HomeMy WebLinkAboutContract 53037-FP3 FORT WORTH.,
TRANSPORTATION AND PUBLIC WORKS
NOTICE OF PROJECT COMPLETION
City Secretary No:_53037-FP3
Date Received:-Nov 17,2022
City Project No: 01419
Regarding contract 53037 for PARKER HENDERSON ROAD FROM MANSFIELD HIGHWAY(BUS 287)
KELLIS ST.as required by the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved
by City Council on 09/17/2019 through M&C 19-0169 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: $7,664,922.85
Amount of Approved Change Orders: $-214,374.05 No 1
Revised Contract Amount: $7,450,548.80
Total Cost Work Completed: $7,432,005.38
Less Deductions:
Liquidated Damages: 0 Days Q$650.00/Day
Pavement Deficiencies:
Total Deduction Amount: $0.00
Total Cost Work Completed: $7,432,005.38
Less Previous Payments: $7,060,405.11
Final Payment Due $ 371,600.27
Nov 14,2022
Recommended for Acceptance Date
Asst. Director, TPW - Capital Delivery
1(1e� Nov 14,2022
Accepted Date
interim Director, TRANSPORTATION AND PUBLIC WORKS
DEPARTMENT Client Department
William Johnson(Nov 7,202204:06GMT+1) NOV 17,2022
Asst. City Manager Date
OFFICIAL RECORD
Comments: CITY SECRETARY
FT.WORTH,TX
C'M Virs ura Page
Co.ntractorts Application for Payment Invoice No. 33
To(GAnrr) City,of Fort Worth Imto npPerr_d(r.,cm-TtiI: Due
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Pmjid: 01419 CmncEoes CPW Vmdar No.:
CM.E6703
Cizf SxrpdyNuht r. 53037 e` rc, .arker Henderson Roar!from Mansfield Highway BUS 287)Kellis St.
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I S139.901D S1114,363M 3.CarrenlCoitrsclP6cr(IlwI:' 5 V,16(043M
R 4.TOTAL COMPLETED AND S HED TO DATE
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Progress Estimate City Secretary 53037
Contract Num:
For(contract): Parker Henderson Road from Mansfield Highway(BUS 287)Kellis St.
Application Period: 10-27-22 to 11-9-22
A B C
Item
Specification Unit of Bid Quantity Unit Price Bid Value Estimated Quanti
Bid Item No. Description Installed
Section No. Measure
UNIT I:WATER IMPROVEMENTS
1 3311.0161 6"DR-14 PVC Water Pipe 33 11 12 LF 151.000000 $64.40 $9.724.40 __ 175.000C
2 3311.0261 8"DR-14 PVC Water Pipe 33 11 12 LF 256.000000 $70.00 $17,920.00 281.000C
3 3311.0461 12"DR-14 PVC Water Pipe _ 33 11 12 LF 3599.000000 $109.00 $392,291.00_ 3.016.500C
4 3311.0451 12"Class 350 DIP Water Carrier 33 11 10 LF 22.000000 $118.00 $2,596.00 22.000C
5 3311.0661 16"DR-18 PVC C905 Water Pipe 33 11 12 LF 253.000000 $97.00_ $24,541.00 _ _248.000C
6 0241.1000 Remove Cone Pvmt 0241 15 SY 61.000000 $34.00 $1,734.00__ 89.9000
7 0241.1100 Remove Asphalt Pvmt 0241 15 SY 416.000000 $15.00 $6.226.00 _1632.0001
8 0241.1001 Water Line Grouting 02 41 14 CY 40.400000 $167.00 $6,746.80_ 30.000C
9 0241.1012 Remove 6"Water Line _ 0241 14 LF 92.000000 $11.00 $1.012.00 125.000(
10 0241.1013 Remove 8"Water Line _ __ 0241 14 LF 239.000000 $10.00 $2,390.00 246.000C
11 0241.1015 Remove 12"Water Line _ 0241 14_ LF 2202.000000 $14.00 $30,828.00 _ 2053.006(
12 0241.1016 Remove 16"Water Line 0241 14 LF 292.000000 $14.00 $4,088.00_ _2_93.000C
13 0241.1218 4"-12"Water Abandonment Plug 024114 EA 1.000000 $450.00 $450.00 1.000(
14 0241.1302 Remove&Salvage 6"Water Valve _ 02 41 14 _ -EA _ 6.000000 $230.00 $1,380.00 _ _7,000(
15 0241.1303 Remove&Salvage 8"Water Valve _ 02 41 14 _ EA _ 3.000000 $230.00 $690.00____3.000(
16 0241.1305 Remove&Salvage 12"Water Valve 02 41 14 EA 6.000000 $280.00 $1.400.00 ___4.00D(
17 0241.1510 Salvage Fire Hydrant ___ 024114 EA 4.000000 $335.00 $1,340.00 6.00D(
18 0241.1602 Remove 7'X4'Concrete Water Vault 02 41 14 EA 1.000000 $1,060.00 $1,060.00
19 3201.0112 5'Wide Asphalt Pvmt Repair,Residential 3201 18 LF 556.000000 $52.00 $28,912.00 153.000(
20 3201.0202 Asphalt Pvmt Repair Beyond Defined Width Arterial 3201 17 SY __ 168.000000 $100.00 $16,800.OD
21 3312.0106 Connection to Existing 16"Water Main 331225 EA _ _ _ 1.000000 $5,056.00 $5,056.00
22 3304.0101 Temporary Water Services(size to match existing _ 33 04 30 LS __ 1.000000 $29.600.00 $29.500.00 1.000(
23 3305.0109 Trench Safety _33 0510 LF 4281.000000 $0.20 $856.20 4023.500(
24 3305.0110 Utility Markers 33 05 26 LS _ 1.000000 $1,670.00 $1,670.00
25 3306.1004 24"Die 112"Thick Steel Casing By Open Cut 33 05 22 LF 20.000000 $167.00 $3,340.00 20.000(
26 3305.1104 24"Dia 1)2"Thick Steel Casing By OtherThan Open Cut 33 05 22 LF _ 20.000000 $835.00 $16.700.00 20.000(
27 3311.0001 Ductile Iron Fittings 33 1111 _ _ TON _ 13.200000 $11.00 $146.20
28 3312.0001 Fire Hydrant _ 33 1240 EA _ - 6.000000 $4,000.00 _ $24,000.00____7.000(
