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HomeMy WebLinkAboutContract 50708-FP2 Jk City Secretary ,a csx 2 Contract No. 50708 -FP2 5V N 2 201 R1H FoRTWORTH. Date Received Sep 12,2019 r C V .50 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: LA FRONTERA PHASE 2 City Project No.: 101145 Improvement Type(s): Water ® Sewer Original Contract Price: $830,460.88 Amount of Approved Change Order(s): Revised Contract Amount: Total Cost of Work Complete: $830,460.88 ' &. Aug 29,2019 Contractor Date RPM Konstruction, LLC Title Turnkey Land Development Coordinator Company Name ,Zell& Allif Aug 30, 2019 Jesse Davis(Aug 30,2019) Project Inspector Date Fred Ehia Fred Ehia(Sep 10,2019) Sep 10,2019 ect Man er Date e Scarlett Morales(Sep 10,2019) Sep 10,2019 CFA Manager Date &4 41 Sep 11, 2019 Dana Burghdoff(So 11,201 Asst. City Manager Date OFFICIAL RECORD page 1 of 2 CITY SECRETARY FT. WORTH,TX Notice of Project Completion Project Name: LA FRONTERA PHASE 2 City Project No.: 101145 City's Attachments Final Pay Estimate 0 Change Order(s): ❑ Yes 0 N/A Pipe Report: 0 Yes ❑ N/A Contractor's Attachments Affidavit of Bills Paid Consent of Surety Statement of Contract Time Contract Time: 120 CD Days Charged: 435 Work Start Date: 6/4/2018 Work Complete Date: 8/13/2019 Page 2 of 2 FoRTWORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name LA FRONTERA PHASE 2 Contract Limits Project Type WATER&SEWER City Project Numbers 101145 DOE Number 1145 Estimate Number 1 Payment Number 1 For Period Ending 8/29/2019 CD City Secretary Contract Number Contract Time 12GD Contract Date Days Charged to Date 435 Project Manager NA Contract is 100.00 Complete Contractor RPMX CONSTRUCTION 5208 TENNYSON PARKWAY SUITE 130 PLANO, TX 75024 Inspectors DICKINSON / DAVIS Thursday,August 29,2019 Page 1 of 4 City Project Numbers 101145 DOE Number 1145 Contract Name LA FRONTERA PHASE 2 Estimate Number I Contract Limits Payment Number I Project Type WATER&SEWER For Period Ending 8/29/2019 Project Funding WATER Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total ------------------------------ 1 6"WATER PIPE 45 LF $24.96 $1,123.20 45 $1,123.20 2 8"WATER PIPE 5985 LF $30.16 $180,507.60 5985 $180,507.60 3 12"WATER PIPE 324 LF $52.00 $16,848.00 324 $16,848.00 4 6"GATE VALVE 9 EA $1,083.68 $9,753.12 9 $9,753.12 5 8"GATE VALVE 21 EA $1,466.40 $30,794.40 21 $30,794.40 6 REMOVE EXISTING 12"WATER LINE 12 LF $29.12 $349.44 12 $349.44 7 CONNECT TO EXISTING 4"-12"WATER MAIN 2 EA $4,017.52 $8,035.04 2 $8,035.04 8 FIRE HYDRANT 9 EA $2,870.40 $25,833.60 9 $25,833.60 9 DUCTILE IRON WATER FITTINGS 6 TN $5,512.00 $33,072.00 6 $33,072.00 10 TRENCH SAFETY 6354 LF $0.32 $2,033.28 6354 $2,033.28 11 1"WATER SERVICE 99 EA $807.04 $79,896.96 99 $79,896.96 Sub-Total of Previous Unit $388,246.64 $388,246.64 SEWER Item Estimated Estimated Completed Completed Description of Items Unit Unit Cost No. Quanity Total Quanity Total --------------------------------------- 1 8"SEWER PIPE 5810 LF $36.92 $214,505.20 5810 $214,505.20 2 8"SEWER PIPE CSS BACKFILL 122 LF $62.40 $7,612.80 122 $7,612.80 3 CONCRETE ENCASEMENT 10 CY $260.00 $2,600.00 10 $2,600.00 4 4'MANHOLE 30 EA $3,146.00 $94,380.00 30 $94,380.00 5 Y DROP MANHOLE 1 EA $8,091.20 $8,091.20 1 $8,091.20 6 4'DROP MANHOLE 3 EA $5,673.20 $17,019.60 3 $17,019.60 7 4'EXTRA DEPTH MANHOLE 120 VF $186.16 $22,339.20 120 $22,339.20 8 4"SEWER SERVICE,TWO WAY CLEANOUT 91 EA $553.28 $50,348.48 91 $50,348.48 9 POST CCTV INSPECTION 5932 LF $1.04 $6,169.28 5932 $6,169.28 10 MANHOLE VACUUM TESTING 34 EA $161.20 $5,480.80 34 $5,480.80 11 EPDXY MANHOLE LINER 30 VF $182.00 $5,460.00 30 $5,460.00 12 TRENCH SAFETY 5932 LF $1.04 $6,169.28 5932 $6,169.28 13 CONNECT TO EXISTING SANITARY SEWER 1 EA $2,038.40 $2,038.40 1 $2,038.40 MAIN --------------------------------------- Sub-Total of Previous Unit $442,214.24 $442,214.24 -------------------------------------- Thursday,August 29,2019 Page 2 of 4 City Project Numbers 101145 DOE Number 1145 Contract Name LA FRONTERA PHASE 2 Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER&SEWER For