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Contract 52536-FP2
City Secretary 52536 -FP2 Contract No. FORTWORTH., Date Received Aug 27,2020 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: Sun Valley Detention Pond City Project No.: 1000093 Improvement Type(s): ® Paving ® Drainage ❑ Street Lights ❑ Traffic Signals Original Contract Rice: $1,655,498.96 Amount of Approved Change Order(s): $72,242.86 Revised Contract Amount: $1,727,741.82 Total Cost of Work Complete: $1,727,741.82 C44w,&kM. 1<4az Charles M.Klutz(Aug 24,202009:02 CDT) Aug 24,2020 Contractor Date Managing partner Title klutz Construction, LLC Company Name Tamara!6 u n Aug 2020 Tamara vaughn(Aug u,202008:28 CDT) g f Project Inspector Date Patrick ley(Au 6,202013:11FT) Aug26,2020 Project Manager Date zmy/e Z914 J' Aug6 2020 Laurie Lewis(Aug 26,202013:20 CDT) u g f CFA Manager Date 0AN-y LuN A&15f Dana Burghdoff( g26,20 14:58 CDT) Aug 26,2020 Asst. City Manager Date OFFICIAL RECORD CITY SECRETARY Page 1 of 2 FT. WORTH, TX Notice of Project Completion Project Name: Sun Valley Detention Pond City Project No.: 1000093 City's Attachments Final Pay Estimate Change Order(s): ® Yes ❑ N/A Contractor's Attachments Affidavit of Bills Paid Consent of Surety Statement of Contract Time Contract Time: 240 CD Days Charged: 262 Work Start Date: 5/9/2020 Work Complete Date: 7/31/2020 Page 2of2 FORT WORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name PAVING&DRAINAGE IMPROVEMENTS TO SERVE SUN VALLEY DET Contract Limits Project Type PAVING&DRAINAGE City Project Numbers 100093 DOE Number 0930 Estimate Number 10 Payment Number 10 For Period Ending 7/31/2020 CD City Secretary Contract Number Contract Time 24(ED Contract Date 5/9/2019 Days Charged to Date 262 Project Manager NA Contract is 97.000 Complete Contractor KLUTZ CONSTUCTION,LLC P.O.BOX 100263 FORT WORTH, TX 76185 Inspectors MILLER,W / VAUGHN,T Wednesday,August 12,2020 Page 1 of 5 City Project Numbers 100093 DOE Number 0930 Contract Name PAVING&DRAINAGE IMPROVEMENTS TO SERVE SUN VALLEY DE Estimate Number 10 Contract Limits Payment Number 10 Project Type PAVING&DRAINAGE For Period Ending 7/31/2020 Project Funding UNIT IQ:DRAINAGE IMPROVEMENTS Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total --------------------------------------- 1 REMOVE 30"STORM LINE 36 LF $30.00 $1,080.00 36 $1,080.00 2 TRENCH SAFETY 973 LF $1.00 $973.00 956 $956.00 3 CONCRETE ENCASEMENT FOR UTILITY PIPES 8 CY $300.00 $2,400.00 8 $2,400.00 4 24"RCP CLASS III 681 LF $135.00 $91,935.00 681 $91,935.00 5 30"RCP CLASS III 9 LF $159.00 $1,431.00 9 $1,431.00 6 36"RCP CLASS III 134 LF $290.00 $38,860.00 134 $38,860.00 7 42"RCP CLASS III 96 LF $248.00 $23,808.00 96 $23,808.00 8 48"RCP CLASS III 53 LF $360.00 $19,080.00 36 $12,960.00 9 4'STORM JUNCTION BOX 1 EA $6,100.00 $6,100.00 1 $6,100.00 10 Y STORM JUNCTION BOX 2 EA $5,200.00 $10,400.00 2 $10,400.00 11 24"PARALLED HEADWALL 1 PIPE 2 EA $4,950.00 $9,900.00 2 $9,900.00 12 48"PARALLEL HEADWALL 1 PIPE 1 EA $15,100.00 $15,100.00 1 $15,100.00 13 4'DROP INLET 1 EA $5,300.00 $5,300.00 2 $10,600.00 14 6'DROP INLET 3 EA $8,450.00 $25,350.00 3 $25,350.00 15 4'GRATE INLET 1 EA $6,650.00 $6,650.00 1 $6,650.00 16 CONC.RETAINING WALL 10224 SF $53.00 $541,872.00 9805.54 $519,693.62 17 FLEXAMALT SLOPE ARMORING MAT 2963 SF $8.10 $24,000.30 2963 $24,000.30 -------------------------------------- Sub-Total of Previous Unit $824,239.30 $801,223.92 -------------------------------------- UNIT IV:PAVING IMPROVEMENTS Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total 1 MOBILIZATION 1 LS $68,000.00 $68,000.00 1 $68,000.00 2 REMOVE MISC CONC STRUCTURE 1 LS $1,250.00 $1,250.00 1 $1,250.00 3 REMOVE CONC PVMT(CO#3) 3190.31 SY $6.00 $19,141.86 3190.31 $19,141.86 4 REMOVE ASPHALT PVMT 102 SY $18.00 $1,836.00 102 $1,836.00 5 REMOVE CONC CURB&GUTTER(CO#3) 1479 LF $2.00 $2,958.00 1427 $2,854.00 6 SITE CLEARING 1 LS $2,500.00 $2,500.00 1 $2,500.00 7 UNCLASSIFEID EXCAVATION BY PLAN 45239 CY $9.12 $412,579.68 45239 $412,579.68 8 SWPPP 1 ACRE 1 LS $4,700.00 $4,700.00 1 $4,700.00 9 CONCRETE RIPRAP 1587 SY $77.00 $122,199.00 1488.4 $114,606.80 Wednesday,August 12,2020 Page 2 of 5 City Project Numbers 100093 DOE Number 0930 Contract Name PAVING&DRAINAGE IMPROVEMENTS TO SERVE SUN VALLEY DE Estimate Number 10 Contract Limits Payment Number 10 Project Type PAVING&DRAINAGE For Period Ending 7/31/2020 Project Funding 10 LARGE STONE RIPRAP GROUTED 391 SY $59.00 $23,069.00 328.55 $19,384.45 11 ASPHALT PVMT REPAIR BEYOND DEFINED 102 SY $100.00 $10,200.00 102 $10,200.00 WIDTH 12 8"CONC PVMT 225 SY $113.00 $25,425.00 231 $26,103.00 13 HYDRATED LIME 5 TN $175.00 $875.00 5 $875.00 14 8"LIME TREATMENT 237 SY $35.00 $8,295.00 237 $8,295.00 15 6"CONC CURB AND GUTTER 541 