HomeMy WebLinkAboutContract 57949-FP1-FP1
City Secretary
Contract No. 57949
FORT WORTH
Date Received 11/8/2023
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: Tradition - Central Phase 3A.2
City Project No.:103755
Improvement Type(s): Water ❑x Sewer ❑x
Original Contract Price:
$1,642,989.74
Amount of Approved Change Order(s):
$11,112.37
Revised Contract Amount:
$1,654,102.11
Total Cost of Work Complete:
$1,654,102.11
61"A0� Nov 8, 2023
Contractor Date
Project Manager
Title
SYB Construction
Company Name
Nov V, 2023
Jas Badlev(Nov8, 202313:34 CST)
Ml r
Project Inspector
Date
Ara,,h Emaynl SAleh, Ph.D._, P.E.
Nov 8 2023
4 rash Emami Saleh, Ph.D., P.E. (Nov 8.202314:27 CST)
Project Manager
Date
Nov 8 2023
Rebecca Diane Owen (Nov R_ 2023 14:28 CST)
CFA Manager
Date
Nov 8, 2023
TPW Director
Date
�Nov
10 2023
WilliamA�son10. 202307:40 GMT+1)
Asst. City Manager
Date
OFFICIAL RECORD Page 1 of 2
CITY SECRETARY
FT. WORTH, TX
Notice of Project Completion
Project Name: Tradition - Central Phase 3A.2
City Project No.: 103755
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: 175 WD
Work Start Date: 11/14/2022
Completed number of Soil Lab Test: 382
Completed number of Water Test: 20
Days Charged: 207
Work Complete Date: 10/4/2023
Page 2of2
FoRTWORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name Tradition, Phase 3A.2
Contract Limits
Project Type WATER & SEWER FACILITIES
City Project Numbers 103755
DOE Number 3755
Estimate Number 1 Payment Number I
City Secretary Contract Number
Contract Date
Project Manager NA
Contractor SYB CONSTRUCTION COMPANY, INC.
421 COMPTON
Inspectors
For Period Ending 10/4/2023
WD
Contract Time 8VID
Days Charged to Date 207
Contract is 100.00 Complete
IRVING, TX 75061
O.AGUILLON / J.BRADLEY
Friday, November 3, 2023 Page 1 of 5
City Project Numbers 103755 DOE Number 3755
Contract Name Tradition, Phase 3A.2 Estimate Number I
Contract Limits Payment Number I
Project Type WATER & SEWER FACILITIES For Period Ending 10/4/2023
Project Funding
UNIT I: WATER FACILITIES
Item
Description of Items
Estimated Unit
Unit Cost
Estimated
Completed
Completed
No.
Quanity
Total
Quanity
Total
1
4"-12" PRESSURE PLUG
6 EA
$270.52
$1,623.12
6
$1,623.12
2
TRENCH SAFETY
4258 LF
$1.30
$5,535.40
4258
$5,535.40
3
DUCTILE IRON WATER FITTINGS
1.3 TN
$33,334.76
$43,335.19
1.3
$43,335.19
W/RESTRAINT
4
8" PVC WATER PIPE
3113 LF
$96.91
5301,680.83
3113
$301,680.83
5
8" PVC WATER PIPE, CSS BACKFILL
60 LF
$109.96
$6,597.60
60
$6,597.60
6
12" PVC WATER PIPE
1033 LF
$153.23
$158,286.59
1033
$158,286.59
7
12" WATER PIPE, CSS BACKFILL
52 LF
$167.38
$8,703.76
52
$8,703.76
8
STD FIRE HYDRANT ASSEMBLY W/ 6" GATE
4 EA
$7,582.92
$30,331.68
4
$30,331.68
VALVE & VALVE BOX
9
CONNECT TO EXISTING 4"-12" W.L. STUB -OUT
3 EA
$2,638.59
$7,915.77
3
$7,915.77
10
1" DOMESTIC WATER SERVICES (CO #1) (CO
99 EA
$1,878.75
$185,996.25
99
$185,996.25
#2)
11
8" GATE VALVE & VALVE BOX
I I EA
$2,786.51
$30,651.61
11
$30,651.61
12
12" GATE VALVE
5 EA
$4,787.54
$23,937.70
5
$23,937.70
13
3/4" IRRIGATION SERVICE LOT 55X BLOCK
1 EA
$1,548.23
$1,548.23
1
$1,548.23
ZZZ (CO #1)
14
RELOCATE PREVIOUSLY INSTALLED FIRE
1 EA
$3,927.89
$3,927.89
1
$3,927.89
HYDRANT APPROX. 10' (CO #1)
Sub -Total of Previous Unit
$810,071.62
$810,071.62
UNIT II: SANITARY SEWER FACILITIES
Item Description of Items
No.
