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Contract 56132-FP1
City Secretary 56132 FP1 Contract No. _ FORTWORTH. Date Received Nov 23,2021 NOTICE OF PROJECT COMPLETION (Developer Projects) The Transportation and Public Works Department upon the recommendation of the Project Manager has accepted the following project as complete: Project Name: DUTCH BROS COFFEE City Project No.: 103073 Improvement Type(s): Water ® Sewer IXI Original Contract Price: $111,984.03 Amount of Approved Change Order(s): Revised Contract Amount: Total Cost of Work Complete: $111,984.03 Tony D`aldone(Nov 22,2021 13:59 CST Nov 22,2021 Contractor Date Project Manager Title Tri Dal Utilities Company Name TR?0 Nov 22,2021 TRO(Nov 22,2021 14:14 CST) Project Inspector Date Vl'ctov V Tovnevo,7v.'E. Nov 22,2021 PrRject Manager Date e Scarlett Morales(Nov 23,202114:04 CST) Nov 23,2021 CFA Manager Date 21wa X * Nov 23 2021 Dana Baghdoff(Nov 23,202 14:44 Asst. City Manager Date Notice of Project Completion OFFICIAL RECORD CITY SECRETARY FT.WORTH,TX Project Name: DUTCH BROS COFFEE City Project No.: 103073 City's Attachments Final Pay Estimate 0 Change Order(s): ❑ Yes ® N/A Pipe Report: ® Yes ❑ N/A Contractor's Attachments Affidavit of Bills Paid Consent of Surety Statement of Contract Time Contract Time: 20 WD Days Charged: 5 Work Start Date: 9/28/2021 Work Complete Date: 11/19/2021 Completed number of Soil Lab Test: 13 Completed number of Water Test: 2 Page 2 of 2 FORT WORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name DUTCII BROS COFFEE Contract Limits Project Type WATER&SEWER City Project Numbers 103073 DOE Number 3073 Estimate Number 1 Payment Number 1 For Period Ending 11/22/2021 WD City Secretary Contract Number Contract Time 2WD Contract Date Days Charged to Date 5 Project Manager NA Contract is 100.00 Complete Contractor TRI DAL EXCAVATION&UTILITIES INC 540 COMMERCE ST SOUTHLAKF., TX 76092 Inspectors GLOVER / OVERSTREET Mondav,November 22,2021 Page 1 of 5 City Project Numbers 103073 DOE Number 3073 Contract Name DUTCH BROS COFFEE Estimate Number I Contract Limits Payment Number I Project Type WATER&SEWER For Period Ending 11/22/2021 Project Funding WATER Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total --------------------------------------- 1 8"DIP WATER 65 LF $120.00 $7,800.00 65 $7,800.00 2 8"WATER CARRIER PIPE 40 LF $69.00 $2,760.00 40 $2,760.00 3 20"CASING BY OTHER THAN OPEN CUT 40 LF $640.00 $25,600.00 40 $25,600.00 4 DUCTILE IRON WATER FITTINGS I TN $4,355.00 $4,355.00 1 $4,355.00 W/RESTRAINT 5 16"X 8"TAPPING SLEEVE&VALVE I EA $17,300.00 $17,300.00 1 $17,300.00 6 1"WATER SERVICE 2 EA $2,010.00 $4,020.00 2 $4,020.00 7 TRENCH SAFETY 65 LF $6.00 $390.00 65 $390.00 8 MEDIUM STONE RIPRAP,DRY 44 SY $52.07 $2,29L08 44 $2,291.08 9 UTILITY SERVICE SURFACE RESTORATION 66.67 SY $15.00 $1,000.05 66.67 $1,000.05 SODDING Sub-Total of Previous Unit $65,516.13 $65,516.13 SEWER Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total 1 8"DIP SEWER PIPE 159 LF $120.00 $19,080.00 159 $19,080.00 2 CONNECT TO EXISTING MANHOLE 1 EA $2,710.00 $2,710.00 1 $2,710.00 3 EPDXY MANHOLE LINER 3.67 VF $350.00 $1,284.50 3.67 $1,284.50 4 T SHALLOW MANHOLE I EA $4,220.00 $4,220.00 1 $4,220.00 5 POST CCTV INSPECTION 159 LF $3.00 $477.00 159 $477.00 6 MANHOLE VACUUM TESTING I EA $473.00 $473.00 1 $473.00 7 CONCRETE COLLAR I EA $150.00 $150.00 1 $150.00 8 CONCRETE ENCASEMAENT FOR UTILITY 44.02 CY $242.00 $10,652.84 44.02 $10,652.84 PIPES 9 4"SEWER SERVICE I EA $3,193.00 $3,193.00 1 $3,193.00 tO TRENCH SAFETY 