HomeMy WebLinkAboutContract 53595-FP1 FORTWORTH®
TRANSPORTATION AND PUBLIC WORKS
NOTICE OF PROJECT COMPLETION
City Secretary No:_53595 -FP1
Date Received: 08/09/2021
City Project Ns: 101120
Regarding contract 53595 for 2018 BOND CONTRACT 2 CLOVER LN&WEST WILL ROGERS WAY as
required by the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by City Council on
01/14/2020 through M&C 20-0017 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: $4,339,731.40
Amount of Approved Change Orders: $11,000.00 Ns 1
Revised Contract Amount: $4,350,731.40
Total Cost Work Completed: $3,944,419.74
Less Deductions:
Liquidated Damages: 0 Days @$650.00/Day
Pavement Deficiencies:
Total Deduction Amount: $0.00
Total Cost Work Completed: $3,944,419.74
Less Previous Payments: $3,747,198.75
Final Payment Due $197,220.99
LAUPe91 Aug 2,2021
Lauren Prieur(Aug 2,202108:39 CDT)
Recommended for Acceptance Date
Asst. Director, TPW - Capital Delivery
QLjQ.L Aug 2,2021
WJ(Aug 2,202 1:56 CDT)
Accepted Date
Director, TRANSPORTATION AND PUBLIC WORKS DEPARTMENT
Client Department
pang Farah %ff Aug 7,2021
na Burg Dandoff ug 7 20211039 CDT)
Asst. City Manager Date
OFFICIAL RECORD
Comments:
CITY SECRETARY
FT. WORTH, TX
C�620 Signature Page
Contractor's A lication for Payment Invoice No. 15-FINAL
To(Oo—) City of Fort Worth ImvidngPeriod(From-To): Imui«Date:
6/121 to 7/821 7/a2021
P.O. FW020-0000003410 From(contractor): Remit to(Ifxot Automatic Depo,it):
Number. McClendon Construction Co.,Inc.
Pmj.t: 101120 Contactors CFW Vendor No:
0000007403
city secretary contract 53595 coo"'2018 Bond Contract 2 Clover Ln.&West Will Rogers Way
Numbee Nome:
Application For Payment
Chan aOrder Smanm—
Approved Change Orders I.ORIGINAL CONTRACT PRICE........................................................... S S4,339731.40
Number Additions Deletions 2.Net change by Change Orden................................................................._S S11,000.00
1 $63,250.00 $52,250.00 3.Cvrmnt Contract Price(Line It2)......................................................... S $4,350,731.40
2 a.TOTAL COMPLETED AND STORED TO DATE
3 (Progmss Estimate,Construethm Allmsance and Change Orden).......S $3,944,419.74
J 5.RETAINAGE: '..
5 a.5.0% S Work Completed......... S
6 b. X Not Used S
7 c.Total Retainage(Line Sa+Line 5b)................................S
8 6.AMOUNT ELIGIBLE TO DATE(Line a-Line 5e)............................. S S3,944 J19.7J
TOTALS $63,250.00 $52,250.00 7,LESS PREVIOUS PAYMENTS(Line 6 from prior Application)........ S 53,747,198.75
NETCHANGEBY SII,000.00 S.AMOUNT DUE THIS APPLICATION..................................................S S197,220.99
CHANGE ORDERS 9.BALANCE TO FINISH,PLUS RETAINAGE
(Column G on Progress Estimate+CA+Cos+Line 5 abm'e).............. S Sa06,311.66
Contractar's Certification 10.CONTRACTTIME:
The Contractor certifies pith the subroi tal of this document and associated Payment Request Submittal a. Daps Awarded 550
on the City fFort Worth Buasaw system that to the best of their knowledge:(1)all presious progress b. Days Added by CO 7
payments received from Corer on account of Work done under the Contract have been applied an c Total Daps 557
account to discharge Commetor's legitimate obligations incurred in connection with Work—ted by
prior Applications for Payment;(2)title of all Work,materials and equipment incorporated in said
Work or othetwise listed in or covered by this Application for Payment will pass to Otsner at time of d. Daps Charged 374
payment free and clear of all Liens,security interests and encambanees(except such as are wwred by Daps Remaining Ig;
e
a Bond accepmble to Os ncr indemnifying Oev—against any such Liens,security interest or
cremallomeces);and(3)all Wort:co—ed by this Application for Payment is in accordance with the
Contract Documents and is not dcfectire.
Liquidated Damages S650.00 x day
Justin Blair(Jul 28,2021 09:09 CDT)
I
e
j
E
This document has been modified from its original form as an EJCDC document and the user rid not highlight the
modifications.You are encouraged to read the document carefully and consult Legal Counsel prior to its execution.
Progress Estimate 53595 Contractor's Anplicafion
" 1 2018➢ond Contract 2 Cl-r L..&West Will Rogers Way "�'^""^=s`• IS-FINAL
,lls.�2a..aw.•,.
