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HomeMy WebLinkAboutContract 49313-FP2 City Secretary 49313 -FP2 Contract No. FORTWORTH, Date Received Oct 9,2018 SCS 00 S -- 1vo8't3 NOTICE OF PROJECT COMPLETION (Developer Projects) The Transportation and Public Works Department upon the recommendation of the Project Manager has accepted the following project as cemp!ete: Project Name: STONE CREEK RANCH PH 6B City Project No.: 100893 Improvement Type(s): ® Paving ® Drainage ® Street Lights ❑ Traffic Signals i Original Contract Price: $1,370,528.33 Amount of Approved Change Order(s): $11,702.44 Revised Contract Amount: $1,382,230.77 Total Cost of Work Complete: $1,382,230.77 (52h2va�� Gene DeVore(Sep 18,2018) Sep 18,2018 Contractor Date RPM xConstruction,LLC Title W Project Manager o Company Name 7";A- Jesse Davis(Sep 26,2016) Sep 26,2018 Pro'ect Inector Date K11.1J-f t;(Se ,MS) Sep 27,2018 Project. Manager Date Jahn Jr�etttifvha�r Jane Scarlett Morale,ISCp 27,20 18) Sep 27,2018 CFA Manager Date Sw,wyAl;a. Se 27,2018 5--Alanis(Sep 27,2018) P Asst. City Manager Date Page 1 of 2 EFAft.RECORD ECRETARYORTH,TX Notice of Project Completion J P Project Name: STONE CREEK RANCH PH 6B City Project No.: 100893 wl h k I� City's Attachments it Final Pay Estimate © 1 Change Order(s): N Yes ❑ N/A I? Contractor's Attachments Affidavit of Bills Paid Consent of Surety �I Statement of Contract Time F Contract Time: 243 CD Days Charged: 348 h Work Start Date: 9/6/2017 Work Complete Date: 8/20/2018 Ih I 9 i I I it I I! Ij I� I; �I II II I� I, I9, Page 2 of 2 �1 l; I h i� 5l0 City Project Numbers 100893 DOE Number 0893 Contract Name STONE CREEK RANCH PH 6B Estimate Number 1 Contract Limits Payment Number 1 Project Type STORM DRAIN&PAVING For Period Ending 8/28/2018 Project Funding Project Manager NA City Secretary Contract Number Inspectors DICKINSON / DAVIS Contract Date Contractor RPMX CONSTRUCTION Contract Time 243 CD 5208 TENNYSON PARKWAY SUITE 130 Days Charged to Date 348 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 $1,382,230.77 Less %Retained $0.00 Net Earned $1,382,230.77 Earned This Period $1,382,230.77 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 $1,382,230.77 Tuesday,September 18,2018 Page 5 of 5 FORT WORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name STONE CREEK RANCH PH 6B Contract Limits Project Type STORM DRAIN&PAVING City Project Numbers 100893 DOE.Number 0893 Estimate Number I Payment Number I For Period Ending 8/28/2018 CD City Secretary Contract Number Contract Time 24ED Contract Date Days Charged to Date 348 Project Manager NA Contract is 100.00 Complete ii Contractor RPMX CONSTRUCTION 5208 TENNYSON PARKWAY SUITE 130 PLANO, TX 75024 Inspectors DICKINSON/ DAVIS ti F�I f� I Tuesday,September 18,2018 Page I of 5 1� 9 �I City Project Numbers 100893 DOE Number 0893 Contract Name STONE CREEK RANCH PII 6B Estimate Number I Contract Limits Payment Number I Project Type STORM DRAIN&PAVING For Period Ending 8/28/2018 Project Funding STORM DRAIN Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total 1 TRENCH SAFETY 1087 LF $1.04 $1,130.48 1087 $1,130.48 2 21"RCP 45 LF $75.92 $3,416.40 45 $3,416.40 3 24"RCP 187 LF $91.52 $17,11.4.24 187 $17,114.24 4 30"RCP 502 LF $106.08 $53,252.16 502 $53,252.16 5 36"RCP 264 LF $140.40 $37,065.60 264 $37,065.60 6 54"RCP 54 LF $304.70 $16,453.80 54 $16,453.80 7 4X2 BOX CULVERT 35 EA $213.20 $7,462.00 35 $7,462.00 8 4'STORM JUNCTION BOX 5 EA $4,368.00 $21,840.00 5 $21,840.00 9 6'STORM JUNCTION BOX 2 EA $7,800.00 $15,600.00 2 $15,600.00 10 10'CURB INLET 4 EA $5,200.00 $20,800.00 4 $20,800.00 I 1 15'CURB INLET 1 EA $7,540.00 $7,540.00 1 $7,540.00 12 20'CURB INLET 2 EA $9,880.00 $19,760.00 2 $19,760.00 13 4'DROP INLET I EA $1,456.00 $1,456.00 1 $1,456.00 14 24"FLARED HEADWALL, 2 EA $2,392.00 $4,784.00 2 $4,784.00 15 54"FLARED HEADWALL 1 EA $16,896.00 $16,896.00 I $16,896.00 16 SWPPP MAINTENANCE 4 MO $3,800.00 $15,200.00 4 $15,200.00 17 INLET PROTECTION 8 EA $95.04 $760.32 8 $760.32 18 12"THICK ROCK R.IPRAP 45 SY $118.56 $5,335.20 45 $5,335.20 19 18"THICK ROCK RIPRAP 56 SY $118.56 $6,639.36 56 $6,639.36 20 CITY BONDS FOR ALL UTILITY 1 LS $49,400.00 $49,400.00 1 $49,400.00 IMPROVEMENTS --------------------------------------- Sub-Total of Previous Unit $321,905.56 $321,905.56 PAVING Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total --------------------------------------- I -------------------------------------- 1 CONCRETE PAVEMENT REPAIR 351 SY $119.09 $41,800.59 351 $41,800.59 2 HYDRATED LIME 295.5 TN $161.20 $47,634.60 295.5 $47,634.60 3 6"LIME TREATMENT 16887 SY $3.54 $59,779.98 16887 $59,779.98 4 6"CONC PVMT 15888 SY $34.79 $552,743.52 15888 $552,743.52 6 BARRIER FREE RAMP del co#4 18 EA $2,964.00 $53,352.00 18 $53,352.00 Tuesday,September 18,2018 Page 2 of 5 City Project Numbers 100893 DOE Number 0893 Contract Name STONE CREEK RANCH PH 6B Estimate Number 1 Contract Limits Payment Number 1 Project Type STORM DRAIN&PAVING For Period Ending 8/28/2018 Project Funding 7 FURNISH/INSTALL ALUM SIGN GROUND 10 EA $364.00 $3,640.00 10 $3,640.00 MOUNT CITY STD 8 TRAFFIC CONTROL 2 MO $520.00 $1,040.00 2 $1,040.00 9 SWPPP MAINTENANCE 2 MO $1,000.00 $2,000.00 2 $2,000.00 10 FURNISH/INSTALL STOP SIGN 7 EA $468.00 $3,276.00 7 $3,276.00 11 FURNISH/INSTALL STREET NAME BLADES 36 EA $260.00 $9,360.00 36 $9,360.00 12 REMOVE BARRICADE 5 EA $520.00 $2,600.00 5 $2,600.00 13 CONNECT TO EXISTING STREET 6 EA $260.00 $1,560.00 6 $1,560.00 14 CONNECT TO CONCRETE HEADER AND 6 EA $260.00 $1,560.00 6 $1,560.00 EXISTING STREET 15 CITY BONDS FOR ALL PAVING 1 LS $22,000.00 $22,000.00 1 $22,000.00 IMPROVEMENTS 16 MAILBOX CLUSTER CONCRETE FOUNDATION 31 SF $124.80 $3,868.80 31 $3,868.80 17 FURNISIMNSTALL SPEED ZONE 2 EA $520.00 $1,040.00 2 $1,040.00 18 FURNISHANSTALL RIGHT TURN 1 EA $468.00 $468.00 1 $468.00 19 FURNISH/INSTALL LEFT TURN I EA $468.00 $468.00 1 $468.00 20 CONC RET WALL W/SIDEWALK FACE CO#3 164 SF $70.40 $11,545.60 164 $11,545.60 21 CONC RET WALL W/SIDEWALK,SIDEWALK 270 SF $18.70 $5,049.00 270 $5,049.00 CO#3 ------------------------------------------ Sub-Total of Previous Unit $824,786.09 $824,786.09 ST LIGHT Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total 1 2"CONDT PVC SCH 80 co#2 4852 LF $8.32 $40,368.64 4852 $40,368.64 2 NO 6 INSULATED ELEC CONDR co#2 14556 LF $2.08 $30,276.48 14556 $30,276.48 3 GROUND BOX TYPE B 12 EA $780.00 $9,360.00 12 $9,360.00 4 RDWY ILLUM FOUNDATION co#2 co#5 25 EA $1,232.40 $30,810.00 25 $30,810.00 5 LED LIGHTING FIXTURE co#2 co#5 25 EA $3,239.60 $80,990.00 25 $80,990.00 6 RDWY ILLUM co#2 co#5 25 EA $754.00 $18,850.00 25 $18,850.00 7 FURNISH/INSTALL ELEC SERV PEDESTAL 3 EA $6,344.00 $19,032.00 3 $19,032.00 8 CITY BONDS FOR ALL STREET LIGHT 1 LS $5,852.00 $5,852.00 1 $5,852.00 IMPROVEMENTS Sub-Total of Previous Unit $235,539.12 $235,539.12 Tuesday,September 18,2018 Page 3 of 5 City Project Numbers 100893 DOE Number 0893 Contract Name STONE CREEK RANCH PH 613 Estimate Number 1 Contract Limits Payment Number 1 Project Type STORM DRAIN&PAVING For Period Ending 8/28/2018 Project Funding Contract Information Summary Original Contract Amount $1,370,528.33 Change Orders Change Order Number 2 ($8,558.16) Change Order Number 3 $16,594.60 Change Order Number 4 $8,892.00 Change Order Number 5 ($5,226.00) Total Contract Price $1,382,230.77 Total Cost of Work Completed $1,382,230.77 Less %Retained $0.00 Net Earned $1,382,230.77 Earned This Period $1,382,230.77 Retainage This Period $0.00 