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Home My WebLink AboutContract 46690-FP1 (2)1 f Depart DOE# /, S /(� Date/ TPW Const. Services Project Manager Risk Management S. Canadv D.O.E. Brotherton CFA Westerman/Scanned ❑ CITY SECRETARV / �G IT WORTH. "miRAcna ra— The Proceeding people have been Contacted concerning the request 'ATION AND PUBLIC WORKS for final payment & have released this project for such payment. Clearance Conducted By Etta Bacy ffq&ole-ft C�QL13S D.O.E. Ns: 7376 Li.--5#"1144 L Regarding contract 117376 for WATER/SANITARY SEWER & STRFFT T,TOFTTING HSC INDUSTRTAT. as required by the WATER DEPARTMENT as approved by City Council on N/A through IVI&C N/A the director of the WATER DEPARTMENT upon the recommendation of the Assistant Director of the Transportation & Public Works Department has accepted the c j c i , r-� 1 Nov 2 3 2015 lilt Original Contract Prices: $133,317.00 Amount f A Change ►F PROJECT COMPLETION moue o Approved Order . Revised Contract Amount: . _._y •._.. $133,317.00 Ns 1 Total Cost Work Completed: $133,317.00 Less Deductions: Liquidated Damages: Pavement Deficiencies: Total Deduction Amount: Total Cost Work Completed: Less Previous Payments: Final Payment Due Recommended for Acceptance Asst. Director, TPW - Infrastructure Design and Construction Accepted Asst. Director, WATER DEPARTMENT Asst. City Manager Comments: FUND ACCT: P265-6021502435 / P275-7021302435 NOV1101 A Liar) 302015 In1tia ; LI SCANNED Days @ $210.00/ Day $0.00 $133,317.00 $133,317.00 /77/7'-/r- Date Date 1FFICIAL RECORD art SECRETARY THE TX tf P2L�5--oa4a.-as- FORT WORTH CITY OF FORT WORTH F1NAI, PAYMENT REQUEST Contract Name WATER, SANITARY SEWER & STREET LIGHTING HSC INDUSTRIAL B Contract Limits Project Type WATER & SEWER City Project Numbers 02435 DOE Number 7376 Estimate Number 1 Payment Number 1 For Period Ending 10/26/2015 CD City Secretary Contract Number 117376 Contract Time 12ED Contract Date 4/9/2015 Days Charged to Date 113 Contract is 100.00 Complete Project Manager Ehia Contractor TRI DAL EXCAVATION & UTILITIES INC 540 COMMERCE ST SOUTHLAKE , TX 76092 Inspectors RODGERS / SALINAS t Wednesday, November 04, 2015 Page 1 of 4 Cd-A City Project Numbers 02435 Contract Name Contract Limits Project Type WATER & SEWER Project Funding UNIT I: WATER IMPROVEMENTS Item No. Description of Items WATER, SANITARY SEWER & STREET LIGHTING HSC INDUSTRIAL I DUCTILE IRON WATER FITTINGS WITH RESTRAINT 2 12" PVC WATER PIPE 3 6" FIRE LINE 4 12" GATE VALVE 5 CONNECT TO EXISTING 12" WATER 6 FIRE HYDRANT ASSEMBLY 7 1" DOMESTIC WATER SERVICE STUB WITH METER 8 1" IRRIGATION SERVICE STUB WITH METER 9 6" GATE VALVE 10 R&R PAVING 11 BARRICADE PLAN Estimated Unit Unit Cost Quanity DOE Number 7376 Estimate Number 1 Payment Number 1 For Period Ending 10/26/2015 Estimated Total 1.2 TN $4,000.00 $4,800.00 819 LF 54 LF 2 EA 1 EA 1 EA 1 EA 1 EA 1 EA 1240 SF 1 EA Sub -Total of Previous Unit UNIT II- SANITARY SEWER IMPROVEMENTS Item No. Description of Items 1 POST -CCTV INSPEGIION 2 MANHOLE VACUUM 1 ESTING 3 8" PVC SANITARY SEWER PIPE 4 8" PVC SANITARY SEWER SERVICE 5 4' DIAME 1 ER MANHOLE Wednesday, November 04, 2015 $47.00 $32.00 $2,550.00 $1,500.00 $3,000.00 $1,800.00 $1,800.00 $1,400.00 $12.00 $827.00 Estimated Unit Unit Cost Quanity 717 5 717 1 5 LF EA EA EA EA Sub -Total of Previous Unit $5.00 $1,347.00 $34.00 $1,291.00 $4,400.00 $38,493.00 $1,728.00 $5,100.00 $1,500.00 $3,000.00 $1,800.00 $1,800.00 $1,400.00 $14,880.00 $827.00 $75,328.00 Estimated Total $3,585.00 $6,735.00 $24,378.00 $1,291.00 $22,000.00 $57,989.00 Completed Quanity Completed Total 1.2 $4,800.00 819 $38,493.00 54 $1,728.00 2 $5,100.00 1 $1,500.00 1 $3,000.00 1 $1,800.00 1 1 1240 1 $1,800.00 $1,400.00 $14,880.00 $827.00 $75,328.00 Completed Completed Quanity Total 717 $3,585.00 5 $6,735.00 717 $24,378.00 l $1,291.00 5 $22,000.00 $57,989.00 Page 2 of 4 City Project Numbers 02435 Contract Name Contract Limits Project Type Project Funding Inspection Supers A,--isw•v tit,/ Project Manager DOE Number WATER, SANITARY SEWER & STREET LIGHTING HSC INDUSTRIAL Estimate Number Payment Number WATER & SEWER For Period Ending Contract Information Summary Original Contract Amount ChanEe Orders Asst. D jector/TPW - Infrastructu l ., f% 6 I Director / Contracting Dep Wednesday, November 04, 2015 Date Date Date//c,/, Design and Construction f/2 3iC Date $133,317.00 Total Contract Price $133,317.00 Total Cost of Work Completed 7376 1 1 10/26/2015 $133,317.00 Less % Retained $0.00 Net Earned $133,317.00 Earned This Period S133,317.00 Retainage This Period $0.00 Less Liquidated Damages Days a / Day LessPavement Deficiency Less Penalty Less Previous Payment Plus Material on Hand Less 15% Balance Due This Payment $0.00 $0.00 $0.00 $0.00 $0.00 $133,317.00 Page 3 of 4 .♦ .tartare *4 SO vs ra llY ir\ N NOv 2 3 2015 !N, 514101 - Co City Project Numbers 02435 DOE Number eybiliteallierie ar.. _ ess Contract Name WATER, SANITARY SEWER ntREET LIGHTING HSC INDUSTRIAL Estimate Number Contract Limits Payment Number Project Type WATER & SEWER For Period Ending Project Funding 7376 1 1 10/26/2015 Project Manager Ehia City Secretary Contract Number 117376 Inspectors RODGERS / SALINAS Contract Date 4/9/2015 Contractor TRI DAL EXCAVATION & UTILITIES INC Contract Time 120 CD 540 COMMERCE ST Days Charged to Date 113 CD SOUTHLAKE , TX 76092 Contract is .000000 Complete Line Fund Account Center CITY OF FORT WORTH SUMMARY OF CHARGES Amount Funded Gross Retainage Net Total Cost of Work Completed $133,317.00 Less % Retained $0.00 Net Earned $133,317.00 Earned This Period Retainage This Period $133,317.00 $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 $133,317.00 Wednesday, November 04, 2015 Page 4 of 4 'P 2&S-6CJ3S 540 Commerce (1) UTILITIES Metro (817) 481 2886 Southlake, TX 76092 Fax (817) 410-8024 AFFIDAVIT STATF OF TFXAS COUNTY OF TARRANT Before nie, the undersigned authority a Notary Public in the state and county aforesaid, on this day personally appeared ScottLangbam, Project Manager of Tri Dal, Ltd, known to me to be a credibleperson, who being by me duly swot n, upon his oath deposed and said; That all person, firms, associations, corporations or other organiza labor and/or materials baye been paid in full; ons furn shing That the wage scale established by the City Council in the City of Fort Worth has been paid; and That there are no claims pending for persona injury and/or property damages; On Contract described as; HSC,Industrial Building DOE #• 7376City Pioiect #' 02435 Water Protect #: P265-6021502435-00 Sanitary Sewer # P275-7021302435-00 BY: Sco t Latngliain Subscribed and sworn before meon this 28.th day of July, 2015 JANItNE:DE5RM ocsy Pubic, state of Texas my Commissiotes Jlj!y 06. 