HomeMy WebLinkAboutContract 57449-FP1City Secretary
-FP1
Contract No. 57449
FORT WORTHa
Date Received 9/11/2023
AT
NOTICE OF PROJECT COMPLETION
(Developer Projects)
The Transportation and Public Works Department upon the recommendation of the Project
Manager has accepted the following project as complete:
Project Name: The Blue Lagoon Dream Addition
City Project No.: 103231
Improvement Type(s): ❑ Paving ❑ Drainage x❑ Street Lights ❑ Traffic Signals
Original Contract Price:
$61,785.00
Amount of Approved Change Order(s):
$4,063.50
Revised Contract Amount:
$65,848.50
Total Cost of Work Complete:
$65,848.50
Sep 6, 2023
Contractor Date
Operations Manager
Title
C & S Utility Contractors, Inc.
Company Name
Sep 77 2023
SereloG arc drIS202309:43 EDT)
Project Inspector
Date
06il ,r,i6i lt1 P.E.
Khal Jaafari P.E. (Sep 8, 2023 23:04 CDT)
Sep 8, 2023
Project Manager
Date
Bichlo NeN� eo1 J65';069':f3-5 CDT)
Sep 11, 2023
CFA Manager
Date
Z.
Lauren Pneur lSeo 11. 202309:47 CDT)
Sep 11, 2023
TPW��'Q/^/�DDii`rector
Date
Wllll�ohnson(S 121�1:26 CDT)
Sep 12, 2023
Asst. City Manager
Date
OFFICIAL RECORD
CITY SECRETARY Page 1 of 2
FT. WORTH, TX
Notice of Project Completion
Project Name: The Blue Lagoon Dream Addition
City Project No.: 103231
City's Attachments
Final Pay Estimate x❑
Change Order(s): ❑x Yes ❑ N/A
Contractor's Attachments
Affidavit of Bills Paid
Consent of Surety
Statement of Contract Time
Contract Time 30 WD
Work Start Date: 6/21/2022
Completed number of Soil Lab Test: 304
Completed number of Water Test: 8
Days Charged: 256
Work Complete Date: 8/7/2023
Page 2of2
FoRTWORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name THE BLUE LAGOON DREAM ADDITION
Contract Limits
Project Type STREET LIGHTING
City Project Numbers 103231
DOE Number 3231
Estimate Number 1 Payment Number 1
City Secretary Contract Number
Contract Date 4/29/2022
For Period Ending
Project Manager NA
Contractor C & S UTILITY CONTRACTORS, INC.
6705 HIGHWAY 287
ARLINGTON , TX 76001
Inspectors O.AGUILLON / S. GARCIA
Contract Time
Days Charged to Date
Contract is 100.00
8/7/2023
WD
3WD
256
Complete
Friday, September 1, 2023 Page 1 of
City Project Numbers 103231
Contract Name THE BLUE LAGOON DREAM ADDITION
Contract Limits
Project Type STREET LIGHTING
Project Funding
UNIT V: STREET LIGHTING IMPROVEMENTS
DOE Number 3231
Estimate Number 1
Payment Number 1
For Period Ending 8/7/2023
Item
Description of Items
Estimated Unit
Unit Cost
Estimated
Completed
Completed
No.
