HomeMy WebLinkAboutContract 45587-FP1 Dep "Vf YPW Const.Services �
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for tial psyssewt A have reiestiei tris F*W for mwb PiTm� PROJECT COMPLETION 15 r f
Clearance Conducted By Etta Bucy D.O.E.]Vit: 6671
Regarding contract 45587 for SANITARY SEWER REHABILITATION CONTRACT 78 as required by the
WATER DEPARTMENT as approved by City Council on 04/12/2014 through M&C C-26744 the director of the
WATER DEPARTMENT upon the recommendation of the Assistant Director of the Tatnsportsdon do Public Works
Department his accepted die project as VE
Original Contract Prices: $608,000.00
Amount or ApprovedCbaogeOrders., rSEP2015 $66.5.74 NbI
Revised Contraet Amount: $674,858.74
Total Cost Work Cowpleted: S579,941.48 f
Less Deductions:
Liquidated Damages: Days®S210.00t Day
Pavement Deficiencies:
Total Deduction Amount: 50.00
Total Cost Work Completed: 5379,941.48
Leis Previous Payments: 5462,298.52
Final Payment D 5117,642..96
Recommended for Acceptance Date
Asst. Director,TPW- Infrastructure Design and Construction
ssrepted Da
st. Director, WATER DEPARTMENT
Z • Awn
. City Manager Da
Comments: FUND ACCT:P258-707170149083
OFFICIAL RECORD
CITY SECRETARY
FT.WORTH,TX
RECEIVE^ Sc" 3 010
QECE8 E
SEP 2 9 2015 I 5 -3
CS �55�`7
City Project Numbers 01490 DOE Number 6671
Contract Name SANITARY SEWER REHABILITATION CONTRACT 78 Estimate Number 20
Contract Limits Payment Number 20
Project Type WATER&SEWER For Period Ending 7/23/2015
Project Funding
Project Manager Sauceda City Secretary Contract Number 45587
Inspectors RODGERS / SAL.INAS Contract Date 4/1/2014
Contractor JACKSON CONSTRUCTION LTD Contract Time 210 CD
5112 SUN VALLEY DRIVE Days Charged to Date 255 CD
FORT WORTH, TX 76119 Contract is 000000 Complete
CITY OF FORT WORTH
SUMMARY OF CHARGES
Line Fund Account Center Amount Gross Retainage Net
------------------------------
Funded hh)
Total Cost of Work Completed $579,941.48
WATER DEPART�,IENT Less %Retained $0.00
Net Earned $579,941.48
ENGINEERING AND FISCAL SERVICES i
Contact Person- Berdena Diggs-Ext. 8429 Earned This Period $117,642.96
317ent prov Signature Retainage This Period $0.00
DEPARTMENT C CK POCK-UP YES ❑
Less Liquidated Damages
0 Days @ $0.00 /Day $0.00
LessPavement Deficiency $0.00
Less Penalty $0.00
Less Previous Payment $462,298.52
Plus Material on Hand Less 15% $0.00
Balance Due This Payment $117,642.96
Wednesday,September 09,2015 Page 5 of 5
FORTNORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name SANITARY SEWER REHABILITATION CONTRACT 78
Contract Limits
Project Type WATER&SEWER
City Project Numbers 01490
DOE Number 6671
Estimate Number 20 Payment Number 20 For Period Ending 7/23/2015
CD
City Secretary Contract Number 45587 Contract Time 216D
Contract Date 4/1/2014 Days Cbarged to Date 255
Project Manager Sauceda Contract is 86.000 Complete
Contractor JACKSON CONSTRUCTION LTD
5112 SUN VALLEY DRIVE
