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HomeMy WebLinkAboutContract 47744-FP2 FORTWORTH, CITY ONTRACT N0. ,F ?- TRANSPORTATION AND PUBLIC WORKS NOTICE OF PROJECT COMPLETION (Developer Projects) City Project No: 02683 W7 W Regarding contract 02683 for PRIMROSE CROSSING-W RISINGER RD as required by the TRANSPORTATION&PUBLIC WORKS as approved by City Council on N/A through M&C N/A the director of the TRANSPORTATION&PUBLIC WORKS upon the recommendation of the Assistant Director of the Transportation&Public Works Department has accepted the project as complete. Original Contract Price: $1,179,239.36 Amount of Approved Change Orders: Ns Revised Contract Amount: Total Cost Work Completed: $1,179,239.36 i0 Recommended for Acceptance Date Asst, Director, TPW - Infrastructure Design and Construction zi 6/ ZV 2 Accepted D Date Director, TRANSPORTA ON & PUBLIC WORKS a --- ;F-/ 2 Asst. City Manager Date Department of W Const. Services CPN#-=W J Date Project,Manager -&., 7 Risk Management S. Canady. Comments: Marn- D.O.E. Brotherton '' OFFaC1At,RICORC F Water V. Gutzier .i CPA J i o ales/Scanned o CITY SECRETARY IV Ir 1"T.WORTH,TX The ProcccdindA6ple have been Contacted concerning the request for final payment&have released this project for such payment. h Rev.9/22/16 Clearance Conducted By Etta Bac FORT WORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name PRIMROSE CROSSING-W RISINGER RD Contract Limits Project Type STORM DRAIN&PAVING City Project Numbers 02683 DOE Number 7541 Estimate Number I Payment Number I For Period Ending 5/2/2017 CD City Secretary Contract Number 117541 Contract Time 16IID Contract Date Days Charged to Date 281 Project Manager Ehia Contract is 100.00 Complete Contractor KODIAK TRENCHING 7 BORING,LLC P O BOX 93929 SOUTHLAKE, TX 76092 Inspectors DICKINSON / CROWLEY Tuesday,May 2,2017 Page 1 of 5 City Project Numbers 02683 DOE Number 7541 Contract Name PRIMROSE CROSSING-W RISINGER RD Estimate Number 1 Contract Limits Payment Number 1 Project Type STORM DRAIN&PAVING For Period Ending 5/2/2017 Project Funding STORM DRAIN Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total 1 REMOVE HEADWALUSET 1 EA $450.00 $450.00 1 $450.00 2 MEDIUM STONE RIPRAP 99 SY $85.00 $8,415.00 99 $8,415.00 3 TRENCH SAFETY 1862 LF $0.30 $558.60 1862 $558.60 4 4'STORM JUNCTION BOX 5 EA $3,579.00 $17,895.00 5 $17,895.00 5 5'STORM JUNCTION BOX 3 EA $4,426.00 $13,278.00 3 $13,278.00 6 21"RCP CLASS III 235 LF $51.05 $11,996.75 235 $11,996.75 7 24"RCP CLASS I11 411 LF $59.15 $24,310.65 411 $24,310.65 8 30"RCP CLASS 111 540 LF $74.65 $40,311.00 540 $40,311.00 9 36"RCP CLASS I11 168 LF $99.60 $16,732.80 168 $16,732.80 10 42"RCP CLASS III 287 LF $130.75 $37,525.25 287 $37,525.25 11 48"RCP CLASS III 221 LF $159.80 $35,315.80 221 $35,315.80 12 24"STRAIGHT HEADWALL 3 EA $1,569.00 $4,707.00 3 $4,707.00 13 30"STRAIGHT HEADWALL 1 EA $1,837.00 $1,837.00 1 $1,837.00 14 36"STRAIGHT HEADWALL 2 EA $2,834.00 $5,668.00 2 $5,668.00 15 42"STRAIGHT HEADWALL 1 EA $3,460.00 $3,460.00 1 $3,460.00 16 48"STRAIGHT HEADWALL 1 EA $3,220.00 $3,220.00 1 $3,220.00 17 10'CURB INLET 10 EA $3,818.00 $38,180.00 10 $38,180.00 18 15'CURB INLET I EA $4,993.00 $4,993.00 1 $4,993.00 19 Y DROP INLET 2 EA $4,068.00 $8,136.00 2 $8,136.00 Sub-Total of Previous Unit $276,989.85 $276,989.85 PAVING ItemDescription of Items Unit Unit Cost Estimated Estimated Completed Completed No. Quanity Total Quanity Total 1 REMOVE CONCRETE CURB&GUTTER 9 LF $10.00 $90.00 9 $90.00 2 HYDRATED LIME 427.392 TN $155.00 $66,245.76 427.392 $66,245.76 3 8"LIME TREATMENT 17808 SY $3.00 $53,424.00 17808 $53,424.00 4 3"ASPHALT PVMT TYPE D 198 SY $35.00 $6,930.00 198 $6,930.00 5 5.5"ASPHALT BASE TYPE B 198 SY $45.00 $8,910.00 198 $8,910.00 6 7"CONC PVMT 16442 SY $36.00 $591,912.00 16442 $591,912.00 7 10"CONC PVMT 294 SY $53.00 $15,582.00 294 $15,582.00 Tuesday,May 2,2017 Page 2 of 5 City Project Numbers 02683 DOE Number 7541 Contract Name PRIMROSE CROSSING-W RISINGER RD Estimate Number i Contract Limits Payment Number I Project Type STORM DRAIN&PAVING For Period Ending 5/2/2017 Project Funding 8 4"CONC SIDEWALK 31031 SF $4.00 $124,124.00 31031 $124,124.00 9 BARRIER FREE RAMP 6 EA $1,200.00 $7,200.00 6 $7,200.00 10 RAISED MARKER 78 EA $3.25 $253.50 78 $253.50 11 RAISED MARKER 1562 EA $3.25 $5,076.50 1562 $5,076.50 12 REFL RAISED MARKER 391 EA $3.25 $1,270.75 391 $1,270.75 13 REFL RAISED MARKER 20 EA $3.25 $65.00 20 $65.00 14 INSTALL ALUM SIGN GROUND MOUNT 5 EA $400.00 $2,000.00 5 $2,000.00 15 REMOVE EXISTING BARRICADE 1 EA $125.00 $125.00 1 $125.00 16 INSTALL STANDARD BARRICADE 2 EA $1,600.00 $3,200.00 2 $3,200.00 17 PAVEMENT HEADER 60 LF $20.00 $1,200.00 60 $1,200.00 18 LANE REDUCTION SIGN TMUTCD I EA $400.00 $400.00 1 $400.00 19 LANE ASSIGNMENT SIGN 1 EA $400.00 $400.00 1 $400.00 20 STOP SIGN 4 EA $400.00 $1,600.00 4 $1,600.00 21 STREET NAME BLADES 6 EA $375.00 $2,250.00 6 $2,250.00 22 DELINEATOR POSTS 14 EA $200.00 $2,800.00 14 $2,800.00 23 YIELD SIGN I EA $450.00 $450.00 1 $450.00 24 RIGHT TURN SIGN 1 EA $450.00 $450.00 1 $450.00 25 DO NOT ENTER SIGN 1 EA $450.00 $450.00 1 $450.00 26 NO RIGHT TURN SIGN 1 EA $450.00 $450.00 1 $450.00 27 4"SOLID YELLOW STRIPING 308 LF $2.25 $693.00 308 $693.00 28 24"SOLID YELLOW CROSSHATCH MARKING 286 LF $15.75 $4,504.50 286 $4,504.50 29 REMOVE 4"SOLID WHITE STRIPING& 86 LF $2.25 $193.50 86 $193.50 REPLACE WITH BROKEN WHITE STRIPING Sub-Total of Previous Unit $902,249.51 $902,249.51 Tuesday,May 2,2017 Page 3 of 5 City Project Numbers 02683 DOE Number 7541 Contract Name PRIMROSE CROSSING-W RISINGER RD Estimate Number I Contract Limits Payment Number I Project Type STORM DRAIN&PAVING For Period Ending 5/2/2017 Project Funding Contract Information Summary Original Contract Amount $1,179,239.36 Chane Orders Total Contract Price $1,179,239.36 V11\ CIDate A'/�'I � Total Cost of Work Completed $1,179,239.36 Contractor / Less %Retained $0.00 Date / Net Earned $1,179,239.36 Inspection Supervi Earned This Period $1,179,239.36 (-7 Retainage This Period $0.00 Date 1 Less Liquidated Damages 4ADit ManagerDays @ /Day $0.00 Date LessPavement Deficiency $0.00 ctor/TPW-Infrastructure Design an Cot ti Less Penalty $0.00 Date I Z"� �1 Less Previous Payment $0.00 Direct. Contracting Depart nt Plus Material on Hand Less 15% $0.00 Balance Due This Payment $1,179,239.36 Friday,June 16,2017 Page 4 of 5 City Project Numbers 02683 DOE Number 7541 Contract Name PRIMROSE CROSSING-W RISINGER RD Estimate Number I Contract Limits Payment Number I Project Type STORM DRAIN&PAVING For Period Ending 5/2/2017 Project Funding Project Manager Ehia City Secretary Contract Number 117541 Inspectors DICKINSON / CROWLEY Contract Date Contractor KODIAK TRENCHING 7 BORING,LLC Contract Time 160 CD P O BOX 93929 Days Charged to Date 281 CD SOUTHLAKE, TX 76092 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 $1,179,239.36 Less %Retained $0.00 Net Earned $1,179,239.36 Earned This Period $1,179,239.36 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 $1,179,239.36 Friday,June 16,2017 Page 5 of 5 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 Matthew Mahone, Managing Director Of Kodiak Trenching and Boring,LLC,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 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; W. Risinger Road D.O.E NO. 7541 By Matthew Mahone Subscribed and sworn before me on this date 26 of May, 2017. LZ I I tk�� k )akatx� o ary Public TArrant, Texas ,attar, JENNIFER NA14ARRO State of Texas ,� __:• Notary Public. r,? Comm.Expires 04-28-2020 No 01Y ID 130640644 CONSENT OF OWNER ❑X SURETY COMPANY ARCHITECT ❑ TO FINAL PAYMENT CONTRACTOR ❑ SURETY ❑ AIA DOCUMENT G707 OTHER PROJECT: Primrose Crossing-W. Risinger Road (name, address) TO (Owner) ARCHITECT'S PROJECT NO: MMCAD, LLC & City of Fort Worth ❑ 1221 1-35 CONTRACT FOR: $1,569,356.80 Carrollton, TX 75006 CONTRACT DATE: March 23, 2016 BOND NO: 1045804 CONTRACTOR: Kodiak Trenching & Boring, LLC In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the (here insert name and address of Surety as it appears in the bond). The Hanover Insurance Company SURETY COMPANY, on bond Of(here insert name and address of Contractor as it appears in the bond), Kodiak Trenching & Boring, LLC CONTRACTOR, hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve the Surety of any of Its obligations to (here insert name and address of Owner) MMCAD, LLC & City of Fort Worth OWNER, as set forth in the said Surety's bond. IN WITNESS WHEREOF , the Surety has hereunto set its hand this 22nd day of May 2017 The Hanover Insurance CompcVy Surety r Signature of Authorized Representative Attest: / Douglas Moore, Attorney-in-Fact (Seal): Title AIA DOCUMENT G707•CIP SENT OF SURETY TO FINAL PAYMENT•APRIL 1970 ONE PAGE EDITION•AIA 0•©1970•THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., NW,WASHINGTON, D.C.20006 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 John R.Ward,Douglas Moore,Emily Mikeska and/or Eva O.Limmer of Ward&Moore Insurance Services LP of Gatesville,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 Attorneys-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 Attorneys-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 22nd day of May 2014. THE HANOVER INSURANCE COMPANY MASSACHUSETTS BAY INSURANCE COMPANY tWITIZE&S $ RANCE OMPANY OF AMERICA 11974 I�Obcrt'rhn as>Vice.Pr�sident µry THE COMMONWEALTH OF MASSACHUSETTS COUNTY OF WORCESTER )ss. Joe Arenstrom, icf. i?rasident On this 22nd day of May 2014 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. BAI,'BAFiAA.GARL1CK Notary Public ,� Cnmrtmn�aanh of Maseachueene !� l AtyGanmSsimExgir�s5ep.21.2}SB . 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 September 7,2001-Citizens Insurance Company of America) GIVEN under my hand and the seals of said Companies,at Worcester, Massachusetts,this 22nd day of May 2017. THE HANOVER INSURANCE COMPANY MASAQHUSETTS BAY INSURANCE COMPANY CIT EN 1 SUR CE OF AMERICA J.N f646Pta,Vice es ent Hanover Insurance Croup- Texas Complaint Notice Commercial Lines IMPORTANT NOTICE AVISO IMPORTANTE To obtain information or make a complaint: Para obtener informacion o para someter una queja: You may call The Hanover Insurance Company/ Usted puede Ilamar al numero de telefono gratis de Citizens Insurance Company of America's toll-free The Hanover Insurance Company/Citizens Insurance telephone number for information or to make a Company of America's para informacion o para complaint at: someter una queja al: 1-800-608-8141 1-800-608-8141 You may also write to The Hanover Insurance Company/ Usted tambien puede escribir a The Hanover Insurance Citizens Insurance Company of America at: Company/Citizens Insurance Company of America al: 440 Lincoln Street 440 Lincoln Street Worcester, MA 01615 Worcester, MA 01615 You may contact the Texas Department of Insurance Puede comunicarse con el Departamento de Seguros to obtain information on companies, coverages, de Texas para obtener informacion acerca de rights or complaints at: companias, coberturas, derechos o quejas al: 1-800-252-3439 1-800-252-3439 You may write the Texas Department