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Home My WebLink AboutContract 49071-FP3 City Secretary 49071 -FP3 Contract No. FORTWORTH. Date Received Dec 31,2019 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: Campus Apartments City Project No.: 190937 Improvement Type(s): Water ® Sewer FA Original Contract Price: $119,313.00 Amount of Approved Change Order(s): $30,866.20 Revised Contract Amount: Totai Cost of Work Complete; $150,179.20 zewo#s Sep 23, 2019 Mary-MaYgaret Lemo (Sep 23,2019) Contractor Date Sec./Tres. Title Wind Terrace,Inc. Company Name L'5) Dec 17, 2019 OscarAguillon(Dec17, 19) Project Inspector Date rrwC-&;v Dec 30 2019 Fred Ehia(Dec30,2019) 7 Project Manager Date Tanie SGdrlo11,Mara dS Dec 30 2019 Janie ScarlettMorait U19) CFA Manager Date Dec 30 Dana Burghdoff(Dec 30,200 2019 Asst. City Manager Date OFFICIAL RECORD CITY SECRETARY Page 1 of 2 FT. WORTH, TX Notice of Project Completion Project Name: Campus Apartments City Project No.: 100937 City's Attachments Final Pay Estimate Change orders): ❑x Yes ❑ NIA Pipe Report: 21 Yes ❑ NIA Contractor's Attachments Affidavit of Bills Paid Consent of Surety Statement of Contract Time Contract Time: 487 CD Days Charged: 506 Work Start Date: 2/27/2018 Work Complete Date: 7/19/2019 Page 2 of 2 FO RTWORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name CAMPUS APARTMENTS Contract Limits Project Type WATER&SEWER City Project Numbers 100937 DOE Number 9370 Estimate Number 1 Payment Number I For Period Ending 7/26/2019 CD City Secretary Contract Number Contract Time 25ED Contract Date 5/1/2017 Days Charged to Date 506 Project Manager NA Contract is 100,00 Complete Contractor RUMSEY CONSTRUCTION,LLC 6617 VILLAGE SPRINGS DRIVE PLANO, T-X 75024 Inspectors MILLER,W / AGUILLON,O Wednesday,August 21,2019 Page[of 5 City Project Numbers 100937 DOE dumber 9370 Contract Name CAMPUS APARTMENTS Estimate Number I Contract Limits Payment Number 1 Project Type WATER&SEWER For Period Ending 712 6120 1 9 Project Funding UNIT I:WATER RvIPROVEMENTS Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total -------- ---- ---- - - ------------- --------- 1 TRENCH SAFETY 280 LF $1.00 $280.00 280 $280.00 2 24"CASING BY OTHER THAN OPEN CUT 128 LF $339.00 $43,392.00 128 $43,392,00 3 DUCTILE IRON WATER FITTINGS 1.2 TN $4,200.00 $5,040.00 1.2 $5.040.00 WIRESTRAINT 4 4"PVC WATER PIPE 28 LF $32.00 $896,00 28 $896.00 5 8"PVC WATER PIPE 33 LF $40.00 $1,320,00 33 $1,320.00 6 10"WATER CARRIER PIPE 128 LF $46.00 $5,888,00 128 $5,888.00 7 10"PVC WATER PIPE 174 LF $48.00 $8,352.00 174 $8,352,00 8 CONNECTION TO EXISTING 4"-12"WATER 2 IFA $850.00 $1,700AD 2 $1,700.00 MAIN 9 1"WATER SERVICE 7 EA $1,300,00 $9,100.00 7 $9,100.00 10 2"WATER SERVICE [ EA $1,500.00 $1,500.00 1 $i,500.00 11 4"WATER METER AND VAULT I EA $13,000.00 $13,000.00 1 $13,000.00 12 6"GATE VALVE I EA $950.00 $950.00 1 $950.00 13 8"GATE VAVLE 2 EA $1,400.00 $2,800.00 2 $2,800,00 14 10"GATE VALVE 3 EA $2,000,00 $6,000.00 3 $6,000,00 Sub-Total of Previous Unit $100,218.00 $1002218.00 UNIT U:SANITARY SEWER IMPROVEMENTS Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total 1 POST-CCTV INSPECTION 103 LF $10.00 —$1,030.00 103 $1,030.00 2 MANHOLE VACUUM TESTING I EA $150.00 $150,00 I $150,00 3 TRENCH SAFETY(CO Aal) 127 LF $2.00 $254.00 127 $254.00 4 CONCRETE ENCASEMENT FOR UTILITY PIPES 2 CY $500.00 $1,000.00 2 $1,000.00 5 4"SEWER PIPE POINT REPAIR 56 LF $35.00 $1,960,00 56 $1,960.00 6 6"2-WAY CLEANOUT 2 EA $600.00 $1,200.00 2 $1,200.00 7 6"SEWER PIPE 25 LF $45.00 $1,125.00 25 $1,125.00 8 6"SEWER PIPE CSS BACKFILL 35 LF $47.00 $1,645.00 35 $1,645.00 9 8"SEWER PIPE 43 LF $48.00 $2,064.00 43 $2,064,00 [0 EPDXY MANHOLE LINER 12 VF $150,00 $100.00 12 $1,800.00 11 4'DROP MANHOLE 1 EA $5,000.00 $5,000.00 1 $5,000.00 Wednesday,August 21,2019 Page 2 of 5 City Project Numbers 100937 DOE Number 9370 Contract Name CAMPUS APARTMENTS Estimate]Number I Contract Limits Payment Number