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HomeMy WebLinkAboutContract 56497-FP2 City Secretary 56497 -FP2 Contract No. FORTWORTH. Date Received Oct 24, 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: 2627 Tillar Street Express CFA City Project No.: 103492 Improvement Type(s): ❑x Paving ❑ Drainage ❑x Street Lights ❑ Traffic Signals Original Contract Price: $25,798.70 Amount of Approved Change Order(s): $26,601.76 Revised Contract Amount: $52,400.46 Total Cost of Work Complete: $52,400.46 Colin warren Oct 18, 2022 Colin Warren(Oct 18,2022 09:13 CDT) Contractor Date Project Manager Title Pennington Utility Construction Company Name a.w. AC Oct 19, 2022 Habte Taezaz(Oct 19,2022 08:51 CDT) Project Inspector Date Oct 19, 2022 Project Manager Date .7gel Awnlef Oct 19 2022 Janie Scarlett Morales(Oct 19,2022 12:04 CDT) CFA /I na er Date �� Oct 19 2022 William Johnson(Oct 9,2022 12:06 CDT) , Asst. City Manager Date OFFICIAL RECORD CITY SECRETARY Page 1 of 2 FT. WORTH, TX Notice of Project Completion Project Name: 2627 Tillar Street Express CFA City Project No.: 103492 City's Attachments Final Pay Estimate ❑x Change Order(s): ❑x Yes ❑ N/A Contractor's Attachments Affidavit of Bills Paid Consent of Surety Statement of Contract Time Contract Time: 40 WD Days Charged: 78 Work Start Date: 12/13/2021 Work Complete Date: 6/14/2022 Completed number of Soil Lab Test: 10 Completed number of Water Test: 6 Page 2 of 2 FORT WORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name 2627 TILLAR STREET Contract Limits Project Type PAVING&STREET LIGHTS City Project Numbers 103492 DOE Number 3492 Estimate Number 1 Payment Number 1 For Period Ending 6/13/2022 WD City Secretary Contract Number Contract Time 4WD Contract Date 10/5/2021 Days Charged to Date 78 Project Manager NA Contract is 100.00 Complete Contractor PENNINGTON UTILITY CONSTRUCTION,LLC 13350 EULESS ST EULESS, TX 76040 Inspectors MILLER,W / TAEZAZ,H Friday,June 24,2022 Page 1 of 4 City Project Numbers 103492 DOE Number 3492 Contract Name 2627 TILLAR STREET Estimate Number I Contract Limits Payment Number 1 Project Type PAVING&STREET LIGHTS For Period Ending 6/13/2022 Project Funding UNIT IV:PAVING IMPROVEMENTS Item Estimated Estimated Completed Completed Description of Items Unit Unit Cost No. Quanity Total Quanity Total --------------------------------------- 1 6"CONCRETE SIDEWALK(CO#1) 272 SF $5.00 $1,360.00 272 $1,360.00 2 4"SLD PVMT MARKING HAS(W) 1130 LF $5.00 $5,650.00 1130 $5,650.00 3 CONCRETE WHEEL STOP 22 EA $150.00 $3,300.00 22 $3,300.00 4 2"SURFACE MILLING(CO#1) 355 SY $2.50 $887.50 355 $887.50 5 PARKING LOT LEGEND HC 4 EA $150.00 $600.00 4 $600.00 6 STEEL BOLLARD(CO#1) 4 EA $250.00 $1,000.00 4 $1,000.00 7 REMOVE CONCRETE PAVEMENT(CO#1) 186 SY $22.50 $4,185.00 186 $4,185.00 8 6"CONCRETE PAVEMENT(CO#1) 138 SY $67.50 $9,315.00 138 $9,315.00 9 6"FLEX BASE TYPE A GR-1(CO#1) 138 SY $57.97 $7,999.86 138 $7,999.86 10 CONCRETE SIDEWALK(CO#1) 429 SY $11.10 $4,761.90 429 $4,761.90 Sub-Total of Previous Unit $39,059.26 $39,059.26 -------------------------------------- UNIT V:STREET LIGHTING IMPROVEMENTS Item Estimated Estimated Completed Completed Description of Items Unit Unit Cost No. Quanity Total Quanity Total 1 LED LIGHTING FIXTURE 1 EA $2,150.00 $2,150.00 1 $2,150.00 2 35'TIMBOR POLE CL 2 1 EA $3,500.00 $3,500.00 1 $3,500.00 3 FURNISH/INSTALL8'WOOD LIGHT POLE ARM 1 EA $1,000.00 $1,000.00 