HomeMy WebLinkAbout062637-FP1 - Construction-Related - Contract - Urban Infraconstruction, LLCFORTWORTH.
TRANSPORTATION AND PUBLIC WORKS
NOTICE OF PROJECT COMPLETION
-FP1
City Secretary No:
62637
Date Received: 02/23/2026
City Project No: 105778
Regarding Contract 62637 2025 Concrete Restoration Contract 2 for as required by the
Transportation & Public Works Department as approved by City Council on 12/20/24 through M&C 24-1084
the Director of the Transportation & 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: $3,981,750.00 Days 210
Amount of Approved Change Orders: $0.00 No 1 Days Added by CO 30
Revised Contract Amount: $3,981,750.00 Total Days 240
Total Cost of Work Completed: $3,890,636.59 Days Charged229
Less Deductions:
Liquidated Damages: Days @ /Day = $ 0.00
Pavement Deficiencies:
Total Deduction Amount: $ 0.00
Total Cost of Work Completed: $3,890,636.59
Less Previous Payments: ($ 3,696,104.72)
Final Payment Due: $ 194,531.87
Patricia L. wa4s IGK
Patrina L 1A'ad111k (Fob 20, 2025 15.15 54 CST)
Recommended for Acceptance
Assistant Director, Transportation & Public Works — Capital Delivery
le&�
Accepted
Director, Transportation & Public Works
02/20/2026
Date
02/20/2026
Date
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
FORT WORTH.
TPW Construction Invoice
City Secretary Contract Number:
Purchase Order:
CS62637
NON PO
Project:
Invoice Number:
105778-105778 - 2025 Concrete Restoration Contract 2
CS62637-009-FINAL+GS-C-1
Contract Name:
Invoicing Period (From — To):
2025 Concrete Restoration 2
N/A to N/A
To:
URBAN INFRACONSTRUCTION
2512 GRAVEL DRIVE
FORT WORTH, TX 76118
Supplier ID:
0000039969
Contract Summary:
1. Original Contract Amount
$3,981,750.00
2. Net Change by Change Orders
$0.00
3. Current Contract Amount (Line 1 +/- Line 2)
$3,981,750.00
4. Total Completed and Stored to Date
$3,890,636.59
(Progress Estimate, Construction Allowance, and
Change Orders)
5. Amount Retained (5.00%)
$0.00
6. Amount Eligible to Date (Line 4 — Line 5)
$3,890,636.59
7. Less Previous Payments (Line 5from prior Invoice)
$3,696,104.72
8. Amount Due this Application
$194,531.87
9. Balance to Finish, Plus Retainage
$91,113.41
(Line 3 — Line 6)
10. Contract Time
a. Days Awarded
210
b. Days Added by Change Order
30
c. Total Contract Days Awarded
240
d. Days Charged this Invoice
0
e. Days Charged from Previouslnvoice(s)
229
f. Contract Days Remaining
11
Payment Application Date:
12.24.2025
Estimate Number:
8
Project Manager:
Otuyelu,lretomiwa
Roles
Inspector:
Sr. 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
Samuel ffevnandez
Samuel Hernandez (Feb 17, 2026 15:01:13 CST)
Page 1 of 3
FORT WORTH-
TPW Construction Invoice
Funding Distribution:
Funding Identification (FIDs) Amount Earned Retainage (FIDs) Retainage Amount to Pay
on�nn_nennna�_c�nnm n_�nc��o_rnoaon_onon $0.00 30100-2060000-105778-RETAIN-$194,531.87 $194,531.87
Contract Bid Items:
A
B
C
D
E
F
G
H
I
J
K
Bid Item
Description
Spec.
UoM
Bid
Unit Price
Bid Value
Estimated
Value this
Previously
Previously
Materials
Total Completed
Retainage
%
Balance to
No.
Section
Quantity
Quantity
Period
Installed
Installed
Presently
and Stored to
this
Period
(H/B)
Finish
No.
