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Home My WebLink AboutContract 45077-FP1 e J FORTWORTH. CITY SECTARY CONTRACT NO, d - -1 Received By Business support Groin Brandy Crane TRANSPORTATION AND PUBLIC WORKS AUG 0 5 2015 NOTICE OF PROJECT COMPLETION D.O.E.Ns: 7124 Regarding contract 45077 for HMAC SURFACE OVERLAY(2013-16)as required by the TRANSPORTATION)AND PUBLIC WORKS DEPARTMENT as approved by City Council on 10/22/2013 through M&C C-26525 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: $1,336,606.22 Amount of Approved Change Orders: Ns 1 Revised Contract Amount: $1,336,606.22` Total Cost Work Completed: $1,333,274.73-- Less 1,333,274.73`Less Deductions: Liquidated Damages: Days Q$210.00/Day Pavement Deficiencies: Total Deduction Amount: $0.00 Total Cost Work Completed: $1,333,274.73 Less Previous Payments: $1,266,610.99 r Final Payment Due $66,663.74 Recommended or Acceptance Date Asst. D` ctor, TPW - Infrastructure Design and Construction LJ L) AcceptedDate Directo , Ic TRANSPORTATION AND PUBLIC WORKS DEPARTMENT Asst. City Manager Date 5912Oo Comments: FUND ACCT:0293-209620217883 �L% �� :� , SLG OFFICIAL RECORD CITY SECRETARY RECEIVED SEP 3 01015 FT. WNTHiTX 11 TPW Construction Invoice 141 11 Cm&act CS45M P.O.# PO-15-86952,PO-14-80254 Payment Date: 6/15/2015 TO:JL.B Conbutim LLC 11w•# CS51i -,,-F�EW^L Estimate No. 37 DOE: 7124 P O Baal 24131 ProjManaW Kristian Sugrim Fart Warta TX 76124 FOR: HMAC Surface Overly 2013-16 ACH Contract Amount $1,336,606.22 Total to Date: $1,333,274.73 $0.00 $1,333,274.73 Previous Estimate: $1,333,274.73 $66,663.74 $1,266,610.99 Earned to Date: $0.00 ($66,663.74) 566,663.74 payer liS3 S1,336,60622 Total to Date: $1,333,274.73 $0.00 $1,333,274.73 Previous Estimate: $1,333,274.73 $66,663.74 $1,266,610.99 Earned to Date: $0.00 ($66,663.74) $66,663.74 Transportation&Public Works BUSYNESS SUPPORT GROUP Contact Person-BRANDY CRA -EsL 2852 Depanmcnt Approv e,-- KAREN KAREN STRIKER DEPARTMENT CHECK PICK-UP YES ❑ Mondry,August 17,2015 Page I of 1 City Project Numbers 02178 DOE Number 7124 Contract Name HMAC SURFACE OVERLAY(2013-16) Estimate Number 37 Contract Limits AT VARIOUS LOCATIONS Payment Number 37 Project Type PAVING For Period Ending 6/152015 Project Funding { Project Manager Sugim City Secretary Contract Number. 45077 Inspectors RODGERS / MASON Contract Date 10222013 Contractor JIB CONTRACTING,LLC. Contract Time 150 CD PO BOX 24131 Days Charged to Date 374 CD FORT WORTH, TX 76 124-1 13 1 Contract is •000000 Complete CrrY OF FORT WORTH SUNIlVIARY OF CHARGES Line Fund Account Center Amount Gross Retainage Net Funded Total Cost of Work Completed $1,333,274.73 Leu %Retained $0.00 TPW Const. Services Net Earned $1,333,274.72 DOE# , Date r Project anagerWCN�nad' tN�. � ) Earned This Period 566,663.73 Risk Management S. / Retainage This Period $0.00 D.O.E. Brotherton ' Less Liquidated Damages CFA Westerman/Scanned 11 0 Days(@ $0.00 /Day $0.00 LessPavemeot Deficiency $0.00 The proceeding people have been Contacted concerning the request Less Penalty $0.00 for final payment&have released this project for such payment Less Previous Payment $1,266,610.49 Clearance Conducted By Etta Racy Plus Material on hand Less 15% $0.00 Balance Due This Payment $66,663.73 Tizanby.June 18,20I5 Page 5 of 5 FORT NORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name HMAC SURFACE OVERLAY(2013-16) Contract Limits AT VARIOUS LOCATIONS Project Type PAVING City Project Numbers 02178 DOE Number 7124 Estimate Number 37 Payment Number 37 For Period Ending 6/15/2015 CD