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HomeMy WebLinkAboutContract 58515-FP1City Secretary -FP1 Contract No. 58515 FORT WORTH. Date Received 10/18/2023 AT 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: Basswood Landing City Project No.: 103976 Improvement Type(s): x❑ Paving ❑ Drainage ❑ Street Lights ❑ Traffic Signals Original Contract Price: $828,326.85 Amount of Approved Change Order(s): -$58,152.45 Revised Contract Amount: $770,174.40 Total Cost of Work Complete: $770,174.40 C4�-C-av%�- Oct 17 2023 Carmen Estep (Oct lJ, 202�16:41 CDT) Contractor Date Office Manager Title Jackson Construction Company Name Oct 1 1 , 2023 Carlosos Garc�'—,202317:11CDT) Project Inspector Date Cu,,.JQ' , P. �. Oct 18, 2023 Project Manager Date 41A Oct 187 2023 Rebecca Olane Owen fOct 18.202315:15 CDT) CFA Manager Date 9 Oct 18, 2023 Lauren Prieur (Oct 18, 202315:23 CDT) TPW Director Date Oct 18 2023 William Inh.— (OA I 2n2i 1529 CDT) Asst. City Manager Date OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Page 1 of 2 Notice of Project Completion Project Name: Basswood Landing City Project No.: 103976 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 270 WD Work Start Date: 2/16/2023 Completed number of Soil Lab Test: 306 Completed number of Water Test: 13 Days Charged: 150 Work Complete Date: 9/22/2023 Page 2of2 FoRTWORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name BASSWOOD LANDING Contract Limits Project Type PAVING IMPROVEMENTS City Project Numbers 103976 DOE Number 3976 Estimate Number 1 Payment Number 1 For Period Ending 9/22/2023 WD City Secretary Contract Number Contract Time 9WD Contract Date Days Charged to Date 150 Project Manager NA Contract is 100.00 Complete Contractor JACKSON CONSTRUCTION LTD 5112 SUN VALLEY DRIVE FORT WORTH, TX 76119 Inspectors G. DEYON / C. GARCIA Tuesday, October 17, 2023 Page 1 of 4 City Project Numbers 103976 DOE Number 3976 Contract Name BASSWOOD LANDING Estimate Number I Contract Limits Payment Number 1 Project Type PAVING IMPROVEMENTS For Period Ending 9/22/2023 Project Funding UNIT IV: PAVING IMPROVEMENTS Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total 38 REMOVE SIDEWALK (CO #4) 2377 SF $5.00 $11,885.00 2377 $11,885.00 39 REMOVE CONC CURB & GUTTER 79 LF $30.00 $2,370.00 79 $2,370.00 40 CONC PVMT REPAIR, RESIDENTIAL 125 SY $187.00 $23,375.00 125 $23,375.00 41 HYDRATED LIME (36#/SY) 140 TN $230.00 $32,200.00 140 $32,200.00 42 6" LIME TREATMENT 7757 SY $6.00 $46,542.00 7757 $46,542.00 43 4" CONC SIDEWALK (CO #1 & #4) 363 SF $8.05 $2,922.15 363 $2,922.15 44 6" CONC PVM 205 SY $70.50 $507,952.50 7205 $507,952.50 45 BARRIER FREE RAMP, TYPE R-1 10 EA $1,500.00 $15,000.00 10 $15,000.00 46 FURNISH/INSTALL ALUM SIGN GROUND 6 EA $575.00 $3,450.00 6 $3,450.00 MOUNT CITY STD 47 TOPSOIL 311 CY $50.00 $15,550.00 311 $15,550.00 48 HYDROMULCH (CO #4) 2317 SY $1.00 $2,317.00 2317 $2,317.00 49 TRAFFIC CONTROL (CO #4) 1 MO $1,800.00 $1,800.00 1 $1,800.00 50 CONNECT TO