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Contract 50172-FP1
�v �•� `vg' ° FORTWORTHT, CSC No.50172-FP1 TRANSPORTATION AND PUBLIC WORKS NOTICE OF PROJECT COMPLETION City Project Ns: 02695 Regarding contract 50172 for 2014 CIP YEAR 3 CONTRACT 7 as requited by the TRANSPORTATION AND PUBLIC WORKS as approved by City Council on W12/2017 through M&C C-28516 the director of the TRANSPORTATION AND PUBLIC WORKS upon the recommendation of the Assistant Director of the Transportation&Public Works Department has accepted the project as complete. Original Contract Prices: $5,472,041.50 Amount of Approved Change Orders: $497,967.00 NO 1,2,&3 Revised Contract Amount: $5,970,008.50 Total Cost Work Completed: $5,615,302.58 Less Deductions: Liquidated Damages: Days®$210.00/Day Pavement Deficiencies: Total Deduction Amount: $0.00 Total Cost Work Completed: $5,615,302.58 E Less Previous Payments: $5,334,537.45 P k Final Payment Due $280,765.13 �r Apr 28,2020 9F UumPrkKw(W2k2=) Recommended for Acceptance Date Asst. Director, TPW - Capital Delivery P ,AIRargJ0�22 Mo> A r 28 2020 Accepted Date Director,TRANSPORTATION AND PUBLIC WORKS Client Department Dana& Apr 28,2020 Dana 9u0dotf pr28,2=) Asst. City Manager Date Comments: i OFFICIAL RECORD CITY SECRETARY FT. WORTH;TX TPW Construction Invoice Contract: CS50172 P.O.# 18-102959;FW020-1208 Payment Date: 2/24/2020 TO:Wiiliam J.Schultz,Inc dba Circle C Constr INv.# CS50172-23 FINAL Estimate No. 23 DOE: P O BOX 40328 ProjManager Mary Hanna Fort Worth TX 76140 FOR: 2014 CIP Year 3 Contract No.7 Contract Amount: $5,970,008.50 Completed Ret Pen Adi Pay Total to Date: $5,615,302.58 $0.00 $0.00 $0.00 $5,615,302.58 Previous Estimate: $5,615,302.58 $0.00 $0.00 $0.00 $5,334,537.45 Earned to Date: $0.00 ($280,765.13) $0.00 $0.00 $280,765.13 Payments: 59601-0600430-5740010-0O2695-001783 $1,123,459.00 59601--2060000--0O2695-CRETAN-- Total to Date: $987,307.00 $0.00 $0.00 $0.00 $987,307.00 Previous Estimate: $987,307.00 $49,365.35 $0.00 $0.00 $937,941.65 Earned to Date: $0.00 ($49,365.35) $0.00 $0.00 $49,365.35 59607-0700430-5740010-0O2695-001783 $1,577,404.50 59607--2060000--0O2695-CRETAN-- Total to Date: $1,511,048.97 $0.00 $0.00 $0.00 $1,511,048.97 Previous Estimate: $1,511,048.97 $75,552.45 $0.00 $0.00 $1,435,496.52 Earned to Date: $0.00 ($75,552.45) $0.00 $0.00 $75,552.45 34014-0200431-5740010-0O2695-0O2483-9999-14010199 $2,031,688.00 CO#1:$301,946.00 34014--2060000--0O2695-CRETAN-- CO#3:$16,200 Total to Date: $1,909,597.56 $0.00 $0.00 $0.00 $1,909,597.56 Previous Estimate: $1,909,597.56 $95,479.88 $0.00 $0.00 $1,814,117.68 Earned to Date: $0.00 ($95,479.88) $0.00 $0.00 $95,479.88 Thursday,March 5,2020 Page 1 of 2 Contract: CS50172 P.O.# 18-102959;FW020-1208 Payment Date: 2/24/2020 TO:Wiiliam I Schultz,Inc dba Circle C Constr INv.