HomeMy WebLinkAboutContract 47575-FP1 Department of TP &W Const.Services
C?N# . Data
Project anager l / '
Risk Management C adv L — ,)T Wo RT jamLT® cry SECmJ�
D.O.E. Brotherton T/ 1 '-
CFA Westerman/Scanned It-"7— (o i CONTRACT NO.
Esteban Perez/Scanned /6./�
The Proceeding people have been Contacted
concerning the request for final payment& have ATION AND PUBLIC WORKS1
released this project for such payment. F PROJECT COMPLETION S- )) ---CUo�517
Developer Projects) DOE 739
Clearance Conducted By 0"' M m City Project Ns: 02517
Regarding contract 117396 for SEVEN OAKS ADDITION,PHASE ONE 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 recommendation of the Assistant Director of the Transportation&Public Works
Department has accepted the project as complete.
p � C� CDMC
Original Contract Price: SAN 2017 $847,040.00
Amount of Approved Change Orders: $32,577.30 Ns 1
Revised Contract Amount: $879,617.30
Total Cost Work Completed: $879,617.30
ecommended for Acceptance Date
Asst. Director, TPW - Infrastructure Design and Construction
Accepted Date
Asst. Director, WATER DEPARTMENT
Asst. City Manager Date
Comments:
s
JAN 4, 2017 'k
Rev.9/22/16
L2A
C
C 5 2017City Project Numbers 02517 BDOE Number 7396
Contract Name SEVEN OAKS ADDITION,PHASE ONE Estimate Number 1
Contract Limits Payment Number 1
Project Type WATER&SEWER For Period Ending 11/28/2016
Project Funding
Project Manager Jaafazi City Secretary Contract Number 117396
Inspectors DICKINSON / DUARTE Contract Date
Contractor JACKSON CONSTRUCTION LTD Contract Time 240 CD
5112 SUN VALLEY DRIVE Days Charged to Date 240 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
Total Cost of Work Completed $879,617.30
Less %Retained $0.00
Net Earned $879,617.30
Earned This Period $879,617.30
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 $879,617.30
Monday,November 28,2016 Page 5 of 5
a (D5- a -25T7
FORT WORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name SEVEN OAKS ADDITION,PHASE ONE
Contract Limits
Project Type WATER&SEWER
City Project Numbers 02517
DOE Number 7396
Estimate Number 1 Payment Number 1 For Period Ending 11/28/2016
CD
City Secretary Contract Number 117396 Contract Time 24GD
Contract Date Days Charged to Date 240
Project Manager Jaafari Contract is 100.00 Complete
Contractor JACKSON CONSTRUCTION LTD
5112 SUN VALLEY DRIVE
FORT WORTH, TX 76119
Inspectors DICKINSON / DUARTE
Monday,November 28,2016 Page 1 of 5
� >I
City Project Numbers 02517 DOE Number 7396
Contract Name SEVEN OAKS ADDITION,PHASE ONE Estimate Number I
Contract Limits Payment Number 1
Project Type WATER&SEWER For Period Ending 11/28/2016
Project Funding
WATER
Item Description of Items Estimated Estimated Completed Completed
Quanity
No. Unit Unit Cost Total Quanity Total
