HomeMy WebLinkAboutContract 52223-FP1 FORTWORTH CSC No. 52223-FP1
WATER DEPARTMENT
ENGINEERING AND FISCAL SERVICES
NOTICE OF PROJECT COMPLETION 5—9 b O ) — CO ) 8-2 q
cs s a �a,3
Regarding contract 52223 for Meadow Lakes Lift Station Sanitary Sewer Force Main Jenkin Heights Lift Station
as required by the Water Department as approved by City Council on 3-19-2021 through M&C C-2996 the Director
of the Water Department,upon the recommendation of the Sr. Capital Projects Officer, Capital Projects Delivery,Water
Department,has accepted the project as complete.
Original Contract Prices: $4,016,075.00
Amount of Approved Change Orders: $80,879.98 Ns 4
Revised Contract Amount: $4,096,954.98
Total Cost Work Completed: $4,029,685.98
Less Deductions:
Liquidated Damages: 0 Days @$630.00/Day
Other Deductions(see comments):
Total Deduction Amount: $0.00
Total Cost Work Completed: $4,029,685.98
Less Previous Payments: $3,848,271.55
Final Payment Due $181,414.43
5C) 0 9 ZU 1 12-
Recommended for Acceptance Date
Assistant Director, Water Department
Christopher 1-fa r
Christopher Harder(Sep 20,2021 16:17 CDT)
Accepted Date
Director, Water Department
Dana Burghdoff(Sep 20,20 17:00 CDT
City Manager Date
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Project Name: DOE. Ns:
Meadow Lakes Lift Station Sanitary Sewer Force Main Jenkin Heights Lift Station
Comments:
�RCoUI --co��aq
CS 5�a aa3
City Project Numbers 01829 DOE Number 1829
Contract Name Meadow Lakes Lift Station Sanitary Sewer Force Main,Jenkin Heights Lift S Estimate Number 35
Contract Limits Council District 7 Payment Number 35
Project Type Sewer For Period Ending 5/5/2021
Project Funding
Project Manager Domenech City Secretary Contract Number 52223
Inspectors Johnson / Reed Contract Date 3/19/2019
Contractor Mountain Cascade of Texas Contract Time 532 CD
11729 E FM 917 Days Charged to Date 660 CD
Alvarado, TX 76009 Contract is .000000 Complete
CITY OF FORT WORTH
SUMMARY OF CHARGES
Line Fund Account Center Amount Gross Retainage Net
Funded
Total Cost of Work Completed $4,029,685.98
Less 0 %Retained $0.00
Net Earned $4,029,685.98
Earned This Period $181,414.60
Retainage This Period $0.00
Less Liquidated Damages
0 Days @ $0.00 /Day $0.00
LessPavement Deficiency $0.00
Less Penalty $0.00
Less Previous Payment $3,848,271.38
Plus Material on Hand Less 15% $0.00
Balance Due This Payment $181,414.60
Wednesday,July 07,2021 Page 6 of 6
FORT WORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name Meadow Lakes Lift Station Sanitary Sewer Force Main,Jenkin Heights Lift Sta.
Contract Limits Council District 7
Project Type Sewer
City Project Numbers 01829
DOE Number 1829
Estimate Number 35 Payment Number 35 For Period Ending 5/5/2021
CD
City Secretary Contract Number 52223 Contract Time � lPG O
Contract Date 3/19/2019 Days Charged to Date 660
Project Manager Domenech Contract is 98.000 Complete
Contractor Mountain Cascade of Texas
11729 E FM 917
Alvarado, TX 76009
Inspectors Johnson / Reed
Wednesday,July 07,2021 Page 1 of 6
City Project Numbers 01829 DOE Number 1829
Contract Name Meadow Lakes Lift Station Sanitary Sewer Force Main,Jenkin Heights Lift S Estimate Number 35
Contract Limits Council District 7 Payment Number 35
Project Type Sewer For Period Ending 5/5/2021
Project Funding
Unit I S.S.Force Main
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
---------------------------------------
2 DUCTILE IRON WATER FITMGS 5 TN $4,000.00 $20,000.00
W/RESTRAINT
1 3331.4221 16"Sewer Force Main(CO#1) 6306 LF $197.00 .,242,282.00 6306 .1,242,282.00
2 3331.4310 21"Sewer Pipe 120 LF $118.00 $14,160.00 120 $14,160.00
3 3305.300616"Sewer Carrier Pipe(CO#1) 299 LF $191.00 $57,109.00 299 $57,109.00
4 3305.1106 36"Casing By Other Than O(CO#1) 299 LF $860.00 $257,140.00 299 $257,140.00
5 3125.0101 SWPPP >1 acre LS 1 LS $15,000.00 $15,000.00 1 $15,000.00
6 3305.0109 Trench Safety(CO#1) 6306 LF $1.00 $6,306.00 6306 $6,306.00
7 0241.3001 Sanitary Line Grouting of 325 CY $140.00 $45,500.00 325 $45,500.00
8 3201.0614 Perm.Cone Pvmt Repair,Re 6500 SF $15.00 $97,500.00 6500 $97,500.00
9 3201.0400 Temp.Asphalt Trench Repai 4500 LF $21.00 $94,500.00 4500 $94,500.00
10 3201.0113 Perm.Asphalt Trench Repair(CO#2) 0 LF $47.00 $0.00
11 3201.0201 Asphalt Pvmt Repair Beyond(CO#2) 0 SY $80.00 $0.00
12 3216.0101 6"Cone Curb and Gutter(CO#2) 0 LF $35.00 $0.00
13 3305.0202 Select Embedment/CSS 100 CY $120.00 $12,000.00 100 $12,000.00
