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Contract 44333-FP1
S� ' FORT WORTH® CITY������� =ceiverj Sy R�siness SupPcrt Grotf t, r�9ne p J 1;1 TRANSPORTATION AND PUBLIC WORKS NOTICE OF PROJECT COMPLETION D.O.E.Ns: 5495 Regarding contract 44333 f r ALTA VISTA ROAD as required by the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by City Council on 03/26/2013 through M&C C-26177 the director of the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT upon the recommendation of the Assistant Director of the Transportation&Public Works Department has accepted the project as complete. Original Contract Prices: $1,029,706.09' Amount of Approved Change Orders: $9,750.21 Ne 1 Revised Contract Amount: $1,039,456.30 Total Cost Work Completed: $922,901.21 Less Deductions: Liquidated Damages: Days @$210.00/Day Pavement Deficiencies: Total Deduction Amount: $0.00 Total Cost Work Completed: $922,901.21✓ v Less Previous Payments: $913,672.21 Final Payment Due $9,229.00 /Z<30- Recommended for Acceptance Date Asst. Director, TPW - I fra ructure Design and Construction 1Z Accepted Date Director, TRANSPORTATION AND PUBLIC WORKS DEPARTMENT City Manager Date Comments: FUND ACCT:C115-541200-020115136543 C2o2 5V124, 5.62S3 LLC INTER-OFFICE CORRESPONDENCE DATE: January 12,2015 TO: Whom It May Concern FROM: Andy Anderson,Assistant i ctor, ransportation and Public Works SUBJECT: Bid Tab Amount and Construction Master Amount Discrepancy D.O.E.No. 5495 The bid tabulation amount for the TPW portion of this project with JLB Contracting, LLC was$1,022,214.15. This amount is included within the approving M&C and was reflected in subsequent Change Orders. The TPW portion of the contract per the M&C is$1,029,706.09; which does not match the amount entered into the project tracking data base"Construction Master" $1,022,214.15. Departmental management is aware of this error in early data entry and notes that final payment for the project and all previous payments are below that which was authorized and payments are based upon work performed and not the total bid amount. I have authorized the final payment, noting this base information tracking error. TPW Construction Invoice Contract: CS,"333 P.O.# PO-13-77445 Payment Date: 6/15/2014 TO:JLB Contracting,LLC 1NV.# CS44333-.'rr0AL Estimate No. 28 DOE: 5495 P O Box 24131 ProjManager Wilma Smith Fort Worth TX 76124 FOR: Alta Vista Road-N Beach St to Eddleman Drive Contract Amount: $1,029,706.09 Total to Date: $922,901.20 $0.00 $922,901.20 Previous Estimate: $922,901.21 $9,229.01 $913,672.20 Earned to Date: ($0.01) ($9,229.01) $9,229.00 Payments: C115-541200-020115136543 $421,164.49 Total to Date: $421,164.49 $0.00 $421,164.49 Previous Estimate: $421,164.49 $4,211.64 $416,952.85 Earned to Date: $0.00 ($4,211.64) $4,211.64 C202-541200-202760056283 $608,541.60 Total to Date: $501,736.71 $0.00 $501,736.71 Previous Estimate: $501,736.72 $5,017.37 $496,719.35 Earned to Date: ($0.01) ($5,017.37) $5,017.36 ACH FINAL PAY Transportation&Public Works BUSINESS SUPPORT GROUP Contact Person-BRANC 852 Department Approtur KAREN STRIKER DEPARTMENT CHECK PICK-UP YES ❑ Monday,January 19,2015 Page 1 of 1 City Project Numbers 00562 DOE Number 5495 Contract Name ALTA VISTA ROAD Estimate Number 28 Contract Limits N BEACH ST TO EDDLEMAN DR Payment Number 28 Project Type PAVING&STORM DRAIN For Period Ending 6/15/2014 Project Funding Project Manager SmithW City Secretary Contract Number 44333 Inspectors GREGROY / MILLER,TOM Contract Date 3/26/2013 Contractor JLB CONTRACTING,L.L.C. Contract Time 165 CD PO BOX 24131 Days Charged to Date 177 CD FORT WORTH, TX 