HomeMy WebLinkAboutContract 49000-FP1 Y +
FORTWORTH®
—'" CITY SECRETARY
CONTRACT N0,
TRANSPORTATION AND PUBLIC WORKS
NOTICE OF PROJECT COMPLETION
(Developer Projects)
(+inn ez)(— City Project Ns: 100611
Regarding contract 100611 for STONE CREEK RANCH PHASE 6A as required by the
TRANSPORTATION&PUBLIC WORKS as approved by City Council on N/A through M&C N/A the director
of the TRANSPORTATION&PUBLIC WORKS upon the recommendation of the Assistant Director of the
Transportation&Public Works Department has accepted the project as complete.
Original Contract Price: $974,049.10
Amount of Approved Change Orders: $18,720.00 Ne 1,2
Revised Contract Amount: $992,769.10
Total Cost Work Completed: $992,769.10
Recommen fo Acceptance Date
Asst. Dir r - I a arc re D��t�Tl ttan
J�ce a
Accepted Date
Asst. Dire , TRANSPORTATION & PUBLIC WORKS
Asst. City Manager Department of TP&W Const, ervices Date
CIIN# (, / •Dat _
Project rlanager
Risk Management an dy --
Comments: D.O.E. Brotherton
CFA Morales/Scanned
Gutzler/Scanned I
jg;M,,AJJ..Ei* Ve Proceeding people have been C ntacted
concerning the request for final payment& have
DEC , released this project for such payment
Initial- Clearance Conducted By Q..�lcavu&t vn4
FORT WORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name STONE CREEK RANCH PHASE 6A
Contract Limits
Project Type STORM DRAIN&PAVING
City Project Numbers 100611
DOE Number 0611
Estimate Number 1 Payment Number 1 For Period Ending 11/7/2017
CD
City Secretary Contract Number Contract Time 200:D
Contract Date Days Charged to Date 181
Project Manager NA
Contract is 100.00 Complete
Contractor GILCO CONTRACTING,INC.
6331 SOUTHWEST BLVD.
BENBROOK, 'TX 76132-1063 j
Inspectors LAYER / ROGERS
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Thursday,December 7,2017 Page 1 of 5
I
City Project Numbers 100611 DOE Number 0611
Contract Name STONE CREEK RANCH PHASE 6A Estimate Number I
Contract Limits Payment Number I
Project Type STORM DRAIN&PAVING For Period Ending 11/7/2017
Project Funding
STORM DRAIN
ItemDescription of Items Unit Unit Cost
Estimated Estimated Completed Completed
No. Quanity Total Quanity Total
1 CONCRETE RIPRAP 173 SY $87.00 $15,051.00 173 $15,051.00
2 TRENCH SAFETY 2269 LF $1.00 $2,269.00 2269 $2,269.00
3 21"RCP 152 LF $80.00 $12,160.00 152 $12,160.00
4 24"RCP 1241 LF $87.00 $107,967.00 1241 $107,967.00
5 27"RCP 714 LF $98.40 $70,257.60 714 $70,257.60
6 30"RCP 37 LF $110.00 $4,070.00 37 $4,070.00
7 42"RCP 125 LF $210.00 $26,250.00 125 $26,250.00
8 4'STORM JUNCTION BOX 3 EA $8,100.00 $24,300.00 3 $24,300.00
9 5'STORM JUNCTION BOX 1 EA $9,000.00 $9,000.00 1 $9,000.00
10 6'STORM JUNCTION BOX 1 EA $11,500.00 $11,500.00 1 $11,500.00
11 24"SET 3 PIPES 2 EA $4,200.00 $8,400.00 2 $8,400.00
12 27"SET 2 PIPES 2 EA $3,900.00 $7,800.00 2 $7,800.00
13 10'CURB INLET 8 EA $6,000.00 $48,000.00 8 $48,000.00
14 4'DROP INLET I EA $5,400.00 $5,400.00 1 $5,400.00
15 SWPPP MAINTENANCE 4 MO $500.00 $2,000.00 4 $2,000.00
16 INLET PROTECTION 9 EA $175.00 $1,575.00 9 $1,575.00
17 18"THICK ROCK RIPRAP 6"THICK BEDDING 232 SY $54.00 $12,528.00 232 $12,528.00
