HomeMy WebLinkAboutContract 49766-FP1 City Secretary 49766 -FP1
Contract No.
RrCEIVE[i FORTWORTH. Date Received Dec 10,2018
DEC1820185-(.o ou T— Ivl01�
C1TY1,O FORTVVORTH y/
Cl ECRETARY
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: PARK 820 AND GROENDYKE TRUCKING PUBLIC IMPROVEMENTS
City Project No.: 101071
Improvement Type(s): Water ❑x Sewer
Original Contract Price: $240,085.20
Amount of Approved Change Order(s): $38,625.00
Revised Contract Amount:
Total Cost of Work Complete: $278,710.20
r"ge VICG19AV- Dec 3,2018
Brunt Vilh,-rlD"+ _
Contractor Date
Contracts Administrator
Title
Vilhauer Enterprises,LLC
Company Name
►J
Daniel Roy(Dee 5,2019) Dec 5,2018
Project Inspector Date
ro o Dec 5f 2018
Pr 'ect Manager Date
�ZMeitald-
J p
e Scarlett Morales(Dec 6,201H) Dec 6,2018
CFA Manager Date
11169&Amx�
Susan Alanis(Dec 9,2019) Dec 9,2018
Asst. City Manager Date
Page 1 of 2
OFFIUAL kIELUkOj
Notice of Project Completion
Project Name: PARK 820 AND GROENDYKE TRUCKING PUBLIC IMPROVEMENTS
City Project No.: 101071
City's Attachments
Final Pay Estimate ❑x
Change Order(s): ❑x Yes ❑ N/A
Pipe Report: ® Yes ❑ N/A
Contractor's Attachments
Affidavit of Bills Paid
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Consent of Surety
1
Statement of Contract Time
Contract Time: 360 CD Days Charged: 353
Work Start Date: 11/13/2017 Work Complete Date: 10/31/2018
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510 0Q'W - 1610'-11
City Project Numbers 101071 DOE Number 1071
Contract Name PARK 820 AND GROENDYKE TRUCKING PUBLIC IMPROVEMENTS Estimate Number 1
Contract Limits Payment Number 1
Project Type WATER&SEWER For Period Ending 10/31/2018
Project Funding
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Project Manager NA City Secretary Contract Number
Inspectors GREGORY / BELL Contract Date 9/26/2017
Contractor VILHAUER ENTERPRISES,LLC Contract Time 360 CD
10750 JOHN W ELLIOTT DR Days Charged to Date 353 CD
FRISCO, TX 75033 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 $278,710.20
Less %Retained $0.00
Net Earned $278,710.20
Earned This Period $278,710.20
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 $278,710.20
Monday,November 5,2018 Page 5 of 5
FORT WORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name PARK 820 AND GROENDYKE TRUCKING PUBLIC IMPROVEMENTS
Contract Limits
Project Type WATER&SEWER
City Project Numbers 101071
DOL Number 1071
Estimate Number 1 Payment Number I For Period Ending 10/31/2018
CD
City Secretary Contract Number Contract Time 36ED
Contract Date 9/26/2017 Days Charged to Date 353 j
Project Manager NA Contract is 100.00 Complete
Contractor VILHAUER ENTERPRISES,LLC I.
