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Contract 54749-FP1
FORT WORTH, WATER DEPARTMENT NOTICE OF PROJECT COMPLETION -FP1 City Secretary No: 54749 Date Received: 10/06/2023 City Project JV!?: 02382 Regarding contract 54749 Sanitary Sewer Rehab Contract 90 Part 1 for as required by the WATER DEPARTMENT as approved by City Council on 9/22/2020 through M&C 20-0704 the director of the WATER DEPARTMENT upon the recommendation of the Assistant Director of the Water Department has accepted the project as complete. Original Contract Prices: Amount of Approved Change Orders: Revised Contract Amount: Total Cost Work Completed: Less Deductions: Liquidated Damages: Pavement Deficiencies: Total Deduction Amount: Total Cost Work Completed: Less Previous Payments: Final Payment Due Recommended for Acceptance Asst. Director, WATER DEPARTMENT chn"ftoyher IfWY (er Christopher H a rd r(Oct 4, 202311:56 CDT) Accepted Director, WATER DEPARTMENT b�nw 8rc`gl2r7v>� Dana Burghdoff (Oct , 2023 0 : 0 CDT) Asst. City Manager $ 1,897,659.00 $ 264,389.00 2Va- 3 _ $ 2,162,048.00 $ 2,038,533.10 Days @ $650.00/ Day $ 2,038,533.10 $ 1,939,057.44 $ 99,475.66 Oct 4, 2023 Date Oct 4, 2023 Date Oct 6, 2023 Date Comments: OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX To (Owner) P. O. Number: Project: Contractor's Application for Payment Invoice No. 13 (FINAL) City of Fort Worth Invoicing Period (From - To): Invoice Date: FW060-0000010670 From (Contractor): Remit to (If Not Automatic Deposit): City Secretary Contract Number: Approved Change Orders Number 1 2 3 4 5 6 7 8 TOTALS NET CHANGE BY CHANGE ORDERS WILLIAM J SCHULTZ, INC DBA CIRCLE C CONSTRUCTION 02382 Contractor's CFW Vendor No.: 0000007744 54749 Contract Name: amme:: SANITARY SEWER REHAB CONTRACT 90- PART 1 Application For Payment Change Order Summary 1. ORIGINAL CONTRACT PRICE............................................................ $ Additions Deletions 2. Net change by Change Orders.................................................................. $ $82,000.00 $105,000.00 3. Current Contract Price (Line 1 f 2)......................................................... $ $392,389.00 $105,000.00 4. TOTAL COMPLETED AND STORED TO DATE $4,995.00 $4,995.00 (Progress Estimate, Construction Allowance and Change Orders)....... $ 5. RETAINAGE: a. X $2,038,533.10 Work Completed.......... $ b. X Not Used $ c. Total Retainage (Line 5a + Line 5b)................................ $ 6. AMOUNT ELIGIBLE TO DATE (Line 4 - Line 5c).............................. $ $479,384.00 $214,995.00 7. LESS PREVIOUS PAYMENTS (Line 6 from prior Application)......... $ $264,389.00 8. AMOUNT DUE THIS APPLICATION................................................... $ 9. BALANCE TO FINISH, PLUS RETAINAGE (Column G on Progress Estimate+ CA + COs + Line 5 above) ............... $ Contractor's Certification 10. CONTRACT TIME: 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. ® Affidavit of Bills Paid 7-r SkeC%N Consent of Surety TeresaS e y Oct 3,2— 8.14 CDT) a, Days Awarded b, Days Added by CO C. Total Days d, Days Charged e, Days Remaining 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. $1,897,659.00 $264,389.00 $2,162,048.00 $2,038,533.10 $2,038,533.10 $1,939,057.44 $99,475.66 $123,514.90 420 420 329 91 C-620 Signature Page C-620 Unit Price Progress Estimate Progress Estimate CH,seo.- 54749 Contractor's Application Contract Nam SANITARY SEWER REHAB CONTRACT 90- PART I AnIti.d.-mrbnr 13 (FINAL) (Application Period. Aaalication Date. a B C D E F G Tmal Compined / Balance to F-A 9pttifioauon Brd Qa®aty Urn Pnoe Brd Valae Bstimald Quantity Valae Prevroasly Installed Valae Vdue'Thns Penal Materials Presently and St (B (B-F) Bot-No Desoripnuu Secfioo No. Unrt ofMeasua Ioslelled St-d(..I in Cl ,E)Dare CD+6) B UNIT 1: 77FF,,f�� IMPROVEMENTS 1 2 8"PVC H�a,$II 6"PVC Wafer Pace LF LF 1754.00000f1 4100000�1 $50.0 $SO.IXI $8].]000/ $2.OSO.00J 17M 0000000 41000000 $87.7000� $2.OSO.00J 81]00.0000000 2050.0000 $8].7000 100.0% $2.OSO.OG 100.0% 3 Dudile Iran yYalx itljryys p•�Roestraint IReoas TON 1.000000 S6.000.0 $8.000(OJJ 10000000 $8.0000 6000.0000000 $8.0000 100.0% $600.0 6 F. 110 rrv'Asahall Pav&ffiin55a (2" HMAC on 8" Flex Basel LF 198] 00000 0000qf $4 800.00 $43.]600 0U 2.00000000 198].0000 $9.00 00J $43.]14.OU 9600.0000000 43]14.00000 $9.600 00 0 0% $43.]14.0� 100.0% 8 Cm, PVM Rlman, Rasidenbal SV 15300000J�J $120.01/ J $$8.30.OU 12438000000 $$56250 15625.00000 $$5625.6� $3.000.01 $3.434.401 9 9 4"Coot Sidewalk 6" Con. Curb and Gutter SF LF 50.00000 100.00000f1(J $15.00 $15.0 $]5000 $75000 3]5.0000000 100.0000 $5.62500 SC00.0 5825.0000000 4000.0000 500-% $5.62500 ]50.0% $4.00.0� 100.0% -$4.8]5.01 11 12 9" Con. V.IIav Gutter. Reaid.d.I Tom... Water Semce SV LS 5.00000 J 100000 $40.0 120.000.0d $200 00J $20.000.0 1.000000 J $20.00.0 20000.00000 $20.00.d 100.0% $200.01 13 14 1"Water Service 1" Water Semce Metal Reconnection EA EA 15.000OOU1 15 00000 $1,000.0 $200.01/ $15.000O0 $3.000.0 15.0000000 14 00000 HM $15.0000J $280.0 15000.0000000 2800.0000000 $15.0000/ 100.0% $2-Wo 00 .00 0 1 $200.01 15 16 Construdion Staking As-Butll Sunov (C.nstruM �•.�c••.�n LS LS 1.000OOUJ 100000 $3.000.0 $2.000.01/ $3.000 OOJ $2.00.0 1.0000000 100..no, $3.00 OOJ $2.00.0 3000.00000000 200000000000 $3.000 00/ 100.0% $2.000.OU 100.0% 1] 18 Trek Contrel Emlaal.ry Excavation of EXlstino UNdies MO EA 6.00000U 400000J�j $2,500.0 $1.000.01/ $15.0001 $4.00.0(f�� 5.0000000 400..000 $12.5000J 34.00.0 � 12500.00000000 4000.00000 $12.50000 833% $4.00.OU 100.0% $2,500.01 19 20 Connect to Existing 6"to 12"Water Main WGate Valve EA EA 6.000= 800000 $1,500.0 $1.300.01� $9.0000J $10.40.0 6.0000000 80000000 $9.0000J $10.40.0 9000.0000000 10400.000000 $9.0000/ 100.0% $10.40.O 100.0% 1 21 22 6"Gate Valve Trench Safety EA LF 2.00000U 6800000 $900.0 $150d $1.8000J $1.020, 10000000 680000000 $90000J $1.020.0 900.00000000 102000000000 $90000/ 500% $1.020.0 100.0% $900.0 23 24 SWPPP>1 acre tiamlNovAetland LS LS 1.000=j 1 $5,000.0 �$40.00 $5.0000J 10000000 $5.0000J�� 13 . $$1.8000J 5000.00000000 11820.0000000 $5.00000 100.0% $$].82000 3869% 26 RRam Reollac.6-Inch C.ncrrete G.fte, av LIF SF 16500000Q $9 0000 195.5000000 315.0000 $].8]5.066 ]8]5.0000 S].8]5.0� 190.9% $11,1180.01 �3.]50.01 28 10-Inc(yand Reo1'PSfl Stan Drainmelnlel T°o EA SV (����f 3]80.000OOQJ �5$6.01� J $22.680.OUJ 30400000000 $18.0000 180]2.00000 / $18.0]2.OU ]9.]% $4.500.01 $2,74.00.01 29 0 Cemen GS.d 2-Inch HMAC Sudace Course Tvce"D'Mu TN SV 49.00000 3]8000000� 000000EA 300.00 $300.0 814.I0000J $14.00.00 40.0000000 3000.00000 0000000 $12.0000 $$2.500.0 QZOO.0(OJJ 12000.0000000 42:00.00000 100.0000000 $12.0000 816% 79.4% $$2.500.0� ]9.4% $2.]00.01 $10.530.01 31 32 RI.&HIM RemSto. Be. Pavemendt S.eadM.roms C��`SC....�Vushia'D'Miooina EA LF 36 00000Q $2.$115d 500.00 $2.50000J .500 00 32.0000 54 0 $2.5000 00 1 L`d11.Goncrele Cdlar dl (���� g �.0� 166. 