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Contract 57279-FP1
FORTWORTH, WATER DEPARTMENT NOTICE OF PROJECT COMPLETION -FP1 City Secretary No: 57279 Date Received: 8/27/2024 City Project JV!?: 103123 Regarding contract 57279 Horne St. Water and Sanitary Sewer Rehabilitation for as required by the WATER DEPARTMENT as approved by City Council on 3/08/2022 through M&C 22-0184 the director of the WATER DEPARTMENT upon the recommendation of the Assistant Director of the Water Department has accepted the project as complete. Original Contract Prices: Amount of Approved Change Orders: Revised Contract Amount: Total Cost Work Completed: Less Deductions: Liquidated Damages: Pavement Deficiencies: Total Deduction Amount: Total Cost Work Completed: Less Previous Payments: Final Payment Due ia17 sl&P k- Recommended for Acceptance Asst. Director, WATER DEPARTMENT a� ,ceder Christopher Har er(Aug 27, 202407:35 CDT) Accepted Director, WATER DEPARTMENT 0and BurgHdoff Dana Burghd off (Aug 2 , 202418:38 CDT) Asst. City Manager Comments: $ 4424116.20 $-23,751.50 2,- 1 a_ $ 4,400,364.70 $ 3,883,715.08 Days @ $650.00/ Day $ 3,883,715.08 $ 3,689,529.33 $194,185.75 Aug 26, 2024 Date Aug 27, 2024 Date Aug 27, 2024 Date OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX C-620 Signature Page Contractor's Application for Payment Invoice No.Final - 22 To (Owner) City of Fort Worth Invoicing Period (From -To): Invoice Date: 7/01/2024 - 7/22/2024 7/22/2024 P O 7p� From (Contractor): OO Remit to ( If Not Automatic Deposit ): Number: Code C Construction Project: 103123 Contractor's CFW Vendor No.: City secretary contract 57279 Contract Horne Street Water and SanitarySewer Rehab Project : NumberName: : Application For Payment Change Order Summary lAoproved Change Orders 11. ORIGINAL CONTRACT PRICE.......................................................... S 54,424,116.20 Number Additions Deletions 12. Net change by Change Orders................................................................ S -$23,751.50 1 $65,448.50 $65,448.50 13. Current Contract Price (Line 1 t 2)....................................................... $ $4,400,364.70 2 $66,070.00 $66,070.50 14. TOTAL COMPLETED AND STORED TO DATE 3 $714,147 00 $737,998.00 1 (Progress Estimate, Construction Allowance and Change Orders)....... $ $3,883,715.08 4 $22,750.00 522,750.00 15. RETAINAGE: 5 1 a. X $3,883,715.08 Work Completed.......... $ 6 1 b. X Not Used S 7 1 c. Total Retainage (Line 5a + Line 5b) ............................... S 1 8 16. AMOUNT ELIGIBLE TO DATE (Line 4 - Line 5c)............................. $ 53,883,715.08 TOTALS $968,415.50 $892,167.00 17. LESS PREVIOUS PAYMENTS (Line 6 from prior Application)........ S 53,689,529.33 NET CHANGE BY-$23,751.50 S. AMOUNT DUE THIS APPLICATION ................................................. S $194,185.75 CHANGE ORDERS 9. BALANCE TO FINISH, PLUS RETAINAGE (Column G on Progress Estimate+ CA + Cos + Line 5 above) .............. $ 5516,649.62 Contractor's Certification 10. CONTRACT TIME: The Contractor certifies with the submittal of this document and associated Payment Request Submittal a. Days Awarded 550 on the City of Fort Worth Bu-saw system that to the best of their knowledge: (1) all previous progress b. Days Added by CO 55 payments received from Owner on account of Work done under the Contract have been applied on a Total Days 605 account to discharge Contractor's legitimate obligations incurred in connection with Work covered by prior Applications for Payment; (2) title of all Work materials and equipment incorporated in said Work or otherwise listed in or covered by this Application for Payment will pass to Owner at time of d. Days Charged 575 payment free and clear of all Liens, security interests and encumbrances (except such as are covered