14 3305.0202 Select Backcfill(to replac 4100 CY $32.00 $131,200.00
15 0330.0001 Concrete Encase Sewer Pipe 40 CY $170.00 $6,800.00 40 $6,800.00
16 3292.0200 Seeding,Broadcast(CO#1) 4486 SY $2.00 $8,972.00 4486 $8,972.00
17 3305.0110 Utility Markers 9 EA $200.00 $1,800.00 9 $1,800.00
18 3310.0102 6"-12"Tree Removal 3 EA $500.00 $1,500.00 9 $4,500.00
19 3110.0103 12"-18"Tree Removal 2 EA $700.00 $1,400.00 16 $11,200.00
20 3339.1001 4'Manhole 2 EA $6,800.00 $13,600.00 2 $13,600.00
21 0241.1118 4"-12"Pressure Plug 2 EA $2,200.00 $4,400.00 2 $4,400.00
22 3331.6103 4"Sewer Air Release Valve 2 EA $35,000.00 $70,000.00 2 $70,000.00
23 3331.0102 6"Sewer Pipe,Point Repa 10 EA $2,500.00 $25,000.00 10 $25,000.00
24 3331.0103 8"Sewer Pipe,Point Repa 10 EA $2,600.00 $26,000.00 10 $26,000.00
25 3331.0101 4"Sewer Pipe,Point Repa 10 EA $2,400.00 $24,000.00 10 $24,000.00
26 3331.3314 4"Sewer Service,Reinsta 3 EA $900.00 $2,700.00 1 $900.00
27 3339.0001 Epoxy Manhole Coating(4 f 12 VF $240.00 $2,880.00 12 $2,880.00
28 3331.4108 6"Sewer Pipe 500 LF $60.00 $30,000.00 500 $30,000.00
29 3331.4115 8"Sewer Pipe 500 LF $62.00 $31,000.00 500 $31,000.00
Wednesday,July 07,2021 Page 2 of 6
City Project Numbers 01829 DOE Number 1829
Contract Name Meadow Lakes Lift Station Sanitary Sewer Force Main,Jenkin Heights Lift S Estimate Number 35
Contract Limits Council District 7 Payment Number 35
Project Type Sewer For Period Ending 5/5/2021
Project Funding
30 9999.0000 Sewer Service Repair 10 EA $660.00 $6,600.00 10 $6,600.00
31 9999.0001 Odor Control Unit 2 EA $5,800.00 $11,600.00 2 $11,600.00
32 347 1.0001 Traffic Control 6 MO $5,000.00 $30,000.00 9.5 $47,500.00
33 3305.0115 Exploratory Excavation 29 EA $2,000.00 $58,000.00 35 $70,000.00
34 3301.0001 Pre-CCTV Inspection of Exi 2200 LF $7.00 $15,400.00 3239 $22,673.00
35 3301.0002 Post-CCTV Inspection of 16 6720 LF $1.00 $6,720.00 120 $120.00
36 3301.0003 Post-CCTV Inspection of21 120 LF $1.00 $120.00
37 9999.0002 Post-CCTV Inspection of Ex 2200 LF $1.00 $2,200.00
38 9999.0003 Construction Survey(As-bu 1 LS $1,500.00 $1,500.00 1 $1,500.00
39 9999.0004 Construction Staking 1 LS $6,000.00 $6,000.00 1 $6,000.00
40 9999.0005 Replace Existing Manhole a 1 LS $8,000.00 $8,000.00 1 $8,000.00
41 9999.0006 Headwall at Station 13+25, 1 LS $6,500.00 $6,500.00 1 $6,500.00
42 9999.0007 Construction Allowance(CO#1,2) 0.43915 LS $100,000.00 $43,915.00 0 $0.00
43 6"Cement Stabilization&3"Type D HMAC(CO#2) 4720 SY $43.00 $202,960.00 6827 $293,561.00
44 6"Curb and Gutter(Revised Price)(CO#2) 1984 LF $25.00 $49,600.00 1984 $49,600.00
45 DrivewayApproach(CO#2) 140 SY $135.00 $18,900.00 165 $22,275.00
46 ADARamp(CO#2)(CO#4) 0 EA $1,625.00 $0.00 0 $0.00
47 Relocate 8-inch Water line(CO#3) 1 LS $7,117.09 $7,117.09 1 $7,117.09
48 Excavate trench for electrical conduit(CO#4) 1 LS $4,277.89 $4,277.89 1 $4,277.89
49 ADA Ramp Type RI(CO#4) 9 EA $2,300.00 $20,700.00 9 $20,700.00
--------------------------------------
Sub-Total of Previous Unit $2,742,858.98 $2,680,572.98
Unit 11 S.S.Gravity Main
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
---------------------------------------
1 3331.4210 12"Sewer Pipe 150 LF $275.00 $41,250.00 170 $46,750.00
2 0241.2001 Sanitary line Grouting Aba 420 CY $140.00 $58,800.00 420 $58,800.00
3 3305.3004 12"Sewer Carrier Pipe 1100 LF $82.00 $90,200.00 1100 $90,200.00
4 3305.0109 Trench Safety 750 LF $1.00 $750.00 770 $770.00
5 3305.1104 24"Casing By Other Than O 1020 LF $810.00 $826,200.00 1020 $826,200.00
6 3305.1104 24"Casing for Aerial Cros 80 LF $250.00 $20,000.00 80 $20,000.00
7 3216.0101 6"Conc Curb and Gutter 30 LF $35.00 $1,050.00 79 $2,765.00
8 3201.0400 Temp.Asphalt Trench Repai 140 LF $21.00 $2,940.00
9 3201.0113 Perm.Asphalt Trench Repai 140 LF $47.00 $6,580.00
Wednesday,July 07,2021 Page 3 of 6
City Project Numbers 01829 DOE Number 1829
Contract Name Meadow Lakes Lift Station Sanitary Sewer Force Main,Jenkin Heights Lift S Estimate Number 35
Contract Limits Council District 7 Payment Number 35
Project Type Sewer For Period Ending 5/5/2021
Project Funding
10 3201.0201 Asphalt Pvmt Repair Beyond 200 SY $80.00 $16,000.00
11 3137.0102 Large Stone Riprap,Dry 24 22 SY $150.00 $3,300.00 22 $3,300.00
12 3292.0100 Block Sod Placement 50 SY $50.00 $2,500.00 50 $2,500.00
13 3339.1001 4'Manhole 4 EA $12,000.00 $48,000.00 5 $60,000.00
14 3339.1003 4'Extra Depth Manhole 79 VF $145.00 $11,455.00 79 $11,455.00
