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Home My WebLink AboutContract 53877-FP1FORTWORTHo TRANSPORTATION AND PUBLIC WORKS NOTICE OF PROJECT COMPLETION City Secretary No:_53877 -FP1 Date Received: Jun 3, 2021 City Project Ne: 102334 Regarding contract 53877 for 2020 BRIDGE REI-iABILITATION CONTRACT 1 as required by the TR�TSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by City Council on 03/03/2020 through M&C 20-0117 the director of the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT upon the recommendation of the Assistant Director of the Transportation & Public Works Department has accepted the project as complete. 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 L.�e� P�r,eu� Laurcn Pricur li`=1ay 2-. Recommended for Acceptance Asst. Director, TPW - Capital Delivery W Jo�on (Ma 28.2021 u�.3 � CDTI Accepted Director, TRANSPORTATION AND PUBLIC WORKS DEPARTMENT Client Department $411,258.05 $92,730.55 Ns 1 $503,988.60 $497,885.78 0 Days @ $650.00/ Day $0.00 $497,885.78 $472,991.49 $24,894.29 May 28, 2021 Date May 28, 2021 Date Dqnq Bu�qHdoff o�naeurgndoff�3unz,zozin:iscor� .1U11 2, 2021 Asst. City Manager Date Comments: OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX C�2o Slgreture Pege '�O"""' City of Fort Wort)i P•�� Fwo2o-ooa000aiss Numiw: vmjeci 102334 ctrys«murco�wu 53877 Nwubrr: Appllnllan For Pa�menl PeriodlPmn-To): ImniaDue: w ( IlNa AmomalaDcpaii ): CFW Veodor Na: ��'�"' 2020 Biid e Rehabilitation Contract 1 H.m« g The Couvac�arcutifiu wi�h �6e nrbmiiW ofih[i docwie�n �nd au«isled eaymcut RequectSvhmilW on �ha Ciiy af FoM1 Wonh➢�a�r »akm iL� lo ihe bat otihe'vYwwlMyr. ( I) dl pmiow Pmgw WS�a� rashW Gam Ouu+an �cwwl of Work done under Ihe Cae4act hm•e beea �ppliat on �aawx ro dtxhupe CoamcrorY I<{iJm+l<obiiga�[ou in.wrcd In eaMxilaa wiiL Wo�k cocurd by piorApplimJoiu Cor Pa7vuat; 2) 8�1e of 41 Woh, nni<rials �nd equipment ineoryoraud in sild Wwk orolhemise �if�ed io nr mrered 6y Nh ADP�Jan Cw Pa�ranl xill pau Io Oxnrr u t(nw of paymenl fm v.d clarof �il IJ�Iu, �muiry inkruu ond enau�M.nm ('supt sueh u ue mvcrcd by e Bood attepuble io Oxncr ind<mni�int a�nn+piM uy evcM1 Ueiv, securiry inlem� a .��u.,h�ecnl� �ndl31 all Woh mrend 6v Ihls Aoolinlion Iot PalmeN ls in aao�dmc<xilh Iha Montgomery(Nfay7_Q7_07_7 Y6:01 CDT) � � ORIGINALCOATMCTPAICG.._....�.._.�......�...-_.-.._..�... S SIII.ISA.03 Net�hioAe6yCh�oReOrd�rx...�...__.�._..__.................».—. t 59].7J0.55 � C0ltt6tConfHCIP[IN(WGl143�..._"—'"_.._..�.........�...._-S 530J.9dC.60 TOTAL CONPLETE➢ AND STOR¢0 TO DATE (Pra¢raiPatlm�4Coe�W<Jeo.Wo�nouandC6aWta0�den}.,,... S 3197,E8S.78 RETAINAGE: . �. SOX x s+m.ees.�e Wock Comvltled.__._ S b. X NetU�M S r.TWIR�1.lu.xeNoeS.�Lfoe561--..-.—.—_...� 3 M�OUt:/'ELICIBLETOOA7Ep.lx�-UneScl...._..-......� 5 5/97.!lS.7d LFSSPRil70U5PAYMENiS(Linl�&amD��e�:PP�eallon}_.....5 3171,991.�9 A�10WTDUE71i19APPLICATION_....�•-+......_..._.._......-....3 SIIp9/19 HAL4\CC TO FI\TSII� PLUS AETAfNAGE (Co1�m�GonPro�re�iPttlmatHG+CO�+LIneSaEo�•e}.�.�._ S 56,10t.!] I. CONTMCfT1AfE: �, Dnys A�nrded I50 , y, Da�s Added by CO �, 1'oniDayi ISO d. Dq�Ch�r(ed ISO e. Dq� Pem�lnlny Thia docunent la� bean moCAMd fmm II� oriyhel form ea en EJCDC downeM end ihe uaer d!d tal Nghipht 1he mod'�ficalbro. Youare airuxa9W m read Na doaanent (areNy aM oonSvA Lep�l Cauneel prbt W Xc e�mcNbn. Progress Estimale ��yn Conlractar's Applicalian `�" ]OSOIIrldgcReM1abilltatlonContnctl ��` ]6M�1 -••�=u o�,mnon-m�mon °�` . �..__-=,vnv,.'r.w�'.d`�.".��-�,�.=.,�w �,.,.N„o caN w.w aa.. ProRress �stimutc Constructlon Allowancc Usngc Contractor's ApplicaHon nnm��rotvs F^r�'•�� 1021N =mon�taien<�.eauneece.�nen c�s„� s�e11 �rt�-�r� 7&vtn.i �ti�.s,. o�roino3�-mniaoi� .m:y,,,o-- �n�no�� ° u,a c o r,.ac..�e-� �.� n.�.n<uru� f Om4ra.U1 l'dMe .UtnvY�4 n:elPd��l' �y� hn:+�J t'!_R:� 4_rtiu�rer-Jl mlS+�eJUDu 10 10-11 Im\ab Uc+�+'+m �.�L� L'ud�lem � Wibl tru��JVJx MtJ 5�-�NluliCl �E� . 5«•„ A�r �..�,.�a�eryJacomui�k»'t _. _ ft130 L!!�1•� IwroDUD 4f!a[.l Y}dW f�5_�041 i(,�vt Fmn<m19..RJ:<1u4N�ln'slTr�i'e'.n . I�sn.i� HU� hl�'.Ib ��ftnuuA fixfs f91..Ltl 3i�ef3f 1] )1� IW fl�}IL10 fl� IUf n i..+�., � n., n-:. m. s r� e... w �+F �� m,. u ec u: e. �. �. „f o; ,... s�.. � �� E c�� w m+trt:.miv�,r.n+..W u�m u m,mo.khaue+.a IeW e..n+��.hmh<.mm. CAVfAvg�Qtl✓ Pro�ress Estimntc Conslructlan Allowance Usage Contrnctm•'s AppllcaHon CONSTRUCTION ALLOIVANCE ITENS TO DE REDUCGD M1�tn.+.a+t' 102J3�1 ]0300rW6eI1iY+61tiiiliaoCeoira�ll ��"F'"� 7&F(nal �„�:,.�.,:u o�rovio=i-o�r�vioxi 'ro�'^°�= �nanou 0 f 0 E � EJIumTr4� 4.+�p:a •R'K� lti�.lflrun Q'�uM14u V�t�rn �M<a\'�u tA�U.N �.<t5N M11�1'vJ N.�V.N I:nVUJ ':rvV.+l A'uL1el N.�V�I i �at�'a Cm�ava.W.+�< _ . . G IO:Jv.�p fI�nIUO fI�01�N . .. . . . ... . ._ . _ _ � �IILN Ns:am N�1�J[..aue�L(SKAv�aNJ:wdJn�t:jLjth e,�ss-�vv«=,•.vti��d�m,.��ehN��.Wc«,n�.,o<,� Cd}dCIwSaQ'tlr ProRress�sthnatc ChangcOrderNumher �� Conh•actor's ApplicaHou ADD[TIONS mi�r 102374 2030Ddd6eR<ha60btloo6elnnl �na�?,��,g v��t '��s'��•^`'� 7&Ilnol ""•oi II1Mo11 a«•.W..� ouoinoi� -ov�u:a2i ` C D E F uu� e�nrde � �aiN CUQ�+tpn.W L'vYlrrte (L�C�Irt ��P-•� YJ.� T��m>/ \'�L:T�"a \I._u'vShsnl/ �SCNnO^.+ I�I IO.fI W.��Or:akm pm�:n �� oar V`u: 4t'kl laz.lel\'1� Mol Sxwllo.�6C1 IOr� 0 !4 J 11MOVA�OCO`:C(�tt0.5CN� _ VSY 21IQ8:01 fll)l0 H11J3 2�141N9) f+ll_6 fUIJd SISi15 I(�W4 d .V)pO.�o15U0 n' �1UV1 1 Vut . N!rt�1 OS�)ri]b) Ui�b Nd10 51I[�0 14)4'.: . 1 C0�'CSTRRFl.U0.i\'EATIfAL10VFAlIfM1 SF IVAIWiYM S]]Ul S>l,!61U 9liw Ni.Ii2t0 1fl.11lta H{tl. 1.3•. i!ni'!fn 1 \NLI�UYEAIOL1lIFAOVEAL\1' TY II.IN:rp'p .11F�+)r/� 111�'t).