159 LF $2.39 $380.01 159 $380.01 11 UTILITY SERVICE SURFACE RESTORATION 66.67 SY $15.00 $1,000.05 66.67 $1,000.05 SODDING 12 REMOVE SIDEWALK 250 SF $4.59 $1,147.50 250 $1,147.50 13 4"CONC SIDEWALK 64 SF $10.00 $640.00 64 $640.00 14 BORROW BY PLAN 66.25 CY $16.00 $1,0%00 66.25 $1,060.00 Mondav,November 22,2021 Page 2 of 5 City Project Numbers 103073 DOE Number 3073 Contract Name DUTCH BROS COFFEE Estimate Number I Contract Limits Payment Number I Project Type WATER&SEWER For Period Ending 11/22/2021 Project Funding Sub-Total of Previous Unit $46,467.90 $46,467.90 Mondav,November 22,2021 Page 3 of 5 City Project Numbers 103073 DOE Number 3073 Contract Name DUTCH BROS COFFEE Estimate Number I Contract Limits Payment Number I Project Type WATER&-SEWER For Period Ending 11/22/2021 Project Funding Contract Information Summary Original Contract Amount $111,984.03 Chan!e Orders Total Contract Price $111.984.03 Total Cost of Work Completed $111,994.03 Less %Retained $0.00 Net Earned $111,994.03 Earned This Period $111,984.03 Retainage This Period $0.00 Less Liquidated Damages Days @ /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 $111,984.03 Mondav,November 22,2021 Page 4 of 5 City Project Numbers 103073 DOE Number 3073 Contract Name DUTCH BROS COFFEE Estimate Number I Contract Limits Payment Number I Project Type WATER&SEWER For Period Ending 11/22/2021 Project Funding Project Manager NA City Secretary Contract Number Inspectors GLOVER / OVERSTREET Contract Date Contractor TRI DAL EXCAVATION&UTILITIES INC Contract Time 20 WD 540 COMMERCE ST Days Charged to Date 5 WD SOUTHLAKE, TX 76092 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 $1 11,984.03 Less %Retained $0.00 Net Earned $111,984.03 Earned This Period SI 11,984.03 Retainage This Period S0.00 Less Liquidated Damages 0 Days @ S0.00 /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 $1 11,984.03 Mondav,November 22,2021 Page 5 of 5 FORT WORTH. ' "o TRANSPORTATION AND PUBLIC WORKS November 19, 2021 Tri Dal Construction 540 Commerce St. Southlake,TX 76092 RE: Acceptance Letter Project Name: Water&Sanitary Sewer Extension To Serve Dutch Brothers Coffee Project Type: Water&Sanitary Sewer City Project No.: 103073 To Whom It May Concern: On November 19, 2021 a final inspection was made on the subject project. There were no punch list items identified at that time. The final inspection indicates that the work meets the City of Fort Worth specifications and is therefore accepted by the City. The warranty period will start on November 19, 2021,which is the date of the final inspection 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 682- 201-8448. Sincerely, VrcM,V Torwm-o L7v?E Victor Tornero, Project Manager Cc:Travis Overstreet, Inspector Randy Horton, Inspection Supervisor Mike Glover, Senior Inspector Victor Tornero, Program Manager Triangle Eng., Consultant Tri Dal Construction, Contractor Accelerated Development, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev.08/20/19 FORTWORTH TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PROJECT NAME: Dutch Brothers Coffee PROJECT NUMBER: 103073 DOE NUMBER: N/A WATER PIPE LAID SIZE TYPE OF PIPE LF WL-I 8' DIP 65' WL-1 8' PVC 40' FIRE HYDRANTS: N/A VALVES(16" OR LARGER) N/A PIPE ABANDONED SIZE TYPE OF PIPE LF N/A N/A N/A N/A DENSITIES: Yes NEW SERVICES: 1" Copper 2 (EA) SEWER PIPE LAID SIZE TYPE OF PIPE LF 0+00- 1+59 8" DIP 159 PIPE ABANDONED SIZE TYPE OF PIPE LF N/A N/A N/A N/A DENSITIES: Yes NEW SERVICES: 4" PVC 1 (EA) TRANSPORTATION AND PUBLIC WORKS CONTRACTOR'S