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Home My WebLink AboutContract 58567-FP1.FORT WORTHo '"o TRANSPORTATION AND PUBLIC WORKS NOTICE OF PROJECT COMPLETION -FP1 City Secretary No. 58567 Date Received: 2/23/2024 City Project JV!?: 104176 Regarding contract 58567 Concrete Restoration Contract 1 at Various Locations for as required by the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by City Council on 11/29/2022 through M&C 22-1000 the director of the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT upon the recommendation of the Assistant Director of the Transportation & Public Works Department has accepted the project as complete. Original Contract Amount: 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: $1,375,745.00 Days 180 $ 12,000.00 Ns 1 Days Added by CO 131 $ 1,387,745.00 Total Days 311 $ 965, 341.34 Days Charged 311 Days @ $ / Day $ 965, 341.34 $ 917,074.27 Final Payment Due $ 48,267.07 /— Feb 23, 2024 Pattia L. Wadsack (Feb 23, 202413:27 CST) Recommended for Acceptance Date Asst. Director, TPW - Capital Delivery Lauren rieur (Feb 23, 202413:29 CST) Feb 23, 2024 Accepted Date Director, TRANSPORTATION AND PUBLIC WORKS DEPARTMENT �o — — _— — .b 23.2024 Asst. City Manager Date Comments: OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX C-620 Signature Page Contractor's Application for Payment Invoice No. 11 Final To (Owner) City of Fort Worth Invoicing Period (From - To): Invoice Date: 01/01/2024-01/31/2024 2/20/2024 P. O. FW020-0000009029 From (Contractor): Remit to ( If Not Automatic Deposit): Number: Makou, Inc. Project: 104176 Contractor's CFW Vendor No.: 700000265 City secretary Contract 58567 Contract 2023 Concrete Res Contract 1 Number: Name: me: Application For Payment Change Order Summary (Approved Change Orders 11. ORIGINAL CONTRACT PRICE.......................................................... $ $1,375,745.00 Number Additions Deletions 12. Net change by Change Orders................................................................. $ $12,000.00 1 $12,000.00 13. Current Contract Price (Line 1 t 2)........................................................ $ $1,387,745.00 2 14. TOTAL COMPLETED AND STORED TO DATE 3 I (Progress Estimate, Construction Allowance and Change Orders)....... $ $965,341.34 4 15. RETAINAGE: 5 I a. X $965,341.34 Work Completed.......... $ 6 I b. X Not Used $ 7 I c. Total Retainage (Line 5a + Line 5b)................................ $ 8 16. AMOUNT ELIGIBLE TO DATE (Line 4 - Line 5c)............................. $ $965,341.34 TOTALS $12,000.00 17. LESS PREVIOUS PAYMENTS (Line 6 from prior Application)........, $ $917,074.27 NET CHANGE BY $12,000.00 8. AMOUNT DUE THIS APPLICATION ................................................. �9. $ $48,267.07 CHANGE ORDERS BALANCE TO FINISH, PLUS RETAINAGE (Column G on Progress Estimate+ CA + Cos + Line 5 above) .............. $ $422,403.66 Contractor's Certification 10. CONTRACT TIME: The Contractor certifies with the submittal of this document and associated Payment Request Submittal a. Days Awarded 180 on the City of Fort Worth Buzzsaw system that to the best of their knowledge: (1) all previous progress b, Days Added by CO 131 payments received from Owner on account of Work done under the Contract have been applied on Total Days account to discharge Contractor's legitimate obligations incurred in connection with Work covered by C. 311 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 d Days Charged 3 i 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); e, Days Remaining and (3) all Work covered by this Application for Payment is in accordance with the Contract Documents and is not defective. Liquidated Damages $650.00 x day Consent of Surety add�.�iLG� maqsc6d khan (Feb22,202ai5:02CST) Affidavit of Bills Paid 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. C-620 Unit Price Progress Estimate Progress Estimate Cuy Searelmy CgmnaU Nam: Fm°(eO"tin` . 2023 Concrete Res Contract 1 wpphcano.Prnoa. 01/01/2024-01/31/2024 w Item Specula Umt of Btd Quantity Umt Price Btd Item No. Descnpkon $echo. No. Measure 1 01350201 Remoblicabon 017000 EA 1.000000 $500.00 2 3471,0002 Palable Message San 147113 WK 24.000000 $300.00 9999,0000 Remove and Replace 6" Concrete Dnvevrdy 02 41 13/ 32 13 3 20 BE 1100.000000 $12.00 9999,0000 Remove Concrete and Replace with 7" Concrete Pavement HES 024115/3213 4 13 BY 12145.000000 $91.00 5 3123,0101 Unclassified Excavation 31 23 16 CV 200.000000 $25.00 6 Base, A. GR-2 3�2�111,0�212j24 1211 23 CV 1200.000000 $50.00 7 CFlex TTvoe am�entleoth, i2 2 �3 3V $18$O9:U� 8 3z92:oj8� Bcor)A)a 2UW:U�U�U� 9 3291.0100 Tocsoil 3291 to CV 100.000000 $35.00 10 3213,0700 JointSealant 321313 LF 2000.000000 $4.00 11 3305,0108 Miscellaneous Adiustmenl fUbhbesl 330514 LS 1.000000 $5.000.00 12 9999.0000 Gecond Tensar(TRIA% 140475) a Aooroved equal 999900 SV 5000.000000 $2.50 13 3217.2001 Raised Marker TV W 321723 EA 200.000000 $5.00 14 3217.2002 Raised Marker TV Y 321723 EA 200,000000 $5.00 15 3217.2101 REFL Raisetl Marker TY l-A 321723 EA 100.000000 $5.00 18 3217.2102 REFL Raisetl Marker TYl-C 321723 EA 100.000000 $5.00 17 3217,2103 REFL Raised Marker TY II -A -A 321723 EA 100.000000 $5.00 18 3217,2104 REFL Raised Marker TY II-C-R 321723 EA 100.000000 $5.00 19 3441,1301 LooDDetector Cade Sawcut 344110 LF 600.000000 $12.00 20 3441,130214 AWG L000 Detect Cade 344110 LF 600.000000 $5.00 21 3217,0001 4" Solid Thermmiastic(HAS1 Lane Line 321723 LF 1000.000000 $5.00 22 3217,0201 6" SOIitl Thermoolastic(HASI Lane Line 121123 LF 400.000000 $8.00 23 3217.0301 8" SLD Pvmt Marking HAE 32 17 23 LF 400.000000 $8.00 24 3217.0401 18" SLD Pvmt Markin HAE 32 17 23 LF 400.000000 $10.00 25 3217.0501 24" SLD Pvmt Markma HAE 321723 LF 800.000000 $12.00 3213.0501 Remove In Replace Bamer Free Ramp, Type P-1 02 41 13/ 32 13 26 20 EA 2.000000 $2.500.00 m 3213.0501 Reove andReplace Bamer Free Ramp, Type R-1 02 41 13/ 32 13 27 26 EA 2.000000 $3.000.00 3213.0501 Remove antl Replace Ban er Free Ramp, Type M-1/M-2 02 41 13/ 32 13 28 20 EA 2.000000 $2.500.00 9999.0000 Remove an tl Replace 4" Sidewalk 02 41 13/ 32 13 29 26 BE 450000000 $10.00 30 3305.0106 Manhole Adiustment. Mara 330514 EA 2:000000 $500.00 31 3217.5001 Curb Address Painting 321725 EA 10.000000 $75.00 32 I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I 9999.0096 Paving Construction Allowance EA 1.000000 $50.000.00 58567 Contractor's Application A.ultcaum Number: 11 Final wpphcagon Dam. 2/20/2024 B C D E F Bahmated Quatmty Matuaals Presendy Total Completed Btd Wh c metstlM value Prevtwely Iretalled vane Vome Thta Penh Stored (.or,. C) and Stood to Date (B (p +E) B $500.001 I I $7.200.001 imoo00001 $300,00 $300.001 $300.00 4.2% ED 9418.160000001 68.600000001 1163.690000001 49.290000001 552.090000001 I 1185.050000001 0.93054('001 5214.410000001 2..000000001 89.000000001 86.000000001 271.760(100001 $4.968.81 $857.052.561 $1.715.001 $56.184.501 $8,672.201 $4,968.811 $4.740.201 $4.652.701 $13.036.021 $1.000.001 $445.001 S430.001 $1.358.801 I $336.641 $240.001 $857.052.56 77.5% $1.715.00 34.3% $58.184.50 97.0% $8.872.20 32.9% $4.968.81 27.6% $4.740.20 59.3% $4.652.71Q 93.1% $13.036. 