# CS50172-23 FINAL Estimate No. 23 DOE: P O BOX 40328 ProjManager Mary Hanna Fort Worth TX 76140 FOR: 2014 CIP Year 3 Contract No.7 Contract Amount: $5,970,008.50 Completed Ret Pen Adi Pay Total to Date: $5,615,302.58 $0.00 $0.00 $0.00 $5,615,302.58 Previous Estimate: $5,615,302.58 $0.00 $0.00 $0.00 $5,334,537.45 Earned to Date: $0.00 ($280,765.13) $0.00 $0.00 $280,765.13 Payments: 52002-0200431-5740010-0O2695-0O2883-9999 $1,190,682.00 CO#2:$79,045.50 52002--2060000--0O2695-CRETAN-- CO#3:$54,000.50 Total to Date: $1,160,574.05 $0.00 $0.00 $0.00 $1,160,574.05 Previous Estimate: $1,160,574.05 $58,028.70 $0.00 $0.00 $1,102,545.35 Earned to Date: $0.00 ($58,028.70) $0.00 $0.00 $58,028.70 30100-0200431-5740010-0O2695-0O2483-9999 $46,775.00 CO#3:$46,775 Total to Date: $46,775.00 $0.00 $0.00 $0.00 $46,775.00 Previous Estimate: $46,775.00 $2,338.75 $0.00 $0.00 $44,436.25 Earned to Date: $0.00 ($2,338.75) $0.00 $0.00 $2,338.75 Thursday,March 5,2020 Page 2 of 2 0 to a d m c rn i N 9 V VOl• O VOl Val Val 7 N O r O Vi V O a O M N r VO1 !O CD CD O O n W W ern = a v ., 7 O 10 10 M N W5 W5 � sF EA CC �'. fn to to to N Ca W V e e d q + avi . d - • � UU o 0 V d z € O t3 a •� A S e "-H• y H a ` YU e0 •u^� W U ai a C �y to d W m rn ES [~ aOa e p q W A " F o U :3i c m LU Nr od oa ccm V CA U N f0 yUy�� CD W d p w A € d r-a •• CDF o c L7 d aoi w � O N to 'z p Cyy4.d d m '" [ O U y v 'O'O e, a'di a� o pU •O.L-. 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BIM 360 Document Management Page 1 of 2 AUTODESK`BIM 360 fortworthgov>CO2695-2-2014 Bond Year 3 Contract-7- A IA •�� Document Management FOLDERS REVIEWS TRANSMITTALS ISSUES Reviews > Review detail OPEN #26 - Final Review Due date: Mar 14 FINAL-Construction Invoice Approval Workflow Start review Void entire review Export Report Name- Description Versi PROGRESS 2014 CIP Contract 7 Est 23 Final.xlsm Vl Initiator Initial Review n 2014 CIP Contract 7 Estimate 23 FinaL.pdf Vl TS Teri Skelly Mar 6,10:18 AM <t.skelly@circlecconstruction.com> Submitted to Reviewer 1 Reviewer 1 Initial Review 1 n EN emanuel nieto Mar 10,2:31 PM <emanuel.nieto@fortworthtexas.gov> Submitted to Reviewer 2 Reviewer 2 Initial Review 2 n MH Mary Hanna Mar 10,4:16 PM <mary.hanna@fortworthtexas.gov> Submitted to Reviewer 3 Reviewer3 Initial Review3 n LZ Lane Zarate Mar 10,5:03 PM <Lan e.za rate @fortworthtexas.gov> Submitted to Reviewer 4 Approved Reviewer 4 Initial Review 4 n LP Lauren Prieur Mar 11,1:18 PM <Lauren.prieur@fortworthtexas.gov> Submitted to Approver No comments Approver Final Review n Tpw Bsap Recon Team Send email notification https:Hdocs.b360.autodesk.com/projects/b8f9cefd-be 1 c-4e39-92b8-eae8daf852e2/reviews/... 4/27/2020 BIM 360 Document Management Page 2 of 2 https:Hdocs.b360.autodesk.com/projects/b8f9cefd-be 1 c-4e39-92b8-eae8daf852e2/reviews/... 4/27/2020 O � 2 n N N O O m m on a N J m n N N N t7 o a o O m u00i a n O N O N � N a 0 0 0 0 c a AD m iL a z z z z z U U U U U J N N N N N co-4 ? U U U U U N � cr M Q I O d :r O a1 7 O d v J Q � � d C C9 o a N n 0 0 0 0 0 o m m o a N m m 01 01 m m m n O m O m O m N O O v m m m m m a o Q in oo m 0 0 a a a a a 0 N Q M N U m m m m m rn rn rn rn rn v rn m N m O o 0 0 0 o r } m U u m W W m m m m m S y $ v c $ N �0 N N N N N IL Q J Q S. LL d FORTWORTH rev 03/05/07 TRANSPORTATION & PUBLIC WORKS FINAL STATEMENT OF CONTRACT TIME FINAL STATEMENT NO.:1 NAME OF PROJECT: 2014 CIP Year 3-Contract 7 PROJECT NO.: 2695 CONTRACTOR: Circle C DOE NO.: N/A PERIOD FROM:03/12/18 TO: 11/01/19 FINAL INSPECTION DATE: 19-Dec-19 WORK ORDER EFFECTIVE: CONTRACT TIME: WD QQ CD DAYS DAYS DAY OF REASON FOR DAYS DAY OF REASON FOR DAYS CHARGED CHARGED MONTH DURING CREDITED MONTH DURING CREDITED 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 OTHERS* DAYS TOTAL & HOLIDAYS &TOO COLD RELOCATIONS CHARGED DAYS THIS 600 PERIOD PREVIOUS PERIOD TOTALS 600 TO DATE *REMARKS: V Z--r/Z0 z CONTRACTOR DATE INSPECTOR DATE ENGINEERING DEPARTMENT (D The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TX 76012-6311 (817)392-7941 •Fax: (817)392-7845 FORTVVORT City of Fort Worth CITYSECRETARY�.