13 4" - 12" END & PLUG
14 POST -CCTV INSPECTION
15 VACUUM TEST MANHOLES
16 TRENCH SAFETY
17 TRENCH WATER STOPS
18 SDR-26 4" SEWER SERVICES
19 8" SDR-26 PVC SEWER PIPE
20 8" PVC SANITARY SEWER PIPE W/ CSS
BACKFILL
Estimated
Unit
Unit Cost
Estimated
Completed
Completed
Quanity
Total
Quanity
Total
1
EA
$392.85
$392.85
1
$392.85
4296
LF
$4.03
$17,312.88
4296
$17,312.88
26
EA
$214.50
$5,577.00
26
$5,577.00
4296
LF
$1.30
$5,584.80
4296
$5,584.80
7
EA
$650.00
$4,550.00
7
$4,550.00
98
EA
$1,707.02
$167,287.96
98
$167,287.96
1813
LF
$99.57
$180,520.41
1813
$180,520.41
76
LF
$111.61
$8,482.36
76
$8,482.36
Friday, November 3, 2023 Page 2 of 5
City Project Numbers 103755 DOE Number 3755
Contract Name Tradition, Phase 3A.2 Estimate Number I
Contract Limits Payment Number I
Project Type WATER & SEWER FACILITIES For Period Ending 10/4/2023
Project Funding
21 10" SEWER PIPE
2307 LF
$120.40
$277,762.80
2307
$277,762.80
22 10" PVC SANITARY SEWER PIPE W/ CSS
100 LF
$133.81
$13,381.00
100
$13,381.00
BACKFILL
23 4' STD DIA. MANHOLE
26 EA
$4,885.76
$127,029.76
26
$127,029.76
24 4' EXTRA DEPTH MANHOLE
75 VF
$392.60
$29,445.00
75
$29,445.00
25 CONNECT TO EXISTING 8" SEWER
1 EA
$1,971.67
$1,971.67
1
$1,971.67
26 CONNECT TO EXISTING 10" SEWER
2 EA
$2,366.00
$4,732.00
2
$4,732.00
Sub -Total of Previous Unit
$844,030.49
$844,030.49
Friday, November 3, 2023 Page 3 of 5
City Project Numbers 103755
Contract Name Tradition, Phase 3A.2
Contract Limits
Project Type WATER & SEWER FACILITIES
Project Funding
Contract Information Summary
Original Contract Amount
Change Orders
Change Order Number 1
Change Order Number 2
DOE Number 3755
Estimate Number I
Payment Number I
For Period Ending 10/4/2023
$1,642,989.74
$7,354.87
$3,757.50
Total Contract Price $1,654,102.11
Total Cost of Work Completed $1,654,102.11
Less % Retained $0.00
Net Earned $1,654,102.11
Earned This Period $1,654,102.11
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
$1,654,102.11
Friday, November 3, 2023 Page 4 of 5
City Project Numbers 103755 DOE Number 3755
Contract Name Tradition, Phase 3A.2 Estimate Number I
Contract Limits Payment Number I
Project Type WATER & SEWER FACILITIES For Period Ending 10/4/2023
Project Funding
Project Manager NA City Secretary Contract Number
Inspectors O.AGUILLON / J.BRADLEY Contract Date
Contractor SYB CONSTRUCTION COMPANY, INC. Contract Time 80 WD
421 COMPTON Days Charged to Date 207 WD