15 3339.1002 4'Drop Manhole 2 EA $11,400.00 $22,800.00 2 $22,800.00
16 3339.1101 5'Manhole 2 EA $12,200.00 $24,400.00 2 $24,400.00
17 3339.1005 5'Extra Depth Manhole 52 VF $190.00 $9,880.00 52 $9,880.00
18 3339.1102 5'Drop Manhole 1 EA $13,000.00 $13,000.00 1 $13,000.00
19 3339.0001 Epoxy Manhole Coating(4 f 32 VF $240.00 $7,680.00 115 $27,600.00
20 3339.0001A Epoxy Manhole Coating(5 45 VF $280.00 $12,600.00 70 $19,600.00
21 3305.0110 Utility Markers 3 EA $200.00 $600.00 3 $600.00
22 3201.0614 Conc Pvmt Repair,Resident 75 SF $15.00 $1,125.00 116 $1,740.00
23 3125.0101 SWPPP >1 acre 1 LS $5,000.00 $5,000.00 1 $5,000.00
24 3471.0001 Traffic Control 8 MO $2,500.00 $20,000.00 8 $20,000.00
25 3305.0115 Exploratory Excavation 1 EA $3,000.00 $3,000.00 1 $3,000.00
26 3301.0001 Pre-CCTV Inspection 1010 LF $7.00 $7,070.00 749 $5,243.00
27 3301.0002 Post-CCTV Inspection 1280 LF $1.00 $1,280.00 1280 $1,280.00
28 9999.0002 Construction Survey 1 LS $1,300.00 $1,300.00 1 $1,300.00
29 9999.0003 Construction Staking(As B 1 LS $1,500.00 $1,500.00 1 $1,500.00
30 9999.0004 Adjust Existing Piers and 2 EA $6,600.00 $13,200.00 2 $13,200.00
31 9999.0005 Connect to Existing Manhol 1 EA $3,300.00 $3,300.00 1 $3,300.00
32 9999.0006 Remove and Replace 12'Dra 1 LS $6,000.00 $6,000.00 1 $6,000.00
33 9999.0007 Decommission Jenkin Height 1 LS $30,000.00 $30,000.00 1 $30,000.00
34 9999.0008 Decommission Jenkin Height 1 LS $4,000.00 $4,000.00 1 $4,000.00
35 9999.0009 Decommission Lift Station 1 LS $5,000.00 $5,000.00 1 $5,000.00
36 9999.0010 Oncor Coordination to Disc 1 LS $1,530.00 $1,530.00 1 $1,530.00
37 9999.0011 Headwall Remove and Repla 1 LS $6,400.00 $6,400.00 1 $6,400.00
38 9999.0012 Construction Allowance I LS $50,000.00 $50,000.00
--------------------- ------------------
Sub-Total of Previous Unit $1,379,690.00 $1,349,113.00
--------------------------------------
Wednesday,July 07,2021 Page 4 of 6
City Project Numbers 01829 DOE Number 1829
Contract Name Meadow Lnkcs Lift SlationSanitaryScnecrPorcclvinin,knkin Heights URS Estimate Number 35
Contract Limits Council Districl7 Payment Number 35
Project Type Sewer For Period Ending 5/5/2021
Project Fun cling
Contract Information Summary
Origiunl Comlrnct Amount $4,016,075.00
Change Orders
Change Order Number 1 $63,410.00
Chnngc Order Number 2 $0.00
Change Order Number 3 $7,117.09
Change Onler Number 4 $10,352.89
Total Contract Price $4,42r34t}98 U,096,954.98
_ tc Total Cost of Work Completed $4,029,685.98
Coal Less 0 %Retained $0.00
;7--r Net Earned $4,029,685.98
Date 7—/
InspccdonSupervisor Earned This Period $181,414.60.43
� Z� � Retainage This Period $0.00
t.Do
Gl��fh�1/ D a t c ZZ Z� Less Liquidated Damages
Projccl Manager
Drays a /Day $0.00
WA Date LessPavemeut Deficiency $0.00
AssL DircclodrPW Less Penalty $0.00
CH✓istophe✓l�g✓ale✓ Less Previous Payment $3,898,27I.-M.55
christopherHar (L,,pzgzoziie:,,CDT) Date
Dircclor/Contrncling Deparmmcm Plus Material on Hand Less 15% $0.00
Balance Due This Payment $181,414.60.43
Wednesday,Jmly 07,2021 I'ngc 5 of 6
City of Fort Worth
Inspector's Estimate Worksheet
City Project Numbers 01829
Contract Name Meadow Lakes Lift Station Sanitary Sewer Force Mai DOE Number 1829
Contract Limits: Council District 7 Estimate Number 35
Project Type Sewer Payment Number 35
Control Number 182901 For Period Ending S /op/
Contract: 52223
Contract Date: 3/19/2019
Contract Time 532 CD
Inspectors Johnson Reed
Days Charged to Date 660 CD
/
Date Prepared by Inspector % / 7 Contract is %Complete
Construction ID: 12778
Item Description of Items Estimated Uni Unit Cost Previous Quanity Completed Total Cost
No. Quanity Quanity for Month Quanity
---------------------------------------
Unit I S.S. Force Main
2 DUCTILE IRON WATER 5 TN $4,000.00
FITTINGS W/RESTRAINT
1 3331.4221 16"Sewer Force 6306 LF $197.00 6306
Main(CO#1)
2 3331.4310 21"Sewer Pipe 120 LF $118.00 120
3 3305.3006 16"Sewer Carrier 299 LF $191.00 299
Pipe(CO#1)
4 3305.1106 36"Casing By Other 299 LF $860.00 299
Than O(CO#1)
5 3125.0101 SWPPP >_1 acre LS 1 LS $15,000.00 1
6 3305.0109 Trench Safety(CO#1) 6306 LF $1.00 6440
7 0241.3001 Sanitary Line Grouting 325 CY $140.00 325
of
8 3201.0614 Perm. Conc Pvmt 6500 SF $15.00 6500
Repair, Re
9 3201.0400 Temp.Asphalt Trench 4500 LF $21.00 4500
Repai
10 3201.0113 Perm.Asphalt Trench 0 LF $47.00
Repair(CO#2)
11 3201.0201 Asphalt Pvmt Repair 0 SY $80.00