34 35 Manhde AdiuMenl Concrete Grass Sod Reolacement EA SV 300000Q' Sit 0000W $1$500.Of $15.0 $4.500.09� SW 00J $3000.0U 3 00.000 % $1.500.01 $840.01 36 C.nstruction Allowance -Water LS t00000J $50.0oud $50.00.06 $50.000.0, UNIT 2: SANITARY SEWER IMPROVEMENTS 10" Sewer Ppe (AII Depths) 33 I1 10 33 31 12 1 333129 LF 1445.000000 $85.0 $122.82500 1625.0000000 $138.12500 138125.0000000 $138.12500 112.5% -$15.300.0 1W DIP Sewer Pipe wah Protean401 Coding 331110 2 331111 LF 440.000000 $100.0 144.0000 544.000.0 10" Pipe Enlargement (10" to 10") 33 31 23 3 10"DIPSewerPioewithPretecto401Coatinabv Otherthan Ooen Cut 330524 LF 50.000000 $100.0 $5.0000 $5,000.0 8" Sewer Pipe 33 I l 10 3331 12 4 5 8" Sewer Carney PaceI1 333129 330524 LF LF 1655.000000 2000000d $48.00 $85.01� $19.44000 $1.70.0"JJ 1117.0000000 $53.61600 53616.0000000 $53.61600 6]5% $25,824.0 $7.]00.01 rdpc1c� ulhan Open Cut f8"t..)ec)o d0l Coatin.tinnfbvoOlheren lce $$48.00 $$63.264.OU 163264.00 $$63.264.0� .000001 9 6"P00 Enlam.oramtm.m 333123 LF 1250.0000Q. $61.120.0U 1318.0000000 J W W 00 5262% $61,920.01 10 16" Casing By 0... Cd 330522 LF SO.000OOG $200.0 $10.0000 52.0000000 $10.4000 10400.0000000 $10.4000 1U.0% -$400.01 W Sewer Ppe, CIS Backfill 33 11 10 333 12 11 12 4" Prrvale Sever Service 33312. 33 31 50 LF LF 45.000000 115.000OOJ $125.0 $85.01� $5.62500 $9.T/5.0 47.0000000 $5.87500 5875.0000000 $5.87500 104.4% -$250.0 $9.]]5.01 13 4"Sewer Service. 33J150 Each 35.000OOG $1.200.0 $42.0000 29.0000000 $34.8000 34800.00000000 $34.8000 829% $].200.01 Semce Rem"Homment. Pipe Enlargement including 333123 14 service lines and cI.h.Ht Each 38.000000 $1.500.0 $570000 39.0000000 $56.51100 58500.00000000 $58.5000 102.6% -$1.500.0 15 16 17 Trench Safety Past -CCTV Inspection PraDGTV In.-mn 330510 J30131 330131 LF LF LF 427100000J 5453.00000( 154000000 $1. $5.0 $50d 34.271.0 $2].26500J $].... 3313.0000 48W.0000000 4894.0000 33.313.0 $24.47000J $24.470.0 3313.0000000 244]0.0000000 244]0.00000 $3.313.0� T.6% $24.47000 897% $24.470.0� 31].8% $958.01 $2,795.01 416.]]0.01 18 19 6" Sewer Abandonment Plua 10"Seger Abantlonmenl Plua 024114 024114 Each Each 5.00000UJ 500000JJ $1.500.0 $1.500.01� $].5000J $].500.0(f 2.0000000 80000000 $3.0000J $12.00.0(f 3000.0000000 1200000000000 $3.00000/ 400% $12.0000U 160.0% $4,500.01 $4.500.01 20 Sanitary Line Grouting 024114 CY 43.00000� $200.0 $8.6000 4300000 $8.6000 6800.00000000 $8.60000 100.0% 4' Manhole (to 6f1 Depth) 33 39 10 21 333920 Each 42.000000 $5.000.0 $210.0000 33.0000000 $185.0000 185000.00000000 $185.00000 788% $45.000.0 4' Extra Depth Manhole (over 6f1 Depth) 33 39 10 22 23 Eooxv Manhde Liner 33392. 333960 VF VF 124.000000 36600000 J, $150.0 $350.01� $16.6000 $128.10.0 124.0000000 192.0000 $16.6000 $6].20.0 18600.00000000 6]200.000000 $16.6000/ 100.0% $6].20.OU 52.5% $0.900.0 24 25 Concrete Collar Manhde Vacuum Teslma 33051] 330130 Each Each 41.000OOQ 41000001/ $450.0 $150.: $18.45000J $6.150.0 33.0000000 $14.85000 14850.0000000 $14.85000 805% $3.800.01 $6.150.01 26 Remove 4' Seger Manhde 024114 Each 1.00000U $600.0 $8000 1.0000000 $8000 800.00000000 $8000 100.0% 1 27 28 Remove and Reolara 6' Wooden Fence Rem -and Redace 6'Chain Link. Aluminum 323129 323113 LF LF 118'00000' 2]0.00000Q $25.01� $25.0 $29.615.0 $6.75000 9]T0000000 1201.0000000 $24.425.0 $3.2000 2442500000000 32"'0000000 $24.425.OU 82.3% $3.2000/ 474% $5.250.01 $3,550.01 29 Rem -and Redace Wall U' 024113 LF 3000000d/ $125.01� $3.]50.0 � 30.000000 $3.]50.0 � 3]50.000000 $3.]SO.0 100.0% 30 31 Remo Reol... 21" RCP Storm Drain Remo Redace 24" RCP Storm Dram 024114 0241 14 LF LF 10.000OOU 10 OOOOOJ// $250.0 $250.01� $2.5000J $2.500.066 10.0000000 10.0000 $2.5000J $2.500.066 2500.0000000 2500.0000 $2.51100 100.0% $2.500.0� 100.0% 32 RemovdReplace 42" RCP Storm Drain 0241 14 LF 10.000OOU $350.0 83.500 00 $3.500.0 33 Block S.d Placement 32 92 13 SV 616.000OOJ stood $6.160.0 � 50.0000 $500.0 � 500.0000 $500.d 8.1% $5.660.01 34 35 6"-12"Tree Removal C.nstruction Slaking J11000 Ot ]t 23 Each LS 11.00000(ff 1 00000 $1,500.0 $25.000.OfI 816.50000J $25.000.0 11.0000000 1.0000 $16.5000J $25.00.0 18500.0000000 25000.00000 $18.5000 100.0% $25.00.0� 100.0% 36 37 As -Built Survev Emlaal.ry Excavalmn of Existing UHIHma Ol]123 330530 LS Each 1.00000ff BOOOOOJJ $12,000.0 $1.000.0(I $12.00000 $6.00.0 1.000000 8.0000 $12.0000 $8.00.0 12000.0000000 8000.0000 $12.0000 100.0% $8.00.0� 133.3% $2.000.01 38 SWPPP>1 Ac 312500 LS 1.000001 $5.000.0 $5.0000 1.000000 $5.0000 5000.0000000 $5.0000 100.0% This document has been modified a.. its III.] form as a" EJCDC document and the user drd pot hrghlrght the modifica0ons. You are encouraged to read the d ormt-finlly and-Ilt Legal Counsel Pnor to ns exec H- C-620 Unit Price Progress Estimate Progress Estimate G'ty Secretary 54749 Contract Nwu SANITARY SEWER REHAB CONTRACT 90- PART 1 Appepaaon P�;oa. A B C Item 6peti0cetion Bid Qa®my Umt&roe Brdvame E,tm WQuantity Bid Item No Descnpnon Section No. Unn of Measure Inslalletl 39 Traffic Cwhol 347113 MG 6.00000 J $2.500.0d $15.000.d 8.00000 40 41 Tempomry Asphalt Paving Repair (2" HMAC on 6" Flex Basel 5' Wlde Permanent Asohall Pvml Repair Resldential 3201 18 320117 LF LF 912.00000(if 7500000�l $22.00 $65.0d $20.064 OOJ 54.875.0 � 912.00000 350.o. 42 43 TWide Permanent Asohalt P-t Repair. Residential TWide Permanenl Asohalt P=t Repair Aertenal 320117 320117 LF LF 130.00000i� 2500000d $85.00 $125.01� $11.05000J $3.125.066 504.00000 44 5'Wide Permanent Asphalt Parking Ld Pvml Repair 320117 LF 230.Oo000d $65.00 $14.95000 230.00000 45 5' Wide Permanent Asohall All, Pvml Repair 320117 LF 16500000d $65.01� $10.725.0 16500000 Permanent Asphalt Pavement Repair Beyond Damned W idlh, Residential 3201 17 46 SV 89000000 $25.00 $2.225.00 3400000 G--te Alley Repair (Remove and Replace) Id for services (All 32 13 20 47 Thicknesses) SV 71000000 $85.00 $6.035.00 Concrete Parking Lot Repair (Remove and Replace) 32 1320 48 fAll thicknesses) SV 161 000000 $85.00 513.685.00 23200000 Cmc Pvmt Repair (Remove and Replace) Residential 320129 49 50 fAlI thicknesses) 6"Coot Curb and Gutter Repair 32 16 13 SV LF 111 000000 SOO.000OOld/ $85.00 $40.00 529.835.00 $20.00000 24600000 288.00000 51 UhIiNAtlmslmenl LS 100000U��J $2.500.01� $2.500.I � 1.00000 52 53 Remove and Replace Concrete Curb B Gutter Remove a Id Replace 6-Inch Concrete Drwewav LF SF 225.00000U 21100000�J�j $40.00 $25.01� $9.000OOJ $5.275.0 � 211.10001 54 55 Remove and Replace SB Storm Drainwelnlet Tao 10-Inc PWI07�/�P EA SV 1.00000U 3780.00000 $4.500.00 $6.01� 54.50000J $22.680.0 301200000 56 57 Cemerlf iv)adi n i26 6/svin 2-Inch HMACSudace Course Tvoe"D"Mu TN SV 49.00000� 3]8000000U $300.00 $13.: $14.]00 00 $51.030.0 4000001 300300000 58 Remove 30-ft HMAC Speed Cushion w/stripping EA 1.00010� $2.500.00 $2.500 00 1.00000 59 Stop Bars Pavement Madongs LF I� 36 000000L $15M $W 00 1 58.000(10 60 61 Water Valve Box Adiustment W llh Concrete Cdlar Manhde Advshnenl Concrete Cdlar EA EA 2.000000 300000d/ $50000 $1.50000 $1.00000 54.500.0 2.00000 3.00000 62 Remweand Replace ,'[pane Units EA 2.00000ll $5.500.00 $11.00000 2.00000 63 Abantlonment Pluq `\Cut B PIug),All I-) EA 6 000000 $1.500.00 $9.000.00 MOM g4 Sewer ConstrucM1an Alloxance 017123 LS 1.000000 580.000.00 $80.000 00 Totals $1.897.659.00 Contractor's Application Aoogca[io°Number. 13 (FINAL) Application Date. D E F G Total Coupined / Balance to Flmsh Value Prewouslylpstalled Value Materials Presently Value This Pepad and Storedm Dare (1� (B-, 6t-d(notin C) (D+E) B $2QOOO.OU� 2000B00000000 $2QOOO.OU 133.3% �S.00Q001 $20.06400J $22.750.0 20064.00000000 22750.00000000 $20.06400 100.0% $22.750.0� 466.7% 317.875.001 $42.84000 42840.00000000 $42.84000 387.7%-111.790.001 $3.125.001 $14.95000 14950.00000000 $14.95000L 100.0% $10.725.0 10725,00000000 $10.725.o mo.0% $850.00 85000000000 $850.00 38.2% $1.375M $6.035M $19.720.00 19720.00000000 $19.720.00 144A% -$6.035MI $20.910.00 20910.00000000 $20.910.00 70.1% $8.925.OBJ $11.52000 $2.500.0 11520.00000000 2500.00000000 $11.52000 578% $8A80.M $2.500.0� 100.0% I $5.275.0 5275.00000000 $9.000.001 $5.275.d 100.0% $18.072.0 � 18072.00000000 14.500.001 $18.071d 79.7% $4.608.001 $12.00000J 140.540.5 12000.00000000 40� 50000000 $12.00000 816% $2,700.001 540.540.5� 79.4% $10.489.501 $2.. 