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Contract 42361-FP1 (2)
CITY OF FORT WORTH NOTICE OF PROJECT COMPLETION . <I. -~'i (e os--851/0"L 6Cf~OJ-C0157:2 ~ (:,~ 4 2 3 (. \ ~ Regarding City Secretary Contract 42361 for the Rolling Hills Water Treatment Plant (RH WTP) -Phase 5 Chemical Facilities Improvements, (City Proiect # 01572) which was requested by the Water Department and approved by City Council on 09/13/2011 through M&C C-25161 , the Director of the Water Department, upon the recommendation/ approval of the City Proiect Manager , has accepted the project as complete. Final Payment (Pay Application # 22) will be issued in accordance with Administrative Regulation C-6. Original Contract Price: Amount of Approved Change Orders: Revised Contract Amount: Less Liquidated Damages: $ $ $ $ 4 ,065,895.00 16,361.00 4,082,265.00 0.00 Number: 01 (@$ /Day) rJ. ,,, -c.-¥' u.. .J Less Chemical Loss: $ 24,875.00 J Hh ~ J!, T otal C ontract Cost : Le ss Previous Payment s: Final Payment Due: ~~£ R ecommended & Approved FWWD Project Manager, Farida Goderya Approval as to Legality CFW Legal, Doug Black $ $ $ 4,057,381.00 3,954 ,477 .57 102,03.4:3 o} ( 2Sl 2-o\~ D ate tke,/~ (:, Date r ti --i OFFICIAL. RECORD CITY SECRETARY FT. WORTH, TX ~~J~ l·,2'~lt. Assistant City Manager, J~ AILED Date Date ofFinaJ Completion A Date of Warranty Start NA ~ Pt Le.c~ -"' s , I l52..- APPL1cAT10N AND CERTIFICATION FOR PAYMENT sq&o1-co1s-ia. AJA DOCUMENT G702 PAGE ONE OF TWO PAGES TO ENGINEER COM Smith 100 Throckmorton Street Ft. Worth, TX 78102 Suite 800 FROM CONTRACTOR: Legacy Contracting LP dba Control Specialist Services LP PO 1479 Decatur, TX 78234 PROJECT: 01572 Rolling Hilts WTP Phase 5 2500 Southeast Loop 820 Fort Worth, TX 76140 CONTRACTOR#: 11 -1 018 CONTRACTOR'S APPLICATION FOR PAYMENT Application la made for payment, as ahown below, In connection wilh the Contract. Continuation ShHt, AIA Document 0703, 11 attached . 1, ORIGINAL CONTRACT SUM .. .. .. .. • .. .. .. .. .. .. .. $ 4,oe5,895.00 2, Ntt ch1ng1 by Change Ordtra .. , . . . . . . . . . . . . . . . . . . . . . . . . . . $ (8,514.00) 3. CONTRACT SUM TO DATE (Line 1 + 2) ........•..•......... $ 4,057,381 .00 4. TOTAL COMPLETED & STORED TO DATE ................. $ 4,057,381 .00 (Column G on G703) e. RETAINAGE : 1 . 3 % of Completed Work _, _____ 12_2 __ ,303_."4_3_ (Column D + E on G703) b. 3 % of Stored Material ... • ...... ____ _ (Column F on G703) Total Retalnage (Lln11 ea + !lb or $ Tot,il In Column I of G703) ... , ........................ . -----8. TOTAL EARNED LESS RETAINAGE •..•.... , ..•.•.. , . . . . . $ 4,057,381 .00 (Line 4 Lea• Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR $ 3,954 ,4n.57 PAYMENT (Line 8 from pr1or Certificate),.,.,,, •. , •....• ·,.·----.,. B. CURRENT PAYMENT DUE "".. .. .. . .. .. .. .. .. .. .. .. .. IS 102,103.43 I 11 . BALANCE TO FINISH , INCLUDING RETAINAGE ... , •... , . $ (Line 3 Len Line 8) CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total change approved In cr1vlou1 month, bv owner s -$ - Total approved this Month s 16,361 .00 s - TOTALS $ 16,361 .00 $ 24,875.00 NET CHANGES by Change Order $ (8,5 14.00) XIX 6880MdNY 8702 XPfiLJCXiioN XNB C@hfiPICXY@N FOR PAYMENT iiM @Ti6W XJX -t°'--' ,~ '-4 , --- APPLICATION NO: Final Distribution to : I / APPUCATK>N DATE: 12/312015 [iJ OWNER ~I.>.<"~ I '"1 16 PERIOD FROM: 6125/2013 CxJ ARCHITECT C=:J GENERAL CONTRACTOR PO# ]'fDSo INVOICE # (.\ 'L lli l -1-,7- that to the best IX the Contraclol's knowledge , ~ by this Application for Payment has been completed .• in aa:ontance will the Contract Ooa.menls, lhat aft amounts have been paid by the Contractor • ,"' 1 .• ...::J °t 1 4, ()0 , e>C- tor \IVol1( for wf1k:h previous Certificates for Payment -issued and paymenlS received ....... •• ·, from U1e Owner, and that current payment shown herein is now due . ' . • • ,~: 1 ::RACTA'~~LP ~<-= Date: ___ Dec-'-. 3..:..,20_1_5 _:_, _) _____ I b_:l_,'-9{ D'b I L~~ State of: TEXAS County 9f: WISE 1,.. ~ d). O J ..5 Subscribed and ~"? to before me~· r cf day of 7) t:,f!.,e n1 <.v>( , Notary Public: ;CY{t.