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FORTWORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name LAKE VISTA RANCH
Contract Limits
Project Type WATER&SEWER
City Project Numbers 02393
DOE Number 7322
Estimate Number I Payment Number 1 For Period Ending 10/15/2015
CD
City Secretary Contract Number 117322 Contract Time 18ED
Contract Date Days Charged to Date 191
Project Manager Long Contract is 100.00 Complete
Contractor GILCO CONTRACTING,INC.
6331 SOUTHWEST BLVD.
BENBROOK, TX 76132-1063
Inspectors LAYER / TAEZAZ
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Thursday,October 15,2015 Page 1 of 4
City Project Numbers 02393 DOE Number 7322
Contract Name LAKE VISTA RANCH Estimate Number I
Contract Limits Payment Number 1
Project Type WATER&SEWER For Period Ending 10/15/2015
Project Funding
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WATER
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Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total I
----- -------- ---------------------
1 8"PVC WATER PIPE 4712 LF $2028 $95,559.36 4712 $95,559.36
2 8"GATE VALVE 13 EA $1,230.00 $15,990.00 13 $15,990.00
3 6"GATE VALVE 8 EA $850.00 $6,800.00 8 $6,800.00 j
4 FIRE HYDRANT 8 EA $2,740.00 $21,920.00 8 $21,920.00 i
5 16"X8"TAPPING SLEEVE&VALVE 1 EA $4,000.00 $4,000.00 1 $4,000.00
6 1"WATER SERVICE 124 EA $720.00 $89,280.00 124 $89,280.00
7 TRENCH SAFETY 4712 LF $0.10 $471.20 4712 $471.20
8 4'WIDE ASPHALT PVMT REPAIR 24 LF $83.00 $1,992.00 24 $1,992.00
9 TRAFFIC CONTROL 1 MO $1,500.00 $1,500.00 1 $1,500.00
10 DUCTILE IRON WATER FITTINGS 1.4 TN $3,650.00 $5,110.00 1.4 $5,110.00
W/RESTRAINT
Sub-Total of Previous Unit $242,622.56 $242,62156
SEWER
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
1 8"SEWER PIPE 4217 LF $25.86 £109,051.62 4217 $109,051.62
2 8"SEWER PIPE CSSBACKFILL 547 LF $44.50 $24,341.50 547 $24,341.50
3 4"SEWER SERVICE 124 EA $520.00 $64,480.00 124 $64,480.00
4 4'MANHOLE 23 EA $2,145.65 $49,349.95 23 $49,349.95
5 TRAFFIC CONTROL 1 MO $1,500.00 $1,500.00 1 $1,500.00
6 CONCRETE ENCASE SEWER PIPE 142 CY $60.00 $8,520.00 142 $8,520.00
7 4'WIDE ASPHALT PVMT REPAIR 24 LF $86.00 $2,064.00 24 $2,064.00
8 POST CCTV INSPECTION 4764 LF $1.40 $6,669.60 4764 $6,669.60
9 TRENCH SEAFETY 4764 LF $1.00 $4,764.00 4764 $4,764.00
10 MANHOLE VACUUM TESTING 23 EA $91.31 $2,100.13 23 $2,100.13
11 4'EXTRA DEPTH MANHOLE 53 VF $100.00 $5,300.00 53 $5,300.00
12 EPDXY MANHOLE LINER 5 VF $180.00 $900.00 5 $900.00
13 CONNECT TO EX MANHOLE I EA $1,500.00 $1,500.00 1 $1,500.00
Sub-Total of Previous Unit $280,540.80 $280,540.80
Thursday,October 15,2015 Page 2 of 4
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City Project Numbers 02393 DOE Number 7322
Contract Name LAKE VISTA RANCH Estimate Number 1
Contract Limits Payment Number 1 f
Project Type WATER&SEWER For Period Ending 10/15/2015
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Project Funding
Contract Information Summary
Original Contract Amount $523,163.36
Change Orders
Total Contract Price $523,163.36
Date Total Cost of Rork Completed $523,163.36
tra ))) Less %Retained $0.00
Date / Net Earned $523,163.36
/
Inspectioil Su so Earned This Period $523,163.36
Retainage This Period $0.00
Date `✓`G'201„
Less Liquidated Damages
Project Man
Days @ /Day $0.00
Date
'��' LessPavement Deficiency $0.00
Asst,Dire 4X--Iaasirue Design and ons etion Less Penalty $0.00
/ Less Previous Payment $0.00
P,Director!Contracting Dep nt Plus Material on Hand Less 15% $0.00
Balance Due This Payment $523,163.36