Beyond(CO#2)
12 3216.0101 6"Conc Curb and 0 LF $35.00
Gutter(CO#2)
13 3305.0202 Select Embedment/ 100 CY $120.00 100
CSS
Wednesday,December 30,2020 Page 1
City of Fort Worth
Inspector's Estimate Worksheet
City Project Numbers 01829
Contract Name Meadow Lakes Lift Station Sanitary Sewer Force Mai DOE Number 1829
Contract Limits: Council District 7 Estimate Number 35
Project Type Sewer Payment Number 35
14 3305.0202 Select Backfill(to replac 4100 CY $32.00
15 0330.0001 Concrete Encase 40 CY $170.00 40
Sewer Pipe
16 3292.0200 Seeding, 4486 SY $2.00 4635
Broadcast(CO#1) -/`/ <�`/�'�o - d2
17 3305.0110 Utility Markers 9 EA $200.00 �, /P6U
18 3310.0102 6"-12"Tree Removal 3 EA $500.00 9
19 3110.0103 12"-18"Tree Removal 2 EA $700.00 16
20 3339.1001 4'Manhole 2 EA $6,800.00 2
21 0241.1118 4"-12"Pressure Plug 2 EA $2,200.00 2
22 3331.6103 4"Sewer Air Release 2 EA $35,000.00 2
Valve
23 3331.0102 6"Sewer Pipe, Point 10 EA $2,500.00 10
Repa
24 3331.0103 8"Sewer Pipe, Point 10 EA $2,600.00 10
Repa
25 3331.0101 4"Sewer Pipe, Point 10 EA $2,400.00 10
Repa
26 3331.3314 4"Sewer Service, 3 EA $900.00 1
Reinsta
27 3339.0001 Epoxy Manhole 12 VF $240.00 12
Coating(4 f
28 3331.4108 6"Sewer Pipe 500 LF $60.00 500
29 3331.4115 8"Sewer Pipe 500 LF $62.00 500
30 9999.0000 Sewer Service Repair 10 EA $660.00 10
31 9999.0001 Odor Control Unit 2 EA $5,800.00 2
32 3471.0001 Traffic Control 6 MO $5,000.00 9.5
33 3305.0115 Exploratory Excavation 29 EA $2,000.00 35
34 3301.0001 Pre-CCTV Inspection 2200 LF $7.00 3239
of Exi
35 3301.0002 Post-CCTV Inspection 6720 LF $1.00 120
of 16
Wednesday,December 30,2020 Page 2
City of Fort Worth
Inspector's Estimate Worksheet
City Project Numbers 01829
Contract Name Meadow Lakes Lift Station Sanitary Sewer Force Mai DOE Number 1829
Contract Limits: Council District 7 Estimate Number 35
Project Type Sewer Payment Number 35
36 3301.0003 Post-CCTV Inspection 120 LF $1.00
of 21
37 9999.0002 Post-CCTV Inspection 2200 LF $1.00
of Ex
38 9999.0003 Construction Survey 1 LS $1,500.00 1
(As-bu
39 9999.0004 Construction Staking 1 LS $6,000.00 1
40 9999.0005 Replace Existing 1 LS $8,000.00 1
Manhole a
41 9999.0006 Headwall at Station 1 LS $6,500.00 1
13+25,
42 9999.0007 Construction 0.43915 LS 100,000.00 0.25594
Allowance(CO#1,2) —,
43 6"Cement Stabilization&3"Type 4720 SY $43.00 6827
D HMAC(CO#2)
44 6"Curb and Gutter(Revised 1984 LF $25.00 1984
Price)(CO#2)
45 DrivewayApproach(CO#2) 140 SY $135.00 165
46 ADA Ramp(CO#2)(CO#4) 0 EA $1,625.00 0
47 Relocate 8-inch Water line(CO#3) 1 LS $7,117.09 1
48 Excavate trench for electrical 1 LS $4,277.89 1
conduit(CO#4)
49 ADA Ramp Type R1 (CO#4) 9 EA $2,300.00 9
estimated Total This Unit $2,742,858.98 Completed Total This Unit $2,704,798.98
—— --------- --------------
Construction ID: 12779
Item Description of Items Estimated Uni Unit Cost Previous Quanity Completed Total Cost
No. Quanity Quanity for Month Quanity
—— —— —— —— -------
Unit II S.S. Gravity Main
1 3331.4210 12"Sewer Pipe 150 LF $275.00 170
Wednesday,December 30,2020 Page 3
City of Fort Worth
Inspector's Estimate Worksheet
City Project Numbers 01829
Contract Name Meadow Lakes Lift Station Sanitary Sewer Force Mai DOE Number 1829
Contract Limits: Council District 7 Estimate Number 35
Project Type Sewer Payment Number 35
2 0241.2001 Sanitary line Grouting- 420 CY $140.00 420
Aba
3 3305.3004 12"Sewer Carrier Pipe 1100 LF $82.00 1100
4 3305.0109 Trench Safety 750 LF $1.00 770
5 3305.1104 24"Casing By Other 1020 LF $810.00 1020
Than O
6 3305.1104 24"Casing for Aerial 80 LF $250.00 80
Cros
7 3216.0101 6"Conc Curb and 30 LF $35.00 79
Gutter
8 3201.0400 Temp.Asphalt Trench 140 LF $21.00
Repai
9 3201.0113 Perm.Asphalt Trench 140 LF $47.00
Repai
10 3201.0201 Asphalt Pvmt Repair 200 SY $80.00
Beyond
11 3137.0102 Large Stone Riprap, 22 SY $150.00 22
Dry 24
12 3292.0100 Block Sod Placement 50 SY $50.00 �Q SG �SOO
13 3339.1001 4'Manhole 4 EA $12,000.00 5
14 3339.1003 4'Extra Depth Manhole 79 VF $145.00 79
15 3339.1002 4'Drop Manhole 2 EA $11,400.00 2
16 3339.1101 5'Manhole 2 EA $12,200.00 2
17 3339.1005 5'Extra Depth Manhole 52 VF $190.00 52
18 3339.1102 5'Drop Manhole 1 EA $13,000.00 1
19 3339.0001 Epoxy Manhole 32 VF $240.00 115
Coating(4 f
20 3339.0001A Epoxy Manhole 45 VF $280.00 70
Coating(5
21 3305.0110 Utility Markers 3 EA $200.00 ✓� ,3 00
22 3201.0614 Conc Pvmt Repair, 75 SF $15.00 116
Resident
23 3125.0101 SWPPP >_1 acre 1 LS $5,000.00 1