LF $12.00 $6,492.00 571.18 $6,854.16 16 6'CHAIN LINK ALUMINIUM(CO#2) 554 LF $25.00 $13,850.00 554 $13,850.00 17 BLOCK SOD PLACEMENT 13397 SY $7.34 $98,333.98 11660 $85,584.40 18 TRAFFIC CONTROL 2 MO $1,000.00 $2,000.00 2 $2,000.00 19 12"CONC CURB AND GUTTER(CO#3) 624 LF $23.00 $14,352.00 390 $8,970.00 20 ASPHALT PAVEMENT REPAIR(CO 1)(CO#4) 45.75 SY $100.00 $4,575.00 45.75 $4,575.00 21 4500 PSI CONCRETE FOR PAVEMENT(CO 1) 1 LS $3,500.00 $3,500.00 1 $3,500.00 22 REMOVE 12"WATER(CO#1) 30 LF $16.00 $480.00 30 $480.00 23 12"WATERLINE LOWERING(CO#1) 1 EA $13,000.00 $13,000.00 1 $13,000.00 24 TRENCH SAFETY(CO#1) 120 LF $2.00 $240.00 120 $240.00 25 DUCTILE IRON FITTINGS(CO#1) 0.3 TN $8,500.00 $2,550.00 0.3 $2,550.00 26 CONNECT TO EXIST 12"WATER(CO#1) 2 EA $2,500.00 $5,000.00 2 $5,000.00 27 REMOVE 8"SEWER(CO#1) 88 LF $16.00 $1,408.00 88 $1,408.00 28 TRENCH WATERSTOP(CO#1) 1 EA $1,000.00 $1,000.00 1 $1,000.00 29 CONNECT TO PROPOSED 8"SEWER(CO#1) 2 EA $1,000.00 $2,000.00 2 $2,000.00 30 8"PVC SANITARY SEWER(CO#1) 88 LF $110.00 $9,680.00 88 $9,680.00 31 4'DIA MANHOLE(CO#1) 1 EA $6,000.00 $6,000.00 1 $6,000.00 32 REM EXIST CONCRETE DROP INLET(CO#1) 1 EA $1,200.00 $1,200.00 1 $1,200.00 33 MANHOLE COLLAR(CO#1) 1 EA $650.00 $650.00 1 $650.00 34 VACUME TEST MANHOLE(CO#1) 1 EA $500.00 $500.00 1 $500.00 35 POST IV SANITARY SEWER(CO#1) 88 LF $13.50 $1,188.00 88 $1,188.00 36 MANHOLE COATINGS(CO#1) 8 VF $450.00 $3,600.00 8 $3,600.00 37 CONCRETE ENCASEMENT SEWER(CO#1) 1 CY $300.00 $300.00 38 INSTALL CONCRETE DROP INLET(CO#1) 1 EA $5,500.00 $5,500.00 1 $5,500.00 39 6"CONCRETE PVMT(CO 3) 41 SY $75.00 $3,075.00 41 $3,075.00 Sub-Total of Previous Unit $903,502.52 $874,730.35 -------------------------------------- Wednesday,August 12,2020 Page 3 of 5 City Project Numbers 100093 DOE Number 0930 Contract Name PAVING&DRAINAGE IMPROVEMENTS TO SERVE SUN VALLEY DE Estimate Number 10 Contract Limits Payment Number 10 Project Type PAVING&DRAINAGE For Period Ending 7/31/2020 Project Funding Contract Information Summary Original Contract Amount $1,655,498.96 Chanize Orders Change Order Number 1 $60,296.00 Change Order Number 2 $3,175.00 Change Order Number 3 $6,696.86 Change Order Number 4 $2,075.00 Total Contract Price $1,727,741.82 Total Cost of Work Completed $1,675,954.27 Less %Retained $0.00 Net Earned $1,675,954.27 Earned This Period $85,768.97 Retainage This Period $0.00 Less Liquidated Damages Days @ /Day $0.00 LessPavement Deficiency $0.00 Less Penalty $0.00 Less Previous Payment $1,590,185.30 Plus Material on Hand Less 15% $0.00 Balance Due This Payment $85,768.97 Wednesday,August 12,2020 Page 4 of 5 City Project Numbers 100093 DOE Number 0930 Contract Name PAVING&DRAINAGE IMPROVEMENTS TO SERVE SUN VALLEY DE Estimate Number 10 Contract Limits Payment Number 10 Project Type PAVING&DRAINAGE For Period Ending 7/31/2020 Project Funding Project Manager NA City Secretary Contract Number Inspectors MILLER,W / VAUGHN,T Contract Date 5/9/2019 Contractor KLUTZ CONSTUCTION,LLC Contract Time 240 CD P.O.BOX 100263 Days Charged to Date 262 CD FORT WORTH, TX 76185 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 $1,675,954.27 Less %Retained $0.00 Net Earned $1,675,954.27 Earned This Period $85,768.97 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 $1,590,185.30 Plus Material on Hand Less 15% $0.00 Balance Due This Payment $85 768.97 Wednesday,August 12,2020 Page 5 of 5 v m o 0 0 0 0 0 0 0 0 0 0 0 0 U o 0 0 0 0 0 0 0 0 0 0 0 0 0 m 0 0 0 0 0 0 0 0 0 0 0 � Jm oovou�oomo Dino M�^ Z O N O O O O O O ,` 1 O F 1 l J O O O O O O O O O O O O O o o W 0 0 0 0 0 0 0 0 0 0 0 0 0 N U16 1.6--O N 0 0 0 0 0 0 0 0 0 N U G G a 0 0 0 0 0 O O V1 O O Otn�n O�ONN� = U Z J O F W W t<® o N 6 L >N y pp�� 1� O U LLJ j `CO z LLJ W z U N N N Z_ 2 O O W S U0 a U w w tea, w Q i_,.r z H w J U ? 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UOU w LL Z I w U U ¢ w 0N o 4 N o� LU N y v > CDN w W � U N m UI m a 0 0 0 0 0 0 0 0 00000000 �000dod<d ¢ m o 0 0 0 o m LL O F z W y LU C t0 M 715 m 0 C N C E U La W W - ¢ c O y U O of to m m o >z Of of U r 0 Q U a O J�1N' Y m U c S o Ci m m d m n 'u a W G 0 m 0- ~p O ? n m c O .!0- L m L._ U m O O LU W Z M W Q O _ p > F. �— Ka a U bi c °' m a W z W w w 0 LL N E ei a E of 7 m E c W W w mm t ( a > >, m m 1L > m H� o o . 5 a Jag ro ¢a a 4 m z F ¢ o m z F- E�`- o Y U' U a W Q F O F u rn o m z U cwi�FW��n, zcwi� W�- Y U a0 WO F OU w W2w 00 LL m �0 .