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Contract 57313-FP1
FORTWORTH, TRANSPORTATION AND PUBLIC WORKS NOTICE OF PROJECT COMPLETION -FP1 City Secretary No: 57313 Date Received: 7/28/2023 City Project N!?: 103609 Regarding contract 57313 2021 Street Rehabilitation Project for as required by the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by City Council on 3/8/2022 through M&C 22-0149 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: $ 2,067,672.76 Amount of Approved Change Orders: $ 10,237.25 No 3 Revised Contract Amount: $ 2,077,910.01 Total Cost Work Completed: $ 2,020,624.17 Less Deductions: Liquidated Damages: _ Days @ $ Pavement Deficiencies: Total Deduction Amount: $ Total Cost Work Completed: $ 2,020,624.17 Less Previous Payments: $ 1,919,592.96 Final Payment Due $ 101,031.21 Tatni is L. ww(fach Jul 27, 2023 Patricia L. Wadsack (Jul27, 202318:02 CDT) _ Recommended for Acceptance Date Asst. Director, TPW - Capital Delivery A."�"�- Jul 27, 2023 Lauren Prieur (Jul 27, 2023 18:07 CDT) Accepted Date Director, TRANSPORTATION AND PUBLIC WORKS DEPARTMENT William Johnson (Ju 28, 202310:21 CDT) Asst. City Manager Comments: Ju128,2023 Date / Day MVOFFICIAL RECORD CITY SECRETARY FT. WORTH, TX C-620 Signature Page Contractor's Application for Payment To (Owner) City of Fort Worth Invoicing Period (From -To): 6/l/2023 to 6/30/2023 P. G. FW020-0000008101 Number: Project: 103609 City Secretary Contract Number: Approved Change Orders Number 1 2 3 4 5 6 7 8 TOTALS NET CHANGE BY CHANGE ORDERS Contractor's Certification CS57313 Application For Payment Change Order Summary Additions $9,000.00 $1,237.25 $68,568.15 $78,805.40 From (Contractor): Texas Materials Group Contractor's CFW Vendor No.: 0000000257 Contract Namme:: 2021 Street Rehabilitation $10,237.25 Deletions $68,568.15 $68,568.15 The Contractor certifies with the submittal of this document and associated Payment Request Submittal on the City of Fort Worth Buzzsaw system that to the best of their knowledge: (1) all previous progress payments received from Owner on account of Work done under the Contract have been applied on account to discharge Contractor's 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 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 encumbrances); and (3) all Work covered by this Application for Payment is in accordance with the Contract Documents and is not defective. Liquidated Damages $650.00 x day Invoice No. 14 FINAL Invoice Date: 7/11/2023 Remit to ( If Not Automatic Deposit): I1.ORIGINAL CONTRACT PRICE.......................................................... $ 12. Net change by Change Orders................................................................. $ 13. Current Contract Price (Line 1 t 2)........................................................ $ 14. TOTAL COMPLETED AND STORED TO DATE (Progress Estimate, Construction Allowance and Change Orders)....... $ 15. RETAINAGE: a. X $2,020,624.17 Work Completed.......... $ b. X Not Used $ c. Total Retainage (Line 5a + Line 5b) ............................... $ 16. AMOUNT ELIGIBLE TO DATE (Line 4 - Line 5c)............................. $ 17. LESS PREVIOUS PAYMENTS (Line 6 from prior Application)........ $ 8. AMOUNT DUE THIS APPLICATION ................................................. $ 9. BALANCE TO FINISH, PLUS RETAINAGE (Column G on Progress Estimate+ CA + Cos + Line 5 above) .............. $ 10. CONTRACT TIME: a, Days Awarded b, Days Added by CO C. Total Days d, Days Charged e, Days Remaining Consent of Surety Affidavit of Bills Paid $2,067,672.76 $10,237.25 $2,0779910.01 $2,020,624.17 $2,020,624.17 $1,919,592.96 $101,031.21 $57,285.84 160 194 354 352 2 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-620 Unit Price Pmgresa Eidl-te Progress Estimate Fnr(-) 2021 Street Rehabilitation Applsavon P.d 6/l/2023 to 6/30/2023 A dT Specificvnon Bid Quavtity Bid Item No Description Section No Uni[ of Measure 1 p135.0201 REMOBILIZATION 017000 EA 1 2 0241 1300 REMOVE CONC CURB & GUTTER 0241 13 LP 1000 3 3 16.0102 7" CONC CURB AND GUTTER 32 16 13 LF 5400 4 0241 0401 REMOVE CONCRETE DRIVE 0241 13 SF 3080 5 3 13.0401 6" CONCRETE DRIVEWAY 321320 SF 3080 6 0241 1400 REMOVE CONC VALLEY GUTTER 0241 13 SY 30 7 3216.03017" CONC VALLEY GUTTER 32 16 13 SY 30 S 32120600 ASPHALT PAVEMENT LEVEL -UP 32 12 73 TN 5 $ 3 12.0302 2" ASPHALT PAVEMENT, TYPE D 32 12 16 SY 49826 10 0241 1506 2' SURFACE MILLING 0241 15 SY 3200 11 3212.0900 CRACK SEALING OF EXISTING PAVEMENT 32 1273 GAL 5 12 3124 0101 ASPHALT PAVEMENT BASE REPAIR 32 01 07 CY 25 13 0241.170012" PAVEMENT PULVERIZATION 321273 SY 46626 14 3211 0600 CEMENT MODIFICATION 26 LB/SY 32 11 33 TN 607 l5 3212.OSOl 2"ASPHALT PAVEMENT, TYPE B 32 12 16 SY 46626 16 3123010E UNCLASSIFIED EXCAVATION 312316 CY 90 17 3292.BIBB BLOCK SOD REPLACEMENT 3292 13 SY 805 I R 3217 0501 24" SOLID EXTRUDE THERMOPLASTIC (HAE)(125 MIL) 32 1723 LF 212 19 3217.040E 18" SOLID EXTRUDE THERMOPLASTIC (HAE)(125MIL) 32 17 23 LF 2221 20 3217 0201 8" SOLID EXTRUDE THERMOPLASTIC (HAE)(125 MIL) 32723 LF 5275 21 3217.0001 6" SOLID EXTRUDE THERMOPLASTIC (HAE)(125MIL) 32 172 LF 1016 22 3217 0001 6" SOLD) EXTRUDE THERMOPLASTIC (HAE)(125MIL) 32 1723 LF 24123 23 3217,0101 6" SOLID EXTRUDE THERMOPLASTIC (HAE)(125MIL) 32 1723 LF 19637 24 32172103 REF L RAISED MARKER TY E-A-A 321723 EA 291 25 3217.2104 REEL RAISED MARKER TY B-C-R 32 1723 EA 135 26 3217 ]002 THERMOPLASTIC PREFORMED LANE LEGEND ARROW 32 1723 EA 9 27 3217, 004 THERMOPLASTIC PREFORMED LANE LEGEND ONLY 32 1723 EA 2 28 3217 5001 CURB ADRESS PAINTING 32 1725 EA 14 29 3291,0100 TOPSOIL 329119 CY 85 30 32110122 FLEX BASE, TYPE A, GR-2 32 1123 CY 10 31 3305.0108 MISCELLANEOUS ADJUSTMENT (UTILITIES) 3305 14 LS 1 32 3305 0112 WATER VALVE BOX ADJUSTMENT (WITH CONCRETE 3305 14/33 EA 2 33 3305.0112 MANHOLE ADJUSTMENT (WITH CONCRETE COLLAR) 330 14/33 EA 14 STIN�S GN 300 SY) 1 10 LS 1 35 Ol7l OIOI TR5511 O1 71 23 LS 1 ;6 3471 0002��lYCAJfLE�. 'AGE BOARD 347 13 WK 50 37 9999.0096 PAVING CONSTRUCTION ALLOWANCE LS 1 City Secretary CS57313 Cordmct Num Unit Price $500 00 $8.65 $46 50 $7.30 $10 80 $37.85 $108 20 $411.45 $1085 _ $4.00 $1970 _ $413.50 $670 _ $264.25 $936 _ $65.80 $13 00 $7.55 $5 95 $1.90 $1 90 $1.20 $1 20_ $4.60 $4 60 $216.35 $216 35 $36.80 $54 10 $140.75 $10,00000 $975.00 $1,300 00 S4,785.00 $5,409 00 $506.05 $100,00000 B Bid Value Contractor's Application Applicsvou Nmvbcc 14 FINAL Applicsvou Dare 7/11/2023 C U E F G Total Completed / Balance tv Fimsh Estimated Quantity Quantity Vnlue Previously Installed Value Materials PresevOy Value This Period and Storedm Dale IT) (B-F) Iiti,d Smred(votm C) D+E) B 1.0000000di $500.011 $500.0 $35,996111 $500.0 100.0% $35,99611 4161%-$27,34611 4161400000001 $35,99611 This document has been modifM from its M'd.l form as an EJCDC document and the user did not higlilight the modi6cano.. You are rncomaged to read de documem carefully and -It Legal C-I poor m na execvnom C-620 Unit Price Pmgreaa Estimate Progress Estimate 2021 Street Rehabilitation Applsaaon P.d 6/l/2023 to 6/30/2023 Item Bid Item No Deurip[ion C'tySry CS57313 Contractor's Application Contract Num Apphcaaon Nwnbcv 14 FINAL Applicsaon Date 7/11/2023 A B C U E F G Total CompletN / Balance to Fi h Estimated Quantity Materials Presently Specifics... Uni[of Measure Bid Quantity Unit Price Bid Value liismlled Velne Previously 1..1led Value Value This Period Stored (norm C) and Stored to Dale (P) (B-f') Section No (D+E) B This document has been modiFlM from its origiwl form as an EJCDC document and the user did not higNight We moddl—... You are rncomaged to read d d carefully and c 1t Legal C.0 poor m its execvnom C-620 Unit Price Progress Estimate Progress Estimate Cry Seen CS57313 Conhact Num 2021 Street Rehabilitation Applsaaon P.d 6/l/2023 to 6/30/2023 A H I m Bid Item No Description Specr& .. Unit of Measure Bid Quantity Unit Price Bid Value Section No Totals $2,067,672.76 Contractor's Application Applresaou Nmubcv 14 FINAL Applresaou Date 7/11/2023 C U E F G Total CompletN / Balance to Fi h Estimated Quantity Velne Previously Installed Value Materials P.