Period Ending 8/29/2019 Project Funding Contract Information Summaty Original Contract Amount $830,460.88 Change Orders Total Contract Price $830,460.88 Total Cost of Work Completed $830,460.88 Less %Retained $0.00 Net Earned $830,460.88 Earned This Period $830,460.88 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 $830,460.88 Thursday,August 29,2019 Page 3 of 4 City Project Numbers 101145 DOE Number 1145 Contract Name LA FRONTERA PHASE 2 Estimate Number 1 Contract Limits Payment Number I Project Type WATER&SEWER For Period Ending 8/29/2019 Project Funding Project Manager NA City Secretary Contract Number Inspectors DICKINSON / DAVIS Contract Date Contractor RPMX CONSTRUCTION Contract Time 120 CD 5208 TENNYSON PARKWAY SUITE 130 Days Charged to Date 435 CD PLANO, TX 75024 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 $830,460.88 Less %Retained $0.00 Net Earned $830,460.88 Earned This Period $830,460.88 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 $830,460.88 Thursday,August 29,2019 Page 4 of 4 FoRTWORTH TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PROJECT NAME: La Frontera Phase 2 PROJECT NUMBER: 101145 DOE NUMBER: WATER PIPE LAID SIZE TYPE OF PIPE LF Water 6" PVC C 900 45 Water 8" PVC C 900 5985 Water 12" PVC C 900 324 Water 1" Copper Service 99 FIRE HYDRANTS: 9 VALVES(16" OR LARGER) PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: Yes NEW SERVICES: SEWER PIPE LAID SIZE TYPE OF PIPE LF Sewer 8" HDPE 5810 PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: Yes NEW SERVICES: TRANSPORTATION AND PUBLIC WORDS FINAL BILLS PAID AFFIDAVIT THE STATE OF TEXAS COUNTY OF DENTON BEFORE ME, the undersigned authority, personally appeared Laura Mitchell (hereinafter referred to as "Contractor"), known to me to be a credible person, and after being by me duly sworn, upon oath stated and affirmed that: "My name is Laura Mitchell and I am the Controller of RPM xConstruction, LLC hereafter sometimes referred to in this affidavit as "Contractor". Contractor's business address is 5208 Tennyson Pkwy, Suite 130, Plano, TX 75024 . The undersigned Contractor has personal knowledge of the facts stated herein and has full authority to make the agreements in this affidavit on behalf of Contractor. Pursuant to and in accordance with a written construction contract between RPM xConstruction, LLC Contractor, and Chateau Group No. 11, LTD, Owner, Contractor furnished materials and labor for the construction, renovation, or repair of improvements located on or relating to project known as La Frontera located at FM 1220, City of Fort Worth Tarrant County, Texas. All work provided for under said written construction contract, together with all changes and supplements thereto, has been fully completed in accordance with the terms and provisions thereof. Contractor has paid each of its subcontractors, laborers,suppliers and materialmen in full for all labor and materials provided to Contractor for or in connection with the construction, renovation, or repair of improvements on or relating to the subject Property, or any portion thereof, excepting only the amounts owed for the following specified bills to the persons identified below. Contractor warrants and represents that the following specified bills will be paid to Contractor by Owner/Administrator in reliance on this Final Bills Paid Affidavit: Name of Payee Address Telephone No. Amount Owed Other than the above specified bills owed to the above referenced persons, Contractor is not aware of any unpaid bills, claims, demands, or causes of action by any of its subcontractors, laborers, suppliers, or materialmen for or in connection with the furnishing of labor or materials, or both, for the construction, renovation, or repair of improvements located on or related to the subject Property. In consideration of the funds paid to Contractor by Owner and by Lender on behalf of Owner in reliance on this affidavit, Contractor waives and releases all of Contractor's statutory and constitutional mechanic's lien rights connected with the construction of the