t�lc.ao B;JP-h Lshee P..IJ� acihs.f t.s. l>n:->hL-i..^�f c.5. f..ta ert,:.f _v�fld =hc- t� akeaeEes
s
f Wa' Prw -. IIx LF- a12 s112w 316fmOmwa W).> Ia 63t)5 -)1 Wt 9J ax R.°Aa25
�,a flz cn ] ubow 2a mJW awW000O aSwW 22a.5oow axaw wo%
�i dsi � m 111 le LP J4. svrow RSBSW dmwwoo st SWw St.SwW n5ww ws%
- i3ti-1 maa rd Fev^att III Ton. 0w,w] Osw NW W aipmw 5O63.ro SEbSro 5665 O t4 ax t).JWJ
5 Uil a:bf lcvha+Paq Ilx tF. 3N OOGrO 243w 2<M1W 35a5wVALJ SiS.IRw 215.IUW -1U 114 4 ft0.523w
rbf x tF Wwwm S)1w fa2W UW1YUw 2w N2W 231tiW W�
yyp5. xn Sn 3f. :OONwOGa w6W fOW 525ww
B UI2MW aGa^:vaia lfx^o ra fa SISww NSOMw f2OWwOw waW aWow BOW .ro G% ;R.9Oow
W1zO o)rn nYa, >,.. r. snsww
f Va zf PA IwmW SWW w S41bWW
t U.:ml..t la u N WJw W]w e2.W[OYRt aUW 9l Sw al% flt:Ww
t p<mnnecbvr zlo EA. d. SupW LnW 6I.WM.W SA iWW mim at% -R.m'aw
Ia Uf2aJl Tvhs Sake Xa+R�a-semat tl lz to En iw[oO[ Si MOW f2EmW 20VAOOO 2WOW SxaWW S2aoOW WOb
15 Ni2ZaJ TS'(i!v SNke tlx to rn. NSWw -.. 54 waW 20WawW RwOW atlgW RWow tW0%
16 b]W m]W wiNW f1bA
f e to is 1 I. B>
f II+ rA w ...mow BWWWN m] O'A
t9 oa�ilR�Y.na vl S.Yx um Irs+l la FA � ffWW Rsww f6WWlOW ImOw SSW]W IaW % Rmbw
w I51] a I+ FA 2 431
Rmw
21 J.Vfdw avan_wxax Px.rw aecaalT ku:.0 on ar fB lv bw nW S1R wow <al).Waww sf R.mw 5fi2).ab ftamb 4qv. 22a)b
a 0.>DI G la SY Nww:C <sW &`Ow
a W IJ By 2a Aw ...Law R.IDJw
W as ur prlhsa IOwtoc 1WOwow
2 wi Ae w FA abw W RBMW R5m
ri eM +In SY Wbw W w IB WCObJ] w SbW Gx
b Il W 2WWm W 'ww 2WfW7W ssSwW ssSw o%
a R1td5i tYRP Was awErHV lJ 11 to tF NtWbwt z9w w 2nW.:YA Nw.Ow� fiw..da.W itmoww 1t2tx t>SOD]
_r_Rsu eac5 111 le lF JS SvSw 03bw OTrSW
i a Rf2O1�4rvatKn¢e Eaxv l'�IY Was Va.:n tl lzxt FA fO Namw N3 bJw x6.abWm s]a.2ww S)a Xam R33mw fm o% -taatW W
OW2Cn eE aare.f �N 65xm �
M Y 1 xl LE tWWW Smw ]wWDA Sa m].w N.BwW
J IGPBa l>r I2l LE f HEww IwD»]J NAww N.6ww N.E•Aw tw O%
J Co- 0..wance. mmm is 1WwcC Swm]w WJw wOW
f 1t15 BSe•.a Pya
I UJI• tF ESl U2.t56 B fxa StagN.w Na 5).-
�� )J If 1O.11 JI
12 h
£92w W Ia ttANm EUm &ew 913% 'mw
ta115 Sew Pau,SAia U1114111
Ii Jl 11:5 SM.)Eab
2 LF •Af 0.Ww 1�8W 391IXgvT-0 S%)�.w SM.td.'A 336.)5550
] O2af.31W 6'Snw PEvda'_wtpsa ox+l l+ E4 3 SSww ff wlW awwWw St.Sww St�.W St.SWw IW G% -S�w
WI-Lv1 II+ EA 1.. Sf W]W 16WW Bw.TA-m wJw S4.�w £3Em W30b ;JawJw
E)a 50 1OPc-).W ESS.wwww 45a5x N4.SaW faSa w% -ffSsw
]:GfpW aozvreeWxPa fteurlY Y.s4.on 6' xol lx tF 60� UU N:Sxm fl55wwl)w0 NWJ3s Sa.Wa35 NW]23 1w E:plw
wJ2 Ill tF 12]a
d Vacvua T<Aw r to u U Sew W 2m W fa.PzwJ.W :'A W SaYO W R 2b W O-%
bt12 aCrRat a5lx u t)ww fibw SWmwCV RtwW R>bW Rlw 5W 0% ;N.w]w
e!r- lot 13 to 12)I QWGJ wb R]r.W 11m.LW:mw 5.'etb R4x.W i59 b ssB% .Raw
O ]Uf.]tp aSew Sense. +lJrx3 Fl• a 513mw m.5ww 2JatWwG 32E>wW 52a.>'AAJ E2flxwW idi% -Sli'Aw
12 I fuv-M.a Lo-� o•J � II N ssl If.D�U SR SSJ.aw.w W
U f a6a'p uaJue o,J � f ssf sst f... ssl Sa ssf
11 x asu,^ax us Mrs 4J FA t R R 2 R.. $3.1w.W R
rr aww aww mW.tVJ amw aww lm ox
U�IwJ a'Frn ary VaMa'n »1910.JJN
1s ;n r 5 fvOw S2YAw aT:OAb Si Fasw -. Sf..(SSW ft6Csw )t0% 5'«SW
Wa3 Wx1 ma4^.xePre_-cv9 W'-ay ))J9W
4 1'P m f>m.W Stt6Uw 6aWaMW Nt6w. fi).4w.W t>0:5 1w Gx
Ca .a�Slx U.ln Pae ll Ot lO � 2a Siw.W N3ww famJGmW f25ub FYN2W f2N Wsx 5155>b
xe W<i.:m15✓ LYa Grttiv CY 5 ltww S)bW Sww]ow fxwW Rmw iw a%
9mamJt. �+aial5erry I)I El La IaWx 22amw YG4bW fwGGxFA 22aSJw S2a'4w 31111
ro 5'�wW cc+mtcom EvnarlGPSftML>n 5w,rn of)i xl LS 1roJ>][ USww 3].N]W froJOJDP U.wJw SaBOOw U9GJw 1w Ov.