Installed this
Quantity
Value
Stored
Date (D+F+G)
(B-H)
Period
(not in F)
Unit
0170.0101 Specified
$ 14,000.00
0.0000
$ .00
0.0000
$ .00
$
.00
$ .00
0.00%
$ 14,000.00
EA
1 $ 14,000.00
$ .00
1.001
Remobilization
_
Unit
0241.1300 Remove Conc Curb
1,600
$
8.00
$ 12,800.00
0.0000
$ .00
0.0000
$ .00
$
.00
$ .00
$
.00
0.00%
$ 12,800.00
SF
1.002
& Gutter
1,600
$
12.00
$ 19,200.00
_
0.0000
$ .00
0.0000
$ .00
$
.00
$ .00
$
.00
0.00%
$ 19,200.00
Unit 3213.04016" Concrete
SF
1.003
Driveway
21,000
$
17.00
$ 357,000.00
0.0000
$ .00
26,866.270
$ 456,726.59
$
.00
$ 456,726.59
$
.00
Unit
0241.1000 Remove Conc Pvmt
SY
127.93%
$- 99,726.59
1.004
$2,457,000.00
0.0000
$ .00
0
26,866.270
$3,143,353.59
$
.00
$3,143,353.59
Unit 3213.0104 9" Concrete
SY
21,000 $ 117.00
$ .00 127.93%
$-686,353.59
1.005
Pavement
0
_
Unit
3123.0102 Unclassified
CY
6,000
$
81.00
$ 486,000.00
0.0000
$ .00
2,065.9100
$ 167,338.71
$
.00
$ 167,338.71
$
.00
34.43%
$ 318,661.29
1.006
Excavation by Survey
_
Unit
3211.0123 8" Flexible base,
Sy
10,500
$
20.00
_
$ 210,000.00
0.0000
$ .00
1,262.7600
$ 25,255.20
$
.00
$ 25,255.20
$
.00
12.03%
$ 184,744.80
1.007
Type A, GR-2
Unit
9999.0004 Geogrid Tensar
_
SY
5,100
$
8.00
$ 40,800.00
0.0000
$ .00
0.0000
$ .00
$
.00
$ .00�
$
.00
0.00%
$ 40,800.00
1.008
(TRIAX 140-475) or Approved
Equal
TN
Unit 3212.0401 HMAC Transition
50
$
300.00
$ 15,000.00
0.0000
$ .00
10.5000
$ 3,150.00
$
.00
$ 3,150.00
$
.00
21.00%
$ 11,850.00
L009
Unit
3292.0100 Block Sod
3,500
$
12.00
$ 42,000.00
0.0000
$ .00
425.0000
$ 5,100.00
$
.00
$ 5,100.00
$
.00
12.14%
$ 36,900.00
SY
1.010
Replacement
L
Unit
3291.0100 Topsoil
CY
250
$
125.00
$ 31,250.00
0.0000
$ .00
30.5000
$ 3,812.50
$
.00
_
$ 3,812.50
$
.00
12.20%
$ 27,437.50
1.011
Unit
3213.0700 Joint Sealant
LF
500
$
3.00
$ 1,500.00
0.0000
$ .00
0.0000
$ .00
$
.00
$ .00
$
.00
0.00%
$ 1,500.00
1.012
Page 2 of 3
FORT WORTH..
TPW Construction Invoice
A
B
c
U
E
F
G
H
I
J
K
Bid Item
Description
Spec.
UOM
Bid
Unit Price
Bid Value Estimated
Value this
Previously
Previously
Materials
Total Completed
Retainage
%
Balance to
No.
Section
Quantity
Quantity
Period
Installed
Installed
Presently
and Stored to
this Period
(H/B)
Finish
No.
