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HomeMy WebLinkAboutContract 56559-FP1 City Secretary Contract No. 56559 -FP1 FORTWORTH, Date Received Jun 27,2022 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: 14700 BLUE MOUND ROAD City Project No.: 103526 Improvement Type(s): Water ❑x Sewer ❑x Original Contract Price: $15,135.00 Amount of Approved Change Order(s): $8,950,00 Revised Contract Amount: Total Cost of Work Complete: $24,085.00 chrn uyers o Myers(Jun 23,202217:18 CDT) Jun_23, 2022 Contractor Date Project Director Title MYCON General Contractors Company Name �-115" � Jun 24, 2022HerS et (Jun 24, CDT) Project Inspector Date � a,/'M6z" Jun 24, 2022 Project Manager Date Janie Scar(ett Morales(Jun 24,202214:48 CDT) Jun 24 2022 CFA Manager Date D�avra Q"kda�� Jun 27 2022 Dana Burghdof((:run 27,202212:19 CDT)un 27,202212:19 CDT) Asst. City Manager Date OFFICIAL RECORD CITY SECRETARY FT.WORTH, TX Page 1 of 2 Notice of Project Completion Project Name: 14700 BLUE MOUND ROAD City Project No.: 103526 City's Attachments Final Pay Estimate ❑x Change Order(s): ❑x Yes ❑ N/A Pipe Report: ❑x Yes ❑ N/A Contractor's Attachments Affidavit of Bills Paid Consent of Surety Statement of Contract Time Contract Time: 20 WD Days Charged: 107 Work Start Date: 11/29/2021 Work Complete Date: 5/17/2022 Completed number of Soil Lab Test: 7 Completed number of Water Test: 2 Page 2 of 2 FORT WORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name BLUE MOUND ROAD EXPRESS CFA Contract Limits Project Type WATER City Project Numbers 103526 DOE Number 3526 Estimate Number 1 Payment Number I For Period Ending 5/30/2022 WD City Secretary Contract Number Contract Time IWD Contract Date Days Charged to Date 107 Project Manager NA Contract is 100.00 Complete Contractor MYCON GENERAL CONTRACTORS 208 E LOUISIANA STE 200 MCKINNEY, TX 75069 Inspectors MILLER / SUTTERFIELD Thursday,June 23,2022 Page 1 of 4 City Project Numbers 103526 DOE Number 3526 Contract Name BLUE MOUND ROAD EXPRESS CIA Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER For Period Ending 5/30/2022 Project Funding WATER Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total --------------------------------------- 1 SALVAGE 2"WATER METER 1 EA $100.00 $100.00 1 $100.00 2 UTILITY SERVICE SURFACE RESTORATION 55 SY $2.00 $110.00 55 $110.00 SEEDING 3 TRENCH SAFETY 15 LF $100.00 $1,500.00 15 $1,500.00 4 DUCTILE IRON WATER FITTINGS 0.6 TN $3,000.00 $1,800.00 0.6 $1,800.00 W/RESTRAINT 5 4"DIP WATER PIPE 10 LF $20.00 $200.00 10 $200.00 6 6"WATER PIPE 5 LF $25.00 $125.00 5 $125.00 7 4"WATER METER AND VAULT 1 EA $1,700.00 $1,700.00 1 $1,700.00 8 4"GATE VALVE 1 EA $1,400.00 $1,400.00 1 $1,400.00 10 16X6 TAPPING SLEEVE&VALVE(CO#1) 1 EA $10,550.00 $10,550.00 1 $10,550.00 11 4"PVC PIPE(CO#1) 50 LF $12.00 $600.00 50 $600.00 12 EXCAVATION(CO#1) 1 EA $4,200.00 $4,200.00 1 $4,200.00 13 REMOVE/REPLACE SIDEWALK(CO#1) 40 SF $45.00 $1,800.00 40 $1,800.00 -------------------------------------- Sub-Total of Previous Unit $24,085.00 $24,085.00 -------------------------------------- Thursday,June 23,2022 Page 2 of 4 City Project Numbers 103526 DOE Number 3526 Contract Name BLUE MOUND ROAD EXPRESS CFA Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER For Period Ending 5/30/2022 Project Funding Contract Information Summary Original Contract Amount $15,135.00 Change Orders Change Order Number 1 $8,950.00 Total Contract Price $24,085.00 Total Cost of Work Completed $24,085.00 Less %Retained $0.00 Net Earned $24,085.00 Earned This Period $24,085.00 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 $24,085.00 Thursday,June 23,2022 Page 3 of 4 City Project Numbers 103526 DOE Number 3526 Contract Name BLUE MOUND ROAD EXPRESS CIA Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER For Period Ending 5/30/2022 Project Funding Project Manager NA City Secretary Contract Number Inspectors MILLER / SUTTERFIELD Contract Date Contractor MYCON GENERAL CONTRACTORS Contract Time 10 WD 208 E LOUISIANA STE 200 Days Charged to Date 107 WD MCKINNEY, TX 75069 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 $24,085.00 Less %Retained $0.00 Net Earned $24,085.00 Earned This Period $24,085.00 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 $24,085.00 Thursday,June 23,2022 Page 4 of 4 FORTWORTH. TRANSPORTATION AND PUBLIC WORKS June 13, 2022 Mycon General Contractors, Inc 17311 Dallas Parkway, Suite 300 Dallas,Texas 75248 RE: Acceptance Letter Project Name: 14700 Blue Mound Road Project Type: Developer/water City Project No.: 103526 To Whom It May Concern: On June 1, 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 15, 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 15, 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- 392-2481. Sincerely, v�66�Q uJ'M'Av Debbie Willhelm, Project Manager Cc: Hershel Stanley Sutterfield, Inspector Wade Miller, Inspection Supervisor Manny Nieto,Senior Inspector Victor Tornero, Program Manager Manhard Consulting, Ltd, Consultant Mycon General Construction, Inc, Contractor Walmart, Inc, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev.8/20/19 FORTWORTH TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PROJECT NAME: Dom Tap and Meter for 14700 Blue Mound Road PROJECT NUMBER: 103526 DOE NUMBER: N/A WATER PIPE LAID SIZE TYPE OF PIPE LF DIP 4" ductile 10 if Eagle 6" pvc/slip joint 5 if Eagle 4" pvc/slip joint 50 if FIRE HYDRANTS: VALVES(16" OR LARGER) PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: yes NEW SERVICES: 4"meter and vault 1 ea SEWER PIPE LAID SIZE TYPE OF PIPE LF PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: NEW SERVICES: TRANSPORTATION AND PUBLIC WORKS _` The City of Fort Worth• 1000 Throcl=orton Street•Fort Worth,TX 76012-6311 � d� (817)392-7941 •Fax:(817)392-7845 N ~ N U 0) >- o 0 0 0 z Q N zo n O Q a 0 N O o 0 0 U U J o 0 d w Q w y o 0 0 3 3 a o 0 0 7 � w tV °' o a ❑ U Co LU o ' p W za� cc m �0 o 0 0 = W U w sos U (5 U O Q o z o ❑ y o 0 0 CL o 0 0 0 0 0 0 —y w w en W O 00-1 ❑ U w z C) d Ii N 0 0 0 0 O N F- U o 0 o O O z Y o 0 o U _ H n fl W I� r` = O U o ZCD z Z ao m a � U o a v = O z ° C! 0 0 U Q o 0 0 0 w en en W a U 000 3 0 ~ o 0 _0 o 0 0 0 Q_ o 0 0 _c Q z z a) U U i 0 0 0 � >. C C .�. �» rn an 0 � .L L w U c W U w o u> 0 0 j w C; c. 0 m w 7 Q p N C) 0. o O o o 0 0 f— LO 0 0 0 0 64 en to o 0 co W `0 ~o A) ❑ U a_ w" C � O co — U N y > O o 09 0 U W M y 0 w 0 0 C p (n � ea eA «» 69 W Q EU o r > M C Fw- m c6 O Cl) (6 U Q o p C) U Np p v U) o0 0o uo o0 0 t9 N CO o O N N Lo 'd' C) O vi rn U Q N > N N > 0 U p m X a ) F- z w ❑ 0 U O F Q ww Z F c a x Z z w z o WF �n O (D Q 2i F- — F- U = Q zz Un ❑ o < U z w w Q a a o W C)Z F- w z Q Q ❑ � F- w a w w CV ❑ O a. z to to w U Q O U O O F- OC C) w w Q w a U LU< Q F (n t C) F w w F z } k z 9 z w J a O ti --i U) o z O j FO > 0 U U U LL LL Z n O w U 0 Q � F \"1\\�\\\ \ ca e e e \ uS8888G t eaaawaa ƒ RG2 - \ & G o \ CO $ \ _ ) / \ 04 - o 0 e { . § � { � § � G� u e [ u 0 \ } \ § ! \ e { / K / / z / ) f $ § / r \ \ a06 / { mw / / E { ; «ug , : ugn us § / 5CL 5 / > _ ; % \ ± � J , S / � { ) E + % \ 2j = ° mL _ C=X / \ 0 ) o Q 2 - 7 x \ § 1LX § \ } 2 / g G d J \ § z w a) Qc > £ R ^ § \ § k / e \ iL/ / b < / / ) ( \ z « = < L \ \ ) � = eua -ium ( w 0 » / § { 2 yQ k /( \ .0 ]\ }< » � \ w+ LO \ / \\ z e\ /W \- / ® / 20 i CO 3 \ a) U) ° � � d ® � f { 82 q f � ' m \ ( } \ 2 ) & ) \ s ) \ / / 2 7 0 0) § � \ � et333 } 2 z z z z o 7 ± § \ H z co k - 0 @ j AFFIDAVIT STATE OF Texas COUNTY OF Dallas Before me, the undersigned authority, a notary public in the state and county aforesaid, on this day personally appeared Charles P Myers, Sr. Project Manager Of MYCON General Contractors, Inc,known to me to be a credible person, who being by me duly sworn,upon his oath deposed and said; That all persons, firms, associations, corporations, or other organizations furnishing labor and/or materials have been paid in full; That the wage scale established by the City Council in the City of Fort Worth has been paid in full; That there are no claims pending for personal injury and/or property damages; On Contract described as; ContractNo. 103526 BY( '�� Charles P Myers Subscribed and sworn before me on this date 2nd of May, 2022. EE SNONDA LAURES#�,�Notery Public,State of Texas Expires 12.19-2023Notary Public o�;, '�� Notary ID 128830915 Dallas,TX 0062 19-1 MAINTENANCE BOND Paget of3 1 SECTION 00 6219 2 MAINTENANCE BOND 3 Bond#076487R 4 THE STATE OF TEXAS § 5 § KNOW ALL BY THESE PRESENTS: 6 COUNTY OF TARRANT § 7 8 That we MYCON General Contactors,Inc. known as 9 "Principal"herein and Westfield Tnsurance Company a corporate surety 10 (sureties, if more than one)duly authorized to do business in the State of Texas, known as 11 "Surety"herein(whether one or more), are held and firmly bound unto the Developer,Walmart, 12 Inc, authorized to do business in Texas ("Developer") and the City of Fort Worth,a Texas 13 municipal corporation("City"),in the sum of fifteen thousand one hundred thirty five&No/100 14 Dollars ($15,135.00),lawful money of the United States,to be paid in Fort Worth,Tarrant 15 County,Texas,for payment of which sum well and truly be made jointly unto the Developer and 16 the City as dual obligees and their successors,we bind ourselves, our heirs, executors, 17 administrators,successors and assigns,jointly and severally, firmly by these presents. 18 19 WHEREAS, Developer and City have entered into an Agreement for the construction of 20 community facilities in the City of Fort Worth by and through a Community Facilities 21 Agreement, CFA Number CFA 21-0103; and 22 WHEREAS,the Principal has entered into a certain written contract with the Developer 23 awarded the end day of November 20 21 ,which Contract is 24 hereby referred to and a made part hereof for all purposes as if fully set forth herein,to furnish all 25 materials, equipment labor and other accessories as defined by law, in the prosecution of the 26 Work, including any Work resulting from a duly authorized Change Order(collectively herein, 27 the"Work")as provided for in said Contract and designated as 14700 Blue Mound Road Water 28 Tap; and 29 30 WHEREAS,Principal binds itself to use such materials and to so construct the Work in 31 accordance with the plans, specifications and Contract Documents that the Work is and will 32 remain free from defects in materials or workmanship for and during the period of two (2)years 33 after the date of Final Acceptance of the Work by the City("Maintenance Period"); and 34 CITY OF FORT WORTH 14700 Blue Mound Road Water Tap STANDARD CITY CONDITIONS—DEVELOPER AWARDED PROJECTS CPN 103526 Revised January 31,2012 006219-2 MAINTENANCE BOND Page 2 of 3 1 WHEREAS,Principal binds itself to repair or reconstruct the Work in whole or in part 2 upon receiving notice from the Developer and/or City of the need thereof at any time within the 3 Maintenance Period. 