HomeMy WebLinkAboutContract 55050-FP1 FORT WORTH.
TRANSPORTATION AND PUBLIC WORKS
NOTICE OF PROJECT COMPLETION
City Secretary No:_55050 -FP1
Date Received:Mar 7,2022
City Project Ne: 102540
Regarding contract 55050 for HIGHLAND HILLS,MONTICELLO,AND JESSAMINE CONCRETE
REHABILITATION as required by the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as
approved by City Council on 11/17/2020 through M&C 20-0851 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: $ 999,095.00
Amount of Approved Change Orders: $76,200.00 N91,2
Revised Contract Amount: $1,065,295.00
Total Cost Work Completed: $1,062,294.84
Less Deductions:
Liquidated Damages: 0 Days @$650.00/Day
Pavement Deficiencies:
Total Deduction Amount: $0.00
Total Cost Work Completed: $1,065,294.84
Less Previous Payments: $1,012,030.10
Final Payment Due $ 53 264.74
L6LGL &K'Pnc tw
Lauren Prieur(Mar4,202213:38 CST) Mar 4,2022
Recommended for Acceptance Date
Asst. Director, TPW - Capital Delivery
wj(Mar7,202209:1 ST) Mar 7,2022
Accepted Date
Director, TRANSPORTATION AND PUBLIC WORKS DEPARTMENT
Client Department
0cgn67 2441 OAC
Dana Burghdoff(Mar 7,2022 09:51 CST) Mar 7,2022
Asst. City Manager Date
Comments: OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
C-620 Signature Page
Contractor's A L Hcation for Payment Invoice No. 18-Final
To(Owner). City of Fort Worth Invoicing Period(From-To): Invoice Date:
VW2-2n3l22 2232022
P.0 �,W020—����004872 From(Contractor): Remit to(NNot Automatic Deposit):
Number. Makou Inc
Project: 102540 Contractor's CFW Vendor No.:
7000000265
City Secretary Contract 55050 Contra
Number. .Cc:2020 Highland Hills,Monticello and Jessamine Concrete Rehabilitation
Name:
Application For Payment
Change Order Summary
ArDrovod Chan eOrders 1.ORIGINAL CONTRACT PRICE......_.._........................................_.... S $989,095.00
Number Additions Deletions 2.Net change by Change Orden............................................................. S S76,200.00
1 S129,800.00 $81,000.00 3.Current Contract Price(Line lt2)................................................._..... S SI,065,295.00
2 $27,400.00 4.TOTAL COMPLETED AND STORED TO DATE
3 (Progress Estimate,Construction Allowance and Change Orders)....... S $1,065,294.84
4 S.RETAINAGE:
5 a.5.0% X Work Completed..........S
6 b. X Not Used S
7 c.Total Retains a Line 5a+Line 56
8 6.AMOUNT ELIGIBLE TO DATE(Line 4-Line 5c)............................. S SI,065,294.84
TOTALS $157,200.00 $81,000.00 7,LESS PREVIOUS PAYMENTS(Line 6 from prior Application)........5 S1,012.030.10
NEf CHANGEBY $76,200.00 S.AMOUNT DUE THIS APPLICATION................................................. S S53,264.74
CHANGE ORDERS 9.BALANCE TO FINISH,PLUS RETAINAGE
(Column G an Progress Estimate+•CA+Cos+Line 5 above)..............S S0.16
Contractor's Certification 10.CONTRACT TIME:
The Contractor certifies with the submittal of this document and associated Payment Request Submittal a. Days Awarded 230
on Ore City of Fort Worth Buzzsaw system that to the best of their knowledge;(1)all previous progress b, Days Added by CO 30
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 a Total Days 260
prior Applications for Payment;(2)tide of all 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 ofpaymeot d. Days Charged 260
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); a Days Remaining
and(3)all Work covered by this Application for Payment is in accordance with the Contract Documents
and is not defective.