FORT WORTH, TX 76119
Inspectors RODGERS / SAUNAS
Wednesday,September 09,2015 Page 1 of 5
City Project Numbers 01490 DOE Number 6671
Contract Name SANITARY SEWER REHABILITATION CONTRACT 78 Estimate Number 20
Contract Limits Payment Number 20
Project Type WATER&SEWER For Period Ending 723/2015
Project Funding
WATER RdPROVEMENTS
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
— -- -- — —— -- ---- ———— ————--—-- -— — ---
1 8"PVC WATER PIPE(CO#2) 274 LF $39.00 $10,686.00 274 $10,686.00
2 10"PVC WATER PIPE(CO#2) 1745 LF $44.00 $76,780.00 1745 $76,780.00
3 TEMPORARY ASPHALT PAVING REPAIR(CO 2387 LF $15.00 $35,805.00 2387 $35,805.00
#2)
4 6"CONC PVMT(CO#2) 35 SY $90.00 $3,150.00
5 6"CONC CURB AND GUTTER 50 LF $32.00 $I,600.00 19.4 $620.80
6 TEMPORARY WATER SERVICES I LS $9,908.00 $9,908.00 1 $9,908.00
7 TRENCH SAFETY(CO#2) 1275 LF $1.00 $1,275.00 1274 $1,274.00
8 DUCTILE IRON WATER FITTING W/RESTRAINT 1.5 TN $10,000.00 $15,000.00 1.5 $15,000.00
9 FIRE HYDRANT SALVAGE AND INSTALL 4 EA $3,000.00 $12,000.00 4 $12,000.00
10 CONNECTION TO EXISTING 4"-12"WATER 2 EA $1,250.00 $2,500.00 2 $2,500.00
MAIN
11 I"WATER SERVICE METER 39 EA $400.00 $15,600.00 38 $15,200.00
RECONNECTION(CO#2)
12 I"WATER SERVICE(CO#2) 16 EA $1,000.00 $16,000.00 16 $16,000.00
13 6"GATE VALVE WBOX 4 EA $750.00 $3,000.00 4 $3,000.00
14 8"GATE VALVE W/BOX 3 EA $1,100.00 $3,300.00 3 $3,300.00
15 10"GATE VALVE WBOX 4 EA $1,500.00 $6,000.00 4 $6,000.00
16 TRAFFIC CONTROL 3 MO $1,500.00 $4,500.00 3 $4,500.00
17 REMOVE&RELOCATE FIRE HYDRANT(CO#1) 2 LS $6,705.17 $13,410.34 2 $13,410.34
18 1 1/2"WATER SERVICE(NEW)(CO#2) 1 EA $1,500.00 $1,500.00 1 $1,500.00
19 TEMP.WATERLINE @ POTTER LANE(NEW) 1 LS $4,718.00 $4,718.00 1 $4,718.00
(CO#2)
Sub-Total of Previous Unit $236,732.34 $232,202.14
SANITARY SEWER ff"ROVEMENTS
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
1 6"SEWER PIPE POINT REPAIR(CO#2) 15 LF $200.00 $3,000.00 15 $3,000.00
2 8"PIPE ENLARGEMENT 670 LF $I15.00 $77,050.00 640 $73,600.00
3 PIPE SAG ADJUSTMENT 30 LF $150.00 $4,500.00
5 8"PVC SEWER PIPE(CO#2) 1058 LF $47.00 $49,726.00 1097.86 $51,599.42
7 8"SEWER ABANDONMENT PLUG 3 EA $100.00 $300.00 3 $300.00
Wednesday,September 09,2015 Page 2 of 5
City Project Numbers 01490 DOE Number 6671
Contract Name SANITARY SEWER REHABILITATION CONTRACT 78 Estimate Number 20
Contract Limits Payment Number 20
Project Type WATER&SEWER For Period Ending 723/2015
Project Funding
8 REMOVE SEWER MANHOLE(CO#3) 11 EA $500.00 $5,500.00 8 $4,000.00
9 CONCRETE ENCASE SEWER PIPE 10 CY $150.00 $1,500.00
10 7"WIDE ASPHALT PVMT REPAIR ARTERIAL 1239 LF $85.00 3105,315.00 925 $78,625.00
(CO#3)
11 TEMPORARY ASPHALT REPAIR(CO#3) 300 LF $15.00 $4,500.00 470 $7,050.00
12 4"CONC SIDEWALK(CO#3) 8 SF $5.00 $40.00 69.6 $348.00
13 60"CONCRETE DRIVEWAY(CO#3) 765 SF $7.00 $5,355.00 134.42 $940.94
14 6"CONC CURB AND GUTTER 185 LF $32.00 $5,920.00 215.21 $6,886.72