29 3312.0117 Connection to Existing 4"-12"Water Main 33 12 25 EA _ _ 5.000000 $3,444.00 $17,220.00_ _ 5.000(
30 _ 3312.1002 2"Water Air Release Valve&Vault 33 1230 EA 1.000000 $7.000.00 _ $7,000.00 _ 1.000(
31 3312.2863 Furnish_&Install 6"Water Meter and 7'x4'Vault ___ 33 1211 EA _ 1.000000 $21,100.00 __$21,100.00 _ 1.000(
32 3312.3002 6"Gate Valve _ _ _ 33 1220 EA _ -9.000000 $1,200.00 _ $10.800.00 9.000(
33 3312.3003 8"Gate Valve _ _ _33 12 20 __ EA 3.000000_ $1,700.00_ $5,100.00 4.0001
_ 34 3312.3005 12"Gate Valve _ _ _ 33 1220 _ EA _ 12.000000 _ $2,700.00 ___$32,400.00 12.0001
35 9999.0010 6"x 6"Cut-in Tee _ _ 999900 LS 1.000000 __ $5,900.00 _ _ $5.900.00 1.0001
36 9999.0020 12"x 12"Cut-In Tee&Gate Valve _ _99 99 0o LS 1.000000 _ $7,800.00 _ $7,800.00_ 1.0001
37 9999.0030 Relocate Valve Assembly in 7'x4'Vault 99 99 00 LS 1.000000 $2,400.00 $2.400.00 _ 1.0001
_ 38 _9999.0040 1"Water Service __ _ 999900 EA 33.060000 $2,100.00_ _ $69,300.00 _ _ 37.0001
39 9999.0050 Box for 1"Water Meter _99 99 00 EA 16.000000 $400.00 _ $6,400.00 37.0001
40 9999.0060 Connect to Existing Water Meter _ __ 99 99 00 EA 17.000000 $290.00 $4,930.00
41 9999.0070 Relocate Existing Water Meter&Box _99 99 00 _EA 10.000000 $325.00 _ $3.250.00
42 9999.0071 8"Concrete Pavement _999900 SY 51.000000 $162.00 $8,262.00 89.900_1
9999.0080 Construction Contingency Allowance to cover cost of 999900
improvements not itemized All work completed under this Item shall be
43 approved-by owner inwriting. __ LS 1.000000 _ $100,000.00 $100,000.00
_UNIT II-STORM WATER IMPROVEMENTS
1 _6241.0401_Remove Concrete Drive _ _ _ _024113 SF 1033.000000 __ $1.00 $1,033.00_
2 0241.0500 Remove Fence 024113 LF 1493,000000 __ $5.00 $7,465.00
3 0241.0600 Remove Wall<4' _ _ 02 4113 LF 40.000000 $13.00 $520.00
4 0241.0800 Remove Rip Rap 0241 13 SF 1110.000000 $1.10 $1,221.00 1110.000'
5 0241.0900 Remove Misc Conc Structure ___ 0241 13 LS 1.000000 $3.500.00 $3,500.00_
6 0241.1000 Remove Concrete Pavement _ , 0241 15 SY 502.000000 $10.50 $5,271.00 498.000
7 0241.1100 Remove Asphalt Pvmt _ 024115 SY 2334.000000 $9.50 $22,173.00 2021.000
8 0241.3013 Remove 18"Storm Line 0241 14 LF 238.000000 $9.00 $2,142.00_
9 0241.3015 Remove 24"Storm Line _ _0241 14 LF 14.000000 $10.00 $140.00
10 0241.3201 _Remove 7'x7'Box Culvert 0241 14 LF 185.000000 $44.00 $8.140.00 185.066
11 0241.4401 Remove HeadwalVSET _02 41 14 EA 2.000000 $1.884.00 $3,768.00_ _ ___2.000
12 3110.0102 6"-12"Tree Removal _ 31 1000 EA 4.000000 $350.00 $1,400.00 7.000
13 3110.0103 12"-18"Tree Removal 311000 EA 3.000000 $850.00 $2,550.00 5.000
14 3293.0104 Plant4"Tree 329343 EA 12.000000 $1,080.00 $12,960.00
15 3441.4108 Remove Sign Panel&Post 344130 30 EA 6.000000 $95.00 _ $570.00 7.000
16 _ 9999.0160_Remove&Salvage_Advance Warning System 99 99 00 LS 1.000000 $6,000.00 $6,000.60 1.000
PAVING
17 3123.0101 _Unclassified Excavation by Plan _ _3123 16 _ CY 583.000000 $35.00 $20,405.00 583.000
18 3124.0101 Embankment by Plan 31 24 00 CY __ 6142.000000 $19.00 $97,698.00 5142.000
19 3137.0101 Concrete Riprap 313700 SY _ 41.000000 $115.00 $4,715.00 46.600
20 3211.0126_12.5"Flexible Base,Type A GR-2 32 1123 SY _ 1222.000000 $18.00 $21,996.00 4385.000
21 3211.0400 Hydrated Lime _ 321129 TN _ 86.000000 $170.00 $14.620.00 10.570
22 3211.0502 8"Lime Treatment 32 11 29 SY 3601.000000 $8.50 $30,608.50_ 438.000
23 3212.0502 4.5"Asphalt Base Type B _321216 _ SY 1222.000000 $27.50 $33.605.00__ _515.000
_ 24 M 3.0105 10"Concrete Pvmt _ _ 3213 13 _ SY 2116.000000 $75.00 $168,700.00 _2362.600
25 3213.0301 4"Concrete Sidewalk 32 13 20 _ SF 8619.000000 _ $10.00 $86,190.00 _ 7452.650
213 26 3 .0401 6"Concrete Driveway _321320 SF 2102.000000 $11.00 $23.122.00 775.500
27 3216.0102 7"Conc Curb and Gutter _ _32 16 13 LF _ 67.000000 $60.00 _ $3.420.00 _ 106.000
28 U32.0203_TxDOT Std Ret Wall-RW 1(L)C _ _ _ _323213 SF 182.000000 - _$70.00 $12,740.00 442._000
29 3291.0100 Topsoil 329119 CY 426.000000 $23.00 $9,798.00
30 3292.0100 Block Sod Placement 329213 SY 20112.000000 $4.10 $8.249.20 2000.000
31 3292.0400 Seeding,Hydromulch _ _ __ 3292 13 SY 1186.000006 $1.15 __ $1,362.75
32 3292.0500 Seeding,Soil Retention Blanket 3292 13 SY 1373.000000 _ $1.50 _ $2.059.50
33 3305.0114 Manhole Adjustment,Majorw/Cover 33 05 14 EA 1.000000 $2,800.00_ _ $2.800.00 _ 1.000
This document has been modified from its original form
modifications.You are encouraged to read the document
Progress Estimate City Secretary 53037
Contract Num:
For(contract): Parker Henderson Road from Mansfield Highway(BUS 287)Kellis St.
