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Home My WebLink AboutContract 59132-FP1FORT WORTH, TRANSPORTATION AND PUBLIC WORKS NOTICE OF PROJECT COMPLETION -FP1 City Secretary No. 59132 Date Received: 8/6/2025 City Project JV!?: 103055 & 103059 Regarding contract 59132 5th St @ Carroll St & Carroll St @ Merrimac SDR for as required by the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by City Council on 2/14/2023 through M&C 23-0080 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: Final Payment Due TaWcla L. ww(sack PAL,— L Wad sa Ck(J a 129, 202511'.2357 CD I; Recommended for Acceptance Asst. Director, TPW - Capital Delivery $1,048,090.00 Days 140 $ 0.00 )V2 Days Added by CO $ Total Days $ 954,090.00 Days Charged 140 Days @ $ $ 954,090.00 $ 906,385.50 $ 47, 704.50 Jul 29, 2025 Date L .t4.rm Prt~ Lauren Pri eur IJu129. 202111 21-S / CDT Accepted Director, TRANSPORTATION AND PUBLIC WORKS DEPARTMENT Asst. City Manager Comments: Jul 29, 2025 Date Aug 4, 2025 Date / Day OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX C-620 Signature Page To (Owner) P. O. Number: Project: Contractor's Application for Payment Invoice No.Final City of Fort Worth Invoicing Period (From- To): Invoice Date: City Secretary Contract Number: 212 zozs From (Contractor): Remit to ( If Not Automatic Deposit): Vortex Lining Systems, LLC 103055 & 103059 Contractor's CFW Vendor No.: 7000003631 18150 Imperial Valley Drive, Houston, TX 77060 59132 Contract 5th Street at Carroll Street to Railroad Storm Drain & Carroll Street and Merri Name: Application For Payment Change Order Summary Approved Change Orders Number Additions 1 2 3 4 5 6 7 8 TOTALS NET CHANGE BY CHANGE ORDERS Contractor's Certification 1. ORIGINAL CONTRACT PRICE......................................................... $ Deletions 2. Net change by Change Orders................................................................ $ 3. Current Contract Price (Line 1 f 2)....................................................... $ 4. TOTAL COMPLETED AND STORED TO DATE (Progress Estimate, Construction Allowance and Change Orders)...... $ 5. RETAINAGE: a. X $954,090.00 Work Completed.......... $ b. X Not Used $ c. Total Retainage (Line 5a + Line 5b) ............................... $ 6. AMOUNT ELIGIBLE TO DATE (Line 4 - Line 5c)............................ $ 7. LESS PREVIOUS PAYMENTS (Line 6 from prior Application)......., $ 8. AMOUNT DUE THIS APPLICATION ................................................ $ 9. BALANCE TO FINISH, PLUS RETAINAGE (Column G on Progress Estimate+ CA + Cos + Line 5 above) .............. $ 10. CONTRACT TIME: The Contractor certifies with the submittal of this document and associated Payment Request Submittal on the City of Fort Worth Buzzsaw system that to the best of their knowledge: (1) all previous progress payments received from Owner on account of Work done under the Contract have been applied on account to discharge Contractor's legitimate obligations incurred in connection with Work covered by prior Applications for Payment; (2) title of all Work, materials and equipment incorporated in said Work or otherwise listed in or covered by this Application for Payment will pass to Owner at time of payment free and clear of all Liens, security interests and encumbrances (except such as are covered by a Bond acceptable to Owner indemnifying Owner against any such Liens, security interest or encumbrances); and (3) all Work covered by this Application for Payment is in accordance with the Contract Documents and is not defective. Liquidated Damages $650.00 x day Ross Cooke Apr 4,20n 0940 EDT) a, Days Awarded b, Days Added by CO C. Total Days d, Days Charged e. Days Remaining Contractor: Vortex Lining Systems, LLC Brandon Garrastazu Sr. Accountant Consent of Surety IJ fOIU $1,048,090.00 $1,048,090.00 $954,090.00 $954,090.00 $906,385.50 $47,704.50 $94,000.00 140 140 140 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. Progress Estimate CitySecmti, 59132 Contract Num F°t(°°tl°) 5th Street at Carroll Street to Railroad Storm Drain & Carroll Street and Merrimac Street Storm Drain Apphcatmn Puwd. A B C D I[em Specification Bid Qnanhty Unit P.. Bid Value Estimated Qi 1y Value Previously lnsmlled Bid Item No. D-ipt- S-Nc Unnof Measure Installed Unit 1 -Storm Wale, Rehabilitation b�SAPL -Sth Street at Carroll at - Raan AND 