15 BLOCK SOD PLACEMENT 80 SY $10.00 $800.00 160 $1,600.00
16 SEEDING HYDROMULCH 430 SY $3.00 $1,290.00 583 $1,749.00
17 TRENCH SAFETY(CO#3) 1270 LF $1.00 $1,270.00 1078.16 $1.078.16
18 SERVICE REINSTATEMENT PIPE 6 EA $1,600.00 $9,600.00 6 $9,600.00
ENLARGMENT(CO 02)
19 4"SEWER SERVICE 4 EA $1,100.00 $4,400.00 5 $5,500.00
20 4"SEWER SERVICE 2-WAY CLF.ANOIJT 4 EA $250.00 $1,000.00 5 $1,250.00
22 8"DIP SEWER PIPE 100 LF $200.00 $20,000.00 30 $6,000.00
23 6"PVC SEWER PIPE 25 LF $42.00 $1,050.00 15 $630.00
24 WASTEWATER ACCESS CHAMBER 1 EA $2,500.00 $2,500.00 1 $2,500.00
25 4'MANHOLE(CO#2) 21 EA $3,700.00 $77,700.00 13 $48,100.00
26 EPDXY MANHOLE LINER(CO#3) 43 VF $250.00 $10,750.00
27 4'SHALLOW MANHOLE 1 EA $2,000.00 $2,000.00
29 TRAFFIC CONTROL(CO#3) 7 MO $1,500.00 $10,500.00 7 $10,500.00
30 ABANDON 8"SEWER AND FILL WITH 109 LF $5.00 $545.00 651 $3,255.00
FLOWABLE FILL
31 CONCRETE ROCKWALL INSTALLED(CO#1) 1 LS $5,154.40 $5,154.40 1 $5,154.40
32 PRE-CCTV(CO#1) 1535 LF $3.00 $4,605.00 903 $2,709.00
33 POST CCTV(CO#1) 2293 LF $2.00 $4,586.00 837 $1,674.00
34 MANHOLE OUTSIDE DROP CONNECTION(CO 1 EA $2,200.00 $2,200.00 1 $2,200.00
#3)
35 DIA MANHOLE EXTRA DEPTH(CO#3) 20.5 VF $350.00 $7,175.00 20.5 $7,175.00
36 CLEANOUT CASTING(CO#3) 1 EA $900.00 $900.00 I $900.00
37 EXTRA DEPTH FOR SF.WF.R PIPE(CO 03) 479 LF $5.00 $2,395.00 479 $2,395.00
38 7"CONCRETE VALLEY GUTTER(CO#3) 80 SF $10.00 $800.00 297 $2,970.00
39 EXPOSED AGG CONCRETE(CO#3) 420 SF $10.00 $4,200.00 444.97 $4,449.70
Sub-Total of Previous Unit $438,126.40 $347,739.34
Wednesday,September 09,2015 Page 3 of 5
City Project Numbers 01490 DOE Number 6671
Contract Name SANITARY SEWER REHABILITATION CONTRACT 78 Estimate Number 20
Contract Limits Payment Number 20
Project Type WATER&SEWER For Period Ending 723/2015
Project Funding
Contract Information Summary
Original Contract Amount $608,000.00
Change Orders
Change Order Number 1 $21,050.57
Change Order Number 2 $45,723.17
Change Order Number 3 $85.00
Total Contract Price $674,858.74
4"4Dat ( /A/ Total Cost of Work Completed $579,941.48
Con r Less %Retained $0.00
Net Earned $579,941.48
Dat
Inspection Supervisor Earned This Period $117,642.96
5/tr��s Retainage This Period $0.00
,r9LLDZ Date ( Less Liquidated Damages
oject Mar
r
9 Days® /Day $0.00
Date — `��/Qr LessPavement Deficiency $0.00
Ass ctor/fPW-Infrastructure Design and Construction Less Penalty $0.00
Date Less Previous Payment $462,298.52
Director/Con ng Department Plus Material on Hand Leu 15% $0.00
Balance Due This Payment $117,642.96
Wednesday,September 09,2015 Page 4 of 5
CRY SECIRRYAW �
CONTRACT 140. >
Fv_ RT WO RT H City of Fort worth
Change Order Request
Project Name:I Sanitary Sewer Rehabilitation Contract 78 City Sec No.: 1 45587
Project No.(s): P258.707170149083 DOE No. 6671 CltyProj.No.:J 01490
Project Description: The replacement of water and sanitary sewer mains on Oakmont Lane,Pershing Avenue,Home Street and a Sanitary