�) Il.l%WCr� 51).iYll9 11).H1.19 111.191.19 I(OWt TH+� St I]135 i1] N 311.�N_1f WI•: SWl.bl n�a.�sw.we,e.wn,fum:.m.-;wr�,u,.urnca �a�,a.�...tq�'d.m rt.+:h�ri�aa Yw t�e uwnAV umal E�1 an�veR6Y ul ca,ul f�G�Cau�vipa u u ana�:�a CdNCNy�Qv� ProRress Esfimate Changc OrdcrNumLcr � Contractor's Application DELG'PIONS r,<„�...r I02134 3oto u.wi� n<n.em,ibnc.nnn i �K�•'�^'� 7& Flml .yis�:.rew: OJ/ol/1ot1-OJpI/lOtl ��`�""Oje �nv=ai � o c u E � � wc�+ow ", y,..a.e o.*i:, v„��., t��n.. tTUNMiv F�Nu.d n.�uw M1fU.rl `ML�inl vai�,d n�,.u,u n.+u� n�..�.�i ri> sm..,xd °`� vey ntr iwh,n�.�nJm..lu.h=Wa.nnnrXnca.,cm,�wnwurdwei�l,r,a,.b n.aVetiruY.uvem.vriDUu�ralfsS�wn�aJ.fYa+1 cuSW�Co.i+elt��Lams•a Cit of Fort Worth Summa of Char es CitySca<mryComnctNum: 53877 20206�9dgeRehahilitationConh•actl p,p,; I'1V020-0000004153 pNjuWomLer. ]02334 �ppiia�ionrcaod: 03/0]/2021-03/31/202t .{�p��ion 7&F�nal �PPlicalionDate: 4/29/1021 YumLer: ;itv of Fort Worth Summary of Charqes CitySarcmryCoNnctNum: I 53877 I 20206ridgeRehabilpnllonContractl Ip.O.: �•�ru<o-vuuuuur.�� I p�ujatNumber. nppuc uon Applicaiion Pmad: 03/01/2021 - 03/3112021 7& Finnl �PPlication Daie: 4/28/1021 NumLcr. _ itv of Fort Worth Summary of Cha CilySccrtmryContnclNum: I 51877 I 2020DrldgcRchTbilll�llanConlractl Ip,O,; r�roco-uuuuuuy�o.a I pNjuWuniLer. AppliwiionPeriod: I 03/01/202t-03/JI/2021 I ^Numher:" � 7&Flnal I ApplicolionD�tr. I 4/28/2021 Cit of Fort Worth Sum CitySecretnryContmclYunc 53877 2020ll�4dgcRchabllftafionConlract npplin�lon reriod: 03/01/2021 - 03/31/20t1 � PundinA Iduntllloation (FIO) ! Tolal Completed i ' Am Tolels �� '3010U0200431-5740010402334-E02680-9999 ' i 5497885.70 �. p I I !0 I 10 � n ��. i .. , . � P �. C\YVLV•UUVUUU4IDJ p��jutNum�<r. 1023J4 Appliw�ion 7 3c Final App�imiion D�te: 4/28/2021 Nunibcr t Ramalning �� j Gross ��. ' Rolalnage ��. ( Nel I i __. I S6 102.82 ��I I ' li � I i � I i I i � � I � '� I . '. , . . '�. 10 � � � p i � I Grand Total 97,805.78 6,102.02 0,00 ( 24,894.29 524,89d29 FORTWORTH Routing and Transmittal Slip Transportation and Public Works Department DOCUMENT TITLE: Chanae Order#1-2020 Bridae Rehabilitation Contract1 M&C�-01 �_ CPN: 102334 CSO # 53877 DOC# DOCUMENTS FOR CITY MANAGER'S SIGNTURE: All documents received from any and all City Departments requesting City Manager's signature for approval MUST BE ROUTED TO THE APPROPRIATE ACM for approval first. Once the ACM has signed the routing slip, David will review and take the ne� steps. NEEDS TO BE NOTARIZED: ❑ Yes X No RUSH: ❑ Yes X No SAME DAY: ❑ Yes X No NEXT DAY: ❑ Yes X No ROUTING TO CSO: ❑ Yes ❑ No Action Rea �i�. red: ❑ As Requested ❑ For Your Information � Signature/Routing and or Recording ❑ Comment ❑ File ❑ Attach Signature, Initial and Notary Tabs Return to: Please call at ext. for pick up when completed. Thankyou. CSC No, 53877-COl FORT�ORTH;: City of Fort Worth Change Order Request Project Name 2020 Bridge Rehabilitation Contract 1 City Sec # 53877 Client Project #(s) 102334 ''"'`"' Bridge Repair at 18 locations Description Contraclor Gibson & Associates, Inc. Change Order #�—] Date 12129/2020 City Project Mgr. Tariqul Islam City Inspector poug Bevins Contract Time Dept. TPW Totals WD Original Contract Amount $411,258.05 $411,258.05 150 Exlras to Date Credits to Date Pending Change Orders (in M&C Process) Conlract Cost io Date $411,258.05_ $411,258,05 150 730.55 Revised Contract Amount Original Funds Available for Change Orders Remaining Funds Available for this CO Addilional Funding (if necessary) 730.55 CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS % OF ORIGINAL CONTRACT 22.55°/a MAX ALLOWABLE CONTRACT AMOUNT (ORIGINAL CONTR,4CT COST+ 25%) $514,072.56 JUSTIFICATION (REASONS) FOR CHANGE ORDER This change order adds 100,76 square feet of overheadlvertical concrete repair and 17.17 square yards of multi-layer polymer overlay to this contract. During consiruclion, more damage was idenlifietl than the originally planned quantity of backwall and deck soffit of the Hemphili Street Bridge, It was also identified that the While Sefllement Road eridge deck required more muliti-layer polymer overlay than lhe originally planned quantity. As a result,100.76 square feet of additional overhead/vertical concrete repair and 17.17 square yards of additional polymer overlay are needed to complete the project. This change order also includes the addition of two minor items to lhe contract, The proposed change order amount is an increase of $92,730.55 with a revised total contract amount of $503,988.60. It is understood and agreed that the acceptance of this Change Order by the contractor conslitutes an accord and satisfaction and represents payment in full (both time and money) for ail costs arising out of, or incidental to, the above Change Order. The ProjectlProgram Manager signing below acknowledges that helshe is the person responsible for the monitoring and administration of this contracl, including ensuring all performance and reporting requirements. Contracto�s Com an Name Contractor Name Contract Si nature Date Gibson & Associates, Inc. "'°^� "°a'°� "'"°�"�" ""',107 Fo►ir__� i� ProJect Name Client Project# Project Descrip6on ConUactor City Project Mgr. City of Fort Worth Change Order Additions 2020 Bridge RehabllllaUon ConUact 1 City Sec # 53877 102334 Bridge Repair at 101ocaGons Gibson & Associales, Inc. Change Order# �1 Date 12/2912020 Tariqul Isiam City Inspector poug Bivens ADDITIONS ITEM DESCRIPTION DEPT Qty Unit UnitCost Total 3 REMOVING CONC (APPR SLAB) TPW 2.12 SY 213.00 51.56 6 APPROACH SLAB TPW 0.52 CY 5020,00 26.40 7 CONC STR REPAIR (VERTICAL 8 OVERHEAD) TPW 100.76 SF $740.00 7,5 2.40 8 MULTI-LAYER POLYMER OVERLAY TPW 17.17 SY $1,007.00 17,290.19 Change Order Additions Page 2 of 6 Change Order Additions Page 3 of 6 roRr�.