£/cA~ My Commission expires: O,:;;;J ):;I g /,;;. ~~~~~~~~~~ {~/~·\ ~ Nolory Public . Slate o l l ei.a s tnao:on:lancewilllleConlradDoclments, based onon-site observatlonsand iiif:/~{~j Comm . Ex ptrl:!5 0 2 28 ;,o 19 comprising 1heapplication, lheArchited certifies to the Owner that to the best of -,,,,t,,?:,.!~•'' Not a ry ID l 24A58498 ArChilecl's knOwledge, information and belief the Wol1c has progressed as indlcatd.' l;:ai~iiij;;::;;::;;::====::;;;::;:J « the Work is in accordance with the Contract Documents, and the Contractor is entilled to payment IX the AMOUNT CERTIFIED. AMOUNT CERTIFIED ....... . ------- (Ntach ~planalion if amount oertifled differ9s from the amount applied. Initial all figures on this App6calicn and on the Continua/ion Sheet thaJ are changed lo confonn to the amount certified.) ARCHITECT : By: Date :__,-,.,------------ Thls Cer1ificaee is not negotiable. The AMOUNT CERTIFIED ls payable only lo the Conlractor named herein. lssuance, payment and acceplance IX payment are without ~ d the Owner or Contractor underlhls Contract. I." f\ (. { ~V-~L'J C-::,. \_\,J ~,,~ \:..c:.;~ f-\t.t._.:1 -5<--!:..-~' l.) r-\..c... \-{J ~c:.. ' N . A,l CONTINUATION SHEET AIA Document 0702, APPLICATION AN O CERTIFICATE FOR. P AYMENT , contai ning Contrac:101"11lgned Cartiflcatlon ls attached . In tabulallon1 below, amou nts are slated to th e nearest dollar . Us.e Column I on Contracts wh ere variable retalne ge for fine It ems may app ly. A B ITEM DESCRIPTION OF WORK NO. Bl-1 Bid Item #1 RH WTP Improvements 1-1 Bonds 1-2 Insurance 1-3 Mobilization 1-4 General Contracting Submittals General Demolition 1-5 Handrail , Platforms, Gratina , Metals 1-6 Misc. Concrete 1-7 Piping , Mechanical, Equipment, Pump: 1-8 Tanks New Chemical Feed Structure 1-9 Chemical Feed Structure Formwork 1-10 Chemical Feed Structure Concrete 1-11 New Bulk Storage Form Work 1-12 New Bulk Storage Concrete 1-13 Uooer Deck Structure Formwork 1-14 Unner Deck Structure Concrete 1-15 Concrete Reoairs (@ Existing Storage 1-16 Fill Sand Material Delivered 1-17 Fill Sand Material Placed 1-18 Re inforcement Masonrv 1-19 Glazed Structural Clay Tile 1-20 Glass Block Metals-Gratina . Sta i rs Railina & Bollards 1-21 Grat ino 1-22 Stairs 1-23 Railing 1-24 Platforms 1-25 Diamond Plate Pioe Trench 1-26 Doors and Hardware Pa int Crvstalline WP & Fluid Annlied TM 1-27 Finish Painting 1-28 Fluid Aoolied Traffic Membrane C SC HEDULED VALUE 49 ,341.00 52,000.00 17,500.00 8 ,000 .00 5 800.00 8 500 .00 7 ,700.00 3 ,000.00 34 ,000 .00 18,000.00 23 ,000.00 13 ,000 .00 29,000.00 15,000.00 17,000.00 5,500 .00 3 ,500_00 12 ,850.00 71 ,250.00 4 ,750.00 22 ,500 .00 6 ,000 .00 27 ,000 .00 4 ,000.00 9 ,500.00 19,500 .00 44,000.00 15,000.00 A/A DOCUMENT G703 Legacy Contracting LP Rolling HIiis WTP D I E WO RK COMPLE TED FROM PR EVI OUS THISPERIOO APPLICATIONS 49 ,341 .00 0 .00 52,000 .00 0 .00 17 ,500 .00 0 .00 8,000 .00 0 .00 5 ,800 .00 0.00 8,500.00 0 .00 7,700 .00 0.00 3,000.00 0 .00 34,000.00 0 .00 18,000.00 0 .00 23,000 .00 0 .00 13,000.00 0 .00 29,000 .00 0 .00 15,000.00 0.00 17,000.00 0 .00 5,500 .00 0 .00 3,500 .00 0 .00 12 ,850 .00 0 .00 71 ,250 .00 0 .00 4,750 .00 0 .00 22,500 .00 0 .00 6 ,000 .00 0 .00 27,000 .00 0 .00 4 ,000 .00 0 .00 9,500 .00 0 .00 19 ,500 .00 0.00 44,000.00 15,000.00 0.00 F PRES ENTLY STORED (NOT IN D OR E) 0 .00 0 .00 0 .00 0 .00 0 .00 0 .00 0 .00 0 .00 0 .00 0 .00 0 .00 0 .00 0 .00 0 .00 0 .00 0 .00 0 .00 0 .00 0 .00 0.00 0.00 0.00 0 .00 0 .00 0 .00 0.00 0 .00 0 .00 APPLICATION NUMBE R: Fl ne l APP LICATION DATE: 12/03/15 PERIOD FROM : 06/25/13 suacONTRACT NO : G TOTAL ... CO MPLE TED (G /C) AND STORED 49,341 .00 100% 52 ,000.00 100% 17 ,500.00 100% 8 ,000.00 100% 5 ,800.00 100% 8,500.00 100% 7 ,700.00 100% 3,000.00 100% 34 ,000.00 100% 18 ,000.00 100% 23 000.00 100% 13,000.00 100% 29 ,000 .00 100% 15,000 .00 100% 17 ,000 .00 100% 5 ,500 .00 100% 3 ,500 .00 100% 12 ,850 .00 100% 71 ,250 .00 100% 4 ,750 .00 100% 22,500.00 100% 6 ,000 .00 100% 27 ,000.00 100% 4,000.00 100% 9 ,500 .00 100% 19,500.00 100% 44,000 .00 100% 15,000 .00 100% I t H I BALANC E VALUE OF TO FINI SH WORK THIS CC -GI ESTIMATE 0 .00 0 .00 0 .00 0.00 0 .00 0 .00 0 .00 0 .00 0.00 0 .00 0 .00 0.00 0 .00 0.00 0 .00 0.00 0 .00 0.00 0.00 0.00 0 .00 0.00 0.00 0.00 0 .00 0.00 0 .00 0.00 0 .00 0.00 0 .00 0.00 0.00 0.00 0 .00 0.00 0 .00 0.00 0 .00 0.00 0 .00 0.00 0 .00 0 .00 0 .00 0.00 0 .00 0.00 o_oo 0.00 0 .00 0 .00 0.00 0 .00 0 .00 0.00 CONTINUATION SHEET AIA Documenl 0702. APPLICATION AND CERTIFICATE FOR PAYMENT, cont alf'Wlg Contractor's signed Cert!Ocallon Is attachod. l n tabulallon, below. amounts are ataled to the neare st dollar. Use Colu mn I on Contracts where variable retalna ge fOf' line It ems may apply, A 8 ITE M DESCRIPTION OF WORK NO . 1-29 Crvstalline Waterproofing Eauioment Installation 1-30 FRP Tanks 1-31 Sumo Pumps 1-32 Polvmer Feeders 1-33 Chemical Feed Pumps 1-34 End Suction Pumps Mechanical/Yard Pioino 1-35 Chemical Feed Area 1-36 New Bulk Storage Area 1-37 Existino Bulk Storage Area 1-38 Pipe Trench PVC 1-39 New Pipe Trench 1-40 Rapid Mix Area 1-41 Fluosilicic Acid Area 1-42 Basement Area 1-43 Emeraencv Evewash Showers 1-44 Fire Protection Sprinkler Heat Trace & Insulation 1-45 Ferric Sulfate Storage Insulation 1-46 Ferric Sulfate Storage Heat Trace 1-47 Sodium Hvdroxide Insulation 1-48 Sodium Hvdroxide Heat Trace 1-49 Eve Washes Insulation 1-50 Eye Washes Heat Trace Bid Item #1 Subtotal Bl-2 Bid Item #2 Trench Safety 2-1 Trench Safety Svstem Bid Item #2 Subtotal Bl-3 Bid Item #3 Chemical Feed Eauioment 3-1 Ferric Sulfate Feed Equipment 3-2 Sodium Hydroxide Feed Eauioment 3-3 Hydro Fluosilicic Acid Feed Eouioment 3-4 Start Uo 3-5 Submittal Documents C SCHEDULED V ALUE 28 ,000.00 5 ,000 .00 8,000.00 1 200.00 1,800 .00 13 ,900.00 26,000 .00 25 000 .00 30,250.00 26,650 .00 13 ,270.00 2 ,000 .00 2 ,389 .00 13,350.00 26 000 .00 14 000 .00 7 ,1 00.00 9 600.00 17 ,600.00 39,600.00 600.00 2 ,500.00 4 ,500 .00 93,000.00 55,800 .00 37,200.00 8 ,000.00 5,000 .00 A/A DOCUMENT G 703 Lega cy Co ntracti ng LP Rolling Hills WTP D E WORK COMPLETED FROM PREVIOUS THIS PERIOD APPLICATI ONS 28 ,000 .00 0.00 5 000 .00 0.00 8 000.00 0 .00 1 200 .00 0.00 1,800 .00 0 .00 13 ,900 .00 0.00 26 ,000 .00 0 .00 25,000 .00 0 .00 30,250 .00 0.00 26 ,650 .00 0 .00 13 ,270 .00 0 .00 2,000.00 0 .00 2,389.00 0 .00 13 ,350.00 0 .00 26,000 .00 0 .00 14,000 .00 0.00 7,100 .00 0 .00 9,600.00 0 .00 17,600 .00 0 .00 39 ,600.00 0.00 600 .00 0 .00 2 ,500 .00 0 .00 4,500 .00 93,000 .00 0 .00 55,800.00 0 .00 37 ,200.00 0 .00 8,000 .00 0.00 5,000.00 0 .00 F PRESE NTI.Y STORED (NOT IN D OR El 0 .00 0.00 0 .00 0 .00 0 .00 0 .00 0.00 0.00 0 .00 0 .00 0 .00 0 .00 0 .00 0.00 0 .00 0 .00 0.00 0 .00 0.00 0.00 0.00 0 .00 0.00 0 .00 0.00 0 .00 APPLICATION NUMBER: Final APPLICATION DATE: 12/03/1 5 PERIOD FROM: 08/25/13 SUBCONTRACT NO: G TOTAL 'I<, COMPLETED (G/C) AND STORE D 28 ,000 .00 100% 5,000 .00 100% 8,000.00 100% 1 ,200.00 100% 1,800.00 100% 13,900.00 100% 26,000.00 100% 25,000.00 100% 30 ,250.00 100% 26 ,650.00 100% 13 ,270.00 100% 2,000.00 100% 2,389 .00 100% 13,350.00 100% 26,000 .00 100% 14,000 .00 100% 7 ,100 .00 100% 9,600 .00 100% 17,600 .00 100% 39 ,600 .00 100% 600.00 100% 2 ,500.00 100% 4 ,500.00 100% 93 000 .00 100% 55 ,800 .00 100% 37,200.00 100% 8 ,000 .00 100% 5 ,000 .00 100% H I BALANCE VAL UE OF TO FINISH WORK THIS (C -GJ ESTIMATE 0.00 0.00 0.00 0.00 0 .00 0.00 0 .00 0.00 0 .00 0.00 0 .00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0 .00 0.00 0 .00 0.00 0.00 0.00 0.00 0.00 0 .00 0.00 0 .00 0.00 0 .00 0.00 0 .00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0 .00 0.00 0.00 0.00 0.00 4 ,500 .00 0.00 4,500.00 0.00 0.00 0.00 0.00 0.00 0.00 0 .00 0.00 0.00 0.00 CONTINUATION SHEET AIA Oocumctnt G702. APPLICATKJN ANO CERTIFICATE FOR PAYMENT, c:o ntatnlng Contractots signed Certmcauon fs attached. In tab ul allons below, amounts are 1taled to lhe nearest doRar . Uso Column I on Contracts where var1ablo retain age for llna Item a may apply. A a ITEM DESCRIPTION OF WORK NO . 