1 $1,000.00 4 6-6-6 TRIPLEX ALUM ELEC CONDUCTOR 164 LF $40.80 $6,691.20 164 $6,691.20 --------------------------------------- Sub-Total of Previous Unit $13,341.20 $13,341.20 Friday,June 24,2022 Page 2 of 4 City Project Numbers 103492 DOE Number 3492 Contract Name 2627 TILLAR STREET Estimate Number I Contract Limits Payment Number 1 Project Type PAVING&STREET LIGHTS For Period Ending 6/13/2022 Project Funding Contract Information Summary Original Contract Amount $25,798.70 Change Orders Change Order Number 1 $26,601.76 Total Contract Price $52,400.46 Total Cost of Work Completed $52,400.46 Less %Retained $0.00 Net Earned $52,400.46 Earned This Period $52,400.46 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 $52,400.46 Friday,June 24,2022 Page 3 of 4 City Project Numbers 103492 DOE Number 3492 Contract Name 2627 TILLAR STREET Estimate Number I Contract Limits Payment Number 1 Project Type PAVING&STREET LIGHTS For Period Ending 6/13/2022 Project Funding Project Manager NA City Secretary Contract Number Inspectors MILLER,W / TAEZAZ,H Contract Date 10/5/2021 Contractor PENNINGTON UTILITY CONSTRUCTION,LLC Contract Time 40 )VD 13350 EULESS ST Days Charged to Date 78 )VD EULESS, TX 76040 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 $52,400.46 Less %Retained $0.00 Net Earned $52,400.46 Earned This Period $52,400.46 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 $52,400.46 Friday,June 24,2022 Page 4 of 4 DEVELOPER-AWARDED-PROJECT CHANGE ORDER PROJECT NAME: 2627 Tlllar Street CHANGE CONTRACT: WATER,SEWER,PAVING,&STREET LIGHT IMPROVEMENTS ORDER No: CFA# CFA-21-0128 CITY PARTICIPATION: No CITY PROJECT# 103492 1 FID# 30114-0200431-103492-EO7685 FILE# K-2846 X-27008 INSPECTOR: Habte Taezaz Phone No: (214)223-5635 REVIEWED PROJECT MANAGER: Debbie J.Willhelm,P.E. Phone No: (817)392-2481 By Debbie J.Wilthelm at 5:21 pm,Apr 10,2022 CONTRACT UNIT WATER SEWER PAVING DRAINAGE STREETLIGHTS CONTRACT Developer Developer Developer Developer Developer DAYS Cost city cost cost City Cost Cost City Cost Cost city cost Cost City Cost ORIGINAL CONTRACT $41,218.00 $12,909.00 $12,457.50 $13,341.20 40 EXTRAS TO DATE CREDITS TO DATE CONTRACT TO DATE $41,218.00 $0.00 $12,909.00 $0.00 $12,457.50 $0.00 $0.00 $0.00 $13,341.20 $0.00 40 AMOUNT OF PROP.CHANGE ORDER $69,127.00 ($6,120.00) $26,601.76 REVISED CONTRACT AMOUNT $110,345.00 $0.00 $6,789.00 $0.00 $39,059.26 $0.00 $0.00 $0.00 $13,341.20 1 $0.00 40 TOTAL REVISED CONTRACT AMOUNT PER UNIT $110,345.00 $6,789.00 $39,059.26 $0.00 $13,341.20 REVISED COST SHARE Dev.Cost: $169,634.46 City Cost: $0.00 TOTAL REVISED CONTRACT $169,534.46 Revised:10-12-2011 Page 1 You are directed to make the following changes in the contract documents: CRY BID ITEM PAY ITEM# # QUANTITY UNIT REM DESCRIPTION UNIT PRICE I TOTAL UNIT I:WATER IMPROVEMENTS 1 331110 39 LF 3311.01416"Water pipe $68.00 $2652.00 2 320129 61 BY 3201.0616 Cone Pvmt Repair,ArteriaVlndustrial $135.00 $6 235.00 3 320117 125 LF 3201.0132 5'Wide Asphalt Pvmt Repair,Industrial $65.00 $8125.00 d 320117 -24 LF 3201.013719 Wide Asphalt Pvmt Repair,Industrial $65.00 -$1 560.00 5 330510 22 CY 3305.0206 Imported Embedment/Backfill Acceptable Backfill $80.00 $1 760.00 6 331111 0.39 TON 2211.0001 Ductile Iron Water Fittings w/Restraint $4,000.00 $1 560.00 8 331225 1 EA 3312.4004 8"x 6"Tapping Sleeve&Valve $4,500.00 $4 500.00 11 331210 -1 EA 3312.2203 2"Water Service $6 100.00 -$6 