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Home My WebLink AboutContract 47701-FP2 Depart W Const.Services CRN# Da Project Manager �� W0RTH@Risk Management C nad - CITY SECRETARY r) D.O.E. Brotherton CONTRACT No ` 11c) CFA Morales/Scanned Gutzler/Scanned The Proceeding people have been Contacted ATION AND PUBLIC WORKS concerning the request for final payment&have ' PRO CT COMPLETION � l 1 released this project for such payment. Developer Projects) � "'n 0 ` _ /Zr Clearance Conducted By t�/mfiaia City Project Ne: 100159 Regarding contract 100159 for SCENIC VILLAGE as required by the WATER DEPARTMENT as approved by City Council on N/A throER DEPARTMENT upon the recommendation of the Assistant Director of the Trantr epartment has accepted the project as complete. i✓� N JUN 01 2018 Original Contract Price: Y�.... $46,322.00 Amount of Approved Change Orders: Ne Revised Contract Amount: Total Cost Work Completed: $46,322.00 Recommen eptance Date Asst. Direct r, PW - Development Services Accepted Date Asst. Director, WATER DEPARTMENT Asst. City Manager Date 6, 56789pj r mettts:�,�`��,p � ALl �1� Rev.9/22 8 2 9 9 ijl JUN 01 2018 54-9(a0l 100151 City Project Numbers 100159 ;1N �,�.- - ,� DOE Number 0159 Contract Name SCENIC VILLAGE Estimate Number 1 Contract Limits Payment Number 1 Project Type WAETR&SEWER For Period Ending 5/22/2018 Project Funding Project Manager NA City Secretary Contract Number Inspectors LAYER / ROGERS Contract Date Contractor RUMSEY CONSTRUCTION,LLC Contract Time 500 CD 6617 VILLAGE SPRINGS DRIVE Days Charged to Date 60 CD PLANO, TX 75024 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 $46,322.00 Less %Retained $0.00 Net Earned $46,322.00 Earned This Period $46,322.00 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 $46,322.00 Tuesday,May 22,2018 Page 4 of 4 FART ORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name SCENIC VILLAGE Contract Limits Project Type WATER&SEWER City Project Numbers 100159 DOE Number 0159 Estimate Number 1 Payment Number 1 For Period Ending 5/22/2018 CD City Secretary Contract Number Contract Time SOLD Contract Date Days Charged to Date 60 Project Manager NA Contract is 100.00 Complete Contractor RUMSEY CONSTRUCTION,LLC 6617 VILLAGE SPRINGS DRIVE PLANO, TX 75024 Inspectors LAYER / ROGERS Tuesday,May 22,2018 Page 1 of 4 City Project Numbers 100159 DOE Number 0159 Contract Name SCENIC VILLAGE Estimate Number 1 Contract Limits Payment Number I Project Type WATER&SEWER For Period Ending 5/22/2018 Project Funding WATER Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total 1 TRENCH SAFETY 398 LF $1.00 $398.00 398 $398.00 2 DUCTILE IRON WATER FITTINGS 0.3 TN $4,000.00 $1,200.00 0.3 $1,200.00 W/RESTRAINT 3 4"WATER PIPE 52 LF $20.00 $1,040.00 52 $1,040.00 4 6"PVC WATER PIPE 42 LF $25.00 $1,050.00 42 $1,050.00 5 8"PVC WATER PIPE 398 LF $30.00 $11,940.00 398 $11,940.00 6 FIRE HYDRANT 1 EA $2,200.00 $2,200.00 1 $2,200.00 7 1 1/2"WATER SERVICE 1 EA $650.00 $650.00 1 $650.00 8 2"WATER SERVICE 2 EA $850.00 $1,700.00 2 $1,700.00 9 6"GATE VALVE 3 EA $650.00 $1,950.00 3 $1,950.00 10 8"GATE VALVE 4 EA $950.00 $3,800.00 4 $3,800.00 Sub-Total of Previous Unit $25,928.00 $25,928.00 SEWER Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total ----------------------------------------- I ------------------ - - - 1 POST CCTV INSPECTION 192 LF $1.00 $192.00 192 $192.00 2 MANHOLE VACUUM TESTING 4 EA $125.00 $500.00 4 $500.00 3 TRENCH SAFETY 192 LF $1.00 $192.00 192 $192.00 4 4"SEWER SERVICE 1 EA $300.00 $300.00 1 $300.00 5 6"SEWER SERVICE 1 EA $600.00 $600.00 1 $600.00 6 8"SEWER SERVICE 2 EA $800.00 $1,600.00 2 $1,600.00 7 8"SEWER PIPE 192 LF $30.00 $5,760.00 192 $5,760.00 8 WASTEWATER ACCESS CHAMBER 2 EA $625.00 $1,250.00 2 $1,250.00 9 4'MANHOLE 4 EA $2,500.00 $10,000.00 4 $10,000.00 Sub-Total of Previous Unit $20,394.00 $20,394.00 -------------------------------------- Tuesday,May 22,2018 Page 2 of 4 City Project Numbers 100159 DOE Number 0159 Contract Name SCENIC VILLAGE Estimate Number 1 Contract Limits Payment Number I Project Type WAETR&SEWER For Period Ending 5/22/2018 Project Funding Contract Information Summary Original Contract Amount $46,322.00 Change Orders Total Contract Price $46,322.00 DateTotal Cost of Work Completed $46,322.00 Co'6r,vfor Less %Retained $0.00 Dat ?