HomeMy WebLinkAboutContract 58684-FP1AC Coded 08.06.25
Vendor Name: Jackson Construction LTD
Vendor Number: 0000008063
Invoice No.: 58684-FP1
Invoice Date: ##/##/##
Release Retainage:
56005-2060000-102687-RETAIN $1,290.08
59601-2060000-102687-RETAIN $429,629.97
59605-2060000-102687-RETAIN $74,102.27
FORT WORTH
WATER DEPARTMENT
ENGINEERING AND FISCAL SERVICES
NOTICE OF PROJECT COMPLETION
CSC No. 58684-FP1
Regarding contract 58684 for the Northside IV 24 — Inch Water Transmission Main Phase 1B project as
required by the Water Department and approved by City Council on 12-13-2022 through M&C 22-1043 the
Director of the Water Department, upon the recommendation of the Assistant Director, Capital Projects
Delivery, Water Department has accepted the project as complete.
Original Contract Price: $ 10,499,744.25
Amount of Approved Change Orders: $ 0.00 No 3
Revised Contract Amount: $ 10,499,744.25
Total Cost Work Completed: $ 10,100,448.68
Less Deductions:
Liquidated Damages: 0 Days @ $650 /Day
Other Deductions: $ 0.00
Total Deduction Amount: $ 0.00
Total Cost of Work Completed: $ 10,100,448.68
Less Previous Payments: $ 9,595,426.36
Final Payment Due: $ 505,022.32
C o � 2.5-
7A, 5�J,:,I�,
Recomm�hded for Acceptance Date
Assistant Director, Water Department
chn, ko her 1fadel-
ChrFctr)phar H g ?Q?S 14-nTS1 Cn
Accepted Date
Director, Water Department
cv� 08/10/2025
Asst. City Manager Date
Project Name: Northside IV 24 — Inch Water Transmission Main Phase 1 B CPN 102687
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
FORT WORTH.
Date 07/22/2025
Jackson Construction Ltd
5112 Sun Valley Dr
Fort Worth, TX 76119
RE: Acceptance Letter
Project Name: Northside IV 24 — Inch Water Transmission Main Phase 1B
Project Type: Water
Project No: 102687
Contract No: 58684
To Whom It May Concern:
On 12/6/2024 a final inspection was made on the subject project. There were punch list items
identified at that time. The punchlist items and corrected items were completed on 7/7/2025. 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 7/7/2025 which is the date of the final inspection and will
extend of two (2) years in accordance with the Contract Documents.
If you have any questions concerning this letter of acceptance, please feel free to contact me at
817-392-6054.
Sincerely,
Tony Sholola, P.E., Assistant Director, Water Department
TS /
Cc: Chris Harder, P.E., Director, Water Department
Laura Wilson, P.E., Deputy Director Water Department
Suzanne Abbe, P.E, Project Manager, Water Department
Wade Miller, Construction Manager, Water Department
John Robinson, Inspection Supervisor, Water Department
Shane Behn, Inspector, Water Department
Half, Consultant
Jackson Construction Ltd, Contractor
Fort Worth
nll-Amedcacny WATER DEPARTMENT
1 I I I I1 THE CITY OF FORT WORTH * 200 TEXAS STREET * FORT WORTH, TEXAS 76102
817-392-8240 * FAX 817-392-8195
1964 •1993 •2011
_r Printed on recycled paper
FORTWORTH
Capital Projects Delivery, Water Department
CONTRACTOR'S EVALUATION OF CITY
1) PROJECT INFORMATION
Name ojContractor
Jackson Construction Ltd
Water Engineering Inspector
Shane Behn
CPN Number Project Doculty
102687 O Simple QQ Routine Q Complex
