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Home My WebLink AboutContract 54468-FP3 City Secretary Contract No. 54468 -FP3 FORTWORTH, Date Received Nov 15,2021 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: Chapel Creek Ranch City Project No.: 102533 Improvement Type(s): Water ❑x Sewer Rx Original Contract Price: $480,415.55 Amount of Approved Change Order(s): $4,480.20 Revised Contract Amount: Total Cost of Work Complete: $484,895.75 Albe�tG�c�ntcies Nov 10,2021 Albert Grantges(Nov 1 ,2021 09:11 CST) _ Contractor Date Vice President Title Burnsco Construction, Inc. Company Name a.&WAC Nov 10, 2021 Habte Taezaz(Nov 10,202109:13 CST) Project Inspector Date 2. Nov 10, 2021 Project Manager Date LiG��r�obero�beGca 7aeie R Nov 10 2021 F-1—o„ f,„n h-11 of lank nn (ni ins omi vr¢ rcr� CFA Manager Date B AOcd Nov 10 2021 nana R .ghrinff(� .,i n T i o�ati rcT) Asst. City Manager Date OFFICIAL RECORD CITY SECRETARY Page 1 of 2 FT. WORTH, TX I Notice of Project Completion Project Name: Chapel Creek Ranch City Project No.: 102533 City's Attachments Final Pay Estimate ❑ Change Order(s): ❑x Yes ❑ N/A Pipe Report: ❑x Yes ❑ N/A Contractor's Attachments Affidavit of Bills Paid Consent of Surety Statement of Contract Time Contract Time: 60 WD Days Charged: 136 Work Start Date: 1/4/2021 Work Complete Date: 10/19/2021 Completed number of Soil Lab Test: 340 Completed number of Water Test: 8 Page 2 of 2 FORT WORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name CHAPEL CREEK RANCH Contract Limits Project Type WATER&SEWER City Project Numbers 102533 DOE Number 2533 Estimate Number 1 Payment Number 1 For Period Ending 10/19/2021 WD City Secretary Contract Number Contract Time 6WD Contract Date 7/20/2020 Days Charged to Date 60 Project Manager NA Contract is 100.00 Complete J g Contractor BURNSCO CONSTRUCTION,INC. 6331 SOUTHWEST BLVD FORT WORTH, TX 76132 Inspectors MILLER,W / TAEZAZ,H Tuesday,November 2,2021 Pagel of 5 City Project Numbers 102533 DOE Number 2533 Contract Name CHAPEL CREEK RANCH Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER&SEWER For Period Ending 10/19/2021 Project Funding UNIT I;WATER IMPROVEMENTS Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total --------------------------------------- 1 4"-12"PRESSURE PLUG 2 EA $100.00 $200.00 2 $200.00 2 CONC PVMT REPAIR,ARTERIALANDUSTRIAL 335 SY $125.00 $41,875.00 335 $41,875.00 3 8"WATERLINE LOWERING 9 EA $1,350.00 $12,150.00 9 $12,150.00 4 TRENCH SAFETY 2969 LF $0.10 $296.90 2969 $296.90 5 DUCTILE IRON WATER FITTINGS 0.513 TN $12,050.00 $6,181.65 0.513 $6,181.65 W/RESTRAINT 6 8"PVC WATER PIPE 2271 LF $32.00 $72,672.00 2271 $72,672.00 7 12"PVC WATER PIPE 698 LF $52.30 $36,505.40 698 $36,505.40 8 FIRE HYDRANT&GATE VALVE 4 EA $3,890.00 $15,560.00 4 $15,560.00 9 CONNECTION TO EXISTING 4"-12"WATER 2 EA $1,700.00 $3,400.00 2 $3,400.00 MAIN 10 V WAER SERVICE 80 EA $850.00 $68,000.00 80 $68,000.00 11 8"GATE VALVE&BOX(CO 2A) 5 EA $1,370.00 $6,850.00 5 $6,850.00 12 12"GATE VALVE&BOX 1 EA $2,500.00 $2,500.00 1 $2,500.00 13 TRAFFIC CONTROL 1 MO $2,700.00 $2,700.00 