Quanity
Total
Quanity
Total
1
2" CONDT PVC SCH 80 (T) (CO#2)
955 LF
$18.50
$17,667.50
955
$17,667.50
2
FURNISH/INSTALL LED LIGHTING FIXTURE
12 EA
$295.00
$3,540.00
12
$3,540.00
3
RDWY ILLUM FOUNDATION TY 1,2, & 4
12 EA
$1,100.00
$13,200.00
12
$13,200.00
4
RDWY ILLUM TY 11 POLE
12 EA
$1,898.00
$22,776.00
12
$22,776.00
5
FURNISH/INSTALL TYPE 33B ARM
12 EA
$300.00
$3,600.00
12
$3,600.00
6
NO 10 INSULATED ELEC CONDR (CO #2)
2865 LF
$1.00
$2,865.00
2865
$2,865.00
7
FURNISH/INSTALL LED LIGHTING FIXTURE (70
4 EA
$550.00
$2,200.00
4
$2,200.00
WATT ATBO COBRA HEAD)
Sub -Total of Previous Unit
$65,848.50
$65,848.50
Friday, September 1, 2023 Page 2 of 4
City Project Numbers 103231
Contract Name THE BLUE LAGOON DREAM ADDITION
Contract Limits
Project Type STREET LIGHTING
Project Funding
Contract Information Summary
Original Contract Amount
Change Orders
Change Order Number 2
Total Contract Price
DOE Number 3231
Estimate Number 1
Payment Number 1
For Period Ending 8/7/2023
$61,785.00
$4,063.50
$65,848.50
Total Cost of Work Completed $65,848.50
Less % Retained $0.00
Net Earned $65,948.50
Earned This Period $65,848.50
Retainage This Period $0.00
Less Liquidated Damages
Days @ / Day
LessPavement Deficiency
Less Penalty
Less Previous Payment
Plus Material on Hand Less 15%
Balance Due This Payment
$0.00
$0.00
$0.00
$0.00
$0.00
$65,848.50
Friday, September 1, 2023 Page 3 of 4
City Project Numbers 103231
Contract Name THE BLUE LAGOON DREAM ADDITION
Contract Limits
Project Type STREET LIGHTING
Project Funding
Project Manager NA
Inspectors O.AGUILLON / S. GARCIA
Contractor C & S UTILITY CONTRACTORS, INC.
6705 HIGHWAY 287
ARLINGTON, TX 76001
DOE Number 3231
Estimate Number 1
Payment Number 1
For Period Ending 8/7/2023
City Secretary Contract Number
Contract Date
4/29/2022
Contract Time
30 WD
Days Charged to Date
256 WD
Contract is .000000
Complete
CITY OF FORT WORTH
SUMMARY OF CHARGES
Line Fund Account Center Amount Gross Retainage Net
Funded
Total Cost of Work Completed $65,848.50
Less % Retained $0.00
Net Earned $65,848.50
Earned This Period $65,848.50
Retainage This Period $0.00
Less Liquidated Damages
0 Days @ $0.00 / Day
$0.00
LessPavement Deficiency
$0.00
Less Penalty
$0.00
Less Previous Payment
$0.00
Plus Material on Hand Less 15%
$0.00
Balance Due This Payment
$65,848.50
Friday, September 1, 2023 Page 4 of 4
DEVELOPER -AWARDED -PROJECT CHANGE ORDER
PROJECT NAME: Blue Lagoon Dream Addition CHANGE
CONTRACT: ORDER No:
CFA # CFA #21-0147 1 CITY PARTICIPATION: No
CITY PROJECT # CPN 4103231
FID # 30114-0200431-E07685
FILE # W-2767 I X-26870
INSPECTOR: Oscar Aguillon Phone No: 817 992 2600
PROJECT MANAGER: Khal Jaafari, PE Phone No: 817 392 7872
CONTRACT UNIT
WATER SEWER PAVING DRAINAGE STREET LIGHTS CONTRACT
Developer Developer Developer Developer Developer DAYS
Coat City Cast Cost CI# Cott Cost Cl Cost Cost -T CICost Coat C Coat
ORIGINAL CONTRACT $233,581.00 - $0.00 i190,246-00 $0.00 $0.00 $160,424.00 $0.00 _ $0.00 120
EXTRAS TO DATE
CREDITS TO DATE
CONTRACT TO DATE $233,581.00 $0.00 $190,249.00 I , 30.00 $0.00 _ $0.00 I $160.424.00 $0.00 $0.00 $0.00 120
AMOUNT OF PROP CHANGE ORDER SQ,OQ $2,403.75 i0.00 $0.00 y $O.DO 50.00�
REVISED CONTRAfT AMOUNT $233,581.00 50.00 $192,651.75 So 06 $0.00 f0.00 $160,424.00 50.00 $0.00 U.00 120
TOTAL REVISED CONTRACT AMOUNT
PER UNIT $233,581.00 $192,651.75 f0.00 $160,424.00 50.00
REVISED COST SHARE Dev. Cost: $586,656.75 City Cast: 50.00
TOTAL REVISED CONTRACT $586,656.75
Revised: 10-12-2011 Pign 1
You are directed to make the following changes in the contract documents:
CITY BID ITEM
PAY ITEM #
# QUANTITY UNIT ITEM DESQRIPTION
UNIT PRICE
TOTAL
Unit 11 - Item 1
3331-4115 -69 L.F. S" Sewer Pipe (SDR-26 ASTm 03034)
$34.00
-$24346.00
3331-4119 71 L.F. 8" Sewer Pipe (DIP)
$92.25
$6,549.75
Unit 11- Item 2
3339-1001 1 EA 4' Manf�Ole
$3,200,00
$3,200.00
Unit It - Item 3
339-1002 -1 EA 4' Drop Manhole
$5,000.00
-$5 400.00
TOTAL
�2,403.751
REASONS FOR CHANGE ORDER
Location of existing sanitary stubout varied from anticpated location. Sanitary afign�ustad to accommodate the change and pipe has been charrgad from
PVC to Ductile iron due to only 1.0 foot separation between proposed storm crossing and sanftary pipe.
