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Home My WebLink AboutContract 44850-FP1 (2)FORTWORTH� TRANSPORTATION AND PUBLIC WORgS NOTICE OF PROJECT COMPLETION 7` C�s��r��^,� � � � ��,. ;�5�1 l� i- I I D.O.E. Ns: 7074 `t �f SSa Regarding contract 8z��32 for HMAC SURFACE OVERLAY (2013-]3) as required by the TItANSPORTATION�.ND PUBLIC WORKS DEPARTMENT as approved by Ciry Council on 09/10/2013'� through M&C C-26429 the director of the TRE�.I�TSPORTATION AND PUBLIC WORBS DEPARTMENT upon the recommendation of the Assistant Diuectot of the Transportation & Public Works Depattment has accepted the project as complete. Original Contract Prices: Amount of Approved Change Orders: Revised Contract Amount: Total Cost Work Completed: Less Deductions: Liquidated Damages: Pavement Deficiencies: Total Deduction Amount: Total Cost Work Completed: Less Previous Payments: Final Payment Due �� Recommended for Acceptance Asst. Direct�TPW - Infrastructure Design and Construction , � - �"� � Accepted Director, TRANSPO TATION AND PUBLI WORKS DEPARTMENT $1,554,411.70'� $66,100.27'�Ns 1,2 $1,620,511.97 '� $1,620,511.98 �� a ^I � Days @ $210.00/ Day $0.00 $1,620,511.98 $1,539,058.97 $81,453.01 _ �� /� Date ��z� �i �f Date �G%�...+-.�-�+-.� � /,�,�/4 City Manager Date Comments: FC1ND ACCT: C293-2086202132 //' , �i�i�n � o�� s .�o� r��fr's.s-�.y �� o% T��.s al•�.��-h� < -s /,�i/ �/�� - � �1� �, �y.-y// � => �� /�0�.>� f p'� ��/• l.>G,�S � � f. �D !'!G!/�'�,d��'.S. �2 — �J� �T � ��.�.�� TPW Construction Invoice i��. t �- �� Contract: CS44850 P.O. # PO-13-79735 Payment Date: 10/15/2014 TO: JLB Contracting, LLC �'• # CS44850-24 Esrimate No. 24 DOE: 7074 P O Box 24131 ProjManager Kristian Sugrim Fort Worth 7'X 76124 FOR: �MAC Surface Overlay 2013-13 Contract Amount: $1,620,511.97 Total to Date: $1,620,511.98 $0.00 $1,620,511.98 Previous Estimate: $1,620,062.08 $81,003.11 $1,539,058.97 Earned to Date: 5449.90 (581,003.11) 581,453.01 Payments: ---_ ------ - - � C293-541200-208620213283 $815,298.49 CO#1 -$36,412.63, CO#2 -$1,680.00, FINAL PAY is $0.01 over the - --- — --- ---- - -- - -- -- - -- ---- - .contract amouni— -- Total to Date: $815,298.49 $0.00 Previous Estimate: $814,95534 $40,747.77 Eamed to Date: $343.15 ($40,747.77) $815,298.49 $774,207.57 $41,090.92 --- -- l P253-541200-608170213283 $402,606.75 CO#1-$13,163.82,C0#2-$840.00 Total to Date: $402,606.75 $0.00 $402,606.75 Previous Estimate: $402,500.00 $20,125.00 $382,375.00 Eamed to Date: $106.75 ($20,125.00) $20,231.75 - - - -- - -- -- --- -- P258-541200-708170213283 $402,606.74 CON 1-$13,163.82, CO#2 -$840.00 l -- — -- ----- --- --- ---- _ - - - - --- ---- ------ -� Totalto Date: $402,606.74 $0.00 $402,606.74 Previous Estimate: $402,606.74 $20,130.34 $382,476.40 Earned to Date: $0.00 ($20,13034) $20,130.34 �►C H FIN�L PAY Saturday, December 06, 2014 Page 1 of 1 City Project Numbers 02132 Contract Name HMAC SURFACE OVERLAY (2013-13) Contract Limits AT VARIOUS LOCATIONS Project Type PAVING Project P'unding Project Manager Sugrim Inspectors RODGERS / WOLFF Contractor JLB CONTRACTING, L.L.C. PO BOX 24131 FORT WORTH, 1'X 76124-1131 DOE Number 7074 Estimate Number 24 Payment Num6er 24 ror Period Ending 10/15/2014 City Secretary Contract Number 44850 Contract Date 9/10/2013 Contract Time 285 CD Days Charged to Date 285 CD Contract is .000000 Complete CITY OF FORT WORTH SUMMARY OF CHARGES Line Fund Account Center Amount Gross Retainage Net Funded Department of T W C;onst. aervices DOE# a � . Dat / Project Manager %f% � �l ana ement J Pa e ��1 Risk M g v � D.O.E. Brotherton � � CFA Westerman/Scanned ❑ The Proceeding people have been Contacted concerning the request for final payment & have released this project for such payment Clearance Conducted By Etta Bacy Friday, October 31, 2014 Total Cost of Work Coropleted $1,620,511.98 Less % Retained $0.00 Net �arned $1,620,511.97 Earned This Period $81,453.00 2etainage 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 $1,539,058.97 Plus Material on Hand Less 15% $0.00 Balance Due This Payment $81,453.00 Page 5 of 5 FURTWORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name HMAC SURFACE OVERLAY (2013-13) Contract Limits AT VAItIOUS LOCATIONS