Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Contract 55049-FP1
FORT W0RTH@ TRANSPORTATION AND PUBLIC WORKS NOTICE OF PROJECT COMPLETION City Secretary No:_55049-FP1 Date Received: Feb 22,2022 City Project Ne: 102804 Regarding contract 55049 for HMAC Surface Overlay 2019-7 as required by the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by City Council on 11/10/2020 through M&C 20-0828 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: $ 850,650.00 Amount of Approved Change Orders: $ Ne 1 Revised Contract Amount: $ 850,650.00 Total Cost Work Completed: $ 610,326.61 Less Deductions: Liquidated Damages: 0 Days @$650.00/Day Pavement Deficiencies: Total Deduction Amount: $0.00 Total Cost Work Completed: $ 610,326.61 Less Previous Payments: $ 579,810.28 Final Payment Due $ 30,516.33 L�e�P�ceuY Lauren Prieur(Feb 22,2022 10:55 CST) Feb 22,2022 Recommended for Acceptance Date Asst. Director, TPW - Capital Delivery i WJ(Feb 22,2022 11.t CST) Feb 22,2022 Accepted Date Director, TRANSPORTATION AND PUBLIC WORKS DEPARTMENT Client Department 19ana Feb 22 2022 Asst. City Manager Date Comments: OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX C-620 Signature Page Contractor's Application for Payment Invoice No. 11-Final To(Owner) City of Fort Worth Invoicing Period(From-To): Invoice Date: 1/1/2022-2/7/2022 2/7/2022 P.O. FW020-0000004811 From(Contractor): Remit to(If Not Automatic Deposit): Number: Advanced Paving Ac uisiton LTD Project: 102804 ContractorsCFW Vendor No.: 0000023239 City Secretary Contract 55049 contract FDAAC Surface Overlay 2019-7 Number: Name: Application For Payment Change Order Summary Approved Change Orders 1. ORIGINAL CONTRACT PRICE........................................................ $ $850,650.00 Number Additions Deletions 2. Net change by Change Orders............................................................... $ 1 3. Current Contract Price(Line 1 t 2)...................................................... $ $850,650.00 2 4. TOTAL COMPLETED AND STORED TO DATE 3 (Progress Estimate,Construction Allowance and Change Orders)..... $ $610,326.61 4 5. RETAINAGE: 5 a.5.0% X Work Completed......... $ 6 b. X Not Used $ 7 c.Total Retainage(Line 5a+Line 5b).............................. $ 8 6. AMOUNT ELIGIBLE TO DATE(Line 4-Line 5c)........................... $ $610,326.61 TOTALS 7. LESS PREVIOUS PAYMENTS(Line 6 from prior Application)....... $ $579,810.28 NET CHANGE BY 8. AMOUNT DUE THIS APPLICATION............................................... $ $30,516.33 CHANGE ORDERS 9.BALANCE TO FINISH,PLUS RETAINAGE (Column G on Progress Estimate+CA+COs+Line 5 above)............. $ $240,323.40 Contractor's Certification 10. CONTRACT TIME: The Contractor certifies with the submittal of this document and associated Payment Request Submittal a. Days Awarded 180 on the City of Fort Worth Buzzsaw system that to the best of their knowledge:(1)all previous progress b, Days Added by CO 50 payments received from Owner on account of Work done under the Contract have been applied on C. Total Days 230 account to discharge Contractors legitimate obligations incurred in connection with Work covered by prior Applications for Payment;(2)title of all Work,materials and equipment incorporated in said Work or otherwise listed in or covered by this Application for Payment will pass to Owner at time of d, Days Charged 230 payment free and clear of all Liens,security interests and encumbrances(except such as are covered by a Bond acceptable to Owner indemnifying Owner against any such Liens,security interest or e. Days