NO CITY FUNDS INVOLVED IN THIS CONTRACT, DEVELOPER IS RESPONSIBLE FOR 100% OF THE CHANGE ORDER COST AND NO
REIMBURSEMENT FROM THE CITY WILL BE SOUGHT BY THE DEVELOPER.
RECOMMENDED:
Thom Gov Engi ring., Li
By:
Name; Thomas Hoover
Title: Manager
APPROVED:
707 AVENUE, LLC
Name: ,tamai Alaffs
Tit1w Gamer
APPROVED:
Penn Utility Constrzlctfon, LLC
Narne; f7anr,„Sa sv�dr��_
Titlo:
Revised: 10-12-2011 P;Ig D
THE CITY OF FORT WORTH, TEXAS
FORT WORTH PLANS FOR THE CONSTRUCTION OF
WATER, SEWER, PAVING, DRAINAGE
& STREET LIGHT IMPROVEMENTS
TO SERVE
THE BLUE LAGOON DREAM ADDITION
(EAST CHASE CORRECTION PLAT, LOTS 1, 2 & 3, BLOCK 13)
BETSY PRICE
MAYOR
DAVID COOKE
CITY MANAGER
MICHAEL OWEN, P.E.
CITY ENGINEER, TRANSPORTATION AND
PUBLIC WORKS DEPARTMENT
CHRISTOPHER P. HARDER, P.E.
DIRECTOR, WATER DEPARTMENT
IPRC RECORD NO. IPRC21-0015
CITY PROJECT NO. #103231
FID NO. 30114-0200431-103231-E07685
FILE NO. W-2767
NOVEMBER 4, 2021
d
LOWERY RD.
A PROJECT Ro
�D LOCATION
JOHN T. VHItL R /
ANDERSON BLVD
0�i
LOCATION MAP
6 - 1-1000'
MAPSCO NO. 67-T
COUNCIL DISTRICT #5 ezg8".aP; rlll��L FD �`
OWNED/DEVELOPED BY: PREPARED BY:
THOMAS HOOVER ENGINEERING, LLC
P.O. BOX 1808
KEL.LER, TEXAS 76244
((817 913-1350 PHONE
t.B..E. FIRM REGISTRATION NO. 006009
SHEETINDEX
SHEET NO. DESCRIPTION
UNIT 1. WATER AND SANITARY SEWER IMPROVEMENTS
I "'ER SHEET
4 CRY STANOARDGENERAL NOTES
5 OVERALL —PLAN
8 SITE PLAN ENIARGED(1 OF 2)
GED(2 OF 2)
WATE PLAN
1"11
1
SANI YS LNi "
13 SANITARY SEWER LINES S28 SS
ER
GSION CONTROL DETAILS
1] OVERALL EXISTING DRAINAGE AREA MAP
18 ONSITE EXISTING DRAINAGE AREA MAP
PROPOSEDDRAINA AAREALMAP
21 C 22-28 PAVING PLAN
29 3 GNAGE AND LIGHTING PIAN
30 SIDEWALK PLAN
Vi6EW' V. T~,h. T.E.