i21arO.unCucmn xe mm 15 I S'A W]w W]W W
t WaitwJ Fe-ma Csx P.z3 +I It st an Ntw iW aN]tlY�D] i130..m SIS:a.w S15w3b h'3.% .lam
i - GeT3GLs z+l It LF iR Rw NSmW fz+4w
f5 II+ aF ]IO fiw IOW aBwwOwO Saaw W.w SH 55%
i Imtl le+e +I Ia tit N.w n W J4w A SJaw f33.w 53 23Y 2w
¢ 5 SP33 mw Y..et. mmm a4Li 8. 2'�+.Ow E16W.1 ).wWwW Ew E56wW S66w )5% w
P>/-'O Pa ra lteou. or a LF Ma.. NGw SCOW .SUAOmbO 22e0 22+¢w af42 m
Tvicea fU).wJVWW t42 53]% 2B
Y zlx fa sv a:0. S16w zmw f43W )T`% v
P M. +z rt ll 5Y atJ w[wC 24Eb RB.vtM :65.]mmGW SU02).3i tUB2)6 >U BZt 5% 313]5aY
w u16ww u16aW
ara +I o LF
3a9mJ>JJN
r5 wmx YO W w 35.wwPW 515E.AV w ROW W R w] P'b
tt JdtwW uw +I o LF tloww5 tOW aw Sd wwww ilmfeOW retu 3% rOw
m+ t sv a:V.wnoJ[ �W w Bw4mJw EfJ.:Ww sR.roOW 20O 5 JW
15 3d9 W]I P�wrm J+mmnSc +a o FA Jwwx S)twW is 2ww Jwi?Vw SW. SW YAW SnriJW IW0%
i
E
{
{
i.
e._mnYm re aa�»lurt.i v4 Grc=a-a��i2-S®S r+uS2ec1[_Ica.taurua-�z
Proeress Estimate _ 53595 Contractor's Application
on 2018➢ d C-1-1 2 Clm'er Ln.&�V A WiII Rogers Way ISFINAL
r..
Arv5_>;.,,i�:,! 6lim m]razt --
5� >c�a T.. •
is vosaias T,w,s>-N; a)fn Ir sm s1m isisox Bxomiam 3ss;m
to : isi.m si r: sSZW
fr amsa;w c.�arr,�.-.p;m�nu:.wa ,n).l Fn. 2 4»w aoao zmmmea wDw :a�mo uBm w,
,al,l ,P sda saw <w ,asWoxmW sxw PJ2w ax zs,% -steam
fB J,eoD oi. =,"u a`" ,Ivm Is , r»m ww ,..woxwoo .]Pow so W�
2D ID;6'. +f G�e� ia» tF ED Sides f 6wm wmmWw s25Nw �3Nw 525Nm f»o'% ��
x ai:owf far �.r;M z ife Try xD :,v3w kaow -..
a mtzNw t w.-_vsr,.x. »fz o en to s25ww sn wam ,ommaxo snomm sz.WJm sIx .1 IDaaw
3 N.2NDI 4 u<s,aes-:.ernes. zfn Ee to. 53Nw wow toanD V vomw arrow o*
x I.mDt s�.f na s x 51»w xsiw e2oNwwo z5mw sfzwaw stSPo al% sa TEOW
N s�n.DOD1c«,.s,ra�sawPl�•.a<n a,�n t J»w vJ»m l:Wxi.:. :waww sJawm azwm Imo-n s»oiow
fn c,+.a�.. n sr w m 16awPNewn w .ores zsl w t%
m •+. R r - » s zzs f n sNiaxamxm zr rm.6m.m edz 6% .5
a acaorrcn Prmn..cmrw w1n e.Pa,n a:.n.v. - D:,v sr f4fu smw s.wrxaw zwu5mmmo sw sNm sc�arow s.�Dd]o azo% w
5 ma+.(wn Rr�,.,..wn•»<a Duos � m: stxw si aszm :.,zawwww sl.Sww sssww sfsww adP-< szm5m
m •,a lu sr zwa sta» awes 12amwow esw .slues sills ose .oao
,nwrei�. 1u � ]aN um s62.»Jm n,smNDwD row uarmw uJrNw urx eaow
x IfDm P-s a -swum mom 2ammmu faw.w s,.amw sloo0 woe f:wOw
�.-.i t a am rn. J. mlm. W.m awwNo n5ww sJwDW wD J% smum
„N,.,I am ca ,. s,.,»Po sf fWw za000apDx Jmw szwow 2m o% sf1»w
T 1 )now
r,�R.,,n.M rn a siwoPo si abw ,w00000D z2Dw f.vsow a% wsmw
nin lPP. zi>-a» : vvw Ls :f000000 smtSD.m a.,sdW +wololw - soW aiatwW Id yrlam
u 3il,rem x' wrm�,n 1f z> s ia»i uw s315ww ;arumDwiw nis.sw 5nrew snazsw ,W ze zimm
•+. +fa;,,-.ar )» =r fzrs sdW sm I:mwPowoo rxaw stoxszaw ozva wra .s121m,
»iirml am cr..-a.0 N s foss) nm +w 11B1awolw00 N suaDZN an Br%
td 321J.m1/d Gan<Sidewsit Atlia<ent to Cuh N +. fur sdW Ii Slzm w,9.0m0W[p m SS2Po .552E w6'b f30am
tr .roll fMOf ;lMnC Trnn�rem )x li fa T! L'o Siaiw Smmow 45 KJwrW st,mr si sfsm],x3 51tWra^s Nye H25o2rS
t9 32f30f02 ]"Coot R+A vD ST 14A20mm0 5,6» 4wW ta]N.smmmo sEaf 6w.a5 fwdasbai Sdda 9m 6e -fiB5Y215
11 32130.`i01 6vrer F—RIII Tsu R-1 )z v:a En f6fpmW sSSww wlww fAmmxW tasmw siawow f95m a sil.Nom
+p 3213UA3 Barr F66 Ramp T—M-i :> En iwmm .Imes aw.W ammmoo _ S6aww 56 awes »as fwoe
N 32130`A Pzmv Fl�ftaTq T)Te 11 :o Ea it ,»w nwOW 12 Um> w22mw SJixww 1)23»m Ue to -H wOw
23 321].4'At Rome 4'PmH Vvkna. -ttv if fi f)m stow SroPo
N 321)430] Revre Rss4 ` I.w ss5w 582m
xa 3217—; `..Rod M,3rk NAE No >v tF 2» aw iwow E25ww
N 1217." CvO A�esSPastsq )iDv rJ.. » oW W da DmP%W m A.oww pw liA a6e
3231 N12 rF�erc-as Vtood h5e W
32320100 RMWdl Atlzcaa SG ,, m �'awml SIBTaOw