Remaining encumbrances);and(3)all Work covered by this Application for Payment is in accordance with the Contract Documents and is not defective. sA8V Z. � � Sam L.Garrett(Feb 21,2022 13:56 CST) This document has been modified from its original form as an EJCDC document and the user did not highlight the modifications.You are encouraged to read the document carefully and consult Legal Counsel prior to its execution. C 0 UP4 Pd.PrPBres.Es5T Progress Estimate 55049 Contractor's Application HMAC Surface Overlay 2019-7 Appl-i'N' , it-Final 'tBBum"°"P`doa 11u2022-2nt2022 ^wum"m'Dm` 2I7/1U22 A B C D E F �'° TaW Campk0d Y. B-Fv¢+M1 Bid Lem No. pnmiption SM+Gstiw Ur�i1o(Mennue Bid Q--q Unit Pnn VdVdue diry Vdu< PrmwalYSminlled Vdue Vdue)IvaPmad 5� � �y uW SmMlo Doe (F) (9-F) SMimi No. (D+E) B D1 7000 EA 1 Mo-SIDOOD REMOVE QNCPAVEMENT XES .4111 SY 400.000000 $00Do _ f]320000 __.._, --- _ S]3.WOOao .. ..._-._�.____....9899.0000 FLEX BASE. VMT 01411J 6Y 400000000 $60.00 _ - i$300000 _...._. _... ...._-- ___i1O00000 _ 4 3311.0122 FLE%BASE EA.OR-1 311115 LY _ 50000000 _$$7 D6 .__137.47500 ._.______,_ DOD Do 6 __.0212.1 00 r VE E PULVEENT,TYP of 4111 SY 1.500000000 _ 15 So b1J).4)500 1%31, 000000 11104fi504 $SIIO24S 5U4 f110_4fi50d 004% _$2)00`.89 6 3212.0302 C 6 PAVEMENT,TYPED 121216 BY 10260000000 155.00 E300.10000 15831p40000DO SW481611a E240870.43 __8346_8]0<3 BU.1%%_ $B11-- ) 32 .0800 CE E ODIFICATIO.201691ev J2II11 TN 2fi0.000000 $155.00 S40.J0000 20104000000 f]1161 WO .11 17 ]0 8$1.71110 ]]0%. _ $B 130.00 0 02 ]00 E O CONE CURB6OU ER MD. lF 2500.000000 $3.00 SB.00D DO 539O0000OO 1.-S8 7..17.9 __. 82.)1B 96 01,6 _ E6,B05)1 B 329002 •CO CCURB ANOOU E .4111 LF 1500.000000 _ E30.00 $13500OD 2424-0p000 $)617p Bp f)fi11080 $)6.17080 3-044% _ $.,-31 10 2 0 O CONE E 02411) „._6F 4500.000000 3300 513,50000 2424.23000000 __E].2]28B 1)3)Wfi9 _ 2S,406B 744% $D-20 .. _ -. .. -_ .... _- 11 9 P ESIDE J14113 6F 4500000000 $9.5D ."90000 M23D7000000 $10,460.01 E20.624,01 510.48001 21%%_ _ $a70BW0 .......__12.._ REMOVE SID 011111 fiF 1000.000000 $1.9$ S],B0000 M21 SS..0099 50614.98 80814.99 _. U,6249941 21L1% $0,73dB9 13__._._.3113. 1 ECONE SO J31J20 SF _ 1000.000000 DO $$160000 84(III-00000 Sd1J8d.41 E4130441 E42.304.41 31L1% _b2B104.41 Old1. 00 REMOVEC L LUTE ER 01411J SY _ _ SO C00000 _$]]00 „ - $L65000 89A4000000 51159.51 _ S2]50.62 _ _ E3.]50.52 116 B% 5600.51 IS 0216.0301 RE CO NC L OU ER 02 41 13 SY _ 2.Do.00 89]00_ _ $4.150 a 4.00a.O00D V.I.. $132G050'D8 _ ____,.. ,_.83_504_16 04_4% ____ $045_i0 16 _0241.0300 REMOVE RAMP o1411] EA _ 1o.D00o00 $I65.00 53.30000 800000000 S 32000 41320.G0 81,33000 400% S1,BB�.00 17 311.0601 BAR E EE RAMP.TYPE R-1 J21120 _ EA 5000000 $192500 5N6250D 600000000 8$1,925 0 f1t 55000_ __ „_511.550 C0 1000% 10 3230603 B E EE RAMP EM-1 32 U. EA 5000000 SLB15.00 $9.62500 1U0000000 S1 B3500 f1 B2500 S1_B2500 10.0%%__ S).70000 18 32 30604 FREE RAMP TYPE M-2 --_ _ - - _ _-_ --- ----321120 FA 5,.00000 11.B2500 SB,81600 _- f9,625B0 20 32 30609 FREE E - JJ 11 io _FA 5000000 $1,BBOOp EBB0000 T00000000 $130fi000 $13 Bfi0.00 _S1J96000 140.0% $396000 - - - - _-- _-__ ...- 01D.OJ S L EARINO 311000 SY. 200.006000 E110p E4,40000 5000000000 S1,00000 $moo- __ _ 51,10000 tt EJ,30000 21 TREE REMOVAL 311000 _.EA__ 0000000 $3.00000 E8,00000 200000000 5800000 Sfi 00000 SB 00000 100:0% 23 U CLASSIFIED C TO 112116 CY 60000000 $5000 3250D Do __ ... Do Do 2 OC 600 E C 329211 6Y 115D C00000 f9.00 $BB0000 85313000000 f)97807 $)fi1B01 $),8)B 0] )),6%_ f1210 B] 15 3217,0305 STOP BARS 4 331)21 LF 150000000 f10.00 $1,500.00 .._ SI:S000p 3217.00014'SOLID THERMOPLASTIC 331)23 lF 150.000D00 110_00 41.SOp Op _ _51.50D00 9117.000IE THERMOPLASTIC JJ I)21 17 IHA51 CENT-ER.R LINE LF 150.000000 ,SO Do 41,50000 _ _... _____ 321).0 L dLSNO LD WHITE THERMOPLASTIC(HAE) J )2 L O ID ..L_F..._......