HomeMy WebLinkAbout045172-CO2 - Construction-Related - Contract - Archer Western ConstructionFC3 RT WC� �F:T �� City of Fort Worth
�-. .
Change Order Request
Project Name� Village Creek WRF Gravity Belt Thickener Addition
Project No.(s)� P27570530 0184780 � DOE No. �
City Secre�rY
Contract fVo ,� _
City Secretary Copy
� City Sec No. I 45172
� City Proj. No. � 1847
Project Description:l Installation of additional Gravity Belt Thickener to the Existing Gravity Belt Thickeners Building.
Contractor:� Archer Western Construction. I Change Order: � 2 � Date: �
City Project Mgr.� 5eiavash Mir � City Inspector: I Robert Walker �
Phone Number:� 817-392-8404 � Phone Number:� 817-944-9984 �
Dept.
Original Contract Amount
Extras to Date
Credits to Date
Pending Change Orders (in M&C Process)
Contract Cost to Date
�Amount of Proposed Change Order
Revised Contract Amount
Original Funtls Available for Change Orders
Remaining Funds Available for this CO
Additional Funding (if necessary)
Sewer I
$931,000.00
$57,977.68 �
�
,$988,977.68 �
$35,084.66 �
$1,024,062.34 �
$27,930.00 I
+
$35,084.66 �
Totals
$931,000.00
$57,977.68
I
�
. J
10l26l2016 �
Contract Time
(Calender days)
300
90
$988,977.68 390
$35,084.66 028
$1,024,062.34 418
$27,930.00
$35,084.66
CHANGE ORDERS fo DATE (lNCLUDINC TNIS ONE) AS % OF ORIGINAL CONTRACT � 10.00%
MAXALLOWABLE CONTRACT AMOUNT (ORIGINAL CONTRACT COST+ 25%) $1,163,750.00 �
JUSTIFICATION (REASONS) FOR CHANGE ORpER
This Change order was City directive to repair the 54 inch primary effluent line going to basins.
Staff concurs with the Contractor's cost breakdown as attached.
Additional detail can be found in the followin� pages.
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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 antl money) for ali costs arising out of, or incidental to, the above Change Order. �
� Contractor's Company Name Contractor Name Contracfor Signature I Date �
� Archer Westem Construction. L � nda � /�I
�a vc � ; --��tM.b1�� ��'ur,�c.�-- � 1 b�a� �l � �'
�Ins ector U
P .,. .,t:,:. � Date Project-�lanager > I` Date
Assistant Director (Water Dept)
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M&C Number � �.�
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� Date , Construetion Supervispr,(Wate� Dept) % bate �' o
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ij,�.v , �; ���`� � � , ��1�� �, ;, ;� � '�t� � l'c ,(�, i��� uj
� qate � Assistant City Manager � Date a�
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Council Action (If Required)
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M&C Date Approved j I
FORT V'VORT� City of Fort Worth
�� Change Order Additions
Project Name � Village Creek WRF Gravity Belt Thickener Addition
Project No.(s) � P27570530 0184780 � DOE No.�
Project I Effluent line Pipe repoair .
Description
I City Sec No. � 45172
� City Proj. No. � 1847
Contractor � Archer Western Construction. � Change Order: �2 Date: � 10I2612016 �
City Project Mgr. � Seiavash Mir � City Inspector � �
ADDITIDNS
I I�M u�s(:FtIN I IUN DEPT Qty Unit Unit Cost � Total
1 Material: Femco Coupling, 54" pipe, Form Material, Blind Flange 30". SEWER $9,306.00
2 Equiptment: Tamper, Trench Box, Excavator, Cat 420, Truck F150, Excavator Sewer $8,930.86
3 Labor sewer $11,382.95
4 Insurance , and OHP $5,464.85
Sewer $35,084.66
Page 1 of 1 Additions Sub Total $35,084.66
i 1
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December 7, 2015
Fort Worth Water Department
1000 Throckmorton Street
Fort Worth, Texas 76102
ATT
RE
Dear Farida,
C S� 4 S �� 2 .�Y�� �; ��►�
Ms. Farida Goderya, PhD, PE
Sr. Prof Engineer � Facilities Project Manager
Village Creek WRP — Effluent Line Pipe Repair
City of Fort Worth Water Department
Time and Material Billing
Attached is a time and material billing for the Village Creek Pipe Repair. The cost for this work is
$35,084.66.
