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^ o, Contract No.
� � FORT WORTHO
Date Received
ar7 2019
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 completed.
Project arae: VICTORY AT BA SWOOD
City Project o.: 100725
Improvement Type(s): 0 Paving 0 Drainage 0 Street Lights 0 Traffic Signals
Odginal Contract Price: $205,402.50
Amount of Approved Change Order(s):
Devised Contract Amount:
Total Cost of Work Complete: $205„432.50
Feb 148 2019
Contractor Date
Presi ent/'Owner
Title --
Pennington
e _..din On Concrete
Company Name _._._.
:mm Feb 14 2019
Project Inspector Date
Feb 19,2019
Project Manager Date
., �, 5Feb 19,2019
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CFA Manager Date
A�Anil b b„4,1 %..... Feb 19,2019
Asst, City Manager Date
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t Iilu��j�I,, 11 R
MY
SEMEN jib
Notice of Project Completion
Project Name:VICTORY AT BASSWOOD
City Project No.: 100725
City's Attachments
Final Pay Estimate I-XJ
Change Order(s): ❑ Yes ® N/A
Contractor's Attachments
Affidavit of Bills Paid
Consent of Surety
Statement of Contract Time
Contract Time: 270 CD Days Charged: 407
Work Start Date: 10/9/2017 Work Complete Date: 11/19/2018
Page 2 of 2
6 ) — /0 0e7
City Project Numbers 100725 DOE Number 0725
Contract Name V 1(7 fORY A'T'BASSWOOD Estimate Number I
Contract Limits Payment Number I
Project Type PAVING For Period Ending 1 21412 0 1 8
Project Funding
Project Manager NA City Secretary Conti-act Number
Inspectors DICKINSON / CHAMBERS Contract Date
Contractor PF`NNINGTON CONCRETE Contract Time 270 CD
13350 EULESS ST Days Charged to Date 407 CD
FULESS, TX 76040 Contract is .000000 Complete
CITY OF FORT W01ZTH
SUMMARY OF CHARGES
Line Fund Account Center Amount Gross Retainage Net
Funded
------------- .....................
Total Cost of Work Completed $205,432.50
Less %Retained $0.00
Net Earned $205,432.50
Earned This Period $205,432.50
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"Phis Payment $205,432.50
Tuesday,December 4,2018 Page 4 of 4
FORTWORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name VICTORY AT BASSWOOD
Contract Limits
Project Type PAVING
City Project Numbers 100725
DOE Number 0725
Estimate Number l Payment Number I For:Period Ending 12/4/2018
CD
City Secretary Contract Number Contract Time 27(YD
Contract Date Days Charged to Date 407
Project Manager NA Contract is 100.00 Complete
Contractor PENNINGTON CONCRE'T'E
13350 EULESS ST
EULESS, TX 76040
Inspectors DICKINSON / CHAMBERS
Tuesday,December 4,2018 Pagel of 4
City Project Numbers 100725 DOE Number 0725
Contract Name VICTORY AT BASSWOOD Estimate Number I
Contract Limits Payment Number I
Project Type PAVING For Period Ending 12/4/2018
Project Funding
PAVING
Item Description of Items Estimated Unit thtit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
1 REMOVE CONC CURB&GUTTER 790 LF $5.00 $3,950.00 790 $3,950.00
2 6"LIME TREATMENT 2414 SY $9.00 $21,726.00 2414 $21,726.00
3 8"CONC PVMT 821 SY $67.50 $55,417.50 821 $55,417.50
4 G"CONC PVMT 1428 SY $59.40 $84,823.20 1428 $84,823.20
5 6"CONC CURB&GUTTER 1401 LF $5.00 $7,005.00 1401 $7,005.00
6 8"SLD PVMT MARKING HAS 758 LF $3.00 $2,274.00 758 $2,274.00
7 REFL RAISED MARKER 39 EA $10.00 $390.00 39 $390.00
8 FURNISH/INSTALL ALUM SIGN GROUND I EA $1,240.00 $1,240.00 1 $1,240.00
MOUNT CITY STD
9 LANE LEGEND ARROW 2 EA $843.00 $1,686.00 2 $1,686.00
10 LANE LEGEND ONLY 2 EA $843.00 $1,686.00 2 $1,686.00
11 24"SLD PVMT MARKING PAINT 24 LF $20.00 $480.00 24 $480.00
12 4"CONC SIDEWALK 2568 SF $4.85 $12,454.80 2568 $12,454.80
13 VALVE BOX ADJUSTMENT I EA $300.00 $300.00 1 $300.00
14 TRAFFIC CONTROL 2 MO $6,000.00 $12,000.00 2 $12,000.00
Sub-Total of Previous Unit $205,432.50 $205,432.50
Tuesday,December 4,2018 Page 2 of 4
City Project Numbers 100725 DOE Number 0725
Contract Name VICTORY AT BASSWOOD Estimate Number 1
Contract Limits Payment Number 1
Project Type PAVING For Period Ending 12/4/2018
Project Funding
Contract Information Summary
Original Contract Amount $205,432.50
Change Orders
Total Contract Price $205,432.50
Total Cost of Work Completed $205,432.50
Less %Retained $0.00
Net Earned $205,432.50
Earned This Period $205,432.50
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 $205,432.50
Tuesday,December 4,2018 Page 3 of 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 London Graham,
Director of Financial Operations Of Leland Pennington Inc.,DBA
Pennington Concrete,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
BY
London Graham
Subscribed and sworn before me on this date 13 of February,2019.