Liquid Damages S650.00 x day
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magso d khan(Mar3,2022 14:59 CST)
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CSC No.55050-COI
FORT WORTH, City of Fort Worth
Change Order Request
Project Name Highland Hills,Monticello and Jessamine St City Sec# 55050
Client Project#(s) 102540
Project The repair and reconstruction of failed sidewalks,curbs&gutter,ramps and driveways
Description
Contractor Makou Inc Change Order# 1 Date 51512021
City Project Mgr. Salman Shahid City Inspector F Rodney Beecham
Contract Time
Dept. TPW Totals CD
Original Contract Amount $989,095.00 989,095.00 230
Extras to Date
Credits to Date
Pending Change Orders(in M&C Process)
Contract Cost to Date $989,095.00 $989,095.00 230
Amount of Proposed Change Order 48,800.00 $48,800.00 0
Revised Contract Amount $1,037,895.00 $1,037,895.00 230
Original Funds Available for Change Orders $0.00
Remaining Funds Available for this CO $0.00
Additional Funding(if necessary) $48,800.00 $48,800.00
CHANGE ORDERS to DATE(INCLUDING THIS ONE)AS%OF ORIGINAL CONTRACT 4.93%
MAX ALLOWABLE CONTRACT AMOUNT(ORIGINAL CONTRACT COST+25%) $1,236,368.75
JUSTIFICATION(REASONS)FOR CHANGE ORDER
This change order is to add an additional$48,800.00 to the construction contract 55050 with revised contract amount of$1,037,895.00.Project has available funds required
for this change order through the General Capital Project fund and does not need additional funding.
To match the existing curb and gutter on the project site,the 18"gutter with 7"curb needs to be revised to 24"a gutter with 7"curb.Also,some gutters and ramps need an
additional asphalt transition due to several cracking in the existing pavement.
It is understood and agreed that the acceptance of this Change Order by the contractor constitutes an accord and satisfaction and represents payment in
full(both time and money)for all costs arising out of,or incidental to,the above Change Order. The Project/Program Manager signing below
acknowledges that he/she is the person responsible for the monitoring and administration of this contract,including ensuring all performance and
reporting requirements.
Contractor's Company Name Contractor Name Contract Signature Date
A110 000V141y
Makou Inc Maqsood Khan May 11,2021
Inspector/inspection Supervisor Date Project Mana erlPro ram Manager Date
Assistant Director(Dept) May Date021 Director,Contrac '_ ""'�'����"�� May 12,2021
12, TDP
( tin Department(Dept) Date
:,_,,,7", May 12,2021 i , May 12,2021
Assistant City Attorney Date Assistant City Manager Date
May 13,2021 May 13,2021
Council Action if required
M&C Number M&C Date Approved 10/ 88/ 0014
ATTEST:
Mary J.Kayser,City Secretary
City of Fort Worth
Change Order Additions
Project Name I Highland Hills,Monticello and Jessamine St City Sec# 55050
Client Project# 1 102540
Contractorl Makou Inc PM1 Selman Shahid Inspector) Rodney Beecham
Change Order Submittal# O1 Dale 51512021
ADDITIONS
Unit Unit Cost Total
ew oncre e ur)&24"(3ulter F
ev) Asphalt Transition TPW 200.00000000 ton $187.00 e,
TPW 129,800.00
Sub TotalAdditions $129,800.00
Change Order Additions Page 2 of 4
FrntrII City of Fort Worth
Change Order Deletions
Project Name I Highland Hills,Monticello and Jessamine St City Sec# 55050
Client Project# 102540
Contractor Makou Inc PM Selman Shahid Inspector Rodney Beecham
Change Order Submittal# O1 Date 515f2021
