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Home My WebLink AboutContract 47583-FP4 vepartow k.onsx. ervices CPN# ruMb - Date Project anager S --3—/ 7 Risk — Risk Management Ca dv �T WO RT H CIN SECRETARY D.O.E. Brotherton — O CONTRACT NO. CFA Westerman/Scanned Esteban Perez/Scanned The Proceeding people have been Con cte concerning the request for final payment& have 'ATION AND PUBLIC WORKS 5q 6o) — COQ406 released this project for such payment. )F PROJECT COMPLETION Developer Projects) DOC733�! Clearance Conducted By RAama6 3�9� City Project Ne: 02400 if-S& 87583 Regarding contract 117334 for STONE CREEK RANCH PH 5 as required by the WATER DEPARTMENT as approved by City Council on N/A through M&C N/A the director of the WATER DEPARTMENT upon the recommendation of the Assistant Director of the Transportation&Public Works Department has accepted the project as complete. D MAR 3 Q 2017�C� L� O C� Original Contract Price: $1,010,747.60 Amount of Approved Change Order $5,956.00 Ns 1 Revised Contract Amount: $1,016,703.60 Total Cost Work Completed: $1,016,703.60 -i �iw � KtiAk Recommended for Acceptance Date Asst. Director, TPW - Infrastructure Design and Construction — a-lG-vr%- I 3�3ol f 7 Accepted Date Asst. Director, WATER DEPARTMENT /` z LJ4 - Asst. City Manager Date Comments: HMAIZM.D MAR 0 5 2017 it 5� =-e-Qq 16 0 Rev.9/22/16 FORT WORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name STONE CREEK RANCH PH 5 Conti-act Limits Project Type WATER&SEWER City Project Numbers 02400 DOE Number 7334 Estimate Number 1 Payment Number 1 For Period Ending 2/16/2017 CD City Secretary Contract Number 117334 Contract Time 150;D Contract Date Days Charged to Date 150 Project Manager Jaafari Contract is 100.00 Complete Contractor BURNSCO CONSTRUCTION,INC. 6331 SOUTHWEST BLVD FORT WORTH, TX 76132 Inspectors LAYER / ROGERS Friday,February 17,2017 Pale I of 5 City Project Numbers 02400 DOE Number 7334 Contract Name STONE CREEK RANCH PH 5 Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER&SEWER For Period Ending 2/16/2017 Project Funding WATER Item Description of items Estimated Estimated Completed Completed Quanity No. Unit Unit Cost Total Quanity Total P p ---------------- -------------- --- - ----------------- 1 TRENCH SAFETY FOR WATER 2670 LF $0.10 $267.00 2670 $267.00 2 DUCTILE IRON WATER FITTINGS W/RES 1.4 TN $4,300.00 $6,020.00 1.4 $6,020.00 3 8"WTER PIPE 2409 LF $28.00 $67,452.00 2409 $67,452.00 4 12"WATER PIPE 261 LF $39.00 $10,179.00 261 $10,179.00 5 FIRE HYDRANT ASSEMBLY 2 EA $3,800.00 $7,600.00 2 $7,600.00 6 1"WATER SERVICE 82 EA $800.00 $65,600.00 82 $65,600.00 7 8"GATE VALVE 5 EA $1,230.00 $6,150.00 5 $6,150.00 8 12"GATE VALVE 1 EA $2,200.00 $2,200.00 1 $2,200.00 9 SWPPP MAINTENANCE 1 LS $500.00 $500.00 1 $500.00 10 MJ SOLID SLEEVE 3 EA $800.00 $2,400.00 3 $2,400.00 -------------------------------- - ------ Sub-Total of Previous Unit $168,368.00 $168,368.00 SEWER Item Completed No. Description of Items Estimated Estimated Completed Com P Unit Unit Cost P p Quanity Total Quanity Total — ----------- ______ _ _ 1 POST CCTV INSPECTION 3764 LF $1.40 $5,269.60 3764 $5,269.60 2 MANHOLE VACUUM TESTING CO#1 15 EA $110.00 $1,650.00 15 $1,650.00 3 TRENCH SAFETY 3764 LF $1.00 $3,764.00 3764 $3,764.00 4 TRENCH WATER STOPS 13 EA $250.00 $3,250.00 13 $3,250.00 5 4"SEWER SERVICE SDR 26 82 EA $1,530.00 $125,460.00 82 $125,460.00 6 8"SEWER PIPE 1842 LF $75.00 $138,150.00 1842 $138,150.00 7 8"SEWER PIPE CEMENT STABILIZED 60 LF $87.00 $5,220.00 60 $5,220.00 BACKFILL 8 8"SEWER PIPE CSS BACKFILL 1601 LF $250.00 $400,250.00 1601 $400,250.00 9 10"SEWER PIPE CSS BACKFILL CO#1 238 LF $246.00 $58,548.00 238 $58,548.00 10 CONCRETE ENCASEMENT FOR UTILITY PIPES 40 LF $50.00 $2,000.00 40 $2,000.00 11 EPDXY MANHOLE LINER 20.3 VF $200.00 $4,060.00 20.3 $4,060.00 12 4'MANHOLE CO#1 14 EA $5,400.00 $75,600.00 14 $75,600.00 13 4'DROP MANHOLE 1 EA $6,600.00 $6,600.00 1 $6,600.00 14 4'EXTRA DEPTH MANHOLE CO#1 104 VF $110.00 $11,440.00 104 $11,440.00 15 CONNECT TO EXISTING STUBOUT 3 EA $800.00 $2,400.00 3 $2,400.00 Friday,February 17,2017 Page 2 of 5 City Project Numbers 02400 DOE Number 7334 Contract Name STONE CREEK RANCH PH 5 Estimate Number 1 Contract Limits Payment Number I Project Type WATER&SEWER For Period Ending 2/16/2017 Project Funding 16 10"SS DIP SLIP LINING CO#1 19 LF $10.00 $190.00 19 $190.00 17 10"DIP SS CO#1 19 LF $236.00 $4,484.00 19 $4,484.00 ------ ---------- ---------------- - - - --- Sub-Total of Previous Unit $848,335.60 $848,335.60 ------------------ - ---------- ---- -- ---- Friday,February 17,2017 Page 3 of 5 City Project Numbers 02400 DOE Number 7334 Contract Name STONE CREEK RANCH PH 5 Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER&SEWER For Period Ending 2/16/2017 Project Funding Contract Information Summary Original Contract Amount $1,010,747.60 Chance Orders Change Order Number 1 $5,956.00 Total Contract Price $1,016,703.60 Dated —)9 Total Cost of Work Completed $1,016,703.60 Contrac J Less %Retained $0.00 Dat /�� / Net Earned $1,016,703.60 - e Inspection Su s Earned This Period $1,016,703.60 Retainage This Period $0.00 Date X1'1 Less Liquidated Damages Proj ct Manager kkaQ Days @ /Day $0.00 Date � LessPavement Deficiency $0.00 Asst.Diirrector//TPW--Infrastructure Design an�Construction Less Penalty $0.00 Date 3�3�� Less Previous Payment $0.00 Director/Contracting Department Plus Materiae or, 2-➢arae;Less 15% $0.00 ---IZc. Balance Due This Payment $1,016,703.60 Friday,February 17,2017 Pa--c 4 of 5 ECED E MAR 3 0 2017 0, City Project Numbers 02400 DOE Number 7334 Contract Name STONE CREEK RANCH PH 5 Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER&SEWER For Period Ending 2/16/2017 Project Funding Project Manager Jaafari City Secretary Contract Number 117334 Inspectors LAYER / ROGERS Contract Date Contractor BURNSCO CONSTRUCTION,INC. Contract Time 150 CD 6331 SOUTHWEST BLVD Days Charged to Date 150 CD FORT WORTH, TX 76132 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 $1,016,703.60 Less %Retained $0.00 Net Earned $1,016,703.60 Earned This Period $1,016,703.60 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 $1,016,703.60 Friday,February 17,2017 Page 5 of 5 FORTWORTH rev 03/05/07 TRANSPORTATION & PUBLIC WORKS FINAL STATEMENT OF CONTRACT TIME FINAL STATEMENT NO.FINAL NAME OF PROJECT: STONE CREEK RANCH PH5 PROJECT NO.: 2400 CONTRACTOR: Burnsco Construction,Inc. WATER& SANITARY SEWER DOE NO. 7334/CPN 02400 PERIOD FROM TO: FINAL INSPECTION DATE: 15-Feb-17 WORK ORDER EFFECTIVE CONTRACT TIME 150 O WD* CD DAY OF DAYS REASON FOR DAYS DAY OF DAYS REASON FOR DAYS MONTH CHARGED CREDITED MONTH CHARGED CREDITED DURING DURING 1. 16. 2. 17. 3. 18. 4. 19. 5. 20. 6. 21. 7. 22. 8. 23. 9. 24. 10. 25. 11. 26. 12. 27. 13. 28. 14. 29. 15. 30. 31. SAT,SUN, RAIN,TOO WET, UTILITIES OTHERS* DAYS TOTAL & HOLIDAYS & TOO COLD RELOCATIONS CHARGED DAYS THIS PERIOD 0 0 PREVIOUS PERIOD 150 150 TOTALS TO DATE 150 150 *REMARKS: FINAL ESTIMATE CONTRACT TIME PROJECT 100%COMPLETE. 1 CONTRACTOR j DATE I P CJ DAVE ENGINEERING DEPARTMENT L The City of Fort Worth• 1000 Throckrnorton Street•Fort Worth,TY 76012-6311 (817) 392-7941 •Fax: (817) 392-7845 FORTWORTHREV:8/20/16 TRANSPORTATION AND PUBLIC WORKS PERFORMANCE EVALUATION OF CONTRACTOR I) CONTRACTOR&PROJECT DATA Name of Contractor Project Name Burnsco Construction, Inc. Stone Creek Ranch Ph5 Inspector City Project Number Joe Rogers 2400 Construction Components Project Manager 0 Water 0 Waste Water El Storm Drainage❑ Pavement Khal Jaafari Initial Contract Amount Project Difficulty $1,207,625.10 O Simple OO Routine O Complex Final Contract Amount Date $1,213,581.10 2/14/2017 II)PERFORMANCE EVALUATION 0-Inadequate 