HomeMy WebLinkAboutContract 46462-FP1 . � FORTWORTH.
RE E�VED CITY SECRETARY [_ "
�82019
CONTRACT to
C11Y�fF0AfWd TRANSPORTATION AND PUBLIC WORKS
C cgE[ARY
r' NOTICE OF PROJECT COMPLETION
a City Project Ns: 02113
Regarding contract 46462 for SOUTH MAIN STREET as required by the
TRANSPORTATION&PUBLIC WORKS as approved by City Council on 2/10/2015 through M&C C-27184 the
director of the TRANSPORTATION&PUBLIC WORKS upon the recommendation of the Assistant Director of
the Trans ortation&Public Works Department has accepted the project as complete.
Original Contract Prices: $7,848,347.56
Amount of Approved Change Orders: $745,814.61 NO 1,2,3,4,5,6,7,8,9
Revised Contract Amount: $8,594,162.17
Total Cost Work Completed: $8,580,465.26
Less Deductions:
Liquidated Damages: Days @$210.00/Day
Pavement Deficiencies:
Total Deduction Amount:
Total Cost Work Completed: $8,580,465.26
Less Previous Payments: $8,151,442.00
Final Paymen ue $429,023.26
xe
Recommen r Acceptance Date
Asst. Dir cto T - Infrastructure Design and Construction
Accepte bite
Director, TRANSPORTATION & PUBLIC WORKS
1
Asst. Iity Manager Date
Comments:
OFFICIAL RECORD
CITY SECRETARY
FT.WORTH,TX
IDepartment of TF &W Const. Services
( reeEst
Date
Z-Aan;ajger-.
Risk "'Aanagement Canadd
D.O.E. Brothertdn
CFA Morales/Scanned A
Gu]Lz er/Scanned
The fProceeding people have een Contacted
concerning the request for final payment& have
released this project for such payment.
Clearance Conducted By Aama6z
FORT WORTH rev 03/05/07
TRANSPORTATION & PUBLIC WORKS
FINAL STATEMENT OF CONTRACT TIME
FINAL STATEMENT NO.:Final#59
NAME OF PROJECT: S.Main St. -Vickery Blvd.to Magnolia Ave.
PROJECT NO.: 2113 CONTRACTOR: JLB Contracting,LLC.
DOE NO.: Wf'g
PERIOD FROM:03/09/15 TO: 12/12/18 FINAL INSPECTION DATE: 26-Jul-18
WORK ORDER EFFECTIVE: CONTRACT TIME: 910
WD QQ 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.
8. 23.
9. 24.
10. 25.
11. 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
PERIOD 0
PREVIOUS
PERIOD 0
TOTALS T-
TO DATE 909
*REMARKS: Project Substantially completd and Time Stopped on 9/2/2017 with 909 CD's charged
Total of 910 CD's awarded,per Project Manager email 5/2/18
Z
CONTRACTOR DATE I DATE
ENGINEERING DEPARTMENT
�s° The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TX 76012-6311
(817)392-7941 •Fax: (817)392-7845
TPW Construction Invoice
Contract: CS46462 P.O.# PO-15-87603 Payment Date: 11/30/2018
TO:JLB Contracting,LLC INV.# CS46462-59 Estimate No. 59 DOE:
P O Box 24131 ProjManager PAT BUCKLEY
Fort Worth TX 76124
FOR: S MAIN ST-VICKERY BLVD TO MAGNOLIA AVE
Contract Amount: $8,594,162.18
Completed Ret Pen Adj Pay
Total to Date: $8,580,465.26 $0.03 $0.00 $0.00 $8,580,465.23
Previous Estimate: $8,580,465.26 $429,023.29 $0.00 $0.00 $8,151,441.97
Eamed to Date: 50.00 ($429,023.26) $0.00 $0.00 $429,023.26
Payments:
39007-0200431-5330201-CO2113-CO2383 $457,212.81
Total to Date: $446,814.74 $0.03 $0.00 $0.00 $446,814.71
Previous Estimate: $446,814.74 $22,340.74 $0.00 $0.00 $424,474.00
Earned to Date: $0.00 ($22,340.71) $0.00 $0.00 $22,340.71
39007-0200431-5740010-CO2113-CO2383 $1,440,791.21
Comments:CO#9:$190,578.25
Total to Date: $1,582,329.91 $0.00 $0.00 $0.00 $1,582,329.91
Previous Estimate: $1,582,329.91 $79,116.50 $0.00 $0.00 $1,503,213.41
Earned to Date: $0.00 ($79,116.50) $0.00 $0.00 $79,116.50
39007-0600430-5740010-CO2113-00148$$283,225.44
Total to Date: $281,484.73 $0.00 $0.00 $0.00 $281,484.73
Previous Estimate: $281,484.73 $14,074.24 $0.00 $0.00 $267,410.49
Earned to Date: $0.00 ($14,074.24) $0.00 $0.00 $14,074.24
RecOlved By
ro ect Supl�rt ZG1 IA'S":: ORDER rvit �
� 19
JAN 1 1 2019 Transportation&Public Works ' Page 1 of 3
BUSINESS SUPPORT GROUP
Contact Person/Phone Number
ANDREA MUNOZ X 2372
TPWScarp
Department Approval Signature(Printed)
CAROL BUKOVIC X 8648
Ilt AP 9 e' �j/
Contract: CS46462 P.O.# PO-15-87603 Payment Date: 11/30/2018
TO:JLB Contracting,LLC INV.# CS46462-59 Estimate No. 59 DOE:
P O Box 24131 ProjManager PAT BUCKLEY
Fort Worth TX 76124
FOR: S MAIN ST-VICKERY BLVD TO MAGNOLIA AVE
Contract Amount: $8,594,162.18
Completed Ret Pen Ad.j Pay
Total to Date: $8,580,465.26 $0.03 $0.00 $0.00 $8,580,465.23