P P
———————————————— —
1 DUCTILE IRON WATER FITTINGS 5 TN $5,000.00 $25,000.00 5 $25,000.00
W/RESTRAINT
2 6"PVC WATER PIPE 80 LF $18.00 $1,440.00 80 $1,440.00
3 8"PVC WATER PIPE 4175 LF $19.00 $79,325.00 4175 $79,325.00
4 16"PVC C905 WATER PIPE 3130 EA $71.00 $222,230.00 3130 $222,230.00
5 FIRE HYDRANT 4 EA $2,600.00 $10,400.00 4 $10,400.00
6 CONNECTION TO EXISTING 16"WATER LINE 1 EA $1,750.00 $1,750.00 1 $1,750.00
7 1"WATER SERVICE co#1 67 EA $590.00 $39,530.00 67 $39,530.00
8 COMBINATION AIR VALVE ASSEMBLY FOR 1 EA $10,000.00 $10,000.00 1 $10,000.00
WATER
9 6"GATE VALVE 4 EA $680.00 $2,720.00 4 $2,720.00
10 8"GATE VALVE 18 EA $1,100.00 $19,800.00 18 $19,800.00
11 16"GATE VALVE WITH VAULT 4 EA $14,500.00 $58,000.00 4 $58,000.00
12 BLOW-OFF 2 EA $8,500.00 $17,000.00 2 $17,000.00
13 4'WIDE ASPHALT PAVEMENT REPAIR co#1 1135 SY $78.00 $88,530.00 1135 $88,530.00
14 AUTOMATIC FLUSH VALVE 1 EA $4,400.00 $4,400.00 1 $4,400.00
15 UTILITY TRENCH EXCAVATION, 2900 LF $0.10 $290.00 2900 $290.00
EMBEDMENT AND BACKFILL
16 CONCRETE ENCASEMENT FOR UTILITY PIPES 22 CY $243.00 $5,346.00 22 $5,346.00
17 12"ROCK RUBBLE RIP-RAP PER DETAIL 190 SY $55.00 $10,450.00 190 $10,450.00
18 PRESSURE/STERILIZATION TESTING 7385 LF $0.50 $3,692.50 7385 $3,692.50
19 EXPLORATORY EXCAVATION 6 EA $900.00 $5,400.00 6 $5,400.00
Sub-Total of Previous Unit $605,303.50 $605,303.50
SEWER
Item Completed
Description of Items Estimated Estimated Com leted Com
No. p Unit Unit Cost P p
Quanity Total Quanity Total
1 POST CCTV INSPECTION 4225 LF $1.50 $6,337.50 4225 $6,337.50
2 MANHOLE VACCUM TESTING 17 EA $200.00 $3,400.00 17 $3,400.00
3 UTILITY TRENCH EXCAVATION, 4225 LF $1.00 $4,225.00 4225 $4,225.00
EMBEDMENT&BACKFILL
4 4"SEWER PIPE 66 LF $525.00 $34,650.00 66 $34,650.00
5 8"SEWER PIPE co#1 3737 LF $25.00 $93,425.00 3737 $93,425.00
Monday,November 28,2016 Page 2 of 5
City Project Numbers 02517 DOE Number 7396
Contract Name SEVEN OAKS ADDITION,PHASE ONE Estimate Number I
Contract Limits Payment Number I
Project Type WATER&SEWER For Period Ending 11/28/2016
Project Funding
6 8"SEWER PIPE CSS BACKFILL 80 LF $46.00 $3,680.00 80 $3,680.00
7 10"SEWER PIPE 904 LF $31.00 $28,024.00 904 $28,024.00
8 10"SEWER PIPE CSS BACKFILL 20 LF $52.00 $1,040.00 20 $1,040.00
9 4'MANHOLE 14 EA $3,000.00 $42,000.00 14 $42,000.00
10 4'EXTRA DEPTH MANHOLE 50 VF $230.00 $11,500.00 50 $11,500.00
11 5'MANHOLE 2 EA $6,300.00 $12,600.00 2 $12,600.00
12 EXTRA DEPTH MANHOLE 20 VF $300.00 $6,000.00 20 $6,000.00
13 4'DIA DROP MANHOLE 1 EA $4,315.00 $4,315.00 1 $4,315.00
14 EPDXY MANHOLE LINER co#1 95.9 VF $197.00 $18,892.30 95.9 $18,892.30
15 TRENCH SAFETY 4225 $1.00 $4,225.00 4225 $4,225.00
Sub-Total of Previous Unit $274,313.80 $274,313.80
---------------------------------------