Less Liquidated Damages Days @ /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 $1,382,230.77 Tuesday,September 18,2018 Page 4 of 5 p m Z O m Z 7 n O Cn C m a � 0 o O m Sc Di -�G D ° m � � z0 � � � m0m m � �kMm o o D z 0 C- 0 < o m o y o y m Ri D n D 1 m o p o -0-1 0 m Z m m -I o m z z D = + D c7 (� ar m z -+ 1 D = D o czi m � I >� � z m 7J 0 m x 1 0 0 c m z � a 00 ` o n cNn ro A N O N A <O O N J 3 N N to m V O O Cl) W � C7 OV 00 zr (D CCD w Di 1A 4p 07 m W@ Cl) Cl) C, 1J Q w C- 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NO CITY FUNDS INVOLVED IN THIS CONTRACT. DEVELOPER IS RESPONSIBLE FOR 100%OF THE CHANGE ORDER COST AND NO REIMBURSEMENT FROM THE CITY WILL BE SOUGHT BY THE DEVELOPER. RECOMMENDED: APPROVED: APPROVED: ape-Dawson Engineers,Inc. LGI Homes-Texas,LLC RPM Construct) . LC Bt.. - By: - - g. a r ame: lms P.E. E Name: Elaine Torres Name: C;ent Title: Officer Title: P E �t it II 1 I� Revised:10-12-2011 Page 2 1 i j t, i �I O m O oZ m m 7J z I_ {m 0 0 C) C) "O a -I r m Z D D 0 :D m g —{ m D zz o 0 „ 0 b mm 4# Mm4; -041- 1 4 < < o o o n -nj m D m N :0 N (n A -D 0 p 0 O fJ �7 O Z < Q m m m o p � 7J 0 0 m -1 z 9 a m D ' D W o a o —q 0 m 0 z m m ? 1 0 N z z a x -4 D a C) m o rn z m z x oC 0 U o m Z n m 0 h 0 m m f z m � y pN (D (n co O M (n V1 to O W W O O D � IV O O O O O O O OJ J (D O -O (1t o fn O V J W 00 O A7 rn w LO o cQn o m v6 6 Wco (7 :; w W W D 3 O O W �! 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O o G DZ 3 Z Z n N .� JJ O (t1 0 D o o _Z w co m O 0 1 N W OCD V n m J CD c�. 0 O N 0 1 r N N C I rn m tD (p (O a �I N N O N toll N {' W N Ul tr C3 �I D O n mm D 0 0 0 3] Z Z G) y u o m o 0 0 O N N to N V N fJ O O, N m O W m r w r N O O O 5a N pN !!P 0 W � Z P [O N p t W � L i j� N j � � _~ m « $ § \ \ km -0\\ \ { \ \ � \ & & Q& a & ® } j \ / §\ \ ) } \ � § ! / 3 f ( } } > § X. § ® e / I § K n Rn Cb / � ( � � � [ R (2 § § } / 2 i » m m A o y — G Q in \ & @ / j \ k ) m> m & 6a \ / =A - \ � _ \zl- aeaj j / ) c e / } 322$2In$ § [Z $ I a z m » o ) ® = r == r= k2§0 »22%a§/§ ±]e c z ) ! § F? oG - > P& pP=� e ' )§ * � E§ E\/( , \G )� 3\_3 § g /) k� )k \ §% \�){ 77 Pm o 2/ 2 . \ § m pLn k22 ] m ± jR ) / / R _ m C. \ § 7 \ t m k ; \ / m 3 } o m R :13 ) » S / eeeeee § } e/ ora E §0ND to _ ° e\ m m 9'q OD\\ -ocl ±- \*C>41 / . $ )\ i ( ) .� ►�q�IC; FINAL BILLS PAID AFFIDAVIT THE STATE OF TEXAS COUNTY OF DENTON BEFORE ME, the undersigned authority, personally appeared (1 �. �; \``� ,•' \h (hereinafter referred to as "Contractor"), known to me to be a credible person, and after being by me duly sworn, upon oath stated and affirmed that: �n "My name isU;�G� \`� '�� and I am the , ` , of ��� rf`��%�c • hereafter sometimes referred to in this affidavit as "Contractor'. Contractor's business address is .C, „ The undersigned Contractor has personal knowledge of the facts stated herein and has full authority to make the agreements in this affidavit on behalf of Contractor. Pursuant to and in accordance with a written construction contract between A� "K V-Ag,m jx Contractor, and Owner, Contractor furnished materials and labor for the construction, renovation, or repair of improvements ,,Ocated on or relating t� roject known as L �._h_ 1 h i� located,, -v�. �`};\n�'9h;l� , ; City of 4 County,Texas.All work provided for under said written construction contract,together with all changes and supplements thereto, has been fully completed in accordance with the terms and provisions thereof. Contractor has paid each of its subcontractors, laborers, suppliers and materialmen in full for all labor and materials provided to Contractor for or in connection with the construction, renovation, or repair of improvements on or relating to the subject Property, or any portion thereof,excepting only the amounts owed for the following specified bills to the persons identified below. Contractor warrants and represents that the following specified bills will be paid to Contractor by Owner in reliance on this Final Bills Paid Affidavit: Name of Payee Address Telephone No. Amount Owed 1 �tcI— U. r, iLhc c Ci 9- ����.,�, CL,��:.