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HomeMy WebLinkAboutContract 49172-FP1 City Secretary 49172 -FPI Contract No. FoRTWORTH., Date Received Aug 21,2018 NOTICE OF PROJECT COMPLETION (Developer Projects) The Transportation and Public Works Department upon the recommendation of the Project Manager has accepted the following project as complete: Project Name: TAVOLO PARK City Project No.: 100549 Improvement Type(s): Water N Sewer N Original Contract Price: $1,710,219.80 Amount of Approved Change Order(s): $32,762.50 Revised Contract Amount: $1,742,982.30 Total Cost of Work Complete: $1,742,982.30 Ab G,artges(A.g1r201V Aug /)2010 Contractor Date Contract Manager Title Burnsco Construction,Inc. Company Name MI-AZ&'� Aug21 2018 Neal Fiore(Aug 21,2018) g Project inspector Date p Fred Lhla(Aug 21,2018) Aug 21,2018 Project�IIan ger Date �zaf?I2 c)��tt/i'�0l�G1�21' Janie Scarlett Morales(Aug 21.2018) Aug 21,2018 ,l CFA Manager Date t�rO Aug 21 2018 Susan Alanis A '21, 8 a ACV City ager Date 2a 24�� OFFICIAL k— CITY SECRETARY age 1 of 2 � p�G RAN �v MT. =�RT11IiTX CO 4i 3 � t /110 g I Notice of Project Completion Project Name:TAVOLO PARK City Project No.: 100549 City's Attachments Final Pay Estimate ❑x (� Change Order(s): © Yes ❑ N/A I Pipe Report: ® Yes ❑ N/A I Contractor's Attachments Affidavit of Bills Paid I Consent of Surety Statement of Contract Time 1 Contract Time: 270 CD Days Charged: 373 f f Work Start Date: 7/24/2017 Work Complete Date: 7/31/2018 i i i i I !,I Page 2 of 2 City Project Numbers 100549 DOE Number 05119 Contract Name TAVOLO PARK Estimate Number I Contract Limits Payment Number I Project Type WATER&SEWER For Period Ending 8/6/2018 Project Funding ,NII Project Manager NA City Secretary Contract Number Inspectors OWEN / SAMANIEGO Contract Date Contractor BURNSCO CONSTRUCTION,INC. Contract Time 270 CD 6331 SOUTHWEST BLVD Days Charged to Date 373 CD FORT WORTH, TX 76132 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 $1,742,982.30 Less %Retained $0.00 Net Earned $1,742,982.30 Earned This Period $1,742,982.30 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 $1,742,982.30. Monday,August 6,2018 Page 5 of 5 FoRTWURTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name TAVOLO PARK Contract Limits Project Type WATER&SEWER City Project Numbers 100549 DOE Number 0549 Estimate Number 1 Payment Number 1 For Period Ending 8/6/2018 CD City Secretary Contract Number Contract Time 27GD Contract Date Days Charged to Date 373 Project Manager NA Contract is 100.00 Complete Contractor BURNSCO CONSTRUCTION,INC. 6331 SOUTHWEST BLVD FORT WORTH, TX 76132. Inspectors OWEN / SAMANIEGO III i i li I Monday,August 6,2018 Page] of 5 City Project Numbers 100549 DOE Number 0549 Contract Name TAVOLO PARK Estimate Number 1 Contract Limits Payment Number 1 (I Project Type WATER&SEWER For Period Ending 8/6/2018 Project Funding WATER Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total - —.._.. -------- --------------------- ---------- 1 6"WATER PIPE 280 LF $21.00 $5,880.00 280 $5,880.00 2 8"WATER PIPE 8430 LF $25.60 $215,808.00 8430 $215,808.00 3 10"WATER PIPE CO#1 1653 LF $32.00 $52,896.00 1653 $52,896.00 4 12"WATER PIPE 3490 LF $44.00 $153,560.00 3490 $153,560.00 5 24"CASING BY OTHER THAN OPEN CUT 114 LF $430.00 $49,020.00 114 $49,020.00 6 12"WATER CARRIER PIPE 114 LF $72.00 $8,208.00 114 $8,208.00 7 DUCTILE IRON WATER FITTINGS 20 TN $3,950.00 $79,000.00 20 $79,000.00 W/RESTRAINT 8 16"X 12"TAPPING SLEEVE&VALVE 1 EA $9,500.00 $9,500.00 1 $9,500.00 9 CONNECTION TO EXISTING 4"-12"WATER 1 EA $1,100.00 $1,100.00 1 $1,100.00 MAIN 10 1"WATER SERVICE CO#1 183 EA $950.00 $173,850.00 183 $173,850.00 11 6"GATE VALVE 