1 $2,700.00 -------------------------------------- Sub-Total of Previous Unit $268,890.95 $268,890.95 ---------------------------------- UNIT II:SANITARY SEWER IMPROVEMENTS Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total --------------------------------------- 1 UTILITY SERVICE SURFACE RESTORATION 15 SY $10.00 $150.00 15 $150.00 SODDING 2 UTILITY SERVICE SURFACE RESTROATION 814 SY $3.00 $2,442.00 814 $2,442.00 HYDROMULCH 3 POST-CCTV INSPECTION(CO IA) 2667 LS $2.40 $6,400.80 2667 $6,400.80 4 MANHOLE VACUUM TESTING(CO I A) 15 EA $110.00 $1,650.00 15 $1,650.00 5 TRENCH SAFETY(CO IA) 2667 LF $1.00 $2,667.00 2667 $2,667.00 6 4"SEWER SERVICE 68 EA $710.00 $48,280.00 68 $48,280.00 7 8"SEWER MAIN(CO IA) 2667 LF $30.00 $80,010.00 2667 $80,010.00 8 8"SEWER PIPE CSS BACKFILL 200 LF $20.00 $4,000.00 200 $4,000.00 9 EPDXY MANHOLE LINER 47 VF $280.00 $13,160.00 47 $13,160.00 10 4'MANHOLE(CO IA) 14 EA $2,900.00 $40,600.00 14 $40,600.00 11 4'DROP MANHOLE I EA $4,800.00 $4,800.00 1 $4,800.00 Tuesday,November 2,2021 Page 2 of 5 I City Project Numbers 102533 DOE Number 2533 Contract Name CHAPEL CREEK RANCH Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER&SEWER For Period Ending 10/19/2021 Project Funding 12 EXTRA DEPTH MANHOLE(>6.0') 39 VF $150.00 $5,850.00 39 $5,850.00 13 TRAFFIC CONTROL 1 MO $500.00 $500.00 1 $500.00 14 PRESSURE RATED 4"SEWER SERVICE 7 EA $785.00 $5,495.00 7 $5,495.00 -------------------------------------- Sub-Total of Previous Unit $216,004.80 $216,004.80 -------------------------------------- Tuesday,November 2,2021 Page 3 of 5 City Project Numbers 102533 DOE Number 2533 Contract Name CHAPEL CREEK RANCH Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER&SEWER For Period Ending 10/19/2021 Project Funding Contract Information Summary Original Contract Amount $480,415.55 Change Orders Change Order Number IA $3,110.20 Change Order Number 2A $1,370.00 Total Contract Price $484,895.75 Total Cost of Work Completed $484,895.75 Less %Retained $0.00 Net Earned $484,895.75 Earned This Period $484,895.75 Retainage This Period $0.00 Less Liquidated Damages Days @ /Day $0.00 LessPavement Deficiency $0.00 Less Penalty $0.00 Less Previous Payment $0.00 Plus Material on Hand Less 15% $0.00 Balance Due This Payment $484,895.75 Tuesday,November 2,2021 Page 4 of 5 i I I I i I i City Project Numbers 102533 DOE Number 2533 Contract Name CHAPEL CREEK RANCH Estimate Number I Contract Limits Payment Number I Project Type WATER&SEWER For Period Ending 10/19/2021 Project Funding Project Manager NA City Secretary Contract Number Inspectors MILLER,W / TAEZAZ,H Contract Date 7/20/2020 Contractor BURNSCO CONSTRUCTION,INC. Contract Time 60 WD 6331 SOUTHWEST BLVD Days Charged to Date 60 WD FORT WORTH, TX 76132 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 $484,895.75 Less %Retained $0.00 Net Earned $484,895.75 Earned This Period $484,895.75 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 $0.00 Plus Material on Hand Less 15% $0.00 Balance Due This Payment $484,895.75 Tuesday,November 2,2021 Page 5 of 5 DEVELOPER-AWARDED-PROJECT