Previous Estimate: $8,580,465.26 $429,023.29 $0.00 $0.00 $8,151,441.97
Earned to Date: $0.00 ($429,023.26) $0.00 $0.00 $429,023.26
Payments:
31002-0060419-5740010-CO2113-CO2383 $2,970,050.00
Total to Date: $2,777,589.90 $0.00 $0.00 $0.00 $2,777,589.90
Previous Estimate: $2,777,589.90 $138,879.50 $0.00 $0.00 $2,638,710.40
Earned to Date: $0.00 ($138,879.50) $0.00 $0.00 $138,879.50
31002-0060419-5740010-CO2113-CO2383-- $750,000.00
Total to Date: $734,124.34 $0.00 $0.00 $0.00 $734,124.34
Previous Estimate: $734,124.34 $36,706.22 $0.00 $0.00 $697,418.12
Earned to Date: $0.00 ($36,706.22) $0.00 $0.00 $36,706.22
59651-0200431-5740010-CO2113-CO2883 $150,000.00
Total to Date: $130,947.35 $0.00 $0.00 $0.00 $130,947.35
Previous Estimate: $130,947.35 $6,547.37 $0.00 $0.00 $124,399.98
Earned to Date: $0.00 ($6,547.37) $0.00 $0.00 $6,547.37
Monday,January 14,2019 Page 2 of 3
Contract: CS46462 P.O.# PO-15-87603 Payment Date: 11/30/2018
TO:JLB Contracting,LLC INV.# CS46462-59 Estimate No. 59 DOE:
P O Box 24131 ProjManager PAT BUCKLEY
Fort Worth TX 76124
FOR: S MAIN ST-VICKERY BLVD TO MAGNOLIA AVE
Contract Amount: $8,594,162.18
Completed Ret Pen Adj Pay
Total to Date: $8,580,465.26 $0.03 $0.00 $0.00 $8,580,465.23
Previous Estimate: $8,580,465.26 $429,023.29 $0.00 $0.00 $8,151,441.97
Earned to Date: $0.00 ($429,023.26) $0.00 $0.00 $429,023.26
Payments:
59601-0600430-5740010-CO2113-C01483 $1,261,191.21
-CO#I-$19,006.79,2-32,401.00,3-
9,705.00,4-14,958.00,5-7,825.00,6-
4,400.00
Total to Date: $1,314,754.16 $0.00 $0.00 $0.00 $1,314,754.16
Previous Estimate: $1,314,754.16 $65,737.71 $0.00 $0.00 $1,249,016.45
Earned to Date: $0.00 ($65,737.71) $0.00 $0.00 $65,737.71
59607-0700430-5740010-CO2113-C01383 $1,164,691.51
-CO#1-$19,359.72,CO#5-$2,590.00
Total to Date: $1,195,420.13 $0.00 $0.00 $0.00 $1,195,420.13
Previous Estimate: $1,195,420.13 $59,771.01 $0.00 $0.00 $1,135,649.12
Earned to Date: $0.00 ($59,771.01) $0.00 $0.00 $59,771.01
39303-0200431-5740010-CO2113-CO2383 $117,000.00
CO#8:$117,000
Total to Date: $117,000.00 0.00 $0.00 $0.00 $117,000.00
Previous Estimate: $117,000.00 $5,850.00 $0.00 $0.00 $111,150.00
Earned to Date: $0.00 ($5,850.00) $0.00 $0.00 $5,850.00
Monday,January 14,2019 Page 3 of 3
Contractor Final Estimate Approval Final - 1 - Submit Page 2 of 3
FORTWORTHR, Contractor Final Estimate Approval
Date Started: 11/30/2018 M Date Due: 12/17/2018 }
Invoiced Amount:
(Amount from $ 429,023.26 Request No.: Final - 1 - Submi
Line 8 of C-620)
Project Name: 02113 - South Main
Project Number: 02113
Invoice No.: 59
Reference:
Contractor: Sam Davis
Discussion: final estimate - retainage only
(Limit 5000)
Approval Status:
https://projectpoint.buzzsaw.com/ bz_web/Forms/FormPrint.aspx?Siteld=51500&Processl... 1/14/2019
Contractor Final Estimate Approval Final - 1 - Submit Page 3 of 3
Approved: Yes
Comments:
User: Joe Rogers
Date: 2018-12-13 10:05 AM
Approved: Yes
Comments:
User: Etta Bacy
Date: 2018-12-13 10:22 AM
Approved: Yes
Comments:
User: Sam Davis
Date: 2018-12-13 10:25 AM
Approved: Yes
Comments:
User: Mark Owen
Date: 2018-12-13 1:54 PM
Approved: Yes
Comments:
User: Patrick Buckley
Date: 2018-12-14 11:23 AM
Approved: Yes
Comments:
User: Jeremy Williams
Date: 2018-12-14 2:27 PM
Approved: Yes
Comments:
User: Mike Domenech
Date: 2018-12-14 2:36 PM
i
Approved: Yes
Comments:
User: Ricardo Matute
Date: 2018-12-20 10:04 AM
i
Approved: Yes
Comments:
User: Alexiz Ramirez
Date: 2019-01-14 10:46 AM
https://projectpoint.buzzsaw.com/ bz_web/Forms/FormPrint.aspx?Siteld=51500&Processl... 1/14/2019
Contractor Final Estimate Approval Final - 1 - Submit Page 1 of 3
Routing
Assigned To: TPW AP Control Due Date: 1/19/2019
Assigned By: Sam Davis Due Time: 10:56 AM
Links 1
fortworthgov/Infrastructure Projects/02113 - South Main Street Vickery to Magnolia/Contractor/Submitted
Invoices/Estimate No 59/02113 - South Main - C-620 Contractor\'s Application for Payment 11-30-18.xlsm
Attachments(01
No Attachments have been added to this form.
https://projectpoint.buzzsaw.com/ bz web/Forms/FormPrint.aspx?Site1d=51500&ProcessI... 1/14/2019
N\
d �tJN
rn
io J
m N
o iN yy
I?