1 -Deficient 2-Standard 3-Good 4-Excellent ELEMENT WEIGHT(x) APPLICABLE(Y/N) RATING(0-4) MAX SCORE SCORE 1 Submission of Documents 2 Y 3 8 6 2 Public Notifications 5 Y 4 20 20 3 Plans on Site 5 Y 4 20 20 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 3 60 45 8 Traffic Control Maintenance 15 Y 3 60 45 9 Daily Clean Up 5 Y 3 20 15 10 Citizen's Complaint Resolution 5 Y 1 3 20 15 11 Property Restoration 5 Y 3 20 15 12 After Hours Response 5 N 13 Project Completion 5 Y 3 20 15 TOTAL ELEMENT SCORE(A) 376 BONUS POINTS(25 Maximum)(B) TOTAL SCORE(TS) 376 III)CONTRACTOR'S RATING Maximum Score(MS)=448 or sum of applicable element score maximums which= 428 Rating( [TS/MS[ x 100%) 376 428 = 88% Performance Category Excellent <20%=Inadequate 20%to<40%=Deficient 40%to<60%=Standard 60%to<80%=Good >80%=Excellent Inspector's Comments(INCLUDING EXPLANATION OF BONUS POINTS AWARDED) Inspector Signature Conactor Signature r Inspector's Supervisor Signature CONTRACTOR'S COMMENTS TRANSPORTATION AND PUBLIC WORKS The City of Fort Worth• 8851 Camp Bowie West Blvd. •Fort Worth,TK 76116 • (817) 392-8306 11b it O i 1i H REV:02/22/07 TRANSPORTATION AND PUBLIC WORXS CONTRACTOR'S EVALUATION OF CITY I)PROJECT INFORMATION Date: 12/14/2017 Name of Contractor Project Name Bumsco Construction,Inc. Stone Creek Ranch Ph5 DOE Inspector Project Manager Joe Rogers Khal Jaafari DOE Number Project D cid), Tipe of Contract CPN 02400 O Simple O Routine O Complex 0 Water E Waste Water❑ Storm Drainage[:] Pavement Initial Contract Amount Final Contract Amount $1,010,747.60 $1,016,703.60 II)PERFORMANCE EVALUATION 0-Inadequate 1 -Deficient 2-Standard 3 -Good 4-Excellent ELEMENT RATING ELEMENT RATING INSPECTION EVALUATION PLANS&SPECIFICATIONS 1 Availability of Inspector 1 Accuracy of Plans to Existing Conditions 2 Knowledge of Inspector L,; 2 Clarity&Sufficiency of Details t 3 Accuracy of Measured Quantities 3 Applicability of Specifications 4 Display Of Professionalism 4 Accuracy of Plan Quantities l 5 Citizen Complaint Resolution LJ PROJECT MANAGER EVALUATION 6 Performance-Setting up Valve Crews,Labs q 1 Knowledge And/Or Problem Resolution L.j ADMINISTRATION 2 Availability of Project Manager �. 1 Change Order Processing Time q 13 Communication y 2 Timliness of Contractor Payments Ll 14 Resolution of Utility Conflicts lj 3 Bid Opening to Pre-Con Meeting Timeframe III)COMMENTS&SIGNATURES COMMENTS Signature Contractor Signature DOE Inspector Signature DOE Inspector's Supervise a ¢� INSPECTOR'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 FG R 71 07 TRANSPORTATION AND PUBLIC WORDS PIPE REPORT FOR: PROJECT NAME: STONE CREEK RANCH PH5 PROJE,CT NUMBER: 2400 DOLE NUMBER: 7334 WATER PIPE LAID SIZE TYPE OF PIPE LF WATER 12" PVC 261 8" PVC 2409 FIRE HYDRANT'S: 2 VALVES(16" OR LARGER) PIPE ABANDONED SIZE TYPE OF PIPE LF NONE DENSITIES: ALL PASSED NEW SERVICES: 1" 82 EACH/COPPER 3,690 SEWER PIPE LAID SIZE TYPE OF PIPE LF SANITARY SEWER 10" PVC 238 10" DIP 19 8" PVC 3503 PIPE ABANDONED SIZE TYPE OF PIPE LF NONE DENSITIES: ALL PASSED NEW SERVICES: 4" 82 EACH/PVC 4,100 TRANSPORTATION AND PUBLIC WORKS ` The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TX 76012-6311 (817) 392-7941 •Fax: (817) 392-7845 CONSENT] OF OWNER ❑ SURETY COMPANY ARCHITECT ❑ CONTRACTOR ❑ TO FMAL PQYMEMT SURETY ❑ Conforms with the American institute of OTHER Architects, AIIA Document G707 Bond No 022053003 PROJECT: Stone Creek Ranch Phase V-Water, Sanitary Sewer, and Drainage Improvements (name, address) Fort Worth Texas TO (Owner) LGI HOMES-TEXAS, LLC AND THE CITY OF FORT -I ARCHITECT'S PROJECT NO: WORTH CONTRACT FOR: 1450 Lake Robbins Dr.,Suite 430 Stone Creek Ranch Phase V-Water, Sanitary Sewer, and Drainage Improvements The Woodlands TX 77380 CONTRACT DATE: CONTRACTOR: BURNSCO CONSTRUCTION, INC. 