WA9801-CS000119SHIMEK, JACOBS & FINKLEA, L.L.P.
CONSULTING ENGINEERS
FILE COPY
8333 Douglas Avenue, #820 Dallas, Texas 75225-5816 Fax (214) 361-0204 Phone (214) 361-7900
ROSS L. JACOBS. P.E.
RONALD V. COI~,VAY, P.E.
JOHN W. BIRKHOFF, P.E.
JOE R. CARTER. P,E.
GARY C. HENDRICKS. P.E.
January 19, 2000
Mr. Kenneth M. Griffin, P.E.
City of Coppell
Post Office Box 478
Coppell, Texas 75019
Re: State Highway 121 Water Line
Project No. WA-98-01; Bid No. Q-0199-02
Dear Mr. Griffin:
We are enclosing three (3) copies of Pay Request No. 3 and Final in the amount of $29,784.58 for work
performed by H&W Utility Contractors, on the State Highway 121 Water Line through December 22, 1999.
This project is now complete.
Also enclosed are two (2) executed copies of the Contractor' s Affidavit of Final Payment & Release.
If you concur with this Pay Request, please have it executed for the City of Coppell and forward one copy
along with the payment due to H&W Utility Contractors.
Sincerely
Enclosures
co: Mr. Larry Davis
H&W Utility Contractors
" ! I
2 -,8~0204 SHII~EK,JACOSS~FI~LE PAGE
12/22/iS99 11:29 i4 ~
CONTRACTOR'S AFFIDAVIT OF FINAL PAYMENT AND RELEASE
TIlE STATE OF TEXAS §
COUNTY OF ELLIS §
("Afttaut"), who, after being by me duly sworn, deposes and says that he is ~t'e 1, i den4-
of H & W Utility Conlxactors (corporation, parmership~ trade name)
of ~ ftl-L~/ County, State of Texas (the "Co:ltl'actof'), which said Contractor was
awarded the cone. tact dated the 23rd day of March 19 99 , for the construction
of State Highway 121 Water Line, Project No. WA - 9801
in The City Coppell, Texas (the "Work"), for a total consideration of
Chic Huneked Seventy Eight Thousand, Tlu'ee Hundred Forty Four Dollars and Thin'y Four Cents ($178,344.34) Dollars
to be paid to the said Conlxactor (the "Contract"), and that Af~ant has full power of authorit>' to make this affidavit.
That The City of Coppall (the "Owner") has approved the final
estimate on said Work, and that the said Contractor has fully satisfied and pa:d any and all claitos that may be
covered by Chapter 53 of the Texas Property Code, and Article 5160 of the Revised Civil Statutes of the State of
Texas, or any other applicable sta~tes or charter provisions, and that all just bills for labor and materials have been
paid axxd discharged by said Contractor insolaf as they pertain to the Work in question.
That in addition to any funds which may have been previously paid by the Owner, the Contractor hereby
accepts the amount of Tw®aty Nine Tbousanll~ Seven Ru~dr~l Eilhty l~oar DOllmrs and FiI~ light Ce~lt$ ($ ,~S,TS4.5~) Dollam
as FULL AND FINAL PAYMENI under the aforementioned Contract, and hereby waives and releases an>. right
Af~ant and/or the Contractor may have to pursue claims of any nature agamst the Owna arising out of or in any
toanner eormected with the performance of the Work and/or the Contract, including but not limited to elmms of third
pa~ties that supplied material and/or labor for the Work for or through the Conh'actor CSubcontraciors"), as well as
claims for delay, additional compensation or tbr recovery of liquidated damages whwh may have been withheld by
th~ Owner, The Contractor shall defend, hold harmless and indemmfy the Ovmer from any such claims of such
Subcontractors. The Conln~to~ fu~her releases the O~.er from any claim or liabili~I arising fi'om any act or
neglect of the Owner related to ~r connected with the Contract. This affidavit is given pursuant to the final paylle. ent
/;-,,
l e.,, ,-,,, 4t 1" .7
SUB SCRIBED AND SWORN TO BEFORE ME, this the I./-U( day of
(Pfinl~l Nan:e
12/22/1599 11:29 214-3tT204 SHIMEK,JAOOBS~F~E PAGE 82
CONTRACTOR'S AFFIDAVIT OF FINAL PAYMENT AND RELEASE
THE STATE OF TEXAS §
§
COUNTY OF ELLIS §
BEFORE ME, the undosigned authority, on this day penonally appeare if/,/~ -t/J
<" .ant'),,vho,. erbei gbymed.lyswo ,depo.sands.y,,hath. i,
of H & W Uflli~ Contacts (go~o~a~on, p~ship, ~ade na~)
of ~ e~ Co~, State of Texas (the "C~ac~f'), whWh sa~d Con.ac~ was
aw~ded the contact da~ed the 23rd day of M~ch ~ 9 99 , f~ ~ cons~ction
of State Highway 121 Water Line, Project No. WA- 9801
~e Ci~ Coppell, T~xas (~e "Work"), for a to~l c~sid~ion of
One Hu~&ed $even~ Ei~t ~aad, ~e~ H~&~ Fo~ ~our DoIIaB ~ ~ Four ~ ($178,~34) DOlI~S
to be paid to the said Con~aclor (~e "~acP), ~d ~at Affiant has ~I1 ~w~ of au~on~ to make this
That The City of Coppell (the "Owner") llas apptoved the final
estimate on said Work, and that the said Contractor has ~lly satisfied and paid any and all claims .'hat may be
covered by Chapter 53 of the Texas Proper~ Code, and Ariicle 5160 of the Revised Civil Statutes of the State of
Texas, or an}, oth~ applicable statutes or chattel provisions, and that all just bills for labor and materials have been
paid and discharged by said Contractor insolaf as they pertain to the Work in questloB.
That in additio~ to any i~l:lds which may have been previously paid by the Owner, the Contractor hereby
accepts the amol/ln Of Twelgy ~ea Thou~,ads Seven Hoadred £iGMY Four Dollars and lriey glpt CeMs ($ 29~754.58) Dollan
as FULL AND FINAL PAY~!ENT under the aforementioned Conreset, and h~r~by waives and releases ally light
M~ant and/or the Contractor may have to pursue claims of any nature against the Owner arising out of or in any
raann~r connected with the performance o~ the Work and/or the Contract, including but not limited to claims of third
par~ies that suppiled material and/or labor for the Work For or tl~ough the Contractor ("$ubconll'actcrs"), as well as
claims for delay, additional con'~ensation or l~or ~cov~y of liquidoral damages ~vhich may have been withheld by
the Owner, The Contractor shall deTend, hold harmless and indemnify the Owner flora troy sucl~ elauns of such
Subcontractors. The Conuactor further releases the Owner from any claim or liability. arising froIll any act or
neglect of the Ovaer reh.ed to or connected with the Contract. This affidavit is gi,,'en pursuant '~o the final paymere
By
(Prinled Name) %/
SUBSCRIBED ~NrD SWORN TO BEFORE ME, thxs theaa,~afday of ,,~b¢ tem/ga--