DELETIONS
Unit unit cost ola
Concrete u u er -oi
TPW 81,000.00
Sub Total e e ons
Change Order Deletions Page 3 of 4
MISBE for this Change Order
MISBE Sub Type of Service Amount for this CO
Total $0.00
Previous Change Orders
CO# DATE AMOUNT
Total $0.00
C
FORTWORTH
Routing and Transmittal Slip
Transportation and Public Works
Department
DOCUMENT TITLE: Change Order# 2 — Highland Hills, Monticello and Jessamine St
M&C 21-0896 CPN: 102540 CSO # 55050 DOC# CO#2
Date: 0110512022 FM Department Initials Date Out
To: Makou Inc Jan 7 2022
1. Magsood Khan (Contractor) makouinc@gmaii.com mk
2. Curtis Hollingsworth (Inspector) TPW-Signature X Jan 7,2022
3. Iretomiwa Otuyelu (PM) TPW-Signature Jan 6,2022
4. Riad Nursallah (PgM) TPW-Reviewer - Jan 9,2022
5. Lane Zarate (Sr CPO) TPW-Reviewer cZ_ Jan 13,2022
6. Lauren Prieur AD TPW-Signature 4e Jan 14,2022
7. William Johnson Director TPW-Signature Jan 14,2022
8. Doug Black (ACA) LAW-Signature — Jan 14,2022
9. Dana Burghdoff(ACM) CMO-Signature — Jan14,2022
10. Jannette Goodall CSO-Signature Jan 18,2022
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 next 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 Required:
❑ As Requested ❑ Attach Signature, Initial and Notary Tabs
❑ For Your Information
X Signature/Routing and or Recording
❑ Comment
❑ File
Return to: Please call Iretomiwa Otuyelu at ext. for pick up when completed. Thank you.
CSC No.55050-0O2
FOR__T WORTH:: City of Fort Worth
Change Order Request
Project Name Highland Hills,Monticello and Jessamine St City Sec# 55050
Client Project#(s) 102540
Project Description The repair and reconstruction of failed sidewalks,curbs&gutter,ramps and driveways
Contracto Makou Inc Change Order# 2 Date 12/17/2021
City Project Mgr. Iretomiwa Otuyelu City Inspector Curtis Hollingsworth
Dept. TPW Contract Time
Totals (CD)
Original Contract Amount $989,095.00 $989,095.00 230
Extras to Date $48,800.00 $48,800.00
Credits to Date
Pending Change Orders(in M&C Process)
Contract Cost to Date $1,037,895.00 $1,037,895.00 230
Amount of Proposed Change Order $27,400.00 $27,400.00 30
Revised Contract Amount $1,065,295.00 $1,065,295.00 260
Original Funds Available for Change Orders $0.00
Remaining Funds Available for this CO $0.00
Additional Funding(if necessary) $27,400.00 $27,400.00
CHANGE ORDERS to DATE(INCLUDING THIS ONE)AS%OF ORIGINAL CONTRACT 7.70%
MAX ALLOWABLE CONTRACT AMOUNT(ORIGINAL CONTRACT COST+25%) $1,236,368.75
JUSTIFICATION(REASONS)FOR CHANGE ORDER
This change order is to add an additional$27,400.00 to the construction contract 55050 with revised contract amount of$1,065,295.00.Project has available funds required
p for this change order through the General Capital Project fund and does not need additional funding.
It was found during the final stage of project that the actual quantaties of Miscellaneous utility adjustments,Driveways and SOD replacement were more than originally
estimated
I
It is understood and agreed that the acceptance of this Change Order by the contractor constitutes an accord and satisfaction and represents payment in
full(both time and money)for all costs arising out of,or incidental to,the above Change Order. The Project/Program Manager signing below
acknowledges that he/she is the person responsible for the monitoring and administration of this contract,including ensuring all performance and
reporting requirements.
