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Contract 57089-FP1
FORTWORTH, TRANSPORTATION AND PUBLIC WORKS NOTICE OF PROJECT COMPLETION -FP1 City Secretary No: 57089 Date Received: 9/1/2023 City Project N!?: 102411 Regarding contract 57089 Moss & Phillips Safe Routes to School for as required by the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by City Council on 12/14/2021 through M&C 21-0972 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: $ 1,449,726.40 Amount of Approved Change Orders: $ 58,721.00 No 1 Revised Contract Amount: $ 1,508,447.40 Total Cost Work Completed: $ 1,419,427.05 Less Deductions: Liquidated Damages: _ Days @ $ Pavement Deficiencies: Total Deduction Amount: $ Total Cost Work Completed: $ 1,419,427.05 Less Previous Payments: $ 1,348,455.70 Final Payment Due $ 70,971.35 Patricia L. WadsacK Sep 1, 2023 Patricia L. Wadsack (Sep 1, 2023 15:43 CDT) Recommended for Acceptance Date Asst. Director, TPW - Capital Delivery Lauren Prieur (Sep 1, 202315.44 CDT) Sep 1, 2023 Accepted Date Director, TRANSPORTATION AND PUBLIC WORKS DEPARTMENT William Jo h risen (S 1, 202316:54 CDT) Asst. City Manager Sep 1, 2023 Date / Day OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Contractor's Application for Payment Invoice No. 202201-16 FINAL 1To (Owner) City of Fort Worth Invoicing Period (From - To): Invoice Dale: 07/01/2023 - 07/31/2023 8/1/2023 P. O. FW020-0000007332 From (Contractor): Remit to ( If Not Automatic Deposit ): Number: Northstar Construction, LLC Project: 102411 Contractor's CFW Vendor No.: 0000009565 City Secretary Contract 57089 contract CC Moss and ML Phillips SRTS Improvements Number: Name: Application For Payment Change Order Summary (Approved Change Orders 11. ORIGINAL CONTRACT PRICE.......................................................... S S1,449,726.40 Number Additions Deletions 12. Net change by Change Orders................................................................ S $58,721.00 1 $64,221.00 $5,500.00 13. Current Contract Price (Line 1 t 2)....................................................... $ $1,508,447.40 2 14. TOTAL COMPLETED AND STORED TO DATE 3 I (Progress Estimate, Construction Allowance and Change Orders)....... $ $1,419,427.05 4 15. RETAINAGE: 5 A. X $1,419,427.05 Work Completed.......... $ 6 I b. X Not Used $ 7 I c. Total Retainage (Line 5a + Line 5b) ............................... S 8 16. AMOUNT ELIGIBLE TO DATE (Line 4 - Line 5c)............................. $ $1,419,427.05 TOTALS $64,221.00 $5,500.00 17. LESS PREVIOUS PAYMENTS (Line 6 from prior Application)........, $ $1,348,455.70 NET CHANGE BY $58,721.00 8. AMOUNT DUE THIS APPLICATION ................................................. $ $70,971.35 CHANGE ORDERS 9. BALANCE TO FINISH, PLUS RETAINAGE (Column G on Progress Estimate+ CA + COs + Line 5 above) .............. $ $89,020.35 Contractor's Certification 10. CONTRACT TIME: The Contractor certifies with the submittal of this document and associated Payment Request Submittal a. Days Awarded 270 on die City of Fort Worth Buzzsaw system that to the best of their knowledge: (1) all previous progress b, Days Added by CO 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 c. Total Days 270 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 Days Charged free and clear of all Liens, security interests and encumbrances (except such as are covered by a Bond d 270 acceptable to Owner indemnifying Owner against any such Liens, security interest or encumbrances); e, Days Remaining and (3) all Work covered by this Application for Payment is in accordance with the Contract Documents and is not defective. Liquidated Damages $1,000.00 x day Affidavit of Bills Paid Nichael h. %feimlich Michael A. Heimdch(Aug 30,202311:19 CDT) �"" Consent of Surety This document has been modified from Its odglnal 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. 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I Jill, I 7 �i'j�jy"I" iiJiii IIiI"iJi�'IJI!JJI j�l�i i! I, I � I '� I . oeooa000aooa�a�veeeve0000a0000.............. � I E < 0 a E � F tl o a s � e 9 C C d y " a � W U b[ a w � j !I I I II II z Progress Estimate Change Order Number I I I Contractor'srgvovt4talfbn ADDITIONS For (contract): 102411 CC Moss and MI Phillips SRTS Improvements City Secretary 57089 Applcation Numbcr, 202201-16 FINAL Contract Num: Application Period: 07/01/2023 - 07/31/2023 Application Date: 8/12023 A B C D E 11 F Item Addition Tom l Completed % Balance to Finish Change Order Item Specification CO Quantity to Add Unit Price Change Order Estimated Quantity Installed Value Previously Installed Value Value This Materials Presently Period Stored (not in C) and Stored to Dam B _ Na. Description Seetion No. Unit of Measure Value (D +E) B 47 7049.6195 WATER