2Ii f �t BY:, h. t Janine DeShazo Notary Public in Tarrant County, Texas CONSENT OF SURETY COMPANY TO FINAL PAYMENT AIA DOCUMENT G707 PROJECT: HSC Industrial Building (name, address) Fort Worth, TX TO (Owner) rCity of Fort Worth I00 Throckmorton Street OWNER ARCHITECT CONTRACTOR SURETY OTHER 0 0 HCFA No.: 2014-051 CONTRACT FOR: Water, Sanitary and Street Fort Worth, TX 76102 Lighting CONTRACT DATE; April 9, 2015 CONTRACTOR: TRI DAL UTILITIES, LTD. 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) TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA ONE TOWER SQUARE, HARTFORD CT 06183 , SURETY COMPANY, on bond of (here insert name of Contractor) TRI DAL UTILITIES, LTD. 540 COMMERCE 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) CITY OF FORT WORTH 100 THROCKMORTON STREET, FORT WORTH, TX 76102 , OWNER, as set forth in the said Surety Company's bond, Bond No. 106229771 IN WITNESS WHEREOF, the Surety Company has hereunto set its hand this 28th clay of July, 2015. Attest: cletIAe_, (Seal): Tonle Petranek, Witness NOTE: This form is to used as a companion document to AIA DOCUMENT G706, CLAIMS, Current Edition TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA Sure,y Company i to aolA Signature of Authorized Representative Trenae Donovan Title Attorney -In -Fact • CONTRACTORS AFFIDAVIT OF PAYMENT AND -DEBTS AND AIA DOCUMENT G707 • CONSENT OF SURETY COMPANY TO FINAL PAYMENT • APRIL 1970 EDITION • AIA® ® 1970 - THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., NW, WASHINGTON, D.C. 20006 ONEPAGE r1 :Nana ^V• •�•. 1 • r. a�� r,4 rr-, _«b- _ __ EZ • ;� ... - ' . It 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 229569 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. 0 0 6.3 9 9 5 2 8 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 Iaws of the State of Wisconsin (herein collectively called the "Companies"), and that the Companies do hereby make, constitute and appoint Clem F. Lesch. Steven W. Lewis. Eric Lesch, Roger Hales, Jennifer Picchi. Trenae Donovan. and Tonic Petranck of the City of Irving , State of Texas , 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. • 1N:WITIOSS1.YHEREOF, the Companies have caused this instrument to be signed and their corporate seals to be hereto affixed, this d9 of Julie - 2015 • 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 State of Connecticut City of Hartford ss. By: 24th 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 On this the 24th day of June 2015 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 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, and that he, as such, beingauthorized 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. \_eittil C Made C. Tetrcault, Notary Public 58440-8-12 Printed in U.S.A. WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of 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, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, which resolutions are now in full force and effect, reading as follows: RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys -in -Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the powergiven him or her; and it is FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary; and it is FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if required) by one or more Attorneys -in -Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seat