—flyliismlled Value This Period and Stomdto Date (F) (B -F) Stored (votm C) (D+E) B i F I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I $140.209.501 This document has been modiFlM from iU origiral form as an EJCDC document and the user did not higlilight We moddl—.ns. You are rncomaged to read d d carefully and c 1t Legal C.0 poor m its execvmm C-620 Change Order Progress Estimate For (oommet) 103609 2021 Street Rehabilitation Appheafion Period Item Item Number Description 38 Remove and replace 4" sid—alk/lead walk Construction Allowance Usage ADDITIONS City Secretary CS57313 Carms. Num 6/1/2023 to 6/30/2023 A B C D Estimated Quantity Specification Unit of Measure Quantity m Add Unit Price Addifion Value Installed Vame Section No SF 400.00000000 $9.32 $3,728.00 179.25000000 $1,670,61 Contractor's Application Apphcatmn Number 14 FINAL Applicatmn Date 7/11/2023 E F Total Completed / Balance to Finish Previously Valueod Materials Presently and Stored to Date (F) (B -F) manned value Period stores <not in c) (D I E) B $1,670.61 $1,670.6t 44.8% $2,057.391 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 This document has been modified from its original form as an EICDC document and the user did not highlight the modifications. You are encouraged to read the document ca emlly and consult Legal Counsel prior m its execution C-620 Change Order Totals I I I 1 1 $3,728.001 1 $1,670.611 $1,670.611 1 1 $1,670.611 44.8% 1 $2,057.391 This document has been modified from its original form as an EICDC doeanam and the user did not highlight the modifications. You are eneomaged to read the doeoment —filly and —It Legal Counsel prior to its execution C-620 Change Order Progress Estimate �For(conhec(). 103609 2021 Street Rehabilitation Application Period. be Bid Item Number Description I 37 Paving Construction Allowance Totals Construction Allowance Usage CONSTRUCTION ALLOWANCE ITEMS TO BE REDUCED 6/1/2023 to 6/30/2023 A 6 C Specification Unit of Measure Quantity to Delete Unit Price Re hichon Value Not Used Sechon No EA t.00000000 $3,728.00 Application Number. Application Date. D E Not Used Not Used Not Used Not Used This document has been modified from its original form as an EICDC document and the user did nor highlight the modifications. You are encouraged to read the document carefully and consult Legal Counsel prior to its execution Contractor's Application 14 FINAL 7/11/2023 F Not Used I Not Used Not Used C-620 Change Order Progress Estimate For (`ontraa) 103609 2021 Street Rehabilitation Apphcation Period Item Change Order Item Description No. 38 18 inch - 24 inch tree removal 39 24 inch and larger tree removal Change Order Number I 1 ADDITIONS 6/1/2023 to 6/30/2023 City Secretary CS57313 Contract Nam: A B Addition Specification Unit of Measure CO Quanhty to Add Unit Price Change Order Section No Value EA t.00000000 $2,000.00 $2,000.00 FA 200000000 $3,500 00 $7,000 00 C D Estimated Quantity Value previously Value This h.billed Installed Value Period t.00000000 $2,000.00 $2,000.001 200000000 $7,000.00 $7,000.00 This document has been modified from its original form as an EICDC document and the user did not highlight the modifications. You are encouraged to read the document cwemlly and consult Legal Counsel prior m its execution Contractor's Application 14 FINAL 7/11/2023 E F iTotal Completed / Balance to Finish Materials Presently Q and Stored to Date (F) (B - F) Smred (no[ v C) (D I E) B $2,000.00 100.0% $7,000 00 100.0 % C-620 Change Order Totals 1 $9,000.001 1 $9,000.001 $9,000.001 1 1 $9.000.001 100.0% 1 This document has been modified from its original form as an EICDC doeanam and the user did not highlight the modifications. You are eneomaged to read the dacament —filly and consult Legal Coansel prior to its execution C-620 Change Order Progress Estimate 117m (oommet) 103609 2021 Street Rehabilitation IApplicamm Period. be Change Order Item Description No. Totala Change Order Number 1 1 DELETIONS 6/1/2023 to 6/30/2023 A E C Deletion Specification CO Quantity to Unit Price Change Order Not Used Seen -No Unit of Measure Delete Value Applieation Number Application Date. D E Not Used Not Used Not Used Not Used This document has been modified from its original form as an EICDC doeanam and the user did not highlight the modifications. You are encouraged to read the daeument —filly and consult Legal Counsel prior to its execution Contractor's Application 14 FINAL 7/11/2023 F Not Used Not Used Not Used C-620 Change Order Progress Estimate IFe,omaraet) 103609 2021StreetRehablhtatien Application Period Item Change Order It.. Description No. 40 Remove and prep 4" existing pavement marking 41 Remove and prep 24" existing pavement marking Totals Change Order Number 1 2 Contractor's Application ADDITIONS City semetary CS57313 Appheatron Nnmher 14 FINAL Contract Num: 6/1/2023 to 6/30/2023 Appheatmn Date 7/11/2023 A B C D E F Addition Change Estimated Quantity Previously Value Thrs Materials Presently Total Completed % Specification Unit of CO Quantity to Add Unit Price Order Value Order Installed Va fe Installed Value Period Stored (not m C) and Stored to Date (F) Seen -No Measure B TPW LF 22900000000 $3.45 $790.051 2571 00000000 $8,869.95 $8,869.95 1 $8,869.95 11227% 6� 86.00000000 $447.20 $447.20 This document has been madrfied from its original form as an EJCDC document and the user did not highlight the modifications. You are encouraged to read the document eareflly and Consult Legal Counsel prior m its execution $9,317.15 7531% Balance to Finish (B -F) -$8,079.90 I "I C-620 Change Order Progress Estimate Change Order Number 1 2 DELETIONS IFor(contraoq. 103609 2021 Street Rehabilitation Application Namber. Application period. 