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Home My WebLink AboutContract 57922-FP1FORT WORTH, TRANSPORTATION AND PUBLIC WORKS NOTICE OF PROJECT COMPLETION -FP1 City Secretary No: 57922 Date Received: 12/11/2023 City Project N!?: 102877 57922 North Riverside Dr Pavement Marking & Signage Improvements Regarding contract for as required by the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by City Council on 6/14/2022 through M&C 22-0455 the director of the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT upon the recommendation of the Assistant Director of the Transportation & Public Works Department has accepted the project as complete. Original Contract Prices: $ 1,707,683.14 Amount of Approved Change Orders: $ 45,305.56 Ns 2 Revised Contract Amount: $ 1,752,988.70 Total Cost Work Completed: $ 1,594,612.03 Less Deductions: Liquidated Damages: _ Days @ $ / Day Pavement Deficiencies: Total Deduction Amount: $ Total Cost Work Completed: $ 1,594,612.03 Less Previous Payments: $ 1,514,881.43 Final Payment Due $ 79,730.60 At2� L. Gr/alell� Dec 11, 2023 Patricia L. Wadsack (Dec 11, 202310:12 CST) Recommended for Acceptance Date Asst. Director, TPW - Capital Delivery or. �,... Lauren Prieur (Dec 11, 202310:19 CST) Dec 11, 2023 Accepted Date Director, TRANSPORTATION AND PUBLIC WORKS DEPARTMENT w William Johnson 202311:40 CST) Dec 11 ,2023 (Die Asst. City Manager Date Comments: OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX C-620 Signature Page Contractor's Application for Payment Invoice No. 12 Final To (Owner) City of Fort Worth Invoicing Period (From -To): Invoice Date: 10/5/2023-11/09/23 11/13/2023 P. O. FW020-0000008191 From (Contractor): Remit to ( If Not Automatic Deposit): Number: Texas Materials Group Project: 102877 Contractor's CFW Vendor No.: 0000000257 City Secretary Contract 57922 Contract 2021 HMAC 2 N. Riverside Dr Resurfacing Number: Name: Application For Payment Change Order Summary (Approved Change Orders 11. ORIGINAL CONTRACT PRICE............................................................... $ $1,707,683.14 Number Additions Deletions 12. Net change by Change Orders.....................................................................1 $ $45,305.56 1 $45,305.56 13. Current Contract Price (Line 1 f 2)............................................................ $ $1,752,988.70 2 $27,291.08 $27,291.08 14. TOTAL COMPLETED AND STORED TO DATE 3 I (Progress Estimate, Construction Allowance and Change Orders)....... $ $1,594,612.03 4 15. RETAINAGE: 5 I a. X $1,594,612.03 Work Completed.......... $ 6 I b. X Not Used $ 7 I c. Total Retainage (Line 5a + Line 5b).................................. $ 8 16. AMOUNT ELIGIBLE TO DATE (Line 4 - Line 5c)................................. $ $1,594,612.03 TOTALS $72,596.64 $27,291.08 17. LESS PREVIOUS PAYMENTS (Line 6 from prior Application)........... $ $1,514,881.43 NET CHANGE BY $45,305.56 8. AMOUNT DUE THIS APPLICATION...................................................... $ $79,730.60 CHANGE ORDERS 9. BALANCE TO FINISH, PLUS RETAINAGE (Column G on Progress Estimate+ CA + COs +Line 5 above) ................. $ $158,376.67 Contractor's Certification 10. CONTRACT TIME: The Contractor certifies with the submittal of this document and associated Payment Request Submittal a. Days Awarded 180 on the City of Fort Worth Buzzsaw system that to the best of their knowledge: (1) all previous progress b, Days Added by CO 101 payments received from Owner on account of Work done under the Contract have been applied on account to discharge Contractor's legitimate obligations incurred in connection with Work covered by C. Total Days 281 prior Applications for Payment; (2) title of all Work, materials and equipment incorporated in said Work or otherwise listed in or covered by this Application for Payment will pass to Owner at time of d Days Charged 2g1 payment free and clear of all Liens, security interests and encumbrances (except such as are covered by a Bond acceptable to Owner indemnifying Owner against any such Liens, security interest or e, Days Remaining encumbrances); and (3) all Work covered by this Application for Payment is in accordance with the Contract Documents and is not defective. Liquidated Damages $650.00 x day Affidavit of Bills Paid a MAtthew Harper (NOV 30, 20 310:47 CST) Consent of Surety This document has been modified from its original form as an EJCDC document and the user did not highlight the modifications. You are encouraged to read the document carefully and consult Legal Counsel prior to its execution. Progress Estimate DDLa°t Nam PO`1t0"18L1i 2021 HMAC 2 N. Riverside fir Resurfacing APPIuvu"P,"oa- 10/5/2023-11/09/23 A BmuemNo D P Ira wnDfM I Bra Quemiry Ilnrt Pr�cn 1 2 RemobilDaLon Remove Canc Cuh B Geder sPmLaD ND 1350201 024 EA LF 100000G 55000000011 51000 y/,' 480 3 I 5 8 ]^r'mn nrm antl Gone Remove Cancreu Dover IB"Concrete Dnvewav Removeltlewalk fio1o� 02410401 132/30401 102410100 LF SF SF SF 55000000,�,ry� 350000000U 350000000 582000000,�,Yy� Sd34 $3 S10'y $2 I32130J22 SS 51100000000 8 9 10 ECerbdatbaekof55��p,4 byµ l�y�7'I T.