AFFIDAVIT OF FINAL PAYMENT THE STATE OF TEXAS § § KNOW ALL MEN BY THESE PRESENTS: COUNTY OF TARRANT § BEFORE ME, the undersigned authority, on this day personally appeared Jason Biermeier ("Affidant"), who, after being by me duly sworn, deposes, and says that he is V.P. of Operations , a Limited Partnership (corporation, partnership, trade name) of Tarrant County, State of Texas (the "Contractor"), which said Contractor was awarded the contract dated end day of August , 200 2021, for the construction of Dutch Bros. TX0501 at Tarrant Parkway, Fort Worth,TX (the "Work"), for a total consideration of One Hundred Fourteen Thousand Eight Hundred Thirty-Six&00/100 Dollars to be paid to the said Contractor (the "Contract"), and that Affidant has full power of authority to make this affidavit. That DB Fort Worth Tarrant Investment LLC,dba Accelerated Development Services LLC (the "Owner") has approved the final pay estimate on said Work, and that the said Contractor has fully satisfied and paid any and all claims that may be covered by Chapter 53 of the Texas Property Code and Article 5160 of the Revised Civil Statutes of the State of Texas, or any other applicable statutes or charter provisions, and that all just bills for labor and materials have been paid and discharged by said Contractor insofar as they pertain to the work in question. That in addition to any funds which may have been previously paid by the Owner, the Contractor hereby accepts the amount of Eleven_Thousand Four Hundred Eighty-Three and 60/loo Dollars as FULL AND FINAL PAYMENT under the aforementioned Contract, and hereby waives and releases any right Affidant and/or the Contractor may have to pursue claims of any nature against the Owner arising out of or in any manner connected with the performance of the Work and/or the Contract, including but not limited to claims of third parties that supplied material and/or labor for the Work for or through the Contractor ("Subcontractors"), as well as claims for delay, additional compensation or for recovery of liquidated damages which may have been withheld by the Owner. The Contractor shall defend, hold harmless and indemnify the Owner from any such claims of such Subcontractors. The Contractor further releases the Owner from any claim or liability arising from any act or neglect of the Owner related to or connected with the Contract. This affidavit is given pursuant to the final payment rovisions of the Contract, and shall not be deemed to alter or modify the terms and provisions of sa Co7ifiq7L Tri D Ufd. By: ( ffidan) Ja n iermeier V.P. of Operations (Prin d am SUBSCRIBED AND SWORN TO BEFORE ME, this the 19th day of November q.n 2021 .�••�, PO 9 •• , y: [Notary Steal] (Nota Pu lic in an for the Stat o Texas) `y s R Ju S wberger by (Printed Name of Notary) •°�� s y F?�'•m � � °°• �, y My commission expires: 8-28-22 e$ 08-28.� �ares���9 CONTRACTOR'S AFFIDAVIT OF FINAL PAYMENT INVOICE N O . 5597 Page 1 PCL Contract Bonding Agency ACCOUNT N'O. OP DATE 1452 Hughes Rd,Suite 229 TRIDA-6 EL 11/19/2021 Grapevine,TX 76051 Payment& Performance Bond Phone: 972-459-4749 Fax: 972-459-4535 POLICY a LOAN# 107431892 21069-1 DUTCH COMPANY MFM Travelers Casualty and Surety PRODUCER Lesch Tri Dal Utilities Ltd. Eric � EFFECTIVE EXPIRATION RAI,ANCF,DI`-F.ON Accounts Payable 07/07/2021 09/03/2021 12/31/2021 540 Commerce St AMOE_NT PAID AMOUNT DUE Southlake,TX 76092 S 1 53 00 Itm # Due Date Trn Type Description Amount 9612 12/31/21 +EN PPB Dutch Bros Ft Worth Final $153 . 