76 124-1 13 1 Contract is .894315 Complete CITY OF FORT WORTH SUMMARY OF CHARGES Line Fund Account Center Amount Gross Retainage Net Funded Total Cost of Work Completed $922,901.21 Less %Retained $0.00 Departm t TLEAW Const. Services Net Earned $922,901.21 DOE#� (Date ,// Earned This Period $9,229.0fo Project Manager l��� G� Dep. Of Law BlackRetainage This Period $0.00 Risk Management Joey Page Less Liquidated Damages D.O.E. Brotherton 0 Days @ $0.00 /Day $0.00 CFA Knight/Scanned ❑ r L LessPavement Deficiency $0.00 The Proceeding people have been Contacted concerning the request Less Penalty $0.00 for final payment&have released this project for such payment. Less Previous Payment $913,672.21 Clearance Conducted By Etta Bacy Plus Material on Hand Less 15% $0.00 Balance Due This Payment $9,229.01) Tuesday,June 17,2014 Page 6 of 6 FORTWORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name ALTA VISTA ROAD Contract Limits N BEACH ST TO EDDLEMAN DR Project Type PAVING&STORM DRAIN City Project Numbers 00562 DOE Number 5495 Estimate Number 28 Payment Number 28 For Period Ending 6/15/2014 CD City Secretary Contract Number 44333 Contract Time 16ED Contract Date 3/26/2013 Days Charged to Date 177 Project Manager SmithW Contract is .894315 Complete Contractor JLB CONTRACTING,L.L.C. PO BOX 24131 FORT WORTH, TX 76 124-1 13 1 Inspectors GREGROY / MILLER,TOM Tuesday,June 17,2014 Page I of 6 City Project Numbers 00562 DOE Number 5495 Contract Name ALTA VISTA ROAD Estimate Number 28 Contract Limits N BEACH ST TO EDDLEMAN DR Payment Number 28 Project Type PAVING&STORM DRAIN For Period Ending 6/15/2014 Project Funding Unit III-Drainage Improvements Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total -- -- ------------------------------- 1 3341.0201 21"RCP,Class 111 52 LF $47.00 $2,444.00 51.29 $2,410.63 2 3341.0205 24"RCP,Class III 15 LF $72.00 $1,080.00 14.11 $1,015.92 3 3341.0208 27"RCP,Class III 16 LF $90.00 $1,440.00 21.95 $1,975.50 4 3341.0309 36"RCP,Class III 22 LF $120.00 $2,640.00 21.74 $2,608.80 5 3341.0409 48"RCP,Class 111 600 LF $150.00 $90,000.00 621.11 $93,166.50 6 3349.0002 5'Storm Junction Box 2 EA $4,325.00 $8,650.00 2 $8,650.00 7 3349.5001 10'Curb Inlet 4 EA $3,065.00 $12,260.00 4 $12,260.00 8 3349.7001 4'Drop Inlet 1 EA $4,250.00 $4,250.00 1 $4,250.00 9 9999.0000 Concrete Collar Conne 1 EA $490.00 $490.00 1 $490.00 10 3305.0108 Miscellaneous Structu 1 EA $3,045.00 $3,045.00 1 $3,045.00 11 0241.3401 Remove 4 Storm Juncti 1 EA $415.00 $415.00 1 $415.00 12 0241.4202 Remove 5'Drop Inlet 1 EA $430.00 $430.00 I $430.00 13 0241.4001 Remove 10'Curb Inlet 1 EA $330.00 $330.00 1 $330.00 14 0241.3015 Remove 24"Storm Line 4 LF $5.00 $20.00 4 $20.00 15 0241.3019 Remove 36"Storm Line 76 LF $5.75 $437.00 76 $437.00 16 0241.3023 Remove 48"Storm Line I I LF $12.25 $134.75 11 $134.75 17 0241.3112 48"Storm Abandonment 1 EA $490.00 $490.00 1 $490.00 18 0241.4401 Remove Headwall/SET 2 EA $120.00 $240.00 2 $240.00 19 3305.0109 Trench Safety 705 LF $1.24 $874.20 705 $874.20 20 3305.0103 Exploratory Excavatio 1 EA $350.00 $350.00 1 $350.00 21 9999.0000 Vacuum Excavation of I EA $790.00 $790.00 1 $790.00 22 Lower 48"Storm Drain(CO#1) 150 LF $30.00 $4,500.00 150 $4,500.00 23 Additional Dept on SD Manholes(CO#1) 1 EA $850.00 $850.00 1 $850.00 Sub-Total of Previous Unit $136,159.95 $139,733.30 Unit IV-Paving Improvements Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total 1 3110.0101 Site Clearing 1 LS $14,400.00 $14,400.00 1 $14,400.00 2 3123.0101 Unclassified Excavati 6800 CY $16.25 $110,500.00 6800 $110,500.00 3 3124.0101 Embankment 500 CY $2.51 $1,255.00 500 $1,255.00 Tuesday,June 17,2014 Page 2 of 6 City Project Numbers 00562 DOE Number 5495 Contract Name ALTA VISTA ROAD Estimate Number 28 Contract Limits N BEACH ST TO EDDLEMAN DR Payment Number 28 Project Type PAVING&STORM DRAIN For Period Ending 6/15/2014 Project Funding 4 3211.0501 6"Lime Treatment 9558 SY $1.82 $17,395.56 9232.32 $16,802.82 6 3211.0400 Lime 129 TN $147.00 $18,963.00 140.42 $20,641.74 7 3213.0104 9"Cone Pvmt 7663 SY $42.68 $327,056.84 7437.6 $317,436.77 8 3213.0101 6"Cone Pvmt 226 SY $39.64 $8,958.64 226.06 $8,961.02 9 3213.0401 6"Concrete Driveway 3785 SF $4.29 $16,237.65 4357.79 $18,694.92 10 3212.0302 2"Asphalt Pvmt Type 1186 SY $9.50 $11,267.00 719.88 $6,838.86 11 3212.0501 4"Asphalt Pvmt Type 1186 SY $19.15 $22,711.90 719.88 $13,785.70 12 3213.0301 4"Cone Sidewalk 10661 SF $3.06 $32,622.66 11461.66 $35,072.68 13 3232.0100 Cone Ret Wall with Si 1288 SF $21.30 $27,434.40 1266.55 $26,977.52 14 9999.0000 6"Sidewalk Curb 237 LF $2.51 $594.87 382.67 $960.50 15 9999.0000 Rock Retaining Wall 146 SF $25.55 $3,730.30 146 $3,730.30 16 9999.0000 5'Barrier Free Ramp 4 EA $930.00 $3,720.00 4 $3,720.00 17 9999.0000 5'Barrier Free Ramp 2 EA $565.00 $1,130.00 2 $1,130.00 18 9999.0000 4 Barrier Free Ramp P 2 EA $970.00 $1,940.00 2 $1,940.00 19 9999.0000 Rolled Curb 228 LF $4.00 $912.00 209 $836.00 20 3214.0100 Brick Pvmt 80 SY $74.50 $5,960.00 74.63 $5,559.94 21 3217.2103 REFL Raised Maker TY 151 EA $4.65 $702.15 151 $702.15 22 3217.2002 Raised Marker TY Y 230 EA $3.30 $759.00 230 $759.00 23 3217.0303 12"SLD Pvmt Marking 80 LF $7.70 $616.00 80 $616.00 24 3217.0402 18"SLD Pvmt Marking 253 LF $10.90 $2,757.70 253 $2,757.70 25 3441.4006 Install Alum Sign Gro 29 EA $373.00 $10,817.00 29 $10,817.00 26 3441.4007 Install Alum Sign Ex 13 EA $293.00 $3,809.00 13 $3,809.00 27 9999.0000 Project Designation S 2 EA $346.00 $692.00 2 $692.00 28 3471.0002 Portable Message Sign 2 WK $590.00 $1,180.00 2 $1,180.00 29 9999.0000 Remove&Salvage Ex S 27 EA $370.00 $9,990.00 27 $9,990.00 30 0241.1000 Remove Cone Pvmt 128 SY $8.30 $1,062.40 128 $1,062.40 31 0241.0401 Remove Concrete Drive 5265 SF $0.83 $4,369.95 5837.79 $4,845.37 32 0241.0100 Remove Sidewalk 1802 SF $1.04 $1,874.08 1867 $1,941.68 33 0241.0300 Remove ADA Ramp 4 EA $110.00 $440.00 4 $440.00 34 0241.0500 Remove Fence 380 LF $2.13 $809.40 380 $809.40 35 3231.0211 Barbed Wire Fence,Met 376 LF $7.46 $2,804.96 376 $2,804.96 36 3305.0111 Valve Box Adjustments 11 EA $265.00 $2,915.00 16 $4,240.00 37 3305.0107 Manhole Adjustments Mi 5 EA $445.00 $2,225.00 5 $2,225.00 38 3305.0108 Miscellaneous Structur 3 EA $2,960.00 $8,880.00 3 $8,880.00 Tuesday,June 17,2014 Page 3 of 6 City Project Numbers 00562 DOE Number 5495 Contract Name ALTA VISTA ROAD Estimate Number 28 Contract Limits N BEACH ST TO EDDLEMAN DR Payment Number 28 Project Type PAVING&STORM DRAIN For Period Ending 6/15/2014 Project Funding 39 9999.0000 Adjust Fire Hydrant to 2 EA $806.00 $1,612.00 2 $1,612.00 40 9999.0000 Relocate Pole Mounted i EA $1,215.00 $1,215.00 l $1,215.00 41 9999.0000 Relocate Mast Arm Moun 1 EA $3,410.00 $3,410.00 1 $3,410.00 42 3291.0100 Topsoil 760 CY $16.00 $12,160.00 760 $12,160.00 43 3471.0001 Traffic Control 4 MO $1,695.00 $6,780.00 4 $6,780.00 44 3292.0400 Seeding,Hydromulch 4550 SY $1.02 $4,641.00 4550 $4,641.00 45 3125.0101 SWPPP>1 acre i LS $1,065.00 $1,065.00 1 $1,065.00 46 9999.0000 Restoration ofLandsca 10000 LS $1.00 $10,000.00 47 9999.0000 Utility Adjustments 25000 EA $1.00 $25,000.00 1328726 $13,287.26 48 9999.0000 Tree Replacement 25000 EA $1.00 $25,000.00 49 3900.0111 Misc Force Account-In 35000 EA $1.00 $35,000.00 