23 EA $940.00 $21,620.00 23 $21,620.00 12 8"GATE VALVE 28 EA $1,310.00 $36,680.00 28 $36,680.00 13 10"GATE VALVE 3 EA $1,900.00 $5,700.00 3 $5,700.00 14 12"GATE VALVE 9 EA $2,230.00 $20,070.00 9 $20,070.00 15 8"WATER LINE LOWERING CO#1 11 EA $3,100.00 $34,100.00 11 $34,100.00 16 10"WATER LINE LOWERING CO#1 5 EA $3,200.00 $16,000.00 5 $16,000.00 17 FIRE HYDRANT 23 EA $3,100.00 $71,300.00 23 $71,300.00 18 CONCRETE ENCASEMENT FOR UTILITY PIPES 3 CY $720.00 $2,160.00 3 $2,160.00 19 TRENCH SAFETY 13853 LF $0.10 $1,385.30 13853 $1,385.30 20 2"WATER SERVICE CO#1 5 EA $1,900.00 $9,500.00 5 $9,500.00 21 11/2"WATER SERVICE CO#1 2 EA $1,500.00 $3,000.00 2 $3,000.00 16B 12"WATERLINE LOWERING CO#I 1 EA $3,200.00 $3,200.00 1 $3,200.00 Sub-Total of Previous Unit $973,537.30 $973,537.30 SEWER Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total ------------ ---------------------------- 1 4"SEWER SERVICE 181 EA $1,180.00 $213,580.00 181 $213,580.00 i 2 8"SEWER PIPE 7447 LF $35.00 $260,645.00 7447 $260,645.00 3 8"DIP SEWER PIPE,CSS BACKFILL 40 LF $69.00 $2,760.00 40 $2,760.00 Monday,August 6,2018 Page 2 of 5 If City Project Numbers 100549 DOE Number 0549 i Contract Name TAVOLO PARK Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER&SEWER For Period Ending 8/6/2018 Project Funding 4 10"SEWER PIPE 1271 LF $45.00 $57,195.00 1271 $57,195.00 5 10"DIP SEWER PIPE CSS BACKFILL 20 LF $81.00 $1,620.00 20 $1,620.00 6 CONCRETE ENCASEMENT FOR UTILITY PIPES 12 CY $720.00 $8,640.00 12 $8,640.00 7 4"-12"PRESSURE PLUG 2 EA $100.00 $200.00 2 $200.00 8 4'MANHOLE 38 EA $3,900.00 $148,200.00 38 $148,200.00 9 4'EXTRA DEPTH MANHOLE 103 EA $150.00 $15,450.00 103 $15,450.00 10 5'MANHOLE 2 EA $6,940.00 $13,880.00 2 $13,880.00 11 T EXTRA DEPTH MANHOLE 14 EA $220.00 $3,080.00 14 $3,080.00 12 CONCRETE COLLAR 1 EA $300.00 $300.00 1 $300.00 13 VACUUM MANHOLE TESTING 40 EA $110.00 $4,400.00 40 $4,400.00 14 EPDXY MANHOLE LINER 79 VF $200.00 $15,800.00 79 $15,800.00 15 POST CCTV INSPECTION 8778 LF $1.50 $13,167.00 8778 $13,167.00 16 TRENCH SAFETY 8778 LF $1.00 $8,778.00 8778 $8,778.00 35A MANHOLE ADJUSTMENT MAJOR C04I 1 EA $1,750.00 $1,750.00 1 $1,750.00 --------------------------------------- Sub-Total of Previous Unit $769,445.00 $769,445.00 --------------------------------------- Monday,August 6,2018 Page 3 of 5 i t City Project Numbers 100549 DOE Number 0549 Contract Name TAVOLO PARK Estimate Number I Contract Limits Payment Number I Project Type WATER&SEWER For Period Ending 8/6/2018 Project Funding Contract.Information Summary Original Cont►•actAmount $1,710,219.80 Change Orders Change Order Number 1 $32,762.50 Total Contract Price $1,742,982.30 Total Cost of Work Completed $1,742,982.30 Less %Retained $0.00 Net Earned $1,742,982.30 Earned This Period $1,742,982.30 Retainage This Period $0.00 Less Liquidated Damages Days @ /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 $1,742,982.30 Monday,August 6,2018 Page 4 of 5 m9 0 x ;00Z n U1 X _n n n a D m Z Z o z OL m ES DI D Z O -a o D m 0 O � -� O a 0o x n r < z v i O ° O -� '0 -0 O -1 N � o �o -' oo � � -z, m � z a ma 0 D m m � D C- C- n D a -; Z o w Z z y m m -ai D n n m o -'� -4 K z G) Z = O O aZ m 1 m 3 O -i 0 m z 1 o to v w m y. cU'o m N o D ('� SCA y N O O N �p � 0 � fOD 0/1 to V N ? 