104.3% $1.000.00 100.0% $445.00 44.5% $430.00 86.0% $1.358.80 27.2% $336.64 10.5% $240.00 2.5% $300.00 6.7% G Balance. Fmsh B-F) W. $248.142.441 $3.285.001 $1.815.501 $18.127.801 $13.031.191 $3.500.001 $3.259MO $347.30 -$536.031 $555.001 $70.001 $500.001 $500.001 $500.001 $7.200.001 $3.000.001 $3.641.201 $2.400.001 $2.863.361 $4.000.001 $9.360.001 NO $4.200.001 $1.000.001 $750.001 $50.000.001 I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I This document has been modified fimm its m igirial form as an UCDC document aM the user did m htghhghl the modifications You ere encouraged to read the document carefully aM consult Legal Coureel prior. tb exewhon. C- 20 Unit Pnce Progress Est—te Progress Estimate 2023 Concrete Res Contract 1 wppbcatronPrnoa. 01/01/2024-01/31/2024 I[em end Itcnr No. Descnphm Crty senraary 58567 Contract Nam: A B spectficahoa Umt of Btd Quantity Unrt Price Brd Value Sectron No. Measure Contractor's Application wnW..on Number: 11 Final wpph-1. Date. 2n0/2024 E F G Toml Completed % Balance m F—h Value TM, Penod Matenals Pms c and Stored to Date (F) (B - F) Smred(notm C) (D+E) B Tbis document bas been modified fiom its original form as an E1CDC document and the user did mt htghlrgM dre modificmfione You ere encouraged to read the document carefully v consult Legal Course) prior to rb exavfiom C-620 Unit Pnce Progress Estimate Progress Estimate 2023 Concrete Res Contract 1 wpphcatronPrnoa. 01/01/2024-01/31/2024 Ifm end Itcnr No. Deacnpoon Totals Crty secretary 58567 Contract Nmn: A B specrficahon Umt of Brd Quantity Una Pnce Brd Value Sectron No. Measure $1.375.745.00 Va Contractor's Application wpolmatro. Number: 11 Final wpplmatron Date. 2/20/2024 E F G Total Completed % Balance m Fa—h Materials Presendy Value Thre Period Scored (not m C) and Stored m Dam ((B - F) B (p+E) B $0.00 $957.632.44 69.6% $418.112.571 Tlria document lus been modified fiom its original form as an MCDC document aM the user am not la hlrghl the modificafiona You ere encouraged w read the document carefully aM consult Legal Counsel prior f r exavfion C-620 Change Order Progress Estimate Construction Allowance Usage Contractor's Application ADDITIONS For (...tract) 104176 2023 Conerete Res Contract 1 City Secretary 58567 Application Number 11 Final CoatractNwm IApplicali. Period: 01/01/2024-01/31/2024 Application Data 2/20/2024 A B C D E F Item Balance to Finish Total Completed SpemOoanon Unit of Q.-fig, to Add Estimated Q...tity Unit Price Addition value Previously Value This Materials Presently vale and Stored to Dan. (F) (B - F) Item Number Desenption Section No. Measure Installed Installed Value Period Stored(not in C) (D"E) B Totals This docta lent has been modified from ns original Joan as an E1CDC 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 C-620 Change Order Progress Estimate Construction Allowance Usage Contractor's Application CONSTRUCTION ALLOWANCE ITEMS TO BE REDUCED Fm (coctmc0: 104176 2023 Concrete Res Contract 1 Application Number: 11 Final Application Period: 01/01/2024-01/31/2024 ApplicationDte' 2/20/2024 A B C D E F Item Bid Item Number Description Specification Unit of Quantity to Delete Unit Price Reduction Value Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used Section No. Measure Totals This document has been modified from ns onginal 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 C-620 Change Order Progress Estimate Change Order Number 1 1 ADDITIONS IFm (contrac). 104176 2023 Concrete Rea Contract 1 (Application Period: Item Change Order Item De—ption No I I Miscellaneous Admstments Totals A Contractor's Application City Secretary 58567 Application Number: 1� FID81 Contract Num: 01/01/2024-01/31/2024 Application Date: 2/20/2024 B C D E F Addition Estimated Quantity Previously Value This Materials Presently Total Completed Specification Una of CO Quantity to Add Section No. Measure Unit Price Change Order Value Installed Value Installed Value Period Stored (not to C) and Stored to Date (D I E) (F) B 330514 LS 1.00000000 $12.000.00 $12.000.00 1 $7.708.91 64.2% 0.64240900 $7,708.91 $7,708.91 $0.00 $7.708.91 $7,708.91 $0.00 This document has been modified from its original forts as an E1CDC 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 Balance to Finish (B - F) $4.291.09 S4,291.09 C-620 Change Order Progress Estimate Change Order Number 1 DELETIONS For (contrach: 104176 2023 Concrctc R. Contract 1 Application Number: Applicant°° Period 01 /01 /2024-01 /31 /2024 Apnllcalion Date A B C D E Item CO to Deletion Change Order Item No. p 1ety Descxipnton Specification Unit of Section No. Measure Unit Price Change Order Not Used Value Not Used Nen Used Nen Used Nen Used Totals This document has been modified from as ongnod 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 Contractor's Application 11 Final 2/20/2024 F Not Used Not Used Not Used C-620 Change Order Progress Estimate Change Order Number 1 2 ADDITIONS Contractor's Application IFor (contracl): 104176 2023 Concrete Res Contract 1 City Secretary: 58567 Apphea — Number. 