� * _ Change Order Request Breakdown CONMCTNO.� Project Name 2014 CIP Year 3 Contract 7 City Sec# 50172 -� Client Project#(s)l c02695 Contractorl Circle C Construction Company PM Mary Hanna Inspectorl Christopher Bell Change Order Submittal# Date 5/15/2018 Dept. TPW Stormwater Water Sewer Contract Time Totals CD Original Contract Amount 1,713,542.00 1,057,636.00 $1,123,459,00 $1,577,404.50 $5,472,041.50 450 Extras to Date Credits to Date Pending Change Orders(in M&C Process) Contract Cost to Date $,1,7,13,542.00 $1057,636.00 $1,123,459.00 $1,577,404.50 $5,472,041.50 450 Amount of Proposed Change Order $301,946.00 $0.00- 0.00:. $0.00 $301,946:00 90 Revised Contract Amount 2,015,486,00 ,057,636.00 1,123, 59.00 $1,577, 04.50 $5,773,987,50 540 Original Funds Available for Change Orders $0:00 Remaining Funds Available for this CO $O.OD $0.00 $0.00 $0.00 Additional Funding(if necessary) $301,946.00' , $301,94600 CHANGE ORDERS fo DATE(INCLUDING THIS ONE)AS%OF ORIGINAL CONTRACT 5,52% MAX ALLOWABLE CONTRACT AMOUNT(ORIGINAL CONTRACT COST+25%) $6;840,051.88. This change order provides funding for a discrepancy between the quantities provided in the plans and bid documents to deliver the original scope. i I [4 I E i 'T v EOIFFICIAL SECRETARY1Tr City of Fort Worth Change Order Additions Project Name 2014 CIP Year 3 Contract 7 City Sec it 50172 Client Project 1t c02695 Contractor Circle C Construction Company PM Mary Hanna Inspector Ch stopher hell Change Order Submittal It Dale 5i15/2018 ADDITIONS ty Unit Unit Cost 10181 ITEM DESCRIPTION -DEPJ u Concrete nveway TPW $36,000.00 32 3,030 Conc St ewalk 0. DO SF 2• 32 . 101 "Conc ur and Gutter TPW 0 LF 99 .0000 Remove and Replace a ey utter TPW 0 S 5.0 Remove Sidewa k TPW 0 0 SF , 0 021,0 1 Remove oncreleDrve TPW- 3,0 . 0 SF D 02 1.1300 Remove one Curb&Gutter TPW .000 0 F 0 99. 00 Remove&Rep ace torm Drainage net Top TP EA D 5. 07 an ole dluslment, inor TPW . 0 0 EA .0 3 3217. 100 Curb ress Painting I P .000 00 E 0 3292.0100 Block o lacement 170.OD 0 0. 0 45—3305.0111 ater Varve ustment(vrl Concrete o tar P 0 0 0 E W5.0108 M scellaneous truclure Adjustment(WM) TPW 4 .00 0 50.0 f' ipyy $301,946.00 Stormwater $0.00 Water $0.00 Sewer $0.00 Sub olalAadluons 30,9 6. Change Order Additions Page 2 of 4 Foar WOHrrt City of Fort Worth Change Order Deletions Project Name 2014 CIP Year 3 Con act 7 City Sec# 50172 ClientProjoct# c02695 Contractor Circle C Construction Company PM Mary Hanna Inspector Christopher Bell Change Order Submittal8 CO Date 5/15/2018 DELETIONS ITEM DESCRIPTION DEV Ity Unit Unit Cost ola I i i E TPW $0.00 Stormwalor $0.00 Water $0.00 Sewer 0.00$ Sub Total De letions Change Order Deletions Page 3 of 4 M/SBE Breakdown for this Change Order M/SBE Sub Type of Service Amount for this CO Total $0.00 Previous Change Orders