HomeMy WebLinkAboutContract 50181-FP1 City Secretary 50181 FP1
Contract No.
FORTWORTHO. Date Received Sep 19,2019
RECENED
1
SEP 9 2019
OSEP A FtTWO NOTICE OF PROJECT COMPLETION
CRY ETppY (Developer Projects)
The Transportation and Public Works Department upon the recommendation of the Project
Manager has accepted the following project as complete:
Project Name: PUBLIC STORAGE FORT WORTH
City Project No.: 101078
Improvement Type(s): ❑ Paving ❑ Drainage ® Street Lights ❑ Traffic Signals
Original Contract Price: $4,000.00
Amount of Approved Change Order(s): -$4,000.00
Revised Contract Amount: $0.00
Total Cost of Work Complete: $0.00
"0b xla-K� Sep 18, 2019
Rob Borchardt(Sep 18,2019)
Contractor Date
VP Accounting
Title
Embree Construction Group,Inc.
Company Name
Steven Aguirre ep 18,2019) Sep 18, 2 019
Project Inspector Date
//z&z IV Sep 19, 2019
victory.Tornero Jr.(Sep 19.20191
Project Manager Date
,7"Ir S4V/,MeAIPWl2J Sep 19, 2019
Janie Scariett Morales(Sep 19,2019)
CFA Manager Date
Dana Burghdoff( p 19,201M Sep 19, 2019
Asst. City Manager Date
OFFim RECORD Page 1 of 2
CITY SECRETARY
FT.WORTH,TX
Notice of Project Completion
Project Name: PUBLIC STORAGE FORT WORTH
City Project No.: 101078
City's Attachments
Final Pay Estimate ❑x
Change Order(s): 0 Yes 0 N/A
Contractor's Attachments
Affidavit of Bills Paido
Consent of Surety
Statement of Contract Time
Contract Time: 100 CD Days Charged: 487
Work Start Date: 3/19/2018 Work Complete Date: 8/28/2019
Page 2 of 2
FORT WORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name PUBLIC STORAGE FORT WORTH
Contract Limits
Project Type STREET LIGHTS
City Project Numbers 101078
DOE Number 1078
Estimate Number 1 Payment Number 1 For Period Ending 8/28/2019
CD
City Secretary Contract Number Contract Time INED
Contract Date 1/31/2018 Days Charged to Date 487
Project Manager Contract is Complete
Contractor EMBREE CONSTRUCTION GROUP,INC.
8050 AIRPORT RD.
GEORGETOWN, TX 78628
Inspectors CORDOVA / AUIRRE,S
Thursday,September 12,2019 Page 1 of 4
City Project Numbers 101078 DOE Number 1078
Contract Name PUBLIC STORAGE FORT WORTH Estimate Number I
Contract Limits Payment Number 1
Project Type STREET LIGHTS For Period Ending 8/28/2019
Project Funding
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
--- - ------------------------------
----- --------
Sub-Total of Previous Unit
--------------------------------------
Thursday,September 12,2019 Page 2 of 4
i
i
I
City Project Numbers 101078 DOE Number 1078
Contract Name PUBLIC STORAGE FORT WORTH Estimate Number I
Contract Limits Payment Number I
Project Type STREET LIGHTS For Period Ending 8/28/2019
Project Funding
Contract Information Summary
Original Contract Amount $4,000.00
Change Orders
r
Total Contract Price #Err o
Total Cost of Work Completed #Error
Less %Retained $0.00
Net Earned $0.00
Earned This Period $0.00
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 $0.00
Thursday,September 12,2019 Page 3 of
City Project Numbers 101078 DOE Number 1078
Contract Name PUBLIC STORAGE FORT WORTH Estimate Number 1
Contract Limits Payment Number I
Project Type STREET LIGHTS For Period Ending 8/28/2019
Project Funding
Project Manager City Secretary Contract Number
Inspectors CORDOVA / AUIRRE,S Contract Date 1/31/2018
Contractor EMBREE CONSTRUCTION GROUP,INC. Contract Time 100 CD
8050 AIRPORT RD. Days Charged to Date 487 CD
GEORGETOWN, TX 78628 Contract is Complete
CITY OF FORT WORTH
SUMMARY OF CHARGES
Line Fund Account Center Amount Gross Retainage Net
Funded
----------------- - ------
Total Cost of Work Completed #Error
Less %Retained $0.00
Net Earned $0.00
Earned This Period $0.00
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 $0.00
Thursday,September 12,2019 Page 4 of 4
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AFFIDAVIT
STATE OF Texas
COUNTY OF WilIiamson