Dec 7, 2021
DIRECTOR'S DESIGNEE FOR CONSTRUCTION PLAN APPROVAL '
RESOLUTION NO.01-10-2020
Dec 6, 2021
REVIEWED: DATE:
PROJECT MANAGER
X-26870
3
z
$_
v v v v v I� r
F
S` AS GAS— S— GAS— CAS —CAS —GAS —GAS— GAS —SY0)—�lo tl0—CAS—CAB—CAS—GAS—GAB
— m W-O(.8'W W W W-3653.86 W W W IX.B1Y— W
CFW )'W-042]
PROPOSED 313'42
VARIABLE WIDTH -205.8]' I-y
UBLIC SANITARY G '102.96' 4 XOA LI
DRAINAGE BSXT. B�NI'25'10' (PUHOABLIC)
LOT I
I:BLrc) b dOHN T. WHITE ROAD NORT (PUBI
0+89.10 rau
PF 1188_13� .m = /595 SP Y� (VARIABLE WHIS RO.R'.) 2.726
SW3,95.6
R STUB 717
I \8"38_ - ----__
%-09402 B
I TA a+2J.61 55- • —_-^-- -I1NSTALL 4.0' DIA. M
RIM-5
A-
52 yy11;;1,xF i I I I
N I LI F IN=53�.99 61N I { I LU 3 -P R + �- I \ _5- LOT I LOT P I LOT 3
TA 0+00.00 SB-4
X NSTALL 4.0' DIA. MH \ 1 Ilitm-mi.so
A S+J2.23 55-
P. .C. 96 YI IM=542.73 I LOT 3 g TA 0+00.00 SS-2
NSTALL 45 IF - - _ STALL 4.0' MA I
I
I SSNR STUBWT (EAS I` � J �T D I
IN=535.41 L /I IIN-541.21
TANEWMANHOLEIN=535.41i1 LOT 4 LJ I_1R.21
VER EXISTING STUBOV OUT=saS. ,ONT=541.11 TII
IMIN5+0.(N 0 la 0+ae 00�i + }L
IN T (S)=534.43 NSTALL 45 LF 8' SSWR I I_ 1 111
OUT (5)=534.43 ND O PLUG - LOT SLOT 5 "f
H FUTURE INSTALLED I I.0 I�
o£ uI \ RPHASE I3—
Cu_'_- I I
C p i- ` a LOT 6 --
r r
01
b„1 ml �LOT 7
LOT / � LOT P � LOT 9
mR 11 \•\ I —� J i I
L°T
1. YD3L0 GRANGE REVLSION BASED ON SI UBOOT LOCATION OT/Pe/PP
1 2. REVLSBD Pot CITY COMMeNTS l0/Oe/Pl
1 1. REVLS6D PER CITY GOMIRff1T3 o4/oe/81
1 No. REVISIONS/ SUBMISSIONS hate
0 Op1E CAL( �-
�l
R_ BOA �i
O
BEFORE y
f :•
ix9u�s L iioo�T'A"•
�, i 82493 I
w, ._-
SANITARY SEWER NOTES
MANHOLE FLOWLINES
6.9.4.1. MANHOLES SHALL BE DESIGNED WITH A 0.10-FOOT DROP FROM THE INLET
EIEVATON TO THE OUTLET ELEVATION FOR ANY FLOW DIRECTION CHANGES
EXCEEDING 60 DECREES.
6.9.4.2. FLOWLNE ELEVATION DIFFERENCES OF 24-INCHES, OR LESS, A HDRAUUC
SLIDE IS REQUIRED IN ACCORDANCE WITH THE CITY'S STANDARD
CONSTRUCTION SPECIFICATIONS AND DETAILS.
CORROSION PREVENTION
6.9 &1 MANHOLES ARE REQUIRED TO BE LINED IN ACCORDANCE MTH THE CITYS
STANDARD CONSTRUCTION SPECIFICATIONS AND DETAILS WHEN ANY OF THE
FOLLOWING CONDITIONS EXIST:
-MANHOLES TRANSITIONING FROM FORCE MAINS TO GRAVITY MAINS;
-DROP MANHOLES:
-MANHOLES CONSTRUCTED WITH A HYDRAULIC SLIDE
mTHOMAS HOOVER ENGINEERING, LLC
P.O. BOX 1808
KELLER, TEXAS 11144
(817) 913-1350 PH.