�hP 1 ICmc Ret wall etlmcenl lO s'dewalk 72 Alocd Blw Remove coot valley Dotter 13.2010o 0241 Lt.SV IF SF 1 2111111,�,Yy� So O.Oo00 $3968_ 4569 $384 � 11 I]"t'.r Remove ADA Ramo 020 'y I SF 300000 .2000000 "'" $150_ 13 IBamer Free Ramo.Twe R-1 Bartrer Free Re.D. Twe M-1 132130501 1321305m SF I SF 30000000,�,ry� 100000000 S2]d� $257i 15 18 IRame. Free Ram"Tw. M-2 BartKK Free Ramo. Twe P-1 30504 3213 0506 SF I SF 100000001A 22. 00000� 5252 $2575 1] 18 AsoM1alt Pareme"t Level Lo AaD1 Pavement Base RZ.11 132120600 31240101 3N I CY ]00000 20/0000/ 51956U $404 33_ 19 20 21 ICrxk s.alm"mFndm"Pawm>n1 2"Surfaw Milline ]"Remove Concrek Pa✓emenl 2120900 0241150 9999 6 GA 2000000 $V 04000.00000 6Y 1000000 5318 $1 Sd39S 22 23 12"Asobali Pavement TvoeD 124-IneM1 antl lamer Tree Removal 132120J03 �31100102 $V 04000.00000 EA 2.0000 $138�, 58260Q 25 B"-12'Tree 131210002 1 EA Cy 50 00 21 28 1Cum Atltlresa Paineno Taosoil 32920100 1321]Soo1 32" 010 Sy EA GY �$S3B29O6S_1 151,00000000 0000002 35000001; 10/0000/ $88 Sd08 $43 29 30 1FIev Rac. Tvn.A GR-2 Miacelleneoua Adl.__t Ltj,tl..I _ 1 3ttL CY LS 1000000. 1.000006 5126 M,.00- 31 IWATE R VALVE BOX AO.II I88��7FFCRETE RI6ER) 330� 0501 WA TER VALVE BOX AD ON 33 12 - FA 1600000i 9506�32 $ 33 35 38 3] 11- IN�C!Hj BTTANDPA(RO P{{{L113A�� rFf� (jj( 111MNH6�E nU ekf R�SER�LLARI (MANHOLE AAAef fj� SCELLANEO(5'STORM TOP( 3312 03 330501/2 DRAIN INLET 33050108 EA I EA EA 1 EA t00000W IS 000001 1.000000_ Sd396y�Y? 8 AS18d'i $4,39500 Q IMMISC LLANEOUB STRVC ADJVSTMENT(10'STORM IPBRT BLEMESSyi�N' PIPE 78FT bLE ME 9�E 91GF1 DRAIN INLET I33050108 133460101 _I34T10002 LF WK 1.000000 100000006. 3000000 $494]2� 4110Q $499 dA 41 42 1513E CL`E�A(1RryIaNgGT��('7�(}�� 199990000 6Y 1000000 1.00000 5223�/ 88000000 IGI YA PAVEAIENY AIARKINGOHNDN IGNAGE 2 8" 6LD Pint Marklne HAS IWI 1 6"SLD P-1 Mark no HASM 132170101 I321]0102 LF LF 1 15]90.00000 12020.0000 $180 518� 3 4 6" BRK P_Marking HAS IWL 6" BRK Pvmt MaAino HAS-1 1321]OIOJ 1321]010] LF LF 99000000 '0000000 $180 518� 5 8 8" 6LD Pint Marklne HAS M1NW 12"slnPvml Manion HAF/ 32170201 ]oiol LF LF 4260 00000 240000 $2 30_ 5111 8 9 18"SLD Pwnt Marklne HAEM 24" SLD P.t Markme HAE 1W1 Lana Legend Arrow 321]0401 1321]05.I 321] 1002 LF EA 19000000 15800000 3' 00000� $1006_ 5112 $1812 10 I ......... Only Lana Legend Bike AT- 1]1004 321] 009 EA EA 21000001; 2:00000� U. $181 12 lane Leoentl Bikerow 1321] 1006 EA 2000001; .57 3�/ 13 14 Lana Legend Sbartar la".I."end 18^vwtl Tru"nle rwl 321] 100] 121]101 EA EA 2-00000! 80000001; $842 ]Q- Sd94S 15 18 Reiaetl Marker TY W REFL Raisetl Maker TYII-A-A 321 001 1321]2103 Fh EA 1]000000� 1SO 00000I1 $340 Sd sr 18 RE FL Raised Marker TY II-C-R IS 1Fum15M1/I"smIIRRFe Assembly Double Sitletl f8olarl 321]3104 134411&3 EA EA 14/00000 4.00000r $480 51018d 0�/ 19 Fornl.11Insult Alum ton Gmuntl Mau"t'= 3441400J EA 20000006 $43421 20 21 Remove Sio" Panel antl Post Remove antl Remaull Slen Panel and P_ 13441 I108 13441411 EA EA 4.000OOr 2.00000� 5106 31 $543 - 22 23 FumisM1/Insult Alum Sion MaM Arm Moun FurnlaM1llnaull Alum Sion E. Pale MDon11 3441 I001 134414004 EA EA 2.000OOr 1500000� 582395 $54860 24 Pavement Ma .. Co"stmcio" Allowance LS 1.000006- $20000 Oe am, $33.275 5238 865 $11 3]5 53]450 $1? 141 844 fifi0 $a 958 810990 $11 Sd 12020 .2 3350. 58 C InN miry 200000( 7-OODOIX 7 866 88000t 8025 18I- 1496s 33- 35000( 43 55000t 2471 31s0 03000( 513450Oct 850000 , 35108 5100IX 34598 510M 2 000Z 212 5 95000( 120009 0( $25]0320 8 $a 39500 $494129 $1 100 $514159561980308 B14 S223 $000 $25264146 519232001 $1 420 $]9014075 $ 5175'0W 11 46 S0838 $d 983T $a "1l Se 932 5 � $128540J 5296]0((II�� $5]800J 591200((ffI 179 $e]2. 1417380((((U II11�� 2 $808520J. 0 Sdn dd�((f77�I 24 8108]9 5166] I 8822900/ 15 $4543980 492812] 94 $2556] 8 5858659 $35 5' 5] 5115 236 89 $513 ]1 SS ]0889 $1882218 Liam T.M .r $480227 32 5 $121 832960 53930 818 ]00 00 3$2S1 8261 50 $11 COB 98 $e388 ]O $6 99] 90 Si 4. SG $23,46580 31]8128U $8]200 $1,3. Q $8392 50 Contractor's Application µgLcm""NumSer 12 Final Avvlwro"Daa 11/132023 Pr 11ed W. Veue 36is P-d MSI:d I IO % Bila"wto vnd 5t ve G P,,.Wr (B-P) yW C)y .