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Thursday,October 15,2015 Page 3 of 4
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City Project Numbers 02393 0 V 5 DOE Number 7322
Contract Name LAKE VISTA RANCH ' Estimate Number 1
Contract Limits Payment Number I
Project Type WATER&SEWERS For Period Ending 10/15/2015
Project Funding
Project Manager Long City Secretary Contract Number 117322
Inspectors LAYER TAEZAZ Contract Date
Contractor GILCO CONTRACTING,INC. Contract Time 180 CD
6331 SOUTHWEST BLVD. Days Charged to Date 191 CD
BENBROOK, TX 76132-1063 Contract is .000000 Complete
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CITY OF FORT WORTH I
SUMMARY OF CHARGES
Line Fund Account Center Amount Gross Retainage Net
Funded
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Total Cost of Work Completed $523,163.36
Less %Retained $0.00
Net Earned $523,163.36
6
Earned This Period $523,163.36
Retainage This Period $0.00
Less Liquidated Damages
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0 Days @ $0.00 /Day $0.00 f
LessPavement Deficiency $0.00
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Less Penalty $0.00
Less Previous Payment $0.00
Plus Material on Hand Less 15%
$0.00
Balance Due This Payment $523,163.36
Thursday,October 15,2015 Page 4 of 4
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FORTWORTH rev 03/05/07
TRANSPORTATION&PUBLIC WORKS
FINAL STATEMENT OF CONTRACT TIME
FINAL STATEMENT NO.I
NAME OF PROJECT: Lake Vista Ranch Phase I
PROJECT NO.: 2393 CONTRACTOR: Gilco Contracting,Inc.
DOE NO. 7322
PERIOD FROM-03/31/15 TO: 10/715 FINAL INSPECTION DATE: 7-Oct-15
WORK ORDER EFFECTIVE 3/31/2015 CONTRACT TIME 180 0 WD *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.
S. 23.
9. 24.
10, 25.
Il. 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 191
PERIOD
PREVIOUS
PERIOD
TOTALS 191
TO DATE
*RE ARKS: A
u
A
u T
All L/
C I' XT C T DATE INSP CTOR D)m(rE
ENGINEERING DEPARTMENT
Tlic City of Fort Worth- 1000 Throckmorton Street•Fort Worth, x 76012-63 11
(817)392-7941 •Fax:(817)392-7845
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FORTWORTHREV:0-1/20/07
TRANSPORTATION AND PUBLIC WORKS
PERFORMANCE EVALUATION OF CONTRACTOR
1) CONTRACTOR&PROJECT DATA
Name of Contractor ProjeciName
Gilco Construction,Inc. bake Vista Ranch Phase 1
DOEIWector DOE Number
Rudy Medellin 7322
DOE Inspector Project Manager
Q Water Q Waste Water El Storm Drainage R1 Pavement Aaron Long
Initial ContractAmoamt Project Difficulty
$1,751,328.23 O Simple OO Routine O Complex
Final ContractAmount Date
$1,751,328.23 10/6/2015
11)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 ofDocuments 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 4 60 60
5 Work Performed 15 Y 3 60 45
6 Finished Product 15 Y 4 60 60
7 Job Site Safety 15 Y 3 60 45
8 Traffic Control Maintenance 15 Y 4 60 60
9 Daily Clean Up 5 Y 3 20 15
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 4 20 20
TOTAL ELEMENT SCORE(A) 406
BONUS POINTS(25 Maximum)(B)
TOTAL SCORE(TS) 406
CONTRACTOR'S RATING
Maximum Score(MS)=448 or sum of applicable element score maximums which= 448
Rating([TS/MS]*100%) 406 / 448 = 91%
Performance Category Excellent
<20%=Inadequate 20%to<40%=Deficient 40%to<60%=Standard 60%to<80%=Good/ 80%=Fxcellent
Inspector's Comments(INCLUDING EXPLANATION OF BONUS POINTS AWARDED)
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/ /_
Signature DOE Inspector --�--�-° Signature Contractor Y 't
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 •Fag: (817)392-7845
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BTL*J I Lake Vista Development, L. P.