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) LIBERTY MUTUAL INSURANCE COMPANY 175 Berkeley Street Boston MA 02116 SURETi Y CCMPAMY on bond of (here insert name and address of Contractor) BURNSCO CONSTRUCTION, INC. 6331 Southwest Boulevard Benbrook TX 76132 CONTRACTOR, hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve the Surety Company of any of its obligations to (here insert name and address of Owner) LGI HOMES-TEXAS, LLC AND THE CITY OF FORT WORTH 1450 Lake Robbins Dr., Suite 430 The Woodlands TX 77380 OWNER, as set forth in the said Surety Company's bond. IN WITNESS,WHEREOF, the Surety Company has hereunto set its hand this 18th day of January, 2017 LIBERTY MUTUAL INSURANCE COMPANY Surety Company a Attest:Robbi Morales (Seal):.. Signature of Authorized Representative Soohinie Hunter Attorney-in-Fact Title NOTE: This form is to be used as a companion document to AIA DOCUMENT G706, CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS, Current Edition ONE PAGE THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. 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. Certificate No.7555572 Liberty Mutual Insurance Company The Ohio Casualty Insurance Company 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 oflndiana(herein collectively called the"Companies"),pursuant to and by authority herein set forth,does hereby name,constitute and appoint, Don E.Cornell;Kelly A.Westbrook;::Ricardo J.Reyha:Robb)Morales,-Sophinie Hunter"Tin a-McEwah;:V.DeLene-Marshall all of the city of Dallas state of TX each Individually if there be more than one named,its true and lawful attorney In fact.fo make,execute,seal,acknowledge and deliver,for and on its behalf as surety and as its act and deedany 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 bythe president and attested by secretary of the Companies in thelrown proper persons. IN WITNESS WHEREOF,this Power of Attorney alas-beeh subscribedliyali?authorized officer or official of theGomparnesrld,the_corpprate-Seats of the Companies have been affixed. thereto this 30th day of November :.:=2016 Pt,tusugf �tjv4su 'C The Ohio Casualty Insurance Company 0 1919 1912 1991 3 Liberty Mutual Insurance Company m n , a a i ° W. a West merican Insurance Company e a w * * By. STATE OF PENNSYLVANIA ss David M.Carey;Assistant Secretary +-� COUNTY OF MONTGOMERY C Q On this 30th day of November , 2016,before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance C cv:F' v d Company,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 0 wherein contained by signing on behalf of the corporations by himself as a duly authorized officer. LL > IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at King of Prussia,Pennsylvania,on the day and yearfirstabove written. - O:CCE tC A'PAST COMMONWEALTH OF PENNSYLVANIA. G%� / Nw <Ey-Fly. Notarial Seal C'y Fw 5 v Teresa Pastella,Notary Public B 0 d R d of Upper Mesion Twp.,Montgomery County y• 1�' .L _ O L My Commission Expires March 28,2017 Teresa Pastella,Notary Public -� R OG�Q�W y`G - Member,Pennsylvania Association of Notaries - -O E C 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 -N_e Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows: t C ca L .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 0_c r to such limitation as the Chairman or the President may prescribe,shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Corporation to make;execute,seal, _ +a O ;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 _ 1 E powers of attorney,shall have full power to bind the Corporation bytheirsignature and execution of any such instruments and to attach thereto the seal ofthe Corporation. When so a O M executed,such 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 attorney-in-fact under >- 4— " the 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. WC >, P r ARTICLE XIII—Execution of Contracts-SECTION 5.Surety Bonds