Wednesday,December 30,2020 Page 4
City of Fort Worth
Inspector's Estimate Worksheet
City Project Numbers 01829
Contract Name Meadow Lakes Lift Station Sanitary Sewer Force Mai DOE Number 1829
Contract Limits: Council District 7 Estimate Number 35
Project Type Sewer Payment Number 35
24 3471.0001 Traffic Control 8 MO $2,500.00 8
25 3305.0115 Exploratory Excavation 1 EA $3,000.00 1
26 3301.0001 Pre-CCTV Inspection 1010 LF $7.00 749
27 3301.0002 Post-CCTV Inspection 1280 LF $1.00 1280
28 9999.0002 Construction Survey 1 LS $1,300.00 1
29 9999.0003 Construction Staking 1 LS $1,500.00 1
(As B
30 9999.0004 Adjust Existing Piers 2 EA $6,600.00 2
and
31 9999.0005 Connect to Existing 1 EA $3,300.00 1
Manhol
32 9999.0006 Remove and Replace 1 LS $6,000.00 1
12'Dra
33 9999.0007 Decommission Jenkin 1 LS $30,000.00 1
Height
34 9999.0008 Decommission Jenkin 1 LS $4,000.00 1
Height
35 9999.0009 Decommission Lift 1 LS $5,000.00 1
Station
36 9999.0010 Oncor Coordination to 1 LS $1,530.00 1
Disc
37 9999.0011 Headwall Remove and 1 LS $6,400.00 1
Repla
38 9999.0012 Construction Allowance 1 LS $50,000.00
stimated Total This Unit $1,379,690.00 Completed Total This Unit $1,346,013.00
Wednesday,December 30,2020 Page 5
City of Fort Worth
Inspector's Estimate Worksheet
City Project Numbers 01829
Contract Name Meadow Lakes Lift Station Sanitary Sewer Force Mai DOE Number 1829
Contract Limits: Council District 7 Estimate Number 35
Project Type Sewer Payment Number 35
o� Total Itemized Amount(Including Change Order $4,122,548.98
i
DATE Total Cost of Work Completed ynf;9 ( 99
Inspector Less --.— %Retained �0 . /�/.
Net Earned 70
Previous Payment $3,848,271.38
Material on Hand 15%
Balance Due This Payment 0/n f8)
Wednesday,December 30,2020 Page 6
FoRTWORTH rcv 03/05/07
WATER ENGINEERING &FISCAL SERVICES
FINAL STATEMENT OF CONTRACT TIME
FINAL STATEMENT NO.:35
NAME OF PROJECT: Meadow Lakes Lift Station Sanitary Sewer Force Main
PROJECT NO.: 1829 CONTRACTOR: Mountain Cascade
CITY PROJECT pig y'
PERIOD FROM:12/16/20 TO: 05/05/21 FINAL INSPECTION DATE: 5/5/2021
WORK ORDER EFFECTIVE:7/15/2019 CONTRACT TIME: 532 Q WD QQ CD
DAY OF DAYS REASON FOR DAYS DAY OF DAYS REASON FOR DAYS
MONTH CHARGED CREDITED MONTH CHARGED CREDITED
DURING DURING
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 DAYS TOTAL
E
&HOLIDAYS &TOO COLD RLOCATIONS OTHERS* CHARGED DAYS
THIS 535 535
PERIOD
PREVIOUS 125 125
PERIOD
TOTALS 660 660
TO DATE
*REMARKS:
R DATE INSPECTOR DATE
Capital Projects Delivery,Water Department
The City of Fort Worth•1000 Throck morton Street•Fort Worth,TX 76012-6311
(817)392-4477 •Fax:(817)392-8460
FORTWORTH REV:02/20/07
Capital Projects Delivery, Water Department
PERFORMANCE EVALUATION OF CONTRACTOR
1) CONTRACTOR&PROJECT DATA
Name of Contractor Project Naive
Mountain Cascade Meadow Lakes Sanitary Sewer Force Main
Il'ater L•ngineering Inspector DOE Number
Jesse Reed 1829
Iflater Engineering Inspector Project dlanager
❑Water 0 Waste Water ❑Storm Drainage ❑ Pavement Walter Norwood
Initial Contract Amount Project Diffrcully
$4,122,548.98 0 Simple Routine 0 Complex
final Contract Amount Date
$3,848,271.38 7/7/2021
II)PERFORMANCE EVALUATION
0-Inndequnte l-Deficient 2-Standard 3-Good 4-Excellent
ELEMENT WEIGHT(x) APPLICABLE(Y/N) RATING(0-4) MAX SCORE SCORE
1 Submission of Documents 2 Y 3 8 6
2 Public Notifications 5 Y 3 20 15
3 Plans on Site 5 Y 4 20 20
4 Field Supervision 15 Y 3 60 45
5 Work Performed 15 Y 3 60 45
6 Finished Product 15 Y 3 60 45
7 Job Site Safety 15 Y 4 60 60
8 Traffic Control Maintenance 15 Y 4 60 60
9 Daily Clean Up 5 Y 4 20 20
10 Citizen's Complaint Resolution 5 Y 3 20 15
11 Property Restoration 5 Y 4 20 20
12 After Hours Response 5 Y 4 20 20
13 Project Completion 5 Y 3 20 15
TOTAL ELEMENT SCORE(A) 386
BONUS POINTS(25 Maximum)(B)
TOTAL SCORE(TS) 386
1I1)CONTRACTOR'S RATING
Maximum Score(MS)=448 or sum of applicable element score maximums which= 448
Rating(ITS/MS] * 100%) 386 / 448 = 86%
Performance Category Excellent
<20%=Inadequate 20%to<40%=Deficient 40%to<60%=Standard 60%to<80%=Good >_80%=Excellent
Inspector's Comments(INCLUDING EXPLANATION Or BONUS POINTS AWARDED)
Signature Inspector -- Signature Contractor
Signature Inspector's Supervisor
CONTRACTOR'S COMMENTS
Capital Projects Deliver},Water Department
The City of Fort Worth • 1000 Throckmorton Street•Fort V./orth,TX 76012-6311
(817)392-4477•Fax:(817)392-8460
FoRTWORTHREV:02/22/07