IRVING, TX 75061 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 $1,654,102.11
Less % Retained $0.00
Net Earned $1,654,102.11
Earned This Period $1,654,102.11
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
$1,654,102.11
Friday, November 3, 2023 Page 5 of 5
DEVELOPER -AWARDED -PROJECT CHANGE ORDER
PROJECT NAME:
Tradition - Phase 3A.2
CONTRACT:
(A) Water/Sewer/Storm Drain, (B) Paving,
(C) Street Lights
CFA#
22-0085
CITY PARTICIPATION:1 0%
CITY PROJECT #
103755
FID #
30114-0200431-103755-EO7685
FILE #
W-2809, X-27123
INSPECTOR:
Jason Bradley
Phone No: 214-883-5921
PROJECT MANAGER:
Yogesh Patel
Phone No: 817-392-2373
REVIEWED
CHANGE
ORDER No: By AraSh Emami Saleh at 10:38 am, Oct 20, 2023
1
CONTRACT UNIT
WATER
SEWER
DRAINAGE PAVING
STREET LIGHTS
GRADING
Developer
Developer
Developer
Cost City Cost
Developer Cost City Cost
Developer Cost
City Cost Developer Cost City Cost
Cost
City Cost
Cost City Cost
IORIGINAL CONTRACT
$798,959.25 $0.00
$844,030.49 $0.00
$262,672.96
$0.00 $973,868.05 $0.00
$134,578.98
$0.00
$0.00 $0.00
EXTRAS TO DATE
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
CREDITS TO DATE
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
CONTRACT TO DATE
$798,959.25 $0.00
$844,030.49 F' $0.00
$262,672.96
$0.00 $973,868.05 $0.00
$134,578.98
$0.00
$0.00 $0.00
(AMOUNT OF PROP. CHANGE ORDER
$7,354.87
$0.00 L
$0.00
$0.00
$0.00 '
$0.00
'
I REVISED CONTRACT AMOUNT
$806,314.12 $0.00
$844,030.49
$262,672.96
$0.00 $973,868.05 $0.00
$134,578.98
$0.00
$0.00 $0.00
TOTAL REVISED CONTRACT AMOUNT
PER UNIT
$806,314.12
$844,030.49
$262,672.96 $973,868.05
$134,578.98
$0.00
REVISED COST SHARE
Dev. Cost:
$3,021,464.60
City Cost:
$0.00
TOTAL REVISED CONTRACT
$3,021,464.60
You are directed to make the following changes in the contract documents:
CITY PAY ITEM
CITY BID ITEM #
# QUANTITY
UNIT
ITEM DESCRIPTION
3312.2003
10 1
EA
1" Domestic Water Service
9999.0020
61 * 1
EA
3/4" Irrigation Service
9999.0021
62* 1
EA
Relocated Previously Installed Fire Hydrant
REASONS FOR CHANGE ORDER
1. Added a domestic service, added an irrigation service, and relocated a previoulsy installed hydrant
NO CITY FUND3INVOLVEDINTHIS CONTRACT- DEVI
REIMBURSEMENT FROM THE CITY WILL BESOUGHT
RECOMMENDED:
APPROVED
Goodwin and Marshall, Inc.
Toll %Ufh
By: A.
13y.
Name: Matt Baacke, P.E.
Name:
Title: Project Engineer
TUa.
_CZER I RESI'ONStBLE FOR 100% OF THE CHANGE ORDER COST AND No
XTHEDEVELOPER.