METER BOX FA 20.00000000 $651.05 $13,021.00 900000000 $5208.40 $5.208.40 $5208.40 40.0% $7,812.60 48 9608.6001 Unique Change Order Item 91 Utility Adjustments (UOM: SY 50000.00000000 $1.00 $50.000.00 33254.80000000_ S33254.80 $33254.90 S33254.80 66.5% $16,74520 49 0100.6003 Prep ROW (Tree)(5" to 12" DIA) _ CY 2.00000000 $600.00 _ _ $1x200.00 ___ 4.00000000 $2,400.00 , $2,49-0 0 _ $2,400.00 _ 200_0%-$1,200.001 —. __ -------- _. I__ ......... __ Totals S64.221.00 $40,863.20 S40.86320 S40.863.20 63.6% S23357.80i This docmncnt has been modified from its original form as an EiCDC documentand mthe user did not highlight the modifications. You are encouraged to read the document carefully and consult Legal Counsel prior to its execution. C-620 Change Order Progress Estimate Change Order Number DELETIONS For (contract): 102411 CC Moss and MI, Phillips SRTS Improvements Application Period: Item Change Order Item Description No- 13 ____ 0479-6005 Adiustine Manholes (WaterValve Bo<) Totals 07/01/2023 - 07/31/2023 CO Quantity to Deletion Unit of Mcssurc Delete Unit Price Change Order Not Used Value _20-_-$275-00 $5,500.00 I ---- -- --------- — - -- - Contractor's Application Application Number: 202201-16 FINAL Application Date: 8/1/2023 Not Used Not Used I Not Used Not Used Not Used Not Used I ---------- A —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 II 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 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 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 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 I I I I This document has been modified from its original form as an E]CDC document and the user did not highlight the modifications- You are encouraged to read the document catefidly and consult Legal Counsel prior to its execution - Not Used City of Fort Worth Summary of Charqes City Secretary Contract Num: I 57089 I CC Moss and ML Phillips SRTS Improvements P. O.: FW020-0000007332 Project Number: 102411 Application Period: 07/O1/2023 - 07/31/2023 Application I 202201-16 FINAL Application Date: 8/1/2023 Number. Funding Identification (FID) Total Completed Amt Remaining Gross Retainage Net Original Contract 34018-0200431-5740010-102411-003880-9999-18010207 $558,742.66 $28,842.74 31001-0200431-5740010-102411-003880 $819,821.18 $42,319.82 J 0 - 0 0 0 - p 0 0 — - 0 0 Change Order 34018-0200431-5740010-102411-003880-9999-18010207 31001-0200431-5740010-102411-003880 $40,863.20 $17,857.80 0 0 - 0 — - - 0 - 0 0 _- 0 0 -. 0 - Change Order 2 34018-0200431-5740010-102411-003880-9999-18010207 : 31001-0200431-5740010-102411-003880 S 0 p 0 0 - -- 0 0 - - 0 0 City of Fort Worth Summary of Charqes City Secretary ContractNum: I 57089 I CC Moss and MIL Phillips SRTS Improvements P. O.: FW020-0000007332 I Project Number: 102411 Application Period: 07/01/2023 - 07/31/2023 Application I 202201-16 FINAL Application Date: 8/1/2023 Number: Funding Identification (FID) Total Completed Amt Remaining Gross Retainage Net Change Order 3 34018-0200431-5740010-102411-003880-9999-18010207 31001-0200431-5740010-102411-003880 0 - 0 - 0 0 0 0 0 0- 0 Change Order 4 34018-0200431-5740010-102411-003880-9999-18010207 31001-0200431-5740010-102411-003880 - - 0 p 0 0 0 = 0 _ 0 0 0 Change Order 5 34018-0200431-5740010-102411-003880-9999-18010207 31001-0200431-5740010-102411-003880 0 _ - 0 — 0 0 __.. 0 - 0 ' p 0 0 City of Fort Worth Summary of Charges City Secretary Contract Num: I 57089 I CC Moss and ML Phillips SRTS Improvements I P. O.: FW020-0000007332 Project Number: 102411 Application Period: 07/01/2023 - 07/31/2023 Application I 202201-16 FINAL Application Date: 8/1/2023 Number: Fundinq Identification (FID) Total Completed Amt Remaining Gross Retainage Net Change Order 6 34018-0200431-5740010-102411-003880-9999-18010207 31001-0200431-5740010-102411-003880 p p 0 — p _ - p _ 0 0 0 0 Change Order 7 34018-0200431-5740010-102411-003880-9999-18010207 31001-0200431-5740010-102411-003880-- 0 - 0 0 0 0 — - 0-- 0 0 - - - - 0 Change Order 8 34018-0200431-5740010-102411-003880-9999-18010207 = = 31001-0200431-5740010-102411-003880 0 0 - 0 0 p - 0 0 0 0 _._ City of Fort Worth Summary of Charges City Secretary ContractNum: I 57089 CC Moss and ML Phillips SRTS Improvements P. O.: FW020-0000007332 I Project Number: 102411 Application Period: I 07/O1/2023 - 07/31/2023 Application I 202201-16 FINAL I Application Date: 8/1/2023 I Number. Funding Identification (FID) Total Completed Amt Remaining Gross Retainage Net Totals 34018-0200431-5740010-102411-003880-9999-18010207 $558,742.66 $28,842.74 31001-0200431-5740010-102411-003880 $860,684.38 $60,177.62 0 0 0 0 0 - 0 0 0 - 0 Grand Total I I $1,419,427.05 I I $89,020.35 I I $0.00 I I ($70,971.35)I 1 $70,971.35 Doug, per Vania's request, is