HomeMy WebLinkAboutContract 46521-FP2 (2).
anson
Department of TP &W Const. Services
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The Proceeding people have been Cofitacted concerning the request for final
payment & have released this project for such payment.
Clearance Conducted By Shameka Kennedy
;T WORTH
Regarding contract 117322 for LAKE VISTA RANCH I as required by the
TRANSPORTATION & PUBLIC WORKS as approved by City Council on N/A through M&C N/A 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.
crnr SEcRErAm'
GONTNACT no
Lc c5;lir Fif)a
Original Contract Prices:
Amount of Approved Change Orders:
Revised Contract Amount:
Total Cost Work Completed:
Less Deductions:
Liquidated Damages:
Pavement Deficiencies:
Total Deduction Amount:
Total Cost Work Completed:
Less Previous Payments:
Final Payment Due
ITION AND PUBLIC WORKS
PROJECT COMPLETION
LEReageafiviterAr��j3f/
Recommended for Acceptance
Asst. Director, TPW - Infrastructure Design and Construction
•
0'
Accepted
Director, TRANSPORTATION & PUBLIC WORKS A,�,/5
; st. City Manager
(&'
mments: C205-541200-207760239383
crn, ZmA
nhosen
rni NOVI 3 2015
0 mtmk � '1 Q.(yo
$1,228,164.87
$1,228,164.87
$1,228,164.87
$0.00
$1,228,164.87
Date
I//fr
Date
Ns
D.O.E. N.: 7322
Oil/ 116,5,21
Days @ $210.00/ Day
/-1,91 (tr
Date
A•
OFFICuii. RECORD
CITY SECRETARY
Ft WOlim, TX
FORT WORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name LAKE VISTA RANCH
Contract Limits
Project Type STORM DRAIN, PAVING & ST LIGHT
City Project Numbers 02393
DOE Number 7322
Estimate Number 1 Payment Number 1 For Period Ending 10/15/2015
CD
City Secretary Contract Number 117322 Contract Time 18CD
Contract Date Days Charged to Date 191
Contract is 100.00 Complete
Project Manager Long
Contractor GILCO CONTRACTING, INC.
6331 SOUTHWEST BLVD.
BENBROOK , TX 76132-1063
Inspectors LAYER / TAEZAZ
Thursday, October 15, 2015 Page 1 of 5
City Project Numbers 02393
Contract Name
Contract Limits
Project Type
Project Funding
STORM DRAIN
Item
No.
LAKE VISTA RANCH
STORM DRAIN, PAVING & ST LIGHT
Description of Items
1 18" RCP
2 21" RCP
3 24" RCP
4 30" RCP
5 36" RCP
6 42" RCP
7 48" RCP
8 7X3 BOX CULVERT
9 4' STORM JUNCTION BOX
10 5' STORM JUNCTION BOX
11 10' CURB INLET
12 15' CURB INLET
13 TRENCH SAFETY
14 TRAFFIC CONTROL
15 REMOVE RIP RAP
16 REMOVE MISC CO1NC STRUCTURE
17 24' WIDE ASPHALT PAVEMENT
18 18" TXDOT
19 24" TXDOT
20 42" TXDOT
21 36" TXDOT
22 TXDOT SKEWED BOX CULVERT HEADWALL
23 TXDOT SKEWED BOX CULVERT HEADWALL
24 PYRAMAT WITH SOD OVERLAY
25 5" CONCREIE CHANNEL LINING
26 TWISTED GABIONS
27 TWISTED GABION MATTRESSES
28 10' WIDE 8" CONC SLAB
29 STORM LINE GROUTING
Thursday, October 15, 2015
Estimated
Quanity
Unit Unit Cost
90 LF $37.00
192 LF $42.00
1100 LF $46.00
394 LF $59.00
83 LF $80.00
227 LF $104.00
343 LF $140.00
261 LF $316 67
2 EA $3,300.00
3 EA $3,600.00
4 EA $3,200.00
10 EA $4,000.00
2429 LF $0.50
1 MO $2,500.00
402 SF $2.00
112 LS $28.00
28 LF $420.00
2 EA $1,200.00
3 EA $1,800.00
1 EA $4,500.00
1 EA $4,200.00
1 EA $13,100.00
1 EA $29,100.00
2414 SY $23.50
205 SY $60.00
30 CY $400.00
54 CY $500.00
47 LF $95.00
22 CY $200.00
Sub -Total of Previous Unit
DOE Number 7322
Estimate Number
Payment Number
For Period Ending 10/15/2015
Estimated
Total
$3,330.00
$8,064.00
$50,600.00
$23,246.00
$6,640.00
$23,608.00
$48,020.00
$82,650.87