If you have questions regarding this invoice, please contact Wayne Pursley at 817-401-5043.
Sincerely,
Archer Western Contractors, Ltd.
�� ���
Linda Laver
Assistant Project Manager
attachment
1411 Greenway Drive
Irving, Texas 75038
Direct dial: 972-457-8508
e-mail: jpolak@walshgroup.com
T&M-001
Date: December 4, 2015
Project: Village Creek WRP Effluent Line Pipe Repair
Owner. City of Fort Worth
Contractor: Archer Western Contractors,LTD
Engr: JQ Infrastructure
CHANGE DESCRIPTION:
Repair existing 54" Effluent Line
DESCRIPTION
Labor:
Eusebio Loredo
Eusebio Loredo
Juan Jimenez
Juan Jimenez
Wayne Pursley
Malthew Dueling
QTY UIM UNIT PRICE
�� � y� S�i7 z
M�c� G-���5
� ��
LABOR MATERIAL EQUIPMENT SUB
40 MH "� 1525 $ 610.00
8 MH $ 22.86 $ 183.00
40 MH $ 21.00 $ 640.00
8 MH $ 31.50 $ 252.00
40 MH $ 67.00 $ 2,680.00
48 MH $ 48.00 $ 2,304.00
Total MHs 184
� Materials:
IFortiline Fernco Coupling
Hobas Pip.54" Hobas Pipe
Home DepiMastic
Form Material
Blind Flange 30" (From AW Yard)
I
IEquipment:
Rental Onc Tamper
United Reni Trench Box
RDO Excavator
Walsh CAT 420 Tractor Loader (includes Fuel)
I Walsh F150 Pickup Truck (includes Fuel)
IFuel for Excavalor (40% of Rentaq
Subconiractor:
Hillon Haul CAT420 Tractor
SUBTOTALS:
1 LS $ 1,737.16
1 LS $ 6,857.83
1 LS $ 41.01
128 SF $ 2.50
1 EA $ 350.00
0 EA $ -
1 DY $ 96.12
1 WK $ 1,868.80
1 WK $ 2,865.67
48 HR $ 35.00
48 HR $ 13.00
1 LS $ 1,146.27
1 LS $ 650.00
LS
SMALL TOOLS @ $21MH
SAFETY SUPPLIES @ $2IMH
PAYROLL BURDEN @ 55 % OF LABOR
SUBTOTALS:
15% OHP(LM&E)
5% OHP (Sub)
3% BOND & INSURANCE
� TOTAL AMOUNT OF THIS PROPOS!{L
I
$ 1,737.16
$ 6,857.83
$ 41.01
§ 320.00
$ 350.00
$ -
$ 96.12
$ 1,868.80
$ 2,865.67
$ 1,660.00
$ 624.00
$ 1,146.27
TOTALS I
I
�
I
I
$ 650.00 � I
$ - I
� - I
$ - I
$ 6,869.00 $ 9,306.00 $ 8,930.86 $ - $ 25,105.86I
$ 368.00 $ 368.00
$ 368.00 $ 368.00 -
$ 3,777.95 I $ 3,777.95
$ 11,382.95 $ 9,306.00 $ 8,930.86 $ - I$ 29,619.81
I $ 4,442.97
$ - �
$ 1,021.88
$ 35,084.66 '��� ;
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�Timesheet Employee Summary
Date Filter Specification: From: All Dates To: All Dates
I� Regular Overtime Premium
ILOREDO, EUSEBIO - 103351 40.00 8.00
Marquez Jimenez, Juan - 135040 40.00 8.00
I 80.00 16.00
80.00 16.00
Report Totafs:
�u��a�o �.. �5.a5
__--
1 m�a1 =� `l 93 . �
� �.�.n = a � � oa
o�c�.�. _ � OQa. o�
80.00 16.00
Total
48.00
48.00
96.00
96.00
96.00
� I
I
;
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PCtimecard November20, 2095 Page � of 9
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JOB.NO '•. -I SLS • I" .I
�� 1 ��
IUOM I ORDERED I SHIPPED I OR ERED
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- ��
>UE DATE I' - SNIP DATE
� � �
UNIi PRICE . EXTENDED PRICE
:.: :��
REL'�IV�D :OV � `� �0�5
' � ' � � � $1.737.16
NO f2ETURNS ACCEPTED WI7HOUT PRIOR AUTHORI7ATION. AUTHORIZED RETURNS ARE SUBJECT TO RES70CKING F�ES, • �0.00
SPECIAL ORDER IT�MS ARE NOT RETURNABLE. ALL CLAIMS MUST BE FILED WITH THE CARRIER. �0.00
ALL SALES ARE SUBJECI` i0 THE TERMS AND CONDITIONS OF SALE PRIN7ED ON THIS PAGE AND THE BACK OF PAGE ONE. • �0,00
• ' � $1,737,16
F�RTILINE .
