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Home My WebLink About062535-FP1 - Construction-Related - Contract - Roy Jorgensen Associates, Inc.FORTWORTHo TRANSPORTATION AND PUBLIC WORKS NOTICE OF PROJECT COMPLETION -FP1 City Secretary No: 62535 Date Received:l2/22/2025 City Project Na: 105239 Regarding contract 62535 2024 Bridge Rehabilitation Contract 2 for as required by the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by Ciry Council on �2��o�2o2a �rough M&C 24-1080 the director of the TRANSPORTATION AND PUBLIC WORKS DEPARTMEN'I' upon the recommendation of the Assistant Director of the Transportation & Public Works Departrnent 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: $ 872,762.50 Days 180 $ �.�� ]�'o � Days Added by CO 30 $ 872,762.50 To��ys 210 g 655,638.95 Days Charged21 O _ Days @ $ / Day � g 655,638.95 $ 622,856.98 Final Payment Due $ 32,781.97 �at�icia L. Wa�f,tacl� �Z��s�2o25 ��'atr cia l_ bN�dsac�c (Dec 18, 7�75 '. �_3�_ 19 CS-� Recommended for Acceptance Date Asst. Director, TPW - Capital Delivery ��^- 12/19/2025 Lauren Prieur (Dec 19, 2025 0814:16 CST) Accepted Date Director, TRANSPORTATION AND PUBLIC WORKS DEPARTMENT �•i��yr,��.�xK•1:�•� CITY SECRETARY FT. WORTH, TX d F�RT �VC�RTH�� TPW Construction Invoice City Secretary Contract Number: C562535 Project: 105239 - 105239 - 2024 Bridge Rehabilitation Contract 2 Contract Name: 2024 Bridge Rehab Con 2 To: Roy Jorgensen Associates, Inc. PO Box 7� Buckeystown, MD 21717 Supplier ID: 7000004740 Contract Summary: 1. Original Contract Amount 2. Net Change by Change Orders 3. Current Contract Amount (Line 1+/- Line 2J 4. Total Completed and Stored to Date (Progress Estimate, Construction Allowance, and Change Orders) 5. Amount Retained (5.00%) 6. Amount Eligible to Date (Line 4— Line 5) 7. Less Previous Payments (Line 6 from prior Invoicef 8. Amount Due this Application 9. Balance to Finish, Plus Retainage (Line 3 — Line 6J 10. ContradTime a. Days Awarded b. Days Added by Change Order c. Total Contract Days Awarded d. Days Charged this Invoice e. Days Charged from Previous Invoice(s) f. Contract Days Remaining Purchase Order: NON-PO Invoice Num6er: CS62535-009-FINAL+GS-C-1 Invoicing Period (From —To): N/A to N(A $ 872,762.50 $ .00 $ 872,762.50 $ 655,638.95 5 .00 $ 655,638.95 $ 622,856.98 $ 32,781.97 $ 217,123.55 180 30 21� 0 210 � Payment Application Date: 11.03.2025 Estimate Number: 8 Project Manager: Islam, Tariqul Roles Inspector: Sc Inspector: Project Manager: Contractors Certification: Payment Approvals Date: The Contractor certifies with the submittal of this document and associated Payment Request Submittal on the City of Fort Worth eBuilder 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 N. 6rumbaugh (Dec 1, 2 14:46:15 EST) Funding Distribution: Page 1 of 4 F�RT �V�RTH� TPW Construction Invoice Funding Identification (FIDs) Amount Earned $0.00 C Retainage (FIDs) � 30100-2060000-105239-RETAIN Retainage Amount to Pay $32,781.97 $32,781.97 Contract Bid Items: Bid Item Description No. A B Unit 0170.0101 REMOBILIZATION 1.001 Unit 3471.0001 TRAFFIC CONTROL 1.002 Unit 0104.6001 REMOVING CONC 1.003 (PAV) Unit 0104.6009 REMOVING CONC 1.004 (RIPRAP) Unit 0104.6015 REMOVING CONC I.005 (SIDEWALKS) Unit 0104.60D REMOVING CONC 1.006 (APPRSLAB) Unit 0104.6031 REMOVING CONC 1.007 (HEADWALL) Unit 0104.6064 REMOVING CONC I.00S (MISC) Unit 0110.6001 EXCAVATION 