x6 BF
21 +i)iv 5P. 2x5 2Po 55] >W .elm Wes
N 32320101 Cox R6{VIa3 wN Sdvz:.s SNne'n »)xv sF ,wf vm s12mxPo x445JwPwm 9.Y6iw SID.BSSw B6s2 I(b J'e
N 32 to, TOPwl )isl la n. xoo sbw s5 m6w 410m0omam o2wPo 210.2»w slD.x»w 3ti 0% -Ss.iaw
m 3292.010J &'ack 5odp a*k »ax» sv tmx.. srst S4f15W a6rdwWOW zl.ia].s'l fir.5arw sx]ia 1•3.54 -slB ai2.w
». .11 6'00 Rrtira'ed L'rz )z»3 nf. �o slwm Sa56o0w Y3wwmN 342 wOm 315.5wm sa55m t620% 13AW
J3 Yfi3 o000 RamoaReo'xe SD lrei Too mmm �.. tD Sa 6wm Sa95mw Bwwmm SN6NW i39.6mm v6.av wD% WW
» 33050100 MaJdz Adv6Ar'e+A Major »ml+ rA. , w5wm PJmm flOw0.rol0 1364mm 526.4w.w sti.4nw EAo 6% -in?ww
N 33050f0] 3Ne'e Akv=trterl Msur m awYAmO SI. ,.. �
w 3YK 0111 V Box�d+slmtvR O50m �
w 59'A 4114110 5Cwb
Jr 34410 Rb-roe ard Ra'.ashM Spa Parma aM Fosr mmwDwo
a 34>i im T R SC CaYfd mromN .rol
34411632 Srlfod Zorn Fa Az 'nt`UC) 1. 'fwwww
s is Tile 9939.000 Stse N s Saly pHR 11 ,zDmxwDJ f�
J
6rA. auw
of 9:P.9 NO2 Fr e'Protecs Paf M.ar to PA. ammJ. w w awmow0 m ..Wes
t oe
ai 31230101--t E¢az[an br Flea )tv5 Cv 2w DNDl[ WW w NJomoomo sNON. sNwow saDm fmo'e
4J 3305 RMi PropIN E*R brzNl�-ltf ,)os o cv .b w ttOw 13N WPJwJ slrauw w).4eD.w »I.4Nm waDw aaDPo
.ec-of BackNS-0ex3x ffi to it kalfnm) )-J n% 61
[ CmuF �zl' tF. m. W
��SUUGur6 Ad d0rtm 1 LS f m w aw wSIIaW
10Ntlwx f6c
211]05312 SLOR,MMzdrna W.E Nl1 )i ttv LP N ow w. m0o0xN 24fo S32 1411 m00%
32]0'A1 tY SLD RrtI Mvk H4E Ml1 w- ] )Z 1t LP NDmtW w w mrialy sLa". w
321]0002 'SLDftna MaSknp—(Y) )i It sF m xW m ProNmo iRvw S'xUw SYnw 3m D% awes
1 a9 32f]2103 REfLR dlVzhvttllAA »Ixv En 8. sxaw sxmm Nm
» ssss Does w. rvw cww„scowworsw�vaml� Ea. z s»w ..awes El,owes
s """"odor u�zaa raa«rvode Pid en, c4 ,. wJW W 1.mwww saw uoow sxD Poo-e
5x 5999000J nstaBt PA Po'z,Pd Vka�3RuCcn ra x i5om 6rww Lmm00o0 Sesw SSSSsw Sd>» »o'b S61bw
w sss3000s sralw_r5,:o.Dmd zPoPw rA. f.... z6wm szwW facoc600x rz6wm szwom xaai m.Dx
it """". on:ta3lknTsrz.DP.il Err rn i si owPo sf mow f:VN0D0 S1.WDw Eiwo.W sl owes IwD'e
52 32130202 J'—R�rtd RES(aa rzrx47 Rx5o0w -JiDn Sv W]wJu SEsm 5ww
5d 3211 G1138"Fk.b'e kYze.T>P6 GR.1(ss fexCPol »Ilv st wx.. sites SS.svw u`'mw
' n 321]430a RBrroe iY RM MSh:+.q(cmum_'a1 >x lry ,s xfD6oDocr ww Siww Saww
&ek Pma flomob 6m
� 5J >z 11 fa 5Y www s2&mm 16mm>aw 55 SSwJm ssw] 'OJ V6 Exwiw
» 32140200321401D3 8xk R,rd RepS'a )i 11 fa s fa iwow ssroxw NLNCOmO 59 mqm ShcW.w uom w6% -E26wm
w 9999.0006T P WeN „e tl tali. rA r2 rwm omm RC?mmm 5'Aom i•A wow isa 000 w0'%
999900m 51 elR i z1a11P hl a+:er Pole SDw:00m
61 )mm rF s 25w 125w 22f35 32f25w s2ixs WD%
63 9999.Ow85 Prti Sa<a 64hers. ilr» [A ss.. ilOm SJwm JS.wmmLV Sxwm SJww m». Iw056
w 9999.o009 ParklnaSWce Letters si,ry FA m Smm SYAw v.DNCOIU 19mm Sr?xW s_7±xw fwD%
6i DBGB,LOD.aGPS.SurveY mmm SS fow)o_
Y339000i Cpr5tfuctan$faY3A mmm LS aoIXAv[ Sid.Swm 9YAm twwDODo Sfd SSOw SfB.S»w ila Bww ,w o%
€ w _J990}35 Coratrwtnn A"nnence. mmm SS f... Sfw COOm Etw WDm sfW mow
e,.iS-cv Y.ace•a:s.d,lu rtNCe 6��n�':'ry el en+-3i�da C,::.I Fl.xun n,a-an
C 0Change IXder
Progress Estimate Construction Allowance Usage Contractor's Application
ADDITIONS
101120 2018 i.d Cpnl-2 Cbver Lm IN'e Wifll Rogers W°y c'tls 53595 AW""`"'�iv lir 15-FINAL
,1kyAwa,D=�c nESd�..,;.r em�5 611/2I to 718/21 7/SnO21
0 D E F
❑em ic,.il Ccmpinnf .e Oilsx wFv.W
Slccifi:vis (j+'ntiq'WTS1 ue T.itti.r t'il�:c Lutq ty hc.;.�7 VahxlNa f.:exivl�Fecerety (D
rJS(D E)
lien[:mtn LF�wm 'ni etElcsswe � laF_ Lr.=W.4il l'a4x Pm.J ES+.m+f(wa nC) r B
&cum!a
6) 9339 prK R<lxcNmen li0`J ux"", � itti A fl,Hq(O 59,.YgW 1WF.OJgJ 59Sfgtq 59,500W 59,A.W. IWV'.