of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys -in -Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I, Kevin E. Hughes, the undersigned, Assistant Secretary, of 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, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company 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 in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this fr- day of l0 1 lea. tee Kevin E. Hughes, Assistant Secretary To verify the authenticity of this Power of Attorney, call 1-800-421-3880 or contact us at www.iravelersbond.com. Please refer to the Attorney -In -Fact number, the above -named individuals and the details of the bond to which the power is attached. WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER REV: 02/01/05 r 1 - CISCQ LOCATION 1. D. SANITARY Y SEWER SERVICE F ORT DATE: DOE NUMBER; WORK ORDER #?: JzIP CODE: iMM0t VLD MAC: STREET: 1300 Mcacivarn i 1 • , :— 7/28/2015 737.E 76106 48-R 1 • ADDITION:: PROJECT NAME: PROJECT #: CONTRACTOR: INSPECTOR: z MSC 7ndt st a 3�ii chrigr 2436 Dal Utilities, Ltd. Martina. Salinas INSPECTOR TELEPHONE: 817-35.O-3321 81i • I 1 { [ 1 t 7VF • 2OSI:I- i:ST of NV/ Prop Corner a. • REV: 02/01/05 DATE: 28-Jul-15 DOE NUMBER: 7376 ¥, .1). ORDER #: ZIP CODE: 76106 MAPSCO: 48-R TAD MAP: STREET: 1300 Mecham 1300 Mecham 1300 Mecham 1300 Mecham WATER SERVICK REPORT ADDITION: PROJECT NAME; PROJECT #: CONTRACTOR: INSPECT OR: CISCO LOCATION I.D. A.E.S.S. HSC Inciiistrial Building 2435 Tri Dal Utilities Martina Salinas INSPECTOR TELEPHONE: 817-350-3321 6 1" T 5LF EAST of N.W. Prop Corner DOM MT EAST of N.W. Prop Corner IRR J15Lt? EAST of N.\V. Prop Corner 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 FORT WORTH TRANSPORTATION AND PUBLIC WORKS PERFORMANCE EVALUATION OF CONTRACTOR I) CONTRACTOR & PROJECT DATA tVame of Contractor Tri-Dal Utilities DOE Inspector Martina Salinas DOE Inspector Water Waste Water Storm Drainagen Pavement Initial Contract Amount $133,317.00 Final Contract Amount $133,317.00 II) PERFORMANCE EVALUATION 0 - Inadequate 1 - Deficient 2 - Standard 3 - Good 4 - Excellent 'WEIGHT (x ) 2 5 5 15 15 15 15 15 5 5 5 5 5 Project Name HSC Industrial -Building DOE Number 7376 Project Manager Fred Ehia Projectl7fculty 0 Simple Date 11/10/2015 Routine APPLICABLE (Y / N) RATING (0 - 4) Y 3 Y Y Y Y Y Y Y Y N Y N Y 3 4 3 3 4 4 4 3 4 2 REV: 02/20/07 0 Complex 1MAX SCORE 8 20 20 60 60 60 60 60 20 20 20 SCORE 6 15 20 45 45 60 60 60 15 20 10 TOTAL ELEMENT SCORE (A) 356 BONUS POINTS (25 Maximum) (B) TOTAL SCORE (TS) 356 III) CONTRACTOR'S RATING Maximum Score (MS) = 448 or sum of applicable element score maximums which = 408 Rating (-ITS / MS] * 100%) 356 / 408 = 87% Performance Category Excellent <20% = Inadequate 20% to <40% = Deficient 40% to <60% = Standard 60% to <80% = Good >_80% = Excellent Inspector's Comments (LNCLUDING EXPLANATION OF BONUS POINTS AWARDED) • Signature DOE Inspector Signature DOE Inspector's Supervisor CONTRACTOR'S COMMENTS gnature Contractor ZRAiNSPORTATION AND PUBLIC WORKS _ The City of Fort Worth • 1000 Throckmorton Street • Fort Worth, TY 76012-6311 (817) 392 - 7941 • Fax: (817) 392 - 7845 • • 1) PROJECT INFORMATION Wow ofComracto • TrI-Dal Utilities DOE Inspector Martina Salinas DOE Number Project Difficulty 7376 10 Siniple e Routine 0 Complex Initial Contract