+� B 42 0. I 1200011 2111 JJ 31000 001 84643888J $48.439.B1\1398A $13.16480 33858859HHH1HHH $$65865.9U 2293� 3d86159011I S$152388tl 50011 � $115.236.86 2580� 3]05]8891 $395800 510990001 8513] J SS]068 $513]1 .... $5]O68A 484069I 31586391 81S 4.c8 38848805 724% $JS 86468.05 24% $86468.05 1050°� 1711 $511805 3452E- $2 52500 $13.74736 $13.]4].31 2471% 521.3S2S0 $819238 $34,368 $3d.SSSSIL 425% 5136' 001 US 497. $61439IS $000 $81,43989 798% 563 0001 $1556011 $480227 S2 8000 $480.227.32 786% $4395001 $1.A.t'8 318d8 $1648.6 '000° J $3930oUof�I 500? $39300 101099J 3290950J $18.]0098 52989 $18.]OO.0' 141T86� $2 SOS. 2100°� $550000I 3158818 $26150 $O 00 $28150 8O% $4 133'1 512 690 001 $2,78000 $2.78000 139% $17,220001 $11,40% $11.406.96 750% 5109851 43332 1 $5 39d "501 $SC9300 US.]O $8.888 70 37 5% 5166801 814014 50 $d 39566I $4 94] 28I $6997 9O 514. $8.99] 91, 48 ]% $14495U 850% 51100001 $] 99] 60 5]8011 880 000 00 823C858$ $23.485.B1\ 829% 81 ]9840 31]8128 � $1i 612.811 918% 3181.201 $B]21 31800 M(7I $8]201, 424% $16000U '000.,� $912.1 $8392. $3.39250 34 A% $6 C65501 5221001 8109008 $1.89008_ 884% "'M1 312892 $808] 50 $1289?50 ]35% $BBB] 50 1000°: 54657501 $4 511 T) Sa sai zk io60°�A 58932 � $893250 1000°J $128560J $1.2854" 10008GA 52967 $5.. $296]OU 1000° $50881, 8]8% $7140 58592 J $8592U .2% 35280II 3203680U�� $20368.00 500%. SB]2 OOI $2036800 $808520� $8,11121, 1100 JJJ 8108]dd6(07Jf7 $108]Bl\ 1,00°�A 316' $8.22800 $164]9U 1000° $822900 100t This dawmenr M1anbem nudr6ed fiom nab. d form eaw Y d10 1m ."d rh<unerE.."orbi�ligM11 rbe moAO<ano"a You a.e mwu.Peed ro natl Netlowrta"r artNllY and co"aulr Legl Cowin P"orronn execum" Progress Estimate 57922 PO`1t0"18L1i 2021 HMAC 2 N. Riverside fir Resurfacing o"Y�I rv°m aPPluvu"P,"oa- 10/5/2023-11/09/23 A e � Iien Bid Yam No B P Sxmn No Uml ofMeenure Btl Quenery Bnrt Price Bitl Veloe C Nnrellal nary Contractor's Application nPvlum""Numder 12 Final n E F G P VelNIA I aila"ceto F�meh Me�vly Prazwlly � Veloe y mlletl Ve oe TM1isrnotl 81 lnul " 1 le B (B F) N' BI 11523A5889 51.52365889 5000 51.523A58.89 892% 1IM YYe 25J This dawmeni M1ubem mod�Eea fion, GIs o"d"ilfo.m m en Netldedowed Ih<unerd�d "bidaiBM1r ibe moAS<ano"a You a.e mcomv8ed to natl ow"ml artNllY a"d —14,Ipl Cowin 1 P"oriovn execum" C620 Change Order Progress Estimate Construction Allowance Usage ADDITIONS For (rono-act): 102877 2021 HMAC 2 N. Riverside Dr Resurfacing C'ty S"re , 57922 Contract Nnm Applma°°" Pmnd 10/5/2023-11/09/23 Item Item Number Description Totals B C ty to Add Specification QuantiUnitl . Addition Value Estimated Quannty Section No Unit ofMeawre hvatallN D W.W P masly 1-11ed Valve E Valve This Matmala Presently Pamd StorN (mtm C) Contractor's Application 12 Mnal 11/13/2023 F Tool Completd % Balance. Finish aM 3t=b Date (F) (B-P) D+E) B This documrnl has barn moMfled bum its original form ea an BICDC dowmeot and the user dldoo[ Idghlight the modifications.Vou 11 rnworaged to read the document ca Wly and —It Legal C-1 prior to its execution. C-620 Change Order Progress Estimate Construction Allowance Usage CONSTRUCTION ALLOWANCE ITEMS TO BE REDUCED Fm (—,t): 102877 2021 HMAC 2 N. Riverside Dr Resurfacing Appuwbon I-ed: 10/5/2023-11/09/23 A B C Item BsII—Number Desunptmn S-fiwcion Unit of Measure Q..ity.Delete Unic lhice Reduction Value NM Used Sation No. I I I I I I I I I I I I I I I I I I I I I I I I I I I I I Totals Applswfion Number: Appbwfion Date: D E Not USN NM Used NM Used Not USN Contractor's Application 12 Final 11/13/2023 F Not Used NM Used Nat Us rn�s daumwl nas hern momnN fiom ns od�nal roan ea an elcDc aowmwt aoa me user manor lagnngnt the modifications. Voa 11 en 11r d.read.¢aaumenc carefully and —It Legal Couruel prior. its execution. C-620 Change Order Progress Estimate Change Order Number 1 1 ADDITIONS For (wntran0 102877 2021 HMAC 2 N. Riverside Dr Resurfacing city $ecrecary Cl— N— 57922 Appheatron Pend 10/5/2023-11/09/23 A B C D Item A.— EstimatedQuantrty Prenoasly Change Order Item Description Sp ficatmn UnitofMeawre COQoantiryto Add Unic Puce Change Order InsreIIN VaWe In11a Value No. S--No Value 43 ove end Reoiece xurorre Toes 11-111 -6tdu real mcurb TPW EA 10.00000000 11-115.00 111-150.00 10.00WWW 111-150.00 $16.150.00 44 Remave and —I..cmb and¢ utter lbr h--tiles TMLF 1200000WW $15500 $19,60000 1107000WW $17,15850 $17.15850 45 Rem—nd reolace 10 Fc. Inlet Too finclodine 2 ft wall) TPW EA 1.00wwo $10.555.56 $10.555.56 1.00wwo $10.555.56 $10.555.56 Touts $45,30556 $43.964.06 $43,864.06 Value This Pa.ad Contractor's Application 12 Final 11/13/2023 F Tool Completed Balance to Finish and Sb .Date (F) (B-F) MI E) B $16.150.00 100.0% $17,15850 923% $1.441.501 $10.555.56 100.0% $43.964.06 968% $IA41.501 This documwl has bern moMfled bom its original form ea an E1CDC dowmeot and the user didoo[ highlight the modifications. Vou 11 enworaged W read the document—lWly and —It Legal C-1 prior to its execution. C-620 Change Order Progress Estimate Change Order Number 1 1 DELETIONS E, (rottrract): 102877 2021 HMAC2 N. Riverside Dr Resurfacing Appl.ea°°" Pe"°d 10/5/2023-11/09/23 A B C Item CO Q.""to Dd...Gunge Ord, Item D.ipnon S-tfi-lion Unit of Measure Dele[e Unit Pace Change Order Nol Ure No. S,tion No. Valve I I I I I I I I I I I I I I I I I I I I I I I I I I I I I Totals Appliarion Number: AMI—tan Date D E Not USN Not Used N.Ure Nor Used Contractor's Application 12 Final 11/13/2023 P Not ure Not ure N. UsN rn�e daumwl na. bern momnN 6om ne original rorm ea an BICDc aowmwt aoa me