00 City of Fort Worth Final CP $114, 836 @ $25, 15/M + 2nd yr Maint @ $2 . 50, 2 . 25/M (1 Original) Invoice Balance: $153 . 00 Thank you for your business ! CONSENT OF OWNER x SURETY COMPANY ARCHITECT ❑ TO FINAL PAYMENT CONTRACTOR ❑ AIA DOCUMENT G707 SURETY ❑ OTHER ❑ Bond# 107431892 PROJECT:Dutch Bros Coffee-Public Water, Sewer,and Paving Improvements TO(Owner): CONTRACT FOR: Construction City of Fort Worth 1000 Throckmorton Street Fort Worth,TX 76102 CONTRACT DATE: CONTRACTOR: Tri Dal Utilities,Ltd. In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above,the Travelers Casualty and Surety Company of America One Tower Square Hartford,CT 06183 ,SURETY COMPANY, on bond of 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 City of Fort Worth 1000 Throckmorton Street Fort Worth,TX 76102 ,OWNER, As set forth in the said Surety Company's bond IN WITNESS WHEREOF, the Surety Company has hereunto set its hand this 19th day of November,2021. Travelers Casualty and Surety Company of America Surety ignatur of utho ' representative Attest: - - (Seal) Eric Lesch,Witness Felix Navejar Name Atntorney-In-Fact zC r W, A�� COWL AIA DOCUMENT G707 CONSENT OF SURETY COMPANY TO FINAL PAYMENT APRIL 1970 EDITId`iST�� ••• rI!' •. ©1970-THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVE.,NW,WASHINGTON,D.C. R��r��n����•,�•`'' Aak Travelers Casualty and Surety Company of America Travelers TRAY LERS Casualty and Surety Company St.Paul Fire and Marine Insurance Company POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS:That Travelers Casualty and Surety Company of America,Travelers Casualty and Surety Company,and St. Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut(herein collectively called the "Companies"),and that the Companies do hereby make,constitute and appoint Felix Navejar,of Grapevine,Texas,their true and lawful Attorney-in- Fact to sign,execute,seal and acknowledge any and all bonds, recognizances,conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons,guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF,the Companies have caused this instrument to be signed,and their corporate seals to be hereto affixed,this 3rd day of February, 2017. By:"AFffF4M ,4 Oman Robert L. Raney,Se or Vice Presidentase) State of Connecticut City of Hartford ss. On this the 3rd day of February,2017,before me personally appeared Robert L.Raney,who acknowledged himself to be the Senior Vice President of Travelers Casualty and Surety Company of America,Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, and that he,as such,being authorized so to do,executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. In Witness Whereof,I hereunto set my hand and official seal. My Commission expires the 30th day of June,2021 0 Man C.Tetreault,Notary Public This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Travelers Casualty and Surety Company of America,Travelers Casualty and Surety Company,and St.Paul Fire and Marine Insurance 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 power given 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 seal 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 Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance 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 remains in full force and effect. Dated this 19th day of November,2021. .°' Zo Kerins -Hughes,Ass tah4,ffieeretary T� To verify the authentidty of this Power ofAttorney,please call us at 1-80O X 80, Please refer to the above-mimed Attorney-in-Fad and the details of the bond to which t/rie +rry ,jX i lied.