/`/� Net Earned $46,322.00 Inspection Supe or _ Earned This Period $46,322.00 � / Retainage This Period $0.00 Date / 2d � /Proje t anager Less Liquidated Damages —{ 11 Days @ /Day $0.00 Date J�'�+1 Y� LessPavement Deficiency $0.00 Asst. c / Less Penalty $0.00 Cl Datey C� 0� Less Previous Payment $0.00 Director/Contracting Department Plus Material on Hand Less 15% $0.00 Balance Due This Payment $46,322.00 Tuesday,May 22,2018 Page 3 of 4 FORTWORTH rev 03/05/07 TRANSPORTATION & PUBLIC WORKS FINAL STATEMENT OF CONTRACT TIME FINAL STATEMENT NO.:1 NAME OF PROJECT: Scenic Village PROJECT NO.: 100159 CONTRACTOR: Stanford Construction DOE NO.: N/A PERIOD FROM;06/20/16 TO: 04/19/18 FINAL INSPECTION DATE: l9-Apr-18 WORK ORDER EFFECTIVE:6/20/2016 CONTRACT TIME: 500 o WD 0 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 f S S PREVIOUS PERIOD TOTALS TO DATEJC *REMARKS: G CONTRAC19k DATE INSPECTOR DATE ENGINEERING DEPARTMENT The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TZ 76012-6311 (817) 392-7941 •Fax: (817) 392-7845 FORTWORTH TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PROJECT NAME: Scenic Village PROJECT NUMBER: 100159 DOE NUMBER: WATER PIPE LAID SIZE TYPE OF PIPE LF 8 inch pvc 8 inch C900 pvc 398 6 inch pvc -Cm-ch C900 pvc 42 4 inch 4 inch pvc 52 FIRE HYDRANTS: 1 VALVES(16" OR LARGER) PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: yes NEW SERVICES: 1.5" copper 1 2" copper 2 SEWER PIPE LAID SIZE TYPE OF PIPE LF 8"sewer 8" pvc 192 PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: yes NEW SERVICES: 8" pvc 2 6" pvc 1 4" pvc 4 TRANSPORTATION AND PUBLIC WORKS The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TX 76012-6311 FORTWORTH. TRANSPORTATION AND PUBLIC WORKS INSPECTION PUNCH LIST 1. Route and seal crack in paving at Bird St and building 11 2. Route and seal crack in paving at Bird st and building 12 3. all control joints in paving need to be 1 and half inch deep 4. Establish grass along Oakhurst Scenic row 5.lnstall rip rap on outfall of existing 54" storm line on west side of Oakhurst scenic 6.Samm nhole at north east corner of lillian needs repair.wating on direction from sewer dept Contract Inspector CONSENT OF OWNER x SURETY COMPANY ARCHITECT ❑ TO FINAL PAYMENT CONTRACTOR ❑ AIA DOCUMENT G707 SURETY ❑ OTHER ❑ Bond#4407495 PROJECT: Street Light Improvements-Scenic Village, (name,address) TO(Owner)FW Bluff Apartments L.P. ARCHITECT'S PROJECT NO: 14160 N.Dallas Parkway#750 CONTRACT FOR: Dallas,TX CONTRACT DATE:3/30/2016 75254 CONTRACTOR:Bean Electrical,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) SureTec Insurance Company 1330 Post Oak Blvd.,Ste 1100 Houston,TX 77056 ,SURETY COMPANY, on bond of (here insert name and address of Contractor) Bean Electrical,Inc. 821 E Enon Fort Worth,TX 76140 ,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) FW Bluff Apartments L.P. 14160 N.Dallas Parkway#750,Dallas,TX 75254 ,OWNER, as set forth in the said Surety Company's bond IN WITNESS WHEROF, The Surety Company has hereunto set its hand this 3rd day of May, 2018. SureTec Insurance Company Surety Company Signature of Authorized Representative -,•» ' '--::,� ,. Attest , (seal): Mistie Beck, Attorney-in-Fact >y Title ` NOTE:This form is to be used as a companion document to AIA DOCUMENT 0706,CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBT AND CLA Current Edition AIA DOCUMENT G707"CONSENT OF SURETY COMPANY TO FINAL PAYMENT"APRIL 