11 Final Contract Num IAppheati. Perod: 01/01/2024-01/31/2024 Apphcanon Date: 2/20/2024 A B C D E F Item Balance m Finish Addition Change Estimated Quantity Previously Value This Materials Presently Total Completed % B (F) Change Order Item Descn tlon No. p Spemfication Umt of CO Quantity to Add Unit Price Order Value Swim No. Measure fsW led Value Installed Value Period Stored (not in C) and Stored to Date (D+E) (P) B Totals 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 careflly and consult Legal Counsel prior to its execution C-620 Change Order Progress Estimate Change Order Number 1 2 DELETIONS For grey 8G1t' 104176 2023 Concrete Res Contract 1 IAppltcation Period: 01/01/2024-01/31/2024 A B C I Item CO Quantity to Deletion Change Change Order item Description Specification Untt of Delete Unit Price Order Value Not Used No. Seaton No. Measure I I I I I Totals Contractor's Application Appheatmn Number. 11 Final Apphcatmn Date: 2/20/2024 D B F Not Used Not Used Not Used Not Used Not Used Not Used Not Used 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 C-620 Change Order Progress Estimate Change Order Number 1 3 Contractor's Application ADDITIONS IFar (contrect): 104176 2023 Concrete Res Contract 1 City Secretary 58567 Application Number: 11 Final Contract Num: (Application Period: 01/01/2024-01/31/2024 Application Date; 2/20/2024 A B C D E F Item Balance to Finish Addition estimated Quantity Previously Value This Materials Presently Total Completed % (B - F) Change Order Item Descn tlon Specification Unit of CO Quantity to Add Unit Price Change Order Installed Valuo lnstalled Value Period Stored (mt in C) and Stored to Date (F) No. p SwimNo. Measure Valne (D+E) B Totals 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 emeflly and consult Legal Comsel prior to its .....firs, C-620 Change Order Progress Estimate Change Order Number 1 3 Contractor's Application DELETIONS For (commc0: 104176 2023 Concrete Res Contract 1 Application Number: 11 Final Application Period: 01/01/2024-01/31/2024 Application Date: 2/20/2024 A B C D E F Item I CO QMto Deter - Change Order Item Deletety Description Specification Unit of Unit Price Change Order Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used No. Section No. Measure Value Totals This document has been modified from its original form as an EJCDC document and the user did not highlight the modifications Yon are encouraged to read the document carefully and consult Legal Counsel prior to its execution C-620 Change Order Progress Estimate Change Order Number 1 4 Contractor's Application ADDITIONS IFm (tramact): 104176 2023 Concrete Res Contract 1 City Secretary 58567 Application Number: 11 Final Contract Num: IApplicaoon Period: 01/01/2024-01/31/2024 Application Date: 2/20/2024 A B C D E F Item Balance to Finish Addition EstimatedQuantity Previously Valueod Materials Presently Total Completed (g_p) Change Order Item Specification Unit of CO Quantity to Add �Gf1pt1O° Unit Price Change Order Installed nsta Value Installed Value Period Stored (not m C) and Stored to Date (F) No Section No Measure Value (D I E) B Totals 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 C-620 Change Order Progress Estimate Change Order Number 1 4 Contractor's Application DELETIONS For (commc0: 104176 2023 Concrete Res Contract 1 Application Number: 11 Final Application Period: 01/01/2024-01/31/2024 Application Date: 2/20/2024 A B C D E F Item I CO QMto Deter - Change Order Item Deletety Description Specification Unit of Unit Price Change Order Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used No. Section No. Measure Value Totals This document has been modified from its original form as an EJCDC document and the user did not highlight the modifications Yon are encouraged to read the document carefully and consult Legal Counsel prior to its execution C-620 Change Order Progress Estimate Change Order Number 1 5 Contractor's Application ADDITIONS IFm (tramact): 104176 2023 Concrete Res Contract 1 City Secretary 58567 Application Number: 11 Final Contract Num: IApplicaoon Period: 01/01/2024-01/31/2024 Application Date: 2/20/2024 A B C D E F Item Balance to Finish Addition EstimatedQuantity Previously Value This Materials Pre sently Total Completed (g_p) Change Order Item Specification Unit of CO Quantity to Add �Gf1pt1O° Unit Price Change Order Installed nsta Value Installed Value Period Stored (not m C) and Stored to Date (F) No Sodium No Measure Value (D I E) B Totals 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 C-620 Change Order Progress Estimate Change Order Number 1 5 Contractor's Application DELETIONS For (comma): 104176 2023 Concrete Res Contract 1 Application Number: 11 Final Application Period: 01/01/2024-01/31/2024 Application Date: 2/20/2024 A B C D E F Item I CO to Deter - Change Order Item Desm Spectfication Umt of �0° Delete Unit Price Change Order Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used No. Seaton No. Measure Value Totals This document has been modified from its original form as an EJCDC document and the user did not highlight the modifications Yon are encouraged to read the document carefully and consult Legal Counsel prior to its execution C-620 Change Order Progress Estimate Change Order Number 1 6 ADDITIONS Contractor's Application IFar (contrect): 104176 2023 Concrete Res Contract 1 City Secretary 58567 Application Number: 11 Final Contract Num: (Application Period: 01/01/2024-01/31/2024 Application Date; 2/20/2024 A B C D E F Item Balance to Finish Addition estimated Quantity Total Completed Previously Value This Materials Presently % (B - F) Change Order Item Descn tlon Specification Unit of CO Quantity to Add Unit Price Change Order Installed Value lnstalled Value Period Stored (mt in C) and Stored to Date (F) No. p Swim No. Measure Valne (D+B) B Totals 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 emeflly and consult Legal Comsel prior to its .....firs, C-620 Change Order Progress Estimate Change Order Number 1 6 Contractor's Application DELETIONS For (commc0: 104176 2023 Concrete Res Contract 1 Application Number: 11 Final Application Period: 01/01/2024-01/31/2024 Application Date: 2/20/2024 A B C D E F Item I CO QMto Deter - Change Order Item Deletety Description Specification Unit of Unit Price Change Order Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used No. Section No. Measure Value Totals This document has been modified from its original form as an EJCDC document and the user did not highlight the modifications Yon are encouraged to read the document carefully and consult Legal Counsel prior to its execution C-620 Change Order Progress Estimate Change Order Number 1 7 ADDITIONS Contractor's Application IFar (rimm ct): 104176 2023 Concrete Res Contract 1 City Secretary 58567 Application Number: 11 Final Contract Num: (Application Period: 01/01/2024-01/31/2024 Application Date; 2/20/2024 A B C D E F Item Balance to Finish Addition estimated Quantity Total Completed Previously Value This Materials Presently % B _ ( F) Change Or d« Item No. Desmptton Spemfic N.. Unit of CO Quandry to Add unit Price change order Seaton No. Measure Valve Installed valve and Stored to Date Installed Valve Period Stored (not in C) (p+B) (F) B Totals 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 .....firs, C-620 Change Order Progress Estimate Change Order Number 1 7 Contractor's Application DELETIONS For (commc0: 104176 2023 Concrete Res Contract 1 Application Number: 11 Final Application Period: 01/01/2024-01/31/2024 Application Date: 2/20/2024 A B C D E F Item I CO QMto Deter - Change Order Item Deletety Description Specification Unit of Unit Price Change Order Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used No. Section No. Measure Value Totals This document has been modified from its original form as an EJCDC document and the user did not highlight the modifications Yon are encouraged to read the document carefully and consult Legal Counsel prior to its execution C-620 Change Order Progress Estimate Change Order Number 1 8 Contractor's Application ADDITIONS IFm (tramact): 104176 2023 Concrete Res Contract 1 City Secretary 58567 Application Number: 11 Final Contract Num: IApplicaoon Period: 01/01/2024-01/31/2024 Application Date: 2/20/2024 A B C D E F Item Balance to Finish Addition EstimatedQuantity Previously Valueod Materials Presently Total Completed (g_p) Change Order Item Specification Unit of CO Quantity to Add �Gf1pt1O° Unit Price Change Order Installed nsta Value Installed Value Period Stored (not m C) and Stored to Date (F) No Section No Measure Value (D I E) B Totals 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 C-620 Change Order Progress Estimate Change Order Number 1 8 Contractor's Application DELETIONS For (commc0: 104176 2023 Concrete Res Contract 1 Application Number: 11 Final Application Period: 01/01/2024-01/31/2024 Application Date: 2/20/2024 A B C D E F Item I CO QMto Deter - Change Order Item Deletety Description Specification Unit of Unit Price Change Order Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used No. Section No. Measure Value Totals This document has been modified from its original form as an EJCDC document and 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 Contract Num: 58567 I 2023 Concrete Res Contract 1 I p. 0.: FW020-0000009029 project Number: 104176 Number: pl Application Period: 01/01/2024-01/31/2024 I Apumbr: I 11 Final Application Date: 2/20/2024 Funding Identification (FID) Total Completed Amt Remaining I Gross Retainage Net I Original Contract 130100-0200431-5740010-104176-E03380-9999 $957,632.44 $418,112.57 $0.00 10 10 10 10 10 10 10 10 10 10 I I Change Order 1 130100-0200431-5740010-104176-E03380-9999 $7,708.91 $4,291.09 ($0.00) 10 10 10 10 10 10 10 10 10 10 I I Change Order 2 130100-0200431-5740010-104176-E03380-9999 10 10 10 10 10 10 10 10 10 10 I $0.00 ($0.00) City Secretary Contract Num: 58567 Application Period: Funding Identification (FID) I Change Order 3 I30100-0200431-5740010-104176-E03380-9999 Io I0 I0 I0 I0 I0 I0 I0 I0 I0 I I Change Order 4 I30100-0200431-5740010-104176-E03380-9999 Io I0 Io I0 Io I0 Io I0 Io I0 I I Change Order 5 I30100-0200431-5740010-104176-E03380-9999 Io I0 Io I0 Io I0 Io I0 Io I0 I City of Fort Worth Summary of Charqes 2023 Concrete Res Contract 1 I P. 0. : O1/01/2024-01/31/2024 I Application Number: Total Completed Amt Remaining FW020-0000009029 11 Final Gross Project Number: 104176 Application Date: 2/20/2024 Retainage Net City Secretary Contract Num: 58567 Application Period: Funding Identification (FID) I Change Order 6 I30100-0200431-5740010-104176-E03380-9999 Io I0 I0 I0 I0 I0 I0 I0 I0 I0 I I Change Order 7 I30100-0200431-5740010-104176-E03380-9999 Io I0 Io I0 Io I0 Io I0 Io I0 I I Change Order 8 I30100-0200431-5740010-104176-E03380-9999 Io I0 Io I0 Io I0 Io I0 Io I0 I City of Fort Worth Summary of Charqes 2023 Concrete Res Contract 1 I P. 0. : O1/01/2024-01/31/2024 I Application Number: Total Completed Amt Remaining FW020-0000009029 11 Final Gross Project Number: 104176 Application Date: 2/20/2024 Retainage Net City of Fort Worth Summary of Charges City Secretary ContractNum: 58567 2023 Concrete Res Contract 1 �p. o.: FW020-0000009029 Project Number: 104176 Application Period: 01/01/2024-01/31/2024 Application 11 Final Application Date: 2/20/2024 Number: Funding Identification (FID) Total Completed Amt Remaining Gross Retainage Net Totals 30100-0200431-5740010-104176-E03380-9999 $965,341.34 $422,403.66 $0.00 $0.00 0 0 0 0 0 0 0 0 0 0 Grand Total $965,341.34 $422,403.66 $0.00 1 ($48,267.07)1 1 $48,267.07 FORT WORTH. Routing and Transmittal Slip Transportation & Public Works Department DOCUMENT TITLE: 2023 Concrete Restoration Contract 1 M&C: N/A Date: 5-2-2023 CPN: 104176 CSO: DOC#: To: Name Department Initials Date Out 1. Valentina Riera TPW - initial May 2, 2023 2. Maqsood Khan Vendor - signature May 2, 2023 3. Russell Rogers TPW - signature`R May 3, 2023 4. Tariqul Islam TPW - signature 7-1 May 2, 2023 5. Omar Elbagalati TPW - signatures May 4, 2023 6. Leon Wilson TPW - initial May 4, 2023 7. Michael Owen TPW - signatures May 4, 2023 8. Lauren Prieur TPW - signature May 4, 2023 9. Doug Black Legal - signature w'' May 9, 2023 10. William Johnson CMO - signature w, May 9, 2023 11. Jannette Goodall CSO - signature 7� May 10, 2023 12. TPW Contracts TPW DOCUMENTS FOR CITY MANAGER'S SIGNATURE: All documents received from any and all City Departments requesting City Manager's signature for approval MUST BE ROUTED TO THE APPROPRIATE ACM for approval first. Once the ACM has signed the routing slip, David will review and take the next steps. NEEDS TO BE NOTARIZED: ❑YES ®No RUSH: ❑YES ®No SAME DAY: ❑YES ❑No NEXT DAY: ❑YES ❑No ROUTING TO CSO: ®YES ❑No Action Required: ❑ As Requested ❑ For Your Information ® Signature/Routing and or Recording ❑ Comment ❑ File ❑ Attach Signature, Initial and Notary Tabs Return To: TPWContractsaFortWorthTexas.2ov at ext. 7233 for pick up when completed. CSC No. 58567-COI Fox_ T� x; Project