2 GROUNDfT�IAO7NF-UffnEAM]O�BILIJZ�AT(IJO}EWATERING 999999 LS 10000 $29,500.0� $29,500.0 1.000000 $29.50 $29.! STORM I/�QI(=�i� LU'IUX(i_VATION PLAN(SWPPP) AND 015713 3 IMPLEMENTATION LS 100000, $3,025.011 $3,025.00J 1.0000000J $3,025.IX $3.1 4 TRAFFIC CONTROL 347113 MO 40000��1 $3,625.0„ $14.500.O'QQ(% 2.000000,Q/%I $7,250.IX $7,: 5 CHEMICAL GROUT INJECTION R} 109000011J $$5.400.00 109.000000U $36,750.01• $36.1 I,1� J I/(F(��r`�n 1p(/gyp(// �G W W W EA $6 0.011 1 $5,400.0\ $5.i a L IEI2AL SE12 (:E 12EINSTATEMENT&BRUSHING ... EA 120000 i1 $30.011 $4200.00 1z.00000001 $a.zoo.a $a.: SOIL VOID) 030132 �/fI, $$11.2G .010 1 I 0 PRE CCTV INSP�CTOIONL LF 0000000ff $10.52 125.0011 900.000000UJJ $10,125. $10.' 11 POST CCTVINSPECTION 330132 LF 000000df $% $5. 75.00� 90.000000U $5. 75.0O $5,' 12 NORMAL CLEANING OF STORM DRAIN 330450 LF 90 000011J $27.0„ $24. 00.00J 900.000000UJ $24,300.0d $24.: 13 HEAVY CLEANING OF STORM DRAIN 330450 LF 100000 $54.011 $540.0 10.000000 $540.0/ V INSTALLATION OF SAPL, COMPLETE, IN PLACE AND READY TO USE 33 31 71 � 14 PUMPINGI LF 0000000 $475.0(I $427,500.00 90.0000000 $427,0O.00J $427.! 15 iiV�QS�111UM1'jfffASS ii��li5 1�LfMl'�'�N(L, 330310 LS 1 00000d $2,500.0f1 $2,500.0 1.000000 $2,00.0a11� $2.! Unit 1 - Storm Water Rehabilitation by CIPP - Carroll Street anti Merrimac Street BYPASS PUMPIING/DEWATERING/ GROUNDWATER MANAGEMENT 999999 1 LS 1000000 $9,300.0[ 1 $9.300.00 1.0000000 $9.300.0 $9,: STORMWATER POLLUTION PREVENTION PLAN (SWPPP) AND 015713 2 IMPLEMENTATION LS 100000 $3,000.0[1 $3,000.00 1.0000000 $3.00.0 $3,1 3 L 347113 WK 20000JJ $720.0f1 $14,500.0 1.000000JJ $7250. 1' $7,: 4 `LAT��%%E ... EA 30000G/fI, $3,000.0f1 $9,001 3.000000U $9.00.a1 $9,1 5 fRfAL ` I $42$7.00 .800.0'(%I' $$4,340.00 4000000UJ $16,SOO.OJ $16,1 '(.IV INSPECTION fXflL��('j 330132 EF 62000000 620.000000f Q 0( $a.340. f $4,a 7 fff JfON [' 330132 LF 8200000(1f 620 $3.7. $2. 25.001 620.000OOOOdf $2,325.a fJ $2,: OF S I�fi(rl $( 33 04 50 LF 00002f $S.Sf $5,270.00/ 000OOOdf $5270.5 $5,: 9 HEAVY ��%f ST�j�tyj nJ2 Jn 33 U450 LF 3950000(1 $52.01 $20,540.00 39520 395.000OOOd $20,540.a1 $20.! INSTALC'rVF 9U-'1�(.iii i`Iflf', IYMPLETE, IN PLACE AND READY LA 33 31 12 TO USE LF 82500001� $2$3,000.06 .600.00 624.000000t1 $2$2,400.a� 66.600. 661 $2$2.i 11 LATERAL SEROT VICEI(i�ii��TI Q�tiial�l�l�'�i OSHING ... EA $600.O0 This document has been moddi,d from its piial form as an E1CDC document and the user did not highhghl the modifications. You are encouraged to read the document carefully and consult Legal Counsel prior , its execution. C-620 Unit Price Progress Estimate Contractor's Application Appliwhon Nember: Final Apyli-ion Date: 2/12/2025 E ls Va1ne Thiseno Pd hSPmsently F Total Completed % and Stored- red m Date IF) G Balance In Fiiimh (B - F) t-d stored (not in c> (D+E) B $51.000.0d 100.0% $29.500.Od 100.0% $3.025.00 100.0% $7250.Od 50.0% $7,250.00 $26,250.00 $36.750.Od 100.0% $5.400.od 100.0% $4200.od 100.0% $52,650.00 $10.1z5.od 100.0% $5. 75.od 10o.0% $24.300.Od 100.0% $540.0d 100.0% $427.500.00 100.0% $2.500.Od 100.0% $9.300.00 100.0% $3.000.00 100.0% $7250.Od 50.0% $7,250.00 $9.0oo.0d 100.0% $16,a00.Od 100.0% $4.340.0d 100.0% $2.325.Od 100.0% $5.270.od 100.0% $20.540.Od 100.0% $266.600.00 100.0% $2.400.Od 80.0% $600.00 Progress Estimate CitySecmtaz 59132 Contract Num F°r(°°tl°) 5th Street at Carroll Street to Railroad Storm Drain & Carroll Street and Merrimac Street Storm Drain Apphcaho° Perwd A B I[em Bid Item No. D—iphon Specification Unnof Measure Bid Qaanhty U.. P.. Bid Value S.—Nc C Eshmmed Q—Iny Installed This document has been modified from its onginal form as an EICDC document and the user did not highhght the modifications. You are encouraged to read the document carefully and consult Legal Counsel prior m its execution. Previously Insmlled VA C-620 Unit Price Progress Estimate Contractor's Application Appliwhon Number: Final Apphcmmn Date: 2/12/2025 E F G Total Completed % Balance to Finish Valne'I'his Penod Materials Presently and Stored m Date (F) (B - F) stored (not in G) (n+E) B Progress Estimate City S—taz 59132 Contract Num F°rl °°tl° / 5th Street at Carroll Street to Railroad Storm Drain & Carroll Street and Merrimac Street Storm Drain A B Imm Bid Item No. D —iphon Specification Unn of Measure Bid Quantity Unn P.. Bid Value S.