EX PAVING 108 LF $24.00 $2,592.00 108 $2,592.00 51 TRAFFIC CONTROL (BASSWOOD BLVD) (CO 1 MO $38,500.00 $38,500.00 1 $38,500.00 #4) 52 BARRIER FREE RAMP, TYPE R-I (CO #4) 2 EA $5,800.00 $11,600.00 2 $11,600.00 53 CONC PVMT REPAIR, RESIDENTIAL (CO #4) 269 SY $193.75 $52,118.75 269 $52,118.75 Sub -Total of Previous Unit $770,174.40 $770,174.40 Tuesday, October 17, 2023 Page 2 of 4 City Project Numbers 103976 Contract Name BASSWOOD LANDING Contract Limits Project Type PAVING IMPROVEMENTS Project Funding Contract Information Summary Original Contract Amount Chanhe Orders Change Order Number 1 Change Order Number 4 Total Contract Price DOE Number 3976 Estimate Number 1 Payment Number 1 For Period Ending 9/22/2023 $828,326.85 ($147,250.60) $89,098.15 $770,174.40 Total Cost of Work Completed $770,174.40 Less % Retained $0.00 Net Earned $770,174.40 Earned This Period $770,174.40 Retainage This Period $0.00 Less Liquidated Damages Days @ / Day LessPavement Deficiency Less Penalty Less Previous Payment Plus Material on Hand Less 15% Balance Due This Payment $0.00 $0.00 $0.00 $0.00 $0.00 $770,174.40 Tuesday, October 17, 2023 Page 3 of 4 City Project Numbers 103976 Contract Name BASSWOOD LANDING Contract Limits Project Type PAVING IMPROVEMENTS Project Funding Project Manager NA Inspectors G. DEYON / C. GARCIA Contractor JACKSON CONSTRUCTION LTD 5112 SUN VALLEY DRIVE FORT WORTH, TX 76119 DOE Number 3976 Estimate Number 1 Payment Number 1 For Period Ending 9/22/2023 City Secretary Contract Number Contract Date Contract Time 90 WD Days Charged to Date 150 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 $770,174.40 Less % Retained $0.00 Net Earned $770,174.40 Earned This Period $770,174.40 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 $770,174.40 Tuesday, October 17, 2023 Page 4 of 4 REVIEWED 1 l By Andrew Goodman of 3:07pm, Mar 30, 2023 J DEVELOPER -AWARDED -PROJECT CHANGE ORDER PROJECT NAME: Basswood Landing CHANGE CONTRACT: 58515 ORDER No: CFA # 22-0108 CITY PARTICIPATION: No CITY PROJECT # 103976 DOE # 1 WATER PROJECT # X-27266 SEWER PROJECT # I FILE # IW-2822 INSPECTOR: Carlos Garcia Phone No: 817-925-43841 PROJECT MANAGER: Andrew Goodman Phone No: 817-392-6251 CONTRACT UNIT WATER SEWER PAVING DRAINAGE STREET LIGHTS Developer Developer Developer Developer Developer Cost City Cost Cost City Cost Cost City Cost Cost City Cost Cost City Cost IORIGINAL CONTRACT $432,078.55 $707,633.40 $828,326.85 $447,492.20 $54,412.96 (EXTRAS TO DATE ICREDITS TO DATE I CONTRACT TO DATE $432,078.55 $0.00 $707,633.40 $0.00 $828,326.85 $0.00 I $447,492.20 I $0.00 I $54,412.96 $0.00 (AMOUNT OF PROP. CHANGE ORDER ($147,250.60) IREVISED CONTRACT AMOUNT I $432,078.55 $0.00 I $707,633.40 $0.00 I $681,076.25 $0.00 I $447,492.20 I $0.00 I $54,412.96 I $0.00 TOTAL REVISED CONTRACT AMOUNT PER UNIT $432,078.55 $707,633.40 $681,076.25 $447,492.20 $54,412.96 REVISED COST SHARE IDev. Cost: $2,322,693.36 City Cost: $0.00 TOTAL REVISED CONTRACT I $2,322,693.36 I (CONTRACT DAYS 90 90 90 Revised: 10-12-2011 Page 1 I REVIEWED ByAMrvwGoo . ].9lpm.M.,30.2W3 You are directed to make the following changes in the cmtract docum nts: PAY ITEM # CITY B9 ITEM QUANTITY UNIT � DES R,j ON UNIT PRICE TOTAL l 43 3213.0301 (18,292) SF 4" Concrete Sidewalk Ae�uce Contract) $8.05 ($147,250.60)J I I TOTAL REASONS FOR CHANGE ORDER Removal of lot sidewalks no longerbeing constructed with this contract. Sidewalks will be built as part of Builders contract. 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: Pelo��ton Land Solutions By. cs)t � Name: Amanda Mata. P.E. Title: Project Manaqer APPROVED: RSR-Basswood-Ger, LC� i By: �� J Name: Seth Carpenter Title: Vice President APPROVED: Jackson Construction. Ltd. By. Name: Troy L Jackson Title: President Revised: 10-12-2011 Page 2 REVIEWED By Aldmw Goodman of 10:07am, May 09, 202? DEVELOPER -AWARDED -PROJECT CHANGE ORDER PROJECT NAMF=,. Basswood Landinq CHANGE CONTRACT: (A) Water, Sewer and Drain a e, (B) Pavinq, (C) Street Lights ORDER No: CFA# 22-0108 CITY PARTICIPATION: NO CITY PROJECT # 103976 DOE'- 2 WATER PROJECT# X-27266 SEWER PROJECT # FILE # W-2322 INSPECTOR Carlos Garcia Phone No: 817-925-43841 PROJECT MANAGER Andrew Goodman Phone No: 817-392-6251 CONTRACT UNIT WATER SEWER I PAWING DRAINAGE STREET LIGHTS CONTRACT DevoloperCc CRYCgst DcA?IcperCost CRY Cost DevelonerCoJ CJtvCesi I DevaloporCostl CGyCost DevelocerCost CrtyCost I DAYS ORIGINAL CONTRACT S43Z07855 $707,0140 S828,326.85 I S447,492.20 I S54,4124G 90 EXTRAS TO DATE �CRED7S TO DATE I I s1a7 asn.6o I I I CONTRACT TODATE $432,078.55 SDAO I S707,G33,40 I *LQO I SG81,07G25 I M011 I S447,492.20 I ;0.00 I S54Ai2-S6 I S0.00 I 90 JAMDUNT OF PROP. CHANGE ORDER IS (35,025,00) I I I �REV�S�DCONjR��1'Ah10UNT S43207855 $0.00 S672608.40 If 50.00 I $G81,07625 I 50,00 $d47.49220 I _ so S54,41Z96 50.00 90 iO A R_�$E CTAMOUNT PER UNIT MZ07855 $672,608.40 I $681,076.Z5 $447A922U $W12.96 .^vMSED COST SHARE pov. Cosf: $2,237,668.36 (City Cost: TOTAL REVISED CONTRACT =87,668.36 Revised: 10-12-2011 Page 1 REVIEWED 1 lBy Andmw Goodman at 10:07 am, May 09, 2027 J You are directed to make the follrnving changes in the T ntract documentsCITY BID fiE PAY17EMm MQUANTITY UNIT L DESCRIPTION I UNIT PRICE I TOTAL UNITII: SANITARY SEWER [MPROVENJE, 21 3301.0001 I -2 335 LF ISre-� Inspection I $15.00 15 (35,025.00) TOTAL l is (35,025.00) REASONS FOR CHANGE ORDER Pre -CCTV inspection not needed NO CITY FUNDS INVOLVED IN THIS CONTRACT. DEVELOPER 15 RESPONSIBLE FOR 100 % OF THE CHANGE ORDER COST AND NO REIMBURSEMENT FROM THE CITY WILL BE SOUGHT BY THE DEVELOPER - RECOMMENDED: APPROVED: APPROVED: Pollott/on Land Solutions RSR-Basswood e , ;Noss Utilities, Z By: �I/- ct B BY Name: Amanda Mata. P.E. Name: Seth Carpenter Name: Garrett Moss Title: Proiect Manaqer Title: Vice President Title: President Revised: 10-12-2011 Page 2 PROJECT NAME: I CONTRACT: I CFA # CITY PROJECT # DOE # WATER PROJECT # SEWER PROJECT m FILE # INSPECTOR: PROJECT MANAGER: DEVELOPER -AWARDED -PROJECT CHANGE ORDER Basswood Landinq (A) Water, Sewer and DrainaPe, (B) Pavinq, (C) Street Lights 22-0108 CITY PARTICIPATION:) NO 103976 IX-27266 I IW-2822 Carlos Garcia Phone No: 817-925-43841 Andrew Goodman Phone No: 817-392-6251 WATER SEWS Developer Cost rr)lYir4ii IDeveloporCost ORIGINAL CONTRACT $432.078.55 I 5707,633.40 EXTRAS TO DATE CREDITS TO DATE S35,025.00 CONTRACT TO DATE $432.078.55 I S0.00 S672,608A0 AMOUNT OF PROP. CHANGE ORDER I I S (70,814.14) TOTALR9VISE9REIS DCO�NTRAC AMOUNT] S Z076.55 50.00 $601,79426 REVIEWED By Andrew Goodman at 10:14 am, May 09, 2023 CHANGE ORDER No: 3 CONTRACT UNIT R PAVING DRAINAGE STREET LIGHTS LveloperCost CAY Cggt Developer Cost Clty goal Developer Cost Clty Cost CIV;p5t S828,326.85 I S447,492.20 12.96 $147,250.60 S0.00 S681.07625 I $0.00 S447,49220 ;9,09 ' S54,412.96 I ;y9.09 $0.00 I S681,076.25 $0.00 I S447,49220 S0.00 S54,412.96 $0.00 I PER UNIT S432,078.SS $601,794.26 REVISED COST SHARE IDev. Cost: $2,216,854.22 TOTAL REVISED CONTRACT $681.07625 JI S447,49220 I SS4.412.96 ICity Cos $2,216,854.22 I CONTRACT DAYS 90 I 90 90 Revised: 10-12-2011 Page 1 REVIEWED lBy Andrew Goodman at 10:14 am, May 09, 2023 You are direcled to make the followina changes in the ntract docume is ary BI❑ITEM ` PAY ITEM i T QUANTITY UNIT 9/sewer ESCRIPTION I UNIT PRICE TOTAL Ut� II: SANITARY SEWER IMPROVEM 1 12 3331.4115 -283 LF Pipe $70.51 S (19,954.33)1 13 3305.1104 -223 LF 24' Casino Other Than Open Cut $859.50 S (191,668.50) 14 3339.1001 1 EA 4' Manhole $8,804.00 $ 8,804.00 16 3339.0001 17.6 VF Epoxy Manhole Liner $507.88 S 8,938.69 17 3339.1003 7 VF 4' Exba Depth Manhole $250.00 $ 1.750.00 18 3305.0202 20 CY Imported � bedr�en ckflt. CSS $247,00 $ 4,940.00 20 33054109 I 93 LF French $ $2.00 $ 186.00 I 22 3301.0002 I -26 LF Post -CCTV Inspection $4.00 $ (104.00) I 23 3301.0101 I 1 I EA Manhole Vacuum Testinq S150.00 S 150.00 I 38 f 3305.1103 I 104 I LF I 20" Casin Byy Other Than Open Cut I $822.00 $ 85,488.00 39 I 3331.4119 I 104 I LF j 8�IP Sewer Pipe I $130.00 S 13,520.00 40 II 9999.0008 I 153 LF I 8" SDR 26 PVC Sewer Pipe � ASTM 02241) I S112.00 S 17,136.00 l l I I I I I TOTAL $ (70,814,14)1 REASONS FOR CHANGE ORDER Revised SSA alignment NO CITY FUNDS INVOLVED IN THIS CONTRACT. DEVELOPER IS RESPONSIBLE FOR 100% OF THE CHANGE ORDER COST AND NO REIMBURSEMENT FROM THE CRY WILL BE SOUGHT BY THE DEVELOPER. RECOMMENDED. APPROVED: APPROVED: Peloton Land Solutions RSR-Basswood O r, Mass Utilities, L By. ey. By Name: Amanda Mata, P.E_ Name: Seth Carpenter Name: Garrett Mass Title: Project Manager Title: \rce President Title: Pm,:Irlant Revised: 10-12-2011 Page 2 PROJECT NAME: CONTRACT: CFA # CITY PROJECT # DOE # WATER PROJECT# SEWER PROJECT# FILE # INSPECTOR: PROJECT MANAGER: DEVELOPER -AWARDED -PROJECT CHANGE ORDER Basswood Landing (A) Water, Sewer and Drainage, (B) Paving. (C) Street Lights 22-0108 CITY PARTICIPATION 103976 X-27266 W-2322 Carlos