��i1'1&.c�A.. �r' Sys-�'�-oi1�✓�-t�'i c�i,ZG�.� . Other than the above specified bills owed to the above referenced persons, Contractor is not aware of any unpaid bills, claims,demands, or causes of action by any of its subcontractors, laborers,suppliers,or materialmen for or in connection with the furnishing of labor or materials, or both, for the construction, renovation, or repair of improvements located on or related to the subject Property. In consideration of the funds paid to Contractor by Owner and by Lender on behalf of Owner in reliance on this affidavit, Contractor waives and releases all of Contractor's statutory and constitutional mechanic's lien rights connected with the construction of the Project, conditioned on the actual payment or collection if payment is made by check or draft. Contractor further understand that this Final Bills Paid Affidavit is being given pursuant to and in accordance with Sections 53.085 and 53.259 of the Texas Property Code and that the intentional, knowing, or reckless making of a false or misleading statement in this Affidavit constitutes an offense under said Section and is a Class A misdemeanor. Contractor hereby indemnifies and holds harmless Owner from any and all claims, demands or causes of action, and any costs,expenses, and attorney's fees incurred in connection therewith, arising from or connected with,the RAProject Management\PublicWMY\Affidavit of Bills Paid-Final.doc Name of Payee Address Telephone No. Amount Owed Rct, fsoi.QJg Sy7li4i "- I� c 'll-Wrl .1jv� &ru vj� `1Sl U0 1Zll 1 r statements and representations contained herein." EXECUTED this1 day of � '� ' , 2018. ­R W. C -hv e- o� L L-C By: Printed Name: ATTEST: Title:' _�2,ws, Pri*t Narne: THE STATE OF TEXAS COUNTY OF Before me, the undersigned authority, on this day personally appearedAz-X-`o';�!:� �����-�';L�V�� who first being duly sworn by me to be the person whose name is subscribed to the foregoing Final Bills Paid Affidavit, acknowledged that he/she has the authority to make this Final Bills Paid Affidavit, and further acknowledged to me that he/she executed the same for the purpose and consideration therein expressed. GIVEN UNDER MY HAND AND SEAL OF OFFICE, on this tti day f `\_', uc,. 20 Nota Pu- is in and fbr they State o11=S (NOTARY SEAL) Printed Name: 4\\,2, Commission Expires: �I Iii RAProject Management\Public\AMYWffidavit of Bills Paid-Final.doc CONSENT OF OWNER SURETY COMPANY ARC111TE'CT TO FINAL PAYMENT CONTRACTOR SURr'I'Y AIA DOCUMENT G707 OTIIER Bond No. 22605,57 PROJECT: Stone Creek Ranch,Phase 6B,City Project No. 100893 (name,address) TO(Owner) [ City of Fort Worth& ] ARCHITECT'S PROJECT NO: LGI Homes-Texas,LLC CONTRACT FOR: Construction ] CONTRACT DATE: CONTRACTOR: RPM xConstruction,LLC 5208 Tennyson Parkway,Suite 130 Plano,TX 75024 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) North American Specialty Insurance Company 5200 Metcalf OPN111 Overland Park,KS 66202 SURETY COMPANY, On bond of(here insert name and address of Contractor) RPM xConstruction,LLC 5208 Tennyson Parkway,Suite 130 Plano,TX 75024 , CONTRACTOR, hereby approves of the final payment to the Contractors,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) City of Fort Worth & LGI Homes-Texas,LLC , as set forth in the said Surety Company's bond. OWNER, IN WITNESS WHEREOF, the Surety Company has hereunto set its hand this 31st