APPROVED: For) SY8 Cons[rin�
1 BY.
gosh Gardner Name: j±JUslin Castor �j
Land bovalownenI Managor Tnle_ I ir'%' c c,� i1V c!v C
UNIT PRICE
$1,878.75
$1,548.23
$3,927.89
CONTRACT
DAYS
firm
175
0
175
TOTAL 1
$1,878.751
$1,548.231
$3,927.89 1
$7,354.87 1
Revised: 10-12-2011 Page 1
DEVELOPER -AWARDED -PROJECT CHANGE ORDER
PROJECT NAME:
Tradition - Phase 3A.2
CHANGE
(CONTRACT:
(A) Water/Sewer/Storm Drain, (B) Paving, (C) Street Lights
ORDER No:
ICFA#
22-0085 CITY PARTICIPATION:1 0%
CITY PROJECT #
103755
IFID #
30114-0200431-103755-EO7685
2
(FILE #
W-2809, X-27123
INSPECTOR:
Jason Bradley Phone No: 214-883-5921
PROJECT MANAGER:
Arash Emami Saleh Phone No: 817-392-2373
CONTRACT UNIT
WATER SEWER DRAINAGE PAVING
STREET LIGHTS
GRADING
CONTRACT
Developer
Developer
Developer
DAYS
Cost City Cost Developer Cost City Cost Developer Cost City Cost Developer Cost
City Cost
Cost City Cost
Cost City Cost
IORIGINAL CONTRACT
$798,959.25 $0.00 $844,030.49 $0.00 $262,672.96 $0.00 $973,868.05
$0.00
$134,578.98 $0.00
$0.00 S0.00
175
EXTRAS TO DATE
$7,354.87 $0.00 $0.00 $0.00
$0.00
$0.00
CREDITS TO DATE
$0.00 $0.00 $0.00 $0.00
$0.00
$0.00
CONTRACT TO DATE
$806,314.12 $0.00 $844,030.49 $0.00 $262,672.96 $0.00 $973,868.05
$0.00
$134,578.98 kL $0.00
$0.00 $0.00
175
(AMOUNT OF PROP. CHANGE ORDER
$3,757.50 $0.00 $0.00 $0.00
$0.00 ,
$0.00
0
REVISED CONTRACT AMOUNT
$810,071.62 $0.00 $844,030.49
$262,672.96 $0.00 $973,868.05
$0.00
$134,578.98 Pill$0.00
$0.00 $0.00
175
TOTAL REVISED CONTRACT AMOUNT
PER UNIT
$810,071.62 $844 , 010.49
$262,672.96 $973,868.05
$134,578.98
$0.00
REVISED COST SHARE
Dev. Cost: $3,025,222.10 City Cost:
$0.00
TOTAL REVISED CONTRACT
$3,025,222.10
You are directed to make the following changes in the contract documents
CITY PAY ITEM
CITY BID ITEM # # QUANTITY UNIT
3312.2003 10 2 EA
REASONS FOR CHANGE ORDER
1. Updating contract quantities to match approved construction plans.
NO CITY FUNDS INVOLVED IN T141S CONTRACT. DEV
REIMBURSEMENT FROM THE CITY WILL BE SOVGt1T
RECOMMENDED:
APPROVEC
G000ddlwin and Marshall, Ino.
By: / frr
Toll Sooh
Br,
Name: Matt Baacke, P.E.
Name:
Title: Project Engineer
Idle- r
ITEM DESCRIPTION
1" Domestic Water Service
.CjZr2R M RESPONSIBLE FOR 100% OF THE CHANGE ORDER COST AND No
T IE DEVELOPER.
APPROVED:
F, P-C 3
Y8 ConSfru ion Co. In�
'/J h Gardner Name: 7 Amlin Castor �j
Land Development Manager Trtte_ I }�i} V l{r"C'GJ C r- � 4^t C
REVIEWED
By Arash Emami Saleh at 8:50 am, Sep 29, 2023
UNIT PRICE TOTAL
$1,878.75 $3,757.501
$3,757.50 1
Revised: 10-12-2011 Page 1
PROJECT NAME:
PROJECT NUMBER:
DOE NUMBER:
PIPE LAID
8" PVC Water Pipe
12" PVC Water Pipe
FIRE HYDRANTS: 4
PIPE ABANDONED
DENSITIES:
NEW SERVICES:
PIPE LAID
8" PVC Sewer Pipe
10" PVC Sewer Pipe
PIPE ABANDONED
DENSITIES:
NEW SERVICES:
FORTWORTH
TRANSPORTATION AND PUBLIC WORKS
PIPE REPORT FOR:
Tradition Ph.3A.2
103755
WATER
SIZE TYPE OF PIPE
8" PVC
12" PVC
VALVES (16" OR LARGER)
SIZE TYPE OF PIPE
l " Domestic Water Service
0.75" Irrigation Service
SEWER
SIZE TYPE OF PIPE
8" PVC
10" PVC
SIZE TYPE OF PIPE
4" PVC Sewer Service
TRANSPORTATION AND PUBLIC WORKS
(D The City of Fort Worth • 1000 Throckmorton Street • Fort Worth, TX 76012-6311
(817) 392 - 7941 • Fax: (817) 392 - 7845
LF
3,173
1,085
LF
99 Services
1 Service
LF
1,889
2,407
LF
99 Services
FORTWORTH.
