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tI pl a wee ndeeeed eis p'ed t0""c'p'ow& TION AND PUBLIC WORKS
Clearance Gondud®d By Shameka Kwi,edy PROJECT COMPLETION
D.O.E.Ns: 7211
Regarding contract 1172U for CVS-FORT WORTH STORE#10489 as required by the WATER DEPARTMENT
as approved by City Council on N/A through M&C N/A the director of the WATER DEPARTMENT upon the
reca�nendation of the Assistant Director of the Transportation&Public Works Department has accepted the project
as complete.
Original Contract Priem- 582,411.00
Amount of Approved Change Orders: N91
Revised Contract Amount: 582,411.00
Total Coat Work Completed: 582,411.00
Less Deduedoas:
Liquidated Damages: Days®$210.00✓Day
Pavement Deficiencies:
Total Deduction Amount: 50.00 i
Total Coat Work Completed: $82,411.00
Less Previous Payments:
Final Payment Due 582,411.00
Recommended for Acceptance Date
° Asst. Director,TPW-Infrastructure Design and Construction
¢ 9
Accepted / Datb 11
Asia. Director, WATER DEPARTMENT tJ 2 r 1S
Ais+• City Manager Date f
Comment- FUND ACCT:WATER M5-6071402260/SEWER P275-7071302260
OFFICIAL RECORD
CITY SECRETARY
FT.WORTH,TX
FORTWORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name CVS-FORT WORTH STORE#10489
Contract Limits
Project Type WATER&SEWER
City Project Numbers 02260
DOE Number 7211
Estimate Number 1 Payment Number I For Period Ending 1/152015
CD
City Secretary Contract Number 117211 Contract Time 1861)
Contract Date Days Charged to Date 222
Project Manager Long Contract is 100.00 %Complete
Contractor M-CO
6816 HARMONSON ROAD
N RICHLAND IM, TX 76180
Inspectors LAYER/ MEI'O
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Wednesday,January 21,2015 Page 1 of 4
eg
City Project Numbers 02260 DOE Number 7211
Contract Name CVS-FORT WORTH S"CORE#10489 Estimate Number I
Contract Limits Payment Number I
Project Type WATER&SEWER For Period Ending 1/15/2015
Project Funding
WATER
ItemDescription of Items Unit Unit Cost
Estimated Estimated Completed Completed
No. Quanity Total Quauity Total
1 8"WATER PIPE 250 LF $30.00 $7,500.00 250 $7,500.00
2 24"CONCRETE AWAA C303 WATER PIPE 324 LF $133.00 $43,092.00 324 $43,092.00
3 CONNECTION TO EXISTING 24"WATER MAIN 2 EA $5,000.00 $10,000.00 2 410,000.00
4 FIRE HYDRANT 1 EA $2,360.00 $2,360.00 1 $2,360.00
5 1"WATER SERVICE.,METER RECONNECTION I EA $300.00 $300.00 1 $300.00
6 1"WATER SERVICE 1 EA $300.00 $300.00 1 $300.00
7 1 1/2"WATER SERVICE 1 EA $807.00 $807.00 1 $807.00
8 6"GATE VALVE 2 EA $835.00 $1,670.00 2 $1,670.00
9 8"GATE VALVE 1 EA $935.00 $935.00 1 $935.00
10 8"X 8"TAPPING SLEEVE&VALVE 1 EA $2,790.00 $2,790.00 1 $2,790.00
11 MANHOLE VACUUM TESTING I EA $104.00 $104.00 1 $104.00
Sub-Total of Previous Unit $69,858.00 $69,858.00
SEWER