CHANGE ORDER PROJECT NAME: Cha of Crack Ranch (A)Water,Sevier R Storm Drain REVIEWED (B)Paving CHANGE CONTRACT: C Slreot Li hts ORDER No: By D Willhelm at 0:32 am,Dec 17,2020 CFA It 2020-0056 CITY PART(CIPATION:j NO CITY PROJECT It 102533 DOE it NIA 1A FID 0 1301114-0200431-102533-EO7685 FILE tt W-2683&X-26337 INSPECTOR: Hable,Taezas Phone No: 214.223.5635 PROJECT MANAGER: Debbie Willhelm Phone No: 817-392-2401 CONTRACT UNIT WATER SEWER PAVINO DRAINAGE STREETLIGHTS CONTRACT Oov¢lopar D¢Volopor Davolopor DAYS Cost CI Cos. Dovolopor Cost City Cost D¢velo er Cosl Ciry Cosl Cost Clry Cost Cost City Cosl ORIGINAL CONTRACT $267,62D95 S212IS94460 $477,876.01) $203,581.50 $52,521.28 13DWD EXTRAS TO DATE CREDITS TO DATE CONTRACT TO DATE $267,523.95 $0.00 $212,894.60 $0.00 $477,876.00 $0.00 $203,581.50 $0.00 $52.521.28 $0.00 130 WD AMOUNT OF PROP.CHANGE ORDER $$,110.20 p REVISED CONTRACTAMOUNT $267.520.05 $0.00 S2%,004.6D $0.00 $477,876.00 $0.0 $2D3,581.50 1 $0.00 $52,621.28 1 $0.00 130 WD TOTAL REVISED CONTRACT AMOUNT PER UNIT $267.520.05 $216,004.e0 $477,076.00 $203.581.50 $52.21.28 REVISED COST SNARE GOV.Cost: $1,217,504.53 iCIIy CO61: $0.00 TOTAL REVISED CONTRACT $1,217,504.53 ROvlsed:10-12-2011 Pago 1 �I You are directed to make the folloWn than es In the contract documents: UNIT If:SANITARY SEWER IMPROVEMENTS CITY BID ITEM PAY ITEM M QUANTITY UNIT REM DESCRIPTION UNIT PRICE TOTAL 3 3301.0002 3 LF 3301.0002 Post-CCTV Inspection $2.40 $7.20 4 3301.0101 i EA 3301.0101 Manhole Vacuum Testing $110.00 $110.00 5 3305.0109 3 LF 3305.0109 Trench Safety $1.00 $3.00 7 3331.4115 3 LF 3331A116 B'Sewer Mein $30.00 $90.00 f0 3339.1001 1 EA 3339.10014'Manhole, $2,900.00 $2.900.00 TOTAL $3,110.20 REASONS FOR CHANGE ORDER The addition crone SS Manhole Is necessary to re-align SS-3 to connect to the existing B'SS under Chapel Creek Blvd.Changes correspond to Revision 1 as shown on Sheet 18 or the construction plans. NO.CITY FUNDS INVOLVED IN THIS CONTRACT DEVELOPER 18 RESPONSIBLE FOR 100%OF 111E CI IANOE ORDER COST AND NO REIMODUSEMENT FROM THE CITY WILL DE$OIIOHT By THE DEVELOPER, REGO 11 IENDED: APPROVf:O: APPROVED! SMn�ldEnglnoorin9 Croup,PLLC Clar moml Chapel f ,LLC BunWn Con r.11 ,,1 r otfu. By. Namo.—Rgao�H/ill�J—_• Name: I,Islk Men Name. 3gv"Wrrr yXd+r sue, Tale:Vee Presklanl Two: ^7r,MrasM1iaat VP-Land Tpta. L,!^PtpslRanl i Revised:10.12-2011 Page 2 I, I I DEVELOPER-AWARDED-PROJECT CHANGE ORDER I PROJECT NAME_: Chapel Creek Ranch (A)Water,Sewer&Slom1 Drain (6)Paving CHANGE CONTRACT: C Street LI 11ts ORDER No: CFA1t 2020-0056 TICIPATION:1 NO CITY PROJECT 8 102533 -'-"- DOEtt NIA 2A REVIEWED FID 30114-0200431.102533 E07605 By D Wlllhelm at 11:22 am,Mar 22,2021 FILE It W.2683&X-26337 INSPECTOR: 1-fable Taezas Phone No: 214.223.5635 PROJECT MANAGER: Debbie Willhelm Phone No: 817-392-2481 CONTRACT UNIT WATER SEWER PAVINGK$Do0 DRAINAGE STREETLIGHTS CONTRACT Developer Developer Devvloper DAYS Cost .CII C0s1 Devolo er Cast CIIVCost Develo or CaslCost Cil'C051 Cost ,-CllyCoit. ORIGINALCONTRACT $267,620.95 $212.694.60 5477,076.00 $203,681.60 $62,621.28 130 WD EXTRAS TO C ATE $3,110.20 CREDITS TO DATE CONTRACT TO DATE $267.620.05 $0,06 $216,004.80 $0.00.. $477,876.00 $203,681.60 ,50,00_... $52,621.20 $0.00 130 WD AMOUNT OF PROP.CHANGE ORDER $070.00 0 REVISED CONTRACT AMOUNT $288,690.95 50.00 S218,004.80 $0.00 $477,076.00 ,.30,00' $203,581.60 $0.00' S62,621.28 $0.00 130 WD TOTAL REVISED CONTRACT AIAOUNT PER UNIT $268,890.95 $210,OOA.80 $477876.00 $203,601.60 $52,621.28 REVISED COST SHARE DOv.Cost: $1,218.874.63 IClty Cast: $0:00 TOTAL REVISED CONTRACT $1,218,874.53 Revisea:10.12.2011 Page 1 III You are directod remake Om following dia2iio.In the contract documents: UNIT 1:WATER IMPROVEMENTS ' CITY AID ITP.AI PAY ITEMtt tt QUANTITY I ITEM DESCRIPTION UNITPRICE I TOTAL 11 3312.3D03 1 EA 3312.30038'Gel.Valve h Box 1 $1.370.00 1 51,370.G0 TOTAL $1 370.00 REASONS FOR CHANGE ORDER Th.addluon of one 8'Gate Valve Is necessary to help connect the proposed 12'valor line to Our existing 8'waledine under We stpolnl Blvd.Changes correspond to Revision 2 as shown on Sheol 9 of the consemcllon plans. , NO CITY FUNDS INVOLVED IN THIS CONTRACT.DEVELOPER 18 RESPONSIBLE FOR 100%OF THE CHANGE ORDER COST AND NO REIMBURSEMENT FROM THE CITY WILL BE SOUGHT BY THE DEVELOPER. RECOMMENDED: APPROVED: APPROVED: Shield Engineering Group,PLLC Clairmont Chapel Cm!),LLC Burnsm Cons a lion Inc. By: s\e"' By: By: e--` Nsme:Ryan 0 Name: Mark Allen Name: Ab Grantees Title:Vice President Title: VP-Lend Title: Vlm President Revised:10-12.2011 Page 2 FORTWORTH TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PROJECT NAME: Chapel Creek Ranch PROJECT NUMBER: 102533 DOE NUMBER: N/A WATER PIPE LAID SIZE TYPE OF PIPE LF 8" PVC 2271 12" Pvc 698 I FIRE HYDRANTS: 4 VALVES(16" OR LARGER) N/A PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: NEW SERVICES: 80(1") COPPER SEWER PIPE LAID SIZE TYPE OF PIPE LF 8" PVC 2667 PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: NEW SERVICES: 68(4") PVC TRANSPORTATION AND PUBLIC WORKS The City of Fort Worth•1000 Throckmorton Street•Fort Worth,TZ 76012-6311 (817)392-7941 •Fax:(817)392-7845 FORT WORTH, TRANSPORTATION AND PUBLIC WORKS October 19, 2021 Burnsco Construction Inc.. 6331 SW Blvd. Benbrook,Texas 76132 RE: Acceptance Letter Project Name: Chapel Creek Ranch Project Type:01,02,04 City Project No.: CPN: 102533 To Whom It May Concern: On October 14, 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 October 19,2021. 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 October 19, 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- 392-2481. Sincerely, T P.fJfJL2 V. U/��L Debbie J.Willhem, Project Manager Cc: Habte Taezaz, Inspector Wade Miller, Inspection Supervisor Ariel Duarte,Senior Inspector Victor Tornero, Program Manager Shield Engineering Group,Consultant Burnsco Construction Inc., Contractor Mark Allen-Clairemont Chapel Creek LLC, Developer File E-Mail: Douglas W.Wiersig, P.E., PhD., Director,TPW Chris Harder, P.E.,Assistant Director,Water Richard Martinez,Assistant Director,TPW Wendy Chi-Babulal,P.E.,Water Marisa Conlin,Traffic