user manor lagnngnt the modifications. Voa 11 en 11,cdroread the aaumenc carefully and —It Legal Couruel prior to its execution. C- 20 Change Order Progress Estimate Change Order Number 1 2 Contractor's Application ADDITIONS For(--) 102877 2021 HMAC 2 N. Riverside Dr Resurfacing City Secretary ApplscanOn Number 12 Final C-1 Num: 57922 Appl"°tr°n Pe,°a 10/5/2023-11/09/23 ^PPI'w1an Date 11/13/2023 A B C D E F Item Balavicem Finish Addition Change Estimated Quantity Previously Value This M1lateruls Presently Total Completed % B ( P) CM1ange Order Item D—h'. Speci-in Uvit of Measure CO Quantity m Add P Umt Mn Order Value Installed Value InAallei Value Perlod StorN (votmC) aMStorN to Date M No, Section No. (D+E) B Um12-New 25 Fumishllristall-1 Assembly Double Sided(Solar) with svread four EA 2.00000000 $13.645.54 $27291.08 2.00000000 $27291.08 $27291.08 $27.291.08 100.0% Tatals $27.291.08 $21191.08 $27.291.08 $27.291.08 IWO% This document has bern moMfled bom its original form es an EICDC dowmevt and the user dldno[ M1lghlight the modifications. Vo" 11 enwuraged to read the document carefully and wnsult Legal Couruel prior to its execution. C-620 Change Order Progress Estimate Change Order Number 1 2 DELETIONS F° (convaot). 102877 2021 HMAC 2 N. Riverside Dr Resurfacing AwI'whmt P-ed` 10/5/2023-11/09/23 A B C Item CO Quanaty to Delwou Change Change Ord, item DacriphOn S-fiwcion Unit of Measure Dele[e Unit Pnce Order Value Noc Used N. S,tion No. Umt2.l-18 FumiaMnatallR B Assembly Doable Sided lSolarl EA 200000000 $10.1844 $20.j,6800 Umt2.=4 Pavement Markin¢ Construction Alle_M EA 0.34615400 S20.000.06 $6.23.0br Totals SM291.09 Apphcarion Number: Application Date: D E NM Used Not Used N. Used Noc Used Contractor's Application 12 Final 11/13/2023 F NM Used NN Used N. Uaed This documwl has bern moMfled fiom its original form es an FJCDC dowmeor and the user didoo[ Idghlight the modifications. Vou 11 enwuraged ro read the document carefully and wnsuh Legal Couruel prior to its execution. City Secretary Contract Num: 57922 Application Period: Funding Identification (FID) On inal Contract 30100-0200431-5740010-102�'/-006280-9999 0 0 0 0 0 0 0 0 0 0 Changye Order 1 30100-0200431-5740010-102877-006280-9999 0 0 0 0 0 0 0 0 0 0 Change Order 2 30100-0200431-5740010-102877-006280-9999 0 0 0 0 0 0 0 0 0 0 City of Fort Worth Summary of Charqes 2021 HMAC 2 N. Riverside Dr Resurfacing P. 0.: FW020-0000008191 10/5/2023-11/09/23 Application 12 Final Number: Total Completed Amt Remaining Gross $1,523,456.89 $184,226.25 $0.00 $43,864.06 $1,441.50 $27,291.08 ($27,291.08) Project Number: 102877 Application Date: 11/13/2023 Retainage Net $0.00 City of Fort Worth Summary of Charqes City Secretary Contract Num: 57922 2021 HMAC 2 N. Riverside Dr Resurfacing P. p, ; FW020-0000008191 Application Period: I 10/5/2023-11/09/23 I Application I 12 Final Number: Funding Identification (FID) I Chan a Order 3 130100-0200431-5740010-10287 _006280-9999 10 10 10 10 10 10 10 10 10 10 I I Chan eOrder 4 130100-0200431-5740010-10287 _006280-9999 10 10 10 10 10 10 10 10 10 10 I I Changge Order 5 130100-0200431-5740010-102877-006280-9999 10 10 10 10 10 10 10 10 10 10 I Total Completed Amt Remaining Gross Project Number: 102877 Application Date: 11/13/2023 Retainage Net City of Fort Worth Summary of Charqes City Secretary Contract Num: 57922 2021 HMAC 2 N. Riverside Dr Resurfacing P. p, ; FW020-0000008191 Application Period: I 10/5/2023-11/09/23 I Application I 12 Final Number: Funding Identification (FID) I Chan a Order 6 130100-0200431-5740010-10287 _006280-9999 10 10 10 10 10 10 10 10 10 10 I I Chan a Order 7 130100-0200431-5740010-10287 _006280-9999 10 10 10 10 10 10 10 10 10 10 I I Changge Order 8 130100-0200431-5740010-102877-006280-9999 10 10 10 10 10 10 10 10 10 10 I Total Completed Amt Remaining Gross Project Number: 102877 Application Date: 11/13/2023 Retainage Net City Secretary Contract Num: 57922 Application Period: Funding Identification (FID) Totals 30100-0200431-5740010-102877-006280-9999 0 0 0 0 0 0 0 0 0 0 City of Fort Worth Summary of Charqes 2021 HMAC 2 N. Riverside Dr Resurfacing I. 0.: FW020-0000008191 project Number: 102877 10/5/2023-11/09/23 1 Applicatipon Number: 12 Final Application Date: 11/13/2023 Total Completed Amt Remaining Gross Retainage Net $1,594,612.03 $158,376.67 $0.00 $0.00 Grand Total 1 1 $1,594,612.03 1 1 $158,376.67 1 1 $0.00 1 1 ($79,730.60)1 1 $79,730.60 1 FORT WORTH, Routing and Transmittal Slip Transportation and Public Works Department DOCUMENT TITLE: 2021 North Riverside Resurfacinq Proiect, CO 1 M&C CPN 102877 CSO # 57922 DOC# DATE: 12/1/2022 INITIALS DATE OUT To1,Alexiz Ramirez Dec 22022 Texas Bit — Macabe Faulkner Dec 2, 2022 2 s.Tamara Vaughn (Inspector) Dec 6, 2022 4.Tariqul Islam (PM) % Dec 2, 2022 5 Omar Elbagalati (PGM) ° Dec 6, 2022 6 Leon Wilson (Interim SCPO) Dec 6, 2022 7. Michael Owen (Interim AD) Dec 6, 2022 s Lauren