3-6 O &M Manuals Bid Item #3 Subtotal 81-4 Bid Item #4 Polymer Feed EQuipment 4-1 Submittals 4-2 Eauiornent Deliverv 4 -3 Operation & Maintenance Manuals 4-4 Testino 4-5 Start-Uo 4-6 Trainino Bid Item #4 Subtotal Bl-5 Bid Item #5 FRP Tanks 5-1 Subrnittals 5-3 CPTK-01 5-4 CPTK-02 5-5 SHTK-01 5-6 SHTK-02 5-7 FETK-01 5-8 FETK-02 5-9 FETK-03 5-10 FETK-04 5-11 FETK-05 5-12 FETK-06 5-13 FETK-07 5-14 FETK-08 5-15 Freight 81-6 Bid Item #6 HVAC Furnish & Install HVAC 6-1 A/C Unit 6-2 Fans 6-3 Heaters 6-4 Grilles 6-5 Ductwork 6-6 Hardware 6-7 Controls 6-8 Filter Modules 6-9 Labor 6-10 Startuoff&B C SCHEDULED VALUE 1,000.00 22,000.00 162 000.00 10,000.00 2 ,000.00 2,000 .00 2,000 .00 72,250.00 33,500.00 33,500 .00 35,125.00 35,125.00 31 000.00 31 ,000.00 31,000.00 31,000 .00 31 ,000.00 31 000 .00 31,000.00 31 ,000.00 22,500 .00 10 240.00 32,900.00 11 ,350.00 1 590.00 14,560.00 2,050.00 3 ,200.00 11,175.00 14,350.00 2,100.00 AJA DOCUMENT G703 Legacy Contracting LP Rolling HIiis WTP D I E WORK COMPLETED FROM PREVIOU S THIS PERIOD APPt.lCATIONS 1,000 .00 0.00 22,000 .00 0 .00 162,000.00 0.00 10,000.00 0 .00 2,000 .00 0 .00 2,000 .00 0 .00 2,000 .00 72,250.00 0 .00 33,500 .00 0 .00 33,500.00 0 .00 35,125.00 0 .00 35,125.00 0 .00 31,000.00 0 .0 0 31,000 .00 0.00 31,000.00 0.00 31 ,000 .00 0 .00 31 ,000 .00 0 .00 31 000 .00 0 .00 31,000.00 0 .00 31,000.00 0 .00 22,500.00 0.00 10,240.00 0 .00 32,900.00 0.00 11 ,350 .00 0 .00 1,590.00 0 .00 14,560.00 0 .00 2,050.00 0 .00 3,200 .00 0 .00 11,175 .00 0.00 14 ,350 .00 0.00 2 100.00 0 .00 F PRESENTLY STORED INOT IN D OR El 0.00 0.00 0 .00 0 .00 0 .00 0 .00 0 .00 0.00 0 .00 0 .00 0 .00 0 .00 0 .00 0 .00 0 .00 0 .00 0 .00 0 .00 0 .00 0.00 0 .00 0.00 0 .00 0 .00 0 .00 0 .00 0.00 0.00 0 .00 0.00 0 .00 APPLICATION NUMBER; Flmlf APPLICATION DATE : 12/03/15 PERIOD FROM: 08/25113 SUBCONTRACT NO : G TOTAL % COMPt.ETED (G/C) AND STORED 1,000.00 100% 22,000 .00 100% 162,000.00 100% 10 000.00 100% 2 ,000 .00 100% 2,000.00 100% 2,000.00 100% 72,250.00 100% 33,500.00 100% 33,500 .00 100% 35,125.00 100% 35,125.00 100% 31,000.00 100% 31,000.00 100% 31 000.00 100% 31,000.00 100% 31 ,000 .00 100% 31,000.00 100% 31 000.00 100% 31,000 .00 100% 22,500 .00 100% 10,240.00 100% 32,900 .00 100% 11 ,350.00 100% 1,590.00 100% 14,560.00 100% 2,050.00 100% 3,200.00 100% 11,175.00 100% 14,350.00 100% 2,100.00 100% H I BALANCE VALUE OF TO FINISH WORK TH IS !C ·GI ESTIMATE 0.00 0 .00 0.00 0.00 0 .00 0.00 0 .00 0 .00 0.00 0 .00 0.00 0 .00 0 .00 0.00 0.00 0.00 0.00 0.00 0 .00 0.00 0 .00 0.00 0 .00 0.00 0.00 0 .00 0.00 0.00 0.00 0.00 0.00 0.00 0 .00 0.00 0 .00 0.00 0 .00 0 .00 0.00 0.00 0.00 0 .00 0 .00 0.00 0.00 0.00 0.00 0.00 0 .00 0.00 0.00 0.00 0 .00 0 .00 0.00 0.00 0.00 0.00 0 .00 0 .00 0 .00 0.00 0 .00 0 .00 0.00 0 .00 0.00 0.00 ·---.. -··-···--.. -........ ·-···-·····--·---------- CONTINUATION SHEET AIA Document G702, APPLICATION ANO CERTIFICATE FOR PAYMENT . containing Contractor's slgned Certlflcallon 1, attached . In tabulat lons below, amounts are stated to the nearest dol!ar. Use Colu mn I on Conlracts where varlable retalnage for line Items may apply. A 8 ITEM DESCRIPTION OF WORK NO . 6 -11 Miscellaneous 6-12 T estina & Balancina 6-13 Rentals 6-14 Demo 6-15 Supervision 6-16 Refr Lines Bid Item #6 Subtotal Bl-7 Bid Item #7 Electrical and l&C 7-1 Mobilization Site Communication 7-2 Excavation 7-3 Backlill/Comoaction 7-4 Raceways 7-5 Sand encasement 7-6 Coring 7-7 Enclosures 7-8 Wiring Chemical Buildina 7-9 Demolilion 7-10 Gear 7-11 Fixtures 7-12 Conduit 7-13 Supports 7-14 Enclosures 7-15 Devices 7-16 Wirina 7-17 Terminations 7-18 Testin!'