00 2500.00000000 870.00000000 $2.5. 00 100.0% $870.00 1 $170.001 161.1% I $330.00 $1.000 00 100.0 $1.000 00 1000.00000000 54.500.0 4500,00000000 $4.500.06 100.0% $11.00000 1 1000 00000000 $11.00000 100.0% 1 $3.000.00 3000.00000000 $3.000.00 33.3% $6.000.001 $80,000.001 $1.611.986.10 $1.611.986.10 $1.611.986.10 84.9% $285.672.901 This document has been modified fiom its origiral form as a° UCDC document a°d die user did not highlight the modifications. You are encouraged 0 read the document -hilly and f oIlt Legal Counsel poor tons execution. Progress Estimate Construction Allowance Usage Far(to—) IApphcation Penod Item Number Contractor's Application ADDITIONS SANITARY SEWER REHAB CONTRACT 90- PART 1 City Secretary Applmation Number. 02382 CaotmctNmn. 54749 13 (FINAL) Apphcation Date A B C D E F Item Balance to Finish Estimated Quantity Previously Value This Materials Presently Total Completed Descvphon S .tificatio. Unit of Quantity to Add Um[ Puce Addmoo Value Installed Value 7vsmlled Value Period Stored (not m C) ®d Stored to Date (F) (B - P) Section No. Measure (DIE) B This daemneot has been modified from ns -ginal form as an EJCDC document soil the user did not highlight the modifiaahons. Yon are encooraged to read the docoineot carefully and consult Legal Counsel prior to its exeoutmn. C-620 Change Order Totals Progress Estimate Construction Allowance Usage CONSTRUCTION ALLOWANCE ITEMS TO BE REDUCED IF., (oonnaet). 02382 SANITARY SEWER REHAB CONTRACT 90- PART 1 IApphesbon Penod' A B C I Bem Bad ❑em Number D—rrptrov Sp dficanoo U d of Quantity to Delete Unrt Pnce Reducnov Valve Not Used Section No. Measure Totals Contractor's Application Appbcaeon Number. 13 (FINAL) Application Date: D E F Not Used Not Used Not Used Not Used Not Used Not Used Not Used This doeomeot has been modified from ns ongirml form es sn EJCDC document end the user did not highhght the modifiaatrons. Yon are eneoumged to read the docomeot carefully and consult Legal C—sd prior to its —iron. C-620 Change Order Progress Estimate Change Order Number 1 1 Contractor's Application ADDITIONS IFor (contract). Qi3sz SANITARY SEWER REHAB CONTRACT 90- PART 1 City Secretary 54749 Application Number 13 (FINAL) Contra. Num Apphcetron Period: A Item Change Order Item No D—niption 23 Eooxv Manhole Liner 65 1O'Iulet Removal 66 IO Inlet 67 4' Dra. Drop Manhole 68 Conshreld Corrosion Protection to 4' Dra Manhole Application Date: B C D E F Spo.fi—on Unit of sure SW,on No. Mea CO Qoontity to Add Unit Price Addition Change Order Value Estunated Quantity Installed V�uO Previ,USly Installed Value Value This Materials Presently Period Stored (not m C) Total Compl.ed % and Sto®d to Date (F) (D+E) B VF 300.00000000 $350.00 1115,000.00� 9100000000 $31,850.00 $31,850.00 $31.850.00 303% $1,500.00 $1,500.02 EA 1.00000000 $L500.00 $1.500.001 1.00000000 $L500.00 100.0% $6,500.00 $6,5M 0 EA 1.00000000 $6,500.00 $6.500.001 1.00000000 $6,500.00 100.0% $6,500.001 $6,500.001 EA 1.00000000 $6,500.00 $6,500.001 1.00000000 1 1 $6,500.00 100.0% $30,375.001 $30,375001 VF 30000000000 $225.00 $67,500.001 13500000000 1 1 $30,375.00 450% Thrs document has been modified Gom rts mgmal form as an ESCDC document and the user did not highlight the modrficatmns. You are encouraged to read the document cmfuUy and —olt Legal Counsel poor tons execution Balance to Fmrsh (B - F) $73350.00� $37,125.001 C-620 Change Order C-620 Change Order Totals 582,000.00 Sd4,675.00 576,725.00-$31,850.00 Sd4,675.00 547% $37,125.001 Progress Estimate Change Order Number I Contractor's Application DELETIONS For (connect): SANITARY SEWER REHAB CONTRACT 90- PART 1 Applicanon Number: 02382 13 FINAL APPlu shoo Period: Application Date. A B C D E F Item CODeletey to Deletion Change Order Item Descnphon No Specification Unitof Sectwn No Measure Unt[Price Change Order Value Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used 23 Epoxy MaMole Liner 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 VF 30000000000 $350.06 $105,000.00 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 Tntala $105,000.06 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 fom us ongmal form as an ESCDC document and the user did not highlight the modifications. You are encouraged to read the document carelWly and consult Legal Counsel poor to rts execution Progress Estimate Change Order Number 1 2 1 ADDITIONS IFor (conti 02382 SANITARY SEWER REHAB CONTRACT 90- PART 1 City Secretary 54749 Contract Num. Apphcetion Period: A B C Item Addition Change Estimated Quantity Change Ordtt Item Descnptron Specifica0on Unrt of CO Quantity to Add Unit Price Order Value Installed No Section No. Measure I 6 TEMPORARY ASPHALT REPAIR (2"HMAC ON 6" FLEX BASE LF 498.00000000 $22.00 $10,736.00 488.00000000 I 9 4'CONC SIDEWALK SF 104,00000000 $50.00 $5,200.00 13 I"WATERSERVICE EA 3.00000000 $1,000.00 $3,00000 300000000 I 8 -EXPLORATIRY EVCAVATION OF EXISITING UTILITIES EA 11010,000 $1,000.00 $3,00011 311010100 I 19 CONNCECT TO EXISTING 6" TO 12" WATER MAIN EA 1.00000000 $1,500.00 $1,500 00 1 00000000 I 21 6" GATE VALVE EA 1.00000000 $900.00 $900.00 1.00000000 22 _ TRENCH SAFETY _ LF 42.00000000 $15.00 $630.00 42.00000000 32 STOP BARS PAVEMENT MARKINGS LF 28 00000000 $15.00 $420.00 28.00000000 33 WATER VALVE BOX ADJUSTMENT WITH CONCRETE LOLL EA 1.00000000 $500.00 $50000 100000000 I 10"SEWERPIPE LF 21900000000 S48.0I $10,51200 5 !8"SEWER CARRIER IF 255 00000000 $85.00 $21,67500 255.00000000 9 6" PIPE ENLARGEMENT In" TO 8") IF 1239.00000000 S48.00 $59,472.00 1239.00000000 26 REMOVE 4' SEWER MANHOLE EA 19.00000000 $800.00 $15,200.00 19.00000000 40 mac TEMPORARY ASPHALT PAVING REPAIR (2" hON 6" Flex LF 202 00000000 $22.00 $4,444 00 202'00000000 41 5' WIDE PERMANANET ASPHALT PVMT REPAIR, RESIDENT] IT 75 00000000 $65.00 $4,875 00 75.00000000 42 7' WIDE PERMANENT ASPHALT PVMT REPAIR, RESIDENTIA LF 315 00000000 $85.00 $26,775 00 315.00000000 I 44 5, WIDE PERMANENT ASPHALT PARKING LOT PVMT REPA! IF 370.00000000 $65.00 $24,050.00 370.00000000 I 45 ]' WIDE PERMANENT ASPHALT ALLEY PVMT REPAIR LF 25.00000000 $65.00 $1,625.00 25.00000000 I 48 CONCRETE PARKING LOT REPAIR(REMOVE AND REPLACE SY 38.00000000 $85.00 $3,230.00 38.00000000 53 REMOVE AND REP LACE 6- INCH CONCRETE DRIVEWAY SF 5900000000 $25.00 $1,47500 59.00000000 59 STOP BARS PAVEMENT MARKINGS I LF I 6.00000000 1 _ $500.001 $3,00000 600000000 60 WATER VALVE BOX ADJUSTMENT WITH CONCRETE COLL, EA 6.00000000 $500.00 $3,00000 600000000 61 MANHOLE ADJUSTMENT CONCRETE COLLAR EA 2.00000000 $1,500.00 _ 13,000.10 2.10000000 I 69 6" DIP SEWER PIPE WITH PROTECTO 401 COATING LF 20.00000000 $75.00 $1.500.00 20.00000000 I 1 IO" SEWER CARRIER PIPE LF 185,00000000 $225.00 S41,625.00 185.00000000 I 2 24"DIA CASING PIPE LF 18500000000 $725.00 $134, 12510 181.000000 I 73 -POINT REPAIR `SAG ADJUSTMENT) IF 10000000000 $75.00 $7,50000 ]00.00000000 74 GRAVEL ROAD REPAIR Sy 80.00000000 $25.00 $2,000.00 80.00000000 59-1 STOP BARS PAVEMENT MARKINGS I LF I 6.00000000 $500.00I5.00 I -$3,000.00 -6.00000000 59-2 STOP BARS PAVEMENT MARKINGS LF _ 28 00000000 $ $420 00 28.00000000 D Pi ---sly Value This Value Installed Value Penod $10,736.00 $10,736.00 $3,00000 $3,00000 $3,00000 $3,00000 $1,50000 $1,50000 $500 $21,675 $4,444001 $4,444 00 $4,875001 $4,875 00 $261775 00 $26,775 00 $24,050.00 $24,05000 1 L625.00 $1,625.01 $3,230.00 $3,230.00 $1,47500 $1,47500 $3,000 00 $3,00000 $3'000 00 $3,000 00 131-0.00 $3,000.00 $1,500.011 $1.500.00 S41,625.00 $41,625.00 $134, 12500 $134, 12500 $7,500 00 $7,500 00 $3,000.0f $420 X This document has been modified Gom ns mgmal form as an ESCDC document and the user did noI highlight the modrfica0ons. You are encouraged to read the doc-t carefully and consult Legal Counsel poor to its execution Contractor's Application Number: 13 (FINAL) Date: E F Balance to Finish Materials Presently Total Completed % B Stored (not m C) and Stored 11Date (Ir) (DIE) B $10736.00 100.0% $5,200.00 $3,000.00 101 13,00100 100.0% $1,500.00 100.0% $900.02 100.0 , $630.00 100.0% $420.00 101 $500.00 100.0% $10,512.00 $21,675.00 100.0% $59,472+00 100.0% $15,200.00 100.0% $4,444.00 101 $4,87100 ]00.0% $26,775.00 ]00.0% $24,050.00 100.0% $1,625.00 100.0% $3,230.00 100.0% $1,475.00 100E% $3,000.001 100.0% I 1 $3,000.00 100.0% $3,000.00 100.0% $1.500+00 100.0% $41,625.00 100.0% $134,125.00 100.0% $7,500.00 100.0% $2,000+04 100.0% $3,000.00 100.0% $420.00 ]00.0% C-620 Change Order C-620 Change Order Totals I I $392,3R9.00 $37fi,677.00 5379,257.00-S2,SAO.00 $37fi,fi77.001 9fi.0% I 515,712.00 Progress Estimate Change Order Number 2 Contractor's Application DELETIONS IFor(contracp: 02382 SANITARV SEWER REHAB CONTRACT 90-PART 1 Apphoafen Nwnber: 13(FINAL) IAppl®ahon P-od Apphcatton Date A B C D E F ❑cm CO Quantity to Deletion Change Change Order Item Description No Specifca0on Um[ of $eMmn No. Measure Delete Unit Price Order Value Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used 36 CONSTRUCTION ALLOWANCE -WATER LS 0.50000000 $50,000.00 $25,00000 $25,000.00 64 SEWER CONSTRUCTION ALLOWANCE LS 1.00000000 $80.000.00 $80.000.00 $80.000.00 Totals 1 $105,000.06. This document has been modified fora rts mgmal form as an ESCDC document and the user did not highfght the modifca0ons. You are encouraged to read the doc—t carefully and —of Legal Coonsel poor to rts execution Progress Estimate Change Order Number I 3 1 Contractor's Application ADDITIONS IFor (oo.to h. 02382 SANITARY SEWER REHAB CONTRACT 90- PART 1 Crty Secretary 54749 Application Number. 13 (FINAL) Contract Nom IApphcation Period. Item Change Order Item No. Description 37 PAVEMENTSTRIPING MOBILIZATION 8 4" SLD PVMT MARKING Has (Y) 39 8-IS LD PVMT MARKING HAS 40 12" SLD PVMT MARKING HAE (W) 41 11" SLD PVMT MARKING BAE (WI 42 LANE LEGEND ARROW 43 LANE LEGEND ONLY 44 REFL RAISED MARKER TY II -A -A 45 REFL RAISED MARKER TY II-C-R 46 PAVMT MARKING PREP 4" 47 PVMT MARKING 8" 48 PAVMT MARKING PREP 12" 49 PVMT MARKING 24" 50 PVMT MARKING PREP ARROW 51 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 PVMT MARKING PREP WORD A Specrfrcahon Umt of Sec[ron No Measure EA LF LF LF LF EA EA EA EA LF LF LF LF EA EA CO Qoantrty to Add 1.00000000 260 00000000 90.00000000 17000000000 23.00000000 100000000 1.00000000 1400000000 5.00000000 17000000000 90.00000000 17000000000 23.00000000 100000000 1.00000000 Dart Pm, $1.413.13 $2 26 $2.26 $791 $9.04 $15827 $16000 $904 $9 04 $113 $1 13 $141 $170 $87 81 $87.81 B Addrnon Change Order Value $1.413.13 $587 60I $203.401 $1,344701 $207,12 $15827 $16000 $12656 $45 20I $192101 $10170 $23970 $39101 $87 81I $87.811 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 C Estimated Quantity Installed 1.00000000 260.00000000 90.00000000 170.00000000 23.00000000 1.00000000 1.00000000 14000000d0 5.00000000 17000000000 90.00000000 1]0.00000000 23.00000000 1.0000"0 1.00000000 D Value $1413.13 Pn,,aa sly Installed Valne $1,413.131 Value Thrs Penod Application Data. E Matenals Presently Stored (not h, C) F Balance to Fmrsh Total Completed and Scored to Date % (B - (DE) B $1.413.13 100.0% $587 60 1000% $203.40 100.0% $1,34470 1000% $207.92 100.0% $1582] 100M $160.00 100.0% $12656 1000% $45 20 100.0% $19210 1000% $to' 70 100.0% $23970 1000% $3910 100.0% $87 81 l00 0% $87.81 100.0% 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 $587.60 $587.60 $203.40 $203.40 $1,344.70 $1,344.70 $207.92 $207.92 $15827 $15827 $160.00 $1-.00 $126.56 $126.56 $45.20 $45.20 $192.10 $192.10 $101.70 $101.70 $239.70 $239.70 $39.10 $39.10 $87.81 $87.81 $87.81 $87.81 This dom-nt hss been modified from ns -ginal form as an EJCDC document sod the user did not highlight the modificehons. Yon are encooraged to read the docomeot carefully and -.It Legal Counsel prior to its exeoutmn. C-620 Change Order C-620 Change Order Totals Progress Estimate Change Order Number 1 3 DELETIONS IPor (oonaaet). 02382 SANITARY SEWER REHAB CONTRACT 90- PART 1 IApplicaLon Penod' $4.995.00 $4,995.00 $4,995.00 A B C D I Item Deletion o Change Order Item I Specification Unit Qontity to t of Unit P— Change Order Not Used Not Used No. Descnphon Section No. Measure Delete Value 36 CONSTRUCTION ALLOWANCE LS 0.09990000 $50.00000 $4.995.00 Not Used $4.995.00 100 0% Contractor's Application Appl—not Norobe, 13 (FINAL) Application Date' E F Not Used Not Used Not Used Not Used Not Used $4,995.00 Totals $4,995.00 1 1 This docmneat has been modified from ns -ginal form as an EJCDC document sod the user did not highlight the modifications. Yon are encouraged to read the document carefully and consult Legal Counsel prior to its execution. City of Fort Worth Summary of Charqes City Secretary ContractNum: 54749 SANITARY SEWER REHAB CONTRACT 90- PART 1 IP.FNV060-0000010670 project Number: 02382 Application Period: 0 nO.: Applicatio 13 (FINAL) Application Date: 1/0/1900 Number: Funding Identification (FID) Total Completed Amt Remaining Gross Retainage Net I Or! gginal Contract I 156002 0600430 5740010 CO23$2 C01780 9999 $366,641.60 $69,067.40 156002 0700430 5740010 CO2382 C01780 9999 $1,245,344.50 $216,605.50 10 10 10 10 10 10 10 10 10 I I 1 Change Order 1 I 9g44110,275.00 8 23 � 3 $76,725.00 I �o62 5740010 CO2382 CO1780 9999 ($105,000.00) 10 10 10 10 10 10 10 10 10 I I I Change Order 2 I 156002 0600430 5740010 CO2382 C01780 9999 $20,686.00 $5,200.00 156002 0700430 5740010 CO2382 C01780 9999 $358,571.00 $10,512.00 10 10 10 10 10 10 10 10 10 I I 1 Change Order 3 I 56002 0600430 5740010 CO2382 C01780 9999 $4,995.00 City of Fort Worth Summary of Charqes City Secretary ContractNum: 54749 SANITARY SEWER REHAB CONTRACT 90- PART 1 ApplicatioIP.nO.: FNV060-0000010670 project Number: 02382 Application Period: 0 Number: 13 (FINAL) Application Date: 1/0/1900 Funding Identification (FID) Total Completed Amt Remaining Gross Retainage Net 6002 0700430 5740010 CO2382 C01780 9999 10 10 10 10 10 10 10 10 I I I 1 Change Order 4 156002 0600430 5740010 CO2382 C01780 9999 156002 0700430 5740010 CO2382 C01780 9999 10 10 10 10 10 10 10 10 10 I I I 1 Change Order 5 156002 0600430 5740010 CO2382 &1780 9999 186002 0700430 5740010 CO2382 C01780 9999 1 1 10 10 10 10 10 10 10 10 I I I 1 Change Order 6 156002 0600430 5740010 CO2382 C01780 9999 156002 0700430 5740010 CO2382 C01780 9999 10 City Secretary Contract Num: 54749 Application Period: Funding Identification (FID) 10 10 10 10 10 10 10 10 I 1 Change Order 7 156002 0600430 5740010 CO2382 �01780 9999 156002 0700430 5740010 CO2382 C01780 9999 10 10 10 10 10 10 10 10 10 I I Change Order 8 156002 0600430 5740010 CO2382 C01780 9999 156002 0700430 5740010 CO2382 C01780 9999 10 10 10 10 10 10 10 10 10 I 1 Totals 156002 0600430 5740010 CO2382 C01780 9999 186002 0700430 5740010 CO2382 C01780 9999 1 10 10 City of Fort Worth Summary of Charqes SANITARY SEWER REHAB CONTRACT 90- PART 1 IP. O.: FNV060-0000010670 project Number: 02382 0 I Applicah``on I 13 (FINAL) Application Date: 1/0/1900 Number: Total Completed Amt Remaining Gross Retainage Net $469,047.60 $184,542.40 $1,603,915.50 $122,117.50 City of Fort Worth Summary of Charqes City Secretary ContractNum: 54749 SANITARY SEWER REHAB CONTRACT 90- PART 1 IP. O.: FW060-0000010670 project Number: 02382 Application Period: 0 Application 13 (FINAL) Application Date: 1/0/1900 Number: Funding Identification (FID) Total Completed Amt Remaining Gross Retainage I Net 10 $0.00 j0 $0.00 10 $0.00 $0.00 $0.00 $0.00 $0.00 10 $0.00 $0.00 $0.00 $0.00 $0.00 10 $0.00 $0.00 $0.00 $0.00 $0.00 10 $0.00 $0.00 $0.00 $0.00 $0.00 10 $0.00 $0 00 0 Grand Total $2,072,963.10 $306,659.90 $0.00 1 ($99,475.66)1 1 $99,475.66 1 CSC No. 54749-CO1 Ft3I2T WoMT14 City of Fort Worth 1-111. s— Change Order Request Project Name:' Sanitary Sewer Rehabilitation Contract 90 - Part 1 Project No.