1970 EDITION"AIA " 1970 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVE.NW WASHINGTON,D.C.2006 WARNING: Unlicensed photocopying violates U.S.copyright laws and is subject to legal prosecution. Br, I E',',A N E,L E C71 -Rl,ICA,L,J o j I N C 821 E.Etuon venue P 817-561-7400 BEI Fort Worth,Texas 76140 F 817-561-7403 ttlrn•.l,c•,a tc lrcu•irsLc<,t u 4 �> 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 Roy E. Bean II, President of Bean Electrical,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; Street Light Improvements-Scenic Village BY Roy E. Bean II,President Subscribed and sworn before me on this date 4th of May 2018. 7,,LCHPRYLEER. 'SPREE'y ubliC.State of TexosNotary P lic\,. � m.Expires 02-29-2020Noiory ID 1690225 Tarrant,Texas gym" Bean Electrical, Inc. TECL17979 Regulated by The Texas Department of Licensing and Regulations,P.O.Box 12157,Austin,Texas 78711,1 800 803 9202,512 463 6599,website www.license.state.tx.us/complaints EM INSURANCE CONSENT OF SURETY TO FINAL PAYMENT To (Owner): City of Fort Worth&FW Bluff Apartments,LP Address: City/State/Zip: Fort Worth,TX In reference to Project: 1001591 Concrete work at Scenic Village Fort Worth,TX $142,608.06 Bond# S343043 Contractor: Mountain Top Concrete, LLC 1900 Samuels Ave.Fort Worth,TX 76102 Owner: City of Fort Worth&FW Bluff Apartments,LP Employers Mutual Casualty Company as Surety,for the contractor on the above described project, hereby approves of final payment to the contractor,and agrees that final payment to the contractor shall not relieve the Surety of any of its obligations as set forth in the above bond. In witness whereof,this 2nd day of May 2018 Seal: Employers Mutual Casualty Company Surety Attest: V� .� By: t John Sate ~ Attorney-in-Fact i 7614(8-14) /EMC. INSURANCE P.O.Box 712-Des Moines,IA 50 306-071 2 N0, 697302 CERTIFICATE OF AUTHORITY INDIVIDUAL ATTORNEY-IN-FACT KNOW ALL MEN BY THESE PRESENTS,that: 1. Employers Mutual Casualty Company,an Iowa Corporation 5. Dakota Fire Insurance Company,a North Dakota Corporation 2. EMCASCO Insurance Company,an Iowa Corporation 6. EMC Property&Casualty Company,an Iowa Corporation 3. Union Insurance Company of Providence,an Iowa Corporation 7. Hamilton Mutual Insurance Company,an Iowa Corporation 4. Illinois EMCASCO Insurance Company,an Iowa Corporation hereinafter referred to severally as"Company"and collectively as"Companies",each does,by these presents,make,constitute and appoint MICHAEL T.STERLACCI,JOHN G.SUTTER,AMY ALLRED,RHONDA COX,BROOKE BERRYHILL its true and lawful attorney-in-fact,with full power and authority conferred to sign,seal,and execute its lawful bonds,undertakings,and other obligatory instruments of a similar nature as follows: Inan amount not exceeding Eight Million Dollars........................................................................................................................................................$8,000.000.00 and to bind each Company thereby as fully and to the same extent as if such instruments were signed by the duly authorized officers of each such Company,and all of the acts of said attorney pursuant to the authority hereby given are hereby ratified and confirmed. AUTHORITY FOR POWER OF ATTORNEY This Power-of-Attomey is made and executed pursuant to and by the authority of the following resolution of the Boards of Directors of each of the Companies at a regularly scheduled meeting of each company duly called and held in 1999: RESOLVED:The President and Chief Executive Officer,any Vice President,the Treasurer and the Secretary of Employers Mutual Casualty Company shall have power and authority to(1)appoint attomeys-in-fact and authorize them to execute on behalf of each Company and attach the seal of the Company thereto, bonds and undertakings,recognizances,contracts of indemnity and other writings obligatory in