and Undertakings.Any officer of the Company authorized for that purpose.in writing by the chairman or the president, cc m and subject to such limitations as the chairman or the resident may prescribe,shall appoint such attorne s in-fact,as may be necessary to act in behalf of the_Com an to make,execute-, _�C% � L J P YP PP Y Y ry _ P Y O 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 "a Z v -respective powers of attorney,shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seat of the Company. When so 0 c executed such instruments shall be as b riding as if signed by the president and attested tiythesecretary. Certificate of Designation—The Presldent:of the Company,acting pursuantto the Bylaws of the Company aufhonzes David M:Carey,Assistant;Secretary to-appoint such attorneys-in ~ fact as may be necessary to act on behalf of the Company to:make,execute,seal,acknowledge and delver as_surety any.and all undertakings,-ponds,recognizances and other surety obligations. Authorization—By unanimous consent of the-Company's Board of Directors,the Company consentsthat facsimile or mechanically reproducedsgnature of any assistant secretary ofthe Company,wherever appearing upon a certfied cppy of any:power of attorney issued by the Company in connection wlthzUrety bonds,shall be valid=and binding upon the Company with the same force and effect as though manually atfized _ I, Renee C. Llewellyn, the undersigned, Assistant:Secretary, The Ohio Casualty Insurance.Company, Liberty Mutual Insurance Company and;West American Insurance-Company do hereby certify that the original power of attorney the foregoing is•;a full true and correct copy of the Power of Attorney executed by said.Companies, is in:full force and effect-and has not been revoked. 1_ IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this (b day of ia_ 4 a 20 LZ . P�1'Y INSUh, P�tNS Uqq A`t1NS URR. �hJpHP0/7gT�f <J\;pHPORq�F,ti�f _ �SLpFPCP,q:�ti�� n ° t919 0 1912 °a ~ 1991 By: a' y a Renee C.Llew , ssistant Secretary .�,yf[YkAMPS�'F�'aD p�jfi�sSA�US,,�Q'� 3 MOIA[:P F '1 - I 55 of 300 LMS 12873 082016 L!3y' 1 V'f1u tua SURETY TEXAS TEXAS IMPORTANT NOTICE AVISO IMPORTANTE To obtain information or make a complaint: Para obtener informacion o para someter una queja: You may call toll-free for information or to Usted puede Ilamar al numero de telefono gratis make a complaint at para informacion o para someter una queja al 1-877-751-2640 1-877-751-2640 You may also write to: Usted tambien puede escribir a: 2200 Renaissance Blvd., Ste. 400 2200 Renaissance Blvd., Ste. 400 King of Prussia, PA 19406-2755 King of Prussia, PA 19406-2755 You may contact the Texas Department of Puede comunicarse con el Departamento de Insurance to obtain information on companies, Seguros de Texas - para obtener informacion coverages, rights or complaints at acerca de companias, coberturas, derechos o 1-800-252-3439 quejas al 1-800-252-3439 You may write the Texas Department of Insurance Puede escribir al Departamento de Seguros Consumer Protection (1 l 1-1 A) de Texas Consumer Protection (111-1 A) P. 0. Box 149091 P. 0. Box 149091 Austin, TX 78714-9091 Austin, TX 78714-9091 FAX: (512) 490-1007 FAX # (512) 490-1007 Web: http•//www.tdi.texas.gov Web: http://www.tdi.texas.gov E-mail: ConsumerProtectiongtdi.texas.gov E-mail: ConsumerProtectiongtdi.texas.gov PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS 0 RECLAMOS: Should you have a dispute concerning your Si tiena una disputa concerniente a su prima o a premium or about a claim you should first un reclamo, debe comunicarse con el agente o contact the agent or call 1-800-843-6446. primero. Si no se resuelve la disputa, puede If the dispute is not resolved, you may contact the entonces comunicarse con el departamento (TDI) Texas Department of Insurance. ATTACH THIS NOTICE TO YOUR UNA ESTE