HomeMy WebLinkAboutContract 59676-FP1FORT WORTHa
-FP1
City Secretary
Contract No. 59676
Date Received 10/11/2023
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: West Square Tract Sewer Extension
City Project No.:104680
Improvement Type(s): Water ❑ Sewer x❑
Original Contract Price: $193,326.00
Amount of Approved Change Order(s):
Revised Contract Amount:
Total Cost of Work Complete: $193,326.00
Oct 6, 2023
Contractor Date
Vice President
Title
BurnsCo Construction, Inc.
Company Name
C-"Ik LozL,
Erik Loza (Oct 9.2023 08:34 CDT)
Oct 9, 2023
Project Inspector
Date
sang Adhi (E�oc2aa�Tl
Oct 11, 2023
Project Manager
Date
do
Oct 11)2023
Rebecca Diane Owen (Oct 11. 2023 08:47 CDT)
CFA Manager
Date
It&'�
Oct 11, 2023
TPW Director
Date
Willia�1.hn— 14. 20731744 Cf7T)
Oct 14 2023
i
Asst. City Manager
Date
OFFICIAL RECORD Page 1 of 2
CITY SECRETARY
FT. WORTH, TX
Notice of Project Completion
Project Name: West Square Tract Sewer
Extension City Project No.: 104680
City's Attachments
Final Pay Estimate x❑
Change Order(s): ❑ Yes ❑x N/A
Pipe Report: x❑ Yes ❑ N/A
Contractor's Attachments
Affidavit of Bills Paid
Consent of Surety
Statement of Contract Time
Contract Time: 11 WD Days Charged: 13
Work Start Date: 8/07/2023 Work Complete Date: 8/30/2023
Completed number of Soil Lab Test: 18
Completed number of Water Test: 0
Page 2of2
FoRTWORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name WEST SQUARE TRACT SEWER EXTENSION EXPRESS CFA
Contract Limits
Project Type SANITARY
City Project Numbers 104680
DOE Number 4680
Estimate Number 1 Payment Number I For Period Ending 8/15/2023
WD
City Secretary Contract Number Contract Time MID
Contract Date Days Charged to Date 13
Project Manager NA Contract is 100.00 Complete
Contractor BURNSCO CONSTRUCTION, INC.
6331 SOUTHWEST BLVD
FORT WORTH, TX 76132
Inspectors MILLER / E. LOZA
Friday, October 6, 2023 Page 1 of 4
City Project Numbers 104680 DOE Number 4680
Contract Name WEST SQUARE TRACT SEWER EXTENSION EXPRESS CFA Estimate Number 1
Contract Limits Payment Number 1
Project Type SANITARY For Period Ending 8/15/2023
Project Funding
UNIT I: SANITARY IMPROVEMENTS
Item
Description of Items
Estimated Unit
Unit Cost
Estimated
Completed
Completed
No.
Quanity
Total
Quanity
Total
1
POST - CC TV INSPECTION
753 LF
$3.00
$2,259.00
753
$2,259.00
2
MANHOLE VACUUM TESTING
4 EA
$150.00
$600.00
4
$600.00
3
TRENCH SAFTEY
753 LF
$2.00
$1,506.00
753
$1,506.00
4
CONCRETE COLLAR
4 EA
$630.00
$2,520.00
4
$2,520.00
5
IMPORTED EMBEDMENTBACKFILL. CSS
60 LF
$70.00
$4,200.00
60
$4,200.00
6
8" SEWER MAIN
753 LF
$167.00
$125,751.00
753
$125,751.00
7
EPDXY MANHOLE
41 VF
$430.00
$17,630.00
41
$17,630.00
8
4' MANHOLE
1 EA
$4,820.00
$4,820.00
1
$4,820.00
9
4' DROP MANHOLE
3 EA
$9,700.00
$29,100.00
3
$29,100.00
10
ECTRA DEPTH MANHOLE (6.0)
26 VF
$190.00
$4,940.00
26
$4,940.00
Sub -Total of
Previous Unit
$193,326.00
$193,326.00
Friday, October 6, 2023 Page 2 of 4
City Project Numbers 104680
Contract Name WEST SQUARE TRACT SEWER EXTENSION EXPRESS CFA
Contract Limits
Project Type SANITARY
Project Funding
Contract Information Summary
Original Contract Amount
Change Orders
Total Contract Price
DOE Number 4680
Estimate Number 1
Payment Number 1
For Period Ending 8/15/2023
$193,326.00
$193,326.00
Total Cost of Work Completed $193,326.00
Less % Retained $0.00
Net Earned $193,326.00
Earned This Period $193,326.00
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
$193,326.00
Friday, October 6, 2023 Page 3 of 4
City Project Numbers 104680
Contract Name WEST SQUARE TRACT SEWER EXTENSION EXPRESS CFA
Contract Limits
Project Type SANITARY
Project Funding
Project Manager NA
Inspectors MILLER / E. LOZA
Contractor BURNSCO CONSTRUCTION, INC.