�m� w F IL- z�vC>W LU LLa 0 ❑ cn�wzdU mw `-m >F OJ m Q -2iWJfr Q� wcwA w11-- U J LLI O UFa-a_ OK Q> J a zm¢o --10 Jm 0 Oz o w1- w¢ w p ¢ Q N p - -O N g O 9 CD 0,1 on Q(n W W �i o U N � �a o 0 a O a o w - 'mo =' F F~-¢ > = m a > m Q '� Q a a Q 2 w¢ w m > - d m 0 1L g W a z E ui a E ui 0 a~ Q m m z I- ¢ U m z F- O co W W S ¢ ~ 007 -»U WmJ w zU` zF a Y ¢O ¢u m 0 �Za �O o m o ¢W ¢ o g W z wO O a U C1 co I- F_W U z O a_ x K p o a O OLLI a m F'V m uj n 0 _ OU m Z Q V� o w y - J e _ E w o m o tomnmo Q JZ a = m > `° U Cl)M Cl)M N N = >LL 0 >p g m m = a Q d ���Fh� o �o� �W o ¢ w y� o w` 0 - o z I=- d o - ¢ ¢ in ai y Si y w Ew m m z ~ �aJ; k m m ~ m m ~ E z z mi la 't U ia O m y c Q E Q U va U .�i� ? l•�...... r o • ts a W U io GD U r(llll cn mzoorc)� Q 7� (V W4 O v ® m IY9I � GFW Sognaiures Final Audit Report 2020-07-21 Created: 2020-07-14 By: Patrick Buckley(Patrick.Buckley@fortworthtexas.gov) Status: Signed Transaction ID: CBJCHBCAABAAkzitbyu58v-gBgf7-m8E4OQ7au3lpYSG "CFA100093-Sun Valley Detention Pond-CO-1 CFW Signatures " History L l Document created by Patrick Buckley(Patrick.Buckley@fortworthtexas.gov) 2020-07-14-4:12:10 PM GMT-IP address:209A 94.29.100 LSo Document e-signed by Patrick Buckley(Patrick.Buckley@fortworthtexas.gov) Signature Date:2020-07-14-4:17:54 PM GMT-Time Source:server-IP address:209.194.29.100 h' Document emailed to Jonathan Russell Orussell@dunawayassociates.com)for signature 2020-07-14-4:17:56 PM GMT Email viewed by Jonathan Russell Qrussell@dunawayassociates.com) 2020-07-14-4:35:57 PM GMT-IP address:66.190.102.35 lea Document e-signed by Jonathan Russell Qrussell@dunawayassociates.com) Signature Date:2020-07-14-4:36:46 PM GMT-Time Source:server-IP address:66.190.102.35 Document emailed to Bowie Holland (bowie@empireroofing.com)for signature 2020-07-14-4:36:48 PM GMT i Email viewed by Bowie Holland (bowie@empireroofing.com) 2020-07-15-3:48:04 PM GMT-IP address:66.196.228.162 6a Document e-signed by Bowie Holland (bowie@empireroofing.com) Signature Date:2020-07-15-3:48:43 PM GMT-Time Source:server-IP address:66.196.228.162 Document emailed to Charles M. Klutz(klutzconstruction@sbcglobal.net)for signature 2020-07-15-3:48:45 PM GMT 'I") Email viewed by Charles M. Klutz(klutzconstruction@sbcglobal.net) 2020-07-15-3:55:50 PM GMT-IP address:98.139.133.172 FORT WORTH, Adobe Sign tp Document e-signed by Charles M. Klutz (klutzconstruction@sbcglobal.net) Signature Date:2020-07-15-3:59:45 PM GMT-Time Source:server-IP address:47.51.211.209 Document emailed to kiran konduru (kiran.konduru@fortworthtexas.gov)for approval 2020-07-15-3:59:47 PM GMT Email viewed by kiran konduru (kiran.konduru@fortworthtexas.gov) 2020-07-15-6:37:02 PM GMT-IP address:209.194.29.100 Cep Document approved by kiran konduru (ki ran.konduru@fortworthtexas.gov) Approval Date:2020-07-15-6:39:14 PM GMT-Time Source:server-IP address:209.194.29.100 Document emailed to Michael Owen (Michael.Owen@fortworthtexas.gov) for approval 2020-07-15-6:39:16 PM GMT l Email viewed by Michael Owen (Michael.Owen@fortworthtexas.gov) 2020-07-16-8:34:10 PM GMT-IP address:209.194.29.100 GSQ Document approved by Michael Owen (Michael.Owen@fortworthtexas.gov) Approval Date:2020-07-16-8:34:34 PM GMT-Time Source:server-IP address:209.194.29.100 E'4' Document emailed to Greg Simmons (Gregory.Simmons@fortworthtexas.gov)for signature 2020-07-16-8:34:36 PM GMT ,.`I Email viewed by Greg Simmons (Gregory.Simmons@fortworthtexas.gov) 2020-07-16-9:22:02 PM GMT-IP address:209.194.29.100 Document e-signed by Greg Simmons (Gregory.Simmons@fortworthtexas.gov) Signature Date:2020-07-16-9:22:24 PM GMT-Time Source:server-IP address:209.194.29.100 I Document emailed to Richard A. McCracken (richard.mccracken@fortworthtexas.gov)for signature 2020-07-16-9:22:25 PM GMT I Email viewed by Richard A. McCracken (richard.mccracken@fortworthtexas.gov) 2020-07-21 -2:40:56 AM GMT-IP address:99.110.253.108 Document e-signed by Richard A. McCracken (richard.mccracken@fortworthtexas.gov) Signature Date:2020-07-21 -2:51:52 AM GMT-Time Source:server-IP address:99.110.253.108 Document emailed to Dana Burghdoff(Dana.Burghdoff@fortworthtexas.gov)for signature 2020-07-21 -2:51:54 AM GMT "i Email viewed by Dana Burghdoff(Dana.Burghdoff@fortworthtexas.gov) 2020-07-21 -5:04:15 PM GMT-IP address:209.194.29.100 0� Document e-signed by Dana Burghdoff(Dana.Burghdoff@fortworthtexas.gov) Signature Date:2020-07-21 -5:05:13 PM GMT-Time Source:server-IP address:209.194.29.100 FORT WORTH., r; i Adobe Sign I Signed document emailed to Charles M. Klutz(klutzconstruction@sbcglobal.net), Dana Burghdoff (Dana.Burghdoff@fortworthtexas.gov), Greg Simmons (Gregory.Simmons@fortworthtexas.gov), Patrick Buckley (Patrick.Buckley@fortworthtexas.gov), and 5 more 2020-07-21-5:05:13 PM GMT I, FORTWORTH, Adobe Sign m a C � U s r ¢ N N N O N O � U 5 N co U o 0 H J F- W w W N w o 0 I.fs a 0 0 0 F z m o !Lf ❑U m W LLJ Z N U N N N _ D W N N N it z C7 U ro m ao d6 �r U Z N ❑ f9 y O O O O O N > 0 0 W �> � O V g oo W N O r ^ ? m N 1? z C7 U m m m `O U co a0 Z U co � F- > W ° ¢ U m U Z a o0 Z O z d U U o 0 0 w w _ >N f- U