6/1/2023 to 6/30/2023 Application Date. A B C D E Item CO Quantity to Deletion Change Change Order Item p Descrinon Specification Unit of else Unit price Order Vafe Not Used Not Used Not Used Not Used Not Used No. Section No. Measure Totals This doa a— has been modified fiom its original form as an EJCDC document and the user did not highlight the modifications. You are encouraged to read the document careflly and consult Legal Counsel prior to its execution Contractor's Application 14 FINAL 7/11/2023 F Not Used Net Used Not Used C-620 Change Order Progress Estimate Change Order Number 1 3 ADDITIONS Contractor's Application IFur(contmd) 103609 2021 Street Rehabilitation City Secretary CS57313 Apphcatum Number: 14 FINAL Contract Noun Appl—fien, Permd 6/1/2023 to 6/30/2023 Applteation Date; 7/11/2023 A B C D E F Item Addition Estimated (mummy Previously Value This Total Completed Materials Presently Chan Order Item S ectfication Unit of CO Quantity to Add Unit Price Change Order Deem'tption Installed Value Installed Value Period and Stored to Date (P) Stored (not in C) No. Section No. Measure Value (D+E) B 42 Install 10" Two B HMAC Base for temporary driveway TPW SF 336.00000000 $36 00 $12,096 00 336.00000000 $12,096 00 $12,096001 1 $12,096 00 100.0 % 43 Remove 10' Concrete at two (2) driveways; haul off and dispose TPW SF 410.00000000 $11 50 $4,71500 44 Remove asphalt tranattma at two (2) driveways; haul off and dispose TPW SF 510.00000000 $12 00 $6,12000 45 Pour 10" thick valley umber at (2) driveways using HES concrete TPW SY 103.00000000 $24525 $25,26075 46 Remove temporary asphalt driveway and make the meaback to orimnq TPW SF 336.00000000 $23.90 $8,030.40 47 4' Solid White Skip Line TPW LF 70.00000000 $1.90 $133.00 48 4" Solid Yellow Center Line TPW LF 6094.00000000 $1.15 $7,008.10 49 4" Solid White Edge Line TPW LF 4526,00000000 $1.15 $5,204.90 410.00000000 $4,71500 $4,71500 510.00000000 $6,12000 $6,12000 103.00000000 $25,26075 $25,26075 336.00000000 $8,030.40 $8,030.40 230.00000000 $437.00 $437.00 7928.00000000 $9,117.20 $9,117.20 6432.00000000 $7,396.80 $7,396.80 This document has been madtfied from its original form as an EJCDC ducument and the ,or did not highlight the modifications. You are encouraged to read the document carefully and consult Legal Counsel prior to its execution $4,71500 100.0 % $6,12000 100.0 % $25,26075 100.0% $8,030.40 100.09A $437.00 328.6% $9,117.20 130.1 $7,396.80 142.1 Balance to Fmtsh (B-F) -$304.00 -$2,109.10 -$2,191.90 C-620 Change Order Totals I I I 1 1 $68,568.151 1 $73,173.151 $73,173.151 1 1 $73,173.151 106.7% 1-$4,605.00I This domment has been madrfied fiom n, o,,giml form as an FJCDC document and the user did not highlight the modifimtions. You are encouraged to read the document careflly and consult Legal Counsel pnor to its execution C-620 Change Order Progress Estimate �Fmtceo-aa>. 103609 2021Street Rehabilitation Appheation Pertod. I he Change Order Item Desmpfion No. I 37 Paving Constmcfion Allowance Totals Change Order Number 1 3 DELETIONS Application Number. 6/1/2023 to 6/30/2023 Appheaeon Date` A B C D E COQ tityro Deletion Spectficatton Unit of Delete Unit Price Change Order Not Used Not Used Not Used Not Used Not Used Section No. Measure Vafe TPW LS 068568150 siomoo o6 $68,56814 $68,568.14. This domment has been madtfied dom its original form as an EJCDC document and the user did not highlight the modi esti . You are encouraged to read the document careflly and consult Legal Counsel prior to its execution Contractor's Application 14 FINAL 7/11/2023 F Not Used Not Used Nes Used C-620 Change Order Progress Estimate Change Order Number 1 4 Contractor's Application ADDITIONS Far(conhacl) 103609 2021 Street Rehabilitation City Secretary CS57313 Applieatmn Number 14 FINAL Contract Num: Applrwhon Ported 6/1/2023 to 6/30/2023 Appliennon Date 7/11/2023 A B C D E F Item Balance to Finish "ly Addition Estimated Qnanhty Previously Value Thrs Ma[evals Presently Total Completed % (B - F) Change O[det Item CO Quantity f Add Deem lion Speciflwtion Umt of Quan Change Order Cart Prn a Chan Installed Value Installed Value Period Stored (not rn C) and Stored to Date (F) No. p Seen -No. Measure Value (D+E) B This dowaa— has been madrfied dom na ongioal form as an EJCDC document and the ,or did not highlight the modi6wtions. You are encouraged w read the document eareflly and consult Legal Counsel prior to its execution C-620 Change Order Totals This domment has been madrfied fiom n, ongiml form as an FJCDC document and the user did not highlight the modifimtions. You are encouraged to read the document careflly and consult Legal Counsel pnor to its execution C-620 Change Order Progress Estimate Change Order Number 1 4 DELETIONS IFor(contrad). 103609 2021 Street Rehabilitation Application Menber. (Application Period. 6/1/2023 to 6/30/2023 Application Date. A B C D E I Item Deletion Change Order Item Specification Unit of Quantity to Unit Price Change Order Not Used Not Used Not Used Not Used NotUsed No. Desrnption Section No. Mesa— Del- Value Totals This domment has been modified dom its original form as an EJCDC document and the user did not highlight the modifications. You are encouraged to read the decument careflly and consult Legal Counsel prior to its execution Contractor's Application 14 FINAL 7/11/2023 F Not Used Not Used Not Used City of Fort Worth Summary of Charqes City Secretary Contract Num: CS57313 2021 Street Rehabilitation �p. 0. FW020-0000008101 Project Number: 103609 Application Period: 6/1/2023 to 6/30/2023 Application 14 FINAL Application Date: 7/11/2023 Number: Funding Identification (FID) Original Contract 30100-0200431-5740010-103609-006280-9999 0 0 0 0 0 0 0 0 0 0 Change Order 1 30100-0200431-5740010-103609-006280-9999 0 0 0 0 0 0 0 0 0 0 Change Order 2 30100-0200431-5740010-103609-006280-9999 0 0 0 0 0 0 0 0 0 0 Total Completed $1,929,133.87 $9,000.00 $9,317.15 Amt Remaining $138,538.89 ($8,079.90) Gross Retainage Net City Secretary Contract Num: I CS57313 Application Period: Funding Identification (FID) Change Order 3 1 30100-0200431-5740010-103609-006280-9999 10 10 10 10 10 10 10 10 10 10 Change Order 4 1 30100-0200431-5740010-103609-006280-9999 10 10 10 10 10 10 10 10 10 10 Change Order 5 1 30100-0200431-5740010-103609-006280-9999 10 10 10 10 10 10 10 10 10 10 City of Fort Worth Summary of Charges 2021 Street Rehabilitation I p 0.: FW020-0000008101 6/1/2023 to 6/30/2023 I Apph Numbber:eer: I 14 FINAL Total Completed Amt Remaining Gross $73,173.15 ($73,173.15) Project Number: 103609 Application Date: 7/11/2023 Retainage Net City Secretary Contract Num: I CS57313 Application Period: Funding Identification (FID) Change Order 6 1 30100-0200431-5740010-103609-006280-9999 10 10 10 10 10 10 10 10 10 10 Change Order 7 1 30100-0200431-5740010-103609-006280-9999 10 10 10 10 10 10 10 10 10 10 Change Order 8 1 30100-0200431-5740010-103609-006280-9999 10 10 10 10 10 10 10 10 10 10 City of Fort Worth Summary of Charges 2021 Street Rehabilitation I p 0.: FW020-0000008101 6/1/2023 to 6/30/2023 I Apph Numbber:eer: I 14 FINAL Total Completed Amt Remaining Gross Project Number: 103609 Application Date: 7/11/2023 Retainage Net City of Fort Worth Summary of Charges City Secretary Contract Num: I CS57313 I 2021 Street Rehabilitation L 0.: FW020-0000008101 project Number: 103609 Number: Application Period: I 6/1/2023 to 6/30/2023 I Appli eer: I 14 FINAL Application Date: 7/11/2023 Funding Identification (FID) Total Completed Amt Remaining Gross Retainage Net Totals 1 30100-0200431-5740010-103609-006280-9999 10 10 10 10 10 10 10 10 10 10 $2,020,624.17 $57,285.84 Grand Total 1 1 $2,020,624.17 1 1 $57,285.84 1 1 $0.00 1 1 ($101,031.21)1 1 $101,031.21 1 FORTWORTH.