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Contract 52330-FP1
FORT WORTH, TRANSPORTATION AND PUBLIC WORKS NOTICE OF PROJECT COMPLETION City Secretary No: 52330 -FP1 Date Received; Sep 30,2021 City Project Ne: 101569 Regarding contract 52330 for 2018 CIP CONCRETE RESTORATION CONTRACT 6 as requited by the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by City Council on 04/09/2019 through M&C 29091 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: $2,100,483.80 Amount of Approved Change Orders: $ Ne Revised Contract Amount: $2,100,483.80 Total Cost Work Completed: $25028,163.94 Less Deductions: Liquidated Damages: 0 Days @$650.001Day Pavement Deficiencies: Total Deduction Amount: $0.00 Total Cost Work Completed: $2,028,163.94 Less Previous Payments: $1,926,755.74 Final Payment Due $101,408.20 L�e�P�ceuY Lauren Prieur(Sep 28,202116:20 CDT) Sep 28,2021 Recommended for Acceptance Date Asst, Director, TPW - Capital Delivery Q Sep 29,2021 WJ(Sep 29,20 09:55 CDT) Accepted Date, Director, TRANSPORTATION AND PUBLIC WORKS DEPARTMENT Client Department 0cgn67 2441 %ff Sep 29,2021 Dana Burghdoff((9ep 29,202110:14 CDT) Asst, City Manager Date Comments: OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX C-620 Signature Page Contractor's Application for Payment Invoice No. 27 FINAL To(Owner) City of Fort Worth Invoicing Period(From-To): Invoice Date: 10n0n020-IMIn020 7/30/2021 P.0. FW020-0000001883 From(Contractor): Remit to(If Not Automatic Deposit): Number. ounclusContractin Inc. Project: 101569 Contractor'sCFW Vendor No.: 7000W392 Ome®Contracting,Inc. 2518 Chalk Hill Rd.Dallas.TX 75212 City Secretary Contract 52330 c°"`ra°t 2018 CIP Concrete Restoration Contract 6 Number. Name: Application For Payment Change Order Summary Approved Change Orden 1.ORIGINAL CONTRACT PRICE...........................................................S $2,100,483.80 Number Additions Dcictioas 2.Net change by Change Orders................................................................. S 1 3.Current Contract Price(Line I f 2)........................................................ S S2,I00,483.80 2 4.TOTAL COMPLETED AND STORED TO DATE 3 (Progress Estimate,Construction Allowance and Change Orders)....... S S2,028,163.94 4 5.RETAINAGE: 5 a. X S2,028,163.94 Work Completed..........S 6 It. X Not Used S 7 r.Total Retainage(Line 52+Line 5b)................................S 8 6.AMOUNT ELIGIBLE TO DATE(Line 4-Line 5c)....-.......................S $2,028,163.94 TOTALS 7.LESS PREVIOUS PAYMENTS(Line 6 from prior Application).........S S1,926,755.74 NET CHANGE BY &AMOUNT DUE THIS APPLICATION..........................-.....................S S101,408,20 CHANGE ORDERS 9.BALANCE TO FINISH,PLUS RETAINAGE (Column G on Progress Estimate+CA+Cos+Line 5 above)...............S S72J19.86 Contractor's Certification 10.CONTRACT TIME: The Contractor«rtifies with the submittal of this document and associated Payment Request Submittal a. Days Awarded 450 on the City ofFon ns Days Worth Buaw system that to the best of their knowledge:(1)all previous progress b, Added by CO payments received from Owner on account of Work done under the Contract have been applied on account to discharge Contractor's legitimate obligations incurred in connection with Work covered by e. Total Days 450 prior Applications for Payment;(2)tide ofalt Work,materials and equipment incorporated in said Work or otherwise listed in or covered by this Application for Payment will pass to Owner at time of payment d. Days Charged 420 free and clear of all Liens,security interests and encumbrances(except such as are covered by a Bond acceptable to Owner indemnifying Owner against any such Liens,security interest or encumbrances): e. Days Remaining 30 and(3)all Work covered by this Application for Payment is in accordance with the Contract Documents and is not defective. Liquidated Damages S650.00 x day Daniel Garcia(pep 28,202110:22 CDT) This document has been modified from its original form as an EJCDC document and the user did not highlight the modif—tions.You are encouraged to read the document carefully and consult Legal Counsel prior to its execution. 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CD0 o 0a. o 0 FR b w 00 �V (0 7 c00 (00 _ � O 00 00 0u O O O CD O O O ((00 (00 00 1+ — ^0 O N p n O O � m N m G m o o O M bi W O N � n Cl) o p � w s z�a - - - - -- - -- - - - - - -- 0 o .. 