1.009 (ROADWAY) Unit 0360.6003 CONC PVMT (CONT I.O10 REINF-CRCP)(9") Unit 0360.6027 CURB (TYPE I1) 1.011 Unit 0400.6005 CEM STABIL BKFL 1.012 Unit 0401.6001 FLOWABLE BACKFlLL 1.013 Unit 0420.6054 CL C CONC 1.014 (HEADWALL) Unit 0420.6074 CL C CONC (MISC) Spec. UoM Bid Unit Price Bid Value Section Quantity No. EA MO SY SY SY SY CY CY CY SY LF CY CY CY CY 1 6 148 2 7 294 1 1 192 148 120 192 4 1 1 $ 5,000.00 S 5,000.00 $ 8,500.00 $ 51,000.00 $ 50.00 $ 7,400.00 $ 80.00 $ 160.00 $ 100.00 $ 700.00 $ 80.OD $ 23,520.00 $ 500.00 $ 300.00 $ 500.00 $ 350.00 $ 50.00 $ 9,600.00 $ 250.00 $ 37,000.00 $ 50.00 $ 6,000.00 $ 325.00 $ 62,400.00 $ 550.00 $ 2,Z00.00 $ 1,250.00 $ 750.00 $ 1,250.00 $ 1,500.00 Estimated Quantity Installed this Period 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 G H I 1 K D E F value this Previously Previously Period Installed Installed Quantity Value $ .00 0.0000 $ .00 S o0 6.0000 5 si,000.00 $ .00 142.0600 $ 7,103.00 $ .00 2.0000 $ 160.00 $ .00 6.8900 $ 689.00 S oo siossoo 5 za,saa.00 $ .00 0.6000 $ 300.00 $ .00 23500 $ 1,175.00 5 0o i9o.000o S e,soo.00 S oo ia�.0000 5 a6,�so.00 $ .00 164.0000 $ 8,200.00 5 0o iss.0000 5 se,a�s.oa $ .00 1.0000 $ 550.00 $ .00 0.6000 $ 750.00 $ .00 2.8500 $ 3,562.50 Materials Total Completed Retainage % Balance to Presently and Stored to this Period (H/B) Finish Stored Date�D+F+G) (B-H) (not in F) S .00 $ .00 $ .00 0.00% S 5,000.00 S oo $ si,000.o0 5 0o ioo.00i 5 00 $ .00 $ 7,103.00 $ .00 95.99% $ 297.00 S oo S i6o.00 S oo ioo.00i S ao $ .00 $ 689.00 $ .00 98.43% $ 11.00 $ .00 $ 24,844.00 $ .00 105.63% $- 1,324.00 S oo S soo.00 5 0o ioo.00i S o0 S oo S i,vs.00 S o0 335J1% S szs.00 $ .00 $ 9,500.00 $ .00 98.96% $ 100.00 $ .00 $ 36,750.00 $ .00 99.32% $ 250.00 5 0o S a,zoo.00 5 0o ia6.6�r S- z,zoo.00 $ .00 $ 59,475.00 $ .00 95.31% $ 2,925.00 S o0 5 sso.00 S oo zs.00r S 1,6so.00 $ .00 $ 750.00 $ .00 100.00% $ .00 $ .00 $ 3,562.50 $ .00 237.50% $- 2,062.50 Page 2 of 4 Bid Item Description No. 1.015 Unit 0422.6015 APPROACH SLAB 1.016 Unit 0429.6003CONCSTR 1.017 REPAIR(DECK REP(PART DEPTH)) Unit 0429.6007 CONC STR REPAIR I.O1S (VERTICAL& OVERHEAD) Unit 0429.6009 CONC STR REPAIR 1.019 (STANDARD) Unit 0432.6002 RIPRAP (CONC�(5 1.020 IN) Unit 0439.6013 MULTI-LAYER 1.021 POLYMER OVERLAY Unit 0446.6013 CLEAN & PAINT 1.022 EXIST STR (SYSTEM III- A)(BEARINGS) Unit 0454.6007HEADERTYPE 1.023 EXPANSIONJOINT Unit 0531.6001CONCSIDEWALKS 1.024 (4") Unit 0540.6001 MTL W-BEAM GD 1.025 FEN (TIM POST) Unit 0540.6007 MTL BEAM GD FEN 1.026 TRANS (TL2) Unit 0540.6016 DOWNSTREAM I-027 ANCHORTERMINALSECTION Unit 0540.6020 MTL W- BEAM GD 1.028 FEN (LOW FILL NLVERT) Unit 0542.6001 REMOVE METAL 1.029 BEAM GUARDFENCE Unit 0542.6002 REMOVE TERMINAL 1.030 ANCHOR SECTION Unit 0544.6001 GUARDRAIL END 1.031 TREATMENT(INSTALL) A Spec. Section No. UoM Bid Unit Price Quantity CY SF SF SF CY SY EA LF SY LF EA EA LF LF EA EA F�RT �V�RTH� TPW Construction Invoice B C D E F G H I 1 K Bid Value Estimated Value this Previously Previously Materials Total Completed Retainage % Balance to Quantity Period Installed Installed Presently and Stored to this Period (H/B) Finish Installed this Quantity Value Stored Date (D+F+G) (B-H) Period (not in F) 185 $ 1,125.00 $ 208,125.00 0.0000 $ .00 105.0100 $ 118,136.25 $ .00 $ 118,136.25 $ .00 56.76% $ 89,988.75 166 $ 180.00 $ 29.880.00 0.0000 $ .00 159.6000 $ 28,728.00 $ .00 $ 28,728.00 $ .00 96.14% $ 