HomeMy WebLinkAboutContract 55143-FP1 FORT WORTH,
TRANSPORTATION AND PUBLIC WORKS
NOTICE OF PROJECT COMPLETION
City Secretary No:55143-FP1
Date Received: June 3,2022
City Project Ns:102861
Regarding contract 55143 for Concrete Restoration#2 as required by the TRANSPORTATION AND PUBLIC
WORKS DEPARTMENT as approved by City Council on 08/25/2020 through M&C 20-0873 the director of
the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT upon the recommendation of the
Assistant Director of the Transportation&Public Works Department has accepted the project as complete.
Original Contract Prices: $849,817.75
Amount of Approved Change Orders: $85,218.75 Ne 1
Revised Contract Amount: $935,036.50
Total Cost Work Completed: $922,107.00
Less Deductions:
Liquidated Damages: 0 Days Q$650.00/Day
Pavement Deficiencies:
Total Deduction Amount: $0.00
Total Cost Work Completed: $922,107.00
Less Previous Payments: $876,001.65
Final Payment Due $46,105.35
Lauren Prieur(Jun 2,202212:46 CDT) Jun 2,2022
Recommended for Acceptance Date
Asst. Director, TPW - Capital Delivery
LT
William M Johnson un 2,2022 14:02 CDT) Jun 2,2022
Accepted Date
Director, TRANSPORTATION AND PUBLIC WORKS DEPARTMENT
Client Department
� B�AGu7�Dana Burghdoff(Arn 2,202 9:08 CDT) Jun 2 2022
Asst. City Manager Date
Comments:
OFFICIAL RECORD
CITY SECRETARY
FT.WORTH,TX
0.620 Signature Page
Contractor's Application for Payment Invoice No. 11-FINAL
To(0tner): City Of Fort Worth Invoicing Period(From-To): Invoice Date:
5H122 Thm 5111722 5/11/2022
P.O. FW020-004943 From(Contractor): Renal to(IfN0l Automatic Deposit):
Number: Omega Contracting Inc.
Project: 102861 Contractor's CFW Vendor No.:
7000000382
City Secretary Contract Contract
Number: 55143 Name:2021 Concrete Restoration Contract 2
Application For Payment
Change Order Summary
Approved Change Orders 1,ORIGINAL CONTRACT PRICE............................ S S849,817.75
Number Addilion, Deletions 2.Net change by Change Orders ......................... S S85,218.75 j
I S85,218.75 3,Current Coalrncl Price(Line 1.+2)......................... S S935,W6.50
2 4.TOTAL COMPLETED AND STORED TO DATE
3 (Progress EsOmnte,Construction Allowance and Chnnge Orders)....,.. S S922,107.00
't 5.RETAINAGEi
5 n. x $922,107.00 Work Completed,.......,,S
6 b, x Not Used S
7 c.Total Retetnnge(Lin.Sit+LineSb)...........I...........,n......S
8 6.AMOUNT ELIGIBLE TO DATE(Line d-Line Sc)............................. S $922,107.00
TOTALS S85,218.75 7.LESS PREVIOUS PAYMENTS(Line 6 front prior Application),.,,....,S S876,00L65
NET CHANGE BY S$$,218.75 S.AMOUNT DUE THIS APPLICATION., ............................... S S46,105.35
CHANGE ORDERS 9.BALANCE TO FINISH,PLUS RETAINAGE
(Column G an Progress Eslima(ef CA+Cos+Line 5 above)...............S S12,929.50
Contractor's Certification 10.CONTRACI'TIME:
The Contractor certifies wills the submittal ofdtis document and associated Payment Request Submittal n. Days Awarded ISO
on the City of Fort Worth Bunsmv system dint to the best of dmirlasosvledge:(1)all previous progress b. Days Added by CO 85
payments received from Omer on account of ftfl;done uderthe Contract have been applied on
account to discharge Conunctors legitimate obligations incurred in connection%ith Work covered by e. Total Days 265
prior Applications for Payment;(2)Iille of ainvork,materials and equipment incorporated in said
Work orolhcrnise listed in ureovered by this Application for Paymcnl will pass to Ossacr at time of d. DAYS Charged payment free and clear orall Liens,security interests and encumbrances(except such as arc covered by J g 265
a Bond Acceptable to O"iner indemnifying Ooner against any such Liens,security interest or e. Days Remaining
encumbrances);and(3)all Work covered by this Application for Payment is in accordance with the
Contract Documents and is not defective.
