HomeMy WebLinkAboutContract 49840-FP4 City Secretary 49840 -FP4
Contract No.
FORTWORTH..) Cate Received Oct 29,2018
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 complete:
Project Name: PINE MEADOWS PHASE II
City Project No.: 100824
Improvement Type(s): ® Paving ❑ Drainage ❑ Street Lights ❑ Traffic Signals
Original Contract Price: $418,625.55
Amount of Approved Change Order(s):
Revised Contract Amount:
Total Cost of Work Complete: $418,625.55
o Lo Jul 23, 2018
Rob Taylor IJ 23,2018]
Contractor Date
Project Coordinator
Title
Gilco Contracting,Inc.
Company Name
rA0WA,-M d11#`' Jul 23, 2018
Tom
has Miller(Ju123,20181
Project Ins ector Date
Gt
Patrick BucNlry(J.1 25,2013) Jul 25) 2018
Pr jept an Date
I/911/2 Y, yo P aCet Jul 25, 2018
Janie Scarlett Morales(Jul 25,2018)
CFA Manager Date
Jul 25, 2018
Asst. City Manager Date
OFFICIAL iRM�- RD Page 1 of 2
CITY SECRETARY
Ft WORTH,TX
Notice of Project Completion
Project Name: PINE MEADOWS PHASE II
City Project No.: 100824
City's Attachments
Final Pay Estimate IX
Change Order(s): ❑ Yes lZ N/A
Contractor's Attachments
Affidavit of Bills Paid
Consent of Surety
Statement of Contract Time
Contract Time: 90 CD Days Charged: 197
Work Start Date: 1/3/2018 Work Complete Date: 7/18/2018
Page 2 of 2
5q&ol-
City Project Numbers 100824 DOE Number 0824
Contract Name PINE MEADOWS PHASE.11 Estimate Number 1
Contract Limits Payment Number I
Project Type PAVING&ST SIGN For Period Ending 7/19/2018
Project Funding p
Project Manager NA City Secretary Contract Number
Inspectors OWEN / RODRIGUEZ Contract Date
Contractor G1LCO CONTRACTING,INC. Contract Time 60 CD
6331 SOUTHWEST BLVD. Days Charged to Date 197 CD
BENBROOK, TX 76132-1063 Contract is .000000 Complete €�
�I
CITY OF FORT WORTH
SUMMARY OF CHARGES
Line Fund Account Center AmountGross Retainage Net
Funded
----...--- - ----- ............ ------- ---
t
Total Cost of Work Completed $418,625.55
Less %Retained $0.00
Net Earned $418,625.55
Earned This Period $418,625,55
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 $418,625.55
Monday,hely 23,2018 Page 4 of 4
FQRTWORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name PINE MEADOWS PL-IASE II
Contract Limits j
Project Type PAVING&ST SIGN
City Project Numbers 100824
DOE Number 0824 �1
Estimate Number I Payment Number 1 For Period Ending 7/19/2018 Ij
CD
�i
i
City Secretary Contract Number Contract Time 6GD
Contract Date Days Charged to Date 197
Contract is 100.00 Complete
Project Manager NA
Contractor GILCO CONTRACTING,INC.