day of August 2018 North American Specialty Insurance Company Surety Company ik Attest: Signature of Authorized Representative � (Seal):��1 ������/Lr�� (J Andrea Rose Crawford Attorney-In-Fact Title NOTE: This form is to be used as a companion document to AIA DOCUMENT G706,CON'TRACTOR'S AFFIDAVIT OF PAYMENT Of DEBTS AND CLAIMS. Current Edition AIA DOCUMENT'G707 CONSENT OF SURETY COMPANY TO FINAL.PAYMENT APRIL.1970 EDITION AIA ONE PAGE 1970 THE AMERICAN INSTITUTE OF ARCI 11TECTS, 1735 New York Ave..NW,WASI IING'TON,D.C. 20006 1111 1, SWISS RE CORPORATE SOLUTIONS NORTH AMERICAN SPECIALTI' INSURANCE C01V1PANY WASHiNGTON INTERNATIONAL INSURANCE COMPANY WESTPORT INSURANCE CORPORATION GENERAL POWER OF ATTORNEY KNOW AM,MEN BY"fliESl:PKI:SF,N`I'S,ll IAT Noah,American Specialty Insurance Company.a corporation duly urgani/_cd and c�istin� under laws of the State ofNevv Hampshire,and having its principal Office in the City of Overland Park,Kansas and Washington International Insurance Company a corporation organized and existing under the laws of'the State of New I lampshire and having its principal office in the City ofOverland Park.Kansas,and Westport insurance Corporation.organized under the laws of the Statc of Missouri,and having its principal office in the City of Overland Park,Kansas each does hereby make,constitute and appoint: SAMMY JOE MULLIS,JR„JOHN WILLIAM NEWIJY,CHERT LYNN IRBY.WILBER'F RAYhiONU WATSON,M101AFL,I- 1'IJLLIS.SANDRA LFI: RONEY.D1:1RA LlSli MOON, AAUREA ROSfi CRANVI:ORD.MARY JO%AKR/.I:WSKI.JA1iliS n RMERS,JR.•TROP RUSSELL KEY,LINDA MICalliLL[:STALUIIR AND C'11Rt5'rC)i'111iN.CARL,SUNDhkRG JOIN(LY UR SICV'PY ALLY Its true and lawful Attorney(s)-in-Pact•to make,execute.scat and deliver,for and on its behalf and as its act and decd,bonds or other writings obligatory in the nature ofa bond on behalf ofsaid Companies.as surety,on contracts ofsuretyship as are or may be required or permitted by law.regulation,contractor otherwise,provided that no bond or undertaking or contract or suretyship executed tender this authority shall eNceed illy alnoutttof: ONE 1-IUNDRED TWENTY MVI?MILLION(S 125.000.000.00)DOLLARS Phis Power of Attorney is granted and is signed by facsimile under and by the authority of the IbllowinL Resolution,adopted by the Boards of Directors ofNorth American Specialty Insurance Company and Wash in,,ton International Insurance Company at meetings duly called and held on March 24.2b00 and We. Insurance Corporation by written consent of its ENccutiv'c Commiltee dated July 18,2011. "RliS01.VIiU,that any two of fhe President,any Senior Vice President,any Vice President.any Assistant Vice President. the Secretary or arty Assistant Secretary be,and each or any ofthem hereby is authorized to execute a Povv'cr ofAltontcy qualilying the attorney'maned in the given Povver of Attorney to execute on behall'of the Company bonds,undertakings and all contracts ol'surety,and that each or any of them hereby is authorized to attest to tine execution of any such Power of Attorney and to attach therein the seal of the Company: and it is FUR11II:R RESOI,VED,that the signature ofsuch officers and the seal of•the Company may be affixed to any such Power ofAttorney Dr to any certificate relating thereto by facsimile,and any such Power of Attorney or certificate hearing such facsimile signmures or facsimile seal shall be binding upon the Company when so affixed and in the future with regard to any bond.undertaking or contract of surety to lvhich it is attached." \\0\\18nluwp//i �towm, "% $ pNN (•,\h117Y/ /4i/ 's' CN.S(/"k,'� i...f� / � �.ttttttb• �`rG�"', I3y. �•1,.�-EAL StA$dC '� _ o Rte•.. _ .