1,152.00 428 $ 345.00 $ 150,420.00 0.0000 $ .00 251.1000 $ 86,629.50 $ .00 $ 86,629.50 $ .00 57.59% $ 63,790.50 16 5 zoo.00 5 3,zoa.00 o.0000 5 00 0.0000 5 00 5 0o S o0 5 00 o.oar S 3,zoo.00 0 5 z,000.o0 5 aoo.00 o.0000 5 00 o.a000 5 soo.00 5 00 5 soo.00 S oo ioo.00i 5 00 22 $ 185.00 $ 4,070.00 0.0000 $ .00 53.4000 $ 9,579.00 $ .00 $ 9,879.00 $ .00 242.73% $- 5,809.00 i6 S s,000.00 S 4a,000.00 o.00ao 5 0o i6.0000 5 4s,000.00 S oo S 4s,000.00 S oo ioo.00i S o0 izo S sso.00 S az,000.00 o.0000 5 00 0.0000 5 0o S o0 5 00 5 00 0.00°o S 4z,000.00 7 $ 180.00 $ 1,260.00 0.0000 $ .00 6.8900 $ 1,240.20 $ .00 $ 1,24010 $ .00 98.43Y-� $ 19.80 455 $ 35.00 $ 15,907.50 0.0000 $ .00 452.5000 $ 15,537.50 $ .00 $ 15,837.50 $ .00 99.56"� $ 70.00 i 5 z,zso.00 S z,zso.00 o.00ao 5 0o i.0000 5 z,zso.ao S oo S z,zso.00 S oo ioo.00�� s o0 4 5 i,sso.00 5�,aoo.00 o.0000 S oo n.0000 5�,400.0o S .00 S�,aoo.00 5 .00 ioo.00°� s o0 ss S iis.00 $ a,ozs.00 o.0000 5 0o as.0000 5 a,ozs.00 5 0o S a,ozs.00 S oo ioo.00s„ 5 00 453 $ 5.00 $ 2,265.00 0.0000 $ .00 450.0000 S 2,250.00 $ .00 $ 2,250.00 $ .00 99.349-�� $ 15.00 z S sso.00 5�oo.00 o.00ao 5 0o z.0000 5�oo.00 S oo S�oo.o0 5 0o ioo.00°-, s o0 3 $ 4,500.00 $ 13,500.00 0.0000 $ .00 3.0000 $ 13,500.00 $ .00 $ 13,500.00 $ .00 100.00"-� 5 .00 Page 3 of 4 Bid Item Description No. Unit 0544.6003 GUARDRAIL END 1.032 TREATMENT (REMOVE) Unit 0658.60531NSTLOMASSM 1.033 (OM-3L)�TWT)GND Unit 0658.6057 INSTL OM ASSM 1.034 (OM-3R)(TWT)GND Unit 0776.6053 REPLACE(STEEL 1.035 RAIL) Unit 0750.6002 CNC CRACK REPAIR 1.036 (DISCRETE)(INIECT) Unit 0750.6004CONCCRCK 1.037 REPR(DISCRETE)(ROUTAND SEAL) Unit 9999.0000 CONSTRUCTION 1.038 ALLOWANCE (Please enter $70,000.00 for the Unit Price.) Unit CONCRETE RAIL REPAIR 1.039 Unit INSTALLSIGN 1.040 A Spec. Section No. UoM Bid Unit Price Quantity F�RT �V�RTH� TPW Construction Invoice B C D E F G H I 1 K Bid Value Estimated Value this Previously Previously Materials Total Completed Retainage % Balance to Quantity Period Installed Installed Presently and Stored to this Period (H/B) Finish Installed this Quantity Value Stored Date (D+F+G) (B-H) Period (not in F) EA 2 $ 500.00 $ 1,000.00 0.0000 $ .00 2.0000 $ 1,000.00 $ .00 $ 1,000.00 $ .00 100.00% S .00 En z S aso.00 S �oo.00 o.0000 5 .00 z0000 5�oo.o0 5 .o0 5 �oo.00 S oo ioo.00r S o0 EA 3 $ 350.00 S 1,050.00 0.0000 $ .00 3.0000 S 1,050.00 S .00 $ 1,050.00 $ .00 100.00% $ .00 LF 15 $ 425.00 $ 6,375.00 0.0000 $ .00 15.0000 $ 6,375.00 $ .00 $ 6,375.00 $ .00 100.00% $ .00 �F ia $ sso.00 5 n,soo.00 o.0000 S oo z9.0000 5 1o,iso.00 S oo S 1o,iso.00 5 0o zozl4r S- s,zso.00 LF 243 $ 205.00 $ 49,815.00 0.0000 $ .00 346.0000 $ 70,930.00 $ .00 $ 70,930.00 $ .00 142.39% $- 21,115.00 0 S 45,240.00 0.0000 $ .00 0.0000 $ .00 S .00 $ .00 $ .00 0.00% 5 45,240.00 �F o 5 z,ioo.00 S zi,aoo.00 o.0000 S oo io.0000 5 zi,000.o0 5 00 $ zi,000.o0 5 0o ioa.00i $ o0 EA o S soo.00 5 i,000.00 o.0000 S .00 z.0000 S Z,000.00 S .o0 5 Z,000.o0 5 .00 ioo.00i S .00 $ 872,762.50 $ 0.00 $ 655,638.95 $ 0.00 $ 655,638.95 $- 75.12% 5 217,123.55 32,781.97 Page 4 of 4 �kJl\� ��11�] Routing and Transmittal Slip Transportation and Public Works Department DOCUMENT TITLE: 2024 Bridae Rehabilitation Contract 2, CO 1 M&C cPN 105239 CSO # 62535 DOC# DATE: To: �. Crystal Greene (Business Support) 2. Roy Jorgensen Assoc. — Craig Duncan s. Eddie Walker (Inspector) 4. Daniel Roy (Sr. Inspector) 5.Tariqul Islam (PM) 6 Zelalem Arega (PGM) � Mary Hanna (SCPO) $. Patricia Wadsack (AD) 9. Lauren Prieur (Director) � o. Doug Black (ACA) � �. Jesica McEachern (ACM) INITIALS � C� CD L� Eddie Walker ��RoY «i,��'�...