Project Type PAVING City Project Numbers 02132 DO� Number 7074 Estimate Number 24 Payment Number 24 For Period Ending 10/15/2014 CD City Secretary Contract Number 44850 Contract Time 28�D Contract Date 9/10/2013 Days Charged to Date 285 Project Manager Sugrim Contract is 100.00 % Complete Contractor JLB CONTRACTING, L.L.C. PO BOX 24131 PORT WORTIi, TX 76124-1 1 3 1 Inspectors RODGERS / WOLFF Friday, October 31, 2014 Page l of 5 ,�;�I Z�� l 1' "1 �� City Project Numbers 02132 Contract Name HMAC SURFACE OVERLAY (2013-13) Contract Limits AT VARIOUS LOCATIONS Project Type PAVING Project Funding PAVING DOE Number 7074 Estimate Number 24 Payment Number 24 For Period Ending 10/15/2014 Item Description of [tems Estimated Unit Unit Cost Estimated Compteted Completed No. Quanity Totat Quanity Total _ -___ __.--.__ --.__ -- -- _ ---_._.- - - -- --------- -- 1 3305.0108 Miscellaneous Adustments (UtiliNes) 1 LS $6,000.00 $6,000.00 0.385323 $2,311.94 2 0241.1300 Remove Concrete Curb & Gutter 18600 LF $7.85 $146,010.00 14109.82 $110,762.09 3 3216.0102 7" Concrete Curb & Gutter 18600 LF $15.70 $292,020.00 14378.42 $225,741.19 4 0241.0401 Remove Concrete Driveivay 15200 SF $3.36 $51,072.00 8867.3 $29,794.13 5 3213.0401 6" Concrete Driveway 15200 SF $336 $51,072.00 8867.3 $29,794.13 6 0241.0100 Remove Sidewalk 6800 SF $2.25 $15,300.00 8740 $19,665.00 7 3213.03014" Concrete Sidewaik 10080 SF $2.80 $28,224.00 8740 $24,472.00 8 3213.03514" Concrete Sidewalk Exposed Aggregate 50 SF $4.20 $210.00 81 $340.20 9 0241.1400RemoveConcreteValleyGutter 50 SY $22.40 $1,120.00 55.2 $1,236.48 10 3216.0301 6" Concrete Valley Gutter 70 SY $44.80 $3,136.00 55.2 $2,472.96 11 8" Pavement Pulverization 31850 SY $3.50 $111,475.00 17541.58 $61,395.53 12 9999.0000 Roadbond ENl Soil Stabilizer 249 GA $1 I2.00 $27,888.00 150 $16,800.00 13 3211.0600 CementModification(131bs/sy) 207 TN $113.00 $23,391.00 123.22 $13,923.86 14 0241.1506 2" Pavement Surface Milling 35920 SY $1.61 $57,831.20 67181 $108,161.41 15 3212.0900 Crack Sealing of Existing Pavement 455 GA $26.70 $12,148.50 16.85 $449.90 16 3212.0302 2" Asphalt Pavement Type D 67800 SY $8.61 £583,758.00 84722.58 $729,461.41 17 3305.0t i l Water Valve Box Adjustments (w/Steel 37 EA $130.00 $4,8I0.00 Riser) 18 3305.0112 Water Valve Box Adjustments (with 27 EA $275.00 $7,425.00 16 $4,400.00 Concrete Coliar) 19 3305.0107 Miscellaneous Struchue Adjustrnents 13 EA $39.00 $507.00 22 $858.00 (Water Meter Box) 20 3349.0101 Manhole Adjustments (w/Steel Riser) 36 EA $260.00 $9,360AU 21 3305.0122 Manhole Adjustments {with Concrete 30 EA $535.00 $16,050.00 26 $13,910.00 Collaz) 22 9999.0000 Painting House Addresses 151 EA $17.00 $2,567.00 I50 $2,550.00 23 3292.0100 Block Sod Replacment 810 SY $6.70 $5,427.00 2527 $16,930.90 24 02Q1.0300 Remove ADA Ramp 3 EA $670.00 $2,010.00 21 $14,070.00 25 9999.0000 ADA Ramp 6 EA $1,350.00 $8,100.00 23 $31,050.00 26 9999.0000 Miscellaneous Construction 1 LS $87,500.00 $87,500.00 0.710964 $62,209.38 27 Stopbazw/prep(CO#1) 1447 LF $16.30 $23,586.10 1648 $26,862.40 28 4" Solid Yellor or White w/ prep (CO # 1) 8693 LF $1.55 $13,474.15 17452 $27,050.60 29 2 Way Tum Lane Striping w/ prep (CO # 1) 780 LF $4.30 $3,354.00 '778 $3,345.40 Friday, October 31, 2014 Page 2 of 5 City Project Numbers 02132 Contract Name HMAC SURFACE OVERLAY (2013-13) Contract Limits AT VARIOUS LOCAT'IONS Project Type PAVING Project Funding DOE Number 7074 Estimate Number 24 Payment Number 24 For Period Ending 10/IS/2014 30 Gore-Yellow or White w/ prep (CO #1) 380 LF $8.55 $3,249.00 237 $2,026.35 31 Bike Lane w/ symbol onty w/prep (CO #1) 10 EA $305.00 $3,050.00 32 Bike Lane w/ arrow w/prep (CO #1) 10 EA $670.00 $6,700.00 25 $16,750.00 33 Bike Lane - shazed w/ prep (CO # 1) 1 EA $335.00 $335.00 1 $335.00 34 Arrowleft(CO#1) 5 EA $275.00 $1,375.00 12 $3,300.00 35 Arrow right or straight (CO ttl) 5 EA $355.00 $1,775.00 I $355.00 36 Text Only (CO #i) 13 EA $305.00 $3,965.00 14 $4,2�0.00 37 36" Yield Triangle w/ prep (CO #1) 14 EA $40.50 $567.00 14 $567.00 38 4" Reflective marker (CO #1) 42 EA $5.00 $210.00 480 $2,400.00 39 8"Refiectivemarker(CO#1) 22 EA $50.00 $1,100.00 22 $1,100.00 40 Traffic Signal Loops (CO #2) 280 LF $12.00 $3,360.00 782.4767 $9,389.72 Sub-Total of Previous Unit $1,620,511.95 $1,620,511.97 Friday, October 31, 2014 Page 3 of 5 City Project Numbers 02132 Contract Name HMAC SURFACE OVERLAY (2013-13) Contract Limits AT VARIOUS LOCATIONS Project Type PAVING Project Funding Contract Information Summary Original Contract Amount ChanEe Orders Change Order Number 1 Change Order Number 2 Date il ? � ntr � to Date � � �`—� �� Inspection Supervisor �✓►-�"`a-.