ItemEstimated Estimated Completed Completed
Description of Items Unit Unit Cost
No. Quanity Total Quanity Total
1 7"CONC DRIVEWAY 441 SF $6.00 $2,646.00 441 $2,646.00
2 6"CONC CURB&GUTTER 130 LF $2.00 $260.00 130 $260.00
3 REMOVE ASPHALT DRIVE 70 SY $4.00 $280.00 70 $280.00
4 REMOVE CONC.CURB&GUTTER 70 LF $4.00 $280.00 70 $280.00
5 I2"-18"TREE REMOVAL 2 EA $500.00 $1,000.00 2 $1,000.00
6 SEEDING-HYDROMULCH 116 SY $0.75 $87.00 116 $87.00
7 TRAFFIC CONTROL 1 MO $8,000.00 $8,000.00 1 $8,000.00
Sub-Total of Previous Unit $12,553.00 $12,553.00
N
L RECORDCRETARYRTH, TX
Wednesday,January 21,2015 Page 2 of 4
City Project Numbers 02260 DOE Number 7211
Contract Name CVS-FORT WORTH STORE#10489 Estimate Number 1
Contract Limits Payment Number 1
Project Type WATER&SEWER For Period Ending 1/152015
Project Funding
Contract Information Summary
Original Contract Amount 582,411.00
Change Orders
Total Contract Price $82,411.00
Total Cost of Work Completed $82,411.00
Date '�
Contra / Less %Retained $0.00
' 2 / IIS Net Earned $82,411.00
Date Earned This Period 582,411.00
Inspection Su r /
Retainage This Period $0.00
Date d' �� Less Liquidated Damages
Project M f
Q Days @ /Day $0.00
Date—W—4' LessPavement Deficiency $0.00
Asst irec or/TP,3i�-Infrastructure Design and Construc on Less Penalty $0.00
(/ ate Less Previous Payment $0.00
k5t. Director/Conhwft Dep t Plus Material on Hand Less 15% $0.00
�� IS Balance Due This Payment $82,411.00
G
2"
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Wednesday,January 21,2015 Page 3 of 4
pEC EE WE
APR 09 2015 0?�S —o a�lob
City Project Numbers 02260 By DOE Number 7211
Contract Name CVS-FORT WORTH STORE#10489 Estimate Number 1
Contract Limits Payment Number 1
Project Type WATER&SEWER For Period Ending 1/15!2015
Project Funding
Project Manager Long City Secretary Contract Number 117211
Inspectors LAYER / NIETO Contract Date
Contractor M-CO Contract Time 180 CD
6816 HARMONSON ROAD Days Charged to Date 222 CD
N RICHLAND HIL, TX 76180 Contract is 000000 Complete
CITY OF FORT WORTH
SUMMARY OF CHARGES
Line Fund Account Center Amount Gross Retainage Net
Funded
Total Cost of Work Completed $82,411.00
Less %Retained $0.00
Net Earned $82,411.00
Earned This Period $82,411.00
Retainage This Period $0.00
Less Liquidated Damages
0 Days @ $0.00 /Day $0.00
LessPavement Deficiency $0.00
Less Penalty $0.00
Less Previous Payment $0.00
Plus Material on Hand Less 15% $0.00
Balance Due This Payment $82,411.00
Wednesday,January 21,2015 Page 4 of 4
OFFICIAL (RECORD
CITY SECRETARY
FT.WORTH, TX
FORTWORTH rev 03'05`0'
TRANSPORTATION&PUBLIC WORKS
FINAL STATEMENT OF CONTRACT TIME
FINAL STATEMENT NO.:1
NAME OF PROJECT: CVS Fort Worth Store#10489
PROJECT NO.: 02260 CONTRACTOR: M-Co Cmshr wdoa,Inc.