�r l��,i�� aPae 9 Lauren Prieur � Douglas Black �� DATE OUT 07/18/25 07/21/25 07/17/25 07/21/25 07/23/25 07/23/25 07/23/25 07/24/25 07/25/25 07/25/25 07/25/25 �2. Jannette Goodall (CS) 4� o7/2a/25 Ja�inette Goodall DOCUMENTS FOR CITY MANAGER'S SIGNTURE: All documents received from any and all City Departments requesting City Manager's signature for approval MUST BE ROUTED TO THE APPROPRIATE ACM for approval first. Once the ACM has signed the routing slip, Jay will review and take the next steps. NEEDS TO BE NOTARIZED: U Yes ❑✓ ►vo RUSH: ❑ Yes �✓ No SAME DAY: � Yes �✓ No NEXT DAY: ❑Yes �✓ No ROUTING TO CSO: ❑✓ Yes ❑No Action Reauired: ❑ As Requested ❑ Attach Signature, Initial and Notary Ta � Signature/Routing and or Recording ❑ Comment ❑ File Return to: Please call at ext. for pick up when completed. Thank you. CSC No. 62535-CO1 FORT WORTH,,, City of Fort Worth �� Change Order Request Project Name � 2024 Bridge Rehabilitation Contract 2 � City Sec #� 62535 Client Project #(s) � 105239 Project Description Bridge Rehabilitation at 14 Locations Contractor � Roy Jorgensen Associates, Inc. � Change Order #� 1 � Date � 7/24/2025 City Project Mgr.� Tariqul Islam � City Inspector� Eddie Walker Dept. Original Contract Amount Extrasto Date Credits to Date Pending Change Orders (in M&C Process) Contract Costto Date �Amount of Proposed Change Order Revised Contract Amount Original Funds Available for Change Order Remaining Funds Available for this CO Additional Funding (if necessary) TPW $872,762.50 0 CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS % OF ORIGINAL CONTRACT 0.00% MAXALLOWABLECONTRACTAMOUNT(ORIGINALCONTRACTCOST+25%J $1,090,953.13 JUSTIFICATION (REASONS) FOR CHANGE ORDER This change order includes the addition of two bridge repair locations: Silver Creek Rd Bridge over Live Oak Creek for concrete rail repair and W Lancaster Ave Bridge over Foch St for deck soffit repair. Both locations sustained damage due to recent traffic incidents and require necessary repairs. A new bid item is being added for the concrete rail repair at the Silver Creek Rd Bridge. Two quotes were obtained for this bid item: $21,000 from Roy Jorgensen Assosiates, Inc. and $28,500 from Gibson & Associates, Inc. Staff reviewed the proposed unit prices and determined Roy Jorgensen's quote to be reasonable. The net change order amount will be $0, as the additional cost will be covered using the construction allowance pay item. Staff also support the contractor's request for an additional 30 calendar days to complete the expanded scope of work. It is understood and agreed that the acceptance of this Change Order by the contractor constitutes an accord and satisfaction and represents payment in full (both time and money) for all costs arising out of, or incidental to, the above Change Order. The Project/Program Manager signing below acknowledges that he/she is the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. Contractor's Company Name Contractor (Name) Contract Signature Date RoyJorgensen Associates, Inc, Craig Duncan �'��_,^ o�/u/zs Inspector/Inspection Supervisor Date Project and Contract Compliance Manager Date r� �;� � T�� o�/i7/zs =M�l�+�ri o7/23/25 Program