—Nc C-620 Unit Price Progress Estimate Contractor's Application Appliwhon Number: Final Apyhcmmn Date: 2/12/2025 C D E F G EshmQumtity MeTotal Completed % Balance to Fiuish I Insta-lled Value Previously Insmlled Value Valne'I'heno is Pd Store—dd Presently TWO (not iv CJ and Stored m Da" ((B - P) � B+EI B This document has been modified from its ongmal form es an EICDC document and the user did not highhgM the modifications. You are encouraged to read the document carefully and consult Legal Counsel prior m its execution. Progress Estimate CitySecretaz 59132 Contract Num F°r( °°tl° ) 5th Street at Carroll Street to Railroad Storm Drain & Carroll Street and Merrimac Street Storm Drain Apphcaho° Perwd A B Item Bid Item No. D—iphon Specification Unnof Measure Bid Quanhry U.. P.. Bid Value S.—Nc Totals C D Eshmated Quantity Value In $954.090.00 This document has been modified from its ongmal folio es an EICDC document and the user did not highhght the modifications. You are encouraged to read the document carefully and consult Legal Counsel prior m its execution. C-620 Unit Price Progress Estimate Contractor's Application Appliwhon Number: Final Apphcation Date: 2/12/2025 E F G Total Completed % Balance to Fiuiah Previously Installed Value Valne'I'his Penod Mt,,,,, Presently and Stored to Date (F) (B - F) stored (not in c>+E) B $954,090.001 $954.090.00 91.0% $94.000.00 C-620 Change Order Progress Estimate Construction Allowance Usage ADDITIONS For 5th Street at Carroll Street to Railroad Storm Drain & Carroll Street and Merrimac Street Storm City Secretary O55 & 103 Drain Comma Num: 59132 Application Period: A B C D Item Spec�ficat�on Quantity to Add Umt Pr— Addnm Value Estimated Quantity Value Item Number Descnphon Unrt of Measure Installed Section No. Pre—al y Value Thas Installed Value Period This document has been modified from its original form as an EEICDC 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 Final Application Date: 2/12/2025 E F Mat-aTotal Completed / Balance to Finish Stored tated (not m C) Presently and Stored to Date (F) (B -F) S( (D+E) B C-620 Change Order I Totals I I I I I I I I I I I I I I Progress Estimate Construction Allowance Usage Contractor's Application CONSTRUCTION ALLOWANCE ITEMS TO BE REDUCED For (eummet): 055 & 1035th Street at Carroll Street to Railroad Storm Drain & Carroll Street and Merrimac Street Storm Drain Appl—tum Number. Final Appl—tron Penod. Apphcatum Date: 2/12/2025 A B C D E F Item Specification Quantity to Delete Umt Pnce Reduehon Value Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used Bid Item Number Description Unit of Measure Section No. Totals This document has been modified from its original form as an EEJCDC 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 I I I Contractor's Application ADDITIONS For (contract). 055 & 103 5th Street at Carroll Street to Railroad Storm Drain & Carroll Street and Merrimac Street Storm City Secretary 59132 Application Number: Final Drain Contract Num: Application Period: Application Date: 2/12/2025 A B C D E F Item Addition Total Completed Balance to Finish Change Order Item Spec CO Quavtny to Add Unit Puce Change Order Estimated Quantity Value Installed Prev�wsI l Value This Materials Presently Installed Period Stored C) and Stored to Date (F) (B -F) No. Description Section No. Unrt of Measure on No. Value Value (not m � � � B This document has been modified from its original form as an EEICDC 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 Totals Progress Estimate Change Order Number 1 Contractor's Application DELETIONS For (contract): 055 & 103 5th Street at Carroll Street to Railroad Storm Drain & Carroll Street and Merrimac Street Storm Drain Apphcahon Number. Final Application Period: Application Date: 2/12/2025 A B C D E F Item CO Quant�Ty to Deletron Change Order Item Specification Description Unit Measure Delete Umt Pace Change Order Not Used Net Used Net Used Net Used Net Used Not Used Not Used Not Used No. of Section No. Value Totals This document has been modified from its original form as an EEICDC 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 2 ADDITIONS For (contract). 