E3 02JI OX.q Rmurx TDA Rmp FA ±3.ttIXiri0 SYgfq SJ UOW YGWCUW 51,A0) S+,Apt Sl,ErgW 101J°. SWJ f0
€
Tot+l+ J 100.00 51J�00.00 00.00 00.00 101 i^:: �53g0.00
1
€
C
E
1
E
{t
F
tt
k
1
�SE�s mw,Ix�,onwrw,5 ra�a��,Ir m�E)coc s,�nwv-«-..aeoc.n�,€:n�n
m.,hr.:.e,�Fry 9x��, w�esi dx dxwrsl curfWly a„San,�I..,-�Ec�.ulmMW w«.,,n;a�
csm enJ�ye o.det
Progress Estimate Construction Allowance Usage Contractor's Application
CONSTRUCTION ALLOWANCE ITEMS TO BE REDUCED
101120 2018 nond Cwtracl 2 Ctorer Innagars R'ay 15-FINAL
611121 to 718121
F. F
It®
Bid ltw T:vhx �Tt`+'�i(�[iam SM m�Ta Uni+NA(evtee Q�'Jw<SWUe!ne Uril Ftia RelxtiaVhe ..et C'ssf :.vU:N �.etUssd t:m UssJ ::et UsN tKn Ux.f trot Usd tta UsN
E5 9?Y3hU5 Cm�.tiat NlaAmx is O.1J1(LttA n[9.VA4J SISIW<0
E
I
t
5
[I io1�L SIJ 100.90
p
t
t'
k€
I
Thv.L�werJ Ev tern�N4em vt mtjril(rnnumE)CDC.k yen did my wy„�x Ne
mclifiuiims t'eu ue eruuyNWrcd tFt d�ee cutfidp'W nassut LeSil Cctvct{ewa W at etmtim
"W Charge W,,
Progress Estimate Change Order Number Contractor's Application
ADDITIONS
Fa(cawacp' 101120 2018 Bond Contract 2(1—,L &NV-Midi Rogers Wly Ckn 5 595 Ary.S:axm hm l<r. 15-FINAL
Cwtra:l r�
611121 t0718/21 t6O1 7/8/2021
A ➢ C D F
Chmye Ilan SpwiG>tien L'r'c of CO trw^nio AdJ NIAut Pme fwy Der ��'� y Pmi0mly Viloe Lle� Uumiil+PmrnOj y�5meed ocDu< (F) ➢'ID'F)
To. Salim t�'o. \(eawe \'ilu: Wt+&d Sn+ta�d Vilss Pmiai Suvel( 'v,C) IDYE) D
33 9993.0000MIn 20'x 12'Tc<IL'rG3 X'ainl � IOWPJ0.�0 3J8.$OJ 00 5]B,SOO CO IOOOOOttq 538�50000 StB,SCOf9 SIH,SOO.fJ 1000'e
22 3J31.110t J'Scwn Smse(mbcrewxrcee lL'>U 25rna IS OODD0000 5"65o. S21J.. nomwoo0 -,M. S56,t50.00 SISI%W 733°0 Sfi,-.00
i
i
I
i
Tw+➢ 861 50.00 SS0650.00 i 650.00 55 650.00 896°e 600.00
i
i
t
}
4
f
i
rm�,m.,�,m„wca,�n�sr ar�mod�lr„�F�rncahmnu.w u,�,u.ce�o�Ie�J�me
�s��t'on,R�.:ow,a�+wr<b50�ao.,mma o,Rr�y' vw�mu0t�lc�.�.a�w�u�:�oea.
c.5zocha�ye seer
Progress Estimate Change Order Number Contractor's Application
DELETIONS
Fo<lUmo-.¢ 1o112o 2018 nond Contraet 2 Clusr Ln&W.et Nil[Rogm AV9y A{yaexen>,•w 15-FINAL
APPSacax Pam 611/21 to 718121 'tpphrOii D"" 7B2o21
A 0 C ° E F
❑em COQ,n w °ekew
Cn—ONct lum Spiifi:atiov Vteii.f Pc'aw L`xM Pte Chvye Oxb \M L'xN \M L'ud \M L`xN \M C'xN \M t'xd �M L'xd \'d Vud fM Vxed
\a Sextian�a Stca l'ahx
11 Cam:eti.nb onmx310'nEer nuax(t4m.1:R'akx EAA I..UOW00 527SOO pI IN,71100
13 Crn+trv.am APowar>c Vrt 2:Srna LS 0.19500000 55(50000J 52{�]5000
T.tah 1532YJ.00
t
I
t
de
k
t
F
t
{
t
t
t
The Jnvn:rt Av bcmm�5ficl fr�vn itx aipulfttmm mFlCOCM and th:uw did rc{hexthc
ma5fiarssu}'w ue m;amgd w rtad the dav�mt wef¢�y'vd cent LcyY Cowin pwv to m eaw�.IDnrt
City of Fort Worth Summary of Charges
City Secretary Contract Nun 53595 2018 Bond Contract 2 Clover Ln.&Nest Will Rogers Way P.O.: FW020-0000003410 Project Number: 101120
Application Period: 6/1121 to 7/8/21 Application 15-FINAL Application Date: 7/8/2021
Number.