Installed this
Quantity
Value
Stored
Date (D+F+G)
(B-H)
$ 1,600.00
Period
0.0000
$ .00
1.0000
$ 800.00
(not in F)
$
.00
$ 800.00
50.00%
$ 800.00
Unit 0241.0300 Remove ADA Ramp
EA
2 $ 800.00
$ .00
1.013
Unit
3213.0506 Barrier Free Ramp,
EA
2
$ 2,500.00
$ 5,000.00
0.0000
$ .00
1.0000
$ 2,500.00
$
.00
$ 2,500.00
$
.00
50.00%
$ 2,500.00
1.014
Type P-1
Unit
0241.0100 Remove Sidewalk
SF
400
$ 5.00
$ 2,000.00
0.0000
$ .00
0.0000
$ .00
$
.00
$ .00
$
.00
0.00%
$ 2,000.00
L LO15
Unit
3213.03014" Conc Sidewalk
200
$ 7.00
$ 1,400.00
0.0000
$ .00
0.0000
$ .00
$
.00
$ .00
0.00%
$ 1,400.00
SF
$ .00
1.016
Unit
3305.0107 Manhole
11
$ 1,300.00
$ 14,300.00
0.0000
$ .00
2.0000
$ 2,600.00
$
.00
$ 2,600.00
$
.00
18.18%
$ 11,700.00
EA
1.017
Adjustment, Minor
Unit
3217.5001 Curb Address
EA
5
$ 100.00
$ 500.00
0.0000
$ .00
0.0000
$ .00
$
.00
$ .00
$
.00
0.00%
$ 500.00
1.018
Painting
Unit
3305.0111 Valve Box
5
$ 1,000.00
$ 5,000.00
0.0000
$ .00
0.0000
$ .00
$
.00
$ 00
$
.00
0.00%
$ 5,000.00
EA
1.019
Adjustment
Unit
3213.03114" Conc Sidewalk,
200
$ 8.00
$ 1,600.00
_
0.0000
$ .00
0.0000
$ .00
$
.00
$ .00
SF
$
.00
0.00%
$ 1,600.00
1.020
Adjacent to Curb
200
$ 12.00
$ 2,400.00
_
0.0000
$ .00
0.0000
$ .00
$
.00
$ .00
0.00%
$ 2,400.00
Unit 3217.0501 24" SLID Pvmt
LF
$ .00
1.021
Marking HAE (W)
Unit
3217.2001 Raised Marker TY W
_
500
$ 8.00
_
$ 4,000.00
0.0000
$ .00
0.0000
$ .00
$
.00
$ .00
$
.00
0.00%
$ 4,000.00
EA
1.022
Unit
3217.2002 Raised Marker TY Y
EA
300
$ 8.00
$ 2,400.00
0.0000
$ .00
0.0000
$ .00
$
.00
$ .00
$
.00
0.00%
$ 2,400.00
Unit
3471.00O1Traffic Control
7
$ 10,000.00
$ 70,000.00
0.0000
$ .00
8.0000
$ 80,000.00
$
.00
$ 80,000.00
$
.00
114.29%
$- 10,000.00
MO
1.024
$ 35,000.00
_
0.0000
$ .00
0.0000
$ .00
$
.00
$ .00
0.00%
$ 35,000. 00
Unit
9999.1000 Irrigation
LS
1 $ 35,000.00
$ .00
1.025
Adjustment & Landscape
Repair Allowance (Please enter
$35,000.00 for the Unit Price.)
I_
$ 150,000.00
0.0000
$ .00
0.0000
$ .00
$
.00
i
$ .00
0.00%
$ 150,000.00
Unit
9999.0002 Construction
0
$ .00
1.026
Allowance (Please enter
$150,000.00for the Unit Price.)
$3,981,750.00
$ 0.00
$3,890,636.59
$ 0.00
$3,890,636.59
$-
97.71%
$ 91,113.41
194,531.87
Page 3 of 3
CSC No. 62637-COI
Fowl Woii-rlI.
Project Namel 2025 Concrete Restoration Contract 2
Client Project#(s)105778
Project Description
Contractor Urban Infraconstruction, LLC
City Project Mgr. Irotomiwa Otuyelu
Dept
Original Contract Amount
Extras to Date
Credits to Date
Pending Change Orders (in M&C Process)
Contract Cost to Date
�Go to ADD & DEL Tabs to Enter CO Backup
Revised Contract Amount
Original Funds Available for Change Orders
Remaining Funds Available for this CO
Additional Funding (if necessary)
TPW
$3,981,750.00
City of Fort Worth
Change Order Request
City Sec # I 62637
Concrete panel replacement at various locations
ChangeOrder#1 1 j Date 9/8/2025
City Inspectorl Omar Fries
Contract Time
Totals (CD�
$3,981,750.00 10
CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS % OF ORIGINAL CONTRACT 0.00%
MAX ALLOWABLE CONTRACT AMOUNT (ORIGINAL CONTRACTCOST+ 25%) $4,977,187.50
JUSTIFICATION (REASONS) FOR CHANGE ORDER
In accordance with this Change Order, the Contractor shall furnish all labor and materials as specified in Change Order #1. This change order adds concrete restoration work on
Village Creek Road from Martin Street to Martin Street and on Carey Street from Martin Street to Martin Luther King Jr. Freeway. During construction on Martin Street, staff
evaluated these adjacent segments and determined that both are in poor condition due to heavy truck traffic, making immediate repairs necessary to preventfurther
deterioration. Including these additional locations will provide consistent pavement quality, reduce the need for future repairs, and improve efficiency by avoiding repeat
mobilizations. The work will be performed using available contract quantities and does not significantly alter the overall project scope.