28093 $28,093.00 50 9999.0000 4"Cone Sidewalk for Co 3352 SF $6.15 $20,614.80 3738.33 $22,990.73 51 Landscape and Irrigation at SE Eddleman(CO#1) 4400.21 LS $1.00 $4,400.21 4400.21 $4,400.21 Sub-Total of Previous Unit $834,391.47 $767,469.62 Unit V-Street Light Improvements Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total -------------------------------------- - -1 2605.3011 2"CONDT PVC SCH 40(T 2015 LF $5.22 $10,518.30 2015 $10,518.30 2 3441.1502 Ground Box,Small,w/ 9 EA $820.00 $7,380.00 3 $2,460.00 3 3441.3002 Rdwy Ilium Assmbly TY 14 EA $1,190.00 $16,660.00 4 3441.3101 100W BPS PC Lighting F 14 EA $180.00 $2,520.00 5 3441.3301 Rdwy Ilium Foundation 14 EA $830.00 $11,620.00 6 3441.3404 2-2-2-4 Quadplex Alum 2012 EA $2.47 $4,969.64 7 3441.3502 Relocate Street Light i EA $1,370.00 $1,370.00 1 $1,370.00 8 9999.9999 Exploratory Vacuum Exe 5 EA $270.00 $1,350.00 5 $1,350.00 9 3441.3312 Contact Enclosure,Pad 1 EA $875.00 $875.00 10 2605.0111 ELEC SERV PED 1 EA $4,150.00 $4,150.00 Sub-Total of Previous Unit $61,412.94 $15,698.30 Tuesday,June 17,2014 Page 4 of 6 City Project Numbers 00562 DOE Number 5495 Contract Name ALTA VISTA ROAD Estimate Number 28 Contract Limits N BEACH ST TO EDDLEMAN DR Payment Number 28 Project Type PAVING&STORM DRAIN For Period Ending 6/15/2014 Project Funding Contract Information Summary Original Contract Amount $1,022,214.15 Change Orders Change Order Number 1 $9,750.21 Total Contract Price $1,031,964.36 Date Y Z�-1(- Total Cost of Work Completed $922,901.21 ContractQ Less %Retained $0.00 Net Earned $922,901.22 Date G Inspection Supervisq Earned This Period $9,229.01 � Retainage This Period $0.00 late 7-6-14 Less Liquidated Damages Project Days @ /Day $0.00 ate/,7 LessPavement Deficiency $0.00 Asst.Direc Less Penalty $0.00 2��t-Date Less Previous Payment $913,672.21 Director/Contracting Department Plus Material on Hand Less 15% $0.00 Balance Due This Payment $9,229.01 Tuesday,June 17,2014 Page 5 of 6 BuySpeed Online https://bso.fortworthgov.org/bso/purchaseorder/invoice/invoiceSw=a... Buy Accounts Payable Department Access NIGP Code Browse I My Account I Customer Service I Current Organization:CITY OF FORT WORTH January 21,2015 3:02:03 PM CST P*0 About Home Documents Brandy Crane Invoice#: CS44333-FINAL Vendor#:0000016042 Vendor Group#:01 Status;41R-Ready for Approval General Items Credits Subcontractors Accounts Routing Attachments Notes(2) Reminder Change Order Summary Back to PO General Validation Warnings • Account code 13-C202-541200-202760056283 is in the red by$4,071.00. • You are going to final pay the following partially paid po items:[1,3]. Header Information Invoice Number: CS44333-FINAL Invoice Status: 41R-Ready for Invoice Type: 3way Approval matching Invoice Description: CS44333-FINAL Alta Vista Road-N Beach St to Invoice Date: 06/15/2014 Effect Date: 01/19/2015 Eddleman Drive Payment Amount: $9,229.00 Handling Code: ACH(DIRECT Payment Date: 07/10/2014 DEPOSIT) Payment Terms: Payment Term o Payment 0.0% Day: Discount: Paid-Bank/Check: Alternate Id: Entered By: Brandy Crane Entered Date: 01/21/2015 Credit Amount: $0.00 Updated By: Brandy Crane Updated Date: 01/21/2015 Received Date: 11/13/2013 12:22:00 PM Notes: returned per brandy crane moving funds from C202 to C115 on FINAL PAY Purchase Order Information Purchase order PO-13-00077445 PO Description CS44333 Number: PO Amount: $1,039,456.30 Remaining To $111,596.36 Buyer: Karen Striker Invoice: PoVendor Information Vendor: 0000016042-JLB CONTRACTING LLC Address Grp: 01 Vendor Remit-to JAMES HUMPHREY Address: P O BOX 24131 ACH ONLY FORT WORTH,TX 76124-1131 US Fed