AVISO A SU POLIZA: POLICY: This notice is for information only and does not Este aviso es solo para proposito de informacion. becorne a part or condition of the attached y no se convierte en parte o condicion del document. documento adjunto. NP 70 68 09 01 LMS-15292 10115 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 Ab Grantges, Contract Mgr, Of Burnsco construction, 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 North has been paid in full; That there are no claims pending for personal injury and/or property damages; On Contract described as; Stone Creek Ranch V-Nater, Sanitary Sewer and Storm Drain BY �- Ab Grantges, tontract Manager Subscribed and sworn before me on this date 14th of February, 2017. Notary Public LEI A MCQUIEN S`04P• �'@�'•� Tarrant County, Texas _ :' �__Notary Public,state of Texas ;�•v` y`Comm. 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A { 5 \ ) n §)ƒ ƒ z (\) % N z ) CD _ k ( ( § m§ ; \ 2 9 ° a)� § � , c%13 z¥ y § CD \ e §�03 0 §\ @ [ In or _) $�§ 2 �% &\ ) ( §Z ` C) \ // -n-n , UM \ x s ~ k R ) / J $ 22 @ / / ^ �� M ( �) k ± `§ 2« % ƒa z \�}A r ¢�22Qe� CD\ ) 77)§/// SD ac w /\ o 2 % to$�9z \ } » 0 z a z ca w » a /( 7 q \ u &CD 4 \ < \ \ 2 / 2 \ 2 \ w � f# G | j \ § _ q E ha �§« :Nz\\ ] C,O �\\ \\� � \ :7 CONSEMT OF OWNER ❑ SURETY COMPANY ARCHITECT ❑ CONTRACTOR ❑ TO FONA[L PAYMENT SURETY ❑ Conforms with the American Institute of OTHER Architects, AIA Document G707 Bond No 022053003 PROJECT: Stone Creek Ranch Phase V-Water, Sanitary Sewer, and Drainage Improvements (name, address) Fort Worth Texas TO (Owner) LGI HOMES-TEXAS, LLC AND THE CITY OF FORT ARCHITECT'S PROJECT NO: WORTH CONTRACT FOR: 1450 Lake Robbins Dr.,Suite 430 Stone Creek Ranch Phase V-Water,Sanitary Sewer,and Drainage Improvements The Woodlands Tx 77380 CONTRACT DATE: CONTRACTOR: BURNSCO CONSTRUCTION, INC. 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) LIBERTY MUTUAL INSURANCE COMPANY 175 Berkeley Street Boston MA 02116 , SURETY COMPANY on bond of (here insert name and address of Contractor) BURNSCO CONSTRUCTION, INC. 6331 Southwest Boulevard Benbrook TX 76132 , CONTRACTOR, hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve the Surety Company of any of its obligations to (here insert name and address of Owner) LGI HOMES-TEXAS, LLC AND THE CITY OF FORT WORTH 1450 Lake Robbins Dr., Suite 430 The Woodlands TX 77380 , OWNER, as set forth in the said Surety Company's bond. IN WITNESS,WHEREOF, the Surety Company has hereunto set its hand this 18th day of January, 2017 LIBERTY MUTUAL INSURANCE COMPANY Surety Company Attest:Robbi Morales (Seal):,-' Signatur"'e of Authorized Representative Sophinie Hunter Attorney-in-Fact Title NOTE: This form is to be used as a companion document to AIA DOCUMENT G706, CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS, Current Edition ONE PAGE THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT.IS PRINTED ON RED BACKGROUND. 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. Liberty Mutual Insurance Company Certificate No 7555572' The Ohio Casualty Insurance Company 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 ofandiana(herein collectively called the `Companies"),pursuant to and.by authority herein set forth,does hereby name;constitute and appoint, Don E.Cornell;Kelly A.Westbroo.k;:.Ricardo J.Reyna;Rob.bi Morales Sophinie Hunter-.T7na McEwan`V DeLene`Marshall all of the city of Dallas state of TX. each Individually if there be more than one named;its true and lawful attorney In-fact.to make,execute,seal,acknowledge and deliver,for and on its behalf as surety 68 asits 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 bythe president and attested by:fhe secretary of the Companies in their own.proper persons. IN WITNESS WHEREOF,this Power of Attorney has been subscribed by an authorized off or-.0. cial`of