Funding Identification(FID) Total Completed Amt Remaining Gross Retainage Net
Original Contract _.... _....
156002-0600430-5740010-101120-001780-9999 $1,147,309.70. $63,529.55
'..56002-0700430-5740010-101120-001780-9999 $281,425.25 $42,409.15
52002-0200431-5740010-101120-002480-9999 $536,902.15 $60,366.35
34018-0200473-5740010-101120-002480-9999-18010199 $1,922.132.64 $285,656.61 '..,
0
0
0
0
0
0
0
.Change Order 1 _..
56002-0600430-5740010-101120-001780-9999 $56,650.00. ($45,650.00)',
56002-0700430-5740010-101120-001780-9999
52002-0200431-5740010-101120-002480-9999
34018-0200473-5740010-101120-002480-9999-18010199
0
0
0
0
0
0
0
.Change Order 2
56002-0600430-5740010-101120-001780-9999
56002-0700430-5740010-101120-001780-9999
52002-0200431-5740010-101120-002480-9999
34018-0200473-5740010-101120-002480-9999-18010199
0
S 0
0
0
0
t
City of Fort Worth Summary of Charges
City Secretary Contract Num: 53595 2018 Bond Contract 2 Clover Ln.&West Will Rogers Way P,O.: FW020-0000003410 Project Number. 101120
Application Period: 6/1/21 to 7/8/21 Application 15-FINAL Application Date: 7/8/2021
Number:
Funding Identification(FID) Total Completed Amt Remaining Gross Retainage Net
Change Order 3 '..
56002-0600430-5740010-101120-001780-9999
56002-0700430-5740010-101120-001780-9999
'..52002-0200431-5740010-101120-002480-9999
34018-0200473-5740010-101120-002480-9999-18010199
0
0
0
0
0
0
0
_. _...... Change Order 4
56002-0600430-5740010-101120-001780-9999
56002-0700430-5740010-101120-001780-9999
'...52002-0200431-5740010-101120-002480-9999
''.34018-0200473-5740010-101120-002480-9999-18010199
0
0
0
0
0
0
0
Change Orders
56002-0600430-5740010-101120-001780-9999
56002-0700430-5740010-101120-001780-9999
52002-0200431-5740010-101120-002480-9999
34018-0200473-5740010-101120-002480-9999-18010199
0
0
0
0
0
0
0
i
I
r
City of Fort Worth Summary of Charges
City Sccrctap Contract Num: 53595 2018 Bond Contract 2 Clover Ln.&West Will Rogers Way P.O.: FW020-0000003410 project Number. 101120
Application Pe od: 6/1/21 to 7/8/21 Application 15-FINAL Application Date: 7/8/2021
Number.
Funding Identification(FlD) Total Completed And Remaining Gross Retainage Net
_... Change Order 6
--..56002-0600430-5740010-101120-001780-9999
56002-0700430-5740010-101120-001780-9999
52002-0200431-5740010-101120-002480-9999
34018-0200473-5740010-101120-002480-9999-18010199
0
0
0
0
0
0
0
Change Order 7
156002-0600430-5740010-101120-001780-9999
56002-0700430-5740010-101120-001780-9999
52002-0200431-5740010-101120-002480-9999
34018-0200473-5740010-101120-002480-9999-18010199
0
'...0
0
0
0
0
0
Change Order 8
56u02-0600430-5740010-101120-001780-9999
56002-0700430-5740010-101120-001780-9999
52002-0200431-5740010-101120-002480-9999
34018-0200473-5740010-101120-002480-9999-18010199
0
0
0
0
0
I 0
0
I
c
r
i
I
f
�i
I
i
City of Fort Worth Summary of Charges
City Secretary Contract Num: 53595 2018 Bond Contract 2 Clover La.&Nest Will Rogers Way P.O.: FW020-0000003410 Project Number. 101120
Application Period: 6/1/21 to 7/8/21 Application 15-FINAL Application Date: 7/8/2021
Number.
Funding Identification(FID) Total Completed Amt Remaining Gross Retainage Net
_.. _. Totals...... _....
56002-0600430-5740010-101120-001780-9999 $1,203,959.70 $17,879.55
56002-0700430-5740010-101120-001780-9999 $281,425.25
52002-0200431-5740010-101120-002480-9999 $536,902.15 $60,366.35
34018-0200473-5740010-101120-002480-9999-18010199 $1,922,132.64 S285,656.61
0
0
0
0
0
0
0
Grand Total $3,944,419.74 $406,311.66 $0.00 1 ($197,220.99) $197,220.99
I
I
I
i
€I
I
i
{i
1
k
S
t'
E
(j
g
't
l
I
CSC No. 53595=C01--
jFC))RT W(3RTH
— �— Change Order Request
Project Name 2018 Bond Contract 2 City Sec No.53595
Project No(s)101121 DOE No. F N/A City Pro.No, 1)1120
Project Full-deplh reconstruction of Clover land and W.Will Rogers Road including concrete paving and water,sanitary sewer
Descdplion and storm sever Improvements
Contractor mCbndonconsVKWacomp3ny,Inc, Change0rderil 1 1 1 Dale: 7/10/2020
Clly PraJecl Ngr Scoll TaylorlGreg Robbins City Inspector Troy Gardner
Phone Number. 0 17.392-2333 Phone Number. 60&225�6901
ConlaalThe
Dept. UNIT 1:Water UNIT 2:GCW0r UNIT 3:storm UNIT 4,TPW Totals (Colandareay3)
Original Contract Amount $1,210,039.25 5323,034A0 5597,260,fi0 52,207,709.25 $4,539,731.40 650
i Extras to Dale
Credits to Dale
PoriclA Change Orders(in M&C Process)
Contract Cost loDale _51,210,039.26 $323,034.40 $697,260.60 $2,207,789.26 $4,339,731A0 550
Amount of Proposed Chan 0rder $11,000.00 $0.00 $0,00 $0.00 $11,000.00 07
Revised Contract Amount $1,221,0 99.26 $323,0 44.40 $597,260.60 $2,207,789.25 $4,360.731.40 667 —
Od $0,00 g.FundsAvailableforChangaOrders 530,325.00 $16,192.00 $52,6$0.00
.00
Re mainingFundsAvailableforthisCO $0.00 10.00 $0.00 $11,00000
Addilional Funding(If necessary) $11, 00000
e
CHANGE ORDERS to DATE(INCLUDING THIS ONE)AS%OF ORIGINAL CONTRACT 664./o
$5,424,664.26
JUSTIFICATION(REASONS)FOR CHANGE ORDER
Change Order No.1 will provide for the following:
o Cutting In a 24"x12"tee to an existing 24-Inch cast Iron water main on Clover Lane instead of
simply connecting the 12-Inch to the 24-Inch main as originally proposed.