(s):I 56002 0700430 CO2382 CO1783 I DOE No. I N/A Project Description:I Contractor: City Project Mgr.I Phone Number: CitySec No.: 54749 City Proj. No.: 102382 Rehabilitation of deteriorated sewer lines in the Meadowbrook Neighborhood and paving in Tierney Road. SYlllam J. Schulz, Inc. dba Circle C Construction Company, Co. Walter Norwood 817-392-5026 Dept. Unit 1 Water Original Contract Amount $435,709.00 Extras to Date Credits to Date Pending Change Orders (in M&C Process) Contract Cost to Date $435,709.00 Amount of Proposed Change Order Revised Contract Amount $435,709.00 Original Funds Available for Change Orders $21,785.00 Remaining Funds Available for this CO $21,785.00 Additional Funding (if necessary) CHANGE ORDERS to DATE (INCLUDING THIS ONI MAX ALLOWABLE CONTRACT AMOUNT (Of Change Order# City Inspector: Phone Number,I Unit 2 Sewer $1,461,950.00 I $1,461;950100 -$23,000.00 $1,438,950.00 $73,098.00 $73,098.00 :) AS % OF ORIGINAL CONTRACT !IGINAL CONTRACT COST + 25%) 1 I Date: Mathew L. Wilson 817-392-8306 2MONS) FOR CHANGE ORDER Change Order Number 1 provides for the following: Totals $1,897,659.00 $1,897,659.00 23,000.00 $ 1,8 4,659.00 $94,883.00 $94,883.00 1.21 % $2,372,073.75 I� 1/5/2021 I Contract Time ICalender days) 420 420 14 434 • Addition of storm drain structures to resolve storm drain conflict with the sewer main in Tierney Road. Substitution of Antimicrobial Additive (Conshield) in lieu of epoxy coating in some manholes. Staff recommends the addition of an additional 14 calendar days for the change order. 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. wdr�a.schu� me anecmteccoa a ObntrBctor a .. Co 1�tractor Sig�1atuie — ucranca„pay,Cn Ten $ke((y PiLedCL v 01121121 Matthew Wilson �. 1/22/21 g•2G(y+gg 1-22-21 - - Director (Water - o--ns� Da[e` ch � s ay 12, zou (�fJQ " ....,, 1/22/21 I Date. Ass4W.Ci Mana. r Date May 13, 2021 May 13, 2o21 _ Council Action (If R _ 1 M&CNumber N/A M&C Date Approved I N/f- OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Fk3 a W40 R'r City of Fort Worth Change Order Additions Project Name Sanitary Sewer Rehabilitation Contract 90 - Part 1 City Sec No.: j 54749 Project No.(s): 56002 0700430 CO2382 C01783 DOE No.1 N/A City Proj. No.: 02382 Project Rehabilitation of deteriorated sewer lines in the Meadowbrook Neighborhood and paving in Tierney Road. I Description Contractor j William J. Schutz, Inc. dba Circle C Construction Company, Co. I Change Order: Date:1 1/5/2021 City Project Mgr. Waiter Norwood I City Inspector Mathew L. Wilson N ADDITIONS tJ<r 4t4it'1tuN„ �tlj 2Sewer 1,UU��A tM00.00 �1$1,50HO T ota— OU 65 1U'InletRemoval Unit 66 10 Inlet Unit 2 Sewer 1.00 Fro $6,500.00 $6,500,00 67 4' Dia. Drop Manhole Unit 2 Sewer 1.00 FA $6,500.00 $6,500.00 68 Conshield Corrosion Protection in 4' Dia. Manhole Unit 2 Sewer 300.00 VF $225.00 $67,500.00 Page i of 1 Unit 1 Water Unit 2 Sewer $82,000.00 Additions Sub Total $82,000.00 lw"a-r wioaX14 City of Fort Worth Change Order Deletions Project Name Sanitary Sewer Rehabilitation Contract 90 - Part 1 City Sec No.: 54749 Project No.(s): 56002 0700430 CO2382 C01783 DOE No. I N/A City Proj. No.: 02382 Project Description I Rehabilitation of deteriorated sewer lines in the Meadowbrook Neighborhood and paving in Tierney Road. YYIIIIGIII %/. JidiUIL, uw. uva Quulc �., t,unsuuvuuu 9 Date 1/5/2021 Contractor I (�mm�en„ �.. � Change Order: 1 City Project Mgr. Walter Norwood City Inspector: Mathew L. Wilson DELETIONS IT 23M IDESCRIPTIOEpoxy Ma ho eR Liner Unit 2 SewerD8P� � � � 300 00 VF�t " �Uriit Cis# $350.00 $105,000.00 Unit 1 Water Unit 2 Sewer N $105,000.00 Page 1 of 1 Deletions Sub Total $105,000.00 MMBE Breakdown for this Change Order MWBE'Su6 Previous Change Orders Total $0.00 Page 1 of 1 Contract Compliance Manager By signing I acknowledge that I am the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. Signature Name of Employee � l Title ATTEST: "for Ronald P. Gonzales (May 13, 202113:13 CDT) Mary J. Kayser City Secretary OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX CSC No. 54749-CO2 F®R-r Warn—riA City of Fort Worth W Change Order Request Project Name:1 Sanitary Sewer Rehabilitation Contract 90 - Part 1 City Sec No.: 1 54749 j Project No.(s):l 56002 0700430 CO2382 C01783 1 DOE No. I N/A Cily Proj. No J 02382 Project Description:! Rehabilitation of deteriorated sewer lines in the Meadowbrook Neighborhood and paving in Tierney Road. Contractor. wllGam J. Schulz, Inc, dba Circle C Construction Company, Co. ( Change Order # 2 1 Date: 4/27/2022 City Project Mgr.I Walter Norwood City Inspector: Matthew Wilson Phone Number. 817-392-5026 Phone Number,1 (682)215-9539 Dept. Unit 1 Water Unit 2 Sewer Original Contract Amount $435,709.00 $1,461,950.00 Extras to Date Credits to Date Pending Change Orders (in M&C Process) Contract Cost to Date S435,709.00 S1,461,950,00 !Amount of Proposed Change Order S806.00 $286,503.00 Revised Contract Amount $436.595.00 $1.748,453.00 Original Funds Available for Change Orders $21785.00 1 $73,098.00 Remaining Funds Available for this CO $21:785.00 $73,098.00 Additional Funding (if necessary) $213,405.00 CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS 96 OF ORIGINAL CONTRACT MAX ALLOWABLE CONTRACT AMOUNT (ORIGINAL CONTRACT COST + 25%) JU$XI i QN (R6�[S90f 0R CHANGE -ORDER Change Order Number 2 provides for the following: • Replacement of Sanitary Sewer line M-187 under Lancaster Avenue. Additional quantities required for the completion of the project. Totals Contract Time (Calender days) S1,897,659.00 -420 S1,897,659.00 420 $287.389.00 090 $2.185r,048,00 510 $94,603.00 $94, 083.00 $213,405.00 15.1440 IS2,372,073,75 Staff recommends the addition of an additional 90 calendar days for the change order. 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. t an wilor's Company Name _ I Co tractor Narno � �n iac or 5l nalure � Dale j WilomJ SCnul/.Inc dn Orda C ConitruMon Compaq, Co. eri Skelly war' M&C Number I ('rnlnc(I Aclfnn (it ReOnfred) M&C Date Approved 4/2R 22 FORT Wk) R-r n City of Fort Worth Change Order Additions Project Name I Sanitary Sewer Rehabilitation Contract 90 - Part 1 I Cily Sec No.: 1 54749 Project No.