ID: `..'5121 Remit Text: Email:loliphant@jIbcontracting.com Phone:(817)261-2991 Id:29010 Misc&Freight Invoice Account Event Type Fiscal Year Account Code Transaction Amount Misc 13 C11 5-541200-020115136543 $196,671.69 Misc 13 C202-541200-202760056283 -$196,671.71 Misc 13 C115-205000-000115136543 $4,211.64 Misc 13 C202-205000-000000056200 $5,017.37 Total: $9,228.99 1 of 2 1/21/2015 3:02 PM BuySpeed Online https://bso.fortworthgov.orglbso/purchaseorder/invoice/invoiceSumma... Item Information Invoice Item#/PO Item#:1 Alta Vista Road-N Beach St to Eddleman Drive C202-541200-202760056283 CS44333 M&C C-26177 Date 032613 PO Permit Invoice Discount% Original Final Item Status To Pay Amount Pay Amount Pay 3PPR-Partial Receipt $0.00 $0.00 0.0% $0.00 Yes MAKE: ASSET MODEL: ASSET MANUF: ASSET SERIAL: ASSET VIN: ASSET TAG: Event Type Fiscal Year Account Code Transaction Amount Exp. 15 C202-541200-202760056283 $0.00 Enc. 15 C202-541200-202760056283 $0.00 Invoice Item#/PO Item#:3 CO#1-$9,750.21-Alta Vista Road-N Beach St to Eddleman Drive C202-541200-202760056283 CS44333 PO Permit Invoice Discount% Original Final Item Status To Pay Amount Pay Amount Pay 3PPR-Partial Receipt $0.00 $0.01 0.0% $0.00 Yes MAKE: ASSET MODEL: ASSET MANUF: ASSET SERIAL: ASSET VIN: ASSET TAG: Event Type Fiscal Year Account Code Transaction Amount Exp. 13 C202-541200-202760056283 $0.01 Enc. 13 C202-541200-202760056283 -$0.01 Approval Path: Delete Approver Order Approval Level Approver Date Date Approved/Disapproved Comment Sequence Path Type Requested Approved/Disapproved /Canceled View ID ICanceled by Add New Primary Add/DeleteApprover Print Copyright©2015 Periscope Holdings,Inc.-All Rights Reserved.default 2 of 2 1/21/2015 3:02 PM Page: 1 Document Name: untitled BC AVAILABLE FUNDS INQUIRY 162 NEXT FUNCTION: ACTION: ------------------------------------------------------------------------------- ------------------------------------------------------------------------------- COMP / ACCT / CNTR ALTERNATE COMP / ACCT / CNTR C202 205000 000000056200 ACCT DESC: RETAINAGE PAYABLE ORIG APPROPRIATION: 0.00 CNTR DESC: Alta Vista Elementary LAST ACTIVITY: 01/17/2015 0. 00 NA 0. 00 0. 00 NA - 0.00 - 0. 00 NA - 0.00 5, 017.37- (LIABILITY ) - 0. 00 --------------------- --------------------- 5, 017.37 (AVAIL BAL) = 0.00 (AVAIL BAL) L OVEREXPEND A E C G V TOLERANCE BDG YTD P EST N L R ACTIVE INACTIVE L POST AMT PCT GRP LTD P REV EXP C COMM S P STAT DATE DATE 1 Y 9999 999 L N N Y N N 2 9 0 Date: 01-19-2015 Time: 12:20:14.51 Page: 1 Document Name: untitled BC AVAILABLE FUNDS INQUIRY 162 NEXT FUNCTION: ACTION: ------------------------------------------------------------------------------- - ------------------------------------------------------------------------------- COMP / ACCT / CNTR ALTERNATE COMP / ACCT / CNTR C115 205000 000115136543 ACCT DESC: RETAINAGE PAYABLE ORIG APPROPRIATION: 0. 00 CNTR DESC: Alta Vista Elementary School A LAST ACTIVITY: 01/17/2015 0. 00 NA 0. 00 0. 00 NA - 0. 00 0. 00 NA - 0. 00 4,211. 64- (LIABILITY ) - 0.00 --------------------- --------------------- 4, 211. 64 (AVAIL BAL) = 0. 00 (AVAIL BAL) L OVEREXPEND A E C G V TOLERANCE BDG YTD P EST N L R ACTIVE INACTIVE L POST AMT PCT GRP LTD P REV EXP C COMM S P STAT DATE DATE 1 Y 9999 999 L N N Y N N 2 1 0 Date: 01-19-2015 Time: 12: 19:58. 