Project, conditioned on the actual payment or collection if payment is made by check or draft. Contractor further understand that this Final Bills Paid Affidavit is being given pursuant to and in accordance with Sections 53.085 and 53.259 of the Texas Property Code and that the intentional, knowing, or reckless making of a RAProject Management\Public\Job Files\2182G LaFrontera, Fort Worth-Westwood Real Estate\Billings Suppliers Owed List\Affidavit of Bills Paid- Final.doc false or misleading statement in this Affidavit constitutes an offense under said Section and is a Class A misdemeanor. Contractor hereby indemnifies and holds harmless Owner from any and all claims, demands or causes of action, and any costs, expenses, and attorney's fees incurred in connection therewith, arising from or connected with,the statements and representations contained herein." EXECUTED this q day of 2018. By: Printe Nam ATTEST: Title: 0 � Printed Name: a THE STATE TEXAS COUNTY OF Before me, the undersigned authority, on this day personally appeare , a N who first being duly sworn by me to be the person whose name is subscribed to the foregoing Final Bills Paid Affidavit, acknowledged that he/she has the authority to make this Final Bills Paid Affidavit, and further acknowledged to me that he/she executed the same for the purpose and consideration therein expressed. GIVEN UNDER MY HAND AND SEAL OF OFFICE, on this the day\o a - 20 `���++++++����►�►,,,,� Notary Pubblin an, for the TAVQ��iWO State o _ XAS (NOTARY SEAL,��yQUBik►••.� _ W = Printed Name:6\- `C-\�c Commission Expire cz "Y AA "'PATE o�"�!'�N \ \ �9 ti . •''••...Ia '�Off' ��• RAProject Management\Public\Job Files\2182G LaFrontera, Fort Worth-Westwood Real Estate\Billings Suppliers Owed List\Affidavit of Bills Paid- Final.doc North American Specialty Insurance Company 1200 Main Street,Suite 800,Kansas City,MO 64105 C (DPYF CHANGE RIDER To be attached to and form a part of Type of Bond: Payment and Performance Bond No: 2269562 Principal: RPM xConstruction, LLC Surety: North American Specialty Insurance Company In favor of Obligee: City of Fort Worth Dated: 3/23/2018 In consideration of the premium charged for the attached bond, it is hereby agreed to change the following: Description: The Bonded Amount is Increased From: S3.091,063.64(Three Million,Ninety-One'I'housand,Sixty-Three and 64/100 DOLLARS) To: S3,091,696.64(Three Million,Ninety-One Thousand,Six Hundred Ninety-Six and 64/100 DOLLARS) The attached bond shall be subject to all its agreements, limitations and conditions except as herein expressly modified. The rider is effective: 08/14/2019 BY: North American Specialty Insurance Company Name: Andrea Rose Crawford Title:Attorney-in-Fact SWISS RE CORPORATE SOLUTiONS NORTH AMERICAN SPECIALTY INSURANCE COMPANY WASHINGTON INTERNATIONAL INSURANCE COMPANY WESTPORT INSURANCE CORPORATION GENERAL POWER OF ATTORNEY KNOW ALL MEN BY TTTESIi PRESENTS,THAT North American Specialty Insurance Company,a corporation duly organized and existing under laws ofthe State of New I Eennpshirc,and having its principal office in the City of'Overland Park,Kansas and Washington international Insurance Company iI corporation organized and existing under the laws of the State oi'Nccv I lampshirc and having its principal office in the City of Overland Park,Kansas,and Westport insurance Corporation,organized under the laws of•the Slate ofMl issouri,and having its principal office in the City of Overland Park,Kansas each does hereby make.constitute and appoint: SAMMY JOG MULLIS,JR.,JOIIN WILLIAM NEWBY.Cl!1:R1 LYNN iRBY.WILBERT RAYMOND WATSON,MICIIAHL L.TULLIS.SANDRA LEE RONEY,DEBRA LEE MOON, ANDR EA ROS Ii CRAWFORD.MARY JO%AK RLEW'SKI.JAM NS R.ROGERS,JR.,TROY RUSSELL KEY,LINDA MICI IHLIX STALDER AND CHRIS•1'OPI I[R CARL SUNDnERG JOINTLY OR SEVERAI AN Ili true and lawful Atiorney(s)-in-Fact,to make,execute,seal and deliver,I'or and on its behalf and as its act and deed,bonds or other Writings obligatory in the nature ofa bond on behalf ol'each of said Companies,as surety,on contracts ofsuretyship as