Liquidated Damages S650 xday
✓�GZ�IIG�C7�GlGl ��
Daniel Garcia(Jun 2,2022 07:36 CDT)
This document has been modified from its original form as an EJCDC document and the user did not highlight the
modifications.You are enwuraged to read the document carefully and consult Legal Counsel prior to Its execution.
Consent of Surety
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FORTWORTH
Routing and Transmittal Slip
Transportation and Public Works
Department
DOCUMENT TITLE: _ Change Order# 1 - 2021 Concrete Restoration Contract 2
M&C 20-0873 CPN: 102861 CSO # 55143 DOC# CO# 1
Date: 910912021 FM Department Initials Date Out
To: Omega Contracting Inc.
1. Daniel Garcia (Contractor) dgarciaRazteca-omeaa.com o
2. Steve Johnson (Inspector) TPW-Signature
3. Iretomiwa Otuyelu (PM) TPW-Signature
4. Jeffrey Perrigo (Pgk4 TPW-Reviewer
5. Lane Zarate (Sr CPO) TPW-Reviewer L
6. Lauren Prieur AD TPW-Signature LLP
7. William Johnson (Director) TPW-Signature
8. Doug Black(ACA) LAW-Signature 49
9. Dana Burghdoff(ACM) CMO-Signature
10. ,Ron Gonzales CSO-Si nature
DOCUMENTS FOR CITY MANAGER'S SIGNTURE: All documents received from any and all City
Departments requesting City Manager's signature for approval MUST BE ROUTED TO THE
APPROPRIATE ACM for approval first. Once the ACM has signed the routing slip, David will review
and take the next steps.
NEEDS TO BE NOTARIZED: ❑ Yes X No
RUSH: ❑ Yes X No SAME DAY: ❑ Yes X No NEXT DAY: ❑ Yes X No
ROUTING TO CSO: ❑ Yes ❑ No
Action Reauired:
❑ As Requested ❑ Attach Signature, Initial and Notary Tabs
❑ For Your Information
X Signature/Routing and or Recording
❑ Comment
❑ File
Return to: Please call Iretomiwa Otuyelu at ext. for pick up when completed. Thank you.
CSC No.55143-COI
FORTWORTH> City of Fort Worth
Change Order Request
Project Name 2021 CONCRETE RESTORATION CONTRACT 2 City Sec# 55143
Client Project#(s)l 102061
Project Description The Repair and Reconstruction of Failed Concrete Pavement at Various Locations in the City.
Contractor] OMEGA CONTRACTING INC Change Order 4 1 1 Date 813112021
City Project Mgr.1 Irelomiwa Oluyelu City Inspector Steve Johnson
Contract Time
Dept TPW Totals (CD)
Original Contract Amount $849,817.75 $849,817.75 180
Extras to Date
Credits to Date
Pending Change Orders(n M&C Process)
Contract Cost to Dale $849,817.75 $849,817.75 180
Amount of Proposed Change Order $85,218.75 $85,218.75 40
Revised Contract Amount $935,036.60 $935,036.50 220
Original Funds Available for Change Orders $0.00
Remaining Funds Available for this CO $0.00
Additional Funding(if necessary) $85,218.76 $85,218.75
CHANGE ORDERS to DATE(INCLUDING THIS ONE)AS%OF ORIGINAL CONTRACT i0.03%
MAX ALLOWABLE CONTRACT AMOUNT(ORIGINAL CONTRACT COST+25%) $1,062,272.19
JUSTIFICATION(REASONS)FOR'CHANGE ORDER
This Change Order is to add the amount of$85,218.75 and 40 calendar days to the Construction Contract#55143.
During the course of construction at the Intersection of Saratoga Downs Way&Grandstand Way,unsuitable soil was exposed requiring the need to excavate and remediate
the subgrade to a depth of 3112 feel.The creation of new items is needed to address the changed conditions and the level of effort required to stabilize the soil as staled in
the geotechnical report.
i
II
It is understood and agreed that the acceptance of this Change Order by the contractor constitutes an accord and satisfaction and represents payment in
full(both time and money)for all costs arising out of,or incidental to,the above Change Order.The Project/Program Manager signing below
acknowledges that he/she Is the person responsible for the monitoring and administration of this contract,including ensuring all performance and
reporting requirements.