by a Bond acceptable to Owner indemnifying Owner against any such Liens, security interest or e. Days Remaining 30 encumbrances); and (3) all Work covered by this Application for Payment is in accordance with the Liquidated Damages $650 00 x day to Affidavit of Bills Paid K qo, Consent of Surety 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. CSC No. 57279-COI )FORTWORTli City of Fors: Worth ---- Change Order Request Project Namo:I Water Sanitary Sewer Replacement on Horne Street I City Soo No,: 167279 Project No,(s):I 103123 I DOE No. I N/A I Clly Pro), No,:I 103123 Project Doscrlplion:l Replacing water line, Sonllary Sewer lines on Horne St,, Carver Dr., Diaz Ave, and alleyways. Conlraclorl William J. Sclwilz, ino, dba Circle C Conshue[ion, Co. Change order II L ' I Dale: I 710/2022 City Project Mgr,I Suby Varughose ( City Inspector: I Cody Horton Phone Number,I 017-392-7003 Phone Numbed 817-475.6903 Dept, Water Sewer Totals ConlractTimo (Cnlonrim• days) OdglnalContract Amount $2,905,104.26 $1,619,011,95 $4,424,116.20 550 Extras to Dale Credits to Dale Pending Change Orders (in M&C Process) Contract Cost to Data $2,906,104.26 $1,619,011.95 $4,424,116.20 560 Amount of Proposed Chmrgo Order $0.00 $0.00 $0.00 025 Reviser! ConlraclAmount $2,005,104.25 $1,619,011.05 $4,424,116.20 576 Original Funds Available for Change Orders $145,265.00 $75,951.00 $221,206.00 Renralning Funds Available for this CO $145,266.00 $76,051.00 $221,200.00 Additional Funding (if necessary) CHANGE ORDERS (o DATE (INCLUDING THIS ONE) AS % OF ORIGINAL CONTRACT 0,00% 1$6,630,145.26 MAXALLOWABLECONTRACTAMOUNT(ORIGINALCONTRACTCOST+25%) JUSTIFICATION (REASONS) FOR CHANGE ORDER Change Order No.1 will provide compensation forthe installation of standard Oft diameter concrete manholes that were Inadvertantly Installed by contractor In Ileu of polymer concrete manholes. The change order will also provide for the Installation of temporary asphalt paving on Carver Drive that Is required due to the delay of TPW contractor to conduct asphalt paving Improvements on the street. Staff recommends the addition of 25 calendar days to the project for the change order. It is understood and agreed [hat the acceptance of this Change Order by the contractor constitutes an accord and sallstaction and represents payment In (till (both time and money) for all costs arlsing ou[ of, or lneldenlal to, the above Change Order, Contractor's Company Name I CoalraolorNante I �eniraolor Sk nature I Data 1YalamJ.Schultz,Inc,dbaChde0Consifu Wn,co. Teri S. Skelly I a�� 7•,ta Z r Inspector Loaf yYe4t3'Y- Dlreolor (Water 'Alm Assistant City Attorney M&C Number j NIA Dale Pro sot Manager 01 7/15/2022 u6y� l' lmlz Data Con I410n Su ORhor (TPW) Jul 20, 2022 Dale / HIS to Chy: anagor Jul 21, 2022 Council Action (II ttequired� I M&C Dale Approved I NIA Dale 7/20/2022 Dale Dale Jul 21,2022 F-OnT WORT" City of FortVVorth Change Order Additions Project Name I Water Sanitary Sewer Replacement on Horne Street City Sec No.; 57270 Project No.(s); 1 103123 1 DOE No.1 N/A 1, City Pro), No,; 110I3123 Project I Replacing water line, Sanitary Sewer lines on Horne St., Carver Dr., Diaz Ave, and alleyways. Description Contractor I William J. SChU11Z, Inc, dba Circle C Construction, Co. ' Change Order Dale;1 71012022 City Project Mgr. I Suby Varuyhese I City Inspector I Cody Horton ITEM UESCRIPI IUN 45 4' STD Concrete MH 40 4' STD Drop MH 47 4' STD Concrete Extra Deplir MH 40 Epoxy MI-1 Liner 40 Temporary Aspliall Paving (? HMAC on U' Flex Base) ADDITIONS DEPT Sewer Sewer Sewer Sewer Sewer GIN Unit 'UnitCost Total 3.00 EA $6,500.00 $19,600.00 2.00 EA $7,600.00 $15,000.00 15.73 VF $200.00 $3,146.00 31.70 VF $325.00 $10,302.60 700.00 LF $25.00 $17,600.00 Water Sewer $G5,440.50 Page 2 of 4 Addlllons Sub Tolal $65,440.50 Y'0wr