� o �T'a" 1 ^� c � �gg2 G c S. ct` b�s Jtcxcr�.An rr>on,.ran s,c t �s,n;;ton mrrnuUonu nwrucc nCu,nparn' �,• 4�'*• ^� U J SEAL ;p G O: Senior VW,1'rradrnt nr North Amen,."6pcnalp Luurana•(.tunpuov •� SEALor \`• c w z 1973 .0 Soni.,\ire Pre idem f\1.1p.,l LuuroncrAM9S"A Carporatinu 555...::: perp a $' of i vF1 a� ///h ON "+': Mike A.It-,Sonia,Vicrma Pidrnt of\t'nshn;toniImcrnati.nnl Lsurnnco Can rnni *'"�,� //I/ftt11114111\\\\ �rafccir,;;;ytmn'` I R Seni.r Vire Prrxidrnt of�onh American Slu<iait�luwrunco('on,pany rulf9ttr+ &Sema Vico Prt Wtw or Westport hxsu r:a,tt Carporali.n IN WFI'NI:SS WFIERI?OF.North American Specialty insurance Company,Washington International Insurance C'onnpony and Westport Insurance Corporation have caused their official seals to be hereunto affixed.and these presents to he signed by their authorized oilicers this this__20th day of Aumist -)0 18 North American Specialty Insurance Cuntpany Washin<gton International Insurance Company State of Illinois Westport insurance Corporation County of Cook ss: On this 20th day of_August20 18•before mc.a Notary Public personally appeared Steven P.Anderson ,Senior Vice President of Washington International insurance Company and Senior Vice President of North Amcricun Specialty Insurance Company and Senior Vice 1'residcrnt of Westport Insurance Corporation and Michael A. Ito Senior Vice President of Washington lntcrn:Itional[nstu:uncc C'mtnpanv and Senior V'iec fresidcnt of North American Specialty Insurance Company and Senior Vice President of Westport Insurance Corporation,personally known to Inc,who being by me duly sworn,acknowledged that they signed the above Povver of Attorney as officers of and acknowledged said instrument to be the voluntary act and deed oftheir respective companies, ,i 1 Ur(';:1,*{ Shit M KEN1 Kcnn\.\}tar\ Public 1, Jeffrey Goldberg, the duly elected Vice President and Assistant Secretary ol'Northiimerican Specialty Insur:ntcc C:urnpany.Washington International Insurance Company and Westport lnsuraucc Corporation do hereby certifi'that the above and I'orcgoing is a true and correct c01e of a Power of Attorney given by said North American Specialt}'insurance Company.Washiill,toil international tional Insurance Company and Westport Insurance Corporation which is stili in full force and effect. iN WITNESS WIIEREOF.i have set Illy hand and allixed the seals ofthe Companies this 'hit da':of August 20 18 JrIY'i Goldbeg2.\'ace I'res+drrot C:\:atstarU Srrtetnry e(Wu,¢ha5tnon Intcmauonal Insurance Co Pan,& Nath Amwm;.,Speaalty lasurattce Company&v,P,eside,tt.@ Assistant SaarMarry o(q'cstport In;u,ana-('o,yonnoa North American Specialty Insurance Company Washington International Insurance Company Westport Insurance Corporation TEXAS CLAIMS INFORMATION IMPORTANT NOTICE ADVISO IMPORTANTE In order to obtain information or make a complaint: Para obtener informacion o para someter un queja: You may contact Jeffrey Goldberg,Vice President Puede comunicarse con Jeffrey Goldberg,Vice — Claims at 1-800-338-0753 President—Claims,al 1-800-338-0753 You may call Washington International Insurance Usted puede llamr al numero de telefono gratis de Company and/or North American Specialty Insurance Washington International Insurance Company and/or Company's and/or Westport Insurance Corporation North American Specialty Insurance Company's and/or toll-iree number for information or to make a Westport Insurance Corporation para informacion o complaint at: para someter una queja al: 1-800-338-0753 1-800-338-0753 You may also write to Washington International Usted tambien puede escribir a Washington Insurance Company and/or North American Specialty International Insurance Company and/or North Insurance Company and/or Westport Insurance American Specialty Insurance Company and/or Corporation at the