10750 JOHN W ELLIOTT DR
FRISCO, TX 75033
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Inspectors GREGORY / BELL
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Monday,November 5,2018 Page 1 of 5
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City Project Numbers 101071 DOE Number 1071
Contract Name PARK 820 AND GROENDYKE TRUCKING PUBLIC IMPROVEMENTS Estimate Number I
Contract Limits Payment Number I
Project Type WATER&SEWER For Period Ending 10/31/2018
Project Funding
UNIT I:WATER IMPROVEMENTS
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
----------------------------------_ _ ----
1 TRENCH SAFETY 1748 LF $1.00 $1,748.00 1748 $1,748.00
2 DUCTILE IRON WATER FITTINGS 1.9 TN $3,158.00 $6,000.20 1.9 $6,000.20
W/RESTRAINT
3 8"WATER PIPE 96 LF $26.00 $2,496.00 96 $2,496.00
4 12'WATER PIPE 1652 LF $37.00 $61,124.00 1652 $61,124.00
5 12"WATER PIPE,CSS BACKFILL 196 LF $54.00 $10,584.00 196 $10,584.00
6 FIRE HYDRANT 1 EA $2,900.00 $2,900.00 1 $2,900.00
7 24'X 12"TAPPING SLEEVE&VALVE i EA $6,900.00 $6,900.00 1 $6,900.00
8 2"WATER SERVICE 6 EA $2,650.00 $15,900.00 6 $15,900.00
9 T GATE VALVE 2 EA $1,000.00 $2,000.00 2 $2,000.00
10 12"GATE VALVE 8 EA $1,800.00 $14,400.00 8 $14,400.00
11 12"C900 PVC PIPE(CO#1) 20 FT $56.50 $1,130.00 20 $1,130.00
12 12"DUCTILE IRON PIPE(CO#1) 60 FT $98.75 $5,925.00 60 $5,925.00
13 BORE FOR US WATERS(CO#1) 60 FT $384.50 $23,070.00 60 $23,070.00
14 10"GATE VALVE(CO#1) 2 FT $1,750.00 $3,500.00 2 $3,500.00
15 FITTINGS(CO#1) 1 LS $3,500.00 $3,500.00 1 $3,500.00
16 ADDITIONAL TESTING CHLORINATION(CO#1) 1 LS $1,500.00 $1,500.00 1 $1,500.00
Sub-Total of Previous Unit $162,677.20 $162,677.20
UNIT 11:SANrrARY SEWER IMPROVEMENTS
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
——————————————————————————————————————-
1 POST-CCTV INSPECTION 1968 LF $1.00 $1,968.00 1968 $1,968.00
2 MANHOLE VACUUM TESTING 8 EA $125.00 $1,000.00 8 $1,000.00
3 TRENCH SAFETY 1968 LF $1.00 $1,968.00 1968 $1,968.00
4 CONCRETE COLLAR 7 EA $1,000.00 $7,000.00 7 $7,000.00
5 6'SEWER SERVICE 2 EA $700.00 $1,400.00 2 $1,400.00
6 T SEWER SERVICE 2 EA $750.00 $1,500.00 2 $1,500.00
7 T SEWER PIPE 1968 LF $32.00 $62,976.00 1968 $62,976.00
8 T SEWER PIPE CSS BACKFILL 90 LF $54.00 $4,860.00 90 $4,860.00
9 EPDXY MANHOLE LINER 36 VF $176.00 $6,336.00 36 $6,336.00
Monday,November 5,2018 Page 2 of 5
City Project Numbers 101071 DOE Number 1071
Contract Name PARK 820 AND GROENDYKE TRUCKING PUBLIC IMPROVEMENTS Estimate Number I
Contract Limits Payment Number 1
Project Type WATER R SEWER For Period Ending 10/31/2018
Project Funding
10 4'MANHOLE 7 EA $3,175.00 $22,225.00 7 $22,225.00
I 1 4'DROP MANHOLE I EA $4,300.00 $4,300.00 1 $4,300.00
12 4'EXTRA DEPTH MANHOLE 5 VF $100.00 $500.00 5 $500.00
----------------------------------------
Sub-Total of Previous Unit $116,033.00 $116,033.00
Monday,November 5,2018 Page 3 of 5
City Project Numbers 101071 DOE Number 1071
Contract Name PARK 820 AND GROENDYKE TRUCKING PUBLIC IMPROVEMENTS Estimate Number 1
Contract Limits Payment Number I
Project Type WATER&SEWER For Period Ending 10/31/2018
Project Funding
Contract Information Summary
Original Contract Amount $240,085.20
Change Orders
Change Order Number 1 $38,625.00
Total Contract Price $278,710.20
Total Cost of Work Completed $278,710.20
Less %Retained $0.00
Net Earned $278,710.20
Earned This Period $278,710.20
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 $278,710.20
Monday,November 5,2018 Page 4 of 5
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tORTWORTH
TRANSPORTATION AND PUBLIC WORKS
PIPE REPORT FOR:
PROJECT NAME: Park 820 and Groendyke Trucking Public Improvement
PROJECT NUMBER: 101071
DOE NUMBER: N/A
WATER
PIPE LAID SIZE TYPE OF PIPE LF
Water 8 PVC 96
Water 12 PVC 1672
Water 12 DIP 60
FIRE HYDRANTS: VALVES(16" OR LARGER)
PIPE ABANDONED SIZE TYPE OF PIPE LF
DENSITIES:
NEW SERVICES: 6" PVC 2 EA
8" 2 EA
SEWER
PIPE LAID SIZE TYPE OF PIPE LF
Sewer 8 PVC 1968
PIPE ABANDONED SIZE TYPE OF PIPE LF
DENSITIES:
NEW SERVICES: 6 PVC 2EA.