_.. 150.000000 __$10:00 E1,50000 ___ _ _ _ ............. ......_.___ ........._ .. _ f1.50000 19 33 T.600 CURBLLANE O J21J2J EA ... 16.000090 $50_00 5100000 .____... f1oP.900 30 3305.0108 MISCELLANEOUS S ES 110J 11 l3 Tomb 50,000.00 5600000 _88 D04.00 31 3306.0108 MISCELLANEOUS S US U US E 330514 �1000000 58,000.00 90990 - se,ggo po RISER WATER VALVE BO%AOJUSTMENT(WITH STEEL 110J 14 31 SE E4 000000p E150.00 E1.1000p .___...._ -... ...._._-_ _$1.10D 00 3]040112 WATER VALVE BOX ADJUSTMENT(WITH CONCRETE 3J os 14 33 ISE EA 0.00000. f25000 5200000 1500000000 fO]5D 00 $3)50.00 _. .__.$J_,7500p 187.5% ___S1i50.00 34 9]2.2003 STANDARD PLASTIC METER00 33 12 toUIO FA _4.000000 $25�.OD ._1000 DO oD 35____3 2003 ANDARD CONCRETE METERBO% 331210 FA d0000G0 WOOD __$15.000 ..__.._.... ........... -__- _--_.__ . ......_. 30 00%ADJUS MENT J]1210 FA 10000000 515000 lI.50000 100000000 f15900 i1500D f15000 f00% St,]50.00 3349.0107 MAN E ADJUSTMENT 31114 HOL 37_ _ EEEL IS EA 4.000000 $300 DO $1,20000 3306.0112 RETECE I-AF S MENT 11 OJ 1) 30 3305.0 8 MISC CLAN E4 4.00OOOp .__ f500.00 $200000 800000000 SJ.00000 f]00000 _ _ SJ.0000 1500%. _ $1.00000 3306.0103 MISCELLANEOUS STRUCTURE ADJUSTMENT 330514 JB I NLET TOPI EA 1.000000 51.50000 5250000 E2500_00 3306.0108 MISCELLANEOUS STRUCTURE ADJUSTMENT 3os 14 3 40il, iTO M A EA 1.000000 E350000 $J,50000 _ _. _.........._ _._.__.$3 Soo 00 41 9]B00 $` O ED SUBDRAINPIIW Jl n6o0 LF dO0000. _ ._ESpGO ,...,_$1,50000 42 999900% CO 9 RUCTION ALLOWANCE FA 1.000000 E50.O0000 3$0,00000 _.._.. 550000_00 T.I.I. 010f60.00 fe1002i.91 SHO N.St f10120.f1 )1 %% 11.0 20.40 rlW da..vW by b:m madi0ed 0®aa mi®�ul rmm mm rilclx domm�u wd Ou ua dW nol higFJigN IM1e modifiroimm.Tw me enmmePd b ned 0x dxmeN mrzrW ly cnd emmW l 1�Comuel Pim b is eamdimi City of Fort Worth Summary of Charges City Secretary Contract Num: 55049 HMAC Surface Overlay 2019-7 p,0.: FW020-0000004811 project Number: 102804 Application Period: 1/1/2022-2/7/2022 Application 11-Final Application Date: 2/7/2022 Number: - Funding Identification FID ___.. _..___ _ g ( ) � Total Com leted � Amt Remaining � Gross Retainage Net � Original Contract - -- -- -- ___ -- ---- - ---------------- 30100-0200431-5740010-102804-006280-9999 $610,326.61 $2401323.40 57cb DO 0 J.0 i 6,D0 D.uO 0 DD 0 nn n nD �D Do 0 �,n!q; 0 uu un o uu 0 nu un 0 i1(m o 0 0 OJ -�D 000 0') Du o o no oJw - Cha-rilpe Order 1 — - -- - - — -- — - — — 30100-0200431-5740010-102804-006280-9999 p ,P1 0 ti Crj ni 0 ;n o0 ;y.i ii5 ;ri DD ,'u] lilt) 0 nn 000 D� 0 30 �IJ I li 1,i1'1 o 0 0 0 0 DJu, D nq — --- —Change Order 2-- --- -- - . -- — - — — — 30100-0200431-5740010A02804-006280-9999 0 (C 0 Do 00 0 ou 'u; 0 J711 ni d0 SD U�� uq On 0 �[i Oii �.in" _D L'0 p ;C i ;Q pr 0 u u, aJ nu 0 "!�1�r� rn� �o o rn ��! �o u,� uo uu City of Fort Worth Summary of Charges City Secretary Contract Num: 55049 HMAC Surface Overlay 2019-7 P.0.: FW020-0000004811 Project Number: 102804 Application Period: 1/1/2022-2/7/2022 Application 11-Final Application Date: 2/7/2022 Number: Funding Identificatlon(FID) Total Completed Amt Remaining Gross Retainage Net Chan a Order 3 30100 0200431-5740010-102804-006280-9999 uu 0 0 p uu �,�ni i un nn a nn o �ur� un sua� uu,i oaun 0 u nu :�a nu 0 zu PI n,, o 0 1 1 0 0 I,nr, Chan eOrder4 30100-0200431-5740010-102804-006280-9999 uu o ut uu ui, ��J I ou o o