L) h N N O
r ° N 1 N N
��. b 10 � N � O O O D\
00 'It O0 O r O
0000 R h n v N J
� oo6o)
666 V�9 V) V'1
CN
N9 4f fA 69 H Yn FA 69 Yf 69 Y>
Bpd: W yap Q U�
d y O e 4 11
'O
e°o o o a m G d G W a
a
v, h T Q J o
O E O u ry a .a o CW7 u ai rn
N E Z z + 1' o
oo
CCn
Q s a d Q w a z a e —
p
.>°.. �—
CL
c
E �
a o O W a s ci W W C O o U e� o c
d r
z 0. z U e U
O v O d 0 Z Z m
e
0o u 'z U F0 d w Q .�.1 Q m U c U d
v vi ,o r ao a m
O � d ti N
CD
o E o f
o o o
y Fo U c x �, > o yQ c
°a
w Ov o 10z a 3 ' > v o Na
C� o
QI 0. ^ °- 3
O ea o $ m Ala
so' O 'a ay
Gwy .5 U o c E 4 eu._
° z .� ami d
z8 E y
C1 o g U o tq3 K2R.-a o
v�v c n
d
V OE
P., E 60) CU
ME p N o G O 0.i ttl V._ L 0
kyi/} N G N .D y G C
'°O FO W pTp E C
O N O q N O O O O � � N � '°O'.�y' � ❑ V t0 N 7 ��p
o o m o.? y `.0. 0 J
y..�
�0+ Fr 00 a s d 6v vi 6v 6" 6o0v iA us us -a E a ie p °•y ° � F E
V PLO
51
O ~ $oa > >
.,
00.
o U
q ^ v n o c ao o, O U ow 8 h = ° 3
r 9 U �+ o I n r� o
�"" L t�V F V..V•. d 'O
c m c
0 O [7 U.0 o y
U H o at0 n o l °
E
= q 8 8 8853 8 88 8 888 s.s.se8- 88886 8. 8 8 88 88 8 3 88888 gs.a. 8
a a
d
S ��w 8s 8 888 88g 98 ss s
�0 88 8 85; 8 888 8. 8.8 8. R 88 1 8. 8 88. 8 8.88.8 888.8 $ 88,888.8 8 8,8 8
°s »
�9 C3 E
d Z �yy
8
�g
$ 88 8 8$ 8 8.8.8 8 88 8 R 88 - 8 S 88 8888 888.8 8 888888 � 88 8.
s F4 s 9
8$ S 8$ S 883 $ 88 8. R 88 S 8 S 8$ S 888$ 888$ 3 838$8- 3 8.8 8
'sm X94 4 s3 $gym m 30 $ � � m
8' S 888 8�3 3 88.888s;�8$ 8888R 8 -S a 8883 8.8.88 8 8$ 8 885 888 8
v
983»�
89888E8$4S28889898.88888RP 9P 8888.nw88988-848.8.889888898S88a8a8a888a8888 8
a as
�g
¢ aa E
z°
=RR _ n 'i 'i - X5;8
a _ _ R ___ 8_ 3 S"_' S p S 8 8 S
m
g45
g N ?a b 3 c g 3 ' �' E
_rc
. mmN� �� � ve-me
5 2 5 8-n p "8 R
m
y
n ��s���� �r ��R �x ssmR�RA Z! 0.6��:
w w �
E
8.8 88 p 8 88.88. 8 8 S N888888.8.8 8p88.R.m 8.8.. m 8
»"
� a
d
�8. �.88gp88.8g�8 n _9 8 88SSB$8 �as. X808 9A9.$0 8g88
88888888888 88. 8 .888.8.8 8r8 888 2 8 a 8 8 88. 8:8-.E8 $88 888.E 88A388.. 88 8.8
s .§
a
$ 8888888888888 8 88.888 8n8 888 2 G $ 88. 88. 88m88 $8.8 888 as 888 8N 88
8888.888.888.8 v 88 8. 8888.8 8 A 8 888 1_$ 9 E 8 888 88.188 988 8.8.8E 99888 88 88
� g �a8sRo $ m m Axa ` ^
Via» P. » 9 »» » »
a
888888888$8888888888.8.888$898888 978 888 88 N 88pi8828888898a88888s8888 888
8888888888888888888.88888.8898888 '8" 828 88888.1-88288.8889?88aa a 8888 8..8.8.
» ww s� a�� xsg yw yes w a �» ww �� s» las »»asa a p »
�a
www moww�>wwww w m LL mmm m mmm��bN�uhwwwwwmm�5w m mw� mw
2
8 --
�
a -- - -- -- - P-9--
<bR' °� � ti$ arma�o m 333 �$ dp gAA o8m
i" s z Nmemmnm
98N8R9mp8x -rte
E
Q s$$ 2$s$$$ 28rv848888888888 $$ �
o $ �
d �
8ggm888„mg eg $ja6 gp. $aR S8s.8sa88aE888888888a88a88888.88888 888p
sem, 888888858888,888.8 `mp,8.U3'N8a 8888. 8. 888.88888%iRR _888.8888 S.S888888S8.g888. 88��
g
$ 8888888$88888888 mR88t3S88 8888 8. 888.88888RR8 8.88.888.8.888.88888588$88. 8v32.P.
8..8.a 8888s8$888888 ;884888 888.8 8 89,.8888s8lCRR8888888.888888.8858gg8.8.. 83.8�l
a
8888888885888888 2 998 88888.88888 898888889RRR8.8888888888.88.88588888882
$$88,888889888888 -Ei5zm88888888.8,8 888 �m
.888s88R8.88.88888$88.8.882ZWER 88884n
-.
z 99 cs°�53» s»a»»z�Na� xx s g "»tt
B$
m �.6
=ss. as aaaaa�a- sa �s�� sssssse
ms'm m�� m� asss�m�m
o� ys IE z ��
g E g "
za vv �og �g >ddFgFm � �g arcAA a <�°gdo" --ga d aFaAWu o
€�a �ioo yh 338
z z o m e m
E E ��Z m v 1 u°o
�„ Baa Hz zu� LL aNmaa0a�a
gB s--- �s g RF,9988888v^
W
8
bD
L �
a
E
w a 8 8 8 8.8. 8 S. 8 8 R
s $ F R III8
a •a � m
� y o
gg 8 805888A*88 g8888-8888888 88 8 8
m
Ss 8 ^D;s.a.8sss8 8.8888m8888.889 aa. s s a
gpa gasp agm�uas
B
E
88 8 " `8888888 88888°8888888 88 S S S
»
88 8 "^88.88888 88888'°8888.888 88. S F �
w�isg� » $
S8 8 R 8888. 88 8888888.888.88.&&888 8. $ F
m
sffi
8.S 889°'m8.8.8888. 88888888.$888<8.8.8 8 ' R �
}y €
»gg »
uv ¢fi€g
R5
p E
Z
E 6
�g w W w u�W u�www u�ren U V U w W 42 w u N m
5
z°
8
s
"96
z � o ffiI 8 N
`y8' $m m m m m g e j a 5 "5m is d
0 0 0 0 o n a Y
Y@ w p U�U p c mg�• @ vii F 4¢g
W m m p N N g g g gggg J g gtt gg gg
E7 oiz
ARIA
RRR � a8888.888��8.8.88Rs � �88
W
0
U
U
O 9
•d m
a r
�' � a=" sssaasagsas s
� �ppS
C s
U �S
wa
�h 9
& 8 y 8 i 3
8 8 A 8 a 8
o =a»tt�xN 5m
b 81 8'A Ai -
z g �Ptts�tts
as�agsas��s $s
g
gg$g gg$gg$ gg$gg$g$g gg$gg$ 6
m
� ki f3 f3 f3 F3 F3 �{Yi tl9
cn
z o
Z
u �S �
v
cu
e a
w
r
U
RM.
