HomeMy WebLinkAboutContract 46019-FP1 Pepa>rtm MtOf TPW Const. eirvices PSFRI
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CIA"S r Jd
C a err rtraa "ylvbave been Coqhtejcd op aten the request PUBLIC U
(or n `hive r+ert* ,,,projeel for remh Payment
Ck rants Cqudectod By Etta Savy D.O.E.Nss 7227
�' �5i��71t`1'A."�""f(��T�A t'"�I��;IC 1�t.7 tsAR s aPp `v°erl �it ��atassceii an /A
/�4 °ectar a`I' PC�rR'�`ATI�i`d` BI�TC�C3 IIET"ARTiVIEI�J'T ears '
reed: ,, elation of the,Assis Directdr of the,Transportation&Pub e Wo&lbeipartrnent has accepted the project
tap
ieto
0,010441 Contract Prices; $469;021,56
Amount of Approveti Cbauge Orders: &I
itevastarrlr, ct Amount: $469;62746
Totai Ct t Wbw Completed: $469,627.56
�edrNtions:
`L iguidMed Darmages'. Days 10:001'Day
Pave�tuant Dei� i �e�e�.
100110duetion Amount. S0:00
Tdtsfl Cwt Work Cunxpieted; 469,627�56
L44, Maus i"ayment�t
in ; 'aymnt Drs $469,627.56
I ootrt r n ed for Acceptance Crate
Asst` reotor, TPW Trrfrastruetur+ Design and Construction
til 6J C.",
Accepted Date
TRANSPORTATION AND,PUBLIC WORK, DEPARTMENT
Asst, City,Manager ' Date
C,otwme o, FUM C205-2087602283-60815, 02283
CITY SECRETARY II
FT ,
I u
FORT WORTH
CITY OF FORT WOWrH
FINAL PAYTvWNT REQUEST
Contract Name PRIMORIS(x)uwr
Contract Limits
Project Type PAVD4G&DRAINAGE
City Project Numbers 02283
DOE Number 7227
Estimate Number 1 Payment Number I For Period Ending 6/30/2015
CD
City Secretary Contract Number 1l 7227 Contract Time 13ED
Contract Date Days Charged to Date 184
Project Manager Ehia Contract is 100.00 Complete
Contractor MUCKLEROY&FALLS
P O,BOX 100206
FORT WORTH, TX 76185
Inspectors Rte DGERS1 GLOVER
Mond",July 06,2015 Page 1 or 5
ozz-741
City Project Numbers 02283 DOE Number 7227
Contract Name PRIMORIS COURT Estimate Number I
Contract Limits Payment Number I
Project Type PAVING&DRAINAGE For Period Ending 6/30/2015
Project Funding
UNIT III:DRAINAGE IMPROVEMENTS
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
I 7'X2'REINFORCED CONC.BOX CULVERT 377 LF $265.00 $99,905.00 377 $99,905.00
2 36"CLASS III RCP 76 LF $104.76 $7,961,76 76 $7,961.76
3 8'X6'DROP INLET WITH CONCRETE APRON I EA $14,202.00 $14,202.00 1 $14,202.00
4 CONNECT TO EXISTING TXT INLET I EA $2,754.00 $2,754.00 1 $2,754.00
5 UNCLASSIFIED CHANNEL EXCAVATION 2030 CY $8.10 $16,443.00 2030 $16,443.00
6 BROADCAST SEEDING WITH EROSION 7450 SY $1.78 $13,261.00 7450 $13,261.00
MATTING FOR PROPOSED CHANNELJDITCI I
AREAS
7 30"TYPE"B"HEADWALL 2 EA $6,372.00 $12,744.00 2 $12,744.00
8 12"DRY ROCK RIP RAP WITH FILLER FABRIC 600 SY $55.08 $33,048.00 600 $33,048.00
9 TRENCH SAFETY 453 LF $2.70 $1,223.10 453 $1,223.10
10 5"CONCRETE RIP RAP 90 SY $108.00 $9,720.00 90 $9,720.00
Sub-Total of Previous Unit $211,261.86 $211,261.86
UNIT IV:PAVING IWROVE
Item Description of Items Estimated unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
I ROW PREP//STRIP&STOCKPILE TOPSOIL ON 495 CY $7.02 $3,474.90 495 $3,474.90
ADJACENT PROPERTY
2 UNCLASSEFED ROADWAY EXCAVATION 345 CY $7.56 $2,608.20 345 $2,60820
3 COMPACTED FILLJROADWAY EMBARKMENT 1760 CY $5.94 $10,454.40 1760 $10,454.40
4 SUBGRADE PREP/MANIPULATION 3360 SY $3.24 $10,886.40 3360 $10,886.40
5 HYDRATED LINE-27#PER SY 45 TN $172.80 $7,776.00 45 $7,776.00
6 SAW CUT DEMO&DISPOSE OF EXIST 80 LF $5.40 $432.00 90 $432.00
CONCRETE CURB&GUTTER
7 DOWEL&CONNECT TO EXISTING CONCRETE 80 LF $10.80 $864.00 80 $864.00
9 07"REINF.CONCRETE PAVING(4.00OPSI) 3065 SY $37.26 £114,201.90 3065 $114,201.90
9 06"INTEGRAL CONCRETE CURB 1270 LF $2.70 $3,429.00 1270 $3,429.00