$6,600.00
$10,800.00
$ I2,800.00
$40,000.00
$1,214.50
$2,500.00
$804.00
$3,136.00
$11,760.00
$2,400.00
$5,400.00
$4,500.00
$4,200.00
$13,100.00
$29,100.00
$56,729.00
$12,300.00
$12,000.00
$27,000.00
$4,465.00
$4,400.00
$511,367.37
Completed Completed
Quanity Total
90 $3,330.00
192 $8,064.00
1100 $50,600.00
394 $23,246.00
83 $6,640.00
227 $23,608.00
343 $48,020.00
261 $82,650.87
2 $6,600,00
3 $10,800.00
4 $12,800.00
10 $40,000.00
2429 $1,214.50
1 $2,500.00
402 $804.00
112 $3,136.00
28 $11,760.00
2 $2,400.00
3 $5,400.00
1 $4,500.00
1 $4,200.00
1 $13,100.00
1 $29,100.00
2414 $56,729.00
205 $12,300.00
30 $12,000.00
54 $27,000.00
47 $4,465.00
22 $4,400.00
$511,367.37
Page 2 of 5
City Project Numbers 02393
Contract Name LAKE VISTA RANCH
Contract Limits
Project Type STORM DRAIN, PAVING & ST LIGHT
Project Funding
PAVING
Item
No.
Description of Items
1 HYDRA I'EDLIME
2 6" LIME TREATMENT
3 6" CONC PVMT
4 4" CONC SIDEWALK
5 BARRIER FREE RAMP
6 VALVF BOX ADJUSTMENT
7 TRAFFIC CONTROL
8 MANHOLE ADJUSTMENT
9 DEAD END BARRICADE
ST LIGHT
Item
No.
Estimated Unit
Quanity
263 TN
17513 SY
16447 SY
1735 SF
15 EA
15 EA
1 MO
22 EA
3 EA
Sub -Total of Previous Unit
Description of Items
1 2" CONDT PVC SCH 80
2 INSTALL LIGHTING FIXTURE
3 LED LIGHTING FIXTURE
4 RDWY ILLUM FOUNDATION
5 RDWY ILLUM FOUNDATION
6 NO 10 INSULATED ELEC CONDR
Thursday, October 15, 2015
Estimated
Quanity
2765 LF
20 EA
20 EA
20 EA
20EA
8295 LF
Unit
Sub -Total of Previous Unit
Unit Cost
$150.00
$2.30
$30.55
$4.15
$1,750.00
$100.00
$1 000.00
$200.00
$1,500.00
Unit Cost
$7.00
$100.00
$450.00
$1,080.00
$1,600.00
$0.70
DOE Number 7322
Estimate Number 1
Payment Number 1
For Period Ending 10/15/2015
Estimated
Total
$39,450.00
$40,279.90
5502,455.85
$7,200.25
$26,250.00
$1,500.00
$1,000.00
$4,400.00
$4,500.00
$627,036.00
Estimated
Total
$19,355.00
$2,000.00
$9,000.00
$21,600.00
$32,000.00
$5,806.50
$89,761.50
Completed Completed
Quanity Total
263 $39,450.00
17513 $40,279.90
16447 $502,455.85
1735 $7,200.25
15 $26,250.00
15
1
22
3
Completed
Quanity
2765
20
20
20
20
8295
$1,500.00
$1,000.00
$4,400.00
$4,500.00
$627,036.00
Completed
Total
$19,355.00
$2,000.00
$9,000.00
$21,600.00
$32,000.00
$5,806.50
$89,761.50
Page 3 of 5
City Project Numbers 02393
Contract Name
Contract Limits
Project Type
Project Funding
Contra
1
Inspection
Project Mana
Ass
LAKE VISTA RANCH
STORM DRAIN, PAVING & ST LIGHT
Contract Information Summary
Original Contract Amount
Change Orders
Dnh /V ZO'/\
/6 Lie4
-- - Date Date/A/%C
r/TPW - Infrastructure Design and Construction
DirectgfV Contracting Departn
Date
i Date lI II / 45X
it
IA° il4
1ofr"(
DOE Number 7322
Estimate Number 1
Payment Number 1
For Period Ending 10/15/2015
$1,228,164.87
Total Contract Price $1,228,164.87
Total Cost of Work Completed
Less % Retained
Net Earned
Earned This Period $1,228,164.87
Retainage This Period $0.00
Less Liquidated Damages
Days @ / Day
LessPavement Deficiency
Less Penalty
Less Previous Payment
Plus Material on Hand Less 15%
Balance Due This Payment
$1,228,164.87
$0.00
$1,228,164.87
$0.00
$0.00
$0.00
$0.00
$0.00
$1,228,164.87
Thursday, October 15, 2015 Page 4 of 5
1
City Project Numbers 02393
Contract Name
Contract Lunits
Project Type
Project Funding
LAKE VISTA RANCH
STORM DRAIN, PAVING & ST LIGHT
Project Manager Long
Inspectors
LAYER / TAEZAZ
Contractor GILCO CONTRACTING, INC.
