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Contract 51395-FP1
89 FORT WORTH® 13 CSC No.5 95-FP1 RECEIVED ,o DEC 27 2019 E c,OF FORT WORTH TRANSPORTATION AND PUBLIC WORKS CIIY SECHETARY t� NOTICE OF PROJECT COMPLETION City Project NQ: 101610 11016 8 b 9 Regar ' g contract 51395 for BRICK PAVEMENT REHABILTION 2019 AT VARIOUS LOCATIONS as required by the TRANSPORTATION&PUBLIC WORKS as approved by City Council on 9/11/2018 through M&C C-28824 the director of the TRANSPORTATION&PUBLIC WORKS upon the recommendation of the Assistant Director of the Transportation&Public Works Department has accepted the project as complete. Original Contract Prices: $306,250.00 Amount of Approved Change Orders: $1,825.21 NQ 1 Revised Contract Amount: $308,075.21 Total Cost Work Completed: $306,562.33 Less Deductions: Liquidated Damages: Days Q$210.00/Day Pavement Deficiencies: Total Deduction Amount: Total Cost Work Completed: $306,562.33 Less Previous Payments: $291,234.21 Final Payment Due $15,328.12 kl� E 4UH4tez Dec 20,2019 Richard E Martinez(Dec 20,2019) Recommended for Acceptance Date ASSt. Director, TPW - Capital Delivery William Ja n(Dec23,2019) Dec 23,2019 Accepted Date Director, TRANSPORTATION & PUBLIC WORKS Client Department B r Dec 23 2019 ff Dana Burghdoff ec 23,2019} � Asst. City Manager Date Comments: OFFICIAL RECORD, CITY SEC e FT. W��;Qq't rs ices Con5t.$ery ate -gepartment of �C3 Cphl# e 'D protect .. a ent Gates RIsKanagem grotherton IScanned CFA Morales ed een Contacted GuZlerlScann le have b ment&have The Proceeding pe Oest for final PayQnt cone d Lhi pr°Sect for sucY+ pay ri' re l Cleara nce Conducted BY a m 5 19 NJW r rn .n 0 j � �-� 4h N! 47 N V} iA iA iA 6A fig M n c A z _ o a 4 T a •� O � c � = a � A � C7 � � fY, `� m ❑ ' a �y � R Q f N p A � : F o 1 : a 3 z a a ad r x 0� o _ _ r y ❑ e e � a N p Q M F F Q a F cn g V a M Rai L a) a 0.0 p W❑ - k" � � U :� � d F � Z U ❑ R: � �u U a u, 3 c m Z oc ri r� r Lei Is � oc am m 51 Y t.. a u y c c o w y,,, m r a r� a � =s_ a � �ar .�, .� a V o a eC Fry C v z � ° U� ❑ O C dV '� ue U a T c. 13 I � V FORT WORT H rev 03/05/07 TRANSPORTATION& PUBLIC WORKS FINAL STATEMENT OF CONTRACT TIME FINAL STATEMENT NO.:7 FINAL NAME OF PROJECT: Brick Pavement Rehabilitation 2019 at Various Locations PROJECT NO.: 101510 CONTRACTOR: Green Scaping DOE NO.: NA PERIOD FROM 01/07/19 TO: 07/23/19 FINAL INSPECTION DATE: 23-Jul-19 WORK ORDER EFFECTIVE 117/2019 CONTRACT TIME: 210+5=215 © WK) Ca DAY OF DAYS REASON FOR DAYS DAY OF DAYS REASON FOR DAYS MONTH CHARGED CREDITED MONTH CHARGED CREDITED DURING DURING 1. 15. 2. 17. 3. is. 4. 19. 5. 20. d. 21. 7. 22. 8. 23. 9. 24. 10. 25. 11. 26. 12. 27. 13. 28. 14. 29. 15. 30. 31. SAT,SUN, RAIN,TOO WET, UTILITIES DAYS TOTAL &HOLIDAYS &TOO COLD RELOCATIONS OTHERS * CHARGED DAYS THIS PERIOD PREVIOUS PERIOD TOTALS TO DATE 187 *REMARKS., � r dc f2_i -I .017/ - CONTRI GTOR ©ATE SPE DATE ENGINEERING EPARTMENT (D The City of Fort Worth• 1000 Throekmorton Street•Fort Worth,TX 76012-6311 (817)392-7941 •Fax: (817)392-7845 SEBoPOIp8p$$iq$$" � ill V J � � MN��kW9H��NV�f kO � x G� o fn N K Nr c7 �. + u rc Q � d w U � L A � S! Y a a Lri u] y aa ❑ N Yl O a pp � S S O Y $ I I Bx € o8�8yy000 Spp pQp pop pB o po pgp o v ✓1 � p u� p�u� p�n�MM c�c � f�'1 -, j �N�41N V1W�6�nMMM � C uyy �s �Z Q 'C �tl1NN�s��NMNUIs � ?�g a x � - ' �' - � W N 7rJ�N V W LLNlTALLN 4eq a S O Fj O a ca Q G �w r w¢ r ¢N w .p OCR a z m d T¢ F r oC]Y UW m 2 % W W n`2 Q 0. a�oaW gLlox w a F1 z,5FYY�] a WA4 ¢ VUz a DC s'c c¢moua°mm°E r as Iw _ � E Nca vimm�m © e a I I I � N O d m 69 M 2 69 C .. cq C lV cq O � � d c. LC a oa N 4 P G P � x C z � o L K. U °Q. 7 OD co } r N CV co IV 4 � 41 69 E T E a c?N N CL d Lq Lq a a U LL x L7 LL � � C Y o O O E c: c a m ° c a w - m r = Ci tm a a r o LL O o � a n � v U � - P 1 m b 0 0 0 O O O O b C. f 0 Liberty �Mutual- SURETY Bond #022057047 OWNER ❑ CONSENT OF SURETY ARCHITECT Cl TO FINAL PAYMENT CONTRACTOR Conforms with the American Institute of