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O o0 00000• oA Z j H O O O O O O o 0 0 0 p p O 0 0 0 0 0 0 0 p O n 0 to a o 0 0 0 0 0 0 0 0 0 m - z y j p p O_ W W Nom' iNm jcns W yNyN jfn a p' tit A to A V1 W O y A O W ±W W W fD A m W mmONmCD W Jw W:*4d(OV NNNOfTt0a 0 N A 0 0 0 0 m O N W V t N1, 0 0 0 0 0 0 0 I Q m 0 0 0 A D D O O M W O o 0 0 0 0 0 0 0 r W O O O O O O O 0 O O N O O O O O O O O o 0 o r C O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 O O d O m N FOR TOT A TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PROJECT NAME: Tavolo Park PROJECT NUMBER: 100549 DOE NUMBER: N/A WATER PIPE LAID SIZE TYPE OF PIPE LF 6"inch PVC 280 LF 8"inch PVC 8430 LF 10"inch PVC 1653 LF 12"inch PVC 2490 LF Water Carrier Pipe 12"inch Ductile Iron 114 LF FIRE HYDRANTS:23 VALVES(16"OR LARGER) 0 PIPE ABANDONED SIZE TYPE OF PIPE LF N/A DENSITIES: In Buzzsaw NEW SERVICES: 183-1"inch copper 3111 LF SEWER PIPE LAID SIZE TYPE OF PIPE LF 8"inch SDR-26 PVC 7447 LF 10"inch SDR-26 PVC 1271 LF 10"inch Dip Sewer Pipe 20 LF PIPE ABANDONED SIZE TYPE OF PIPE LF N/A DENSITIES: In Buzzsaw NEW SERVICES: 181-4"inch SDR-26 PVC 4706 LF TRANSPORTATION AND PUBLIC WORKS � s The City of Fort Worth•1000 Throckmorton Street•Fort Worth,TX 76012-6311 J (817)392-7941•Fax:(817)392-7845 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 Ab Grantges, Contract Mgr, Of Burnsco constriction, Inc.,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; Tavolo Park CPN 100549 -Water, Sanitary Sewer and Storm Drain BY x, Ab Grantges, 06ntract Manager Subscribed and sworn before me on this date 6th of August, 2018. NRary Public Tarrant County, Texas MARY FIA � tivarvPuuio.siafeof Texosl x�`�:` - Comrn.E::pires 1u-14-218 l 4; tJofcry ID 5144239 CONSENT OF OWNER ❑ SURETY COMPANY ARCHITECT ❑ TO FINAL PAYMENT CONTRACTOR ❑ SURETY ❑ Conforms with the American Institute of OTHER Architects,AIA Document G707 Bond No 022056869 PROJECT: (name, address)Tavolo Park Phase 1 TO (Owner) Fort Worth TX PATE RANCH SINGLE FAMILY,LP AND CITY OF ARCHITECT'S PROJECT NO: FORT WORTH CONTRACT FOR: 10210 N Central Expwy#300 Tavolo Park Phase 1 -Water,Sewer&Drainage Improvements Dallas TX 75231 _I CONTRACT DATE: CONTRACTOR:BURNSCO CONSTRUCTION,INC. 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 Company) LIBERTY MUTUAL INSURANCE COMPANY 175 Berkeley Street Boston MA 02116 , SURETY COMPANY on bond of (here insert name and address of Contractor) BURNSCO CONSTRUCTION, 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) PATE RANCH SINGLE FAMILY, LP AND CITY OF FORT WORTH 10210 N Central Expwy#300 Dallas TX 75231 OWNER, as set forth in the said Surety Company's bond. IN WITNESS,WHEREOF, the Surety Company has hereunto set its hand this 30th day of July,2018 LIBERTY MUTUAL INSURANCE COMPANY i1 �. Surety Company Attest:Tina McEwan dim. (Beal): Sign re of Authorized Representative Sophinie Hunter Attorney-in-Fact Title NOTE: This form is to be used as a companion document to AIA DOCUMENT G706, CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS, Current Edition ONE PAGE THfS 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.8138333 Liberty Mutual Insurance Company The Ohio Casualty Insurance Company WestAmerican Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS:That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire,that i Liberty Mutual Insurance Company is a corporation duly organized under the laws of the Stale of Massachusetts,and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana(herein collectively called the"Companies"),pursuant to and by authority herein set forth,does hereby name,constitute and appoint, Bobbi Morales Don E.Cornell;-So hinie Hunter V.DeLene Marshall;Tina McEwan•Ricardo J.Reyna;Kefly A.Westbrook f all of the city of Dallas state of TX each individually if there be more than one named,its true and lawful attorney-in-fact to make,execute,seal,acknowledge Iy and deliver,for and on its behalf as surety and as its act.and deed,any and all undertakings,bonds,recognizances and other surety obligations,in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by