I Project Type WATER&SEWER For Period Ending 7/26/2019 Project Funding 12 4'EXTRA DEPTH MANHOLE 6 VF $150,00 $900.00 6 $900.00 13 CONNECT TO EXISTING SEWER MANHOLE 4 EA $1,015.00 $4,060.00 4 $4,060.00 (CO A[) 14 8'WIDE ASPHALT PVMT REPAIR(CO Al) 14 LF $520.56 $7,281.84 14 $7,287.84 15 CONC PVMT REPAIR(CO Al) 13 SY $585,63 $7,613.19 13 $7,613.19 16 6"SEWER PIPE POINT REPAIR(CO A[) 24 LF $276,25 $6,630.00 24 $6,630.00 17 6"SEWER SERVICE(CO Al) 2 EA $655.00 $1,310.00 2 $1,310.00 18 TRAFFIC CONTROL(CO Al) 1 LS $4,932.17 $4,932.17 1 $4,932.I7 ----- ------- ---- --- -- ----------------- Sub-Total of Previous Unit $49,961,20 $49,961.20 --------- ------------------ ----------- Wednesday,August 21,2019 Page 3 of 5 City Project Numbers 100937 DOE Number 9370 Contract Name CAMPUS APARTMENTS Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER&SEWER For Period Ending 7/26/2019 Project Funding Contract Information Sumtnary Original Contract Amount $119,313.00 Change Orders Change Order Number Al $30,866.20 Total Contract Price $150,179,20 Total Cast of Work Completed $150,179,20 Less %Retained $0.00 Net Earned $150,179,20 Earned This Period $150,17910 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 $150,179,20 Wednesday,August 21,2019 Page 4 of 5 City Project Numbers 100937 DOE Number 9370 Contract Name CAMPUS APARTMENTS Estimate Number 1 Contract Limits Payment Number I Project Type WATER&SEWER For Period Ending 7/26/2019 Project Funding Project Manager NA City Secretary Contract Number Inspectors MILLER,W I AGUILLON,0 Contract Date 5/1/2017 Contractor RUMSEY CONSTRUCTION,LLC Contract Time 250 CD 6617 VILLAGE SPRINGS DRIVE Days Charged to Date 506 CD PLANO, TX 7.5024 Contract is 000000 Complete CITY OF FORT WORTH SUMMARY OF CHARGES Line Fund Account Center Amount Gross Retainage Net Funded Total Cast of Work Completed $150,179.20 Less %Retained $0.00 Net Earned $150,179.20 Earned This Period $150,179.20 Retainage This Period $0.00 Less Liquidated Damages 0 Days @ $0.00 J 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 $150,179.20 Wednesday,August 21,2019 Page 5 of 5 0 n c x v n n 0 Tl - 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N Ol Cn d o n ❑ ti ntn wo�oQm `w' f7+ fA w E9 w fA 6N 6% m w OJ Ip W O7 67 N O A y�y o O VpOcpAQo N ` FORTWORTH TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PROJECT NAME: Water,Sewer,Paving,Drainage&Street Light Improvements To Serve Campus A attments PROJECT NUMBER: 100937 DOE NUMBER: NIA WATER PIPE LAID SIZE TYPE OF PIPE LF yes 4" PVC 28 LF yes 8" PVC 33LF yes 10" PVC 174LF FIRE HYDRANTS: NIA VALVES(16"OR LARGER) PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: yes NEW SERVICES: l" Copper 7 Eacll. 2" Copper I Each 4" PVC i Eacli SEWER PIPE LAID SIZE TYPE OF PIPE LF es 4" PVC 56LF es 6" PVC 83LF yes 8" PVC 43LF PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: ye's NEW SERVICES: 6" PVC 4 Each TRANSPORTATION AND PUBLIC WORKS The City of Fart Worth•1000 Throckmorton Street•Fort Worth,TX 76012-6311 (817)392-7941 •Fax:(817)392-7845 IWAIA Document G704 2017 Certificate of Substantial Completion PROJECT.(name anti address) CONTRACT INFORMATION: CERTIFICATE INFORMATION: Campos Drive Apartments Contract For:General Construction Certificate plumber.001 BGOlob Nuniberk16147 Late:07-25-20I6 Date-09-16-2019 OWNER:(name and addressl ARCHITECT:(name and address) CONTRACTOR:(name and address) A.h1TT X Muhi-Ilouszng,Inc. BGO Architects Wind Terrace,Inc 30141 Agoura flillas Road 4202 Beltway Drive 1201 E 13th Street The Work identified below has beert reviewed and found,to the Architect's best knowledge,information,and belief,to be substantially complete.Substantial Completion is the stage hi the progress of the Work when the Work or designated portion is sufficiently complete in accordance with the Contract Documents so that the Owner can occupy or utilize the Work for its intended use.The date of Substantial Completion of the Project or portion designated below is the date established by this CWifiicate. (Idenlif the Work orportion thereof,that is substantlalk complete.) The above-mentioned project consists of 224 for rent dwelling units including 03 different unit types and 02 different building types. The buildings are 03 story wood-frarned. A Club leasing building consisting of4,000+'-square feet as required by owner. It also includes a pool,a playground,and a pavillion. The project is known as Campus Drive Apartment%and is located in Ft Worth,Texas. sG0 Architects Jaron DaiN.C,0-0. 