WAT�RWORKS
� 7025 NorEhwinds Dr.�NW
� Concord, NC 28027 -
= Payment Inquiries 70�-788-9800
I NVOI�E INVOICE NUMB�R; 3532267
f` BlLL OF EADING: 128700
��
� INVOlCE DATE; 10l3Ul95
� DU� DATE: 11I29115
1= ' ,
Please Remi( Pa menf To�
Y •
FORTILINE, INC
PO BOX 538388
ATI.AiVTA, GA 30353-8388
Warehouse:
FORTII.INE FORT WORTH
1705 CYPRESS S'f.
HAL70M CITY, TX 76117-5212
SHIP TO Tetephone: 682-747-0879
ARCHER WESTERN CONSTRUCTION
Rolling Hills WTP Phase 6
2500 Southeast Loop 820
Fort Worth, TX 76940
SOI.D TO
20731 MB 0.439. E0337X 10660 D1519200602 P2815143 0001;0005
��h��ll�lu��llP�u���I�fi��Il�il�li�Il�i�I�li���I�n����ii�E��
�ARCHER WESTERN CONSTRUCTION
1411 GREENWAY DR
iRVING TX 75038-241b
039 3480927 3532267
.� � e.
215024WP Rolling Hills
/TPGD2462508 FERNCO LDC 57.50 (OD) X 57.50
C/O LINE # OOQ68
(OD) COUPLING
MARK A�DED PER WAYNE FOR
REPAIR
6001:00�5
Page 'f of 1
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HOBAS PIPE USA
`�:' ` ' Piant Houston
i' . 1413 E. Richey Rd. •
SOLD TO: �" ��' ' HOUSTON 7X 77073
`"Orig�eal
Received '+n Texas Reoional 4�ce H O�A S°
Archer Westem Construction, LLC ���( '� � Page 1 of 1
1411 Greenway Drive
IRVING TX 75038 p�y Angie Chavea 1NV010E # 2041007849 �
USA DAiE: �1/09/2015
SHIP TO: JOB NUMBER: 13410D0962
Archer Western Construction, LLC
City of Fort Worth
Village Creek 54" Repair
Fort Worth, Texas
TERMS P.O. NO. SALES PERS�IJ SHIPPED VIA Sh{IPPING DATE SHIPPED FROM
30 days after invoice date P� 215024-WP Simonson John Truck 11/09/2015 Houston, Texas
[tem Material Material descripEion
10 9254750 P54-50-0072-PP-PE-PE
20 600360 Freight per Truck
Subtofal
QuantitV Unit
17,330 FT
� au
\
Unii price
351.00
77b,00
m
waBas si��. o� �.aniN�
PLEASE REMIT 70:
iHANK YOU!!!
184�022409
kOgAS PIPE USA
1413 E, Richey Road,
Houstort, TX 77073
707AL AMOUNT DUE:
USD Tota�
6,062.$3
775.00
6,857.83
6,857.83
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1151 BRIDGEWOOD QRIUE
F1', WORTH, TX 76112 (B17>q96-3212
653q 00001 07813 11/10/15 08:51 AM
CASHIER SARRH - SMM056
081'125201408 201 HENRY <A�
?01 FIBEREQ ROQF COATING 0.9GAL
2Q14.50 29.00
077f)89150056 3"WHTBRSBRSH <A>
(�HIP 3.0 FLAT BRL15H
E>@i , 48 8. 88
SUBTOTAL 37,88
SALES 7AX 3.13
TOTAL $41.01
XXX>IXXXXXXXX2027 HOME DEpOT 41.01
AUTfi COUE 010588/001q112 7A
ARCHER WESY�RN CONTR i
DUEI_ING MATT � I i
_ TAL - � �
..;,�,:,,. .��__;.� ��o.:oo.�::::�.. ., ,..,,..