T.B. P.E. FIRM REGISTRATION NO. 006009
0 40
THE BLUE LAGOON DREAM ADDITION
Scale m Feet
LOTS 1, 2 & 3, BLOCK 13
OWNER/APPlXANf EASTCHASE CORRECTION PLAT
707 AVENUE, LLC IN THE CITY OF FT. NORTH,
4148 SUCK ROCK CHASE TARRANT COUNTY, TEXAS
EULESS,
9-3285 TX. ISO
ao 13.04 ACRES OF LAND
9]2/9]
'"Y�OFE PREPARER/EN6INEER THE BLUE LAGOON DREAM ADDITION
THOMHOOVER ENGINEERING. LLC
BO
P.O. BOX SANITARY SEWER — LINE S1
76
KELLER, -1 50 P JRM scNi LLT no. LLT
81]/913-1350 PHONE m JRM
CONTACT: THOMAS HOOVER "" 103231 C10
tom.BlengOy9M1oo.rnm ECX m TlN 07/2S/22
DEVELOPER -AWARDED -PROJECT CHANGE ORDER
PROJECT NAME:
Blue Lagoon Dream Addition
CHANGE
CONTRACT:
Street Lights (Unit V)
ORDER No:
CFA #
CFA921-0147
CITY PARTICIPATION:I
No
I CITY PROJECT #
CPN #103231
IFID #
30114-0200431-EO7685
2
FILE #
W-2767 IX-26870
INSPECTOR:
Oscar Aguillon
Phone No:
817 992 2690
PROJECT MANAGER:
Khal Jaafari, PE
Phone No:
817 392 7872
CONTRACT UNIT
l
WATER
SEWER
PAVING
DRAINAGE I
STREET
LIGHTS
I CONTRACT
Developer
Developer
Developer
Developer
IDoveloper
DAYS
Cost CityCost
Cost
Ci Cost
Coat City Cost
Cost
City Cost
Cost
City Cost
I
IORIGINAL CONTRACT
$0.00
$0.a0 I
$0.00
) $0.00
$61,786.00
$0.0o l
120
(EXTRAS TO DATE
CREDITS TO HATE
�
I�
IGONTRACT TO DATE
$0.00 $0.00 $0.00
A
$0.00 $0.00
$0.00
$0.00
$61,785.00
$Uxo
120
IAMOUNT OF PROP. CHANGE ORDER
$0.00
$0.08
$0.00
$4,063,50
$0.00
REVISED CONTRACT AMOUNT
$0.00 $0.00 $0,00
$0.00 $0.00
$0.00
$q,p#3
$65,848.50
$0.00
I 120
TOTAL. REVISED CONTRACT AMOUNT
PER UNIT
$0.00
$a.00
$0.00
$0.00
$65,848.50
REVISED COST SHARE
Dev. Cost: $65,848.60
:City Cast:
TOTAL REVISED CONTRACT
$65,848.5a
Revised: 10-12-2011 Page 1
You are directed to make the following changes in the contract documents
CITY BID ITEM
PAY ITEM #
# QUANTITY UNIT ITEM DESCRIPTION UNIT PRICE
TOTAL
Unit V - Item 1
2605-3015 189 LF - 2" Conduit PVC Schedule 80 (T) $18.50
$3,496,50
k Unit V - Item 6
3441-1410 _ _ 567 _ _LF No. 10 Insulated Electric Condr. $1.00
$567.00
TOTAL _ .. - -
$4.063.501
REASONS FOR CHANGE ORDER
The existing street light at the intersection of Nadeel and John T. White North was determined to stay and that the conduit/wiring to R9 would be run to a new
handhole. The light R2 was in conflict with the Fire hydrant and was subsequently moved across to the northeast corner of Nadeel and Arkan.
NO CITY FUNDS INVOLVED IN THIS CONTRACT. 0EVELCPER IS RESPONSIBLE FOR 100% OF THE CHANGE ORDER COST AND NO
REIMBURSEMENT FROM THE CITY WILL BE 80UGHT BY THE DEVELOPER.
RECOMMENDED: APPROVED:
Thomas er Engineen LLC 707 AVENUE, LLC
By: By: 1
Name: Thomas Hoover Name: Jamal Aloffe
Title: Manager Title: Owner
APPROVED:
C & S Utifi c!or7, ;nc. _.