0$-30-2019 ARCHITECT(Firm ftnt) $MATIJRE PRINTED NAME AND TITLE DATE OF SUBSTANTIAL COMPLETION WARRANTIES Tltc date of Substantial Completion of the Project or portion designated above is also the date of conunenceutcat of applicable warranties required by the Contract Documents,except as stated balov.: (Identfft•warranties that do eat commence o+a the dare ofSuhsta dial Completion,lfa►n;and indicate their dale of commencement j WORK TO BE COMPLETED OR CORRECTED A list of items to be completed or corrected is attached hereto,or transrttitted as agreed upon by the patties.and identified as fouoct-.;: fldenq�y the list of Work to he completed or corrected.) The failure to include env items an such list does not alter the responsibility of the Contractor to complete all Rrork in accordance with the Contract Documents.Unless otherwise agreed to in writing,the date of commencement of warranties for items on ti,e attached list will he the date of issuance of the final Certificate of Payment or the date of final payment,whichaver o.xurs dust.The Contractor will complete of correct the Work on the Iist of items attached hereto within ( }days from the above date of Substantial Completion. Cost csdmate of Work to he completed or corrected: S The responsibilities of the Owner and Contractor For security,maintenance,heat.utilities,damago to the Work,insurance,and other itenls identi fied below shall ba as follows: (?1ole:Ovmer;s and Conlrwctor's legal and Ounrance counsel should renew ktsitrunce requirernnents and coverage.) the Owner and Contractor hereby accept the responsulaili' s assigned to them in this Certificate of Substantial Completion: Wind Terrace,Inc., Mary-Margaret Lemons A Texas nonprofit corporation Secretary 09-20-2019 CONTRACTOR(Firm IG PRINTED NAME AND TITLE DATE Xrwle/ Mary-Margaret Lemons FW Campus Apartments,LP Ss cretarylTreasurer 09_20_2019 OWNER Firm.Vame) 311 TURF PRINTED NAME AND TITLE DATE "By:FW Campus Apartments GP,LLC,a Texas mi llability company,its General Partner By:Fort Worth Affordability Inc.,a Texas non-profit corporation,its Sole Member AFA Doctimant 0704 2011.Copyright a 1963,1978,1992,2000 and 2017 by The American Inatitute of Archi'ftec.%All rtghts rasetved.WARNING;Th€s AtA°1 Document is protected by U.5.Copyright taw and International Treaties.unauthorized reproduction or distribution of this AM4 Document,Or any portion of it,may result in severe civil and criminat pan atues,and will be prosecuted to the maximum extent possible under the law.This document seas produced by WA sohwara at 13.00TI Cr on 0911612019 under Order No 51 21 122 11 5 which expires an 01109,2020,and is not for resale. User Notes: JZISM 7A38j AFFIDAVIT OF COMPLETION Date: September 16, 2019 Owner: FW Campus Apartments, LP Owner's Mailing Address: 1201 East 1311 Street, Fort Worth, TX 76102 (Tarrant County) Original Contractor: Wind Terrace, Inc. Original Contractor's Mailing Address: 1201 East 131h Street, Fort Worth, TX 76102 (Tarrant County) Property: Being all of Lot 1, Block 1, CAMPUS APARTMENTS an addition to the City of Fort Worth, Tarrant County, Texas, as recorded in Instrument Number D217113437 of the Official Public Records, Tarrant County, Texas. Improvements: All buildings, structures and other improvements, existing and to be developed, built and constructed by FW Campus Apartments, LP on the Property, which shall consist of a 224-unit apartment complex. Affiants, FW Campus Apartments, LP and Wind Terrace, Inc., on oath swear that the following statements are true and within the personal knowledge of Affiants: 1. Ownership Representation. "Owner' is the owner of the Property herein described. 