Prieur (Interim Director) Dec 6, 2022 g Doug Black (ACA) v44 Dec 7, 2022 10. William Johnson (ACM) IWj Dec 9, 2022 11, Jannette Goodall (CS) C)?1a Dec 9, 2022 DOCUMENTS FOR CITY MANAGER'S SIGNTURE: All documents received from any and all City Departments requesting City Manager's signature for approval MUST BE ROUTED TO THE APPROPRIATE ACM for approval first. Once the ACM has signed the routing slip, David will review and take the next steps. NEEDS TO BE NOTARIZED: U Yes❑✓ No RUSH: ❑Y ❑✓ SAME DAY: ❑Yes ❑✓ No NEXT DAY: []Yes ❑✓ No ROUTING TO CSO: ❑✓ Yes ❑No Action Required: ❑ As Requested ❑ Attach Signature, Initial and Notary Ta ■ Signature/Routing and or Recording ❑ Comment ❑ File Return to: Please call at ext. for pick up when completed. Thank you. CSC No. 57922-COl Fox_ T� x; Project Namel 2021 North Riverside Resurfacing Project Client Project #(s)I 102877 City of Fort Worth Change Order Request City Sec # I 57922 Project Description) Street resurfacing and signage improvement at N. Riverside Dr from 200 ft south of Clary Ave to NE 28th St Contractorl Texas Bit Change Order#I 1 1 Date 12/1/2022 City Project Mgr.l Tariqul Islam City Inspector Tamara Vaughn Dept Original Contract Amount Extras to Date Credits to Date Pending Change Orders (in M&C Process) Contract Cost to Date Amount of Proposed Change Order Revised Contract Amount Original Funds Available for Change Orders Remaining Funds Available for this CO Additional Funding (if necessary) TPW $1,707,683.14 Contract Time Totals (CD) $1,707,683.14 180 CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS % OF ORIGINAL CONTRACT 2.65% MAX ALLOWABLE CONTRACT AMOUNT (ORIGINAL CONTRACT COST+ 15%) $2,134,603.93 JUSTIFICATION (REASONS) FOR CHANGE ORDER This change order is to add $45,305.56 dollar and 28 calendar days to contract # 57922. During construction, it was identified that, within the project limit of N. Riverside Dr, there are twelve historic curb tiles. Ajoined evaluation of all curb tiles was done by Riverside Neighborhood Association, City's Historic Preservation Office and TPW staff. After evaluation, it was found that all tiles are badly cracked and are very fragile for saving. Considering existing conditions, all parties came to an agreement that out of twelve historic tiles ten of them will be replaced to match with existing as much as possible and best two of them will be saved. A quote was received from contractor for this special type of work and compared with similar work done in City's recent projects. The price for historic tile replacement work was found reasonable. Also, the curb and gutter replacement price was negotiated with contractor and staff considered it acceptable for small amount of concrete pour. This change order also includes removal and replacement of 10 ft curb inlet including 2 ft inlet wall. To prepare and install ten historic curb tiles and replacement of a curb inlet, 28 calendar days are proposed to add to the contract. It is understood and agreed that the acceptance of this Change Order by the contractor constitutes an accord and satisfaction and represents payment in full (both time and money) for all costs arising out of, or incidental to, the above Change Order. The Project/Program Manager signing below acknowledges that he/she is the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. Contractor's Company Name Contractor (Name) 111L, Contract Signature I Date 41 Texas Bit Macabe Faulkner tira�-FaulkG�1—z 1— rAm&o� Dec 2, 2022 acner Inspector/Inspection Supervisor Date Project and Contract Compliance Manager Date 11 c 6, 2022 �- Dec 2, 2022 Program Manager Date 7eDc Senior Capital Project Officer Date 6, 2022 Dec 6, 2022 Assistant Director (Dept) Date Director, Contracting Department (Dept) Date Yr<:&3— Dec 6, 2022 I.L— P Dec 6, 2022 nt City Attorney Date lAssistant City Manager Date L;; Dec 7, 2022 �` Dec 9, 2022 m��Council Action (if required) M&C Number I ATTEST: Jannette Goodall, City Secretary M&C Date Approved FORTWORTH Project Name 2021 North Riverside Resurfacing Project Client Project # 102877 Contractorl Texas Bit City of Fort Worth Change Order Additions I I EM DESCHIP I ION Unit 1 -New 4$ Remove and Replace Historic Tiles 1 mchX1 inch - 6 tiles tall) in Curb Unit 1 -New 44 Remove and Replace Curb and Gu er for historic tiles Unit 1 -New 45 Remove and Replace 10 ft. Inlet Top (including 2 ft wall) City Sec # 57922 ### I lPMl Tariqul Islam Inspectorl Tamara Vaughn O1 Date j 12/1/2022 1 4/28/2022 ADDITIONS DEPI TPW TPW TPW uty Unit Unit Cost I otal 10.0000000U EA $1,615.OU $16,150.00 120.00000000 LF $155.00 $18,600.00 1.00000000 EA $10,555.56 10,555.56 TPW $45,305.56 Sub Total Additions $45,305.56 Change Order Additions Page 2 of 4 ITEM FORTWORTH City of Fort Worth Change Order Deletions Project Name I 2021 North Riverside Resurfacing Project Client Project # I 102877 Contractorl Texas Bit PMI Tariqul Islam DELETIONS DESCRIPTION DEPT City Sec # 1 57922 ### Inspeclorl Tamara Vaughn Date 1 12/112022 4/28/2022 Oty Unit Unit Cost Total I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I TF W $0.001 I I I Sub Total Deletions $0,001 Change Order Deletions Page 3 of 4 M/SBE for this Change Order M/SBE Sub Type of Service Amount for this CO 2021 North Riverside Resurfacing Project 102877 Total $0.00 Texas Bit Previous Change Orders co # DATE AMOUNT Total I $0.00 1 FORT WORTH, Routing and Transmittal Slip Transportation and Public Works Department DOCUMENT TITLE: 2021 North Riverside Resurfacing Proiect, CO 2 M&C CPN 102877 CSO # DATE: 7/13/2023 INITIALS To: Valentina Riera i� 1. Texas Bit — Matthew Harper 2. 