Before me, the undersigned authority, a notary public in the state
and county aforesaid, on this day personally appeared Rob Borchardt. VP
of Accounting Of Embree ConstrtictiDn Group, Inc, known to me to be a
credible person, who being by me duly sworn, upon his oath deposed and
said;
`1"hat all persons, Firms, associations, corporations, or other
organizations furnishing labor and/or materials have been paid in tuII
That the wage scale established by the City Council in tho City of
Fort Worth has been Laid in full;
That there are no claims pending for personal injury and/or
property damages;
On Contract described as:
Site Utilities - Added water and Sewer pipe
BY A9�4
Rob Borchardt, VP of Accounting
Subscribed and sworn before me on this date 9th of September, 2019,
UV
Notary Public _
Williamson County, Texas
� , r CQURTNEY ADAM5
µsuu
ns N oMy public,Stale 0i Texas
Comm.Expires 05.02-2021
rE•`:ti` Notary ID 12941059 1
Liberty BOND NUMBER 58S210535
Mutual.
SURETY
OWNER
�CONSENT OF SURETY Akc'Itttl-('[' El('()N I llnl'I t iR
TO FINAL PAYMENT
Conforms with the American Institute of tiURIAY
Architects,AIA Document G707 01I1FR El
IOOW°NI-I� PS LPT Properties Investors and City of Fort ARCI11 I CTS PROJECT NO.:
'Nea„i'rra,lardr',,o Worth, Texas CP101078
1000 Throckmortnn Street. Fort Worth, Texas CON TRACT FOR:
6102
Public Storage Fort Worth Water, Sewer, Sidewalk Paving and Street Lights
F'R(7JNC`f: P
tNara, afldadrh, „ Newton Business Park Addition, Lot 1, Block A CONTRACT DATED:
IH 35 8 Golden Triangle,Fort Worth, TX
In accordance with the pr visions of the Contract between the Owner and the Contractor as indicated above-the
rin.rrl flume and ar/t/w.v%„r.Ira en r
Liberty Mutual Insurance Company
175 Berkeley Street, Boston, MA 02116 SURIFTN'
on tx,nd of
Flees-rr rr in,r and addre.ix to/r ivararrr+r,
Embree Construction Group, Inc
4747 Williams Drive,Georgetown, TX 78633 CONTRAcTOR.
hereby approves of the Final payment to the Contractor,and agrees that f"final paynicru to the Contractor shall not relieve the Surety of any of its
obligations to
lgr,a- "rune"urtelurlder,c,r a1 Owner)
P5 LPT Properties Investors and City of Fort Worth, Texas
1000 Throckmorton Street.Fort Worth,Texas 76102 oWNER.
as set limh in said Surety's bond.
IN WITNESS WHEREOF,the Surcty has hereunto set rls hand on Ihis(late: September 1Oth,2019
dolverr in a•rrritg the ntrrrflh 1r,llO$4Vd h, der name,it darn acre!,car r
Liberty Mutual Insurance Company
f Snrev,'1
rd ufrrhr+,r:rr!n/r,ar rnnrn r,
Canettia Doss.Secretary 6Gr aloe,
¢%,iksupq
cJ 4e,araq�' y
�912 n Kenneth Nitsche,Attome -In-Fact
Y
r!'rerrrerl rrer,nr caret 7idrJ
dd BACH se.-0D
This Power of Attorney limits the acts of those named herein,and they have no authority to
bind the Company except in them an ner and to the extent herein stated.
Liberty Liberty Mutual Insurance Company
Mutual, The Ohio Casualty Insurance Company Certificate No: 8197872
SURETY West American 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
Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts,and West American insurance Company is a corporation duly organlzed
under the laws of the State of Indiana(herein collec6voly called the"Companies"),pursuant to and by authority herein set forth,does hereby name,constitute and appoint,
David Ferguson,Violet Fmsch,Kenneth Nitsche,Gary A.Nitsche,Robert James Nitsclic,Robert K,Nitsche,Craig Parker,Nina Smith
afl of the city of. Giddings state of TFx each individually if there be more than one named,its true and lawful attomey-in-fact 10 make,
execute,seal,acknowledge and deliver,for and on its behalf as surety and as its act and deed,any and all undertakings,bands,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 the president 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 I s1 day of November 2018 .