99 FoRTWORTH REV:02'22107 TRANSPORTATION AND PUBLIC WORKS CONTRACTOR'S EVALUATION OF CITY n PROJECT INFORMATION Date: Name of Contractor Project Name JLB Alta Vista from Beach to Eddleman DOE Inspector Project Manager Thomas Miller Wilma Smith DOE Number Project Difficulo, Type of Contract 5495 1 0 Simple Q Routine 0 Complex 0 Water E] Waste WaterO Storm DrainageE] Pavement Initial Contract Amount Final Contract Amount $1,063,291.09 $1,073,725.30 II)PERFORMANCE EVALUATION 0-Inadequate 1 -Deficient 2-Standard 3-Good 4-Excellent ELEMENT RATING ELEMENT RATING (0-4) (0-4) INSPECTION EVALUATION PLANS&SPECIFICATIONS 1 Availability of Inspector 1 Accuracy of Plans to Existing Conditions 3 2 Knowledge of Inspector 2 Clarity&Sufficiency of Details -5 3 Accuracy of Measured Quantities 3 3 Applicability of Specifications 3 4 Display Of Professionalism 3 4 Accuracy of Plan Quantities 5 Citizen Complaint Resolution 3 PROJECT MANAGER EVALUATION 6 Performance-Setting up Valve Crews,Labs 3 1 Knowledge And/Or Problem Resolution z ADMINISTRATION 2 Availability of Project Manager 2 1 Change Order Processing Time 0 3 Communication Z 2 Timliness of Contractor Payments 4 Resolution of Utility Conflicts ?/ 3 Bid Opening to Pre-Con Meeting Timeframe Z III)COMMENTS&SIGNATURES COMMENTS Signature Contractor Signature DOE Inspector Signature DOE Inspector's Supervisor - INSPECTOR'S COMMENTS TRANSPORTATION AND PUBLIC WORKS A The City of Fort Worth•1000 Thtockmorton Street•Fort Worth,Tx 76012-6311 (817)392-7941 •Fax:(817)392-7845 FoRTWORTHREV:02/20/07 TRANSPORTATION AND PUBLIC WORKS PERFORMANCE EVALUATION OF CONTRACTOR CONTRACTOR&PROJECT DATA Name of Contractor Project Name JLB Alta Vista from Beach to Eddleman DOE Inspector DOE Number Thomas Miller 5495 OE Inspector Project Manager 0 Water 0 Waste WaterO Stone Drainage0 Pavement Wilma Smith Initial Contract Amount Project Difficulty $1,063,291.09 0 Simple 0 Routine 0 Complex Final ContractAmount Date $1,073,725.30 1/24/2014 II)PERFORMANCE EVALUATION 0-Inadequate 1-Deficient 2-Standard 3-Good 4-Excellent ELEMENT WEIGHT(x) APPLICABLE(Y/N) RATING(0-4) MAX SCORE SCORE 1 Submission of Documents 2 Y 3 8 6 2 Public Notifications 5 Y 3 20 15 3 Plans on Site 5 Y 3 20 15 4 Field Supervision 15 Y 3 60 1 45 5 Work Performed 15 Y 3 60 45 6 Finished Product 15 Y 3 60 45 7 Job Site Safety 15 Y 3 60 45 8 Traffic Control Maintenance 15 Y 3 60 45 9 Daily Clean Up 5 Y 3 20 15 10 Citizen's Complaint Resolution 5 Y 3 20 15 11 Property Restoration 5 Y 3 20 15 12 After Hours Response 5 Y 3 20 15 13 Project Completion 5 Y 3 20 15 TOTAL ELEMENT SCORE(A) 336 BONUS POINTS(25 Maximum)(B) TOTAL SCORE(TS) 336 III)CONTRACTOR'S RATING Maximum Score(MS)=448 or sum of applicable element score maximums which= 448 Rating([TS/MS]* 100%) 336 / 448 = 75% Performance Category Good <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 DOE Inspector Signature Contractor Signature DOE Inspector's Supervisor CONTRACTOR'S COMMENTS _ TRANSPORTATION AND PUBLIC WORKS The City of Fort Worth•1000 Throckmorton Street•Fort Worth,TX 76012-6311 (817)392-7941•Fax:(817)392-7845 CONSENT OF OWNER ❑ SURETY COMPANY ARCHITECT CONTRACTOR ❑ TO FINAL PAYMENT SURETY ❑ OTHER (SIMELAR TO AIA DOCUMENT G707) Bond No. 6067184 PROJECT: Pavement Reconstruction and Water and Sanitary SeNver Main Replacement on Alta Vista Road (name,address) from North Beach Street to Eddleman Drive,Fort Worth,Texas TO (Owner) ARCHITECTS PROJECT NO: F—City of Fort Worth CONTRACT FOR: Above Project 1000 Throckmorton Street Fort Worth, Texas 76102 CONTRACT DATE: CONTRACTOR: JLB Contracting,LLC In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above,the(here insert name and address of Surety Company) Westfield Insurance Company 555 Republic Drive, Suite 450 Plano, Texas 75074 ,SURETY COMPANY, on bond of(here insert name and address of Contractor) JLB Contracting, LLC P.O. Box 24131 ,CONTRACTOR, Fort Worth, Texas 