Contractor's Company Name Contractor(Name) Contract Signature Dale
nrua
OMEGA CONTRACTING INC Daniel Garcia I h-1 Sep 13,2021
Inspectorllnspection Supervisor Date Project and Contract Compliance Manager Date
Sep 13,2021 is Sep 14,2021
Program Manager Dale Senior Capital Project Officer Date
Sep 14,2021 Cent ZVale Sep 14,2021
Assistant Director(Dept) Dale Director,Contracting Department(Dept) Dale
^«w.pn«<r Sep 15,2021 a ^r Sep 15,2021
Assistant City Attorney Dale Assistant City Manager Dale.
Sep 15,2021 Sep 15,2021
Council Acliorr(if required)
M&C Number M&C Date Approved F
ATTEST:A,,, �?
Ronald P.Gonzales,Acting City Secretary
Fou_T Wow City of Fort Worth
"� Change Order Additions
Project Name 1 2021 CONCRETE RESTORATION CONTRACT 2 City SeG B 55143
Client Project fl 1 102861
Contractorl OMEGA CONTRACTING INC PMJ Irelomhva Oluyelu Inspectorl Steve Johnson
Change Order Submittal N 0 Dale 8/3 112 0 21
AUDITIONS
MOO
Unit Unit Cost Total
2 B C FI L USING ONLY FLEXB SETO A TO DEPTH TP C 63.753 3 STONEATB TTOhIOFBASE T TPW .50
I
TPW 85,218.75
Sub Totaldilons 85,2111.75
Change Order Additions Page 2 of 5
Polo WoltTn City of Fort Worth
Change Order Deletions
Project Name 1 2021 CONCRETE RESTORATION CONTRACT City Sac N 55143
CllentProjact# 1 102661
Contractor OMEGA CONTRACTING INC PM Iretom(wa0luyelu Inspector Steve Johnson
Change Order Submittal N 0 Date 6131/2021
DELETIONS
ty Unit Unit osl ola
TPV1 0.00
-----
Sub TotalDeletions
Change Order Deletions Page 3 of 5
MISBE for this Change Order
MISBE Sub Type of Service Amount for this CO
Total $0.00
Previous Change Orders
co# DATE AMOUNT
i
I
Total $0.00
From: Otuyelu.Iretomiwa S
To: Munoz,Filoaonio
Cc: Daniel Garcia
Subject: CPN102861 Change Order
Date: Thursday,September 9,2021 9:13:41 AM
Attachments: Outlook-Fort Worthmno
CPN102861 COl(Saratoga Downs Way).Asm
Good morning, Filo
Please find attached the change order for the above-mentioned project.
Daniel Garcia is the Contractor; email: gdarcia@azteca
It is important that we expedite this Change Order routing as we have been at this location for
over a month now and the residents are getting fed up.
Please let me know if you have any questions,thanks.
Iretomiwa S.Otuyelu E.I.T.
Graduate Engineer
City of Fort Worth
Transportation and Public Work Department
817.392.6747
City of Fort Worth — Working together to build a strong community.
VeN
rORT WORTH.
FORTWORTH
Routing and Transmittal Slip
Transportation and Public Works
Department
DOCUMENT TITLE: Change Order# 2 —2021 Concrete Restoration Contract 2
M&C 20-0873 CPN: 102861 CSO # 55143 DOC# CO#2
Date: 1/27/2022 FM Department initials Date Out
To: Omega Contracting Inc G Jan 31 2022
1. Daniel Garcia (Contractor) dgarcia(@azteca-omega.com DG
D
2. Steve Johnson (Inspector) TPW-Signature Jan 31,2022
3. lretomiwa Otuyelu (PM) TPW-Si nature Jan 31,2022
4. Riad Nursallah PgM TPW-Reviewer RiX Feb 1,2022
5. Lane Zarate (Sr CPO) TPW-Reviewer - Feb3,2022
6. Lauren Prieur(AD) TPW-Signature Feb 3,2022
7. William Johnson Director TPW-Signature Feb 3,2022
8. Doug Black(ACA) LAW-Signature Feb 3,2022
9. Dana Burghdoff(ACM) CMO-Signature Feb 3,2022
10. Jannette Goodall(CSO) CSO-Signature Feb4,2022
DOCUMENTS FOR CITY MANAGER'S SIGNTURE: All documents received from any and all City
Departments requesting City Manager's signature for approval MUST BE ROUTED TO THE
APPROPRIATE ACM for approval first. Once the ACM has signed the routing slip, David will review
and take the next steps.