Monday,November 28,2016 Page 3 of 5
City Project Numbers 02517 DOE Number 7396
Contract Name SEVEN OAKS ADDITION,PHASE ONE Estimate Number I
Contract Limits Payment Number I
Project Type WATER&SEWER For Period Ending 11/28/2016
Project Funding
Contract Information Summary
Original Contract Amount $847,040.00
Chance Orders
Change Order Number 1 $32,577.30
Total Contract Price $879,617.30
i ��2m✓ti'��Hate �1 ��[ Total Cost of Work Completed $879,617.30
Contrac r , Less %Retained $0.00
Net Earned $879,617.30
Date
Inspection Supervisor Earned This Period $879,617.30
// Retainage This Period $0.00
k414U Date 1 2?i /I'1 Less Liquidated Damages
Project Mandg
Days @ /Day $0.00
Date 2`f '7 LessPavement Deficiency $0.00
Asst. iirrector/TPW-Infrastructure Design and Constructions Less Penalty $0.00
rtIC( - Date 0- Less Previous Payment $0.00
Director/Contracting Department Plus Material on Hand Less 15% $0.00
Balance Due This Payment $879,617.30
Monday,November 28,2016 Page 4 of 5
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FORTWORTH,
N
TRANSPORTATION AND PUBLIC WORKS
STATEMENT OF CONTRACT TIME
STATEMENT#
FINAL STATEMENT# 1 DOE 7396
NAME OF PROJECT: Seven Oaks Addition Phase One Contractor Jackson
YEAR:j 2016
PROJECT NO.: FINAL INSPECTION DATE _f0_1_1 812-016
2517 WD CD
CONTRACT TIME 240 1 g
PERIOD FROM: 11/16/2016TO: 11/30/2016 MID - Month DEVELOPMENT (Y/N) Y
WORK ORDER EFFECTIVE: 1/25/2016BEG( /n MI--(y—/—n—)-I— Y
DAY OF MONTH DAYS REASON FOR DAY OF MONTH DAYS REASON FOR
CHARGED DAYS CREDITED CHARGED DAYS CREDITED
1 Wed 16 Wed 0 OTH
2 Thu 17 Thu 0 OTH
3 Fri 18 Fri 0 OTH
4 Sat 19 1 Sat 0 OTH
5 Sun 20 Sun 0 OTH
6 Mon 21 Mon 0 OTH
7 Tue 22 Tue 0 OTH
8 Wed 23 Wed 0 OTH
9 Thu 24 Thu 0 OTH
10 Fri 25 Fri 0 OTH
11 Sat 26 Sat 0 OTH
12 Sun 27 Sun 0 OTH
13 Mon 28 Mon 0 OTH
14 Tue 29 Tue 0 OTH
15 Wed 30 Wed 0 OTH
31 Thu
NA Wkn&Hol Wea Utl Oth
Not Applicable SAT,SUN,and WEATHER UTILITIES OTHERS DAYS TOTAL DAYS
HOLIDAYS RELOCATE CHARGED
THIS PERIOD 0 0 0 15 0 15
PREVIOUS PERIOD 9 240 249
TOTAL TO DATE 0 0 0 24 240 264
REMARKS:
6TH:Job Completed
Signature: /y
� ''�2G Signature:
(Print Name) - ��'� , c?4i= �)/� Ariel Dua e/
CONTRACTOR /
, j` A ` DATE r/' ,�� `, SPECTOR DATE 11/28/2016
FORTWORTHREV:02'22/07
TRANSPORTATION AND PUBLIC WORKS
CONTRACTOR'S EVALUATION OF CITY
I)PROJECT INFORMATION Date: 11/29/2016
Nanze of Contractor Project Name
Jackson Construction Seven Oaks Addition,Phase One
DOE Inspector Project Manager
Ariel Duarte Khal Jaafari
DOE NumberPoject LDcu11j Tz pe of Contract
7396 CPN 02517 JO'
Simple OO Routine O Complex El Water[Z Waste Water❑ Storm Drainage❑ Pavement
Initial Contract Amount Final Contract Amount
$847,040.00 $879,617.30
II)PERFORMANCE EVALUATION
0-Inadequate 1 -Deficient 2- Standard 3 -Good 4-Excellent