8 PVC 2EA.
TRANSPORTATION AND PUBLIC WORKS
The City of Fort Worth•1000 Throckrnorton Street•Fort Worth,TX 76012-6311
(817)392-7941 •Fax:(817)392-7845
'JiLHAUEii
ENTERPRISES,LLC
CHANGE ORDER REQUEST
PROJECT: Park 820 COR: 3
GC: Ridgemont ENGINEER: Pacheco Koch
CONTRACTOR: Viihauer Enterprises,LLC
PROJ.NO: 17559 DATE: 1/5/2018
RE: CFA Revisions
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CFA Revisions I
Item Description Qty UOM Price Extended I
1 12"C900 PVC Pipe 2D LF $ 56.50 $ 1,130.00
2 12"DIP 60 LF $ 98.75 $ 5,925.00
!
3 Bore for US Waters 60 LF $ 384.50 $ 23,070.00
4 10"Gate Valve 2 EA $ 1,750.00 $ 3,500.00
5 Fittings 1 LS $ 3,500.00 $ 3,500.00 !
6 Additional Testing&Chlorination 1 LS $ 1,500.00 $ 1,500.00
Bid Total: $38,625.00
Additional days to be added to contract: 5 Sub-Total Utilities: $38,625.00 l
TOTAL CHANGE ORDER: $38,625.00 J
ORIGINAL CONTRACT $1,368,327.00
PREVIOUS CHANGES $26,159.00
THIS CHANGE $38,625.D0
REVISED CONTRACT $1,433,111.00 tt
Bid proposal based on plans:Revised 12"Water Connection C
Eng.: Pacheco Koch Dated: 12/6/2017
Thank you,
Vilhauer Enterprises,LLC
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COST BREAKDOWN
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January 9,2018 Detailed breakout for Boring.
CUSTOMER: Ridgemont
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PROJECT: Park 820/Groendyke CFA Revisions
Description Unit Qty Unit$ Labor Equipment Material
Bore for the Waters of US.
LABOR
SUPERVISOR W/TRUCK HR 6 $78.00 $468.00
EQUIPMENT OPERATOR HR 6 $61.00 $366.00
LEAD MAN HR 6 $48.00 $288.00
PIPE LAYER HR 6 $44.00 $264.00
LABORER HR 6 $40.00 $240.00
EQUIPMENT
John Deere 470 Excavator HR 6 $170.00 $1,020.00
John Deere 624 G Loader HR 6 $105.00 $630.00
Caterpillar CP 323 Compactor HR 6 $105.00 $630.00
MATERIAL/SUB/RENTAL EQUIP.
EMBEDMENT TN 0 $21.49 $0.00
12"DIP LF 0 $31.10 $0.00
12"PVC LF 0 $19.76 $0.00
10"C900 LF 0 $14.00 $0.00
10"Gate Valve EA 0 $1,251.41 $0.00
Spacers/End Seals LS 1 $1,184.33 $1,184.33
CASING PIPE LF 60 $50.00 $3,000.00
FITTINGS EA 0 $199.07 $0.00
SUBCONTRACTOR LF 60 $190.00 $11,400.00
CONCRETE CY 0 $125.00 $0.00
it
LABOR $1,626.00
EQUIPMENT $2,280.00
MATERIALS $15,584.33 (�
OVERHEAD 0.10 $1,949.03
SUBTOTAL $21,439.36
PROFIT 0.05 $1,071.97
SUBTOTAL $22,511.33
BOND 0.03 $562.78
TOTAL $23,074.11
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Vilhauer Enterprises LLC, 10750 John W Elliott Dr, Frisco,TX,75033*972-782-4443
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Final Bills Paid Affidavit
by Contractor
BEFORE ME,the undersigned authority,personally appeared Brent Vilhauer (hereinafter referred to as
"Contractor"),known to me to be a credible person,and after being by the duly sworn,upon oath stated and affirmed that:
"My name is Brent Vilhauer and I am the Contract Administrator of Vilhauer Enterprises,LLC
_.