wo R,r City of Fort Worth Change Order Deletions Project Name Water Sanitary Sewer Replacement on Horne Street City Sec No.: 67279 Project No,(s); 103123 1 DOE No, N/A City Pro], No,; 103123 Project Description I Replacing water line, Sanitary Sewer lines on Horne St., Carver Dr„ Diaz Ave, and alleyways, I Contractor William J. Schultz, Inc, dba Circle C Construction, Co, I Change Order; 0 Dale I 71812022 I City Project Mgr, Suby Varughese City Inspector; I Cody Horton DELETIONS ITEM DESCRIPTION T DEPT Qly Unit Unit cost Total 46A Pre Cast Polymer MH Sewer 3,00 EA $10,600.00 $31,600.00 46A Pre Cast Polymer Drop MH Sewer 2,00 EA $12,600.00 $26,000.00 47A Pre Cast Polymer Extra Depth MH Sewer 15,73 VF $350.00 $6,605,60 44 Sanitary Sewer Construction Allowance Sewer 0.03443 LS $100,000.00 $3,443.00 — --- 'Water Sewer $66,448.60 Deletions Sub Total $65,446.50 Page 3 of 4 MIWaE Breakdown for this Change Order MWBE Sub Type of Service Previous Change Orders Co# - DATE Total Page 4 of 4 Total AMOUNT Amount for this CO 0 nn $0.00 ,Contract Comnllance Manarer By signing I acknowledge that I mn the person responsible for the monitoring and n(innhnistration ofthis contract, Including ensuring nil performnncc mid reporting requirements. Signature suby Wrughese N11111e ofEnnploycc Professional Engineer Title ATTEST; Tannet l e S. Goodall Jannette S. Goodall (Jul21, 202213:51 CDT) Jannette S, Goodall City Secretary CPN-103123 Change order-1 notes The Contractor provided a price proposal for the 4' concrete manhole, 4' drop manhole, and epoxy manhole liner exchange with polymer manhole. The Contractor also provides the price proposal for the temporary asphalt paving, which is required on Carver drive due to the delay of the TPW paving crew. The project manager negotiated the temporary asphalt -paving price ($28/lf to $25/lf). The proposal covets the additional cost associated with the fittings, equipment, fuel, and labor costs. This proposed price is fair and reasonable compared to other projects and bid values. The Contractor requested additional 25 days for the additional work, CSC No. 57279-CO2 F6 wr WO wr yr City of Fort Worth n_4 -3�a`r Change Order Request Project Name: 1 Water & Sanitary Sewer Replacement on Home Street I City Sec No,: 157279 1 Project No.(s):1 103123 1 DOE No. I N/A City Proj, No,:I 103123 �+ Project Description:) Replacing Water & Sanitary Sewer Lines on Horne St,, Carver Dr„ Diaz Ave., and alleyways. I Contractor) William J. Schultz, Inc, dba Circle C Construction, Co. Change Order 11 L 2 J Date: 1112912022 !!!!I City Project Mgr.1 Pratima Poudyal City Inspector: Cody Horton Phone Number:) 817-392.6149 Phone Number:I 817476.6903 Dept, Unit I Water Unit II Sewer Totals Contract Time (Calendar days)_ Original Contract Amount $2,905,104.26 $1,519,011.95 $4,424,116.20 550 Extras to Date $0,00 $0.00 $0.00 25 Credits to Date Pending Change Orders (in M&C Process) Contract Cost to Dale $2,905,104..25 $1,619,011.95 $4,424,116.20 575 Amount of Proposed Change Order •$0.60 $0.00 •$0.50 0 Revised Contract Amount $2,906,103.75 $1,619,011.95 $4,424,115,70 576 _ Original Funds Available for Change Orders $145,255.00 $76,951.00 $221,206.00 Remaining Funds Available for this CO $145,256.00 $75,951,00 $221,206.00 Additional Funding (if necessary) CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS % OF ORIGINAL CONTRACT 0.00% — m� MAXALLOWABLE CONTRACTAMOUNT (ORIGINAL CONTRACT COST+ 25%) $6,530,146,25 JUSTIFICATION (REASONS)TOR CHANGE ORDER Change Order No. 2 provides compensation for the following: • Installation of bored private service in order to relocate water meter away from driveway and avoid cutting the driveway and sidewalk, • 4 Inch temporary water Jumper lines In order to avoide service disruptions to customers. • Asphalt transition over 4 Inch temporary jumper for protection at streets crossings. • Additional traffic control for protection of the jumper lines. • Cost for demobilization and remobilizalion for election, It is understood and agreed that the acceptance of Oils 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, Ore above Change Order. Contractor's Company Name Contractor Name Contractor Signature I Dale I Wloram I Schultz, Inc. dna crab cc mtrucuoa, co. I Teri Skelly I To-t , .,,k414,.'