Manager Date Senior Capital Project Officer Date �� 07/23/25 f�"_ 07/23/25 Assistant Director (Dept) Date Director, Contracting Department (Dept) Date p"�``"`a ` "V"�� 07/24/25 �--�'� 07/25/25 Assistant City Attorney Date Assistant City Manager Date ' 07/25/25 07/25/25 Council Action (if required) M&C Number I N/A I M&C Date Approved I N/A � Contract Time Totals (CD) 5872,762.50 180 ATTEST: Jannette Goodall, City Secretary FoK r WoerH City of Fort Worth �"�"'�- Change OrderAdditions Project Name � 2024 Bridge Rehabilitation Contrac[ 2 � City Sec p� 62535 � ClierrtProjectp � 105239 � Contractorl RoyJorgensenAssociates,lnc. I PMI Tariqullslam � Inspectorl EddieWalker I Change OrderSubmittalri � Date 7/24/2025 � ADDITIONS ITEM DESCRIPTION DEPT Qty Unit � UnitCost Total 18 CONC STR REPAIR (VERTICAL & OVERHEAD) TPW 5.00000000 SF 5345.00 $2 `760.00 39-New CONCRETERAILREPAIR TPW 10.00000000 LF $2,100.00 $21,000.00 40-new INSTALLSIGN TPW 2.00000000 EA SS00.00 $1.000.00 I 1 1 1 1 1 1 1 1 I TPN $24,760.00 � � � � Sub Total Additions 524,760.00 � Change Order Additions Page 2 of 4 FoKr WoKry City of FoR Worth -�'t'�- Change Order Deletions ProjectName � 20248ridgeRehabilitationContrect2 � CitySec# � 62535 � ClientProjectit � 105239 � Contractorl RoyJorgensen Associates, Inc. � pM I Tariqul Islam � Inspector� Eddie Walker � Cha nge Order Submittal #� Date I 7/24/2025 I DELETIONS ITEM DESCRI P110N DEPT Qty Unit � Unit Cost Total 38 9999.0096 PAVINGCONSTRUCTIONALLOWANCE TPW 035371429 EA $70,000.00 5z4,760.00 TPN 524,760.00 Sub Total Deletions $24,760.00 Change Order Deletions Page 3 of 4 M/SBE Sub Not Applicable Co # Not Applicable E for this Change Order Tvae of Service Amount for this CO Not Applicable Previous Change Orders DATE Not Applicable Total $0.00 AMOUNT Not Applicable Total I $0.00 � 105239-CNCO-2024 Bridge Rehabilitation Contract 2, CO 1 Final Audit Report Created: By: Status: Transaction ID 2025-07-17 Andrea Munoz (Andrea.Munoz@fortworthtexas.gov) Canceled / Declined CBJ CH BCAABAA7AghtCuxrRpAYv-ipljeTDT5dTaArFN B 2025-07-24 "105239-CNCO-2024 Bridge Rehabilitation Contract 2, CO 1" Hi story Document created by Andrea Munoz (Andrea.Munoz@fortworthtexas.gov) 2025-07-17 - 9:30:59 PM GMT- IP address: 204.10.90.100 Document emailed to Crystal Greene (crystal.greene@fortworthtexas.gov) for filling 2025-07-17 - 9:35:53 PM GMT Document emailed to craig duncan (craig_duncan@royjorgensen.com) for signature 2025-07-17 - 9:35:53 PM GMT Document emailed to Eddie Walker (Eddie.Walker@fortworthtexas.gov) for signature 2025-07-17 - 9:35:54 PM GMT Email viewed by Eddie Walker (Eddie.Walker@fortworthtexas.gov) 2025-07-17 - 9:36:23 PM GMT- IP address: 99.109.99.98 ��:, Document e-signed by Eddie Walker (Eddie.Walker@fortworthtexas.gov) Signature Date: 2025-07-17 - 9:37:14 PM GMT - Time Source: server- IP address: 99.109.99.98 Email viewed by Crystal Greene (crystal.greene@fortworthtexas.gov) 2025-07-18 - 12:29:53 PM GMT- IP address: 104.47.64.254 _.