thepresident and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF,this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 26th day of June 2018 ;N 52IPA '�� ro The Ohio Casualty Insurance Company t 1�1s o r 7912 1991 Liberty Mutual Insurance Company M' Westgmerican Insurance Company = 4 � :. it•. ..:/ � By: STATE OF PENNSYLVANIA ss David M.Carey Assistant Secretary a " COUNTY OF MONTGOMERY � � c O On this 26th da of June 2016 _— 0 01 Y before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance � pro Company,The Ohio Casualty Company,and West American Insurance Company,and that he,as such,being authorized so to do,execute the foregoing instrument for tile purposes �v,w R therein contained by signing on behalf of the corporations by himself as a duly authorized officer. W > IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at King of Prussia,Pennsylvania,on the day and year first above written. ' O CL IgA PAS,, COMMONWEALTH OF PENNSYLVANIA Notarial Seal 16�� O 4) 1` ° �� v I Toresa Pastella,Notary Public By, C v 1.G -D� /(� _ Q OF L P Upper MerionTwp.,Montoomery County Teresa Pastella,Notary Public s My Commission Expires March 28,2021 Orte+ ZOTq OWE Momtwr,Pennsylvanki Association of Nowries c This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual 00 Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows: =p 4—cri i to L ARTICLE IV—OFFICERS—Section 12,Power ofAttomey.Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President,and subject c a; to such limitation as the Chairman or the President may prescribe,shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Corporation to make,execute,seal, o.S acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Such aftorneys-in-fact,subject to the limitations set forth in their respective E 6 powers of attorney,shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so d p executed,such instruments shall be as binding as it signed by the President and attested to by the Secretary.Any power or authority granted to any representative or attomey-in-fact under > >, the provisions of this article may be revoked at any time by the Board,the Chairman,the President or by the officer or officers granting such power or authority. d r_ ARTICLE XIII—Execution of Contracts—SECTION 5_Surety Bonds and Undertakings.Any officer of the Company authorized for that purpose in writing by the chairman or the president, r o? > L and subject to such limitations as the chairman or the president may prescribe,shalt appoint such attomeys-in-fact as may be necessary to act in behalf of the Company to make,execute, M Z y seal,acknowledge and deriver as surety any and all undertakings,bonds;recognizances and other surety obligations. Such attomeys4n-fact subject to the limitations set forth in their =o0 respective powers of attorney,shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so V o executed such instruments shall be as binding as if signed by the president and attested.by the secretary, � 0 Certificate of Designation—The President of the Company,acting pursuant to the Bylaws of the Company,authorizes David M.Carey,Assistant Secretary to appoint such attomeys-in- ~`— fact as may be necessary to act on behalf offhe Company to make,execute,seal,acknowledge and deliver as surety an and all undertakings,bonds,recognizances and other surety obligations. Authorization—By unanimous consent of the Company's Board of Directors,the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company,wherever appearing upon a certified-copy of any power of attorney issued by the Company in connection with surety bonds,shall be valid and binding upon the Company with the same