�7 L`^"� Date Il �`'�'t� Project My}�_� / Director / �� Date //'G b ;[!� W- Infrastructure Design and Construction � � �" �te �� /� oting Department DOE Number 7074 Estimate Number 24 Payment Number 24 For Period Ending 10/15/2014 $1,554,411.70 $62,740.27 $3,360.00 Total Contract Price $1,620,511.95 Total Cost of Work Completed $1,620,511.98 Less % Retained $0.00 Net Earned $1,620,511.97 Earned This Period $81,453.00 Retainage This Period $0.00 Less Liquidated Damages Days @ / Day LessPavement Deficiency Less Penalty Less Previous Payment Plus Material on Nand Less 15% Balance Due This Payment $0.00 $0.00 $0.00 $1,539,058.97 $0.00 $81,453.00 Friday, October 31, 2014 Page 4 of 5 BuySpeed Online https://bso.forlworthgov.org/bso/do cumendapprovaUdocApproval. sdo � ��'� � �-� � a� 0 Q�� Accounts Payable Department Access NIGP Code Browse � My Account � Customer Service � Current Organimtion�.�CITY OF FORT WORTH DeCembe� 10, 2014 7:41:53 AM CST r! A% About ( Home Doamerrts � BrandyCrane Invoice #: CS44850-FINAL Vendor #:0000016042 Vendor Group #:01 Status: 41R - Ready forApproval [yj General Items Credits Subcontractors Accounts Routing Athachments Notes Reminder Change Order Summary Back to PO _ __ - - ------ - -- ----- - --- --- - ----- - --- - - -- -- -- _ General Validation Wamings � • Account code 1�C293-541200-208620213283 is in the red by $38,092.00. i • Account code 1&C293541200.208620213283 is in the red by $38,092.00. � Header Information Invoice Number: csaasso-FiNn� IIIVOICe StetUS: 41R - Ready for �nvoice Type: 3 way Approval matching Invoice Description: CS44850-FINAL HMAC Surface Overlay IIIVOIC@ D8i@: 10/15/2014 Effect Date: 12/10/2014 2013-13 Payment Amount: $s�,453.01 HBIldl1119 COde: ACH (DIRECT payment Date: �vos�zo�a DEPOSIn Payment Terms: Payment Term Day: Paid-Bank/Check: Alternate Id: Entered By: erendy Crane Entered Date: Credit Amount: 50.00 Updated By: Brandy Crane Updated Date: Received Date: 11/04/2014 07:39:00 AM Purchase Order Information Purchase order p0-13-00079735 PO Description Number: PO Amount: S�,szo,e��.sa Remaining To Invoice: PoVendor Information Vefld0l': 0000016042 -JLB CONTRACTING LLC Address Grp: Vendor Remit-to JAMES HUMPHREY Address: P o eox za�s� ACH ONLY FORT WORTH, TX 76124-1131 Fed ID• US ' Email: lol (phant@j Ibcon Vacti ng.com Phone: (817)261-2991 Id: 29010 Misc & Freight Invoice Account Event Type Fiscal Year Account Code Misc 13 P25&205000-000000213200 Misc 13 P253-205000-000000213200 Misc 13 C293-20500a000000213200 Item Information o Payment o.o�a Discount: 12/10/2014 12/10/2014 CS44850 $o.00 Buyer: 01 ••'••'S121 Total: Remit Text: Karen SUiker Transaction Amount $20,130,34 $20,125.00 $40,747.77 $81,003.11 1 of 2 12/10/2014 7:41 AM BuySpe�d Online https://bso.fortworthgov.org/bso/documendapprovaUdocApproval.sdo invoice Item #/PO Item #: 7 CO#2- $1,680.00 - 2013-13 HMAC Surface Overlay C293-541200-208620213283 CS44850 PO Permit Involce Discaunt % Origtnal Finai Item Status To Pay Amount PayAmount Pay 3PCR - Complete Receipt $0.00 $449.89 0.0% $0.00 Yes MAKE: ASSET MODEL: ASSET MANUF: ASSET SERIAL: ASSET VIN: ASSET TAG: Event Type Fiscal Year Account Code Transaction Amount Exp. 15 C293-541200-208620213283 $449.89 Enc. 15 C293-541200.208620213283 -5449.89 Invoice Item #/PO Item #: �0 FINAL PAY- $0.01 - 2013-13 HMAC Surfaoe Overlay C293-541200-208620213283 CS44850 PO Permlt invoice Discount % Original Final Item Status To Pay Amount PayAmount Pay 3PCR - Complete Receipt $0.00 $0.01 0.0% $0.00 Yes MAKE: ASSET MODEL: • ASSET MANUF: ASSET SERIA�: ASSET VIN: ASSET TAG: Event Type Fiscal Year Account Code Transaction Amount Exp. 13 C293-541200-208620213283 $0.01 Enc. 13 C293-541200-208620213283 -$0.01 Approval Path: Delete Approver Order Approval