Application Period: 10-27-22 to 11-9-22
A B C
Item
Specification Unit of Bid Quantity Unit Price Bid Value Estimated Quanta
Bid Item No. Description Installed
section No. Measure
34 9999.0200 Concrete Header 99 99 00 LF 48.000000 $27.00_ $1,296.00 _ 24.0000
35 9999.0220 Rip-Rap(RW Mow Sbip)(4 In) 999900 CY __ 12.000000 $950.00 $11,400.00 20.8400
36 6999.0230 Rail(Handrail)(PRD-13 TY F) 99 99 00 LF _ _ 968.000000 $115.00 $111,320.00 96.9.0000
37 6999.0240 Wheel Stop 999900 -EA 3.000000 $60.00 $180.00_
38 9999.0250 Brick Wall w/Pilasters 99 99 00 LF 40.000000 $150.00 $6,000.00 80.0000
DRAINAGE
39 0241.1100 Remove Asphalt Pvmt 0241 15 SY 112.000000 $20.00 $2.240.00 672.000E
40 3201.0112 5'Wide Asphalt Pvmt Repair,Residential 3201 18 LF 200.000000 $62.00 $12,400.00_
41 3301.0002 Post-CCTV Inspection 330510 LF 1250.000000 $2.00 $2,500.00
42 3305.0109 Trench Safety _33 01 31 LF 1250.000000_ $1.00 $1,250.00
43 3305.0116 Concrete Encasement for Utility Pipes _3305 10 _ CY 4.000000 __ $167.00 $668.00 _
44 3137.0101 Concrete Riprap _313700 SY 2.000000 $112.00 $224.00_ 82.970C
45 3341.0103 18"RCP,Class III _3341 10 LF 415.000000 $170.00 $70,550.00 420.000E
46 3341.0205 24"RCP,Class III _3341 10 LF 419.000000 $157.00 $65,783.00 426.000C
47 3341.0309 36"RCP,Class III _ _ 3341 10 LF 166.000000 $241.00 $40,006.00 _ 166.000C
48 3341.0409 48"RCP,Class III _ _3341 10 LF 17.000000 $314.00 $5,338.00 16.000C
49 3341.0502 54"RCP,Class III 3341 10 LF 210.000000 $353.00 $74,130.00_ 210.000C
50 3341.1001 3x2 Box Culvert 3341 10 LF _ 21.000000 $272.00 $5,712.00 18.000E
51 3349.0001 4'Storm Junction Box 334910 EA _ 1.000000 $4.185.00 $4,185.00 1.000(
52 3349.4103 18"_SET,1 pipe 33 4940_ _ _ EA _ 2.000000 $3.350.00 $6,700.00 2.000(
53 3349.4105 24"SET,1 pipe _334940 Fla _ 1.000000 $3,661.00 $3,661.00 1.000(
54 3349.5001 IV Curb Inlet 334920 EA 9.000000 $4,266.00 $38,394.00 10.000(
55 3349.7001 4'Drop Inlet 33 49 20 EA 1.000000 $5.436.00 $6,436.00 1.000(
56 3349.7002 5'Drop Inlet 33 49 20 EA 1.000000 $6,023.00 $6,023.00 _ 1.000(
57 9999.0090 VxIYPJB 999900 EA 1.000000 $9,702.00 $9,702.00 1.000(
58 9999.0120 PW-1 for 2-Tx2'MBC EA 1.000000 $7,738.00 $7,738.00_ _ 1.000(
SIGNING AND PAYMENT MARKINGS
59 3217.0002 4"SLD Pvmt Marking HAS(Y) 321723 LF 1718.000000 $1.05 $1,803.90_ 1468.000(
60 3217.0501 24"SLD Pvmt Marking HAE(W) 321723 LF 21.000000 $6.00 $126.00
61 3441.4003 Fumish/lnstall Alum Sign Ground Mount City Std. 344130 _ EA 1.000000 $495.00 $495.00
CULVERT
62 3123.0101 Unclassified Excavation by Plan-Channel 3123 16 CY 3862.000000 $22.00 $84.964.00_ 3862.000(
_ 63 3137.0101 Concrete Riprap 313700 SY 94.000000_ $134.00 $12,596.00_ 134.000(
64 3291.0100 Topsoil 3291 19 CY 34.000000 $23.00 $782.00
65 3292.0100 Block Sod Placement 329213 _ SY 1220.000000 _ $4.10 $5.002.00 _ 120_0.0_00(
66 9999.0350 Gravity Wall 99 99 00 SF 3804.000000_ $75.00 $285,300.00 3945.000(
67 9999.0370 Interlocking Articulating Concrete Blocks 99 99 00 _ SF 9370.000000 $24.00 $224,880.00 9223_.000(
68 9999.0380 Turf Reinforcement Mat 999900 SY_ 1220.000000 $18.90 $23,058.00
69 9999.0390 Construction Contingency Allowance to cover cost of 999900 LS 1.000000 $100,000.00 _ $100,000.00
70 9999.0392 Temporary Special Shoring 949900 LS 1.000000_ $1.00 $1.00
UNIT III-PAVING&DRAINAGE
1 0241.0100 Remove Sidewalk 0241 13 SF 607.000000 $1.00 $607.00
2 0241.0401 Remove Concrete Drive 0241 13 SF 508.000000 $1.00 $508.00 656.000(
3 0241.0403 Remove Brick Drive 0241 13 SF 6.000000 _ $7.00 $42.06
4 0241.0500 Remove Fence 024113 _ LF 4192.000000 $5.00 $20.960.00 4067.0001
5 0241.1000 Remove Concrete Pavement 024115 SY 1032.000000 $12.00 $12,384.00 964.900(
6 0241.1100 Remove Asphalt Pvmt 024115 SY _ 7921.000000 $11.00 $87,131.00 1_2122.90_0_(
7 0241.1300 Remove Conc Curb&Gutter 024115 _ LF 149.000000 $2.50 $372.50
8 0241.1700 Pavement Pulverization 0241 15 SY 3697.000000 $11.55 $42.700.35 3846.0001
9 0241.3011 Remove 15"Storm Line 0241 14 LF 378.000000 $25.40 $9,601.20_