it okay to replace the TxDOT change order (57089-001) on the CSCO website with this change order? FORT WORTH, This version combines the TxDOT and CFW change orders into one file. Thanks, Andrea a�4 Routing and Transmittal Slip dwb Transportation & Public Works Department DOCUMENT TITLE: Construction Change Order No. 1— CC Moss and ML Phillips SRTS Improvements M&C: 21-0972 1 CPN: 102411 CSO: 57089 DOC#: 1 Date: To: Name Department Initials Date Out 1. Bus. Support Partner — Sara Cox TPW-initial s� Aug 11, 2022 2. Michael A. Heimlich - Contractor Contractor MAM Aug 12, 2022 3. Matt Cain - Inspector TPW - signer Aug 21, 2022 4. Brendan McInnes —Project Manger TPW-initialer Aug 22, 2022 5. Chad Allen — Contract Compliance Mngr TPW - signA Aug 30, 2022 6. Lissette Acevedo — Program Manager TPW - sign A Aug 31, 2022 7. Martin Phillips — Acting AD TPW - sign M Sep 1, 2022 8. Lauren Prieur— Acting Director TPW - sign L� Sep 2, 2022 9. 10. Doug Black — City Attorney Legal - signer Sep 2, 2022 11. William Johnson ACM CMO - sign � Sep 5, 2022 12. Jannette Goodall - CSO CSO - sign ,� Sep 6, 2022 13. TPW Contracts TPW DOCUMENTS FOR CITY MANAGER'S SIGNATURE: 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: ❑ As Requested ❑ For Your Information ® Signature/Routing and or Recording ❑ Comment ❑ Attach Signature, Initial and Notary Tabs ❑ File Return To: TPWContracts(aMortworthtexas.00v, for pick up when completed; list "Please call Brendan �v ext # 2817 for questions. Thank you. " CSC No. 57089-COl FORTWORTH., City of Fort Worth Change Order Request Project Name CC Moss and ML Phillips SRTS Improvements Client Project #(s)I City Project Number 102411- TxDOT CSJ 0902-90-084 I City Sec # 1 57089 Project Description SRTS project improvements including construction of new and reconstruction of existing sidewalks, curb ramps, driveways, curb and gutter, small retaining walls, signs, crosswalks and pavement markings within an approximate quarter mile of both the C.C. Moss and M.L. Phillips Elementary School Campuses. Contractor Northstar Construction, LLC Change Order #I City Project Mgr.1 Brendan McInnes, PE 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) TPW $1,449,726.40 $0.00 $0.00 $0.00 I Datel City Inspector Matt Cain $1,449,726.40 $58,721.00 $1,508,447.40 $144,972.64 $144,972.64 Contract Time Totals (CD) $1,449,726.40 270 0 0 0 $1,449,726.40 270 $58,721.00 0 $1,508,447.40 270 $144,972.64 $144,972.64 CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS % OF ORIGINAL CONTRACT 4.05% MAX ALLOWABLE CONTRACT AMOUNT (ORIGINAL CONTRACT COST+ 25%) $1,812,158.00 JUSTIFICATION (REASONS) FOR CHANGE ORDER This change order is necessary in order to make revisions to the contract to compensate the contractor for removing 6-12" trees in ROW, adjusting irrigation and water service (paid by invoice with markups per TxDOT Spec 9L), and placing new meter boxes in location where the existing ones could not be salvaged. Contractor has submitted prices for the added work, and it was reviewed and determined to be fair and reasonable for the scope. 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 Norlhstar Construction, LLC Mike Hiemlich �Lf4,&4 tfeiir�lic6i Aug2, 2 222 g Inspectorllnspection Supervisor Date Project and Contract Compliance Manager Date %^ Aug 21, 2022 CQ � Aug 22, 2022 Date Senior Capital Project Officer Date Aug 31, 20221 Pow.. ion Aug 31, 2022 Date DW Enent (Dept) Date �WPF Assist a Sep 1, 2022 1,a Date I Ass i Sep 2, 2022 „A Council Action (if required) M&C Number I I M&C Date Approved Sep 2, 2022 Date Sep 5, 2022 ATTEST:7LEerZfZE 2'S. a0&dA / Jan nette S. Goodall (Sep 6, 202209:26 CDT) Jannette Goodall, City Secretary FORT WORTH City of Fort Worth �T�- Change Order Additions Project Name CC Moss and ML Phillips SRTS Improvements City Sec # 57089 Gient Project # City Project Number 102411- TxDOT CSJ 0902-90.084 1 Contractor Northstar Construction, LLC PMI Brendan McInnes PE I Inspectorl Matt Cain Change Order Submittal # 0 Date i I ADDITIONS HEM BM UESCRIP I ION UEP 1 47 7049.6195 WA I ER ME I ER BOX I PW 48 9608.6001Unique Change Order Item #1 Utility Adjustments (UOM: DOL) TPW 49 0100.6003 Prep ROW (Tree)(5" to 12" DIA) TPW Uty Unit Umt Cost 1 total 1 20.00000000 EA $651.U5 $13,021.001 50,000.00000000 SY $1.00 sbuxuxul 2.00000000 CY $600.00' $1,200.001 TNVV $64,221.00 Sub Total Additions $64,221.00 Change Order Additions Page 2 of 4 Foe_ T�RTH City of Fort Worth Change Order Deletions Project Name I CC Moss and ML Phillips SRTS Improvements ' City Sec # 57089 I Client Project # I City Project Number 102411- TxDOT CSJ 0902-90.084 Contractor Northstar Construction, LLC PMJ Brendan McInnes, PE Inspectorl Matt Cain Change Order Submittal # O Date I DELETIONS HEM EM UEb(:HIP 110N UEP 1 13 0479.6005 Adjusting Manholes (Water Valve Box) TPW (sty Unit Unit Cost total 1 20.00000000 CY $275.00� $5,500.001 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 1 1 TPW $5,500.00 I I I Sub Total Deletions $5,500.00 Change Order Deletions Page 3 of 4 M/SBE for this Chanae Order M/SBE Sub I Tvpe of Service I Amount for this CO Total $0.00 Previous Change Orders co # DATE I AMOUNT Total I $0.00 I INSTRUCTIONS FOR PREPARING THE CHANGE ORDER (Local Agency) The following information is provided to assist you in preparing the Change Order (CO). 