.I 7-19 Fire Alarm Chemical Storaae 7-20 Excavation 7-21 Backlill/Comoact 7-22 Sand encasement 7-23 Fixtures 7-24 Conduit 7-25 Supports 7-26 Endosures C SCHEDULED VALUE 2 850 .00 3 ,000.00 2 ,050 .00 4,935 .00 2,300.00 1,350.00 17 ,700 .00 28 ,250 .00 28,250 .00 22 ,600 .00 8,475 .00 3 ,955 .00 2 ,825.00 10 ,735.00 33,900.00 158,200 .00 27,685 .00 124 ,300 .00 39,550.00 50 ,850.00 8 475 .00 96 ,050 .00 8,475.00 8,475 .00 16,950.00 3,955 .00 3 955 .00 1,695.00 16 950.00 96,050 .00 28,250.00 16,950.00 A/A DOCUMENT G703 Legacy Contracting LP Rolling HIiis WTP D I E WORK CO MPLETED FROM PREVIOUS THIS PER IOD APPLICATIONS 2,850.00 0 .00 3,000 .00 2,050 .00 0 .00 4 ,935 .00 0.00 2 ,300.00 0 .00 1,350 .00 0.00 17 ,700 .00 0.00 28 ,250 .00 0 .00 28 ,250 .00 0.00 22 ,600.00 0 .00 8 475 .00 0 .00 3,955 .00 0.00 2,825 .00 0 .00 10 ,735.00 0.00 33 ,900.00 0.00 158,200.00 0.00 27 ,685 .00 0.00 124 ,300 .00 0 .00 39,550 .00 0.00 50 850 .00 0.00 8 ,475 .00 0 .00 96,050 .00 0 .00 8,475.00 0 .00 8,475 .00 0 .00 16,950.00 0 .00 3 ,955.00 0 .00 3,955 .00 0 .00 1,695.00 0.00 16,950.00 96,050 .00 0 .00 28 250 .00 0 .00 16 ,950.00 0 .00 F PRESENTLY STORED !N OT IN D OR El 0 .00 0 .00 0 .00 0 .00 0 .00 0 .00 0 .00 0 .00 0 .00 0 .00 0.00 0 .00 0.00 0.00 0.00 0 .00 0.00 0 .00 0 .00 0 .00 0.00 0 .00 0 .00 0.00 0 .00 0 .00 0.00 0.00 0 .00 0 .00 0 .00 0 .00 APPLICATION MJMBER : Final APP LICATION CATE: 12/03/15 PERIOD FROM: 06/25/1 3 SUBCONTRACT NO : G TOTAL % COMP LETED (G/C) AND STORED 2 ,850 .00 100% 3 ,000 .00 100% 2 050 .00 100% 4 ,935.00 100% 2,300.00 100% 1,350.00 100% 17,700 .00 100% 28 ,250 .00 100% 28 ,250 .00 100% 22,600 .00 100% 8,475 .00 100% 3,955 .00 100% 2,825 .00 100% 10 735.00 100% 33,900.00 100% 158,200 .00 100% 27,685.00 100% 124,300.00 100% 39,550.00 100% 50 ,850.00 100% 8,475.00 100% 96,050.00 100% 8,475 .00 100% 8,475 .00 100% 16,950.00 100% 3,955 .00 100% 3,955 .00 100% 1,695 .00 100% 16 ,950 .00 100% 96 ,050.00 100% 28,250 .00 100% 16,950.00 100% l H I BALANCE VALUE OF T.OFIN!SH WORK THIS IC -GI ESTIMATE 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0 .00 0.00 0.00 0.00 0 .00 0.00 0.00 0.00 0 .00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0 .00 0.00 0.00 0.00 0 .00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0 .00 0.00 0 .00 0.00 0.00 0.00 0.00 0 .00 0.00 0 .00 0.00 0 .00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 CONTINUATION SHEET AIA Document G702 , APPllCATION ANO CERTIFICATE FOR PAYMENT , containing contractor's signed Certtncat ron Is atlached . In tabulatlons below . amoonls are stated lo the nearest dollar. Use Column I on Cont ra cts where vartable retalnage for Une Items may apply . A B ITEM DESCR IPTI ON OF WORK NO. 7-27 Devices 7-28 Wirino 7-29 Terminations 7-30 Testino Chemical Feed Buildina 7-31 Gear 7-32 Fixtures 7-33 Conduit 7-34 Supports 7-35 Enclosures 7-36 Devices 7-37 Wirinq 7-38 Terminations 7-39 Testinq Clarifiers 1 1 A 2 2A 7-40 Gear 7-41 Conduit 7-42 Supports 7-43 Enclosures 7-44 Devices 7-45 Wiring 7-46 Terminations 7-47 Testing Clarifiers 3 3A 4 4A 7-48 Gear 7-49 Conduit 7-50 Suooorts 7-51 Enclosures 7-52 Devices 7-53 Wirina 7-54 Terminations 7-55 Testinq North Sludae Vault 7-56 Conduit 7-57 Supoorts C SCHEDULED VALU E 8,475 .00 49,720.00 5,650 .00 5,650.00 8,475.00 14,125.00 67,800.00 16,950.00 16,950.00 8 ,475 .00 22 600.00 5,650 .00 5,650 .00 22,600 .00 63 ,562.50 28 ,250.00 11,300.00 8,475 .00 39,550 .00 5 ,650.00 5 ,650 .00 22,600 .00 63,562 .50 28,250 .00 11,300.00 8,475 .00 39,550 .00 5 650 .00 5,650.00 15,255 .00 6 ,780.00 A/A DOCUMENT G703 Legacy Contracting LP Rolling HIiis WTP D I E WORK COMPLETED FROM PREVIOU S THIS PER IOD AP PLI CATIONS 8,475.00 0 .00 49,720 .00 0 .00 5,650.00 0.00 5650.00 0.00 8,475 .00 0.00 14125.00 0.00 67,800 .00 0 .00 16,950.00 0.00 16,950.00 0.00 8,475 .00 0.00 22,600 .00 0.00 5,650 .00 0 .00 5,650.00 0 .00 22 600 .00 0.00 63,562.50 0.00 28,250.00 0.00 11 ,300.00 0.00 8 ,475 .00 0 .00 39,550.00 0 .00 5,650 .00 0 .00 5,650.00 0 .00 22,600.00 0 .00 63,562 .50 0 .00 28 250 .00 0 .00 11,300.00 0 .00 8,475.00 0 .00 39,550.00 0 .00 5,650.00 0 .00 5,650.00 0 .00 15,255.00 0 .00 6,780 .00 0.00 F PRESENTLY STORED (NOT IN D OR El 0.00 0 .00 0 .00 0 .00 0.00 0 .00 0 .00 0 .00 0 .00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0 .00 0 .00 0.00 0 .00 0 .00 0 .00 0 .00 0.00 0.00 0 .00 0.00 0 .00 0 .00 ------------------------------------·-------------- APPLICATION NUMBER: Final APPLIC ATION DATE : 12/03115 PERICO FROM : 06125/13 SU BCONTRACT NO : G TOTAL % COMPLETED (G /C) ANO STDREO 8 ,475 .00 100% 49,720 .00 100% 5,650 .00 100% 5,650 .00 100% 8,475.00 100% 14,125.00 100% 67,800.00 100% 16,950.00 100% 16,950.00 100% 8,475 .00 100% 22,600 .00 100% 5,650.00 100% 5,650 .00 100% 22 600 .00 100% 63,562 .50 100% 28,250.00 100% 11 ,300 .00 100% 8 ,475.00 100% 39,550.00 100% 5,650.00 100% 5,650.00 100% 22,600.00 100% 63,562.50 100% 28 ,250 .00 100% 11,300.00 100% 8,475 .00 100% 39,550 .00 100% 5,650.00 100% 5,650 .00 100% 15,255.00 100% 6 ,780 .00 100% l H I BALANCE VALUE OF TOFlNISH WORK THI S IC -G) ESTIMA'Tc 0.00 0.00 0.00 0.00 0 .00 0.00 0 .00 0.00 0 .00 0.00 0 .00 0.00 0 .00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0 .00 0.00 0 .00 0.00 0.00 0.00 0.00 0.00 0 .00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0 .00 0.00 0 .00 0.00 0 .00 0.00 0 .00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0 .00 0.00 CONTINUATION SHEET AIA Dooumtnt G702, APPUC M ION ANO CElltlFiCIITE FOR PAYMENT. eonteinlrlg ConlrtelOl'1 1io,,td Ctrtlneatlon l1 lff1chtd. In t11Hitltj on1 btlow, _., ,,. 1tlltd 14 u,, nH111t dolt.,, UH Cotl#M t on Contf1Ci1 wtltft v1~11M, retltnltf for lint Item• may •Pl'fv. A 8 lflM OMICIII PTION OF WORK NO. 7-58 Enclo1urea 7.59 Winna 7-60 Terminations 7-81 Testlna ! g .,w IA/alar \la, ill 7•62 Oema 7-63 Wlrfna 7.64 Termination 7-65 Tesllna Prlmt Control, lnAll'I. 7-66 Submlttal/Oe alan 7-67 Ultrasonic Level Transmffters 7-68 Float Level switch 7-69 Pressure Gauae 7-70 PressureNacuum Switch I l=IAld !:lan,I""'• 7-71 Network Switch 7-72 Fiber Colle & Network Cable UPS 7.73 Eaton Ferruos Pl r. & P•nal Producta 7.74 PLC -24 7.75 RTU/PLC •9 7-76 RTU/PLC-10 7.77 PLC -A 7-78 PLC -8 7.79 PLC-24 7-80 Control Panels 7-81 O&M'a 7-82 Tralnlna Bid Item #7 Subtotal Bl-8 Bid Item #8 HSQ Technoloav Allowance C SCHBlUI.ED VNJJE 6,780.00 8475.00 1130.00 1,130.00 2825.00 12430.00 847.50 847.50 41 810.00 40680.00 3 955.00 6215.00 5650.00 14,690.00 36160.00 16 950.00 84 750.00 12 204.00 12 204.00 20 340.00 20 340.00 18 080.00 72 772.00 11 300.00 5650.00 AIA DOCUfENT 6703 Legacy Conlracmg LP Rolling Has WTP D I E -COIIFlETEO F-PREVIOUS THISPERIOO N'PI.ICATIOHS 6 780.00 0 .00 8,475.00 0 .00 1130.00 0.00 1,130.00 0.00 2 825.00 0.00 12430.00 0.00 847.50 0 .00 847 .50 0.00 41,810.00 0.00 40,680.00 0.00 3,955.00 0.00 6215.00 0.00 5,650.00 0 .00 14690.00 0 .00 36160.00 0 .00 16,950.00 0 .00 84,750.00 0 .00 12.204.00 0 .00 12204.00 0 .00 20340.00 0 .00 20 340.00 0.00 18,060.00 0 .00 12m.oo 0 .00 10,325.00 975.00 5650.00 0 .00 F PRESEHTLY STORED _,,. IND OR El 0 .00 0.00 0.00 0 .00 0 .00 0.00 0.00 0 .00 0 .00 0.00 0 .00 0.00 0.00 0.00 0.00 0.00 0 .00 0.00 0.00 0.00 0.00 0 .00 0 .00 0 .00 0 .00 APPLICATION,.._, Anal APPU:ATION Cl.A.TE: 12'0311 5 PERKX>FROM: 08125113 SUBCONTRACT NO: G TOTAL 'Mo COloFlETEO (G/C) AHO STORED 6,780.00 100% 8,475.00 100% 1130.00 100% 1,130.00 100% 2,825.00 100% 12,430.00 100% 847.50 100% 847.50 100% 41,810.00 100% 40,680.00 100% 3 ,955.00 100% 6,215.00 100% 5,650.00 100% 14,690.00 100% 36,160.00 100% 16 950.00 100% 84,750.00 100% 12 204.00 100% 12,204.00 100% 20 340.00 100% 20,340.00 100% 18,080.00 100% 72,772.00 100% 11,300.00 100% 5,650.00 100% •, H I BAV,NCE VALUE OF TO FINISH WORKTHIS IC -GI ESTIMATE 0.00 0.00 0 .00 0.00 0.00 0.00 0.00 0.00 0 .00 0.00 0 .00 0.00 0 .00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 975 .00 0.00 0.00 0.00 975.00 CONTINUATION SHEET AIA Dowlllill10102, APPLICA1ION ~ CIIITl,tC At l '°" PAYMIHT, COfll""'"'G In IIIMliltlOfll Ml<IW, llfflOIHltl lrl ltlll<l to 1111 ntMff4 dollll , UH Column I on C-• ...,.,. y-rolllnlfl ,., ""'"""' "11\1 oppfy, .. B ll~M Dt!1CAIP1'ION Of' WORK NO , 8-1 Proiect Plan Submittal 8-2 Ooerator Interface Submittal 8-3 Process Control Strateav Submittal 8-4 O&M Manual Submittal 8-5 Work in Proaress Prior to UFT (Monthl 8-6 Comoletion of Unwitnessed Factory Te 8-7 Comolelion of