Contractor's Company Name Contractor(Name) Contract Signature Date
Makou Inc Maqsood Khan Jan 7,2022
InspectorAnspection Supervisor Date Project and Contract Compliance Manager Date
Jan 7,2022 Jan 6,2022
Program Manager Date Senior Capital Project Officer Date
Jan 9,2022 Jan 13,2022
Assistant Director(Dept) Dale Director,Contracting Department(Dept) Date
Jan 14,2022 _ Jan 14,2022
Assistant City Attorney Date Assistant City Manager Date
8 Jan 14,202281141644� Jan 14,2022
Council Action(if required)
M&C Number M&C Date Approved F—
ATTEST:
etic 5.G-d,j(Jan 18,202209' CST(
Jannette Goodall,City Secretary
FORT WORTH City of Fort Worth
-SIT-- Change Order Additions
Project Name Highland Hills,Monticello and Jessamine St City Sec# 55050
Client Project 102540
Contractor Makou Inc PMJ Iretomiwa Oluyelu Inspector Curtis Hollingsworth
Change Order Submittal# 0 Date 12I17I2021
ADDITIONS
ty Unit Unit Cost I ota
isce aneous Adjustments ti Nes
5 02 .0401 Remove ncrele Driveway TP 680.00000000 SF 2.25
6 3213.0401 6"Concrete Driveway TPW 680.00000000 SF $7.73
24 3217.0100 Curb Address Painting TPW 100.00000000 EA 50.00 5,
25 3292,0100 Block Sod Replacement TPW 700.00000000 SY 8.00
I
TPW 27,400.00
u otal Additions $27,400.00
Change Order Additions Page 2 of 5
Poe�H City of Fort Worth
Change Order Deletions
Project Name Highland Hills,Monticello and Jessamine St City Sec# 55050
Client Project# 102540
Contractorl Makou Inc PMJ Iretomhva Otuyelu Inspector Cu tis Hollingswo th
Change Order Submittal# 0 Date 1 211 712 0 2 1
DELETION5
ty Unit Cost lotal
TPW 0.00
uTotal Deletions
Change Order Deletions Page 3 of 5
MISBE for this Change Order
MISBE Sub Type of Service Amount for this CO
Total $0.00
Previous Change Orders
co# DATE AMOUNT
Total $0.00
FORTWORTH.
TRANSPORTATION AND PUBLIC WORKS
March 1, 2022
Makou inc.
7100 S Cooper St. STE 15
Arlington TX, 76001
RE: Acceptance Letter
Project Name: Highland Hills, Monticello, and Jessamine Concrete Rehabilitation
Project Type: Paving
City Project No.: 102540
To Whom It May Concern:
On February 2, 2022 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 March 1, 2022. 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 March 1, 2022, 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 682-
331-6747.
Sincerely,
Iretomiwa Otuyelu, Project Manager
Cc: Curtis Hollingsworth, Inspector
Mark Owen, Inspection Supervisor
Edwin R. Rodriguez, Sr.,Senior Inspector
Marry Hanna, P.E., Program Manager
City of Fort Worth, Consultant
Makou Inc., Contractor
City of Fort Worth, Developer
File
E-Mail: TPW_Acceptance@fortworthtexas.gov
Rev.8/20/19
BOND#: 1021772
CONSENT OF SURETY OWNER
TO FINAL PAYMENT ARCHITECT ❑
❑
AIA Document G707 CONTRACTORSURETY ❑
(Instructions on reverse side) OTHER ❑
TO OWNER: ARCHITECT'S PROJECT NO.:
(Nam,and add,,,,)
City of Fort Worth
CONTRACT FOR:
PROJECT: CONTRACT DATED: November 17,2020
(Name and address)
2020 Highland hills,Monticello and Jessamine Concrete Rehabilitation Project
City Project No. 102540
In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above,the
(Insert name and address of Surety)
Oklahoma Surety Company
1437 South Boulder,Suite 200
Tulsa,OK 74119
,SURETY,
on bond of
(/usen nam and address afC'nnrrwrrnr)
Makou, Inc.
6204 Parkside Dr.
Arlington,TX 76001
,CONTRACTOR,
hereby approves of the final payment to the Contractor,and agrees that final payment to the Contractor shall not relieve the Surety of
any of its obligations to
(1—err name and uddr,ss?fO wrr)
City of Fort Worth
OWNER,
as set forth in said Surety's bond,
IN WITNESS WHEREOF,the Surety has hereunto set its hand on this date: February 17, 2022
(lusort in—icing the mmndi/ollaucd h,the mtrnerlc dare and, ,)
Oklahoma Surety Company
(Str,0
I",,- "I
(Srbnmrnrc nfmn,nri_ed represenlunrr)
Attesaac, 4&
(Seal): Angie tran Brent M.Blonigan, Attorney-in-fact
(Primed name and ride)
CAUTION: You should sign an original AIA document that has this caution printed in red.An
original assures that changes will not be obscured as may occur when documents are reproduced.