5742 AIRPORT FREEWAY
FORT WORTH, TX 76117
817-222-2806
Customer: 1054
ARCHER-WESTERN CONTRACTOR
141�. GREENWAY DR
IRVING, TX 75038
Job Site:
ARCHER-WESTERN CONTRACTOR
1411 GREENWAY DR
IRVZNG, TX 75038
j;
I , - .,
C#: 972-457-85p0 J$#: 972-457-85Q0
Page
Remit To:
P.O. BOX 489
COLLEYVILLE,
817-545-8999
TX 76034
RENTAL RETURN
1
Invoice #..• 542124-OOOI
Invoice date 11/12/15
Date out.... 11/12/15 10:28 AM
Date in..... 11/12/15 3:22 PM
Job Loc..... VILLAGE CREEK WASTEWATER
Job No . . . . . . FORT T�70RTH
P.O. #...... 215024-975001
Ordered By.. MATTHEW
Terms....... Net 1.0 Days
Qty Equipment # Min Day Week 4 Week Amount
1 JUMPING JACK TAMPER 80.00 80.00 260.00 580.00 80.00
13760 Make: BOMAG Model: BT60 Ser #: 101541114354
Sub-total:
Damage waiver:
Tax:
Total:
80.00
8.80
7.32
96.12
_,:_ _
,. ;::.:. _
,_ : IF THE ERUIP�v1ENT DOESNOT WORi< : :... ..::.:::;:.;..;:.;:.:.;;.: MULTlP��$NIFTS qR CUSTPM�RISR�SFO�ISI�C�FOR ,,
'PROP£RLYN9�IFYTN�r)�F10E,qTONCE . ,; ;:OUER'C�tvjERFlTESMAYAPP�;Y ... :.. .. ,:, R�FUELlNG,,Dq�vjAGE50RREF!A1RS....__.
1. Loss/Damage Waiver (11 % of gross rental charges)will be charged uniess customer Is a commerc(al account which elects lo provlde its own insurance coverage under Paragraph 13 to follow. Loss/Damage �
Waiver is NOT INSURANCE and does not cover upsel, overtumed, tire or overhead damage or accessory Items regardless of (aull.
2. Customer must call lo release equipmenl and Is responsible for released equlpment unlll II is picked up. '
3. Customer is fully responsi6le for the iheft of items rented.
4. Malerials purchased not returnable withoul nor approval and receipt. Relums subject to a restocking fea.
I have,had �he opportunity �o reacPthe term s and condit'ons on both sides of this agreement, I t�ave received and understand the safety instr ctions on the •
operation o the eqwpment am renting. I have receivec� a complete copy of this agreement an agree to ihe terms and conditions on both si�es.
(Carefully read the terms and conditions on the reverse side of this page)
X
CUSI'OMER SIGNATURE DATE NAME PRINTED DELIVERED BY DATE
Terms: NET 10 DAYS
616.00
48.Q0
76.38
1,356.36
Extende8 Amt.
185.00
185,00
370,00
1,726.38
142.42
1,668.80
7HIS ItN010E IS ISSUED SUBJflC7 TO THE TER1dS AND COND1T101iS OF'fHE RENTAL AGREEhiENT� WHICH ARE INCORPORATED HEREIN eY ftEF�RENCE,
A COPY OF THE REMTAL AOReEMENT IS AVAIIABLE UPON RE�UEST.
You Can NowAccess lnvolce Hlstoryend Updafo Purohaso O�ders Onitno Pagc:: 1
� To Sign Up, contsct LRConUofSuppoR@ur.com `
QUnited Reni�a�'s� ������i��{�d���i���i������i��i�i�i���
sRRxCH C 6
2425 �' MAIN ST '
Ri��t�..,SR TX 76248-5124 . / 1.
lfa" 7-379-7133 ��
817-379-7107 FAX -
41 �
� .ARCI3ER VdESTERN ,y '
� 4500 WILMA LN �'
ARLINGTON TX 76012-5409
A
h Oifice: 972-457-8500 Ce11: 817-771-4266
ARCHER WESTERN ARLING�ON
1411 GRE�NWAX DR
IRVING TX 75038-2410
Originai
Reteived in Texas Reoional C
IV�Y y�
8y kngie Chavez
RENTAL ITEtdS:
Qty Eguipment DescYiption Minimum
1 230711238V TREiaCFi BOX ALUM 8' X 12� W/STEEL FRAME
Make: SPEEDSHORE Model: 8X12
Se=ial: 612-3-BP
1 1227875 PRENCH SOX ALtJ41 B' S'�- 12' 42/ST£�L �'RPS7E
hSake: SHE�DSHORS Model: APS-SF-0812
SexiaLc 11-4Q97.