following address: Westport Insurance Corporation al: 1450 American Lane 1450 American Lane Suite 1100 Suite 1100 Schaumburg,IL 60173 Schaumburg,IL 60173 You may contact the Texas Department of Insurance Puede escribir al Departmento de Seguros de Texas to obtain information on companies,coverages, para obtener informacion acerca de companias, rights or complaints at: coberturas,derechos o quejas al: 1-800-252-3439 1-800-252-3439 You may write the Texas Department of Insurance: Puede escribir al Departmento de Seguros de Texas: P.O. Box 149104 P.O. Box 149104 Austin,TX 78714-9104 Austin,TX 78714-9104 Fax: (512)475-1771 Fax: (512)475-1771 Web: httob1/yyww-tdi.state.tx.us Web: http://www.tdi.ctat .tx ac Email:ConsumerProtection@tdi.state.tx.us Email:ConsumerProtection@tdi.state.tx.us PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE 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 first contact the reclamo,debe comunicarse con el Washington Washington International Insurance Company and/or International Insurance Company and/or North North American Specialty Insurance Company and/or American Specialty Insurance Company and/or Westport Insurance Corporation. If the dispute is not Westport Insurance Corporation primero. Si no se resolved,you may contact the Texas Department of resuelve la disputa, puede entonces comunicarse Insurance. con el Departmento de Seguros de Texas. ATTACH THIS NOTICE TO YOUR POLICY: UNA ESTE AVISO A SU POLIZA This notice is for information only and does not Este aviso es solo para proposito de infromacion y no become a part or condition of the attached se converte en parte o condicion del documento document. adjunto. Greensheet for Stone Creek Ph 6B CPN#100893 SDPSL Adobe Sign Document History 10/18/2018 -~ - Created: 09/18/2018 By: Shameka.Kennedy@fortworthtexas.gov Status: Signed Transaction ID: CBJCHBCAABAADV_DVhzo_04fxg5w-011MgxSbkkubUuy "Greensheet for Stone Creek Ph 6B CPN#100893 SDPSL" Histo ry "tel Document created by Shameka.Kennedy@fortworthtexas.gov 09/18/2018-4:00:19 PM CDT-IP address:209.194.29.100 C� Document emailed to Gene DeVore(edevore@rpmxconstruction.com)for signature 09/18/2018-4:05:24 PM CDT Document viewed by Gene DeVore (edevore@rpmxconstruction.com) 09/18/2018-4:21:59 PM CDT-IP address:47.51.222.114 Chi Gene DeVore(edevore@rpmxconstruction.com) uploaded the following supporting documents: File Attachment 1 �, File Attachment 2 09/18/2018-4:26:21 PM CDT be Document e-signed by Gene DeVore(edevore@rpmxconstruction.com) Signature Date:09/18/2018-4:26:21 PM CDT-Time Source:server-IP address:173.226.162.50 Document emailed to Jesse Davis oesse.davis@fortworthtexas.gov)for signature 09/18/2018-4:26:24 PM CDT rO Shameka.Kennedy@fortworthtexas.gov replaced signerjesse.davis@fortworthtexas.gov with jesse.davis@Iamb-star.com 09/20/2018-8:23:34 AM CDT-IP address:209.194.29.100 Y Document emailed to jesse.davis@Iamb-star.com for signature 09/20/2018-8:23:34 AM CDT bc. Document e-signed by Jesse Davis (jesse.davis@fortworthtexas.gov) Signature Date:09/26/2018-8:11:49 AM CDT-Time Source:server-IP address:209.194.29.100 FORTWORTH. w,:R_�w � J Adobe Sign �_ Document emailed to Randy Horton (randall.k.horton@fortworthtexas.gov)for approval 09/26/2018-8:11:51 AM CDT Document viewed by Randy Horton (randall.k.horton@fortworthtexas.gov) 09/26/2018-9:57:27 AM CDT-IP address:209.194.29.100 6,'10 Document approved by Randy Horton (randall.k.horton@fortworthtexas.gov) Approval Date:09/26/2018-9:58:58 AM CDT-Time Source:server-IP address:209.194.29.100 C'�r Document emailed to Khal Jaafari (khal.jaafari@fortworthtexas.gov)for signature 09/26/2018-9:59:00 AM CDT Document viewed by Khal Jaafari (khal.jaafari@fortworthtexas.gov) 09/27/2018-2:52:50 