10 0241.3013 Remove 18"Storm Line 0241 14 LF 213.000000 $28.40 $6.049.20
11 3110.0102 6"-12"Tree Removal 31 1000 EA _ 53.000000 $350.00 $18,550.00 45.0001
12 3110.0103 1248"Tree Removal 31 10 00 EA 18.000000 $850.00 $15,300.00 12.0001
13 3110.0104 18"-24"Tree Removal 311000 EA 6.000000 $1.200.00 $7,200.00_ 5.0001
14 3110.0105 24"and Larger Tree Removal 311000 EA 6.000000 $2,000.00 $12,000.00_ 6.0001
15 3293.0104 Plant 4"Tree 32 93 43 EA 135.000000 $1,080,00 $145,800.00
16 3441.4108 Remove Sign Panel&Post 34 41 30 EA 8.000000 $95.00 $760.00
17 9999.0140 Remove&Relocate Mailbox 99 99 00 EA 6.000000 $800.00 $4.800.00 _ 6.0001
18 9999.0150 Remove&Relocate Bollard 99 99 00 EA 3.000000 $185.00 $556.00 40.0001
19 9999.0170 Construction Contingency Allowance to cover cost of 999900 LS 1.000000 $50.000.00 $50,000.00
PAVING
20 0171.0101 Construction Staking 017123 LS 1.000000 $50.000.00 $50.000.00 _ 1.0001
1 21 3123.0101 Unclassified Excavation by Plan _ 3123 16 CY 9924.000000 $48.00 $476.362.00_ _ _9924.0001
22 3124.0101 Embankment by Plan 31 24 00 _ _ CY 738.000000 $26.00 $19.188.00 _ 738.0001
23 3125.0101 SWPPP a 1 acre 31 25 00 LS 1.000000 $51,425.00 $51.425.00 1.0001
24 3211.0124 10"Flexible Base,Type A,GR-2 321123 SY 612.000000 $18.00 $11,016.00
25 3211.0126 12.5"Flexible Base,Type A,GR-2 32 11 23 SY 1172.000000 $19.00 $22,268.00 1472.260,
26 3211.0400 Hydrated Lime 321129 TN 282.000000 $170.00 $47,940.00 246.000i
27 3211.0502 8"Lime Treatment 32 11 29 SY �6554.000000
00000 $6.25 $73,475.00 _ __ 12889.500�
28 3212.0302 2"Asphalt Pvmt Type D 321216 SY $12.50 $81,925.00 5844.000
2g 3212.0500 2.5"Asphalt Base Type B 32 l2 16 SY 00000 $20.00 $9,260.00 100.000
This document has been modified from its original form;
Il modifications.You are encouraged to read the document
H
Progress Estimate City Secretary 53037
Contract Num:
For(contract): Parker Henderson Road from Mansfield Highway(BUS 287)Kellis St.
Application Period: 10-27-22 to 11-9-22
A B C
Item
Bid Item No.
Specification Unit of Bid Quantity Unit Price Bid Value Estimated Quamit
Description
Section No. Measure Installed
30 3212.0502 4.5"Asphalt Base Type B 321216 ___ SY 1172.000000 $26.00 $30.472.00 _ 2_362.0000.
31 3213.0105 10"Concrete Pvmt 321313 SY 9468.000000 $72.00 $680,976.00 9534.7100
32 3213.0301 4"Concrete Sidewalk 321320 SF 34262.000000 $9.00 $308,358.00 31765.0000
33 3213.0401 6"Concrete Driveway 321320 SF 9102.000000 $11.00 $100,122.00 9523.0000
34 3213.0505 Barrier Free Ramp,Type M-3 321320 EA 1.000000 $1.900.00 $1.900.00 _ _1.0000
35 3213.0506 Barrier Free Ramp,Type P-1 321320 EA 3.000000 $1.450.00_ $4,350.00 _ 3.0000
36 3213.0507 Barrier Free Ramp,Type P-2 3213 20 EA 14.000000 $1,450.00 $20,300.00 __ 15.0000
37 3216.0102 7"Cone Curb and Gutter 321613 LF 106.000000 $40.00 $4,240.00__ 213.000_0
38 3232.0100 Cone Rat Wall with Sidewalk,Face 323213 SF 429.000000 $40.00 $17.160.00 _528.0000
39 3291.0100 Topsoil 329119 CY 1453.000000 $23.00 $33,419.00 930.0000
40 3292.0100 Block Sod Placement 329213 SY 8765.000000 _ $4.10 $35,936.50 _ _3300.0000
41 3292.0400 Seeding,Hydromulch 329213 SY 8717.000000_ $1.15 $10,024.65 7255_._0000
42 3305.0108 Miscellaneous Structure Adjustment-Water Meter vault 330514 EA 1.000000 $7,500.00 $7,500.00 _
43 3305.0114 Manhole Adjustment,Major w/Cover 330514 EA 3.000000 $2,800.00 $8,400.00_ 3.0000
44 9999.0180 Concrete Curb(Dowel) 999900 LF 1357.000000 $15.00 $20,355.00 950.0000
45 9999.0190 Mountable Curb and Gutter 99 99 00 LF 100.000000 $30.50 $3.050.00
46 9999.0200 Concrete Header 99 99 00 LF 141.000000_ $22.00 $3.102.00 _ 69.0000
47 9999.0260 Construction Contingency Allowance to cover cost of .999900 LS 1.000000 $100,000.00 $100,000.00 _
TRAFFIC CONTROL
48 3211.0125 12"Flexible Base,Type A,GR-2 321123 SY 9709.000000 $18.00 $174,762.00 _ 7331.1000
19 3212.0304 4"Asphalt Pvmt Type D 321216 SY 7902.000000 $26.00 $205,452.00 _ 6766.2_000
50 3441.1802 Relocate School Zone Warning Flasher Assmbly(Solar) 3441 10 LS 2.000000 $5,800.00 $11,600.00 2.0000