055 & 103 5th Street at Carroll Street to Railroad Storm Drain & Carroll Street and Merrimac Street Storm City Secretary 59132 Drain Contract Num: Application Period: A B Item Change Order Item Specification CO Quantity to Add Una Puce Addmon Change No. Descnphou Section No. Unrt of Measure Order Value C D Estrmated Quacatay Value Insta led Previously Value This Installed Value Perod This document has been modified from its original form as an EEJCDC 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 Application Number: Final Application Date: 2/12/2025 E F Balance to Finish Matenals Presently Total Completed % and Stored to Date (F) (B F) Stored (vot m C) (DIE) B C-620 Change Order Totals I I I I I Progress Estimate Change Order Number 1 2 Contractor's Application DELETIONS For (..tact): 055 & 103 51h Street at Carroll Street to Railroad Storm Drain & Carroll Street and Merrimac Street Storm Drain Apphcaho, Number. Final Apphcaho, Pmod. Apphcaho. Date: 2/12/2025 A B C D E F Change Order Item Specification Unit Price CO Quantity to Deletion Change Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used No. DescriptiItem Unit of Measure on Delete Order Value Section No. Totals This document has been modified from its original form as an EEICDC 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 ADDITIONS For (contract). 055 & 103 5th Street at Carroll Street to Railroad Storm Drain & Carroll Street and Merrimac Street Storm City Secretary 59132 Drain Contract Num: Application Period: A B Item Addition Change Order Item Unit of Measure Specification CO Quantity to Add Unit Price Change Order No. Description Section No. Value C D Estimated Quantity Value Installed Contractor's Application . PP co—o mo—, Final Application Date: 2/12/2025 E F Balance to Finish Previously Value This Materials Presently anTotal Completed d Stored to Date (F) (B - F) Installed Value Period Stored (not in C) (D + E) B This document has been modified from its original farm as an EEICDC 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 DELETIONS For (wntmet} 055 & I035th Street at Carroll Street to Railroad Storm Drain & Carroll Street and Merrimac Street Storm Dram Application' Nambec Final Application Period: Application Date: 2/12/2025 A B C D E F Item CO Quantity to Deletion Change Order Item No. Sp—rcat,Unit of Measure on Descnp4on Section No. Delete Umt Pr— Change Order Not Used Value Not Used Not Used Not Used Not Used Not Used Not Used Not Used Totals This document has been modified from its original form as an EEICDC 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 ADDITIONS For (contract). 055 & 103 5th Street at Carroll Street to Railroad Storm Drain & Carroll Street and Merrimac Street Storm City Secretary 59132 Drain Contract Num: Application Period: A B Item Addmon Change Order Item Descvption Spec�ficat�or, Unit of Measure CO Quantity to Add Unit Puce Change Order No. Section No. Value C D Estimated Quanhly Value Installed Contractor's Application . Pp— —aau,— Final Application Date: 2/12/2025 E F Balance to Finish Total Completed % Installed V) Plled Valsly Valueue Pend MaStored tenals Presently and Stored to Date (F) (B _ P od (not m C) (D I E) B This document has been modified from its original form as an EEICDC 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 (wntmet} 055 & I035th Street at Carroll Street to Railroad Storm Drain & Carroll Street and Merrimac Street Storm Dram Application' Nambec Final Application Period: Application Date: 2/12/2025 A B C D E F Item CO Quantity to Deletion Change Order Item No. Sp—rcat,Unit of Measure on Descnp4on Section No. Delete Umt Pr— Change Order Not Used Value Not Used Not Used Not Used Not Used Not Used Not Used Not Used Totals This document has been modified from its original form as an EEICDC 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 ADDITIONS For (contract). 055 & 103 5th Street at Carroll Street to Railroad Storm Drain & Carroll Street and Merrimac Street Storm City Secretary 59132 Drain Contract Num: Application Period: A B Item Addu" Change Order Item Descnpbon Spec�ficat�or, Unit of Measure CO Quantity to Add Unit Puce Change Order No. Section No. Value C D Estimated Quantity Value Installed Contractor's Application vvaa„ n,.mn� Final Application Date: 2/12/2025 E F Balance to Finish Total Completed % ) Palled Val Value This Matenals Presently and Stored to Date (F) (B _ P Installed Value Perod Stored (not m C) (D I E) B This document has been modified from its original farm as an EEICDC 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 (wntmet} 055 & I035th Street at Carroll Street to Railroad Storm Drain & Carroll Street and Merrimac Street Storm Dram Application Number: Final Application Period: Application Date: 2/12/2025 A B C D E F Item CO Quant�Ty to Delehun Change Order Item No. Speoficat,Dart of Measure on Descnp4on Section No. Delete Umt Pr— Change Order Not Used Value Not Used Not Used Net Used Net Used Not Used Not Used Not Used Totals This document has been modified from its original form as an EEICDC 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 6 ADDITIONS For (contract). 