NEEDS TO BE NOTARIZED: ❑ Yes X No
RUSH: ❑ Yes X No SAME DAY: ❑ Yes X No NEXT DAY: ❑ Yes X No
ROUTING TO CSO: ❑ Yes ❑ No
Action Reauired:
❑ As Requested ❑ Attach Signature, Initial and Notary Tabs
❑ For Your Information
X Signature/Routing and or Recording
❑ Comment
❑ File
Return to: Please call lretomiwa Otuyelu at ext, for pick up when completed. Thank you.
CSC No.55143-CO2
FOK__ 1'WOIt'PIi City of Fort Worth
-- ''r— Change Order Request
Project Name 2021 Concrete Restoration Contract 2 City Sec N 1 55143
Client Projectll(s) 102861
Project Descdplion Concrete Panel replacement at various locations In the city
Coniracto Omega Contracting Inc Change Orderfl 2 1 Datel 112712022
City Project Mgr. Iretomiwa Oluyelu City Inspector Steve Johnson
Dept, TPW Contract Time
Totals (CD)
Original Contract Amount $849,817,75 $849,817.75 180
Extras to Dale $85,218.75 $85,218.75 To—
Credits
to Dale
Pending Change Orders(in M&C Process)
Contract Cost to Dale $935,036.50 $935,036.50 220
Go to ADD&DEL Tabs to Enter CO Backup $0.00 45
Revised Contract Amount $935,036.50 $935,036.60 265
Original Funds Available for Change Orders $0.00
Remaining Funds Available for this CO $0.00
Additional Funding(if necessary)
CHANGE ORDERS to DATE(INCLUDING THIS ONE)AS%OF ORIGINAL CONTRACT 10,0311
MAX ALLOWABLE CONTRACT AMOUNT(ORIGINAL CONTRACT COST+25%) $1,062,272.19
JUSTIFICATION(REASONS)FOR CHANGE ORDER
This Change Order Is to add 45 calendardays to Construction Conlract 1l55143.
The unexpected sub-grade failure at Saratoga Downs Way required special attention.We had to excavate 3 it deep,perform geotechnical inspections,and determine the
best method to fix the sub-grade;all of which were not in the scope of work,This along with the nationwide shortage of materials and labor has caused a reasonable delay in
completing the project.
It is understood and agreed that the acceptance of this Change Order by the contractor constitutes an accord and satisfaction and represents payment in
full(both time and money)for all costs arising out of,or incidental to,the above Change Order.The Project/Program Manager signing below
acknowledges that he/she is the person responsible for the monitoring and adminlstration of this contract,including ensuring all performance and
reporting requirements.
Contractors Company Name Contractor(Name) Contract Signature Dale
OMEGA CONTRACTING INC Daniel Garcia Jan 31,2022
Inspeclorllnspeetion Supervisor Date Project and Contract Compliance Manager Date
Jan 31,2022 Jan 31,2022
Program Manager Date Senior Capital Project Officer Dale
Rtnd Nrrsr;«!�O, Feb 1,2022 Feb 3,2022
Assistant Director(Dept) Date Director,Contracting Department(Dept) Date
Feb 3,2022 Feb 3,2022
Assistant City Attorney Date lAssistant City Manager Dale
f5 Feb 3,2022I'll Feb 3,2022
Council Action(if required)
M&C Number M&C Date Approved F
ATTEST: 7ahhe��e S Goo�'all
Jannelt<s.WWall rr<n�,20,02)"is CsTI
Jannette Goodall,City Secretary
four WORTH City of Fort Worth
Change Order Additions
Project Name 1 2021 Concrete Restoration Conbact2 City See It 55143
Client Project N 1 102861
Contractorl Omega Contracting Inc PMJ Irelomiwa0tuyelu Inspector SleveJohnson
Change Order Submittal# 2 Dale 1@712022
ADDITIONS
ly unit Unit Cost Total
TPW $0.00
Sub Totalons 0,00
Change Order Additions Page 2 of 5
Foterrr_li City of Fort Worth
Change Order Deletions
Project Name 1 2021 Concrete Restoration Contract 2 City Sec tt 55143
ClientP(ojecttt 1 102861
Contractor Omega Contracting Inc PMJ Imtomhva Oluyelu Inspeclor FSteve Johnson
Change 0rderSubmillall) Dale @71202