51 3471.0001 Traffic Control 3471 13 MO _ 15.000000 $6,000.00 $90.000.00 15.0000
52 9999.0270 Temporary 15"CMP 99 99 00 LF 466.000000 $41.75 $19.455.50 171.0000
53 9999.0280 Temporary 18"CMP 99 99 00 LF _ _ _ 56.000000 $41.75 $2,338.00 20.0000
54 9999.0290 LPCB Type 1,Fumish&Install 99 99 00 LF 1240.000000 $50.00 $62,000.00_ 1240.0000
55 9999.0300 LPCB Type 2,Furnish&Install 99 99 00 LF 120,000000 $50.00 $6,000.00 120.0000
56 9999.0310 Removable Paving Marking(W)4"(SLD) 999900 LF 12372.000000 $1.00 $12,372.00__
57 9999.0320 Removable Paving Marking(Y)4"(SLD) 999900 LF 12512.000000 $1.00 _ $12.512.00 9152.0000
58 9999.0330 Removable Paving Marking(W)12"(SLD) 999900 LF 64.000000 $1.00 $64.00 93.000C
59 9999.0340 Orange Mesh Construction Perimeter Fence 99 99 00 LF 915.000000 $4.70 $4.300.50 1523.0000
DRAINAGE
60 0241.1100 Remove Asphalt Pvmt 02 41 15 SY 112.000000 $20.00 $2,240.00
61 3201.0112&Wide Asphalt Pvmt Repair,Residential 3201 18 LF 200.000000 _ $54.00 $10.800.00 _
62 3301.0002 Post-CCTV Inspection 330510 LF 1900.000000 $1.70 $3,230.00
63 3305.0109 Trench Safety 330131 LF 1900.000000 $0.60 $1,140.00 _
64 3137.0101 Concrete Riprap 313700 _ SY 102.000000 $125.00 $12,750.00 _ 66.9000
65 3341.0103 18"RCP,Class III 3341 10 LF 69.000000 $116.00 $8,004.00 _ _ 112_.000C
66 3341.0201 21"RCP,Class III 3341 10 LF 263.000000_ $149.00 $39.187.00 269.000C
67 3341.0205 24"RCP,Class III 3341 10 LF 896.000000 $139.00 $124,544.00_ 9_01.000C
68 3341.0208 27"RCP,Class III 3341 10 LF 667.000000 $162.00 $108,054.00 __ 6.94.000(
69 3341.0302 30"RCP,Class III 33 4110 _ LF 7.000000 $197.00 $1,379.00 _ 7.0_001
70 3349.0001 4'Storm Junction Box 334910 EA 8.000000 $4,136.00 $33.088.00 8.000C
71 3349.4103 18"SET,1 pipe 33 49 40 EA 2.000000 $3,356.00 $6,712.00 _ _ _ 2.0001
72 3349.6001 19 Recessed Inlet 33 49 20 EA 5.000000 $4,502.00 $22,510.00__ _ 5.000C
73 3349.6002 16 Recessed Inlet 33 49 20 EA 2.000000 $5,125.00 $10,250.00 2.000(
74 3349.7001 4'Drop Inlet 33 49 20 EA 1.000000 $5,386.00 $5.386.00_ _ 1.000(
75 9999.0100 19 Open Back Recessed Inlet 99 99 00 EA 3.000000 $5,299.00 $16,897.00 3.000(
76 9999.0110 10'Curb&Grate Inlet Type 1 99 99 00 EA 1.000000 $3.934.00 $3,934.00__ 1.000(
77 9999.0130 3/8"Steel Plate for SW Crossing 99 99 00 _ SF 45.000000 $35.00 $1,575.00 50.000_(
SIGNING AND PAVEMENT MARKINGS
78 3217.0001 4"SLD Pvmt Marking HAS(W) 321723 LF 3042.000000 $1.05 $3,194.10 2798.000(
79 3217.0002 4"SLD Pvmt Marking HAS(Y) 32 1723 LF 8784.000000 $1.05 $9,223.20_ 8148.00IX
_ 80 3217.0005 4"DOT Pvmt Marking HAS(W) 32 1723 LF 976.000000_ $1.05 $1,024.80 _ 270.0001
81 3217.0201 8"SLD Pvmt Marking HAS(W) 32 1723 LF 150.000000 $2.00 $300.00__ 121.0001
82 3217.0202 8"SLD Pvmt Marking HAS(Y) 32 1723 LF 188.000000 $2.00_ $376.00_ 204.000(
83 3217.0301 12"SLD Pvmt Marking HAE(W) 32 1723 LF 90.000000 $4.00 $360.00__ _
84 3217.0501 24"SLD Pvmt Marking HAE(W) 32 17 23 LF 476.000000 $8.00 $3.808.00__ _404.000(
85 3217.1002 Lane Legend Arrow 321723 EA 2.000000 $135.00 $270.00 2.0_0_0(
86 3217.1004 Lane Legend Only 32 17 23 EA 2.000000__ $135.00 $270.00 _ 2.000(
87 3217.1006 Lane Legend Bike 321723 EA 12.000000 $430.00 $5.160.00 11.000(
88 3217.1007 Lane Legend Sharrow 321723 EA 3.000000 $410.00 $1.230.00 4.000(
89 3217.2102 REFL Raised MarkerTY I-C 32 1723 EA 8.000000 $4.00 $32.00 7.000(
90 3217.2103 REFL Raised MarkerTY II-A-A 321723 EA _ 112.000000 $4.00 $448.00 98.000(
91 3441.4003 FumishMstall Alum Sign Ground Mount City Sid. 344130 EA 30.000000 $495.00 $14,850.00 _ _ 28.0.00_(
ILLUMINATION
92 3441.1401 NO 4 Triplex OH insulated Else Condr 3441 10 LF 1695.000000 $5.00_ _ $8,475.00 1.695.0_00(
93 3441.3323 Fumish/Install 8'Wood Light Pole Arm 3441 10 EA 10.0000on $780.00 $7,800.00 10.000(
This document has been modified from its original form a
`, modifications.You are encouraged to read the document,
Progress Estimate City Secretary 53037
Contract Num:
For(contract): Parker Henderson Road from Mansfield Highway(BUS 287)Kellis St.