901 Airport Freeway,Suite 40.0
North Richland Hills,Texas 76180
(817)849-5100 Fax(8t7)849-5101
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October 2,2015
Mr.Dale Gilreath
Gilco Contracting, Inc.
6331 Southwest Blvd.
Beribrook,Texas 76132
Re: Lake Vista Ranch, Ph, 1
Water, Sewer,Paving,Drainage, and Street Light Improvements
CoFW Project No. 02393
CoFW File No. W-2350
CoFW DOE No, 7322
Dear Mr. Gilreath,
This letter will document that BNM Lake Vista Development,L.P..confirms that Gilco
Contracting,Inc. has completed the work associated with the above referenced contract in an
appropriate time frame, subject to completion of any warranty or maintenance work as identified
and required by the City of Fort Worth,and that no liquidated damages will be assessed by.BNM
Lake Vista Development,L.P. in connection with the work.
Sincerely,
y�
Bruce French
BNM:Lake Vista Development,L.P.
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cc: File,Lake Vista(Development)
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H:VMTERHEADIHNM Lake.Vista Development LP.dbcx
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October 2, 2016
City of Fort Worth
CFA Administration
1000 Throcknorton St.
Fort Worth, TX 76102 j
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RE: Final Waiver of Lien; Paving and Street Light Improvements to serve West Fork
Ranch Phase 813: DOE#7322 City Project#02393 j
The purpose of this letter is to acknowledge that we have been paid in full by Jabez f
Development,L.P. for the public improvements constructed to serve Lake Vista Ranch,
Ph. 1,in Fort Worth,Texas. As a result,we hereby waive,release and relinquish all
rights to assert any claim or demand for lien in connection with this project.
Please feel free to contact me with any questions you may have.
Sincerely,
i eia Hubbard
Operations Director
6331 Southwest Blvd.
Benbrookc, Texas 76132
Office: 817.735.1600
Fax: 817.735.1613
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AFFIDAVIT
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STATE OF TEXAS
COUNTY OF TARRANT
Before me the undersigned authority, public in the state
� tY� a notary p
and county aforesaid, on this day personally appeared Leia Hubbard,
Operations Director Of Gilco Contracting, Inc.,known to me to be a
credible person,who being by me duly sworn,upon her oath deposed and
said;
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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;
Paving and Street Light Improvements to serve: Lake Vista Ranch,Ph. I
BY Leia Hubbard
Subscribed and sworn before me on this 2nd of October ,2015.
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MARY PANNELL `y \
�yp9a
Notary Public,State of Texo§ j
My commission Expim Notaroublic
October 19, 2010 Tarrant County, TX
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CONSENT OF OWNER ❑
SURETY COMPANY ARCHITECT ❑
CONTRACTOR ❑
TO FINAL PAYMENT SURETY ❑
Conforms with the American Institute of OTHER
Architects, AIA Document G707
Bond No 022050638
PROJECT: Lake Vista Ranch-Water,Sewer, Paving, Drainage&Street Lights
(name, address)
Fort Worth TX
TO (Owner)
BNM LAKE VISTA DEVELOPMENT,LP&CITY OF ARCHITECT'S PROJECT N0:
FORT WORTH CONTRACT FOR:
9001 Airport Freeway,Suite 400 Lake Vista Ranch-Water,Sewer,Paving, Drainage&Street Lights
Fort Worth TX 76180 CONTRACT DATE:
CONTRACTOR:GILCO CONTRACTING,INC.