10 04"REINF,CONCRETE SIDEWALK 7450 SF $4,86 $36,207.00 7450 $36,207.00
11 4.0'WIDE REINF.CONC.FLUME WITH STEEL 30 SF $24.84 $74520 30 $745.20
PLATE
12 06"REINF.CONCRETE DRIVE APPROACH 650 SF $6.48 $4,212.00 650 $4,212.00
13 RE-SPREAD TOPSOILICURB BACKFILL 495 CY $22.69 $11,226.60 495 $11,226.60
Monday,July 06,2015 Page 2 of 5
City Project Numbers 02283 DOE Number 7227
Contract Name PRIMORIS COURT Estimate Number l
Contract Limits Payment Number I
Project Type PAVING&DRAINAGE For Period Ending 6/30/2015
Project Funding
14 BROADCAST SEF.DPARKWAYS 3950 SY $0.81 $3,199.50 3950 $3,199.50
15 ADA BARRIER FREE RAMPS 6 EA $918.00 $5,508.00 6 $5,508.00
16 INSTALL MAINTAIN&REMOVE TRAFFIC I LS $2,430.00 $2,430.00 1 $2,430.00
CONTROL
17 INSTALL MAINTAIN&REMOVE EROSION l LS $9,498.60 $9,498.60 1 $9,498.60
CONTROL
18 INSTALL TRAFFIC SIGNS 2 EA $594.00 $1,188.00 2 $1,188.00
Sub-Total of Previous Unit $228,341.70 $228,341.70
UNIT V:STREET LIGHTING M4PROVEMENTS
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
I INSTALL STREET LIGHT 4 EA $7,506.00 $30,024.00 4 $30,024.00
Sub-Total of Previous Unit $30,024.00 $30,024.00
Monday,July 06,2015 Page 3 of 5
City Project Numbers 02283 DOE Number 7227
Contract Name PRIMORIS COUR"I' Estimate Number I
Contract Limits Payment Number I
Project Type PAVING&DRAINAGE For Period Ending 6(3082015
Project Funding
Contract Information Summaa
Original Contract Amount S469,627.56
Change Orders
Total Contract Price $469,627.56
Total Cost of Work Completed S4.69,627.56
ContWtor Less %Retained $0.00
Net Earned &469,,627.56
Earned This Period S469,627,56
Inspection Supervisor
Retainage This Period 50.00
roject MR r Less Liquidated Damages
Days @ Day $0.00
LessPavement Deficiency $0.00
t.D' dor/TPWIn6micture Design and Comstruction Less Penalty $0.00
Less Previous Payment $0.00
Date bl"111"
Dirl9or I Contracting Depawynt Plus Material on and Less 15% SUO
Balance Due This Payment 5469,627.56
Monday,July 06,2015 Page 4 of 5
City Project Numbers 02283 DOE Number 7227
Contract Name PRIMORIS COURT Estimate Number I
Contract Limits Payment Number I
Project Type PAVING&DRAINAGE For Period Ending 6/3012015
Project Funding
Project Manager Ehia City Secretary Contract Number 117227
Inspectors RODGE115 1 GLOVER Contract Date
Contractor MUCKLEROY&FALLS Contract Time 135 CD
P.O BOX 100206 Days Charged to Date 184 CD
FORT WORTH, TX 76185 Contract is .000000 Complete
CITY OFF 'T WORTH
SUMMARY OF CHARGES
Line Fund Account Center Amount Gross Re Net
Funded
Total Cost of or Completed $469,627.56
Less %Retained $0.00
Net Earned $4698627®56
Earned This Period $469,627.56
Retainage This Period $0.00
Less Liquidated Damages
0 Days@ $0.00 /Day $0.00
LessPavement Deficiency MOO
Less Penalty $0.00
Less Previous Payment $0.00
Plus Material on Hand Len 15% $0.00
Balance Due This Payment $469,627.56
Monday,July 06,2015 Page 5 of 5
1
t")
Primorle 9ervioea Corparntion
July 15, 2015
CITY OF FORT WORTH
PLANNING & DEVELOPMENT DEPARTMENT
CFA DIVISION
'1000 Throckmorton Street,
Fort Worth, Texas. 76102
Ref: Community Facilities Agreement
D.O.E. NO. 7227
CITY PROJECT NO, 02283
WATER PROJECT NO, P264-6081502283-83
SEWER PROJECT NO. P274-7081302283-83 X-22633 FILE NO. K-2315
To The City of Fort Worth:
The above completed Project has been accepted by the Owner, Primoris Services Corporation
(PSC). The work is satisfactory and according to the Contract Documents. The Owner, PSC, waives
any Liquidated Damages due to the late completion of the Project.