� Project Name Client Project# Project DescripGon ConUaclor City Project Mgr. City of Fort Worth Change Order Deletions 2020 Bridge RehabilitaUon ConUact 1 City Sec # 53877 102334 Bridge Repair at 141ocations Gibson & Associates, Inc. Change Order�l �1 Date 12/29f2020 Tariq�l Islam City Inspector poug Bivens � •� � � .. � '�' �� = �� .�,. �.. . ,. Change Order Deletions Page 5 of 6 Previous Change Orders r""�"�°",�" City of Fort Worth ACCEPTANCE OF PREVIOUS MBE COMMITMENT FORM (for use with CHANG� ORDERS or AMENDMENTS greater than $50,000) To be Completed by City Project Manager Change Order (for Construction Contract) Project Name: City Project Number 102334 2020 Bridge Rehabilitation Contract 1 City Project Manager Contractor: • Tariqul Islam Gibson & Associates, Inc. City's MBE Project Goai: Original Amount of Contract: $411,258.05 Accepted MBE Commitment: Total of Previous Change Orders: $0.00 Date of Last MBE Report: Amount for this Change Order: $92,730.55 • Change Order #: 1 Revised Amount of Contract; $503,988,60 Date; 12/22/2020 15 /o 15 % Language to be inserted in the M&C for this Contract Gibson & Associates, Inc, agrees to maintain its initial MBE commitment of 15°/a that it made on the original contract and extend and maintain that same MBE commitment of 15% to this first change order, Therefore Gibson & Associates, Inc, remains in compliance with the City's BDE Ordinance and attests to its commitment by its signature on the Acceptance of Previous MBE Commitment form executed by an authorized representative of its company. To be Completed by the Representative of the Contractor Alan C. Meador, III Vice President Printed Signature Title Gibson & Associates, Inc. CompanX Name 11210 Ryliecrest Dr. Address Balch Springs, TX 75180 City/State/Zip l✓ ��a MBE % Paid to Date G G Authorized ignature/Dal� Contact Name (if different) treym @gibsonassoc, net E-mail address (972) 557-1199 Phone number as of (972) 557-1552 Fax Number 12/22I2020 Date City Project Manager has reviewed t e work associated with this Change Or er� , - considers it the same or similar to work in the original Contract, and recommends that the Contractor have the option to retain and confirm its existing MBE commitment. Tariqul Islam '�%GtYI�'Gt� lj(.G{�l 12/28/2020 City Project Manager City Project Manager Signature Date Adrian Zavala 53877 MIWBE Compliance Staff ID # Adrian Zavala DigftallysignedbyAdrfanZavala Date: 2020.12.2914:5629 -O6'00' 25.90% MBE Current % Level via Last Report Rec'd 12/29/2020 M/WBE Signature Date CITY COUNCIL AGENDA DATE: CODE: SUBJECT: 3/3/2020 REFERENCE *"M&C 20- LOG NAME: 202020 BRIDGE REHABILITATION NO.: 0117 CONTRACT 1 C TYPE: CONSENT PUBLIC NO HEARING: Authorize Execution of a Contract with Gibson & Associates, Inc., in the Amount of $411,258.05 for2020 Bridge Rehabilitation at Eighteen Locations (COUNCIL DISTRICTS 2, 4, 5, 7, 8 and 9) RECOMMENDATION: It is recommended that the City Council authorize the execution of a contract with Gibson & Associates, Inc., in the amount of $411,258.05 for 2020 Bridge Rehabilitation Contract 1 at eighteen locations, DISCUSSION: This contract provides for the repair and rehabilitation of eighteen bridges listed on the attachment provided. The major bridge repairs and rehabilitations include approach slab replacement, deck overlay, structural repair, metal beam guard fence repair and guardraii end treatment replacement (City Project No.102334). Construction for this proJect is expected to start approximately March 2020 and to be completed by approximately August 2020. Upon completion of the project there will be no anticipated impact on the general fund operatingbudget. This project was advertised for bid on September 26, 2019 and October 3, 2019 in the Fort Worth Star-Telegram. On October 24, 2019, the foilowing bids were received: Bidders Amount Gibson & Associates, Inc. $411,258.05 Scott Tucker Construction Co. $557,065.68 Joe Funk Construction � $676,751.30 M/WBE OFFICE: Gibson & Associates, Inc., is in compliance with the City's BDE Ordinance by committing to 15\% MBE participation on this project. The City's MBE goal on this project is 15\%. The City reserves the right to increase or decrease quantities of individual pay items within the contract provided that the total contract amount remains within plus or minus 25 percent of the contract award, This project is located in COUNCIL DISTRICTS 2, 4, 5, 7, 8 and 9. FISCAL INFORMATION/CERTIFICATION: The Director of Finance certifies that upon approval of the above recommendation funds are available in the current capital budget in the General Capital Projects Fund 2020 Bridge Rehab Contract 1 project. Prior to any expenditure being incurred, the Transportation & Public Works Department has the responsibility to validate the availability of funds. I Fund Department I Account Projec ID ID FROM Fund Department Account Projec ID ID Submitted for C(ty Manager's Office bv: Originatinq Department Head: Additional Information Contact: �TACHMENTS m Activity Budget Reference # Amount Year (Chartfleld 2) m Activity Budget Reference # Amount Year Chartfield 2 Dana Burghdoff(8018) William Johnson (7801) Jeffrey Perrigo (8117) omciai sna w u�e ciry ot Fa� v�o�u�, Tezas rORT ��'URTI I �� Contract Compliance Managei•: By signing I acknowledge that I am the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. Tariqul Islam / 'r"R,f^!.9(•t.