Level Approver Date Date Approved/Disapproved Comment Sequence Path lype Requested Approved/Disapproved /Canceled View ID 1Canceled by Add Primary New qdd/Delete Approver Print Copyright � 2014 Periscope Holdings, Inc. - All Rights Reserved. default 2 of 2 12/10/2014 7:41 AM Page: 1 Document Name: untitled BC AVAILABLE FUNDS INQUIRY NEXT FUNCTION: ACTION: ------------------------------------------------------------------------------- ----------------------------------------------------------------------------- COMP / ACCT / CNTR ALTERNATE COMP / ACCT / CNTR C293 205000 000000213200 ACCT DESC: RETAINAGE ORIG APPROPRIATION: 0.00 CNTR DESC: HMAC Surface Overlay (2013-13) LAST ACTIVITY: 12/06/2014 0.00 NA 0.00 - 0.00 NA - 0.00 - 0.00 NA - 0.00 - 40,747.77- (LIABILITY ) - 0.00 --------------------- --------------------- = 40,747.77 (AVAIL BAL) = 0.00 (AVAIL BAL) L OVEREXPEND A E C G V TOLERANCE BDG YTD P EST N L R ACTIVE INACTIVE L POST AMT PCT GRP LTD P REV EXP C COMM S P STAT DATE DATE 1 Y 9999 999 L N N Y N N 2 9 0 Date: 12-06-2014 Time: 14:28:19.63 Page: 1 Document Name: untitled BC AVAILABLE FUNDS INQUIRY NEXT FUNCTION: ACTION: ------------------------------------------------------------------------------- ------------------------------------------------------------------------------- COMP / ACCT / CNTR ALTERNATE COMP / ACCT / CNTR P253 205000 000000213200 ACCT DESC: CONTRACT RETAINAGE PAY ORIG APPROPRIATION: 0.00 CNTR DESC: HMAC Surface Overlay (2013 - 1 LAST ACTIVITY: 12/06/2014 0.00 NA 0.00 - 0.00 NA - 0.00 - 0.00 NA - 0.00 - 20,125.00- (LIABILITY ) - 0.00 --------------------- --------------------- = 20,125.00 (AVAIL BAL) = 0.00 (AVAIL BAL) L OVEREXPEND A E C G V TOLERANCE BDG YTD P EST N L R ACTIVE INACTIVE L POST AMT PCT GRP LTD P REV EXP C COMM S P STAT DATE DATE 1 Y 9999 999 L N N Y N N 2 9 0 Date: 12-06-2014 Time: 14:28:28.13 Page: 1 Document Name: untitled BC AVAILABLE FUNDS INQUIRY NEXT FUNCTION: ACTION: ------------------------------------------------------------------------------- ------------------------------------------------------------------------------- COMP / ACCT / CNTR ALTERNATE COMP / ACCT / CNTR P258 205000 000000213200 ACCT DESC: CONTRACT RETAINAGE PAY ORIG APPROPRIATION: 0.00 CNTR DESC: HMAC Surface Overlay (2013 - 1 ZAST ACTIVITY: 12/06/2014 0.00 NA 0.00 - 0.00 NA - 0.00 - 0.00 NA - 0.00 - 20,130.34- (LIABILITY ) - 0.00 --------------------- --------------------- = 20,130.34 (AVAIL BAL) = 0.00 (AVAIL BAL) L OVEREXPEND A E C G V TOLERANCE BDG YTD P EST N L R ACTIVE INACTIVE L POST AMT PCT GRP LTD P REV EXP C COMM S P STAT DATE DATE 1 Y 9999 999 L N N Y N N 2 9 0 Date: 12-06-2014 Time: 14:28:35.03 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 SAM DAVIS, PRESIDENT of JLB CONTRACTING, LLC, known to me to be a credible person, who being by me duly sworn, upon his oath disposed 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; and That there are no claims pending for personal injury and/or property damages; On contract described as; HMAC OVERLAY 2013-13, Fort Worth, TX. JLB CONTRACTING, LLC BY �- v �� Sam Davis President Subscribed and sworn before me on this �g�day of �tY�n 2014 . U' N T Y PUBLIC AND FOR TARRANT COUNTY, TEXAS My commission expires 3-10-17 �""+�"'� LINDA OLIPHANT r x v,�. a �;��. .,,: ., _•, z Notary Public, State of Texas r„ My Commission Expires 'N'f '�4�� March 10, 2017 .,�� `� CONSENT OF owrrEx ❑ SURETY COMPANY CONTRACTOR ❑ TO FINAL PAYMENT S�TY ❑ • OTHER (SIMILAR TO AIA DOCUMENT G707) Bond No. 6067207 PROJECT: HMAC Surface Overlay (2013-13), City Project No. 02132 (name, address) Fort �7p�� Texas TO (Owner) ARCHIT'ECT'S PROJECT NO: � City of Fort Worth I CONTRACT FOR: Above Project 1000 Throcicmorton Street � Fort Worth, Texas 76102 � CONTRACT DATE: September 10, 2013 CONTRACTOR: 7LB Contracting, LLC In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the (here insen name and address of Surety Company) westfield Insi,uance Company 555 Republic Drive, Suite 450 Plano, Texas 75074 , SURETI' COMPANY, Ori bOild Of (here insert name and address oF Contractor) JLB Contracting, LLC P.O. Box 24131 Fort Worth, Texas 76124 ,CONTRACTOR, hereby approves of the final payment to