Initial Contract Amount
$10,499,744.25
11) PERFORMANCE EVALUATION
0 - Inadequate 1 - Deficient 2 - Standard
ELEMENT
INSPECTION EVALUATION
11 Availability of Inspector
12 Knowledge of Inspector
13 Accuracy of Measured Quantities
14 Display Of Professionalism
15 Citizen Complaint Resolution
16 Performance - Setting up Valve Crews, Labs
1 ADMINISTRATION
1 Change Order Processing Time
2 Timliness of Contractor Payments
13 Bid Opening to Pre -Con Meeting Timeframe
II1) COMMENTS & SIGNATURES
COMMENTS
Signature Contractor
Signature Inspector
Signature Inspector's Supervisor
INSPECTOR'S COMMENTS
REV: 09/20/24
Date: 117-Jul-25
Project Name
Northside IV 24-Inch Water Transmission Main Phase I
Project Manager
Suzanne Abbe
Type oJContract
0 Water ❑ Waste Water ElStorm Drainage ❑Pavement
Final Contract Amount
$10,499,744.25
3 - Good 4 - Excellent
RATING ELEMENT
(0 - 4)
IPLANS & SPECIFICATIONS
1
Accuracy of Plans to Existing Conditions
4
I 2
Clarity & Sufficiency of Details
</
13
Applicability of Specifications
It
4
14 Accuracy of Plan Quantities
1 PROJECT
MANAGER EVALUATION
1
Knowledge And/Or Problem Resolution
12
Availability of Project Manager
Y13
Communication
3
14
Resolution of Utility Conflicts
y
I
,
Capital Projects Delivery, Water Department
The City of Fort Worth • 200 Texas Street • Fort Worth, TX 76012-6311
(817) 392 - 4477 • Fax: (817) 392 - 8460
RATING
(0-4)
FORTWORTHREV:09/20/24
Capital Projects Delivery, Water Department
PERFORMANCE EVALUATION OF CONTRACTOR
1) CONTRACTOR & PROJECT DATA
Name of Contractor
Project Name
Jackson Construction Ltd
Northside IV 24-Inch Transmission Main Phase I
Water Engineering Inspector
CPN Number
Shane Behn
102687
Water Engineering Inspector
Project Manager
El Water ❑ Waste Water ❑ Storm Drainage ❑ Pavement
Suzanne Abbe
Initial Contract Amount
Project Doculty
$10 499,744.25
Q Simple QQ Routine Q Complex
Fina) Contract Amormt
Date
$10,499,744.25
7/ 17/2025
11) PERFORMANCE EVALUATION
1 0 - Inadequate I - Deficient 2-Standard 3-Good 4 - Excellcnt
ELEMENT
WEIGHT (x)
APPLICABLE (Y / N)
1
Submission of Documents
2
Y
2
Public Notifications
5
Y
3
Plans on Site
5
Y
14
Field Supervision
15
Y
15
Work Performed
15
Y
6
Finished Product
15
Y
7
Job Site Safety
15
Y
8
Traffic Control Maintenance
5
Y
9
Daily Clean Up
10
Y
10
Citizen's Complaint Resolution
5
Y
11
Property Restoration
5
Y
12
After Hours Response
5
I Y
13
Project Completion
5
+ Y
III) CONTRACTOR'S RATING
RATING (0 - 4) MAX SCORE SCORE
4 8
8 ✓
3 20
20 t S
4 20
20
3 60
60 ► 5
4 60
60 ✓
4 60
60 ✓
4 60
60 ✓
4 20
20 be
3 20 'yp]
20 „ O 1
4 20 1
1840
4 20
20 ✓
3 20
20 1
3 20
20 1
TOTAL ELEMENT SCORE (A)
BONUS POINTS (25 Maximum) (B)
TOTAL SCORE (TS)
388
Maximum Score (MS) = 448 gr sum of applicable element score maximums which = 428 ✓
Rating ( (TS / MS] * 100%) 388 / 428 m 91a/a
Performance Category lixceilent
<20% = Inadequate 20% to <40% = Deficient 40% to <60% = Standard 60% to <80% = Good >_80% = Excellent
Inspector's Comments (INCLUDING EXPLANATION OF BONUS POINTS AWARDED)
Signature Inspector Signature Contractor '1 �-
Signature Inspector's Supervisor
CONTRACTOR'S COMMENTS
U
Capital Projects Delivery, Water Department