are or may be required or permitted by law,regulation,contract or otherwise,provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the amount of: ONE HUNDRED TWENTY FIVE MILLION(S125,000,000.00)DOLLARS This Power of Altorncy is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors ofNorlh American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held on March 24,2000 and Westport insurance Corporation by written consent of its Executive Committee dated July 18,2011. "RESOLVID,that any two of the President,any Senior Vice President,any Vice President,any Assistant Vice President, the Secretary or any Assistant Secretary be,and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named in the given Power of Attorney to execute on behalf of the Company bonds,undertakings and all contracts of surety,and that each or any of'them hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is FURTT IER RESOLVED,that the signature ofsuch officers and the seal of the Company may be affixed to any such Power of Altorncy or to any certificate relating thereto by facsimile,and any such Power ol'Attorney or certificate bearing such facsimile signatures or facsimile seal shall be binding upon the Company when so affixed and in the future with regard to any bond,undertaking or cmriract of surety to which it is attached." ���OU1\\AUTY/j���/// aapgsa"j10NA(u0'r T�T /�/ RS7Glr �6QGpPPojRj SG9�� 4,= GoaPor tisGN a Ry f% 1 _ ,, \F�%4MXCtr G¢ 2i F•_y�_ a 2e sS�l F•,. Stcvcn .:m crsnn,. nmr ice rest nua :is un-tun ntcrnnt unn nzuranec Company 4, `�"N'- SEAL n O. .m &Senior Vice President orxnrth American Spcclalty Insurance Company # 5 � 1973 rVi�' U' :nz &Senior\'ire Presideiitof\I'estparl Insurance Corporation it •........�1gL a BV �J��/l"l Y,h'•dr�8ttou •' �r rrr�71,u:f9tlt \like A.Ito,N-ioe V,re President orwashinplau Inlernarionnl Insurance Company �•\,rr• &Senior Vice President of Noah American Specialty Insurance Cmnpm'y 'r''+iii7Stlfra�'�S &Senim•Vice President or Westport Insurance Carpontion IN Wi7NIiSS Wl1EREOF.North American Specialty insurance Company,Washington International Insurance Company and Westport Insurance Corporation have caused their official seals to be hereunto alfixcd,and these presents to be signed by their authorized officers this this_ 20th day of August .20 18 North American Specialty Insurance Company Washington International Insurance Company Stale of Illinois Westport Insurance Corporation County of Cook ss: On this 201h day of August 20 18.before me,a Notary Public personally appeared Steven P.Anderson ,Senior Vice President of Washington international insurance Company and Senior Vice President of North American Specialty Insurance Company and Senior Vice President of Westport Insurance Corporation and Michael A.It Senior Vice President of Washington International insurance Company and Senior Vice President of North American Specialty Insurance Company and Senior Vice President of Westport Insurance Corporation,personally known to me, who being by me duly sworn,acknowledged that they signed the above Power of Altorncy as officers of and acknowledged said instrument to be the voluntary act and deed oftheir respective companies. oFFICIAI.-KE L M.KENW , Lin—, ^u!:iir---State r:I Illir.:5•. - Cunanistinn bp•n� 12/042021 M.Kenn%•,Notary Public i, ,Eeffircy Goldbergthe duly elected Vice President and Assistant Secretary of North American Specialty Insurance Company,Washington international Insurance Company and Westport Insurance Corporation do hereby certify that the above and foregoing is a true and correct copy of a Power ol'Attorney given by said North American Specialty Insurance Company,Washington International Insurance Company and Westport Insurance Corporation which is still in full force and cllcct. IN WITNESS Wi ll:REOF.I have set my hand and affixed the seals of the Companies this 141h day of August 70 19 Jeffrey Goldberg,Vice President&Assistant Secretary or Washington International Insurance Company& North Aniedcau Specialty Insurance Company&Vice President&-Assistant Secretary of