By:
Name:
Title: Of rllth v��4 t_
Revised: 10-12-2011 Page 2
DEVELOPER -AWARDED -PROJECT CHANGE ORDER
PROJECT NAME:
Blue Lagoon Dream Addition
I CHANGE
CONTRACT:
ORDER No:
CFA #
CFA #21-0147 I CITY PARTICIPATION:I No
CITY PROJECT #
CPN #103231
DOE #
30114-0200421-E07685
I 3
WATER PROJECT #
SEWER PROJECT #
FILE #
W-2767 / X-26870
INSPECTOR:
Oscar Aguillon Phone No:
817 992 2600
PROJECT MANAGER:
Khal Jaafai, PE Phone No:
817 392 7872
CONTRACT UNIT
WATER SEWER
PAVING DRAINAGE
STREET LIGHTS
CONTRACT
Developer Developer
Developer Developer
Developer
DAYS
Cost City Cost Cost City Cost
Cost City Cost Cost
City Cost Cost City Cost
ORIGINAL CONTRACT
$233,581.00 $190,248.00
$160,424.00
120
EXTRAS TO DATE
$2,403.75
CREDITS TO DATE
CONTRACT TO DATE
$233,581.00 $0.00 $192,651.75 $0.00
$0.00 $0.00 $160,424.00
$0.00 $0.00 $0.00
120
AMOUNT OF PROP. CHANGE ORDER
$9,000.00
($210.00)
REVISED CONTRACT AMOUNT
$242,581.00 $0.00 $192,651.75 $0.00
$0.00 $0.00 $160,214.00
$0.00 $0.00 $0.00
120
TOTAL REVISED CONTRACT AMOUNT
PER UNIT
$242,581.00 $192,651.75
$0.00 $160,214.00 $0.00
REVISED COST SHARE
Dev. Cost: $595,446.75
City Cost:
$0.00
TOTAL REVISED CONTRACT
$595,446.75
Revised: 10-12-2011 Page 1
m era r—r Kud I3 make ow
'CITY BIG ITEM
FAY rrpAi t s I OUAHTITY WiiT C1' m AESCMPTNIN 11wefT PTaCP IOTA!
f S 37 S 2 20D2I FA 11 W ww serAce 3 woo s 255m 00
Un I�MPctr 0 M12-2m 1 -15 CA 1' Wrier Service Sahsae ; 1.100,00 oamom
VNI I - ran 1 33i 1-02D5 .i EA 24' RCP, C=aa Ill i 70.40 5 (210 00
rQTAL f 3,790 00
R A—eckS FM CHAWGZ OPMER LOCZA er of sxfsLry sar.':� , x'u5or.' yw;iad f m w0:pe&dkcsbon. San±ay byrrard a01W fa ec=mavdo:n fim chsnpo s nd p+aa Jts been chmysGfmm
ANC ie Dudis I= dL* to Qnfy 1, 0 fa^t caps.-wG beMgwn prapa::ad s c-m crz-. m2 and sLvWy pJ;o,
Psbb Jrft s bf QVPbetkl 60n) NO Cf Y FUNDS INVOLYFt3 IN THIS CONTRACT, DEVELOPER M RE5PQH3IBLE FOR 1007.' OF THE CHANGE: =0ER COST AMD NO
RRIX2URSEW ENT FROM THE CTiY W LL 9E SOWHT BY THE DEVELOPER.
KEC F RPP7l4YEL1- APPRUifI<D-
En LC '0Y A%mm v, LLC PcnrA7,- x+ UtW cor LLC
Wave
Y � I
Win»: TT�rrsas I{a^tior N�s1o, dsrnsl Aa^e Nauna: Q� x., y �. g +i3�€r1f�l
TfU0. Wn3*W Tit* C?wnor 'T61 PM T
pov.7 pd:10-12-2211 Pa9a2
FORTWORTH.
TRANSPORTATION AND PUBLIC WORKS
July 27, 2023
C & S Utility Contractors, Inc.
6705 Highway 287
Arlington, TX 76001
RE: Acceptance Letter
Project Name: The Blue Lagoon Dream Addition
Project Type: T/PW — Street Lights and Signage Improvements
City Project No.: 103231
To Whom It May Concern:
On August 10, 2023 a final inspection was made on the subject project. There were no punch list items
identified at that time. The final inspection indicates that the work meets the City of Fort Worth
specifications and is therefore accepted by the City. The warranty period will start on August 10, 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-
392-7872.