76124 hereby approves of the final payment to the Contractor, and agrees that the final payment to the Contractor shall not relieve the Surety Company of any of its obligations to(here insert name and address of Owner) City of Fort Worth 1000 Throckmorton Street Fort Worth, Texas 76102 ,OWNER, as set forth in the said Surety Company's bond. IN WITNESS WHEREOF, The Surety Company has hereunto set its hand this 17th day of June 2014 WESTFIELD CE COMPANY Surety Comp sy Signature oVAuthorized resentative Attest: (Seal): Kyle W. Sweeney Attorney—in—Fact Title Note:This form is intended to be used as a companion document to the Contractor's Affidavit of Payment of Debts and Claims,Current Edition THIS POWER OF ATTORNEY SUPERCEDES ANY PREVIOUS POWER BEARING THIS SAME POWER#AND ISSUED PRIOR TO 04/20111,FOR ANY PERSON OR PERSONS NAMED BELOW. POWER NO. 4220052 06 General Westfield Insurance Co. Power of Attorney Westfield National Insurance Co. Ohio Farmers Insurance Co. CERTIFIED COPY Westfield Center, Ohio Know All Men by These Presents, That WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, corporations, hereinafter referred to individually as a 'Company' and collectively as 'Companies,' duly organized and existing under the laws of the State of Ohio, and having its principal office in Westfield Center, Medina County,Ohio,do by these presents make,constitute and appoint CHARLES D.SWEENEY,MICHAEL A.SWEENEY,KYLE W.SWEENEY,ELIZABETH GRAY,JOINTLY OR SEVERALLY of FORT WORTH and State of TX its true and lawful Attorney(s)-in-Fact,with full power and authority hereby conferred in its name, place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings, or other instruments or contracts of suretyship- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - -- - - - -- LIMITATION: THIS POWER OF ATTORNEY CANNOT BE USED TO EXECUTE NOTE GUARANTEE, MORTGAGE DEFICIENCY, MORTGAGE GUARANTEE,OR BANK DEPOSITORY BONDS. and to bind any of the Companies thereby as fully and to the same extent as if such bonds were signed by the President,sealed with the corporate seal of the applicable Company and duly attested by its Secretary,hereby ratifying and confirming all that the said Attorney(s)-in-Fact may do in the premises. Said appointment is made under and by authority of the following resolution adopted by the Board of Directors of each of the WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY: 'Be It Resolved,that the President,any Senior Executive,any Secretary or any Fidelity&Surety Operations Executive or other Executive shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: The Attorney-in-Fact. may be given full power and authority for and in the name of and on behalf of the Company,to execute,acknowledge and deliver,any and all bonds, recognizances,contracts, agreements of indemnity and other conditional or obligatory undertakings and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney-in-Fact shall be as binding upon the Company as if signed by the President and sealed and attested by the Corporate Secretary.' 'Be it Further Resolved,that the signature of any such designated person and the seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile,and any power of attorney or certificate bearing facsimile signatures or facsimile seat shall be valid and binding upon the Company with respect to any bond or undertaking to which It is attached' (Each adopted at a meeting held on February 8,2000). -In Witness Whereof,WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY have caused these presents to be signed by their Senior Executive and their corporate seals to be hereto affixed this 20th day of APRIL A.D.,2011 . '�,yWNWlyu- ,,,aNN.a•...,,. N,�NaNIIIIIII11 Corporate $SO�k "t ,.