Co# DATE AMOUNT i I I i i i Total $0.00 FORT WORTH City of Fort Worth Change Order Request Breakdown ProjectNamel 2014 CIP Year 3 Contract 7 City Sec# 1 50172 Client Project#(s)l c02695 71 Contractorl Circle C Construction Company PM Mary Hanna Inspectorl Christopher Bell Change Order Submittal# Date 1 8/1/2018 Dept. TPW Stormwater Water Sewer Contract Time Totals CD Original Contract Amount $1,713,542.00 $1,057,636.00 $1,123,459.00 $1,577,404.50 Totals 450 Extras to Date $301,946.00 $301,946.00 90 Credits to Date Pending Change Orders(in M&C Process) Contract Cost to Date $2;015,988.00 $1;057636 00=> 1 123,459 00 , >%$1,577,AQ45�-- $5,773,987.50 540 Go to ADD&DEL Tabs to Enter CO Backup 0.00_„ 7 045 30,�==' 0.00, ,- . ; �$O,OAN- $79,045.50 30 Revised Contract Amount 21)�5986.00 " " . 1;1366$1,50,;< 1,123,459 00, ,.._ 157Z,404 50,"; $5,853,033.00 570 Original Funds Available for Change Orders $0.00 Remaining Funds Available for this CO Additional Funding(if necessary) 45.50 $79,045.50 CHANGE ORDERS to DATE(INCLUDING THIS ONE)AS%OF ORIGINAL CONTRACT „ 9 MAX ALLOWABLE CONTRACT AMOUNT(ORIGINAL CONTRACT COST+15%) g This change order provides funding to address the erosion/stability issues and the addition of headwalls to the culverts on Meadowbrook Drive. I I City of Fort Worth Change Order Additions Project Name 2014 CIP Year 3 Contract 7 City Sec# 50172 Client Project# c02695 Contractorl Circle C Construction Company PM Mary Hanna l Inspectorl Christopher Bell Change Order Submittal# Date 8I1I2016 ADDITIONS ty Unit Unit CostTotal n t - Remove Tied Concrete Block Erosion Mat Stormwater 2,194.00000000 SF 2.00 —O—n,tT-7r 3349. 000 Headwall,Box Culvert(TxDOT PW Parallel) Stormwater 4,500.0 00000 SF $6.05 n t - 3137.9999 Tied Concrete Block Erosion Mat Stormwater 945.00000000 SF $42.50 mt - Erosion Control Mat Stormwater 2,520.00000000 SF $2,06 m - 3305.0109 Trench Safety Stormwater 191.00000005 LF 5.00 Unit -18 lConstruction Staking Stormwater 1.00000000 LS $1,500.00 I i I E i I i I I E TPW $0.00 Stormwater $79,045.50 Water $0.00 ` Sewer $0.00 Sub Total Additions 79,045.50 Change Order Additions Page 2 of 4 FORT WoaTlt City of Fort Worth —"V__ Change Order Deletions Project Name 2014 CIP Year 3 Contract 7 City Sec# 50172 Client Project# c02695 _ Contractor Circle C Construction Company PM Mary Hanna Inspector Christopher Bell Change Order Submittal# Date 8/112018 DELETIONS ITEMD ty nit mt Cost Total I E: iI TPW $0.00 Stormwaler $0.00 Water $0.00 Sewer $0.00 Sub Total Deletions 0.00 Change Order Deletions Page 3 of 4 MISBE Breakdown for this Change Order ,Type of Seru�ce .._ -, w Amount for-this,CO.. Total0 00 Previous Change Orders C0# DATE . . AMO,N { k Totalb� C;Y W Change Urder Approval UUAppr-U2 rage 2 of J WORTHO., Cit Of Fort Worth CITY SECRETARYFORT y CONTRACT NO. 5017 a U Change Order Request Approval (Change Order Breakdown Available in Links) For Change Order Submittal No.: 2 Change Order No.: COAppr-02 Date Started: 2018-08-06 City Sec. No.: 50172 Date Due: 2018-09-25 Project Name: 2014 CIP Year 3 — Contract 7 02695 DOE Numbers: Project Numbers: Project This is a combined paving, water/sanitary sewer main, Description: stormwater and box culvert improvements project in