SURETY Architects,AiA Document G707 OTHER TO OWNER: City of Fort Worth ARCHITECT'S PROJECT NO.: 200 Texas Street City Project Number: 101610 Fort Worth,TX 76102 (Name and adarem) CONTRACT FOR: Brick Pavement Rehabilitation PROJECT: Brick Pavement Rehabilitation 2019 CONTRACT DATED: (Nome alnladdrm) Various Locations In accordance With the provisions of the Contract between the Owner and the Contractor as Indicated above,the (117rer7 name aril address oJ:sirrerl) Liberty Mutual Insurance Company 175 Berkeley Street, Boston, Massachusetts 02116 SURETY, on bond of (hzsei4 name pill address of Conlmruu) C Green Scaping, LP,2401 Handley Ederville Rd., Fort Worth,TX 76118 ,CONTRACTOR, hereby approves of the final payment to the Contractor,and agrees that filial payment to the Contractor shall not relieve the Surety of any of its obligations to (Inven mare andad(lrev of(hraer) City of Fort Worth OWNER, as set forth in said Surety's bond. IN WITNESS WHEREOF,the Surety has hereunto set its hand on this date: (hrerr1 In uvining the mvmh 161jalrc r by the lummr)c date amr wor) i I Liberty Mutual Insurance Company r�` � ��� (Slrr•e!v} tr1'f�Z,� I Atic;t: (Siplanis of an V drepresenrarire) I f eY��q ■t)- �sevorypr�'' Cyndy Cates,Attorney in Fact Y�� (Printed name aiml title) d�"tsgcHu`�..2a 6'17 I LMS•12134 1=1 This Power of Attorney limits the acts of Ihose named herein,and they have no authority to bind the Company except in the manner and to the extent herein stated, - Liber� Liberty Mutual Insurance Company mutuAl, The Ohio Casualty Insurance Company Certificate No: 8200272 SURFTY West American 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 oorporation 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, Kylie Kelsoe,Cyndy Cates,Maurice Haywood,James E.King,Jeff 11.King all of the city of Denton state of TX each individually if there be more than one named,its true and lawful atomey-in-fact to make, execute,seal,admoWedge and deliver,for and on is 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 I they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. i 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 l t.thhday of January , 2019 Liberty Mutual Insurance Company hNSURq �SY INS&,p a IKSOD The Ohio Casualty Insurance Company �]�oarcryr yn yJ G�RPOq�f yy VP�flsePoqqn yn West American Insurance Company 1�1912� o p y1919� a 4 1991 y W �3yss4crlug ya yp NAM4g�,ab rs, 40,AAPr da S7 o David M.Carey,Assistant Secretary State of PENNSYLVANIA s La � County of MON''GOVERY ss � tm U w On this I I th day of January 2019 before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary of Liberty Muluai insurance o a 2 Company,The Ohlo Casualty Comparry,and West American Insurance Company,and that he,as such,being authorized so to do,execute the foregoing instrument for the purposes— � therein contained by signing on behatof the corporations by himself as a duly authorized officer. w IN WITNESS WHEREOF,I have hereunto subscribed my name and affrxed my notarial seal at Fing of Prussia.Pennsylvania,on the day and year first above written. =a 03 ��Aarh�vF�r�r COMMONWEALTHOFPENNSYLVANIA ¢a• O y Notarial Seal -� .� or Teresa Pasten7wp,la,Notary ery C O M ❑� Upper N1BnonTWp.,A+Lmlgomery Cvunhy 13y: `y � My Commiss+an Expires March 28.2021 Teresa Pastella,Notary Pubtle o @ fA � Mambw..Pen;yXmnl,As&cerion of Notariss 0 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 6' o.E Insurance Company,and West American Insurance Company which resolubons are now in full force and effect reading as follows: a m E - ARTICLE IV-OFFICERS:Section 12.Power of Attorney. 