Svstem lntearalion Test 8-8 Comolelion of Witnessed F actorv Test 8-9 Comoletlon of Ooerational Readlnas T 8-1 0 Comoletion of Functional DemonstratJc 8-11 HSQ Trainina 8-12 Deliverv of Flnal O&M Manuals 8-13 Comoletlon of Site Acceotance Test l5 Bid Item #8 Subtotal co CHANGE ORDERS C0-01 PCM 01 CMR 01 028 038 & 048 CO Subtotal DED01 neaotiated deduct chemicals Bid Item #8 Subtotal GRAND TOTALS e l!ICHEllUlED VM.UE 12 570 .00 12,570.00 12 570.00 12 570 .00 50,279 .00 12,570.00 12570.00 25139.00 25139.00 25139.00 12 570.00 25139.00 12 570 .00 16 361 .00 -24 875.00 4,057,381.00 AIA DOCUMENT G703 Legacy Coneracting LP Roang ... WTP D I E -~ FACM PAl,ViOUII THISPEAIOO N'PUCA- 12,570.00 0.00 12,570.00 0.00 12 ,570.00 0.00 12 570.00 0.00 50,279.00 0.00 12 ,570.00 0.00 12.570.00 0.00 25.139.00 0.00 25,139.00 0.00 25.139.00 0.00 12,570.00 0.00 25.139.00 12 570.00 0.00 16,361.00 0.00 -24 875.00 4,076.781.00 -19.AOO.OO F PRE.Saffi.Y ST011£D INClT II D 0A El 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ·o.oo APPLICATION NUMBER : Finl! APPUCATtoN DATE: 12'D311S PERIOD FROM: 08/25/13 SUBCONTRACT NO: G TOTAL .. COMPLETED (G/C) MDSTOAEO 12,570.00 100% 12,570 .00 100% 12,570.00 100% 12,570.00 100% 50,279.00 100% 12,570.00 100% 12 570.00 100% 25,139.00 100% 25,139 .00 100% 25.139.00 100% 12,570.00 100% 25139.00 100% 12,570.00 100% 16 361 .00 100% -24,875.00 4057 381.00 0% H BAl»ICE TO FINISH (C .Gl 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 I VAL~Of' WOAKTHIS ESTIMATE 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 l I, MINORITY AND WOMEN BUSINESS ENTERPRISE PARTICIPATION MONTHL V REPORT FORM * TOTAL PAYMENTS RECEIVED FROM CITY TO-DATE: $_3,954,4n.57 ____________ CONTRACT OR P .O . No. _4_2_3_6_1 ---------- PRIME COMPANY NAME LEGACY CONTRACTING, LP NOTICETOPROCEEODATE 10/21/2012 DATESFORTHISREPORT:FROM 06,14 To 12,15 CONTRACT NAME ROLLING HILLS WTP PHASE 5 CHEMICAL FACILITIES IMPROVEMENTS LAST PAYMENT RECEIPT DATE FROM CITY 12 /12 /13 -------- ORIGINAL CONTRACT AMOUNT CHANGE ORDER/AMENDMENTS AoomoNs OR REVISED CONTRACT AMOUNT % OF PROJECT COMPLETED DELETIONS *PROVIDE EXPUHATION FOR AOOITION!l/oe.E Chg/Amend. #_1_ $16,361.00 100 % $4,065,895.00 Chg/Amend.# $ $4,082,256.00 Do not use 100':', unless a F,nal Summarv Rennn Is atlached. NAME OF M/WBE FIRM(S)** i SCOPE OF WORK PERFORMED BY MlwBE ORIGINAL MWBE DOLLAR AMOUNT PAID TO MIWBE %OF WORK NAME OF NON•MWBE SUBCONTRACTOR FOR ! CONTRACT INVOICED TO COMPLETED ALL TIERS BELOW THE 1" TIER*** AMouNr AMOUNT PAID DATE PAID TO DATE THIS MONTH • MMG Building 1 Portable Toilet Rental 851 .33 0 1,806.42 1,806.42 100 • Cowtown Aedi Mix 1 Concrete Suoolier 20,235.00 0 22,843.25 22,843.25 100 • Eaale Aooreaate Transoortatio 1 Hauling Services 251 .70 0 6,559.15 6,559.15 100 • LKT & Ass ociate s LLC 1 Pipe, Pipe Fittings, Etc 141,780.00 0 149882.25 149753.57 100 • Garland Heatina & A/C 1 H.V.A.C . Services 105,000.00 0 105000.00 65,030.32 100 • Buyers Barricades 1 Sions 395.11 0 395.11 395.11 100 • Fralre's Rebar, Inc 1 Concrete Reinforcement 2,730.00 0 1,920.06 1,920.06 100 • Duran Industries 2 Electrical and Wiring Suoolies 340,915.34 0 169468.92 169468.92 100 • Clemons Truckina Co . 1 Haulino Services 3 ,075.50 0 1,356.75 1,356.75 100 An explanation is required when MWBE(s) has not been engaged in the contract to date or when there is no M/WBE activity this month 'El< I In how •a rov d" additlon s/deietlon & will affect our orl nal MWBE utilization use additional sheets as necessa LEGACY HAS NOT HAD ANY CONSTRUCTION ACTIVITY AT JOBSITE SINCE JULY 2013. PRINT NAME TITLE DATE Sharon TIiiery Project Mgmt Admin 12/3/2015 *SUBMIT THE FIRST COMPLETED MONTHLY REPORT AFTER THE FIRST PAYMENT AND BEGINNftG WfTH TffE SECOND APPLICATION FOR PAYMENT, INCLUDING PROOF OF PAYMENT DOCUMENTATION 0 You ARE REQUIRED TO IDENTIFY THE NAME OF THE NON-MlwBE SUBCONTRACTOR WHEN THE M/WBE LISTED IS OTHER THAN 1 ST TIER REV. 5119/03 •. Phone: 940-626-1415 Legacy Contracting, LP dba CON'mOL SPEC1ALIST Services LP. PO Box 1479 * 4916 E Hwy 380 Decatur, TX 76234 FAX: 940-626-1486 CONDITIONAL WAIVER AND RELEASE ON FINAL PAYMENT Project : City of Fort Worth . Rolling Hills Water Treatment Plant Phase 5 Job No . 