Capital Projects Delivery,Water Department
CONTRACTOR'S EVALUATION OF CITY
I)PROJECT INFORMATION Date: 7-Jul-21
Name of Conh•aclor Project Name
Mountain Cascade Meadow Lakes Sanitary Sewer Force Main
11"aler Engineering Lispeclor Project Hanger
Jesse Reed Walter Norwood
DOE Number Project Dii ficully Type of Contract
1829 1 0 Simple (0) Routine 0 n$3,848,271.38
❑Water 2Waste Water [IStorm Dralnage ❑Pavement
Inilial Contract Aniolml final Conlracl Amount
$4,122,548.98
II) PERFORMANCE EVALUATION
0-Inadequate 1 -Deficient 2-Standard 3 -Good 4-Excellent
ELEMENT RATING ELEMENT RATING
(0-4) (0-4)
INSPECTION EVALUATION PLANS&SPECIFICATIONS
I Availability of inspector I Accuracy of Plans to Existing Conditions L f
2 Knowledge of Inspector q 2 Clarity&Sufficiency of Details
3 Accuracy of Measured Quantities 4-3 Applicability of Specifications
4 Display Of Professionalism Li 4 Accuracy of Plan Quantities
5 Citizen Complaint Resolution L/ PROJECT MANAGER EVALUATION
6 Performance-Setting up Valve Crews, Labs Iq I Knowledge And/Or Problem Resolution
ADMINISTRATION 2 Availability ofProiectManager
1 Change Order Processing Time &-1 3 Communication
2 Timliness of Contractor Pa tnents Ll 4 Resolution of Utility Conflicts
3 Bid Opening to Pre-Con Meeting Tin effame
III)COMMENTS&SIGNATURES
COMMENTS
Signature Contractor `
Signature Inspector ---
Signature Inspector's Supervisor
INSPECTOR'S COMMENTS
Capital Projects Delivery,Water Department
The Cih,of Fort Worth•1000 Throckmorton Street•Fort Worth,TZ 76012-6311
(817)392-4477•Fax:(817)392-8460
CSC No.52223-CO5
FORT WORTH City of Fort Worth
Change Order Request
Project Name:1 Meadow Lakes Lift Station Sanitary Sewer Force Main City Sec No.: 1 52223
Project No.(s): 56016-0700430-CO1783 I DOE No. N/A City Proj.No.: 01829
The construction of the S.S.gravity main from Jenkin Heights Lift Slalon to Meadow Lakes Lift Station,the force main from Meadow
Project Description: Lakes Lift Station to east of Boat Club Rd.and the decommissioning of Jenkin Heights Lift Station.
Contractor: Mountain Cascade of Texas,LLC Change Order 4 L�J Date: 7/812021
City Project Mgr.1 waiter Norwood City Inspector: I Jesse Reed
Phone Number: 817-392-5026 1 Phone Number: 817-392-8362
Sewer Gravity Totals Contract Time
Dept. Sewer Force Main Main (Calender days)
Original Contract Amount $2,616,385.00 $1,379,690.00 $3,996,075.00 365
Extras to Date $80,879.98 $80,879.98 167
Credits to Dale
Pending Change Orders(in M&C Process)
Contract Cost to Date $2,697,264.98 $1,379,690.00 $4,076,954.98 532
Amount of Proposed Change Order $0.00 $0.00 $0.00 128
Revised Contract Amount $2,697,264.98 $1,379,690.00 $4,076,954.98 660
Original Funds Available for Change Orders $159,843.00 $159,843.00
Remaining Funds Available for this CO F $78,963.02 $78,963.02
Additional Funding(if necessary)
CHANGE ORDERS to DATE(INCLUDING THIS ONE)AS%OF ORIGINAL CONTRACT 2.02%
MAX ALLOWABLE CONTRACT AMOUNT(ORIGINAL CONTRACT COST+25%) $4,995,093.75
JUSTIFICATION(REASONS)FOR CHANGE ORDER
Change Order No.5 will provide an additional 128 calendar days on the project due to the following:
• The time it took for grass seed to become established.
• The time it took to remove debris and re-tv a newly installed sewer main that initially appeared to have a sag
in it.
• The time it took to reconstruct an existing sewer service line that was originally constructed from the center
of a residence,across a driveway and underneath a storm drain curb inlet before connected to the project
sewer main.
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.
Contractor's Company Name Contractor Name nt a D to
Mountain Cascade of Texas,LLC Andy McCulloch 2
Inspector Dale Pro' ct Man@ Date
Director(Water Dept) Date Construction Super/vlisor Watar
Dept)
et / Dates}
u112,2021
Assistant Cl Attorney Date Assistant City Manager Date
Seely, iJut 19,202u IJut2l,2021
Council Action If Required)
M&C Number NIA M&C Date Approved
FaRT We Riz—r f City of Fort Worth
Change Order Additions
Project Name Meadow Lakes Lift Station Sanitary Sewer Force Main City Sec No.: 52223
Project No.(s): 56016-0700430-CO1783 DOENo.[:= City Proj.No.: 01829
Project The construction of the S.S.gravity main from Jenkin Heights Lift Staton to Meadow Lakes Lift Station,the force main
Description from Meadow Lakes Lift Station to east of Boat Club Rd.and the decommissioning of Jenkin Heights Lift Station.