ELEMENT RATING ELEMENT RATING
INSPECTION EVALUATION (0-4) (0-4)
PLANS&SPECIFICATIONS
1 Availability of Inspector 91 1 Accuracy of Plans to Existing Conditions
2 Knowledge of Inspector 2 Clarity&Sufficiency of Details
3 Accuracy of Measured Quantities 3 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 4711
1 Change Order Processing Time 3 Communication
2 Timliness of Contractor Payments4 Resolution of Utility Conflicts
3 Bid Opening to Pre-Con Meeting Timeframe �S
III)COMMENTS&SIGNATURES
COMMENTS
Signature Contractor
Signature DOE Inspector /
Signature DOE Inspector's Supervisor
INSPECTOR'S COMMENTS
TRANSPORTATION AND PUBLIC WORKS
The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TX 76012-6311
10 (817)392-7941 •Fax: (817)392-7845
FORTWORTH REV.8/20/16
TRANSPORTATION AND PUBLIC WORKS
PERFORMANCE EVALUATION OF CONTRACTOR
I) CONTRACTOR&PROJECT DATA
Name of Contractor Project Name
Jackson Construction Seven Oaks Addition,Phase One
Inspector City Project Number
Ariel Duarte 2517
Construction Components Project Manager
21 water[Z Waste Water❑ Storm Drainage EJ Pavement Khal Jaafari
Initial Contract Amount Project Difficulty
$847,040.00 O Simple (0) Routine O Complex
Final Contract Amount Date
$879,617.30 11/29/2016
II)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 2 8 4
2 Public Notifications 5 Y 3 20 15
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 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 3 20 15
10 Citizen's Complaint Resolution 5 Y 1 4 20 20
11 Property Restoration 5 Y 4 20 20
12 After Hours Response 5 Y 4 20 20
13 Project Completion 5 Y 3 20 15
TOTAL ELEMENT SCORE(A) 399
BONUS POINTS(25 Maximum)(B)
TOTAL SCORE(TS) 399
III)CONTRACTOR'S RATING
Maximum Score(MS)=448 or sum of applicable element score maximums which= 448
Rating([TS/MS] * 100%) 399 / 448 = 89%
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)
Inspector Signature P � k;, Contractor Signa
Inspector's Supervisor Signature
CONTRACTOR'S COMMENTS
TRANSPORTATION AND PUBLIC WORKS
The City of Fort Worth•8851 Camp Bowie West Blvd. •Fort Worth,TY 76116 • (817) 392-8306
FoRTWORTH
TRANSPORTATION AND PUBLIC WORKS
PIPE REPORT FOR:
PROJECT NAME: Seven Oaks Addition,Phase One
PROJECT NUMBER: 2517
DOE NUMBER: 7396
WATER
PIPE LAID SIZE TYPE OF PIPE LF
6"' PVC 80
8" PVC 4175
16" PVC 3130
FIRE HYDRANTS: 4 VALVES(16" OR LARGER) 4
PIPE ABANDONED SIZE TYPE OF PIPE LF
DENSITIES:
NEW SERVICES: 67(1") COOPER
SEWER
PIPE LAID SIZE TYPE OF PIPE LF
4" PVC 66
8" PVC 3817
10" PVC 924
PIPE ABANDONED SIZE TYPE OF PIPE LF
DENSITIES:
NEW SERVICES: 67(4") PVC
TRANSPORTATION AND PUBLIC WORKS
The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TX 76012-6311
(817) 392-7941 •Fax: (817)392-7845
CONSTRUCTION LTD.