City Secretary Contract Number 45077 Contract Time 15CED Contract Date 10/22/2013 Days Charged to Date 374 Project Manager Sagrim Contract is 100.00 Complete Contractor JLB CONTRACTING,L.L.C. PO BOX 24131 FORT WORTH, TX 76124-1131 Inspectors RODGERS / MASON Thursday,June 18,2015 Page 1 of 5 City Project Numbers 02178 DOE Number 7124 Contract Name HMAC SURFACE OVERLAY(2013-16) Estimate Number 37 Contract Limits AT VARIOUS LOCATIONS Fayment Number 37 Project Type PAVING For Period Ending 61152015 Project Funding PAVING Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total __ ___ _---- I _1 MISCELLANEOUS ADJUSTMENTS(UTILITIES) 1 LS $6,000.00 $6,000.00 0244186 $1,465.12 2 REMOVE CONCRETE CURB&GUTTER 10202 LF $3.30 $33,666.60 13366.5 $44,109.45 3 7'CONCRETE CRUB&GUTTER 11824 LF $18.75 5221,700.00 16394 $307,387.50 4 REMOVE CONCRETE DRIVEWAY 7371 SF $2.20 $16,21620 8727.67 $19,200.87 5 6'CONCRETE DRIVEWAY 7651 SF $5.00 $38,255.00 11027.67 $55,13835 6 REMOVE SIDEWALK 1140 SF $1.10 $1,254.00 287935 $3,16729 7 4'CONCRETE SIDEWALK 1140 SF $4.40 $5,016.00 332735 $14,640.34 8 REMOVE CONCRETE VALLEY GUTTER 329 SY $29.75 $9,787.75 158.35 $4,710.91 9 6"CONCRETE VALLEY GUTTER 509 SY $59.55 $30,310.95 224.56 $13,372.55 10 8'PAVEMENTPULVER17-ATION 48109 SY $3.60 5173,192.40 37063.31 $133,427.92 11 ROADBOAD ENI SOIL STABILIZER 376 GA $110.00 $41,360.00 281 $30,910.00 12 CEMENT MODIFICATION(13LBS/SY) 313 TN $111.00 $34,743.00 249.08 $27,647.88 13 PAVEMENT WEDGE MILLING(2'TO 0"DEPTH, 8834 SY $1.93 $17,049.62 3906.67 $7,539.87 5-WIDE) 14 CRACK SEALING OF EXISTING PAVEMENT 88 GA $27.00 $2,376.00 189 $5,103.00 15 ASPHALT PAVEMENT TYPE D 63294 SY $8.81 5557,620.14 61933.8 $545,636.78 16 WATER VALVE BOX ADJUSTMENTS 9 EA $130.00 $1,170.00 4 $520.00 (W/STEEL RISER) 17 WATER VALVE BOX ADJUSTMENTS(WITH 18 EA $220.00 $3,960.00 23 $5,060.00 CONCRETE COLLAR) 18 UNCLASSIFIED STREET EXCAVATION 220 CY $19.60 $4,312.00 236 $4,625.60 19 CRUSHED LIMESTONE 20 CY $88.00 $1,760.00 20 ASPHALT PAVEMENT LEVEL-UP 10 TN $150.00 $1,500.00 21 ASPHALT PAVEMENT BASE REPAIR 14 CY $240.00 $3,360.00 45.5 510,920.00 22 MANHOLE ADJUSTMENTS(W/STEEL RISER) 16 FA $255.00 $4,080.00 5 $1,275.00 23 MANHOLE ADJUSTMENTS(WITH CONCRETE 36 FA $440.00 $15,840.00 28 $12,320.00 COLLAR) 24 PAINTING HOUSE ADDRESSES 127 EA $19.00 $2,413.00 251 $4,769.00 25 BLOCK SOD REPLACEMENT 1941 SY $7.16 $13,897.56 2504.58 $17,932.79 26 REMOVE/REPLACE 30'SPEED CUSHION 4 FA 52,290.00 $9,160.00 (WITH STRIPPING) 27 BUTT JOINT-MILLING 10 EA $275.00 $2,750.00 11 $3,025.00 Thursday,June 18,2015 Page 2 of 5 City Project Numbers 02178 DOE Number 7124 Contract Name HMAC SURFACE OVERLAY(2013-16) Estimate Number 37 Contract Limits AT VARIOUS LOCATIONS Payment Number 37 Project Type PAVING For Period Ending 6/152015 Project Funding 28 MISCELLANEOUS ADJUSTMENTS(WATER 2 EA $38.00 $76.00 METER BOX) 29 REMOVE ADA RAMP 2 EA 5220.00 $440.00 30 ADA TAMP 5 EA $1,100.00 $5,500.00 9 59,900.00 31 REMOVE 10'CURB INLET TOP 2 EA $550.00 $1,100.00 32 10'CURB INLET TOP 2 EA $1,100.00 $2,200.00 33 MISCELLANIOUS CONSTRUCTION 1 LS $74,540.00 $74,540.00 0.663664 $49,469.51 Sub-Total of Previous Unit $1,336,60622 $1,333,274.72 Thursday,Juac 18,2015 Page 3 of 5 City Project Numbers 02178 DOE Number 7124 Contract Name HMAC SURFACE OVERLAY(2013-16) Estimate Number 37 Contract Limits AT VARIOUS LOCATIONS Payment Number 37 Project Type PAVING For Period Ending 6/15/2015 Project Funding Contract Information Summary Original Contract Amount $1,336,60622 Change Orders Change Order Number 1 $0.00 Total Contract Price $1,336,60622 Date )� Total Cost of Work Completed $1,333,274.73 Con to Less •/.Retained $0.00 f ��s Net Earned $1,333,274.72 Date InspecKion Supervisor Earned This Period $66,663.73 Retainage This Period $0.00 Date �g 5 Less Liquidated Damages Project M Days •Day $0.00 Date LTi LessPavement Deficiency $0.00 irector/CPW-Infrastructure Design and Construction Less Penalty $0.00 LJ. Date �> Less Previous Payment $1,266,610.99 Direct Contracting Departrnen Plus Material on Hand Less 15% $0.00 Balance Due This Payment $66,663.73 Thursday,lune 18,2015 Page 4 of 5 BuySpeed Online httpsJ/bso.fortwor ftov or&%Wdocument/Wmval/docApproval-silo Buy Ta Online Accounts Payable Basic Purchasing Deparbnent Access MGP Coda Browse I My Account I Customer Service I Co.a. O►ysnfatbntC OF FORT WORTH August 18,2016 7:04:01 AM CDT P Q40 About r----_ ____. None Dom BrandyCnuu Invoice#: CS45077-FINAL Vendor#:0000016042 Vendor Group#:01 Stirb,s:4iR-Ready for Approval � General IEerrrs Credits Subcontractors Accounts Routing AttachnsMs Niles Reminlder Changs Order Sur rnary Back to PO General Validation Warnings e You Bra gotrg to final pay the Mining Peery Paid PQ -i11 Header information Invoice Number. CS45077-FINAL Invoice Status: 4I for Invoice Type: 3rtre�bcy Ing Invoice Description: CS45077-FINAL HMAC 2013-1e Invoice Date: 08/1512015 Effect Date: 0811ar2015 Payment Amount; $88,883.74 Handling Code: A CT Payment Date: 07/1=015 Payment Terns: Payment Terns Dry: 0 Paye 0.0% Discount: Paid-Bank/Check: Alternate Id: Entered By: Brandy crane Entered Date: 0811812015 Credit Amount: $0.00 Updated By: Brarwy Crane Updated Date: 0aner2015 Received Date: 05rn12015 07:02:00 AM Purchase Order Information Purchase order PO-15-00088952 PO Description CS45077 Number. PO Amount: $4,119.09 Remaining To $3,331.48 Buyer. Brandy Crane Invoice: PoVendor Information Vendor. o000o "a-JLB CONTRAGME Address G 01 LLC �' Vendor Remit-to JAMES HUMPHREY Address: P O BOX 24131 ACH ONLY FORT WORTH,TX 78124-1131 us Fed ID: —5121 Remit Text: Email:IoWU1ntC 7b=*ac irg.00m Phone:(817)281-2991 Id:29010 Misc dr Freight Invoice Account Event Type Fiscal Year Account Cade Transaction Amount Misc 15 C293S41200-209820217883 50.01 Misc 15 0293-2055000-000000217000 $88,883.74 Total: $88,883.73 Item Information Invoice Item#IPO Item#:1 HMAC 2013-16 C293-541200-209820217883 M&C:C-26626 DaM:102213 CMgk l PO-1440234 1 oft 8/18/2015 7:04 AM BuySpeed Online httpsJ/bso.fartworthgov.org/bso/document/approval/docApprovaLsdo PO Pernmt Invoice Discount% Orlgmw Final Item Status To Pay Amount PayAm unt Pay 3PPR-Partial Receipt $O.DO $0.01 0.0% 10.00 Yes MAKE ASSET AAODEL• ASSET MAANUF: ASSET SERIAL: ASSET VIN: ASSET TAG: Event Type Fmcal Year Amount Code Transaction Amount Exp. 15 C293-541200-208020217083 $0.01 Enc. 15 C293-541200-209820217893 30.01 Approval Path: Delete Approver Order Approval Level Approver Deft Data ApprovedIDIsapproved Co at Sequence Path Type Requested ApprovedlDlsapproved Canceled View ID Canceled by Add Primary New Add0elets Approver Print CoW%"O 2015 Perisoops Ho*Xm Inc.-AN RW to Reserved.defardt 2 oft 8/18/2015 7:04 AM Page: 1 Document Name: untitled BC AVAILABLE FUNDS INQUIRY 162 NEXT FUNCTION: ACTION: ------------------------------------------------------------------------------- ------------------------------------------------------------------------------- COMP / ACCT / CNTR ALTERNATE COMP / ACCT / CNTR C293 205000 000000217800 ACCT DESC: RETAINAGE ORIG APPROPRIATION: 0.00 CNTR DESC: HMAC Surface Overlay 2013-16 LAST ACTIVITY: 08/15/2015 0.00 NA 0. 