In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above,the
Ihere insert name and address of Surety Company)
LIBERTY MUTUAL INSURANCE COMPANY
175 Berkeley Street
Boston MA 02116 , SURETY COMPANY
on bond of there insert name and address of Contractor)
GILCO CONTRACTING,INC_
6331 Southwest Boulevard
Benbrook TX 76132 , CONTRACTOR,
hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve
the Surety Company of any of its obligations to (here insert name and address of Owner)
BNM LAKE VISTA DEVELOPMENT,LP &CITY OF FORT WORTH
9001 Airport Freeway,Suite 400
Fort Worth TX 76180 , OWNER,
as set forth in the said Surety Company's bond,
IN WITNESS,WHEREOF,
the Surety Company has hereunto set its hand this 2nd day Of October,2015
LIBERTY MUTUAL INSURANCE COMPANY
OSurety Q�� Co mpany
Attest: eII AWestbrook
(Seal): Signat6re of Authorized Representative
Sophinie Hunter Attorney-in-Fact
Title
NOTE: This form is to be used as a companion document to AIA DOCUMENT 6706, CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS,
Current Edition
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ONE PAGE
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THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND.
This Power of Attorney limits the acts of those named herein,and they have no authority to bind the Company except in the manner and to the extent herein stated.
Certificate No.7111256
American Fire and Casualty Company Liberty Mutual Insurance Company
The Ohio Casualty Insurance Company West American Insurance Company
POWER OF ATTORNEY
KNOWN ALL PERSONS BY THESE PRESENTS:That American Fire&Casualty Company and The Ohio Casualty Insurance Company are corporations duly organized under the laws of
the State of New Hampshire,that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts,and WestAmerican Insurance Company
is a corporation duly organized under the laws of the State of Indiana(herein collectively called the'Companies'),pursuant to.and by-authodty.herein set forth,does hereby name,constitute
and appoint, Don E.Cornell;Kelly K Westbrook;:Ricardo J.Repna,Rotibi Morales;Sophinie Hunter;:V_.DeL.ene Marshall
all of the city of Dallas state of:TX each_ind_ividually_if there be more fhan one named,its true and.lawful attorney-in-fact-to make,execute,seal,acknowledge
and deliver,for and on its behalf as surety and m its act anddeed any and all undertakings,bonds,dcognlzances and otheh surety obligations 1n"pursuance of these presents and shall
be as binding upon the Companies as if they have been.duty signed by the president and attested by the secretary of the Companies in their owtrproper persons.
IN WITNESS WHEREOF,this Power ofAttomeyhas been subscribed by an authorized officer or-official of the.Companies and.the corporate seals of the Companies have been affixed
theretothis 11th day of September %2015
Pao case - LzY INS wsuR N tNSOy American Fire and Casualty Company
��r` The Ohio Casualty Insurance Company N
a 1906 0 0 7919 } 1912 o z Liberty Mutual Insurance Company m
1991 West Amercan Insurance Company
N 'r•'yy`"!.araes���a �',y "harnvs��Ja ij�acvs,' f<' °:�anT r �
(D * 1 * * * By. Q
are
STATE OF PENNSYLVANIA ss David M.C ;'Assistant Secretary C
as
cc
«_ COUNTY OF MONTGOMERY
pr On this 11th day of September 2015 before me personally appeared David M. Carey,who acknowledged himself to be the Assistant Secretary of American Fire and u I'
0 aD Casualty Company,Liberty Mutual Insurance Company,The Ohio Casualty Insurance Company,and West American Insurance Company,and that he,as such,being authorized so to do, >,�
p execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. LL!