055 & 103 5th Street at Carroll Street to Railroad Storm Drain & Carroll Street and Merrimac Street Storm City Secretary 59132 Drain Contract Num: Application Period: A B Item Addition Change Order Item Specification CO Quantity to Add Unit Price Change Order No. Description Section No. Unit ofMeasam Value C D Estimated Quantity Value Installed Contractor's Application . Pp-----. Final Application Date: 2/12/2025 E F Balance to Finish Previouslyvane This Materials Presently anTotal Completed d stored to Date <F) B "� Installed Value ue Period Stored (not in C) (D + E) B This document has been modified from its original farm as an EEICDC 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 6 Contractor's Application DELETIONS For (wntmet} 055 & I035th Street at Carroll Street to Railroad Storm Drain & Carroll Street and Merrimac Street Storm Dram Application' Nambec Final Application Period: Application Date: 2/12/2025 A B C D E F Item CO Quantity to Deletion Change Order Item No. Sp—rcat,Unit of Measure on Descnp4on Section No. Delete Umt Pr— Change Order Not Used Value Not Used Not Used Not Used Not Used Not Used Not Used Not Used Totals This document has been modified from its original form as an EEICDC 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 7 ADDITIONS For (contract). 055 & 103 5th Street at Carroll Street to Railroad Storm Drain & Carroll Street and Merrimac Street Storm City Secretary 59132 Drain Contract Num: Application Period: A B Item Addaroa Change Order Item Description Specification Unit of Measure CO Quantity to Add Umt Price Change Order No. Section No. Value C D Estrmated Quanhly Value Installed Contractor's Application . Pp.co— "ano,c.: Final Application Date: 2/12/2025 E F Balance to Finish Total Completed % Previously Value This MatenalPresently and Stored to Date (F) (B -F) Installed Value Perod Stored ( (not iv C) (D I F) B This document has been modified from its original form as an EEICDC 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 Totals I I I I Progress Estimate Change Order Number 1 7 Contractor's Application DELETIONS For (..tact): 055 & 103 51h Street at Carroll Street to Railroad Storm Drain & Carroll Street and Merrimac Street Storm Drain Apphcaho, Number. Final Apphcaho, Pmod. Apphcaho, Date: 2/12/2025 A B C D E F Item CO Quantity to Deletion Change Order Item Specification Description Unit afMeasure Delete Unit Price Change Order Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used No. Section No. Value Totals This document has been modified from its original form as an EEICDC 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 ADDITIONS For (contract). 055 & 103 5th Street at Carroll Street to Railroad Storm Drain & Carroll Street and Merrimac Street Storm City Secretary 59132 Drain Contract Num: Application Period: A B Item Addmon Change Order Item Descvption Spec�ficat�or, Unit of Measure CO Quantity to Add Unit Puce Change Order No. Section No. Value C D Estimated Quanhly Value Installed Contractor's Application . Pp— —aau,— Final Application Date: 2/12/2025 E F Balance to Finish Total Completed % Installed V) Plled Valsly Valueue Pend MaStored tenals Presently and Stored to Date (F) (B _ P od (not m C) (D I E) B This document has been modified from its original form as an EEICDC 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 (wntmet} 055 & I035th Street at Carroll Street to Railroad Storm Drain & Carroll Street and Merrimac Street Storm Dram Application' Nambec Final Application Period: Application Date: 2/12/2025 A B C D E F Item CO Quantity to Deletion Change Order Item No. Sp—rcat,Unit of Measure on Descnp4on Section No. Delete Umt Pr— Change Order Not Used Value Not Used Not Used Not Used Not Used Not Used Not Used Not Used Totals This