( Z — 2, - Inspector 6--.1L �44;talv Date 12/5/2022 Project Manager V 4 luau Date 12/06/2022 Director (Wate4opt) Date Construction Supervisor T V Depi) Dale :hnsto�[r@rMnrdei 7. 5 , Dec 6, 2022 wa� 7 &19A1 12/06/22 Assistant City Attorney pate Assistantl0iittykManager Date Dec 8, 2022J"` Dec 9, 2022 t I - - Council Action (Ir Required) II I M&C Number I N/A I M&C Date Approved NIA I lFoR-r ''moo iz,jrii City of Fort Worth Change Order Additions Project Name j Water & Sanitary Sewer Replacement on Home Street , City Sec No,: 57279 Project No,(s): j 103123 1 DOE No, N/A City Pro], No,: 103123 Project I Replacing Water & Sanitary Sevier Lines on Home St., Carver Dr,, Diaz Ave,, and alleyways, I Description Contractor William J. Schultz, Inc. dba Circle C Construction, Co. I Change Order: Date:1 11129/2022 j City Project Mgr. Pralima Poudyal , City Inspector j Cody Horton ADDITIONS Il"EM ---- ----- ULSCItIIj11UN __.. l pEPT Qly Unit 'Unit Total 61 Bored Private Service Unit I Water 40.00 LF $188.00 $7,620.00 62 Temporary 4" Fire Hydrant Jumper Unit I Water 1350.00 LF $28.00 $37,800.00 63 Asphalt Transition Over 4" Pipe Unit I Water 8.00 EA $1250,00 $10,000,00 64 Traffic Control Unit I Water 3.00 MO $2,E00 $6,750.00 65 Demobilize and Remobllization for Election Unit I Water 1.00 LS $4,000.00 $4,000.00 -- Unif I Water $66,070.00 Unit II Sewer Page 1 of 3 Additions Sub Total I$66,070.00 F0R-r tea, R-r]-;II City of Fort Worth �� !• _= Change Order Deletions Project Name Water & Sanitary Sewer Replacement on Horne Street City Sec No.: 57279 Project No.(s): 103123 DOE No, I N/A City Pro), No,: 103123 Project Description I Replacing Water & Sanitary Sewer Lines on Horne St., Carver Dr., Diaz Ave., and alleyways, Contractor I William J. Schultz, Inc. dba Circle C Construction, Co, i Change Order: Date I 11/29/2022 City Project Mgr, Pralima Poudyal City Inspector: Cody Horton DELETIONS ITEM DESCRIPTION DEPT Qty Unit Unit Coot Total 60 Water Construction Allowance Unit I Water 0.4404700 LS $150,000.00 $66,070,50 (Unit I Water $66,070.60 ,Unit II Sewer Page 2 of 3 �Deletlons Sub Total $66,070.50 _ IVIMBE Breakdown for this Change Order__ MWBE Sub Type of Service Amount for this CO Previous Change Orders __._. co# --- DATE- -...._—. .. Total Page 3 of 3 Total $0.00 AMOUNT " -- _. $0.00 .Contract Compliance Manager By signing I acknowledge that I am the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. Signature Pratima Pondyal, P.E. Name of Employee Project Manager Title ATTEST: nett, S. Goodall Dec 9, 202216:�X/ST) ST) Jannette Goodall City Secretary 11/29/2022 CPN 103123 - Horne Street Water & Sanitary Sewer Rehabilitation Change Request 2 Notes Staff has reviewed the change order price and considers it to be fair and reasonable. FORT WORTH City of Fort Worth Change Order Request Project Name: Water & Sanitary Sewer Replacement on Horne Street Project No,(s):l 103123 1 DOE No. I N/A CSC No. 57279-CO3 City Sec No,: 1 57279 City Proj, No.: l 103123 Project Descfiplion:l Replacing Water & Sanitary Sewer Lines on Horne St., Carver Dr., Diaz Ave., and alleyways. Conlractod William J. Schultz, Inc, dba Circle C Construction, Co. Change Order II 3 1 Dale: 3127/2023 CityProJect Mgr,1 Pralima Poudyal City Inspector: Cody Horton Phone Number, 817-392-6149 Phone Number:l 817-475-6903 Dept, Unit