3. Eric Tinner (Inspector) % ET ET 4.Tariqul Islam (PM) 5 Omar Elbagalati (PGM)O 6 Mary Hanna (SCPO) W� 7. Patricia Wadsack (AD) PL w PLW s Lauren Prieur (Director) LP g Doug Black (ACA) &b dwb 10. William Johnson (ACM) Wj 11, Jannette Goodall (CS) JS,G JSG 57922 DOC# DATE OUT Jul 14) 2023 Jul 14) 2023 Jul 17, 2023 Jul 15, 2023 J u l 191 2023 Jul 20, 2023 Jul 20, 2023 Jul 21, 2023 Jul 24, 2023 Jul 24, 2023 Jul 24, 2023 DOCUMENTS FOR CITY MANAGER'S SIGNTURE: All documents received from any and all City Departments requesting City Manager's signature for approval MUST BE ROUTED TO THE APPROPRIATE ACM for approval first. Once the ACM has signed the routing slip, David will review and take the next steps. NEEDS TO BE NOTARIZED: U Yes❑✓ No RUSH: ❑Yes ❑✓ No SAME DAY: [:]Yes❑✓ No NEXT DAY: []Yes ❑✓ No ROUTING TO CSO: ❑✓ Yes [—]No Action Required: ❑ As Requested ❑ Attach Signature, Initial and Notary Ta ■ Signature/Routing and or Recording ❑ Comment ❑ File Return to: Please call at ext. for pick up when completed. Thank you. CSC No. 57922-CO2 Fox_ T� x; City of Fort Worth Change Order Request Project Namel 2021 North Riverside Resurfacing Project I City Sec # I 57922 Client Project #(s)l 102877 Project Description) Street resurfacing and signage improvement at N. Riverside Dr from 200 ft south of Clary Ave to NE 28th St Contractorl Texas Bit Change Order #1 2 1 Date City Project Mgr.l Tariqul Islam City Inspector Dept. Original Contract Amount Extras to Date Credits to Date Pending Change Orders (in M&C Process) Contract Cost to Date Amount of Proposed Change Order Revised Contract Amount Original Funds Available for Change Orders Remaining Funds Available for this CO Additional Funding (if necessary) TPW $1,707,683.14 $45,305.56 7/13/2023 Eric Tinner Contract Time Totals (CD) $1,707,683.14 180 $45,305.56 28 CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS % OF ORIGINAL CONTRACT 2.65% MAX ALLOWABLE CONTRACT AMOUNT (ORIGINAL CONTRACT COST+ 15%) $2,134,603.93 JUSTIFICATION (REASONS) FOR CHANGE ORDER This change order is to add $0 dollar and 73 calendar days to contract # 57922.1.The plan called for installation of Rectangular Rapid Flushing Beacon (RRFB) at NE corner of Hollis SUN. Riverside Dr and SE corner Honeysuckle/N. Riverside Dr intersection. However, during construction it was identified that installation of RRFB with drilled shaft foundation were not possible at these two locations due to existing gas and electrical line. This conflict was resolved by changing drilled shaft foundation with 5ft X 5ft spread foundation. To accomplish the work, a quote was received from contractor and verified with Traffic Management established unit price for similar work, the staff found that contractor's quote was reasonable. The change order added $6,923.08 additional amount to the contract cost and deleted the same amount from construction allowance pay item to make the net change order amount to $0.2.During construction, the Contractor had to stop working until several conflicts were resolved. Due to the type of contract being calendar days, this necessitated to add 73 additional days to contract time as stated below: -Installation of Ped Pole with Push button at Springdale Intersection (25 days): During construction it was identified that N. Riverside Dr and Springdale Dr signalized intersection required installation of pedestrian pole with push button at all four curb ramps to make them ADA compliant. To accomplish this additional work Traffic Management was requested to share cost of the work. Traffic Management came up with their fund to share and completed the work by their preapproved contractor and pre -established unit cost. To prepare the plan and completion of work by Traffic Management the project work was stopped from 1/20/2023 until 2/13/2023. -Supply issue of RRFB and sod (35 days): After completion of all major works contractor notified that they had an issue with their sub to get RRFB with correct materials and supply of sod from their supplier due to persistent wet weather. The work was stopped from 4/19/2022 until 512312022. Contractor's request letter is attached for reference. -Rain/Weather delays (13 days): Experienced