o �.:i:; cry rin �u uu 0 rn;, �,.0 u,; �u 0 r o oil 0 I l uu J.uO( I I (IQ ] 'I, 0.01i 0 o uc I I ol_nu 1 I O en 1 u.uo 1,00 Change Order 5 30100 0200431-5740010-102804-006280-9999 'j III II J I,r o n(I rn, cn 0 o 0 -1 ri I o 0 o o ���,� ��,, �;,i�, nri c 0 rn, � U ri �,uu uu -------- --- -- — — - --- -— — -- — - I - ---- --- City of Fort Worth Summary of Charges City Secretary Contract Num: 55049 HMAC Surface Overlay 2019-7 p,0,: FW020-0000004811 project Number: 102804 Application Period: 1/1/2022-2/7/2022 Application 11-Final Application Date: 2/7/2022 Number: Funding Identificatlon(FID) Total Completed Amt Remaining Gross Retainage --I Net Chan a Order6 30100-0200431-5740010-102804-006280-9999 !cC Oi 0O.p;l .0 OC 00 On Q I!il l,;i;7 �,I,f':fl 0 uu n_nn u6 o o 00 P UOoq UI(U!I0J o )j Joc p.n: 1 pri Chan a Order 7 30100-0200431-5740010-102804-006280-9999 �i : � 0 eo 11 1 CC o o p 0 )C A% �'���( 1,W 0 C, I n; oC I I I 1 �,0) 0 C=�1 [ri nn I I �u nC u;� �n nu 01 0 Change Order 8 - —-- - —— —— ---- -- — ---- — 30100-0200431-5740010-102804-006280 9999 pi 0 1 �n� n; I an 1 Cuo p 0 0 F.iC,1 11, 0 � Ol i'r 0 C: 0 nn U, iii: C 0, 0 u� �.�u�, rs, no au f 0 0 n 0, 1 �•; urJ o o u --- — — — ---- ---— ---- - --— ---- -------_I 1-J, — - City of Fort Worth Summary of Charges City Secretary Contract Num: 55049 HMAC Surface Overlay 2019-7 P.0.: FW020-0000004811 Project Number: 102804 Application Period: 1/1/2022-2/7/2022 Application 11-Final Application Date: 2/7/2022 Number: Funding Identification(Fll)j 'total—Completed Amt Remaining [ Gross ReEainage Net _— Totals .------- 30100-0200431-5740010-102804-006280-9999 $610,326.61 $240.323.40 u0 Q.ui] G 00 0 a 0-1 n��n �r np 200 nn 0 ;n nn n� sun,; ,,,n�; n,00 o ur,1 un 0 a cn u 0 0+i t00n ou o ao 0 o u W, 0 o Grand Total $610.326.61 $240,323.40 $0.00 ($30,616.33)1 1 $30,516.33 FORTWORTH Routing and Transmittal Slip Transportation and Public Works Department DOCUMENT TITLE: Change Order#1 — HMAC Surface Overlay 2019-7 M&C 20-0828 CPN: 102804 CSO # 55049 DOC# CO#1 Date: 112712022 FM Department Initials Date Out To: Advanced Paving Acquisition Ltd ¢� Jan 28 2022 1. Sam Garrett(Contractor) b_garretKatadvancedpavingco.com 5� 5 2. Mark Khan (Inspector) TPW-Si nature i*— Jan 30,2022 3. Iretomiwa Otuyelu (PM) TPW-Si nature 4— Jan 31,2022 4. Riad Nursallah (PgM) TPW-Reviewer Jan 31,2022 5. Lane Zarate (Sr CPO) TPW-Reviewer Feb 1,2022 6. Lauren Prieur(AD) TPW-Signature - Feb 1,2022 7. William Johnson Director TPW-Signature Feb 1,2022 8. Doug Black (ACA) LAW-Signature Feb 2,2022 9. Dana Burghdoff(ACM) CMO-Signature Feb 3,2022 10. Jannette Goodall (CSO) CSO-Si nature Feb 3,2022 DOCUMENTS FOR CITY MANAGER'S SIGNTURE: All documents received from any and all City Departments requesting City Manager's signature for approval MUST BE ROUTED TO THE APPROPRIATE ACM for approval first. Once the ACM has signed the routing slip, David will review and take the next steps. NEEDS TO BE NOTARIZED: ❑ Yes X No RUSH: ❑ Yes X No SAME DAY: ❑ Yes X No NEXT DAY: ❑ Yes X No ROUTING TO CSO: ❑ Yes ❑ No Action Required: ❑ As Requested ❑ Attach Signature, Initial and Notary Tabs ❑ For Your Information X Signature/Routing and or Recording ❑ Comment f ❑ File Return to: Please call Iretomiwa Otuyelu at ext. for pick up when completed. Thank you. CSC No.55049-COl FOR T WORTH City of Fort Worth Change Order Request Project Name HMAC Surface Overlay 2019-7 City Sec# 55049 Client Project#(s) 102804 Project Description Street Rehabilitation of various segments at Brentmoor area Contracto Advanced Paving Acquisition LTD Change Order# 