6 940/5420 SPREADER BAR (KI'fj S" X 11'
1 330/77,7.5 LIFTING SRTpLE 4 LEG X 10'
SALES/IdISC�LLAN'LOUS ZTEMS:
4tv Item
7. DELIVIIiY CHARGE
1 PICKUP CHAR6$
I�ENTAL RETURN
INV4ICE
# 132963697-Q01 _
Cuetomer # : 1?4449
Invoice Date : 11i7.3J15
Rental Out : 11/09/].5 12:00 PM
Rental In : 11/il/15 10:00 AM
UR Job 7�oc :4500 WILMA LN, ARLIN
IIR Job �` : 300
Cuetomer Job ID:
p,Q. � ; VILLP.GE CREEK-21502a
Ordered Bx : MFITTHEW DUGLING
t4rittea Sy : STSVEN ROYE
Salesperson : 5AM NUFF
:tV.�:mm?;xt,�".r7:..'�'.asvi�...�::1T,b�z,:�. -.u�u.��"�t�?_....:.:.�...•-.=x�
; trnroice Amoun� $�1,868.80
�� Senns: Net30Days ~ W V � �~
� Paymentaptfons: Cantactouraedifo�rce 7o4-91G4844
REhIiIT TO: UNITED REMALS (NORTH AM6RICA),INC.
; PD BOX 640514
y DALLASTX75284-0574
Dav tVeek a Week
308.00 642.00 1450.00
P.mount
616.00
308.00 642.0� 1960,00
3.00 3,00 4.00 14.00
36.-19 F19,1Z 219.45
RentaJ. Subtotal:
Price Unit of tdeasure
ie5.000 EACH
185.000 EACH
Sales/Misc Subtotal:
Agreement 5ubtotal:
Tax:
TotaL:
COI�NTS /1JOTES : •
ARE YOU OR XOUR EfhPLOYP.ES IN S7�ED OF OP�RATOR CER2`TFICATION TRP.INING7
CONTACT UNIT�D ACADEhfY TODAY 844-222-2345 OR Y7V7[V.UNTT�DACP.DEAtY.0I2.COD4
TRAI2JING IS NOR AVP_ILABLE 023 CERTAIl� I:QOIBldENT IN CA13AA?�.
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��� Rno Rents / RDo Equipment Co. Sales Manager; FT.5ales�rdoequipmeni.com
5301 Mark IV Parkway Generai Manager; FT.GenMgr�rdoequipment.corn
��� Fort Worth, TX 76131 www.rdoequipment.com
� E N T� Phone: 800-886-3758� Fax: 512-252-362�
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Village Creek WTP �T- FORT vrC TH. TX
4500 Wilma S,n Date �Ime I Page I
_ 1�/2�./209F ]fi,1�:00 (0) � � 1
ARLINGTON, TX 76012 Account No. Phone N0. � fnvoice o. �
Job Site: Villaae Creek S4TP Villaae 3898002 9724578500 3218102
� Shfp Via Purchase Order
ARCHER WESTERN CONTRACTORS, LLC 215024-97.5001.
7.411 GRE�NWAY DIZ
IRVSNG TX 75038-2410
I
DeScription
RENTA�. INVOICE
INVOICE #: R18102 For ContraCt #: 00577.5
Billing #: 1 Covering From 11/06/2015 to il./12f2015
Dea1 # 825oD3 Replacement value = $250,000
Amount
RF G�
210GLC SXCAVATOR BAS Charge for usage of 1 WEEK 1867.00
Stock #: X546407 Serial #; 1F�'210GXHFE523�.73
17atie Out: Z1/06/2015 08:00 Date Returned: 11/].2/2015 08:00
RF CE OTH ATT ::�e�:::�:;_::s.��r.�,:
30: BUCKET FOR 210G Char��e^;�xp:
:!�;i:;; ;-;� �:
StoC1C #: X537489. S.erXa1:-#::.+=�:43�.