o ci U W 3 Q O d y O O O O O z z U o o c n. rr � W ° ° w Q L L 3 0 0 d W M Q N M w w � o 0 0 0 w w W N w o d W ❑U (D C CL J L W ❑ > a o 0 GO O m Y 00 C G W d E >`m N N N ❑ N E Y K U o C E U w a m m Q < N C co(d M Cl) ~ a N O M .. y N > C O Q) O O MO p O O V O O N N C > 0 0 N >w > m o o Z N d r Z Z Y o ci p r � z w 0 Ir p 2 QU O r Q K a W k �k ~ ~ U ° U z ) OZZ= Q F- y ❑ 7 Q U Q o W w Q d Q O W U N O p O ❑ ❑ > N Z f- z a o 0 a z uwi a N w O na a O F- ° p o r w o > > Q O �_- U Q C) O U F- U w w ¢ N i Lij c Uz mOZ Wa 0 CK O LL w w z 0 > 0 > w �a U U � E o 0 0 a v r CD U �U U N UI rn t0 Q. O O J O O Q N� ~U r M C1 to ER W U O N K Q OG C Z U N u N N E C J F- a Z N O OU` N O 10 LL Q - a -° U O _ U E o o m .3 _ a _ N U l0 ❑ -� _ ❑ U N •�- N W U > U CO 0. OI N U V N Q = 'O CLL C N a `Y m z H a U m z H E Y C U LL ;�' E m.� U ¢ LL W C fv_. JLO 0 El 0J+ W •,. f 10 � c m C LL- U 2 m CD - J J y N C N h _ 'O r CD + N �+ �a o U � � •rr r c OFF p ^❑ LLI LU w: > a 3 o o � v m a °�' > >. ai as L m ai o� m z F- m z P Y c Y _ ov 10 � m E LU �q o z N -° z a _ '•C'i y w C rt U Ea �° a o a d ci a c O W❑ pl'O _ N w Q O W N cG Z w W IT Q - w Q m = E w w o _m it: m N '' O c - m d E O w O o Z Z M G C a� w `_ = o c a � w w a m ° c� o € w 3 x m E m E F= m E o w z z Z o r O w m at o 0 m E w U° a C) ~ Z U Od :5i o O Q Q N O 4 0 N U a � O Z m O d N U N } a Of Final Audit Report 2020-07-21 Created: 2020-07-14 By: Patrick Buckley(Patrick.Buckley@fortworthtexas.gov) Status: Signed Transaction ID: CBJCHBCAABAAe24UF6njrm5eyScXyvDVXgZHljc8zUs3 "CFA100093-Sun Valley Detention Pond-CO-2 CFW Signtures" H istory i Document created by Patrick Buckley (Patrick.Buckley@fortworthtexas.gov) 2020-07-14-4:37:40 PM GMT-IP address:209.194.29.100 6© Document e-signed by Patrick Buckley(Patrick.Buckley@fortworthtexas.gov) Signature Date:2020-07-14-4:41:12 PM GMT-Time Source:server-IP address:209.194.29.100 Document emailed to Jonathan Russell Orussell@dunawayassociates.com)for signature 2020-07-14-4:41:14 PM GMT Email viewed by Jonathan Russell Orussell@dunawayassociates.com) 2020-07-14-4:41:34 PM GMT-IP address:66.190.102.35 lSa Document e-signed by Jonathan Russell Orussell@dunawayassociates.com) Signature Date:2020-07-14-4:42:10 PM GMT-Time Source:server-IP address:66.190.102.35 Document emailed to Bowie Holland (bowie@empireroofing.com)for signature 2020-07-14-4:42:12 PM GMT ,01 Email viewed by Bowie Holland (bowie@empireroofing.com) 2020-07-15-8:13:29 PM GMT-IP address:66.196.228.162 I Document e-signed by Bowie Holland (bowie@empireroofing.com) Signature Date:2020-07-15-8:13:52 PM GMT-Time Source:server-IP address:66.196.228.162 I Document emailed to Charles M. Klutz(klutzconstruction@sbcglobal.net) for signature 2020-07-15-8:13:55 PM GMT 'I Email viewed by Charles M. Klutz(klutzconstruction@sbcglobal.net) 2020-07-15-9:24:56 PM GMT-IP address:98.139A 33.173 FORT WORTH, i Adobe Sign FOOcument e-signed by Charles M. Klutz (klutzconstruction@sbcglobal.net) ature Date:2020-07-15-9:25:50 PM GMT-Time Source:server-IP address:47.51.211.209 cument emailed to kiran konduru (kiran.konduru@fortworthtexas.gov)for approval 2020-07-15-9:25:52 PM GMT Email viewed by kiran konduru (kiran.konduru@fortworthtexas.gov) 2020-07-15-10:01:15 PM GMT-IP address:209.194.29.100 6, Document approved by kiran konduru (kiran.konduru@fortworthtexas.gov) Approval Date:2020-07-15-10:02:18 PM GMT-Time Source:server-IP address:209.194.29.100 L_-14. Document emailed to Michael Owen (Michael.Owen@fortworthtexas.gov)for approval 2020-07-15-10:02:20 PM GMT Email viewed by Michael Owen (Michael.Owen@fortworthtexas.gov) 2020-07-15-10:16:04 PM GMT-IP address:209.194.29.100 Document approved by Michael Owen (Michael.Owen@fortworthtexas.gov) Approval Date:2020-07-15-10:20:43 PM GMT-Time Source:server-IP address:209.194.29.100 I Document emailed to Greg Simmons (Gregory.Simmons@fortworthtexas.gov)for signature 2020-07-15-10:20:44 PM GMT Email viewed by Greg Simmons (Gregory.Simmons@fortworthtexas.gov) 2020-07-15-10:27:39 PM GMT-IP address:209.194.29.100 K, Document e-signed by Greg Simmons (Gregory.Simmons@fortworthtexas.gov) Signature Date:2020-07-15-10:28:09 PM GMT-Time Source:server-IP address:209.194.29.100 I Document emailed to Richard A. McCracken (richard.mccracken@fortworthtexas.gov)for signature 2020-07-15-10:28:11 PM GMT I Email viewed by Richard A. McCracken (richard.mccracken@fortworthtexas.gov) 2020-07-15-10:28:25 PM GMT-IP address:99.110.253.108 Document e-signed by Richard A. McCracken (richard.mccracken@fortworthtexas.gov) Signature Date:2020-07-21 -2:52:16 AM GMT-Time Source:server-IP address:99.110.253.108 t► Document emailed to Dana Burghdoff(Dana.Burghdoff@fortworthtexas.gov)for signature 2020-07-21 -2:52:18 AM GMT i Email viewed