Application Period: 10-27-22 to 11-9-22
A B C
Item
Specification Unit of Bid Quantity Unit Price Bid Value Estimated Quantil
Bid Item No. Description Section No. Measure Installed
94 3441.3051 FumishAnstall LED Lt Fixture(137 watt ATB2 Cobra Head) 344120 EA _ 11.000000 $900.00 $9.900.00 11.0000
UNIT II-STORM WAER IMPROVEMENTS
A1-1 9999.0210 Retaining Wall(MSE) 99 99 00 SF 7311.000000
TRAFFIC CONTROL
At-2 3124.0101 Embankment by Plan 312400 CY 7904.000000
Al-3 3211.0125 12"Flexible Base,Type A,GR-2 321123 SY 1301.000000
A14 M2.0304 V Asphalt Pvmt Type D 321216 SY 1072.000000
Al-5 3341.0103 Temporary 12"RCP,Class III 3341 10 LF 40.000000
A1-6 3471.0001 Traffic Control 347113 MO 3.000000
A1-7 9999.0310 Removable Paving Marking(W)4"(SLD) 99 99 00 LF 726.000000 _
Al-8 9999.0320 Removable Paving Marking(1)4"(SLD) 999900 _ LF 958.000000
CULVERT
Al-9 3341.2108 11x11 Box Culvert(Precast) 3341 10 LF 406.000000
9999.0360 PW for 7-11'xl1'MBC _ 999900 EA 2.000000
Al-10 UNIT II-STORM WATER IMPROVEMENTS
A2-1 _9999.0210 Retaining Wal)(MSE) 999900 _ SF 7311.000000
TRAFFIC CONTROL
A2-2 9999.0341 Traffic Control 99 99 00 LS 1.000000
CULVERT - -
A2_3 3341.2108 11x11 Box Culvert(Precast) 3341 10 LF 406.000000
A2-4 9999.0360 PW for 7-11'xl l'MBC 99 99 00 EA 2.000000_
UNIT II-STORM WATER IMPROVEMENTS --
A3-1 9999.0210 Retaining Wall(MSE)_ 99 99 00 _ SF 7861.000000 _ $72.00 $565,992.00 8344.0000
TRAFFIC CONTROL
A3-2 9999.0341 Traffic Control 99 99 00 LS 1.000000 $25,000.00 $25,000.00 1.0000
CULVERT
A3-3 9999.0391 11x11 Box Culvert(Cast-In-Place) 99 99 00 LF 406.000000 $957.00 $388,642.00 406.0000
A3A 9999.0360 PWfor7-11'xll'MBC 999900 EA 2.000000 $80,627.00 $161,254.00 2.0000
This document has been modified from its original form a
modifications.You are encouraged to read the document c
Progress Estimate City Secretary 53037
Contract Num:
For(contract): Parker Henderson Road from Mansfield Highway(BUS 287)Kellis St.
Application Period: 10-27-22 to 11-9-22
A B C
Item
Hid Item No. Description
Specification Unit of Bid Quantity Unit Price Bid Value Estimated Quantil Section No. Measure Installed
This document has been modified from its original form a
modifications.You are encouraged to read the document c
Progress Estimate City Secretary 53037
Contract Num:
For(contract): Parker Henderson Road from Mansfield Highway(BUS 287)Kellis St.
Application Period: 10-27-22 to 11-9-22
A B C
Item
Bid Item No. Description
Specification Unit of Bid Quantity Unit Price Bid Value Estimated Quantii Section No. Measure
Totals $7,664,922.56 Installed
This document has been modified from its original form i
modifications.You are encouraged to read the document
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FORTWORTH
TRANSPORTATION AND PUBLIC WORKS
PIPE REPORT FOR:
PROJECT NAME: Parker Henderson Road
CITY PROJECT NUMBER: c01419
WATER
PIPE LAID SIZE TYPE OF PIPE LF
DR-14 6" PVC 151
DR-14 8" PVC 256
DR-14 12" PVC 3599
Class 350 12" DIP 22
DR-18 16" PVC-C905 253
FIRE HYDRANTS: 6 VALVES(16" OR LARGER) N/A
PIPE ABANDONED SIZE TYPE OF PIPE LF
N/A
DENSITIES: PASSED
NEW SERVICES: N/A
SEWER
PIPE LAID SIZE TYPE OF PIPE LF
PIPE ABANDONED SIZE TYPE OF PIPE LF
DENSITIES:
NEW SERVICES:
TRANSPORTATION AND PUBLIC WORKS
The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TX 76012-6311
(817)392-7941 •Fax: (817)392-7845
CSC No.53037-COI
FORT WORTH City of Fort Worth
� -I Change Order Request
Project Name Parker Henderson Road(Mansfield Highway to Kellis Street) City Sec# 1 53037
Client Project#(s) C01419
Project Water main replacement,pulverization of existing roadway,full reconstruction from Lifestyle Cir.To David Strickland Rd.,replacement of multibox culvert
Description at Prairie Dog Creek and construct sidewalks.