the nature thereof;and(2)to remove any such attomey-in-fact at any time and revoke the power and authority given to him or her.Attomeys-in-fact shall have power and authority,subject to the terms and limitations of the power-of-attorney issued to them, to execute and deliver on behalf of the Company, and to attach the seal of the Company thereto, bonds and undertakings, recognizances,contracts of indemnity and other writings obligatory in the nature thereof,and any such instrument executed by any such attomey-in-fact shall be fully and in all respects binding upon the Company. Certification as to the validity of any power-of-attorney authorized herein made by an officer of Employers Mutual Casualty Company shall be fully and in all respects binding upon this Company.The facsimile or mechanically reproduced signature of such officer,whether made heretofore or hereafter,wherever appearing upon a certified copy of any power-of-attomey of the Company,shall be valid and binding upon the Company with the same force and effect as though manually affixed. IN WITNESS THEREOF,the Companies have caused these presents to be signed for each by their officers as shown,and the Corporate seals to be hereto affixed this 31st day of MARCH 2017 Seals ° •L.� nice G.Kelley,C.6airman Todd Strother �'?S�U'Nj Uy44, 6F'COMP til!•' :�P1Y'L o,s, of Companies 2,3,4,5& ,President Vice President cr of Company 1;Vice Chairman and SEAL 1863 o' -1953,' = CEO of Company 7 I Z IOWA O 31 st On this day of MARCH AD 2017 before me a Notary Public in and for the State of Iowa, personally appeared Bruce G. Kelley and being Todd Strother,who, g b y me duly sworn,did say that they are,and are known to me to be the = "= Chairman,President,Vice Chairman and CEO,and/or Vice President,respectively,of each of The Companies above;that the seals affixed to this instrument are the seals of said corporations; =Y SEAL `< � ` SEAL Y :r_ ` SEAL that said instrument was signed and sealed on behalf of each of the Companies by authority 01, ,,,,. ?; of their respective Boards of Directors;and that the said Bruce G.Kelley and Todd Strother,as wwAAi OPK OLNEi. such officers,acknowledged the execution of said instrument to be the voluntary act and deed �uzu�t of each of the Companies. voNMt3TU4A yJ� My Commission Expires October 10,2019. 9 KATHY LOVERreoE Q01_:�I n Comm784769 s�S�pNV� o Oommilssim Expires October 10,2019 Notary P lic in and for the State of I a Es.. �P CERTIFICATE 1,James D.Clough,Vice President of the Companies,do hereby certify that the foregoing resolution of the Boards of Directors by each of the Companies, and this Power of Attorney issued pursuant thereto on MARCH 31,2017 on behalf of: MICHAEL T.STERLACCI,JOHN G.SUTTER.AMY ALLRED.RHONDA COX,BROOKE BERRYHILL are true and correct and are still in full force and effect. In Testimony Whereof I have subscribed my name and affixed the facsimile seal of n each Company this _day of Vvtn'�< Zo l /� Vice President POA#: 4221049 SureTec Insurance Company LIMITED POWER OF ATTORNEY Snow All Men by These Presents, That SURETEC INSURANCE COMPANY (the "Company"), a corporation duly organized and existing under the laws of the State of Texas, and having its principal office in Houston,Harris County, Texas, does by these presents make,constitute and appoint Tony Fierro,Jay Jordan,Johnny Moss,Steven W.Searcey,Robert J.Shuya,Mistie Beck, Jeremy Barnett,Robert G. Kanuth,Jade Porter,Jennifer Cisneros,Jarrett Willson,Jack Nottingham its true and lawful Attorney-in-fact,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 to include waivers to the conditions of contracts and consents of surety for,providing the bond penalty does not exceed Five Million and 00/100 Dollars($5,000,000.00) and to bind the Company thereby as fully and to the same extent as if such bond were signed by the President,sealed with