t%%JMIIJtJJ
B "k ,
Notary Public ..E Z/.... Z)f*,
Tarrant, Texas m 0 '"'X
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AIA Document G707 _ 1994
Consent Of Surety to Final Payment
PROJECT:(Name and address) ARCHITECT'S PROJECT NUMBER: OWNER:
Victory at Basswood Project No. 100725 CONTRACT FOR:Paving Improvements ARCHITECT:
CONTRACTOR:E]
TO OWNER:(Name and address) CONTRACT DATED:7/13/2017 SURETY:F1
City of Fort Worth
200 Texas St OTHER:M
Ft Worth,TX 76102
In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above,the
(Insert name and address of Surety)
Insurors Indemnity Company
225 S 5th St
Waco,TX 76701
,SURETY,
on bond of
(Insert name and address of Contractor)
Leland Pennington,Inc.dba Pennington Concrete
13350 Euless St
Euless,TX 76040
,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
(Insert name and address of Owner)
City of Fort Worth
200 Texas St
Ft Worth,TX 76102
OWNER,
as set forth in said Surety's bond.
IN WITNESS WHEREOF,the Surety has hereunto set its hand on this date:February 14,2019
(Insert in writing the month followed by the numeric date and year.)
Insurors Indemnity Coml)anv
(Surety)
4
447),;w
S,li`-g�nlature I ofauthor�& representative)
Attest: Monica Hernandez,Attorney-in-Fac
(Sea]): (Printed name and title)
AIA Document G707" —1994.Copyright®1982 and 1994 by The American Institute of Architects.All rights reserved.VJARNfl, A,Wsuvnant H�
protecte,d by U S,CopyriighL LaA1 and kftwykaUonaliTroafiauUnauthadzed mproducticn ar AsbdbuUon cvC TVas AIA1, Or ary�pwtJk*n it,
rIwy reuuft�n Severe c+M and cirkrdnall pvna6fios,and%PW be,prosecuted(,,,o tha nuixknurn extent poasHAe under tho tav,,.This documentwas produced by
AIA software at 09:26:46 ET on 02/14/2019 under Order No.8705792261 which expires on 05130/2019,and is not for resale.
User Notes: (3139ADA71)
POWER OF ATTORNEY of INSURORS INDEMNITY COMPANY
Waco, Texas
KNOW ALL PERSONS BY THESE PRESENTS. Number: CNB-24806-00
That INSURORS INDEMNITY COMPANY, Waco, Texas, organized and existing under the laws of the State of
Texas, and authorized and licensed to do business in the State of Texas and the United States of America, does
hereby make, constitute and appoint
Monica Hernandez of the City of Waco,State of TX
as Attorney in Fact, with full power and authority hereby conferred upon him to sign, execute, acknowledge and
deliver for and on its behalf as Surety and as its act and deed, all of the following classes of document, to-wit:
Indemnity, Surety and Undertakings that may be desired by contract, or may be given in any action
or proceeding in any court of law or equity*, Indemnity in all cases where indemnity may be lawfully
given and with full power and authority to execute consents and waivers to modify or change or
extend any bond or document executed for this Company.
INSURORS INDEMNITY COMPANY
By:
Attest
Tarnmy Tieperm�rr, Sbcreta"rybiive E.Talbert, President
State of Texas
County of McLennan
On the 11u, day of November, 2014, before me a Notary Public in the State of Texas, personally appeared Dave E.
Talbert and Tammy Tieperman,who being by me duty sworn,acknowledged that they executed the above Power of Attorney in
their capacities as President, and Corporate Secretary, respectively, of Insurors Indemnity Company, and acknowledged said
Power of Attorney to be the voluntary act and deed of the Company. Sm"COTO$
iWaij7'PZlc,State of Texas
Insurors Indemnity Company certifies that this Power of Attorney is granted under and by authority of the
following resolutions of the Company adopted by the Board of Directors on November 11, 2014:
RESOLVED,that all bonds, undertakings,contracts or other obligations may be executed in the name of the Company
by persons appointed as Attorney in Fact pursuant to a Power of Attomey issued in accordance with these Resolutions. Said
Power of Attorney shall be executed in the name and on behalf of the Company either by the Chairman and CEO or the
President, under their respective designation. The signature of such officer and the seal of the Company may be affixed by
facsimile to any Power of Attorney, and, unless subsequently revoked and subject to any limitation set forth therein, any such
Power of Attorney or certificate bearing such facsimile signature and seal shall be valid and binding upon the Company and any
such power so executed and certified by facsimile signature and seal shall be valid and binding upon the Company with respect
to any bond or undertaking to which it is validly attached.
RESOLVED, that Attorneys in Fact shall have the 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 to
any and all bonds and undertakings, and any such instrument executed by such Attorneys in Fact shall be binding upon the
Company as if signed by an Executive Officer and seated and attested to by the Secretary or Assistant Secretary of the
Company.
1, Tammy Tieperman, Secretary of Insurors Indemnity Company, do hereby certify that the foregoing is a true excerpt
from the Resolutions of the said Company as adopted by its Board of Directorson November 11,2014,and that this Resolution
is in full force and effect.I certify that the foregoing Power of Attorney is in full force and effect and has not been revoked.
In Witness Whereof, I have set my hand and the seal of INSURORS INDEMNITY COMPANY on this — 14th---.
day of-_-,---_,,February _...__.w2019
farm* rteperm6n, Secrelar�
NOTE- IF YOU HAVE ANY QUESTION REGARDING THE VALIDITY OR WORDING OF THIS POWER OF ATTORNEY,
PLEASE CALL 800 933 7444 OR WRITE TO US AT P.O.BOX 2683,WACO,TEXAS 76702-2683 OR EMAIL US AT
rAAP0 0Z U R, 7r C10 el.