)
§ !
� 2 !
� - ■
� 7
f ■
u
\ 7 �
f
! 11 Hill
!!
Li
! \/
a ! ))
� |!
/)
f a7
r!
|!•\�k(k§k �
\!
m■aae,a !
|
\2 |§|§§§|
j\
` J|
) / 2
� k\
0
v
k
j ■!:||!|
§ 7 ] f«!!!!@!f
ai
0
U
w
U
C
CC 5
u �
C. a0
G � r
88_88888_ 8
+�+ 88888868 i 8
euQ �� age a�a
i
b,
8 81gi8��'�� 8
A � ��j���j� lilil � i � � l ► ji ► ll ! ii iii l ! { � � � !
i
' U
< �5
w �
g g g g g g 8 $8
a �o
N
B
� bbb e
z s
v
�n
r
U
^ 9
O
y = c5'n>. r333
-
£
)
a �
_ ! �
§ ! i
§ �
E !
\ �
! •
! I i
! �
! ( {)
® i `
;\
\�
> �
f ){
~ cn
1111111111 Im
� § �
t ;
) ' �
�
§ �
} � )
\ � �
) �
w
\
2 ) :
\ ; �
) � �! #■# � #
5\
;\)
| )� £ \� 2� � � � L::/ \�\ ` �� � , •]
�w� y
ƒ! •). «y ' � � . � ; � . : � . � . � i � � � � ; .
§ § §
)
!
§ {\\
o ! , »
� ;7 !
I
., � . . . . . . . . . . . , . . .
. . . . . . . .
k ! {
)
2 7
« ! (
«
� � � \
� ° ]
\ �
) ��
, ) � � .
\ \ � � : : : � : ; ; � � . . . . � � . ; : � � � .
! � � � � �
� \\! ;
� �\
f !,
z j\
]]
f x;
® � � ( � �{
° \�
!) ,[ � )
\!
; �}� � � 7
��
, ! � «;
a a ]|
� !;
!!
)!
z � \� k ;]
z (
2
] ) \ \�� . , � i
z ° , , � � �
) k\
c �
& �
\ j � � � �
� ; � ) �
) / \ ' � )
[ ; s
o )
\ �
d
.. ) � `
\ \ ] \!® �
� � / } -
§
/ 7
3 «
_ .
\ � `
/
� ..
$ $ �
! �
� {)
){
! ®
k]
!!
11 1 1111 1111 1
e );
! $ ]|
!!
§i
§ §
� )\
§ !|
o �
[ , ,
v �
§ ,
§ !
c |
0
U
w
U
o w �
� ( � � �
� m � j � '
- �
'a � �
a
d � � � � � ��� a �
L elm sss ssa
.. _ _ __ _
$� sss ss8 � � � a
U °s em ! � � � 3 � j � ! j
ti
F j < � � ( ( �
�� � i
z Q �G � � i l i � � � �
� "' �� 1 � I � [ ! � j t � r
i � i j
�� E � � j I � � � � � � � ; � � j ( � � 1 � � i � � � �
>" �
sass �sas _ � � � � � � � s �
o' �� � � �
s� � ��� � � � k 3 � � � 3 0
�� l�E , ' t i i � � � � � { �s
� � �H 1��� � s < < � i � ��
�'
�z �5a 8884r,�8R� � � i � 1 € i � � � � jj g ,�1,v
�� m ¢2j � ��M`x� � � � � ± t E
U� U
Q
g 8 8 8 8 8 g •�o
B
a �� � ��
� � � � ' � � o
� I � � �
O � U o�- r�... H E
.�+
A � �� �5� 5535 � � � � �
� Qd' � �
E
z �z � � I � � � i ,
o � , � r
a
� � ? � ,
� � �
� � 1 _ � {
� _ i � �
g � i
m ' i
N � � :C..Ss 3 g 1 i i 1 ( i
� o � I l
% i I i � i i, �
� E4 I 1
� �Z � �SIN �b O � j i l `t(`((
/�� � � � � i
U i � � � I
§
$ f � , � � �
\ = i
� ° � �
� ® _) !
_ �
) � � .
2 7
\ � � �
* ..
! f !
) } � � '
/
_ !,
! ' \\
. � c ,
® ]{
\7
j � \}
j)
) , e]
� * � �\
])! '
\)
&/& � /\
\ ' \\
® !\
!!
, � |;
/) 4)
z � �!
2 �
� � »; �
� � � !]
\ � � . ,
$ {)
} , r
\ � �
§ �
4 , � �
) — { � � � —
§
° � (
/
�
7 !
)« �
/ � � \
� ! \
0
U
w
U
1
1
� � m 1 �
� �
•� �
N �
N M
(A o LL W g g � g
L
8 g
Ca_ 0� I
L �96� J,
++ i i
V�C�
e i � � � � ;` � [ � 1 i J j i I t
3 9 '6� ((
� � �� }
a '. '. 5.�
g
s 8
5� a�
S
� �o
Q = �� la � j ! l � � ll ! I � Iilj � i � Il � l � ll ' � I � � � I � � i ! Illi � ' g ��
��
e �� i � E
��
w 1 1 ��
�� s 88 t � 8
z ��u t g
a
��°, � ,�s
8 8 88
� '� �s
7 � ��
� � 1 ��.
9 I
� � � ��
o � � �e
o �
H s
ca � a� ��
� A � a�
� �
Z �z° 1
,9 'y��yah
L y�Ti � i . 1 1 i i ' i t . i ' t
0
d
b0
C
� l '. '. : 1 � � � � �
U ( � � [ �
I
F
� � S �
z � 1 a
E � i
0
as
�..,
c 318:
y B v � � � , i i � � e � � � � i � i i
_ a 1 l � � I
Ot 5 �z 5�_
a � � � �
\ �
\
� ! i
) �
! !