TRANSPORTATION AND PUBLIC WORKS
October 17, 2023
SYB Construction Co., INC
421 Compton Avenue
Irving Texas, 75061
RE: Acceptance Letter
Project Name: Tradition Phase 3A.2
Project Type: Water,Sewer
City Project No.: 103755
To Whom It May Concern:
On October 17, 2023 a final inspection was made on the subject project. There were no punch list items
identified at that time. The final inspection indicates that the work meets the City of Fort Worth
specifications and is therefore accepted by the City. The warranty period will start on October 17, 2023,
which is the date of the final inspection 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-
392-2372.
Sincerely,
Arash Emami Saleh Ph D., P. E.
Arash Emami Saieh, Ph.D., P.E. (Nov 8, 202314:27 CST)
Arash Emami Saleh, Project Manager
Cc: Jason Bradley, Inspector
Don Watson, Inspection Supervisor
Oscar Aguillon, Senior Inspector
Victor Tornero, Program Manager
GM Civil Matt BAacke, Consultant
SYB Construction, Contractor
Toll Brothers, Developer
File
E-Mail: TPW_Acceptance@fortworthtexas.gov
Rev. 08/20/19
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 Brian Wood, Vice
President Of SYB Construction Co., 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;
Tradition Phase 3A.2 CPN# 103755, Fort Worth, Tarrant Cou Rent
BYBrian Wood, Vic
Subscribed and sworn before me on this date 5th of October, 2023.
���1AY COLBI CARLENE BENNETT
izP
Notary Public, State of Texas
Comm. Expires08-16-2027 1i
%: p!c+ary in vw;i 0R52 l
Nat 6A.. Jw..
Dallas, Texas
CONSENT OF OWNER I_I
SURETY COMPANY ARCHITECT ri
ConiTRACTOR a
TO FINAL PAYMENT SURETY 0
OTHER I
AIA DOCUMENT G707 Bond No. 1086245
PROJECT: Tradition, Central Phase 3A.2
(name, address)
TO (Owner)
ARCHITECT'S PROJECT NOS
Toll Southwest, LLC CONTRACT FOR: Construction
2555 SW Grapevine Pwky #100
Grapevine, TX 76051
CONTRACT DATE: September 15, 2022
L
CONTRACTOR: SYB Construction Co., Inc.
421 Compton Ave. Irving, TX 75061
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)
SYB Construction Co., Inc.
421 Compton Ave. Irving, TX 75061 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 insertname and address of Owner)
Toll Southwest, LLC
2555 SW Grapevine Pwky #100 Grapevine, TX 76051 OWNERS,
as set forth in the said Surety Company's bond.
IN WITNESS WHEREOF,
the Surety Company has hereunto set its hand this 5th day of October, 2023
TXe Ha ro er 1psorance Companv
urety Cam
Sig tur of Aut rize pre ntative
Attest;
(Seal): aerie Pflug, Attorney -in -Fact
Title
NOTE: This form is to be used as a companion document to AIA DOCUMENT G706, COt, TRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS AND
CLAIMS, Current Edition
AIA DOCUMENT G707 • CONSENT OF SURETY GOMPANY TO FINAL. PAYMENT • APRI , 1970 EDITION • AIAO ONE PACE
91970 • THE AMERICAN INSTITUTE OF ARCHITECTS. 1735 NEW YORK AVE., NW, Wi SHINGTON, D.C. 20006
THE HANOVER INSURANCE COMPANY
MASSACHUSETTS BAY INSURANCE C()MPANY
CITIZENS INSURANCE COMPANY OF AMERICA
POWER OF ATTORNEY
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:
ThatTHE HANOVER INSURANCE COMPANY and MASSACHUSETTS BAY INSURANCE COMPANY, both being corporations organized and existing underthe
laws of the State of New Hampshire, and CITIZENS INSURANCE COMPANY OF AMERICA, a corporation organized and existing under the laws of the State of
Michigan, (hereinafter individually and collectively the "Company") does hereby constitute and appoint,
Jack M. Crowley, Laurie Pflug, andlor Holly Clevenger
Of Willis Towers Watson Insurance Services West, Inc of Dallas, TX each individually, if there be more than one named, as its true and lawful attorney(s)-in-fact
to sign, execute, seal, acknowledge and deliver for, and on its behalf, and as its act and deed any place within the United States, any and all surety bonds,
recognizances, undertakings, or other surety obligations. The execution of such surety bonds, recognizances, undertakings or surety obligations, in pursuance of