The Ci of Fort Worth • 1000 Throckmorton Street -Fort Worth, TX 76012-6311
(817) 392 - 4477 • Fax: (817) 392 - 840
PROJECT NAME:
PROJECT NUMBER:
DOE NUMBER:
PIPE LAID
Open cut
Open cut
Other than open cut
Open cut
Open cut
FIRE HYDRANTS: 2
PIPE ABANDONED
DENSITIES:
NEW SERVICES:
PIPE LAID
PIPE ABANDONED
DENSITIES:
NEW SERVICES:
FORT WORTH
WATER ENGINEERING & FISCAL SERVICES
PIPE REPORT FOR:
Northside IV 24-Inch Water Transmission Main Phase 1 B
CPN 102687
CSC No. 58684
WATER
SIZE TYPE OF PIPE
24': DIP Water
24" DIP Water Restrained Joints
24" DIP Water Carrier pipe
16" PVC Water pipe Restrained Joints
6" PVC Water
VALVES (16" OR LARGER)
SIZE TYPE OF PIPE
SEWER
SIZE TYPE OF PIPE
SIZE TYPE OF PIPE
WATER ENGINEERING & FISCAL SERVICES
The City of Fort Worth • 1000 Throckmorton Street • Fort Worth, TX 76012-6311
(817) 392 - 4477 • Fax; (817) 392 - 8460
LF
9
LF
LF
LF
4,062
5,514
1,192
59
10
CONSENT OF SURETY
TO FINAL PAYMENT
.ALA Document G707
Bond No. 1097564
TO OWNER
(Marne andaddrns)
City of Fort Worth
200 Texas Street
Fort Worth, TX 76102
PROJECT-
(Mane and addraxq
OWNER
Ar,CH1Tr:CT
CONTRACTOR
SURETY
OTHER
ARCHITECT'S PROJECT NO.:
CONTRACT FOR:
CONTRACT DATED:
Northside IV 24-Inch Water Transmission Main Phase 1 B, City Project No. 102687
In accordance with the provisions of the Contract between die Owner and the Contractor as indicatett above, the
(lnwd nanrr and addim of Slt"I
The Hanover Insurance Company
440 Lincoln Street
Worcester, MA 01653
, SURFTY,
on bond of
(laced mmne and addrvsc o fConrmclur)
Jackson Construction, Ltd.
5112 Sun Valley Drive
Fort Worth, TX 76119
, CONTRACTOR,
hereby approves of the final payment to the Contractor, and agrees that Rnal payment to the Contractor shall not relieve the Surety of
any of Its obligations to
(brwri narnerind addrew of 0a ver)
City of Fort Worth
200 Texas Street
Fort Worth, TX 76102
as set forth in said Surety's bond.
W WITNESS WHEREOF, the Surety has hereunto set its hand on this date: November 20, 2024
pruel9 in mutt dx nrontb foddouv d hr=rGe nruneric d(rrrand)rar )
Attest:
(Sea]):
The Hanover Insurance Company
(S)atNY)
By.
(S�rmturroJunlGorizrdrrprrrnmari 1
Holly Clevenger Attorney -in -Fact
(Piained aurae arrd Ndr)
G707--1994
Liberty POWER OF ATTORNEY
Mutual. Liberty Mutual Insurance Company Certificate No: 8213854—190003
SURETY The Ohio Casualty Insurance Company
West American Insurance Company
KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that
Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized
under the laws of the State of Indiana (herein collectively called the "Companies'), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Blake S.
Bohlig; Brian D. Carpenter; Charles Draper; Kelly Nicole Enghauser; Heather R. Goedtel; Erik T. Gunkel; Michelle Halter; Jessica Hecker, Kathryn E. Kade; Nicole
Langer; Craig Olmstead; Haley Pflug; Laurie Pflug; Michelle Ward; Sara Whitfield
all of the city of Bloomington state of MN each Individually if there be more than one named, its true and lawful attorney -in -fact to make,
execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance
of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies In their own proper
persons.
IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed
thereto this 17th day of April 2025
Liberty Mutual Insurance Company
P� 1NSUR9 P� (Y INS& tNSUgq The Ohio Casualty Insurance Company
ooaPO�rFyca y`�°aPO1�y �P�oaPO�rFyn West American Insurance Company
J3 oc° Qr o� a3 ocn
vi r;1912y 0 0 1919 1991 0
z �o a 0viE
wr`i�9ies�cnus`` •dD 2° HnMvs��-4 Ys �N010" .da3 'C U
ei7* td �y1* IN dM*>� BY: �—
t`u Slate of PENNSYLVANIA ss Nathan J. Zangerle, Assistant Secretary P
oy County of MONTGOMERY o E
oOn this 17th day of April 2025 before me personally appeared Nathan J. Zangerle, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance
to Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes
therein contained by signing on behalf of the corporations by himself as a duly authorized officer. >
IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting, Pennsylvania, on the day and year first above written. O p
co �I, PASS, a O
Commonwealth of Per - Notary seal
p v o`' q< Teresa Paste'
Public —
dr' o Montgomery County `
OF My commissbn exp'ves March 26, 2029 B CI a)
C ��c CQmmiss'an puTbar 1126044 Y • "J
IL-TASI'1-V� g G Memher, Pennsy�anla ssoUetfon of Nolanes Teresa Pastella, Notary Public AQ 0
(n pU C) st
This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual
•— Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows: a M
" 6 ARTICLE IV —OFFICERS: Section 12. Power of Attorney. °O
o ca Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the 0 C:)
a President may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surely m cfl
W l any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact, subject to the limitations set forth in their respective powers of attomey, shall -o );
have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such o am
Z L) instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attomey-in-fact under the .o m
provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. o T
ILL CL
ARTICLE XIII —Execution of Contracts: Section 5. Surety Bonds and Undertakings.
Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe,
shall appoint such attomeys-in-fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings,
bonds, recognizances and other surety obligations. Such attorneys -in -fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the
Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if
signed by the president and attested by the secretary.
Certificate of Designation — The President of the Company, acting pursuant to the Bylaws of the Company, authorizes Nathan J. Zangerle, Assistant Secretary to appoint such
aftomeys-in-fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and
other surety obligations.
Authorization — By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the
Company, wherever appearing upon a certified copy of any power of attorney Issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with
the same force and effect as though manually affixed.
I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do
hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is In full force and effect and
has not been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 15th day of July , 2025 .
P� INSf/,p P�(Y INS& a 1NSU?
J oaaoy J oaPog9 pq VP oaronq ?
j
Y�1912y0 °21919�0 a 1991 0
rdd��S4cHus`�aa y°� BY NAPSDo a drs �NBIANP .aa�
f Renee C. Llewellyn, Assistant Secretary
LMS-12873 LMIC OCIC WAIC Multi Co 02r24
THE HANOVER INSURANCE COMPANY
MASSACHUSETTS DAY INSURANCE COMPANY
CITIZENS INSURANCE COMPANY OF AMERICA
POWER OF A TTORNEY
THIS Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the
extent herein stated.
KNOW ALL PERSONS BY THESE PRESENTS:
That THE HANOVER INSURANCE COMPANY and MASSACHUS ETTS BAY INSURANCE COMPANY, both being corporations organized and existing under the
laws of the State of New Hampshire, and CITIZENS INSURANCE COMPANY OF AMERICA, a corporation organized and existing under the laws of the State of
Michigan, (hereinafter Individually and collectively the *Company*) does hereby oonstitute and appoint,
Holly Clevenger
Of Dallas, TX individually, if there be more than one named, as its true and lawful attomey(s}in-fad to sign, execute, seal, acknowledge and
deliver for, and on its behalf, and as Its act and deed any place within the United States, any and all surety bonds, recognizAnces. undertakings, or other surety
obligations. The execution of such surety bonds, recognizanoes, undertakings or surety obligations. In pursuance of these presents, shall be as binding upon the
Company as if they had been duty signed by the president and attested by the secretary of the Company, in their own proper persons. Provided however, that this
power of attorney limits the acts of those named herein: and they have no authority to bind the Company except in the manner stated and to the extent of any
limitation stated below:
Any such obligations in the United States, not to exceed Forty Million and No/100 ($40,000,000) in any single instance
That this power is made and executed pursuant to the authorityof the following Resolutions passed by the Board of Direciors of said Company, and said Resolutions
remain in full force and effect
Surety Bond Numbor: 1097564
Principal: Jackson Construction, Ltd.