6331 SOUTHWEST BLVD.
BENBROOK, TX 761.32-1063
Inspectors OWEN / RODRIGUEZ
1,
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Monday,July 23,2018 Page 1 of 4 �I
I
City Project Numbers 100824 DOE Number 0824
Contract Name PINE MEADOWS PHASE 11 Estimate Number I
Contract Limits Payment Number I
Project Type PAVING&ST SIGN For Period Ending 7/19/2018
Project Funding
PAVING
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
1 HYDRATED LIME 156.79484 TN $155.00 $24,303.20 156.79484 $24,303.20
2 6"LIME TREATMENT 8035.018 SY $2.85 $22,899.80 8035.018 $22,899.80
3 8"LIME-'TREATMENT 2015 SY $2.85 $5,742.75 2015 $5,742.75
4 6"CONC PVMT 7060 SY $37.60 $265,456.00 7060 $265,456.00
5 7"CONC PVMT 1775.0012 SY $39.45 $70,023.80 1775.0012 $70,023.80
6 5"CONC SIDEWALK 70 SF $10.00 $700.00 70 $700.00
7 BARRIER FREE RAMP 4 EA $2,000.00 $8,000.00 4 $8,000.00
8 BARRIER FREE RAMP 4 EA $2,000.00 $8,000.00 4 $8,000.00
9 BARRIER FREE RAMP 4 EA $1,650.00 $6,600.00 4 $6,600.00
10 INSTALL,TYPE III BARRICADE 1 EA $1,500.00 $1,500.00 1 $1,500.00
i
Sub-Total of Previous Unit $413,225.55 $413,225.55
STREET SIGN
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
1 STREET NAME BLADE 8 EA $500.00 $4,000.00 8 $4,000.00
2 STOP SIGN 4 EA $100.00 $400.00 4 $400.00
3 STREET NAME POST 4 EA $250.00 $1,000.00 4 $1,000.00
------------- ------ — _._._. __ -----------_.._._..- ------
Sub-Total of Previous Unit $5,400.00 $5,400.00
Monday,July 23,2018 Page 2 of 4
City Project Numbers 100824 DOE Number 0824
Contract Name PINE MEADOWS PHASE II Estimate Number 1
Contract Limits Payment Number 1
Project Type PAVING&ST SIGN For Period Ending 7/19/2018
Project Funding
Contract Information Summary
Original ContractAmount $418,625.55
Chanae Orders
Total Conti-act Price $418,625.55
Total Cost of Work Completed $418,625.55
Less %Retained $0.00
Net Earned $418,625.55
Earned This Period $418,625.55
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 $418,625.55
Monday,July 23,2018 Page 3 of 4
GILCO CONTRACTING, INC.
TRANSMITTAL LETTER
PROJECT: Pine Meadows,Phase 2
PROJECT NO.: 1248
DATE:June 26,2018
TO: City of Fort Worth
8851 Camp Bowie W.Blvd.
Fort Worth,Texas 76116
We transmit:
(X)Herewith ( )Under Separate cover via
For Your:
( )Approval ( )Distribution to parties
( )Review&Comment ( )Record
(X) Use ( )Execution
The following:
(X)Other ( )Shop Drawing Prints
( )Specifications ( )Shop Drawing Reproducible
( )Bonds { )Contract Documents
Copies Date Rev.No. Description
1 Final Paperwork&Consent of Surety
REMARKS:
COPIES TO: (with enclosures)
( ) BY: Rob Taylor
6331 Southwest Blvd. /Benbrook,Texas 76132
817/735-1600 ext.316 Fax 817/735-1613
rob@gilcocontracting.com
CONSENT OF OWNER ❑
SURETY COMPANY ARCHITECT ❑
CONTRACTOR ❑
TO FINAL PAYMENT SURETY ❑
Conforms with the American Institute of OTHER
Architects,AIA Document G707
Bond No 022059350
PROJECT:
(name, address)Pine Meadows Phase 2
Fort Worth TX
TO (Owner)
PINE MEADOW DEVELOPMENT COMPANY,LLC AND I ARCHITECT'S PROJECT NO:
CITY OF FORT WORTH CONTRACT FOR:
5137 Davis Blvd Pine Meadows Phase 2-Paving&Street Sign Improvements
Fort Worth TX 76180 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 (Isere 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 Ownor)
PINE MEADOW DEVELOPMENT COMPANY,LLC AND CITY OF FORT WORTH
5137 Davis Blvd
Fort Worth TX 76180 , OWNER,
as set forth in the said Surety Company's bond.