Westport Insurance Co,pomlion NorTch American Specialty Insurance Company Washington dnternational Insurance Company Westport Insurance Corporation TEXAS CLAIMS INFORMATION IMPORTANT NOTICE AMOSO IMPQRTA IITTF, In order to obtain information or make a complaint: Para obtener informacion o para someter un queja: You may contact Jeffrey Goldberg,Vice President Puede comunicarse con Jeffrey Goldberg,Vice — Claims at 1-800-338-0753 President—Claims,al 1-800-338-0753 You may call Washington International Insurance Usted puede Ilamr al numero de telefono gratis de Company and/or North American Specialty Insurance Washington International Insurance Company and/or Company's and/or Westport Insurance Corporation North American Specialty Insurance Company's and/or toll-free number for information or to make a Westport Insurance Corporation para informacion o complaint at: para someter una queja al: 1-800-338-0753 1-800-338-0753 You may also write to Washington International Usted tambien puede escribir a Washington Insurance Company and/or North American Specialty International Insurance Company and/or North Insurance Company and/or Westport Insurance American Specialty Insurance Company and/or Corporation at the following address: Westport Insurance Corporation al: 1450 American Lane 1450 American Lane Suite 1100 Suite 1100 Schaumburg, IL 60173 Schaumburg,IL 60173 You may contact the Texas Department of Insurance Puede escribir al Departmento de Seguros de Texas to obtain information on companies, coverages, para obtener information acerca de companias, rights or complaints at: coberturas,derechos o quejas al: 1-800-252-3439 1-800-252-3439 You may write the Texas Department of Insurance: Puede escribir al Departmento 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: htto://www.tdi.stat-tx. ua Web: htto://www_tdi State.tx,us Email:ConsumerProtection@tdi.state.tx.us Email:ConsumerProtection@tdi.state.tx.us 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 first contact the reclamo, debe comunicarse con el Washington Washington International Insurance Company and/or International Insurance Company and/or North North American Specialty Insurance Company and/or American Specialty Insurance Company and/or Westport Insurance Corporation. If the dispute is not Westport Insurance Corporation primero. Si no se resolved,you may contact the Texas Department of resuelve la disputa, puede entonces comunicarse Insurance. con el Departmento de Seguros de Texas. ATTACH THIS NOTICE TO YOUR POLICY: UNA ESTE AVISO A SU POLIZA This notice is for information only and does not Este aviso es solo para proposito de infromacion y no become a part or condition of the attached se converte en pane o condicion del documento document. adjunto. CONSENT OF OWNER SURETY COMPANY ARCI11TECr TO FINAL PAYMENT CONTRACTOR SURETY AIA DOCUMENT G707 OTHER Bond No. 2269562 PROJECT: Job 921825G,La Frontera Phase 2-Fort Worth, TX (name,address) TO (Owner) [ City of Fort Worth ] ARCHITECT'S PROJECT NO: 1000 Throckmorton Street Fort Worth,TX 76102-6312 CONTRACT FOR: La Frontera Phase 2- ] CONTRACT DATE: CONTRACTOR: RPM xConstruction,LLC 5208 Tennyson Parkway,Suite 130 Plano,TX 75024 In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above,the (here insert name and address ol'Surety Company) North American Specialty Insurance Company 1200 Main Street,Suite 800 Kansas City, MO 64105 , SURETY COMPANY, on bond of(here insert name and address of Contractor) RPM xConstruction,LLC 5208 Tennyson Parkway,Suite 130 Plano,TX 75024 , CONTRACTOR, hereby approves of the final payment to the Contractors,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) City of Fort Worth 1000 Throckmorton Street Fort Worth,TX 76102-6312 OWNER, as set forth in the said Surety Company's bond. IN WITNESS WHEREOF, the Surety Company has hereunto set its hand this 14th day of August 2Q19 North American Specialty Insurance Company Surety Company Signature of Authorized Representative Attest:. fit" (Seal): / Andrea Rose Crawford 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 