the Contractor, and agrees that the fmal 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 Tluocicmorton Street Fort Worth, Texas 76102 ' oWNER' as set forth in the said Surety Company's bond. IN WITNESS WHEREOF, The Surety Company has hereunto set its hand this Attest: 18th day of November 2014 � WESTFIEL 1NSUItANCE COMPANY Surety Co ; : i By Sign o epresentative (Seai): _ Kvle W. Sweenev Attorney-in-Fact Title Note: This form is inteni�led to be used as a companian document to the Contractor's Affidavit of Payment of Debts and Claims, Current Edition THIS POWER OF ATTORNEY SUPERCEDES ANY PREVIOUS POWER BFARING THIS SAME POWER # AND IS$UED PRIG�R TO 04/20/11, FOR ANY PERSON OR PERSONS NAMED BE�OW. General Power of Attorney CERTIFIED COPY POWER NO. 4220052 06 West�eld Insurance Co. Westfield National Insurance Co. Ohio Farmers Insurance Co. Westfieid Center, Ohio Know Aff Men by i'hese Presents, That WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAI INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, corporations, hereinafter referred to individually as a"Company" and co�lectively as "Companies," duly orgahized and existing under the laws of the State of Ohio, and havi�g its principal office in Westfield Center, Medina County, Ohio, do by these presents make, constitute and appoint CHARLES D. SWEENEY, MICHAEL A. SWEENEY, KYLE W. SWEENEY, ELIZABETH GRAY, JOINT�Y OR SEVERALLY of FORT WORTH and State of TX its true and lawful Attorney(s)-in-Fact, with full power and authority hereby conferred in its name, place a�d stead, to execute, acknowledge and deliver any and ail bonds, recognizances, undertakings, or other instruments or contracts of suretyship- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - • LIMITATION: THIS POWER OF ATTORNEY CANPIOT BE USED TO EXECUTE NOTE GUARANTEE, MORTGAGE DEFICIENCY, MORTGAGE GUARANTEE, OR BANK DEPOStTORY BONOS. and to bind any of the Companies thereby as fully and to the same extent as if such bonds were signed by the President, sea�ed with the corporate seal of the applicable Company and dufy attested by its Secretary, hereby ratifying and confirming all that the said Attorney(s)-in-Fact may do in the.premises. Said appointment is made under and by authority of the following resolution adopted by the Board of Directors of each of the WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY: "Be fi Resolved, that the President, any Senior Executive, any Secretary or any Fidelity & Surety Operations Executive or other Executive shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: The Attorney-fn-Fact. may be given full power and authority for and in the name of and on behalf of the Company, to execute, acKnowledge and deliver, any and all bonds, recognizances, contracts, agreements of indemnity and other conditional or obligatory undertakings and any and ail notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney-in-Fact shall be as binding upon the Company as if signed by the President and sealed and attested by the Corporate Secretary." "Be It Further Reso(ved, that the signature of any such designated person and the seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signatures or facsimile seal shail be valid a�d binding upon the Company with respect to any bond or undertaking to which it is attached.' (Each adopted at a meeting held on February 8, 2000). � ln Witness Whereof, WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY have caused these presents to be signed by their Senior Executive and their corporate seais to be hereto a�xed this 20th day of APRIL A.O., 2011 . . Corporate r�o•aSY�.(�/ Seals �,rQt,.• ..,C �xed �`v; .cu 'o .0 �W�� a �l. � _ �ae. � State of Ohio '"""" County of Medina ss : '��ON:��'• ��41$U_�IPi;;-. ? • �HSG� i ; ��•"? " "��'� SEAL. �92. ;�'�Ha�tTE�o;�� .'p= �b:184S;`�?�,: •-. .� ` ;' �'-•. ":..•'' "' � '�, "•..�.. *. ,,,•�``��, '••..�,..�,�.,.•�`'�� WESTFIELD INSURANCE COMPANY WESTFIELD NATIONAL INSURANCE COMPANY OHIO FARMERS INSURANCE COMPANX �� J � � . 