100.00 NEW 024114 1 85 1 LF 10241.1013 Remove 8"Water Line $20.00 $1700.00 NEW 33 0512 1 EA 3305.0003 8"Waterline Lowering $9,465.00 $9,465.00 NEW 3311 10 85 LF 3311.0251 W DIP Water $80.00 $6,800.00 NEW 331211 1 EA 3312.2801 &'Water Meter and Vault $28.395.00 $28 395.00 NEW 331220 1 EA 3312.3002 6"Gate Valve $1,495.00 $1 495.00 NEW 3312 25 2 EA 3312.0117 Connection to Existing 4'12"Water Main $1,050.00 $2100.00 TOTAL $69 127.00 UNIT II:SANITARY SEWER IMPROVEMENTS 1 320129 1 -51 1 SY 13201.0616Zone Pvmt Repair,Arterial/Industrial $120.00 -$6 120.00 TOTAL $6,120.00 UNIT IV:PAVING IMPROVEMENTS 1 321320 -187 SF 3213.0303 6"Concrete Sidewalk $5.00 -$935.00 4 24115 110 BY 0241.1506 2"Surface Milling $2.50 $275.00 NEW 4 EA 4'Steal Bollard $250.05 $1,000.00 NEW 24115 186 BY 0241.1000 Remove Cone Pvmt $22.50 $4,185.00 NEW 321313 138 BY 3213.0101 6"Conc Pvmt $67.50 $9,315.00 NEW 321123 138 SY 3211.0112 6"Flexible Base,Type A GRA $57.97 $7,999.86 NEW 321320 429 SF 3213.0311 4"Conic Sidewalk,Adjacent to Curb $11.10 $4,761.90 TOTAL $26 601.76 REASONS FOR CHANGE ORDER 1.It was nessasary to lower the 8"waterline from a 2'depth to a 4'depth to make service connections. - The propsed 2"watermeter was increased to 3". Changes correspond to Revision No.1 as shown on sheets 4,7,6,&9.1 of the construction plans. 2 Pavement replacement required forADA compliance around landing. Changes correspond to Revision No.2 as shown on sheets 11,16,&20.1 of the construction plans. NO CITY FUNDS INVOLVED IN THIS CONTRACT.DEVELOPER IS RESPONSIBLE FOR 100%OF THE CHANGE ORDER COST AND NO REIMBURSEMENT FROM THE CITY WILL BE SOUGHT BY THE DEVELOPER. RECOMMENDED: APPROVED: APPROVED: Triangle Engineering LLC Vaq ro ill r reef� Pennington Utility Construction By: V y By: By: .-. Name: Jack Zanger Name: KedyAgnor Name: Colin Warren Title:Project Manager Title: Director of Development Title: Protect Manger Revised:10-12-2011 Page 2 ƒ , > o 0 o s - -n m o 0 0 2 em = e = q 2 z ® ) w / ) j > / / % m \ ƒ / / S mm -1 > e > m j ® T ~ / M # 2 2 / % j d / / \ a / \ \ m m ° S / ° > % K 2 / m d z \ \ M § / / Cl % ® 2 z \ / - m E ZZ > ? % > # m W ` /G z m z > A � $ > /m 0 /0 m \ ° 2 ` f y 3 © 2 ® 2 > 0-) 0 o A CT \ coM \ * / 8 S c n \ / % \ \ \ S o m \ / m 0 � 3 4 @ @ T. m cCTIo / \ \ / \ \ \ \ m m \ E gg gr m J 0 / ƒ O \ (D � � ® \ 00 i \ / � \ /\ /ID 5 / e \ # \ \ \ n �� \ \ z \ ) nk \ \ D� / o a a� m m \ & / / y \ / n ® o m 22 > e IQ IQ 7 \ 2 > n m f ) ? f 2 0 � © § £ it- ( 0 ty, � 0m { f O \ ) © m CD ° \ 0 4 ) [ § CD CD CD^ 41 -< / ) w ƒ q 4 ( z CL - m 2 § } k ) \ m 3 m / z ) 57 CD( % f ;o � % > a m m z » o / m Mo § / , n ten , ) k j) ( co w / 2 § 8/ \ C) m m ¥ ; g a o \ m \ \ / \ \ � — & } \ 0 or7 ` e E § \ (D § = _ ± m &mz . CD nw ° o UT ) A \ ( ® § \ c / Ef § = g rzm , ) z co J % m (OD \ > % S / q CD § � \ \ ) (0 co8 \ / \ } m = mco a / / { $ o ) < Z � e o ® 9 ® .<r— ` b \ ) § & Ja2m \ \ M ;u \ Fk \ j I < ;u \ /f ƒ - § § - ) am > MZ (D J2 e m « nm eeg P \ / \ ° @ m7-Q & m k \ \ _/ � §/ / ) 2 n a z = / 2 2 m 7 e } x \ \ m 0. / \ 2 \ / ) ® \\ q n % . G w k \ ED )0 § 88 \\DN ) FORTWORTH. TRANSPORTATION AND PUBLIC WORKS June 14, 2022 Pennington Utilities . 