(s): I 56002 0700430 CO2382 CO1783 I DOE No.1 N/A I City Proj. No.: 1 02382 Project I Rehabilitation of deteriorated sewer lines in the Meadowbrook Neighborhood and paving In Ttemey Road, Description Contractor I William J. Schulz, Inc. dba Circle C Construction Company, Co. I Change Order:Date:1 4-/27/2022 1 City Project Mgr. I Walter Norwood ADDITIONS HEM rM UMMIN I IUN 6 Temporary Asphalt Paving Repair (2' HMAC on 6" Flex Base) 9 4' Conc Sidewalk 13 1" Water Service 18 Exploratory Excavation of Existing Utilities 19 Connect to Existing 6" to 12" Water Main 21 6" Gate Valve 22 Trench Safety 32 Stop Bars Pavement Markings 33 Water Valve Box Adjustment With Concrete Collar 1 10" Sewer Pipe 5 8" Sewer Carrier Pipe 9 6" Pipe Enlargement (6" to 8") 26 Remove 4' Sewer Manhole 40 Temporary Asphalt Paving Repair (2" HMAC on 6" Flex Base) 41 5' Wide Permanent Asphalt Pvmt Repair, Residential 42 T Wide Permanent Asphalt Pvmt Repair, Residential 44 15' Wide Permanent Asphalt Parking Lot Pvmt Repair 45 15' Wide Permanent Asphalt Alley Pvmt Repair 48 1 Concrete Parking Lot Repair(Remove and Replace)(AII Thicknesses) 53 IRemove and Replace 6-Inch Concrete Driveway 59 IStop Bars Pavement Markings 60 1WaterValve Box Adjustment With Concrete Collar 61 JManhole Adjustment Concrete Collar 69 6" DIP Sewer Pipe with Protecto 401 Coaling 71 110" Sewer Carrier Pipe 72 124" DIa. Casing Pipe 73 IPoint Repair (Sag Adjustment)(8110") 74 1Gravel Road Repair I I I I I I City Inspector I Matthew Wilson DEPT Unit 1 Water Unit 1 Water Unit 1 Water Unit 1 Water Unit 1 Water Unit 1 Water Unit 1 Water Unit 1 Water Unit 1 Water Unit 2 Sewer Unit 2 Sewer Unit 2 Sewer Unit 2 Sewer Unit 2 Sewer Unit 2 Sewer (Unit 2 Sewer I Unit 2 Sewer (Unit 2 Sewer (Unit 2 Sewer Unit 2 Sewer IUnit 2 Sewer (Unit 2 Sewer (Unit 2 Sewer Unit 2 Sewer Unit 2 Sewer Unit 2 Sewer I UnIt 2 Sewer (Unit 2 Sewer AUnit 100 LF 104.00 SF 3.00 EA 3.00 EA 1.00 EA 1.00 EA 42.00 LF 28.00 LF 1.00 EA 219.00 LF 255.00 LF 1239.00 LF 19.00 EA 202.00 LF 75.000 LF 315.00 LF 370.00 LF 25.00 ILF 38.00 ISY 159.00 ISF 1 28.001 LF 16.00 IEA 12.00 JEA I 20,OO1LF I 185.00I LF I 185.001LF 100.00ILF i 80.001 SY I I I I I I Unit Cost $22.00 $50.00 $1,000.00 $1,000,00 $1,500.00 $900.00 $15.00 $15.00 $500.00 $48.00 $85.00 $48.00 $800.00 $22.00 $65.00 $85.00 $65.00 1$65.00 1$85.00 I$25,00 1$15,00 I$500.00 1$1,500.00 $75.00 $225.00 $725.00 I $75.00 I$25.00 I I I I I I I I I I I I i I I Unit 1 Water Unit 2 Sewer Total $10.736.00 $5,200,00 $3,000.00 $3,000.00 $1,500.00 $900.00 $630.00 $420.00 $500.00 $10,512.00 $21,675.00 $59,472.00 $15,200.00 $4,444.00 $4,875.00 1$26,775.00 1$24,050.00 1$1,625.00 1$3,230,00 1$1,475.00 1$420.00 1$3,000,00 $3,000.00 $1,500.00 1$41,625,00 1$134,125.00 1$7, 500.00 1$2,000.00 1 1 1 I I I I I I I I I I 1$25,886.00 $366,503.00 Page 1 of 1 Additions Sub Total 1�392,389,00 FORT WORT14 City of Fort Worth Change Order Deletions Project Name I Sanitary Sewer Rehabilitation Contract 90 - Part 1 I City Sec No.: I 54749 Project No.(s): 56002 0700430 CO2382 C01783 I DOE No, I N/A City Proj. No,: 02382 Project Description I Rehabilitation of deteriorated sewer lines in the Meadowbrook Neighborhood and paving in Tierney Road. I VY1111d III J. JUIUIL, III . UVp VIIUC V \iV11D11UbUU11 I Contractor I (�--i r„ Change Order: 2 Dale I 4/27/2022 City Project Mgr, I Walter Norwood I City Inspector: I Matthew Wilson I DELETIONS ITEM DESCRIPTION DEPT Qty, Unit Unit Cost Totoi 36 Construction Allowance -Water Unit 1 Water 0.50 LS $50,000.00 $25.000.00 64 Sewer Construction Allowance Unit 2 Sewer 1.00 LS $80,000.00 $80,000.00 Unit 1 Water Unit 2 Sewer Page 1 of 1 Deletions Sub Total 1$25,000,00 1$80,000.00 1 1$105,000.00 MWBE Sub CO# MIWBE Breakdown for this Change Order Type of service I Amount for this C0 Total 1 $0.00 1 Previous Change Orders DATE AMOUNT I� I Total $0.00 Page 1 of 1 .Contract Compliance Manager By signing I acknowledge that I am the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. Signature Walter Norwood Name of Employee Project Manager Title ►FTvIM" Jannette S. Goodall (May 19, 202210:43 CDT) Jannette Goodall City Secretary 5-9-22 CSC No. 54749 CPN C-02382-1 Notes for Change Order 2 to, Sanitary Sewer Rehabilitation Contract 90, Part 1 Change Order 2 price justification. The prices below were taken from the bid tabs listed above them. All of the other prices used in the change were included in the original bid for this project. This project required a change order to add a 10" bore under Lancaster Ave., SH 180. The new crossing is required to replace the existing crossing that has been compromised by deterioration and a cleaning nozzle that is lodged in the pipe. The prices received are higher than normal due to the shortage of 10 inch dia. sewer pipe of all types. 10" HDPE was used in the casing on the segment. The 24" casing pipe is also higher for the same reason. 2018 BOND YEAR, CONTRACT 9, City Project No.: 101472-2 6" Sewer Pipe — Cost per Ft, $116, $69, Avg. $115 Contract 90, Part 1, Change Order 2 Price - $75/ft Misc. Sewer extensions and Replacements Contract 2019 10" DIP Sewer Carrier Pipe- Cost Per Ft - $225 Contract 90, Part 1, Change Order 2 Price $120/ft Misc. Sewer extensions and Replacements Contract 2019 24" Steel Encasement Pipe — Cost Per Ft - $650 Contract 90, Part 1, Change Order 2 Price - $725/ft 2018 BOND YEAR, CONTRACT 8, City Project No.: 101472-1 8" Sewer Pipe, Point Repair— Cost per Ft, $375, $310, $125, $131 Contract 90, Part 1, Change Order 2 Price - $75/ft City of Fort Worth, Texas Mayor and Council Communication DATE: Tuesday, April 26, 2022 LOG NAME: 60SS90P1 CO2 — CIRCLEC REFERENCE NO.: **M&C 22-0320 SUBJECT: (CD 5 and CD 8) Authorize Execution of Change Order No. 2 in the Amount of $287,389.00 and the Addition of 90 Calendar Days to a Contract with William J. Schultz, Inc. dba Circle C Construction Company, for Sanitary Sewer Rehabilitation Contract 90, Part 1, Project Located in the Meadowbrook and Handley Neighborhood Areas and Adopt Attached Appropriation Ordinance to Effect a Portion of Water's Contribution to the Fiscal Years 2022-2026 Capital Improvement Program RECOMMENDATION: It is recommended that the City Council: 1. Authorize execution of Change Order No. 2 in the amount of $287,389.00 and the addition of 90 calendar days to City Secretary Contract No. 54749 with William J. Schultz, Inc. dba Circle C Construction, for Sanitary Sewer Rehabilitation Contract 90, Part 1, project for a revised contract amount of $2,185,048.00; and 2. Adopt the attached appropriation ordinance increasing estimated receipts and appropriations in the Water and Sewer Capital Projects Fund in the amount of $287,389.00, transferred from available funds within the Water and Sewer Fund, for the purpose of funding the Sanitary Sewer Rehabilitation Contract 90, Part 1, project (City Project No. CO2382) and to effect a portion of Water's contribution to the Fiscal Years 2022-2026 Capital Improvement Program. DISCUSSION: On Tuesday, September 22, 2020, Mayor and Council Communication (M&C) 20-0704, the City Council authorized a construction contract in the amount of $1,897,659.00 with William J. Schultz, Inc. dba Circle C Construction (City Secretary Contract No. 54749) for Sanitary Sewer Rehabilitation Contract 90, Part 1, Project located in the Meadowbrook and Handley neighborhood areas. The contract was subsequently revised by Change Order No. 1 with a deduct amount of $23,000.00 that provided for the replacement of manhole epoxy line with an antimicrobial additive. Change Order No. 2 will provide for replacement of sanitary sewer main M-187 crossing Lancaster Avenue and additional pay item quantities that are