4 5 NOW THEREFORE,the condition of this obligation is such that if Principal shall 6 remedy any defective Work,for which timely notice was provided by Developer or City,to a 7 completion satisfactory to the City,then this obligation shall become null and void; otherwise to 8 remain in full force and effect. 9 10 PROVIDED,HOWEVER, if Principal shall fail so to repair or reconstruct any timely 11 noticed defective Work, it is agreed that the Developer or City may cause any and all such 12 defective Work to be repaired and/or reconstructed with all associated costs thereof being borne 13 by the Principal and the Surety under this Maintenance Bond; and 14 15 PROVIDED FURTHER,that if any legal action be filed on this Bond,venue shall lie in 16 Tarrant County, Texas or the United States District Court for the Northern District of Texas,Fort 17 Worth Division; and 18 19 PROVIDED FURTHER,that this obligation shall be continuous in nature and 20 successive recoveries may be had hereon for successive breaches. 21 22 23 CITY OF FORT WORTH 14700 Blue Mound Road Water Tap STANDARD CITY CONDITIONS—DEVELOPER AWARDED PROJECTS CPN 103526 Revised January 31,2012 006219-3 MAINTENANCE BOND Page 3 of 3 1 IN WITNESS WHEREOF,the Principal and the Surety have each SIGNED and SEALED this 2 instrument by duly authorized agents and officers on this the 4th day of November 3 , 20 21 4 5 PRINCIPAL: 6 MYCON General Contractors.Inc. 7 8 9 10 Signal c 11 ATTEST: 12 i;G PA ecS 130 C h� C�y�w� 14 n ipal)Secretary Name and Title 15 16 Address: 17311 Dallas Plcwy,#300 17 Dallas.TX 75248 18 19 20 Witness as to Mheipal 21 SURETY: 22 Westfield Insurance Company 23 24 25 BY: 26 Signature 6 . 27 28 Dawn Davis, Attorney-in-Fact 29 ATTEST: Name and Title 30 LL �i 31 Address: 555 Republic Drive,#450 32 (Surely)-Segetary Edwayd4lya4 Bowles Plano,TX 75074 33 34 35 Witness as to Surety ~Donnie Doan Telephone Number: (972)516-2600 36 37 *Note: If signed by an officer of the Surety Company,there must be on file a certified extract 38 from the by-laws showing that this person has authority to sign such obligation. If 39 Surety's physical address is different from its mailing address,both must be provided. 40 41 The date of the bond shall not be prior to the date the Contract is awarded. 42 CITY OF FORT WORTH 14700 Blue Mound Road Water Tap STANDARD CITY CONDITIONS—DEVELOPER AWARDED PROJECTS CPN 103526 Revised January 31,2012 IMPORTANT NOTICE STATE OF TEXAS COMPLAINT PROCEDURES 1. IMPORTANT NOTICE AVISO IMPORTANTE To obtain information or make a complaint: Para obtener informacion o para someter una queja: 2. You may contact your agent. Puede comunicarse con sr.r (title) al (telephone number). 