13350 Euless Street Euless Texas, 76040 RE: Acceptance Letter Project Name: 2627 Tillar Street Express CFA Project Type: 01, 02, 03, 06 City Project No.: CPN: 103492 To Whom It May Concern: On June 10, 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 14, 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 14, 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- 392-7949. Sincerely,I T P/yfJL2 V. U/��L Debbie J. Willhem, Project Manager Cc: Habte Taezaz, Inspector Wade Miller, Inspection Supervisor Ariel Duarte, Senior Inspector Victor Tornero, Program Manager Triangle Enginnering LLC, Consultant Pennington Utilities, Contractor Vaquero Tillar Street Partners, Developer File E-Mail: Douglas W. Wiersig, P.E., PhD., Director,TPW Wendy Chi-Babulal, P.E., Water Richard Martinez, Assistant Director,TPW Tony Sholola, P.E., Water Marisa Conlin,Traffic Engineering Richard Zavala, Director, PARD Allen Hall, Superintendent,TPW David Creek, Assistant Director, PARD John Robert Carman, P.E., Director, Water Chris Harder, P.E., Assistant Director, Water Rev.9/15/16 DEVELOPMENT BOND GUARANTEEING PERFORMANCE AND PAYMENT OF IMPROVEMENTS Bond No. 800124627 KNOW ALL MEN BY THESE PRESENTS,that we,Vaquero Tillar Partners,LP as Principal,andl(Atlantic Specialty Insurance Company),Ia corporation organized and existing under the laws of the State of LNew York, and fully authorized to transact business in the State of Texas, as surety,are held and firmly bound unto CITY OF FORT WORTH,TEXAS,200 Texas Street,Fort Worth,Texas,76102, as Obligee,in the penal sum off`($_79,925.70)Ilawful money of the United States of America,for the payment of which well and truly to be made,we bind ourselves,our heirs,executors,administrators, successors and assigns,jointly and severally,firmly by these presents. WHEAREAS,((Vaquero Tillar Partners,LP_,I has agreed to construct in ILBailey's Industrial Addition,in the CITY OF FORT WORTH,TEXAS the following improvements: ;(Water Improvements, Sanitary Sewer Improvements,Paving Improvements, Street Lighting Improvementsi WHEREAS,in the event of bankruptcy,default or other nonperformance by Principal,claims against Principal or the development,Obligee may be left without adequate satisfaction. NOW,THEREFORE,THE CONDITION OF THIS OBLIGATION IS SUCH,that if the said Principal shall construct,or have constructed,the improvements herein described, and shall pay for the cost of all labor,materials and equipment furnished in connection with the construction of said improvements, and shall save the Obligee harmless from any loss,cost or damage by reason of its failure to complete the construction of said improvements or by reason of its failure to pay for the cost of same,then this obligation shall be null and void,otherwise to remain in full force and effect; and upon receipt of a claim by the City of Fort Worth indicating that the construction of said improvements has not been completed,or that the costs for same have not been paid,the Surety will pay to the City of Fort Worth such amount up to the amount of this bond which will allow the City of Fort Worth to complete construction of said improvements and to pay for the costs of same. We hereby agree with you that the draft(s) drawn under and in compliance with the terms of this bond will be duly honored upon presentation at: (Surety)LAtlantic Specialty Insurance Company_ mail code:L55441_� (Surety Addressi_605 Highway 169 North, Suite 800,Plymouth,MN Fax Numbet__N/A­Jconfrimed by a phone call atL952-852-2431--- PROVIDED FURTHER,that this bond shall automatically be increased by the amount of any change order,supplemental agreement or