�i I��wW Name of Employee/Signatui•e Project Mana�er Title � This form is N/A as No City Fiuids are associated with this Contract Printed Name Signature ATTEST: iivt^ R�t�tir7 P. �r�rvz�t,ley �Ronald P. Gonzales(Jan 1J, 202110:Oo CST� Maiy J. ICayser, City Secretaiy FORTWORTHo Routing and Transmittal Slip Transportation & Public Works Department DOCUMENT TITLE: 2020 Bi•idge Rehabilitation Contr•act 1 Construction Allowance M&C: CpN; 102334 CSO: 53877 DOC#: Date: To: Name Department Initials Date Out 1 Mary Kayser CSO - signature � Dec 2, 2020 2 TPW Contracts TPW documents received from auy and atl c;ity llepartments requesting t�iry ivianager s signawre ioi approval MUST BE ROUTED TO THE APPROPRIATE ACM for approval iirst. Once the ACM has sigi�ed the routing slip, David will review and take the next steps. NEEDS TO BE NOTARIZED: ❑YES �No RUSH: ❑YES �No SAME DAY: ❑YES ❑No NEXT DAY: ❑YES ❑No ROUTING TO CSO: �YES ❑No Action Required: ❑ As Requested ❑ For Your Information � Signattu�e/Routing and or Recording ❑ Comment ❑ File ❑ Attacli Signature, Initial and Notary Tabs Return To: TPWContracts @FortWorthTexas.gov at ext. 7233 for pick up when completed. Thank you! CSC No. 53877-AR1 FOR�, City of Fort Worth Construction Ailowance Request ProJect Name 2020 Bridge Rehabililalfon Conlract 1 City Sec 8 53077 Client Projecl �1(s) 102334 Contractor Gibson & Associates, Inc Fundfng AllocaUon Accaunt Original Conlract Amounl ExUas lo Dale Credils to Date Current ConUecl Amount Allowance Funds Previously Allocaled Remaining Funds Available tor lhis Allocalion TPW Cily Inspector poug Bivens Totals JUSTIFICATION (REASONS) FOR CHANGE ORDER IN ACCORDANCE WITH TNIS CONSTRUCTION ALLOWANCE REQUEST, THE CONTRACTOR SHALL; Furnish all labor, equlpmenl, and malerial as per allached proposed Construct(on Allowance Requesl (v+ilh allachmenls) to lhe Conslruclion Allowance Requesl. Th(s construcUon ellowance is to include the removal and replacemenl of approx(malely 180 square (eet of sidewalk and remove and replace approximately 145 square (eel of 9 inch thick asphalt lransition to the conlracl. During construclion, Ihe need lo (1) replace a porilon of lhe exisiting damaged sfdewalk nelwork at Hemphill Slreel Bridge over Federal property and (2) replace lhe damaged asphalt pavemenl lransilion adjacenl to Ihe approach slab of Mark IV Parkway Bridge over Lillle Fossil Creek was identifed. Sta(f consfders lhese unit prfces as reasonable. It is understood and agreed that the acceptance of thls Change Order by the contractor constitutes an accord and satisfaction and represents payment in (ull (both time and money) for all costs arising out of, or incidental to, the above Change Order. The ProJect/Program Manager slgning below acknowledges that he/she is the person respons(ble for the monitoring and administration of this contract, Including ensuring all perFormance and reporting requirements. Coniraolors Comuanv Name Conlractor (Name Contract SI naWre Date '} City of Fort Worth Constructlon Allowance Additions ProJecl Namo 2020 B�d e RehoWlllalbn ConUacl 1 City Sec # 63877 CllentProJeclfl 102334 ConUecla albson & Assaleles, Inc Inapecia Doug Briens AO�ITIONS Change Order Additlons Page 1 oF 3 F�om• W�orc�rr Clty of Fort Worlh "i" Constructton Allowance Deletlons ProJeclNamo 2020�ridgaRehabllilatlonConUactl CltySoc�1 b8877 CI(enl ProJeclll 102334 Contreclor Gibson & Assoclales, Inc Inspector Ooug Bivons Change Order Deletions Page 2 of 3 MISBE Breakdown for this Construction Allowance Previous Construction Allowance CIBSON & ASSOCIATES, INC. Engineers and Contractors 11210 Ryliecrest P.O. Box 800679 Belch Springs, Texas 76180-0579 972/657-119B FAX 667-1 S52 September 3, 2020 Mr. Tariqul Islam Graduate Engineer TPW/Street Services 5001 James Avenue Fo��t Worth, TX 76115 y��p GE [8,�� o� O � �C � � V � ,o t `t�. S M I L L q¢y.P�NSIB1�� INTEGRIiY RE: Project: Ba•idge Rehabilitation at Eighteen Locations 2020-1 Project No,: 102334 County: Taz�rant Dear Sir: Below please find the cliange order pricing requested on the above referenced pxoject. I have iucluded our subcoi�tcactors quote for reference. Add Remove and Replace Concrete Sidewalk 180 SF @$ 27.50 / SF = $ 4,950,00 Our pricing is for the removal and replaceznent of the deteriorated sidewallc discovered at the Hemphill bridge approaches, If there are any questions regarding this matter, please call me. Vety truly yours, GIBSON & ASSOCI ES,1NC. C ��'•_ Trey Meador Vice President IVIA�IAS fn[f��TY [VIII'UEIi1MltC Il��ci�� p��a�lty �a��r��a�� 0�� guoTE Date: 9/3/2020 ProJect: Bridge Rehab at 18 Locations Bid Item No, Sidewalic Removal and Replacement $25 00/square foot Twentv-Five Dollars and 00/100 per sauare foot Maclas Specialty Contracting LLC will provide material, labor, and supervfsion to remove 2 areas of sfdewalk 4.5'x20' for a total of 180sqft. We have excluded P&P eonds, & traffic control. Price may vary if actual area differs from quote. AJ Macias Macias Specialty Contracting LLC 817368-9456 � � � � 2 S�� ;� �� ,��Yr� . �� 2 S s 35�2 Hurdrark ad, Grand Prvlrle, 7X 7505(1 f3.