HomeMy WebLinkAboutContract 56782-FP1-FP1
FORT WORTH.
City Secretary
Contract No. 56782
Date Received 04/20/2023
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: Meacham Commerce Center
City Project No 103202
Improvement Type(s): Water x❑ Sewer x❑
Original Contract Price:
Amount of Approved Change Order(s):
Revised Contract Amount:
Total Cost of Work Complete:
stin Murchison (Apr 18. 2023 09:1T CDT)
Contractor
Rumsey Construction
Title
Project Manager
Company Name
Project Inspector
k�utG 9af�ri P. E.
Khal.laafari P.FIn, 70. 707313'34 CDTI
Project Manager
F 14d .
Rebecca Diane Owen fADr 20, 2023 15:43 CDT)
CFA Manager
X
Lauren Prieur (ADr 20. 2023 15:46 CDT)
TPW Director
William Johnson lAn 21. 202301:43 CDTI
Asst. City Manager
Apr 18, 2023
Date
Apr 18, 2023
Date
Apr 20, 2023
Date
Apr 20, 2023
Date
Apr 20, 2023
Date
Apr 21, 2023
Date
$167,944.50
$85,312.31
$253,256.81
AT
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Page 1 of 2
Notice of Project Completion
Project Name: Meacham Commerce Center
City Project No.: 103202
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 90 WD Days Charged 229
Work Start Date 01/10/2022 Work Complete Date: 1/31/2023
Soil Lab Number of Tests 25
Water Number of Tests 5
Page 2of2
FORT WTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name MEACHAM COMMERCE CENTER
Contract Limits
Project Type WATER & SEWER IMPROVEMENTS
City Project Numbers 103202
DOE Number 3202
Estimate Number 1 Payment Number I
City Secretary Contract Number
Contract Date 12/7/2021
For Period Ending 1/30/2023
WD
Project Manager NA
Contractor RUMSEY CONSTRUCTION, LLC
6617 VILLAGE SPRINGS DRIVE
PLANO, TX 75024
Inspectors W.MILLER / T.VAUGHN
Contract Time 9WD
Days Charged to Date 229
Contract is 100.00 Complete
Wednesday, February 1, 2023 Page 1 of 4
City Project Numbers 103202
Contract Name MEACHAM COMMERCE CENTER
Contract Limits
Project Type WATER & SEWER IMPROVEMENTS
Project Funding
UNIT I: WATER IMPROVEMENTS
DOE Number 3202
Estimate Number 1
Payment Number 1
For Period Ending 1/30/2023
Item
Description of Items
Estimated Unit
Unit Cost
Estimated
Completed
Completed
No.
Quanity
Total
Quanity
Total
1
Trench Safety
303 LF
$1.00
$303.00
303
$303.00
2
2" Private Water Service
134 LF
$58.00
$7,772.00
134
$7,772.00
3
8" PVC Water Pipe
97 LF
$49.00
$4,753.00
97
$4,753.00
4
12" PVC Water Pip (COI)
152 LF
$92.00
$13,984.00
152
$13,984.00
5
Connection to Existing 4"-12" Water Main
2 EA
$1,000.00
$2,000.00
2
$2,000.00
6
8" Gate Valve (CO 1)
3 EA
$1,400.00
$4,200.00
3
$4,200.00
7
10" Gate Valve
1 EA
$1,800.00
$1,800.00
1
$1,800.00
8
12" Gate Valve (CO 1)
3 EA
$2,300.00
$6,900.00
3
$6,900.00
9
Ductile Iron Water Fittings w/ Restraint (CO 1)
3 TN
$1,400.00
$4,200.00
3
$4,200.00
10
Automatic Flusher
1 EA
$4,200.00
$4,200.00
1
$4,200.00
11
Tree Removal (COI)
1 EA
$8,525.00
$8,525.00
1
$8,525.00
12
Pavement Removal & Replace(CO1)
1333 SF
$32.00
$42,656.00
1333
$42,656.00
Sub -Total of
Previous Unit
$101,293.00
$101,293.00
UNIT Il: SEWER IMPROVEMENTS
Item
Description of Items
Estimated Unit
No.