Sewer Easement
Contractor: Jackson Construction,Ltd. Change Order# Date: 4/15f2015
City Project Mgr.1 Roberto C.Sauce a City Inspector. Martina Salinas
Phone Number:l817-392-2387 -� Phone Number: 817-305-3321
Dept. Water Sewer Totals Contract Time
(Calender days)
Original Contract Amount $203,404.00 $404,596.00 z $ (7$jtTQQ t10° 210
Extras to Date $33,328.34 $33,445.40 4 $ 0,w7� =?060
Credits to Date ,
Pending Change Orders(in M&C Process) Zsw, - 4
Contract Cost to Date
Amount of Proposed Change Order 030 i
r
Revised Contract Amount $ j7sz: 43 12fr 41) °•". $Q
Original Funds Available for Change Orders $10,170.00 $20,230.00 (} , ;10 .
Remaining Funds AvaWle.for this C0 jj
Additional Funding(d necessary)
CHANGE ORDERS to DATE(INCLUDING THIS ONE)AS%OF ORIGINAL CONTRACT
MAX ALLOWABLE CONTRACT AMOUNT(ORIGINAL CONTRACT COST+25%) $7601QQa.DO`
_ 5
The change order will provide for the following increased and additional pay item quantities for the
following that are necessary on the project due to actual field conditions that were encountered during t
construction. y
i
t
• Permanent asphalt pavement repair
• Traffic control :
• Exposed aggregate driveway x FO
0000
• Extra depth on sewer pipe �:1 See, oa 4p
• 7-inch concrete valley gutter
8�
• 4-foot diameter manholel
��°�unaooa� y
Z$,0 ,S
Staff concurs with the contractor's request for 30 additional calendar days on the pr
It is understood and agreed that the acceptance of this Change Order by the contractor constitutes an accord and satisfaction and represents payment k
1
In full(bath time and money)for ad costs arising out of,or Incidental to,the above Change 03*
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M&C Number NIA M&C Date Approved NIA',
i
i
FORT WORTH City of Fort worth
Change,Order Additions i
Project Name I Sanitary Sewer Rehabilitation Contract 78 City Sec No.: 45587 i
i
Project No.(s): P258-707170149083 DOE No. 6671 City Proj.No.: 01490 j
,
Project The replacement of water and sanitary sewer mains on Oakmont Lane,Pershing Avenue,Home Street and a Sanitary
Description Sewer Easement
Contractor Jackson Construction,Ltd. Change Order: Date: 4/15/2015
r
City Project Mgr. Roberto C.Sauceda City Inspector Martina Salinas
ADDITIONS If
��*
10 T Permanent Asphalt Repa r Sewer 989.00 LF $85.50$84,065.00 PS i
17 Trench Safety Sewer 785.00 LF $1.00$785.00
29 Traffic Control Sewer 4.00 MO $1,500.00$6,000.00
34 4'Manhole Outside Drop Connection Sewer 1.00 EA $2,200.00$2,200.00
35 4'Dia.Manhole Extra Depth Sewer 20.50 VF 1 $350.00$7,175.00
36 Cleanout Casting Sewer 1.00 EA $900.00$900.00
37 Extra Depth for Sewer Pipe Sewer 479.00 LF $5.00$2,395.00 i
38 7'Concrete Valley Gutter Sewer 80.00 SF $10.00$800.00
39 Exposed Agg Concrete Dwy Sewer 420.00 SF $10.00$4,200.00
i
s
S
3
1
7
Water
Sewer $108,520.00
Page 2 of 4 Additions Sub Total 1$108,520.00
EQA- 21 W.-C r" City of Fort Worth