1 Insert the Contractor's name as it appears in the contract. 2 Insert the work limits for the Change Order. 3 Indicate if a change is major or minor. 4 Give a narrative of the revised work being authorized in the change order. If the CO affects pedestrian elements, state in the narrative that a copy of this CO must be sent to the Field Coordination Section of the Design Division. Address time by one of the following methods: 1) Add the time extension number and time in the box provided. 2) State in the narrative that no time is added by this CO. 3) State in the narrative that time will be addressed later in the project when the time impact of the change order is better known. Methods 1 and 2 are preferred. Method 3 should not be a normal practice. If time can not be agreed on with the contractor upon execution of a CO, method 3 is acceptable. In this case, time associated with this CO will be non- participating until the time justification is provided. 5 Attach any new/revised plan sheet(s). 6 For TxDOT use only. The TxDOT representative must designate if this change order is participating by providing a value for the days and amount participating. If the change order is non -participating, enter a zero "0" in the fields. 7 Direct the contractor to sign in the contractor's signature block. 8 Affix the seal of the authorized local representative in the space located at the left corner of the bottom of the CO Form. Adhere to Change Order Approval Policy of local agency. TXDOT Form 2146-L INSTR (Rev. 10/11) Page 1 of 1 Form 10111) CONSTRUCTION CONTRACT CHANGE ORDER NUMBER: 001 Page 1 of 1 I. CONTRACTOR: Northstar Construction, LLC 0902-90-084 CCSJ: 2. Change Order Work Limits: Sta. ENTIRE PROJECT to Sta. ENTIRE PROJECT Project: Sip 2022(069)TP 3. Type of Change (on Federal -aid non-exempt projects): Minor (Major/Minor) Highway: VA 4. Describe the change and the reason for the change order. When necessary, include County: TARRANT exceptions to this agreement District: FORT WORTH This change order is necessary in order to make revisions to the contract to compensate the contractor for removing 6-12" trees in ROW, adjusting Irrigation and water service (paid by Invoice with markups per TxDOT Spec 9L), and placing Contract new meter boxes in location where the existing ones could not be salvaged. Number. Contractor has submitted prices for the added work, and it was reviewed and determined to be fair and reasonable for the scope. S. New or revised plan sheet(s) are attached and numbered: N/A Each signatory hereby warrants that each has the authority to execute this Change Order. By slgning this chiuVe order, the contractor agrees to waive arty and all The following Information must be provided claims for additional compensation due to any and all other expenses; additional changes for time, overhead and profiC or loss of compensation Time E:xt. #: 0 Days added on this C.0 : 0 as a result of this change. Further, the contractor agrees thatthis agreement — is made In accordance with item 4 and the Contract Exceptions should be noted In the response for •s above. Amt. added by this Change Order $58,721.00 1 For TxDOT use only: THE CONTRACTOR Date Aug 12, 2022 �j �C�fGP.,�� h'iaflllNl�f By u rw A H� I AVWiI],2IIII:i Typed/Printed Name Michael A. Fieimlich Typed/Printed Title president RECOMMENDED FOR EXECUTION: Aug 21, 2022 Matt Cain (Aug 21, 2022 21,03 CDT) Name/Title Inspector Date Utuau � Aug 30, 2022 NameMtle project Manager Date oga-k (Sep 2.2o221s:a cot Sep 2, 2022 NarnIle Sr. Assistant City Attorney Date ?