Garcia Phone No: Andrew Goodman Phone No: WATER Developer Cost City Cost ORIGINAL CONTRACT $432,078.55 EXTRAS TO DATE CREDITS TO DATE CONTRACT TO DATE $432.078.55 $0.00 AMOUNT OF PROP. CHANGE ORDER REVISED CONTRACT AMOUNT $432,078.55 $0.00 TOTAL REVISED CONTRACT AMOUNT PER UNIT $432,078.55 REVISED COST SHARE Dev. Cost: TOTAL REVISED CONTRACT SEWER Developer Cost City Cost $707,633.40 $601,794.26 $0.00 $601,794.26 $0.00 $601,794.26 $2,305,952.37 CHANGE ORDER No: NO 4 817-925-43841 817-392-6251 REVIEWED lBy Andrew Goodman at 3:55 pm, Sep 20, 2023 CONTRACT UNIT PAVING DRAINAGE STREET LIGHTS Developer Cost City Cost Developer Cost City Cost Developer Cost City Cost $828.326.85 $447.492.20 $54,412-96 ...-,--,,.Gc,, $681,076-25 $0.00 $447,492.20 $0.00 $54,412.96 $0.00 $ 89,098.15 $770,174.40 $O.DO $447.492.20 $0.00 I $54,412.96 $0.00 $770.174.40 $447.492.20 I $54,412.96 (City Cost: $0.00 $2,305,952.37 I CONTRACT DAYS 90 90 90 Revised: 10-12-2011 Page 1 You are directed to make the following changes in the ntract documents CITY BID ITEM PAY ITEM R R QUANTITY UNIT ITEM DESCRIPTION UNIT N: PAVING IMPROVEMENTS 38 0241.0100 -757 SF emove Sidewalk 40 3201.0614 269 SY Conc Pvmt Repair, Residential 43 3213.0301 -992 SF 4" Conc Sidewalk 45 3213.0501 2 EA Barrier Free Ram pP. Type R-1 48 3292.0100 450 SY H dromulch 49 3471.0001 -1 MO TraNc Control 57 3471.0001 1 MO Traffic Control (Basswood Blvd) TOTAL REVIEWED By Andrew Goodman at 3:55 pm, Sep 20, 2023 UNIT PRICE I TOTAL $5.00 $ (3.785.00)1 $193.75 S 52.118.751 $8.05 $ (7.985.60)1 $5,800.00 S 11.600.001 $1.00 S 450,001 $1.800.00 S (1,800.00)1 REASONS FOR CHANGE ORDER Revised SS -A argnment 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: Peloton Land Solutions By. Name: Amanda Mata, P.E. Title: Project Manaqer APPROVED: RSR-Basswootl0�e L Name:/ Seth Carpenter Title: Vice President APPROVED: Jackson Construction, Ltd. Name: Troy L Jackson Title: President $38,500.00 S 38.500.001 S 89,098.151 Revised: 10-12-2011 Page 2 REVIEWED l lBy Andrew Goodman at 3:56 pm, Sep 20, 2023 J DEVELOPER -AWARDED -PROJECT CHANGE ORDER IPROJECT NAME: Basswood Landing CHANGE CONTRACT: (A) Water, Sewer and Drainage, (B) Paving, (C) Street Lights ORDER No: ICFA# 22-0108 CITY PARTICIPATION:( NO CITY PROJECT # 103976 IDOE# 5 WATER PROJECT # X-27266 SEWER PROJECT # I IFILE # IW-2822 INSPECTOR: Carlos Garcia Phone No: 817-925-43841 PROJECT MANAGER: Andrew Goodman Phone No: 817-392-6251 CONTRACT UNIT WATER SEWER PAVING DRAINAGE STREETLIGHTS Developer Cost City Cost Developer Cost City Cost Developer Cost City Cost Developer Cost City Cost Developer Cost City Cost ORIGINAL CONTRACT $432,078.55 $707,633.40 $828,326.85 $447,492.20 I $54,412.96 EXTRAS TO DATE $89,098.15 CREDITS TO DATE I $105,839.14 I $147,250.60 ICONTRACT TODATE I $432,078.55 I $0.00 $601,794.26 $0.00 I $770,174.40 $0.00 $447,492.20 $0.00 I $54,412.96 I $0.00 (AMOUNT OF PROP. CHANGE ORDER I I$ 7,872.141 I I I I IREVISED CONTRACT AMOUNT $432,078.55 I $0.00 I $609,666.40 I $0.00 I $770,174.40 I $0.00 $447,492.20 I $0.00 I $54,412.96 ( $0.00 TOTAL REVISED CONTRACT AMOUNT PER UNIT $432,078.55 $609,666.40 $770,174.40 $447,492.20 $54,412.96 REVISED COST SHARE Dev. Cost: $2,313,824.51 (City Cost: , .00 TOTAL REVISED CONTRACT $2,313,824.51 I CONTRACT DAYS I 90 90 90 Revised: 10-12-2011 Page 1 REVIEWED J lBy Andrew Goodman at 3:56 pm, Sep 20, 2023 J You are directed to make the following changes in the contract documents CITY BID ITEM PAY ITEM # # QUANTITY UNIT ITEM UNIT II: SANITARY SEWER IMPROVEMENTS DESCRIPTION UNIT PRICE TOTAL 1 16 3339.0001 15.5 VF Epoxy Manhole Liner $507.88 $ 7,872.14 J � I TOTAL $ 7,872.14 REASONS FOR CHANGE ORDER Added epoxy liner to manholes. 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: Peloton Land Solutions By: Name: Amanda Mata, P.E. Title: Project Manager APPROVED: RSR-BasswgQd7w�ner—,� By: i Name: Seth Carpenter Title: Vice President APPROVED: ----Moss Utilities, LLC By: Name: Shawn Lain Title: Vice President Revised: 10-12-2011 Page 2 FORTWORTH. TRANSPORTATION AND PUBLIC WORKS October 16, 2023 Kirk Young 1201 Cliff Swallow Ct. Granbury, Texas 76048 RE: Acceptance Letter Project Name: Basswood Landing Project Type: Pavi City Project No.: 103976 To Whom It May Concern: On October 6, 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 October 16, 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 October 16, 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- 392-6251. Sincerely, C'J, A'J.' Andrew Goodman, Project Manager Cc: Carlos Garcia, Inspector Gary Deyon, Inspection Supervisor Troy Gardner, Senior Inspector Victor V. Tornero, Program Manager Peloton, Consultant Jackson Construction , Contractor Republic Property Group, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev. 8/20/19 1 GJACKSON CONSTRUCTION LTD. 51 12 SUN VALLEY DRIVE FORT WORTH, TX 761 19 TEL: 817-572-3303 FAX 817-478-0443 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 Troy L. Jackson, President Of Jackson Construction, Ltd, 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; Basswood Landing BY ?roy L. J kson, President Subscribed and sworn before me on this date 16th of October, 2023. Notary P't[61it' Tarrant, Texas CARMEN L. ESTEP �.P1rr� Comm. Expires 04-06-2024 Notary ID 2910611 CONSENT OF OWNER n ARCHITECT t=1 SURETY COMPANY CONTRACTOR u TO FINAL PAYMENT SURETY [� OTHER Uj AIA DOCUMENT G707 Bond No. 1097566 PROJECT: Basswood Landing - City Project No. 103976 (name. address) TO (Owner) F —1 ARCHITECT'S PROJECT NO: City of Fort Worth, TX and RSR - Basswood Owner, LLC CONTRACT FOR: Construction TX ii CONTRACT DATE: May 30, 2023 L�__. CONTRACTOR: Jackson Construction, Ltd. 5112 Sun Valley Drive Fort Worth, TX 76119 in accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the (here insert name and address of Surety Company) The Hanover Insurance Company 440 Lincoln Street, Worcester, MA 01653 SURETY COMPANY, on bond Of (here insert