force and effect as though manually affixed. I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio-Casualty Insurance,Company, Liberty:Mutual Insurance Company, and West American insurance Company do hereby certify that the original power of attorney of which the foregoing is'a full,true and correct copy of the Power of Attorney executed by said Companies,is in-full force and effect and has not been revoked. IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this day of 20 _ ('!INJ ENSU S, . e. 1991 R: By: y y y ssistant Secretary � 9a 44 of 300 LMS 92873 022017 Liberty Mutual. SURETY TEXAS TEXAS IMPORTANT NOTICE AVISO IMPORTANTE To obtain information or make a complaint: Para obtener informacion o para someter una queja: You may call toll-free for information or to Usted puede llamar al numero de telefono gratis make a complaint at para informacion o para someter una queja al 1-877-75I-2640 1-877-751-2640 You may also write to: Usted tambien puede escribir a: 2200 Renaissance Blvd., Ste. 400 2200 Renaissance Blvd., Ste. 400 King of Prussia, PA 1.9406-2755 King of Prussia, PA 19406-2755 You may contact the Texas Department of Puede comunicarse con el Departamento de Insurance to obtain information on companies, Seguros de Texas para obtener informacion coverages, rights or complaints at acerca de companias, coberturas, derechos o 1-800-252-3439 quejas al 1-800-252-3439 You may write the Texas Department of Insurance Puede escribir al Departamento de Seguros Consumer Protection (11 I-IA) de Texas Consumer Protection (111-1A) P. 0. Box 149091 P. 0. Box 149091 Austin, TX 78714-9091 Austin,TX 78714-9091 FAX: (512) 490-1007 FAX# (512) 490-1007 Web: httl2://www.tdi.texas.gov Web: htttp•//�vww.tdi.texas.gov E-mail: ConsumerProtection@tdi.texas.gov E-mail: ConsumerProtection@tdi.texas.gov PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS 0 RECLAMOS: Should you have a dispute concerning your Si tiena una disputa concemiente a su prima o a premium or about a claim you should first un reclamo, debe comunicarse con el agente o contact the agent or call 1-800-843-6446. primero. Si no se resuelve la disputa, puede If the dispute is not resolved, you may contact the entonces comunicarse con el departamento (TDI) Texas Department of Insurance. ATTACH THIS NOTICE TO YOUR UNA ESTE AVISO A SU POLIZA: POLICY: ti This notice is for information only and does not Este aviso es solo para proposito de informacion become a part or condition of the attached y no se convierte en parte o condition del document. documento adjunto. NP 70 68 09 01 LMS-15292 10115 Greensheet for Tavolo Park CPN#100549 WS Adobe Sign Document History 08/22/2018 „u �.....�. ,,.max - Created: 08/07/2018 By: Shameka.Kennedy@fortworthtexas.gov -- Status: Signed Transaction ID: CBJCHBCAABAAkEQ1jJMLGwDkjGaLwNdXxwQ2mYEp2SMD "Greensheet for Tavolo Park CPN#100549 WS" History `�!i Document created by Shameka.Kennedy@fortworthtexas.gov 08/07/2018-7:28:17 AM CDT-IP address:209.194.29.100 C, Document emailed to Ab Grantges (kcarwine@aol.com)for signature 08/07/2018-7:38:06 AM CDT �L_J Document viewed by Ab Grantges (kcarwine@aol.com) 08/07/2018-9:12:16 AM CDT-IP address: 107.77.197.90 Chi Ab Grantges(kcarwine@aol.com) uploaded the following supporting documents: & File Attachment 1 Chi File Attachment 2 08/07/2018-9:21:27 AM CDT cY4 Document e-signed by Ab Grantges (kcarwine@aol.com) Signature Date:08/07/2018-9:21:27 AM CDT-Time Source:server-IP address: 12.246.109.114 Document emailed to Neal Kime (neal.kime@fortworthtexas.gov)for signature 08/07/2018-9:21:28 AM CDT Document viewed by Neal Kime (neal.kime@fortworthtexas.gov) 08/21/2018-10:07:11 AM CDT-IP