3. You may call Westfield Insurance Company, Usted puede Ilamar al numero de telefono gratis de Westfield National Insurance Company, and/or Westfield Insurance Company, Westfield National Ohio Farmers Insurance Company's toll-free Insurance Company, and/or Ohio Farmers telephone number for information or to make a Insurance Company's para informacion o para complaint at: someter una queja al: 1.800-243-0210 1-800-243-0210 4. You may also write to Westfield Insurance Usted tambien puede escribir a Westfield Insurance Company, Westfield National Insurance Company, Westfield National Insurance Company, and/or Ohio Farmers Insurance Company, and/or Ohio Farmers Insurance Company at: Company: Attn: Bond Claims Attn: Bond Claims One Park Circle One Park Circle P O Box 5001 P O Box 5001 Westfield Center, OH 44251-5001 Westfield Center, OH 44251-5001 Fax#330-887-0840 Fax#330-887-0840 5. You may contact the Texas Department of Puede comunicarse con el Departamento de Insurance to obtain information on companies, Sequros de Texas para obtener informacion acerca coverages, rights or complaints at: de companies, coberturas, derechos o quejas al: 1-800-252-3439 1-800-252-3439 6. You may write to the Texas Department of Puede escribir al Departamento de Seguros de Insurance: 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: http://www.tdi.state.tx.us Web: http://www.tdi.state.tx.us E-mail: ConsumerProtection cotdi,state.tx.us E-mail: ConsumerProtection(cbtdi.state.tx.us 7. PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS 0 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, reclamo, debe comunicarse con el agente, Westfield Westfield Insurance Company, Westfield National Insurance Company, Westfield National Insurance Insurance Company, or Ohio Farmers Insurance Company, o Ohio Farmers Insurance Company Company first. If the dispute is not resolved, you primero. Si no se resuelve la disputa, puede may contact the Texas Department of Insurance. entonces comunicarse con ei departamento(TDI). 8. ATTACH THIS NOTICE TO YOUR POLICY: UNA ESTE AVISO A SU POLIZA: Este aviso es This notice is for information only and does not solo para proposito de informacion y no se convierte become a part or condition of the attached document. en parte o condicion del documento adjunto. BD5430 (07-07) ni.�r"wvXr� yr r , ,vlar,I, POWER#AND ISSSUED PRIOR TO 06/05/19, FOR ANY PERSON OR PERSONS NAMED BELOW. General POWER NO. 4220072 03 Power Westfield Insurance Co. of Attorney Westfield National Insurance Co. CERTIFIED COPY Ohio Farmers Insurance Co. Westfield Center, Ohio Know All Men by These Presents, That WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL_ INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, corporations, hereinafter referred to individually as a "Company" and collectively as "Companies," duly organized and existing under the laws of the State of Ohio, and having its principal office in Westfield Center, Medina County, Ohio, do by these presents make,constitute and appoint JOI-IN D. FULKERSON, TOM P, ELLIS, III, DONNIE D. DOAN, KAE PERDUE:, KRISTI MEEK, DAWN DAVIS, WALTER J. DELAROSA, SHARON CLARY, RYAN BOWLES, CHRISTEN TYNER,JOINTLY OR SEVERALLY of DALLAS and State of TX its true and lawful Attorney(s)-in-Fact, with full power and authority hereby conferred in its name, place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings, or oilier instruments or contracts of suretyship- - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - LIMITATION: THIS POWER OF ATTORNEY CANNOT BE USED TO EXECUTE NOTE GUARANTEE, MORTGAGE DEFICIENCY, MORTGAGE U ,OR BANK DEPOSITORY BONDS. and to hind any of the Companies thereby as fully and to the same extent as if such bonds were signed by the President, sealed with the corporate seal of the applicable: Company and duly attested by its Secretary, hereby