DUBTS AND CLAIMS, Current Edition AIA DOCUMENT G707 CONSENT 01.SUit1;TY COMPANY TO FINAL.PAYMENT APRIL 1970 EDITION AIA ONE PAGE 1970 T11H AMEMCAN INS"1'1T11"1'li 01:ARCI II ECTS, 1735 New York Ave..NW,WASt1INGION,D.C. 20006 SWISS RE CORPORATE SOLUTIONS NORTH AMERICAN SPECIALTY INSURANCE COMPANY WASHINGTON INTERNATIONAL INSURANCE COMPANY WESTPORT INSURANCE CORPORATION GENERAL POWER Or ATTORNEY KNOW ALI.MI:N BY TI Ii:Si:PR1iSl:N•1•S,'I'HA'T North American Specially Insurance Company,a corporation duly organized and existing under laws ot•the State oi'Ne\v Ilampshire.and having its principal office in the City of Overland Park,Kansas and Washington international Insurance Company a corporation organized and existing under the laws ofthe State ofNcw i Iampshire and having its principal office in the City of Overland Park,Kansas,and Westport Insurance Corporation,organized under the laws of the State of Missouri,and having its principal office in the City of Overland Park,Kansas each does hereby make,constitute and appoint: SAMMY JOG MULLIS,JR.,JOHN WILLIAM NEW13Y.CHERI LYNN 1RBY,WILBERT RAYMOND WATSON,MICHAGL L.TULLIS,SANDRA LEE RONGY,DEHRA LEE MOON, ANDREA ROSE CRAWFORD.MARY JO%AKR%FWSKI,JAMFS 13.ROGF.RS,JR..IROY RUSSELL Kr:Y.LINDA MICHELIA:STALDER AND CHRISTOPHER CARL SUNDBERG JOIN-ITY OR Sl VERALLY Its true and lawful Allorney(s)-in-Pact,to make.execute,seal and deliver,for and on its behalf and as its act and deed,bonds or other writings obligatory in the nature of a bond on behalfofeach of said Companies,as surety,on contracts ofsurelyship as are or may be required or permitted by law,regulation,contract Or otherwise,provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the amount of: ONE HUNDRED TWENTY FIVE MILLION(S125,000,000.00)DOLLARS This Power ol•Aitorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held on March 24.2000 and Westport Insurance Corporation by written consent of its(Executive Committee dated July 18.2011. "RI;SOLVL'•D.that any two of the President,any Senior Vice President,any Vice President,any Assistant Vice President, the Secretary or any Assistant Secretary be,and each or any of them hereby is authorized to execute a Power ol•Attorney qualifying the attorney named in the given Power of Attorney to execute on behall•of the Company bonds,undertakings and all contracts ofsurcty,and that each or any of them hereby is authorized to attest to the execution orally such Power of Attorney and to attach therein the seal of the Company; and it is FURTI IER RESOLVED.that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile,and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be binding upon the Company when so affixed and in the luture with regard to any bond,undertaking or contract of surety to which it is attached." \\\\1\ltlllllllll///// `a `Np��G\pll TY/N/�i�,� oI aPZIONAC ���yQ;�pPOfigTSG.g�' a Q:GpR�oi TSG o By ! tt^_ S:G i....... _�2iG F•.`�! —•':}' S.�LF Steven n erson„ n!or Vrre rxsr turn as ungton internationalInsurance Company rrNl a, e�?Ob�Th-r��j �? SEAL :n" o € &Senior Vice President or North American Specially Insurance Company !4' SEA! ti T'�a W"7- 1973 Wi m^ =L' ?rri &Senior Vice 1'res3drnl ul"tYestport Insurance Corporntion ^� j By Mike A.Ito,Senior Vice President of\Vnitrintaon Intenlational insurance Compa, &Senior\ice I'Midem of North Ametinn Sltrcialq•Insurance Company " $f11n1Y1\ &Setior\ice Presidrm or Wesgsort Insurance Corporation IN WITNI:SS WI II:RI:OF.North American Specialty Insurance Company,Washington International Insurance Company and Westport Insurance Corporation have caused their official seals to be hereunto affixed,and these presents to be signed by their authorized officers this this 20th day of August ,20 18 North American Specialty Insurance Company Washington International Insurance Company State of Illinois Westport insurance Corporation County of Cook ss: On this 20th day of August .