address:174.206.14.127 do Document e-signed by Neal Kime (neal.kime@fortworthtexas.gov) Signature Date:08/21/2018-10:07:54 AM CDT-Time Source:server-IP address:174.206.14.127 C-+ Document emailed to EDWIN RODRIGUEZ(edwin.rodriguez@fortworthtexas.gov)for approval 08/21/2018-10:07:55 AM CDT Document viewed by EDWIN RODRIGUEZ(edwi n.rod riguez@fortworthtexas.gov) 08/21/2018-12:34:02 PM CDT-IP address: 107.77.198.18 FoxJ> Adobe sign &Q Document approved by EDWIN RODRIGUEZ (edwin.rodriguez@fortworthtexas.gov) Approval Date:08/21/2018-12:34:35 PM CDT-Time Source:server-IP address: 107.77.198.18 C'w Document emailed to Fred Ehia (freidoon.ehia@fortworthtexas.gov)for signature 08/21/2018-12:34:36 PM CDT Document viewed by Fred Ehia (freidoon.ehia@fortworthtexas.gov) 08/21/2018-2:53:36 PM CDT-IP address:209.194.29.100 d4 Document e-signed by Fred Ehia (freidoon.ehia@fortworthtexas.gov) Signature Date:08/21/2018-2:59:07 PM CDT-Time Source:server-IP address:209.194.29.100 C'y Document emailed to Janie Scarlett Morales (Janie.morales@fortworthtexas.gov)for signature 08/21/2018-2:59:09 PM CDT Document viewed by Janie Scarlett Morales Qanie.morales@fortworthtexas.gov) 08/21/2018-3:23:21 PM CDT-IP address:209.194.29.100 ba Document e-signed by Janie Scarlett Morales oanie.morales@fortworthtexas.gov) Signature Date:08/21/2018-3:23:53 PM CDT-Time Source:server-IP address:209.194.29.100 24 Document emailed to Susan Alanis(susan.alanis@fortworthtexas.gov)for signature 08/21/2018-3:23:54 PM CDT it Document viewed by Susan Alanis (susan.alanis@fortworthtexas.gov) 08/21/2018-4:10:52 PM CDT-IP address:209.194.29.100 da Document e-signed by Susan Alanis (susan.alanis@fortworthtexas.gov) Signature Date:08/21/2018-4:25:24 PM CDT-Time Source:server-IP address:209.194.29.100 '+ Document emailed to Allison Tidwell (cso_finalpay@fortworthtexas.gov)for filling 08/21/2018-4:25:26 PM CDT Document viewed by Allison Tidwell (cso_finalpay@fortworthtexas.gov) 08/21/2018-5:21:01 PM CDT-IP address:209.194.29.100 ba Form filled by Allison Tidwell (cso_finalpay@fortworthtexas.gov) Form filling Date:08/21/2018-5:23:30 PM CDT-Time Source:server-IP address:209.194.29.100 y Document emailed to Trudy Brotherton (therese.brotherton@fortworthtexas.gov)for delivery 08/21/2018-5:23:32 PM CDT Document viewed by Trudy Brotherton (therese.brotherton@fortworthtexas.gov) 08/22/2018-7:07:37 AM CDT-IP address:68.116.135.3 6� Document receipt acknowledged by Trudy Brotherton (therese.brotherton@fortworthtexas.gov) Receipt Acknowledgement Date:08/22/2018-7:08:01 AM CDT-Time Source:server-IP address:68.116.135.3 FORTWORTH. Adobe be Sign . Document emailed to Julie A Geho oulie.geho@fortworthtexas.gov)for delivery 08/22/2018-7:08:03 AM CDT Document viewed by Julie A Geho oulie.geho@fortworthtexas.gov) 08/22/2018-7:45:13 AM CDT-IP address:209.194.29.100 c Document receipt acknowledged by Julie A Geho oulie.geho@fortworthtexas.gov) Receipt Acknowledgement Date:08/22/2018-7:45:34 AM CDT-Time Source:server-IP address:209.194.29.100 Document emailed to Sylvia Kelley (tpwcfafiscal@fortworthtexas.gov)for delivery 08/22/2018-7:45:35 AM CDT 5 Document viewed by Sylvia Kelley(tpwcfafiscal@fortworthtexas.gov) 08/22/2018-7:51:32 AM CDT-IP address:209.194.29.100 ba Document receipt acknowledged by Sylvia Kelley(tpwcfafiscal@fortworthtexas.gov) Receipt Acknowledgement Date:08/22/2018-8:51:39 AM CDT-Time Source:server-IP address:209.194.29.100 �1 Signed document emailed to Ab Grantges (kcarwine@aol.com), Fred Ehia (freidoon.ehia@fortworthtexas.gov), Allison Tidwell (cso_finalpay@fortworthtexas.gov), Julie A Geho oulie.geho@fortworthtexas.gov), and 7 more 08/22/2018-8:51:39 AM CDT Fox_ _d Adobe Sign