o Pay Item quanUties for,sewer services that were not provided at the time the project was
advertised for bid.
o The deletion of pay Itern quantities that are no longer needed on the project.
Staff concurs with the contractor's request for 7 additional days on the project.
II is understood and agreed Thal Iho acceplance of This Change Order by ilia conlraclorconslilules on accord and salisfacllon and represents payment
in full(bolh time and money)for all costs arising out of,or Incidental lo,the aboveChange0rder,
Conlrar,I is Cam an Name Contractor Name "I n810 Dale
lendon ConslmeVonCompany,Inc. Justin Slalr ��/3 '2
McC
Inspector
Pro ec M age( Data
�ttT,�Az AK -/-i >Lo
Ireclor JMter Dept)
C Ifucllon S Isor W De I Dale
Assistant C11y Attorney Asslslanl Clly Manager Dale
— u123,2020
�S1'�'-++ no awghdorf( sl.
CouncilAcilon If re uired
M&CNumber NIA M&C Date Approved
Fc,a-r vViaR--F City of fort Worth
--_= _ Change Order Additions
Project Name 2010 Bond Conlracl 2 Cily Sec No. 53595
Project No,(s) 101121 DOE No. N/A Cily Pro.No, 101120
Project Full-depth reconstruction of Clever Land and W,Will Rogers Road Including concrete paving and waler,sanitary sewer and
Description storm sewerlmprovemenls.
Contractor McClendon Construction Company,Inc. Change Order or// 0 Dale;1 7l1012020
City Project Mgr. Scott Taylor/Greg Robbins City Inspector Troy Gardner
i
ADDITIONS
DE6CRIPTIO DEPT Qty Unit Unit Cost Total
33 9999.0000 Cut In 20"x 12"Tee UNIT 1;Water 1 1.00 EA $30,500.00 $38,600.00
22 3331.31014"Sewer Service(tinder concrete) UNIT 2:Sewer 15.00 EA $1,650.00 $24,750.00
I
i
UNIT 1:Water $38,600.00
UNIT 2;Sewer $24,750.00
UNIT 3:Storm
UNIT 4;TPW
Additions Sul)Total $63,250.00
Page 2 of 4
MV-0P,-cki City Of Fort Worth
Change Order Deletions
Project Name 2010 Bond Conlract 2 City Sec No. 53505
Project No,(s) 101121 71 DOE No. N/A City Pro.No. F 101120
Project Description Full-deplii reconstruction of Clover Land and W,Will Rogers Road including concrete paving and water,sanitary se n
and storm sower Improvements. I
Contractor McClendon Construction Company,Inc, Change Order It= Dale 7/10/2020 1
City Project Mgr. Scott TaylorlGreg Robbins City Inspector Troy Gardner
DELETIONS
ITEM DESCRIPTION DEPT _ dly Unit Unit Cost Total
11 3312,0107 Connection to Existing 20"Water Main UNIT 1:Water 1.0000 EA $27,500.00 $27,500.00
21 gg0g.0000 Construction Allowance UNIT 2:Sower 0.4050 LS $50,000.00 $24,760.00
i
I
UNIT 1:Water $27,500.00
UNIT 2:5ewer $24,750.00
UNIT 3:Storm
UNIT 4:TPW
Deletions Sub Total $52,250.00
Page 3 of 4
i
MIUUBE Breakdown for this Change Order
MWBE Sub Type of Service Amount for this CO
Total $0.00
Previous Change Orders
00# DATE AMOUNT
i
i
i
f
Total $0.00
I
i
I
B
k(
4
E
I
6
1
s p5
6
P
t
Contract Compliance Manager
By signing I acknowledge that]ain the Pei-son responsible
for the monitoring and administration of this contract,Including
enstuing all Pe"folmance,and reporting requirements.
Signature
Name ofBmployee
Title
ATTEST:
Mary J.Kayser
City Secretary
FORTWORTH
TRANSPORTATION AND PUBLIC WORKS
PIPE REPORT FOR:
PROJECT NAME: 2018 Bond Contract 2 Clover Lane&West Will Rogers Rd
PROJECT NUMBER: CPN101120
DOE NUMBER:
WATER
PIPE LAID SIZE TYPE OF PIPE LF
Ductile Iron 12" Ductile Iron Pipe 34.5 LF
C900 8" C900 PVC 358.5 LF
C900 6" C900 PVC 83 LF
FIRE HYDRANTS: 6 VALVES(16" OR LARGER) N/A
PIPE ABANDONED SIZE TYPE OF PIPE LF
DENSITIES: Passed
NEW SERVICES: N/A
SEWER
PIPE LAID SIZE TYPE OF PIPE LF
SDR-26 8" PVC 1195 LF
PIPE ABANDONED SIZE TYPE OF PIPE LF
N/A
DENSITIES: Passed
NEW SERVICES: N/A
TRANSPORTATION AND PUBLIC WORKS
�yi Es' The City of Fort Worth•1000 Throckmorton Street•Fort Worth,TX 76012-6311
s
(817)392-7941 •Fax: (817)392-7845
FORTWORTH.