Engineering Tony Sholola, P.E.,Water Allen Hall, Superintendent,TPW Richard Zavala, Director, PARD John Robert Carman, P.E., Director, Water David Creek,Assistant Director, PARD Rev.9/15/16 AFFIDAVIT STATE OF TEXAS COUNTY OF TARRANT Before me, the undersigned authority, a notary public in the state and county aforesaid, on this day personally appeared Ab Grantges,Vice President, Of Burnsco Construction, 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; Chapel Creek Ranch - Water, Sewer and Drainage BY J ) Ab Grantg a President Subscribed and sworn before me on this date loth of November, 2021. CESUA CANALES $ `n Notary ID 9131652996 4 My Commission Expirv� Notary Public July 2`�. Z022 Tarrant County, Texas CONSENT OF OWNER ❑ SURETY COMPANY ARCHITECT ❑ CONTRACTOR ❑ TO FINAL PAYMENT SURETY ❑ Conforms with the American Institute of OTHER Architects,AIA Document G707 Bond No 022227305 PROJECT: (name, address)Chapel Creek Ranch-Water, Sanitary Sewer and Dra Fort Worth TX TO (Owner) IMARKALLEN-CLAIRMONTCHAPFLCREEK, LLC ARCHITECT'S PROJECT NO: AND CITY OF FORT WORTH CONTRACT FOR: 5712 Colleyville Blvd.,Suite 223 Chapei Creek Ranch-Water,Sanitary Sewer and Drainage Improvements Colleyv0le TX 76034 CONTRACT DATE: CONTRACTOR: BURNSCO CONSTRUCTION, INC. In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above,the there insert name and address of Surety Company) LIBERTY MUTUAL INSURANCE COMPANY 175 Berkeley Street Boston MA 02116 , SURETY COMPANY on bond of (here insert name and address of CDntractorl BURNSCO CONSTRUCTION, INC. 6331 Southwest Boulevard Benbrook TX 76132 , 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 Mere insert name and address of Owner) MARK ALLEN-CLAIRMONT CHAPEL CREEK, LLC AND CITY OF FORT WORTH 5712 Colleyville Blvd., Suite 223 Colleyville TX 76034 , OWNER, as set forth in the said Surety Company's bond. IN WITNESS, WHEREOF, the Surety Company has hereunto set its hand this 9th day of November,2021 LIBERTY MUTUAL INSURANCE COMPANY Suret Company Attest: A-17k) (Seal): Signature of Authorized Representative Soohinie Hunter Attorney-in-Fact Title __._ NOTE: This form is to be used as a companion document to AfA DOCUMENT G705. CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DFRTS AND CLAIMS, Current Edition ONE PAGE 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. Liberty Liberty Mutual Insurance Company mu'tucR The Ohio Casualty Insurance Company Certificate No: 8205467-022020 SURETY West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS:That The Ohio Casualty Insurance Company is a corporation duty 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, Don E. Cornell;Joshua Saunders,Kelly A.Westbrook;Mikaela Peppers;Ricardo J.Reyna;Robbi Morales;Sophinie Huntcr;Tina McEwan;Tonie Petranek 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,bands,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 23rd day of April 2021 Liberty Mutual Insurance Company X.1NSUpq PNZY HY36, tNsuR4 The Ohio Casualty Insurance Company i�o0.PeToy� a°o�PO�ro�y�+ a��05iPbtaTQyfi WestAmerican Insurance