�"" "'I""""'"�� Change Order Deletions
Project Name Sanitary Sewer Rehabilitation Contract 78 City Sac No.: 45587
Project No.(s); P258-707170149083 D 0 E No. r66711 City Proj.No,: 01490
Project Description The replacement of water and sanitary sewer mains on Oakmont Lane,Pershing Avenue,Home Street and a
Sanitary Sewer Easement
Contractor Jackson Construction,Ltd. Change Order, Date 4115/201
City Project Mgr, Roberto C.Sauceda City Inspector: FMadina Salinas
DELETIONS
i
DEEM ��� h �`� rt(i"�t+� � U���
I
i
4 6 Inch CIPP Sewer 835.00 LF $90.00$75,150.00
6 Service Recannectlon(C1PP) Sewer 2.00 EA $325.00$650.00
8 Remove Sewer Manhole Sewer 5.00 EA $500.00$2,500,00
11 Temporary Asphalt Pavement Repair Sewer 500.00 LF $15.001$7,500.00 I
12 4"Conc Sidewalk Sewer 407.00 SF $5,001$2,035.00
13 6"Concrete Driveway Sewer 200.00 SF $7.00$1,400.00
21 4°Sewer Service Private Relocation Sewer 120.00 LF $35.00$4,200.00
26 Epoxy Manhole Uner Sewer 60.00 VF $250.00$15,000.00 1
t
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Water
Sewer $108,435,00 t
t
Page 3 of 4 Deletions Sub Total 1$108,435.00
e
if
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MfWBE Breakdown for this Change Order
- - I
Total . 5 GYM���rM`� �
Q °
Previous Change Orders
-12
t YS r
'z -atilt, :3- z4 - T
Total
7
1
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9
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Page 4 of 4
CONSTRUCTION LTD.
5112 SUN VALLEY DRIVE
FORT WORTH,TX 76119
TEL 817-572-3303
FAX:817-478-0443
Affidavit of All Bills Paid
STATE OF TEXAS
KNOW ALL MEN BY THESE PRESENTS:
COUNTY OF TARRANT
I, Troy L. Jackson, of the undersigned principal hereby certify that all
obligations, claims and debts due laborers, materialmen, subcontractors,
suppliers, and others incurred in or contingent to the performance of the
work on the project known as Sanitary Sewer Rehabilitation Contract 78 in the
City of Fort Worth,Texas have been fully paid.
This affidavit is made for the purpose of obtaining payment from the
City of Fort Worth on above construction work.
Subscribed and sworn to before me this Jackson Construction, Ltd. j
Principal
3rd y of September, 0 5
By: CC
Notary Signature Troy L. Jack on,Vic resident
Commission Expires: 04/06/2016
' CARMEN L.ESTEP
g_-A
?r° `m= Notary Public,State Of Texas
My Commission Expires
April 06, 2016
CONSENT OF SURETY OWNER ❑
TO FINAL PAYMENT ARCMTrrCT o
AIADsoct~W G707 CONTRACTOR ❑
SURETY X7
Bond No. BCD1009441 DTA 0
TO OWNEEL ARCHITECT"s PROJECT NO.:
rnbwand&*iw)
City of Fort Worth,Texas
CONTRACT FOR:Sewer Rehabilitation
PROJECT: CONTRACT DATED:
Sewer Rehab/Contract 78
In accordance with the provlsi=of the Contrxt between the Owner and tfie Contractor as hrdic=W aUove,the
0*Wnesse*lodd%.+egr*&n j
The Hanover Insurance Company
440 Lincoln Street
Worcester MA 01653
SURETY,
on bond of
fjnWff name and addr M gr'tb+urWaW)
Jackson Construction, Ltd.