1 Dale 1/27/2022 City Project Mgr. Iretomiwa Otuyelu City Inspector Mark Khan Contract Time Dept. TPW Totals (CD) Original Contract Amount $850,650.00 $850,650.00 180 Extras to Dale Credits to Date Pending Change Orders(in M&C Process) Contract Cost to Date $850,650.00 $850,650.00 180 Go to ADD&DEL Tabs to Enter CO Backup $0.00 50 Revised Contract Amount $850,650.00 $850,650.00 230 Original Funds Available for Change Orders $0.00 Remaining Funds Available for this CO $0.00 Additional Funding(if necessary) CHANGE ORDERS to DATE(INCLUDING THIS ONE)AS%OF ORIGINAL CONTRACT 0.00% MAXALLOWABLE CONTRACTAMOUNT(ORIGINAL CONTRACT COST+25%) $1,063,312.50 JUSTIFICATION(REASONS)FOR CHANGE ORDER This Change Order is to add 50 calendar days to Construction Contract#55049. During the construction of this project,after all paving had been completed,there was enough money left in the contract to increase the quantity of side walks and ramps that needed repair at Terrell Ave.Approximately 4,400 sf of concrete sidewalks was added to the initial estimate of 2,000 sf.We used about 10 days for project administration,and 40 days to complete the extra work. 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. The Project/Program Manager signing below acknowledges that he/she is the person responsible for the monitoring and administration of this contract,including ensuring all performance and reporting requirements. Contractors Company Name Contractor(Name) Contract Signature Date I Advanced Paving Acquisition Ltd Sam Garrett s' p s Jan 28,2022 Inspector/Inspection Supervisor Date Project and Contract Compliance Manager Date Jan 30,2022 s ......... Jan 31,2022 Program Manager Date Senior Capital Project Officer Date Jan 31,2022 Feb 1,2022 Assistant Director(Dept) Date Director,Contracting Department(Dept) Date Feb 1,2022 — Feb 1,2022 Assistant City Attorney Date JAssistant City Manager Dale Feb 2,2022 4 Council Action(if required) M&C Number M&C Date Approved ATTEST:TAnneil'e S.GooAall Janne[te S.Goodall(Feb 3,lot]08:36 CST) Jannette Goodall,City Secretary Foer WORTH City of Fort Worth !'--- Change Order Additions Project Name I HMAC Surface Overlay 2019-7 City Sec# 55049 Client Project# 1 102804 Contractorl Advanced Paving Acquisition LTD PMJ retomiwa Otuyelu Inspecto Marc Khan Change Order Submittal# Date 1/27/2022 ADDITIONS ty Unit Unit Cost Total TPW $0.00 ST—Total Additions Change Order Additions Page 2 of 5 FORTNVOR'm City of Fort Worth Change Order Deletions Project Name HMAC Surface Overlay 2019-7 City Sec# 55049 Client Project# 102804 Contractor Advanced Paving Acquisftion LTD PM Iretomiwa Otuyelu Inspector Mark Khan Change Order Submittal# Date 1/27/2022 OELETICINS nit 1-10 CostTotal I I i I I I TPW $0.00 u ota a etwns Change Order Deletions Page 3 of 5 MISBE for this Change Order MISBE Sub Type of Service Amount for this CO Total $0.00 Previous Change Orders co# DATE AMOUNT Total $0.00 102804-CNCO-HMAC Surface Overlay 2019-7 Final Audit Report 2022-02-04 Created: 2022-01-28 By: Andrea Munoz(Andrea.Munoz@fortworthtexas.gov) Status: Signed Transaction ID: CBJCHBCAABAAiFOeB_ukuwDlwv1612RefgSQ6s6DdJ_I "102804-CNCO-HMAC Surface Overlay 2019-7" History Document created by Andrea Munoz(Andrea.Munoz@fortworthtexas.gov) 2022-01-28-8:06:28 PM GMT-IP address:209.194.29.100 C'y Document emailed to Becky Garrett(bgarrett@advancedpavingco.com)for signature 2022-01-28-8:09:31 PM GMT Email viewed by Becky Garrett(bgarrett@advancedpavingco.com) 2022-01-28-9:23:17 PM GMT-IP address: 18.206.199.142 6o Document e-signed by Becky Garrett(bgarrett@advancedpavingco.com) Signature Date:2022-01-28-10:44:16 PM GMT-Time Source:server-IP address: 12.178.156.194 C'y Document emailed to Mark Khan (mark.khan@fortworthtexas.gov) for signature 2022-01-28-10:44:18 PM GMT Email viewed by Mark Khan (mark.khan@fortworthtexas.gov) 2022-01-30-11:37:20 PM GMT-IP address:174.197.77.146 &0 Document e-signed by Mark Khan (mark.khan@fortworthtexas.gov) Signature Dat •2022-01-30 11:38:22 PM GMT- Time Source:server IP address: 174.197.77.146 Document emailed to I.S. iretomiwa.