Contractor McClendon Construction Company,Inc. Change Order# 1 Date 4/11/2022
City Project Mgr. Alejandra Ayala,P.E. City Inspector Steven Aguirre
Dept. Unit I Water Unit II Storm Water Unit II Alt Storm Unit III Paving& Contract Time
Water Drainage Totals CD
Original Contract Amount $935,257.60 $1,842,785.85 $1,140,788.00 $3,746,091.40 $7,664,922.85 540
Extras to Date 90
Credits to Date
Pending Change Orders(in M&C Process)
Contract Cost to Date $935,257.60 $1,842,785.85 $1,140,788.00 $3,746,091.40 $7,664,922.85 630
Go to ADD&DEL Tabs to Enter CO Backup $0.00 $36,528.60 $0.00 -$177,845.45 $214,374.05 60
Revised Contract Amount $935,257.60 $1,806,257.25 $1,140,788.00 $3,568,245.95 $7,450,548.80 690
Original Funds Available for Change Orders $0.00
Remaining Funds Available for this CO $0.00 $0.00 $0.00 $0.00
Additional Funding(if necessary)
CHANGE ORDERS to DATE(INCLUDING THIS ONE)AS%OF ORIGINAL CONTRACT -2.80%
MAX ALLOWABLE CONTRACT AMOUNT(ORIGINAL CONTRACT COST+25%) $9,581,153.56
JUSTIFICATION(REASONS)FOR CHANGE ORDER
IN ACCORDANCE WITH THIS CHANGE ORDER REQUEST,THE CONTRACT SHALL: Furnish all labor and material as per attached proposed Change Order
Request(with attachments):
Change order deductions are for line items that will no longer be used for the completion of the project. The funds will be used to pay for unforseen field conditions. The
justification for each line item is as follows: C01.1&2: Unforseen waterline and irrigation lines were encountered during construction;redesign of the MSE was necessary
in order to notch the wall out for these lines. C01.3: Handrail was needed at curb inlet north of which was not identified in the design plan set. COI A: Tree mitigation fund
was added to pay for the cost of mitigating trees in lieu of planting per PARD. This change order also reconciles the contract quantities and includes extending the contract
time an additional 60 days. Unit II,Item 20: Flexible base was placed over the Prairie Dog Creek culvert in lieu of Lime Stabilized Subgrade. The time extension is needed
due to shortages and delivery time in rim and cover manhole lids.
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.
Contractor's Cill Name IllDate
McClendon Construction Com an ,Inc. Justin Blair 04/25/zz
Ins ector/Ins ection Supervisor Date Pr6ject and Contract Compliance Manager Date
-AWA 04/22/22 galarc��� 4 04/21/22
Program Manager Date Senior Capital Project Officer RP Date
_,, 04/25/22 h wF 04/25/22
Assistant Director(Dept) Date Director,Contracting Department(Dept) Date
Apr 25,2022 �>R- . p. 04/25/22
v
Assistant City Attorney I Date JAssistant ity Manager Date
04/25/22 Dana 04/25/22
Council Action if re uired
M&C Number NA M&C Date Approved INA
ATTEST:
ahN,,}ia(z»aai
Jannette Goodall,City Secretary
I t,rx r 14'uer tr City of Fort Worth
Change Order Additions
Project Name Parker Henderson Road(Mansfield Highway to Kellis Street) City Sec# 53037
Client Project# C01419
Contractor McClendon Construction Company,Inc. PM Alejandra Ayala,P.E. Inspector Steven Aguirre
Change Order Submittal# O1 Date 4111I2022
ADDITIONS
ITEM DESCRIPTION ut:PT Qty Unit Unit Cost Total
wall Keaesign&L;ast in Place Bends/Caps ni awng re
Casing Pipe Through Wallni avng re
Handrail Unit III Paving Dra LF 5.
Tree Mitigation ni awng re
5"Flexible Base,Type A,GR-2 Unit II Storm Water 3,163.00000000 SY
Unit I Water $0.06
Unit II Storm Water $56,934.00
Unit II Alt Storm Water $0.00
Unit III Paving&Drainage $133,055.00
u o a Additions TTFWN
Change Order Additions Page 2 of 4
City of Fort Worth
Change Order Deletions
Project Name Parker Henderson Road Mansrield fthway to Kellis Street City Sec# 53037
Client Project# C01419
Contracts McClendon Construction Company,—Inc---] PM Alejandra Ayala,P.E. Inspector Steven Aguirre
Change Order Submittal# 0 Date 4111I2022
DELETIONS
ITEM DESCRIPTION DEPT Qty Unit Units a
LMCMUI emova Concrete Unve m rm a er
emova Fence m rm a er
y-IF--rate --IF--
rated Lime m rm a er
ime Treatment m rm a er
Topsoil m rm a er
3201.0112 i e Asphalt PvmtRepair,Residential DROT90—m-Wa-far-
Turf Reinforcementa m rm a er
ree Removal UnitPaving
ree Removal UnTITPavng
a ree ni awng
Fle)dble Base,Type - ni awng r
Concrete Sidewalk ni awng ITYR
Topsoil ni avmg
-lemble Base,Type ni awng ra
Asphalt mType D UnitPaving&Dr,
emporary ni awng V r
Temporary m avmg
9999.0310 Removable Paving Marking ni awng r
Remove Asphalt Pvmtni awng
b'WkIe Asphalt PvmtRepair,Residential ni awng ra
Unit I Water 0.00
Unit II Storm Water 93,462.60
Unit II Alt Storm Water $0.00
Unit III Paving&Drainage 310,900.45
56
a e Drainage
Change Order Deletions Page 3 of 4
MISBE for this Change Order
M/SBE Sub Type of Service Amount for this CO
Total $0.00
Previous Change Orders
CO# DATE AMOUNT
Total $0.00
FORT WORTH.
TRANSPORTATION AND PUBLIC WORKS
October 26, 2022
McClendon Construction Company Inc
548 Memorial Plaza
Burleson,TX 76028
RE: Acceptance Letter
Project Name: Parker Henderson Rd
Project Type: Water,Storm, Paving and Drainage
City Project No.: C01419
To Whom It May Concern:
On August 29, 2022 a final inspection was made on the subject project. There were punch list items
identified at that time. The punch list items were completed on October 26, 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. The warranty period will start on October 26, 2022,which is the date
of the punch list completion and will extend of two (2)years in accordance with the Contract
Documents.
If you have any questions concerning this letter of acceptance, please feel free to contact me at 817-
392-8883.