IN WITNESS,WI-IEREOF,
the Surety Company has hereunto set its hand this 26th day of June,2018
LIBERTY MUTUAL INSURANCE COMPANY
Suret Company `
Wk
Attest. eLen. arsha I
(Seal): Signa re 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.7989052
Liberty Mutual Insurance Company
The Ohio Casualty Insurance Company WestAmedcan 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 Slate 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 of Indiana(herein collectively called the"Companies'),pursuant to and by authority herein set forth,does hereby name,constitute and appoint,
Robbi Morales;Don E.Cornell;Sophinie Hunter,•V DeLene Marshall'Tina McEwan'Ricardo J Reyna;Kelly A.Westbrook
all of the cit of Dallas TX
y state of 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 24th day of January 2018
�Y INSb �t,7Sur,, •,wsu 'p
The Ohio Casualty Insurance Company N
n 319 ^ 191E ? r4 ` 1991 Liberty Mutual Insurance Company m
West American Insurance Company
hCaD
:; r I v1
O STATE OF PENNSYLVANIA ss David M.Carey:Ass�Secretary
COUNTY OF MONTGOMERY
O O On this 24th da of January 2018 O
i Cn Y ,before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance
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 ate'
p 2 therein contained by signing on behalf of the corporations by himself as a duly authorized officer, a�W
R 0
c1 > 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 O.
NgR PAST COMMONWEALTH OF PENNSYLVANIA C
-� ��,urF�ortwF�,rF<C NotarialSual Q M
•� " T lbrers Pastella,Notary Public By: 1L C QJ
O
0 ` of Uppetr MerionTwp.,MontgomeryCnunly Teresa Pastella,Notary Public '- a
O
My Commission Expires March 28,2021 �
O mornber.Pennsylvania Associnhun of Notaries f1
N
G M 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
Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows: rL+e
ai
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 e
to such limitation as the Chairman or the President may prescribe,shall appoint such attorneys411-fact,as may be necessary to act in behalf of the Corporation to make,execute,seal,
O,S acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surely 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 so m 0
�O L 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 attomey-in-fact under >
,a 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, W
= ARTICLE Xlil-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, 00
> 4) and subject to such limitations as the chairman or the president may prescribe,shall appoint such attorneys-in-ract.as may be necessary to act in behalf of the Company to make,execute, '-M
0 V seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Such attomeys-in-fact subject to the limitations set forth in their O o
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 V 0
executed such instruments shall be as binding as if signed by the president and attested by the secretary. 0 ce
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-fn- `-
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.
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 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 030day of 20 .
`1V�NSli �tMiu�; ytNSuy
i •MJ�`.'aPCWai.r9�^ �Jp•.�av'iF.t,'�•Y(� C�,�ofimgW7-rP
BY: _
Renee C.Llewe ryir'Asistanl Secretary
349 of 400
LMS_12873_022017
Liberty
.Mutual.
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 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 (1 I1-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•//ww-vv tdi.texas.gov Web: http://,,vw,,v.tdi.texas.gov
E-mail: ConsumerProtection@tdi.texas.gov E-mail: ConsumerProtectionatdi.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: 11
This notice is for information only and does not Este aviso es solo para proposito de informacion
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 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 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, 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;
Paving Improvements to serve: Pine Meadows,PhasX? �_
BY: Rob Ta, for
Subscribed and sworn before me on this 26th of June , 2018.
Notary'biblic
Tarrant County, TX
MARY RANNELL
Notary Public.state of Texas
tw1 T. Comm.Expiros 10-19-201A
Notary ID 5144239
June 26, 2018
Citv of Fort Worth
CFA Administration
1000 Throckniorton St.
Fort Worth, TX 76102
RE: Final Waiver of Lien; Paving Improvements to serve: Pine Meadows, Phase 2
City Project#100824
File No. W-2463
File No. X-24170
The purpose of this letter is to acknowledge that we have been paid in Rill by Pine
Meadows Development Co.,L.P. for the public improvements constructed to serve Pine
Meadows, Phase 2 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,
Rob Taylor
Project Coordinator
6331 Southwest Blvd.
Benbrook,Texas 76132
Office: 817.735.1600
Fax: 817.735.1613
GILCO CONTRACTING, INC.