Obligeo: City of Fort Worth
RESOLVED: That the President or any Vice President. in conjunction with any Vice President. be and they heretry are authorized and empowered to
appoint Attorneys -in -fact of the Company, In its name and as it acts, to execute and acknowledge for and on its behalf as surety, any and at bonds.
recogn¢anoes, oontraots of indemnity, waivers of eitalion and all other writings obligatory in the nature thereof, with power to attach thereto the seal of the
Company. Any such writings so executed by such Attorneys -in -fact shall be binding upon the Company as if they had been duty executed and
acknowledged by the regularly elected officers of the Comparry in their own proper persons.
RESOLVED: That any and an Powers of Attorney and Certified Copies of such Powers of Attorney and certification in respect thero5o. granted and
executed by the President or Vice President in conjunction with any Vice President of the Company, shall be binding on the Comparryto the same exlenl
as d all signatures therein were manuallyaffixed, even though one or more of any such signatures thereon maybe facsimile. (Adopted OcLober7.1981-
The Hanover Insurance Company: Adopted April 14. 1082 - Massachusetts Bay Insurance Company: Adopted September 7.2001-Citizens Insurance
Company of America and affirmed by each Company on March 24, 2014)
IN WITNESS WHEREOF, THE HANOVER INSURANCE COMPANY, MASSACHUSETTS SAY INSURANCE COk1PANYand CMZENS INSURANCE COMPANY
OF AMERICA have caused these presents to be sealed with their respective corporate seals, duty attested by two Vice Presidents, this 6111 day of April, 2023
Tie Ilaaorer Insurance Company
Nfaswkos m Day Imeras" Company
Cklara lesunace Compxgyf Amerca
J H.IGwteell, • Ptoeldent
STATE OF CONNECTICUT )
COUNTY OF HARTFORD
ss.
The Hamer Iwraace Company
2M,.dyoAz-aV`1c9
lao.nace Company
CowpanyofAmcrkn
ten President
-jg�--
On this 611 day ofApr112023 before me came the above named Executive Vice President and Vice President of The Hanover Insurance Company, Massachusetts
Bay Insurance Company and Citizens Insurance Company of America, to me personally known to be the individuals and otfioors described herein, and
acknowledged that the seals affixed to the preceding instrument are the corporate seals of The Hanover Insurance Company. Massachusetts Bay Insurance
Company and Citizens Insurance Company of America, respectively, and that the said corporate seals and their signatures as officers were duty affixed and
subscnb$d. to Fad instrument by the authonty and direction f sold Corporations.
Wendy Latoumes
{� NotetyPtac.WtoofCorilackut
Aa
q1ts0sul
4xi
y N�fyCcwrtlistllofl EvirtsJuly31.2025 July 31, 2026
I. the undersigned Vice President of The Hanover Insurance Company. Massachusetts Bay Insurance Company and Citizens Insurance Company of America.
hereby eortity that the above and roregoing is a full. true and correct ropy of the Original Power of Attorney issued by said Companies. and do hereby further certify
that the said Powers of Attorney are still In force and effect
GIVEN under my hand and the seals of said Companies, of Worcester, Massachusetts, this 20th day of November 2024
Tie a e faaanace onVa
M sat h say fat ny
CERTIFIED COPY " ` A"'
ale■ Rewd/e►, Vk-i Preslkal
§JACKSON
CONSTRUCTIO r LTD.