ratifying and confirming all that the said Attorneys)-in-Fact may do in the premises. Said appointment is made under and by authority of the following resolution adopted by the Board of Directors of each of the WESTFIELD INSURANCE COMPANY,WESTFIELD li ZONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY: "Be It Resolved,that the President, any Senior Executive, any Secretary or any Fidelity& Surety Operations Executive or other Executive shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorneys)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: The Attorney-In•Fact. may be given full power and authority for and in the name of and on behalf of the Company,to execute,acknowledge and deliver, any and all bonds, recognizances, contracts, agreements of fndemnity and other conditional or obligatory underlakfngs and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney-in-Fact shall be as binding upon the Company as if signed by the President and sealed and attested by the Corporate Secretary." "Be it Further Resolved, that the signature of any such designated person and the seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsirnile:signatures or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached." (Each adopted at a meeting held on February 8, 2000). In Witness Whereof, WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY have caused these presents to be signed by their National Surety Leader and Senior Executive and their corporate:seals to be hereto affixed this 05th day of JUNE A.D., 2019 . .••,,ptlU14/I/„, �,,,•• " ",,,, •��""'I/,I,/„ WESTFIELD INSURANCE COMPANY Corporate +a �SUft� 4, �,, �tt)P1AI ���� �,,� seals �4�r,. .S!c�:''' �5a.• SSG; ,r� , iy�o,,� WESTFIELD NATIONAL INSURANCE COMPANY Affixedi o; '•.4- �r • '•E� OHIO FARMERS INSURANCE COMPANY `•� SEAL _�:c RED �ea �� ,'~••I...a.•"r dTs .'•.. .•'.'' qi�' '•••.,�..•'''4,``�• .ICI I VwhJ .1 State of Ohio ""'"" """" Dennis P. Baus, National Surety Leader and County of Medina ss.: Senior Executive On this 05th day of JUNE A.D.,2019 , before me personally came Dennis P. Baus to me known, who, being by me duly sworn, did depose and say, that he resides in Wooster, Ohio; that he is National Surety Leader and Senior Executive of WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAI INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, the companies described in and which executed the above instrument; that he knows the seals of said Companies;that the seals affixed to said instrument are such corporate seals;that they were so affixed by order of the Boards of Directors of said Companies;and that he signed his name thereto by like order. Notarial J",,,,••r•r144,rr Seal Affixed 0 i 9' • David A, Kotnik, Attorney at Law, Notary Public State or Ohio tp J ?o My Commission Does Not Expire (Sec. 147,03 Ohio Revised Code) County of Medina ss.; q 1•, I, Frank A. Carrino, Secretary of WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said Companies,which is still in full force and effect; and furthermore,the resolutions of the Boards of Directors, set out in the Power of Attorney are in furl force and effect. In Witness Whereof, I have hereunto set my hand and affixed the seals of said Companies at Westfield Center, Ohio, this 4th day of Novembel. A.D.,, 2021 • Nit .,, •°' ', ''�. ............ic `;v..........V.Y KsU {,jam, SEALSEAL :m- 'sVo� �• _ � ze- Sccr+rtary''.,• ,, :o- � �• •t, Frank A. Carrino, Secretary BPOAC2 (combined) (06-02) `s:r