Amount $133,317.00 II) PERFORMANCE. EVALUATION 0 - Inadequate IELEMENT REV: 02/22/07 TRANSPORTATION AND PUBLIC WORKS CONTRACTOR'S EVALUATION OF CITY _ _Date: I I/I0/2015 Project Name }ISC Industrial Project Manager Fred Ehia Type of Comract P1 Water Waste Water ❑ Storm Drainage 1 1 Pavement Final Contractrintolin S133,317.00 I - Deficient 2 - Standard 3 - Good 4-ExcelIent 1 RATING EC.EiM MITT (0-4) PLANS & SPECIFICATIONS 1 Accuracy of Plans to Existing Conditions 2 -Clarity R Sufficiency of Details 3 -Applicability of Specifications 4 Accuracy _ofPlan-Quantities PROJECT MANAGER EVALUATION Knowledge AndlOr Problem Resolution 2 Availability of Project Manager 3 Conimunication� 4 Resolution or Utility Conflicts INSPECTION EVALUATION I As ailability of Inspector 2 Knowledge Of Inspector 3 Accuracy ofMeasurect Quantities 14 Display Of Professionalism j 5 Citizen CompIaint Resolution 16 Performance - Setting up Valve Crews, Labs ADMINISTRATION I Change Order Processing lime 2 Tpnliness of Contractor Payments 3 Bid Opening to Pre -Con Meeting Tirneframe j 9' HI) COMMENTS & SIGNATURES COMMENTS —16 Signature Contractor Signature DOE Inspector Signature DOE Inspector's Supervisor INSPECTOR'S CONINI EMS r/ TRANSPORTATION AND PUBLIC WORKS The City of Fort Worth •-1000 Tlrxockinoxton Street • Port Worth, TL 76012-6311 (817). 392 - 7941 • Fn: (8I7) 392. - 7845 RATING CO -'I) TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PROJECT NAME: HSC Building PROJECT NUMBER: #02435 DOE NUMBER: 7376 WATER PIPE LAID SIZE TYPE OF PIPE LF Line A 12" PVC 787 Fire hydrant lateral 6" Pvc 22 Fire Line lateral 6" 67 FIRE HYDRANTS. 1 VALVES (16 ' OR LARGER) PIPE ABANDONED SIZE TYPE OF PIPE LF NA DENSITIES Passed NEW SERVICES: 1" Copper SEWER PIPE LAID SIZE TYPE OF PIPE Line A 8" SDR-26 LF PIPE ABANDONED SIZE TYPE OF PIPE LF NA DENSITIES NEW SERVICES: 8" Passes PVC TRANSPORTATION AND PUBLIC WORKS The City of Fort Worth • 1000 Throckmorton Street • Fort Worth, TX 76012-6311 (817) 392 - 7941 • Fax: (817) 392 - 7845 54 716.56 18" STATENIENTN (FINAL STATEMENT# NAME OF PROJECT: IYEAR:I 2015 PROJECT NO.: #02435 'PERIOD FROM: FORT WORTH TRANSPORTATION AND PUBLIC WORKS STATEMENT OF CONTRACT TIME 1 Final I HSC Industrial Building I 911$l2015 ITO: IWORK ORDER EFFECTIVE: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 1 DAY OF MONTH Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue NA Not Applicable THIS PERIOD 'PREVIOUS PERIOD ITOTriL TO DATE REMARKS: Signature: Ata (Print Name) sc"d7 CONTRACTOR Tr/ D�r..L... 1 1 1 I I Contractor i FINAL INSPECTIOY DATE 6/7 /J 5 (CONTRACT Taff I 9/21/2015 I MID - Month I I 120 IDEVELOPMENmI (Y / N) I 6/1/2015 IBEG(v/n)I n I MID n) I v 1 DAYS REASON FOR CHARGED DAYS CREDITED Wkn & Hol SAT,SUN,and HOLIDAYS 0 0 1 1 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Wea WEATHER 0 0 DAY OF MONTH Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun Utl UTILrI�IES RELOCATE 0 0 • Oth OTHERS 0 0 0 DAYS CHARGED 1 1 1 1 1 1 1 1 1 1 1 1 1 REASON FOR DAYS CREDITED DAYS TOTAL DAYS CHARGED 13 13 100. 100 14 _- -- _•- --• - 113 st_ ,tics tom: Signaturet, _ rinta �� a -Martina Salinas _ i rt- - .._�- .ram - -ft. t. • y �. _ tl -sw .• t-a -. -s. --- • ?jy ems+ K _ - •y _ yy, �.is4.r mow"( �C ?WI* �.+' Tr '♦ .1,�� tiaZ'. �.i�r��.:sfALf( �r, r�..�. „..� -t ,. 113 • piDOE I 7376 I oti aPPIL. 1 I L9!!JCsfl- SECRETARY TX