- Routing and Transmittal Slip Transportation and Public Works Department DOCUMENT TITLE: 2021 Street Rehabilitation, CO 1 M&C CPN 103609 DATE: 8/16/2022 To: Alexiz Ramirez 1. Texas Bit 2. s.Sergio Garcia (Inspector) 4.Tariqul Islam (PM) 5 Omar Elbagalati (PGM) 6 Lane Zarate (SCPO) 7. Martin Philips (Interim AD) 8. Lauren Prieur (Interim Director) g Doug Black (ACA) 10. William Johnson (ACM) 11, Jannette Goodall (CS) CSo # 57313 DOC# INITIALS DATE OUT Aug 17, 2022 Aug 18, 2022 y� Aug 20, 2022 T. Aug 22, 2022 T.I. OE Aug 22, 2022 � Aug 22, 2022 LZ MAP Aug 23, 2022 LLP Aug 24, 2022 dwb Aug 25, 2022 X Aug 25, 2022 JSG Aug 26, 2022 JSG 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: U Yes ❑✓ No RUSH: ❑ ❑✓ Vo SAME DAY: []Yes ❑✓ No NEXT DAY: []Yes ❑✓ No ROUTING TO CSO: ❑✓ Yes ❑No Action Required: Ei As Requested ❑ Attach Signature, Initial and Notary Ta ■ Signature/Routing and or Recording ❑ Comment ❑ File Return to: Please call at ext. for pick up when completed. Thank you. CSC No. 57313-COl FORT�WIo Project Name I 2021 Street Rehabilitation Client Project #(s) I 103609 Project Description Contractor I Texas Bit City Project Mgr. I Tariqul Islam Dept Original Contract Amount Extras to Date Credits to Date Pending Change Orders (in M&C Process) Contract Cost to Date Amount of Proposed Change Order Revised Contract Amount Original Funds Available for Change Orders Remaining Funds Available for this CO Additional Funding (if necessary) City of Fort Worth Change Order Request City Sec # I 57313 Pulverization of existing street and 4 inch asphalt overlay at various locations Change Order # I 1 I Date I 8/16/2022 I City Inspector I Sergio Garcia TPW Contract Time Totals (CD) $2,067,672.76 $2,067,672.76 160 $9,000.00 15 $2,076,672.76 175 $100,000.00 CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS % OF ORIGINAL CONTRACT 0.44% MAX ALLOWABLE CONTRACT AMOUNT (ORIGINAL CONTRACT COST + 25%) $2,584,590.95 JUSTIFICATION (REASONS) FOR CHANGE ORDE This change order is to add $9,000 and 15 days to contract #57313 with a revised contract amount of $2,076,672.76. To reduce traffic congestion on Garden Acres Dr it is proposed to add a lane between Old Burleson Rd and 700 ft east of Old Burleson Rd, as such widening of existing roadway is necessary. In order to widen the street 3 existing tress located at north side of the parkway need to remove. The quote for tree removal is attached to this document as reference. Staff checked contractor's unit price for tree removal with recent bids and considered as reasonable. Also, 15 days are proposed to add to the contract for additional scope of work to widen the street. Adequate fund is available in this project to cover the change order cost. 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 Company Name Contractor (Name) Contract Signature Date Texas Bit Jamie Greenway Aug 18, 2022 Inspector/Inspection Supervisor Date Project and Contract Compliance Manager Date y Aug 20, 2022 W Aug 22, 2022 Program Manager Date Senior Capital Project Officer Date Aug 22, 2022 0� Aug 22, 2022 Assistant Director (Dept) Date Director, Contracting Department (Dept) Date Aug 23, 2022 Aug 24, 2022 ssistant City Attorney Date Assistant City Manager Date wa A' o 22 3 s� Aug 25, 2022 Aug 25, 2022 Council Action (if required) M&C Number I I M&C Date Approved AT>EST:Janneffe S. Goodall Jannette S. Goodall (Aug 26, 2022 07:21 CDT) Jannette Goodall, City Secretary FORT f,RTH I Project Name I 2021 Street Rehabilitation Client Project# 103609 Contractor I Texas Bit I I hM UhSGRIP I ION 36- New 16 inch -24 inch I ree Removal 39- New 24 inch and larger I ree Removal City of Fort Worth Change Order Additions PMI Tariqul Islam AD )ITIONS UFPI I PVv TPW 1 CitySec# 1 01313 Inspector) Sergio Garcia I I 1 ' Date 1 6/1612022 I Unit Unit Gost total I .0 uouoU to L,UOu.u( 2,000.UUI 2.00000000 EA t3,500.tfi 17,000.001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 TPW $9,000.001 I I I Sub Total Additions $9,000.001 Change Order Additions Page 2 of 4 I I LIN Foa - Project Name 2021 Street Rehabilitation Client Project# 103609 Contractor[ Texas Bit UtSIMIP I IUIV City of Fort Worth Change Order Deletions PMI Tariqul Islam DELETIONS DEPI CitySec# j 57313 ## I Inspector[ Sergio Garcia Date 1 8/16/2022 Uty unit unit Cost Iota) I pw $0.00 Sub Total Deletions $0.00 Change Order Deletions Page 3 of 4 M/SBE for this Change Order M/SBE Sub Type of Service Amount for this CO Total $0.00 Previous Change Orders CO# DATE I AMOUNT Total I $0.00 1 TEAS A CRH COMPANY PROPOSED CHANGE ORDER # 1 PROJECT: 103609 - 2021 Street Rehab DATE: August 5, 2022 Attn: TariqulIslam, City of Fort Worth DESCRIPTION OF CHANGE AND/OR EXTRA WORK: ADD: Description CO2-1 TPW New 18" - 24" Tree Removal TPW New 24" and Larger Tree Removal (DEDUCT: Description Change Order Add Change Order Deduct Total Change Order Amount = Remove Trees on Garden Acres UNIT Quantity Unit PRICE 1.00 EA $ 2.00 EA $ Quantity Unit 2,000.00 $ 3,500.00 $ UNIT PRICE AMOUNT 2,000.00 7,000.00 AMOUNT $ 9,000.00 $ 9.000.00 All other items and conditions of our contract with you remain the same and this order is made a part thereof. Kindly signify your acceptance and approval of this agreement by signing and returning to us the enclosed copy. ACCEPTED BY OWNER: Submitted By: Texas Bit Texas Materials Group, Inc- a CRH Company By: By: <er) �/_/ Date: Ronald D Stinson, Jr Estimating Manager (817)261-2991 Voice (817) 538-1635 Cell 103609-CNCO-2021 Street Rehabilitation, CO 1 Final Audit Report 2022-08-25 Created: 2022-08-16 By: Andrea Munoz (Andrea. M unoz@fortworthtexas.gov) Status: Canceled / Declined Transaction ID: CBJCHBCAABAAgl8le6xkzG8XGBRxevNUd1GrHfgEOKDS "103609-CNCO-2021 Street Rehabilitation, CO 1" History Document created by Andrea Munoz (Andrea.Munoz@fortworthtexas.gov) 2022-08-16 - 9:28:22 PM GMT- IP address: 209.194.29.100 Document emailed to Alexiz.Ramirez@fortworthtexas.gov for filling 2022-08-16 - 9:40:42 PM GMT Email viewed by Alexiz.Ramirez@fortworthtexas.gov 2022-08-16 - 10:21:02 PM GMT- IP address: 204.10.91.100 -76 Signer Alexiz.Ramirez@fortworthtexas.gov entered name at signing as Alexiz Ramirez 2022-08-17 - 9:08:12 PM GMT- IP address: 209.194.29.100 Form filled by Alexiz Ramirez (Alexiz. Ram irez@fortworthtexas.gov) Form filling Date: 2022-08-17 - 9:08:13 PM GMT - Time Source: server- IP address: 209.194.29.100 Document emailed to jamie.greenway@texasbit.com for signature 2022-08-17 - 9:08:16 PM GMT Email viewed by jamie.greenway@texasbit.com 2022-08-17 - 9:49:39 PM GMT- IP address: 107.77.208.34 Signer jamie.greenway@texasbit.com entered name at signing as Jamie Greenway 2022-08-18 - 10:11:45 PM GMT- IP address: 65.140.34.10 -; Document e-signed by Jamie Greenway (jamie.greenway@texasbit.com) Signature Date: 2022-08-18 - 10:11:46 PM GMT - Time Source: server- IP address: 65.140.34.10 Document emailed to sergio.garciapedroza@fortworthtexas.gov for signature 2022-08-18 - 10:11:49 PM GMT Email viewed by sergio.garciapedroza@fortworthtexas.gov 2022-08-19 - 12:46:58 PM GMT- IP address: 166.137.115.60 FORT WORTHS I Powered icy Adobe Acrobat Sign Email viewed by sergio.garciapedroza@fortworthtexas.gov 2022-08-20 - 4:26:39 PM GMT- IP address: 107.77.196.31 &8 Signer sergio.garciapedroza@fortworthtexas.gov entered name at signing as Sergio Garcia 2022-08-20 - 4:29:38 PM GMT- IP address: 107.77.196.31 AD Document e-signed