� Se 6 2022 Jannette S. Goodall ISev G. 2022 0926 CDT) p Namefntle City Secretary Date Engineer's Seal: Days participating i 1 Arr�oCln� articipatlng. w ►� 2rf 9 Sig itture L f� Date 7 ST P '�� �! --, Name/Title Usa.tt.ac.r.da lntenm5r t00 {Dur11, 2023lS:Itt Aug 31, 2022 Name/Title Interim Sr. CPO Date ®APPROVED ❑ REQUEST APPROVAL P Sep 1, 2022 NameMtle Interim Assistant Director Date ® APPROVED REQUEST APPROVAL �p Sep 2, 2022 Name/Title Interim Director -TPW Date ® APPROVED F-1 REQUEST APPROVAL William Johnsont5 r5.20;2os:41CDT) Sep 5, 2022 NameMtle Assitant City Manager September 5 2022 Date ® APPROVED TABLE A: Force Account Work and Materials Placed into Stock LABOR HOURLY RATE TABLE B: Contract Items REM DESCRIPTION UNIT 0479-6005 ADJUSTING MANHOLES (WM) EA 7049-6195 WATER METER BOX EA 9608-6001 UNIQUE CHANGE ORDER ITEM #1 UTILTIY ADJUSTMENTS (UOM:DOL) DOL 0100-6003 PREP ROW(TREE)(5" TO 12" DIA) EA CONSTRUCTION CONTRACT CHANGE ORDER NUMBER: 001 Estimated Cost: CCSJ: 0902-90-084 Paid by Invoice? (❑ Yes ® No ) EQUIPMENT HOURLY RATE ORIGINAL+ PREVIOUSLY REVISED UNIT PRICE QUANTITY REM COST 275.00 80.00 22,000.00 651.05 0.00 0.00 1.00 0.00 0.00 600.00 0.00 0.00 NEW QUANTITY ITEM COST OVERRUN/ UNDERRUN 60.00 16,500.00 - 5,500.00 20.00 13,021.00 13,021.00 50,000.00 50,000.00 50,000.00 2.00 1,200.00 1,200.00 TOTALS 22,000.00 80,721.00 58,721.0q TXDOT Form 2146-L TAB (Rev. 10/11) Page 1 of 2 CONSTRUCTION CONTRACT CHANGE ORDER NUMBER: TABLE B: Contract Items (Continued) ITEM DESCRIPTION UNIT UNIT PRICE The "Totals" from Table B of the previous work sheet: TOTALS TXDOT Form 2146-L TAB (Rev. 10/11) Page 2 of 2 ORIGINAL+ PREVIOUSLY REVISED QUANTITY ITEM COST 22,000.00 22,000.00 CCSJ: QUANTITY NEW ITEM COST OVERRUN/ UNDERRUN 80,721.00 58,721.00 80,721.00 58,721.00 102411-CNCO-Construction Change Order No. 1 — CC Moss and ML Phillips SRTS Improvements Final Audit Report 2022-08-29 Created: 2022-08-10 By: Andrea Munoz (Andrea. Munoz@fortworthtexas.gov) Status: Canceled / Declined Transaction ID: CBJCHBCAABAA3DLvv7t26jvWQoFKMEYsdzubGMB6J7yM "102411-CNCO-Construction Change Order No. 1 — CC Moss a nd ML Phillips SRTS Improvements" History Document created by Andrea Munoz (Andrea.Munoz@fortworthtexas.gov) 2022-08-10 - 2:29:51 PM GMT- IP address: 204.10.91.100 Document emailed to Sara.Cox@fortworthtexas.gov for filling 2022-08-10 - 3:45:21 PM GMT Email viewed by Sara.Cox@fortworthtexas.gov 2022-08-11 - 4:51:18 PM GMT- IP address: 204.10.91.100 Signer Sara.Cox@fortworthtexas.gov entered name at signing as Sara Cox 2022-08-11 - 4:52:30 PM GMT- IP address: 204.10.91.100 g Form filled by Sara Cox (Sara.Cox@fortworthtexas.gov) Form filling Date: 2022-08-11 - 4:52:31 PM GMT - Time Source: server- IP address: 204.10.91.100 Document emailed to mike@northstar93.com for signature 2022-08-11 - 4:52:34 PM GMT Email viewed by mike@northstar93.com 2022-08-11 - 11:12:49 PM GMT- IP address: 75.140.227.86 Signer mike@northstar93.com entered name at signing as Michael A. Heimlich 2022-08-12 - 5:49:35 PM GMT- IP address: 75.140.227.86 4 Document e-signed by Michael A. Heimlich (mike@northstar93.com) Signature Date: 2022-08-12 - 5:49:37 PM GMT - Time Source: server- IP address: 75.140.227.86 FoRTWORTHy I P--e"Y Adobe Acrobat Sign Document emailed to matt.cain@fortworthtexas.gov for signature 2022-08-12 - 5:49:40 PM GMT Andrea Munoz (Andrea. Mu noz@fortworthtexas.gov) added mcain@multatech.com as an alternate for matt.cain@fortworthtexas.gov 2022-08-19 - 10:13:30 PM GMT- IP address: 204.10.91.100 Document emailed to mcain@multatech.com for signature 2022-08-19 - 10:13:31 PM GMT Email viewed by mcain@multatech.com 2022-08-21 - 3:29:57 AM GMT- IP address: 104.28.97.18 4 ;_, Signer mcain@multatech.com entered name at signing as Matt Cain 2022-08-22 - 2:03:41 AM GMT- IP address: 99.61.135.144 AQ Document e-signed by Matt Cain (mcain@multatech.com) Signature Date: 2022-08-22 - 2:03:44 AM GMT - Time Source: server- IP address: 99.61.135.144 Document emailed to brendan.mcinnes@fortworthtexas.gov for signature 2022-08-22 - 2:03:45 AM GMT Email viewed by brendan.mcinnes@fortworthtexas.gov 2022-08-22 - 3:30:53 AM GMT- IP address: 104.28.97.19 �6 Signer brendan.mcinnes@fortworthtexas.gov entered name at signing as Brendan McInnes 2022-08-22 - 12:32:59 PM GMT- IP address: 70.241.106.163 (r30Document e-signed by Brendan McInnes (brendan.mcinnes@fortworthtexas.gov) Signature Date: 2022-08-22 - 12:33:00 PM GMT - Time Source: server- IP address: 70.241.106.163 P* Document emailed to Chad.Allen@fortworthtexas.gov for signature 2022-08-22 - 12:33:03 PM GMT Email viewed by Chad.Allen@fortworthtexas.gov 2022-08-29 - 1:12:40 PM GMT- IP address: 209.194.29.100 p Document canceled by Andrea Munoz (Andrea. M unoz@fortworthtexas.gov) 2022-08-29 - 2:59:03 PM GMT- IP address: 204.10.91.100 FORTWORTHy I P--edby Adobe Acrobat Sign 102411-CNCO-Construction Change Order No. 1 — CC Moss and ML Phillips SRTS Improvements Interim Agreement Report 2022-09-16 Created: 2022-08-29 By: Andrea Munoz (Andrea. Mu noz@fortworthtexas.gov) Status: Out for Filling Transaction ID: CBJCHBCAABAAOOBhKSwAhOgtzbEXMWUbXdRtgi2PtvuN Agreement History Agreement history is the list of the events that have impacted the status of the agreement prior to the final signature. A final audit report will be generated when the agreement is complete. "102411-CNCO-Construction Change Order No. 1 — CC Moss a nd ML Phillips SRTS