the corporate seal of the Company and duly attested by its Secretary,hereby ratifying and confirming all that the said Attorney-in-Fact may do in the premises. Said appointment shall continue in force until 121$V2018 and is made under and by authority of the following resolutions of the Board of Directors of the SureTec Insurance Company: Be it Resolved that the President,any Vice-President,any Assistant Vice-President,any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: Attorney-in-Fact may be given full power and authority for and in the name of and of behalf of the Company,to execute,acknowledge and deliver,any and all bonds,recognizances,contracts,agreements or 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-Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary. Be it.Resolved,that the signature of any authorized officer and 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 signature or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached. (Adopted at a meeting held on 20°i of April, 1999.) In Witness Whereof,SURETEC INSURANCE COMPANY has caused these presents to be signed by its President,and its corporate seat to be hereto affixed this 12th day of October,A.D. 2017 . SURETEC TE ANY 35��o ru�'7 X 9Og By: W W o John Knox rest nt State of Texas ss: 7� � 0 County of Harris -` On this 12th day of October,A.D.2017 before me personally came John Knox Jr.,to me known,who,being by me duly sworn,did depose and say,that he resides in Houston,Texas,that he is President of SURETEC INSURANCE COMPANY,the company described in and which executed the above instrument;that he knows the seal of said Company;that the seal affixed to said instrument is such corporate seal;that it was so affixed by order of the Board of Directors of said Company,and that he signed his name thereto by like order. 'y 4�ti`�,rn�s XENIA CHAVEZ � rF+s Notary Public,State of Texas Comm.Expires 09-10-2020 101, fill��` Notary ID 129117659 X a avez,Notary Public y commission expires September 10,2020 I,M.Brent Beaty,Assistant Secretary of SURETEC INSURANCE COMPANY,do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney,executed by said Company,which is stili in full force and effect;and furthermore,the resohitions of the Board of Directors,set out in the Power of Attorney are in full force and effect. Given under my hand and the seal of said Company at Houston,Texas this da of _ (}1 ,A.D. B nt Befty,Assistant$ e6 Any instrument issued in excess of the penalty stated above is totally void and without any validity. For verification of the authority of this power you may call(713)812-0800 any business day between 8:00 am and 5:00 pry r'' a 72 -Al RUMSEY CONSTRUCTION 04/23/2018 City of Fort Worth CFA Administration 1000 Throckmorton St. Fort Worth,TX 76102 RE:Scenic Village DOE#: n/a City Project#CP100159 The purpose of this letter is to acknowledge that Rumsey Construction, LLC have been paid in full by FW Bluff Apartments, L.P.for the public improvements constructed to serve Scenic Village 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, Gary Wells COO/Partner 4329 Reeder Dr. Carrollton,TX 75010* Ph: 214-614-8140* Fax:214-556-1110 CONSENT OF OWNER M SURETY COMPANY ARCHITECT TO FINAL PAYMENT CONTRACTOR AIA DOCUMENT G707 SURETY OTHER . PROJECT: Scenic Bluff Apartments (name, address) Fort Worth, Tx TO (Owner) rCityof FortWorth & FW BluffCITY PROJECT NO: 100159 rtments, LP Fort Worth, TX CONTRACT FOR: $241,269.60 CONTRACT DATE: 313012016 CONTRACTOR: Rumsey Construction, LLC BOND NO: 1047873 4329 Reeder Drive Carrollton, TX 75010 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 as it appears in the bond). The Hanover Insurance Company SURETY COMPANY, on bond of(here insert name and address of Contractor as it appears in the bond), Rumsey Construction, LLC 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(here insert name and address of Owner) City of Fort Worth & FIN Bluff Apartments, LP OWNER, as set forth in the said Surety's bond. IN WITNESS WHEREOF , the Surety has hereunto set its hand this 13th day of April 2017 The Hanover Insurance Com any Surety �y ure Signature of Auth rized Representative Attest: Douglas Moore,Attorney-in-Fact .