00 0. 00 NA - 0.00 0.00 NA - 0.00 66, 663.74- (LIABILITY ) - 0.00 --------------------- --------------------- 66, 663.74 (AVAIL BAL) = 0.00 (AVAIL BAL) L OVEREXPEND A E C G V TOLERANCE BDG YTD P EST N L R ACTIVE INACTIVE L POST AMT PCT GRP LTD P REV EXP C COMM S P STAT DATE DATE I Y 9999 999 L N N Y N N 2 9 0 Date: -1 - 15 Time: 07:44:34.11 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 SAM DAVIS, PRESIDENT of JLB CONTRACTING, LLC, known to me to be a credible person,who being by me duly sworn,upon his oath disposed 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;and That there are no claims pending for personal injury and/or property damages; On contract described as; HMAC Surface Overlay 2013-16, Fort Worth,TX. JLB CONTRACTING, LLC BY *'"�� Sam Davis President Subscribed and sworn before me on thisj,�L day of 2015 N T Y PUBLIC AND FOR TARRANT COUNTY, TEXAS My commission expires 3/10/2017 NeIN1Iy LINDA OLIPHANT Notary Public.State of Texas MY Commission Expires March 10. 2017 CONSENT OF OWNER ❑ SURETY COMPANY ARCHITECT R a TO FINAL PAYMENT SURETY ❑ (SEYM AR TO AIA DOCUMENT G707) Bond No. 6067215 PROJECT: HMAC Surface Overlay(2013-16),City Project No. 02178 (fie,mss)Fort Worth,Texas TO (Owner) ARCHITECPS PROJECT NO: City of Fort Worth CONTRACT FOR: Above Project 1000 Throclanorton Street Fort Worth, Texas 76102 CONTRACT DATE: October 22,2013 CONTRACTOR JLB Contracting,LLC In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above,the(hm invert name and sad—ofs'°°'''c-w-y) Westfield Insurance Company 555 Republic Drive, Suite 450 Plano,Texas 75074 ,SURETY COMPANY, on bond of(here insert name and address of Contractor) JLB Contracting,LLC P.O.Box 24131 ,CONTRACTOR, Fort Worth, Texas 76124 hereby approves of the final payment to the Contractor,and agrees that the final payment to the Contractor shall not relieve the Surety Company of any of its obligations to(hen insert name and address ofOww) City of Fort Worth 1000 Throclanorton Street Fort Worth, Texas 76102 'OWNER, as set forth in the said Surety Company's bond. IN WITNESS WHEREOF, The Surety company has hereunto set its hand this 8th day of July 2015 WESTFIELD INSURANCE COMPANY Surety Co B Si ep Attest: (Seal): kyle W. Swecnev Attorney-in—Fact True Now This fansmd m bt'6sed�is airniat doctuneat to the Contracta's Affidavit of Payment of Debt and Clams,Current Edition THIS POWER OF ATTORNEY SUPERCEDES ANY PREVIOUS POWER BEARING THIS SAME POWER#AND ISSUED PRIOR TO 04=n1,FOR ANY PERSON OR PERSONS NAMED BELOW. Genefal POWER NO. 4220052 06 Power Westfield Insurance Co. of Attorney Westfield National Insurance Co, Ohio Farmers Insurance Co. CERTIFIED COPY Westfield Center, Ohio Know Ali Men by These Presents, That WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, corporations, hereinafter referred to individually as a 'Company' and collectively as 'Companies,' duly organized and existing under the laws of the State of Ohio,and having its principal office in Westfield Center, Medina County,Ohio,do by these presents make,constitute and appoint CHARLES D.SWEENEY,MICHAEL A.SWEENEY,KYLE W.SWEENEY,ELIZABETH GRAY,JOINTLY OR SEVERALLY of FORT WORTH and State of TX its true and lawful Attorney(s)-in-Fad,with full power and authority hereby conferred in Its name, place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings, or other instruments or contracts of suretystip- - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - -- - - - -- LIMITATION: THIS POWER OF ATTORNEY CANNOT BE USED TO EXECUTE NOTE GUARANTEE, MORTGAGE