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Li e
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SURETY
Important Notice
TO OBTAIN INFORMATION OR TO MAKE A COMPLAINT:
You may write to Liberty Mutual Surety at:
Liberty Mutual Surety
Interchange Corporate Center
450 Plymouth Road, Suite 400
Plymouth Meeting, PA 19462-8284
You may contact the Texas Department of Insurance to obtain information on
companies, coverages, rights or complaints at:
1-800-252-3439
You may write the Texas Department of Insurance:
P. O. Box 149104
Austin, TX 78714-9104
Fax: (512) 475-1771
Web: http://www.tdi.state.tx.us
E-mail: ConsumerProtectionCa),tdi.state.tx.us
Premium or Claim Disputes
Should you have a dispute concerning a premium, you should contact the agent first. If you
have a dispute concerning a claim, you should,contact the company first. If the dispute is not
resolved, you may contact the Texas Department of Insurance.
Attach This Notice To Your Policy:
This notice is for information only and does not become a part or condition of the
attached document.
LMIC-3500
FORTWORTH
TRANSPORTATION AND PUBLIC WORKS
PIPE REPORT FOR:
PROJECT NAME: Lake Vista Ranch Phase I
PROJECT NUMBER: 2393
DOE NUMBER: 7322
WATER
PIPE LAID SIZE TYPE OF PIPE LF
Water 811 PVC 4712
FIRE HYDRANTS: 8 VALVES(1611 OR LARGER)
PIPE ABANDONE D SIZE TYPE OF PIPE LF
DENSITIES: Yes
NEW SERVICES: Copper 2480
SEWER
PIPE LAID SIZE, TYPE OF PIPE, LF
Sewer 811 PVC 4217
PIPE All ANDONE,D SIZE TYPE OF PIPE LF
DENSITIES: Yes
NEW SERVICES: 4" PVC 2480
TRANSPORTATION AND PUBLIC WORKS
The City of Fort Worth-1000'nirockmoiton Street-Fort Worth,TX 76012-6311
(817)392-7941 -Fax:(817)392-7845
FORTWORTHREV:02l22l07
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TRANSPORTATION AND PUBLIC WORDS
CONTRACTOR'S EVALUATION OF CITY
I)PROJECT INFORMATION Date: 10/6/2015
Name of Contractor {Project Name
Gilco Contracting,Inc. (Lake Vista Ranch Phase 1
IDOE Inspector Pr4lect Manager
jRudy Medellin Aaron Lon
DOENennber Project Difficulty ?Type of Contract
7322 IO Simple *Routine O Complex I R]Water E]Waste Water 0 Storm Drainage Pavement
Initial Contract Amount IFina1 ContractAmount
$1,751,328.23 $1,751,328.23
II)PERFORMANCE EVALUATION
0-Inadequate 1-Deficient 2-Standard 3-Good 4-Excellent
ELENM'NI' RATING ELEMENT RATING
1INSPECTIONEVALUATION� 4PLANS&SPECIFICATIONS _ {
1 Availability of Inspector — — _ �1 Accuracy of Plans to Existing Conditions�w F—Tt
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12 Knowledge of Inspector _ _ i �. ��Clarity&Sufficiency of Details ( (.
3 Accuracy of Measured Quantities 0 3 Applicability of Specifications
4 Display Of Professionalism I C 1 14 Accuracy of Plan Quantities
5 Citizen Complaint Resolution _ �� (PROJECT MANAGER EVALUATION
6 Performance-jettt&lp Valve Crews Labs 1 Knowledge And/Or Problem Resolution
12 Availability of Project Manager
1 Change Order Processing Time _
3 Communication
IAD�ISTRATION I._
imlmess of Contractor Payments J4 Resolution of Utility Conflicts L c
3 Bid Opening to Pre-Con Meeting Timefr ame
III)COMMENTS&SIGNATURES
COMMENTS
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Signature Contractor
Signature DOE Inspector "r
Signature DOE Inspector's Supervisor
INSPECTOR'S COMMENTS
TRANSPORTATION AND PUBLIC WORKS
? The City of Fort Worth-1000 Th2ockmorton Street-Fort Worth,TX 76012-6311
(817)392-7941 -Fag:(817)392-7845