DOE NO.: 7211
PERIOD FROM:06109/14 TO: 01/15/15 FINAL INSPECTION DATE: 6-Jan-15
WORK ORDER EFFECTIVE:6/9/2014 CONTRACT TIME: 180 0 VHB* 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 OTHERS* DAYS TOTAL
&HOLIDAYS &TOO COLD RELOCATIONS CHARGED DAYS
THIS
PERIOD 222 222
PREVIOUS
0 0
PERIOD
TOTALS
TO DATE 222 222
*REMARKS:
C NT COR DATE SPEC76R
ENGINEERING DEPARTMENTRECORD
13 The City of Fort Worth-1000 Throckmorton Street-Fort Worth,TX 76012 3�1 TY SECRETARY
(817)392-7941 -Fax:(817)392-7845 UI
FT. WORTH,TX
FORTWORTHREV:02120/07
TRANSPORTATION AND PUBLIC WORKS
PERFORMANCE EVALUATION OF CONTRACTOR
CONTRACTOR&PROJECT DATA
Name of Contractor Project Name
M-Co Construction,Inc CVS-Fort Worth Store#10489
DOE Inspector DOE Number
Emanuel Nieto 7211
DOE Inspector Project Manager
Q water2l Waste Water❑ Storm Drainage❑ Pavement Aaron Lon
Initial Contract Amount Project Duff—Ity
$82,411.00 O Simple .Q Routine O Complex
Final Contract Amount Date
$82,411.00 1/2/2015
11)PERFORMANCE EVALUATION
0-Inadequate I-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 4 8 8
2 Public Notifications 5 Y 4 20 20
3 Plans on Site 5 Y 4 20 20
4 Field Supervision 15 Y 3 60 45
5 Work Performed 15 Y 4 60 60
6 Finished Product 15 Y 3 60 45
7 Job Site Safety 15 Y 4 60 60
8 Traffic Control Maintenance 15 Y 4 60 60
9 Daily Clean Up 5 Y 4 20 20
10 Citizen's Complaint Resolution 5 Y 4 20 20
11 Property Restoration 5 Y 3 20 15
12 After Hours Response 5 Y 4 20 20
13 Project Completion 5 Y 3 20 15
TOTAL ELEMENT SCORE(A) 408
BONUS POINTS(25 Maximum)(B)
TOTAL SCORE(TS) 408
1I1)CONTRACTOR'S RATING
Maximum Score(MS)=448 or sum of applicable element score maximums which= 448
Rating(fTS/MS]*100%) 408 / 448 = 91%
Performance Category Excellent
<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 X
Signature DOE Inspector's Supervisor -
CONTRACTOR'S COMMENTS
_ TRANSPORTATION AND PUBLIC WORKS OFFICIAL RECORD
The City of Fort Worth•1000 Throckmorton Street•Fort Worth,TX 76012-63 1 1CITY SECRETARY
(817)392-7941 •Fax:(817)392-7845 FT,WORTH,TX
FORTWORTHREV 02/22/07
TRANSPORTATION AND PUBLIC WORKS
CONTRACTOR'S EVALUATION OF CITY
1)PROJECT INFORMATION _ Date- F2/2/2015
Name of Contractor ----� ---_---_---_---------_--_ Project Name--- ----.1 �!— —
M-Co Construction, Inc— _ -- _RCVS-Fort Worth Store 410489 --
DOE Inspector 'Project Manager
Emanuel Nieto _Aaron Lon
DOE Number lFrojectDifficultv I Tjpe of Contract
7211 10 Simple (*) Routine 0 Complex El water0 Waste water Storm Drainage Pavement
Initial Contract Amount Final Contract Amount
i$82,411.00 $82,411.00
Il)PERFORMANCE EVALUATION
0-Inadequate I -Deficient 2-Standard 3 -Good 4-Excellent _
ELEMENT �— —ii--� RATING IELEMENT ---- — -- RATING
(0-4)
INSPECTION EVALUATION —IPLANS&SPECIFICATIONS
1 Availabilityof Inspector -- — 1 Accuracy of Plans to ExistingConditions —�
2 Knowledge of Inspector — i2 Clarity&Sufficiency of Details
3 Accuracy of Measured Quantities y _Applicability of Specifications y
4 Dis lay Of Professionalism 14 Accuracy of Plan Quantities
5 Citizen Complaint Resolution PROJECT MANAGER EVALUATION