(Seal): Title AIA DOCUMENT ENT��7017 �NSIENTOFSuRE_TYTO FINAL PAYMENT APRIL 1970 IA a THE - ONE PAGE EDITION®AIA 0*@ 1970 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVE.,NW,WASHINGTON,D.C.20006 THE HANOVER INSURANCE COMPANY MASSACHUSETTS BAY INSURANCE COMPANY CITIZENS INSURANCE COMPANY OF AMERICA POWERS OF ATTORNEY CER77FIED COPY KNOW ALL MEN BY THESE PRESENTS: That THE HANOVER INSURANCE COMPANY and MASSACHUSETTS BAY INSURANCE COMPANY,both being corporations organized and existing under the laws of the State of New Hampshire,and CITIZENS INSURANCE COMPANY OF AMERICA,a corporation organized and existing under the laws of the State of Michigan,do hereby constitute and appoint John R.Ward,Douglas Moore,Emily Mikeska and/or Eva O.Limmer of Ward&Moore,Insurance Services LP of Gatesville,TX and each is a true and lawful Attorney(s)-in-fact to sign,execute,seal,acknowledge and deliver for,and on its behalf,and as its act and deed anyplace within the United States,or,if the following line be filled in,only within the area therein designated any and all bonds,recognizances,undertakings,contracts of indemnity or other writings obligatory in the nature thereof,as follows: Any such obligations in the United States,not to exceed Thirty Five Million and Noll 00($35,000,000)in any single instance and said companies hereby ratify and confirm all and whatsoever said Attorney(s)-in-fact may lawfully do in the premises by virtue of these presents. These appointments are made under and by authority of the following Resolution passed by the Board of Directors of said Companies which resolutions are still in effect "RESOLVED,That the President oranyVice president,in conjunction withany Vice president,beand theyare hereby authorized and empowered to appoint Attorneys-in-fact of the Company,in its name and as its acts,to execute and acknowledge for and on its behalf as Surety any and all bonds,recognizances, contracts of indemnity,waivers of citation and all other writings obligatory in the nature thereof,with power to attach thereto the sealof the company.Anysuch writings so executed by such Attorneys-in-fact shall be as binding upon the company as if they had been duly executed and acknowledged by the regularly elected officers of the Company in their own proper persons.,(Adopted October 7,IS81-The Hanover Insurance Company;Adopted April e r 1982- Massachusetts Bay Insurance Company;Adopted September 7,2001-Citizens Insurance Company of America) IN WITNESS WHEREOF,THE HANOVER INSURANCE COMPANY, MASSACHUSETTS BAY INSURANCE COMPANY and CITIZENS INSURANCE COMPANY OF AMERICA have caused these presents to be seated with their respective corporate seals,duly attested by two Vice Presidents, this 22nd day.of May 2014. wwur THE NANOVSR INSURANCE CoMpANy MASSACHt1SEi'I"+�BAY INSURANCE COMP ANy u, CITl EMS UP*4NCE MPANY 4F AMERICA i RobertThomas.Vice President THE COMMONWEALTH OF MASSACHUSETTS ) COUNTY OF WORCESTER )ss. JUC15 Ustnrta, is President On this 22nd day of May 2014 before me came the above named Vice Presidents of The Hanover Insurance Company,Massachusetts Bay insurance Company and Citizens Insurance Company ofAmedca,to me personally known to be the individuals and officers described herein,and acknowledged thatthe seals affixed to the preceding instrument are the corporate seals of The Hanover Insurance Company,Massachusetts-Bay Insurance Company and Citizens Insurance Company of America,respectively,and that the said corporate seals and their signatures as officers were