document has been modified from its original form as an EEICDC 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. City of Fort Worth Summary of Charges City Secretary Contract Num: � 59132 � Sth Street at Carroll Street to Railroad Storm Drain &c 1P. O.: 0 Project Number: 103055 & 103059 Carroll Street and Merrimac Street Storm Drain Application Period: 0 Application Final Application Date: 2/12/2025 Number: Funding Identification (FID) Total Completed Amt Remaining Gross Retainage Net Original Contract 52007-0200431-5330500-103055-002880-9999 $346,825.00 $7,850.00 52007-0020431-5330500-103059-002880-9999 $607,265.00 $86,150.00 0 0 0 0 0 0 0 0 0 Change Order 1 52007-0200431-5330500-103055-002880-9999 52007-0020431-5330500-103059-002880-9999 0 0 0 0 0 0 0 0 0 Change Order 2 52007-0200431-5330500-103055-002880-9999 52007-0020431-5330500-103059-002880-9999 0 0 0 0 0 0 0 0 0 Change Order 3 52007-0200431-5330500-103055-002880-9999 City of Fort Worth Summary of Charges City Secretary Contract Num: 59132 Sth Street at Carroll Street to Railroad Storm Drain & 11' 0 I I O . Carroll Street and Merrimac Street Storm Drain l Application Period: I 0 I Application I Final Number: Funding Identification (FID) 52007-0020431-5330500-103059-002880-9999 0 0 0 0 0 0 0 0 0 Chance Order 4 52007-0200431-5330500-103055-002880-9999 52007-0020431-5330500-103059-002880-9999 0 0 0 0 0 0 0 0 0 Chance Order 5 52007-0200431-5330500-103055-002880-9999 52007-0020431-5330500-103059-002880-9999 0 0 0 0 0 0 0 0 0 Chance Order 6 52007-0200431-5330500-103055-002880-9999 52007-0020431-5330500-103059-002880-9999 0 Total Completed Amt Remaining Gross Project Number: 1103055 & 103059 Application Date: 2/12/2025 Retainage Net City of Fort Worth Summary of Charges Sth Street at Carroll Street to Railroad Storm Drain &c City Secretary Contract Num: � 59132 � 1P. O.: 0 Project Number: 103055 & 103059 Carroll Street and Merrimac Street Storm Drain Application Application Period: 0 Number: Final Application Date: 2/12/2025 Funding Identification (FID) Total Completed Amt Remaining Gross Retainage Net 0 0 0 0 0 0 0 0 Change Order 7 52007-0200431-5330500-103055-002880-9999 52007-0020431-5330500-103059-002880-9999 0 0 0 0 0 0 0 0 0 Change Order 8 52007-0200431-5330500-103055-002880-9999 52007-0020431-5330500-103059-002880-9999 0 0 0 0 0 0 0 0 0 Totals 52007-0200431-5330500-103055-002880-9999 $346,825.00 $7,850.00 52007-0020431-5330500-103059-002880-9999 $607,265.00 $86,150.00 0 0 0 0 0 0 0 0 0 City of Fort Worth Summary of Charges Sth Street at Carroll Street to Railroad Storm Drain & 0 City Secretary Contract Num: I 59132 I I P. O. Carroll Street and Merrimac Street Storm Drain l Application Period: I 0 I Application I Final Number: Funding Identification (FID) Grand Total Total Completed Amt Remaining I I Gross 1 1 $954,090.00 1 1 Project Number: 1103055 & 103059 Application Date: 2/12/2025 Retainage Net $94,000.00 1 1 $0.00 1 1 ($47,704.50)1 1 $47,704.50 1 FORTWORTH. M, TRANSPORTATION AND PUBLIC WORKS September 18, 2023 Vortex Lining Systems, LLC 18150 Imperial Valley Dr. Houston, TX 77060 RE: Acceptance Letter Project Name: 5th Street at Carroll St and Carroll St at Merrimac SDR Project Project Type: Storm Drain City Project No.: 103055, 103059 To Whom It May Concern: On August 29, 2023 a final inspection was made on the subject project. There were no punch list items identified at that time. The final inspection indicates that the work meets the City of Fort Worth specifications and is therefore accepted by the City. The warranty period will start on September 29, 2023, which is the date of the final inspection and will extend of two (2) years in accordance with the Contract Documents. If you have any questions concerning this letter of acceptance, please feel free to contact me at 817- 300-9960. Sincerely, Mike Crenshaw, P.E., CFM, Project Manager Cc: Sergio Garcia, Inspector Donald Watson, Inspection Supervisor Oscar Aguillon, Senior Inspector Linda S. Young, P.E., Program Manager HDR Inc., Consultant Vortex Lining Systems, LLC, Contractor N/A, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev. 08/20/19 CONSENT OF SURETY OWNER ❑ TO FINAL PAYMENT ARCHITECT ❑ AIA DOCUMENT G707 A CONTRACTOR ❑ - . SURETY 0 OTHER ❑ PROJECT: Carroll Street and Merrimac Street Storm Drain (name, address) Rehabilitation - CPN 103055 and 