name and address of Contractor) Jackson Construction, Ltd. 5112 Sun Valley Drive Fort Worth, TX 76119 , 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 insert name and address of Owner) City of Fort Worth, TX and RSR - Basswood Owner, LLC TX OWNERS, as set forth in the said Surety Company's bond. W WITNESS WHEREOF, the Surety Company has hereunto set its hand this 17th day of October, 2023 The no er Insurance Company �Z Sur ty o pang n� Si ature of gcGthorized Representative Attest: r[ (Seal). �11 � Laurie Pflug,Attorney-in-fact Title NOTE: This form is to 0e used as a companion document to AIA DOCUMENT G706, CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS, Current Edition AIA DOCUMENT G707 - CONSENT OF SURETY COMPANY TO FINAL PAYMENT - APRIL 1970 EDITION - AIA ONE PAGE © 1970 - THE AMERICAN INSTITUTE OF ARCHITECTS. 1735 NEW YORK AVE., NW, WASHINGTON, D.C. 20006 THE HANOVER INSURANCE COMPANY MASSACHUSETTS BAY INSURANCE COMPANY CITIZENS INSURANCE COMPANY OF AMERICA POWER OFATTORNEY THIS Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. KNOW ALL. PERSONS BY THESE PRESENTS: That THE HANOVER INSURANCE COMPANY and MASSACHUSETTS BAY INSURANCE COMPANY. both being corporations organized and existing under the laws of the State of New Hampshire. and CITIZENS INSURANCE COMPANY OF AM ERICA. a oorpotabon organised and twisting under the laves of the State of Michigan. (here"Iter individually and colitctively the'Company7 does thereby consftAte and appoint, Holly Clevenger Of Dallas, TX iri&vidually,ifihere bernove ftn*nenamed. asits; trueand lawliul aftme-Asyb-factiosign.exeersie.s l.arknowledgeand deliver for. and on its behalf, and as its act and deed any place within the united States. any and all surety bonds. recwiaanm, undertakings. or other surety obligations. The execution of such surety bonds, reoagrtamtroes, un0eriakings or surety obligations. in purwanoe of these prexanM, shall be as binding capon the Company as if they had been duly signed by the president and allesled by the secretary of the Company, in their own proper persons. Provided however, that this power of attorney linhits the ads of those named herein: and they have no authority to bind the Company except in the manner stated ,and to the extent of any [imitation stated beioaw; Any such obligations in the United States, not to exceed Forty Million and NoJ100 (340.000,000) in any single instance That this power is matte and executed pursuant io the authocity ofthe following ResotuSons passed by the Board of Directors of said Company, and saidResokiiions remain in full force and effect: Surety Bond Number: 1097566 Principal: Jackson Construction, Ltd. Obligeo: City of Fort Worth, TX and RSR - Basswood Owner, LLC RESOLVED: That the President or any Vice President. in conjunction initth any Vim President. be and they heeby are tauthcrized and empowered to appoint Attomeys-in-fact of the Company. in its name and as it abets, to execute and