Quanity
1
Trench Safety
1414.5 LF
2
Post -CCTV Inspection
1414.5 LF
3
Manhole Vacuum Testing
5 EA
4
6" Sewer Carrier Pipe
45.5 LF
5
8" Sewer Carrier Pipe
1369 LF
6
Epoxy Manhole Liner
66 VF
7
4' Manhole
5 EA
8
Connect to Existing Manhole
1 EA
9
MH Adj Major (COI)
1 EA
10
Sand Blast Recoat MH (COI)
7 LF
11
hnport Embedment Backfill CSS (COI)
6 CY
Sub -Total
of Previous Unit
Unit Cost
Estimated
Completed
Completed
Total
Quanity
Total
$1.00
$1,414.50
1414.5
$1,414.50
$2.00
$2,829.00
1414.5
$2,829.00
$100.00
$500.00
5
$500.00
$30.00
$1,365.00
45.5
$1,365.00
$36.00
$49,284.00
1369
$49,284.00
$450.00
$29,700.00
66
$29,700.00
$9,000.00
$45,000.00
5
$45,000.00
$1,600.00
$1,600.00
1
$1,600.00
$13,521.31
$13,521.31
1
$13,521.31
$750.00
$5,250.00
7
$5,250.00
$250.00
$1,500.00
6
$1,500.00
$151,963.81
$151,963.81
Wednesday, February 1, 2023 Page 2 of 4
City Project Numbers 103202
Contract Name MEACHAM COMMERCE CENTER
Contract Limits
Project Type WATER & SEWER IMPROVEMENTS
Project Funding
Contract Information Summary
Original Contract Amount
Change Orders
Change Order Number 1
Change Order Number 1
Total Contract Price
DOE Number 3202
Estimate Number 1
Payment Number 1
For Period Ending 1/30/2023
$167,944.50
$65,041.00
$20,271.31
$253,256.81
Total Cost of Work Completed $253,256.81
Less % Retained $0.00
Net Earned $253,256.81
Earned This Period $253,256.81
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
$253,256.81
Wednesday, February 1, 2023 Page 3 of 4
City Project Numbers 103202
Contract Name MEACHAM COMMERCE CENTER
Contract Limits
Project Type WATER & SEWER IMPROVEMENTS
Project Funding
Project Manager NA
Inspectors W.MIL.LER / T.VAUGHN
Contractor RUMSEY CONSTRUCTION, LLC
6617 VILLAGE SPRINGS DRIVE
PLANO, TX 75024
DOE Number 3202
Estimate Number 1
Payment Number 1
For Period Ending 1/30/2023
City Secretary Contract Number
Contract Date
12/7/2021
Contract Time
90 WD
Days Charged to Date
229 WD
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 $253,256.81
Less % Retained
$0.00
Net Earned
$253,256.81
Earned This Period $253,256.81
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
$253,256.81
Wednesday, February 1, 2023 Page 4 of 4
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FORTWORTH
TRANSPORTATION AND PUBLIC WORKS
PIPE REPORT FOR:
PROJECT NAME: Meacham Commerce Center
CITY PROJECT NUMBER: 103202
WATER
PIPE LAID SIZE TYPE OF PIPE LF
12" PVC 152
8" PVC 97
FIRE HYDRANTS: VALVES (16" OR LARGER)
PIPE ABANDONED SIZE TYPE OF PIPE LF
DENSITIES:
NEW SERVICES:
SEWER
PIPE LAID SIZE TYPE OF PIPE LF
8" SDR26 45.5
6" SDR26 1369
PIPE ABANDONED SIZE TYPE OF PIPE LF
DENSITIES:
NEW SERVICES:
TRANSPORTATION AND PUBLIC WORKS
The City of Fort Worth • 1000 Throckmorton Street • Fort Worth, TX 76012-6311
(817) 392 - 7941 • Fax: (817) 392 - 7845
FORTWORTH.
''no,
TRANSPORTATION AND PUBLIC WORKS
January 31, 2023
Rumsey Construction
4329 Reeder Dr.
Carrolton, TX, 75010
RE: Acceptance Letter
Project Name: Meacham Commerce Center
Project Type: 01, 02
City Project No.: 103202
To Whom It May Concern:
On January 27, 2023 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 January 31, 2023. 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 January 31, 2023, 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-
392-7872.
