HomeMy WebLinkAboutContract 43477-FP1 (2))epart ent of TP &W Const.
�.�. � ��. Services
)OE# ► „L- , — - Date
'roject Manager3/-tr
Zlsk Management Lf?ge IT WORTH
•o CITY SECRETAM,
,.O.E. Broth P, �* . ^ �� Y -IR
CFA Westerman/Scanne
Che Proceedingpeople 1
p ple have been C._ to •d concerning the request for final
'aliment & have released this project for such payment.
;learance Conducted By Shameka Kennedy
Ca ffetil g 7 7
Regarding contract 116939 for MCPHERSON BLVD FROM OLD GRANDBURY RD as required by the
TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by City Council on N/A through
M&C N/A 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:
Amount of Approved Change Orders:
Revised Contract Amount:
Total Cost Work Completed:
Less Deductions:
Liquidated Damages:
Pavement Deficiencies:
Total Deduction Amount:
Total Cost Work Completed:
Less Previous Payments:
Final Payment Due
'ATION AND PUBLIC WORKS
)F PROJECT COMPLETION
Recommended for Acceptance
Asst. Director, TPW - Infrastructure Design and Construction
Accepted
chi—)/1
$1,846,131.71
$107,661.09 Ns 1,2,3
$1,953,792.80
$1,833,683.35
$0.00
$1,833,683.35
$1,560,170.73
$273,512.62
Date
Director, TRANSPORTATION AND PUBLIC WORKS DEPARTM Ni
hih(
>31,14444.04
City Manager
Comments: FUND ACCT: C205-2067602015
D.O.E. Ns: 6939
Days @ $210.00/ Day
/ PS"
Date
3/23A5'
Date
ORICPAL RECORD
CITY SECRETARY4
FORT WORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name MCPHERSON BLVD
Contract Limits FROM OLD CRANBURY RD TO FUTURE CHISHOLM TRL PKWY
Project Type PAVING
City Project Numbers 02015
DOE Number 6939
Estimate Number 13 Payment Number 13 For Period Ending 12/15/2014
CD
City Secretary Contract Number 116939 Contract Time 22ED
Contract Date Days Charged to Date 709
Contract is 94.000 Complete
Project Manager Ehia
Contractor MARIO SINACOLA & SONS EXCAVATING
10905 RESEARCH RD
FRISCO , TX 75033
Inspectors LAYER / NIETO
OFFIC;la 12ECORD
010 v SECRETARY
re, WORTH, TX
Monday, March 09, 2015 Page 1 of 5
'"7,
City Project Numbers 02015
Contract Name MCPHERSON BLVD
Contract Limits PROM OLD GRANBURY RD TO FUTURE CHISHOLM TRL PKWY
Project Type PAVING
Project Funding
PAVING
Item
No.
Description of Items
1 REMOVE FENCE
2 REMOVE ASPHALT PVMT
3 2" CONDT PVC SCH 40
4 4" CONDT PVC SCH 40
5 .6"-12" TREE REMOVAL
6 12"-18" TREE REMOVAL
7 18" 24" TREE REMOVAL
8 UNCLASSIFIED EXCAVATION
9 EMBANKMENT
10 SWPPP > 1 ACRE
11 SLAB RIPRAP
12 LIME
13 8" LIME TREATMENT
14 3" ASPHALT PVMT TYPE D CO#3
15 6" ASPHALT BASE TYPE B CO#3
16 10" CONC PVMT
17 4" CONC SIDEWALK
18 4" SLD PVMT MARKING PAINT
19 4" SLD PVMT MARKING PAINT
20 4" BRK PAVEMENT MARKING PAINT
22 18" SLD PVMT MARKING PAINT
23 REFL RAISED MARKER TY II -A A
24 TOPSOIL
25 SEEDING HYDROMULCH
26 21" RCP CLASS III
27 24" RCP CLASS III
28 30" RCP CLASS III
29 36" RCP CLASS III
30 42" RCP CLASS III
31 5X4 BOX CULVERT
32 5X5 BOX CULVERT
Monday, March 09, 2015