acknowledge for and on its behalf as surety. any and as bonds. tecogoizanees.contsaofsofiodemnity,wahveasofeitationand all other writings obligatory inthenakrreihanea.wilhpowertoaftachtheralotheseat the Company. Arty such whitings zoo oxecuted by such Xtforhteyrrin•fad OW be binding upon than Company as it they hod been duty executed and acknowledged by the regularly elected officers elf Coe Company in their own properpersons. RESOLVED; That any and all Powers of Attorney and Certified Copiers of such Powers of Amy and in raspoct thereto. gran_isd and executed by the President or Yee President in co*ns5anwob any Yoe Presidentof the Company, shall the bkvd'ehgon the Company to the same extent as if ant signatures therein were manually affixed. even though one ormoreof any such signat wes thereon maybe facsimile_ (Adopted Octo a 7,1981— The Hanover Insurance Company: Adopted Apeit 14,1082—Massachusetts Bay insurance Company: Adopted Septernber7.2001— Ci*,¢ans Insurance Company of Atnerica and aftkrned by each Company on March 24. 2014) IN WITH ESS WHEREOF, THE HANOVER INSURANCE. COMPANY. MASSACHUSETTS BAY INSURANCE COMPANY and CITIZENS INSURANCE COMPANY OF AMFRICA have caused these presents to he sealed with their respective corporate seats. duly attested by two Vice Presidents. this 91' day of April, 2023 Ike llaaartr lasauaaict comp ay Afswachaaeta tray taerereaace Ceatpatay CWaM Urlwaaaft-4C41nle+hi f N, "X1 ifitckt, tMdl f STATE 0; CONNECTICUT } COUNTY OF HARTFORD } ss Tit Hats ovtt lasarawc Company Mt W-,"te C+rr"-y feaa £awx/rryoe[wrsetkar Sift M. AliendM.. Vim Prrltldent On this 6u' day of April 2023 before me came the above named Executive Vioe President and Vice President of The Hanover Insurance Company, Massachusetts Say insurance Company and Citzens insurance Company of Ameriw. to me personally known to be the individuals and officers described herein. and acknowledged that the seals affixed to the preceding instrument are the corporate seats of The Hanover Insurance Company, Massachusetts Bay insurance Company and Citizens Insurance Company of Americo. respectively. and that the said corporate seals and their signatures as officers were duly affixed and subsaibQd to sold instrumen Iry tho authority and direction of said Corporations. I r Wendy Latoumes Nol a'Ty Ptart Stet! of Cormckut ' - — n f Latou llir it y es.# t,1Q 6 Myaarlrn e x aly $1, 2M 1, the undersigned Vice President of The Hannover Insurance Company, Massachursetts Bay Insurance Company and Citizens insurance Company of America. hereby cetrtify that the above and foregoing is a fug. true and correct copy of the Original Power of Attorney issued by said Companies. and do hereby hwtw certify that the said Pourers of Attorney are still in farce and effect. GIVEN ureter my hared and the seats of said Companies, at Worcester. Massachusetts, this . __17th_ . _ day of October 2023 Tie �- IaeMnerr b Bug jr I ay CER.TIRED COPY A C!a Rar.rtdltr, tics I'rrskkat