Eastern Hills and Lakewood addition neighborhoods. Project/Contract Compliance Mary Hanna City Inspector: 'Christopher Bell Manager: Contractor: Circle C Construction Company COUNCIL ACTION (If Required): M&C Log Name: N/A M&C Number: M&C Date: COST AND DAYS SUMMARY: Requested Department: Cost($) Fund Account Center: Days: TPW/Stormwater $ 79,045.50 52002-0200431-5740010-c02695-c( 30 Total Cost: $ 79,045.50 Total Requested Days: 30 Approval Status: i https://projeetpoint.buzzsaw.com/ bz web/Forms/FormPrint.aspx?SiteId=51500&Processl... 8/21/2018 CFW Change Order Approval COAppr-02 Yage J of J Approved: Yes Comments: User: Teri Skelly Date: 2018-08-06 2:12 PM Ameo , Approved: Yes Comments: x User: Mary Hanna MM J. K� ity P R �k j Date: 2018-08-06 3:56 PM ,..• Approved: Yes 'Comments: ! ' User: Lane Zarate f Date: 2018-08-07 6:16 PM M&C: Approved: Yes 1295: ^J A Comments: User: Ricardo Matute Date: 2018-08-09 11:02 AM Approved: Yes Comments: User: Doug Wiersig Date: 2018-08-10 3:48 PM Approved: Yes Comments: User: Doug Black Date: 2018-08-17 6:38 PM Approved: Yes Comments: User: Susan Alanis Date: 2018-08-20 10:08 AM Action Required: Please review and approve https://projeetpoint.buzzsaw.con-Y bz web/Forms/FormPrint.aspx?Siteld=51500&Processl... 8/21/2018 Contract Compliance Manager: By signing, I acknowledge that I am the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. Mary Hanna, 'AARd, PMP Senior Proj anager FORT WORTH, City of Fort worth '11� Change Order Request Breakdown Project Namel 2014 CIP Year 3 Contract 7 City Sec# 1 50172 Client Project#(s)l c02695 Contractor Circle C Construction Company PM Mary Hanna Inspectorl Christopher Bell Change Order Submittal# 0 Date 811I2018 Dept. TPW Stormwater Water Sewer Contract Time Totals CD Original Contract Amount $1,713,542.00 $1,057,636.00 $1,123,459,00 $1,577,404.50 $5,472,041.50 450 Extras to Date $301,946.00 $301,946.00 90 Credits to Date Pending Change Orders(in M&C Process) Contract Cost to Date $2,015,488.00 $1,057.636.00 $1,123,459.00 $1,677,404.50 $5,773,987.50 540 Go to ADD&DEL Tabs to Enter CO Backup $0.00 $79,045.50 $0.00 $0.00 $79,045.50 30 Revised Contract Amount 2,015,488.00 1,136,681.50 1,123,459.00 1,577,404.50 $5,853,033.00 570 Original Funds Available for Change Orders $0.00 Remaining Funds Available for this CO $0.00 $0.00 $0.00 $0.00 Additional Funding(if necessary) $79,045.50 $79,045.50 CHANGE ORDERS to DATE(INCLUDING THIS ONE)AS%OF ORIGINAL CONTRACT 6.96% MAX ALLOWABLE CONTRACT AMOUNT(ORIGINAL CONTRACT COST+15%) $6,840,051.88 JUSTIFICATION(REASONS)FOR CHANGE ORDER This change order provides funding to address the erosion/stability issues and the addition of headwalls to the culverts on Meadowbrook Drive. City of Fort Worth Change Order Additions Project Name 2014 CIP Year 3 Contract 7 City Sec# 50172 ClientProjecl# c02695 conuactorl Circle C Construction Company PM Mary Hanna Inspector Christopher Bell Change Order Submittal# 0 Date 8/1/2018 ADDITIONS —ITEM DESCRIPTION DEPT y Unit Unit Cost Total m -l Remove Tied Concrete Block Erosion Mat Stormwater 2,194,00000000 SF 2.00 mt - 3349.1000 Headwall,Box Culvert(TXDOT PW Parallel) Stormwater 4,500.00000000 SF 6.00 _17nit - 3137.9999 Tied Concrete Block