5112 Sun Valley Drive
Fort Worth TX 76119
, CONTRACTOR
hereby approves of the final payment to the Contrz=,and agrees that Anal payment to the Contractor shall ntx relieve the Surety of
any of m obiigattom to
~n~ard i hA qfO"gol
City of Fort Worth,Texas
OWNER,
as set forth in said Surety's bond
IN WITNESS WHEREOF,the surety has hereunto mks hand out this date: September 3,2015
llnant tnx�led�tAraooethj6�Jareedb,Tterdlweandj.r+..1
The Hanover Insurance Company
_ (3�rntrerrgf r1
AUM Jack M. Crowley Attomey-in-Fact
(sea),
rP„aned+»+eemddde)
Surety Phone No. 508-853-7200 x-4476
UM-1994
THE HANOVER INSURANCE COMPANY
MASSACHUSETTS BAY INSURANCE COMPANY
CITIZENS INSURANCE COMPANY OF AMERICA
POWERS OF ATTORNEY
CERTIFIED COPY
KNOW ALL MEN BY THESE PRESENTS: That THE HANOVER INSURANCE COMPANY and MASSACHUSETTS BAY INSURANCE COMPANY,both being
corporations organized and existing under the laws of the State of New Hampshire,and CITIZENS INSURANCE COMPANY OF AMERICA,a corporation
organized and existing under the laws of the State of Michigan,do hereby constitute and appoint
Steven R.Foster,Jack M.Crowley,Patricia A.Smith and/or Marie Perryman
of Dallas,TX and each is a true and lawful Attorney(s)-in-fact to sign,execute,seal,acknowledge and deliver for,and on its behalf,and as its act and deed
any place within the United States,or,if the following line be filled in,only within the area therein designated any and all bonds,recognizances,undertakings,
contracts of indemnity or other writings obligatory in the nature thereof,as follows:
Any such obligations in the United States,not to exceed Thirty Five Million and No/100($35,000,000)in any single instance
and said companies hereby ratify and confirm all and whatsoever said Attorney(s)-in-fact may lawfully do in the premises by virtue of these presents.
These appointments are made under and by authority of the following Resolution passed by the Board of Directors of said Companies which resolutions
are still in effect:
"RESOLVED,That the President or any Vice President,in conjunction with any Vice President,be and they are hereby authorized and empowered to appoint
Attomeys-in-fact of the Company,in its name and as its acts,to execute and acknowledge for and on its behalf as Surety any and all bonds,recognizances,
contracts of indemnity,waivers of citation and all otherwritings obligatory in the nature thereof,with power to attach thereto the seal of the Company.Any such
writings so executed by such Attomeys-in-fact shall be as binding upon the Company as if they had been duly executed and acknowledged by the regularly
elected officers of the Company in their own proper persons."(Adopted October 7,1981 -The Hanover Insurance Company;Adopted April 14,1982-
Massachusetts Bay Insurance Company;Adopted September 7,2001-Citizens Insurance Company of America)
IN WITNESS WHEREOF, THE HANOVER INSURANCE COMPANY, MASSACHUSETTS BAY INSURANCE COMPANY and CITIZENS INSURANCE
COMPANY OF AMERICA have caused these presents to be sealed with their respective corporate seals,duly attested by two Vice Presidents,
this 5th day of December 2011.
THE HANOVER INSURANCE COMPANY
,"4as�, MASSACHUSETTS BAY INSURANCE COMPANY
11 a�ccr ; Ir i�g CITIZENS SURANCE pMPANY OF AMERICA
SEAL
Robert Tomas.Virc President
THE COMMONWEALTH OF MASSACHUSETTS
COUNTY OF WORCESTER )ss. Joe�rertstrom,Vice President
On this 5th day of December 2011 before me came the above named Vice Presidents of The Hanover Insurance Company,Massachusetts Bay Insurance
Company and Citizens Insurance Company of America,to me personally known to be the individuals and officers described herein,and acknowledged that the
seals affixed to the preceding instrument are the corporate seals of The Hanover Insurance Company,Massachusetts Bay Insurance Company and Citizens
Insurance Company of America, respectively, and that the said corporate seals and their signatures as officers were duly affixed and subscribed to said
instrument by the authority and direction of said Corporations.