18 CITY BONDS FOR ALL UTILITY 1 LS $18,000.00 $18,000.00 1 $18,000.00
IMPROVEMENTS
19 GUARDRAIL CO#1 905 LF $24.00 $21,720.00 905 $21,720.00
Sub-Total of Previous Unit $408,247.60 $408,247.60
PAVING
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
I HYDRATED LIME 209.25 TN $155.00 $32,433.75 209.25 $32,433.75
2 6"LIME TREATMENT 11957 SY $3.15 $37,664.55 11957 $37,664.55
3 6"CONC PVMT 11122 SY $35.65 $396,499.30 11122 $396,499.30
4 BARRIER FREE RAMP 14 EA $1,950.00 $27,300.00 14 $27,300.00
5 BARRIER FREE RAMP 5 EA $1,900.00 $9,500.00 5 $9,500.00
6 FURNISH/INSTALL ALUM SIGN GROUND 9 EA $500.00 $4,500.00 9 $4,500.00
MOUNT CITY STD
Thursday,December 7,2017 Page 2 of 5
City Project Numbers 100611 DOE Number 0611
Contract Name STONE CREEK RANCH PHASE 6A Estimate Number I
Contract Limits Payment Number I
Project Type STORM DRAIN&PAVING For Period Ending 11/7/2017
Project Funding
7 TRAFFIC CONTROL 2 MO $2,500.00 $5,000.00 2 $5,000.00
8 SWPPP MAINTENANCE 2 MO $500.00 $1,000.00 2 $1,000.00
9 FURNISWINSTALL STOP SIGN 9 EA $150.00 $1,350.00 9 $1,350.00
10 FURNISH/INSTALL STREET NAME BLADES 16 EA $150.00 $2,400.00 16 $2,400.00
11 REMOVE BARRICADE I EA $500.00 $500.00 1 $500.00
12 CONNECT TO EXISTING STREET 2 EA $750.00 $1,500.00 2 $1,500.00
13 CONNECT TO CONCRETE HEADER AND 1 EA $500.00 $500.00 1 $500.00
EXISTING ST
15 CITY BONDS FOR ALL PAVING 1 LS $8,300.00 $8,300.00 1 $8,300.00
IMPROVEMENTS
16 MAILBOX CLUSTER CONCRETE FOUNDATION 112 SF $4.50 $504.00 112 $504.00
Sub-Total of Previous Unit $528,951.60 $528,951.60
ST LIGHT
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quauity Total Quanity Total
1 1 1/4"CONDT PVC SCH 80 2182 LF $6.60 $14,401.20 2182 $14,401.20
2 NO 6 INSULATED ELEC CONDR 6546 LF $0.95 $6,218.70 6546 $6,218.70
3 GROUND BOX TYPE B 8 EA $550.00 $4,400.00 8 $4,400.00
4 RDWY ILLUM FOUNDATION 8 EA $935.00 $7,480.00 8 $7,480.00
5 LED LIGHTING FIXTURE 8 EA $950.00 $7,600.00 8 $7,600.00
6 RDWYILLUM 8 EA $1,765.00 $14,120.00 8 $14,120.00
7 CITY BONDS FOR ALL ST LIGHT 1 LS $1,350.00 $1,350.00 1 $1,350.00
IMPROVEMENTS
Sub-Total of Previous Unit $55,569.90 $55,569.90
Thursday,December 7,2017 Page 3 of 5
City Project Numbers 100611 DOE Number 0611
Contract Name STONE CREEK RANCH PHASE 6A Estimate Number 1
Contract Limits Payment Number I
Project Type STORM DRAIN&PAVING For Period Ending 11/7/2017
Project Funding
Contract Information Summary
Original Contract Amount $974,049.10
Change Orders
Change Order Number 1 $21,720.00
Change Order Number 2 ($3,000.00)
Total Contract Price $992,769.10
Date /L ° Total Cost of Work Completed $992,769.10
tractorLess %Retained $0.00
j Z Z .17 Net Earned $992,769.10
Date Earned This Period $992,769.10
Inspection Supervisor
Retainage This Period $0.00
A v Date Less Liquidated Damages
je t anage
Days @ /Day $0.00
Pro
Date LessPavement Deficiency $0.00
Asst, t W-I 04.E Less Penalty $0.00
Date
�'Q f Less Previous Payment $0.00
Direct n cting Department Plus Material on Hand Less 15% $0.00
Balance Due This Payment $992,769.10