by Dana Burghdoff(Dana.Burghdoff@fortworthtexas.gov) 2020-07-21 -5:06:48 PM GMT-IP address:209.194.29.100 rSq Document e-signed by Dana Burghdoff(Dana.Burghdoff@fortworthtexas.gov) Signature Date:2020-07-21 -5:07:15 PM GMT-Time Source:server-IP address:209.194.29.100. FORT WORTH., Adobe Sign Signed document emailed to Greg Simmons (Gregory.Simmons@fortworthtexas.gov), Dana Burghdoff (Dana.Burg hdoff@fortworthtexas.gov), Bowie Holland (bowie@empi reroofing.com), Michael Owen (Michael.Owen @fortworthtexas.gov), and 5 more 2020-07-21 -5:07:15 PM GMT FORTWORTH, Adobe Sign � § ( , § A 9 ° 0 � m 1. C § / >� �2 - 0w � Ly my ) o .. a 2 2 LU g« com / f U w ƒ 2 ° o ! - \ Cl) CD /® ) ( ® \ Zo o qG , m OD°° \ / ( i / K \ \ 1-7 j § k) § ƒ .. .. a ( J \ § o e@ \ a- o- / K � - \ / \a- k) \ \ \ - /\ / { 22 ) \ / / \ \ { ) / ) \ \ \ \ k } ) j \ e \ ` < / # ® w ) ) (- § a ® § \ $ / ` _ & : row \ m \ @ \ } » ) z < \ 2 ) § B ~ » § j ) � \ \L \ \ [ b j 2 § \ 2 < \ \ \ f ±\ \ / ( \ ) § ) \ e o n _ # < a = m o > a o s % (L o 0 o x a m E z § [ \ o < m - ± C�A - L N N rn N a 0 0 ro 0 0 0 m mnrn O ��moco ~ ci o� w U o o }} w d o000 F- a' C J ry N N E C U m ❑ N T E U m y N N U `m c s m �. mmorn 3 .c m OLL Q U O o U d E o o w 3 p i Q .y-• Q 10 .N N N'-II N (0 w o y w ,� m U Q m E m w p'.J, 9" K U tio ui U Q V Y m Z F Q U m Z 1- U LL _f•' � j p lU O n ❑ :�, - U Z U cEc Uoc in a m m F- F- en �'-.ja.�. .....• U U o w EmUm x w F No' E K 0 o U _ _ N ip o m a U 3 N �J CD J C n fn FQa a' O ul 0 8 N OF p > ❑ _ W y O a m e E ti a LL o f ei Vim Q to m Z P Q U m Z F- Z co J J(n o N � U U (0 E 0 ❑ m pW a ti L°i o w p z W II j C ry W U 2 m" _ a m p U n c C N ❑ C - - C U 5 C ❑ p W p�'U - N N W p w ❑ C p N ❑ i y W O O M Z W y _ j C y Z C ' j UI o aoi o ' 0 .cQ = m "m o ❑_ =� a °7 m - r Q' W O `o o o o)rNi c w o U a c a LL toy D w m m Q Q o O ❑ w Q U Q� U au) z z 3 m E F m E F m I 0 Z Z z w � s O w m at � C7 Y E LU C9 p } �• V O a Q Q R N w a a pcli LL O m N o' w Y w GFW Signature Final Audit Report 2020-07-21 Created: 2020-07-14 By: Patrick Buckley(Patrick.Buckley@fortworthtexas.gov) Status: Signed Transaction ID: CBJCHBCAABAAN4yEi8trOnHUKwfu5EkDe_fQGMeS98gz "CFA100093-Sun Valley Detention Pond-CO-3 CFW Signature" H istory ;'j Document created by Patrick Buckley(Patrick.Buckley@fortworthtexas.gov) 2020-07-14-4:44:33 PM GMT-IP address:209.194.29.100 CSa Document e-signed by Patrick Buckley (Patrick.Buckley@fortworthtexas.gov) Signature Date:2020-07-14-4:48:08 PM GMT-Time Source:server-IP address:209.194.29.100 Document emailed to Jonathan Russell Orussell@dunawayassociates.com)for signature 2020-07-14-4:48:10 PM GMT Email viewed by Jonathan Russell Qrussell@dunawayassociates.com) 2020-07-14-4:48:35 PM GMT-IP address:66.190.102.35 tt Document e-signed by Jonathan Russell Orussell@dunawayassociates.com) Signature Date:2020-07-14-4:48:59 PM GMT-Time Source:server-IP address:66.190.102.35 C4 Document emailed to Bowie Holland (bowie@empireroofing.com) for signature 2020-07-14-4:49:01 PM GMT "i Email viewed by Bowie Holland (bowie@empireroofing.com) 2020-07-15-0:18:28 AM GMT-IP address:66.196.228.162 iso Document e-signed by Bowie Holland (bowie@empireroofing.com) Signature Date:2020-07-15-3:47:46 PM GMT-Time Source:server-IP address:66.196.228.162 Document emailed to Charles M. Klutz(klutzconstruction@sbcglobal.net)for signature 2020-07-15-3:47:48 PM GMT Email viewed by Charles M. Klutz (klutzconstruction@sbcglobal.net) 2020-07-15-4:00:01 PM GMT-IP address:98.139.133.172 FORTWORTH., I -__. Adobe Sign Document e-signed by Charles M. Klutz (klutzconstruction@sbcglobal.net) Signature Date:2020-07-15-4:01:56 PM GMT-Time Source:server-IP address:47.51.211.209 E Document emailed to kiran konduru (kiran.konduru@fortworthtexas.gov)for approval 2020-07-15-4:01:58 PM GMT Email viewed by kiran konduru (kiran.konduru@fortworthtexas.gov) 2020-07-15-5:03:08 PM GMT-IP address:209.194.29.100 Document approved by kiran konduru (kiran.konduru@fortworthtexas.gov) Approval Date:2020-07-15-6:41:21 PM GMT-Time Source:server-IP address:209.194.29.100 Document emailed to Michael Owen (Michael.Owen@fortworthtexas.gov)for approval 2020-07-15-6:41:22 PM GMT Email viewed by Michael Owen (Michael.Owen@fortworthtexas.gov) 2020-07-15-7:08:44 PM GMT-IP address:209.194.29.100 Document approved by Michael Owen (Michael.Owen@fortworthtexas.gov) Approval Date:2020-07-15-7:09:10 PM GMT-Time Source:server-IP address:209.194.29.100 -' Document emailed to Greg Simmons (Gregory.Simmons@fortworthtexas.gov)for signature 2020-07-15-7:09:12 PM GMT i Email viewed by Greg Simmons (Gregory.Simmons@fortworthtexas.gov) 2020-07-15-8:11:27 PM GMT-IP address:209.194.29.100 %< Document e-signed by Greg Simmons (Gregory.Simmons@fortworthtexas.gov) Signature