� 7-3G3-.9456 GIBSON & �►.SSOCxAT�S, I1`IC. Engineers and Contractors 11210 pylfecrest P.O. 8ox 800579 8aloh Springs, Texas 75180-OG79 9721657-1189 FAX 857-1652 October l5, 2020 Mr. Tariqul Islam Graduate Engiueer TPW/Street Services 5001 James Avenue Fort Wo�tli, TX 76115 RE: Pcoject:2020 Bridge Rehabilitation Contract I Bridge Repair l8 Locations Pi•oject No,: 102334 County: Tarrant Dear Sir: p CENE ��, cy A � � y 1 S� �F AN[P��'. s K� t � Rs S� �Nte�niry SP�N91B��'� Upon stai�ting the approach slab repairs at the Mark IV Parkway bi•idge, it was noted the existing aspl�att roadway was severely detecio►•ated where it transitioned to tlle approach slab, After retnoving the existing approach slab, we found that a portion of tlie roadway will need to be replaced to tie into the iiew approacli slabs. Below please find our pricing foc tliis additional work, Add Approach Siab Asphalt Transition 145 SF (c� $ 62.54 / SF = $ 9,a68.30 Our pricing incltides removing a 5' x 29' sectioii of paving and replacing it witli appi•oximately 9" of Type D asphalt. I have attached ottr subcoatractors yuote for reference. If there are any questions regarding this matter, please call tne. Very huly yours, GTBSON & ASSOCIATES, INC. � Trey Meador Vice President ,� MACIAS SPECIALTY CONTRACTING, LLC 3502 Hardrocic Rd, Grand Prniric, TX'15050 M: 817-368-9456 ��I�� A vetieran-owned, HU�3 aertified MB�ID�� conr,rete specialty contractor lYtCNtiT CONInAG71N0 llC uote For: Gibson & Associates Date: October 14, 2020 Customer Proiect: Bridge Rehab at 18 Locations - Asphalt Paving Replacement at Mark IV Attention: Trey Meador Scope of Work: Chanqe Order Macias Spec(alty Contracting will provide equlpment and manpower to: 1) Remove approximately 145SF x 9" deep of asphalt and re-apply same qty of fype D asphalt as specified by the City of Fort Worth. Macias will remove 5' x 29' of �� ,� the existing asphalt and dispose. Macias will put (n place Type "D" asphalt up to 9" deep In approximately 3" lifts and using a roller in between each lift to have the final grade match the existing asphalt and concrete grade/profile. Quoted Price: 1) $56.85/SF at 145 SF = $8.243.25 SC �f ��1 �C' /, ( (l+an� ••.�', ° �C.Z SY�'{ pROPOSAL IS BASED ON THE EXCLUSIONS AND CONDITIONS BELOW. PLEASE READ CAREFUI.LY. AddlUonal cha�ges wlll appty wlfh change o(candlflons, • 4uotedprlcetsbasedofflnformallonprovidedbylhecuslomer.Anyvariancesnotedinlhefieldwillbebilledacaordingly, • Jotnt sealaM at the new asphall and concrete Jolnls or existing asphalt Jolnls. • Layouf, shoring and bracinc�, IreHic conlrol and 6arricades is exciudad. • Protecllon of all surroundfng surfaoes Is excluded, All cleaning Is excluded. • Orientalion,badging,drugtesling,parkingtees,parmils,temporarywalisandberrlcades,endrelenllon,areallexcluded. CustomerAcceptance; Date: From: Abe Jackson 817-368-9456 �maciasspecialtv.com Asphait Tle In at Mark IV Parkway Materlal Type D Asphalt 8 tons x 115,00 / ton $920.00 Materlal Subtotai $920.00 25% Compensation 230.00 Material Total $1,150.00 Labor Crew Cost per Day"* Number of Days 1,200.00 2 Labor Subtotal 65% Taxes & Insurance 25% Compensatfon Labor Total 2 400.00 $2,400,00 $1,320.00 6� 00.00 $4,320.00 EQuipment Foreman Truck Crew Truck Bobcat Dump Truck Asphalt Roller Asphalt Rake / Misc Tools *•Crew Cost Per Day: Foreman Laborer 8hrslday x$21.61 / hour x 2 days Shrs/day x$14.04 I hour x 2 days 8hrs/day x$31.14 / hour x 2 days 4hrs/day x$65.00 I hour x 2 days $290.00 / Day x 2 days $125.00 / day x 2 days Equipment Subtotal 15% Compensation Equlpment Total $360.00/day $21.00/hr x 10 hr/day x 41ea Crew cost per day: *kk Misc Equlpment (ncludes generators, small power tools, hand tools, etc. $345,76 $224.64 $498.24 $520.00 $580.00 250.00 $2,418.64 362.80 $2,781,44 Grand Total: $ $ 360,00 $ 840.00 $ 1,200.00 $1,150.00 $4,320.00 $2,781.44 8,251.44 $ 8,251,00 I 145 SF =$ 56,90 / SF �� EquipmentWa��h,. www,equipmentwatch.com All pdces shown fn US dollars ($) Adjustments for TK 247 in All Saved Models october is, 2020 Mlscelianeous 4X2 3/4165 CREW GAS , On•Hlphviay Light Duly Trucks �t,�,,;;,�'��` l:�(�1��:.�i'iiY;; ''I.1C�i: ��. : Size Class: '�s'7�*"';: °.` ;�� :ti..� �,�p} 100 -199 HP _ ,,., WelghL• �v;7=?:":�:ci �ci'..�v;" A70D Ibs .rdel�it:<� Configuratfon for 4X2 3/4165 CREW GAS Axle Configuration GX2 Horsepower 165•a Ton Rating 3/4 Cab Type Po�ver Mode Crew Gasoline Blue Book Rates " FHWA Rate is equal to ihe monthly ownershfp cost divided by 176 plus the houdy est(mated operating cost, Ownerehlp Cosis Esltmated oparating Costs Monlhly Weekly Dally Hourly Hourly Published Rales USD $785.00 USD $220.00 US� $55.00 U9D $8.00 US� $9.63 AdJustments Ragion ( 100%) • Modei Year (USD $8.03) (2016: 98.98%) AdJusted Houriy • Ownershlp Cost (t00%) Hourly Operaling Cost (100°/a) Totel: USD 5778,97 Non-Acttve Use Rates Slandby Rale Idling Rele (USD $2.25) (USD $0.56) (USD $O.aB) U9D S217.75 USD S64.A4 USD $7,92 i FHWA Rale" � Hourly I USD $14.09 I USD $14,04 Hourly USD $3.13 USD $11.21 Rate Element Ailoaatfon Element Percentage Velue Depreclatlon (ownership) 56% USD $439.60Imo Overhaul (ownershlp) 28% USD $227.651mo CFC (ownership) 3% USD $23,65/mo Indirect (ownershlp) 12°/ USD $94.20/mo Fuel (aperaling) @ USD 2.17 71% USD $6.801hr Revised Date: 2nd half 2020 7hese are lhe most accurate rates for lhe selecled Revfsion Date(s), However, due to more frequent online updaies, these rates may not match Rental Rete Blue Book Print. Visit the Cost Recovery Producl Gulde on our Help page for more Information. USD S9�63 The equipment represented in this report has been exclusively prepared for TRISH BLACKBURN (TRISH@GIBSONASSOC.NET) ��3 Equipmen�Wakch.