Time: To accommodate the added scope, staff supports the contractor's request for an additional 30 calendar days to the contract time.
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
Urban Infraconstruction, LLC I Anup Tamrakar VW
I Sep 18, 202E
is�oectorflnspection Supervisor
Date
Project and Contract Compliance Manager
Date
Sep 18, 202_`►
Sep 22, 202E
4ogram Manager
Date
Senior Capital Project Officer
Date
3s111md2b—
Sep 25, 202E
—
10/02/2025
ssilnt Director De
Date
Director, Contracting Department (Dept)
Date
10/03/2025�+�
10/03/2025
assistant City Aftorney
Date
lAssistant City Manager
I Date
QG
10/06/2025
10/13/2025
Council Action rrf required)
M&C Number I N/A M&C Date Approved NIA
ATTEST:
Jannette Goodall, City Secretary
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Fi>err wow rn City of Fort Worth
—`T — Change Order Additions
Project Name 1 2025 Concrete Restoration Contract 2 ' City Sec # I 62637
Client Project # 1 105778 1
Contractorl Urban Infraconslruction, LLC I PMI Iretomiwa Otuyelu I Inspectorl Omar Frias
Change Order Submittal # 0 Date 1 9/8/2025 1
ADDITIONS
I I FM UESL;Pjp I WIN UtP I LtiY Unit Unit Cost I otal
TF'I $0.00
Sub Total Additions $0.00
Change Order Additions Page 2 of 3
I I tM
r+Fra'r 44errrrrl City of Fort Worth
-V� Change Order Deletions
Project Name 2025 Concrete Restoration Contract 2 j City Sec # 1 62637
Client Project# ! 105778 1
Contnactorl Urban Infraconstruction, LLC PMI Iretomiwa Otuyelu Inspectorl Omar Frias
Change Order Submittal # Date 9j I8I2025J
DELETIONS
UtJUHn'IIUN UtNI uty
unit unauost total
I
I
I
I
I
I
TF W $0.00
I
I
I
Sub Total Deletions $U.UU
Change Order Deletions Page 3 of 3
105778-CNCO-2025 CONCRETE
RESTORATION CONTRACT 2 - CO 1
Interim Agreement Report 2025-09-26
Created: 2025-09-17
By: Andrea Munoz (Andrea. Munoz@fortworthtexas.gov)
Status: Out for Signature
Transaction ID: CBJCHBCAABAA-iuR60r99IAkDQWrSOKLhxBtN5kyQLnW
Agreement History
Agreement history is the list of the events that have impacted the status of the agreement prior to the final signature. A final audit report will
be generated when the agreement is complete.