6331 SOUTHWEST BLVD
FORT WORTH, TX 76132
DOE Number 4680
Estimate Number 1
Payment Number 1
For Period Ending 8/15/2023
City Secretary Contract Number
Contract Date
Contract Time 11 WD
Days Charged to Date 13 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 $193,326.00
Less % Retained $0.00
Net Earned $193,326.00
Earned This Period $193,326.00
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
$193,326.00
Friday, October 6, 2023 Page 4 of 4
FORT WORTH,
TRANSPORTATION AND PUBLIC WORKS
PIPE REPORT FOR:
PROJECT NAME: West Square Tract Sewer Extension
CITY PROJECT NUMBER: 104680
WATER
PIPE LAID SIZE TYPE OF PIPE
N/A
FIRE HYDRANTS: N/A VALVES (16" OR LARGER)
PIPE ABANDONED SIZE TYPE OF PIPE
DENSITIES: N/A
NEW SERVICES:
I SEWER
PIPE LAID SIZE TYPE OF PIPE
Open Cut 8" PVC
PIPE ABANDONED SIZE TYPE OF PIPE
N/A
DENSITIES: YES ALL PASS
NEW SERVICES: N/A
TRANSPORTATION AND PUBLIC WORKS
The City of Fort Worth • 1000 Throckmorton Street • Fort Worth, TX 76012-6311
(817) 392 - 7941 • Fax: (817) 392 - 7845
LF
LF
LF
LF
753
FORTWORTH.
M,
TRANSPORTATION AND PUBLIC WORKS
September 6, 2023
Burnsco Construction, Inc.
6331 Southwest Blvd.
Benbrook, TX 76132
RE: Acceptance Letter
Project Name: WEST SQUARE TRACT SEWER EXTENSION
Project Type: Sewer
City Project No.: 104680
To Whom It May Concern:
On September 6, 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 September 6,
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-
392-24.
Sincerely,
5Ate;
Sandi Adhik r, P. E. (Oct 11, 202308:44 CDT
Sandip Adhikari, Project Manager
Cc: Erik Loza, Inspector
Wade Miller, Inspection Supervisor
Emanuel Nieto, Senior Inspector
Andrew Goodman, Program Manager
Shield Engineering Group, Consultant
Burnsco Construction, Contractor
Clairemont MCD, 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 Ab Grantges,
Contract Mgr, Of Burnsco Construction, 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;
West Square Tract - Sanitary Sewer Extension
BYlg�.... ..
Ab Grants, Vice President
Subscribed and sworn before me on this date 6th of October, 2023.
otaryv r tal5�lic
Tarrant County, Texas
ti''�r,�KASSANDRA CANALES
'x{�=
° a Notary Puhlic, State of 7axas _
Comm, Expires 01-23-2027
�4�h1ri�P Notary !D 134158873
CONSENT OF
SURETY COMPANY
TO FINAL PAYMENT
Conforms with the American Institute of
Architects, AIA Document G707
OWNER
❑
ARCHITECT
❑
CONTRACTOR
❑
SURETY
❑
OTHER
PROJECT:
(name, address)West Square Tract Sewer Extension - Sanitary Sewer Improvements
TO (Owner)
Bond No 022235978
TX
F —1 ARCHITECT'S PROJECT NO:
CLAIREMONT MCD, LLC AND CITY OF FORT WORTH CONTRACT FOR:
500 West 7th Street, Suite 1220 West Square Tract Sewer Extension - Sanitary Sewer Improvements
Fort Worth TX 76102 �f CONTRACT DATE: 3/15/2023
CONTRACTOR: BURNSCO CONSTRUCTION, INC.
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)
LIBERTY MUTUAL INSURANCE COMPANY
175 Berkeley Street
Boston MA 02116 , SURETY COMPANY
on bond of (here insert name and address of Contractor)
BURNSCO CONSTRUCTION, INC.
6331 Southwest Boulevard
Benbrook TX 76132
,CONTRACTOR,
hereby approves of the final payment to the Contractor, 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)
CLAIREMONT MCD, LLC AND CITY OF FORT WORTH
500 West 7th Street, Suite 1220
Fort Worth TX 76102 , OWNER,
as set forth in the said Surety Company's bond.
1N WITNESS, WHEREOF,
the Surety Company has hereunto set its hand this
Attest:
(Seal):
15th day of September, 2023
LIBERTY MUTUAL INSURANCE COMPANY
Surety
�,,Company
et�
)o0 ltnt - Go
Signature of Authorized Representative
Soohinie Hunter
Title
Attorney -in -Fact
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
ONE PAGE
This Power of Attorney limits the acts of those named herein, and they have no authority to
bind the Company except in the manner and to the extent herein stated.
Llhel" t : Liberty Mutual Insurance Company
Mutual, The Ohio Casualty Insurance Company Certificate No: 8205467-022020
SURETY West American Insurance Company
POWER OF ATTORNEY
KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that
Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized
under the laws of the State of Indiana (herein collectively called the "Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Don E.