Sincerely,
l
21�
Don Haan
Special Projects
Primoris Services Corporation
CON'S ENT OF OWNER
SURETY COMPANY ARCHITECT
TO FINAL PAYMENT (,ONFRACTOR
SURETY
AJA DOCUMENT G707 O'ITIER
tudN .
PROJECT: Primoris Court-Pavement,Water and Sewer Improvements,Ft Worth TX
(name,address)
TO(Owner) Q ity of Fort Worth ARC t-irmcrs PROJECTNO:
1000 Throckmorton
Ft Worth,TX 76102 CONTRACT FOR: Construction
CONTRACT DATE: 9/4/2014
CONTRACTOR: MuclderOY&F2118
5801 Edwards Ranch Rd
Fort Worth, TX 76109
.......... ...............-
accordance' with the provisions of the Contract between the Owner and the Contractor as indicated above,the
(here insert name and address of"Surcry Company)
North American Specialty Insurance Company
650 Elm Street SURETY COMPANY,
Manchester,NH 031,01
on bond of(here insert name and address of'Contractor)
Muckleroy&Falls
5801 Edwards Ranch Rd
Fort Worth,TX 76109 CONTRACTOR,
hereby approves of the final payment to the Contractors,and agrees that final payment to the Contractor shall not relieve
the Surety Company of any of its obligations to(here insert name and w1 dress of'Owner)
City of Fort Worth
1000 Throckmorton
Ft.Worth,TX 76102 OWNER,
as set forth in the said Surety Company's bond.
IN WITNESS WHEREOF,
the Surety Company has hereunto set its and this 13th day of July 2015
North American Specialty Insurance Company
Surety Company
Signature of Authorized Representative
(Seal): Debra Lee Moon Atto rue v-1n-Fact
Titi–e
....... „f,,,,,,,,,...... ......... ................I................1-1-1-—-------------- ..........
N(YrE: "Mis om 6 to be used as a compnnion document to AIA DOCUMENT G706,CONTILACT)R'S AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS,
Current Edition
................ ..........-................. ......................................