by Sergio Garcia (sergio.garciapedroza@fortworthtexas.gov) Signature Date: 2022-08-20 - 4:29:40 PM GMT - Time Source: server- IP address: 107.77.196.31 P+ Document emailed to Tariqul.Islam@fortworthtexas.gov for signature 2022-08-20 - 4:29:42 PM GMT Email viewed by Tariqul.Islam@fortworthtexas.gov 2022-08-22 - 2:28:00 PM GMT- IP address: 107.211.9.66 A) Signer Tariqul.Islam@fortworthtexas.gov entered name at signing as Tariqul Islam 2022-08-22 - 2:28:59 PM GMT- IP address: 107.211.9.66 JIG Document e-signed by Tariqul Islam (Tariqul.Islam @fortworthtexas.gov) Signature Date: 2022-08-22 - 2:29:00 PM GMT - Time Source: server- IP address: 107.211.9.66 C, Document emailed to omar.elbagalati@fortworthtexas.gov for signature 2022-08-22 - 2:29:03 PM GMT Email viewed by omar.elbagalati@fortworthtexas.gov 2022-08-22 - 5:56:52 PM GMT- IP address: 47.185.62.153 It Signer omar.elbagalati@fortworthtexas.gov entered name at signing as Omar Elbagalati 2022-08-22 - 5:57:09 PM GMT- IP address: 47.185.62.153 6© Document e-signed by Omar Elbagalati(omar.elbagalati@fortworthtexas.gov) Signature Date: 2022-08-22 - 5:57:10 PM GMT - Time Source: server- IP address: 47.185.62.153 C'y Document emailed to Lane.Zarate@fortworthtexas.gov for signature 2022-08-22 - 5:57:13 PM GMT Email viewed by Lane.Zarate@fortworthtexas.gov 2022-08-22 - 6:00:47 PM GMT- IP address: 209.194.29.100 GS© Signer Lane.Zarate@fortworthtexas.gov entered name at signing as Lane Zarate 2022-08-22 - 6:05:50 PM GMT- IP address: 209.194.29.100 CS© Document e-signed by Lane Zarate (Lane.Zarate@fortworthtexas.gov) Signature Date: 2022-08-22 - 6:05:52 PM GMT - Time Source: server- IP address: 209.194.29.100 C'. Document emailed to Martin.Phillips@fortworthtexas.gov for signature 2022-08-22 - 6:05:54 PM GMT FoRTWORTHS I P-e"Y Adobe Acrobat Sign Email viewed by Martin.Phillips@fortworthtexas.gov 2022-08-23 - 7:39:15 PM GMT- IP address: 209.194.29.100 -' Signer Martin.Phillips@fortworthtexas.gov entered name at signing as Martin A Phillips 2022-08-23 - 9:38:52 PM GMT- IP address: 209.194.29.100 -76 Document e-signed by Martin A Phillips (Martin.Phillips@fortworthtexas.gov) Signature Date: 2022-08-23 - 9:38:53 PM GMT - Time Source: server- IP address: 209.194.29.100 Document emailed to Lauren.Prieur@fortworthtexas.gov for signature 2022-08-23 - 9:38:56 PM GMT Email viewed by Lauren.Prieur@fortworthtexas.gov 2022-08-23 - 9:39:08 PM GMT- IP address: 209.194.29.100 -; Signer Lauren.Prieur@fortworthtexas.gov entered name at signing as Lauren Prieur 2022-08-24 - 12:14:39 PM GMT- IP address: 108.209.194.42 Document e-signed by Lauren Prieur (Lauren.Prieur@fortworthtexas.gov) Signature Date: 2022-08-24 - 12:14:41 PM GMT - Time Source: server- IP address: 108.209.194.42 Document emailed to Priscilla.Ramirez@fortworthtexas.gov for approval 2022-08-24 - 12:14:43 PM GMT Email viewed by Priscilla.Ramirez@fortworthtexas.gov 2022-08-24 - 4:40:53 PM GMT- IP address: 174.205.36.117 -76 Signer Priscilla.Ramirez@fortworthtexas.gov entered name at signing as Priscilla Ramirez 2022-08-24 - 4:41:15 PM GMT- IP address: 174.205.36.117 -; Document approved by Priscilla Ramirez (Priscilla. Ram irez@fortworthtexas.gov) Approval Date: 2022-08-24 - 4:41:16 PM GMT - Time Source: server- IP address: 174.205.36.117 Document emailed to Douglas.Black@fortworthtexas.gov for signature 2022-08-24 - 4:41:18 PM GMT Email viewed by Douglas.Black@fortworthtexas.gov 2022-08-25 - 6:13:27 PM GMT- IP address: 209.194.29.100 Signer Douglas.Black@fortworthtexas.gov entered name at signing as DBlack 2022-08-25 - 6:16:38 PM GMT- IP address: 209.194.29.100 -'r Document e-signed by DBlack (Douglas.Black@fortworthtexas.gov) Signature Date: 2022-08-25 - 6:16:39 PM GMT - Time Source: server- IP address: 209.194.29.100 Document emailed to William.Johnson@fortworthtexas.gov for signature 2022-08-25 - 6:16:41 PM GMT FoRTWORTHS I P-e"Y Adobe Acrobat Sign - Document canceled by Andrea Munoz (Andrea.Munoz@fortworthtexas.gov) 2022-08-25 - 7:16:09 PM GMT- I address: 209.194.29.100 FoRTWORTHS I Paw 4"Y Adobe Acrobat Sign FORTWORTH. Routing and Transmittal Slip Transportation and Public Works Department DOCUMENT TITLE: 2021 Street Rehabilitation, CO 2 M&C CPN 103609 DATE: 11/11/2022 To: Alexiz Ramirez 1. Texas Bit 2 3.Sergio Garcia (Inspector) 4.Tariqul Islam (PM) �_ Omar Elbagalati (PGM) r, Leon Wilson (Interim SCPO) 7. Michael Owen (Interim AD) 8. Lauren Prieur (Interim Director) 9 Doug Black (ACA) 10. William Johnson (ACM) 11, Jannette Goodall (CS) CSO # 57313 DOC# INITIALS DATE OUT N ov ' 2022 , Nov ' 2022 , 20- Nov 1 E 2022 SG J. , Nov 16 , 2022 T.I. Nov 1 E , 2022 OE za,) Nov 16 2022 Nov 17 2022 vo-a Nov 17, 2022 dwb Nov 17, 2022 dwb W;,. Nov 1 , 2022 JSG Nov 18 2022 JsG 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 ❑✓ No RUSH: ❑Yes ❑✓ No SAME DAY: ❑Yes ❑✓ No NEXT DAY: ❑Yes❑✓ No ROUTING TO CSO: ❑✓ Yes ❑No Action Required: Ei As Requested ❑ Attach Signature, Initial and Notary Ta ■ Signature/Routing and or Recording ❑ Comment ❑ File Return to: Please call at ext. for pick up when completed. Thank you. CSC No. 57313-CO2 Fox x,. Project Name I 2021 Street Rehabilitaiton Client Project #(s) I 103609 Project Description Contractor I Texas Bit City Project Mgr. I Tariqul Islam City of Fort Worth Change Order Request City Sec # I 57313 Pulverization of existing street and 4 inch asphalt overlay at various locations Change Order # I 2 I Date I 11/10/2022 City Inspector I Sergio Garcia Dept. TPW Contract Time Totals (CD) Original Contract Amount $2,067,672.76 $2,067,672.76 160 Extras to Date $9,000.00 $9,000.00 15 Credits to Date Pending Change Orders (in M&C Process) Contract Cost to Date $2,076,672.76 $2,076,672.76 175 Amount of Proposed Change Order $1,237.25 $1,237.25 15 Revised Contract Amount $2,077,910.01 $2,077,910.01 190 Original Funds Available for Change Orders $91,000.00 I $91,000.00 Remaining Funds Available for this CO $82,000.00 $82,000.00 Additional Funding (if necessary) CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS % OF ORIGINAL CONTRACT I 0.50%0 MAX ALLOWABLE CONTRACT AMOUNT (ORIGINAL CONTRACT COST+ 25%) $2,584,590.95 JUSTIFICATION (REASONS) FOR CHANGE ORDER# This change order is to add $1,237.25 and 15 calendar days to contract #57313 with a revised contract amount of $2,077,910.01. To reduce traffic congestion on Garden Acres Dr it is proposed to add a lane between Old Burleson Rd and 700 ft east of Old Burleson Rd, as such widening of existing roadway is necessary. In order to install new pavement marking on proposed widened street existing striping at intersection of Old Burleson Rd need to be removed and prepped. These items were not originally included in the bid. The contractor's quote for these items have been reviewed by staff and found reasonable for a small amount of work. Adequate fund is available in this project to cover the change order cost. Due to persistent wet weather and additional striping work staff recommends to add 15 calendar days to the contract. 