Date Out; 1�./06/2015 $.: ;!ie":,..'"-?`^�'^;,.,
Q� . .: ,Q�O,,;:;r,vr_m��„uta;,:�.
.• �llC3 '.::1' �!I«ICSiiE!uii-';�:+
HAULINGC
HAULINGC
�
oE Z WEEK
=.Returned: 11/12/207.5 08;00
:;�i (;i�IiiF;�i�:ei-; i;'���:��,iii'�:`;- ;.imw�r;;;i�i;'+r•.:
>. , yt, t � A, . uiPu' = ii :':=
�; _,:r.�::,::;�: YVS). r�'�� :,�;:Et!>•t'i5 '• ����{:, :,;1.;�;ial�
rge.'s:�Cret�;ti.ts;i;;?�",:.f,;€,::: �`i:iv;I+'>` �'=''�''"!
;::.u::r�_: '::a,.; t'i,,:::;�:s, �:;i:��
=° ;i;��t;ii ... r.., . . I.t��
_�_�� �� _�.-��t�f f_:ii��ii;� �+:i
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r.c�?�f@uS_•: ` �iti_.�; -� i�.f:l�:'!iiiv.
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`i ��' c; PsY;iCef'i �';;?c�i� ':>'''3 5 0:�OAS„�:�a?�' ':!;:% 3 5 0. 0 0
�':,,,.
3,:� ;��::,.: l: �.u�, �; ;< ��AQ.4.0., 1��:� :0�,�400.00
' � � i = >4��r x ;. F iy A� •:
..: . 4!?ti':n. � ,�. � i_'' ' ? `i!� �` ' �'1 j ,.., l �i:
�Sub�otal: ����267.7 . 00
2-TERP TAX �..5%: 28.01
2-HEY .00255: 4.76
TXFT-TX FpRT WORTH 8.25%: 215.90
5N`£ERNAL A/R: 2865.67
**�**�x�*�x�*,�*,t�*,r*��********�*****,t****��x**��*���x�**,r**��,��**#,����r;r�,���x*�*
PLEASE REMIT TO: i2D0 TRUST $� 8Q-5800
P.O. BOX 7160
FARGO, I�TJ 58106-7160
**�**�*�,�*��*�,*��**,***,��***��,���*��*�W���*��������-���*�*��**���I�V`�D�`����2 2015
I 5alesperson
�E3 / C09
PRINTNAh1�. � TITLE AUTHORIZEDSYl3NATURE DATE
THIS TRANSACTION IS INTENDER AS A TRUE LEASE ANO NOT A SAIL. Lessee agrees that tfils document, ot copy thereof, may be Atled Wilh all necossary authorRies es a protect�e llCC•7 (inandng
eiatement.
RDO �qufprrlent Co. (Lessor) herobY leases to lessee the oquipment Ident�ied. Lessee has receNed and aprees to all terms and condilions hereln and on lirst page, TERMS AND CONDI710NS. Lessee
vrarran�s end represents that au data and intormation furNshed to tessor as an indueement to leasa the equlpment to lessee is true and cortecL Lessee acknowledges that tho equipment win be relurned in a
good, cleen and unoontaminated condi6on, Gee of any and all hazardous subslances. AI� equfpment leased hereUnde� Has received w8fi Operelof s Manuals and al! satety gquipment installed. Operation and
servicing has been explatnedio me,
Hilton Truct�inq
P.O.Box 886
Az4e Tx. 76098
TEL (817) 999-166J.
FAX (£i17) 238-9608
Bill To:
Archer Westere Cantractors
1411 Gr�enway Dr. Irving TX 75038
5erial Number Load Description
150 X 61&7 CaC 420
Date: i1-3-15 From: Rollin Hills WTP Ft Worth
To: Village Creek WTP Arlington
150 X 6167 Cat 420
Date: 11-18-�5 From: Village Creek WTP Ariington
To: Rollln Hills WTP Ft Worth
Commenis
Thank you for your buslness
! � ��
1
iNVOICE
Irtvoice No. HT15578
Date i1/18/2015
Ref f�o.
Cust P0. 2�5029
Terms 14 Days
Amount
$325.00
$325.00
Totai $650AU
Amount Paid
Arnount Due
���cr.�v£j� �s�%�ij w�: Lui� .
$0.00
$650.00
Page 1 of I
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