DELETIONS
HEM
DESCRIPTION DEPT ry Unit Unit Cost Total
I
TPW $0.00
Sub Totala et ons
Change Order Deletions Page 3 of 5
MISBE for this Change Order
MISBE Sub Type of Service Amount for this CO
Total
Previous Change Orders
Co# DATE AMOUNT
Total $0.00
FO RT WO Of)
TRANSPORTATION AND PUBLIC WORKS
May 31, 2022
Omega Contracting
2518 Chalk Hill Rd. Dallas,Texas,75212
RE: Acceptance Letter
Project Name: Concrete Restoration 42
Project Type: Cocrete restoration
City Project No.: 102861
To Whom It May Concern:
On May 11, 2022 a final inspection was made on the subject project. There were punch list items
identified at that time. The punch list items were completed on June 1, 2022. The final inspection and
the corrected punch list items indicate that the work meets the City of Fort Worth specifications and is
therefore accepted by the City. The warranty period will start on June 1, 2022,which is the date of the
punch list completion and will extend of two (2)years in accordance with the Contract Documents.
If you have any questions concerning this letter of acceptance, please feel free to contact me at 817-
392-6747.
�Sincerely,
Otuyelu Iretomiwa, Project Manager
Cc: Steve Johnson, Inspector
Mike Glover, Inspection Supervisor
Daniel Roy, Senior Inspector
Mary Hanna, Program Manager
N/A, Consultant
Omega Contracting, Contractor
N/A, Developer
File
E-Mail: TPW_Acceptance@fortworthtexas.gov
Rev.8/20/19
Band Number 107287800
CONSENT OF
SURETY COMPANY
TO FINAL PAYMENT
PRO.R;CT: 2021 Concrete Restoration Contract 2 - Project Number
(nume. addm-m) 102861
TO(Owner)
City of Fort Worth, Texas
CONTRACT FOR: Construction
1000 Throckmorton Drive
Fort Worth, TX 76108
CONTRACTOR: CONTRACT DATE:
Omega Contracting, Inc 12/1/2020
2518 Chalk Hill Road
D
In accordance with the provisions of the Contract between the Owner and the Contractor as
indicated above, the (Isere insert mama and addrres of Surety Co.)
Travelers Casualty and Surety Company of America
One Tower Square
Hartford, CT 06183 ,SURETY COMPANY,
on bond of(here tnwrt rutine and addreew of(Aintractor)
Omega Contracting, Inc
2518 Chalk Hill Road
Dallas, TX 75212 , CONTRACTOR
hereby approves of the final payment to the Contractor and agrees that final payment to the
Contractor shall not relieve the Surety Company of any of Its obligations to(here inl+rrt name and
nddtvan of Owner)
City of Fort Worth, Texas
1000 Throckmorton Drive
Fort Worth, TX 76108 01,VNER.
as met forth in the said Surety Company's Bond.
IN WITNESS WHEREOF, Travelers Casualty and Surety Company of America
tho Suroty Company has horounto not its hand this 191-h_ day of-May 2022
Travelers CasualtX and SuretV Company of America
8la .1} d A S
5isunlpre aa!'Aultaat axei l?tpresa±nlatir�
Elizabeth Ortiz
Attarneir-Fact
Travelers Casualty and Surety Company of America
Travelers Casualty and Surety Company
TRAVELERS J St. Raul Fire and Marine Insurance Company
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and
St. Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein
collectively called the"Companies"),and that the Companies do hereby make,constitute and appoint Elizabeth Ortiz of
l3ULVERDE , Texas , their true and lawful Attorney(s)-in-Fact to sign, execute, seal and
acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of
the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or
guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law.
IN WITNESS WHEREOF,the Companies have caused this instrument to be signed, and their corporate seals to be hereto affixed,this 21st day of April,
2021.