�_ Form filled by Crystal Greene (crystal.greene@fortworthtexas.gov) Form filling Date: 2025-07-18 - 7:47:15 PM GMT - Time Source: server- IP address: 204.10.90.100 �_ Email viewed by craig duncan (craig_duncan@royjorgensen.com) 2025-07-21 - 3:36:14 PM GMT- IP address: 104.47.58.254 :� Document e-signed by craig duncan (craig_duncan@royjorgensen.com) Signature Date: 2025-07-21 - 3:37:43 PM GMT - Time Source: server- IP address: 50.24.76.14 �ORT��IiTHg Paweredbv � Adobe Acrobat Sign Document emailed to Daniel Roy (daniel.roy@fortworthtexas.gov) for signature 2025-07-21 - 3:37:45 PM GMT Document emailed to Tariqul Islam (Tariqul.lslam@fortworthtexas.gov) for signature 2025-07-21 - 3:37:45 PM GMT �-' Email viewed by Daniel Roy (daniel.roy@fortworthtexas.gov) 2025-07-21 - 3:38:39 PM GMT- IP address: 104.47.65.254 -�: Document e-signed by Daniel Roy (daniel.roy@fortworthtexas.gov) Signature Date: 2025-07-21 - 3:38:56 PM GMT - Time Source: server- IP address: 204.10.90.100 Andrea Munoz (Andrea.Munoz@fortworthtexas.gov) added alternate signer Zelalem Arega (Zelalem.Arega@fortworthtexas.gov). The original signer Tariqul Islam (Tariqul.lslam@fortworthtexas.gov) can still sign. 2025-07-22 - 4:06:00 PM GMT- IP address: 204.10.90.100 Document emailed to Zelalem Arega (Zelalem.Arega@fortworthtexas.gov) for signature 2025-07-22 - 4:06:01 PM GMT Email viewed by Zelalem Arega (Zelalem.Arega@fortworthtexas.gov) 2025-07-23 - 1:41:07 PM GMT- IP address: 52.244.179.71 =�3�: Document e-signed by Zelalem Arega (Zelalem.Arega@fortworthtexas.gov) Signature Date: 2025-07-23 - 1:55:22 PM GMT - Time Source: server- IP address: 208.184.124.181 Document emailed to Zelalem Arega (Zelalem.Arega@fortworthtexas.gov) for signature 2025-07-23 - 1:55:23 PM GMT - Email viewed by Zelalem Arega (Zelalem.Arega@fortworthtexas.gov) 2025-07-23 - 1:55:56 PM GMT- IP address: 104.47.64.254 =��;. Document e-signed by Zelalem Arega (Zelalem.Arega@fortworthtexas.gov) Signature Date: 2025-07-23 - 1:57:54 PM GMT - Time Source: server- IP address: 208.184.124.181 Document emailed to Mary Hanna (Mary.Hanna@fortworthtexas.gov) for signature 2025-07-23 - 1:57:56 PM GMT Email viewed by Mary Hanna (Mary.Hanna@fortworthtexas.gov) 2025-07-23 - 2:06:06 PM GMT- IP address: 104.47.64.254 ��J;_: Document e-signed by Mary Hanna (Mary.Hanna@fortworthtexas.gov) Signature Date: 2025-07-23 - 2:36:17 PM GMT - Time Source: server- IP address: 208.184.124.181 Document emailed to Patricia Wadsack (patricia.wadsack@fortworthtexas.gov) for signature 2025-07-23 - 2:36:20 PM GMT �ORT��IiTHg Paweredtry � Adobe Acrobat Sign Document canceled by Andrea Munoz (Andrea.Munoz@fortworthtexas.gov) 2025-07-24 - 4:10:27 PM GMT- IP address: 204.10.90.100 �ORT��IiTHg Paweredtry � Adobe Acrobat Sign Affidavit of Compliance with City of Fort Worth Prevailing Wages Danne M. Anderson (Name of person signing affidavit) �J � � �`��_ ,� �- -�' � _ (Signature of Officer or Agent) do hereby certify that the wages paid to all employees of Roy Jorgensen Associates, Inc. (Company Name) for all hours worked on the 2024 Bridge Rehabilitation Contract 2, CPN 105239 (Project name and location) project, during the period from January 27, 2025 to October 9, 2025 (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 5th �.a.��`� GRACE CARTER Notary Public - State of Maryland Frederick County My Commission Expires Apr 25, 2029 � Proiect Accountant (Title) day of November , 2025_ ( . �r /�cr�c, �.� _. ( ,��'L, Z,, ' �%-- :-�-� � _ �. (Notary Public) Revised 3/08/2024 CONSENT OF SURETY TQ FINAL PAYMENT AIA Dr�curnerat G707 Bond No. 30BSBJ67127 TO OWNER (Nmnr curd adrlrrs) City of Fort Worth 200 Texas Street Fort Worth, TX 76102 p�20JEC'T: (Ntanr o7x1 ud/hd.e� 2024 Bridge Rehab Contract 2, Project No. 105239 OWVF.R nRcx2Trcr CO'�T'RACTOR SURL•TY OTtiER ARCHITECT'S PROJECT ?