I Water Unit II Sewer Totals Contract Time (Calendar days) Original Contract Amount $2,905,104.25 $1,519,011.95 $4,424,116,20 550 Extras to Date $0.00 $0.00 25 Credits to Dale $0.50 $0.60 Pending Change Orders (In M&C Process) Contract Cost to Dale $2,905,103.75 $1,519,011.95 $4,424,116.70 575 Amount of Proposed Change Order •$594.00 •$23,157.00 •$23,751.00 0 Revised Contract Amount $2,904,609.75 $1,495,854.95 $4,400,364.70 575 Original Funds Available for Change Orders $145,255.00 $75,951.00 $221,206.00 Remaining Funds Available for this CO $145,265.50 $75,961.00 $221,206.60 Additional Funding (if necessary) CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS % OF ORIGINAL CONTRACT 0.54% MAXALLOWABLE CONTRACTAMOUNT (ORIGINAL CONTRACT COST+ 25%) $5,630,145.25 JUSTIFICATION (REASONS) FOR CHANGE ORDER Change Order No, 3 provides for the following: • The replacement of ductile Iron pipe with PVC DR 14 (water) and 160 PSI PVC (sewer) due to the non -availability of DIP for water and sanitary sewer installation. Message boards to inform motorists of detours and road closures. Installation of 2" Air Release Valve (ARV) Relay of a segment of a project sewer main due to previously unknown conflict with a gas line that was encountered during construction. Polymer Manhole Modifications 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, I Conirnclat'o Company Ngma I co. Contractor Nome C 1raclot Signalurp I Data f �YuamJ.scnu��,Inc.dbaCircloCConslnxlon,Ten 6keIN 7;7--A .' c r..�/ y-/Z-Z.� inspector�A I Director (Waler 166PI) IC/rrisfanlrer HnrJer Senior AMaIttant Oily Attorney M&C Number I NIA Date Project MDFa of 04/17/2023- 06le Conowcb patvisor TPW DeUlj S . Apr 20, 2023 �,{�% Okla As51sl ra Su0. Managor Apr21,2023 Council Action (it Required) M&C Dale Approved NIA Date 1 A/19/2023 Date 04/17/23 We Apr 21, 2023 FORT WORTH City of Fort Worth Change Order Additions Project Name Water & Sanitary Sewer Replacement on Horne Street City Sec No.: 1 57279 Project No.(s): 103123 ! DOE No,1 N/A I City Proj. No,: j 103123 Project Replacing Water & Sanitary Sewer Lines on Horne St,, Carver I Dr., Diaz Ave., and alleyways. Description . Contractor j William J. Schultz, Inc, dba Circle C Construction, Co. Change Order: Date: 1 3127/2023 City Project Mgr, I Pralima Poudyal ( City Inspector I Cody Horton ADDITIONS I I tM UhSCRIN I IUN DEPT Qt Unit Unit Cost Total 1-3 8" PVC DR-14 Water Pipe Unit I Water 7,198.00 LF $84.00 $604,632.00 1-66 2" ARV Combination Unit I Water 1.00 EA $15,000.00 $15,000.00 1-67 Message Boards Unit I Water 12.00 WK $500.06 $6,000.00 2-1 160 PSI Pressure Rated PVC Sewer Pipe(ASTM-2241) Unit II Sewer 846.00 LF $90.00 $76,140.00 2-49 Polymer Manhole Modifications Unit II Sewer 3.00 EA $2,000.00 $6,000.00 2-64 Labor to Relay Sanitary Sewer Pipe with Strom Drain and Gas Line Unit II Sewer 0.75 DY $8,500.00 $6,375.00 JUnit I Wa er $626,632.00 lUnit II Sewer $88,515.00 1 Page 1 of 3 1Additions Sub Total $714,147.00 FORT' Woo R'Tm City of Fort Worth Change Order Deletions Project Name Water & Sanitary Sewer Replacement on Horne Street City Sec No.: 57279 Project No.(s): 103123 1 DOE No, I N/A City Proj. No.: 103123 Project Description I Replacing Water & Sanitary Sewer Lines on Horne St., Carver Dr., Diaz Ave., and alleyways. Contractor I William J. Schultz, Inc. dba Circle C Construction, Co. Change Order: F 3 ] Date I 3/27/2023 City Project Mgr, Pralima Poudyal City Inspector: I Cody Horton DELETIONS ITEM 'DESCRIPTION DEPT Qty Unit UnitCost Total 1-2 8" DIP Water Unit I Water 7,198 LF $87.00 $626,226.00 2-3 8" DIP Sewer Pipe with Proleclo 401 Unit II Sewer 846.00 LF $132.00 $111,672.00 'Unit I Water $626,226.00 jUnil II Sewer $111,672.00 1 Pate 2 of 3 (Deletions Sub Total $737,898.00 MIWBE Breakdown for this Change Order MWBE Sub Type