Date:2020-07-15-8:12:25 PM GMT-Time Source:server-IP address:209.194.29.100 I Document emailed to Richard A. McCracken (richard.mccracken@fortworthtexas.gov)for signature 2020-07-15-8:12:30 PM GMT ''l Email viewed by Richard A. McCracken (richard.mccracken@fortworthtexas.gov) 2020-07-16-12:40:34 PM GMT-IP address:99.110.253.108 Document e-signed by Richard A. McCracken (richard.mccracken@fortworthtexas.gov) Signature Date:2020-07-21 -2:52:37 AM GMT-Time Source:server-IP address:99.110.253.108 ! Document emailed to Dana Burghdoff(Dana.Burghdoff@fortworthtexas.gov)for signature 2020-07-21 -2:52:39 AM GMT Email viewed by Dana Burghdoff(Dana.Burghdoff@fortworthtexas.gov) 2020-07-21 -5:07:22 PM GMT-IP address:209.194.29.100 CSp Document e-signed by Dana Burghdoff(Dana.B urghdoff@fortworthtexas.gov) Signature Date:2020-07-21 -5:07:44 PM GMT-Time Source:server-IP address:209.194.29.100 FORTWORTH, Adobe Sign Signed document emailed to Dana Burghdoff(Dana.Burghdoff@fortworthtexas.gov), Patrick Buckley (Patrick.Buckley@fortworthtexas.gov), Greg Simmons (Gregory.Simmons@fortworthtexas.gov), Bowie Holland (bowie@empireroofing.com), and 5 more 2020-07-21 -5:07:44 PM GMT FORTWORTH.. 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C— w � z v o o.� 'g m v d U T G F H3 0 1 kf%�- I........ o J o o O a � J O ti m N 3 W y T• _ W N a > C° > Q p y a O 10 a ui O Q K j> e w = m Y LD a m E ti a E a g� m z i a LL m z i= ° N Y c c a w b o z _ wCZ c U N W c W E -w W m O m y d m a o a @ — c U o w m y O C O N i°1_ U Q L y Lu w ,n Q Lu _ E 01 z c co y xk c '2 j m m Q1 Q C Z Z L c� co o w w U a s m U N 3 m m ro 1- m m Z Z Z � ° z O m m ik p 0 m O W Z aN = otJ N U N w aa_ a � O v a Z o O w m � N a ,_�F 0 h \3 (l A fi �a CM/ �.S) iynii,ureas Final Audit Report 2020-07-23 Created: 2020-07-22 By: Patrick Buckley(Patrick.Buckley@fortworthtexas.gov) Status: Signed Transaction ID: CBJCHBCAABAAanDixewugeGgShfY62jW9y6ybl_icjy9 "CFA100093-Sun Valley Detention Pond-CO-4 CFW Signtures" History "i Document created by Patrick Buckley(Patrick.Buckley@fortworthtexas.gov) 2020-07-22-8:14:27 PM GMT-IP address:209.194.29.100 G5a Document e-signed by Patrick Buckley(Patrick.Buckley@fortworthtexas.gov) Signature Date:2020-07-22-8:18:25 PM GMT-Time Source:server-IP address:209.194.29.100 Document emailed to Jonathan Russell Orussell@dunawayassociates.com) for signature 2020-07-22-8:18:27 PM GMT Email viewed by Jonathan Russell Orussell@dunawayassociates.com) 2020-07-22-9:09:37 PM GMT-IP address:66.190.102.35 Document e-signed by Jonathan Russell Orussell@dunawayassociates.com) Signature Date:2020-07-22-9:10:07 PM GMT-Time Source:server-IP address:66.190.102.35 Document emailed to Bowie Holland (bowie@empireroofing.com)for signature 2020-07-22-9:10:09 PM GMT i Email viewed by Bowie Holland (bowie@empireroofing.com) 2020-07-22-9:23:34 PM GMT-IP address:66.196.228.162 It Document e-signed by Bowie Holland (bowie@empireroofing.com) Signature Date:2020-07-22-9:23:56 PM GMT-Time Source:server-IP address:66.196.228.162 Document emailed to charles M. Klutz (klutzconstruction@sbcgloba[.net)for signature 2020-07-22-9:23:58 PM GMT ") Email viewed by charles M. Klutz (klutzconstruction@sbcglobal.net) 2020-07-22-9:26:37 PM GMT-IP address:69.147.93.139 FORT WORTH, Adobe Sign 14 Document e-signed by charles M. Klutz (klutzconstruction@sbcglobal.net) Signature Date:2020-07-22-9:27:39 PM GMT-Time Source:server-IP address:47.51.211.209 I Document emailed to kiran konduru (kiran.konduru@fortworthtexas.gov)for approval 2020-07-22-9:27:40 PM GMT i Email viewed by kiran konduru (kiran.konduru@fortworthtexas.gov) 2020-07-22-10:42:43 PM GMT-IP address:209.194,29.100 tea Document approved by kiran konduru (kiran.konduru@fortworthtexas.gov) Approval Date:2020-07-22-10:43:24 PM GMT-Time Source:server-IP address:209.194.29.100 Document emailed to Greg Simmons (Gregory.Simmons@fortworthtexas.gov)for signature 2020-07-22-10:43:26 PM GMT Email viewed by Greg Simmons (Gregory.Simmons@fortworthtexas.gov) 2020-07-23-2:59:00 AM GMT-IP address:68.112.56.97 %- Document e-signed by Greg Simmons (Gregory.Simmons@fortworthtexas.gov) Signature Date:2020-07-23-3:00:08 AM GMT-Time Source:server-IP address:68.112.56.97 i Document emailed to Richard A. McCracken (richard.mccracken@fortworthtexas.gov)for signature 2020-07-23-3:00:10 AM GMT i Email viewed by Richard A. McCracken (richard.mccracken@fortworthtexas.gov) 2020-07-23-12:24:03 PM GMT-IP address:209.194.29.100 Document e-signed by Richard A. McCracken (richard.mccracken@fortworthtexas.gov) Signature Date:2020-07-23-12:25:19 PM GMT-Time Source:server-IP address:209.194.29.100 Document emailed to Dana Burghdoff(Dana.Burghdoff@fortworthtexas.gov)for signature 2020-07-23-12:25:21 PM GMT `i Email viewed by