hereafter sometimes referred to in this affidavit as"Contractor". Contractor's business address is
P.O.Box 957,Frisco,TX 75034 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 Vilhauer Enterprises, Ll C, Contractor,and
Ritlgemont Commercial
Construction Owner/Administrator,Contractor furnished materials and labor for the construction,
renovation,or repair of improvements located on or relating to project known as,:park 820 and Groendyke Transportation;-Public
l,mprovements City Protect No 101071 City of FortWorth Tarrant County,Texas,legally
described in Exhibit"A"attached hereto and made a part hereof for all purposes(the "Property"). All work provided
for under said written constriction 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/Administrator in reliance on this Final Bills Paid Affidavit:
Name of Payee Address Telephone No. Amount Owed
N/A
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/Administrator and by Lender on behalf of Owner/Administrator
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 53.035 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/Administrator 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
statements and representations contained herein."
Form 16—Final Bills Paid Affidavit Page 1 of 3
May 1, 2009
EXECUTED this 30th day of November 2018
Vilhauer Enterprises, LLC
[Name of Contractor Company]
By:
Printed Name:Brent Vilhauer
Title: Contracts Administrator'
Notary's Acknowledgement
Before me,the undersigned authority,on this day personally appeared
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 the 30th,day of November 2018
(Seal)
Notary Public,State of Texas
My commission expires
Form 16—Final Bills Paid Affidavit Page 2 of 3
May 1, 2009
EXHIBIT"A"
Form 16—Final Bills Paid Affidavit Page 3 of 3
May 1, 2009
CONSENT OF OWNER
SURETY COMPANY ARCHITECT
TO FINAL PAYMENT CONTRACTOR
SURETY
AIA DOCUMENT G707 OTHER
Bond No. PB10063500047
PROJECT: Park 820 and Groendyke Trucking Public Improvements,Fort Worth TX
(name,address)
TO(Owner) [ City of Fort Worth ] ARCHITECT'S PROJECT NO:
1000 Throckmorton Street
Fort Worth,TX 76102-6312 CONTRACT FOR: Construction
[ ] CONTRACT DATE: 9/25/2017
CONTRACTOR: Vilhauer Enterprises,LLC
10750 John W.Elliott Rd
Frisco,TX 75033
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)
Philadelphia Indemnity Insurance Company
One Bala Plaza,Suite 100 , SURETY COMPANY,
Bala Cymyyd,PA 19004
on bond of(here insert name and address of Contractor)
Vilhauer Enterprises,LLC
10750 John W.Elliott Rd
Frisco,TX 75033 , 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
1000 Throckmorton Street
Fort Worth,TX 76102-6312 ,OWNER,
as set forth in the said Surety Company's bond.
IN WITNESS WHEREOF,
the Surety Company has hereunto set its hand this 6th day of November , 2018
Philadelphia Indemnity Insurance Company
Surety Company
Signature of Authorized Representative
Attest•
(Seal): Debra Lee Moon Attornev-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
AIA DOCUMENT G707 CONSENT OF SURETY COMPANY TO FINAL PAYMENT APRIL 1970 EDITION AIA ONE PAGE
1970 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 New York Ave.,NW,WASHINGTON,D.C. 20006
372
PHILADELPHIA INDEMNITY INSURANCE COMPANY
One Bala Plaza,Suite 100
Bala Cynwyd,PA 19004-0950
Power of Attorney
KNOW ALL PERSON'S BY THESE PRESENTS:That PHILADELPHIA INDEMNITY INSURANCE COMPANY(the Company),a corporation organized and
existing under the laws of the Commonwealth of Pennsylvania,does hereby constitute and appoint Sammy Joe Mullis,Jr.,John William Newby,Troy Russell Key,
Sandra I.ee Roney,Debra Lee Moon,Linda Michelle Stalder and/or Andrea Rose Crawford of Mullis Newby Hurst,LP. ,its true and lawful Attomcy-in-fact
with full authority to execute on its behalf bonds,undertakings,recognizances and other contracts of indemnity and writings obligatory in the nature thereof,issued in
the course of its business and to bind the Company thereby,in an amount not to exceed$25,000,000.