! ! !
! !
` \)
] /}
� )\
! B;
!'
�\
�
§
) -
(
2
k �
(
0
U
U
� 9 w
um
a
R 8 S. 8 R, UL�»
�B I � IIIIj � IIl � cillllll � I � EI � � ' Ij1 � 111 � I � l � � j ) � � � ,
�a
o
211
c Q o -
s
d
on
� 5 a
z G t 5 G c S .9 5 -F 2
== G.�,€ € U ..`
N U
-
y p m P MIR1, P p a R " a A axl
\
k
< r< < < r !
! !!!
!)
. . . !\
(»y± 4■ | \;
a;®® ._
-. : !!
2k12 §| ){
l§
!!
)k
§§§| n§ 4
®y{ / g
0
U
U
O SS
u
a ^�
a
H �
L gz
V
L
a z
0
U I
z d �
B
w
� 8 z
i
a o
a�
5 U
z
�r
u w�
888888���8888s 8s88s8s8s88s88888��8888888m8�8��s�s88��88888��s��a a
01110 a
U 8
888888RRR88888 8888888888s888888i4888888mffi8M88'FSi8888e88888m88 «M g8
O �
F
� A
Z �z
0
d
R 4
g3> 4 3J7 g- �S AAg- ykU
3336"�A. 36. gi�sC sa > UUUU �, ~�ecGg88e� ga ._
+moi n oc�o� 3 E33HBa�JSg <w aa� � 3 � " a99 .�,� �Oz°z
E N MR- o»s»mg8oos�ao'soo�a$<��o�o��s��s"s_�s�oM�a�r�
�«r.1A A 14,414rdb�dby H-?}.A.�,:AddJ,J,�J, -A-A-A ,A did�b�
a
U
5"$
5,�
�a�
��
ss
°s
a€
��
�g
5�,
es
��
5
��
��
By�,
E 5
8�
��
��
)
\ z
�
_
) $
� !l
/\
\)
!
�!
,
\\3 I }]
� !!
z ` HIMLl
§
\ w
0
z ! �
d �
�
E ! ® \
O
U
w
U
O 2
u � �
d o
888 888 8888 88888888888 88 8
U F
I
w
�B I I I I j1 i III � I
sss aaa sas � � aasas sa " �'�
o "
U B U N N N N M N M» M
888 888 88RR 88888888888 88 g8
a j
gg gg g$ gg8 gggg$g$g$ gg$$ $$g$gg gg gR gg g g g �
� m � g3 k�2i SRSi Zi F3 �tf3 F3 p.y 2S 252i i � .�9
3 �
E p �
z o
L �c
u o
O
d
C
� u
h 8 � i
XXXXxxr�3X
p, ILLL
(
$ 7
� ®
k ~ !
/ � a
w ..
! ! ;
$ $
! �
t]
/ \\
� }\
! -
_
§»
: )|
� ]!
z §
@
± �
v ,
d ! � .
k
�
j (
.. ) �
]2
a • $ /
N
O
M
t i
I I �
NC _
Gm t uJ� viu
E o c
z � •b
m a �
a Q
M
O
O � von vY a,ce w�
O a
O
i
� p
N
L O u
CU
d P
z
A N Pm „ to
(0 v w �4o 4o v �
E
E
O
F
LL .y vOMN V SNN cJ O
_
f'7 ' O J Y
m I�Nf-: •vim O , �vr
0 v n GD N r S - N S �
O rn M E m�vm N m L c�
'~ omin omci M M o
(p�
' O VI M N r M N T W NM m a
w
� a
0 _ r� MN n O S .. ---
'T Ln r V ro OD o O '
w co co
�� mV 8
E am in cD c M M o
O V OMDN rr N cD HN i � i9
U NW cj(MMN/9
pMppp pMpppMM L�pMp qM pMp cn Mm PUMP
QMp pMp pMp QMp L�MMM {Q�p{0�p(pip fL'mM QMpM
MM M UGO�l fh 22 P UmMP AA V'f`•) w V M �f7RM UODYw
N N N N N N N N N N�N 6 N N N N N v
O O O O O O O O O O O O O O O O O O 0 0 0 O O O O o 0 0
�UUU�UUU UUUU�UUU UUUUUUU U��U�UUU
chAA(b E^Sind cbchchcb Wch�Jcb rScbchcd Wdc�cS ihcbcb�5 ch r5
NN N N N NNNNNC�N NN NNNN0 NN N NN N N v N NN
lo w N w V O o o 0 O O O 0 0 0 0 O O O N O O O O o o o M O O O O O O o
a d�
ddddd Pddd�ddd Edddddd Pddd�ddd
c IO pp
=O U O O S S M S O O m O S S S M S S 0 m N 8 8 S M S S 8 O Np S O O M S S S
'4 U (gMvvvovva Mv'7 vo vvg 9 *vvo v vv gv vovvv
V u C M r r r N r r r C M r r r N r r r c M r r r N r r r C M r r r N r r r
Q hN M4?m u1 u)m �m N o u)�u)u)u) W m u)6to��1n un ��L? wmwLo6
o c 'v •cam.-doJS�dd r �d>o-dd L dd6o.=�d L dd�S�dd
U Q pMMM'- MMM V'n(n oMMM V i+7 NIM�OM M V C7 P1M�-oMMM
LL Boo go o 000co 000 Floc oo oos 000
gym„ z N N m N r N N f0 o N m r N N m O N r N N 9 O N m r
999 0 o 0 0
99 o 0 o g o o q`$o 0 0 0 0 999
n cS p��r ��Sr�N��. QrrrNa��n
�• go$grmoo SgQS��i�i�i Qoorm� $i�i�ig��i omi omi
rnrnm��o-n rn cna,
C.1 M M M M C:)lnmin M MM cn C9mu)m M M M MC)1nmN M M M M0v)v�u)
i
0
M
M
.r
N
O
� � d
' A c
z
d
a d
M
O
O 1O1n -
O a
O
1
rl
M c E
-C z
U z
� ( _....-... ._. _. .-. - _ ......... .... _. .-........._
TTT Ci
0 al
to 00
a Cco g
m d E w N N N
E
E 1(�
H
I..L
0 0 N .....