5112 SUN VALLEY D VE
FORT WORTH, TX 76 419
TEL: 817-572-3303
FAX: 817-478-0443
STATE OF TEXAS
COUNTY OF TARRANT
AFFIDAVIT
Before me, the undersigned authority, a notary public in the state
and county aforesaid, on this day personally appeared Troy L. Jackson,
President Of Jackson Construction, Ltd, known to me to be a credible
person, who being by me duly sworn, upon his oath deposed and said;
That all persons, firms, associations, corporations, or other
organizations furnishing labor and/or materials have been paid in full;
That the wage scale established by the City Council in the City of
Fort Worth has been paid in full;
That there are no claims pending for personal injury and/or
property damages;
On Contract described as;
Northside 1V 24" Water Transmission Main, Ph 1 B
BY /' /1
Troy L ackson, President
Subscribed and sworn before me on this date 21 st of November, 2024.
eS s
•tea •ic
Tarrant, Texas
{tw�i
;.��� CARMEN L. ESTEP
r?;'= Notary Public, State of Texas
:+,0= Comm. Expires 04.06 2028
Notary ID 2910611
CSC No. 58684-CO3
FgC RT W®RTI-1 City of Fort Worth
--�'*—�— Change Order Request
Project Name: I Northside IV 24-Inch Water Transmission Main Phase 1 B J City Sec No.: 58684
Project No.(s):l 66020 0700430 MOM 102687 001700 1 DOE No. I N/A I City Pro). No.: 102687
Project Description: 24-Inch wafer transmission main extends from Heritage Trace Parkway to Bonds Ranch Road along Business Highway i
1 287. J
Conlractod Jackson Construction, Ltd. Change Order fl Dale: 10/28/2024
City Project Mgr.1 Suzanne Abbe City Inspector: I Shane Behn
Phone Number:1 817-392-8209 I Phone Number:1 682-328.1264
Dept, Water Totals Contract Time
f Calerdor days)
Odglnal Contract Amount $10,499,744.25 $10,499,744,26 460
Extras to Date 0165
Credits to Dale
Pending Change Orders (in M&C Process)
Contract Cost to Dale $10,499,744.25 1 $10,499,744.25
'Amount of Proposed Change Order $0.00 I $0.00 030
Revised Contract Amount $10,499,744.25 I $10,499,744.25 655
Original Funds Available for Change Orders $262.494.00 I ( $262,494.00
Remaining Funds Available for this CO $262,494.00 + I $262,494.00
Additional Funding (If necessary)
CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS % OF ORIGINAL CONTRACT
MAXALLOWABLECONTRACTAMOUNT (ORIGINAL CONTRACT COST+25%) �$13,124,680.31
JUSTIFICATION (REASONS) FOR CHANGE ORDER
Change Order No, 3 provides compensation for rock riprap protection of the culvert near the flow transfer station,
Staff recommends an additional 30 calendar days for the addlllonal work and final clean up on the project,
It is understood and agreed that the acceptance of this Change Order by the contractor consl(tules 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,
Contraclor's Company Name
I
Contractor Name Contractor Signature
Date
Construction, Ltd.