more than average yearly rain days and couldn't do any work on the following days: 8/22/2022, 8/23/2022, 8/31/2022, 9/1/2022, 9/2/2022, 10/24/2022, 10/28/2022, 11/4/2022, 11/14/2022, 12/13/2022, 2/14/2023, 3/2/2023 and 3/16/2023. The inspector's log and email communications and weather report pertaining to these delays have been documented. It is understood and agreed that the acceptance of this Change Order by the contractor constitutes an accord and satisfaction and represents payment in full (both time and money) for all costs arising out of, or incidental to, the above Change Order. The Project/Program Manager signing below acknowledges that he/she is the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. Contractor's Company Name Contractor (Name) Contract Signature Texas Bit Matthew Harper „ I Date Jul 14, 2023 Inspector/Inspection Supervisor Date Project and Contract Compliance Manager -�•� Jul 17, 2023 Jul 15, 2023 Program Manager Date Senior Capital Project Officer Date �a Ju119,2023 -- Ju120,2023 Assistant Director (De Date Director, Contracting Department (Dept) Date Ju120, 2023 Jul21, 2023 Date Assistant City Manager Date Lss,,stanl..C,it,,Attome Ju124,2023 Ju124,2023 Council Action (i M&C Number I ATTEST: a . .. Jannette Goodall, City Secretary M&C Date Approved FORT WORTH City of Fort Worth Change Order Additions Project Name 1 2021 North Riverside Resurfacing Project Client Project # 1 102877 Contractorl Texas Bit I PMI ADDITIONS I I EM DtSGRIP I IUN DEP I Unit 2 -New 25 Furnish/Install RRFB Assembly Double Sided(Solar) with spread foundaiton TPW City Sec# 1 57922 1 ### I Tariqul Islam Inspectorl Eric Tinner I Ragle, Inc. 0 Date 1 7/13/2023 1 4/28/2022 Qty Unit 2.00000000 EA Umt cost I otal 1 $13,645.54 $27,291.081 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I TPW $27,291,081 I I I I I I Sub Total Additions $27,291.081 Change Order Additions Page 2 of 4 FORTWORTH City of Fort Worth Change Order Deletions Project Name 1 2021 North Riverside Resurfacing Project City Sec # 1 57922 1 ### Client Project # 102877 1 Contractorl Texas Bit I PMI Tariqul Islam I Inspector Eric Tinner Ragle, Inc. F--2 Date 1 7/1312023 4128/2022 DELETIONS ITEM I DESCRIPTION DEPT Oty Unit Unit Cost Total 1 Umt2,Item1drunmshllnslall KKFB Assembly Double Sided (Solar) I PW 2.00000000 to $10,184.00 $20,368.001 Unit2,ltem24[Pavemenl Marking Construction Allowance TPW 0.34615400 EA $20,000.00 $6,923.081 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 TF W I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I 1 I $27,291.081 1 Sub Total Deletions 1 1 $27,291.081 Change Order Deletions Page 3 of 4 M/SBE for this Change Order M/SBE Sub Type of Service Amount for this CO 2021 North Riverside Resurfacing Project 102877 2021 North Riverside Resurfacing Project Total $0.00 Previous Change Orders co # DATE AMOUNT 12/7/2022 $45,305.56 Total I $45,305.56 FORTWORTH. TRANSPORTATION AND PUBLIC WORKS November 13, 2023 Texas Bit,Texas Materials Group 420 Decker Drive, Suite 200 Irving,Tx 75062 RE: Acceptance Letter Project Name: North Riverside Dr Pavement Marking & Singnage Impr Project Type: 03 City Project No.: 102877 To Whom It May Concern: On June 5, 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 November 6, 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 November 6, 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- 880-4257. Sincerely, Tariqul Islam (Dec 8, 202311:43 CST) Tariqul Islam, Project Manager Cc: Eric Tinner, Inspector Wade Miller, Inspection Supervisor Ariel Duarte , Senior Inspector Riad Nusrallah, Program Manager N/A, Consultant Texas Bit, Contractor N/A, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev. 8/20/19 AFFIDAVIT STATE OF TEXAS COUNTY OFTARRANT Before me, the undersigned authority, a notary public in the state and county aforesaid, on this day personally appeared Donnie Blackburn, Vice President of Texas Materials Group, 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 anti/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; 2021 NMAC 2 N. Riverside Dr Resurfacing CPN 102877 BY Donald Blackburn Donnie Blackburn GM/Vice President Texas Materials Group, Inc. JNPUBLIC N �2rn 2023. Subscribed and sworn before me on thi JAMIE GREENWAY%`Notary Public, State of Taxes Comm. Expires 09.25.2024 I AND FORD Notary ID 12115454UNTY, TEXASMy commission expires ` CONSENT OF SURETY OWNER TO FINAL PAYMENT ARCHITECT -_ CONTRACTOR _ AIA Document G707 SURETY (Instructions on reverse side) Bond No. 014249306 OTHER TO OWNER: ARCHITECT'S PROJECT NO: (Name and address) City of Fort Worth 200 Texas Street CONTRACT FOR: Forth Worth, TX 76102 2021 North Riverside Resurfacing Project, City project No. 102877 PROJECT: CONTRACT DATED: .rune 14, 2022 (Name and address) 2021 North Riverside Resurfacing Project, City project No. 102877 In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the (Insert name