of Insurance: Puede escribir al Departamento de Seguros de Texas: P. O. Box 149104 R O. Box 149104 Austin, TX 78714-9104 Austin, TX 78714-9104 Fax: (512) 475-1771 Fax: (512) 475-1771 Web: http://www.tdi.texas.gov Web: http://www.tdi.texas.gov E-mail: ConsumerProtection@tdi.texas.gov E-mail: Con sumerProtectionOtdi.texas.gov PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS O 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 contact the agent or the reclamo, debe comunicarse con el agente o la com- company first. If the dispute is not resolved, you may pania primero, Si no se resuelve la disputa, pued6 contact the Texas Department of Insurance. entonces comunicarse con el departamento (TDI). ATTACH THIS NOTICE TO YOUR POLICY:This UNA ESTE AVISO A SU POLIZA: Este aviso es solo notice is for information only and does not become para proposito de informacion y no se convierte en a part or condition of the attached document. parte o condicion del documento adjunto. The Hanover Insurance Company 1440 Lincoln Street,Worcester,MA 01653 151.1457(12/13)Paget of t Citizens Insurance Company of America 1808 North Highlander Way,Howell,MI 48843 hanover.com ALL PURPOSE MAINTENANCE BOND RIDER Rider to be attached to and form a part of bond number 1045804 described as 2 Year Maintenance Bond on behalf of Kodiak Trenchinq and Boring LLC (Principal), and in favor of MMCAD LLC and City of Fort Worth TX (Obligee), executed by The Hanover Insurance Company as Surety, effective March 23 2016 The Principal and The Hanover Insurance Company hereby consent to changing the said bond as follows: The Maintenance Bond amount is INCREASED to One Million Five Hundred Sixty Nine Thousand Three Hundred Fifty Seven and no/100 dollars-------------($1,569,357.00) Nothing herein contained shall vary, alter or extend any provision or condition of the bond other than as above stated. Signed, Sealed and dated this 22nd day of May 2017 The Hanover Insurance Company Surety BY: Douglas Moore, ttorney-in-Fact 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 John R.Ward,Douglas Moore,Emily Mikeska and/or Eva O.Limmer of Ward&Moore Insurance Services LP of Gatesville,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 Attorneys-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 Attorneys-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 22nd day of May 2014. THE HANOVER INSURANCE=COMPANY MASSACHUSETTS BAY INSURANCE COMPANY CITIZENS SURANCE OMPANY OF AMERICA t®Y3 / r -0-1; ri"Fh�,mns,VicttPresident THE COMMONWEALTH OF MASSACHUSETTS COUNTY OF WORCESTER )ss. Joe Arenstr'om, iey�President On this 22nd day of May 2014 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. ookp IIARBARAA.GAR'"NotaryPubliC,pdyCommssi+x�Ex�i:�s5ep1.21,2fiS6 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 22nd day of May 2017. THE HANOVER INSURANCE COMPANY MASA HUSETT BAY I RA CE COMPANY CIT EN f SUR CE OF AMERICA J. h I ete,Vice es ent The 14 over Innssrance Group- Texas Complaint Notice Commercial Lines ' 0000 IMPORTANT NOTICE AVISO IMPORTANTE To obtain information or make a complaint: Para obtener informacion o para someter una queja: You may call The Hanover Insurance Company/ Usted puede Ilamar al numero de telefono gratis de Citizens Insurance Company of America's toll-free The Hanover Insurance Company/Citizens Insurance telephone number for information or to make a Company of America's para informacion o para complaint at: someter una queja al: 1-800-608-8141 1-800-608-8141 You may also write to The Hanover Insurance Company/ Usted tambien puede escribir a The Hanover Insurance Citizens Insurance Company of America at: Company/Citizens Insurance Company of America al: 440 