DEFICIENCY, MORTGAGE G 19M00ffMOR BANK DEPOSITORY BONDS. and to bind any of the Companies thereby as fully and to the same extent as if such bonds were signed by the President,sealed with the corporate seal of the applicable Company and duly attested by its Secretary,hereby ratifying and confirming all that the said Attorney(s)4n-Fad may do in the,premises. Said appointment Is made under and by authority of the following resolution adopted by the Board of Directors of each of the WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY. 'Be it Resoived,that the President,any Senior Executive,any Secretary or any Fidelity&Surety Operations Executive or other Executive shall be and Is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(3)4n-Fact to represent and ad for and on behalf of the Company subject to the following provisions: The Attorney-ln-Fact. may be given full power and authority for and In the name of and on behalf of the Company,to execute,acknowledge and deliver,any and all bonds, recognizances,contracts,agreements of indemnity and other conditional or obligatory undertakings and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney-in-Fad shall be as binding upon the Company as it signed by the President and sealed and attested by the Corporate Secretary.' Be K Further Resolved,that the signature of any such designated person and the seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile,and any power of attorney or certificate bearing facsimile signatures or facsimile seal shall be valid and binding upon the Company with rasped to any bond or undertaking to which it is attachad.' (Each adopted at a meeting held on February 8,2000). in Witness Whereof,WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHiO FARMERS INSURANCE COMPANY have caused these presents to be signed by their Senior Executive and their corporate seals to be hereto affixed this 20th day of APRIL A.D..2011 . �''"""` "'•w WESTFIELD INSURANCE COMPANY Gcrp�zrata +f.SY�.ti S10NA(, ,y6 Seals Q� .•-•••�C�t ,•►�P,..-•-•••.!HS;G, }�S WESTFIELD NATIONAL INSURANCE COMPANY Af""'dUT)O' L��T -'. +��;:•'� �3 OHIO FARMERS INSURANCE COMPANY i'; rp -t_1648 '... ..•• Sym •'may- Y B . 1, 1 Y State of Ohio "'"•••.....•. F"`""•••«•'"' Richard L Kinnaird,Jr.,National Surety Leader and County of Medina ss.: Senior Executive On this 20th day of APRIL A.D.,2011 ,before me personally came Richard L Kinnalyd, Jr.to me known,who, being by me duty sworn,did depose and say,that he resides°in Medina,Ohio;that he is Senior Executive of WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, the companies described in and which executed the above Instrtunent that he knows the seals of said Companies'.that the seals affixed to said Instrument are such corporate seals;that they were so affixed by order of the Boards of Directors of said Companies;and that he signed his name thereto by like order. Notarial , Seat a\A L s Affixed 2:-�:d4► .�:r • William J.Kahelin,A ney at Law, Notary Public State of Ohio L Y�� 0 My Commission Does Not Expire(Sec.147.03 Ohio Revised Code) County of Medina ss.: *tk y •t f0 I,Funk A..Carrino,Secretary of WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, do hereby.certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said Companies,which is still in full force and effect;and furthermore,the resolutions of the Boards of Directors,set out In the Power of Attorney are In full force and effect- In ffectin Witness Whereof, I have hereunto set my hand and affixed the seals of said Companies at Westfield Center, Otto, this 8th day of July gA.D., 2015 `"io!