Sincerely,
Khal raa- qa i P. E.
Khal Jaafari P.E. (Sep 8, 2023 23:04 CDT)
Khal Jaafari, P.E., Project Manager
Cc: Sergio Garcia, Inspector
Donald Watson, Inspection Supervisor
Oscar Aguillon, Senior Inspector
Victor Tornero, P.E., Program Manager
Thomas Hoover Engineering, LLC, Consultant
C & S Utility Contractors, Inc., Contractor
707 Avenue, LLC, 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 Charles Saylors,
President Of C&S Utility Contractors, 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;
Blue Lagoon Dream Addition - CPN 103231
BY
Charles Saylors, President
Subscribed and sworn before me on this date 07 of July, 2023.
Notary Public
Tarrant, Texas
is
SLAKE MENAPACE
Notary ID #130991676
My Commission Expires
February 2. 2025
.._.::,. SURETEC INSURANCE COMPANY
2103 CityWest Boulevard, Suite 1300
Houston, TX 77042
OWNER
ARCHITECT
CONSENT OF SURETY CONTRACTOR
TO FINAL PAYMENT SURETY
OTHER
BOND NO.: 4433275
TO OBLIGEE:
(Name and Address)
City of Fort Worth
200 Texas Street, Fort Worth, TX 76102
PROJECT:
(Name and Address)
CFA No. 103231
Blue Lagoon Dream Addition
PRINCIPAL: C & S Utility Contractors, Inc.
Street Light Improvements
CONTRACT DATED:
At the request of the Obligee and the Principal indicated above, (Insertname and address of Surety)
I
SureTec Insurance Company, 2103 CityWest Boulevard, Suite 1300, Houston, TX
77042, SURETY,
on bond of (Insert name and address of contractor)
C & S Utility Contractors, Inc., 6705 Highway 287, Arlington, TX 76001
, CONTRACTOR,
and conditioned on the representation by Obligee that all Contract provisions relating to the payment
of final payment under the Contract have been satisfied by Principal as of the date of final payment,
and that no claims by Obligee or any third party are known or believed by Obligee or its
representatives to exist as of the date of final payment, representations as to the truth and accuracy
of the foregoing conditions being deemed to have been made by Obligee in connection with this
request for Consent of Surety, hereby approves of the final payment to the Principal, and agrees that
final payment in accordance with the terms hereof shall not relieve the Surety of its obligations to
(Insert name and address of Obligee)
City of Fort Worth, 200 Texas Street, Fort Worth, TX 76102
as set forth in said Surety's bond.
IN WITNESS WHEREOF, the Surety has hereunto set its hand on this date: August 8,
(Insert m writing the month followedby the numeric date and year) A
SureT
raresentative)
Frank Swingle,
SIC COS Final Payment rev 10_2021 Page I of 1
POA #: 4221060
SureTec Insurance Company
LIMITED POWER OF ATTORNEY
KnowAIIMen by These Presents, That SURETEC INSURANCE COMPANY (the "Company"), a c o rpo ration duly organized and
existing under the laws of the State ofTexas, and having its principaloffice in Houston, Harris County, Texas, does by these presents
make, constitute and appoint
Frank Swingle, Warren Gravely, Jr., Ed Veale, Matthew B. Elmore, Kirk D. Dreyer, John M. Huff, Stacey Healy,
DeAnna Hansford Crombie, Lynsie DeCet, Lawrence Wesson, Jr., Katie Hunt, Crystal Carlson, Collin Brence
its true and lawful Attorney -in -tact, with fullpowerand authority hereby conferred in its name, place and stead, to execute, acknowledge
and deliver anyandallbonds, recognizances, undertakings or other instruments or contracts ofsuretyship to include waivers to the
conditions of contracts and consents ofsurety for, providing the bondpenalty does not exceed
Five Million and 00/100 Dollars ($5,000,000.00)
and to bind the Company thereby as fully and to the same extentas if such bond were signed by the President, sealedwith the corporate
seal of the Company and duly attested by its Secretary, hereby ratifyingand confirming allthat the said Attomey-in-Factmay do in the
premises. Said appointment is made underandby authority of the followingresolution softhe Board of Directors of the SureTec
Insurance Company:
Be it Resolved, that the President, any Vice -President, any Assistant Vice -President, any Secretary or any Assistant Secretary shall be and is
hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and act for an d o n
behalf of the Company subject to the following provisions:
Attorney -in -Fact may be given full power and authority for and in the name of and of behalf of the Company, to execute, acknowledge and
deliver, any and all bonds, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings and any and all
notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such
Attorney -in -Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary.