3 o � m o 0 o C�" o 0000 a ro 00 b (D 111 C O th J � 4) O Z N m O N H O O O O O 0 0 Cl 0 0 WW O � n N O N (T o o "n o � � 7 a o � y w m ❑ p 0_ o d d ° P N (° 7 .. W (Op fl W c v CD o 0 0 (D m 00 rt ro O n d 'T1 cn 69 N N O O 3 N M rn rn m o O w w �'., o N O C y O � P. P vs v3 3 rn m m � O o � III J c � ° o 0 0 � ICl o Ca" o 00 - °o w ba ro ;u v 3. N p O ID W N N O H O _ N J � W O � Z N O O � � A O OJ N O FORT WORTH., TRANSPORTATION AND PUBLIC WORKS September 17,2021 Omega Contacting Inc. 2518 Chalk Hill Road Dallas,Texas 75212 RE: Acceptance Letter Project Name: 2018 CIP Concrete Restoration Contract 6 Project Type: Paving City Project No.: 101569 To Whom It May Concern: On December 9, 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 June 28, 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 June 28,2021,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- 392-2333 . Sincerely, Gregory Robbins, Project Manager Cc:Jeremy Hickman, Inspector Ron Cordova, Inspection Supervisor Gary Deyon, Senior Inspector Mary Hanna, Program Manager Click here to enter text., Consultant Omega Contracting Inc, Contractor Click here to enter text., Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev.8/20/19 AFFIDAVIT STATE OF TEXAS COUNTY OF DALLAS Before me, the undersigned authority, a notary public in the state and county aforesaid, on this day personally appeared Daniel Garcia, Operations Manager Of Omega Contracting, 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, corporations, or other organizations furnishing labor and/or materials have been paid in full; That the wage scale established by the City Council in the City of Fort Worth has been paid in full; That there are no claims pending for personal injury and/or property damages; On Contract described as, 2018 CIP Concrete Restoration-Contract 6 Chapel Creek&WestPoint Blvd. City Project No. 101569 BY Daniel Garcca, Operations Manager Subscribed and sworn before me on this date 28th of June, 2021. F Notary Public p County, State { ME' ISSA MAR ;; EZ 'd'rp 4 G li"fl. CKp7in�s 09�i8-2023 t Liberty 2200 Renaissance Blvd.,Suite 400 �Mutqql- "� King of Prussia,PA 19406-2765 Ph.(610)832-8240 SURETY CONSENT OF SURETY TO FINAL PAYMENT To: (Obligee or Obligee's representative) City of Fort Worth 200 Texas Street Fort Worth, TX 76102 RE: Principal:Omega Contracting, Inc. Obligee:City of Fort Worth 2518 Chalk Hill Road 200 Texas Street Dallas, TX 75212 Fort Worth, TX 76102 Contract Number: Contract Date: Contract/Project Description: 2018 CIP Concrete Restoration, Contract 6, 101569 In accordance with the provisions of the contract between the Obligee and the Principal described above, LIBERTY MUTUAL INSURANCE COMPANY,a Massachusetts stock insurance company,as Surety(the"Surety"),on the Principal's bond number 022223722 (the"Bond")hereby consents to the final payment to the Principal by the Obligee and agrees that final payment to the Principal shall not relieve the Surety of any of its obligations to Obligee as set forth In the Bond. IN WITNESS WHEREOF,the Surety has hereunto set its hand and seal this 5th day of May 2021 , LIBERTY MUTUAL INSURANCE COMPANY (Surety) By: (Seal), L Attorney-in-Fact Surety Phone No. 617-357-9500 LMIC•3100 Rev.3104 This Power of Attorney llmfts the acts of those named herein,and they have no authority to bind The Company except in the manner and to the extent herein staled, Liberty Liberty Mutual insurance Company mutu5l. The Ohio Casualty Insurance Company Certificate No: 8204952-971801 SURETY West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS:That The Ohio Casualty Insurance Company Is a corporation duly organized under the laws of the State of New Hampshire,that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts,and West American Insurance Company is a 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, Alyson Carmichael;Ashley Britt;Barry K.McCord;David T.Mictette;Lacey Mayfield;Lauren O.Moudy,Aii€cole Jeannette;Robert C.Davis;Robert M.Overbey,Jr.; Tabitha Dorman all of the city of Houston 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 an its behalf as surely 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 15th day of March , 2021 . Liberty Mutual Insurance Company 4 INSUR V11 INSU 1148uR The Ohio Casualty Insurance Company JP ono Qy JP nro ' P ¢vo ¢L�Yd�agr m�s Rcwu'�s rFp aDOfi �O 2aoh ArnvRga�T\�oa sm �C C.SG 2 00�ry ofaN'tPar pa DCyr West American Insurance Insurance Company y 1912 n 1919 ' C)y ° 1 1991 o p A ro David M.Carey,Assistant Secretary w 10 State of PENNSYLVANIA ss :County of MONTGOMERY o +� On this t 5th day of March 2021 before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance 20 `N Company,The Ohio Casualty Company,and