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 reauirements. Contractor's Company Name Contractor (Name) Contract Signature Date Texas Bit Jamie Greenway I Nov 16, 2022 Inspector/Inspection Supervisor ProjectandContract Compliance Manager Date - Nov 16, 2022 **;- Nov 16, 2022 Program Manager Date Senior Capital Project Officer Date Nov 16, 2022'° Nov 16, 2022 Assistant Director (Dept) Date Director, Contracting Department (Dept) Date -11 7"-� 6 - Nov 17, 2022 A� Nov 17, 2022 nt City Attomey Date Assistant City Manager Date Nov 17, 2022 Nov 18, 2022 Council Action (if required) M&C Number I M&C Date Approved ATTEST: La nette S. Goatali Jannette Goodall, City Secretary FORT WORTH City of Fort Worth Change Order Additions Project Name 1 2021 Street Rehabilitation CitySec # bt313 ### Client Project# 1 103609 1 Contractor Texas Bit PMI Tariqul Islam I Inspectorl Sergio Garcia Texas Bit 0 Date 1 110012022 ADDITIONS ITEM DESCRIPTION DEPT Qty Unit Unit Cost Total 40- New Remove and prep 4 " existing pavement marking TPW 229.00000000 LF 3.4t 790.05 41- New Remove and prep 24 " existing pavement marking TPW 86.00000000 LF 5.2t 47.20 TM $1,237.25 Sub Total Additions $1,237.25 Change Order Additions Page 2 of 4 I I LM FOR_ rH City of Fort Worth Change Order Deletions Project Name 1 2021 Street Rehabilitation CitySec# 1 57313 ### Client Project # 1 103609 1 Contractor) Texas Bit PMI Tani Islam I Inspectorl Sergio Garcia Peachtree Construciton Ltd 0 Date 1 11/10/2022 1 DELETIONS DhSGRIPI ION UhPI Qty Unit Unit Cost total TV $0.00 Sub Total Deletions $0.00 Change Order Deletions Page 3 of 4 M/SBE for this Chanae Order M/SBE Sub I Type of Service I Amount for this CO Total $0.00 Previous Change Orders co # DATE I AMOUNT Total I $0.00 I TEAS A CRH COMPANY PROPOSED CHANGE ORDER # 2 PROJECT: 103609 - 2021 Street Rehab DATE: October 26, 2022 Attn: TariqulIslam, City of Fort Worth DESCRIPTION OF CHANGE AND/OR EXTRA WORK: ADD: Description CO3-1 TPW New Remove 4" Exisiting Pavement Markings TPW New Remove 24" Exisiting Pavement Markings (DEDUCT: Description Lead walks, due to Curb & Gutter work to ensure water flow. UNIT Quantity Unit PRICE AMOUNT Elimination to be by flail wheel method, no waterblasting Change Order Add Change Order Deduct Total Change Order Amount = 229.00 LF $ 86.00 LF $ Quantity Unit 3.45 $ 5.20 $ UNIT PRICE 790.05 447.20 AMOUNT $ 1,237.25 $ 1.237.25 All other items and conditions of our contract with you remain the same and this order is made a part thereof. Kindly signify your acceptance and approval of this agreement by signing and returning to us the enclosed copy. ACCEPTED BY OWNER: Submitted By: Texas Bit Texas Materials Group, Inc- a CRH Company By: By: Date: Jamie Greenway Project Manager (214) 543-5705 Cell 1909MUTI909".l Routing and Transmittal Slip Transportation and Public Works Department DOCUMENT TITLE:.2021 Street Rehabilitation, CO 3 M&C------ CPN — -WQ2— CSo # 57 313 DOC# DATE: 1/3/2023 INITIALS DATE OUT ' To: 1 Alexiz RamirezNalentina Riera Jan 4, 2023 Texas Bit Jan 5, 2023 2. 3. Sergio Garcia (Inspector) ;u Jan 4, 2023 4.Tariqul Islam (PM) Jan 4, 2023 Omar Elbagalati (PGM) a Jan 5, 2023 F Leon Wilson (Interim SCPO) Lw Jan 5, 2023 7. Michael Owen (Interim AD) ... :ma:.... Jan 5, 2023 g_ Lauren Prieur (Interim Director) Jan 5, 2023 g_ Jeremy Anato-Mensah (ACA) Jan 6, 2023 10. William Johnson (ACM) Jan 9 2023 11, Jannette Goodall (CS) JSG Jan 9 2023 JsG 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: LcJ YesO No RUSH: OYes*No SAME DAY: OYes*No NEXT DAY: OYesl111 No ROUTING TO CSO: AYes ONo Action Required: ❑ As Kequested ❑ Attach Signature, Initial and Notary Ta ■ Signature/Routing and or Recording ❑ Comment ❑ File Return to: Please call at ext.,_ for pick up when completed. Thank you. CSC No. 57313-CO3 Foe. Project Name I 2021 Street Rehabilitaiton Client Project #(s) I 103609 Project Description! Contractor! Texas Bit City Project Mgr. I Tariqul Islam City of Fort Worth Change Order Request City Sec# 1 57313 Pulverization of existing street and 4 inch asphalt overlay at various locations Change Order#I 3 I Date 1/3/2023 City Inspector! Sergio Garcia Dept. TPW Contract Time Totals (CD) Original Contract Amount $2,061,612. /6 $2,061,612.16 160 Extras to Date $10,237.25 $10,237.25 30 Credits to Date Pending Change Orders (in M&C Process) Contract Cost to Date $2,077,910.01 $2,077,910.01 190 Amount of Nroposed Change Urder $0.00 30 Revised Contract Amount 2,077,910.01 $2,011,91U.01 220 Original Funds Available for Change Orders 82,000.00 $82,000.00 Remaining Funds Available for this CO $71,762.75 Additional Funding (if necessary) CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS% OF ORIGINAL CONTRACT r 0.50% MAX ALLOWABLE CONTRACT AMOUNT (ORIGINAL CONTRACT COST+ 25%) $2,584,590.95 JUSTIFICATION (REASONS) FOR CHANGE ORD This change order is to add $0 and 30 calendar days to contract #57313 with a revised contract amount of $2,077,910.01. During construction on Garden Acres Dr it is identified that driveway approaches of a trucking company located on this street needs special base treatment and asphalt paving for heavy truck traffic. To eliminate drainage issue at these drive approaches, a 10" thick concrete valley gutter with sub base is also proposed to install. As the trucking company can't dose driveway for their operation,a temporary drive approach is proposed to be installed to facilitate construction which would be removed and make the area back to original after completing the construction. For pavement marking, 4-inch-wide solid and skip lines are proposed to add to this contract as these items were not originally included. The contractor's quote to accomplish the additional work was reviewed by staff and found reasonable for such a labor-intensive work in a confined area. To cover the cost of additional work, a portion of construction allowance has been deleted. For the added scope of work 30 days are proposed to add to the contract. 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 Company Name Contractor (Name) Contract Signature Texas Bit Jamie Greenway Jan 5, 2023 Inspector/InspectionSupervisor Date Project and Contract Compliance Manager Date Jan 4, 2023 *AC Jan 4, 2023 Program Manager Date Senior Capital Project Officer Date < Jan 5, 2023 - -- -- - -: Jan 5, 2023 Assistant Director (Dept) Date Director,Contracting Department (Dept) Date Jan 5, 2023 Jan 5, 2023 Assistant City Attorney Date Assistant City Manager Date 'J°° Jan 6, 2023 Jan 9, 2023 Council Action (if required) M&C Number I I M&C Date Approved ATTEST: .Ti1nnP,lfR G �ao//al! Jannette Goodall, City Secretary FORT WORTH City of Fort Worth v---- Change Order Additions Project Name 1 2021 Street Rehabilitation I City Sec# 1 57313 I ### Client Project# 1 103609 1 Contractor! Texas Bit P4 Tariqul Islam I Inspector) Sergio Garcia TexasBit Date 1 1/3/2023 ADDITIONS ITEMY DESCRIPTION DEPT nit Unit Cost Total F „a V lPW JOIyy ...VVV ."✓; a3- New I�Iwe �o wuuieur auvvu ty uuvewara, am o11 anu uiayoae +TPW 4110.00000006 SF $11.5y as New ;remove aspnat transition at two (q orlveways; naul on ana alspose TPW 510.00000001 SF 112.od yb,'l2v.v aS New rour lV mi(K valley gutter at two onveways using rind concrete IMY IVS.UVUVUVLJ Jv yL4J. 0,0"ov./�1 Orr New kemove temporary asphalt ca veway ana maKe me area oacK to origin at I rvv 33b.uvvuuvtn ,,r y26. $tr,u3v.4y 4/- New a aono vvmte,,Kip Line 1 rvv /u.uuuuuuun Lr 1 i.1 �iss.u�{ 4a-New l ,,ono xenowcemerune Irvv 0,va4.vvvvvmU Lr Z,-1.