6 Performance-Setting up Valve Crews, Labs „— 1 Knowledge And/Or Problem Resolution
ADMINISTRATION -- 2 Availability of Project Manager
I Change Order Processing Time _ 3 Communication_
2 Timliness of Contractor Payments — �4 Resolution of Utility Conflicts
3 Bid Opening to Pre-Con Meeting Timeframe — 7 - —
I
III)COMMENTS&SIGNATURES
COMMENTS
Signature Contractor —
Signature DOE Inspector
Signature DOE Inspector's Supervisor
INSPECTOR'S COMMENTS
TRANSPORTATION.\J D PUBLIC WORKS OFFICIAL RECORD
t : The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TX 76012-6311 CITY SECRETARY
(817)392-7941 •Fax: (817)392- 7 845 FT- WORTH, TX
FORTWORTH
TRANSPORTATION AND PUBLIC WORKS
PIPE REPORT FOR:
PROJECT NAME: CVS-Fort Worth Store 410489
PROJECT NUMBER: 02260
DOE NUMBER: 7211
WATER
PIPE LAID SIZE TYPE OF PIPE LF
Water 8" PVC 250
Water 24" DIP 324
FIRE HYDRANTS: 1 VALVES(16"OR LARGER) NA
PIPE ABANDONED SIZE TYPE OF PIPE LF
DENSITIES: Yes
NEW SERVICES: 1" Copper 1 EA
1-112" Copper I FA
SEWER
PIPE LAID SIZE TYPE OF PIPE LF
PIPE ABANDONED SIZE TYPE OF PIPE LF
DENSITIES:
NEW SERVICES:
RD
CITY R�
TRANSPORTATION AND PUBLIC WORKS FT.WORTH,TX
13 The City of Fort Worth-1000 Throd morton Street-Fort Worth,TX 76012-6311
(817)392-7941-F=(817)392-7845
CONSENT OF SURETY OWNER 13
ARCHITECT ❑
TO FINAL PAYMENT CONTRACTOR ❑
SURETY ❑
Conforms with the American Institute of Architects G707 form OTHER ❑
Bond No: PB11509800487
TO OWNER: ARCHITECTS PROJECT NO.: 02260
(Nome and address)
City Of Fort Worth
1000 Throckmorton Street CONTRACT FOR: Water&Paving Improvements
Fort Worth,TX 76102
PROJECT: CONTRACT DATED: 5/23/2014
(Name and address)
Water and Paving Improvements at CVS Store No. 10489, Boat Club Road and Lake Country Drive,
Fort Worth, Texas
In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above,the
(Insert name and address of Surety,
Philadelphia Indemnity Insurance Company
One Bala Plaza, Suite 100
Bala Cynwyd, PA 19004
SURETY
on bond of
(insert name and address of Contractor,
M-CO CONSTRUCTION, INC.
316 County Road 3672
Springtown,TX 76082
,CONTRACTOR
hereby approves 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
(Insert name and address of Owner)
City Of Fort Worth
1000 Throckmorton Street
Fort Worth, TX 76102
OWNER
as set forth in said Surety's bond.
IN WITNESS WHEREOF,the Surety has hereunto set its hand on this date: January27,2015
(Insert in writing the month followed by the numeric dote and year..
Philadelphia Inde ity Insu=Company
(Surety)
(Signature of authorize sentative,
Attest: �—e-� Tobin Tucker,Attorne -in-f
(Seal): Printed name and title)
OFFICIAL RECORD
C11 11 30.VtETARY
FT.WORTH,TX
2540
PH11,.ADELPHIA INDE"NIT) INSURANCE.CON'IPANN Bond Na PB11509800487
One Bala Plaza,Suite 100
Bala Cxrtwvd.PA 19004
Power of Aftorncy
KNOW ALL PFRSONS BY THESE PRESENTS: that PHILADELPIff.\INDENJNITIINSURANCE COMPANY(the Company),a corporation organized and
existing under die laws of the Conhrnonweailh of Pennsylvania,does hereby constitute and appoint. Jared Young,Fred A.Thetford,Jr.,Tobin Tucker,Tom Young
and Fred A.Thetford,III of Contract Bond Agency,LLC.