5th Street at Carroll Street to Railroad Storm Drain Rehabilitation - CPN 103059 TO (Owner) City of Fort Worth 200 Texas Street Fort Worth, TX 76102 ARCHITECT'S PROJECT NO: CONTRACT FOR: CONTRACT DATE: Bond No. ES00010380 In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the (here insert name and address of Surety as it appears in the bond). Everest Reinsurance Company 100 Everest Way, Warren Corporate Center, Warren, NJ 07059 , SURETY, On bond of (here insert name and address of Contractor as it appears in the bond) Vortex Lining Systems, LLC 18150 Imperial Valley Drive, Houston, Tx 77060 CONTRACTOR, hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor as follows: Final Payment The Surety agrees that such final payment to the Contractor shall not relieve the Surety of any Of Its obligations to (here insert name and address or Owner) City of Fort Worth 200 Texas Street, Fort Worth, TX 76102 OWNER as set forth in the said Surety's bond. IN WITNESS WHEREOF; the Surely has hereunto set its hand this 2nd day of April 2025 Attest: (Seal): Everest Reinsurance Company S ety 00 Sig ure of Authorized Representative Aaron P. Clark, Attorney -in -Fact Title AIA DOCUMENT G707A • CONSENT OF SURETY TO REDUCTION IN OR PARTIAL RELEASE OF RETAINAG E • JUNE 1971 EDITION • AIA • 1971 • THE AMERICAN INSTITUTE. OF ARCHITECTS, 1735 NEW YORK AVE., NW, WASHINGTON, D.C. 20006 A everest` POWER OF ATTORNEY EVEREST REINSURANCE COMPANY KNOW ALL PERSONS BY THESE PRESENTS: That Everest Reinsurance Company, a corporation of the State of Delaware ("Company") having its principal office located at 100 Everest Way, Warren, New Jersey, 07059, do hereby nominate, constitute, and appoint: Florence McClellan, Aaron P. Clark, Robert F. Bobo, Timothy F. Kelly, Laura Kneitz, Teresa D. Kelly, Craig C. Payne, Rachel Richardson its true and lawful Attorney(s)-in-fact to make, execute, attest, seal and deliver for and on its behalf, as surety, and as its act and deed, where required, any and all bonds and undertakings in the nature thereof, for the penal sum of no one of which is in any event to exceed UNLIMITED, reserving for itself the full power of substitution and revocation. Such bonds and undertakings, when duly executed by the aforesaid Attorney(s)-in-fact shall be binding upon the Company as fully and to the same extent as if such bonds and undertakings were signed by the President and Secretary of the Company and sealed with its corporate seal. This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Board of Directors of Company ("Board") on April 21, 2016: RESOLVED, that the President, any Executive Vice President, and any Senior Vice President are hereby appointed by the Board as authorized to make, execute, seal and deliver for and on behalf of the Company, any and all bonds, undertakings, contracts or obligations in surety or co -surety with others and that the Secretary or any Assistant Secretary of the Company be and that each of them hereby is authorized to attest to the execution of any such bonds, undertakings, contracts or obligations in surety or co -surety and attach thereto the corporate seal of the Company. RESOLVED, FURTHER, that the President any Executive Vice President, and any Senior Vice President are hereby authorized to execute powers of attorney qualifying the attorney named in the given power of attorney to execute, on behalf of the Company, bonds and undertakings in surety or co -surety with others, and that the Secretary or any Assistant Secretary of the Company be, and that each of them is hereby authorized to attest the execution of any such power of attorney, and to attach thereto the corporate seal of the Company. RESOLVED, FURTHER, that the signature of such officers named in the preceding resolutions and the corporate seal of the Company may be affixed to such powers of attorney or to any certificate relating thereto by facsimile, and any such power of attorney or certificate bearing such facsimile signatures or facsimile seal shall be thereafter valid and binding upon the Company with respect to any bond, undertaking, contract or obligation in surety or co -surety with others to which it is attached. IN WITNESS WHEREOF, Everest Reinsurance Company has caused their corporate seals to be affixed hereto, and these presents to be signed by their duly authorized officers this 