�. otu elu fortworthtexas. ov for signature ( Y @ g ) 9 2022-01-30-11:38:24 PM GMT Email viewed by I.S. (iretomiwa.otuyelu@fortworthtexas.gov) 2022-01-31-8:17:04 PM GMT-IP address:76.233.71.48 6© Document e-signed by I.S. (iretomiwa.otuyelu@fortworthtexas.gov) Signature Date:2022-01-31-8:17:58 PM GMT-Time Source:server-IP address:76.233.71.48 C'► Document emailed to Riad Nusrallah (Riad.Nusrallah@fortworthtexas.gov)for signature 2022-01-31-8:18:00 PM GMT FORTWORTH, I Adobe Sign Email viewed by Riad Nusrallah (Riad.Nusrallah@fortworthtexas.gov) 2022-02-01 -2:58:22 AM GMT-IP address:209.194.29.100 00' Document e-signed by Riad Nusrallah (Riad.Nusrallah@fortworthtexas.gov) Signature Date:2022-02-01 -2:59:20 AM GMT-Time Source:server-IP address:209.194.29.100 C'. Document emailed to Lane Zarate (Lane.Zarate@fortworthtexas.gov)for signature 2022-02-01 -2:59:22 AM GMT �4 Document e-signed by Lane Zarate (Lane.Zarate@fortworthtexas.gov) Signature Date:2022-02-01 -2:13:17 PM GMT-Time Source:server-IP address:75.19.6.67 P-4 Document emailed to Lauren Prieur(Lauren.Prieur@fortworthtexas.gov)for signature 2022-02-01 -2:13:19 PM GMT tj Email viewed by Lauren Prieur(Lauren.Prieur@fortworthtexas.gov) 2022-02-01 -2:39:49 PM GMT-IP address:108.209.194.42 6o Document e-signed by Lauren Prieur(Lauren.Prieur@fortworthtexas.gov) Signature Date:2022-02-01 -2:40:39 PM GMT-Time Source:server-IP address:108.209.194.42 P'4 Document emailed to WJ (William.Johnson@fortworthtexas.gov)for signature 2022-02-01 -2:40:41 PM GMT Email viewed by WJ (William.Johnson@fortworthtexas.gov) 2022-02-01-5:06:29 PM GMT-IP address:209.194.29.100 i SQ Document e-signed by WJ (William.Johnson@fortworthtexas.gov) Signature Date:2022-02-01 -5:07:18 PM GMT-Time Source:server-IP address:209.194.29.100 I C'� Document emailed to Priscilla Ramirez(Priscilla.Rami rez@fortworthtexas.gov)for approval I 2022-02-01 -5:07:20 PM GMT 7611 Email viewed by Priscilla Ramirez(Priscilla.Ramirez@fortworthtexas.gov) 2022-02-01 -5:52:20 PM GMT-IP address: 198.16.31.181 6p Document approved by Priscilla Ramirez(Priscilla.Rami rez@fortworthtexas.gov) Approval Date:2022-02-01 -5:52:45 PM GMT-Time Source:server-IP address: 198.16.31.181 E_4' Document emailed to DBlack(Douglas.Black@fortworthtexas.gov)for signature 2022-02-01 -5:52:47 PM GMT Email viewed by DBlack(Douglas.Black@fortworthtexas.gov) 2022-02-02-6:06:28 PM GMT-IP address:209.194.29.100 64 Document e-signed by DBlack (Douglas.Black@fortworthtexas.gov) Signature Date:2022-02-02-6:07:53 PM GMT-Time Source:server-IP address:209.194.29.100 FORTWORTH, - Adobe sign C'� Document emailed to Dana Burghdoff(Dana.Burghdoff@fortworthtexas.gov)for signature 2022-02-02-6:07:55 PM GMT Email viewed by Dana Burghdoff(Dana.Burghdoff@fortworthtexas.gov) 2022-02-03-1:33:55 PM GMT-IP address:45.29.184.169 64 Document e-signed by Dana Burghdoff(Dana.Burghdoff@fortworthtexas.gov) Signature Date:2022-02-03-1:37:08 PM GMT-Time Source:server-IP address:45.29.184.169 C'. Document emailed to Allison Tidwell (allison.tidwell@fortworthtexas.gov)for approval 