"105778-CNCO-2025 CONCRETE RESTORATION CONTRAC
T 2 - CO 1 " History
iJ Document created by Andrea Munoz (Andrea. Munoz@fortworthtexas.gov)
2025-09-17 - 1:35:30 AM GMT- IP address: 204.10.90.100
:4 Document emailed to LaKeshia Lynch (LaKeshia.Lynch@fortworthtexas.gov) for filling
2025-09-18 - 8:41:28 PM GMT
1— Document emailed to anup@urbaniconstruct.com for signature
2025-09-18 - 8:41:28 PM GMT
Im " Document emailed to Omar Frias (omar.frias@fortworthtexas.gov) for signature
2025-09-18 - 8:41:29 PM GMT
J Email viewed by Omar Frias (omar.frias@fortworthtexas.gov)
2025-09-18 - 8:43:33 PM GMT- IP address: 166.205.54.18
&11-1 Email viewed by anup@urbaniconstruct.com
2025-09-18 - 8:44:26 PM GMT- IP address: 172.226.196.31
AQ Document e-signed by Omar Frias (omar.frias@fortworthtexas.gov)
Signature Date: 2025-09-18 - 8:44:40 PM GMT - Time Source: server- IP address: 166.205.54.18
do Signer anup@urbaniconstruct.com entered name at signing as Anup Tamrakar
2025-09-18 - 8:46:07 PM GMT- IP address: 67.134.205.28
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YQ Document e-signed by Anup Tamrakar (anup@urbaniconstruct.com)
Signature Date: 2025-09-18 - 8:46:09 PM GMT - Time Source: server- IP address: 67.134.205.28
6Q Form filled by LaKeshia Lynch (LaKeshia.Lynch@fortworthtexas.gov)
Form filling Date: 2025-09-19 - 4:55:05 PM GMT - Time Source: server- IP address: 204.10.90.100
L-' Document emailed to Lorrie Pitts (Lorrie.Pitts@fortworthtexas.gov) for signature
2025-09-19 - 4:55:07 PM GMT
C-Document emailed to Iretomiwa Otuyelu (Iretomiwa.Otuyelu@fortworthtexas.gov) for signature
2025-09-19 - 4:55:08 PM GMT
Email viewed by Lorrie Pitts(Lorrie.Pitts@fortworthtexas.gov)
2025-09-19 - 5:47:13 PM GMT- IP address: 66.169.141.161
00 Document e-signed by Iretomiwa Otuyelu (Iretomiwa.Otuyelu@fortworthtexas.gov)
Signature Date: 2025-09-22 - 2:59:29 PM GMT - Time Source: server- IP address: 204.10.90.100
coo Document e-signed by Lorrie Pitts (Lorrie.Pitts@fortworthtexas.gov)
Signature Date: 2025-09-23 - 9:00:14 PM GMT - Time Source: server- IP address: 204.10.90.100
I-_ Document emailed to Zelalem Arega(Zelalem.Arega@fortworthtexas.gov) for signature
2025-09-23 - 9:00:16 PM GMT
6a Document e-signed by Zelalem Arega(Zelalem.Arega@fortworthtexas.gov)
Signature Date: 2025-09-25 - 6:45:18 PM GMT - Time Source: server- IP address: 208.184.124.181
C7 Document emailed to Mary Hanna (Mary. Han na@fortworthtexas.gov) for signature
2025-09-25 - 6:45:21 PM GMT
Email viewed by Mary Hanna (Mary.Hanna@fortworthtexas.gov)
2025-09-25 - 6:46:33 PM GMT- IP address: 104.47.65.254
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105778-CNCO-2025 Concrete Restoration
Contract 2 - CO 1
Interim Agreement Report
Created: 2025-09-26
By: Andrea Munoz(Andrea. M u noz@fortworthtexas.gov)
Status: Out for Signature
Transaction ID: CBJCHBCAABAA4sWHLligjEUYzxWiQHMkKAEETsQ8Th_x
Agreement History
2025-10-02
Agreement history is the list of the events that have impacted the status of the agreement prior to the final signature. A final audit report will
be generated when the agreement is complete.
"105778-CNCO-2025 Concrete Restoration Contract 2 - CO 1"
History
` Document created by Andrea Munoz(Andrea.Munoz@fortworthtexas.gov)
2025-09-26 - 5:24:55 PM GMT- IP address: 204.10.90.100
Document emailed to Mary Hanna (Mary.Han na@fortworthtexas.gov) for signature
2025-09-26 - 5:45:15 PM GMT
Email viewed by Mary Hanna (Mary. Hanna@fortworthtexas.gov)
2025-09-26 - 5:54:10 PM GMT- IP address: 104.47.64.254
FORTWORTH, I Powere"Y
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FORTWORTH®
Routing and Transmittal Slip
Transportation & Public Works
Department
DOCUMENT TITLE: 2025 CONCRETE RESTORATION CONTRACT 2 — CO 1
M&C: 25- CPN: 105778 CSO: 62637
Date: 9/15/2025
To:
Name
1.
LaKeshia Lynch
2.
Urban Infraconstruction, Ltd
3.
Omar Frias
4.
Lorrie Pitts
5.
Iretomiwa Otuyelu
6.
Zelalem Arega
7.
Mary Hanna
8.
Patricia Wadsack
9.
Lauren Prieur
10.
Doug Black
11.
Jesica McEachern
12.
Jannette Goodall
13.