amendment which increase the price of the aforementioned contract. PROVIDED FURTHER,that if any legal action be filed on this bond,the laws of the State of Texas shall apply and that venue shall lie exclusively in Tarrant County,Texas. AND PROVIDED FLIRTER,that the said surety,for value received,hereby stipulates and agrees that no charge,extension of time,alteration or addition to the terms of any contract for the public affect its obligation on this bond,and it does hereby waive notice of any such change, extension of time, alteration or addition to the terms of such contract. This bond is given pursuant to the provisions of Section 212.073 of the Texas Local Government Code, as such may amended from time to time. Signed,sealed and dated this 30th day of September_,2021 ._ Vaquero 'Pillar Partners,LP Atlantic Specialty Insurance Com any By: By. Payton B nchard Attorney-in-Fact intact INSURANCE Power of Attorney KNOW ALL MEN BY THESE PRESENTS,that ATLANTIC SPECIALTY INSURANCE COMPANY,a New York corporation with its principal office in Plymouth, Minnesota,does hereby constitute and appoint: James R.Reid,William Mitchell Jennings,William Blanchard,Lindsay Senior Gingras,Payton Blanchard, Jessica Turner,each individually if there be more than one named,its true and lawful Attomey-in-Fact,to make,execute,seal and deliver,for and on its behalf as surety,any and all bonds,recognizances,contracts of indemnity,and all other writings obligatory in the nature thereof,provided that no bond or undertaking executed under this authority shall exceed in amount the sum of:unlimited and the execution of such bonds,recognizances,contracts of indemnity,and all other writings obligatory in the nature thereof in pursuance of these presents,shall be as binding upon said Company as if they had been fully signed by an authorized officer of the Company and sealed with the Company seal. This Power of Attorney is made and executed by authority of the following resolutions adopted by the Board of Directors of ATLANTIC SPECIALTY INSURANCE COMPANY on the twenty-fifth day of September,2012: Resolved: That the President,any Senior Vice President or Vice-President(each an"Authorized Officer")may execute for and in behalf of the Company any and all bonds,recognizances,contracts of indemnity,and all other writings obligatory in the nature thereof,and affix the seal of the Company thereto;and that the Authorized Officer may appoint and authorize an Attorney-in-Fact to execute on behalf of the Company any and all such instruments and to affix the Company seal thereto;and that the Authorized Officer may at any time remove any such Attorney-in-Fact and revoke all power and authority given to any such Attorney-in- Fact. Resolved: That the Attomey-in-Fact may be given full power and authority to execute for and in the name and on behalf of the Company any and all bonds, recognizances,contracts of indemnity,and all other writings obligatory in the nature thereof,and any such instrument executed by any such Attorney-in-Fact shall be as binding upon the Company as if signed and sealed by an Authorized Officer and,further,the Attomey-in-Fact is hereby authorized to verify any affidavit required to be attached to bonds,recognizances,contracts of indemnity,and all other writings obligatory in the nature thereof. This power of attorney is signed and sealed by facsimile under the authority of the