-t ar,VVa.)I¢ 4e- New ✓• sona white Cage Line I rvv 4,OLb.VVVVVVI U Lr lyl."fd 7yO,YV4. I 1 I 1 I 1 I 1 I I 1 1 1 1 1 I 1 1 1 I 1 1 1 1 I 1 1 1 I I I TF W 1 1 I 1 I 1 I 1 I 1 I 1 I I 1 I 1 I 1 I I I I I I 1 I 1 I 1 I $68,568.1 I Sub Total Additions I I $68,568.1� Change Order Additions Page 2 of 4 FORT WORTH City of Fort Worth Change Order Deletions Project Name I 2u21 street Kehabllltatlon City Sec# I 57313 I ### Client Project # 103609 1 Contractor) Texas Bit PMI Tariqul Islam I Inspectof Sergio Garcia TexasBit [:::I::] Date I 1/3/2023 DELETIONS eivi utouniv I rvw ucr i uny unit unit uost a raving uonstruaion Nnowance I vvv u.oa000 iou w wu,uuu.uu xno, T 'W $68,568.151 Sub lotaj Deletions $68,568.151 Change Order Deletions Page 3 of 4 M/SBE for this Change Order M/SBE Sub Type of Service I Amount for this CO Total $0.00 Previous Change Orders Co# I DATE I AMOUNT Total $0.00 1 "i"w A CRH COMPANY PROPOSED CHANGE ORDER# 3 - REV3 PROJECT: 381315 - 2021 Street Rehab (Garden Acres Drive) DATE: December 19, 2022 Attn: Tariqul Islam DESCRIPTION OF CHANGE AND/OR EXTRA WORK: UNIT ADD: Description Quantity Unit PRICE AMOUNT 16 3123.0101 Unclassified Excavation -to facilitate installation of Temporary Asphalt Driveway 12 CY $ 65.80 $ 789.60 NEW42 Install 10" Type B HMAC base for temporary driveway. 336.00 SF $ 36.00 $ 12,096.00 NEW43 Remove 10" concrete at two (2) driveways; haul off and dispose. 410 SF $ 11.50 $ 4,715.00 NEW44 Remove asphalt transition at two (2) driveways; haul off and dispose. 510 SF $ 12.00 $ 6,120.00 16 3123.0101 Unclassified Excavation - Overexcavate for flex base and additional depth concrete. 60 CY $ 65.80 $ 3,948.00 30 Install 8" flex base into two (2) driveway transtions. 26.14 CY $ 140.75 $ 3,679.21 NEW46 Pour 10" thick valley gutter at two (2) driveways using high early strength redi-mix concrete. 103 SY $ 245.25 $ 25,260.75 NEW47 Remove temporary asphalt driveway and backfill with 9" topsoil and Bermuda sod. 336 SF $ 23.90 $ 8,030.40 29 9" Topsoil 10.27 CY $ 54.10 $ 555.61 17 Bermuda Sod 37.33 SY $ 13.00 $ 485.29 NEW 4" Solid White Skip Lines 70 LF $ 1.90 $ 133.00 NEW 4" Solid Yellow Center Line 6,094 LF $ 1.15 $ 7,008.10 NEW 4" Solid White Edge Line 4,526 LF $ 1.15 $ 5,204.90 Additional time added to contract: 30 DAYS Change Order Add $ 78,025.85 Add 30 Days Total Change Order Amount= $ 78,025.85 All other items and conditions of our contract with you remain the same and this order is made a part thereof. Kindly signify your acceptance and approval of this agreement by signing and returning to us the enclosed copy. ACCEPTED BY OWNER: Submitted By: Texas Bit Texas Materials Group, Inc- a CRH Company Date: Russell A. Harris Commercial Estimator (214) 741-3531 Voice (469) 510-6655 Cell 103609-CNCO-2021 Street Rehabilitation, CO 3 Final Audit Report 2023-01-05 Created: 2023-01-04 By: Andrea Munoz (Andrea.Munoz@fortworthtexas.gov) Status: Canceled / Declined Transaction ID: CBJCHBCAABAAjsZ1mB8Nglr1fAuOuwJNyaP9878oumDw "103609-CNCO-2021 Street Rehabilitation, CO 3" History Document created by Andrea Munoz (Andrea.Munoz@fortworthtexas.gov) 2023-01-04 - 0:41:13 AM GMT- IP address: 204.10.90.100 Document emailed to Valentina.Riera@fortworthtexas.gov for filling 2023-01-04 - 3:15:31 PM GMT -E Document emailed to jamie.greenway@texasbit.com for signature 2023-01-04 - 3:15:31 PM GMT - Document emailed to sergio.garciapedroza@fortworthtexas.gov for signature 2023-01-04 - 3:15:31 PM GMT Document emailed to Tariqul.Islam@fortworthtexas.gov for signature 2023-01-04 - 3:15:32 PM GMT Email viewed by Tariqul.Islam@fortworthtexas.gov 2023-01-04 - 3:17:13 PM GMT- IP address: 204.10.90.100 Email viewed by Valentina.Riera@fortworthtexas.gov 2023-01-04 - 3:17:36 PM GMT- IP address: 204.10.90.100 Signer Tariqul.Islam@fortworthtexas.gov entered name at signing as Tariqul Islam 2023-01-04 - 3:18:18 PM GMT- IP address: 204.10.90.100 Document e-signed by Tariqul Islam (Tariqul.Islam@fortworthtexas.gov) Signature Date: 2023-01-04 - 3:18:20 PM GMT -Time Source: server- IP address: 204.10.90.100 Email viewed by sergio.garciapedroza@fortworthtexas.gov 2023-01-04- 3:39:45 PM GMT- IP address: 107.77.196.183 ,b Signer sergio.garciapedroza@fortworthtexas.gov entered name at signing as Sergio Garcia Pedroza 2023-01-04- 3:40:37 PM GMT- IP address: 107.77.196.183 FoRTWORTH. 1 `4"Y Adobe Acrobat Sign Document e-signed by Sergio Garcia Pedroza (sergio.garciapedroza@fortworthtexas.gov) Signature Date: 2023-01-04- 3:40:39 PM GMT -Time Source: server- IP address: 107.77.196.183 Signer Valentina.Riera@fortworthtexas.gov entered name at signing as Valentina Riera 2023-01-04 - 5:02:01 PM GMT- IP address: 204.10.90.100 r% Form filled by Valentina Riera (Valentina.Riera@fortworthtexas.gov) Form filling Date: 2023-01-04 - 5:02:03 PM GMT -Time Source: server- IP address: 204.10.90.100 Email viewed by jamie.greenway@texasbit.com 2023-01-04 - 10:39:52 PM GMT- IP address: 146.75.164.0 r% Signerjamie.greenway@texasbit.com entered name at signing as Jamie Greenway 2023-01-05-2:42:35 PM GMT- IPaddress: 40.128.134.166 ,� Document e-signed by Jamie Greenway Uamie.greenway@texasbit.com) Signature Date: 2023-01-05- 2:42:37 PM GMT -Time Source: server- IP address: 40.128.134.166 Document emailed to omar.elbagalati@fortworthtexas.gov for signature 2023-01-05 - 2:42:39 PM GMT _.WL,Email viewed by omar.elbagalati@fortworthtexas.gov 2023-01-05 - 3:47:13 PM GMT- IP address: 107.115.171.109 Signer omar.elbagalati@fortworthtexas.gov entered name at signing as Omar Elbagalati 2023-01-05 - 3:48:00 PM GMT- IP address: 107.115.171.109 Document e-signed by Omar Elbagalati (omar.elbagalati@fortworthtexas.gov) Signature Date: 2023-01-05 - 3:48:02 PM GMT - Time Source: server- IP address: 107.115.171.109 Document emailed to Leon.Wilson@fortworthtexas.gov for signature 2023-01-05 - 3:48:05 PM GMT Email viewed by Leon.Wilson@fortworthtexas.gov 2023-01-05 - 3:58:57 PM GMT- IP address: 204.10.90.100 r%'o Signer Leon.WiIson@fortworthtexas.gov entered name at signing as Leon Wilson, Jr. 2023-01-05-4:00:14 PM GMT- IP address: 204.10.90.100 'o Document e-signed by Leon Wilson, Jr. (Leon.Wilson@fortworthtexas.gov) Signature Date: 2023-01-05- 4:00:16 PM GMT -Time Source: server- IP address: 204.10.90.100 Document emailed to Michael.Owen@fortworthtexas.gov for signature 2023-01-05 - 4:00:19 PM GMT Email viewed by Michael.Owen@fortworthtexas.gov 2023-01-05-4:45:56 PM GMT- IPaddress: 204.10.90.100 FORT WORTH 1 Powered 6y Adobe Acrobat Sign L % Signer Michael.Owen@fortworthtexas.gov entered name at signing as Michael Owen 2023-01-05-4:47:20 PM GMT- IP address: 204.10.90.100 Document e-signed by Michael Owen (Michael.Owen@fortworthtexas.gov) Signature Date: 2023-01-05- 4:47:22 PM GMT -Time Source: server- IP address: 204.10.90.100 - Document emailed to Lauren.Prieur@fortworthtexas.gov for signature 2023-01-05 - 4:47:25 PM GMT Email viewed by Lauren.Prieur@fortworthtexas.gov 2023-01-05 - 4:50:29 PM GMT- IP address: 108.209.194.42 b Signer Lauren.Prieur@fortworthtexas.gov entered name at signing as Lauren Prieur 2023-01-05-4:50:54 PM GMT- IPaddress: 108.209.194.42 ,'6 Document e-signed by Lauren Prieur (Lauren.Prieur@fortworthtexas.gov) Signature Date: 2023-01-05- 4:50:56 PM GMT -Time Source: server- IP address: 108.209.194.42 Document emailed to Priscilla.Ramirez@fortworthtexas.gov for approval 2023-01-05-4:50:58 PM GMT iL` Email viewed by Priscilla.Ramirez@fortworthtexas.gov 2023-01-05 - 7:19:04 PM GMT- IP address: 97.99.130.152 Document canceled by Andrea Munoz (Andrea.Munoz@fortworthtexas.gov) 2023-01-05- 7:21:19 PM GMT- IP address: 204.10.90.100 FORTWORTHg 1 P°Ne14"Y Adobe Acrobat Sign FORTWORTH. TRANSPORTATION AND PUBLIC WORKS May 4, 2023 Texas Materials Group, Inc., dba Texas Bit 420 Decker Dr, Suite 200 Irving, Texas 75062 RE: Acceptance Letter Project Name: 2021 Street Rehabilitation Project Project Type: T/PW - Paving City Project No.: 103609 To Whom It May Concern: On 5/18/2023 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 7/7/2023. 