Troy Jackson 1
LeJackson
,o
Inspeotor _ , ,
Data Project Man a
Date
4) ` -A =
I 11/12/2024
Director (W6iefDept)
Date Construction Supervisor (Water Dept)
Date
rr& iv A
`] $ • 11/18/2024 �/„ �»
%� -/Z Zy
-"'Sd)91b'�A's'tii§th'hl'Cl(ywAttbfn`�y
Date Asslstant Citt Manager
Dale
11/19/2024 1 %.�), ,�JZ
1,6�so.fi119.Nl1G:000STI
�11/1A/2(124
riivla<11,11l1111to10'1I'.1•'aC5T1
v)j
Councll Action (1(Gquira"
�
M&C Number N/A
M&C Date Approved NIA
FcpP,-v i 6a-r]H[ City of Fort Worth
Change Order Additions
Project Name I Northside IV 24-Inch WaterTransmission Main Phase 1B 1 City Sec No,; 1 58684
Project No,(s); 1 56020 0700430 5740010102687 001780 DOE No,I N/A I City Proj, No,; 1 102687
Project 24-inch water transmission main extends from Heritage Trace Parkway to Bonds Ranch Road along Business Highway
Description 287,
Contractor 1 Jackson Construction, Ltd, Change Order;[ 2 Date:1 1012812024 9/6/2024
City Project Mgr. I Suzanne Abbe City Inspector I Shane Behn 1
I I EM UESCHIN I ION
57 Culvert Riprap Protection
ADDITIONS
DEPT
Water
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Page 1 of 1
Qly Unit Unit Cost Total
1.00 LS $6,927.78 $6,927.78
I I I
I I I
I I I
I I
I I
I I
I I
Water �$6,927.78
I
Additions Sub Total 1$6,927,78
]Fc>R-Y WWoR-rm City of Fort Worth
�5— Change Order Deletions
Project Name Northside IV 24-Inch Water Transmission Main Phase 16 City Sec No.: 58684
Project No,(s): 66020 0700430 5740010102687 001780 1 DOE No. N/A City Proj, No.: 102687
Project Description I 24-inch water transmission main extends from Heritage Trace Parkway to Bonds Ranch Road along Business
Highway 267.
Contractor I Jackson Construction, Ltd, Change Order: M Date 10/28/2024
City Project Mgr. Suzanne Abbe City Inspector: I Shane Behn
ITEM DESCRIPTION
50 Construction Allowance
DELETIONS
DEPT
Water
Page 1 of 1
Qty Unit Unit Cost Total
0.043290525 LS $160,000,00 $6,927.78
Water
$6,927,78
Deletions Sub Total $6,927.78
MfWBE Breakdown for this Change Order
MWBC Sub I Type of Service Amount for this CO
CO#
Previous Change Orders
DATE
Total
Page 1 of 1
Total
AMOUNT
$0.00
$0.00
10/28/2024
CPN 102687
Northside IV 24-Inch Water Transmission Main Phase 113
Change Request 3 Notes
Change Order No.1 provides for rock rlprap protection of the culvert near the flow transfer station.
During the final Inspection of the vault, plant operations noted that re -grassing the area would not
provide enough protection and that erosion would undermine the road Into the station and a corner of
the fence over time. They requested the culvert be protected with rlprap. The contractor installed
approximately 56 square yards of rlprap, approximately 18 Inches deep and charged by time and
materials (see attached for cost). The resulting unit cost Is approximately $82.47/CY, Recent bid prices
for similar work ranged from $180/CY to $300/CY.
Staff recommends an addition of 30 calendar days to final acceptance for the additional work and final
clean up on the project for a final acceptance date of December 6, 2024.
Jackson Construction, Ltd, City Project No. 102687
Northside IV 24-Inch Water
Change Order Request Transmission Main, Phase 113
Harvest Riprap from another projet and place around drainage system at Transfer vault Date 20-00-29
to stop erosion, one additional load of Flexbase used to regrdade and clean up
driveway area.
Item Description Quantity UM Bid Price Amount
T&M Riprap at Transfer Station and Repair/ Regrade
Driveway 1.000 LS $ 6,927.00 $ 6,927.00
Total
$ 6,927.00
Page 1 of 3 10/28/2024 10:10 AM
JACKSON CONSTRUCTION LTD.
Force Account Daily Time and Material
County Project -_City ._.,•---_-Highway-`� -
NIA
Description of Wollu Harvest Rlprap from anolhorpro/ec( and UI(Ilzo around Intel of Transfer Sfaffon. Addlllonal load of Base and prado work to clean up"ound
Dale; 9127 & 1011 �lransfers(aflonY-
_........ __ .._....._ . EQUIPMENT .....". ....,�. ._..
_ �._.,. Labor ....,...
- -
_...,__.ye..'..
-
_.
}„Description ._.,. Hrs MRate I Amount
Hours
Reg. O.T.Reg.
^ Rate
�y
OT:
Amount
(1)Calerplllar320Trackhoe _..-.�..._.-.-....,...., S 127.53 $�-�•;"'_.._....._,.`�_., ._��.........._.......
