (City Project No. 02694). DISCUSSION: This Mayor and Council Communication (MRC) is to authorize a construction contract for water, sanitary sewer and paving improvements on approximately 3.79 lane miles on the streets listed below: Street From To Chestnut Avenue W. Loraine Street NW 30th Street Market Avenue NW 28th Street W. Loraine Street McKinley Avenue NW 29th Street NW 30th Street McKinley Avenue 23rd Street Azle Avenue NW 23rd Street Columbus Avenue Lincoln Avenue NW 24th Street Robinson Street F Lydon Avenue NW 24th Street Grayson Avenue Ephriharn Avenue NW 30th Street Chestnut Avenue Angle Avenue NW 28th Street McCandless Street Rock Island street NW 31st Street F McCandless Street Rock Island Street The Transportation and Public Works Department's share on this contract is $1,864,066.79 which is available in the Street Improvement Certificate of Obligation (COs) Residuals Fund and 2014 Bond Program Funds (CPN CO2694). The Water department's share on this contract of $2,826,850.63 will be available in the Water Capital and Sewer Capita-Legacy Fund of the project(CPN CO2694). A portion of this project will include 2014 Bond Program funds. Available resources within the General Fund will be used to provide interim financing for these expenses until debt is issued. Once http://apps.cfwnet.orglcouncil_packet/mc_review.asp?ID=25344... 11/8/2019 M&C Review Page 2 of 3 debt associated with this project is sold, bond proceeds will reimburse the General Fund, in accordance with the statement expressing official Intent to Reimburse which was adopted as part of the ordinance canvassing the bond election (Ordinance No. 21241-05-2014), the subsequent ordinance authorizing debt in 2016 (Ordinance No. 22216-05-2016) and additional actions taken by the Mayor and City Council. The project was advertised for bid on August 10, 2017 and August 17, 2017 in the Fort Worth Star-Telegram. On September 14, 2017, the following bids were received: Bidder Amount 11 Time of Completion JLB Contracting, LLC $4,690,917.42 425 Calendar Days Stabile&Winn, Inc $5,251.203,50 Arlo Contracting Services, LLC $5,345,725.00 Ir FNH Construction, LLC $5,369,991.05 McClendon Construction Company, Inc. $5,755,165.95 Jackson Construction Ltd. $6,206,843.50 In addition to the contract amount, $593,260.00 (Water: $219,691.00, Sewer: $114,231.00; TPW: $259,338.00) is required for project management, material testing and inspection and $234,546.00 (Water: $92,991.00; Sewer: $48,352.00; TPW: $93,203.00) is provided for project contingencies. This project will have no impact on the Transportation and Public Works annual operation budget nor on the Water Department's operating budget when completed. Construction is expected to start in January 2018. The sanitary sewer component of this project is part of the Water Department's Sanitary Sewer Overflow Initiative Program. MANBE OFFICE-JLB Contracting, LLC, is in compliance with the City's BDE Ordinance by committing to eight percent MBE participation. The City's MBE goal on this project is eight percent. The project is located in COUNCIL DISTRICT 2. FISCAL INFORMATIONICERTIFICATION: The Director of Finance certifies that funds are available in the current capital budget as appropriated of 2014 Bond and Street Improvement CDs Residuals Funds and upon approval of the above recommendations and adoption of the attached appropriation ordinances, funds will be available in the current capital budget, as appropriated, of the Water Capital Fund and of the Sewer Capital Fund - Legacy. The Fiscal Year 2018 Water Operating Budget includes appropriations of$29,069,236.00 for the purpose of providing Pay-As-You-Go funding for Water Capital Projects. After this transfer for Fiscal Year 2018, the balance will be $24,288,904.00. The Fiscal Year 2018 Water Operating Budget includes appropriations of$29,022,689.00 for the purpose of providing Pay-As-You-Go funding for Sewer Capital Projects. After this transfer for Fiscal Year 2018, the balance will be $26,451,450.00. TO Fund I Department Account I Project Program I Activity Budget I Reference#I Amount http://apps.cfwnet.orglcouiicil_packet/mc_review.asp?ID=25344... 11/8/2019 M&C Review Page 3 of 3 ID ID _� Year (Chartfield Y) FROM Fund Department Account Project Program Activity Budget Reference# Amount ID ID Year Chartfield 2 Submitted for City Manager's Office by: Jay Chapa (5804) Originating Department Head: Douglas Wiersig (7801) Additional Information Contact: Mary Hanna (5565) ATTACHMENTS 2014_CIP Year 3 Contract 5 - 1295 form.pdf 202014 CIP YEAR 3 CONTRACT 5 - JLB 50 AO 18R.docx 202014 CIP YEAR 3 CONTRACT 5 - JLB 70 AO 18R.docx 202014-CIPYEAR3CONTRACT5-JLB MAP. df http://apps.cfwnet.org/council_packet/mc_review.asp?ID=25344... 1 118120 1 9 FoR' TWORTH rgv 03/05/07 TRANSPORTATION & PUBLIC WORKS FINAL STATEMENT OF CONTRACT TIME FINAL STATEMENT NO.:1 NAME OF PROJECT: 2014 CIP Year 3 Contract 5 PROJECT NO.: 2694 CONTRACTOR: JLB Contracting,LLC DOE NO.: NIA PERIOD FROM:02105118 TO: 07/17/19 FINAL INSPECTION DATE: 17-Jul-19 WORK ORDER EFFECTIVE.7/17/2019 CONTRACT TIME: 425 Wo DAY OF DAYS REASON FOR DAYS DAY OF DAYS REASON FOR DAYS MONTH CHARGED CREDITED MONTH CHARGED CREDITED DURING DURING 1. 16. 2• 17. 7*2 r, 3. 18. 4. 19. 5. 20. 6. ' 21. 7. ' _ 22. 8. r 23. 9. 24. 10. 25. 11. 26. 12. - 27. 13. 1 28. 14. J 29. 15. 30. 31. SAT,SUN, RAIN,TOO WET, UTILITIES DAYS TOTAL & HOLIDAYS &TOO COLD RELOCATIONS OTHERS* CHARGED DAYS THIS PERIOD 480 PREVIOUS PERIOD TOTALS ,r TO DATE 7 [cs J� 480 *REMARKS: r J0 - I ' fZ CONTRACTO DATE INSPECTOR DATE ENGINEERING DEPARTb ENT �' The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TX 76012-6311 (817)392-7941 •Fax:(817)392-7845 w Department of TPW Const. Services CPN#()"'J4 Date Project Manager ►N14o.. 1-9-1 c Risk Management S. Gatewood D.O.E. Brotherton ]1-11-[9, Water V. Gutzier 4-11 CFA Janie Morales/Scanned o The Proceeding people have been Contacted concerning the request for final payment&have released this project for such payment. I Clearance Conducted By Etta Bac _. AMBER LAWSON- GREEN SHEET RECEIPT CPN # # DATE 02694 17 12/06/ 19 RECEIVED BY SIGN AND RETURN ROUTING SLIP TO ETTA BACY