and address of Surety) Liberty Mutual Insurance Company 175 Berkeley Street Boston, MA 02116 —SURETY, on bond of (Insert name and address of Contractor) Texas Materials Group, Inc. dba TexasBit, A CRH Company 420 Decker Drive #200 Irving, TX 75062 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 (Insert name and address of Owner) City of Fort Worth 200 Texas Street Forth Worth, TX 76102 OWNER, as set forth in said Surety's bond. IN WITNESS WHEREOF, the Surety has hereunto set its hand on this date: (Insert in writing the month followed by the numeric date and year.) Attest/Witnes ---[� (Seal): Bonnie Rice, Witness November 29, 2023 Liberty Mutual Insurance Company (Surety) (Signature of authorizi(d epreseniative) T Carolyn E. Wheeler, Attorney -In -Fact (Printed name and title) AIA DOCUMENT G707 w CONSENT OF SURETY TO FINAL PAYMENT w 1994 EDITION w AIA 01994 w THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, NW, WASH- INGTON, D.C. 20006-5292 w WARNING: Unlicensed photocopying violates U.S. copy- right laws and will subject the violator to legal prosecution. G707-1994 This Power of Attorney limits the acts of those named herein, and they have no authority to Liberty bind the Company except in the manner and to the extent herein stated. Mutual. Liberty Mutual Insurance Company SURETY The Ohio Casualty Insurance Company Certificate No: 8204866 West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana (herein collectively called the "Companies', pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Carolyn E. Wheeler all of the city of - Knoxville state of Tennessee each individually if there be more than one named, its true and lawful attomey-in-fact to make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 15th day of February, 2021. Liberty Mutual Insurance Company The Ohio Casualty Insurance Company P� 1NSU'D P014 INS& � 1NSUq West American Insurance Company jooaPo� oyn� �J ooaPo�>�yn `VP`oaro&re'LF %� 1912 0 1919 1991 >s �o : �o a o By: rd,�9�sacttuee aa3 Sp �y"haMPs� aa� �s �Notna� aa� David M. Carey, Assistant Secretary m STATE OF PEN NSYLVANIA ss - @ COUNTY OF MONTGOMERY 15 15 Co M On this 15th day of February, 2021, before me personally appeared David M. Carey; who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance Company, N The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes therein p � contained by signing on behalf of the corporations by himself as a duly authorized officer. N > — IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at King of Prussia, Pennsylvania, on the day and year first above written. 7 91' PAST pC - �? � °"Wear <e Commonwealth of Pennsylvania - Notary Seal //�,� ,�, '� ,�, ,� '� ti u s v Teresa Pastella, Notary Public .1�.vLlk�� — oP Montgomery County aj O My commission expires March 28, 2025 By 4 O 4) 1 ��+ Commission number 1126044 Teresa Pastella, Notary Public C 03 4Ry Member, Pennsylvania Association of Notaries ai This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows: w ARTICLE IV - OFFICERS: Section 12. Power of Attorney. Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the ai President may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety o ca any and all undertakings, bonds, recognizances and other surety obligations. Such attomeys-in-fact, subject to the limitations set forth in their respective powers of attorney, o shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such M C: instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attomey-in-fact under the > m provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. ' �i ARTICLE XIII - Execution of Contracts: Section 5. Surety Bonds and Undertakings. Z c Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe, shall appoint such attomeys-in-fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact, subject to the limitations set forth in their respective powers of attomey, shall have full power to bind - the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation -The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attomeys- infact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Authorization - By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with the same force and effect as though manually affixed. I, Renee C. Llewellyn, the undersigned, Assistant Secretary, of Liberty Mutual Insurance Company, The Ohio Casualty Insurance Company, and West American Insurance Company do hereby certify that this power of attorney executed by said Companies is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 29th day of November 2023 P� 1NSLI POSY INS& 1NSUgq Jr,ORP ok1T yn� �J�opaP or�r RgyC+ `VP aaoRyro Ica I ��///� � 1912 � 0 1919 � � 1991 �° By: d� ss<cr.us` a��+aMPs'� da fs 'Noma► ds Renee C. Llewellyn, Assistant Secretary Marsh MSurety POA LMIC OCIC WAIC Multi Co 022021 ` ) o a .r U Cr m c� c a 1_ a Q � a= C .f Q Lo oq L N 19 a) O� cce) o0 o' CD cCD M— a 0 a) L Q Q) u" a