PM CDT-IP address:209.194.29.100 6� Document e-signed by Khal Jaafari (khal.jaafari@fortworthtexas.gov) Signature Date:09/27/2018-2:53:38 PM CDT-Time Source:server-IP address:209.194.29.100 C'-► Document emailed to Janie Scarlett Morales Qanie.morales@fortworthtexas.gov)for signature 09/27/2018-2:53:41 PM CDT Document viewed by Janie Scarlett Morales Qanie.morales@fortworthtexas.gov) 09/27/2018-2:56:58 PM CDT-IP address:209.194.29.100 Do Document e-signed by Janie Scarlett Morales (Janie.morales@fortworthtexas.gov) Signature Date:09/27/2018-2:57:33 PM CDT-Time Source:server-IP address:209.194.29.100 a Document emailed to Susan Alanis (susan.alanis@fortworthtexas.gov)for signature 09/27/2018-2:57:36 PM CDT Document viewed by Susan Alanis (susan.alanis@fortworthtexas.gov) 09/27/2018-3:51:17 PM CDT-IP address:209.194.29.100 bo, Document e-signed by Susan Alanis (susan.alanis@fortworthtexas.gov) Signature Date:09/27/2018-5:40:51 PM CDT-Time Source:server-IP address:209.194.29.100 Document emailed to Allison Tidwell (cso_finalpay@fortworthtexas.gov)for filling 09/27/2018-5:40:55 PM CDT Document viewed by Allison Tidwell (cso_finalpay@fortworthtexas.gov) 10/09/2018-11:02:05 AM CDT-IP address:209.194.29.100 6a Form filled by Allison Tidwell (cso_finalpay@fortworthtexas.gov) Form filling Date:10/09/2018-11:02:33 AM CDT-Time Source:server-IP address:209.194.29.100 C'► Document emailed to therese.brotherton@fortworthtexas.gov for delivery 10/09/2018-11:02:35 AM CDT FORT WORTH. � J Adobe Sign Shameka.Kennedy@fortworthtexas.gov replaced certified recipient therese.brotherton@fortworthtexas.gov with Zelalem Arega. Okay for final (Zelalem.Arega@fortworthtexas.gov) 10/09/2018-12:07:20 PM CDT-IP address:209.194.29.100 M Document emailed to Zelalem Arega. Okay for final (Zelalem.Arega@fortworthtexas.gov)for delivery 10/09/2018-12:07:21 PM CDT Document viewed by Zelalem Arega. Okay for final (Zelalem.Arega@fortworthtexas.gov) 10/17/2018-3:08:35 PM CDT-IP address:209.194.29.100 6a Document receipt acknowledged by Zelalem Arega. Okay for final (Zelalem.Arega@fortworthtexas.gov) Receipt Acknowledgement Date:10/17/2018-3:09:08 PM CDT-Time Source:server-IP address:209.194.29.100 E-'y Document emailed to Julie A Geho (julie.geho@fortworthtexas.gov)for delivery 10/17/2018-3:09:10 PM CDT Document viewed by Julie A Geho (julie.geho@fortworthtexas.gov) 10/17/2018-3:15:57 PM CDT-IP address:209.194.29.100 o Document receipt acknowledged by Julie A Geho Qulie.geho@fortworthtexas.gov) Receipt Acknowledgement Date:10/17/2018-3:16:17 PM CDT-Time Source:server-IP address:209.194.29.100 Document emailed to Monica De Anda (monica.deanda@fortworthtexas.gov)for delivery 10/17/2018-3:16:19 PM CDT Document viewed by Monica De Anda (monica.deanda@fortworthtexas.gov) 10/17/2018-4:43:26 PM CDT-IP address:209.194.29.100 6o Document receipt acknowledged by Monica De Anda (monica.deanda@fortworthtexas.gov) Receipt Acknowledgement Date:10/17/2018-4:43:40 PM CDT-Time Source:server-IP address:209.194.29.100 C: Document emailed to TPW Fiscal Staff(tpwcfafiscal@fortworthtexas.gov)for delivery 10/17/2018-4:43:41 PM CDT Document viewed by TPW Fiscal Staff(tpwcfafiscal@fortworthtexas.gov) 10/18/2018-10:13:02 AM CDT-IP address:209.194.29.100 60 Document receipt acknowledged by TPW Fiscal Staff(tpwcfafiscal@fortworthtexas.gov) Receipt Acknowledgement Date:10/18/2018-10:13:09 AM CDT-Time Source:server-IP address:209.194.29.100 Signed document emailed to jesse.davis@Iamb-star.com, Khal Jaafari (khal.jaafari@fortworthtexas.gov), TPW Fiscal Staff(tpwcfafiscal@fortworthtexas.gov), Randy Horton (randall.k.horton@fortworthtexas.gov), and 10 more 10/18/2018-10:13:09 AM CDT FORTWORTH. 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