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State of Connecticut
By:
City of Hartford ss, Robert L.Rane , enior Vice President
On this the 21st day of April, 2021, before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior
Vice President of each of the Companies, and that he, as such, being authorized so to do, executed the foregoing instrument for the
purposes therein contained by signing on behalf of said Companies by himself as a duly authorized officer,
IN WITNESS WHEREOF,I hereunto set my hand and official seal. . ....... .y ff� ' ,'s �,i /
rtbinnY � 'FG/�'�_`/
My Commission expires the 30th day of June,2026 �+" k
Anna P. Nowik,Notary Public
y-.�1A!lFGSl�u,J�
This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of each of
the Companies,which resolutions are now in full force and effect,reading as follows:
RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice
President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint
Attorneys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority
may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings
obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may
remove any such appointee and revoke the power given him or her;and it is
FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or
any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided
that each such delegation is in writing and a copy thereof is filed in the office of the Secretary;and it is
FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance,
or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive
Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the
Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary;
or (b) duly executed (under seal, if required) by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her
certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority;and it is
FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President,
any Vice President, any Assistant Vice President,any Secretary, any Assistant Secretary,and the seal of the Company may be affixed by facsimile to
any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys-In-
Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power of
Attorney or certificate bearing such facsimile signature or facsimile seat shall be valid and binding upon the Company and any such power so executed
and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or
understanding to which it is attached.
I, Kevin E. Hughes, the undersigned, Assistant Secretary of each of the Companies, do hereby certify that the above and foregoing Is a
true and correct copy of the Power of Attorney executed by said Companies,which remains in full force and effect.
Dated this 19th 'day of, May 2022 .
i r� Kevin E.Hughes,Assl tant Secretary
To. +ieryfly the authenticity of this Power ofAttorney,please call us at 1-8Q0-4213tT8p.
Please r'ai r Po the above-named Attorneys)-in-Fact and the details of the bond to which this PowerefAttomey is attached.
IMPORTANT NOTICE
To obtain information or make a complaint:
You may call Travelers Casualty and Surety Company of America and its affiliates' toll-
free telephone number for information or to make a complaint at:
1-800-328-2189
You may contact the Texas Department of Insurance to obtain information on
companies, coverages, rights or complaints at:
1 -800-252-3439
You may write the Texas Department of Insurance:
P.O. Box 149104
Austin, TX 78714-9104
Fax: (512) 475-1771
Web: htt, ://www.i:di.state.tx.us
E-mail:QgnsumerPro#ection@) di.stote,fix.us
PREMIUM OR CLAIM DISPUTES:
Should you have a dispute concerning your premium or about a claim you should
contact your Agent or Travelers first. If the dispute is not resolved, you may contact the
Texas Department of Insurance.
ATTACH THIS NOTICE TO YOUR BOND:
This notice is for information only and does not become a part or condition of the
attached document and is given to comply with Texas legal and regulatory
requirements.
(PN-042-8)Ed.10.18.07
CONTRACTOR'S Owner City of Fort Worth
AFFIDAVIT OF Contractor Omega Contracting, Inc.
PAYMENT OF Surety Travelers Casualty
RELEASE OF LIENS
TO: (Owner) City of Fort Worth, TX-TPW Contract No: CP No. 102861
200 Texas Street Contract For: City of Fort Worth
Fort Worth, Texas 76102 Contract Date: April 2021
PROJECT: 2021 Concrete Restoration Contract 2 at Various Locations City Project No. 102861
State of Texas
County of Tarrant
The undersigned, pursuant to the General Conditions of the Contract for Construction,hereby certifies that to the
best of his knowledge, information and belief, except as listed below,the Releases or Waivers of Liens attached
hereto include the Contractor, all Subcontractors, all suppliers or materials and equipment, and all performers of
Work, labor or services who have or may have liens against any property of the Owner arising in any manner out
of the performance of the Contract referenced above.
EXECUTIONS: (If none,write"NONE". if required by the Owner,the Contractor shall furnish bond
satisfactory to the Owner for each exception.)
**Final Payments have not been grade Contractor: Omega Contracting, Inc.
to Subcontractors or Vendors as
Omega Contracting, Inc., has not Signature:
received its "Final Payment"" Daniel darcia
Title. Operations Manager
Address: 2518 Chalk Hill Road
Dallas,Texas 75212
Subscribed and sworn to me on this day 20 ova
Notary Public: ' ti►554-6; ffm
SSA MARTMEZ
ublic,State of Te"sMy Commission Expires: ii,, 'd�' .Ex Irea o09 662723 Pary ID 12 3