Liberty Mutual Insurance Company
J
4�tPs . PO rnls� d t,Nst7q The Ohio Casualty Insurance Company
Zj?4OR'��'oy C� �=L�RPO�q Fy cur c°tiPO'i+r�,tit+ West American Insurance Company
1912 " � W _
r s s y 1919 a� o 1991 a /J P9�
vi
W J
Ydy19�R4CM 1S A
0 ya O "�(A/ a3 Y �NOIANP a� LL 1?l/'7
w o,? } * �aa By:
David M.Carey,Assistant Secretary �
20 State of PENNSYLVANIA
a)a) D County of MONTGOMERY ss c
vt m
w cD On this I st day of November 2018 before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance o
o io 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 the purposes
a therein contained by signing on behalf of the corporations by himself as a duly authorized officer. w
Co
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. n a
m ^ o0
O Q �3rNwF �C COMMONWEALTH OF PENNSYLVANIA M
�1 Q
Notarial Seal td O U
O tr �r s� vF.11
Tere&a PNwa a,Notary P�hIiC j C
0 O
+- er MarionTwP..M°nlgnmery County By:
'L� 't'S1'1Ut"�17G nn'Z*n Expires March 2e,2021 Teresa Pastella.Notary Public E
N 7,7rt :,,Yoy Member,Pennsylvania Association of Notaries O M
tl O
mThis 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 w
0 5 Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows: o 0
E N ARTICLE W-OFFICERS:Section 12.Power of Attorney.
o 22 Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject 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,acknowledge and deliver as surety >o
w any and all undertakings.bonds,recognizances and other surety obligations.Such attorneys-in-fact,subject to the limitations set forth in their respective powers of attomey.shall 0 N
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 executed,such-1 o4
Zinstruments shall be as binding as if signed by the President and attested to b the Secretary.An authority g y p y y ry. y power or authori ranted to an representative or attorne -in-fact under the rNi
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. c 00
6
ARTICLE XIII-Execution of Contracts:Section 5 Surety Bonds and undertakings col
Any officer of the Company authorized for that purpose in writing by the chairman or the president,and subject to such limitations as the chairman or the president may prescribe. to-
shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,
bonds.recognizances and other surety obligations.Such attomeys-in-fact subject to the limitations set forth in their 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 executed such instruments shall be as binding as if
signed by the president and attested by the secretary.
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 of the Company to make,execute,seal,acknowledge and deliver as surety any 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 I l)th day of September 2019
P4 iNS17R4 P`,Z`l tMSU a 1TtSUR
,�J o°nr°Rqr�4t+ �J GONroR,��'Q9y VP oRroly�r'Qy
1912 0 ov y 1919 n 1991
Y�d9s8�CHU`' .da yO r`?y.hara49a�a�J �' WouNP a� By:
p,2 * tiN �H1 t gad s�, 1 ' J Renee C.Llewellyn,Assistant Secretary
LMS•12673 LMIC OCIC WAIC Multi Co 062018
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
1-877-751-2640 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 19406-2755 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 a]
1-800-252-3439
You may write the Texas Department of Insurance Puede escribir al Departamento de Seguros
Consumer Protection(I I I-I A) de Texas Consumer Protection(I I I-1 A)
P. O. Box 149091 P. O. Box 149091
Austin, TX 78714-9091 Austin, TX 78714-9091
FAX: (512) 490-1007 FAX# (512)490-1007
Web: http://www.tdi.texas.jzov Web: http://www.tdi.texas.mov
E-mail: ConsumerProtection(aNdi.texas gov E-mail: ConsumerProtectionna.tdi.texas.y-ov
PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS O RECLAMOS:
Should you have a dispute concerning your Si tiena una disputa concerniente 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 resuclve la disputa, puedc
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:
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 condicion del
document. documento adjunto.
NP70680901
LMS•15292 10115