the Comparnes and the corporate seals of the Companies have been affixed- thereto this 30th day of November :2016 Y INSUh, tNSUgq� tNSUR - �°o�o�`o�TFo92m The Ohio Casualty Insurance Company rn 0 1919 0. rT- 1912 1991 Liberty Mutual Insurance Company - -0) WestAmerican Insurance Com Ui � `fli)2rsnaus 2 y Mou,:s t= _ Company 'fA STATE OF PENNSYLVANIA ss David M.Care ;Assistant Secretary: COUNTY OF MONTGOMERY On this 30th day of November 2016 before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance 0 v F- � � Company,The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorised so to do, execute the foregoing instrument for the purposes -�,� O its -therein contained by signing onbehalf of the corporations by himself as a duly authorized officer. y W IN-WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at King of Prussia,Pennsylvania,on the day and yea_rfirst above written_ p.Q tv gP PRSr COMMONWEALTH OF PENNSYLVANIA �oNw�1��! Notarial Seal Teresa Pastella,Notary Public By: O i of Upper Merion Twp.,Montgomery County -Teresa Pastella,Notary Public- i y _ 3 My Commission Expires March 28,2017 d O Member,Pennsylvania Association of Notaries O °3 qRy aoe C «1 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 ql_p Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows: 0) ARTICLE IV—OFFICERS—Section 92.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 0=C to such limitation as the Chairman or the President may prescribe,shall appoint such attorneys-in-fact;as may be necessary to actin-behalf of the Corporation to make,execute,seal, � O� acknowledge and deliver as surety any and all undertakings,bonds;recognizances and other suretyobligations. Such attorneys-in-fact,subject to the limitations set forth in their respectro '-de "�:� E y powers of attorney,shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seat of the Corporation. When so ' m p m executed,such instruments shallbeas binding as if signed by the President and attested to by the Secretary Any power or authority granted to anyrepresentative or attorney-in-fact-unde_r >-- >%-the provisions of this article may be revoked at any time by the Board,the Chairman,the President or by officer or officers -granting such power or authority. O v ARTICLE XIII—Execution.of Contracts—SECTION 5.Sure Bonds and Undertakin s.An officer,of the Company authorized for that purpose-in writing b the chairman or the resident, w C Surety 9 Y" P Y P P 9 Y P L and subject to such limitations as the chairman or the president may prescribe,shall appoint such attorneys-in-fact,as may be necessaryto act in behalf of the-Conlpariyto make,execute; - _M Z v seal,.acknowledge and deliver as surety any arld all undertakings,bonds,recognizances and other surety obligations. Such attorneys-in-fact subject to the limitations set forth in their- c respective powers of attorney,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 O-CD executed such instruments shall be as binding as if signed by the president and attested by the secretary... V r- Certificate of Designation—The Presldent;of the Company,acting pursuant.to the Bylaws of the Company authorizes David-M.Carey,AsslstahtSecretary to appoint such attorneys-n ~ fact as may be necessary to act on behalf, the Company to make,execute,seal,acknowledge and dellveras.surety anyand all undertakmgs,:bonds,recognizances and other surety obligations. Authorization—By unanimous consent ofthe Company's Board of Directors,the.Company,consents,that.facsimile or mechanically reproduced-liogture of any assistant secretary of the Company,wherever appearing upon a certfied copy of any power of attorney issued by the Company in connection wtth 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, The ON6" Casualty Insurance Company, Liberty:'.