+K"''•• ..:.«"'«•� pR'c�,±/� ..P i ••' fie•`'!; ; ��' ,• ,.o: _ ':1648::x'' Frank A.Carrino,Secretary Seen,rr� BPOAC2(combined) (06-02) CONSENT OF OWNER O SURETY COMPANY ARCHITECTNR ❑0 TO FINAL PAYMENT SURETY THER O O (SIMMAR TO AIA DOCUMENT G707) Bond No.6067215 PROJECT: HMAC Surface Overlay(2013-16),City Project No. 02178 (name,mess)Fort Worth,Texas TO (Owner) ARCHITECTS PROJECT NO: F_City of Fort Worth CONTRACT FOR: Above Project 1000 Throckmorton Street Fort Worth,Texas 76102 CONTRACT DATE: October 22,2013 CONTRACTOR: JLB Contracting,LLC In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above,the(here insert name and add'of sarety comrpamy) Westfield-Insurance Company 555 Republic Drive,Suite 450 Plano,Texas 75074 ,SURETY COMPANY, on bond of(here insert name and address of connsetor) JLB Contracting,LLC P.O.Box 24131 ,CONTRACTOR, Fort Worth,Texas 76124 hereby approves of the final payment to the Contractor,and agrees that the final payment to the Contractor shall not relieve the Surety Company of any of its obligations to(here insert came and address of owner-) City of Fort Worth 1000 Throckmorton Street Fort Worth,Texas 76102 'Off' as set forth in the said Surety Company's bond IN WITNESS WHEREOF, The Surety Company has hereunto set its hand this 8th day of July 2015 WESTFIELD INSURANCE COMPANY Surety Compan B 1ZVJA�9�_Z'--,/'�;z Signature orize epresentatrve Attest: (Seal): kyle W. Sweenev Attorney-in—Fact Title Note.This form is inwded to be used as a n document to the Contractors Affidavit of Payment of Debts and Claims,Current Edition IS POWER OF ATTORNEY SUPERCEDES ANY PREVIOUS POWER BEARING THIS SAME JWER#AAO ISSUED PRIOR TO 04120111, FOR ANY PERSON OR PERSONS NAMED BELOW. POWER NO. 4220052 06 Power eras Westfield insurance Co. Po of Attorney Westfield National Insurance Co. CERTIFIED COPY Ohio Farmers Insurance Co. Westfield Center, Ohio Know All Men by These Presents, That WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, corporations, hereinafter referred to individually as a 'Company" and collectively as 'Companies; duly organized and existing under the laws of the State of Ohio,and having its principal office in Westfield Center, Medina County,Ohio,do by these presents make,constitute and appoint CHARLES D.SWEENEY,MICHAEL A SWEENEY,KYLE W.SWEENEY,ELIZABETH GRAY,JOINTLY OR SEVERALLY of FORT WORTH and State of TX its true and lawful Attorneys)-in-Fad,with full power and authority hereby conferred In Its name, place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings, or other instruments or contracts of suretYship- - - - - - - - `- - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - -- - - - - LIMITATION: THIS POWER OF ATTORNEY CANNOT BE USED TO EXECUTE NOTE GUARANTEE, MORTGAGE DEFICIENCY, MORTGAGE OGEE,OR BANK DEPOSITORY BONDS. and to bind any of the Companies.thereby as fully and to the same extent as if such bonds were signed by the President,sealed with the corporate seal of the applicable Company and duly attested by its Secretary,hereby ratifying and confirming all that the said Attorney(s)4n-Fact may do in the.premises. Said appointment is made under and by authority of the following resolution adopted by the Board of Directors of each of the WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY. 