following Resolution adopted by the Board of Directors of ATLANTIC SPECIALTY INSURANCE COMPANY on the twenty-fifth day of September,2012: Resolved: That the signature of an Authorized Officer,the signature of the Secretary or the Assistant Secretary,and the Company seal may be affixed by facsimile to any power of attorney or to any certificate relating thereto appointing an Attomey-in-Fact for purposes only of executing and sealing any bond, undertaking,recognizance or other written obligation in the nature thereof,and any such signature and seal where so used,being hereby adopted by the Company as the original signature of such officer and the original seal of the Company,to be valid and binding upon the Company with the same force and effect as though manually affixed. IN WITNESS WHEREOF,ATLANTIC SPECIALTY INSURANCE COMPANY has caused these presents to be signed by an Authorized Officer and the seal of the Company to be affixed this twenty-seventh day of April,2020. A10'"kk"M,411 INg�9,., -NG�GppPORgr�,9��� 198 r-- 98 0` By 6 ?�S 4, Ydp4'-�b s STATE OF MINNESOTA y y a> Paul J.Brehm,Senior Vice President HENNEPIN COUNTY �!'"tr On this twenty-seventh day of April,2020,before me personally came Paul J.Brehm,Senior Vice President of ATLANTIC SPECIALTY INSURANCE COMPANY,to me personally known to be the individual and officer described in and who executed the preceding instrument,and he acknowledged the execution of the same,and being by me duly sworn,that he is the said officer of the Company aforesaid,and that the seal affixed to the preceding instrument is the seal of said Company and that the said seal and the signature as such officer was duly affixed and subscribed to the said instrument by the authority and at the direction of the Company. ,,a.b� ALISON DWAN NASH•TROUT NOTARY PUBLIC•MINNESOTA � � My Commission Explres 0 January 31,2025 Notary Public I,the undersigned,Secretary of ATLANTIC SPECIALTY INSURANCE COMPANY,a New York Corporation,do hereby certify that the foregoing power of attorney is in full force and has not been.revo d res Athe olutions a ov are now in force. Signed and sealed. Dated t ann r' day of. Q JJ1 �aPolt A 4 G aW r'r�V�.g111 114, qn= SEAL m= =� 1986 This Power of Attorney expires �sy't�W Ycv`'�aa January 31,2025 "y 4y Kara Barrow,Secretary Please direct bond verifications to siirLiy no incactinsurancewm IMPORTANT NOTICE AVISO IMPORTANTE To obtain information or make a complaint: Para obtener informacion o para someter una queja: You may contact your agent. Puede communicarse con su agente. You may call your Insurance Carrier's toll-free Usted puede Ilamar al numero de telefono gratis de su telephone number for information or to make compania de seguros para informacion o para someter a complaint at: una queja al: 1-800-321-2721 1-800-321-2721 You may also write to your Insurance Carrier Usted tambien puede escribir a su compania at de seguros en: Atlantic Specialty Insurance Company Atlantic Specialty Insurance Company Paralegal Paralegal 605 Highway 169 North, Suite 800 605 Highway 169 North, Suite 800 Plymouth, MN 55441 Plymouth, MN 55441 Email: surety@intactinsurance.com Email: surety@intactinsurance.com Phone:1-800-662-0156 Phone:1-800-062-0156 You may contact the Texas Department of Puede comunicarse con el Departamento de Seguros de Insurance to obtain information on Texas para obtener informacion acerca de