Thursday,December 7,2017 Page 4 of 5
City Project Numbers 100611 DOE Number 0611
Contract Name STONE CREEK RANCH PHASE 6A Estimate Number I
Contract Limits Payment Number I
Project Type STORM DRAIN&PAVING For Period Ending 11/7/2017
Project Funding
Project Manager NA City Secretary Contract Number
Inspectors LAYER / ROGERS Contract Date
Contractor GILCO CONTRACTING,INC. Contract Time 200 CD
6331 SOUTHWEST BLVD. Days Charged to Date 181 CD
BENBROOK, TX 76132-1063 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 $992,769.10
Less %Retained $0.00
Net Earned $992,769.10
Earned This Period $992,769.10
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 $992,769.10
Thursday,December 7,2017 Page 5 of 5
FORTWORTH rev 03/05/07
TRANSPORTATION & PUBLIC WORKS
FINAL STATEMENT OF CONTRACT TIME
FINAL STATEMENT NO.:1
NAME OF PROJECT: Stone Creek Ranch Phase 6A
PROJECT NO.: 100611 CONTRACTOR: Gilco Contruction
DOE NO.; N/A
PERIOD FROM:05/10/17 TO: 11/06/17 FINAL INSPECTION DATE: 1-Nov-17
WORK ORDER EFFECTIVE:5/10/2017 CONTRACT TIME: 181 O WR* 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 DAYS TOTAL
& HOLIDAYS &TOO COLD RELOCATIONS OTHERS CHARGED DAYS
THIS 0 0 0 0 0 0
PERIOD
PREVIOUS 0 0 0 0 181 181
PERIOD
TOTALS 0 0 0 0 181 181
TO DATE
*REMARKS:
Mc�n
CONTRA TOR DATE INSPECTOR DATE 1
ENGINEERING DEP ARTAIFNT
The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TX 76012-6311 l�
(817)392-7941 •Fat: (817)392-7845
FORTWORTHREV:02/20/07
TRANSPORTATION AND PUBLIC WORKS
PERFORMANCE EVALUATION OF CONTRACTOR
I) CONTRACTOR&PROJECT DATA
Name of Contractor Project Name
Gilco Construction Stone Creek Ranch PH 6A
DOE Inspector DOE Number
Weyman Oden 100611
DOEInspector Project Manager
❑ Water❑ Waste Water Storm Drainage Pavement Khal Jaafari
Initial Contract Amount ProjectDcultp
$974,049.10 O Simple Routine Q Complex
Final Contract Amount Date
$992,769.10 11/6/2017
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 4 8 8
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 4 60 60
8 Traffic Control Maintenance 15 Y 4 60 60
9 Daily Clean Up 5 Y 3 20 15
10 Citizen's Complaint Resolution 5 Y 4 20 20
11 Property Restoration 5 Y 4 20 20
12 After Hours Response 5 Y 4 20 20
13 Project Completion 5 Y 4 20 20
TOTAL ELEMENT SCORE(A) 443
BONUS POINTS(25 Maximum)(B)
TOTAL SCORE(TS) 443
III)CONTRACTOR'S RATING
Maximum Score(MS)=448 or sum of applicable element score maximums which= 448
Rating([TS/MS] * 100%) 443 / 448 = 99%
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)
Signature DOE Inspector We o r_ SiplAture Contractor
Signature DOE Inspector's Supervisor
CONTRACTOR'S COMMENTS
TRANSPORTATION AND PUBLIC WORKS
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: 11/6/2017 -
Name of Contractor Project Alain
Gilco Construction Stone Creels Ranch Ph 6 A
DOE Inspector Project Manager
Weyman Oden Khal Jaafari -
DOE Number Project Difficulty T)pe of Conoact
100611 Q Simple QQ Routine Q Complex ❑ water[:] Waste WaterO Storm DrainageE] Pavement
Initial Contract Amount Final Contract Aniount -
$974,049.10 $992,769.10