'Be It Resolved,that the President,any Senior Executive,any Secretary or any Fidelity&Surety Operations Executive or other Executive shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)4r Fad to represent and ad for and on behalf of the Company subject to the following provisions: The Attorney-4n-Fact may be given full power and authority for and in the name of and on behalf of the Company,to execute,acknowledge and deliver,any and all bonds, reeognizancees, contracts,agreements of indemnity and other conditional or obligatory undertakings and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorneyan-Fad shall be as binding upon the Company as if signed by the President and sealed and attested by the Corporate Sec:retary.' 'Be It Further Resolved,that the signature of any such designated person and the seal of the Company heretobre or hereafter affixed to any power of attorney or any certificate relating thereto by facsimlW and any power of attorney or certificate bearing facsimile signatures or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached.' (Each adopted at a meeting held on February 8,2000). In Witness Whereof,WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY have caused these presents to be signed by their Senor Executive and their corporate seals to be hereto affixed this 20th day of APRIL A.D.,2011 . Corp—to ....,...N. Seals SVRA# p••'(nONLL<'• ' "mow WESTFIELD INSURANCE COMPANY o "M•"••CN`�s .........'+;sl.: WESTFIELD NATIONAL INSURANCE COMPANY ' 10nd `"i "°' ti =�9= OHIO FARMERS INSURANCE COMPANY iNs a7Lii�3L itr co—; S E AT. :m ooS •�_ �e'* lr� So%•. __0;' : 1648 `! r B State of Ohio ""��* "'"�,,• `�•'.:«......••" Richard L Kinnaird,Jr.,Natronal Surety Leader and County of Medina ss.: Senior Executive On this 20th day of APRIL A.D.,2011 ,before me personally came Richard L Kinnaird, Jr.to me known,who, being by me duly sworn,did depose and say,that he resides`in.Medina, Ohio;that he is Senior Executive of WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, the companies described in and which executed the above instrument;that he knows the seals of said Companies;that the seals affixed to said instrument are such corporate seals;that they were so affixed by order of the Boards of Directors of said Companions;and that he signed his name thereto by like order. Notarial . Seal S%A 1, Affixed P',.•. • William J.Kahelin,A ney at Law,Notary Public State of Ohio 10 010 My Commission Does Not Expire(Sec 147M Ohio Revised Code) County of Medina ss. '+ +- 1,Frank A.Carrino,Secretary of WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, do hereby.certify that the above and foregoing is a true and correct copy of a Power of Attorney,executed by said Companies,which is still In full force and effect;and furthermore,the resolutions of the Boards of Directors,set out in the Power of Attorney are In full force and effect. In Witness Whereof, I have hereunto set my hand and affixed the seals of said Companies at Westfield Center, Ohio, this 8th day of July A°y 2615 •••«N SEALsem'�pRTE�•�3 i /� ,nor, :mc =0: � S } :,� �►' = e, .•_off s ; 1646 -'�V; Frank A.Carrino,-SeCnetaty BPOAC2(combined) (06-02) FORTWORTHRE02/20/07 TRANSPORTATION AND PUBLIC WORKS PERFORMANCE EVALUATION OF CONTRACTOR I) CONTRACTOR&PROJECT DATA Name of Contractor Project Name JLB Contracting,LLC HMAC Surface Overlay(2013-16) DOE Inspector DOE Number William Mason 7124 DOEInspector Project Manager ❑ Water ❑ Waste Water❑ Storm Drainage O Pavement Kristian Sugrim Initial Contract Amount Project Difficulty $1,336,606.22 O Simple O Routine O Complex Final Contract Amount Date $1,333,274.73 7/7/2015 11)PERFORMANCE EVALUATION 0-Inadequate I-Deficient 2-Standard 3-Good 4-Excellent ELEMENT WEIGHT(x) APPLICABLE(Y/N) RATING(0-4) MAX