-)0 I8,before me,a Notary Public personally appeared Steven P.Anderson .Senior Vice President of Washington international Insurance Company and Senior Vice President of North American Specially Insurance Company and Senior Vice President of Westport Insurance Corporation and Michael A.Ito Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty insurance Company and Senior Vice President of Westport Insurance Corporation,personally known to mc, who being by me duly sworn,acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument io be the voluntary act and deed of•thcir respective companies. UFF(CIAl.SEAL IA.KENNY Rn!ary Public-Stan r!II'i� h'y Cummissicu<t i uou�o �;•' M.Kenny,Notary Public 1. Jclfrcy Goldberg , the duly elected Vice President and Assistant Secretary of North American Specialty Insurance Company,Washington International Insurance Company and Westport Insurance Corporation do hereby ccrtil}•that the above and foregoing is a true and correct copy of a Power of Attorney given by said North American Specialty Insurance Company.Washington international Insurance Company and Westport Insurance Corporation which is still in full force and effect. IN WITNESS WIll:REOP,I have set my hand and affixed the seals ofthe Companies this 14111 day of August 20 19 Jeffroy Goldberg,Vice President&Assistant Secretary or Wishmgton Intemational Insurancc Company& Noah American Specially Insurance Company&Vice President&Assistant Secretary of Westpotl Innuance Corporation. Nora h American Specialty Insurance Company Washington International Insurance Company Westport Insurance Corporation TEXAS CLAIMS INFORMATION IMPORTAIIIT NOTICE ADVISO IMPORTANT In order to obtain information or make a complaint: Para obtener informacion o para someter un queja: You may contact Jeffrey Goldberg,Vice President Puede comunicarse con Jeffrey Goldberg,Vice — Claims at 1-800-338-0753 President—Claims,all 1-800-338-0753 You may call Washington International Insurance Usted puede Ilamr al numero de telefono gratis de Company and/or North American Specialty Insurance Washington International Insurance Company and/or Company's and/or Westport Insurance Corporation North American Specialty Insurance Company's and/or toll-free number for information or to make a Westport Insurance Corporation para informacion o complaint at: para someter una queja al: 1-800-338-0753 1-800-338-0753 You may also write to Washington International Listed tambien puede escribir a Washington Insurance Company and/or North American Specialty International Insurance Company and/or North Insurance Company and/or Westport Insurance American Specialty Insurance Company and/or Corporation at the following address: Westport Insurance Corporation al: 1450 American Lane 1450 American Lane Suite 1100 Suite 1100 Schaumburg,IL 60173 Schaumburg,IL 60173 You may contact the Texas Department of Insurance Puede escribir al Departmento de Seguros de Texas to obtain information on companies, coverages, para obtener informacion acerca de companias, rights or complaints at: coberturas, derechos o quejas al: 1-800-252-3439 1-800-252-3439 You may write the Texas Department of Insurance: Puede escribir al Departmento 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: htto://maty^.v.tdi.state.tx.us Web: httua//znwN.td*.state.tx.us Email:ConsumerProtection@tdi.state.tx.us Email:ConsumerProtection@tdi.state.tx.us 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 first contact the reclamo, debe comunicarse con el Washington Washington International Insurance Company and/or International Insurance Company and/or North North American Specialty Insurance Company and/or American Specialty Insurance Company and/or Westport Insurance Corporation. If the dispute is not Westport Insurance Corporation primero. Si no se resolved,you may contact the Texas Department of resuelve la disputa,puede entonces comunicarse Insurance. con el Departmento de Seguros de Texas. ATTACH THIS NOTICE TO YOUR POLICY: UNA ESTE AVISO A SU POLIZA This notice is for information only and does not Este aviso es solo para proposito de infromacion y no become a part or condition of the attached se convene en parte o condicion del documento document. adjunto.