-- - O
� N
0 cn M E N N1On S �cn 0 Nr
z �6 Nm
a g
U 00co O
� � a
0 0.... O LO
�' In1 N N
co LO10d
d N N In aV ,'.aW N
C � N N
U O in
O
F
M MMM M M M M M M M F-M M M M M L�L M M M ._-..—
(pp(��pp co O O co {(pp++pp��m {pp(y�pp o O N�U,co v r°°i
N N N N N N N N N N � N N N N�-
0 0 0 O 4 0 0 0 O O O O W 000 O O O O 0 0 O O O O O O O O
U U U U U U U U U U U U U U 550020000 U U U U m U U U
cdcbcbcb ccbo5d �hd 1b ccSdoS c�cbnc�b cd b cbcAcbA cAA<b
N N N N N C 7 N N N N N N N U N N N NNN N C N N N N N N N C N N N
10
1UUCjf0 Pd°. Qe �U�N N1h Ndf7Mddd)dMdMrnD:UoMUMbiU$U�aGoMMdnModdM - I .fM�oM�dddf 'oddddddmo�o�rd�'n-60do0dosO ��� d0eee�v8v to MOO
vvvMvvvOvNrv�rIdMro<7
IovMr r r N r r r Ao M r r r N r r r M r r r v
0h000 1n00 1AYNn0N0 0 nLO N nn r0 Ina dd Cdd MMOddn hd
O8M gig §§SgO88a 08a999 M
o 00010 0 00-000Z 00 000
h 10 N N O O O
COr co O N r N N O N tO r
oo000 CC9 OO 0000 O . O 00�9 000
N rl-r NI�rnoo
;1O rmm0o oornrno
00
CD IMa.0mMM1n M 1n MMMM Ln LO I10n M M M gSa, 10
1n
0
0
m
M I
N
O '
O O O O
c c o
� o c
m
a
a �
M
O
OVii =,t�i3 iww wv �,viern' �
O a
O c
M �
Co
� v
� z
U z
«� n
cc! N f0 0) CO Co m m N rn
m Of m
C 0 0 0 0 0 0 0 0 OpO
N m N N O
G. u3 UJ riJ v7 c�to rn rA riJ r� 2 O v N n m N m
a 'E V)mnvcuoLo tO
� ¢ m oafnrnwwww �
C E� in vi
C a
L
>O
W �r o t �� o _._to � �o 0 o v m M N to ro M m
o ,cc N 5000o nornn ci�� N
i� o � o m .�r. r-�.7 vcvvr�vnvo vi
O y M O n r W m N v m N m
rl E O N ODN V(Q mry V
"" Un rn ((M(pppaomcOc"!u') o
' y fN f9 � 6NL4we- m
is
ir_) m .70 00 V O M NaammM m
� i O 0 0 0 0 0 0 N O O O O n O 1�h C 7 M '- N
O p m - - U vN V I-vn o m
(� O tl mNvcNO.�p2
E n o M{pa;aD ODA0 v W) o
O m�ONnn ch m
U Vi vi M H N w V) m
M M M M H M M-M -- M M M M�-M M M M MMM M M M
m m m t m m m m m m m L m m t°�im m m m m m
M(")vM uwvm MM V M U m v M V M U co m
N N e-N
{ 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 O o 0 0 0 0 0
U1UUU�UUUL U0002000 00002000
A('7 A A C M A A
NN N N N U N N N N N N N U N N N .N N N N N N
lo
v .0 1V m U U U U M U U U m U U U U M U U U U U U U M U U U
� � e ooddd�ddd poddd�ddd yoddd�ddd
4 N O p O n 0 0 0 N O O O n O O p B N O O O n 0 0 0
f V m O o 0 0 0 0 0 0 m O O O O m o 0 o O O O O O O o 0
M v v v v v v t-M v v v 444
n n n `` M rr n n o n n n
IQ Lm�mmoofmm Lu�mmmou)mm rornmmotomm
d000 dd 665 dd dd o dd
U Q U M apM apM�OMvMMpppM (U apMa MM�OMM apMa fap�C7M�0MMM
LL O O O t�0 o o o o O O O((pp m o O O j O O O o o 0 0
z N N
So
N�p n N N
lo
mNmnO
0000g00 00 OOC� OOOO,�j 0000000�v)on no ,tnoo r—r—vnoomm�i���irno) gooi �xomiomioiM M Um M MM U m m m M M M M U
FORTWORTH
TRANSPORTATION AND PUBLIC WORKS
PIPE REPORT FOR:
PROJECT NAME: S Main St.-Vickery Blvd.to Magnolia Ave 12/12/2018
PROJECT NUMBER: CPN 02113
DOE NUMBER: 7158
WATER
PIPE LAID SIZE TYPE OF PIPE LF
Water 30' DIP 151
Water 16" PVC 4615
Water 12" DIP 988
Water 8" PVC III
Water 6" PVC 666
FIRE HYDRANTS: 18 VALVES(16"OR LARGER) (19)x 16"
PIPE ABANDONED SIZE TYPE OF PIPE LF
DENSITIES: All Passed
NEW SERVICES: 2" Copper 240
1.5" Copper 40
F, Copper 1953
SEWER
PIPE LAID SIZE TYPE OF PIPE LF
Sanitary Sewer 18" DIP 494
Sanitary Sewer 12' DIP 491
Sanitary Sewer 10" DIP 140
Sanitary Sewer 8" DIP 1095
Sanitary Sewer 8" PVC 2746
PIPE ABANDONED SIZE TYPE OF PIPE LF
DENSITIES: All Passed
NEW SERVICES: 4" PVC 1540
TRANSPORTATION AND PUBLIC WORKS
The City of Fort Worth•1000 Throckmorton Street•Fort Worth,TX 76012-6311
(817) 392-7941 •Fax: (817)392-7845
CONSENT OF OWNER ❑
SURETY COMPANY RCHIT CT ❑
❑
TO FINAL PAYMENT SURETY ❑
OTHER
(SIMILAR TO AIA DOCUMENT G707)
Bond No. 3184315
PROJECT: South Main Street(Vickery Blvd. to Magnolia Ave.), City Project No. 02113
(name,address)Fort Worth, Texas
TO (Owner)
ARCHITECTS PROJECT NO:
City of Fort Worth,Texas CONTRACT FOR: Above Project
200 Texas Street
Fort Worth, Texas 76102
CONTRACT DATE:
CONTRACTOR: JLB Contracting. 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 Company) Westfield Insurance Company
555 Republic Drive, Suite 450
Plano,Texas 75074 ,SURETY COMPANY,
on bond of(here insert name and address of Contractor)
JLB Contracting, LLC
P.O. Box 24131 CONTRACTOR,
Fort Worth, Texas 76124
hereby approves of the final payment to the Contractor, and agrees that the final payment to the Contractor shall not relieve the
Surety Company of any of its obligations to(here insert name and address of Owner)
City of Fort Worth
200 Texas Street
Fort Worth,Texas 76102 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 November 2018
WESTFIELD INSURANCE COMPANY
Surety Com
B
Sign f uthorized Representative
Attest:
(Seal): Kyle W. Sweeney Attorney-in-Fact
Title
Note:This form is intended to be used as a companion document to the Contractors Affidavit of Payment of Debts and Claims,Current Edition
THIS POWER OF ATTORNEY SUPERCEDES ANY PREVIOUS POWER BEAHINU I rns SAMt
POVIER # AND ISSUED PRIOR TO 04/20/11, FOR ANY PERSON OR PERSONS NAMED BELOW.