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 7/7/2023, 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- 880-4257. Sincerely, Tanqul Islam (Jul25, 2023 17:28 CDT) Tariqul Islam, Project Manager Cc: Sergio Garcia Pedroza, Inspector Donald Watson, Inspection Supervisor Oscar Aguilon, Senior Inspector Omar Elbagalati, Program Manager N/A, Consultant Texas Bit, Contractor N/A, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev. 8/20/19 CONSENT OF SURETY TO FINAL PAYMENT AIA Document G707 (Instructions on reverse side) Bond No. TO OWNER: (Naive and address) City of Fort Worth 200 Texas Street Forth Worth, TX 76102 PROJECT: (Name and address) 2021 Street Rehabilitaition Project City Project No. 103609 OWNER _ ARCHITECT _ CONTRACTOR _ SURETY 014246430 OTHER ARCHITECT'S PROJECT NO: CONTRACT FOR: 2021 Street Rehabilitaition Project City Project No. 103609 CONTRACT DATED: In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the (Insert name and address of Surety? Liberty Mutual Insurance Company 175 Berkeley Street Boston, MA 02116 —SURETY, on bond of (Insert name and address of Contractor) Texas Materials Group, Inc. dba TexasBit, A CRH Company 420 Decker drive #200 Irving, TX 75062 . CONTRACTOR, hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve the Surety of any of its obligations to (Insert name and address of Owner) City of Fort Worth 200 Texas Street Forth Worth, TX 76102 OWNER, as set forth in said Surety's bond - IN WITNESS WHEREOF, the Surety has hereunto set its hand on this date: (Insert in writing the month fWllowed by the numeric date and year,) AttestfWitness: I� (Seal): °�"6NA sic, Richmond, Witness July 25, 2023 Liberty Mutual Insurance Company {Surety} r (Signature ,fauthorized r pre entative) Stephanie Gross, Attorney -in -Fact (Printed name and title) AIA DOCUMENT G707 w CONSENT OF SURETY TO FINAL PAYMENT w 1994 EDITION w AIA ® 1994 w THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, NW, WASH- [NGTON, D-C. 20006-5292 w WARNING: Unlicensed photocopying violates Ms. copy- right laws and will subject the violator to legal prosecution. G707-'1994 This Power of Attorney limits the acts of those named herein, and they have no authority to Liberty bind the Company except in the manner and to the extent herein stated. mutual. Liberty Mutual Insurance Company SURETY The Ohio Casualty Insurance Company Certificate No: 8244866 West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly Organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana {herein collectively called the "Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Stephanie Gross all of the city of Houston state of Texas each individually if there be more than one named, its true and lawful attorney -in -fact to make, execute, sea(, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surely obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons, IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this I6th day of February, 2021. Liberty Mutual Insurance Company The Ohio Casualty Insurance Company P� tNSUQQ �J f INS& tµsURq West American Insurance Company VL �% p,Xro �L J aHPDRq W P , -R W a` F, ,TKO r) 2° qr�0 0 Y91912y yy19194 1991 on B44�1 ^� �i� s�q CHi15b �a nyAMP`'�`,aa YS �4DJAN¢ -da y• 7` Z g�� * �� 3y1 * >� �M * 1 David M. Carey, Assistant Secretary C: STATE OF PENNSYLVANIA ss COUNTY OF MONTGOMERY Npa On this 15th day of February, 2021, before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance Company, U ry The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes therein 452 contained by signing on behalf of the corporations by himself as a duly authorized officer. (D IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at King of Prussia, Pennsylvania, an the day and year first above written. AS Q � ohwpgf (� Commonwealth of Pennsylvania - Notary Seal e p Teresa Teresa Pastella, Notary Public / � OF Montgomery Caunry d,3 a�� My commissian expires March 28, 2025 By Commission number 1126044 Member PennsylvarEa Association of Notaries Teresa Pastella, Notary Public N This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual N m Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows: ARTICLE IV — OFFICERS: Section 12. Power of Attorney. o Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the President may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety D M any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact, subject to the limitations set forth in their respective powers of akforney, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such ro C: instruments shall be as binding as h signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney -in -fact under the oprovisions of this article may be revoked at any lime by the Board, the Chairman, the President or by the officer or officers granting such power or authority. Z U ARTICLE X1II - Execution of Contracts: Section 5. Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact, subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation —The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attorneys- infact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Authorization — By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with the same force and effect as though manually affixed. , Renee C. Llewellyn, the undersigned, Assistant Secretary, of Liberty Mutual Insurance Company, The Ohio Casualty Insurance Company, and West American Insurance Company do hereby certify that this power of attorney executed by said Companies is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 25th day of July 2023 V Issu V" INg, N V1ysu,4 �Jp`pRPRRgT �[� �J�oot+Po�r'Pgy VP oaPo� qy U Y�1912go oa1919�q a 1991 0 t� ~`y3g Sscaysda� yyM4�i d tS, �NotANA dA Y Renee C. Llewellyn, Assistant Y Secretary 0 o C v- c F= a) _0 > [x Q --D dco 0 a_ C Q o 00 N a° m 00 o' Q �Lo cLo ca oN � m La C Marsh MSurety POA LMIC OCIC WAIC MUM Co_022021 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 Donnie Blackburn, GM/Vice President of TexasBit, Inc., 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; 2021 Street Rehabiliation CPN # 103609 CS-57313 BY ~� Donnie Blackburn GM/Vice President TexasBit, Inc. Subscribed and sworn before me on this JAMIE GREENWAY ����PY PliB'i Notary Public, State of Taxes Comm. Expires 09-25-2024 Notary ID 12115454 My commission expires of --�- 1 11 NOWY P BLiC IN AND Fi TARRANT qOUNTY, TEXAS , 2023.