Improvements" History "I Document created by Andrea Munoz (Andrea.Munoz@fortworthtexas.gov) 2022-08-29 - 3:38:55 PM GMT- IP address: 204.10.91.100 <• Document emailed to Chad.Allen@fortworthtexas.gov for signature 2022-08-29 - 4:16:54 PM GMT t. Email viewed by Chad.Allen@fortworthtexas.gov 2022-08-30 - 4:27:00 PM GMT- IP address: 209.194.29.100 Signer Chad.Allen@fortworthtexas.gov entered name at signing as Chad Allen 2022-08-30 - 6:52:07 PM GMT- IP address: 204.10.91.100 G Document e-signed by Chad Allen (Chad.Allen@fortworthtexas.gov) Signature Date: 2022-08-30 - 6:52:08 PM GMT - Time Source: server- IP address: 204.10.91.100 Document emailed to Lissette.Acevedo@fortworthtexas.gov for signature 2022-08-30 - 6:52:11 PM GMT Email viewed by Lissette.Acevedo@fortworthtexas.gov 2022-08-30 - 8:38:27 PM GMT- IP address: 166.137.115.22 Email viewed by Lissette.Acevedo@fortworthtexas.gov 2022-08-31 - 8:10:01 PM GMT- IP address: 209.194.29.100 FORT WORTHS I P--" 6q Adobe Acrobat Sign -c Signer Lissette.Acevedo@fortworthtexas.gov entered name at signing as Lissette Acevedo, Interim Sr. CPO 2022-08-31 - 8:11:46 PM GMT- IP address: 209.194.29.100 Document e-signed by Lissette Acevedo, Interim Sr. CPO (Lissette.Acevedo@fortworthtexas.gov) Signature Date: 2022-08-31 - 8:11:48 PM GMT - Time Source: server- IP address: 209.194.29.100 Document emailed to Martin.Phillips@fortworthtexas.gov for signature 2022-08-31 - 8:11:50 PM GMT 'k`j Email viewed by Martin.Phillips@fortworthtexas.gov 2022-09-02 - 1:44:48 AM GMT- IP address: 209.194.29.100 Signer Martin.Phillips@fortworthtexas.gov entered name at signing as Martin A Phillips 2022-09-02 - 1:46:10 AM GMT- IP address: 209.194.29.100 rl`c Document e-signed by Martin A Phillips (Martin.Phillips@fortworthtexas.gov) Signature Date: 2022-09-02 - 1:46:11 AM GMT - Time Source: server- IP address: 209.194.29.100 Document emailed to Lauren. Prieur@fortworthtexas.gov for signature 2022-09-02 - 1:46:14 AM GMT Email viewed by Lauren.Prieur@fortworthtexas.gov 2022-09-02 - 2:13:46 AM GMT- IP address: 108.209.194.42 %4 Signer Lauren.Prieur@fortworthtexas.gov entered name at signing as Lauren Prieur 2022-09-02 - 12:52:10 PM GMT- IP address: 108.209.194.42 dg, Document e-signed by Lauren Prieur (Lauren.Prieur@fortworthtexas.gov) Signature Date: 2022-09-02 - 12:52:12 PM GMT - Time Source: server- IP address: 108.209.194.42 L-4 Document emailed to Priscilla.Ramirez@fortworthtexas.gov for approval 2022-09-02 - 12:52:14 PM GMT Email viewed by Priscilla.Ramirez@fortworthtexas.gov 2022-09-02 - 6:19:53 PM GMT- IP address: 174.207.121.162 d� Signer Priscilla.Ramirez@fortworthtexas.gov entered name at signing as Priscilla Ramirez 2022-09-02 - 6:20:13 PM GMT- IP address: 174.207.121.162 d Document approved by Priscilla Ramirez (Priscilla.Ramirez@fortworthtexas.gov) Approval Date: 2022-09-02 - 6:20:14 PM GMT - Time Source: server- IP address: 174.207.121.162 Document emailed to Douglas.Black@fortworthtexas.gov for signature 2022-09-02 - 6:20:17 PM GMT Email viewed by Douglas. Black@fortworthtexas.gov 2022-09-02 - 8:40:53 PM GMT- IP address: 209.194.29.100 FORT WORTHS I P--" 6q Adobe Acrobat Sign -c Signer Douglas.Black@fortworthtexas.gov entered name at signing as DBlack 2022-09-02 - 8:42:22 PM GMT- IP address: 209.194.29.100 Document e-signed by DBlack (Douglas.Black@fortworthtexas.gov) Signature Date: 2022-09-02 - 8:42:24 PM GMT - Time Source: server- IP address: 209.194.29.100 Document emailed to William.Johnson@fortworthtexas.gov for signature 2022-09-02 - 8:42:27 PM GMT 15 Email viewed by William.Johnson@fortworthtexas.gov 2022-09-05 - 12:40:38 PM GMT- IP address: 166.137.19.52 Signer William.Johnson@fortworthtexas.gov entered name at signing as William Johnson 2022-09-05 - 12:43:32 PM GMT- IP address: 166.137.19.52 rl`c Document e-signed by William Johnson (William.Johnson@fortworthtexas.gov) Signature Date: 2022-09-05 - 12:43:33 PM GMT - Time Source: server- IP address: 166.137.19.52 Document emailed to Melissa Brunner (melissa.brunner@fortworthtexas.gov) for approval 2022-09-05 - 12:43:36 PM GMT Document approved by Melissa Brunner (melissa.brunner@fortworthtexas.gov) Approval Date: 2022-09-06 - 2:04:17 PM GMT - Time Source: server- IP address: 209.194.29.100 Document emailed to jannette.goodall@fortworthtexas.gov for signature 2022-09-06 - 2:04:20 PM GMT t� Email viewed by jannette.goodall@fortworthtexas.gov 2022-09-06 - 2:26:18 PM GMT- IP address: 209.194.29.100 e`er Signer jannette.goodall@fortworthtexas.gov entered name at signing as Jannette S. Goodall 2022-09-06 - 2:26:56 PM GMT- IP address: 209.194.29.100 ur Document e-signed by Jannette S. Goodall Qannette.goodall@fortworthtexas.gov) Signature Date: 2022-09-06 - 2:26:58 PM GMT - Time Source: server- IP address: 