duly affixed and subscribed to said instrument by the authority and direction of said Corporations. "w SAPS k GAR11CK f Fotary public J�tOrOf MGSBIR{IWEtf& a " ttp�tampss�tEcplr�sSap1.27,2Dt6 Barbara A.Garlick,Notary Public My Commission Expires September 21,2018 I,the undersigned Vice President of The Hanover Insurance Company,Massachusetts Bay Insurance Company and Citizens Insurance CompanyofAmerica, hereby certify that the above and foregoing is a full,true and correct copy of the Original Power ofAtfomey issued by said Companies,and do hereby further certify that the said Pourers of Attorney are still in force and effect. This Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company ofAmerica. "RESOLVED,That any and all Powers of Attorney and Ceded Copies of such Powers of Attomey and certification in respect thereto,granted and executed by the President or any Vice President in conjunction with any Vice President of the Company,shall be binding on the Company to the same extent as if alt signatures therein were manually affixed,even though one or more of any such signatures thereon may be facsimile.• (Adopted October 7,1981-The Hanover Insurance Company;AdoptedApril 14,1982.Massachusetts Bay insurance Company,Adopted september7,2001-Citizens insurance Company of America) GIVEN under my hand and the seals of said Companies,at Worcester,Massachusetts,this 13th day of Agri! 2017. THE HANOVER INSURANCE COMPANY MA SA HUs CE COMPANY CIT EN sU CE Y OF AMERICA ,. h I e,Vice nt TA nower insumce Group'" Texas Complaint Notice Commercial Lines IMPORTANT NOTICE AVISO IMPORTANTE' To obtain information or make a complaint: Para obtener informacion o para someter una queja: You may call The Hanover Insurance Company/ Usted puede Ilamar al numero de telefono gratis de Citizens Insurance Company'of America's toll-free The Hanover Insurance Company/Citizens Insurance telephone number for information or to make a Company of America's para information o para complaint at: someter una queja al: 1.800-608-8141 1-800-608-8141 You may also write to The Hanover Insurance Company/ Usted tambien puede escribir a The Hanover Insurance Citizens Insurance Company of America at: Company/Citizens Insurance Company of America al: 440 Lincoln Street 440 Lincoln Street Worcester,MA 01615 Worcester, MA 01615 You may contact the Teams Department of Insurance Puede comunicarse con el Departamento de Seguros to obtain information on companies,coverages, de Texas para obtener information acerca de rights or complaints at companies, coberturas, derechos o quejas al: 1-800-252-3439 1-800-252-3439 You may write the Texas Department of Insurance: Puede esca-ibir al Departamento de Seguros de Texas: P O. Box 149104 P. O. Box 149104 Austin,TX 78714-9104 Austin,TX 78714-9104 Fax (5 12)47571771 Fax: (512)475-1771 Web: http://www.tdi.texas.gov Web: http://wwwtdi.texas.gov E-mail:ConsumerProtectionOtdi.texas.gov E-mail:ConsumerProtectionOtdi.texas.gov PREMIUM OR CLAIM PISPUTES: DISPUTAS SOME PRIMAS 0 RECLAMOS: Should you have a dispute concerning your premium Si tiene una disputa concerniente a su prima o a un or about a claim you should contact the agent or the redamo, debe comunicarse con el agente o is com- company first, If the dispute is not resolved,you may pania primero.Si no se resuelve la disputa, puede contact the Texas Department of Insurance. entonces comunicarse con el departamento(TDI). ATTACH THIS NOTICE TO YOUR POLICY:This UNA ESTE AVISO A SU POLI • Este aviso es solo notice is for information only and does not become para proposito de information y no se convierte en a part or condition of the attached document. parte o condition del documento adjunto. The Hanover Insurance Company 1440 Uncoln street,Worcester,MA 61653 oxadsrtt3h9or r Citizens Insurance Company of America 1808 North Highlander Way,Howell,MI 48843m tp