AIA DOCUMMITT'G707 CONSENT OF SURETY COMPANY TO FINAL PAYMENT APRIL 1970 EDITION AEA ONE PAGE
1970 THE AMEMCAN[NSTITUTE OF ARCH111XIrS,1735 Now York Ave.,NW,WA.S'HINGTON,D.C. 20006
NAS SURETY GROUP
NORTH AMERICAN SPECIALTY INSURANCE COMPANY
WASHINGTON INTERNATIONAL,INSURANCE COMPANY
GENERAL POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS,THAT North American Specialty Insurance Company,a corporation duly organized and existing under
laws of the State of New I Ianipshire,and having its principal office in the City of Manchester,New Hampshire,and Washington International
Insurance Company,a corporation organized and existing under the laws of the State of New Hampshire and}raving its principal office in the City of
Schaumburg,Illinois,each does hereby make,constitute and appoint:
SAMMY JOE MULLIS,JR.,JOHN WILLIAM NEWBY,JULIE STORM,CHERI LYNN IRBY,WILBERT RAYMOND WATSON,
CAROLYN J.GOODENOUGH,MICHAEL L.TULLIS,SANDRA LEE RONEY,DEBRA LEE MOON,ANDREA ROSE CRAWFORD,
MARY JO ZAKRZEWSKI,JAMES B ROGERS JR.,TROY RUSSELL KEY,and DAVID MICHAEL LAYMAN JOINTLY OR SEVERALLY
Its true and lawful Attomey(s)-in-Fact,to make,execute,seal and deliver,for and on its behalf and as its act and decd,bonds or other writings
obligatory in the nature of a bond on behalf of each of said Companies,as surety,on contracts of suretyship as are or may be required or permitted by
law,regulation,contract or otherwise,provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the
amount of: FIFTY MILLION($50,000,000.00)DOLLARS
This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of
Directors of both North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held
on the 91h of May,2012:
"RESOLVED,that any two of the Presidents,any Managing Director,any Senior Vice President,any Vice President,any Assistant Vice President,
the Secretary or any Assistant Secretary be,and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named
in the given Power of Attorney to execute on behalf of the Company bonds,undertakings and all contracts of surety,and that each or any of them
hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is
FURTHER RESOLVED,that the signature of such officers and the seal of the Company may be affixed to any such Power of Attomey or to any
certificate relating thereto by facsimile,and any such Power of Attomey or certificate bearing such facsimile signatures or facsimile seal shall be
binding upon the Company when so affixed and in the future with regard to any bond,undertaking or contract of surety to which it is attached."
`\yQ GbQU®A; G
_ '......
SBteven P.Anderson,Senior Vice president of Washington International Insurance Company �~•.4 SEALp".4
ps',Z 7873 Pry,m= &Senior Vice President of Norlh American Specialty Insurance Company
By
Michael A.Iles, en err me leer eat a a.s ...tcm an nsurance omP ry drnaratamaus�
&Seniur Vice President of North American Specialty Insurance Company
IN WITNESS WHEREOF,North American Specialty Insurance Company and Washington International Insurance Company have caused their
official seals to be hereunto affixed,and these presents to be signed by their authorized officers this 1st day of July 2015
North American Specialty Insurance Company
Washington International Insurance Company
State of Illinois
County of Cook Ss:
On this 1st day of Juty 2015 ,before me,a Notary Public personally appeared Steven P.Anderson ,Senior Vice President of
Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and Michael A.Ito,
Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance
Company,personally known to me,who being by me duly sworn,acknowledged that they signed the above Power of Attorney as officers of and
acknowledged said instrument to be the voluntary act and deed of their respective companies.
OFFICIAL SEAL
MKENNY _S ti -1. ;
NOTARY PUBLIC,STATEOFIWNOIS M.Kenny,Notary Public
MY�MMISSION EXPIRES 17J04/�17
1, Jeffrey Goldberg. the duly elected Assistant Secretary of North American Specialty Insurance Company and Washington
international Insurance Company,do hereby certify that the above and foregoing is a true and correct copy of a Power of Attomey given by said North
American Specialty Insurance Company and Washington International Insurance Company,which is still in full force and effect.
IN WITNESS WHEREOF,I have set my hand and affixed the seals of the Companies this 13th day of July 20 15
"frrcy Goldberg,Vice President&Assistant Secrelaq,of
Washington International Insurance Company&North American Specialty Insurance Company
North American Specialty Insurance Company
Washington International Insurance Company
TEXAS CLAIMS INFORMATION
IMPORTANT NOTICE ADVISO.IMPORTANTE
In order to obtain information or make a complaint: Para oblener informacion o para someter un queja:
You may contact Jeffrey Goldberg,Vice President— Puede comunicarse con Jeffrey Goldberg,Vice
Claims at 1-800-338-0753 President—Claims,at 1-800-338-0753
You may call Washington International Insurance Usted Puede liamr al numero de ielefono gratis de
Company and/or North American Specialty Insurance Washington International Insurance Company and/or
Company's toll-free number for information or to North American Specialty Insurance Company's pare
make a complaint at: informacion o para someter una queja al:
1-800-338-0753 1-800-338-0753
You may also write to Washington International Usied tambien Puede escribir a Washington
Insurance Company and/or North American Specialty International Insurance Company and/or North
Insurance Company at the following address; American Specialty Insurance Company al:
475 N. Martingale Road 475 N. Martingale Road
Suite 850 Suite 850
Schaumburg,IL 60173 Schaumburg,IL 60173
You may contact the Texas Department of Insurance Puede escribir al Departmento de Seguros de Texas
to obtain information on companies, coverages, para obtener informacion acerca de companias,
rights or complaints at: coberturas,derechos o quejas at:
1-800-252-3439 1-800-252-3439
You may write the Texas Department of Insurance: Puede escribir al Departmento de Seguros de Texas:
RO, Box 149104 P.O. Box 149104
Austin,TX 78 71 4-91 04 Austin,TX 787 1 4-9 1 04
Fax: (5 12)47 5-17 71 Fax: (512)475-1771
Web: hftp.J1mmw.1dt!s_tde_tx.us Web: http://www.tdi.state.tx.us
Email:ConsumerProtection@tdi.state.tx.us Email:ConsumerProtectiongtdi.state,tx.us
PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS 0 RECLAMOS:
Should you have a dispute concerning your premium Si tiene una disputa concerniente a su prima o a un
or about a claim you should first contact The reclarno, debe comunicarse con el Washington
Washington international Insurance Company and/or International Insurance Company and/or North
North America"Specialty Insurance Company. It the American Specialty Insurance Company primero. Si
dispute is not resolved, you may contact the Texas no se resuelve la dispute, puede entonces
Department of Insurance. comunicarse con el Departmento de Seguros de
Texas.