'chis Power of Attorney is gnmted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of
PHILADELPHIA INDEMNITY INSURANCE COMPANY on the 14"of November,2016.
RESOLVED: That the Board of Directors hereby authorizes the President or any Vice President of the
Company: (1) Appoint Attorneys) in Fact and authorize the Attorney(s) in Fact to
execute on behalf of the Company bonds and undertakings,contracts of indemnity and
other writings obligatory in the nature thereof and to attach the seal of the Company
thereto; and (2) to remove, at any time, any such Attomey-in-Fact and revoke the
authority given. And,be it
FURTHER
RESOLVED: That the signatures of such officers and the seal of the Company may be affixed to arty
such Power of Attorney or certificate relating thereto by facsimile,and any such Power of
Attorney so executed and certified by facsimile signatures and facsimile seal shall be
valid and binding upon the Company in the future with respect to any bond or
undertaking to which it is attached,
IN TESTIMONY WIIEREOF,PHILADELPHIA INDEMNITY INSURANCE COMPANY HAS CAUSED THIS INSTRUMENT TO BE SIGNED AND
ITS CORPORATE SEALTO BE AFFIXED BY ITS AUTHORIZED OFFICE THIS 14Th DAY OF NOVEMBER,2016.
1927
(Seal)
Robert D.O'Leary Jr„President&CEO
Philadelphia Indemnity Insurance Company
On this 14'h day of November,2016,before me came the individual who executed the preceding instrument,to me personally known,and beingby me duly sworn said
that he is the therein described and authorized officer of the PHILADELPHIA INDEMNITY INSURANCE COMPANY;that the seal affixed to said instrument is
the Corporate seal of said Company;that the said Corporate Seal and his signature were duly affixed,
NNO } NN V
NoU iN u
)IM T.C7 ,notary ffy c
to."
c—is Trp.•NOM]OP. C U ^`^ —
my COnunfitKe tapNa/an.�,7011 Y w�--
rr«u•.wn,••w
Notary Public:
residing at: Bala Cynwvd.PA
(Notary Seal)
My commission expires: January R,2018
1,Edward Sayago,Corporate Secretary of PHILADELPHIA INDEMNITY INSURANCE COMPANY,do hereby certify that the foregoing resolution of the Board of
Directors and this Power of Attorney issued pursuant thereto on this 14°i day or November,2016 are true and correct and are still in full force and effect.I do further
certify that Robert D.O'Leary Jr.,who executed the Power of Attorney as President•was on the date of execution of the atta:hed Power of Attorney the duly elected
President of PHILADELPHIA INDEMNITY INSURANCE COMPANY, \��`,pf.` �
In Testimony Whereof I have subscribed my name and affixed the facsimile seal of each Company this day of, •r rte•20—E-
27
0—E-27 Edward Sayago,Corporate Secretary
PHILADELPHIA INDEMNITY INSURANCE COMPANY
IMPORTANT NOTICE ADVISO IMPORTANTE
To obtain information or make a complaint: You may Para obener informacion o para someter una queja:
call the Surety's toll free telephone number for Usted puede Ilamar al numero de telefono gratis de
information or to make a complaint at: para informacion o para someter una queja al:
1-877-438-7459 1-877438-7459
You may also write Philadelphia Indemnity Insurance Usted tanbien puede escribir a Philadelphia
Company at: Indemnity Insurance Company:
One Bala Plaza, Suite 100 One Bala Plaza, Suite 100
Bala Cynwyd, PA 19004 Bala Cynwyd, PA 19004
Attention: Senior Vice President and Attention: Senior Vice President and
Director of Surety Director of Surety
You may contact the Texas Department of Insurance Puede comunicarse con el Departamento de
to obtain information on companies,coverage, rights Seguros de Texas para obtener informacion acerca
or complaints at: de companias,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:
at:
P.O. Box 149104 P.O.Box 149104
Austin,TX 78714-9104 Austin,TX 78714-9104
Fax#512475-1771 Fax#512-475-1771
Web: http:/1www.tdi.state.tx.us Web: htta,//www.tdi.state.tx.us
Email: ConsumerProtection(a)tdi.state:tx.us Email: Con sumerProtection&tdLstate.tx.us
PREMIUM OR CLAIM DISPUTES: Should you have DISPUTAS SOBRE PRIMAS O RECLAMOS:Si
a dispute concerning your premium or about a claim, tiene una disputa concerniente a su prima o a un
you should contact the Surety first. If the dispute is reclamo,debe comunicarse con el Surety primero.Si
not resolved,you may contact the Texas Department no se resuelve la disputa, puede entonces
of Insurance. comunicarrse con el departamento (TDI).