TPW Contracts
Department
Initials
Bus-Sppt
M-
Vendor
--Vl--
TPW - Inspector
or-
TPW — Sr.Inspector
TPW
a.
TPW
T�—
TPW
ter✓
TPW AD
TPW Director
xxv
Legal
CMO
CA
CSO
�, ne
TPW
DOC#: 1
Date Out
Sep 19, 2025
Sep 18, 2025
Sep 18, 2025
Sep 23, 2025
Sep 22, 2025
Sep 25, 2025
Oct 2, 2025
Oct 3, 2025
Oct 3, 2025
Oct 6, 2025
Oct 13, 2025
Oct 13, 2025
CC: Program Manager, Sr. CPO, TPW BSPAP Recon Team, TPW Records Room, TPW Contracts
ALSO List: - Bus Sppt: LaKeshia Lynch; Prg Mgr.: Zelalem Areea: Sr CPO — Mary Hanna
DOCUMENTS FOR CITY MANAGER'S SIGNATURE: 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: DYES NNo
RUSH: DYES NNo SAME DAY: ❑YES El No NEXT DAY: DYES ❑No
ROUTING TO CSO: NYES ❑No
Action Required:
❑ As Requested
❑ For Your Information
N Signature/Routing and or Recording
❑ Comment
❑ File
❑ Attach Signature, Initial and Notary Tabs
Return To: Please notify TPWContracts(&fortworthtexas.gov for pickup when complete. Call ext. 7233 or ext.
8363 with questions. Thank you!
FORT WORTH.
City Secretary's Office
Contract Routing & Transmittal Slip
Contractor's Name: Urban Infraconstruction, LLC
Subject of the Agreement: Please see justification on change order.
M&C Approved by the Council? * Yes ❑ No 10
If so, the M&C must be attached to the contract.
Is this an Amendment to an Existing contract? Yes ❑ No 8
If so, provide the original contract number and the amendment number.
Is the Contract "Permanent"? *Yes 8 No ❑
If unsure, see back page for permanent contract listing.
Is this entire contract Confidential? *Yes ❑ No 8 If only specific information is
Confidential, please list what information is Confidential and the page it is located.
Effective Date: Expiration Date:
If different from the approval date. If applicable.
Is a 1295 Form required? * Yes ❑ No 8
*If so, please ensure it is attached to the approving M&C or attached to the contract.
Project Number: If applicable. 105778
*Did you include a Text field on the contract to add the City Secretary Contract (CSC)
number? Yes 8 No ❑
Contracts need to be routed for CSO processing in the following order:
1. Katherine Cenicola (Approver)
2. Jannette S. Goodall (Signer)
3. Allison Tidwell (Form Filler)
*Indicates the information is required and if the information is not provided, the contract will be
returned to the department.
Affidavit of Compliance with
City of Fort Worth
Prevailing Wages
I, Samuel Hernandez
(Name of person signing affidavit)
Field Engineer
(Title)
do hereby certify that the wages paid to all employees of Urban Infraconstruction LLC
(Company Name)
for all hours worked on the
CPN 105778 — 2025 Concrete restoration Contract 2
(Project name and location)
project, during the period from March 171h. 2025 to November 11th, 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
TARYN PHILLIPS
4 sky
PC,
Notary Public, State of Texas
Comm. Expires 04-14-2029
Notary ID 133039193
Revised 3/08/2024
i
S i \
(Signature of Officer or Agent)
i 2 day of QUJ/ 1/0�
(Notary Public)
, 20Z5.
CONSENT OF SURETY
TO FINAL PAYMENT
A/A Document G707
Bond No. S7A2S00004799
TO OWNER:
(Name anal rr(lilrexi)
City of Fort Worth, Texas
200 Texas Street
Fort Worth, TX 76102
OWNER
ARCHITECT
CONTRACTOR
SURETY
OTHER
ARCHITECT'S PROIEC"f NO.:
CONTRACT FOR: 2025 Concrete Restoration
Contract 2
PROJECT: CONTRACT DATED: December 10, 2024
!Anne and actrin-,vl
2025 Concrete Restoration Contract 2
City Project Number 105778
In accordance with the provisions of the Contract between the Owner and the Conti -actor as indicated above, the•
(lnu•n »sun• ruul aeleir ." ul bon•h.)