� www. equlpmenlwatch.com All pdces shown In US dollars ($) Adjustments for Pl, 23 in Ali Saved Models Oclober 16, zo2o Bobcat S250 (d(sc. 2011) -� Skld Steer Loaders Stze Class: _— � 2201 - 2600 Ibs r Welght: �� t � 70251bs � . 11xF11 � U.'��'F�� .• � Configuratlon for S250 (d(sc. 2011) Oparator Protection ROPS/FOPS Power Mode Dlesel Blue Book Rates " FHWA Rate is equal to lhe monthly ownershfp cost divided by 176 ptus the hou�(y esllmated operating cost. Ownership Cosls Esllmaled Opereling Coals Monthiy Weekly Daily Hourly Hourly Pu611shed Rates USD $2,860.00 USD 5830.00 USD $210.00 USD $32.00 USD $78.19, AdJustmenls � Reglon ( Texas: 88.9°/) (USD $328.56) Model Year - (2011: 100%) Adjusted Hourly - Ownership Cost (100%) Houdy Operatlng Cosl (100%) Total: USD �2,631.44 Non-Active Use Rates Standby Rate Idling Rate Rate Element Allocation (USD §92.13) (USD $23,31) (USD $3.55) USD $737.87 USD #186.69 USD $20,45 FHWA Rele" Hourly USD ,533,01 USD $31.1a Hourly USD $5,23 USD $21,61 Element Percentage Value Depreciation (ownership) 24% USD $710.40/mo Overhaul (ownerahip) . 65% USD $1,92A.00/mo CFC (ownership) 4% USD $118.40/mo Indirecl (avrnership) 7% USD $20720/mo Fuel (opereting) @ USD 2,40 41% USD $B.BB/hr Revised bate: 2nd hal( 2020 These are the most accurate ratas for Ihe selected Revis(on Date(s). However, due to more frequent onifne updates, ihese rates may not match Renlal Hale Blue 600k Print. V(sit the Cost Recovery Product Gulde on our Help page tor more intormation. USD 516.19 The equipment represented in this report has been exclusively prepared for TRISH BLACKBURN (TRISH@GIBSONASSOC.NET) ��F Ec{uipmentWa�ch_ wv+w,equipm enlwatch.com All prices shown In US doliars ($) Adjustments for TK 257 in AI( Saved Modefs Miecellaneous 4X21 1/2 30D CREW QAS On•Highway Llght Duly Trucks Slze Class; 300 HP & Over WeighL• NIA Configuration for 4X21 1/2 300 CREW GAS Axle Conllguralion AX2 Cab Type Crew Horsepower 300,0 Power Mode Qasoline Ton Raling 1 1/2 Blue Book Rates " FHWA Rate (s equal to ihe monlhly ownership cosl dfvided by 176 plus the hourly esUmated operat(ng cost. • Ownershlp Costs Eslimated Opernting Costs Monlhiy Weekly Dally Hourly Hourly Published Rales USD $995:00 USD $280.00 USD $70.00 USD $11,00 USD $16.26 AdJusimenls Reglon ( Mississ(ppl: (USD $53.73) 84.6 % ) Model Year - (2017: 100%) AdJusted Hourly - Ownershfp Cosl (100%) Hourly Opereting Cost (100%) Total: USD 5941.27 Non-Act(ve Use Rates Standby Rale Idling Rate Rate Element Allocation (USD $15.12) (USD $3.78) USD S264.00 USD 568.22 (USD $0.59) US� $10.A1 October 16, 2020 FHWA Rate" Hourly USD $21,91 USD a18.28� USD $21.61 Houriy USD $2.67 USD $17.72 Element Percontage Velue Depreolalion (ownetshlpJ b6% USD $557.20/mo Ovethaul (ownershlp) 29% USD $288.65/mo CFC (ownership) � 3% USD $29.85Jmo Ind(rect (ownership) 12/o USD $119.4o/mo Fuel (opeteling) @ USD 2.17 76% USD �12.37/hr Revlsed Date: 2nd half 2020 These are the most accurate rales for lhe aelected Revislon Date(s). However, due to more frequent onl(ne updales, Ihese rales may not match Rental Rale Blue Book Print. V(sil lhe Cost Recovery Product Quide on our Help page lor more informatlon. The equipment represented in this report has been exclusfvely prepared for TRISH BLACKBURN (TRISH@GIBSONASSOC.NET) 11/24/2020 BIM 360 Document Management B AUTODESK' flIM 360' fortworthgov > 102334 - 2020 Oridge Rehabflitatfon ContraU 1. �� D o c u m e n t M a n a g e m e n t FOLDERS REVIEWS TflANSMI7TAL5 ISSUES Reviews � Review detail c�oseo #6 ( Export Report � I 7his review is closed. ( - _ -- Name n (� ConstructianAllowanceReques[1 CPN102334.pdf Q TI Constructton Allowance Approval Workflow Oescript(on Verslon Markup Comments PROGRESS -- V3 0 No camme initiator initial Review n TI Tariqul Islam Nov4,12:34 PM <tariqut.isla m @ fortwor[htexas.gov� Submi[ted to Reviewer 1 Reviewerl Initlal Rev(ew 1 n 7P 7effrey Perrigo Nov4,1z:41 PM <Je(frey.perrigo@ fortworthtexas.gov> Submitted to Reviewer 2 Reviewer2 InitialReview2 n LZ Lane Zarate Nov 4,1:52 PM �Iane.zarate@ fortworthtexas.gov� Submit[ed to Reviewer3 Reviewer 3 Initial Review 3 n LP LaurenPrieur Nov1o,112BAM <lauren.prieur@ forhvorthtexas.gov> Su6mitted to Reviewer 4 Reviewer 4 Initial Review 4 /� WJ William 7ohnson Nov 10, ]2:41 PM <�yillia m.johnson @fortworthtexas.gov> Submitted to Reviewer 5 Revtewer5 InftlalRevlew5 n DB Douglas Black Nov 24, 1228 PM <dou g. b Ia c k@ forlwort htexa s.gov> Submitted to Approver approved. Approver Final Review /� DB DanaBurghdoff Novz4,z:17PM <dana.bu rghdoff@forlworthtexas.gov> Revtew ended Review dosed � https:!/docs.b360,autodesk.com/projectsl6b49c1 b1-cd56-4538-9f7f-b6722f68c39f/reviews/34215326-cA79-4449-b5e7-f495d73ca902 1/1 Contract Compliance Manager: By signing I acknowledge that I am the perso�i responsible for the monitoring and administratiou of this contract, including ensuring all performance and reportuig requirements. Tariqul Islam / 7'"A,�^ic�Gv%lS�t,vw Name of Employee/Signature Proiect Manager Title ❑ This foi�►n is N/A as No City Funds are associated with this Contract Printed Name Signature ATTEST; �2 �P h:��i� �a�� rRonaldP.Gonzales(Cec2,202013:7 T� Mary J. Kayser, City Secretaiy F�CIRTWORTHo ,~-� TRANSPORTATION AND PUBLIC WORKS May 19, 2021 Gibson and Associates, Inc 11210 Ryliecrest Dr Balch Springs, Texas 75180 RE: Acceptance Letter Project Name: 2020 Bridge Rehabilitation Contract 1 ProjectType: Bridge Maintanence City Project No.: 102334 To Whom It May Concern: On March 31, 2021 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 April 5, 2021. 