Sincerely, /
Alejan Ayala(Nov 14,202212:0 T)
Alejandra Ayala, Project Manager
Cc: Brian McGill, Inspector
Ron Cordova, Inspection Supervisor
Edward Davila,Senior Inspector
Raul Lopez, Program Manager
Bridgefarmer and Associates Inc, Consultant
McClendon Costruction Company Inc,Contractor
City of Fort Worth, Developer
File
E-Mail: TPW_Acceptance@fortworthtexas.gov
Rev.8/20/19
Bond Number TXC611763
CONSENT OF
SURETY COMPANY
TO FINAL PAYMENT
PROJECT: Parker Henderson RoGd
(name.uddrum)
TO(Owner)
City of Fort Worth, Texas
200 Texas Street CONTRACT FOR: Construction
Fort Worth, TX 76102
CONTRACTOR: CONTRACT DATE:
McClendon Construction Company, Inc. 9/17/2019
548 Memorial Plaza
B - T ti 74
In accordance with the provisions of the Contract between the Owner and the Contractor as
indicated above,the (hem invert ruime (and addrees or Surety Co.)
Merchants Bonding Company [Mutual'
PO Box 14498
Des Mines, IA 50306-3498 , SURETY COZ1FANCY,
on bend 60acre tnwrt rutme and addrem of UantntLlor)
McClendon Construction Company, :inc.
548 Memorial Plaza
Burleson, TX 76024 , CONTRACTOR
hereby approves orthe final payment to the Contractor and agrees thut final payment to the
Contractor shall not roliove tho Surety Company of any of Its obligations to(heir inKrt name and
nddreaa or Owner)
City of Fort Worth, Texas
200 Texas Street
Fort Worth, TX 76102 0IVM2R.
as set forth in the said Surety Company's Buna.
IN WITNESS WHEREOF, Merchants Bonding Company [Mutual]
tho Surety Company bon horounto sot its hand this loth day of NOyemher 2022
filer' harts B nd Cove an
Su '1Coml 7
t 'e of Act bo Repmenl at byKett J. Rjll[
h•
Attorney-In-Fact
MERCHANTS
BONDING COMPANY„
POWER OF ATTORNEY
Know All Persons By These Presents,that MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING, INC.,
both being corporations of the State of Iowa(herein collectively called the"Companies")do hereby make,constitute and appoint,individually,
Ana Tomes;Andrew Addison;Betty J Reeh;Bryan K Moore;Elizabeth Ortiz;Michael D Hendrickson;Patricia Ann Lytlle;Patrick Coyla
their true and lawful Attorneys)-in-Fact, to sign its name as surety(les) and to execute, seal and acknowledge any and all bonds, undertakings,
contracts and other written instruments in the nature thereof, an behalf of the Companies in their business of guaranteeing the fidelity
of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any
actions or proceedings allowed by law.
This Power-of-Attorney is granted and is signed and sealed by facsimile under and by authority of the following By-Laws adopted by the Board
of Directors of Merchants Bonding Company(Mutual) on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors
of Merchants Nationa I 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 ❑epartment of Transportation. It is fully understood that consent ng to the State of Florida Department
of Transportation making payment of the final estimate to the Contractor andlor its assignee, shall not relieve this surety company of any of
its obligations under its bond.
In connection with obligations in favor of the Kentucky Department of Highways only,it is agreed that the power and authority hereby given
to the Attomey-in-Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner-
Department of Highways of the Commonwealth of Kentucky at least thirty(30)days prior to the modification or revocation.
In Witness Whereof,the Companies have caused this instrument to be signed and sealed this 19th day of March 2021
�1P0►4[ � 4� ,�P. A .�y•• MERCHANTS BONDING COMPANY(MUTUAL)
9�'' Z: �:�,� '��,•yi; MERCHANTS NATIONAL BONDING,INC.
t%Nx 1933
By
2003
.............
. .• '.•�I •y: ��.• Aresrtferrf
STATE OF IOWA �r'••rr.•••+•+ •••
COUNTY OF DALLAS ss.
On this 19th 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.
1�_IIIA4 S111 POLLY MASON
o -P Commission Number 750576 Marv-�.�
°°°°9 °
My Commission Expires
10YO. January 07, 2023
Notary Public
(Expiration of notary's commission
does not irrvalidate 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
farce and effect and has not been amended or revoked. t
In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on thisw�day of
i..r.."
X�kla co
L P 0
c►.`':�oRPoRq :•�:'o Ar .
2E)03 '►,7 • 1933 secretary
.04
POA 0018 (1/20) ''••......••+•' -•••••••
MEC Ts
BONDING COMPANY
IMPORTANT NOTICE
To obtain information or make a complaint:
You may contact your insurance agent at the telephone number provided by your insurance
agent.
You may call Merchants Bonding Company's toll-free telephone number for information or to
make a complaint at:
1-800-678-8171
You may contact the Texas Department of Insurance to obtain information on companies,
coverages, rights or complaints at:
1-800-252-3439
You may write the Texas Department of Insurance at:
P. Q. Box 149104
Austin, TX 78714-9104
Fax: (512) 475-1771
Web: http://www.tdi.state.tx.us
E-mail: Con sumerProtection c7tdi.state.tx.us
PREMIUM AND CLAIM DISPUTES: Should you have a dispute concerning your premium or
about a claim you should contact the agent first. If the dispute is not resolved, you may contact
the Texas Department of Insurance.
ATTACH THIS NOTICE TO YOUR POLICY: This notice is for information only and does not
become a part or condition of the attached document.
SUP 0032 TX (1109)
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 Justin Blair,Vice President of McClendon
Construction Company,Incorporated,known to me to be a credible person,who being
by me duly sworn,upon his oath deposed and said;
That all persons,firms,associations,corporations or other organizations
furnishing labor and/or materials have been paid in full;
That there are no claims pending for personal injury and/or property damages;
On Contract described as;
Parker Henderson Road(CPN 01419)
Justin Blair
Subscribed and sworn before me on this day of
2 ZZ
MISTY WEBB
Notary Public,State of Texas
Comm,Expires 01-09-2026 No Public in Tarrant
Notary ID 126838467 ounty,Texas