51 12 SUN VALLEY DRIVE
FORT WORTH,TX 76119
TEL:817-572-3303
FAX:817-478-0443
November 16, 2016
City of Fort Worth
CFA Administration
1000 Throckmorton St.
Fort Worth, TX 76102
RE: Seven Oaks Addition, PH 1
DOE# 7396 City Project#02517
The purpose of this letter is to acknowledge that we have been paid in full by Seven Oaks
—FW Ltd for the public improvements constructed to serve Seven Oaks Addition, 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,
Troy L. Jackson
Vice President
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 Seven Oaks Addition, PH 1 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
Principal
16th y of November, 2016
By:
Notary Signature Troy L. Jackson, Vic�7resident
Commission Expires: 04/06/2020
CARMEN L. ESTEP
.�as=Notary Public,state of Texas
N„ .ez Comm.Expires 04-06-2020
Y
Notar ID 2910611
"/uun�r
CONSTRUCTION LTD.
5112 SUN VALLEY DRIVE
FORT WORTH,TX 76119
TEL:817-572-3303
FAX:817-478-0443
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 Troy L. Jackson,
Vice President Of Jackson Construction, Ltd, 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 fall;
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;
Seven Oaks Addition, Ph 1
BY
Troy L. .ackson, Vice President
Subscribed and sworn before me on this date 16th of November, 2016.
Notary lic
Tarrant, Texas
�atrRYPoe�.� CARMEN L. ESTEP
?; Notary Public,state of Texas
•.:4 Comm.Expires 04-06-2020
Notary ID 2910611
CONSENT OF SURETY OWNER p
-TO FINAL PAYMENT tRCIIrFCr
.AIApoC "G707 CONTRACTOR
SURFly
Bond No. BCD1032155 OTHF..R D
TO OBER: ARCI-II:f` CT'S PROJECT N0.:
Na.nernrdu&MM)
Seven Oaks-FW, Ltd
6031 W 1-20, Suite 226 CONTRACT FOR.-Water, Sewer,Paving and Drainage
Arlington, TX 76017
PROJECT: C0NTRAME'DATED:
(Akwwandacddn+V
Seven Oaks Addition/Phase One
Fort Worth, TX
In accordance wah The proxqsiorz of the Contract between the Owner and the Contractor as indicated above,the
{�nsc�t>zainr acrd crddr�cfSurr!t}
The Hanover Insurance Company
440 Lincoln Street
Worcester, MA 01653
SURFTTr,
on bond of
flnsen nwne and addrm5j"Contractor)
Jackson Construction, Ltd.
5112 Sun Valley Drive
Fort Worth, TX 76119
CONTPAC70R,
hereby approves of the final payment to the Contractor,and agrees that final payment to the Contractor shall nc-n relieve rhe Surety of
any of its obligations to
fLars�rt numeundadclren ofCltlner)
Seven Oaks-FW, Ltd
6031 W 1-20, Suite 226
Arlington, TX 76017
2s set:fbrih in said Surety's bond OWNER,
IN WTNESS`3lrtiER OF,the Surety has hereunto set its hand on this date. October 21, 2016
f147,at0 ttr u r irk the r ronYk fotlou ecf r{t rix srrrxztc�ic dateand}�ar,)
The Hanov r Insurance Company
By:
€sig, ajurrt)wr�zrr rani )
Attest:
{5e:23> _ Jack M. Crowley Attorney-in-Fact
{PlInfe«d name andY:P'l
Surety Phone No. 508-853-7200 x-4476
G707-1994
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,.lack 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 other writings 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
MASSACHUSMs BAY INSURANCE COMPANY
CITIZENS StIRAI+3CE QCaMPAI�Y OF AMERICA
SEAL 41+ Ffi
- 1674
'-,'
Robert Thomas,Vice Pre-sident
THE COMMONWEALTH OF MASSACHUSETTS )
COUNTY OF WORCESTER )ss. Joy Srenstro . Vige!1s.�s�c1 1t
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.
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Barbara A.Garlick, Notary Public
My Commission Expires September 21,2018
1,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 September 7,2001-Citizens Insurance Company of
America)
GIVEN under my hand and the seals of said Companies,at Worcester,Massachusetts,this 21 st day of October 2016.
THE HANOVER INSURANCE COMPANY
MASSACHUSETTS BAY INSURANCE COMPANY
CITIZENS INSURANCE COMPANY OF AMERICA
! fin Margosian,Vice President