6331 SOUTHWEST BLVD.
BENBROOK , TX 76132-1063
Line Fund Account Center
Thursday, October 15, 2015
DOE Number 7322
Estimate Number 1
Payment Number 1
For Period Ending 10/15/2015
City Secretary Contract Number 117322
Contract Date
Contract Time
Days Charged to Date
Contract is .000000
CITY OF FORT WORTH
SUMMARY OF CHARGES
Amount
Funded
Gross Retamage
Total Cost of Work Completed
180 CD
191 CD
Complete
Net
$1,228,164.87
Less % Retained $0.00
Net Earned $1,228,164.87
Earned This Period
Retainage This Period
$1,228,164.87
$0.00
Less Liquidated Damages
0 Days @ $0.00 / Day
LessPavement Deficiency
Less Penalty
Less Previous Payment
PIus Material on Hand Less 15%
Balance Due This Payment
$0.00
$0.00
$0.00
$0.00
$0.00
$1,228,164.87
Page 5 of 5
[-1
TRANSPORTATION & PUBLIC WORKS
FINAL STATEMENT OF CONTRACT TIME
FINAL STATEMENT NO. 1
NAME OF PROJECT: Lake Vista Ranch Phase 1
PROJECT NO.: 2393
PERIOD FROM 03/31 / 15 TO: 10/715
WORK ORDER EFFECTIVE 3/31/2015
DAY OF
MONTH
DAYS
CHARGED
DURING
rev 03/05/07
CONTRACTOR: Gilco Contracting, Inc.
DOE NO. 7322
FINAL INSPECTION DATE: 7-Oct-15
CONTRACT TIME 180 0 WD O CD
REASON FOR DAYS
CREDITED
DAY OF
MONTH
1. 16.
2. 17.
3. 18.
4. 19.
5. 20.
6. 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
& HOLIDAYS & TOO COLD RELOCATIONS
THIS'
PERIOD
PREVIOUS
PERIOD
TOTALS
TO DATE
DAYS
CHARGED
DURING
OTHERS *
DATE INSPECTOR'
ENGINEERING DEPARThIENT
The City of Fort ?DATE
• 1000 Throckmorton Street • Fort Worth, TX 7601
(817) 392 - 7941 • Fax: (817) 392 - 7845
REASON FOR DAYS
CREDITED
DAYS
CHARGED
-e3ii
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
TOTAL
DAYS
191
191
/ohS /I S
DATE
•
I) PROJECT INFORMATION
Name of Contractor
Gilco Contracting, Inc.