�0.: cax�r�cr Fox: CONT'RACT nA7"ED� December 10, 2024 tn �ecarciance �vvith rize pravisians c�f the Ccx�ttact ixtween d�e Owner and the Ccxttracr<m as imi�c�trc! atxwe, che (!ns¢rY �xirnr u�x! athlirsr oJS�rrry J Hartford Fire Insurance Company One Hartford Plaza Hartford, CT 06155-0001 on }�nd of (In.�n r�a�nran�odd�.s q/'Cvntracrur/ Roy Jorgensen Associates, Inc. 3735 Buckeystown Pike; P.O. Box 70 Buckeystown, MD 21717-0070 ■ :� :� ■ , SURF,TY, , COVTRACI'OR, hereby ap�roves of the flnal payment co che Contractor, and agr�ees that flnal �yment tci tl�t Contractor sl�all not »elieve the Surery c�f any of its obliga[iqns to !l��atrf nunreund adtJnzcs ofOu ncr� City of Fort Worth 200 Texas Street Fort Worth, TX 76102 as sec fnnh in said 5urery's bcar�r2. I.�i WIT7�'ESS WHEit&Or, the 5urery has hereuntc� set 'su hand cm chb date: OCtober 21, 2025 !Nua�9 i�� uviHrtK lde »ranr6joliow�rlhr �hr monern rl�rund iear.l �O��y� � F� �� S � cd� n �,,�:,� o *. . � '� o n d Auest: i' � ��ewrso �� Robert A. Chlada, Witness to Surety , ovvr,RR, Hartford Fire Insurance Company ��,� � By� ; ��.�,j'l,(_��. �1��,�_ fs7R+urrurrofarabon�o�Arap.w�nreuirl � Diane S. Loughry Attorney-in-Fact (Aii�hr/ i�au�r a��cJ iNlcl G707--199d POWER C�F ATTORNEY KNOW AlL PERSONS BY THESE PRESENTS THAT: Direct fnquiries, Bond Autheniicity and Claims ro: THE HARTFORD BOND. T-14 Orie Hartford Plaza HartRord, Connectfcut a6155 Bond.Ciaims(�ttwharttord c�� aU 888-2663488 or fax 860-757-5835 Apencv Code: SuraPath � Hartford Fire Insurance Company .a c�,rp�,�at�ou duh oreaut:rd tuidr� tliN la,�. ��: d�r ��nt� ofconur,u�u� ❑ Hertford Cesuaity InsuranCe Cortlpany .� r�u'p��rati�n dul� ��r�nnized under the la�� of the StatP or ;»d�ana ❑ Hartford ACCident and Indemnity Company a�o�yorat�on dul� orean�zed und�r d�e IaHs of die State of C'ontier.hrut ❑ Hartford Insurance Compeny of the Midw�ft e o�porahou duly ui �anizPd ut�dei the latti'� oI the State ot Indtana having their homeofficein Nartford. Connecticut (heremafter collect�vely referred to as the 'Companies"1 do hereby make consUtute and appoint Diane S. Loughry ��r Hunt Valley, MD their true and lawful Attomey-in-Fact, to s�gn �ts name as tiuretyl��1 c�nly �s �fe�ineale�l ahr}ve hy � and t� execute, seal and acknowledyethe followlny bond undertak�ng, contract or wntten inst�urt�ent t3ond No 3oBSBJB7127 on behalt ot Roy Jorgensen Associates InC. naming City of Fort Worth as Obfigee �n the amount of See Bond Form on behalf ofthe Companies �n their business ot guarant�:�ny the hdehry of pt�ison5 Uuarenteen�U the performance of contracts and execu5ng or guarantee�ng bonds and undertak�ngs required or perrrNtted in any achons or procP�ling�, allowc�ci by !aw In Witnesa Wheroof, and as authonzed by a Re�olutwn �t the E3oard ot D�rect��s ot the Companie_. on May 23, 2016 the Compari�es have cau,ed ihese presents to be signed by its Assntant Vice Presi�Hn1 and its coipu��ir. �eals t<� be he�eto aff�xed, duly aifesied by its Assistant Secretary f urther, pursuantto ResoluUon ofthe E3oard of Duecior5 ui the c:un�panies tr�r Companies hereby unambiguously atfirni that they are and will !>e baund by any mechanically applied signatures applieci to ihi�s 1'ower ot Attornt�v. �,.......w, , r Q�4t��. �.�S� : �v��ly. �Nt�y �-. 9' . fS y~ ��- :'�`,�:�_�� c4 ; Q .�.Ww.,'� �n - ■ r = t ;i,� n r -o =. +. ,L,, � �, d Ml1�� a1.. '•�,,,k.'