Namel 2023 Concrete Restoration Contract 1 Client Project #(s)I 104176 Project Description) Contractorl Makou, Inc. City Project Mgr.l Tariqul Islam Dept. Original Contract Amount Extras to Date Credits to Date Pending Change Orders (in M&C Process) Contract Cost to Date Amount of Proposed Change Order Revised Contract Amount Original Funds Available for Change Orders Remaining Funds Available for this CO Additional Funding (if necessary) TPW $1,375,745.00 City of Fort Worth Change Order Request City Sec # I 58567 Remove and replace damage concrete panels at various locations Change Order#I 1 1 Date 5/1/2023 City Inspector Russell Rogers Contract Time Totals (CD) $1,375,745.00 180 CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS % OF ORIGINAL CONTRACT 0.87% MAX ALLOWABLE CONTRACT AMOUNT (ORIGINAL CONTRACT COST+ 15%) $1,719,681.25 JUSTIFICATION (REASONS) FOR CHANGE ORDER This change order is to add $12,000 to contract # 58567. During construction it was identified that commercial properties on FAA Blvd and Campus Dr has a lot of sprinkler systems that exist on both sides of the street. For replacing damage concrete panels for these two streets, sprinkler system at many places were damaged and need to be replaced. The cost for the sprinkler system replacement is payable per actual cost invoiced by the licensed plumber plus ten percent overhead for the contractor. The contract has $5,000.00 for this scope of work but this amount is not adequate to cover the actual cost. It is proposed to add $12,000.00 to cover additional cost for this scope of work. It is understood and agreed that the acceptance of this Change Order by the contractor constitutes an accord and satisfaction and represents payment in full (both time and money) for all costs arising out of, or incidental to, the above Change Order. The Project/Program Manager signing below acknowledges that he/she is the person responsible for the monitoring and administration of this contract. including ensuring all performance and reporting reauirements. Contractor's Company Name Contractor (Name) Contract Signature ID Makou, Inc. Magsood Khan o oK na�Ma�,.zoz3�ss�o May 2 2023 spector/Inspection Supervisor Date Project and Contract Compliance Manager wow„ Ma or May 3, 2023 o, May 2, 2023 c� Date May4,2023 Senior C ct Officer w��-� Date May 4,2023 sistant Director (Dept) Date Director, Contracting Department (Dept) Date <p"-- May 4, 2023 May 4, 2023 Assistant City Attorney Date IASSistant City Manager Date (• May 9, 2023 m,on.o M 9, 3.asa o. May 9, 2023 Council Ai M&C Number I ATTEST: (—A may.. Jannette Goodall, City Secretary M&C Date Approved FORT WORTH City of Fort Worth �'*`--- Change Order Additions Project Name 1 2023 Concrete Restoration Contract 1 City Sec # 56567 Client Project # 1 104176 1 Contractorl Makou, Inc. I PMI Tariqul Islam Inspectorl Russell Rogers I Change Order Submittal # O1 Date 1 5/1/2023 1 ADDITIONS I I tM DESORIP I ION DtP I 11 Miscellenious Adjustments TPW Oty Unit Umt(:ost total I 1.00000000 1 $12,000.00 $12,000.001 1 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I TF W $12,000,001 I I I I I I Sub Total Additions $12,000.001 Change Order Additions Page 2 of 4 ITEM FORTWORTH City of Fort Worth Change Order Deletions Project Name I 2023 Concrete Restoration Contract 1 City Sec # 1 58567 Client Project # I 104176 1 Contractorl Makou, Inc. I PMI Tariqul Islam I Inspector Russell Rogers Change Order Submittal # Date 1 5/1/2023 DELETIONS DESCRIPTION DEPT Qty Unit Unit Cost Total I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I TF W $0.001 I I I Sub Total Deletions $0,001 Change Order Deletions Page 3 of 4 M/SBE for this Change Order M/SBE Sub Tvpe of Service Amount for this CO Total $0.00 Previous Change Orders co # DATE I AMOUNT Total I $0.00 1 FORT WORTH. Routing and Transmittal Slip Transportation & Public Works Department DOCUMENT TITLE: CO 2, 2023 Concrete Restoration Contract 1 M&C: N/A CPN: 104176 CSO: DOC#: Date: 5-25-2023 To: Name Department Initials Date Out 1. Valentina Riera TPW - initial Iz- May 26, 2023 2. Magsood Khan Vendor - signature M-%3- May 26, 2023 3. Russell Rogers TPW - signatures May 26, 2023 4. Tariqul Islam TPW - signature T/ May 25, 2023 5. Omar Elbagalati TPW - signatures May 26, 2023 6. Mary Hanna TPW - initialer May 26, 2023 7. Michael Owen TPW - signatures May 30, 2023 8. Lauren Prieur TPW - signature May 30, 2023 9. Doug Black Legal - signatures May 30, 2023 10. William Johnson CMO - signature W May 30, 2023 11. Jannette Goodall CSO - signature May 30, 2023 12. TPW Contracts TPW DOCUMENTS FOR CITY MANAGER'S SIGNATURE: All documents received from any and all City Departments requesting City Manager's signature for approval MUST BE ROUTED TO THE APPROPRIATE ACM for approval first. Once the ACM has signed the routing slip, David will review and take the next steps. NEEDS TO BE NOTARIZED: ❑YES ®No RUSH: ❑YES ®No SAME DAY: ❑YES ❑No NEXT DAY: ❑YES ❑No ROUTING TO CSO: ®YES ❑No Action Required: ❑ As Requested ❑ For Your Information ® Signature/Routing and or Recording ❑ Comment ❑ File ❑ Attach Signature, Initial and Notary Tabs Return To: TPWContractsaFortWorthTexas.2ov at ext. 7233 for pick up when completed. CSC No 58567-0O2 Fox_ T� x; Project Namel 2023 Concrete Restoration Contract 1 Client Project #(s)I 104176 Project Description) Contractorl Makou, Inc. City Project Mgr.l Tariqul Islam Dept. Original Contract Amount Extras to Date Credits to Date Pending Change Orders (in M&C Process) Contract Cost to Date lGo to ADD & DEL Tabs to Enter CO Backup Revised Contract Amount Original Funds Available for Change Orders Remaining Funds Available for this CO Additional Funding (if necessary) City of Fort Worth Change Order Request City Sec # I 58567 Remove and replace damage concrete panels at various locations Change Order #I 2 1 Date 5/25/2023 City Inspector Russell Rogers TPW $1,375,745.00 $12,000.00 Contract Time Totals (CD) $1,375,745.00 180 $12,000.00 CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS % OF ORIGINAL CONTRACT 0.87% MAX ALLOWABLE CONTRACT AMOUNT (ORIGINAL CONTRACT COST+ 15%) $1,719,681.25 JUSTIFICATION (REASONS) FOR CHANGE ORDER This change order is to add Texan Dr to contract # 58567. The contract has FAA Blvd and Campus Dr in scope of work for a total 12,145 SY panel