See Instruction Sheet for Limited License for Reproduction of this document.
AIA DOCUMENT 0707-CONSENT OF SURETY To FINAL PAYMENT.1994 EDITION-AIA Page I of 2
1994-THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVFNUF.NW.WASH-
INGTON.D.C.20006.5292-WARNING:Unlicensed photocopying violates U.S.copy- G7(17-�994
right laws and will subject the violator to legal prosecution.
INSTRUCTION SHEET
FOR AIA DOCUMENT G707,CONSENT OF SURETY TO FINAL PAYMENT
A.GENERAL INFORMATION
1.Purpose
This document is intended for use as a companion to AIA Document G706,Contractor's Affidavit of Payment of Debts and
Claims,on construction projects where the Contractor is required to famish a bond. By obtaining the Surety's approval of final
payment to the Contractor and its agreement that final payment will not relieve the Surety of any of its obligations,the Owner
may preserve its rights tinder the bond.
2.Related Documents
This document may be used with most of the AIA's Owner-Contractor agreements and general conditions,such as A201 and its
related family of documents.As noted above,this is a companion document to AIA Document G706.
3.Use of Current Documents
Prior to using any AIA docutent,the user should consult the AIA,an AIA component chapter or a current AIA Documents List to
determine the current edition of each document.
4.Limited License for Reproduction
AIA Document G707 is a copyrighted work and may not be reproduced or excerpted from in substantial part without the express
written permission of the AIA. The G707 document is intended to be used as a consumable-that is,the original document pur-
chased by the user is intended to be consumed in the course of being used. There is no implied permission to reproduce this
document,nor does membership in The American Institute of Architects confer any ffirther rights to reproduce G707.
A cautionary notice is printed in red on the original of this document. This notice distinguishes an original AIA document from
copies and counterfeits. To ensure accuracy and uniformity of language,purchasers should use only an original AIA document or
one that has been reproduced from an original under a special limited license from the AIA.
A limited license is hereby granted to retail purchasers to reproduce a maximum often copies of a completed or executed G707,but
only for use in connection with a particular project. Further reproductions are prohibited without the express permission of the AIA.
B.CHANGES FROM THE PREVIOUS EDITION
Changes in the location of various items of information were made,without revision to the substance of the document.
C.COMPLETING THE G707 FORM
GENERAL: The bond form is the usual source of required information such as the contract date and the names and addresses of the
Surety,Owner,Contractor and Project.
ARCHITECT'S PROJECT NO.: this information is typically supplied by the Architect and entered on the form by the Contractor.
CONTRACT FOR: This refers to the scope of the contract,such as"General Construction"or"Mechanical Work".
D. EXECUTION OF THE DOCUMENT
The G707 form requires both the Surety's seal and the signature of the Surety's authorized representative.
4194
INSTRUCTION SHEET FOR AIA DOCUMENT G707 CONSENT OF SURETY TO FINAL PAYMENT 1994 Page 2 of 2
EDITION AIAR' THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVENUE,N.W.,
WASHINGTON,D.C.20006-5292 G707-1994
OKLAHOMA SURETY COMPANY
1437 South Boulder,Suite 200,Tulsa, Oklahoma 74119 • Ph: 918-587-7221 - Fax: 918-588-1296
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That the Oklahoma Surety Company,a corporation organized and existing under and
by virtue of the laws of the State of Ohio,does hereby nominate,constitute and appoint the person or persons named below,each individually if
more than one is named,its true and lawful attorney-in-fact,for it and in its name,place and stead to execute on behalf of the said Company,as
surety,any and all bonds,undertakings and contracts of suretyship,or other written obligations in the nature thereof. Brent M.Blonigan,Raul
F.Campa, Rob Dreiling,Debbie Palmer,Kara Pierce,all of RICHARDSON,TX.