necessary to complete the project. The staff has reviewed and verified the quantities for the additional work under this Change Order No. 2. Additionally, to complete this work, staff recommends that the contract time be extended by 90 calendar days. It is the practice of the Water Department to appropriate its CIP plan throughout the fiscal year as projects commence, additional funding needs are identified, and to comply with bond covenants. The actions in the M&C will appropriate funds in support of the Water's portion of the City of Fort Worth's Fiscal Years 2022-2026 Capital Improvement Program, as follows: 60SS90P1CO2 — CIRCLEC Capital Budget Revised Fund Project Name FY2022 CIP Authority Change FY2022 Name Appropriations (Increase/ Budget Decrease) 56002 - CO2382 - SS $ W&S Rehabilitation - Capital Contract 90, Projects Part 'I Fund 'This M&C $287,389.00 $287,389,00 Funding is budgeted in the Transfer to Water/Sewer account of the Water and Sewer operating budgets for the purpose of funding the SS Rehabilitation Contract 90 project within the Water & Sewer Capital Projects Fund. Appropriations for Sanitary Sewer Rehabilitation Contract 90, Part 1, are as depicted below: Fund Existing Additional project Total* Appropriations Appropriations Water & Sewer Capital Projects Fund 56002 Sewer Capital Legacy Fund 59607 $2,685,474.00 $320,483.00 Project Total $3,005,957.00 *Numbers rounded for presentation purposes. $287,389.00 $2,972,863.00 $0.00 $320,483.00 $287,389.00 $3,293,346.00 Business Equity: A waiver of the goal for Business Equity subcontracting requirements was requested, and approved by the DVIN, in accordance with the applicable Ordinance, because the purchase of goods or services is from sources where subcontracting or supplier opportunities are negligible. This project is located in COUNCIL DISTRICTS 5 and 8. FISCAL INFORMATION / CERTIFICATION: The Director of Finance certifies that funds are currently available in the Water & Sewer Fund and upon approval of the above recommendations and adoption of the attached appropriation ordinance, funds will be available in the W&S Capital Projects Fund for the SS Rehab Contract 90 project. Prior to an expenditure being incurred, the Water Department has the responsibility to validate the availability of funds. FUND IDENTIFIERS (FIDs).: TO Fund Department Account Project Program ctivity Budget Reference # ( mount Chartfield 2J FROM Fund Department ccount Project Program ctMR Budget Reference # mount ID ID Year _--(Chartfield 2)_ -I CERTIFICATIONS: Submitted for Citv Manager's Office bv: Dana Burghdoff (8018) Originating Department Head: Chris Harder (5020) Additional Information Contact: Walter Norwood (5026) ATTACHMENTS 1. 60SS90P1CO2-CIRCLEC.docx (CFW Internal) 2. 60SS90P1CO2 — CIRCLEC FID Table (NN 02.15.22).xlsx (CMInternal) 3. 60SS90P1CO2 — CIRCLEC PBS CPN CO2382.pdf (CMInternal) 4.60SS90P1 CO2-CIRCLEC Compliance Waiver. pdf (CFW Internal) 5.60SS90P1CO2-CIRCLEC 1295.pdf (CMInternal) 6.60SS90P1CO2-CIRCLEC MAP.pdf (Public) 7. 60SS90P1CO2-CIRCLEC SAM.pdf (CMInternal) 8.60SS90P1CO2 — CIRCLEC 56002 AO22(r2).docx (Public) 60SS90P I CO2-CIRCLEC FID Table 2 56002 0600430 CO2382 2022 $886.00 2 56002 0700430 4956001 CO2382 2022 $286,503.00 2 56002 0700430 CO2382 2022 $286,503.00 2 56002 0600430 4956001 CO2382 2 56001 0709020 5956001 2 56002 0700430 4956001 CO2382 1 56002 1 56002 0600430 5740010 CO2382 0700430 5740010 CO2382 C01780 C01780 9999 9999 The following entries will be executed by the Water Capital Finance Team as soon as the M&C is approved. $886.00 $286,503.00 Amount Purpose Ver FIDs (Budget) Fund Dept # Account !Project ID Activity Budget CF 2 Program CSC No. 54749-CO3 F_URT WUR-F14 City of Fort Worth Change Order Request Project Name: Sanitary Sewer Rehabilitation Contract 90 -Part 1 CitySec No,: 54749 Project No.(s):l 56002 0700430 CO2382 CO1783 DOE No. I N/A City Proj. No.: 02382 Project Description:) Rehabilitation of deteriorated sewer lines in the Meadowbrook Neighborhood and paving in Tierney Road. Contractord William J. Schutz, Inc, dba Circle C Construction Company, Co. Change Order # 3 1 Date: 6/29/2022 City Project Mgr.1 Walter Norwood CityInspector Matthew Wilson Phone Number: 817-392-5026 Phone Number (682)215-9539 Dept. Unit 1 Water Unit 2 Sewer Totals Contract Time (Catender days) Original Contract Amount $435,709.00 $1,461,950.00 1,897,659.00 420 Extras to Date $886.00 $286,603.00 287,389A 0104 Credits to Date $23,000.00 $23,000.00 Pending Change Orders (in M&C Process) Contract Cost to Date $436,595.00 $1,725,453.00 $2,162,048.00 524 Amount of Proposed Change Order ��0.00 F.00 $0.00 -,2,162,048.00 039 Revised Contract Amount $436,5�J5.00 $1,725,453.00 563 Original Funds Available for Change Orders $21,785.00 $73,098.00 $94,883.00 Remaining Funds Available for this CO $20,899.00 $0.00 $20,899.00 Additional Funding (if necessary) CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS % OF ORIGINAL CONTRACT 13,93% MAX ALLOWABLE CONTRACTAMOUNT (ORIGINAL CONTRACT COST + 25%) $2,372,073.75 JUMFICATIOF ABj�GE ORDER I change Order Number 3 provides for pavement marking and striping on Tierney Road that were not provided at the time the project was advertised for bid. Staff recommends the addition of an additional 39 calendar days for the change order. l 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. contractors COMPM Name ntraCr Name Contractor Signature mate ; l f WdBamJ.Schutr, Inc. dbaClrcletru cConsctionCompany,Co�terl'J/� kelly � �G,c.t'J!�'� I �'Z9-Z�, v Vnspedor DateaL I Project Manager Date Jul 8, 2022 kvYA� Jul 8, 2022 ater Dept) _ Date Construction Supervisor (TPW Dept) Date hn-pher Hard (Ju'. 11, 2L'i2 UT 12 CDT S. Jul 11, 2022 Jul 8, 2022 19*�Iart City Attomey Date Assistant City Manager Date _ J u 1 21, 2022"ff Jul 21, 2022 Council Action (N Required) M&C Number N/A M&C Date Approved NIA FORT WORTH City of Fort Worth -V- Change Order Additions Project Name I Sanitary Sewer Rehabilitation Contract 90 - Part 1 City Sec No.: 1 54749 Project No.(s): 56002 0700430 CO2382 CO1783 ( DOE No.1 N/A I City Proj. No., 1 02382 Project Rehabilitation of deteriorated sewer lines in the Meadowbrook Neighborhood and paving in Tierney Road. Description Contractor William J. Schulz, Inc. dba Circle C Construction Company, Co. I Change Order: Date: ) 6128/2022 City Project Mgr. Walter Norwood I City Inspector Matthew Wilson ADDITIONS HEM tM UhMoKlr t 1UN DEPT City Unit Unit Cost I Total 37 Pavement Striping Mobilization Unit 1 Water 1.00 EA $1,413.13 $1,413.13 38 4" SLD Pvmt Marking HAS (Y) Unit 1 Water 260.00 LF $2.26 $587.60 39 8" SLD Pvmt Marking HAS (W) Unit 1 Water 90.00 LF $2.26 $203.40 40 12" SLD Pvmt Marking HAE (W) Unit 1 Water 170.00 LF $7.91 $1,344.70 41 24" SLD Pvmt Marking HAE (W) Unit 1 Water 23.00 LF $9.04 $207.92 42 Lane Legend Arrow Unit 1 Water 1.00 EA $158.27 $158.27 43 Lane Legend Only Unit 1 Water 1.00 EA $160.00 $160.00 44 REFL Raised Marker TY II -A -A Unit 1 Water 14.00 EA $9.04 $126.56 45 REFL Raised Marker TY II-C-R Unit 1 Water 5.00 EA $9.04 $45.20 46 Pvmt Marking Prep 4" Unit 1 Water 170.00 LF $1.13 $192.10 47 Pvmt Marking Prep 8" Unit 1 Water 90.00 LF $1.13 $101.70 48 Pvmt Marking Prep 12" Unit 1 Water 170.00 LF $1.41 $239.70 49 Pvmt Marking Prep 24" Unit 1 Water 23.00 LF $1.70 $39.10 50 Pvmt Marking Prep Arrow Unit 1 Water 1.00 EA $87.81 $87.81 51 Pvmt Marking Prep Word Unit 1 Water 1.000 EA $87.81 $87.81 Unit 1 Water $4,995.00 Unit 2 Sewer Page 1 of 1 Additions Sub Total $4,995.00 Ft7RT Woo K,r14 City of Fort Worth Change Order Deletions Project Name Sanitary Sewer Rehabilitation Contract 90 - Part 1 City Sec No.: 54749 Project No.