replacement. A request came lately from Northwest ISD to repair Texan Dr from FM 156 to Northwest ISD Private Dr as the section of the street is severely damaged and unsafe for school traffic. Staff reviewed the street and identified about 750 SY panel replacement to address the damage. This repair will cost approximately $75,000 to complete the additional work. The contract has enough quantity available to cover the cost. As Texan Dr is not included in original scope of work an administrative approval is needed to add the street to the contract through a 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. The Project/Program Manager signing below acknowledges that he/she is the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. Contractor's Company Name Contractor (Name) Contract Signature D Makou, Inc. Maqsood Khan May 26, 2023 Inspector/Inspection Supervisor Project and Contract Compliance Manager Date May 26, 2023 � May 25, 2023 Date Senior Capital Project Officer Date rya May 26, 2023 ,. -- May 26, 2023 Assistant Director (Dept) Date Director, Contracting Department (Dept) Date 1 4"'4'f May 30, 2023 0+-•9� May 30, 2023 Assistant City Attorney Date lAssistant City Manager Date ( May 30, 2023 3O„M , o„ May 30, 2023 Council Ac M&C Number I ATTEST: Jannette Goodall, City Secretary M&C Date Approved I I tM FORT WORTH City of Fort Worth �'*`--- Change Order Additions Project Name 1 2023 Concrete Restoration Contract 1 City Sec # 1 56567 1 Client Project # 1 104176 1 Contractorl Makou, Inc. I PMI Tariqul Islam Inspectorl Russell Rogers I Change Order Submittal # Date 1 5/25/2023 1 ADDITIONS UtSCRIPIION UtPI 611y Unit Unit Cost total 1 I I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I TF W $0.001 I I I I I I Sub Total Additions $0.001 Change Order Additions Page 2 of 4 ITEM FORTWORTH City of Fort Worth Change Order Deletions Project Name I 2023 Concrete Restoration Contract 1 City Sec # 1 58567 Client Project # I 104176 1 Contractorl Makou, Inc. I PMI Tariqul Islam I Inspector Russell Rogers Change Order Submittal # 0 Date 1 5125/2023 DELETIONS DESCRIPTION DEPT Qty Unit Unit Cost Total I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I TF W $0.001 I I I Sub Total Deletions $0,001 Change Order Deletions Page 3 of 4 M/SBE for this Change Order M/SBE Sub Tvpe of Service Amount for this CO Total $0.00 Previous Change Orders co # DATE I AMOUNT Total I $0.00 1 FORTWORTH. Routing and Transmittal Slip Transportation & Public Works Department DOCUMENT TITLE: CO 3, 2023 Concrete Restoration Contract M&C: N/A CPN: 104176 CSO: DOC#: Date: 1 /17/2023 To: Name Department Initials Date Out 1. Alexandra Ripley TPW - initialer Jan 23, 2024 2. Magsood Khan Vendor - signature M, Jan 18, 2024 3. Russell Rogers TPW - signature RRt Jan 18, 2024 4. Tariqul Islam TPW - signature %a Jan 18, 2024 5. Mary Hanna TPW - signature Jan 23, 2024 6. Mary Hanna TPW - signatures Jan 23, 2024 7. Patricia Wadsack TPW - signature Jan 30, 2024 8. Lauren Prieur TPW - signature Jan 31, 2024 9. Doug Black Legal - signature Feb 1, 2024 10. Jesica McEachem CMO - signature 11. Jannette Goodall CSO - signature 12. TPW Contracts TPW DOCUMENTS FOR CITY MANAGER'S SIGNATURE: All documents received from any and all City Departments requesting City Manager's signature for approval MUST BE ROUTED TO THE APPROPRIATE ACM for approval first. Once the ACM has signed the routing slip, David will review and take the next steps. NEEDS TO BE NOTARIZED: DYES ®No RUSH: DYES ®No SAME DAY: DYES ❑No NEXT DAY: DYES [:]No ROUTING TO CSO: ®YES ❑No Action Required: U As Requested ❑ For Your Information ® Signature/Routing and or Recording ❑ Comment ❑ File ❑ Attach Signature, Initial and Notary Tabs Return To: TPWContracts(i-�FortWorthTexas.�4ov at ext. 7233 for pick up when completed. FORT WORTH., Project Namel 2023 Concrete Restoration Contract 1 Client Project #(s)l 104176 Project Description) Contractorl Makou, Inc. City Project Mgr.l Tariqul Islam Dept. Original Contract Amount Extras to Date Credits to Date Pending Change Orders (in M&C Process) Contract Cost to Date lGo to ADD & DEL Tabs to Enter CO Backup Revised Contract Amount Original Funds Available for Change Orders Remaining Funds Available for this CO Additional Funding (if necessary) TPW $1,375,745.00 $12,000.00 City of Fort Worth Change Order Request I City Sec # I 58567 Remove and replace damage concrete panels at various locations Change Order#I 3 1 Date 1/17/2024 City Inspector Russell Rogers Contract Time Totals (CD) $1,375,745.00 180 $12,000.00 $1,387,745.00 $1,387,745.00 180 131 $1,387,745.00 311 $58,000.00 $46,000.00 $0.00 $1,387,745.00 $58,000.00 $46,000.00 CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS % OF ORIGINAL CONTRACT 0.87% MAX ALLOWABLE CONTRACT AMOUNT (ORIGINAL CONTRACT COST+ 2591.) $1,719,681.25 This change order will add 131 calendar days to contract due to the following delays: (1) Delay for grass establishment (45 days): The contract was started on 1/30/2023 with a total of 180 calendar days. The contract was substantially completed on 7/28/2023; however, due to summer's excessively hot weather, the grass installation couldn't be until 9/12/2023. (2) Delay due to the additional testing of subgrade 9/13/2023 to 12/07/2023 (88 days): During the final inspection, cracks were identified in several panels at FAA Blvd. To determine the cause of the premature cracks additional testing of subgrade was deemed necessary. To complete the testing by the lab the contractor had to remove couple of concrete panels, wait for the lab to obtain a sample, and get the testing results then reinstall the concrete panels. It is understood and agreed that the acceptance of this Change Order by the contractor constitutes an accord and satisfaction and represents payment in full (both time and money) for all costs arising out of, or incidental to, the above Change Order. The Project/Program Manager signing below acknowledges that he/she is the person responsible for the monitoring and administration of this contract. including ensuring all performance and reporting reauirements. Contractor's Company Name Contractor (Name) Contract Signature Makou, Inc. Magsood Khan ,, ,,,I-11.