Estimated Unit
Quanity
2200 LF
611 SY
5342 LF
60 LF
IO EA
12 EA
1 EA
23355 CY
20072 CY
1 LS
142 SY
374 TN
20768 SY
2488 SY
2488 SY
16840 SY
26656 SF
732 LF
8508 LF
1706 LF
20 LF
230 EA
2129 CY
34584 SY
74 LF
1202 LF
431 LF
459 LF
55 LF
85 LF
87 LF
Unit Cost
DOE Number 6939
Estimate Number 13
Payment Number 13
For Period Ending 12/15/2014
Estimated
Total
$1.00 $2,200.00
$5.00 $3,055.00
$4.73 $25,267.66
$10.00 $600.00
$175.00 $1,750.00
$425.00 $5,100.00
$650.00 $650.00
$4.00 $93,420.00
$1.00 $20,072.00
$21,000.00 $21,000.00
$60.00 $8,520.00
$140.00 $52,360.00
$2.75 $57,112.00
$15.75 $39,186.00
$27.25 $67,798.00
$40.00 673,600.00
$3.45 $91,963.20
$0.50 $366.00
$0.50 $4,254.00
$0.50 $853.00
$4.75 $95.00
$4.20 $966.00
$7.00 $14,903.00
$0.50 $17,292.00
$69.00 $5,106.00
$71.00 $85,342.00
$87.00 $37,497.00
$95.00 $43,605.00
$155.00 $8,525.00
$264.00 $22,440.00
$275.00 $23,925.00
Completed Completed
Quanity Total
2200 $2,200.00
611 $3,055.00
5342 $25,267.66
60 $600.00
10 $1,750.00
12 $5,100.00
1 $650.00
23355 $93,420.00
20072 $20,072.00
1 $21,000.00
142 $8,520.00
374 $52,360.00
20768 $57,112.00
2488 $39,186.00
2488 $67,798.00
16840 $673,600.00
26656 $91,963.20
732 $366.00
8508 $4,254.00
1706 $853.00
20 $95.00
230 $966.00
2129 $14,903.00
34584 $17,292.00
74 $5,106.00
1202 $85,342.00
431 $37,497.00
459 $43,605.00
55 $8,525.00
85 $22,440.00
87 $23,925.00
P4ge 2 of 5
j OFFICIAL RECORD
CITY SECRETARY
City Project Numbers 02015
Contract Name
Contract Limits
Project Type
Project Funding
MCPHERSON BLVD
FROM OLD GRANBURY RD TO FUTURE CHISHOLM TRL PKWY
PAVING
33 4' STORM JUNCTION BOX
34 5' STORM JUNCTION BOX
35 HEADWALL BOX CULVERT CO#3
36 30" FLARED HEADWALL, 1 PIPE
37 42" FLARED HEADWALL, 1 PIPE
38 36" SET, 1 PIPE
39 24" SET, 2 PIPES
40 10' RECESSED INLET
41 15' RECESSED INLET
42 4' DROP INLET
43 GROUND BOX, SMALL W/L1D APRON
45 RDWY ILLUM FOUNDATION TY 3,5,6, AND 8
46 CONTACT ENCLOSURE POLE MOUNT
48 2-2-2-4 QUADPLEX ALUM ELEC CONDUCTOR
CO# 1
49 FURNISH/INSTALL ALUM SIGN GROUND
MOUNT CITY STD
50 TRAFFIC CONTROL
51 PEDESTRIAN RAIL
52 RELOCATE OVERHEAD ELECTRIC LINE
53 END ROAD BARRICADE
44A RDWY ILLUM ASSMBLY TY 18, 18A, 19, AND
D-40 W/DARK BRONZE POWDER CO#1
54 MBGF-11 CO#2
55 SINGLE GUARDRAIL TERMINAL CO#2
56 TERMINAL ANCHOR CO#2
57 24" SLD PAVEMENT MARKING PAINT CO#3
58 CURLEX MATTING MATERIAL CO#3
Monday, March 09, 2015
4 EA $4,300.00
1 EA $5,000.00
38.23 CY $578.00
2 EA $3,000.00
1 EA $4,000.00
1 EA $4,750.00
1 EA $4,250.00
7 EA $2,600.00
1 EA $3,400.00
4 EA $2,400.00
27 EA $651.00
27 EA $900.00
1 EA $1,680.00
5342 LF $1.85
DOE Number 6939
Estimate Number
Payment Number
For Period Ending
$17,200.00
$5,000.00
$22,096.94
$6,000.00
$4,000.00
$4,750.00
$4,250.00
$18,200.00
$3,400.00
$9,600.00
$17,577.00
$24,300.00
$1,680.00
$9,882.70
4 EA $900.00 $3,600.00
6 MO $500.00
26 LF $158.00
1 LS 3220,000.00
2 EA $630.00
27 EA $4,851.00
140 LF $33.00
1 EA $3,400.00