SCORE SCORE I Submission of Documents 2 Y 4 8 8 2 Public Notifications 5 Y 4 20 20 3 Plans on Site 5 N 4 Field Supervision 15 Y 4 60 60 5 Work Performed 15 Y 4 60 60 6 Finished Product 15 Y 4 60 60 7 Job Site Safety 15 Y 4 60 60 8 Traffic Control Maintenance 15 Y 4 60 60 9 Daily Clean Up 5 Y 4 20 20 10 Citizen's Complaint Resolution 5 Y 4 20 1 20 11 Property Restoration 5 Y 1 4 20 20 12 After Hours Response 5 Y 4 20 20 13 Project Completion 5 Y 4 20 20 TOTAL ELEMENT SCORE(A) 428 BONUS POINTS(25 Maximum)(B) TOTAL SCORE(TS) 428 III)CONTRACTOR'S RATING Maximum Score(MS)=448 x sum of applicable element score maximums which= 428 Rating(ITS/MSI• 100%) 428 / 428 100% Performance Category Excellent <20%—Inadequate 20'/to<40'/=Deficient 40%to<60%=Standard 60'/to<800A=Good >_80%=Excellent Inspector's Comments(INCLUDING EXPLANATION OF BONUS POINTS AWARDED) Signature DOE Inspector Signature Contractor Signature DOE Inspector's Supervisor CONTRACTOR'S COMMENTS TRANSPORTATION AND PUBLIC WORKS (a The City of Fort Worth-1000 Throckmorton Street-Fort Worth,TX 76012-6311 (817)392-7941 -Fax:(817)392-7845 FORTWORTHREV:02/22/07 TRANSPORTATION AND PUBLIC WORKS CONTRACTOR'S EVALUATION OF CITY 1)PROJECT INFORMATION Date: 7/7/2015 Name of Contractor Project Name ILB Contracting,LLC HMAC Surface Overlay(2013-16) DOE Inspector Project Manager William Mason Kristian Surgim DOE Number Project D&n/ty Type of Contract 7124 O Simple ® Routine O Complex ❑ Water ❑ Waste Water ❑ Storm Drainage O Pavement Initial Contract Amount Final Contract Amount $1,336,606.22 $1,333,274.73 II)PERFORMANCE EVALUATION 0-Inadequate 1 -Deficient 2-Standard 3-Good 4-Excellent ELEMENT RATING ELEMENT RATING (0-4) (0-4) INSPECTION EVALUATION PLANS&SPECIFICATIONS 1 Availability of Inspector IF 1 Accuracy of Plans to Existing Conditions 3 2 Knowledge of Inspector 2 Clarity&Sufficiency of Details 3 Accuracy of Measured Quantities 3 Applicability of Specifications 4 Display Of Professionalism 4 Accuracy of Plan Quantities 3 5 Citizen Complaint Resolution PROJECT MANAGER EVALUATION 6 Performance-Setting up Valve Crews,Labs 1 Knowledge And/Or Problem Resolution ADMINISTRATION 2 Availability of Project Manager 1 Chane Order Processing Time 3 Communication 2 Timliness of Contractor Payments 4 Resolution of Utility Conflicts Z 3 Bid Opening to Pre-Con Meeting Timeframe III)COMMENTS&SIGNATURES COMMENTS Signature Contractor �_ -- Signature DOE Inspector Signature DOE Inspector's Supervisor INSPECTOR'S COMMENTS TRANSPORTATION AND PUBLIC WORKS The City of Fort Worth-1000 Throckmorton Street-Fort Worth,TX 76012-6311 f 1 (817)392-7941 -Fix:(817)392-7845 FORT WORTH. TRANSPORTATION AND PUBLIC WORKS STATEMENT OF CONTRACT TIME STATEMENT# FINAL STATEMENT# 37 DOE _ NAME OF PROJECT: HNIAC SURFACE OVkM AY 2013-46 Contractor YEAR: 2015 PROJECT NO.: FINAL INSPECTION DATE 0 _ WD CD CONTRACT TIME PERIOD FROM: TO: - Montb neveLor / WORK ORDER EFFECTIVE: BEG(y/n) MID(y/n) DAY OF MONTH DAYS REASON FOR DAY OF MONTH DAYS REASON FOR CHARGED DAYS CREDITED CHARGED DAYS CREDITED 1 16 2 _ - 17 3 18 4 19 5 20 6 21 7 - 22 8 23 924 10 25 11 26 12 - 27 13 : 28 14 29 15 30 31 ,- - fX Not Applicable SAT,SIJN,and WEATHER UTILITIES OTHERS DAYS TOTAL DAYS HOLIDAYS RELOCATE CHARGED THIS PERIOD 0 0 0 0 0 0 PREVIOUS PERIOD 374 374 TOTAL TO DATE 0 0 0 0 374 374 REMARKS: Finaf ttW on 5-27 2015 Vag on puttcblist to be cornpleted.Punchlist completed on O-t5-X015:, t Signature: Signature: (Print Name) -ewo.M_ V1 S (Print Name) W C Mason ca teteron C++ -'`jF a Fs DATE 17 LNSracroR DATE 6117/2015