TRANSMITTAL LETTER
PROJECT: Pine Meadows,Phase 2
PROJECT NO.: 1248
DATE:June 26,2018
TO: City of Fort Worth
8851 Camp Bowie W.Blvd.
Fort Worth,Texas 76116
We transmit:
(X)Herewith ( )Under Separate cover via
For Your:
{ )Approval ( )Distribution to parties
( )Review&Comment ( )Record
(X) Use ( )Execution
The following:
(X)Other ( )Shop Drawing Prints
( )Specifications ( )Shop Drawing Reproducible
( )Bonds ( )Contract Documents
Copies Date Rev.No. Description
1 Final Paperwork&Consent of Surety
REMARKS:
COPIES TO: (with enclosures)
( ) BY: Rob Taylor
6331 Southwest Blvd. /Benbrook,Texas 76132
817/735-1600 ext.316 Fax 817/735-1613
rob@gilcocontracting.com
CONSENT OF OWNER ❑
SURETY COMPANY ARCHITECT ❑
CONTRACTOR ❑
TO FINAL PAYMENT SURETY ❑
Conforms with the American Institute of OTHER
Architects, AIA Document G707
Bond No 022059350
PROJECT:
(name, address)Pine Meadows Phase 2
Fort Worth TX
TO (Owner)
PINE MEADOW DEVELOPMENT COMPANY,LLC AND I ARCHITECT'S PROJECT NO:
CITY OF FORT WORTH CONTRACT FOR:
5137 Davis Blvd Pine Meadows Phase 2-Paving&Street Sign Improvements
Fort Worth TX 76180 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 there 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)
PINE MEADOW DEVELOPMENT COMPANY, LLC AND CITY OF FORT WORTH
5137 Davis Blvd
Fort Worth TX 76180 , OWNER,
as set forth in the said Surety Company's bond.
IN WITNESS,WHEREOF,
the Surety Company has hereunto set its hand this 26th day of June,2018
LIBERTY MUTUAL INSURANCE COMPANY
Su et Company 4
Attest. . eLen. arsha I
(Seal): Signa re 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..
Liberty Mutual Insurance Company Certificate No.7989052
The Ohio Casualty Insurance Company WestAmerican 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 of Indiana(herein collectively called the"Companies'),pursuant to and by authority herein set forth,does hereby name,constitute and appoint,
Robbi Morales;Don E.Cornell'Sophinie Hunter:V.DeLene Marshall,Tina McEwan'Ricardo J Reyna;Kelly A Westbrook
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 24th day of January 2018 51
1tINSUS, .-��-0SrlINSLl&; tC
"C
T';<<''"'�::. � ia.,rp="'^ : ,;<,rr°^>'` • The Ohio Casualty Insurance Company 0)
919 n 1912 ? K tggl ? Liberty Mutual Insurance Company m
o
West American Insurance Company =
O v v i
W k .r By:
c STATE OF PENNSYLVANIA SS David M.Carey'Assistant Secretary C
COUNTY OF MONTGOMERY
d On this 24th da of January 2018 O
Y ,before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance E.