i
Its true and lawful Attorney(s)in fact with fu11 authority to execute on its behalf bonds_undertakings-recognizances and other contracts of inderri and witings
UbhJator} in the n.uure thereof,Issued in the course of its business and to hind the Company thereby,in an amount not to exceed 525,000,000
I his Powcr of Attome� is granted and is signed and scaled by faCsmilC under and by the authority of the following Resolution adopted by the Board of Directors of
PHILADELPHL-m,INDEMNhI Y IN'SI;RANCF COMPANY at a mcetine dul),tailed the I"day of July,2011
RESOLVED: That the Bourd of Dircclors hereby authorizes the President or any Vice President of the
Company to (I) Appoint Attorney(s) in Fact and authorize the Attonncv(s) in Fact to
execute on behalf of the Company bonds and undertakings, contracts of indemnity and
other writings obligator in the nature thereof and to attach the seal of the Company
thereto; and (2) to remote, at any tithe, any such Attomey-in-Fact and revoke the
authority given. And,be it
FURTHER
RESOLVED: Ilhat the signatures of such officers and the seal of the Company may be affixed to any
such Power of Attorney or certificate re!atin!R thereto by facsimile,and any such Power of
Attorney so executed and certified by facsimile signatures and facsimile seal shall be
valid and biding upon the Connpany in the ivatrc with the respect to any bond or
undertaking to,vhich it is attached
IN TESTIMONY WHEREOF,PHILADELPHIA INDEMNITY INSURANCE COMPANY HAS CAUSEDTHIS INSTRUMENT TO BE SIGNED AND
ITS CORPORATE.SEALTO BE AFFIXED BY ITS AUTHORIZED OFFICE,THIS 7"'DAY OF FEBRUARY 2013.
Se
( I a)
Robert D-O Leary Jr.President K CEO
Philadelphia Indemnity Insurance Company
On this 7"'day ofl-ebruary 2013,betbre me came the indn idual who executed the preceding instrument,to me personafly knotynt,and being b) me du)y sworn said that
he is the therein dcscnbed and a.ahornzed officer of the PIDLADF,LPHIA IN'DENINITY INSLR.-INCE CONIPAN'Y:that the seal affixed to said instrument is the
Corporate seal of said Connpany,that the said Corporate Seal and hi;signature etre duly affixed
COMM0fjWPJtLTH OFFEN"Vt_VANM
NOTARIAL SEAL
DANIELLE PORATH,Notary Public
Lower Mot on Twpp Montgorne7 Courry
M Oomrtlss w Expires March 2Z 2018
Notary Public_ �—
residing at Bala Cynwyd-PA _--_
(Notary Seal)
My commission expires: March 22.2016
I,Craig P.Keller,Executive Vice President,Chief Financial Officer and Secretary of PHILADELPHIA INDEMNITY INSURANCE COMPANY,do herby certify that
the foregoing resolution of the Board of Dtrectors and this Power of Attorney issued pursuant thereto are true and correct and are still in full force and effect.I do
further certify that Robert D.O'Leary Jr.,who executed the Power of Attorney as President,was on the date of execution of the attached Power of Attorney the duly
elected President of PHILADELPHIA INDEMNITY INSURANCE COMPANY,
In Testimony Whereof]have subscribed my name and affixed the izestmile seal ofeacb Company this 27th day of January .20 15
Craig P.Keller.Executive Vice President,Chief Financial O
PHILADELPHIA INDIiMNIIY INSURANCE COMPA Y
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
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 Alford Main,
Secretary Of M-Co Construction,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 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;
CVS Store No. 10489,Boat Club Rd. &Lake Country Dr.,FW,TX
B
Alford Main, ecretary
Subscribed and sworn before me on this date 27th of Januar;y,2015.
NotaryJKU
blic 4C #PIFRIES
Tarrant,TexasW � �,pplw"CR TX '
D
ORANGE
DEVELOPMENT INC
Jeff Brewer-VP of Development
1200 Corporate Drive,Ste G50
Birmingham,AL 35242
Office:205.909.3798
CeN: 205261.9200
Email:ibrewerdoramedevinc.com
VIA EMAIL AND USPS
February 2, 2015
Emanuel Nieto
Senior Construction Inspector—Transportation and Public Works
8851 Camp Bowie West.
Fort Worth, TX 76116
Re: CVS 10489 Ft. Worth, TX
Dear Mr. Nieto:
Please accept this letter as record that Orange Development Inc., as developer for the
CVS 10489 Ft. Worth, TX will not charge Walkcon Ltd. (contractor) liquidated
damages for any delays in the project. If you should have any further questions, please
don't hesitate to contact me at the number above.
Regards,
OFFICIAL RECORD
Jeff Brewer CITY SECRETARY
Enclosure FT.WORTH, TX