BARBARA A.GARL1CK
c Notary Public
3 Cemm4nweatlh of Massachusdle
`3 "� ty itmrn;uim E�pr�s Sept.21,218
Barbara A.Garlick, Notary Public
My Commission Expires September 21,2018
I,the undersigned Vice President of The Hanover Insurance Company,Massachusetts Bay Insurance Company and Citizens Insurance Company of America,
hereby certify that the above and foregoing is a full,true and correct copy of the Original Power of Attorney issued by said Companies,and do hereby further
certify that the said Powers of Attorney are still in force and effect.
This Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of The Hanover Insurance Company,
Massachusetts Bay Insurance Company and Citizens Insurance Company of America.
"RESOLVED,That any and all Powers of Attorney and Certified Copies of such Powers of Attorney and certification in respect thereto,granted and executed
by the President or any Vice President in conjunction with any Vice President of the Company,shall be binding on the Company to the same extent as if all
signatures therein were manually affixed,even though one or more of any such signatures thereon may be facsimile." (Adopted October 7, 1981-The
Hanover Insurance Company;Adopted April 14,1982-Massachusetts Bay Insurance Company;Adopted September7,2001-Citizens Insurance Company of
America)
GIVEN under my hand and the seals of said Companies,at Worcester,Massachusetts,this 4th day of September 2015.
THE HANOVER INSURANCE COMPANY
MASSACHUSETTS BAY INSURANCE COMPANY
CITIZENS INSURANCE COMPANY OF AMERICA
1 'n Margosian,Vice President
FORT WORTH
TRANSPORTATION AND PUBLIC WORKS
PIPE REPORT FOR:
PROJECT NAME: Contract 78
PROJECT NUMBER: 1490
DOE NI3MBER: 6671
WATER j
PIPE LAID SIZE TYPE OF PIPE LF
W0031 10" PVC DR-14 1745
Line A 8" C 900 1745
Line B 8" C 900 y
I
FIRE HYDRANTS: 4 VALVES(16"OR LARGER)
PIPE ABANDONED SIZE TYPE OF PIPE LF
W0031 8" Concrete 1745
Line A 4" Concrete 120
Line B 4" Concrete 120
DENSITIES: Passed
NEW SERVICES:
SEWER
PIPE LAID SIZE TYPE OF PIPE LF
L2259 8" SDR 18 848
L2259 8" Fused pipe 400
L07297 8" Fused pipe 52
L07297 8" SDR 18 249.89
L2450 8"
PIPE ABANDONED SIZE TYPE OF PIPE LF
L2259 8" concrete 479
m-163R concrete 300
DENSITIES: Passed
NEW SERVICES:
TRANSPORTATION AND PUBLIC WORKS
la The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TX 76G12-6311
(817)392-7941 •Fax:(817)392-7845
FORTWORTH REV:00/07
TRANSPORTATION AND PUBLIC WORKS
PERFORMANCE EVALUATION OF CONTRACTOR
I CONTRACTOR&PROJECT DATA
Name of Contractor Project Name
Jackson Construction Contract 78
DOE Inspector DOE Number
Martina Salinas 6671
DOE Inspector Project Manager
,t❑ Water Q Waste Water❑ Storm Drainage❑ Pavement Robert Sauceda
Initial Contract Amount Project Doiculty
$608,000.00 0 Simple O Routine 0 comPlex
Final Contract Amount Date
$674,858.74 9/7/2015
111)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 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 3 E60
0 45
6 Finished Product 15 Y 3 0 45