Lincoln Street 440 Lincoln Street Worcester, MA 01615 Worcester, MA 01615 You may contact the Texas Department of Insurance Puede comunicarse con el Departamento de Seguros to obtain information on companies, coverages, de Texas para obtener informacion acerca de rights or complaints at: companies, coberturas, derechos o quejas al: 1-800-252-3439 1-800-252-3439 You may write the Texas Department of Insurance: Puede escribir al Departamento de Seguros de Texas: P. O. Box 149104 P. O. Box 149104 Austin, TX 78714-9104 Austin, TX 78714-9104 Fax: (512) 475-1771 Fax: (512) 475-1771 Web: http://www.tdi.texas.gov Web: http://www.tdi.texas.gov E-mail: ConsumerProtection@tdi.texas.gov E-mail: ConsumerProtection@tdi.texas.gov PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS O 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 contact the agent or the reclamo, debe comunicarse con el agente o la com- company first. If the dispute is not resolved, you may pania primero. Si no se resuelve la disputa, puede contact the Texas Department of Insurance. entonces comunicarse con el departamento (TDI). ATTACH THIS NOTICE TO YOUR POLICY: This UNA ESTE AVISO A SU POLIZA: Este aviso es solo notice is for information only and does not become para proposito de information y no se convierte en a part or condition of the attached document, parte o condicion del documento adjunto. The Hanover Insurance Company 1440 Lincoln Street,Worcester,MA 01653 181-1457(11/13)Page t of 1 Citizens Insurance Company of America 1808 North Highlander Way,Howell,MI 48843 hanover.com Exhibit B Unconditional Waiver and Release of Lien on Progress Payment Project Primrose Crossing Job No. The signer of this document has been paid and has received a progress payment in the sum of $ 6,4_90.00_ for all labor, services, equipment, or materials furnished to the property or to Kodiak Trenching&Boring,LLC. (person with whom signer contracted) on the property of MMCAD,LLC (owner) located at Crowley,TX (location)to the following extent: Primrose Crossin;]Utilities (job description). The signer therefore waives and releases any mechanic's lien right, any right arising from a payment bond that complies with a state or federal statute, any common law payment bond right, any claim for payment, and any rights under any similar ordinance, rule,or statute related to claim or payment rights for persons in the signer's position that the signer has on the above referenced project to the following extent: This release covers a progress payment for all labor, services, equipment, or materials furnished to the property or to Kodiak,Trenching&Boring,LLC. (person with whom signer contracted) as indicated in the attached statement(s) or progress payment request(s), except for unpaid retention,pending modifications and changes, or other items furnished. The signer warrants that the signer has already paid or will use the funds received from this progress payment to promptly pay in full all of the signer's laborers, subcontractors, materialrnen, and suppliers for all work,materials, equipment,or services provided for or to the above referenced project in regard to the attached statement(s) or progress payment request(s). Date ( / 47 (Company name) (Signature) Mv (Title)_BT Before me, a Notary Public, on this day personally appeared known to me to be the person whose name is subscribed to the forgoing instrument and acknowledged to me that he executed the same for the purpose and consideration therein expressed. Give under my hand and seal of office this !`� day of Lu 0 A.D. 20r? / Notary] 36 Vn [Notary Number] �\\\tllli l l II11!