ATTACH THIS NOTICE TO YOUR POLICY: UNA ESTE AVISO A SU POLIZA
This notice is for information only and does not Este aviso es solo para proposito de infromacion y no
become a part or condition of the attached se converle en parle o condicion del clocumento
document. adjunto.
Hevi5ed 5/12 475 N.Martingale Road,Suite 650.Schaumburg,IL 60173
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 Marshall Sharp,
Project Manager Of Muckleroy& Falls, 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 andJor 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;
Primoris Court, CFA 2014-047,DOE: 7227, City Project No: 02283
BY
Marshall S
arshall Sharp
Subscribed and sworn before me on this date 13th of July, 2015.
LUCILLE J. KITCHELL
of
[E: Notary* M Public, e Texas
't
St'
State of Texas
M y commission p
1slon Ex ire
My commission Expires
June 01, 2 0 2 0
Cy ar june 0i
Not P iblic ---
Tarr t,Texas
FORTWORTHREV.02120/07
TRANSPORTATION AND PUBLIC WORKS
PERFORMANCE EVALUATION OF CONTRACTOR
1) CONTRACTOR PROJECT DATA
Name o)'Conlraclor Project Name
t�ucklercn Falls Primoris Court
Inspector DO Number„
Mike Glover 7227
DOF,Inns 1wctor Project Alan agrp,
El Water[:] Waste water[—!J Storm DrahagECv Pavement Fred Elba
Initial Contract Amount Project Difficulty
$469,627.56 C) Shp e Routine 0 Complex
Final Conlowl Amount Date
15469,627.56 7/10/2015
11)PERFORMANCE EVALUATION
0-Inadequate I-Deficient 2-Standard 3-Good 4-Excellent
ELEMENT WEI(]HT(x) APPLICABLE(Y/N) RAT!NCa(�,4 .MAX SCORE SCORE
I Submission ofDocutrients 2 Y 3 8 6
2 Public Notifications 5 Y 3 20 15
3 Plans on Site 5 Y 3 20 Is
4 Field Supervision 15 Y 3 60 45
5 Work.Performed is Y 3 60 45
Finished Product 15 Y 3 60 45
7 Job Site Safe!j 15 Y 3 60 45
8 Traffic Control Maintenance 15 Y 2 60 30
9 DaHX Clean Up 5 Y 3 20 15
10 Citizen's Complaint Resolution 5 Y 3 20 15
II Pros j!y Restoration 5 Y 3 20 15
12 After flours Response 5 Y 3 20 15
113 Project Completion 5 Y 3 20 15
TOTAL ELEMENT SCORE(A) 321
BONUS POINTS(23 Maximum)(B)
TOTAL SCORE ITS) 321
111)CONTRACTOR'S RATING
Maximum Score(MS)—448 Qr sure of applicable efernent score mwXimums which 448
Rating(ITS/MSI* 100%) 321 1 448 - 72%
Performance Category clood,
<200A—Inadequate 20%to <401,65-Wicient 40%to<60%—Standard 60%to<80% Good ?80% cellent
Inspector's Comments(INCLUDING EXPLANATION OF BONUS POINTS AWARDED)
Signature Contra
Signature DOE Inspector ctor
Signature DOE Inspector s Supery isor
CONTRACTOICS COMMENTS
fRANSPOR"I'A'"1710N AND PUBLIC WORKS
The •".1t7 of Fort'%forth• 1000 Throckirnorton Street•Fort Worth,TX 76042 6.311
(817)392 7941 -f-'am(817)392-7845
FORTWORTHREVo 02t22107
TRANSPORTATION AND PUBLIC WORKS
C(aNTRACTOR'S EVALUATION OF CITY
1)PROJECT INFORMATION bate: 7/10/2015
Manoe of Contrcactar Pro ject Name
Muckieroy&Falls Prirnoris Court
DOEInspeclor Project Manage?