Be it Resolved, that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney o r
any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be v a lid
and binding upon the Company with respect to any bond or undertaking to which it is attached. (Adopted at meeting held o n 2 0'h of Ap ril,
1999.)
In Witness Whereof, SURETEC INSURANCECOMPANY has caused these presents to be signedby its President, and its corporate seal
to be hereto affixed this 31 st day of July , A.D. 2023.
SURETEC INSURANCE COMPANY
yUt�1GF
By: -...
Michael C. Keimig, Presiden
r
State of Texas ss:
County of Harris
On this 31 st day of July A.D. 2023 before me personally came Michael C. Keimig, tome known, who, being by me duly sworn, did dep o s e
and say, that he resides in Houston, Texas, that he is President of SURETEC INSURANCE COMPANY, the company described in and which executed
the above instrument; that he knows the seal of said Company; that the seal affixed to said instrument is such corporate seal; that it was so affixed by
order of the Board of Directors of said Company; and that he signed his name thereto by like order.
=. 4,jaY r?"L••
XENIA RIVAS
Notary Public State of Texas
:rtF,w,
Commission # 129117659
Commission Expires 9/10/24
... „ . ...... , , w „ ., . . ,. ,,,. .
Xenia ,Notary Public
My c mmissionexpires September 10, 2024
I, M. Brent Beaty, Assistant Secretary of SURETEC INSURANCE COMPANY, do hereby certify that the above and foregoing is a true and correct copy
of a Power of Attorney, executed by said Company, which is still in full force and effect; and furthermore, the resolutions of the Board of Directors, s et
out in the Power of Attorney are in full force and effect.
Given under my hand and the seal of said Company at Houston, Texas this dayof :1;iY4 A.D.
1
M /entBeaty;Assistan Secretary
Any instrument issued in excess of the penalty stated above Is totally void and without any validity. 4221060
For verification of the authority of this power you may call (713) $12-0800 any business day between 8:30 am and 5:00 pm CST.
SureTec Insurance Company
IMPORTANT NOTICE
Statutory Complaint Notice/Filing of Claims
To obtain information or make a complaint: You may call the Surety's toll free telephone number for information or
to make a complaint or file a claim at: 1-866-732-0099. You may also write to the Surety at:
SureTec Insurance Company
9500 Arboretum Blvd., Suite
400
Austin, TX 78759
You may contact the Texas Department of Insurance to obtain information on companies, coverage, rights or
complaints at 1-800-252- 3439. You may write the Texas Department of Insurance at:
PO Box 149104
Austin, TX 78714-
9104
Fax#: 512-490-1007
Web: httr)://www.tdi.state.tx.us
Email: ConsumerProtection@tdi.texas.gov
PREMIUM OR CLAIMS DISPUTES: Should you have a dispute concerning your premium or about a claim, you
should contact the Surety first. If the dispute is not resolved, you may contact the Texas Department of
Insurance.
SIC TX Rider TDI Required Notices rev 072022 Page 1 of 1
SureTec Insurance Company
THIS BOND RIDER CONTAINS IMPORTANT COVERAGE 114FORMATION
Limitation on Bond Penalty Increase
Notwithstanding any provision in the bonds or subcontract to the contrary, the penal sum of this Bond
shall automatically be adjusted to reflect the additive or deductive amounts of all change orders
issued to the Subcontract; provided, however, that Obligee shall notify Surety if an individual change
order increases the Subcontract Price by more than 10%, and, if at any point the aggregate amount
of all change orders increases the Subcontract Price by more than 35% of the Subcontract Price, the
Surety's consent shall be required to increase the penal sum of this Bond in excess of 35% of the
Subcontract Price, such consent not to be unreasonably withheld. The failure to provide the required
notice shall not release Surety from its obligations to the extent of the bond penalty in force prior the
change that required such notice.
Texas Rider 010106