8y. � � Richard L. Kinnaird, Jr., National Surety Leader and Senior Executive On this 20th day of APRIL A.D., 2011 , before me personally came Richard L. Kinnaird, dr. to me known, who, being by me duly sworn, did depose and say, that he resides'in. Medina, Ohio; that he is Senior Executive of WESTFIELD INSURANCE COMPANY, WESTFIELO NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, the companies described in and wh(ch executed the above instrument; that he knows the seals of said Companies; that the seals affixed to said instrument are such corporate seais; that they were so a�xed by order of the Boards of Directors of said Companies; and that he signed his name thereto by like order. Notarial . ,a��ew� . Seal .•'��\A!� �'''sw ' • .o,ff�xed ,�P,.� � 1J/ � a::�\�...��.,�.��`_ . 2�—�"--'A'`-�—'C' • • •� William J. Kahelin, A rney at Law, Notary Public State of Ohio ;,N� ��o My Commission Does Not Expire (Sec. 147.03 Ohio Revised Code) Counfy of Medina ss.: ., y �,.• � ..�f OF �,r i, Frank A.. Carrino, 5ecretary of WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said Companies, which fs still in full force and effect; and furthermore, the resolutions of the Boards of Direciors, set out in the Power of Attor�ey are in fuil force and effect. In Witness Whereof, 1 have here:anto sef, my hand and affixed the seals of said Companies at Westfield Center, Ohio, this � day of A.D. 1 H Noveml��':.a:"��,... 2014 __, ,,,,,;�;'.;;'�••-.. � _....M:.��.,,.,,,,. �� _ � � � _ .-. _.�. -.- ---..: SEA�,- .:, _. _ . _ m �� ; 1848 .•.O'� ' � ' � ' * ' =� ••.. ..•' ; ,��:,,,, �O�`, ''�.•;,.,.�.,....��. �i'�� ' Secr¢tary Frank A. Carrina,•�ecretary BPOAC2 (combined) (O6-Q2) CONSENT OF OWNER ❑ SURETY COMPANY ON'I'IRAC'TOR ❑ TO FINAL PAYMENT S�TY ❑ • OTHER {SIMILAR TO AIA DOCUMENT G70'n Bond No. 6067207 PROJECT: HMAC Surface Overlay (2013-13), City Project No. 02132 (name, address) Fort WoTth, Texas TO (Owner) � I� CONTRACTOR: City of Fort Worth 1000 Throcicmorton Street Fort Worth, TeYas 76102 JLB Contracting, LLC �ARCHITECTS PROJECT NO: CONTRACT FOR: Above Project � CONTRACT DATE: September 10, 2013 In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the (here insert name and address of Surety Company) westfield Insurance Company 555 Republic Drive, Suite 450 Plano, Te:cas 75074 , SURETY COMPANY, on bond of (here insert name and address of Contractor) JLB Contracting, LLC P.O. Box 24131 Fort Worth, Texas 76124 ,CONTRACTOR, hereby approves of the fmal payment to the Contractor, and agrees that the fmal 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 Throcicmorton Street Foi-t Worth, Texas 76102 , OwNER, as set forth in the said Surety Company's bond. IN WIT'NESS WHEREOF, The Surety Company has hereunto set its hand this Attest: (Seal): - 18th day of Noveinber , 2014 WESTF D NCE COMPANY Surety By Signature of Authorized Representative . - Kvle W. Sweeney Attorney—in—Fact Title Note: This fonn is intended ro be used as 2 companion document to the Contractor's Affidavit of Payment of Debts and Claims, Current Edition TNJS POWER OF ATTORNEY SUPERCEDES ANY PREVIOUS POWER BEARING THIS SAME " POWER # AND ISS+�JED PRIOR TO 04/20/11, FOR ANY PERSON OR PERSONS NAMED BELOW. ' POWER NO. 4220052 06 . General Westfield Insurance Co. Power of Attorney Westfield National tnsurance Co. CERTIFIED COPY Ohio Farmers Insurance Co. Westfieid Center, Ohio Know A(/ Men by These Presents, That WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAI INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, corporations, hereinafter referred to individualiy as a"Company" and coilectively as "Companies," duly organized and existing under the laws of the State of Ohio, and having its principal office in Westfieid Center, Medina County, Ohio, do by these presents make, constitute and appoint CHAR�ES D. SWEENEY, MICHAEL A. SWEENEY, KYLE W. SWEENEY, ELIZABETH GRAY, JOINTLY OR SEVERAL�Y of FORT WORTH and State of TX its true and lawful Attorney(s)-in-Fact, with fuii power and authority hereby conferred in its name, p�ace and stead, to executa, acknowledge and deliver any and ali bonds, recognizances, undertakings, or ather instruments or contracts of suretyship- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - • LIMITATION: THIS POWER OF ATTORNEY CANNOT BE USED TO EXECUTE NOTE GUARANTEE, MORTGAGE DEFICIENCY, MORTGAGE GUARANTEE, OR