West American Insurance Company,and that he,as such,being authorized so to do,execute the foregoing instrument for the purposes t r2 therein contained by signing on behalf of the corporations by himself as a duly authorized officer. (D o IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at King of Prussia,Pennsylvania,on the day and year first above written. OCO D a) pgsr� 0-0 ` ttiONiN� { Commomveallho€Pennsylvania-Notary Seal crY avF q, Teresa Pastella,Nolary Public 43' O f ° 2 7 Montgomery County o+�+ OF My commission expires March 28,2025 t3 0 N Commission number 1126044 y• 4-- , Yuq �C� Member,Pennsylvania Association of Notaries eresa Pastella,Notary Public Q O *'S qj TaRY P� � This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual 000 o•� Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows: E 2� ARTICLE IV—OFFICERS:Section 12.Power of Attorney. $ 00 o 2 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 . c President may prescribe,shall appoint such attomeys-In•fact,as may be necessary to act in behalf of the Corporation to make,execute,seal,acknowledge and deliver as surety ro a any and all undertakings,bonds,reeNnizances and other surety obligations.Such attomeys-in-fact,subject to the limitations set fortis in their respective powers of attorney,shall c 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 o cu Z 4D 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 attomey-in-fact under the o W provisions of this article may be revoked at any time by the Board,the Chairman,the President or by the officer or officers granting such power or authority. ti a 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, bands,recognizances and other surety obligations.Such altameysmin-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 ofthe Company,acting pursuant to the Bylaws of the Company,authorizes David M.Carey,Assistant Secretary to appoint such attomeys-in- fact as may be necessary to act on behalf of the Company to make,execute,seal,acknowledge and deliver as surely 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,Renee C.Llewellyn,the undersigned,Assistant Secretary,The Ohio Casualty 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 said Companies;Win full force and effect and has not been revoked. IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this *ay of PV INsfJ P01 INS& INSU� Rq P Fcvo y j�`oa�oaaroZnfn Uo'J.'`ot�c2arFc � q 1912 $1919 o 1991 o By. day ssyoaug &ASAP- dD� �s, �NDIANr 4a Renee C.Llewellyn,Assistant Secretary LMS-12873 LMIC OCIC WAIC Mull!Co 02121 wPo Liberty mutuao SURETY TEXAS TEXAS IMPORTANT NOTICE AVISO IMPORTANTE To obtain information or make a complaint: Para obtener informacion o para someter una quej a: You may call toll-free for information or to Usted puede llamar al numero de telefono gratis make a complaint at para informacion o para someter una queja al 1-877-751-2640 1-877-751-2640 You may also write to: Usted tambien puede escribir a: 2200 Renaissance Blvd., Ste. 400 2200 Renaissance Blvd., Ste. 400 King of Prussia,PA 19406-2755 King of Prussia, PA 19406-2755 You may contact the Texas Department of Puede comunicarse con el Departamento de Insurance to obtain information on companies, Seguros de Texas para obtener informacion coverages, rights or complaints at acerca de companias, coberturas, derechos o 1-800-252-3439 quejas al 1-800-252-3439 You may write the Texas Department of Insurance Puede escribir al Departamento de Seguros Consumer Protection (1 I1-IA) de Texas Consumer Protection (111-1A) P. O. Box 149091 P. O.Box 149091 Austin, TX 78714-9091 Austin, TX 78714-9091 FAX: (512)490-1007 FAX# (512)490-1007 Web: http://www.tdi.texas.gov Web: W://www.tdi.texas.g_ov E-mail: ConsumerProtection@Ltdi.texas.gov E-mail: ConsumerProtectionnaQtdi.texas.gov PREMIUM OR CLAIM DISPUTES: DISPUTES SOBRE PRIMAS O RECLAMOS: Should you have a dispute concerning your Si tiena una disputa concerniente a su prima o a premium or about a claim you should first un reclamo, debe comunicarse con el agente o contact the agent or call 1-800-843-6446. primero. Si no se resuelve la disputa, puede If the dispute is not resolved,you may contact the entonces comunicarse con el departamento (TDI) Texas Department of Insurance. ATTACH THIS NOTICE TO YOUR UNA ESTE AVISO A SU POLIZA: POLICY: This notice is for information only and does not Este aviso es solo para proposito de informacion become a part or condition of the attached y no se convierte en parte o condicion del document. documento adjunto. NP 70 68 09 01 LMS-15292 10115