Contractor Mountain Cascade of Texas,LLC Change Order:= Date: 7/8/2021
City Project Mgr. Walter Norwood City Inspector Jesse Reed
ADDITIONS
:ITEM �JQRDEPT.. _ Qty. Umf UnitGost - Total'=°;
i
i
i
f�
6
b
Sewer Force Main
Sewer Gravity Main
Page i or 1 Additions Sub Total
FORT -VTO12TH City of Fort Werth
Change Order Deletions
Project Name Meadow Lakes Lift Station Sanitary Sewer Force Main 1 City Sec No.: 52223
Project No.(s): 56016-0700430-CO1783 DOE No. N/A City Proj.No.: 01829
Project Description The construction of the S.S.gravity main from Jenkin Heights Lift Staton to Meadow Lakes Lift Station,the force
main from Meadow Lakes Lift Station to east of Boat Club Rd.and the decommissioning of Jenkin Heights Lift
Contractor Mountain Cascade of Texas, LLC Change Order: F 57] Date 7/8/2021
City Project Mgr. Walter Norwood City Inspector: Jesse Reed
DELETIONS
ITEM` DESCRIPTION DEPT 4ty Unit Unit Cost Total
i 4
I
� I
j I
I I
I
I �
C °
�i
I
Sewer Force Main
Sewer Gravity Main
Page 1 of 1 Deletions Sub Total p
f
I.
1
MMBE Breakdown for this Change Order
MWBE Sub _, TYpe=of Service Amount for this;CO .
Total $0 00
Previous Change Orders
co# = DATE AMOUNT
i
Total $0 00 1
i
f
i
I
ii
,i
Page 1 of 1 i
J
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 repordngrequirements.
sigaature
l�r� �✓ klly1-Jd70 CP
Name of Employee
Title
ATTEST:
RoscaCiJ P. 21,Ic2�
Ronald Gonzales
Acting City Secretary
G
r V!
i
ii
• G
f
ur
f
FORT WORTH
July 07,2021
Mountain Cascade of Texas,LLC
11729 East FM 917
Alvarado,TX 76009
Re:Acceptance Letter
Project Name: Meadow Lakes Sanitary Sewer Force Main,Jenkin Heights Lift Station Decommissioning
Project Type: Sewer
Project Ns: 01829
DOE. Ns: N/A
Contract Ns: 52223 Dated 3/19/2019
Gentleman:
On May 05,2021 a final inspection was made on the subject project. There were punch list items identified at
the time. The punch list items were completed on May 11,2021. 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 May 11,2021,which is the date of punch list completion and will extend
for(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 (817) 392-6054
Yours Truly,
loP'J
Tony Sholola,P.E.,Assistant Director,Water Department
TS /
cc: Chris Harder,P.E.,Director,Water Department
Laura Wilson,P.E.,Deputy Director,Water Department
Captain Michael Skains,Fire Department
Bill Lundval,Sanitary Sewer Systems Superintendent,Water Department
Cesar Zavala, Water Systems Superintendent,Water Department
Walter Norwood,P.E.,Project Manager
David R Johnson,Inspection Supervisor, Capital Projects Delivery,Water Department
Jesse Reed,Inspector,Capital Projects Delivery,Water Department
George Farah,P.E.,API,Consultant
Mountain Cascade of Texas,LLC,Contractor
File
WATER DEPARTMENT
ENGINEERING AND FISCAL SERVICES
THE CITY OF FORT WORTH * 1000 THROCKMORTON STREET * FORT WORTH, TEXAS 76102
817-392-8240 * FAx 817-392-8195
Q* Printed on recycled paper
FORTWORTH
WATER ENGINEERING& FISCAL SERVICES
PIPE REPORT FOR:
PROJECT NAME: Meadow Lakes Sanitary Sewer Force Main
PROJECT NUMBER: 1829
DOE NUMBER: 1829
WATER
PIPE LAID SIZE TYPE OF PIPE LF
FIRE HYDRANTS: VALVES(16" OR LARGER)
PIPE ABANDONED SIZE TYPE OF PIPE LF
DENSITIES:
NEW SERVICES:
SEWER
PIPE LAID SIZE TYPE OF PIPE LF
Force Main 16" PVC 6306
Force Main 21" PVC 120
Force Main 361' Steel Casing 299
SEWER 6" PVC 500
SEWER 8" PVC 500
SEWER 12" PVC 150
PIPE ABANDONED SIZE TYPE OF PIPE LF
Jenkin Heights Lift Station
DENSITIES:
NEW SERVICES:
WATER ENGINEERING&FISCAL SERVICES
The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TX 76012-6311
(817)392-4477•Fax: (817) 392-8460
Bond No. 070208556
CONSENT OF OWNER ❑
SURETY COMPANY ARCHITECT ❑
TO FINAL PAYMENT CONTRACTOR ❑
SURETY ❑
OTHER ❑
PROJECT:
Meadow Lakes Sanitary Sewer Force Main,Jenkin Heights Lift Station Decommissioning,City Project No.:01829
TO: City of Fort Worth
200 Texas Street ARCHITECT'S PROJECMeadow T NO.:akes anitary Sewer Force
CONTRACT FOR:Main.Jenkin Heights Lift Station
Fort Worth,TX 76102 Decommissioning,city Project No.:01829
CONTRACT DATE
CONTRACTOR: March 21, 2019
Mountain Cascade of Texas LLC
In accordance with the provisions of the Subcontract between McCarthy and the Subcontractor as indicated above,the
Liberty Mutual Insurance Company SURETY COMPANY
on bond of 175 Berkeley Street,Boston,MA 02116
Mountain Cascade of Texas LLC SUBCONTRACTOR,
11729 East FM 917,Alvarado,TX 76009
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 City of Fort Worth
200 Texas Street OWNER,
Fort Worth,TX 76102
as set forth in the said Surety Company'
IN WITNESS WHEREOF,
the Surety has hereunto set its hand this 18th day of May 2021
Liberty Mutual Insurance Company
Surety
By: 0-166-
Signature of Authorized Repres ntative
Attest: Ch ran Porydzy,Witne
Alexis Apostolidis,Attorney-in-Fact
Title
(Seal):
NOTE: This forms is to be used as a companion document to AIA DOCUMENT G706,CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS AND
CLAIMS,Current Edition.
surety.doc-12/1/94
NOTARY ACKNOWLEDGMENT OF SURETY:
State of Connecticut
County of Hartford ss.
On this the lath day of May 20 21 ,before me, Timothy S. Huffman,the
undersigned officer, personally appeared AlexisApostoridis , known to me
(or satisfactorily proven) to be the person whose name is subscribed as Attorney-In-Fact
for Liberty Mutual Insurance Company ,and acknowledged that
s/he executed the same as the act of his/her principal for the purposes therein contained.