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 April 5, 2021, 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) 392-2486. Sincerely, Ta�iq�G /Il,��r Tariqul Is am (May 27, 202110�.45 CDT) Tariqul Islam, Project Manager Cc: Doug Bevins, Inspector Ron Cordova, Inspection Supervisor Gary Deyon, Senior Inspector Riad Nusrallah, Program Manager N/A, Consultant Gibson and Associates, Inc, Contractor N/A, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev.8/20/19 �rrlDavlT STATE OF TEXEIS COUNTY OF TARRANT Before me, the undersigned authority, a notary public in the state and county aforesaid, on this day personally appeared Alan C. Meador, III, Vice President Of Gibson & Associates, Inc., 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, coiporations, or other organizations furnishing labor and/or inaterials 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; 2020 Bridge Rehabilitation Contract 1 BY - Alan C. Meador, III Subscribed and sworn before me on this date 20`�' of May, 2021. �a--- !� • ��.�/1/ Notary Public Dallas, Texas ��pY P��i PAM N DAVIS ��lP,... Vg�� :�;�;�:Notary Public, State of Texas 3'��. �-°yQ.� Comm. Expires 03-30-2025 �9�`',...'t�' �� 'a„°;,�r` NOtefy ID 283117-2 coNSENT oF SURETY COlVIPANY TO FlNAL PAYMENT Confnrms with the American Instituta of Architects, AIA Document G707 owN�R ❑ ARCHITECT ❑ CONTRACTOR ❑ SURETY ❑ OTHER Bond No K0889355A PROJ�CT: {name, �ddl'eSS)2020 Bridge Rehabilitation Contract 1 70 (Qwner} � CliY pF FORT WORTH 200 Texas Street Fort Worth Fort Worth. �X � ARCHfTECT'S AROJECT NO: CONTRACT FOR: 2020 Bridge Rehabilitation Contract 1, City Project #102334 rx �s�oz � CONTRACT DATE: s�3/2ozo CONTRACTOR: GIBso�v � ASSoc�ATEs, INC. In accardance with the pro�fsions of the Contract between the Owner and the Contractor as indicated above, the Ihere insert name and address of Surety Campanyj F�DERALINSURANCECOMPANY 2028 Hall's Mill Road whitehouse Station NJ 08889 , SURE7Y COMPANY on bond of ihere insert name and addtess af Contraetorl GIBSQN & ASSOCIATES, INC. P.O. Box 800579 Balch Springs TX 7518p-0579 , CONTRACTOR, �ereby approves of the final payment to the Contractor, and agrees that final payment to the Cantractar shall not r�lieve the Surety Cor�zpany oiany of its obli�ations to 4here insert name and address of Ownerl CiTY OF FOR7 WORTH 200 Texas Street Fort Wor#h TX 76102 , vwNER, as set forth in the said Surety Company's bond. IN WITNBSS, WH�REOF, tIie Surety Compa�y has �ereunto set its hand this Attest: .. {Seaf): ��:��., el�ic�z�c'�.�- 2Qth i�ay of May, 2021 FEDERAL INSURANCE COMPANY Surety Company �� I � _ ➢ ! , — ti,= f "}� s�y"+� `'1 �:� . � Signature of Authorized Representaiive So hinie Hur�ier Aitorne -in-Fact Tit�� NOTE: This /orm is to be used as a companion dacument to AIA nOCUMENi G706, CQN'�RACTOFI'S AFFIDAVl7 OF PAYhfEiVT QF �EBTS ANp Cf.AIMS, Current Edition ONE PAGE Pow�r �f �lttorney Federal l��sitraalce Con��any j Vi�ilant I.nst��-ance Co�n��r�� Pac�t�ic [�1den�ni�� Coi�paf�y Know All 6y These Presents, That FEDETtAL INSUTtA[YCE COMPANY, an Indiana cor�oration. VIGILANT INSURANCE COMPANY, a\'ew York corporatir�n, and PACIFIC I�EMNI'ry COMPq[vv, a tt�isrnnsin co�pnra[ion, dp each t�ereUy conscicuie and appoinc �on E, Cornell, Sophinie Hunter, Tina McEwan, Robbi Mosales, Tonie Petranek, R#cardo J. Reyna, Joshua Saunders a�d Kelly A. Westbrook af Daflas, Texas; Steven pwain 8rockinton of Little Rock, Arkansas----------- e�ch as their true and Iati��Ful Attorney-in-Fact to execute under such desi�,matioo in their names ;ind to af}ix [heir corporate seals to and delivcr f'or and on their behalf as sureq� thereon or otherwfse, bonds and undcrtakings and olher u�ritings o�ligacory in the naEum thereof (other tl�an bail bonds} �cen or exe�uted in tl�e course of 6usiness, and any instrumenls amending or alt�ring il�e same. and conserns ro�he modification or alteration ofa�iy insh ument referred to in said bonds or nbli§ lians. ln Witness Whereof, said FEI}ERAL INSlSRANCE COMPANY, VICILpNT INSIIRANCE COMPANY, and PACIFIC INDEMNITY COMPANY have each executed and atresred these presents and aflixed their curporate seals on rhis 20'" day ofMazch, 2419. ��_`��. ��I.9�h.� €i:nr,n 31. E�hlr;rct�:. ,A.��€��ani �ctirt[cu'y �"�-. � �' � �r��,hcF� tl El:in�y. �'icc €'�t�1,1�°nt �� y� �r� ^w,„ F �r,�Y�� i STATF; OF N E W J F,RSEY County uf 1-lun�erdon Ss. �Z�A�$ a i 9 � - � �: L '� �� sr.�� On this 20'" day ofMarch, 2019, Ucfore me, a�otary Public oFNe+v Jersey, ��ersonally came oasvn y. Chloros, to me kno�vn to be Assist:int Secretary oFFE[]L;RAt, 1\SL:1�;1�CI: CDMPASY, V1CII,.4\T ]NSCRANCE COMPqNS', and PACIFIC 1NDC1�I;v7TY COA?PA�Y, the companies �vhicli execuced the fore�;oicig Power of A[tnmey, and [he said Ua��n h1. Ghloros, being �y �e duly swam, did depose and say [hat slie is Assistant Secretary nf' FEUERAL tNSU]tANCE CDb7i�ANY, V3GILANT I�SURANCE C0�[PAVY, and PACIFIG ]NnEh1NITY GOh9PAN1' and knows the corpora�e seals thereof, thar the seals aFfixed cn the foregoing Power of Attorney are such carporale seals and were thereto stt4xed bv authority of said Companies; and Ihat she signcd said Pcnaer ok Attorne�� as Assistant Secretary of said Cnmpanies by like au[horiry: and thac she is acc�uainted �vidi Stephen fvt. Hancy, and knows him to be V�ce C resident of'said Companfes; and that the signature of S�c��hen �1. Haney, subscribed �n said Power of Auorney is in the genuine handwriting of Stephen iv3. H�ney, and u as therero subscribecl by a�itl�ority oPsaid Companies and in deponen�'s prescnce. �otarial Sca] � "' s qa�� '� P;Aa uorativPwucaFa�� -i� � � � � ��w�t�.