151' day of February 2023. SEAL I Everest Reinsurance Company Gam= By: Anthony Romano, Senior Vice President On this 15", day of February 2023, before me personally came Anthony Romano, known to me, who, being duly sworn, did execute the above instrument; that he knows the seal of said Company; that the seal affixed to the aforesaid instrument is such corporate seal and was affixed thereto; and that he executed said instrument by like order. LINDA ROBINS Notary Public, State of New York No 01RO623973G Qualified In Queens County Term Expires April 25, 2027 Linda Robins, Notary Public I, Nicole Chase, Assistant Secretary of Everest Reinsurance Company do hereby certify that I have compared the foregoing copy of the Power of Attorney and affidavit, and the copy of the Section of the bylaws and resolutions of said Corporation as set forth in said Power of Attorney, with the ORIGINALS ON FILE IN THE HOME OFFICE OF SAID CORPORATION, and that the same are correct transcripts thereof, and of the whole of the said originals, and that the said Power of Attorney has not been revoked and is now in full force and effect. IN WITNESS WHEREOF, I have hereunto set my hand and affixed the seal of said Company, this 2nd day of April 2025. urap.,P Q` `�p40rtyr� O 91 SEAL ' v 6i t97i 0+ '+ruwlko <' By: Nicole Chase, Assistant Secretary ES 00 01 04 16 r 2711E R E.SN, TEXAS IMPORTANT NOTICE To obtain information or make a complaint: You may call toll -free for information or to make a complaint at 1-866-287-1736 You may also write to: Everest National Insurance Company 477 Martinsville Road, PO Box 830 Liberty Corner, NJ 07938-0830 You may contact the Texas Department of Insurance to obtain information on companies, coverages, rights or complaints at 1-800-252-3439 You may write the Texas Department of Insurance Consumer Protection (111-1A) P.O. Box 149091 Austin, TX 78714-9091 FAX: (512) 490 —1001 Web: http://www.tdi.texas.Rov E-mail: ConsumerProtectionC@tdi.texas.sov PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should first contact the agent or call 1-908-604-3000. If the dispute is not resolved, you may contact the Texas Department of Insurance. ATTACH THIS NOTICE TO YOUR POLICY: This notice is for information only and does not become a part of condition of the attached document. N P 70 68 0901 TEXSAS AVISO IMPORTANTE Para obener informacion o para someter una queja: Usted puede Ilamar al numero de telefono gratis para informacion o para someter una queja al 1-866-287-1736 Usted tambien puede escribir a: Everest National Insurance Company 477 Martinsville Road, PO Box 830 Liberty Corner, NJ 07938-0830 Puede comunicarse con el Departamento de Seguros de Texas para obtener informacion acerca de companies, coberturas, derechos o quejas al 1- 800-252-3439 Puede escribir al Departamento de Seguros de Texas Consumer Protection (111-1A) P.O. Box 149091 Austin, TX 78714-9091 FAX# (512) 490-1007 Web: http://www/tdi.texas.Rov E-mail: ConsumerProtection(cDtdi.texas.aov DISPUTAS SOBRE PRIMAS O RECLAMOS: Si tiena una disputa concerniente a su prima o a un reclamo, debe comunicarse con el agente o primero. Si no se resolve la disputa, puede entonces comunicarse con el departamento (TDI). UNA ESTE AVISO A SU POLIZA: Este aviso es solo para proposito de informacion y no se convierte en parte o condicion del document adjunto. Affidavit of Compliance with City of Fort Worth Prevailing Wages I, Ross Cooke Regional Vice Priesident, VLS (Name of person signing affidavit) (Title) do hereby certify that the wages paid to all employees of Vortex Lining Systems, LLC (Company Name) for all hours worked on the 5th at Carroll Street to RR Storm Drain Rehabilitation CPN 103059 and Carroll and Memmac Street Storm Drain Rehabilitation CPN 10355 (Project name and location) project, during the period from 7/08/2023 to 9/11/2023 (Project Dates) are in compliance with the requirements of Chapter 2258, Texas Government Code related to paying established City of Fort Worth wage rates per the project bid documents. I further certify that no rebates or deductions have been or will be made, directly or indirectly, from any wages paid in connection with this project, other than those provided by law. Sworn to and subscribed in my presence this ] Revised 3/08/2024 Signatu of Officer or Agent) day of / �r . 20 Z-S � W� I (Notary Public)