1 EA $900.00
311 LF $5.30
2200 SY $1.60
Sub -Total of Previous Unit
$3,000.00
$4,108.00
3220,000.00
$1,260.00
3130,977.00
$4,620.00
$3,400.00
$900.00
$1,648.30
$3,520.00
$1,953,792.80
13
13
12/15/2014
4 $ 17,200.00
1 $5,000.00
38.23 $22,096.94
2 $6,000.00
1 $4,000.00
1 $4,750.00
1 $4,250.00
7 $18,200.00
1 $3,400.00
4 $9,600.00
27 $17,577.00
27 $24,300.00
1 $1,680.00
5342 $9,882.70
4 $3,600.00
6 $3,000.00
26 $4,108.00
0.454048 $99,890.55
2 $1,260.00
27 $130,977.00
140 $4,620.00
1 $3,400.00
1 $900.00
311 $1,648.30
2200 $3,520.00
$1,833,683.35
OFFICIAL RECORD
CITY SECRETARY
WOftT Tx
Page 3 of 5
City Project Numbers 02015 DOE Number 6939
Contract Name MCPHERSON BLVD Estimate Number 13
Contract Limits FROM OLD GRANBURY RD TO FUTURE CHISHOLM TRL PKWY Payment Number 13
Project Type PAVING For Period Ending 12/15/2014
Project Funding
Contract b
1
c,
Inspection Su
2
Project Man
Contract Information Summary
Original Contract Amount
Change Orders
Change Order Number 1
Change Order Number 2
Change Order Number 3
$1,846,131.71
$80,675.00
$8,920.00
$18,066.09
Total Contract Price $1,953,792.80
3r)oejr
Date
Date /1
Total Cost of Work Completed
Less % Retained
Net Earned
Earned This Period $273,512.62
Retainage This Period
Date
,Datentire
Ass t:-9itector/TPW - Infrastructure Design and Construction
Li U Date - at*
Director / Cijntracting Department
Monday, March 09, 2015
$0.00
$1,833,683.35
$0.00
$1,833,683.35
Less Liquidated Damages
Days @ / Day $0.00
LessPavement Deficiency $0.00
Less Penalty $0.00
Less Previous Payment $1,560,170.73
Plus Material on Hand Less 15% $0.00
Balance Due This Payment $273,512.62
111-a-ge9ut'5 OFFICIAL RECORD
CITY SECRETARY
Ft WORTH, TX
City Project Numbers 02015
Contract Name
Contract Limits
Project Type
Project Funding
MCPHERSON BLVD
FROM OLD GRANBURY RD TO FUTURE CHISHOLM TRL PKWY
PAVING
Project Manager Ehia
Inspectors
Contractor
LAYER / NIETO
MARIO SINACOLA & SONS EXCAVATING
10905 RESEARCH RD
FRISCO , TX 75033
Line Fund Account Center
Monday, March 09, 2015
DOE Number 6939
Estimate Number
Payment Number
For Period Ending
City Secretary Contract Number
Contract Date
Contract Time
Days Charged to Date
Contract is .000000
CITY OF FORT WORTH
SUMMARY OF CHARGES
Amount
Funded
Gross
Retainage
Total Cost of Work Completed
Less % Retained
Net Earned
Earned This Period $273,512,62
Retainage This Period $0.00
Less Liquidated Damages
0 Days @ $0.00 / Day
LessPavement Deficiency
Less Penalty
Less Previous Payment
Plus Material on Hand Less 15%
Balance Due This Payment
116939
13
13
12/15/2014
220 CD
709 CD
Complete
Net
$1,833,683.35
$0.00
$1,833,683.35
$0.00
$0.00
$0.00
$1,560,170.73
$0.00
$273,512.62
Page 5 of 5
OFFICIt* RECORD
CITY SECRET, P
•
FORT WORTH
TRANSPORTATION & PUBLIC WORKS
FINAL STATEMENT OF CONTRACT TIME
rev 03/05/07
FINAL STATEMENT NO.:13
NAME OF PROJECT: Mcpherson Boulevard (From Old Granbury Road to Future Chisholm Trail Parkway;