209.194.29.100 Document emailed to Vania Soto (Vania.Soto@fortworthtexas.gov) for filling 2022-09-06 - 2:27:01 PM GMT Email viewed by Vania Soto (Vania.Soto@fortworthtexas.gov) 2022-09-06 - 6:20:41 PM GMT- IP address: 209.194.29.100 Email viewed by Vania Soto (Vania.Soto@fortworthtexas.gov) 2022-09-08 - 3:09:59 PM GMT- IP address: 209.194.29.100 FORT WORTHS I P--" 6q Adobe Acrobat Sign 102411-CSCO-Construction Change Order No. 1 — CC Moss and ML Phillips SRTS Improvements Final Audit Report 2022-09-28 Created: 2022-09-27 By: Andrea Munoz (Andrea. Mu noz@fortworthtexas.gov) Status: Canceled / Declined Transaction ID: CBJCHBCAABAAwhltDIOJ3CUSssvGIJ8CJK0-B6G210tu "102411-CSCO-Construction Change Order No. 1 — CC Moss a nd ML Phillips SRTS Improvements" History Document created by Andrea Munoz (Andrea.Munoz@fortworthtexas.gov) 2022-09-27 - 9:49:29 PM GMT- IP address: 209.194.29.100 Document emailed to Douglas.Black@fortworthtexas.gov for filling 2022-09-27 - 9:53:12 PM GMT Email viewed by Douglas.Black@fortworthtexas.gov 2022-09-28 - 3:12:20 PM GMT- IP address: 209.194.29.100 Document declined by Douglas.Black@fortworthtexas.gov Decline reason: i don't know how to check the box "approved". you don't need it if you have my initials. 2022-09-28 - 3:14:13 PM GMT- IP address: 209.194.29.100 FORTWORTH. I Powered by Adobe Acrobat Sign FORTWORTH. TRANSPORTATION AND PUBLIC WORKS August 2, 2023 Northstar Construction 3210 Joyce Dr. Fort Worth, TX. 76116 RE: Acceptance Letter Project Name: CC Moss and ML Phillips SRTS Improvements Project Type: Paving City Project No.: 102411 To Whom It May Concern: On February 16, 2023 a final inspection was made on the subject project. There were no punch list items identified at the time. The final inspection indicates that work meets the City of Fort Worth specifications and is therefore accepted by the City. The correction period per General Conditions 00 72 00 section 13.7 will start on February 16, 2023; which is the date of the final inspection and will extend of two (2) years in accordance with the Contract Documents. If you have any questions concerning this letter of acceptance, please feel free to contact me at (817)392-2817. Sincerely, ,.4K— Brendan McInnes (Aug 31, 202314:15 CDT) Brendan McInnes, Project Manager Cc: Matt Cain, Inspector Gary Deyon, Inspection Supervisor Edward D'Avila, Senior Inspector Chad Allen, Program Manager Kimberly -Horn and Associates, Consultant Northstar Construction, Contractor Fort Worth, Tx, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev. 08/20/19 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 Michael A. Heimlich, President Of Northstar Construction, LLC, 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; CPN# 102411 - CC Moss and ML Phillips SRTS Improvements BY Michael A. Heimlich, President Subscribed and sworn before me on this date 15th of August, 2023. o�Af�Y PUB/ SANDY Q. MARTINEZ =®n ID ��1693E My Commission Expires 'q�aF October o6, 2026 Notary P b is Tarrant County, Texas CONSENT OF OWNER ❑ SURETY COMPANY ARCHITECT ❑ TO FINAL PAYMENT CONTRACTOR ❑ SURETY ❑ AIA DOCUMENT 0707 OTHER Bond No. SIJR0067396 PROJECT: CPN 102411 - CC Moss and ML Phillips SRTS Improvements, Ft. Worth TX (name, address) TO (Owner) [ City of Fort Worth ] ARCHITECT'S PROJECT NO: 200 Texas Street Fort Worth, TX 76102 CONTRACT FOR: [ ] CONTRACT DATE: December 14, 2021 CONTRACTOR: Northstar Construction, LLC 2112 Solona Street Fort Worth, TX 76117 In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the (here insert name and address of Surety Company) Argonaut Insurance Company P.O. Box 469011 San Antonio, TX 78246 SURETY COMPANY, on bond of (here insert name and address of Contractor) Northstar Construction, LLC 2112 Solona Street Fort Worth, TX 76117 , CONTRACTOR, hereby approves of the final payment to the Contractors, and agrees that final payment to the Contractor shall not relieve the Surety Company of any of its obligations to (here insert name and address of Owner) City of Fort Worth 200 Texas Street Fort Worth, TX 76102 as set forth in the said Surety Company's bond. IN WITNESS WHEREOF, the Surety Company has hereunto set its hand this 22nd Attes �_i(p.