American Alternative Insurance Corporation
555 College Road East - P.O. Box 5241
Princeton, NJ 08543
SURFIY,
on bond of
(6,.wn nano• urrrl nldre•.cc (# Cowrarrur)
Urban Infraconstruction LLC
2512 Gravel Drive
Fort Worth, TX 76118
, CONTRACTOR,
hereby approvcw of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve the Surety of
any of its obligations to
(G,.u•n n[ane an(i ruoren' of O,rvrer,
City of Fort Worth, Texas
200 Texas Street
Fort Worth, TX 76102
asset forth in said SUIVIN"S b Ond.
IN WITNESS WHER1-OF, the Surety has hereunto set its hand on this date: November 14, 2025
(/aK•rf in li ntrrlq the month JoOoll ell Hi' Ilk, Inimenc drnr and Ivan )
(1, 21 1-4 11-;X) -.,6 - , -, fl,-
,
American A
(S,ueh7 f
(Sti Lptrumr of rr,t
OWNER,
Attest: '
` II
(Seal): Debra Robinson, CiVitn ss Yamillec R dmos, Atornev-in-Fact - -
rl'rnurrinruueiuulridel.—
CAUTION: You should sign an original AIA document that has this caution printers in red. brr-
I i original assures that changes will not be obscured as may occur when documents are-reprachxed.
See Instruction Sheet for Limited License for Reproduction of this document.
AIA DOCUMENT G707 • CONSENT OF St'REIY TO FINA]. PAYMEN-1 • 190i FDI11ON • AIA
G, lWi • 111E A.UF.RKXN INS1111-11: OF .ARCHl1TCTi• !-;; NFw 1 ORK AVF:\1 "E. NV6. vrASH-
INGTON. DC. 2(00(N 5292 • WARNING: Unlicensed photocopying violates U.S. copy-
right lawn and will subject the violator to legal prosecution.
G707-1994
CERTIFIED COPY
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That the AMERICAN ALTERNATIVE INSURANCE CORPORATION, a corporation organized and existing by virtue of the
laws of the State of Delaware ("Corporation") with offices at 555 College Road East, Princeton, N.J. 08543, has made. constituted and appointed, and by these presents,
does make, constitute and appoint:
Russ Frenzel; Brady K. Cox; William D. Baldwin; Brent Baldwin; Michael B. Hill; Keith Rogers; Sam Freireich;
Brock Anglin; Cindy Alford; Yamillec Ramos; Neira Hernandez; Katherine Vanikiotis; and Kristi Date
its true and lawful Attomeys-in-Fact, at Princeton, in the State of New Jersey, each of them alone to have full power to act without the other or others, to make, execute and
deliver on its behalf, as Surety or Co -surety, bonds and undertakings given for any and all purposes, also to execute and deliver on its behalf as aforesaid renewals, extensions,
agreements, waivers, consents or stipulations relating to such bonds or undertakings provided, however, that no single bond or undertaking so made, executed and delivered shall
obligate said Company for any portion of the penal sum thereof in excess of the sum of One Hundred Million Dollars (5100.000,000).
Such bonds and undertakings for said purposes, when duly executed by said Attomey(s)-in-Fact, shall be binding upon said Company as fully and to thesame extent as if signed
by the President of said Company under its corporate seal attested by its Secretary.
This appointment is made under and by authority of a certain Resolution adopted at a meeting of the Board of Directors of said Company duly held on the 27th
day of August. 1975, a copy of which appears below.
IN WITNESS WHEREOF, the AMERICAN ALTERNATIVE INSURANCE CORPORATION has caused its corporate seal to be hereunto affixed, and these presents to be signed
by its duly authorized officers this 241h day of September, 2021.
",aumuuno„',
�\VEI4SUgg1•'''
v�'•GpRPORgTF �9os
By;
rge
Michael G. Kerner
;tea: $EAI.
President
Attest: rr n�rron
IgnacioNv'era
Deputy General Counsel & Secretary
STATE OF NEW JERSEY, COUNTY OF SOMERSET
The foregoing instrument was acknowledged before me by means of online notarization this 241h day of September, 2021, by Michael G. Kerner and Ignacio Rivera, who are
personally known to me.