of Service Amount for this CO Total $0.00 Previous Change Orders CO# DATE AMOUNT Total $0.00 Page 3 of 3 3/27/2023 Water & Sanitary Sewer Replacement on Horne Street CSC: 57279 CPN: 103123 Change Order 3 Notes Staff has reviewed the requested prices and considers them to be fair and reasonable. .Contract Compliance Manager By signing I acknowledge that I am the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. Signature Pratima Poudyal, P.E. Name of Employee Project Manager Title ATTEST: )A,"� A Az-�� Jannette Goodall Clty Secretary CSC No. 57279-CO4 F_ C)►RT WOR-rm City of Fort Worth Change Order Request Project Name:1 Water & Sanitary Sewer Replacement on Horne Street City Sec No.: 1 57279 1 Project No,(s):l 103123 1 DOE No. I N/A I City Proj. No.: 1 103123 Project Description:) Replacing Water & Sanitary Sewer Lines on Horne St., Carver Dr., Diaz Ave., and alleyways. !� Contractor: William J. Schultz, Inc, dba Circle C Construction, Co. Change Order # 4 1 Date: 10/26/2023 City Project Mgr.1 Pratima Poudyal City Inspector: Cody Horton Phone Number:1 817-392-6149 Phone Number: 817475.6903 Contract Time Dept, Unit I Water Unit II Sewer Totals (Calendar days) Original Contract Arnount $2,905,104.26 $1,519.011.95 $4,424,116.20 650 Extras to Date $0.00 $0.00 $0.00 25 Credits to Date $594.50 $23,157.00 $23,751.50 Pending Change Orders (in M&C Process) Contract Cost to Date $2,904,609.75 $1,495,854.95 $4,400,364.70 575 Amount of Proposed Change Order $0.00 $0.00 $0.00 30 Revised Contract Amount $2,904,509.75 $1,495.854.95 $4,400,364.70 605 Original Funds Available for Change Orders $145,255.00 $75.951.00 $221,206.00 Remaining Funds Available for this CO $145,849.50 $99,108.00 $244,957.50 Additional Funding (if necessary) CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS % OF ORIGINAL CONTRACT -0.54% MAXALLOWABLE CONTRACTAMOUNT(ORIGINAL CONTRACT COST+ 2551.) $5,530,145.25 JUSTIFICATION (REASONS) FOR CHANGE ORDER Change Order No. 4 provides for the following: • Labor involved with adjusting the inverts of polymer manholes to match existing conditions. • Polymer grout necessary to adjust polymer manholes. Chain Link Fence replacement subsequent to sewer installation. Staff concurs with the contractor's request for 30 additional calendar days on the change order. It is understood and agreed that the acceptance of this Change Order by the contractor constitutes an accord and satisfaction and represents payment in full (both time and money) for all costs arising out of, or incidental to, the above Change Order. Contractor's Company Name Contractor Name �ontraclor Signature I I Da4&' Wlubam J. Schultz, Inc. dba Circlo C Conslrucllon, co. Teri Skelly Inspector J Date Iedagat r a t= 11 /2/23� 11/02/2023 Director Water Oc�{Sry Del© Consltucllgn Supe� 'sot,jjf'W alit ,� 1 Dec 7, 2023(%"/ Dale 11 /2/23 Assistant City Attorney Date Assistant City Manahel Dale Dec 7, 2023 Dec 8, 2023 Council.Action (if Regknredl M&C Number N/A M&C Date Approved N/A FORT W"P,-F1E-i City of Fort Worth Change Order Additions Project Name I Water & Sanitary Sewer Replacement on Horne Street City Sec No.: j 57279 Project No.(s): j 103123 DOE No.1 N/A City Proj. No.: 103123 Project Description I Replacing Water & Sanitary Sewer Lines on Home St., Carver Dr., Diaz Ave., and alleyways. Contractor William J. Schultz, Inc, dba Circle C Construction, Co. j Change Order: ® Date: 1 1012612023 City Project Mgr. Pratima Poudyal I City Inspector I Cody Horton ADDITIONS I I EM ULSUR1PI IUN DEPT Ql'( Unit Unit Cost Total _ 2-68 Labor to rework Inverts with Polymer Grout Unit II Sewer 1.50 DY $8,500.00 $12,750.00 2-69 Polymer Grout Unit II Sewer 10.00 BG $750.00. $7,500.00 2-70 Chain Link Fence Replacement Unit II Sewer 100.00 LF $25.00 $2,500.00 j Unit I Water I Unit II Sewer $22,750.00 Page 1 of 3 Additions Sub Total $22,750.00 FO RT wool P,.