BANK DEPOSITORY BONDS. and to bind any of the Companies thereby as fuily and to the same extent as if such bonds were signed by the President, sealed with the corporate seal of the app�icabie Company and duly attested by its Secretary, hereby ratifying and confirming ali that the said Attorney(s)-in-Fact may do in the premises. Said appointment is made under and by authority of the following resolution adopted by the Board of Directors of each of the WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY: "Be It Resolved, that the President, any Senior Executive, any Secretary or any Fidelity & Surety Operations Executive or other Executive shali be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney{s)-in-Fact to represe�t and act for and on behaif of the Compa�y subject to the foilowi�g provisions: The Rtlorney-in-Fact, may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknowiedge and deliver, any and all bonds, recognizances, contracts, agreements of indemnity and other conditional or obiigatory undertakings and any and all �otices and documents canceltng or terminating the Company's Ilability thereunder, and any such instruments so executed by any such Attorney-in-Fact shall be as binding upon the Company as if signed by the President and sealed and attested by the Corporate Secretary.' "8e it Further Resolved, that the signature of any such designated person and the seal of the Company heretofore or hereafter a�xed to any power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signatures or facsimile seai shali be valid and binding upon the Company with respect to any bond or undertaking to which it is attached' (Each adopted at a meeting heid on February 8, 2000). � ln Wltness Whereof, WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE CAMPANY have caused these presents to be signed by their Senior Executive and their corporate seals to be hereto affxed this 20th day of APRIL A.D., 2011 . . Corporate ��a��y� Seais �r� �,..•»•�•..,�C�p gs A�xed��v: �L it�yQe, 4 ~± �� ..`� '�'.�(�',�� ' fs State of Ohio "'""" County of Medina ss.: ,.�`P.��pNAL,/ �'. �.pt:. -•!VS;G•: : "' ��' v�= ' 4/:' 'y � ; N; SEAL '� ° ;�'�•. •:o: � '•* ' ,`,,i. '•�,,��,,,,,,. � j � 1V4� � i * � • Q'_' � ♦ WESTFIELO INSURANCE COMPANY WESTFIE�D NATIONAL lNSURANCE COMPANY OHIO FARMERS INSURANCE COMPANX � `� � ` . By: ' Richard L. Kinnaird, Jr., National Surety Leader and Senior Executive On this 20th day of APRIL A.D., 2011 , before me personaliy came Richard L. Kinnaird, Jr. to me known, who, being by me duly sworn, did depose and say, that he resides'in Medina, Ohio; that he is Senior ExeCutive of WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OtilO FARMERS INSURANCE COMPANY, the companies described in and which executed the above instrument; that he knows the seals of said Companies; that the seais affixed to said instrument are such corporate seais; that they were so affixed by order of Yhe Boards of Directors of said Companies; and that he signed his name thereto by (ike order. Notarial ��N,,.•N�.N+.� . Seal r R� A t S�'w " • Aftixed �(Q: � � = p� ��%/�,9`E z:�:�i:�=.r . , • � � William J. Kahelin, A rney at Law, Noiary Public State of Ohio : N �gat o My Commission Does Not Expfre (Sec. 147.03 Ohio Revised Code) County of Medina ss.: '• , y �".t��,.- � ..T� 6F �.r (, Frank /�1.. Carrino, Secretary of WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, do hereby. certlfy that the abov.e and foregoing ts a true and correct copy of a Power of Attorney, executed by said Companies, which is stili in fuil force and effect; and furthermore, the resolutions of the Boards of Directors, set out in the Power of Attorney are in fuii force and effect. !n Witness pWhereof, I have hereunto set my.hand and a�xed the seals of said Companies at Westfield Center, Ohio, fhis 18thday of ��}'D�:n, � �;,;s.,,�r:,, � _ - .. • � un,,, NoveIT� _�'un.,:''"�,. 2.01�. ,:•«otvnr ;:'•,_ - _.•• �c,r�'1••,._ °� � '• i�c+ � - := o: ' -' ��-� = �J�.t.C'i.�.+i 'a � N: r..��Jyf'�L .,�m' - •c,�y�`� ��=f � : y`•, •:p =. . : . , . - , � . - �,r* , - `"'eyw�n�«.a''"'� " '"-.....