Erosion Mat Stormwater 945.00000000 SF $42.56 n t - Erosion Control Mat Stormwater 2,520.00000000 SF $2.05 Ifin-T -17 3305.0109 Trench Safety Stormwater 191.00000005 LF 5.00 mt -18 Construction Staking Stormwater 1.00000000 LS $1,500,00 I E { I TPW $0.00 Stormwater $79,045.50 Water $0.00 Sewer $0.00 Sub Total Additions 79,045.50 Change Order Additions Page 2 of 4 1FORTNWORTII City of Fort Worth lv�-- Change Order Deletions Project Name 2014 CIP Year 3 Contract 7 City Sec# 50172 Client Project# c02695 Contractor Circle C Construction Company PM1 Mary Hanna Inspectof Christopher Bell Change Order Submittal# Date 81112016 DELETION5 ITEM DESCRIPTION DEPT Qty Unit Unit Cost Total TPW $0.00 Stormwater $0.00 Water $0.00 Sewer $0.00 Sub Total Deletions 0.00 Change Order Deletions Page 3 of 4 MISBE Breakdown for this Change Order M/SBE Sub Type of Service Amount for this CO Total $000 Previous Change Orders CO# DATE AMOUNT Total $0.00, i i i E i I FORTWORTIH. City of Fort Worth Change Order Request Project Namal 2014 CIP Year 3 Contract 7 City Sec# 1 50172 Client Project#(s)l c02695 7-1 Project This is a combined paving,water/sanitary sewer main,stormwater and box culvert improvements project in Eastern Hills Description and Lakewood addition neighborhoods. Contractor Circle C Construction Company Change Order# � Date1 4/15/2019 City Project Mgr.I Mary Hanna City Inspector Oscar Aguillon Dept. TPW Stormwater Water&Sewer Totals Contract Time D Original Contract Amount $1,713,5 2. 0 1,057, 36,00 2,700,863.50 $5,472,04 .50 450 Extras to Date $301,946.00 $79,045.50 $380,991.50 90 Credits to Date Pending Change Orders(in M&C Process) Contract Cost to Date 2;0 54 8t44 . .w, 1 ,66.1 ,7 0 6 50 $5,853,033.00 540 Amount of Proposed Chan a Order 62 9t6 QO, ,'Q. _Ott.;` 116,975.5 30 Revised Contract Amount JOE Z,07- 63 v .,_ f70 , $5,970,008.60 570 Original Funds Available for Change Orders $0.00 Remaining Funds Available for this CO Additional Funding(if necessary) 11 _$82277 00kir .$54 Q(]l7 50._ $116,975.6 CHANGE ORDERS fo DATE(INCLUDING THIS ONE)AS%OF ORIGINAL CONTRACT MAX ALLOWABLE CONTRACT AMOUNT(ORIGINAL CONTRACT COST+25%) 6�840,05188 " This Change order No.3 provides funding for additional grading work around Meadowbrook Culverts,installing retaining walls around the new inlets in Monterrey Drive and for the asphalt pavement rehabilitation on Jacqueline Court. i E i It is understood and agreed that the acceptance of this Change Order by the contractor constitutes an accord and satisfaction and represents payment in full(both time and money)for all costs arising out of,or incidental to,the above Change Order. The Project/Program Manager signing below acknowledges that he/she is the person responsible for the monitoring and administration of this contract,including ensuring all performance and reporting requirements. Circle C Construction Company M&C Number C_29T28 M&C Date Approved Fc�er<Nata"te City of Fort Worth Change Order Additions Project Name 1 2014 CIP Year 3 Contract 7 City Sec# 50172 Client Project# c02695 Project Description This is a combined paving,water/sanitary sewer main,stonnwater and box culvert Improvements project in Eastern Hills and Lakewood addition neighborhoods. Contractor