Sincerely,
KhaI Jaafari P.E. (Apr 20, 202313:34 CDT)
Khal Jaafari, Project Manager
Cc: Tamara Vaughn, Inspector
Wade Miller, Inspection Supervisor
Ariel Duarte, Senior Inspector
Victor Tornero, Program Manager
Halff Associates Inc., Consultant
Rumsey Construction, Contractor
Abra Realty Inc, Developer
File
E-Mail: TPW_Acceptance@fortworthtexas.gov
Rev. 8/20/19
AFFIDAVIT OF BILLS PAID
STATE OF TEXAS §
COUNTY OF D1-clt`TMO §
BEFORE ME, the undersigned authority, on this day personally appeared
MRtt' Cp&,A I C. Lou `'2 [title] of Q.urn5` C-D
[subcontractor/supplier], and, upon oath, after first being duly sworn, deposed and stated:
"My name is M A -rc- 1-bo5" and I am the itle]
Of fsubcontractorlsupplier], hereinafter referred to in this affidavit as
"Subcontractor The facts set forth herein are within my personal knowledge and are true and
correct, and I am competent and authorized to make this affidavit on behalf of Subcontractor.
Subcontractor has supplied labor, materials, equipment and/or services under a contract
with WcL% L D_j ("Contractor"), for work to be performed on that
certain project known as M QA ,N keA (the "Project"), located at
fR),&r ► . -ryAs"s (the "Property").
Subcontractor has paid each and all of its subcontractors, laborers, suppliers, vendors
and materialmen in full for all labor, materials, equipment and/or services provided to it for
incorporation in or use or work on the Project, and for any and all costs, expenses and damages
associated therewith, for the period endingZiZ9-►2 Per ► A"(the "Pay Period").
Subcontractor acknowledges that Contractor is relying on Subcontractor's statements and
representations herein in making payment to Subcontractor.
Subcontractor hereby waives and releases any and all rights, claims and causes of
action which Subcontractor may have against Contractor and/or the owner of the Project,
including any and all costs, expenses and damages incurred by Subcontractor, arising out of or
related to all labor, materials, equipment and/or services furnished for incorporation in or use or
work on the Project through the Pay Period.
The undersigned affiant agrees to indemnify Contractor of and from any and all loss,
cost or expense resulting from any false or incorrect information contained in this affidavit.
QVCV,Se" VC,+--S-KQ eRai . 10C-
By:
[Signature of Affiant]
Printed Name: #,,K- P3o c,�%
Title: C-t to ,terL
SUBSCRIBED AND SWORN TO before me on this It day of 2023, by
M A-ty $osc-N [title] off e x% o- -3
[subcontractor/supplier], known to me or proved through photot7!�
ron.
Notary Public in and for the Stat of Texas
My commission expires: L I L -14
{ 1pl'!* SARAH PEREZ
rz n�Notary Public. State of Texas
r4: Comm. Expires 11-21-2024
Notary ID 126730867
NOTICE: This document waives rights unconditionally and states that you have been paid for giving up those
rights. It is prohibited for a person to require you to sign this document if you have not been paid the
payment amount set forth below. If you have not been paid, use a conditional release form.
UNCONDITIONAL WAIVER AND RELEASE ON FINAL PAYMENT
Project M' � i�t.....................Contractor/Subcontractor: twrY "e �T-Jr-
Job No. * * "It IaA.
The undersigned M arv- S(.LX being first duly sworn, on oath deposes and states: (S)He has authority to
execute a waiver of lien for and on behalf of the Contractor/Subcontractor signing this document, which contracted with
(person with whom Contractor/Subcontractor contracted) for providing labor, materials
and/or services to the above listed Project, and the following information is true and accurate.
The signer of this document (Contractor/Subcontractor) has been paid in full for all labor, services, equipment, or materials
furnished to the property or to AfF-1• • t-,D ----1 • ••• ..... •'•••""•'•"'{Berson with whom signer contracted) on the property
of "% tA+4 rA-$Ar- I , L%�L (owner) located at 43t.%ver'- 126-y j, •(location) to the following
extent:212q - 12 fir' (trade/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 final 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.
Date 0L41
Y1n5Eu .-�SsQu (.'no4z (Contractor/Subcontractor name)
Bye_Z (Signature)
C�--!,T L ULCYZ- (Title)
This instrument was executed and acknowledged before me on this 1 day of 'A-rfity L
20 by 6141-r-r✓ O 4E known to me as the person whose name is subscribed above, as
(title) of CAD*-' 19•72u lea- 1 rJC
(company), on beh f of and as th uthorize t of said entity.