2. Construction Contract. The Improvements were constructed on the Property pursuant to an agreement dated May 1, 2017 by and between the Owner and Original Contractor. 3. Date of Completion. The Improvements to the Property were completed on August 27, 2019, said date being the Completion Date. For purposes of this affidavit, "completion" means within the meaning of §53.106 of the Texas Property Code, being the actual completion of the work, including any extras or change orders reasonably required or contemplated under the original contract, other than warranty or repair work. 4. Claim Against Retained Funds. A CLAIMANT MAY NOT HAVE A LIEN ON RETAINED FUNDS UNLESS THE CLAIMANT FILES AN AFFIDAVIT CLAIMING A LIEN NO LATER THAN THE THIRTIETH DAY AFTER THE DATE OF COMPLETION INDICATED IN THIS AFFIDAVIT OF COMPLETION. (9AUAW,kW 1WY/ L F Campu Apart nts, Wind errace I C. By: FW C pus Ap t e s P, LLC, its general partner Mar,argaret mon By: Fort Worth Affor abi ty nc., its sole member Secretary 1 Treasurer By: Mary-Margaret Lemons, Secretary/Treasurer SUBSCRIBED AND SWORN TO before me on h N t ! by Mary-Margaret Lemons (Secretary/Treasurer of Fort Worth Affordability, Inc- t ember of FW Campus Apartments GP, LLC, the general partner of FW Campu pa ents, L } fiaRY Pya� EVA C.KEY My Notary ID#10943269 Notary Public, S of Texas Expires August 15,2021 SUBSCRIBED AND SWORN TO before me on Lie M b'c S by Mary-Margaret Lemons (Secretary 1 Treasurer of Wind Terrace, Inc.) 89 EVA C.KEY Notary Public, St Texas .= My Notary ID#10943269 Expires August 15,2021 1� � �. Document G706-"' — 1994 Contractor's Affidavit of Payment of Debts and Claims PROJECT: (Name and address) ARCHITECT'S PROJECT NUMBER: OWNER: Campus Apartments 16147 ARCHITECT:❑ 4633 Campus Drive CONTRACT FOR:General Construction CONTRACTOR:❑ Fort Worth,TX 76119 SURETY:❑ TO OWNER:(Name and address) CONTRACT DATED:July 25,2016 OTHER:❑ FW Campus Apartments,LP, a Texas limited partnership 3014l Agoura Road,Suite 100 Agoura Hills,CA 91301 STATE OF: Texas COUNTY OF: Tarrant The undersigned hereby certifies that,except as listed below,payment has been made in full and all obligations have otherwise been satisfied for all materials and equipment Furnished,for all work,labor,and services performed,and For all known indebtedness and claims against the Contractor for damages arising in any manner in connec ion with the performance of the Contract referenced above for which the Owner or Owner's property might in any way be held Responsible or encumbered. EXCEPTIONS: See attached list of outstanding balances. SUPPORTING DOCUMENTS ATTACHED HERETO: CONTRACTOR: (Name and address) 1. Consent of Surety to Final Payment. Whenever Wind Terrace,Inc. Surety is involved,Consent of Surety is 1201 E. 1130,Street required, AIA Document G707,Consent of Fort Worth,TX 76102 Surety,may be used for this purpose Indicate Attachment ❑ Yes ® No BY:rn jr�.t�L The following supporting documents should he attached (Signatu a of autho r ed rep sentative) hereto if required by the Owner: Mary-Margaret Lem s,Secretary 1. Contractor's Release or Waiver of Liens, (Printed name and title) conditional upon receipt of final payment, 2, Separate Releases or Waivers of Liens from Subscribed and sworn to before me on this date: Subcontractors and material and equipment �+�6fC r'ribG r 6,.�O}j suppliers,to the extent required by the Owner, accompanied by a list thereof. Notary Public: 3. Contractor's Affidavit of Release of Liens(AIA My Commission Expires: Os -l5-,-zo Document 0706A). _z. .... EVA C.KEY 0.' r _•: My Notary Ili#10943269 .....