PROJECT NO.: 02015 CONTRACTOR: Mario Sinacola and Sons Exc
DOE NO.: 6939
PERIOD FROM: 04/01 / 14 TO: 01 / 15/15 FINAL INSPECTION DATE: 29-Dec-14
WORK ORDER EFFECTIVE:2/4/2013 CONTRACT TIME: 220 0 Wa CD
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
DAY OF
MONTH
THIS
PERIOD
PREVIOUS
PERIOD
TOTALS
TO DATE
REMARKS:
DAYS
CHARGED
DURING
REASON FOR DAYS DAY OF
CREDITED MONTH
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
SAT, SUN, RAIN, TOO WET, UTILITIES
& HOLIDAYS & TOO COLD RELOCATIONS
4c2..H
CONTRALTO
i i
DATE
ENGINEERIN DEPARTMENT OFFICIALRECORD
DAYS
CHARGED
DURING
OTHERS *
REASON FOR DAYS
CREDITED
DAYS
CHARGED
288
1421
1709
TOTAL
DAYS
288
j421
1709
EC
R
The City of Fort Worth • 1000 Throckmorton Street • Fort Worth,
(817) 392 - 7941 • Fax: (817) 392 - 7845
DATE
T17G012-63I1art SECRETARY
fft WORTN, TX
FORT WORTH
TRANSPORTATION AND PUBLIC WORKS
PERFORMANCE EVALUATION OF CONTRACTOR
1) CONTRACTOR & PROJECT DATA
Name of Contractor
Mario Sinacola and Sons Excavating, Inc.
DOE Inspector
Emanuel Nieto
DOE Inspector
Water Waste Water Storm Drainag
Initial Contract Amount
$1,846,131.71
Final Contract Amount
$1,833,683.35
II) PERFORMANCE EVALUATION
10 - Inadequate 1 - Deficient 2 - Standard
ELEMENT
1 Submission of Documents
2 Public Notifications
3 Plans on Site
4 Field Supervision
5 Work Performed
6 Finished Product
7 Job Site Safety
8 Traffic Control Maintenance
9 Daily Clean Up
10 Citizen's Complaint Resolution
11 Property Restoration
12 After Hours Response
13 Project Completion
REV: 02/20/07
Project Name
Mcpherson Boulevard (From Old Granbuty Road to Future Ch
DOE Number
6939
Project Alanager
Pavement Fred Ehia
Project Difficulty
0 Simple 0 Routine 0 Complex
Date
3/9/2015
3 - Good 4 - Excellent
WEIGHT (x )
2
5
5
15
15
15
15
15
5
5
5
5
5
APPLICABLE (Y / N)
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
RATING (0 - 4)
3
4
4
4
4
3
4
4
4
4
3
4
3
MAX SCORE
8
20
20
60
60
60
60
60
20
20
20
20
20
TOTAL ELEMENT SCORE (A)
BONUS POINTS (25 Maximum) (B)
TOTAL SCORE (TS) 421
III) CONTRACTOR'S RATING
Maximum Score (MS) = 448 or sum of applicable element score maximums which = 448
Rating ( [TS / MSJ Y 100%) 421 / 448 = 94%
Performance Category Excellent
<20% = Inadequate 20% to <40% = Deficient 40% to <60% = Standard 60% to <80% = Good >_80% = Excellent
Inspector's Comments (INCLUDING EXPLANATION OF BONUS POINTS AWARDED)
Signature DOE Inspector
Signature DOE Inspector's Supervisor
CONTRACTOR'S COMMENTS
Signature Contractor
TRANSPORTATION AND PUBLIC WORKS
The City of Fort Worth • 1000 Throckmorton Street • Fort Worth, 'IX 76012-6311
(817) 392 - 7941 * Fax: (817) 392 - 7845
SCORE
6
20
20
60
60
45
60
60
20
20
15
20
15
421
UFFICII4L RECORD
TT SECRETARY
Fre WORTH, TX
FORT WORTH
TRANSPORTATION AND PUBLIC WORKS
CONTRACTOR'S EVALUATION OF CITY
I) PROJECT INFORMATION
Name of Contractor
Mario Sinacola and Sons Excavating, Inc.