(s): 56002 0700430 CO2382 CO1783 DOE No. I N/A City Proj. No.: 02382 Project Description I Rehabilitation of deteriorated sewer lines in the Meadowbrook Neighborhood and paving in Tierney Road. Contractor I VY11110111 li. OL11ult, 111L. uua %allwt7 � Vu11MumuU11 Change Order: � Date 6/28/2022 !!!!I ('mmnnnv r'n I City Project Mgr. Walter Norwood ( City Inspector: I Matthew Wilson DELETIONS ITEM DESCRIPTION DEPT Oty Unit Unit Cost Total 36 Construction Allowance Water Unit 1 Water 0.0999 LS $50,000.00 $4,995.00 Unit 1 V�-ater $4,995.00 Unit 2 Sewer Page 1 of 1 Deletions Sub Total $4,995.00 MIWBE Breakdown for this Change Order MWBE Sub I Type of Service I Amount for this CO Total $0.00 1 Previous Change Orders Co# I DATE I AMOUNT Total $0.00 1 Page 1 of 1 Contract Compliance Manner By signing I acknowledge that I am the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. Signature Walter Norwood Name of Employee Project Manager Title ATTEST: c� �BB� J nette S. Goodall (Jul 21, 202213: DT) Jannette Goodall City Secretary 6/29/2022 CPN 02382-1 Sanitary Sewer Rehabilitation Contract 90 - Part 1 Change Request 3 Notes Staff has reviewed the change order price and considers it to be fair and reasonable. FORT WORTH, TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PROJECT NAME: Sanitary Sewer Rehab Contract 90-Part 1 CITY PROJECT NUMBER: 2382 1 WATER PIPE LAID SIZE TYPE OF PIPE Water 8" PVC Water 6" PVC LF FIRE HYDRANTS: 2 VALVES (16" OR LARGER) PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: NEW SERVICES: 1,754 41 SEWER PIPE LAID SIZE TYPE OF PIPE LF Sewer loot C900 1445 Sewer 10" DIP 440 Sewer loot Pipe Enlargement 50 Sewer 8" C900 1655 Sewer 8" Carrier Pipe 20 Sewer 8" DIP 468 Sewer 8" DIP open cut 83 Sewer 8" Pipe Enlargement 1290 PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: NEW SERVICES: TRANSPORTATION AND PUBLIC WORKS The City of Fort Worth • 1000 Throckmorton Street • Fort Worth, TX 76012-6311 (817) 392 - 7941 • Fax: (817) 392 - 7845 FORTWORTH. TRANSPORTATION AND PUBLIC WORKS September 12, 2023 Circle C 856 Valle St Fort Worth TX 76108 RE: Acceptance Letter Project Name: Sanitary Sewer Rehabilitation Contract 90-Part 1 Project Type: Sanitary Sewer City Project No.: 02382 To Whom It May Concern: On February 23, 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 February 23, 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- 392-5026. Sincerely, Walter Norwood, Project Manager Cc: Fabian Diaz, Inspector Donald Watson, Inspection Supervisor Aaron Ybarra, Senior Inspector Tony Sholola, Program Manager Tracy L Long, Consultant Circle C, Contractor NA, 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 Teresa S Skelly, President Of William J Schultz Inc dba Circle C Construction Company, 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; Sanitary Sewer Rehabilitation Contract 90 - Part 1 City Project Number 02382 BY President Subscribed and sworn before me on this date 5 of December, 2022. o' MICHELE S LANKFORf JQ_` ► l I�CQ �r"� *A Notary Public *` STATE OF TEXAS Notary Public '° a + F NotaryID EX t »ssas s +t � cam. �. Tarrant, Texas CONSENT OF SURETY TO FINAL PAYMENT AIA Document G707 Bond No. TXC612316 TO OWNER: City of Fort Worth 1000 Throckmorton Street Fort Worth, TX PROJECT: (name, address) Sanitary Sewer Rehabilitation, Contract No. 90 - Part 1 Fort Worth, TX OWNER ARCHITECT CONTRACTOR SURETY OTHER ARCHITECT'S PROJECT NO.: City Project No. 02382 CONTRACT FOR: Utilities CONTRACT DATED: In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the (Insert name and address ofSuret)) Merchants Bonding Company (Mutual) 6700 Westown Parkway West Des Moines, IA 50266 , SURETY on bond of (Insert name and address of Contractor) William J. Schultz, Inc., dba Circle C Construction Company P. O. Box 40328 Fort Worth, TX 76140 , 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 1000 Throckmorton Street Fort Worth, TX 76102 , OWNER, as set forth in the said Surety's bond. IN WITNESS WHEREOF, the Surety has hereunto set its hand this date: December 05, 2022 (Insert in writing the month followed by the numeric date and year.) Merchants Bonding Company (Mutual) (Surety) (Signature ofauth rEf i:ed representative) i Witness as to Surety: Sheryl A. Klutts, Attorney -in -Fact (S .� (Printed name and title) John A. Miller Note: This form is to be used as a companion document to AIA DOCUMENT G706, CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS, Current Edition AIA DOCUMENT G707 • CONSENT OF SURETY COMPANY TO FINAL PAYMENT • April 1970 Edition • AIA® One Page ©1970 • THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 New York Ave., NW, Washington, D.C. 20006 "k MERCHANTS BONDING COMPANYTM POWER OF ATTORNEY Know All Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., both being corporations of the State of Iowa (herein collectively called the "Companies") do hereby make, constitute and appoint, individually, John A Miller; John R Stockton; Sheryl A Klutts their true and lawful Attomey(syin-Fact, to sign its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. This Power -of -Attorney is granted and is signed and sealed by facsimile under and by authority of the following By -Laws adopted by the Board of Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors of Merchants National Bonding, Inc., on October 16, 2015. "The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Attorneys -in -Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof." "The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually fixed." In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and aut hority hereby given to the Attomey-in-Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond. In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to the Attomey-in-Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner - Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation. In Witness Whereof, the Companies have caused this instrument to be signed and sealed this 11th day of February 2020 ••'• �• •'•••�P� MOP'-. q� °y :.�Q�NG.C�IjJ'o °�o�P09q%; 0, MERCHANTS BONDING COMPANY (MUTUAL) von -o- D:o: ; :rr'-:= MERCHANTS NATIONAL BONDING, INC. Q2 v 2003 -o- o: : a'` 1933 : c: ey •• A' :rJa.• ..% \1d. President STATE OF IOWA COUNTY OF DALLAS ss. On this 11th day of February 2020 before me appeared Larry Taylor, to me personally known, who being by me duly sworn did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the seals affixed to the foregoing instrument are the Corporate Seals of the Companies; and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. e .LA4 s POLLY MASON z Commission Number 750576 D e e O U My Commission Expires January 07, 2023 Notary Public (Expiration of notary's commission does not invalidate this instrument) I, William Warner, Jr., Secretary of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., do hereby certify that the above and foregoing is a true and correct copy of the POWER -OF -ATTORNEY executed by said Companies, which is still in full force and effect and has not been amended or revoked. In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 5th day of December, 2022. ��.••P110 N44 11G . Cg4o. co a • 1933 c; Secretary 2003 POA0018 (1/20) "'"•�'�� •••••••