-Ir H City of Fort Worth Change Order Deletions Project Name Water & Sanitary Sewer Replacement on Horne Street , City Sec No.: 57279 Project No.(s): 103123 ! DOE No, I N/A City Proj, No,: 103123 Project Description I Replacing Water & Sanitary Sewer Lines on Home St., Carver Dr., Diaz Ave„ and alleyways. Contractor William.J. Schultz, Inc. dba Circle C Construction, Co, I Change Order Date I 10/2612023 City Project Mgr. Pratima Poudyal ! City Inspector: I Cody Horton DELETIONS ITEM DESCRIPTION DEPT Qty Unit Unit Cost Total 44 Sanitary Sewer Construction Allowance Unit II Sewer 0.2275 LS $100,000.00 $22,750.00 Unit I Water Unit II Sewer $22,750.00 Deletions Sub Total $22.760.00 Page 2 of 3 Ill MNUBE Breakdown for this Change Order MWBE Sub Type of Service Amount for this CO Total $0.00 Previous Change Orders co f DATE AMOUNT Total $0.00 Page 3 of 3 Contract Compliance Manager By signing I acknowledge that I am the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. I � 'l Signature Pratima Poudyal, P.E. Name of Employee Project Manager Title ATTEST: Jannette Goodall City Secretary 10/26/2023 CPN-103123 Water and Sanitary Sewer Replacement on Horne Street Change Order 4 Notes Staff has reviewed the requested prices and considers them to be fair and reasonable. FORTWORTH TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PROJECT NAME: Horne St Water and Sanitary Sewer Rehabilitation CITY PROJECT NUMBER: 103123 WATER PIPE LAID SIZE TYPE OF PIPE LF OPEN CUT 8" PVC 8,201.61 LF OPEN CUT 12" DIP 15 LF OPEN CUT 6" PVC 49.5 LF OPEN CUT 8" DIP 225 LF FIRE HYDRANTS: 9 EA VALVES (16" OR LARGER) N/A PIPE ABANDONED SIZE TYPE OF PIPE LF GROUTED 8" CIP 35 CY DENSITIES: YES - ALL PASSED NEW SERVICES: 1" COPPER 52 EA 1 1/2" COPPER 2 EA 2" COPPER 8 EA SEWER PIPE LAID SIZE TYPE OF PIPE LF OPEN CUT 8" PVC (160 PSI) 2,208 LF OPEN CUT 8" PVC (SDR-26) 1,261 LF PIPE BURST 8" HDPE 1,084 LF PIPE ABANDONED SIZE TYPE OF PIPE LF GROUTED 8" CIP 2 CY DENSITIES: YES - ALL PASSED NEW SERVICES: 4" PVC 59 EA TRANSPORTATION AND PUBLIC WORKS The City of Fort Worth • 1000 Throckmorton Street • Fort Worth, TX 76012-6311 (817) 392 - 7941 • Fax: (817) 392 - 7845 FORTWORTH. TRANSPORTATION AND PUBLIC WORKS May 16, 2024 Circle C Construction Company PO Box 40328 Fort Worth, TX 76140 RE: Acceptance Letter Project Name: Horne St Water and Sanitary Sewer Rehabilitation Project Type: Water, Sanitary Sewer, Paving City Project No.: 103123 To Whom It May Concern: On April 1, 2024 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 April 3, 2024. 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 April 3, 2024, 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- 392-8528. Sincerely, W. �aua4tc�al Clayton Torrance, Project Manager Cc: Cody Horton, Inspector Troy Gardner, Inspection Supervisor Ariel Duarte, Senior Inspector John Kasavich, Program Manager Shield Engineering Group, PLLC, Consultant Circle C Construction Company, Contractor City of Fort Worth, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev. 8/20/19 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 KEEGAN JONKERS of CIRCLE C CONSTRUCTION, known to me to be a credible person, who being by me duly sworn, upon his oath deposed and said; 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 damage; On Contract described as; Horne Street Water & Sanitary Sewer Rehabilitation City Project Number 103123 Subscribed and sworn before me on this 3'0 kMANDA S JONKERS Notatyr Public STATE OF TEXAS Nobuy ID # 1346 •w+�s m, gym. Exp. Domnber 21t. 2W x BY nor lc rl Day of si(A1y , 2024. 