these presents, shall be as binding upon the Company as if they had been duly signed by the president and attested by the secretary of the Company, in their own
proper persons. Provided however, that this power of attorney limits the acts of those named herein; and they have no authority to bind the Company except in the
manner stated and to the extent of any limitation stated below:
Any such obligations in the United States, not to exceed Fifty Million and No/100 ($50,000,000) in any single instance
That this power is made and executed pursuant to the authority of the following Resolutions passed by the Board of Directors of said Company, and said Resolutions
remain in full force and effect:
RESOLVED: That the President or any Vice President, in conjunction with any Vice President, be and they hereby are authorized and empowered to
appoint Attorneys -in -fact of the Company, in its name and as it acts, to execute and acknowledge for and on its behalf as surety, any and all bonds,
recognizances, contracts of indemnity, waivers of citation and all other writings obligatory in the nature thereof, with powerto attach thereto the seal of the
Company. Any such writings so executed by such Attorneys -in -fact shall be binding upon the Company as if they had been duly executed and
acknowledged by the regularly elected officers of the Company in their own proper persons.
RESOLVED: That any and all Powers of Attorney and Certified Copies of such Powers of Attorney and certification in respect thereto, granted and
executed by the President or Vice President in conjunction with any Vice President of the Company, shall be binding on the Company to the same extent
as if all signatures therein were manually affixed, even though one or more of any such signatures thereon may be facsimile. (Adopted October 7, 1981 —
The Hanover Insurance Company; Adopted April 14, 1982 — Massachusetts Bay Insurance Company; Adopted September 7, 2001 — Citizens Insurance
Company of America and affirmed by each Company on March 24, 2014)
IN WITNESS WHEREOF, THE HANOVER INSURANCE COMPANY, MASSACHUSETTS BAY INSURANCE COMPANY and CITIZENS INSURANCE COMPANY
OF AMERICA have caused these presents to be sealed with their respective corporate seals, duly attested by two Vice Presidents, this 12th day of September,
2023
RrIU 5V � f
A�
The Hanover lawrance Company
Mamchusetts Say Insurance Company
Citizens tttsur*nce Companyof Amerind
J s M�0-1..11.1
STATE OF CONNECTICUT )
COUNTY OF HARTFORD
I he }Hanover Insurance Company
A ttchusetu Ray tnspeanct Company
t :s insurance Company of America
lien M. Mendoza, Vice President
On this 121h day of September, 2023 before me came the above named Executive Vice President and Vice President of The Hanover Insurance Company,
Massachusetts Bay Insurance Company and Citizens Insurance Company of America, 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 seals of The Hanover Insurance Company, Massachusetts Bay Insurance
Company and Citizens Insurance Company of America, respectively, and that the said corporate seals and their signatures as officers were duly affixed and
subscribed to said instrument by the authority and direction of said Corporations.
Wendy Latoumn
Notary Public, State of Ctmtt�ticut
MY Ctlrrursis aotl Expires July 31.1, 5
V"nd 03tou w 0t4ry C
My conwrissiip4sn expires July 31, 2025
I, the undersigned Vice President of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America,
hereby certify that the above and foregoing is a full, true and correct copy of the Original Power of Attorney issued by said Companies, and do hereby further certify
that the said Powers of Attorney are still in force and effect.
GIVEN under my hand and the seals of said Companies, at V,/__tor, Massachusetts, this Sth day of October 2023.
CERTIFIED COPY
The nn a lasurnnce ompan
1!a sat �5 N3ity Ins + DanY
C' n surarlee imspns----.�
Yahn Rowedder, Vice President