DOE Inspector
Emanuel Nieto _
DOE Number Project Difficulty
6939 0 Simple O Routine 0 Complex
Initial Contract Amount
$1,846,131.71
11) PERFORMANCE EVALUATION
0 - Inadequate
ELEMENT
REV: 02/22/07
Date: 3/9/2015
Project Name
Mcpherson Boulevard (From Old Granbuiy Road to Future Chi
Project Manager
Fred Ehia
Tl pe ofConitract
n Water ❑ Waste Water U Storm Drainag= Pavement
Final Contract Amount
$1,833,683.35
1 - Deficient 2 - Standard 3 - Good 4 - Excellent
INSPECTION EVALUATION
1 Availability of Inspector
2 Knowledge of Inspector
3 Accuracy of Measured Quantities
4 Display Of Professionalism
5 Citizen Complaint Resolution
6 Performance - Setting urp Valve Crews, Labs
ADMINISTRATION
1 Change Order Processing Time
2 Timliness of Contractor Payments
3 Bid Opening to Pre -Con Meeting Timeframe
III) COMMENTS & SIGNATURES
COMMENTS
Signature Contractor
Signature DOE Inspector
Signature DOE Inspector's Supervisor
INSPECTOR'S COMMENTS
RATING
(0-4)
-ar
ELEMENT
PLANS & SPECIFICATIONS
Accuracy of Plans to Existing Conditions
2 Clarity & Sufficiency of Details
3 Applicability of Specifications
4 Accuracy of Plan Quantities
PROJECT MANAGER EVALUATION
1 Knowledge And/Or Problem Resolution
2 Availability of Project Manager
3 Communication
4 Resolution of Utility Conflicts
RATING
(0 - 4)
4-
-gt
TRANSPORTATION
AND PUBLIC WORKS
of Fort Worth • 1000 Throckmorton Street • Fort Worth, TX 76012-631
(817) 392 - 7941 • Fax: (817) 392 - 7845
OFFICIAL RECORD
CITY SECRETARY
(��',Io 1'i10RTH, TX
EMERSON - PREW
30600 TELEGRAPH ROAD SUITE 3110 BIRMINGHAM, MICHIGAN 48025 PHONE 248-642-5900 FAX 248-642-2310
.=eLiebt 'tan cez
January 14, 2015
City of Fort Worth and
SLF IV -Legacy Capital LP
1000 Throckmorton
Fort Worth, TX 76102
RE: Mario Sinacola & Sons Excavating, Inc.
Bond No. 105849521
McPherson Boulevard from Old Grandbury Rd
to future Chisholm Trail Parkway
Fort Worth, TX
Gentlemen:
As Surety on the Performance & Payment Bond #105849521 in the penal sum of
$1,846,131.71, guaranteeing performance of the above described contract, we hereby
consent to the release of final payment to the contractor.
TRAVELERS CASUALTY & SURETY COMPANY OF AMERICA
By (- (tin
4nQ4
EDWARD V. BRODZIK, Attorney -in -Fact
cc: Mario Sinacola & Sons Excavating, Inc.
cc: Travelers Casualty & Surety Company of America
EVB/km
Michigan Association
Ass
4
of Insurance Agents
OFFICUAL G3ECORD
CITY SECRETARY
!ail: WORTh, TX
TRAVELERS)
Attorney -In Fact No.
WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER
•
POWER OF ATTORNEY
Farmington Casualty Company
Fidelity and Guaranty Insurance Company
Fidelity and Guaranty Insurance Underwriters, Inc.
St. Paul Fire and Marine Insurance Company
St. Paul Guardian Insurance Company
226985
St. Paul Mercury Insurance Company
Travelers Casualty and Surety Company
Travelers Casualty and Surety Company of America
United States Fidelity and Guaranty Company
Certificate No. 006066504
KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance
Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States
Fidelity and Guaranty Company are corporations duly organized under the laws of the State of Connecticut, that Fidelity and Guaranty Insurance Company is a
corporation duly organized under the laws of the State of Iowa, and that Fidelity and Guaranty Insurance Underwriters, Inc., is a corporation duly organized under the
laws of the State of Wisconsin (herein collectively called the "Companies"), and that the Companies do hereby make, constitute and appoint
Arthur W. Emerson, Edward V. Brodzik, Kathleen M. McCann, and Todd A. Emerson
of the City of Birmingham Farms , State of Michigan , their true and lawful Attorney(s)-in-Fact,
each in their separate capacity if more than one is named above, to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and
other writings obligatory 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.
IN WITNESS o H ui EREOF, the Compp. have caused this instrument to be signed and their corporate seals to be hereto affixed, this
day of v
State of Connecticut
City of Hartford ss.
Farmington Casualty Company
Fidelity and Guaranty Insurance Company
Fidelity and Guaranty Insurance Underwriters, Inc.
St. Paul Fire and Marine Insurance Company
St. Paul Guardian Insurance Company
30th October 2014
On this the day of
By:
30th
St. Paul Mercury Insurance Company
Travelers Casualty and Surety Company
Travelers Casualty and Surety Company of America
United States Fidelity and Guaranty Company
Robert L. Raney, enior Vice President
, before me personally appeared Robert L. Raney, who acknowledged himself to
be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul
Fire and Marine Lnsurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers
Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, and that he, as such, being authorized so to do, executed the foregoing
instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer.
In Witness Whereof, I hereunto set my hand and official seal.
My Commission expires the 30th day of June, 2016.
58440-8-12 Printed in U.S.A.
A.
AA . iSeeta
Marie C Tetreault, otary Pu6Tic
OFFICIALL RECORD
CITY SEC 118Rf
n� k#€aTh, TX
WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER
- 'Mr - •.:
5949 Sherry Lane, Suite 1750 214.368.9191 tel www.stratfordland.com
[)atlas, Texas 75225 214.368.9192 fax
STRATFORDLAND
5949 Sherry Lane
Suite 1750
Dallas, Texas 75225
March 2, 2015
Mr. Michael Sinacola
Marto Sinacola & Sons Excavation, Inc.
10950 Research Road
Frisco, Texas 75033
Reference: McPherson Boulevard -- DOE #6939
City of Fort Worth, State of Texas
Dear Mr. Sinacola:
SLF IV �- Chisholm Trail, L.P. (formerly known as SLF IV / Legacy Capital, L.P.) hereby
notifies you it will not assess any liquidated damages or penalties related to the timing of
completion of this project, This letter is not intended to waive any other rights of the owner or
obligations of the contractor under this construction contract.
If you have any questions, please feel free to contact our office.
Sincerely,
SLF IV — Chisholm Trail. L.P.
Ocie Vest
Sr, Vice President - Entitlements
OFFICIAL RECORD'
CITY SECRETARY
Ft WORTH, TX
AFFIDAVIT
STATE OF
COUNTY OF
Before me, the undersigned authority, a notary public in the state
and county aforesaid, on this day personally appeared Name, Title Of
Company, 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;
Contract Description
BY
ct
Name or Title
Subscribed and sworn before me on this date Day of Month, Year.
fC yo/5
0 Lic)2,--4---Y1,-
NotaPublic
County, State
C�Giti az
77‘
LESLEY J. PRESTON
Notary Public, State of Texas
My Commission Expires
June 131 2017
J
FFICIAL RECORD
CITY' SkalARY
t: :ID WOiTht TX