Circle C Construction CompanX Change Order# u Date 4/1512019 City Project Mgr. F71Ma Hanna City Inspector OscarAguillon ADDITIONS y Unit units otal m m ar ing n P a ype m - Pavement Pulverization m men sy ---Ta— Unit 448 Paving Remobilizalion m Re laming Wall around inlets in Monterrey Stormwater Unitb,19 Slorinmwaterkemobilizalion Slormwater —1Jm Modify Center Portion o ex Mat blormwater 12101", —775-27 Groutedprep biormwater 173-00 SF Unit emove&Replace Pipe Rail 1'ence Stormwaler nHydromulch wt Erosion Control Matormwa er 1,095.00 SF nit Watering the Hydromulcli for One Month Slorwater mt Grading ormwa er III I i t E t t t 1,250,00 { tTPW $62,975.06 Stormwater $54,000.50 Water&Sewer Sub Iota] icons Change Order Additions Page 2 of 4 Fc r Wrr rre City of Fort Worth Change Order Deletions Project Name 2014 CIP Year 3 Contract 7 City Sec# 50172 Client Project# c02695 Project Description This is a combined paving,water/sanitary sewer main,stormwater and box culvert improvements project In Eastern Hills and Lakewood addition neighborhoods. 1 Contractor Circle C Construction CompanyChange Order# 3 J Date 15 19 City Project Mgr. f Mary Hanna City Inspector F OscarAguillon DELETIONS y unit units oa ormwater 0. Water&Sewer 0.00 1-8-576-151 Delelions Change Order Deletions Page 3 of 4 MIWBE Breakdown for this Change Order MWBE Sub Type of Service a Amount for this CQ See attached waiver Total Previous Change Orders co# DATE AMOUNT: v . None TotalO.OQ i I I I E 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 TERESA S SKELLY, PRESIDENT of CIRCLE C CONSTRUCTION, known to me to be a credible person, who being by me duly sworn, upon his oath deposed and said; That all person, 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 damage; On Contract described as; I 2014 CIP Year 3, Contract 7 City Project Number CO2695 i ,o Y?o MICHELE S LANKFOkb�� * �#; Notary Public BY � �o A STATE OF TEXAS qrF aF����? Notary ID#117594 _6 AAy Comm.Fes.October 7,2m j Subscribed and sworn before me on this a2 I S Day of/- , 20't , LQ_*_t Notary Public in Tarrant Cou , TX CONSENT OF SURETY OWNER TO FINAL PAYMENT ARCHITECT ❑ AIA Document G707 CONTRACTOR ❑ SURETY ❑ OTHER ❑ Bond No.TXC608547 TO OWNER: ARCHITECT'S PROJECT NO.: City of Fort Worth City Project No. CO2695 1000 Throckmorton Street Fort Worth,TX CONTRACT FOR: Utilities CONTRACT DATED: December 12,2017 PROJECT: (name, address) 2014 CIP Year 3,Contract 7 in the City of Fort Worth,Texas In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above,the (Insert name and address qf Suret}) Merchants Bonding Company(Mutual) 6700 Westown Parkway West Des Moines,IA 50266 ,SURETY on bond of (Insert name and address of Contractor) William J.Schultz,Inc.,dba Circle C Construction Company P.O.Box 40328 CONTRACTOR, Fort Worth,TX 76140 hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve the Surety of any of its obligations to (Insert name and address of Owner) City of Fort Worth 1000 Throckmorton Street Fort Worth,TX 76102 ,OWNER, as set forth in the said Surety's bond. IN WITNESS WHEREOF,the Surety has hereunto set its hand this date: October 30,2019 (Insert in writing the month followed by the numeric date aid year.) Merchants Bonding Company(Mutual) (Surety