-11 1 Jan 18, 2024 inspector/Inspection Supervisor Date Project and Contract Compliance Manager Date Jan 18, 2024 _ Jan 18, 2024 er tpistant.Director Date Jan 23, 2024 Senior Capital Project Officer Date Jan 23, 2024 (Dept) Date Director, n r 'ng Department (Dept) Date (,o, Jan 30, 2024 Jan 31, 2024 Assistant City Attorne Date A er Date ipaa�_ r Feb 1, 2024 Council Action (i M&C Number M&C Date Approved ATTEST: Jannette Goodall, City Secretary HEM FORT WORTH City of Fort Worth —�T� � Change Order Additions Project Name 1 2023 Concrete Restoration Contract 1 City Sec # 1 58567 1 Client Project# 1 104176 1 Contractorl Makou, Inc. I PMI Tariqul Islam I Inspectorl Russell Rogers I Change Order Submittal # Date 1 1/17/2024 1 ADDITIONS ULSCRIP I ION UtP I Oty Unit Unit Cost I otal 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 TFW $0.001 I I I I I I Sub Total Additions $0.001 Change Order Additions Page 2 of 4 ITEM FoRT WORTH City of Fort Worth 'V- Change Order Deletions Project Name j 2023 Concrete Restoration Contract 1 City Sec # 58567 Client Project # j 104176 1 Contractorl Makou, Inc. PMI Tariqul Islam I Inspectorl Russell Rogers I Change Order Submittal # = Date 1 1/17/2024 1 DELETIONS DESCRIPTION DEPT Oty Unit Unit Cost Total j TF W $0.001 Sub Total Deletions $0.001 Change Order Deletions Page 3 of 4 M/SBE for this Change Order M/SBE Sub Type of Service Amount for this CO Total $0.00 Previous Change Orders Co# DATE I AMOUNT Total I $0.00 1 FORTWORTH. M, TRANSPORTATION AND PUBLIC WORKS February 20, 2024 Makou, Inc. 6204 Parkside Drive Arlington, Texas 76001 RE: Acceptance Letter Project Name: 2023 Concrete Restoration Contract 1 at Various Locations Project Type: Paving City Project No.: 104176 To Whom It May Concern: On October 3, 2023 a final inspection was made on the subject project. There were punch list items identified at that time. The punch list items were completed on December 7, 2023. The final inspection and the corrected punch list items indicate that the work meets the City of Fort Worth specifications and is therefore accepted by the City. The warranty period will start on December 7, 2023, which is the date of the punch list completion 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- 392-2486. Sincerely, Tariqul Islam (Feb 23, 202412:23 CST) Tariqul Islam, Project Manager Cc: Russell Rogers, Inspector Gary Deyon, Inspection Supervisor Troy Gardner, Senior Inspector Mary Hanna, Program Manager City of Fort Worth, Consultant Makou, Inc, Contractor City of Fort Worth, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev. 8/20/19 BOND #, 1024170 CONSENT OF SURETY OWNER TO FINAL PAYMENT 10 ARCHITECT ❑ .41A Docio rear G707 CONTRACTOR [a (Tltarruclions an mverse Si4tc) S[. km �] OTHEk 0 TO OWNER: ARCHITECT'S PROJECT NO_. friau _,fo:jr r - City orport Worth 100Throckmarton 31. CONTRACT FOR — Eori Wont, TX 76102 P wie E T_ CONTRACT' DATE'[): fNaair u,vJaldFern 2023 Concrete resturation Contract 1 In accordance tvL[h the PrOVisions of the Contract b41u'ecn Lhe Uwnar arnd the Curaraclor as indicated above, the {nett name and addrrrss of Surety) Oklahoma Surety Company 1437 Snutb Boulder, SUAL- 200- Tulsa, OIL 74119 - on bond or — — —� SUETY, el— -a Aw exJ,,.ua,':., +gfC'nxnmw�i Mri1ou, Inc- _S33 Simi Dr — - - - Arlington, TX 76W I . - —_-- — _ ,CONTRACTOR. hereby approves of the Final payment to the C mLTpctOr, and agrees [hat t i nal payment to the Contraclor shall not relieve the Surely of any of its obtiptjAs 10 ON 4r+uvary 2. rfrof[hlw,j ly Of Fort )VOrth 1000 Thmehmorton S1.- Fort Worth, T_X 76102 as set Forth in said Surcty's bond, — - - - IN WITNESS WHEKEOF, the Surety has hdrrunlo set its ]sand on this dmtc: January 18, 2024 r1RaL-.i in x,axxy. rh,,.,-�fFi frrlTw�cy.f J . rfn,x--rrrk.i.�r,orcl ,rx�t Oklahoma S urety Companv 4 � � v r F.G�iPlffFf c5r ,,..rlirx'r: � ,f �[X4Ta a':,fufi.'{/ (SaIV Anggic Ast Brent M. Blonigan. Anolney-in-faLt CAUTION., You should sign an original AIA document that has this cautlort printed Irked, An ► + original assures that changes will not be obscured as Irby occur when documents are reproduded, See Irtstmc6on Sheet for Limited License for Reproduction of this document. AM GOCUMPAT 4707-C[)NSF.NT OF SURETY TO Y FrKAL PAYMENT- 191 EDMON - AIA Ps}je 3 aF 2 19914 - THE ANIFM[CAN FYST'ITlrYF. UFARCFIITFM 17?$ NEW YORF AVF"UF_1w35', WASH- It�CT[kV, h {- 2WJ04S292-94ARNW4%: Unikal d PlwFetopylnp YIOt#t . U.S_ Copy- l■r. and will suk—th. vdglviar to Inga1 FF"mllloe, 0707-1 9134 INSTRUCTION SHEET FOR Al DOCTJM ENT G707, CONS FINT OF SURETY TO FINAL PAYMENT A. GENERAL INFORMATION 1. Purpose This document is intended for use aS W cumpanion to AIA Document G706. {-Olktractor'a Affidavit of Hn e t of bts and C 181 nn. On construction Projeet_s where the Contractor is rcgtkired to funs ish u bnnd, By obta irting the Surelysapproval cf f pj,,jj payment to the C-O"(mctGr and its agreentent that fnfti payment Will not Y-Clicve the Surety of any of its obtigacions, [he C}x net may preserve its ri&s under 11,e band. 2. Related Documents This document may be used with magl of the AIA's ()wner-Caninlctar agreements Rrld general tunditinns, such as A20I and its related fAlYtlly of dnckYlttents. As IIOICd above, this is a corttpnnion dpct,ment to AIA IDuc unienc G706_ 3. Use of Current Documents prior to u5irlg any AIA document, the user silottld consult Eire AIA, an AJA component ch;lpter or a current AIA Doctunentc Lill to determine life current eAilion of cac]t doourncnl. 