rI) 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 1 Accuracy of Plans to Existing Conditions
2 Knowledge of Inspector 12 Clarity&Sufficiency of Details
3 Accuracy of Measured Quantities 13 Applicability of Specifications
4 Display Of Professionalism 14 Accuracy of Plan Quantities L4
5 Citizen Complaint Resolution PROJECT MANAGER EVALUATION
6 Performance-Setting up Valve Crews, Labs 1 Knowledge And/Or Problem Resolution
ADMINISTRATION I2 Availability of Project Manager
ns_
1 Change Order Processing Time _ L3 Cormnunication
2 Timliness of Contractor Payments 14 Resolution of Utility Conflicts
3 Bid Opening to Pre-Con Meeting Timefi ame
-r _m
III)COMMENTS& SIGNATURES
COMMENTS
Signature Contractor
Signature DOE Inspector
Signature DOE Inspector's Supervisor
INSPECTOR'S COMMENTS
TRANSPORTATION AND PUBLIC WORKS
s The City of Fort Worth• 1000 Tlhrockmorton Street•Fort Worth,TZ 76012-6311
(817)392-7941 •Fax: (817) 392-7845
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CONSENT Or OWNER ❑
SURETY COMPANY ARCHITECT ❑
CONTRACTOR ❑
TO FINAL L VSA VIVI KI SURETY ❑
Conforms with the American Institute of OTHER
Architects, AIA Document G707
Bond No 022056820
PROJECT:
(name, address)Stone Creek Ranch Phase 6A
Fort Worth TX
TO (Owner)
F ARCHITECT'S PROJECT NO:
LGI HOMES, LLC AND THE CITY OF FORT WORTH CONTRACT FOR:
1450 Lake Robbins Dr., Suite 430 Stone Creek Ranch Phase 6A-Water,Sanitary Sewer, Drainage,
Paving and Street Lighting Improvements
The Woodlands TX 77380 CONTRACT DATE:
CONTRACTOR: GILCO CONTRACTING, 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)
GILCO CONTRACTING, 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, 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 10th day of October, 2017
LIBERTY MUTUAL INSURANCE COMPANY
Surety Company
Attest:V. DeLena r al
(Seal): Sign ture 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 iuthority to'bind the Company except in the manner and to the extent herein stated.
Certificate No.7876978
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[lie 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,
Don E.Cornell;Kelly A.Westbrook; Ricardo J.Reyna;Bobbi Morales;Sophinie Hunter;Tina 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 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 25th day of August 2017 j,
tC
`�g 'o
The Ohio Casualty Insurance Company N
,y 1912 s 1991 `s Liberty Mutual Insurance Company a)
West American Insurance Company N
d N# t *
By:
stf *ur
STATE OF PENNSYLVANIA ss David M.Cared AAssistant Secretary
+= COUNTY OF MONTGOMERY c
its O
L On this 25th day of August 2017,before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance v t—
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 >,W
0 therein contained by signing on behalf of the corporations by himself as a duly authorized officer. O
L L
E
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. O.
y
SP PAS). ` COMMONWEALTH OF PENNSYLVANIA Q
Notarial Seat `—'d•
v Teresa Pasteila.Notary Public By., .. ._._
COF Upper Merlon Twp.,Montgomery County Teresa Pastella,Notary Public '..