Notary Public Aand f�r the State of Texas
My Commission Expires: tl ll7. 1 rZ-
SARAH PEREZ
Jotary Public, State of Texas
Comm. Expires 11-21-2024
Notary ID 126730867
SUBCONTRACTOR/SUPPLIER'S SUB-SUBCONTRACTOR/SUMUPPLIICR LISTING
,�y BEFORE ME, the undersigned authority, on this day personally appeared NAtr- � C, CM C,0 •-�^2 � ��,� [title] of
Ln!w �c'11 � W-v law•- [Subcontractor], and, upon oath, after first being duly sworn, deposed and stated:
"My name is M tk-w a o s (AA _ and I am the Cam.+-r ate V16Y— [title] of 21J fMM CA-S WI-'1 Vn a .- J
[Subcontractor], referred to in this affidavit as "Subcontractor." The facts set forth herein are within my personal knowledge and are true
and correct, and I am competent and authorized to make this affidavit on behalf of Subcontractor. I hereby warrant and represent that the
below is a true and complete listing of any and all subcontractors and/or suppliers whom Subcontractor has or will have utilized to
perform work on the improvements and real property as listed below. I warrant and represent that all listed below have been paid in
full for services/materials provided, or will be paid in full upon receipt of the period progress payment from Contractor, through the
period for which payment has been received. I acknowledge that Contractor may issue joint checks, at its sole discretion, to any/all
suppliers/sub-subcontractors listed below. Subcontractor acknowledges that Contractor is relying on Subcontractor's statements and
representations herein in making payment to Subcontractor. The undersigned affiiant agrees to indemnify Contractor of and from any
and all loss, cost or expense resulting from any false or incorrect information contained in this affidavit.
PROJECT NAME: MgAC%4� NUMBER: 'L1'Lc{
PROJECT ADDRESS: &ACAC V sk*w V-Svyo i Z- 36 W CITY/ST/ZIP t r. V-Qd til, 'CAL `1U I
Signature Printed Name
i - 0 rtun.1 I��NSn�l�n7 c� o .� 1?w!G _ 1i 1 I 1 1 Zo L3
Company I Date
Subscribed and sworn before me this 1 day of Aifa2-I L 20
Not Public, State of Texas
I I
�•`�eRYp��`� SARAHPEREZ CammissionExpires
,00 Notary Public, State of Texas
COmm Expires 11-21-2024
Notary Ili 126730867
Remittance Advice
Page 1 of 1
Check: 118673 Paid by:
Arch -Corr
Corporation
Our Account#:
Date: 04/06/23 Paid to:
Rumsey Construction LLC
Vendor Code:
4428
Amount: 236,721.81
Inv. Date Invoice No.
Job Number
Job Description
Inv. Amount Discount Amount Paid
Retention
11/30/21 2114001-1
2114001
Meacham Commerce Center
73,746.72
0,00
7,374.67
7,374.67
12/31/21 2114001-2
2114001
Meacham Commerce Center
575,521.02
0.00
57,552.10
57,552.10
02/28/22 2114001-3
2114001
Meacham Commerce Center
71,992.81
0.00
7,199.28
7,199.28
04/30/22 2114001-4
2114001
Meacham Commerce Center
195,762.85
0.00
19,576.29
19,576.29
05/31/22 2114001-5
2114001
Meacham Commerce Center
12,15720
0.00
1,215.72
1,215.72
06/30/22 2114001-6
2114001
Meacham Commerce Center
198,442.35
0.00
19,844.24
19,844.24
07/31/22 2114001-7
2114001
Meacham Commerce Center
286,222.20
0.00
28,622.22
28,622.22
08/31/22 2114001-8
2114001
Meacham Commerce Center
64,784.75
0.00
6,478.48
6,478.48
10/31/22 2114001-10
2114001
Meacham Commerce Center
6,426.40
0.00
642.64
642,64
03/01/23 2114001-11
2114001
Meacham Commerce Center
73,467.00
0.00
73,467.00
7,346.70
09/30/22 2114001-9A
2114001
Meacham Commerce Center
147,491.70
0.00
14,749.17
14,749.17
Check Totals 1,706,015.00 0.00 236,721.81 170,601.51
04/06/23
"Void -- Void -- Void -- Void -- Void -- Void -- Void -- Void —Void -- Void --Void -- Void -- Void ""` 118673
Pay **TWO HUNDRED THIRTY-SIX THOUSAND SEVEN HUNDRED TWENTY-ONE AND 81 1 100 DBE*VOID"*
"236,721.81
To the Rumsey Construction LLC **VOID**VOID**
order of 4329 Reeder Dr.
Carrollton, TX 75010
**VOID** File Copy **
Bond Number54-240166
CONSENT OF
SURETY COMPANY
TO FINAL PAYMENT
PROJECT:
(name, addrvs LLreacham Commerce Center, City of Fort Worth, TX
TO (Owner)
Abra Realty, Inc.