Cornell; Joshua Saunders; Kelly A. Westbrook; Mikaela Peppers; Ricardo J. Reyna; Robbi Morales; Sophinie Hunter; Tina McEwan; Tonie Petranek
all of the city of Dallas state of TX each individually if there be more than one named, its true and lawful attorney -in -fact to make,
execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance
of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper
persons.
IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed
thereto this 23rd day of April 2021
Liberty Mutual Insurance Company
\NSUR " INSU tNSUNi The Ohio Casualty Insurance Company
°R4T�y�, y`�P"o°RPORar�y �GPooRPORgTq�n West American Insurance Company
g 1912 0 0 1919 0 2 1991
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�.�9sSACHU`' .aDO SO NAMP�+aa� '(s �NDIANP ,dL - V
By:
David M. Carey, Assistant Secretary a
q State of PENNSYLVANIA _
County of MONTGOMERY ss o E
_ =3 On this 23rd day of April , 2021 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance a)`
Company, The Ohio Casualty Company,
6
and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes
therein contained by signing on behalf of the corporations by himself as a duly authorized officer.
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IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at King of Prussia, Pennsylvania, on the day and year first above written.
of
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PASS,
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MW �< Commonwealth of Pennsylvania - No
7-G r "'c'Y t.�, Teresa Pastella, Notary Public
� tary Seal , 4D-
OF Montgomery County "" ��
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My commission expires March 28, 2025 iLC.t�pv
Bn�J�C�-�
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P Commission number 1126044
SYj:4 Member, Pennsylvania Association of Notaries Teresa Pastella, Notary Public
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This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual
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Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows:
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ARTICLE IV — OFFICERS: Section 12. Power of Attorney.
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Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the
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President may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety
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any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact, subject to the limitations set forth in their respective powers of attorney, shall
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have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such
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instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney -in -fact under theto
provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority.
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ARTICLE XIII — Execution of Contracts: Section 5. Surety Bonds and Undertakings.
Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe,
shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings,
bonds, recognizances and other surety obligations. Such attorneys -in -fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the
Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if
signed by the president and attested by the secretary.
Certificate of Designation — The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attorneys -in -
fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety
obligations.
Authorization — By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the
Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with
the same force and effect as though manually affixed.
I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company,- Liberty Mutual Insurance Company, and West American Insurance Company do
hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and
has not been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 15th day of September , 2023
sub �SY INSrj XNSb'
J ro>zyT-oy�c° 3u°ar°ggr�g2 �G �PORgTF
0 O m W o� '/� �•"'
1912 0 y 1919 o 1991
4.V19sSACHUs.da yONAMP`��`� a3 `( �Nb1ANP' a By.
Renee C. Llewellyn, Assistant Secretary
LMS-12873 LMIC OCIC WAIC Multi Co 02/21
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Liberty
Mutual.
SURETY
TEXAS
IMPORTANT NOTICE
To obtain information or make a complaint:
You may call toll -free for information or to
make a complaint at
1-877-751-2640
You may also write to:
2200 Renaissance Blvd., Ste. 400
King of Prussia, PA 19406-2755
You may contact the Texas Department of
Insurance to obtain information on companies,
coverages, rights or complaints at
1-800-252-3439
You may write the Texas Department of Insurance
Consumer Protection (I I I -1 A)
P. O. Box 149091
Austin, TX 78714-9091
FAX: (512) 490-1007
Web: http://www.tdi.texas.gov
E-mail: ConsumerProtectionntdi.texas.gov
PREMIUM OR CLAIM DISPUTES:
Should you have a dispute concerning your
premium or about a claim you should first
contact the agent or call 1-800-843-6446.
If the dispute is not resolved, you may contact the
Texas Department of Insurance.
ATTACH THIS NOTICE TO YOUR
POLICY:
This notice is for information only and does not
become a part or condition of the attached
document.
NP70680901
LMS-1529210/15
TEXAS
AVISO IMPORTANTE
Para obtener informacion o para someter una
queja:
Usted puede Ilamar al numero de telefono gratis
para informacion o para someter una queja al
1-877-751-2640
Usted tambien puede escribir a:
2200 Renaissance Blvd., Ste. 400
King of Prussia, PA 19406-2755
Puede comunicarse con el Departamento de
Seguros de Texas para obtener informacion
acerca de companias, coberturas, derechos o
quejas al
1-800-252-3439
Puede escribir al Departamento de Seguros
de Texas Consumer Protection (I I I -1 A)
P. O. Box 149091
Austin, TX 78714-9091
FAX # (512) 490-1007
Web: httn://www.tdi.texas.aov
E-mail: ConsumerProtectiono..tdi.texas.gov
DISPUTAS SOBRE PRIMAS O RECLAMOS:
Si tiena una disputa concerniente a su prima o a
un reclamo, debe comunicarse con el agente o
primero. Si no se resuelve la disputa, puede
entonces comunicarse con el departamento (TDI)
UNA ESTE AVISO A SU POLIZA:
Este aviso es solo para proposito de informacion
y no se convierte en parte o condicion del
documento adjunto.