General POWER NO. 4220052 06
Power Westfield Insurance Co.
of Attorney Westfield National Insurance Co.
Ohio Farmers Insurance Co.
CERTIFIED COPY Westfield Center, Ohio
Know All Men by These Presents, That WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO
FARMERS INSURANCE COMPANY, corporations, hereinafter referred to individually as a "Company- and collectively as -Companies," duly
organized and existing under the laws of the State of Ohio, and having Its principal office in Westfield Center, Medina County, Ohio, do by these
presents make, constitute and appoint
CHARLES D. SWEENEY, MICHAEL A. SWEENEY, KYLE W. SWEENEY, ELIZABETH GRAY, JOINTLY OR SEVERALLY
of FORT WORTH and State of TX Its true and lawful Attorney(s)-in-Fact, with full power and authority hereby conferred in its name,
place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings, or other instruments or contracts of
suretyship- - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - -- - -
LIMITATION: THIS POWER OF ATTORNEY CANNOT BE USED TO EXECUTE NOTE GUARANTEE, MORTGAGE DEFICIENCY, MORTGAGE
GUARANTEE, OR BANK DEPOSITORY BONDS.
and to bind any of the Companies thereby as fully and to the same extent as if such bonds were signed by the President,sealed with the corporate
seal of the applicable Company and duly attested by its Secretary, hereby ratifying and confirming all that the said Attorney(s)-in-Fact may do in
the premises. Said appointment is made under and by authority of the following resolution adopted by the Board of Directors of each of the
WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY:
"Be It Resolved,that the President, any Senior Executive, any Secretary or any Fidelity& Surety Operations Executive or other Executive shall
be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and act for
and on behalf of the Company subject to the following provisions:
The Attorney-in-Fact. may be given full power and authority for and in the name of and on behalf of the Company,to execute,acknowledge and
deliver, any and all bonds, recognizances, contracts, agreements of indemnity and other conditional or obligatory undertakings and any and all
notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such
Attorney-in-Fact shall be as binding upon the Company as if signed by the President and sealed and attested by the Corporate Secretary.-
'Be it Further Resolved,that the signature of any such designated person and the seal of the Company heretofore or hereafter affixed to any
power of attorney or any certificate relating thereto by facsimile,and any power of attorney or certificate bearing facsimile signatures or facsimile
seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached.- (Each adopted at a meeting
held on February B,2000).
In Witness Whereof, WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE
COMPANY have caused these presents to be signed by their Senior Executive and their corporate seals to be hereto affixed this 20th day of
APRIL A.D.,2011 .
w....w.». .,,,......•.,,�
Corporate
rQ`#?u$��C�p,` ;'aP�`�NAL.�NSG; MSUWESTFIELD INSURANCE COMPANY
Affixed v: .cZ. �'a WESTFIELD NATIONAL INSURANCE COMPANY
`iQ '�' :y= =�'�:'• -=!� OHIO FARMERS INSURANCE COMPANY
LSAT =7= � �VIRRTfQf�?$�
SL'Illi :rn= EC_.
t A,.. .... By:
State of Ohio "" Richard L. Kinnaird, Jr., National Surety Leader and
County of Medina ss.: Senior Executive
On this 20th day of APRIL A.D., 2011 before me personally came Richard L. Kinnaird, Jr. to me known, who, being by me duly
sworn, did depose and say,that he resides ln Medina, Ohio; that he is Senior Executive of WESTFIELD INSURANCE COMPANY,WESTFIELD
NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, the companies described in and which executed the above
instrument;that he knows the seals of said Companies;that the seals affixed to said instrument are such corporate seals;that they were so affixed
by order of the Boards of Directors of said Companies;and that he signed his name thereto by like order.
Notarial
Seal .,•�.R\A L ati
Affixed �P.\\ //`sit♦ ,
• William J. Kahelin, A rney at Law, Notary Public
State of Ohio ==N dam;p
County of Medina ss.: My Commission Does Not Expire(Sec. 147.03 Ohio Revised Code)
_
QTEOFo '
I, Frank A.Carrino, Secretary of WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS
INSURANCE COMPANY, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said
Companies,which is still in full force and effect;and furthermore,the resolutions of the Boards of Directors, set out in the Power of Attorney are
in full force and effect.