�, No. �Do7�cac � "°'a � %e,�� _` Ca.a�m€� 6+t�"� ts7.ar,s�:+er 2z.2B71 � J S tinE.ir� Pid�l€c cExTT�ica�iarr Resolutions adopred by [he Boards of Direcrors of FEDGRAL INSURANCL f.(7NPA\'Y, �7GILANT 1NSlJRA�CE COhiPANY, and PACIF'IC INUF;h7N17't' COMI'ANY on A�gust 30, 2U]G: "RESOL\�E�, diat the lolluu�ing;iuthnriza[ivn5 relate t0 the csec¢tiGn, Yoi' ancl on hehalf uf Nie Cumpany, of bunds. undertakinti�s, rccngniianres, contracts and o�her i��t�E[ten [ommitinents oFthr. Company entered irtto in the ord]na�7- courseofbusiuesti (each a"LVrit[en ConlmiYment')� fl) Each of the Chairnzan, the president anJ the Vlce P��eyydenls uf theCompan5'isliereby authorized tocxeculeany4VrfrtenCummitment (orandon�ehalfuFtheCqn7pany,tmderthe seal o{the Cum�any uro[henvisc. (Z) Each duiy appuiated attorncy-in-(acf uf Ihe L:nis�pany is hereby authorized [o exe[ute any l5'�itten Commf[nlent }�i� and on liehalf o( the Company, undeE tl:e seal ut the Company or o�hern�35e, tn Fhe exteni that such acFlon is authorizcc] 6y �iicgrant aFlrowers pi�uvideci for in such ne�sun'S w�ritten appointment as such ai torneY�i�{itt, E3) Cach uf the Chairman, the i�resident and the 4'icc I'resfdencg u#' the Cumpany� is hereb}' au[horiud, fut' and un behalf nfthe Cpmpany, to appoii7t io wrilis� ��y person the �itiun�ey- in-FaU nf tlic Company w�ith fiill pox�er and authorih'tp e�ccute, For and un bchall pfehe Company, under the scal of [fie Cumpany or orhenvise. sucli l4'riLLen Commftmcn[s of Lhe Company as n7ay be s}�ecified in sucli u�i[[en apppfnim�nt, which specitication q�ay he by �enei�af rype c�r [las.i uf 14i'ilten C,��mmit�nenis ur by specf0[dtion 0( �ne ur n�prP p�rtiCular LVri[ten Cummittnents, (4) Fa[h ot' fhe Chaii'man. the Pi�esidenf and Yhe Vicu Presidents of ihe Cnmpan5' it 1lereby authui'izcd, f'or and on behalfaf'the Company, to delegate ia wr�ting to any other u�cer uFthe Cumpany tl�e ;mthorit}� to execute, for and on 6eh;i11 of tlte Cnmpany, under ilie Company'S seal or pihenvise, such �Vritten Commi[meats o(the Cnmpariy as air sp�cilied in such ur�tten ddegatinn,whichspecifcatiun may be by geaeral L}�peui' classoC W�iCteu Com�nf[ment5 or by'spe[i�ica[ionufo�7eormorepaRicuiartVrftten[�c�n�n¢timents. {�} 'i'hesigialureai�anyufticerorntherper5onesccuungany45'rittenComnii[mentn�appoinlmentordeic�tinnpursuantrothisResoIulion,andthesealuCrheCumpan}',may�eatte.rcdby facsimfle on such 14'nven Cumioiitmen� or «Tilten appnintmeut ur ddegation. FUR"fHF.H RESOLVED. ihat the I�regoing Resplution shall noc be ctecmed to he an exGusive sta[emen[ oFthe powers aad au[hoary pf afiicers, employres and other per.wns to a[I fur ancl un behalf'nf Yhe Company, and such Resulution shall nut liiiiit nr oYhenvisc aYfecl Lhe exereise ol�any such pou�er u� an[hority utherwise validlg gtanted or veste[I.' I, Dawn h1. Chloros,.assis[m,[ Sccrerary of C'EpGR�,f, I�SU)t��NCF.' COMPANY, VIGIL.qN"l� INSURANCE COMPA�S', and PACIFIC INDEMNITY CONIP�NY (the "Conipanies") do herebv ccrtily rhat , {i) the Foregaing Resolutions adopLed �7y the Roard of Direccors of the Conipanies are truc. con-ect and in fuli F'orce and ef�ect, (ii) rhe fi�regoing Power oFAtiorney is true, correa and ici full Forc� and eFFect. Ui�en tmder my hand and seals oFsaid Con�panies at W'hitehouse Station, N.j. [his May 20, 2021 � n�F � ��. �.` � �3C��—�'�. ��.��h.� � W � 4� r� Cs,.�r� ]�1, i :ltk3rrs;. IN'I'I 3E El'h;Nf YOU WlSH 7'O V tKf F]"I'H G.ALI'fH GIV"fIG'i'Y Of 'l'H 15 I�DNll OR NOTIYY US OF' Ai�"Y 0'I'HER Mi1I'I'8H. PLE 15l CUh'CAC'P LfS A'F'� 'I'cle hpne(908)90�34!33 Fax(9U8}903-365G e�m�il: sumn�rr�irhuhhrn�„ FE[7- VIG-PI (rev. OB-18j ti�t't'i.•1'ai;' Policyholder Informat�ion IVotice 1MPORTANT NOTICE Tc� abtain information or make a complaint: You niay call Chubb's toIl-free telephone number for information or to make a com�laint at 1-800-36-CHUBB 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 AusEin, TX 7$714-9104 FAX # (512) 475-1771 Web: http://www.tdi.state.tx,us E-mail: ConsumerProtection@tdi.state.tx.ils PREMIUM OR CtA1M DISPUTES: Should you have a dispute concerning yaur premium or ahout a c�aim you should contact the agent first. If the dispute is not resolved, you may contact the Texas Department of Insurance. ATTACH TH1S N4TICE TO YOUR POLICY: Tl�is notice is for information only and does not become a part or condition of the attached document. Furm 99-IO-02g4 (Rcv, 1-08) AVISO IMPDRTANTE Para obtener ir�forrnacion o para someter una queJa: Usted puede llar�ar a� numero de telefono gratis de Chubb`s para informacion o pata sameter una queja al 1-800�-36-CHUBB Puede comunicarse con eI Departamento de Se�uros de Texas para �btener informacion acerca de companias, coberturas, derechos o quejas al 1-800-252-3439 Puede escribir al Departamento de Seguros de Texas P.O. Box a49104 Austin, TX 78714-9104 FAX # {512) 475-1771 Web: http://www.tdi.state.tx.us E-mail: ConsumerProtectzon@tdi.state.tx.us DISPUTAS SOBRE PRlMAS O 14EGLAMOS: Si tiene una disputa concernient� a su prima o a un reclamo, debe comunicarse con ei agente prin�ero. Si no se resueve la disputa, puede entonces comunicarse con el d�partamento (TDI). UNA ESTE AVISd A SU POLIZA. Este aviso es solo para proposito de inforn-�acion y no sc convierte en parte o condicion del documento adj unto.