4. Limited License for RePAIdUction AIA Document G707 is a Copyrighted work and Ukfky not be reproduced or cxccrpted from in Substantial pill without r]ie expresv Witten pernlismon of the AIA_ TiceG707 document is intended In be used ns a LrlLsumn6]e4lhdt is, the Original dgCtltttCnl - pur chased by the rise[ is intended #a be consumed in the Oourse of heitig used_ There is net itnptied petmirsiort In rCprodu¢e this d4ekrment. not door membership in The American Inslilule OFArehicects confcr any furlhcr righls to reprodttce G707_ A Clutranaty tiolicc is printed in red on the originar of this doCrrmont. This no icc distinguishes an original A1A dockupent from copies at1d uounlcrfeitx. To ensure-%"ttruuy and klnirorntiity of [anguage, purchasers should use only an originrit AIA document or ❑ne 11ta1 has been reproduced from an ariginQtl under a %Pmlal litmiled license frcmtt the Alp, A limited license is hereby granted to retail isumhmers to reproduce a miXimurn of ken copies Of n completed or excouted G707, hill only for Itse in connection with a particular projeet' Further repTCductinns are Prahibiled witl]OW the express permission or the AIA. B. CHANGES FROM THE 9REVIOUS EDITION C: Itanges in the 14c-mion of variokrs items of iriformalion were made, tuilhout rev73iOn to the substance of I he ducum4i]I. C. COMPLETING THE G707 FORM GCNERAL: The bond form is the usual source Ofregttircd information such as the cotur,10 dateno4i the nnntcs "-A-Lddresges ufthe Surety, Owner. C=untraCWT 8i7d Fruject. ARCHITECTS PROJECT NC)--- ihis information IF, typically supplied by the Airlh it"k ;rttd entcrC6 on the form by the Contractor_ CON3`ItACi' FOR: This refets 10 the scope ofthc contract, such as "General Construction" or'Mechanical Work-. D. EXECUTION OF THE DOCUMENT TItC G707 fumt rcgklires bath the Surety's wal acid the signalltrca£the Surely's authorierd reprosemative_ 4r94 I1STR L,c, riu.ti su EET FOR ALA ntiCCMEN7 GUI .'MN8£NiOF SUR M TO FINAL PAYMENT ',1994 Page 2 of Z MITJON +irA9 THE A_-MERICAN rNSTr1'LJTE of ARC'FITFCTS, 1735 NEW YORK AVENUE. N_w., 'ArASHJNCTON. D.C. 200a6-5292 0707.1 z794 OKLAHO A SURETY COMPANY 1437 South Boulder, Suite 200. Tursa_ Oklahoma 74119 - Ph: 918-567-7221 - Fax7 919-5a8-1296 POWER OF AF70RNEY KNOW ALL MEN BY THESE PRESENTS: i-zr Che Oklahoma SurelyCompariy a v;•_- =e r r we Qj the IH:'f3 of [f 2 $[3La Q; Orr,c, daps hfeby nGr�Ila[a, G7hsri:atB and appoint the FerSCr :.., _ --.: -- -, . - - a - Tara lharr aie Js naar+ed. its true and fawfwi attonla j-,r-race. fcr,q arj in ,rS narre. pl3ce and stead ,r- ax=_'_._'e or. }oralf'Qi L =_ Surety, dply Aral all bards. undertaking "d C.`.+rltl3ci5 Yf 3ur'aty NP of wirer wr ver, obli' . -L F. Campa Rah Dreilirlg da6bie Palmer' Kara Pierce arl of f�ICHARE]SDN, TXgalivr�s in the n_'^erect Br4rt 3 - IN WITNESS WHEREOF. Jh@ Oklahoma Surely Company r,as cause3 rhess pfesenls lc na and ,l5 ccfpnraia Seal hereunr y atf,xed sr,,s 20 da r c# Septerrther 2Q1 SELL •6. ATTEST OKLAHOMA SURETY CCIMRANY .f Sharon NaCW. Assistant Secrelary T:.dd 69z2l12,Vlce Presidart pn this 20 dap of September, 2021 JierQra rile p.efsonallY appeared Toad ainala 10 me knoK'n befrlaj duly r*orrl. 4epase's and says tha! s+he ra5ide5 in Br�Aea Arrow. Oklahorna, lhar 9TLe is a trine Presrdgrrl of Okklahoma $ ure[y Cornpimy, the corrrpany descni]ed In arlrj +'+hive amDruted Chia above r>sirum$nl Thal s+he krlcws lNe seal of *0 said Company_ [ha a4rp( the bt<iHetl [8Ih9 Said Ins[rumarl i such orate deal that it Was S8 8ffixed 'by aulh#,ty of hgr':Fyi office order Ihg fay-L 3,rds of Said Camnany and that &.' ie 5i9r.Ad h;o narre theralQ by ---- .- �_�Hr�F,rA —�� S_ar:aa�'pyl��bmr Commiss�onk 1104$253 JULIE CALLI.ALKAN TLILSA CC{1NTV r.ly Carrm155,34 Expires 09,Da-23 ,.,-)JfV r JP 1rCWWShrillI- roagim Erg Sa p�271� Jul+ Irahan e Ce Plot y E C air Pu Tn s Pj-Ae- : � ,... ...,, ._ , :: A�thprltf ❑f t- .: ' Company by un,jjn.pjc: 5 ,, - . '._... , rN.j Septarfh=- i '' _.' kt Pe 8"m'd ut Dvec'nr5 or Oklahoma Surety __ RESQ3 V-Ej) Ti. ..I, -. •_-, L, r,.'-,:ut,.= _ a -,t hereby =, era, `�enxar Vice PrRAidenls And VICE!Pre-iiozr,, Ica.':' ,r• : a 9rrd5 4r5ds-rr. ' - - ' _ - Sys-m-Farrl,;erscuteon h$IF of the , : .:•e[• s- . „ , ,. = respacJrva hm�ls or �• .:.. , _ ,,_ _- _ IIr2rBol.� ^s Ir ir' .. • .. RI=SOL4EO FtFRTFl E. - -'Er :I ::' r,rne - lne CCrnnan j rna-, :%- ._ - - d:ura of -+:' . :.f rhig 3e= fgf r -i and Wly S-'Cre[r-. ,. .:='"".. .--r-•.�. • 70 su ralysk,f_ :: .. - ., �x r, .. -, _ - y +?f1 FCf:F'6 AaeCVtwn ]f-1,. -:t 5rSr.:' ... - - .. _ sa Lsed to rl,.j ih 2•f2[t 99 tf+cLLp � ... '-e '}�' :.�fldir,tj Uf',:.r. ll••s �'.Cr"sF.tr CERTIFICATION I Sharon Hi3CKf Assistant $gcr@lary JF Oklahoma Suret•r Campar7y Res:.::,! cs c the 'a tar j of O-r�['?o s of Sapl=?—bee 25 2CM _ Attila- 113rur. HacW Assistant 5t�[rnv /ALT,\ MID-CONTINENT CROUP klid-Confluent Casualty I Oklahoma Surety Oklahoma Surety Company Surety Bond Seal Addendum Diuring the COViD-19 pandemic, the use of traditional raised corporate seals has beery made impractical due to Bovernment stay-at-hnrrne orders ancf socral distancing guidelines. As a result, Oklahoma Surety Company has authorized its Attorr3eys-in-Fact to affix Oklahoma Surety Company's corporate seal to any bond or related instruments executed on behalf of Oklahoma Surety Ccn,pany by any such Attorney -in -Fact by attaching this Addendum to said bond or related instrument To the extent this Addendum is attached to a bond or related instrurnerit that is executed on behalf of Oklahoma Surety Cornpany by its Attorney -in -Fact, Oklahon7a Surety Company agrees that the seal belaw shall be deenied afflKed to said bond or related instrument to the same extent as if its raised corporate seal were physicaily affixed to the face of the Bond or related instrument Oated thi> 11 day of April, 2020 Todd Baza;a Vice pfe5i$Ent IID-CONTINENT CASLALTV co pA_\y OK-L MHO LA SUREƒy C UNI PAW STATE OFTEXAS CLAIM NOTI(T YNDORREy£\l 5 k ,arice ,ihS Qa 5l»21<Jofthe T xAs Go vemmentrOde andSeation q 202 (6)v£meTe x3sbopem Cod,!. an nm&eor=k Q m n� k qr y U rQb mg da��m4: \hdm2 y[D-O I|*ExI(':-SU jYrnIPA i(R E TY COMPANY Ro.BOX Ifig IULSA e&-,-j ml ILlLPHONL NO.1a1!£)-7234;9a Ei\ NO L914; E a:R E! w;-w HO|[DER wERE)4 l AYnNTL kllA(l ƒH|SNOTlC{IQ OER »Q\D UPON E E.TIO\OFTHEBOND AFFIDAVIT STATE OF TEXAS COUNTY OF TARRANT Before me, the undersigned authority, a notary public ixn the State and County aforesaid, on this day personally appeared Magsood Khan, Owner ofMAKOU INC., known to me to be credible person, who being duly sw-orn 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, for City of kart Worth Conc. hest. 20 3-1 Project# 104176 That the wage scale established by the City Council in the City of Fort North has been paid in full. That there are no claims pending for personal injury and /or property damages BY------ ,.. ---------------------------------------- ---- MA SODO ICI�IAN, PRI IPAL, MA OU INC. SUBSCIBED & SWORN BY 141E ON THIS DATE -- - NOTARY PUBLIC _ TEXAS `+ CESAR SAAVENA ti tiRpx.. ''f 'f ' Notafy Public, Stale of Texas Comm- Expires 06.20-21D27 yy ''fq°FtN`'a Notary_ IV 132058262 MAKOU Inc. 7100 S. Cooper St. Suite #15 Arlington, TX 76001 rnakoninc mail.com 1 817-798-5426