DOE Inspector
Rudy Medellin
DOE Number Project Difficulty
7322 0 Simple
Initial Contract Amount
$1,751,328.23
II) PERFORMANCE EVALUATION
0 - Inadequate 1 - Deficient 2 - Standard
ELEMENT
FORT WORW
'--Thirpsoc
TRANSPORTATION AND PUBLIC WORKS
CONTRACTOR'S EVALUATION OF CITY
Date: 110/6/2015
Routine 0 Complex
INSPECTION EVALUATION
1 Availability of Inspector
2 Knowledge of Inspector
3 Accuracy of Measured Quantities
4 Display Of Professionalism
5 Citizen Complaint Resolution
6 Performance - Setting up Valve Crews, Labs
ADMINISTRATION
1 Change Order Processing Time
2 Timliness of Contractor Payments
3 Bid Opening to Pre -Con Meeting Timeframe
III) COMMENTS & SIGNATURES
3 -Good
RATING
(0 - 4)
Project Name
Lake Vista Ranch Phase
Project Manager
Aaron Long
Type of Contract
Water Waste Water Storm Drainage Pavement
J
REV: 02/22/07
Final Contract Amount
$1,751,328.23
4 - Excellent
ELEMENT
COMMENTS
Signature Contractor
Signature DOE Inspector
Signature DOE Inspector's Supervisor
INSPECTOR'S COMMENTS
PLANS & SPECIFICATIONS
1 Accuracy of Plans to Existing Conditions
L
zt
LC
t(
2 Clarity & Sufficiency of Details
3 Applicability of Specifications
4 Accuracy of Plan Quantities
PROJECT MANAGER EVALUATION
1 Knowledge And/Or Problem Resolution
2 Availability of Project Manager
L 3 Communication
4 Resolution of Utility Conflicts
TRANSPORTATION AND PUBLIC WORKS
The City of Fort Worth • 1000 Throckmorton Street • Fort Worth, TX 76012-6311
(817) 392 - 7941 • Fax: (817) 392 - 7845
RATING
(0 - 4)
TRANSPORTATION AND PUBLIC WORKS
PERFORMANCE EVALUATION OF CONTRACTOR
I) CONTRACTOR & PROJECT DATA
Name of Contractor
Gilco Construction, Inc.
DOE Inspector
Rudy Medellin
DOE Inspector
Water Waste Water Storm Drainage
J
J
J
Initial Contract Amount
$1,751,328.23
Final Contract Amount
$1,751,328.23
II) PERFORMANCE EVALUATION
0 - Inadequate 1 - Deficient 2 - Standard 3 - Good 4 - Excellent
ELEMENT
1 Submission of Documents
2 Public Notifications
3 Plans on Site
4 Field Supervision
5 Work Performed
6 Finished Product
7 Job Site Safety
8 Traffic Control Maintenance
9 Daily Clean Up
10 Citizen's Complaint Resolution
11 Property Restoration
12 After Hours Response
13 Project Completion
WEIGHT ( x )
2
5
5
15
15
15
15
15
5
5
5
5
5
Project Name
Lake Vista Ranch Phase 1
DOE Number
7322
Project Manager
Pavement Aaron Long
'Project Difficulty
O Simple
Date
10/6/2015
Routine
APPLICABLE (Y / N) RATING (0 - 4)
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
3
4
4
4
3
4
3
4
3
4
3
4
4
REV: 02/20/07
0 Complex
MAX SCORE
8
20
20
60
60
60
60
60
20
20
20
20
20
SCORE
6
20
20
60
45
60
45
60
15
20
15
20
20
TOTAL ELEMENT SCORE (A) 406
BONUS POINTS (25 Maximum) (B)
TOTAL SCORE (TS) 406
III) CONTRACTOR'S RATING
Maximum Score (MS) = 448 or sum of applicable element score maximums which = 448
Rating ( [TS / MS] * 100%) 406 / 448 = 91%
Performance Category Excellent
<20% = Inadequate 20% to <40% = Deficient 40% to <60% = Standard 60% to <80% = Goo >80% = Excellent
Inspector's Comments (INCLUDING EXPLANATION OF BONUS POINTS AWARDED)
Signature DOE Inspector
Signature DOE Inspector's Supervisor
CONTRACTOR'S COMMENTS
Signature Contractor
TRANSPORTATION AND PUBLIC WORKS
The City of Fort Worth • 1000 Throckmorton Street • Fort Worth, TX 76012-6311
(817) 392 - 7941 • Fax: (817) 392 - 7845
BNM Lake Vista Development, L. P.
901 Airport Freeway, Suite 400
North Richland Hills, Texas 76180
(817) 849-5100 Fax (817)849-5101
October 2, 2015
Mr. Dale Gilreath
Gileo Contracting, Inc.