-• - , '�4u * n��'��,, � s"t, 1846 ; ;� • • ,_�__, •. �i��y�/� � � Secn¢tary Frank A. Carriao,.secretary SPOAC2 (combined) (06•02) FORTV�ORTH TRANSPORTATION AND PUBLIC WORKS CONTRACTOR'S EVALUATION OF CIT'Y n PROJECT INFORMATION Date: 11/7/201�F Nmne ofConh•actor JLB Contracting DOG Inspecta• Jeff Wolf DOE1Vrimber• P+•njn�rl�i(/)o+�ln� 707d � Simple QQ Routine Initial Conh•actAi»oxnt $1,�5�,�11.70 In PERI�'ORMANCE EVALUATION 0- Inadequate 1- Deiicient 2- Standard Projec( Nnme HMAC Surface Overlav Contract 2013-1� Projecl i1 fanager REV: 02/22i07 T� f�p n/�Cnnh•nct Q Complex ❑ Water ❑ Waste Water ❑ Storm Drainage ❑✓ Pavement Final C'onh�act Amount $1.620,� 11.97 3 - Good � - E�cellent I2ATING ELEb1�NT (� - �1) INSPECTION EVALUATION 1 Availability of Inspector 2 Itnowlecige of Inspector 3 Accuracy of Measured Quantities =� Displa}� Of Professionalism 5 Citizen Complaint Resolution 6 Performance - Setting up Valve Crews, Labs ADMINISTRATION 1 Change Order Processing Time 2 Tiuiliness of Contractor Payments 3 Bid Opening to Pre-Con Meeting Timeframe IIn COMMENTS & SIGNATURES COMMENTS Rt1TNG i� - 4) PLANS & SPECII'ICATIONS 1 Accuracy of Plans to E�isting Conditions 2- 2 Clarity & Sufficiency of Details 3 3 A licability of S ecifications '3 4 Accuracy of Plan Quantities Z.— PROJECT MANAGER EVALUATION 1 Kno�vledge And/Or Problem Resolutio�i � 2 Availabili of Project Manager 3 3 Conununication 3 4 Resolu[ion of Utilitv Conflicts �3 Signature Contractor �� ; � '' � Signahire DOE Inspector Signature DOE Inspector's Supemisor L�� INSPECTOR'S COMMENTS TRANSPORTATION AND PUBLIC WORILS ��F The Cit�T of Fort �C�orth • 1000 'I'hrockmorton Street • Fort Word�, TX 76012-6311 (81'� 392 - 7941 • F�: (81'� 392 - 78�F5 FORTWORTH TRANSPORTATION AND PUBLIC WORKS PERFORMANCE EVALUATION OF CONTRACTOR CONTRACTOR & PROJECT DATA �ie ofConlracfa• JLB Contracting, LLC. DOE Inspeclor Jeff Wolff DOL• Inspector ❑ Water ❑ Waste Water❑ Storm Drainag� Pavement haitial Conh•act Aniou�rt $1,554,411.70 Final Conn•act A�»ount $1,620,511.97 II) PERFORMANCE EVALUATION Projecl Naine HMAC Surface Overlay (2013-13 DOE N�nnber 7074 Project Manager Kristian Sugrim Prajecl D�culty � Simple 0 Routine Date 11 /4/2014 REV: 02/20/07 Q Complex 0- Inadequate 1- 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 3 20 IS 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 3 60 45 8 Traffic Control Maintenance 15 Y 3 60 45 9 Daily Clean U 5 Y 3 20 15 10 Citizen's Complaint Resolution 5 Y 3 20 15 11 Property Restoration 5 Y 3 20 15 12 After Hours Response 5 Y 3 20 15 13 Project Completion 5 Y 3 20 15 TOTAL ELEMENT SCORE (A) BONUS POINTS (25 Maximum) (B) TOTAL SCORG (TS) III) CONTRACTOR'S RATING Maximum Score (MS) = 448 or sum of applicable element score ma�imums �vhich = 448 Rating ([TS / MS] * 100%) 336 / 448 = 75% Performance Category Good <20% =lnadequate 20% to <40% = Deficient d0% to <60% = Stnnda�•d 60% to <80% = Good >_80% = Lxce!lent Inspector's Comments (INCLUDING E\PLANATION OF BONUS POINTS ANARDGD) 336 336 Signature DOE Inspector Signature Contractor / � � Signature DOE Inspector's Supervisor CONTRACTOR'S COMMENTS TRciNSPORTr1TI0I�T r�ND PUBLIC WORICS The City of Fort Wordi • 1000 Throckmoxton Street • Fort Worth, TX 76012-6311 (817) 392 - 7941 • Fas: (817) 392 - 7845 FORTWORTH� TRANSPORTATION AND PUBLIC WORKS STAT�MENT OF CONTRACT TIME STATCVI�NT# FINAL STATCiVIENT# NAME OT PROJ�CT: 24 � H.M.A.C. Surface Overlay (2013-13) Y�AR: 2014 � PROJGCT NO.: C293-541200-208620213283 DO� 7074 Contrnctor ��B ,t j - y-2� ty I'[NAL INSPCCTION DATG �VD CONTRACT TIi�iG I 285 CD X PERIOD TRO�I: 10/1/2014 TO: 1 0/1 512 01 4 BEG - Month DEVELOPDIEN7 (1' / N N WORK ORDER LrFECTIV�: 10/21/2013 BEG / n MID 1 n n DAY Of hIONTH DAYS RGASON TOR DAY Or MONTH DAYS RCASON rOR CHARGED DAYS CR�DITGD CHARGCD DAYS CRCDITGD 1 Wed 1 16 2 Thu 1 17 3 Fri 1 18 4 Sat 1 19 5 Sun 1 20 6 Mon 1 21 7 Tue 1 22 8 Wed 1 23 9 Thu 1 24 10 Fri 1 25 11 Sat 1 26 12 Sun 1 27 13 Mon 1 28 14 Tue 1 29 15 Wed 1 30 31 NA Wkn & Hol Wea Utl Oth Not Applicablc SAT,SUN,and WEA1'1IGR UTILITIES OTHCRS DAYS TO"I'AL DAYS I-IOLIDAYS RELOCATE CHARGED THIS PGRIOD 0 0 0 0 15 15 PRGVIOUS PCRIOD 0 270 270 TOTAL TO DATC 0 0 0 0 285 285 RCMARICS: � line failure on Collin and Childress. Job complete 100% Time complete 100%