* utual Insurance.Company and West American Insurance Company do hereby certify that the original power of attorney of vihich the foregoing is o full Eros and orcect.dopy of the-Power of Attomey=exdcutedifysaio-Companies, is in:full force and effect and has not been revoked. 1( _ t IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this (d day of 11 20 _ �•(It INS(y �,INSUq 1NSUp - o�r�'9ym F��oHPo�f o2�n -�\`s� .0 1919 0 1912 3 1991 - By: - v o P� ,� 5 a' z Renee C.Llewe ssistant Secreta ry 55 of 300 LMS-1 2873 082016 �n 11 t ur a�u SURETY TEXAS TEXAS IMPORTANT NOTICE AVISO IMPORTANTE To obtain infonmation or make a complaint: Para obtener informacion o para someter una queja: You may call toll-free for information or to Usted puede llamar al numero de telefono gratis make a complaint at para informacion o para someter una queja al 1-877-751-2640 1-877-751-2640 You may also write to: Usted tambien puede escribir a: 2200 Renaissance Blvd., Ste. 400 2200 Renaissance Blvd., Ste. 400 King of Prussia, PA 19406-2755 King of Prussia, PA 19406-2755 You may contact the Texas Department of Puede comunicarse con el Departamento de Insurance to obtain information on companies, Seguros de Texas - para obtener informacion coverages, rights or complaints at acerca de companias, coberturas, derechos o 1-800-252-3439 quejas al 1-800-252-3439 You may write the Texas Department of Insurance Puede escribir al Departamento de Seguros Consumer Protection (I I 1-IA) de Texas Consumer Protection (111-IA) P. 0. Box 149091 P. 0. Box 149091 Austin, TX 78714-9091 Austin, TX 78714-9091 FAX: (512) 490-1007 FAX # (512) 490-1007 Web: http://www.tdi.texas.gov Web: http://www.tdi.texas.gov E-mail: ConsumerProtection@tdi.texas.gov E-mail: ConsumerProtectiongtdi.texas.gov PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS 0 RECLAMOS: Should you have a dispute concerning your Si tiena una disputa concemiente a su prima o a premium or about a claim you should first un reclamo, debe comunicarse con el agente o contact the agent or call 1-800-843-6446. primero. Si no se resuelve la disputa, puede If the dispute is not resolved, you may contact the entonces comunicarse con el departamento (TDI) Texas Department of Insurance. ATTACH THIS NOTICE TO YOUR UNA ESTE AVISO A SU POLIZA: POLICY: This notice is for information only and does not Este aviso es solo para proposito de information, become a part or condition of the attached y no se convierte en parte o condicion del document. documento adjunto. NP 70 68 09 01 LMS-15292 10/15 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 Ab Grantges, Contract Mgr, Of Burnsco construction, 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; Stone Creek Ranch V-Nater, Sanitary Sewer and Storm Drain BY Ab Grantges, ontract Manager Subscribed and sworn before me on this date 14th of February, 2017. Notary Public "ly•lFII," .6''. LEIA MCQUIEN Tarrant County, Texas _°;' =Notary Public,state of Texas v` y`Comm, Expires 06-26-2018 °Fs..`` Notary ID 125446481 ,riw February 15, 2017 Burnsco Construction Inc. Attn: Mr. John Burns 6331 Southwest Blvd Benbrook, TX 76132 Re: Liquidated Damages Project: Stone Creek Ranch Phase V—Water, Sewer&Drainage Pape-Dawson Project No. 61066-01 Contract Number: 001 Owner: LGI Homes—Texas,LLC Ladies and Gentlemen: LGI Homes — Texas, LLC will not be seeking liquidated damages from you on the work you have performed on the above reference project. Should you have any questions,please do not hesitate to contact us. Sincerely, LGI Homes—Texas, LLC Shannon Birt Vice President of Development Cc: Mr. Jason Elms,P.E.—Pape-Dawson Engineers, Inc. Texas Board of Professional Engineers,Firm Registration#470 Dallas I San Antonio I Austin 1 Houston I Fort Worth Transportation I Water Resources I Land Development I Surveying I Environmental 5700 W. Plano Pkwy.,Suite 2500,Plano,TX 75093 T: 214.420.8494 www.Pape-Dawson.com