6331 Southwest Blvd.
Benbrook, Texas 76132
Re: Lake Vista Ranch, Ph. 1
Water, Sewer, Paving, Di ainage, and Street Light Improvements
CoFW Project No. 02393
CoFW File No. W-2350
CoFW DOE No. 7322
Dear Mr. Gilreath,
This letter will document that BNM Lake Vista Development, L.F. confirms that Gileo
Contracting, Inc. has completed the work associated with the above referenced contiact in an
appropriate time frame, subject to completion of any warranty or maintenance work as identified
and requited by the City of Fort Worth and that no liquidated damages will be assessed by BNM
Lake Vista Development, L P. in connection with the work.
Sincerely,
Bruce French
BNM, Lake Vista Development, L.P.
slt/bf
cc: File, Lake Vista (Development)
H:ILLTTERHEAD\BNM Lake Vista Development LP.docx
October 2, 2015
City of Fort Worth
CFA Administration
1000 Throckmorton St.
Fort Worth, TX 76102
RE: Final Waiver of Lien; Paving and Street Light Improvements to serve West Fork
Ranch Phase 8B: DOE # 7322 City Project #02393
The purpose of this letter is to acknowledge that we have been paid in full by Jabez
Development, L.P. for the public improvements constructed to serve Lake Vista Ranch,
Ph. 1, in Fort Worth, Texas. As a result, we hereby waive, release and relinquish all
rights to assert any claim or demand for lien in connection with this project.
Please feel free to contact me with any questions you may have.
Sincerely,
eia Hubbard
Operations Director
6331 Southwest Blvd.
I3enbrook, Texas 76132
Mice: 817.735.1600
Fax: 817.735.1613
AFFIDAVIT
STATE OF TEXAS
COUNTY OF TARRANT
Before me, the undersigned authority, a notary public in the state
and
countyaforesaid, on this day personally appeared Leia Hubbard,
Operations Director Of Gilco Contracting, Inc., known to me to be a
credible person, who beingbyme duly sworn, upon her oath deposed and
said;
That all persons, firms, associations, corporations, or other
organizations furnishinglabor 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 andLightImprovements Street Im rovements to serve: Lake Vista Ranch, Ph. 1
BY Leia Hubbard
Subscribed and sworn before me on this 2nd of October , 2015.
:,:qv o*, MARY PANNELL
Notary Public, State of TWO
1:• ;T, My Commisslon Expltsg
1.74E :' October 19, 2010
Notary ublic
Tarrant County, TX
CONSENT OF
SURETY COMPANY
TO FINAL PAYMENT
Conforms with the American Institute of
Architects, AIA Document G707
OWNER u
ARCHITECT fl
CONTRACTOR ❑
SURETY ❑
OTHER
PROJECT: Lake Vista Ranch - Water, Sewer, Paving, Drainage & Street Lights
(name, address}
TO (Owner)
BNM LAKE VISTA DEVELOPMENT, LP & CITY OF
FORT WORTH
9001 Airport Freeway, Suite 400
Fort Worth
TX 76180
CONTRACTOR: GILCO CONTRACTING, INC.
Fort Worth
TX
Bond No 022050638
7 ARCHITECT'S PROJECT NO:
CONTRACT FOR:
Lake Vista Ranch - Water, Sewer, Paving, Drainage & Street Lights
�I CONTRACT DATE:
In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the
(here insert name and address of Surety Company)
LIBERTY MUTUAL INSURANCE COMPANY
175 Berkeley Street
Boston MA 02116
on bond of (here insert name and address of Contractor)
GILCO CONTRACTING, INC.
6331 Southwest Boulevard
Benbrook
TX 76132
, SURETY COMPANY
, CONTRACTOR,
hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve
the Surety Company of any of its obligations to (here insert name and address of Owner)
BNM LAKE VISTA DEVELOPMENT, LP & CITY OF FORT WORTH
9001 Airport Freeway, Suite 400
Fort Worth TX 76180
as set forth in the said Surety Company's bond.
IN WITNESS, WHEREOF,
the Surety Company has hereunto set its hand this
•
Attest: Telly A. Westbrook
(Seal):
NOTE; This forrn
Current Edition
•
2nd day of October, 2015
LIBERTY MUTUAL INSURANCE COMPANY
Surety Company
/1/Ltil,c)
.