In Witness Whereof, I have hereunto set my hand and affixed the seals of said Companies at Westfield Center, Ohio, this 30tl' day of
NovemberA-D;;� 2018 ,,,
aP.,.......!s 1nsuR
�
; :O ..;p
,,..,_�•-��
�ro 0)1. SEAL Vim; :�' :ae /r Secretary
�Y =, o- t 1848 :!= Frank A. Carrinc, Secretary
BPOAC2 (combined) (06-02)
CONSENT OF OWNER ❑
SURETY COMPANY ARCHITECT
CONTRAOR ❑❑
TO FINAL PAYMENT SURETY
❑
OTHER
(SIMILAR TO AIA DOCUMENT G707)
Bond No. 3184315
PROJECT: South Main Street(Vickery Blvd. to Magnolia Ave.),City Project No. 02113
(name,address)Fort Worth.Texas
TO (Owner)
ARCHITECTS PROJECT NO:
City of Fort Worth, Texas CONTRACT FOR: Above Project
200 Texas Street
Fort Worth, Texas 76102
CONTRACT DATE:
CONTRACTOR: JLB Contracting. 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 Company) Westfield Insurance Company
555 Republic Drive, Suite 450
Plano, Texas 75074 ,SURETY COMPANY,
on bond of(here insert name and address of Contractor)
JLB Contracting,LLC
P.O. Box 24131 CONTRACTOR,
Fort Worth, Texas 76124
hereby approves of the final payment to the Contractor, and agrees that the final payment to the Contractor shall not relieve the
Surety Company of any of its obligations to(here insert name and address of Owner)
City of Fort Worth
200 Texas Street
Fort Worth, Texas 76102 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 November 2018
WESTFIEL9 INSURANCE COMPANY
Surety Co y
By
Signa r on ut epresentative
Attest:
(Seal): Kyle W. Sweeney Attorney—in—Fact
Title
Note:This form is intended to be used as a companion document to the Contractors Affidavit of Payment of Debts and Claims,Current Edition
THIS,POWER OF ATTORNEY SUPERCEDES ANY PREVIOUS POWER BEARING I HI5 SAMt
POWER#AND ISSUED PRIOR TO 04/20/11, FOR ANY PERSON OR PERSONS NAMED BELOW-
` General POWER NO- 4220052 06
Power Westfield Insurance Co.
of Attorney Westfield National Insurance Co.
Ohio Farmers Insurance Co.
CERTIFIED COPY Westfield Center, Ohio
Know All Men by These Presents, That WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO
FARMERS INSURANCE COMPANY, corporations, hereinafter referred to individually as a "Company" and collectively as "Companies," duly
organized and existing under the laws of the State of Ohio, and having its principal office in Westfield Center, Medina County, Ohio, do by these
presents make, constitute and appoint
CHARLES D. SWEENEY, MICHAEL A. SWEENEY, KYLE W. SWEENEY, ELIZABETH GRAY, JOINTLY OR SEVERALLY
of FORT WORTH and State of TX Its true and lawful Attorney(s)-in-Fact, with full power and authority hereby conferred in its name,
place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings, or other instruments or contracts of
suretyship- - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - -- - - - --
LIMITATION: THIS POWER OF ATTORNEY CANNOT BE USED TO EXECUTE NOTE GUARANTEE, MORTGAGE DEFICIENCY, MORTGAGE
GUARANTEE, OR BANK DEPOSITORY BONDS.
and to bind any of the Companies thereby as fully and to the same extent as if such bonds were signed by the President,sealed with the corporate
seal of the applicable Company and duly attested by its Secretary, hereby ratifying and confirming all that the said Attorneys)-in-Fact may do in
the_premises. Said appointment is made under and by authority of the following resolution adopted by the Board of Directors of each of the
WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY:
"Be It Resolved,that the President, any Senior Executive, any Secretary or any Fidelity& Surety Operations Executive or other Executive shall
be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and act for
and on behalf of the Company subject to the following provisions:
The Attorney-in-Fact. may be given full power and authority for and in the name of and on behalf of the Company,to execute,acknowledge and
deliver, any and all bonds, recognizances, contracts, agreements of indemnity and other conditional or obligatory undertakings and any and all
notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such
Attorney-in-Fact shall be as binding upon the Company as if signed by the President and sealed and attested by the Corporate Secretary."
"Be it Further Resolved,that the signature of any such designated person and the seal of the Company heretofore or hereafter affixed to any
power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signatures or facsimile
seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached.- (Each adopted at a meeting
held on February 8,2000).
In Witness Whereof, WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE
COMPANY have caused these presents to be signed by their Senior Executive and their corporate seals to be hereto affixed this 20th day of
APRIL A.D.,2011 .
r,.....»..».,, ,.........,...
Corporate f••aZNli,(k"•s .\\ONAI t �11SU WESTFIELD INSURANCE COMPANY
Seals HiQ',,.. ',� ;'a? •' !�sG;; •• ,jai%,
WESTFIELD NATIONAL INSURANCE COMPANY
Affixed �v: .a. p o: :P: -�;` '•.c^ OHIO FARMERS INSURANCE COMPANY
: 4
, N:, SEAL . lc++aRTEo�3 �D
? �,• .�e. ,ltiy rp : 1848 rae
BY
State of Ohio `"" { ........... * ` Richard L. Kinnaird, Jr., National Surety Leader and
County of Medina ss.: Senior Executive
On this 20th day of APRIL A.D.,2011 , before me personally came Richard L. Kinnaird, Jr. to me known, who, being by me duly
sworn, did depose and say, that he resides-in_Medina, Ohio; that he is Senior Executive of WESTFIELD INSURANCE COMPANY,WESTFIELD
NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, the companies described in and which executed the above
instrument:that he knows the seals of said Companies;that the seals affixed to said instrument are such corporate seals;that they were so affixed
by order of the Boards of Directors of said Companies;and that he signed his name thereto by like order.
Notarial �N .«,....... ,
Seal R\A I- ~`,,
Affixed ZP:' Ste•-
• William J. Kahelin,A rney at Law, Notary Public
State of Ohio _N deo My Commission Does Not Expire(Sec.147.03 Ohio Revised Code)
County of Medina ss.: y �;Ft�:
O
1, Frank A. Carrino, Secretary of WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS
INSURANCE COMPANY, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said
Companies,which is still in full force and effect;and furthermore,the resolutions of the Boards of Directors,set out in the Power of Attorney are
in full force and effect.
In Witness Whereof, I have hereunto set my hand and affixed the seals of said Companies at Westfield Center, Ohio, this 3011' day of
November A°;;,,. 2018
r�\astlR.(kC Ste• `,.•'�\\nNA. /V. X%Sul �
w` .a. :R Oa ,........ SGP ` •..... .'�C`�
4 N c•,��iAL SEAL :m= o;g11kRTEli!�Q•�3 /�i�� /� �/
.m; Secretary 1848 Frank A. Carrino, Secretary
BPOAC2 (combined) (06-02)
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 Sam Davis, President of JLB Contracting, 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;
South Main Street (Vickery to Magnolia)
City of Fort Worth Project # 02113
BY
Sam Davis
President
JLB Contracting, LLC
Subscribed and sworn before me on this ay of ' 2018.
NO PUBLIC IN AND FOR
T T COUNTY, TEXAS
My commission expires
JAMIE GREENWAY
Notary Public,State of Texas
Comm. Expires 09-25-2020
Notary ID 121154b.4