11-1018 Via Emai l: farida .goderya@fortworthgov .org On receipt by the signer of this document of a check from.City of Fort Worth (maker of check) in the sum of S102.903.43 payable to Legacy Contracting, LP (payee or payees of check) and when the check has been properly endorsed and has been pa id by the bank on wh ich it is drawn , this document becomes effect ive to release any mechanic's lien right , any right arising from a payment bond that complies with a state or federal statute , any common law payment bond right any claim for payment , and any rights under any similar ordinance , rule , or statute related to claim or payment rights for persons in the signer's position that the signer has on the property of City of Fort Worth (owner) located at 2500 SE Loop 820. Fort Worth , TX 76140 (location) to the following exten t: Rolling Hills wrP Phase 5 Uob description). Th is release covers flnal payment fo r all labor, services , equipment , or materials furnished to the property or to City of Fort Worth (person with whom signer contracted). Before any recipient of this document relies on th is document. th e re ci pient sho uld ve rify evidence of payment to the signer . The si gne r wa rra nts th at the signer has alrea dy pa id or wm use the funds re cei ved from flnai payment to promptly pay In full all of th e si gne r's laborers , subcontracto rs, mate ri almen, and suppliers fo r all work , materials , equ ipment, or services provi ded for or to the above referenced project up to the date of th is wa iver and re lease . oate ])ec..e re: t :3 , a.c tf:J , o.'':' ') 1 '}c tr, My Com mission Expires: -3Z:!.P' lo-~ 7 . ' ' CONSENT OF SURETY TO OWNER/ OBLIGEE: SUBCONTRACTOR/ PRINCIPAL: City offort Worth Legacy Contracting, LP 2500 SE Looo 820, Fort Worth , TX 76140 4916 E Hwv 380 , Decatur, TX 76234 PROJECT: BOND NUMBER: RollinR Hills Water Treatment Plant Phase 5 TXIFSU0540218 In accordance with the request of the referenced Owner/Obligee and Subcontractor/Principal , International Fidelity Insurance Company, as Surety under the bond above referenced hereby approves and consents to the release of the following payment under the terms and conditions noted below : Owner/Obligee shall remit all funds that would be otherwise payable to Legacy Contracting, LP under Subcontractor/Principal Payment Requisition Number (Final), in the amount as detailed below, such payment shall be made in the name of and payab le to Legacy Contracting, L.P . dba Control Specialist Services, L.P. Payee Amo unt Legacy Contracting, L.P. dba Control Specialist Services, L.P. $102,903.43 Payments via check should be sent in accordance with the mailing directions listed below with instructions that they are for deposit to Account No .: 7877943691 . Payments via wire transfer shou ld be direct ed in accordance with the wiring instructions listed below. Mamna Directions; Wells Fargo, N.A. Moorestown Main Financi al Center 91 East Main Street Moorestown , NJ 08057 Wire Instructions: Wells Fargo N.A. Account No.: 7877943691 Incoming Wire ABA No.: 121000248 ACH ABA No .: 021200025 Ac count Name: Legacy Contracti ng. LP. clba Control Specialist Services, L.P. International Fidelity Insurance Company agrees th at this payment by the Owner / Obligcc shall not otherwise relive the Surety ofany obligations set forth in said Surety's bond it being further understood th at this Consent of Surety is issued under a full and compl ete reserv ation ofall rights, claims and defenses available to International Fidelity Insurance Company whether at law or in equity and that this reservation of rights shall remain in full force and effect unless expressly waived by us, in writing. IN WITNESS WHEEOF, the Surety has hCR:unto set its hand on this date : December 3, 2015 Bryan A Badeaux. Claims Counsel (Printed Title N ame and Tille)