In witness whereof 1 hereunto set my hand.
TIMOTHY S. HUFFMAN
NOTARY PUBLIC-CT 183092
�Q My Commission apires Feb.28,2026
Signature of Notary Public
Date Commission Expires: February 28,2026
Timothy S. Huffman
Printed Name of Notary
This Power of Attorney limits the acts of those named herein,and they have no authority to bind the Company except in the manner and to the extent herein stated.Not
valid for mortgage,note,loan,letter of credit,bank deposit,currency rate,interest rate or residual value guarantees.For bond andlor Power of Attorney(PDA)verification
inquiries,please call 610-832.8240 or email HOSUR@libertymutual.com.
Liberty Liberty Mutual Insurance Company
The Ohio Casualty Insurance Company
10�Mutual. West American Insurance Company
SURETY POWER OF ATTORNEY
KNOWN ALL PERSONS BY THESE PRESENTS:That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire,that Liberty
Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts,and West American Insurance Company is a corporation duly organized under
the laws of the State of Indiana(herein collectively called the"Companies'),pursuant to and by authority herein set forth,does hereby name,constitute and appointAlexis Aoostolidis
of the city of San Francisco ,stale of CA its true and lawful attorney-in-fact,with full power and authority hereby conferred to sign,execute and acknowledge the following
surety bond:
Principal Name: Mountain caccadg9f Texas-.LC
Obligee Name: City of Fort Worth
Surety Bond Number: 070208566 Bond Amount: See Bond Form
IN WITNESS WHEREOF,this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed
thereto this 12r day of March,2021.
�JP o eo Rq! ost,,p9y \�N%Nsuk4 The Ohio Casually Insurance Company
Liberty Mutual Insurance Company
Wes mencan Insurance Company
1912 —x 1919 3 1991
b 2 N vR�
a d =
��2 3 /M01ANP � By; �
* * * David V'Carey,Assistant Secretary
STATE OF PENNSYLVANIA ss
COUNTY OF MONTGOMERY
On this 1211 day of March,2021,before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance Company,The
Ohio Casualty Company,and West American Insurance Company,and that he,as such,being authorized so to do,execute the foregoing instrument for the purposes therein contained
by signing on behalf of the corporations by himself as a duly aulhodzed officer.
IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at Kirin of Pnrssfa.Pennsvivania.on the day and vear first above written.
�Sp.
onw 4rF Commonwealth of Pennsylvania-Notary Seal
F <y Teresa Pastella,Notary Public
OF Montgomery County By;
My commission expires March 28,2025 Teresa Pastella,Notary Public
yA�y�VP���o Commission number 1126044
�4qy pUe� Member.Pennsylvania Association of Notaries
This Power of Atforn Is-made and executed pursuant to and by authority of the tollowrng By-laws and Authonzahons of Liberty Mutual Insurance Uompany,I he Uhio Uasuafty Insurance
Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows:
ARTICLE IV—OFFICERS—Section 12.Power of Attorney.Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President,and
subject to such limitation as the Chairman or the President may prescribe,shall appoint such attomeys-in-fact,as may be necessary to act in behalf of the Corporation to make,execute,
seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Such attorneys-in-fact,subject to the limitations set forth in their
respective powers of attorney,shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation.
When so executed,such instruments shall be as binding as if signed by the President and attested to by the Secretary.Any power orauthodty granted to any representative or attorney-
in-fact under the provisions of this artide may be revoked at any time by the Board,the Chairman,the President or by the officer or officers granting such power or authority.
ARTICLE XIII—Execution of Contracts—SECTION 5.Surety Bonds and Undertakings.Any officer ofthe Company authorized for that purpose in writing by the chairman or the president.
and subject to such limitations as the chairman or the president may prescdbe,shall appoint such adomeys4n-fact,as may be necessary to act in behalf of the Company to make,execute,
seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Such attomeys4n-fact subject to the limitations set forth in their
respective powers of attorney,shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When
so executed such instruments shall be as binding as if signed by the president and attested by the secretary.
Certificate of Designation—The President of the Company,acting pursuant to the Bylaws of the Company,authorizes David M.Carey,Assistant Secretary to appoint such attomeys-in-
fact as may be necessary to act on behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety
obligations.
Authorization—By unanimous consent of the Company's Board of Directors.the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the
Company,wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds,shall be valid and binding upon the Company with
the same force and effect as though manually affixed.
I,Renee C.Llewellyn,the undersigned,Assistant Secretary,of Liberty Mutual Insurance Company,The Ohio Casualty Insurance Company,and West American Insurance Company
do hereby certify that this power of attorney executed by said Companies 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 18th day of May 2D21
JP�%Hsu.?A JP�ZY INStj `PNINSUggN
���oavo/ylq'r� �eg3ooxvoryr�yrm �����oMo2jr�� /j �
o iY.ftiC
0
1912 � 3 = 1919 3 N 1991 a By. �^ f
Ch ab y c�yb y 2 Renee C.Llewellyn,Assistant Secretary
mom)9-rSACHUS` �_ �.'�yHAM�'� !2 yi /ry01ANP t
AFFIDAVIT
STATE OF TEXAS
COUNTY OF JOHNSON
Before me, the undersigned authority, a notary public in the state
and county aforesaid, on this day personally appeared Andrew L.
McCulloch,Vice President Of Mountain Cascade of Texas, LLC,known
to me to be a credible person, who being by me duly sworn, upon his oath
deposed and said;
That all persons, firms, associations, corporations, or other
organizations furnishing labor and/or materials have been paid in full;
That the wage scale established by the City Council in the City of
Fort Worth has been paid in full;
That there are no claims pending for personal injury and/or
property damages;
On Contract described as;
Meadow Lakes Lift Station Sanitary Sewer Force Main,Jenkins Heights
Lift Station Decommissioning
BY
Andre . McCulloch, Vice President
SubscribeILJ
orn before me on this date 12th of May,2021.
ro SUE E p A
WAND JARRELL
�s Notary public,State of Texs a
9 'c Comm.Ex fires P 06-29-2024
;JhInssounty,
bliC n°ii�`��� Notary ID 11962407
Texas