Dana Burghdoff(Dana.Burghdoff@fortworthtexas.gov) 2020-07-23-3:41:18 PM GMT-IP address:209.194.29.100 Document e-signed by Dana Burghdoff(Dana.Burghdoff@fortworthtexas.gov) Signature Date:2020-07-23-3:41:57 PM GMT-Time Source:server-IP address:209.194.29.100 Signed document emailed to Bowie Holland (bowie@empireroofing.com), kiran konduru (ki ran.konduru@fortworthtexas.gov), Dana Burghdoff(Dana.Burghdoff@fortworthtexas.gov), Jonathan Russell Orussell@dunawayassociates.com), and 4 more 2020-07-23-3:41:57 PM GMT FORTWORTH., -. Adobe Sign FORTWORTH. TRANSPORTATION AND PUBLIC WORKS August 3, 2020 Klutz Construction PO. Box 185 Kennedale,Texas 76060 RE: Acceptance Letter Project Name: Sun Valley Detention Pond Project Type: Storm water detention pond City Project No.:100093 Sun Valley To Whom It May Concern: On August 3, 2020 a final inspection was made on the subject project. There were punch list items identified at that time. The punch list items were completed on July 31,2020. The final inspection and the corrected punch list items indicate that the work meets the City of Fort Worth specifications and is therefore accepted by the City. The warranty period will start on July 31,2020,which is the date of the punch list completion and will extend of two(2)years in accordance with the Contract Documents. If you have any questions concerning this letter of acceptance, please feel free to contact me at 817- 716-2997. Sincerely, Patrick a ley(Au 6,2020 13:11 CDT) Patrick Buckely, Project Manager Cc:Tamara Vaughn, Inspector Emanuel Nieto, Inspection Supervisor Wade Miller,Senior Inspector Patrick Bukley, Program Manager Jonathan Russell, Consultant Charlie Klutz, Contractor Bowie Holland, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev.8/20/19 AFFIDAVIT OF BILLS PAID UNCONDITIONAL STATE OF TEXAS COUNTY OF TARRANT Before me, the undersigned authority, a Notary Public in and for the State of Texas, on this day personally appeared, (l'eS �1 . V-1 u of Klutz Construction, LLC , known to me to be a credible person, who being by one duly swdm, on his oath deposed and said; That all invoices for K308, Sun Valley Detention Pond, City Project No.100093 in Fort Worth, Texas have been paid in full. By: S Z Subscribed and sworn before me on this cA I day of , 2020. ,tiPPr p1", LUZ A RAVELO of Pu le r o.r !Votary Public,State of Texas My commission Expires N 9;..........4�r' April 29 2023 NOTARY ID 1288041 0 i CONSENT OF OWNER ❑ SURETY COMPANY ARCHITECONTRACTOR F TO FINAL PAYMENT SURETY ❑ OTHER (SIMILAR TO MA DOCUMENT G707) Bond No. 8245-50-39 PROJECT: Sun Valley Detention Pond,Fort Worth,TX (name,address) TO (Owner) ARCHITECT'S PROJECT NO: City of Fort Worth CONTRACT FOR: 200 Texas Street Fort Worth,TX 76102 CONTRACT DATE: CONTRACTOR: Klutz Construction,LLC 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) Vigilant Insurance Company 2001 Bryan Street,Suite 3600 SURETY COMPANY, Dallas,TX 75201 on bond of(here insert name and address of Contractor) Klutz Construction,LLC P.O. Box 185 CONTRACTOR, Kennedale,TX 76060 hereby approves of the Final payment to the Contractor, and agrees that the 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 200 Texas Street Fort Worth,TX 76102 OWNER, as set forth in the said Surety Company's bond. IN WITNESS WHEREOF, The Surety Company has hereunto set its hand this 21st day of August 2020 VIGILANT IN RANCE COMPANY Surety Comp lay Signature A zed resentative Attest: (Seal): Kyle W. Sweeney Attorney--in-Fact Title Note:This form is intended to be used as a companion document to the Contractor's Affidavit of Payment of Debts and Claims,Current Edition HUE3E3:, Power of Attorney Federal Insurance Company I Vigilant Insurance Company I Pacific Indemnity Company Know All by These Presents,That FEDERAL INSURANCE COMPANY,an Indiana corporation,VIGILANT INSURANCE COMPANY,a New York corporation,and PACIFIC IND13MNI'I'Y COMPANY, a Wisconsin corporation, do each hereby constitute and appoint Elizabeth Gray, Charles D. Sweeney, Kyle W. Sweeney and MichaelA.Sweeney of Fort Worth,Texas-------------------------------------------------------------------------------------------------------------------------------- each as their true and lawful Attorney-in-Fact to execute under such designation in their names and to affix their corporate seals to and deliver for and on their behalf as surety thereon or otherwise,bonds and undertakings and other writings obligatory in the nature thereof(other than bail bonds)given or executed In the course of business,and any instruments amending or altering the same,and consents to the modification or alteration of any instrument referred to In said bonds or obligations. In Witness Whereof,said FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY have each executed and attested these presents and affixed their corporate seals on this 161"day of September,2019. fkrwn N1.Chlor,x; ,ksAst:mt Stcrctal'y Stephen M.