Company 1912 � 0 0 1919 Lui1991 0 f rn>r N r�yy�/;{He �aa y��H x4Mv�'� a� �'s�xNOiAHo•�da 'By. � U C * 1 * t• M • cc ' — ka David M.Carey,Assistant Secretary 0 k`o State of PENNSYLVANIA: ss County of MONTGOMERY o E U ' On this 23rd day of April 2021 before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance e`3 m o 0 ka 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 therein contained by signing on behalf of the corporations by himself as a duly authorized officer. @� c 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. O n 0-0 L {{, '� �''4,, Commonwealth or Pennsylvania-Notary Seal f ,,"� "gt�y fir'? Teresa Pastella r j,Notary Public _ l p Montgomery roomy B �- /J,� L m # /�C[f,( My commission expires March 29.2025 .cU O E @ commission number 1126044 y ID �sd " Member Pennsylvania Associalicn of Motanes Teresa Pasteita,Notary Public Q O �ru 04 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 3 •� Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows: 0CL M ARTICLE IV—OFFICERS:Section 12.Power of Attorney. `° `00 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:8 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 r 2 @ a�i 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 attomey,shall-0100 have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation.When so executed, such CO a) Z0 instruments shall be as binding as if signed by the President and attested to by the Secretary.Any power cr authority granted to any representative or attomey-in-fact under the M 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. 0 n 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 attomeys-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,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.capy of the_Power of Attorney executed by said Companies,is in 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 9th day of November 2021 SNSUR9 �11 INS, 1NSUR AJ GpRPORgr'L JF oRPORQr� VP oRPop,R-p f1912 0 0 1919 1991 `Jy�9ssaµu5 o s By V. or AP d Renee C.Llewellyn,Assistant Secretary y , Y LMS-12873 LMIC CCIC WAIC Multi Go 02f21 O�Liberty Mutual. SURETY TEXAS TEXAS IMPORTANT NOTICE AVISO IMPORTANTE To obtain information or make a complaint: Para obtener informacion o para someter una queja: You may call toll-free for information or to Usted puedc llamar at numero de telefono gratis make a complaint at para informacion o para someter una queja at 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 companies, coberturas, derechos o 1-800-252-3439 quejas at 1-800-252-3439 You may write the Texas Department of Insurance Puede escribir at Departamento de Seguros Consumer Protection (1 I 1-IA) de Texas Consumer Protection (1 I I-1A) P. O. Box 149091 P. O. Box 149091 Austin, TX 78714-9091 Austin, TX 78714-9091 FAX: (512) 490-1007 FAX 9 (512)490-1007 Web: http://www.tdi.texas.gov Web: http://www.tdi.texas.gov E-mail: ConsumerProtection@tdi.texas.gov E-mail: ConsumerProtection&td i.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. primcro. 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-16292 lens