L ���� i My Commission Expires March 28,2021 3. ILS
tv 0 y �i5!'US \G O E
O �QA)' gy Member.Pennsylvania Association of Notanes CL
0 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 O
y Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows:
O)
R 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 O C
4Zto such limitation as the Chairman or the President play prescribe,shall appoint such attorneys-in-fact,as play be necessary to act in behalf of the Corporation to make,execute,seal. y
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
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 seal of the Corporation. When soL. w
C Mexecuted,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 >
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. =
4�
a0=i 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, ,
L and subject to such limitations as the chairman or the president may prescribe,shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Company to make,execute, M
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 00
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 seal of the Company. When so 0o
executed such instruments shall be as binning as if signed by the president and attested by the secretary, a co
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 attorneys-in- r
fact 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.
1, 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 of which 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.
IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this l V day of _,20 .
91 e 1912 ° _ 1991 By:
V "
;5 y' Renee C.Llew ,Assistant Secretary
113 of 400
LMS 12873 022017
V
Liberty
Mutual.
SURETY
TEXAS TEXAS
IMPORTANT NOTICE AVISO IMPORTANTE
To obtain information or make a complaint: Para obtener informacion o para someter una
quej a:
You may call toll-free for information or to Usted puede hamar 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 elDepartaniento nformacide
Insurance to obtain information on companies, Seguros de Texas para obt
ener on
coverages, rights or complaints at acerca de companias, coberturas, derechos o
1-800-252-3439 quej as al
1-800-252-3439
You may write the Texas Department of Insurance Puede escribir al Departamento de Seguros
Consumer Protection (111-1 A) de Texas Consumer Protection (111-1 A)
P. O. Box 149091 P. O. Box 149091
Austin, TX 78714-9091 Austin, TX 78714-9091
FAX: (512) 490-1007 FAX # (512) 490-1007
WWeb: htt>7'//www.tdi.texas.gov
Web: http://www.tdi.texas.gov texas.gov
E-mail: ConsumerProtection@tdi texas.f4ov E-mail: ConsumerProtectionna tdi texas. ov
PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS O RECLAMOS:
Should you have a dispute concerning your Si tiena una disputa
p tcomunicarse t a selprima
a
premium or about a claim you should first un reclamo, d
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 infornlacion
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
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 Rob Taylor, Project
Coordinator of Gilco Contracting, Inc., known to me to be a credible
person, who being by me duly sworn, upon his oath deposed and said;
That all persons, films, 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;
Paving Improvements to serve: Stone Creek Ranch, Phase 6A
r
BY Rob Taylor
Subscribed and sworn before me on this 11th of October , 2017.
KAYE GILL d
Notary ID * 3834532
My Commission Expires Notary Public
5
�a
December 30,2020 Tarrant County, TX
sr� ►
{
October 11, 2017
City of Fort Worth
CFA Administration
1000 Throckmorton St.
Fort Worth, TX 76102
RE: Final Waiver of Lien; Paving Improvements to serve Stone Creek Ranch, Phase 6A
City Project 4100611
Water Project No. 59601-0600430-100611-001580
Sanitary Sewer Project No. 59607-0700430-100611-001380
File No. W-2440
File No. X-23925
u ose of this letter is to acknowledge that we have been aid in full b LGI Homes
Thep purpose g p y
LLC for the public improvements constructed to serve Stone Creek Ranch, Phase 6A in
Fort Worth, Texas. As a result, we hereby waive, release and relinquish all rights to
assert any claim or demand for lien in connection with this project.
Please feel free to contact me with any questions you may have.
Sincerely,
77 Rob Taylor
Project Coordinator
6331 Smiihwesi: Biwi.
Benb ook, Texas 76132
Dike: 817.735.1600
Fax: 817.735.1613