. . _ . �,�. -. y,� .�.. •,,;;wa+o�.�*4 • . »•+' �`--��.�G'��i .� �,.�-� �--..__� �1� Phvllis A Clark, Assistant Secietary _` � `�;'', . riF i i. �''. , �.� . ��oero�.,:a � -. a _ � ! � . �p� 'i O� �' % �9'u `.{, .: ' �rour.. STATE OF FLORIDA ss. Lake Mary COUNTY OF SEMINOLE �� Cl�'� . � �^�il.uti/ Joelle I`t aPierre Ass�stant Vice President On thls Ist day of March, 2024, before +ne pers��nally can� Joe11r. I LaP�e;+�r tu �nr, kn��wri whu t�n�y by me duly swom, did depose and say that (s)he resides in Senunoie County. Si�ate ot F londa that ls)he �ti the As,istani Vice President ol the Crimp�n�es, the corpora6ons descnt�ed in and which executed the above mshument that (s�he knows the seals ol the saia corporat�ons that the seafs affixed to the said �nsirument a�e such corporate seals, that they weie su aftixed bv autnonty ot the [3uard� ct Uirectors of sa�d carporaUons and that (s)he signed hisiher name thereto by like authonty : � '� . ,`�t'-�a�ti,�� r-e.. :,�� Muiluz Arce � i. - �i� lomm�ss�on HH 283i63 Fxyves luly 13 20'_6 1, the undersigned, Assistant V�ce Presidentof theCompanies, UU Nt F2FHY c:t F21 IF Y that the abi,ve ��nd torego�ng is a true and correct copy of the Power of Attomey executed by sald Companies which �s sUll �n full force affechve a� of OCtober 21: 2025 __ ___ Signed and sealed in Lake Mary, Fionda. .. '��RE 1 . e�q N�� °�rr u,��,. r ♦ . f Q. � � i� =ro �°MMp4 � . r� - ai 7 =o �.". o' • d � Z '�'J�i�� ♦ � �,� .' _ � ., � �� I "'-, t,` �a . y s, ,� ��. `P„ f' . ' . �� r �, ��. �� '�_' Pmr'�. �ero�a; og�. �:. � � 'i Iy'y �� 'Ni71Aw* t � ��,. " � � �� K�th D Dozo�s Assistant Vice President SusPaeh POA 20? � AFFIDAVIT STATE OF Mazyland COLTNTY OF Fredericic Before me, the undersigned authority, a notary public in the state and county aforesaid, on this day personally appeared Danne M. Anderson, Project Accountant Of Roy Jorgensen Associates, Inc., 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 fiill; 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; Ciry of Fort Worth 202� Bridge Rehab' � tion Contract #1 5239� �� ' �� v EY 'G� 'i�-- � �. Danne M. Anderson, Project Accountant Subscribed and sworn before me on this date 23rd of October, 2025. (�1�Uz:� ��.�.,.� ) �}�:�>>�� Notary I�ublic Frederick, Maryland CHRISOLYN DEYSHA HARRIS Notary Public - State of Maryland Frederick Counry My Commission Expires Apr 10, 2029 ��x� TRANSPORTATION AND PUBLIC WORKS November 13, 2025 Roy Jorgensen 2706 Hardrock Rd. Grand Praire,TX. 75050 RE: Acceptance Letter Project Name: 2024 Bridge Rehabilitation Contract 2 Project Type: Bridge Repair City Project No.: 105239 To Whom It May Concern: On October 1, 2025 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 October 2, 2025. 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 October 2, 2025, which is the date of the punch list completion and will extend of two (2) years in accordance with the Contract Documents. If you have any questions concerning this letter of acceptance, please feel free to contact me at 817- 392-2486. Sincerely, Tariqul Islam, Project Manager �.. , .,,,, Zelalem Arega, Program Manager z.,�,�a,,�,tn_ Cc: Eddie Walker, Inspector Mike Glover, Inspection Supervisor Cristobal Fuentes, Senior Inspector Zelalem Arega, Program Manager Freese and Nichols,INC, Consultant Roy Jorgensen, Contractor N/A, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev. 8/20/19