CONTRACTOR:
Rumsey Construction, Inc.
CONTRACT FOR: Construction
$253,256.81
CONTRACT DATE:
December 7, 2021
In accordance with the provisions of the Contract between the Owner and the Contractor as
indicated above, the (here invert rirmC and address or surety Co.)
United Fire & Casualty Company
P. O. BOX 73909
Cedar Rapids, IA 52407
, SURETY C0INIPANY,
on bond of(here insert rutme and address of C:ontrimtor)
Rumsey Construction, Inc.
4329 Reeder Drive
Carrollton, TX 75010
.CONTRACTOR
hereby approves of the final payment to tha Contractor and agrees that final payment to the
Contractor shall not relieve the Surety Company of any of its obligations to (here insert name and
nddress oro%vner)
Abra Realty, Inc.
1303 Campbell Road
Houston, TX 77055
as act forth In the said Surety Company's Bonet.
.. O%VNRR.
IA' WITNESS WHEREOF, United Fire & Casualty Company
tho Surotv Companv bass horaunto sot its hand thiai0th day ni February 2023
United Fire Casualty Company
, Surely Campaay
Allyson W. Dean
ofAuthorined Represent ati%*
Attorney -in -Fact
• UNITED FIRE & CASUALTY COMPANY, CEDAR RAPIDS, IA Inquiries: Surety Department
UNITED FIRE: & INDEMNITY COMPANY, WEBSTER, TX 118 Second Ave SE
FINANCIAL PACIFIC INSURANCE COMPANY, LOS ANGELES, CA Cedar Rapids, IA 52401
CERTIFIED COPY OF POWER OF ATTORNEY
INSURANCE (original on file at Home Office of Company — See Certification)
KNOW ALL PERSONS BY THESE PRESENTS, That United Fire & Casualty Company, a corporation duly organized and existing under the laws
of the State of Iowa; United Fire & Indemnity Company, a corporation duly organized and existing under the laws of the State of Texas; and Financial
Pacific Insurance Company, a corporation duly organized and existing under Uie laws of the State of California (herein collectively called the
Companies), and having their corporate headquarters in Cedar Rapids, State of Iowa, does make, constitute and appoint
JOHN WILLIAM NEWSY, TROY RUSSELL KEY, DEBRA LEE MOON, SANDRA LEE RONEY, ANDREA ROSE CRAWFORD, MARLA
HILL, HOWARD COWAN, COLIN E. CONLY, JOHN R. WARD, THOMAS DOUGLAS MOORE, ALLYSON W. DEAN, MONICA RUBY
VEAZEY, EMILY ALLISON MIKESKA, ANDREW GARETH ADDISON, PATRICK THOMAS COYLE, MICHAEL DONALD
HENDRICKSON, BRYAN KELLY MOORE, ELIZABETH ORTIZ ANA OWENS, BETTY J. REEH, EACH INDIVIDUALLY
their true and lawful Attomey(s)-in-Fact with power and authority hereby conferred to sign, seal and execute in its behalf all lawful bonds,
undertakings and other obligatory instruments of similar nature provided that no single obligation shall exceed $20, 000.000.00
and to bind the Companies thereby as fully and to the same extent as if such instruments were signed by die duly authorized officers of die Companies
and all of the acts of said Attorney, pursuant to the authority hereby given aid hereby ratified and confirmed.
The Authority hereby granted is continuous and shall remain in full force and effect until revoked by United Fire & Casualty Company, United Fire &
Indemnity Company, and Financial Pacific Insurance Company.
Ibis Power of Attorney is made and executed pursuant to and by authority of the following bylaw duly adopted by the Boards of Directors of United
Fire & Casualty Company, United Fire & Indemnity Company, mud Financial Pacific Insurance Company.
"Article VI — Surety Bonds and Undertakings"
Section2,AppointmenlofAttomey-in-fact."IN e Preiiiient or any Vice President, or any other officer of the Companies may, from time to time, appoint by written certificates
attorneys -in -fact to act in behalf of the Companies in the execution of policies of insurance, bonds, undertakings and other obligatory instruments of like nature. The signature
of any officer authorved hereby, and the Corporate seal, maybe affixed by facsimile to any power of attorney or special power of attorney or certification of either authorized
hereby; such signature and seal, when so used, being adopted by the Companies as the original signature of such officer and the original seal of the Companies, to be valid
and binding upon the Companies with the same force and effect as though manually affixed. Such attomeys-in-fact, subject to the limitations set of forth in their respective
certificates of authority shall have full power to bind the Companies by their signature and execution of any such instruments and to attach the seal the Companies thereto.