+ Expires August 15,2021 '•.E AIA Document G70611—1994.Copydght0 4970 and 1994 by The American Institute of Architects.All rights reserved.WARNING:This AIA°Document Is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AfAo Document,or any portion of it, t may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 12:16:40 ET an 0912&2019 under Order No.7079790137 which expires on 0 111112020.and is not for resale, User Notes: (369AOA70) WAMTEX 30141 AGOURA RD,STE 100 AGOURA HILLS,CA 91301 Phone 818-706-0694 Fax NOTICE:THIS DOCUMENT WAIVES RIGHTS UNCONDITIONALLY AND STATES THAT YOU HAVE BEEN PAID FOR GIVING UP THOSE RIGHTS.IT IS PROHIBITED FOR A PERSON TO REQUIRE YOU TO SIGN THIS DOCUMENT IF YOU HAVE NOT BEEN PAID THE PAYMENT AMOUNT SET FORTH BELOW.IF YOU HAVE NOT BEEN PAID,USE A CONDITIONAL RELEASE FORM. UNCONDITIONAL WAIVER AND RELEASE ON FINAL PAYMENT Project FW CAMPUS LP Job No CACN The signer of this document has been paid in full for all for all labor,services,equipment,or materials furnished to the property or to AMTEX Construction LLC(person with whom signer contracted)on the property of FW CAMPUS L.P.(owner) located at 4633 CAMPUS DR.,,FORT WORTH,Texas 76119(location)to the following extent:(job description).The signer therefore waives and releases any mechanic's lien right,any right arising from a payment bond that complies with a state or federal statute,any common law payment bond right,any claim for payment,and any rights under any similar ordinance,rule,or statute related to claim or payment rights for persons in the signer's position. The signer warrants that the signer has already paid or will use the funds received from this fmal payment to promptly pay in full all of the signer's laborers,subcontractors,materialmen,and suppliers for all work,materials,equipment,or services provided for or to the above referenced project up to the date of this waiver and release. Company Name:Rumsey Construction Date 06/25/2019 By:Joe Geer Title: CFO Signature: Joe Geer STATE OF: Texas § COUNTY OF: Dallas § This instrument was acknowledged before me on the 25th day of June,2019,by Sarah Perez-Lara , of Rumsev Construction,for the consideration herein expressed,on behalf of same. Sarah Perez-Lara .�O;,.y_ Sarah Perez-Lara Notary Public in and for the Notary i Q * 126730867 STATE OF Texas += = Vy Commission Expires %yor aovember 21, 2020 AFFIDAVIT OF BILLS PAID STATE OF TEXAS § § KNOW ALL MEN BY THESE PRESENTS: COUNTY OF DENTON § Personally, before me the undersigned authority, on this day appeared Gary Wells, who being duly sworn on oath, says that he is a legal representative of Rumsey Construction, LLC and that the contract for the construction of the project, designated as: 1753 Campus Apartments, has been satisfactorily completed and that all bills for materials, apparatus, fixtures, machinery, labor, and equipment used in connection with the constvueltion of this project have been fully paid. 11)6 11r Signature Title Sworn to and subscribed before me this, the 12/10/2019 ES6�? vP"., SARAH PEREZ O�PP �� Notary Pobiic,State of'rex?ls Comm,Expires 11-21-2020 Notary t 12673D$67 Notary Public in and for Denton County, Texas CONSENT OF OWNER SURETY COMPANY ARCHITECT TO FINAL PAYMENT CONTRACTOR ❑ SURETY ❑ AIA DOCUMENT G707 OTHER PROJECT: Water, Sewer, Paving, Drainage & Street Lights to serve Campus Apartments (name, address) Fort Worth, TX TO (Owner) ❑ CITY PROJECT NO: The City of Fort Worth & AMTEX CONTRACT FOR: $394,670.24 Fort Worth, TX CONTRACT DATE November 30, 2017 BOND NO: 1067498 CONTRACTOR: Rumsey Construction, LLC 4329 Reeder Drive Carrollton, TX 75010 In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the (here insert name and address of Surety as it appears in the bond). The Hanover Insurance Company SURETY COMPANY, on bond of(here insert name and address of Contractor as it appears in the bond), Rumsey Construction, LLC CONTRACTOR, hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve the Surety of any of its obligations to(here insert name and address of Owner) The City of Fort Worth & AMTEX OWNER, as set forth in the said Surety's bond. IN WITNESS WHEREOF , the Surety has hereunto set its hand this 3rd day of December 12019 The Hanover Insuranc Com an Surety Signature of Aut rized Representative Attest: Allyson Dean, A orney-in-Fact (Seal): ,t-_ Title AIA DOC T 707;CONSENT O"URETY FINAL AY ENT•APRIL 1970 ONE PAGE EDITION•AIA 0•O 1970•THE AMERICAN INSTITUTE OF CHITECTS, 1735 NEW YORK AVE., NW,WASHINGTON,D.C.20006 THE HANOVER INSURANCE COMPANY MASSACHUSETTS BAY INSURANCE COMPANY CITIZENS INSURANCE COMPANY OF AMERICA POWER OF ATTORNEY 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. KNOW ALL PERSONS BY THESE PRESENTS: That THE HANOVER INSURANCE COMPANY and MASSACHUSETTS BAY INSURANCE COMPANY,both being corporations organized and existing under the laws of the State of New Hampshire,and CITIZENS INSURANCE COMPANY OF AMERICA,a corporation organized and existing underthe laws of the State of Michigan,(hereinafter individually and collectively the"Company")does hereby constitute and appoint John R.Ward,Douglas Moore,Emily Mikeska,Eva O.Limmer and/or Allyson Dean Of Ward&Moore Insurance Services LP of Dallas,TX,Gatesville,TX and Temple,TX each individually,if there be more than one named,as its true and lawful attorney(s)-in-fact to sign,execute,seal,acknowledge and deliver for,and on its behalf, and as its act and deed any place within the United States, any and all surety bonds, recognizances, undertakings, or other surety obligations. The execution of such surety bonds, recognizances, undertakings or surety obligations,in pursuance of these presents,shall be as binding upon the Company as if they had been duly signed bythe president and attested by the secretary of the Company, in their awn proper persons.Provided however,that this power of attorney limits the acts of those named herein;and they have no authority to bind the Company except in the manner stated and to the extent of any limitation stated below: Any such obligations in the United States,not to exceed Thirty Five Million and NoI100($35,000,000)in any single instance That this power is made and executed pursuant to the authority of the following Resolutions passed by the Board of Directors of said Company,and said Resolutions remain in full force and effect: RESOLVED: That the President or any Vice President, in conjunction with any Vice President, be and they hereby are authorized and empowered to appoint Attorneys-in-fact of the Company,in its name and as it acts,to execute and acknowledge for and on its behalf as surety, any and all bonds,recognizances,contracts of indemnity,waivers of citation and all otherwritings obligatory in the nature thereof,with powerto attach thereto the seal of the Company.Any such writings so executed by such Attorneys-in-fact shall be binding upon the Company as if they had been duly executed and acknowledged by the regularly elected officers of the Company in their own proper persons. RESOLVED:That any and all Powers of Attorney and Certified Copies of such Powers of Attorney and certification in respect thereto,granted and executed by the President or Vice President in conjunction with any Vice President of the Company,shall be binding on the Companyto the same extent as if all signatures therein were manually affixed, even though one or more of any such signatures thereon may be facsimile. (Adopted October 7, 1981 —The Hanover Insurance Company;Adopted April 14, 1982—Massachusetts Bay Insurance Company;Adopted September 7,2001 —Citizens Insurance Company of America) IN WITNESS WHEREOF,THE HANOVER INSURANCE COMPANY,MASSACHUSETTS BAY INSURANCE COMPANY and CITIZENS INSURANCE COMPANY OF AMERICA have caused these presents to be sealed with their respective corporate seals,duly attested by two Vice Presidents,this 4' day of