[lancy.Vice['resident STATE OF NEW JERSEY County ofHunterdon On this 16' day of September,2019,before me,a Notary Public of New Jersey.personally came Dawn M.Chloros,to me known to be Assistant Secretary of FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY,the companies which executed the foregoing Power of Attorney,and the said Dawn M. Chloros,being by me duly sworn,did depose and say that she is Assistant Secretary of FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY and knows the corporate seals thereof,that the seals affixed to the foregoing Power of Attorney are such corporate seals and were thereto affixed by authority of said Companies;and that she signed said Power of Attorney as Assistant Secretary of said Companies by like authority;and that she is acquainted with Stephen M. Haney,and knows him to be Vice President of said Companies;and that the signature of Stephen M.Haney,subscribed to said Power of Attorney is in the genuine handwriting of Stephen M.Haney,and was thereto subscribed by authority ofsaid Companies and in deponent's presence. Notarial Seal 4d KATHERINE J.ADELAAR H6rlt1;Y c5 NOTARY PUBLIC OF NEW JERSEY (`�� No.23166B5 4,>bflBLt� Commisskn Expires July 16,2024 Noiary,f'vhac cWfERg� CERTIFICATION Resolutions adopted by the Boards of Directors of FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY on August 30,201G: "RESOLVED,that the fallowing authorizations relate to the execution,for and on behalf of theCompany.of bonds,undertakings,recognizances,contracts and other written commitments of the Company entered into in the ordinary course ofbusiness(each a"Wr-itten CommitmenC9: (1) Each of the Chairman,the President and the Vice Presidents of the Company is hereby authorized to execute any written Commitment forandon behalf of the Company,under the sea]of the Company or otherwise. (2) Each duly appointed attorney-in-fact of the Company Is hereby authorized to execute any Written Commitment for and on behalf of the Company,under the seal of the Company or otherwise.to the extent that such action is authorized by the grant of powers provided for in such person's written appointment as such attorney-in-Fact. (3) Each of the Chairman,the President and the Vice Presidents of the Company is hereby authorized,for and on behalrofthe Company,to appoint in writing any person the attorney- in-fact of the Company with full power and authority to execute,for and on behalfoftheCompany,under the sea]ofthe Company or otherwise,such Written Commitmemsofthe Company as may be specified in such written appointment.which specification may be by general type or class of Written Commitments or by specification of one or more particular Written Commitments. (4) Each of the Chairman,the President and the Vice Presidents of the Company is hereby authorized,for and on behalf of the Company,to delegate In writing to any other officer of the Company the authority to execute,for and on behalf of the Company,under the Company's sea]or otherwise.such Written Commitments of the Company as are specified in such written delegation,which specification may be by general type or class of Written Commitments or by specification ofoneor more particular Written Commitments. (5) The signature of any officer or other person executing any Written Commitment or appointment or delegation pursuant to this Resolution,and the seal of the Company,may be affixed by Facsimile on such Written Commitment or written appointment or delegation. FURTHER RESOLVED, that the foregoing Resolution shall not be deemed to be an exclusive statement of the powers and authority of officers.employees and other persons to act for and on behalf or the Company,and such Resolution shall not limitor otherwise affect the exercise ofanysuch power or authority otherwise validly granted or vested." I,Dawn M.Chloros,Assistant Secretary of FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY(the"Companies")do hereby certify that (i) the foregoing Resolutions adopted by the Board of Directors of the Companies are true,correct and in full force and effect, (ii) the foregoing Power of Attomey is true,correct and in full force and effect. Given under my hand and seals of said Companies at Whitehouse Station,NJ,this 21 st day of August 2020. +m,,,w �..�' lkn•;n �l.t:hltxtx;.Ati�istant tinreCllyt' IN THE EVENT YOU WISH TO VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY USOF ANY OTHER mA!rrFR,PLEASE CONTACT US AT: Telephone(908)903-3493 Fax(9015)903-3656 e-mail!sLirety@chubb.com li FED-VIG-PI rev.0B-18 ( ) I