2022-02-03-1:37:10 PM GMT "J Email viewed by Allison Tidwell (allison.tidwell@fortworthtexas.gov) 2022-02-03-2:32:47 PM GMT-IP address:47.24.14.100 dQ Document approved by Allison Tidwell (allison.tidwell@fortworthtexas.gov) Approval Date:2022-02-03-2:32:59 PM GMT-Time Source:server-IP address:47.24.14,100 Document emailed to Jannette S. Goodall Oannette.goodall@fortworthtexas.gov)for signature 2022-02-03-2:33:01 PM GMT Email viewed by Jannette S. Goodall Oannette.goodall@fortworthtexas.gov) 2022-02-03-2:36:32 PM GMT-IP address:66.169.118.105 6Q Document e-signed by Jannette S. Goodall 0annette.goodall@fortworthtexas.gov) Signature Date:2022-02-03-2:36:58 PM GMT-Time Source:server-IP address:66.169.118.105 P4 Document emailed to Vania Soto(Vania.Soto@fortworthtexas.gov)for filling 2022-02-03-2:37:00 PM GMT Email viewed by Vania Soto (Vania.Soto@fortworthtexas.gov) 2022-02-04-2:54:15 PM GMT-IP address:209.194.29.100 6� Form filled by Vania Soto(Van i a.Soto@fortworthtexas.gov) Form filling Date:2022-02-04-3:04:36 PM GMT-Time Source:server-IP address:209.194.29.100 Q Agreement completed. 2022-02-04-3:04:36 PM GMT i FORTWORTH. be,, i S Adobe sgn FORTWORTH. TRANSPORTATION AND PUBLIC WORKS February 18, 2022 Advanced Paving Co. 2311 Joel Field Rd. Dal laS,TX.75229 RE: Acceptance Letter Project Name: H MAC Surface Overlay 2019-7 Project Type: 03 City Project No.: 102804 To Whom It May Concern: On December21, 2021 a final inspection was made on the subject project. Therewere punch list items identified at that time. The punch list items were completed on January 7,2022. 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. Thewarranty period will start on January 7, 2022, which is the date of the punch list completion and will extend of two(2) years in accordancewith the Contract Documents. If you have any questions concerning this letter of acceptance, please feel free to contact me at 817- 392-6747. Sincerely, 'r I retomiwa Otuyelu(Feb 22,2022 10:51 CST) Iratomiwa S.Otuyelu, Project Manager Cc: Jonathan Maxwell, Inspector Wade Miller, Inspection Supervisor Ariel Duarte,Senior Inspector Riad Nursrallah, Program Manager N/A,Consultant Avanced Paving Co..,Contractor N/A, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev.8/20/19 AFFIDAVIT STATE OF Texas COUNTY OF Dallas Before me, the undersigned authority, a notary public in the state and county aforesaid, on this day personally appeared Sam L. Garrett, Owner Of Advanced Paving Company, known to me to be a credible person, who being by me duly sworn,upon his oath deposed and said; That all persons, firms, associations, corporations, or other organizations furnishing labor and/or materials have been paid in full; That the wage scale established by the City Council in the City of Fort Worth has been paid in full; That there are no claims pending for personal injury and/or property damages; On Contract described as; HMAC Surface Overlay 2019-7 BY Q Sam L. Garrett Subscribed and sworn before me on this date 7th of February, 2022. Nota ublic Dalli , Texas �fwv pie BECKY GARRETT Notary ID#3802638 My commission Expires +�aF October 11,2024 CONSENT OF OWNER ❑ SURETY COMPANY ARCHITECT ❑ CONTRACTOR ❑ TO FINAL PAYMENT SURETY ❑ Conforms with the American Institute of OTHER Architects,AIA Document G707 Bond No TXC612621 PROJECT: (name, addreSS)HMAC Surface Overlay 2019-7 Fort Worth TX TO (Owner) F ARCHITECT'S PROJECT NO: CITY OF FORT WORTH CONTRACT FOR: 1000 Throckmorton Street HMAC Surface Overlay 2019-7 Forlworth TX 76402 —J CONTRACT DATE: 11/10/2020 CONTRACTOR:ADVANCED PAVING