companias, companies,coverages, rights or complaints coberturas, derechos o quejas al: at 1-800-252-3439 1-800-252-3439 You may write the Texas Department of Puede escribir al Departamento de Seguros de Insurance: Texas: P.O. Box 149104, Austin, TX 78714-9104 P.O. Box 149104, Austin, TX 78714 Fax:(512)490-1007 Fax:(512)490-1007 Web:www.tdi.texas.gov Web:www.tdi.texas.gov E-mail: ConsurnerProtection(a)tdi.texas.gov E-mail: ConsumerProtection tdi.texas. ov PREMIUM OR CLAIM DISPUTES: Should DISPUTAS SOBRE PRIMAS o RECLAMOS: Si tiene you have a dispute concerning your premium una disputa concerniente a su prima o a un reclamo, debe or about a claim you should contact the agent comunicarse con el agente primero. Si no se resuelve la first. If the dispute is not resolved, you may disputa, puede entonces comunicarse con el contact the Texas Department of Insurance. departamento(TDI). ATTACH THIS NOTICE TO YOUR POLICY: UNA ESTE"ISO A SU POLIZA: Este aviso es solo This notice is for information only and does opara proposito de informacion y no se convierte en parte not become a part or condition of the attached condicion del documento adjunto. document. VCM PHN TX 001 1013 AFFIDAVIT STATE OF TEXAS COUNTY OF TARRANT Before me, the undersigned authority, a notary public in the state and county aforesaid, on this day personally appeared Jeffrey Maddox, Owner Of Pennington Utility Construction, LLC.,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; CPN 103492 2627 Tillar Street Express CFA Pavin & Street Lights BY __ Jeffrey Maddox Subscribed and sworn before me on this date 27 of June,2022. J-WkQ� '6 �=� otary Public Tarrant County,Texas � LAUREN THOMPSON ` YP4 Notary Public,State of Texas Comm.Expires 0&22-2026 Notary ID 131616269 1111111 w >< Document G707TM - 1994 Consent Of Surety to Final Payment Bond#TXC615064 PROJECT:+Name and a(lrlresv) ARCHITECT'S PROJECT NUMBER: OWNER: Green Sheet CPN 103492 2627 Tillar Street Express CFA Paving&Street Lights CONTRACT FOR: Paving&Street Lights ARCHITECT'❑ TO OWNER:(Name and address) CONTRACT DATED: March 9,2021 CONTRACTOR❑ CG Northern Development & SURETY:❑ City of Fort Worth-Texas St 200 Texas Street OTHER;❑ Fart Worth.TX 76102 In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above.the (lnver'i mum.and address Pf Srrret.%) Merchants Bonding Company(Mutual) P.O.Box 14498 Des Moines, IA 50306-3498 SURETY• on bond of (Lrverr name and address of Cuntrncrnry Pennington Utility Construction,LLC 13108 Euless Street Euless,TX 76040 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 (lrtverf mart++'and rtrddres.v of nu'nerl C.ty of Fort Worth-Texas St 200 Texas Street Fort Worth,TX 76102 OWNER. as set forth in said Surety's bond. IN WITNESS WHEREOF.the Surely has hereunto set its hand on this dale: September 28,2022 (I)Ivert in n citing Me month fnllar,ed 6v 1he nroncrrc-drtte and vear.) Merchants Bonding Company(Mutual) (.S•trrrtt') ����A � lSigrtarrn• ufuutluu•i;crlrcprescn t'c•) Attest: mow`-� Crystal Langhorn,Attorney-in-Fact (Seal): rPrirried nacre turd lade) Elena Sells,Witness AIA Document G7071"-1994.Copyright®1982 and 1994 by The American Inslule of Architects. All rights reserved. WARNING:This AIA'Document Is protected by U.S Copyright Low and International Trestles-Unauthorized reproduction or distribution of this AIA°Document,or any portion of It, .