April,2018. The Franover Insurance-Company The Hanover Insurance C Mpany Massachusetts Bay lnsu�ance company 10190 Massachusetts Bay Insctwa nce Gcampany Citizeeas Insurance Ccmmpany of America Citizens Insura rice Ccxm pa ny at America -John C.Roche. �,T and President 32rrteS H-KaWiecld,N ice President THE COMMONWEALTH OF MASSACHUSETTS ) COUNTY OF WORCESTER On this 4'h day of April,2018 before me came the above named Vice Presidents of The Hanover Insurance Company,Massachusetts Bay Insurance Company and Citizens Insurance Company of America,to me personally known to be the individuals and officers described herein,and acknowledged that the seals affixed to the preceding instrument are the corporate seals of The Hanover Insurance Company,Massachusetts Bay Insurance Company and Citizens Insurance Company of America,respectively,and thatthe said corporate seals and their signatures as officers were duly affixed and subscribed to said instrument by the authority and direction of said Corporations. �01A=N2 J , My Cammsssi—Eapir�,Mumh 4.2022 1,the undersigned Vice President of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America,hereby certify that the above and foregoing is a full,true and correct copy of the Original Power of Attorney issued by said Companies,and do hereby further certify that the said Powers of Attorney are still in force and effect.GIVEN under my hand and the seals of said Companies,at Worcester,Massachusetts,this 3 A day of i k Utiw•LtA 2019 CERTIFIED COPY Tadarc G,tvtaecir<ez ViAk 9identr Hanover Insurance Group' Texas Complaint Notice Commercial Lines IMPORTANT NOTICE AVISO IMPORTANTE To obtain information or make a complaint: Para obtener informacion o para someter una queja: You may call The Hanover Insurance Company/ Usted puede Ilamar al numero de telefono gratis de Citizens Insurance Company of America's toll-free The Hanover Insurance Company/Citizens Insurance telephone number for information or to make a Company of America's para informacion a para complaint at: someter una queja al: 1-800-608-8141 1-800-608-8141 You may also write to The Hanover Insurance Company/ Usted tambien puede escribir a The Hanover Insurance Citizens Insurance Company of America at: Company/Citizens Insurance Company of America al: 440 Lincoln Street 440 Lincoln Street Worcester, MA 01615 Worcester, MA 01615 You may contact the Texas Department of Insurance Puede comunicarse con el Departamento de Seguros to obtain information on companies, coverages, de Texas para obtener informacion acerca de rights or complaints at: companias, coberturas, derechos o quejas al: 1-800-252-3439 1-800-252-3439 You may write the Texas Department of Insurance: Puede escribir al Departamento de Seguros de Texas: P. O. Box 149104 I? O. Box 149104 Austin, TX 78714-9104 Austin, TX 78714-9104 Fax: (512)475-1771 Fax: (512) 475-1771 Web: http://www.tdi.texas.gov Web: http://www.tdi.texas.gov E-mail: ConsumerProtection@tdi.texas.gov E-mail: ConsumerProtection@tdi.texas.gov PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS O RECLAMOS: Should you have a dispute concerning your premium Si tiene una disputa concerniente a su prima o a un or about a claim you should contact the agent or the reclamo, debe comunicarse con el agente o la com- company first. If the dispute is not resolved, you may pania primero. Si no se resuelve la disputa, puede contact the Texas Department of insurance. entonces comunicarse con el departamento (TDI). ATTACH THIS NOTICE TO YOUR POLICY:This UNA ESTE AVISO A SU POLIZA: Este aviso es solo notice is for information only and does not become para proposito de informacion y no se convierte en a part or condition of the attached document. parte o condicion del documento adjunto. The Hanover Insurance company 1440 Lincoln Street,Worcester,MA 01653 181.1457(12113)Aage 1&1 Citizens Insurance Company of America 1808 North Highlander Way,Howell,MI 48843 hanover.com