CO. In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above,the there insert name and address of Surety Company) MERCHANTS BONDING COMPANY(MUTUAL) 6700 Westown Parkway West Des Moines IA 50266 , SURETY COMPANY on bond of {here insert name and address of Contractor} ADVANCED PAVING CO, 2311 Joe Field Rd. Dallas TX 75229-3326 , CONTRACTOR, hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve the Surety Company of any of its obligations to (here insert name and address of Owner) CITY OF FORT WORTH 1000 Throckmorton Street Fort Worth TX 76102 , OWNED, as set forth in the said Surety Company's bond, IN WITNESS,WHEREOF, the Surety Company has hereunto set its hand this 22nd day of December,2021 MERCHANTS BONDING COMPANY(MUTUAL) Surety Company Attest: &W�� (Seal): Signatu e of Authorized Representative So0inie Hunter _ _Attorney-in-Fact Title NOTE: This form Is to be used as a companion document to AIA DOCUMENT G706, CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS, Current Edition ONE PAGE E �rs 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 tailed the"Companies")do hereby make,constitute and appoint,individually, Don E Cornell;Josh Saunders; KellyA Westbrook;Mikaela Peppers;Ricardo J Reyna;Robbi Morales;Sophinie Hunter;Tina MCEwan;Tonie Petranek their true and lawful Attorney(s)-in-Fact, to sign its name as surety(ies) and to execute, seal and acknowledge any and all bands, 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-Atforney 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 consenting 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 Attorney-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 30th day of March 2021 iA 10 Nq4 to. O\NG Cqj `•� ' AO '. MERCHANTS BONDING COMPANY(MUTUAL) R9�•2"� �. O� a99 9y'� MERCHANTS NATIONAL BONDING, INC. v'•. 2003 ;�L7; •�•. 1933 d .•�. : a •ate,• 'I�'J.'•........•.• • • V'••. .. • -(( � •rJ .*• • '.'fly ' � �1••` President STATE OF IOWA ••�+''+•• ,,.,••'` '••...+'' COUNTY OF DALLAS ss. On this 301h day of March 2021 before me appeared Larry Taylor, to me personally 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. �PRtAc s POLLY MASON 0 Commission Number 750576 My Commission Expires ,O,flp 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 22nd day of December 2021 DIY.. ••...• .�P.00Nq�•., .•�1NG CN,,% � (>;40/�4 • Q'OyOVP0y9�9y�• o W 0.0 ' - �'`•_` iC' 8�'GY'aY vt� Fa'llyr`e!J" tv 2003 :y_ 933 Secretary POA 0018 (1/20) ` MERCHANis�k_ BONDING COMPANY. Wxtx ANTS uoWoImoc0wv^wT`muTUxu ' wIxcHawT3m/olowAcuow0/w(j, /nc ,z,. oox 14498 , D8 wo|wFS. |OwA.5[806-]4Y3 (800)678'8/71 ' FAX IMPORTANT NOTICE Have a complaint Q[ need help? |fyox have problem with a claim o,your premium,call your insurance company first. |f you can't work out the. issue,the Texas Department of Insurance may 6e able\o hc|p� Even ifYou file a COmplaint with the Texas Department of Insurance,you should also file a complaint or appeal through your insurance company. |f you don't'you may lose your right to appeal. Merchants Bonding Company (MNua|) To get information or file a complaint with your insurance company: Call:Compliance Officer ai8O0'678'D171 Toll-free: 1f80J-678'8171 Email: eUu|otory@amemhaNsbonding.com Mail:P.O. Box 14498, Des Moines, |ASU3O6'3498 To get insurance information you may also contact your agent: Call: Mail: The Texas Department ofInsurance To get help with an insurance question or file o complaint with the state: Call with a question: 1'Q0U'2S2-3439 File complaint:wwwtdi \exe Email: Mail: M[ 111-1A' P.U. Box 149091,Austin,TX?8714-9@91 SUP 0032T% (1i/10)