�fONA(� INSU y, WESTFIELD INSURANCE COMPANY Sealst�',..•• .. C�*s�� �,•`�P... ••.VS;G,,- ,rr ,.... {�c WESTFIELD NATIONAL INSURANCE COMPANY Affixed We a+ Vol :o.• •:p- - '.e�` OHIO FARMERS INSURANCE COMPANY NJ SEAL .�. - •��1►itTEi�ps3 - �+ t$s `�y•. ::o 1m&. !•r 1, � ```,••,,' f'''�!•l411IIIaNN`••',•`'` By. State of Ohio '` Richard L.Kinnaird,Jr.,National Surety Leader and County of Medina ss.: Senior Executive On this 20th day of APRIL A.D.,2011 ,before me personally came Richard L. Kinnaird, Jr. to me known,who, being by me duly sworn,did depose and say,that he residesin Medina, Ohio;that he is Senior Executive of WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OH16 FARMERS INSURANCE COMPANY, the companies described in and which executed the above Instrument;that he knows the seals of said Companies;that the seals affixed to said instrument are such corporate seals;that they were so affixed by order of the Boards of Directors of said Companies;and that he signed his name thereto by like order. Notarial N,,,NNUII,I,,lw Seal A L s Affixed • William J.Kahelin,A rney at Law, Notary Public State of Ohio s N mfr o My Commission Does Not Expire(Sec.147.03 Ohio Revised Code) County of Medina ss.: 1,Frank A.Carrino,Secretary of WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, do hereby.certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said Companies,which is still in full force and effect;and furthermore,the resolutions of the Boards of Directors,set out in the Power of Attorney are in full force and effect. In Witness Whereof, I have hereunto set my hand and affixed the seals-of said Companies at Westfield Center, Ohio, this 17th day of A.D. June ,.aNa.;,, 20.14 �k,,j�`,' `` CtoN r ' i ! 'l' O i• �.j ,•`�P,.. .,HSG.- 'at .-• �i %A c°{ SEt11� smc �1 AVE rat � Secn¢tary :'!�•- �:+ "s_i Y : o 1@46:**.F Fra6k A.Carrino,4ecretat NIIa Na„a rlllla,NN•`•'', BPOAC2(combined)(06-02) =` J J±T STATE OF TEN-AS COUNTY OF TARR,'I.Ni" Before me, the unde_s _ _ w__.'__c w t i Jizb_'.ic ir_the state and county aforesaid, on this day personally apSs"=i �>�,;� __.ES-IDENT of J?T,B C0NTIRACTfNG, LLC, known to me to be a credible-p:---z o-n, _o b in __- _>s,�ro��,coon his oath disposed and said; That all persons, firnas, ?ss .^ _c_-_ , _ :_�__s c1 other. organizations _fizrnishing labor and/or materials have been nai That the wage scale es wD'_s__: L �c _c nine Ciy ofFor<�Uo ih has been paid;and Thai there are no cla__ .__ _,_ 1__-_-- --, y _d/c p-crier y d rages; Or_contract describes a , -_-._ =s-::. _:__:� _ ,_ `:�To�3 .�K _'resider_': Subscribed and swot- 20'_ PUB= ,_f AND FOR My commission exp=-es 9-10-17 LINDA p� A��iPNANJ �EOf j4Ar^ MY Cor b'�j,State of Texas Mar ssio�Expires ch 10, 2017 FORTWORTH rev 03/05/07 TRANSPORTATION&PUBLIC WORKS FINAL STATEMENT OF CONTRACT TIME FINAL STATEMENT NO.:28 NAME OF PROJECT: Alta Vista Road PROJECT NO.: 00562 CONTRACTOR: JLB DOE NO.: 5495 PERIOD FROM 04/22/13 TO: 06/15/14 FINAL INSPECTION DATE: November 13,2013 WORK ORDER EFFECTIVE:4/22/2613 CONTRACT TIME: 165 ) WOO 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. 11. 26. 12. 27. 13. 28. 14. 29. 15. 30. 31. SAT,SUN, RAIN,TOO WET, UTILITIES DAYS TOTAL &HOLIDAYS &TOO COLD RELOCATIONS OTHERS CHARGED DAYS THIS PERIOD 0 0 0 PREVIOUS PERIOD -14 177 163 TOTALS TO DATE -14 177 163 *REMARKS: CONTRACTOR DATE -INSPECTOR- r DATE ENGINEERING DEPARTIvIFNT s° The City of Fort Worth•1000 Throckmorton Street•Fort Worth,TX 76012-6311 (817)392-7941 •Fax:(817)392-7845