1 Notary Public in Tarrant County, TX CONSENT OF SURETY TO FINAL PAYMENT Bond No. TXC613329 TO OWNER: City of Fort Worth 1000 Throckmorton Street Fort Worth, TX PROJECT: (name, address) Horne St. Water and Sanitary Sewer Rehabilitation in the City of Fort Worth, TX OWNER ARCHITECT CONTRACTOR SURETY OTHER ARCHITECT'S PROJECT NO.: City Project No. 103123 CONTRACT FOR: Utilities CONTRACT DATED: March 8, 2022 In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the (Insert name and address of Suret}) Merchants Bonding Company (Mutual) 6700 Westown Parkway West Des Moines, IA 50266 ,SURETY on bond of (Insert name and address of Contractor) William J. Schultz, Inc., dba Circle C Construction Company P. O. Box 40328 Fort Worth, TX 76140 , CONTRACTOR, hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve the Surety of any of its obligations to (Insert name and address of Owner) City of Fort Worth 1000 Throckmorton Street Fort Worth, TX 76102 , OWNER, as set forth in the said Surety's bond. IN WITNESS WHEREOF, the Surety has hereunto set its hand this date: May 22, 2024 (Insert in writing the month followed by the numeric date and year.) Merchants Bonding Company (Mutual) (Surety) A (Signature ofauthoriV* representative) Witness as to Surety: Sheryl A. Klutts, Attorney -in -Fact (Se _ � _ �0 � �& �0 (Printed name and title) John A. Miller MERCHANTS""k, BONDING COMPANY. POWER OF ATTORNEY Know All Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., both being corporations of the State of Iowa, d/b/a Merchants National Indemnity Company (in California only) (herein collectively called the "Companies") do hereby make, constitute and appoint, individually, John A Miller; Sheryl A Klutts their true and lawful Attomey(s)-in-Fact, to sign its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. This Power-of-Attomey is granted and is signed and sealed by facsimile under and by authority of the following By -Laws adopted by the Board of Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors of Merchants National Bonding, Inc., on October 16, 2015. "The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Attomeys-in-Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof." "The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually fixed." In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and aut hority hereby given to the Attomey-in-Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond. In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to the Attorney -in -Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner - Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation. In Witness Whereof, the Companies have caused this instrument to be signed and sealed this 20th day of March 2023 .••'p"'••., ......... MERCHANTS BONDING COMPANY (MUTUAL) • �Q,NG C�i�A'. MERCHANTS NATIONAL BONDING, INC. cy�ORPO/P4 e0: ; �O; OQ�P09 .9 d/b/a MERCHANTS NATIONAL INDEMNITY COMPANY 1933 c: By •.,A� •.. :7�..•• •.bdk, ''`'�'�: President STATE OFIOWA �'•.,�� i"f •�..•'• •••......•'� COUNTY OF DALLAS ss. On this 20th day of March 2023 before me appeared Larry Taylor, to me personally known, who being by me duly sworn did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the seals affixed to the foregoing instrument are the Corporate Seals of the Companies; and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. prat s Carrrxse nNuriher 702737 ApnTM Notary Public (Expiration of notary's commission does not invalidate this instrument) I, William Warner, Jr., Secretary of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., do hereby certify that the above and foregoing is a true and correct copy of the POWER -OF -ATTORNEY executed by said Companies, which is still in full force and effect and has not been amended or revoked. In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 22nd day of May, 2024. 'O9y 4O�PORq�•�4?,�RP094J• _o_ at :11y:2 -o- o;_: 2003 1933 c; Secretary '•.,..�•.......:��•.• •.day ''`�•: POA0018 (10/22) "' ••••••••