I (Signature of au or•ized representatire) A o t itness as to Surety: Sheryl A.Mutts,Attorney-in-Fact (Seal (Printed name and title) John A.Miller 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 MERCHANT BONDING COMPANY,. POWER OF ATTORNEY Know All Persons By These Presents,that MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC., both being corporations of the State of Iowa(herein collectively called the"Companies")do hereby make,constitute and appoint,individually, John A Miller;John R Stockton;Sheryl A Klutts their true and lawful Attorney(s)-in-Fact, to sign its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. This Power-of-Attorney is granted and is signed and sealed by facsimile under and by authority of the following By-Laws adopted by the Board of Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors of Merchants National Bonding,Inc.,on October 16,2015. "The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Attorneys-in-Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings,recognizances,contracts of indemnity and other writings obligatory in the nature thereof." 'The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company,and such signature and seal when so used shall have the same force and effect as though manually fixed." In connection with obligations in favor of the Florida Department of Transportation only,it is agreed that the power and aut hority hereby given to the Attorney-in-Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond. In connection with obligations in favor of the Kentucky Department of Highways only,it is agreed that the power and authority hereby given to the Attorney-in-Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner- Department of Highways of the Commonwealth of Kentucky at least thirty(30)days prior to the modification or revocation. In Witness Whereof,the Companies have caused this instrument to be signed and sealed this 6th day of April 2017 013 --gkpo#• gyp•; e* RP44 '�•'y•, MERCHANTS BONDING COMPANY(MUTUAL) `14y:V� qJ` y �:VO R'Oj;.y�; MERCHANTS NATIONAL BONDING,INC. ;2:Z _o_ v;�; :ty:= -o- 2003 ;��; y,• 1933 :c: By :•d�• ,:���.� ;mob• • •do:' 1 ••.•�f/''"'�•��""•�•.• •.ply "�' � ,• President STATE OF IOWA COUNTY OF DALLAS ss. On this this 6th day of April 2017 before me appeared Larry Taylor, to me personally known,who being by me duly sworn did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the seals affixed to the foregoing instrument are the Corporate Seals of the Companies;and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. EAALICIA K.GRAM Commission Number 767430 My Commission Expires April 1,2020 Notary Public (Expiration of notary's commission does not invalidate this instrument) I,William Warner,Jr.,Secretary of MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC.,do hereby certify that the above and foregoing is a true and correct copy of the POWER-OF-ATTORNEY executed by said Companies,which is still in full force and effect and has not been amended or revoked. In Witness Whereof,1 have hereunto set my hand and affixed the seal of the Companies on this 30th day of October 12019 . t0N N� C ,. . A� p\. ©,h• • ;3 1933 ;c' Secretary 2003 v POA 0018 (3/17) """"'�••� ••