ATTACH THIS NOTICE TO YOUR BOND: This UNA ESTE AVISO A SU FIANZA DE GARANTIA:
notice is for information only and does not become a Este aviso es solo para proposito de informacion y
part or condition of the attached document. no se convierte en parte o condicion del documento
adjunto.
Green Sheet CPN 101071 Park
820 & Groendyke Trucking
Public Improv. W&S
Adobe Sign Document History 12/12/2018
Created: 11/05/2018
------------
-"---- By: Etta Bacy(etta.bacy@fortworthtexas.gov)
Status: Signed
Transaction ID: CBJCHBCAABAAB_bsRPoebgH_pfPiFpB8B9r9s5xhA6m
"Green Sheet CPN 101071 Park 820 & Groendyke Trucking Pub
lic Improv. W&S" History
R Document created by Etta Bacy(etta.bacy@fortworthtexas.gov)
11/05/2018-11:17:29 AM CST-IP address:209.194.29.100
Document emailed to Brent Vilhauer(chrisb@vilhauerenterprises.com)for signature
11/05/2018-11:23:16 AM CST
Document viewed by Brent Vilhauer(chrisb@vilhauerenterprises.com)
11/05/2018-12:26:37 PM CST-IP address:65.36.36.165
C91 Brent Vilhauer(chrisb@vilhauerenterprises.com) uploaded the following supporting documents:
File Attachment 1
G File Attachment 2
12/03/2018-12:47:55 PM CST
C?c. Document e-signed by Brent Vilhauer(chrisb@vilhauerenterprises.com)
Signature Date:12/03/2018-12:47:55 PM CST-Time Source:server-IP address:65.36.36.165
C' Document emailed to Daniel Roy(daniel.roy@fortworthtexas.gov)for signature
12/03/2018-12:47:56 PM CST
Document viewed by Daniel Roy(daniel.roy@fortworthtexas.gov)
12/05/2018-2:11:39 PM CST-IP address:107.77.197.157
yU. Document e-signed by Daniel Roy(daniel.roy@fortworthtexas.gov)
Signature Date:12/05/2018-2:12:23 PM CST-Time Source:server-IP address: 107.77.197.157
Document emailed to Emanuel Nieto (emanuel.nieto@fortworthtexas.gov)for approval
p 12/05/2018-2:12:24 PM CST
FoR _. I Jdo be Er
Adobe Sign
`u Document viewed by Emanuel Nieto (emanuel.nieto@fortworthtexas.gov)
12/05/2018-2:13:31 PM CST-IP address:209.194.29.100
L Document approved by Emanuel Nieto(emanuel.nieto@fortworthtexas.gov)
Approval Date: 12/05/2018-2:36:31 PM CST-Time Source:server-IP address:209.194.29.100
C. Document emailed to Aaron Long (edward.long@fortworthtexas.gov)for signature
12/05/2018-2:36:32 PM CST
i� Document viewed by Aaron Long (edward.long@fortworthtexas.gov)
12/05/2018-3:36:00 PM CST-IP address:209.194.29.100
G , Document e-signed by Aaron Long (edward.long@fortworthtexas.gov)
Signature Date:12/05/2018-3:36:20 PM CST-Time Source:server-IP address:209.194.29.100
Document emailed to Janie Scarlett Morales (Janie.morales@fortworthtexas.gov)for signature
12/05/2018-3:36:21 PM CST
Document viewed by Janie Scarlett Morales(Janie.morales@fortworthtexas.gov)
12/06/2018-1:37:47 PM CST-IP address:209.194.29.100
C? Document e-signed by Janie Scarlett Morales (Janie.morales@fortworthtexas.gov)
Signature Date:12/06/2018-1:38:44 PM CST-Time Source:server-IP address:209.194.29.100