2-1� a2 Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President,and subject to such imitation as the Chairman or the 0 >, President may prescribe,shall appoint such atomeys-in-fact,as may be necessary to act in behalf of tie Corporaton to make,execute,seal,acknowledge and deliver as surely >1p C any and alt undertakings,bonds,recognizances and other surety obligations.Such attorneys-in-fact,subject to the limitations set forth in their respective powers of attorney,shall L N L 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 executed,such '"co instruments shalt be as binding as if signed by the President and attested to by the Secretary.Any power or authority granted to any representative or attorney-in fact under the E m provisions of this arlicle may be revoked at any time by the Board,the Chairman,the President or by the officer or officers granting such power or authority. o a ARTICLE]fill-Execution of Contracts:Section 5,Surety Bonds and Jndertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president,and subject to such limitations as the chairman or the president may prescribe,i shall appoint such attorneys-in-fact as may be necessary to act in behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings, bonds,recogrhizances and other surety obligations.Such attorneys-in-fact subject to the limitations set forth in their 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 seat of the Company.When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. 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- 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 Direclors,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 1,Renee C.Llewellyn,the undersigned,Assistant Secretary,The Ohio Casualty Insurance Company,Liberty Mutual Insurance Company,and West American Insurance Company do hereby ceflify 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 nave hereunto set.my hand and affixed the seals of said Companies this T st day of October 2019 FV 4NSUR 01 INS& �1Nsu'j" ham` CORp9R4p`�� �q�GORPOr�f'O_ el QµiO�r�C• `a0 S�• T $ `So 1912 {, 1919 h � 1991cy� L D d D c*us a o y*,*4 rs� ❑*e a By.Rewe C.Llewellyn,Assistant Secretary LMs-12873 LMIC OCIC WA1C MLA6 Co 062:'I' i f Liberty Liberty Mutual Surety Attention:LMS Claims mutual. PQ Nox 34526 Seattle,WA 981 M SURETY Phone:(206)473-6210 Fax.-WA)548.68I:3 Email:HOSCLgC libertymutuaLcQm Li E)ertyMtitualSuretyClairsis.corn TEXAS TEXAS IMPORTANT NOTICE AVISO LWORTANTE To obtain information or make a complaint: Para obtener infortnacion 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 information o para someter una queja al 1-877-751-2640 1-877-751-2640 You may also write to: Usted tanibien puede escribir a: Liberty Mutual Surety Claims Liberty Mutual Surer Clainnx 110 Box 34526 PO Box 34526 r Seattle, WA 99124 Seattle. WA 98124 You may contact the Texas Department of Puede comunicarse con el Departairlento de Insurance to obtain information on companies, Seguros de Texas para obtener n1formacion 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 i-IA) de Texas Consumer Protection (111-1A) P. O. Box 149091 P. O. Box 149091 Austin, TX 78714-9091 Austin,TX 78714-9091 FAX: (512)490-1007 FAX#(512)490-1007 Web: htt ://www.tdi.texas. ov Web:htt :Ilwww.tdi.te ' s. ov E-mail: Co tsr imerProtection@tdi.texas.goy E-mail: ConsumerProtection@tdi.texas.gov PREMIUM OR CLAIM DISPUTES: DISPUTAS SABRE PRIMAS O 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 Lin reclamo, debe comunicarse con el agente o contact the agent or tail 1-800-843-6446. primero. Si no se resuelve la disputa, puede If the dispute is not resolved, you may contact the cntonces comunicarse con el departatnento(TDI) Texas Department of Insurance. I 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. doeumento adju nto. NP 70 68 09 01 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 Curtis J. Green, Vice President Of C. Green Scaping, LP,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; i i Brick Pavement Rehabilitation 2019; City Project No. 101610 BY urkis J. Green,Vice President Subscribed and sworn before me on this date 2 of October, 2019. Q m =5'�`�P;;�•,, STACY LEE GEIGENMILLER Notary Public,State of Texas N ry Pubii �� �;: Comm. Expires 03-13-2022 Tarrant, Texas `'�;°,1 a`' Notary ID 125617920