Signahre of Authorized Representative
Soahinie Hunter
Title
, OWNER,
Attorney -in -Fact
is to be used as a companion document to AIA DOCUMENT 0706, CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS,
ONE PAGE
1)
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'THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND.
This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated.
Certificate No. 7111256
American Fire and Casualty Company Liberty Mutual Insurance Company
The Ohio Casualty Insurance Company West American Insurance Company
POWER OF ATTORNEY
KNOWN ALL PERSONS BY THESE PRESENTS: That American Fire & Casualty Company and The Ohio Casualty Insurance Company are corporations 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 Stale of Massachusetts, and West American Insurance Company
is a corporation duly organized under the laws of the State of Indiana (herein collectively called the °Companies"), pursuant to and by authority herein set forth, does hereby name, constitute
and appoint, Don E. Cornell; Kelly A. Westbrook; Ricardo J. Revna: Robb! Morales; Soohinie Hunter; V. DeLene Marshall
all of the city of Dallas state of TX each individually if there be more than one named, its true and lawful attorney -in -fact to make, execute, seal, acknowledge
and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents and shall
be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons.
IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed
thereto this 11 th day of September 2015
STATE OF PENNSYLVANIA
COUNTY OF MONTGOMERY
On this 11 th day of September 2015 , before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of American Fire and
Casualty Company, Liberty Mutual Insurance Company, The Ohio Casualty Insurance Company, 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 behalf of the corporations by himself as a duly authorized officer.
IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting, Pennsylvania, on the day and year first above written.
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Teresa Patella, Notary Public
Plymouth Twp., Montgomery County
My Commission Expires March 28. 2017
Member, Pennsylvania Association of Notaries
American Fire and Casualty Company
The Ohio Casualty Insurance Company
Liberty Mutual Insurance Company
West merican Insurance Company
By:
David M. Carey(ssistant Secretary
By:
Teresa Pastella, Notary Public
This Power of Attorney is made and executed pursuant to an by authority of the following By-laws and Authorizations of American Fire and Casualty Company, The Ohio Casually Insurance
Company, Liberty Mutual Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows:
ARTICLE IV — OFFICERS — Section 12. Power of Attorney. Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject
to such limitation as the Chairman or the President may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal,
acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact, subject to (he limitations set forth in their respective
powers of attorney, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so
executed, such instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney -in -fact under
the provisions of this article may be revoked at any lime by the Board, the Chairman, the President or by the officer or officers granting such power or authority.
ARTICLE XIII — Execution of Contracts — SECTION 5. Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president,
and subject to such limitations as the chairman or the president may prescribe, 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, recognizances 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 seal 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 Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the
Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with
the same force and effect as though manually affixed.
I, Gregory W. Davenport, the undersigned, Assistant Secretary, of American Fire and Casualty Company, The Ohio Casually Insurance Company, Liberty Mutual Insurance Company, and
West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by saki
Companies, is in full force and effect and has not been revoked.
il
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this i Jo day of
By:
I r_
, 20 J .
Gregory W. Davenport, Assistant Secretary
•
LMS_12873_122013
28 of 500
Libel
Mutual,:
SURETY
Important Notice
TO OBTAIN INFORMATION OR TO MAKE A COMPLAINT:
You may write to Liberty Mutual Surety at:
Liberty Mutual Surety
Interchange Corporate Center
450 Plymouth Road, Suite 400
Plymouth Meeting, PA 19462 8284
You may contact the Texas Department of Insurance to obtain information on
companies, coverages, rights or complaints at:
1-800-252-3439
You may write the Texas Department of Insurance:
P. O. Box 149104
Austin, TX 78714-9104
Fax: (512) 475-1771
Web: htto.//www.tdi state.tx.us
E-mail: ConsumerProtection antdi.state.tx.us
Premium or Claim Disputes
Should you have a dispute concerning a premium, you should contact the agent first. If you
have a dispute concerning a claim you should contact the company first. If the dispute is not
resolved, you may contact the Texas Department of Insurance.
Attach This Notice To Your Policy:
This notice is for information only and does not become a part or condition of the
attached document.
LMIC-3500