3 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
p_ therein contained by signing on behalf of the corporations by himself as a duly authorized officer, a�LU
l
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 rL
tU SN PAST COMMONWEALTH OF PENNSYLVANIA / M
or�oawFgrF<! Notarial Seal r/`�A ��� �
•� 1` ° Teresa Pastella,Notary Public By: l�r O
0 OF Upper 1.19f.onUp.,Montr�omery County Teresa Pastella,Notary Public L
i a3G My Commission Expires March 28,2021 3
l lumbar.Prnncylvanin Assmotiun of Notanoe O
to
C M This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casually Insurance Company, Liberty Mutual 0 p
Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows: 7:o
Z
m d ARTICLE IV—OFFICERS—Section 12.Power ofAttomey.Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President,and subject O e
to such limitation as the Chairman or the President may prescribe,shall appoint such attorneys4ri-fact,as may be necessary to act in behalf of the Corporation to make,execute,seal, �+y
O c acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Such attomeys-in-fact,subject to the limitations set forth in their respective
E wpowers 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 so 'R N
O 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 atlomey-in-fact under >
,a A 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. C)
t
to 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, 0
Land subject to such limitations as the chairman or the president may prescribe,shall appoint such attomeys-in-fact,as may be necessary to act in behalf of the Company to make,execute, L M
O seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Such attomeys4n-fact subject to the limitations set forth in their =co
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 seal of the Company. When so 00
executed such instruments shall be as binding as if signed by the president and attested by the secretary. 0-
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- V-
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 surely 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 Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do
hereby certify that the original power of attomey 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 �� day of 20-.
114 lrast� rat,1, a+sok
Jp` ,pcWt„'�'S ]� r�.:1•i•_, •t'�ter+az ��'
u ?
p 1919 � ��1912 � ” � 1991 BY:
Renee C.Llew ssistant Secretary
349 of 400
LMS_12873_022017
Liberty
Mutual.
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 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 eseribir a:
2200 Renaissance Blvd., Ste. 400 2200 Renaissance Blvd., Ste. 400
King of Prussia,PA 1.9406-2755 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 (I I I-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: htt.j2://www.tdi.texas.g Web: http•//ww,,v.tdi.texas. ov
E-mail: ConsumerProtection&a tdi texas.g_ov E-mail: ConsumerProtection(a7tdi 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
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 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 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, firins, associations, corporations, or other
organizations fiirnishing labor and/or materials have been paid in Rill;
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: Pine Meadows,Phase 2
BY: Rob Tar
Subscribed and sworn before me on this 26th of June , 2018.
Notarybrblic
Tarrant County,TX
� .
MARY I'ANNEII
°;,j►�.�G Notary Public,S10le or lexas
i. a? Comm.Expires 10-19-2018
Notary ID 5144239
June 26, 2018
City of Fort Worth
CFA Administration
1000 Throckmorton St.
Fort Worth, TX 76102
RE: Final Waiver of Lien; Paving Improvements to serve: Pine Meadows,Phase 2
City Project#100824
File No. W-2463
File No. X-24170
The purpose of this letter is to acknowledge that we have been paid in fiill by Pine
Meadows Development Co., L.P. for the public improvements constructed to serve Pine
Meadows, Phase 2 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 fee to contact me with any questions you may have.
Sincerely,
/Ro Taylor
Project Coordinator
6331 Southwest Blvd.
BenbrooK Texas 76132
Office: 817.735.1600
Fax: 817.735.1613
C f\ Greensheet for Pine Meadows
Phase 2 CPN#100824 P
----------------- ______. Adobe Sign Document History 10/29/2018
- - Created: 07/23/2018
--- — - By: Shameka.Kennedy@fortworthtexas.gov
Status: Signed
- ^� Transaction ID: CBJCHBCAABAAz8nb-EXFAWyQ6C2A1GHgLx7nfQr_9s6g
"Greensheet for Pine Meadows Phase 2 CPN#100824 P" Histor
Y
3 Document created by Shameka.Kennedy@fortworthtexas.gov
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C Document emailed to Rob Taylor Odt@gilcocontracting.com)for signature
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Chi Rob Taylor Qdt@gilcocontracting.com) uploaded the following supporting documents:
File Attachment 1
File Attachment 2
07/23/2018-9:06:12 AM CDT
Document e-signed by Rob Taylor Odt@gilcocontracting.com)
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FORT WORTH.
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FORT WORTHS
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P Signed document emailed to Janie Scarlett Morales Qanie.morales@fortworthtexas.gov), Julie A Geho
oulie.geho@fortworthtexas.gov), Susan Alanis (susan.alanis@fortworthtexas.gov), Allison Tidwell
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