..
.�
$-
(2) Caterpillar 420 Backhoe 23.00 $ 57.00 $ 1,311.00 Juan
- _ -11.00 _ $
47.60
$
$
522,50
(1)Pickup --^ 11.00 $ 10.99 $ 208.89 Labor/Skilled ---
11,00 2.00 $
22.00
$
33.00 S
308.00
(1)TrashPumps $ 7.80 $ Labor/Skilled
_ i1.00 2.00 $
22.00
$
33.00 S
308.00
Labor/ Skilled
8,00 2,00 $
22.00_S_
33.00 S
^33.00
242.00
$ r Labor/Skilled
8.00 2.00 $
22.00
$
$
242.00
$ Labor/ Skilled _
- 7.00 $
22.00
$
$
154.00
Labor/ Skilled
_
J 7.00 $
-
22.00
$
$
154.00
Labor/ Skilled
----
7.00 S
22.00
$
S
154.00
Sub-Total $ 1,519.69
Sub•Tolal $
2,084.50
15% $ 227.98
55% $
1,146,48
Total Equipment; $ 1,747.87
25% $
521.13
Total Labor $
3,752,11
Materialy �_w _
.�._ ,,^Subcontract
Description Quantity UOM Rate Amount
Quantity
UOM
Rate
Amount
1.5' Recycled Base 24.00 ~ 7N S - 27.00 S �648.00 Tandem Trucks haul RIIprap sourced from a different 10.00 }
HR
S
65.000 $
650.00
_
Sub -Total $ 648.00
Sub•Tolal $
650.00
10% $ 64.80
10% $
65.00
Total Maloriat $ 712.81) _ VT^ ^
W
• Total Subcontract $
�715.000
Approved:
JACKSON CONSTRUCTION LTD.
Dale
Date
JACKSON CONSTRUCTION JOB N 3354
Summary
Labor
S
3,752.11
_
Equiprnont
$
�1,_747.07_
_
Material _ _
Subcontract
S _
$
712.80
715.00
Bond
Total This Shael
$
�� $
101281202410:10 AM
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
Suzanne Abbe
Name of Employee
Senior Engineer, Capital Project Delivery
Title
ATTEST: �p
Jannette Goodall
City Secretary
FORTWORTH rev 09/20/24
WATER ENGINEERING & FISCAL SERVICES
FINAL STATEMENT OF CONTRACT TIME
FINAL STATEMENT NO.: 7
NAME OF PROJECT: Northside IV 24-Inch Water Transmission Main Phase 1 B
CPN No: 102687 CONTRACTOR: Jackson Construction Ltd
CSC No. 58684
PERIOD FROM:07/01/25 TO: 07/15/25 FINAL INSPECTION DATE: 7-Jul-25
WORK ORDER EFFECTIVE:2/20/2023 CONTRACT TIME: 655 Q WD QQ CD
DAY OF DAYS REASON FOR DAYS DAY OF DAYS REASON FOR DAYS
MONTH CHARGED CREDITED MONTH CHARGED CREDITED
DURING DURING
1. 16.
2. 17.
3. 18.
4. 19.
5. 20.
6. 21.
7. 22.
8. 23.
9. 24.
10. 25.
if. 26.
12. 27.
13. 28.
14. 29.
15. 30.
31.
SAT, SUN, RAIN, TOO WET, UTILITIES
& HOLIDAYS & TOO COLD RELOCATIONS
THIS
PERIOD
PREVIOUS
PERIOD
TOTALS
TO DATE
*REMARKS:
OTHERS* DAYS
TOTAL
CHARGED
DAYS
0
0
I655
I655
1655
1655
07/29/2025
� --
CONTRACTOR � DATE 1NSI3 CTOR � � v
ENGINEERING DEPARTNIENT
� The CitSr of Fort Worth • 200 Texas Street • Fort Worth, T176012-6311
(817) 392 - 4477 • Fax: (817) 392 - 8460
7a-a
DATE