7 Job Site Safety15 Y 4 60
8 Traffic Control Maintenance 15 Y 3 0 45
9 Dail Clean U 5 Y 3 0 15
10 Citizen's Complaint Resolution 5 Y 3 20 is
11 EE22n Restoration 5 Y 3 20 15
12 After Hours Re nse 5 Y 4 20 20
13 Project Completion 5 Y 3 20 15
TOTAL ELEMENT SCORE(A) 366
BONUS POINTS(25 Ma ximmn)(B)
TOTAL SCORE(I'S) 3"
III)CONTRACTOR'S RATING
Maximum Score(MS)=448 or sum of applicable element score maximums which= 4llt
Rating((TS/MS]•100%) 366 / 448 = 82%
Performance Category Exodkot
<20%—Inadequate 200A to<40%=Deficient 40%to<60%=Standard 60%to<80%=Good ?$0%=Excellent
Inspector's Comments(INCLUDING EXPLANATION OF BONUS POINTS AWARDED)
Signature DOE Inspector N, Signature Contractot.,Y,�-4��
Signature DOE Inspector's Supervisor
CONTRACTOR'S COMMENTS
TRANSPORTATION AND PUBLIC WORKS
j� The City of Fort Worth•1000'Ihrockmorton Street•Fort Worth,TX 76012-6311
(817)392-7941 •I=(817)392 7845
FORTWORTH REV:02/22/07
TRANSPORTATION AND PUBLIC WORKS
CONTRACTOR'S EVALUATION OF CITY
I)PROJECT INFORMATION Date: 9(4/2015
Name of Contractor Project Name
'Jackson Construction Contract 78
DOE Inspector Project Manager
Martina Salinas Robert Sauceda
DOE Number Prrtject Difficulty 7}7e ref Cnntraet
6671 O Simple OO Routine O Complex O water p Waste Water❑ Stam Dralnagep Pavement
Initial Contract Amount Final Contract Amount
$608,000.00 $ 9;9487 8S
11)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
2 Knowledge of Inspector 2 Clarity&Sufficiency of Details
3 Accuracy of Measured Quantities 13 Applicability of Specifications
4 Display Of Professionalism 4 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 Chane Order Processing Time 3 Communication
2 Timliness of Contractor Payments 14 Resolution of Utility Conflicts
3 Bid Opening to Pre-Con Meeting Timeframe
111)COMMENTS&SIGNATURES
COMMENTS
Signature Contractor
Signature DOE Inspector 1
Signature DOE Inspector's Supervisor
INSPECTOR'S COMMENTS
TRANSPORTATION AND PUBLIC WORKS
t The City of Fort Worth-1000 Throckmorton Street-Fort Worth,TQC 76012-6311
(817)392-7941 -Fax:(817)392-7845
FORTWORTH.
TRANSPORTATION AND PUBLIC WORKS
STATEMENT OF CONTRACT TIME
STATEMENT#
FINAL STATEMENTN DOE
NAME OF PROJECT: IMN. 78 Contractor
YEAR: 2015
PROJECT NO.: FINAL INSPECTION DATE
18 WD CD'
CONTRACT TIME
PERIOD FROM: F BROWTO: -MID Mouth
WORK ORDER EFFECTIVE: I iBE13. -1 NID I n 106.3%
DAY OF MONTH DAYS REASON FOR DAY OF MONTH DAYS REASON FOR
CHARGED DAYS CREDITED CHARGED DAYS CREDITED
1 16 Sac 0
2 _ 17 Sun 0
3 18 Mon 0 -
4 19 Tue 0 pU4
5 20 Wed 0
6 21 Thu 0 - HA
7 22 Fri 0 Pdll
8 23 Sat 0 _ NA
9 24 Sun 0 P+I
10 25 Mon 0 PJA,
11 26 Tue 0 NA,
12 27 Wed 0 NA
13 28 Thu 0 NA
14 29 Fr. 0
15 30 Sa: 0 MA
31 Sun 0 NA
77r
Not Applicable SAT,SUN,and WEATHER UTILITIES OTHERS DAYS TOTAL DAYS
HOLIDAYS RELOCATE CHARGED
THIS PERIOD 0 0 0 0 0 0
PREVIOUS PERIOD 255
TOTAL TO DATE 0 0 0 0 255 255
REMARKS:
OFFICIAL RECORD
CM SECRY
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