� I[ day of March Argonaut Insurance Company Surety Company 4.,-�Lq P ►�-ect Signature of Authorized Repr4tative 2Q23 ,OWNER, (Seal): _ _ , _ Sandra Lee Roney Attornev-In-Fact = Title NOTE: This form is to be used as a companiorEtIcnaument td ArADOCUMF�_ %706, CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS, Current Edition AIA DOCUMENT G707 • CONSENT OF SURLTY-CQMPANY-T6FMAL rAYMENT • APRIL 1970 EDITION • AIAO ONE PAGE © 1970 • THE AMERICAN INSTITUTE OF ARC)MTE6TS;1 35 New York Ave., NW, WASHINGTON, D.C. 20006 Argonaut Insurance Company Deliveries Only: 225 W. Washington, 24t1i Floor Chicago, IL 60606 United States Postal Service: P.O. Box 469011, San Antonio, TX 78246 POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the Argonaut Insurance Company, a Corporation duly organized and existing under the laws of the State of Illinois and having its principal office in the County of Cook, Illinois does hereby nominate, constitute and appoint: Andrea Rose Crawford, Trov Russell Kev. Debra Lee Moon. John William Newbv, Sandra Lee Ronev, Joshua ILTritLSuzanne Elizabeth Niedzwiedz V4\WSyV Their true and lawful agent(s) and attomey(s)-in-fact, each in their separate capacity if more than one is named above, to make, execute, seal and deliver for and on its behalf as surety, and as its act and deed any and all bonds, contracts, agreements of indemnity and other undertakings in suretyship provided, however, that the penal sum of any one such instrument executed hereunder shall not exceed the sum of. S97.550,000.00 This Power of Attorney is granted and is signed and sealed under and by the authority of the following Resolution adopted by the Board of Directors of Argonaut Insurance Company: "RESOLVED, That the President, Senior Vice President, Vice President, Assistant Vice President, Secretary, Treasurer and each of them hereby is authorized to execute powers of attorney, and such authority can be executed by use of facsimile signature, which may be attested or acknowledged by any officer or attorney, of the Company, qualifying the attorney or attorneys named in the given,Fower of attorney, to execute in behalf of, and acknowledge as the act and deed of the Argonaut Insurance Company, all bond undertakings and contracts of suretyship, and to affix the corporate seal thereto." Y IN WITNESS WHEREOF, Argonaut Insurance Company has caused its official seal to be hereunto affixed and these presents to be signed by its duly authorized officer on the 19th day of November, 2021. Argonaut Insurance Company J~`tk c�o . SEAL by: STATE OF TEXAS , `��Gary E. Grose, President COUNTY OF HARRIS SS: .*."'..�,, On this 19th day of November, 2021 A.D., before me, a Notary Public of the State of Texas, in and for the County of Harris, duly commissioned and qualified, came THE ABOVE OFFICER OF THE COMPANY, to me personally known to be the individual and officer described in, and who executed the preceding instrument, and he acknowledged the execution of same, and being by me duly sworn, deposed and said that he is the officer of the said Company aforesaid, and that the seal affixed to the preceding instrument is the Corporate Seal of said Company, and the said Corporate Seal and his signature as officer were duly affixed and subscribed to the said instrument by the authority and direction of the said corporation, and that Resolution adopted by the Board of Directors of said Company, referred to in the preceding instrument is now in force. IN TESTIMONY WHEREOF, I have hereunto set my hand, and affixed my Official Seal at the County of Harris, the day and year first above written. -n . K ATHLEEN M MEE KS NOTARY PUBLIC STATE OF TEXAS MY COMM.. EXP. 07/15/25 NOTARY ID 557902-8 (Notary Public) t, the undersigned Officer of the Argonaut Insurance Company, Illinois Corporation, do hereby certify that the original POWER OF ATTORNEY of which the foregoing is a full, true and correct copy is still in full force and effect and has not been revoked. IN WITNESS WHEREOF, [have hereunto set my hand, and affixed the Seal of said Company, on thea day of 1 \0., _ �., v Jam• 4�ypplyff � V Austin W. King Secretary IF YOU HAVE QUESTIONS ON AUTHEN•i1C1'TY O Tf<IfSbOCUMENT CALL (933) 820-9137. IMPORTANT NOTICE To obtain information or make a complaint: You may call Argonaut Insurance Company and its affiliates by telephone for information or to make a complaint: ARGONAUT INSURANCE COMPANY Please send all notices of claim on this bond to: Argo Surety Claims (413) 773-6359 Deliveries Only: 225 W. Washington, 24th Floor, Chicago, IL 60606 United States Postal Service: P.O. Box 469011, San Antonio, TX 78246 You may contact the Texas Department of Insurance to obtain information on companies, coverages, rights or complaints at: (512) 490-1007 You may write the Texas Department of Insurance: P. O. Box 149104 Austin, TX 78714-9104 Fax: (512) 475-1771 Web: http://www.tdi.state.tx.us E-mail: Cons umerProtectiowda tdi.state.tx.us PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should contact your agent or Argo Surety first. If the dispute is not resolved, you may contact the Texas Department of Insurance. ATTACH THIS NOTICE TO YOUR BOND: This notice is for information only and does not become a part or condition of the attached document and is given to comply with Texas legal and regulatory requirements.