TRANSPORTATION AND PUBLIC WORKS
July 26, 2021
McClendon Construction Company
548 Memorial Plaza
Burleson Tx 76028
RE: Acceptance Letter
Project Name: 2018 Bond Contract 2 Clover Ln &W Will Rogers Rd
Project Type: Water,Sewer, Paving &Stormwater
City Project No.: 101120
To Whom It May Concern:
On April 23, 2021 a final inspection was made on the subject project. There were punch list items
identified at that time. The punch list items were completed on July 1, 2021. The final inspection and
the corrected punch list items indicate that the work meets the City of Fort Worth specifications and is
therefore accepted by the City. The warranty period will start on July 1, 2021, which is the date of the
punch list completion and will extend of two (2)years in accordance with the Contract Documents.
If you have any questions concerning this letter of acceptance, please feel free to contact me at
gregory.robbins@fortworthtexas.gov.
Sincerely,
q`�R
Gergory Robbins, Project Manager
Cc: Steven Aguirre, Inspector
Ron Cordova, Inspection Supervisor
Edward Davila, Senior Inspector
Mary Hanna, Program Manager
Multatech Engineering,Inc, Consultant
McClendon Construction, Contractor
N/A, Developer
File
E-Mail: TPW_Acceptance@fortworthtexas.gov
i
Rev.8/20/19
Bond Number 'I10611787
CONSENT OF
SURETY COMPANY
TO FINAL PAYMENT
PROJ13M 2018 Bond,Contract 2 - \Hater,Sewer,Storm Drain,& Paving Improvements
(name.uddmiw)
TO(Owner)
City of Dort Wordi,Texas
CONTRACT FOR: Construction
1000 Throckmorton Dn've
Dort \North,'I'X 76108
CONTRACTOR: COA7RACT DAM
McClendon Construction Company, Inc. 1/14/21120
548 Memorial Plaza
lliirlre(%n'T\' 764114
In accordance with the provisions of the Contract between the Owner and the Contractor as
Indicated above.the(here insert mime and address of Surely Co.)
Merchants Bonding Company [Mutual]
PO Box 14498
Des ,Moines, IA 50306-3498 .SURETY COUPANY,
on goad of(here tnaart name and addren er comtractor)
McClendon Construction Company, Inc.
548 Memorial Plaza
Burleson,TX 70024 .CONTRACTOR
hereby approves of the final payment to the Contractor and agrees that final payment to the
Contractor shag not rollevo the Suroty Company of any of its obligations to(here ineart name and
address orOwner)
(;it%'of Dort\Vorth,Texas
1000 Throckmorton Drive
Port \North,TX 76108 »OWNRR.
as sot forth in the said Surety Company's Bond.
IN WITNESS WHEREOF. 'Muchants Bonding Company [\iutuall
the Suroty►Company has hereunto set Its hand th 12th day of Ju v 21�I 21
\ter nts Bondi C an Mutual
fld� S
Slynaluie dAuttwriod Represontailkv
Bctry 1. Re
Attorney-in-Fact
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,
Ana Tomes;Andrew Addison;Betty J Reeh;Bryan K Moore;Elizabeth Ortiz;Michael D Hendrickson;Patricia Ann Lyttle;Patrick Coyle
their true and lawful Attorney(syin-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 consent ng 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 Attomey-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 19th day of March 2021
.,.••Pt10%•°.., .••�t1G CO..
LPOR lr, A' q ;�9' MERCHANTS BONDING COMPANY(MUTUAL)
VQ '4!'':Z: . ��VO 9r,.y�• MERCHANT NATIONAL BONDING,INC.
-O- .�:•Z -0- 0� .�•
•�- •
2003 •:��� :y;• 1933 •=e: BY
•, ........'..� �. •�!y"*' \1. President
STATE OF IOWA ••°°'••+•rrr•+�°+,' •••••••••
COUNTY OF DALLAS ss.
On this 19th day of March 2021 before me appeared Larry Taylor,to me personalty 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.
POLLY MASON
0 Commission Number 750576 �t'Y�qMy Commission Expires pat�
January 07,2023 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,I have hereunto set my hand and affixed the seal of the Companies on this�2' day of
��.••PAto%•• •�1NG Cps••.
at. �: •���•
S 'Z" :"C. 1933 'C; Secretary
wp 2003 ;:�A; j :c,,•
.,•d .-• ;ate;: •••dew `1a•:
POA 0018 (1/20) °°"" •��•
MERCHANTS
BONDING COMPANY
IMPORTANT NOTICE
To obtain information or make a complaint:
You may contact your insurance agent at the telephone number provided by your insurance
agent.
You may call Merchants Bonding Company's toll-free telephone number for information or to
make a complaint at:
1-800-678-8171
You may contact the Texas Department of Insurance to obtain information on companies,
coverages, rights or complaints at:
1.800-252-3439
You may write the Texas Department of Insurance at:
P. O. Box 149104
Austin,TX 78714-9104
Fax: (512)475-1771
Web: http://www.tdi.state.tx.us
E-mail: ConsumerProtection@tdi.state.tx.us
PREMIUM AND CLAIM DISPUTES: Should you have a dispute concerning your premium or
about a claim you should contact the agent first. If the dispute is not resolved, you may contact
the Texas Department of Insurance.
ATTACH THIS NOTICE TO YOUR POLICY: This notice is for information only and does not
become a part or condition of the attached document.
SUP 0032 TX(1/09)
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 BJ Blair,Vice President of McClendon
Construction Company,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 there are no claims pending for personal injury and/or property damages;
On Contract described as;
CPN 101120—Clover Lane
By
Blair
Subscribed and sworn before me on this day of
�r 2oA
Justin K Blair
Notary Public,State of Texas Notary Public in Tarrant
Comm.Expires 02/05l2025 County, Texasof Notary ID 12929439-7