� 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 soitware at 14:27:17 on 0411412008 under Order No,1000352359 1 which expires on 411412009.and is not for resale. User Notes: (576737038) MERCHANTS BONDING COMPANY,- POWER OF ATTORNEY Know All Persons By These Presents,that MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC.. both being corporations of the State of Iowa(herein collectively called the"Companies')do hereby make,constitute and appoint,individually, Crystal Langhorn;Elena Se Is;Kathy Sells Lanny Land;Steven W Lewis their true and lawful Attorney(s)-in-Fact, to sign its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings. contracts and other written instruments 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. This Power-of-Attorney is granted and is signed and sealed by facsimile under and by authority of the following By-Laws adopted by the Board of Directors of Merchants Bonding Company(Mutual)on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors of Merchants National Bonding,Inc-on October 16.2015. "The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Attorneys-in-Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto. bonds and undertakings,recognizances,contracts of indemnity and other writings obligatory in the nature thereof." "The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company,and such signature and seal when so used shall have the same force and effect as though manually fixed." In connection with obligations in favor of the Florida Department of Transportation only,it is agreed that the power and aut hority hereby given to the Attorney-in-Fact includes any and all consents for the release of retained percentages andtor final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department Of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond. In connection with obligations in favor of the Kenlucky Department of Highways only,it is agreed that the power and authority hereby given to the Attorney-in-Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner- Department of Highways of the Commonwealth of Kentucky at least thirty(30)days prior to the modification or revocation. In Witness Whereof,the Companies have caused this instrument to be signed and sealed this 13th day of June 2022 BONDING y:p(�pQRq•,Q ' •0o,.�p1P0g9.9y MERCHANTS NATIONAL NY ONDAING`NCTUAL) .s 2003 1933 c: By �.�dai•. •. 6% cv. STATE OF lOWA •••'•k, {7 �,�?�•• •••k + 11a• president COUNTY OF DALLAS ss. """"` On this 13th day Of June 2022 before me appeared Larry Taylor, to me personally known who being by me duly sworn did say that he is President of MERCHANTS BONDING COMPANY ;MUTUAL)and MERCHANTS NATIONAL BONDING. INC.: and that the seals affixed to the foregoing instrument are the Corporate Seals of the Companies;and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. �PRtgt s POLLY MASON o y Commission Number 750576 Z My Commission Expires Po_ Notary ,a,�,P January 07,2023 PubLc (Expiration of notary's commission does not invalidate this instrument) I,William Warner,Jr.,Secretary of MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC..do hereby certify that the above and foregoing is a true and correct copy of the POWER-OF-ATTORNEY executed by said Companies.which is still in full force and effect and has not been amended or revoked. In Witness Whereof,I have hereunto set my hand and affixed the seal of the Companies on this 28TH day of September 2022 2003 1933 Secretary ••J..