SECRETARY'S CERTIFICATE
The undersigned, Ignacio Riven, hereby certifies:
S n Sanfilippo otary Public
S to of New Jersey
My Commission Expires February 8, 2026
1. That the undersigned is Secretary of American Alternative Insurance Corporation, a corporation of die State of Delaware:
2. That the original power of attorney of which the foregoing is a copy was duly executed on behalfof said Corporation on the day of its date, and has not since been
revoked, amended or modified; that the undersigned has compared the foregoing copy thereof with said original power of attomey, and that the same is a true and correct
copy of said original power of attomey and of the whole thereof;
3. That the original resolution of which the following is a copy was duly adopted at, and recorded in the minutes of, a regular meeting of the Board of
Directors of said Corporation duly held on August 4, 1998. and has not since been revoked, amended or modified.
RESOLVED, that each of the following officers of this Corporation, namely, the President, the Executive Vice President, the Senior Vice Presidents,
and the Vice Presidents, be, and they hereby are, authorized, from time to time in their discretion, to appoint such agent or agents or attorney or
attorneys -in -fact as deemed by them necessary or desirable for the purpose of carrying on this Corporation's business, and to empower such agent
or agents or attomey or attomeys-in-fact to execute and deliver, in this Corporation's name and on its behalf, and under its seal or otherwise, surety
bonds, surety undertakings or surety contracts made by this Corporation as surety thereon.
RESOLVED, that the signature of any authorized officer of the Corporation and the Corporation's seal may be affixed by facsimile to any power of
attomey and revocation of any power of attomey or certificate of either given for the execution of any surety bond, surety undertaking, or surety
contract, such signature and seal, when so used being hereby adopted by the Corporation as the original signature of such officer and the original
seal of the Corporation, to be valid and binding upon the Corporation with the same force and effect as though manually affixed.
FURTHER RESOLVED, that any prior appointments by the Corporation of MGAs are, in all respects, hereby ratified, confirmed and approved.
FURTHER RESOLVED, that the Secretary orany Assistant Secretary ofthis Corporation is hereby authorized to certify and deliver to any person to whom
such certification and delivery may be deemed necessary and desirable in the opinion ofsuch Secretary or Assistant Secretary, a true copy ofthe foregoing
resolution.
4. The undersigned has compared the foregoing- copies of said original resolutions as so recorded, and they are the same true and correct copies of said
original resolutions as so recorded and of die whole thereof.
Witness the hand ofthe undersigned and the seal of said Corporation this14th day of November ,()25
o1`"r°° °""�
ION
AMERICAN ALTERNATIVE INSURANCE CORPORATION
41
K'.. SEAL
?'
IPn���!1/oR`,.NAtSlD:4.<Os116116FD't
3E�'
�OFOEIaN
�nnnnauao�P°
_
Ignacio Rivera
g -
Deputy General Counsel R Secretary TRS-100 1-'1
AFFIDAVIT
STATE OF Texas
COUNTY OF Tarrant
Before me, the undersigned authority, a notary public in the state
and county aforesaid, on this day personally appeared John Chen, VP of
Finance Of Urban Infraconstruction LLC, 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,
2025 Concrete Restoration Contract 2, City Project No. 105778
BY
John Chen, VP of Finance
Subscribed and sworn before me on this date 19 of December, 2025.
No4,r�yPubIic O
Tarrant County, Texas
TARYN PHILLIPS
ss°oi Notary Public, State of Texas
..c
Comm. Expires 04-14-2029
Notary ID 133039193
FORTWORTH.
TRANSPORTATION AND PUBLIC WORKS
November 10, 2025
Urban Infraconstruction LLC
2727 Lyndon B Johnson
Farmers Branch TX 73234
RE: Acceptance Letter
Project Name: 2025 Concrete Restoration Contract 2
Project Type: Paving
City Project No.: 105778
To Whom It May Concern:
On November 10, 2025 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 November 10,
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)
392-6747.
Sincerely,
Iretomiwa Otuyelu, Project Manager
Arega Zelalem , Program Manager
Zu4g- n i121t
Cc: Omar Frias, Inspector
Gary Deyon, Inspection Supervisor
Lorrie Pitts, Senior Inspector
Arega Zelalem , Program Manager
NA, Consultant
Urban Infraconstruction LLC, Contractor
NA, Developer
File
E-Mail: TPW_Acceptance@fortworthtexas.gov
Rev. 08/20/19