C, Document emailed to Susan Alanis(susan.alanis@fortworthtexas.gov)for signature
12/06/2018-1:38:46 PM CST
Document viewed by Susan Alanis (susan.alanis@fortworthtexas.gov)
12/09/2018-5:57:46 PM CST-IP address:209.194.29.100
60 Document e-signed by Susan Alanis (susan.alanis@fortworthtexas.gov)
Signature Date:12/09/2018-5:58:02 PM CST-Time Source:server-IP address:209.194.29.100
! Document emailed to Allison Tidwell (cso_finalpay@fortworthtexas.gov)for filling
12/09/2018-5:58:03 PM CST
Document viewed by Allison Tidwell (cso_finalpay@fortworthtexas.gov)
12/10/2018-12:37:40 PM CST-IP address:209.194.29.100
D Form filled by Allison Tidwell (cso_finalpay@fortworthtexas.gov)
Form filling Date:12/10/2018-12:38:21 PM CST-Time Source:server-IP address:209.194.29.100
:. Document emailed to therese.brotherton@fortworthtexas.gov for delivery
12/10/2018-12:38:22 PM CST
Etta Bacy(etta.bacy@fortworthtexas.gov) replaced certified recipient therese.brotherton@fortworthtexas.gov
with Pedro.Hernandez@fortworthtexas.gov
12/11/2018-8:54:09 AM CST-IP address:209.194.29.100
Adobe Sign
. Document emailed to Pedro.Hernandez@fortworthtexas.gov for delivery
12/11/2018-8:54:09 AM CST
Etta Bacy(etta.bacy@fortworthtexas.gov) replaced certified recipient therese.brotherton@fortworthtexas.gov
with Pedro Hernandez (Zelalem.Arega@fortworthtexas.gov)
12/11/2018-12:29:46 PM CST-IP address:209.194.29.100
Cp Document emailed to Pedro Hernandez(Zelalem.Arega@fortworthtexas.gov)for delivery
12/11/2018-12:29:46 PM CST
Document viewed by Pedro Hernandez(Zelalem.Arega@fortworthtexas.gov)
12/11/2018-3:32:57 PM CST-IP address:209.194.29.100
Go Document receipt acknowledged by Pedro Hernandez(Zelalem.Arega@fortworthtexas.gov)
Receipt Acknowledgement Date:12/12/2018-12:58:41 PM CST-Time Source:server-IP address:209.194.29.100
n Document emailed to Julie A Geho oulie.geho@fortworthtexas.gov)for delivery
12/12/2018-12:58:42 PM CST
Li Document viewed by Julie A Geho Ouiie.geho@fortworthtexas.gov)
12/12/2018-3:29:49 PM CST-IP address:209.194.29.100
Document receipt acknowledged by Julie A Geho Qulie.geho@fortworthtexas.gov)
Receipt Acknowledgement Date: 12/12/2018-3:30:08 PM CST-Time Source:server-IP address:209.194.29.100
F-71 Document emailed to TPW Fiscal Staff(tpwcfafiscal@fortworthtexas.gov)for delivery
12/12/2018-3:30:09 PM CST
J Document viewed by TPW Fiscal Staff(tpwcfafiscal@fortworthtexas.gov)
12/12/2018-3:34:36 PM CST-IP address:209.194.29.100
c Document receipt acknowledged by TPW Fiscal Staff(tpwcfafiscal@fortworthtexas.gov)
Receipt Acknowledgement Date:12/12/2018-3:34:43 PM CST-Time Source:server-IP address:209.194.29.100
�' Signed document emailed to Pedro.Hernandez@fortworthtexas.gov, Aaron Long
(edward.long @fortworthtexas.gov), Pedro Hernandez(Zelalem.Arega@fortworthtexas.gov), Etta Bacy
(etta.bacy@fortworthtexas.gov), and 9 more
12/12/2018-3:34:43 PM CST
FORT WORTH.
Adobe sign