Mike Glover Fred Ehia.
DOF Number Project C uelty
7227 0 Fjmp�e (*-) VZokjtjne 0 Canpex F.]water []waste wateir Storm Drainage Pavement
Initial Contract Amount Final Contract Am oust
5469,627°56 J$469,627,56
11)PERFORMANCE EVALUATION
01-Inade testa 1 -Deficient 2-Standard 3-Good 4-Excellent
RATING ELEMENT RATING
(0�
(0-4))
(0-4)
_L!_. _..
INSPECTION EVALUATION PLANS&SPECIFICATIONS
I Availabili!y of Inspector 4 1 Accura
- Lk�c �217 Plans to Existing Conditions 14
2 Knowledge of Inspector 4 2 Clarity&Sufficien.eyof Details 4
3 Accuracy of Measured Quantities 4 3 Applicability of Specifications, 4
4 Display Of Professionalism 4 4 Accurac of Plan uantities 4
5 Citizen Complaint Resolution 4 PROJECT MANAGER EVALUATION
6 Performance-Setting g Valve Crews,Labs 4 1 Knowle�And�,/qr Problem Resolution
ADMINISTRATION - 2 Availabi �4
1 Change Order Processing Tirne -4 3 Communication 4
2 Tinifiness of Contractor Payments 4 4 Resolution
HI)COMMENTS&SIGNATURES
COMMENTS
...........
...........
... ...................................
Signature Contractor
.....................................
Signature DOE Imspector
.... ...
...... ....
........
Signature DOE Inspector's,Supervisor ......
INSPECTOR'S COMMENTS
............. ..............
.......... ....................
mA.NSP0XrATl0N AND PUBUC WORKS
Tlie Gryof Fort Worth•1000 Throckmorton Street•Fort Worth,TX 76012-6311
(817)392.,7941. -Fax:(917)392-7845
FORT WORTH.
TRANSPORTATION AND PUBLIC WORKS
STATEMENT OF CONTRACTTIME
STATEMENT#
FINAL.STATE ENT# 1 DOE
NAME OF PROJECT-. Contractor
YEAR;.. 2015
PROJ C T NO.a F°IN�►L r'PESI"Fa(:I IC)N HATE 11
WD CD
a x
FE11IC1DF°RCIg6o sir TO: .. __ .._.
wY0 C'IRLhER FJF"FFC IIS�F ._ _m I1 t OI I ...�0 M D(van) '
DAY OF MONTH DAYS REASON F'OR DAY OF MONTH DAYS REASON FOR
CHARGED DAYS CREDITED CHARGED DAYS CREDITED
1 Wed 0 NA �16 Wed 0
2 Thus 0 NA 17 Thus 0 _ Ctit
3 Fri 0 'NA 118 Fri 0
4 Sat 0 NA 19 Sat 0
t Brun 0 NA 20 Sun 0
6 Aflort 0 NA 21 Mon 0
7 Ttte 0 NA 22 _._ Tuue 0
8 Wed 0 NA 23 Wed 0
9 Thu 0 NA 24 Thu 0
10 Fri 0 NA 26 Fri 0
11 _ at 0 ANA 26 Sat 0
12 Burt 0 NA 27 Seta 0
13 Mon 0 NA 28 Mon 0 NA
14 Tutu 0 NA 29 0 ;.;
15 WWod 0 NA 30 0
31 w 0 ,
" 111 kn&Hot We* Mull,
Not Applicable SATIST Auotel WEATHER UTILITIES OTHERS DAYS "t"OTAL.DAYS
HOLIDAYS RELOCATE CHARGED
THIS PERIOD 0 0 0 0 0 0
PREVIOUS PERIOD 0 184 164
TOTAL,TO DATE 0 0 0 0 104 164
REMARK
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1ISt"L fi
DATE: ,l i ,,, Au"r ;; ,,; 'O f�.
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