///�� My commission expires the day of , 20� `\���,�� ONHOLL�,sii���� U/— S(A N� PC2 i OF FORTWORTHREV:02/20/07 TRANSPORTATION AND PUBLIC WORKS PERFORMANCE EVALUATION OF CONTRACTOR I) CONTRACTOR&PROJECT DATA Name of Contractor Project Naune Kodiak Trenching and Boring,LLC Primrose Crossing-Risinger Rd DOE Inspector DOE Number John Crowley CPN#02683 DOEInspector Project Manager ❑ water❑ waste Water❑ Storm Drainage0 Pavement Fred Ehia Initial Contract Amount Project DifiJiculty $1,179,239.36 0 Simple 0 Routine 0 Complex Final Contract Annount Date $1,179,239.36 6/9/2017 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 I Submission of Documents 2 Y 1 8 2 2 Public Notifications 5 Y 2 20 10 3 Plans on Site 5 Y 3 20 15 4 Field Supervision 15 Y 3 60 45 5 Work Performed 15 Y 3 60 45 6 Finished Product 15 Y 3 60 45 7 Job Site Safety 15 Y 3 60 45 8 Traffic Control Maintenance 15 Y 2 60 30 9 Daily Clean Up 5 Y 2 20 10 10 Citizen's Complaint Resolution 5 Y 3 20 15 I I Property Restoration 5 Y 3 20 15 12 After Hours Response 5 Y 3 20 15 13 Project Completion 5 Y 2 20 10 TOTAL ELEMENT SCORE(A) 302 BONUS POINTS(25 Maximum)(B) TOTAL SCORE(TS) 302 III)CONTRACTOR'S RATING Maximum Score(MS)=448 or sum of applicable element score maximums which= 448 Rating([TS/MS] * 100%) 302 / 448 = 67% Performance Category Good <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) Signature DOE Inspector Signature Contractor Signature DOE Inspector's Supervisor E� CONTRACTOR'S COMMENTS TRANSPORTATION AND PUBLIC WORKS F The City of Fort Worth•1000 Throckmorton Street•Fort Worth,TX 76012-6311 (817)392-7941 •Fax: (817)392-7845 FORTWORTHREV:02'22/07 TRANSPORTATION AND PUBLIC WORKS CONTRACTOR'S EVALUATION OF CITY I)PROJECT INFORMATION Date: 6/9/2017 Name of Contractor Project Name Kodiak Trenching and Bornin ,LLC Primrose Crossing-Risinger Rd DOE Inspector Project Manager John Crowley Fred Ehia DOENamber ProjectDifficuhy Tjpe of Contract CPN#02683 O Simple Q Routine Q Complex ❑ water[—] wastewatei-D Storm DrainageE] Pavement Initial Contract Amount Final Contract Amount $1,179,239.36 $1,179,239.36 H)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 t l 2 Knowledge of Inspector 2 Clarity&Sufficiency of Details 3 Accuracy of Measured Quantities 4 3 Applicability of Specifications `4 4 Display Of Professionalism u 4 Accuracy of Plan Quantities �{ 5 Citizen Complaint Resolution 4 PROJECT MANAGER EVALUATION 6 Performance-Setting up Valve Crews,Labs 1 Knowledge And/Or Problem Resolution 4 ADMINISTRATION 2 Availability of Project Manager �t 1 Change Order Processing Time LA 3 Communication - 4 2 Timliness of Contractor Payments 4 Resolution of Utility Conflicts 3 Bid Opening to Pre-Con Meeting Timeframe 4 uI)COMMENTS&SIGNATURES COMMENTS Signature Contractor t- 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 (817)392-7941 •Fax: (817)392-7845 FORT WORTHe TRANSPORTATION AND PUBLIC WORKS STATEMENT OF CONTRACT TIME STATEMENT# FINAL STATEMENT# Final CPN 2683 NAME OF PROJECT: Primrose Crossing-Risinger Road Contractor Kodiak YEAR:1 2017 PROJECT NO.:02683 FINAL INSPECTION DATE —z�— NN'D CD CONTRACT TIME 160 X PERIOD FROM: 1 4/16/2017 TO: 1 4/30/2017 MID - Month IDEVELOPMEN11(Y/N)IN WORK ORDER EFFECTIVE: 6/27/2016 BEG n MID %I n) DAY OF MONTH DAYS REASON FOR DAY OF MONTH DAYS REASON FOR CHARGED DAYS CREDITED CHARGED DAYS CREDITED 1 16 2 17 3 18 4 19 5 20 6 21 7 22 8 23 9 24 10 25 11 26 12 27 13 28 14 1 1 29 15 30 31 NA &:?0; Wea Utl Ott) Not Applicable SAT,SUN,and WEATHER UTILITIES OTHERS DAYS TOTAL DAYS HOLIDAYS RELOCATE CHARGED THIS PERIOD 0 0 0 0 0 0 PREVIOUS PERIOD 0 281 281 TOTAL TO DATE 0 0 0 0 281 281 REMARKS: Project Time was stopped on 4/3/2017 Signature: Signature: (Print Name) vj„ L,�� f John Cro CONTRACTOR DATE INSPECTOR DATE 1 4/29/2017