The President or any Vice President, the Board of Directors or any other officer of the Companies may at any time revoke all power and authority previously given to any
anomey-in-fact.
iN WITNESS WHEREOF, the COMPANIES have each caused these presents to be signed by its
p\\prtGi my//
vice coresident and its corporate seal to be hereto affixed this 3rd day of December, 2019
F,G iNSuq „mxnium u.
umnemq% UNITED FIRE & CASUALTY COMPANY
`���s• �/�'' J�•\xuW rJp, ,d4
'$ CtXIYO All ��`
r eo■.o et, z- 3 t007Z �;g=. UNITED FIRE &INDEMNITY COMPANY
.a sLAL FINANCIAL PACIFIC INSURANCE COMPANY
SEALC�(IF ��r.taLt
rrl itnN"�\ rylll if•H1\�` rmnniNu,\x,`•••`` By:
State of Iowa, County of Linn, ss: Vice President
On 3rd day of December, 2019, before me personally came Dennis J. Richmann
to me known, who being by me duly sworn, did depose and say; that he resides in Cedar Rapids, State of Iowa; that he is a Vice President of United Fire
& Casually Company, a Vice President of United Fire & indemnity Company, and a Vice President of Financial Pacific insurance Company the
corporations described in and which executed the above instrument; that he knows the seal of said corporations; that the seal affixed to die said instrument
is such corporate seal; that it was so affixed pursuant to authority given by the Board of Directors of said corporations and that he signed his name thereto
pursuant to like authority, and acknowledges same to be die act and deed of said corporations.
vµLt� Judith A. Jones
i lawa Notarial Seal
Commfaslon number 173041 Notary Public
My Commission Expires 4232024 My commission expires: 412312024
I, Mary A. Bertsch, Assistant Secretary of United Fire & Casualty Company and Assistant Secretary of United Fire & Indemnity Company, and Assistant
Secretary of Financial Pacific Insurance Company, do hereby certify that I have compared the foregoing copy of the Power of Attorney and affidavit, and
the copy of die Section of the bylaws and resolutions of said Corporations as set forth in said Power of Attorney, with the ORIGINALS ON FILE iN THE
HOME OFFICE OF SAiD CORPORATIONS, and that the same are correct transcripts thereof, and of the whole of the said originals, and that the said
Power of Attorney Itas not been revoked and is now in full force mid effect
!n testimony whereof I have hereunto subscribed my name and affixed the corporate seal of the said Corporations
this _ 10th day of February , 20 23
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CUMhIN.�,.c �aLY?! :.Q=
�rAL a-,0 79e6 �Assistant Secretary,
''�%r,,,,"x"bi\it�\`=� �-\'%inimin�o`�\� ,�'�r„r aa•'�r OF&C & OF&i & FPiC
BPOA004912�7-' -
UnaSURETY
IMPORTANT NOTICE
TO OBTAIN INFORMATION OR MAKE A COMPLAINT:
United Fire & Casualty Company
United Fire & Indemnity Company
Financial Pacific Insurance Company
You may call United Fire Group's toll free telephone number for information or to make a complaint at:
800-343-9130
You may also write to United Fire Group at:
United Fire Group
Attn: Surety Department
P.O. Box 73909
Cedar Rapids, IA 52407-3909
-or street address -
United Fire Group
Attn: Surety Department
1 l 8 Second Avenue SE
Cedar Rapids, IA 52401
You may contact the Texas Department of Insurance to obtain information on companies, coverages,
rights or complaints at:
800-252-3439
You may write the Texas Department of Insurance at:
Consumer Protection (l 11-1A)
P.O. Box 149091
Austin, TX 78714-99091
Fax: (512) 490-1007 Web: www.tdi.texas.gov
Email: ConsumerProtection(u,tdi.texas.jzoy
Premium or Claire Disputes:
Should you have a dispute concerning your premium or about a claim, you should contact United Fire
Group 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 a condition of the attached document and is given to comply with Section 2253.021,
Governmental Code, and Section 53-202, Property Code.
HOME OFFICE: 118 Second Avenue SE I PO Box 73909 I Cedar Rapids, Iowa 52407-3909 1 P: 800-332-7977 I F: 319-286-2520 I www.ufgins.com