IN WITNESS WHEREOF,the Oklahoma Surety Company has caused these presents to be signed and attested by
its appropriate officers and its corporate seal hereunto affixed this 20 day of September,2021.
;`o?4owroa��r Ci:
=Y: SEAL
oHio; OKLAHOMA SURETY COMPANY
ATTEST:
it L,4.-( �� I
Sharon Hackl,Assistant Secretary Todd Bazata,Vice President
On this 20 day of September,2021 before me personally appeared Todd Bazata,to me known,being duly swom,deposes and
says that s/he resides in Broken Arrow,Oklahoma,that s/he is a Vice President of Oklahoma Surety Company,the company described in and
which executed the above instrument;that s/he knows the seal of the said Company;that the seal affixed to the said instrument is such
corporate seal;that it was so affixed by authority of her/his office under the By-Laws of said Company,and that s/he signed his name thereto by
like authority.
No PuOgo Commission# 11008253
STATE OF OKLAHOMA State of Oklahoma
SS J TULSA COUP N My Commission Expires: 09-08-23
COfAMI ION O11008tSf
COUNTY OF TULSA Comm,to ,oa oe zass
Julie Callahan,Notary Public
This Power of Attorney is granted by authority of the following resolutions adopted by the Board of Directors of Oklahoma Surety
Company by unanimous written consent dated September 25,2009.
RESOLVED: That the President,the Executive Vice President,the several Senior Vice Presidents and Vice Presidents or any one of
them,be and hereby is authorized,from time to time,to appoint one or more Attorneys-in-Fact to execute on behalf of the Company,as surety,
any and all bonds,undertakings and contracts of suretyship,or other written obligations in the nature thereof;to prescribe their respective duties
and the respective limits of their authority;and to revoke any such appointment at any time.
RESOLVED FURTHER: That the Company seal and the signature of any of the aforesaid officers and any Secretary or Assistant
Secretary of the Company may be affixed by facsimile to any power of attorney or certificate of either given for the execution of any bond,
undertaking,contract of suretyship,or other written obligation in the nature thereof,such signature and seal when so used being hereby adopted
by the Company as the original signature of such officer and the original seal of the Company,to be valid and binding upon the Company with
the same force and effect as though manually affixed.
CERTIFICATION
I,Sharon Hackl,Assistant Secretary of Oklahoma Surety Company,do hereby certify that the foregoing Power of Attorney and
the Resolutions of the Board of Directors of September 25,2009 have not been revoked and are now in full force and effect.
"I"SU.HErk
=O.40P�OR�lF:L
=Y SEAL
Signed and sealed this I day of
Sharon Hacki,Assistant Secretary
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MID-CONTINENT GROUP Surety Bond Seal Addendum
Mid-Continent Casualty I Oklahoma Surety
Oklahoma Surety Company
During the COVID-19 pandemic, the use of traditional raised corporate seals has
been made impractical due to government stay-at-home orders and social
distancing guidelines. As a result, Oklahoma Surety Company has authorized its
Attorneys-in-Fact to affix Oklahoma Surety Company's corporate seal to any bond
or related instruments executed on behalf of Oklahoma Surety Company by any
such Attorney-in-Fact by attaching this Addendum to said bond or related
instrument.
To the extent this Addendum is attached to a bond or related instrument that is
executed on behalf of Oklahoma Surety Company by its Attorney-in-Fact,
Oklahoma Surety Company agrees that the seal below shall be deemed affixed to
said bond or related instrument to the same extent as if its raised corporate seal
were physically affixed to the face of the bond or related instrument.
Dated this 111 day of April, 2020
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OHIO
'rOA1111110
By. 07M 'b WZ,a)m
Todd Bazata
Vice President
I
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 MAQSOOD
KHAN, PRICIPAL Of MAKOU 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;
2020 HIGHLAND HILLS,MONTECILLO AND JESSAMINE
CONCRETE REHABALITION
BY
AfAQSOOD KHAN PRINCIPAL
Subscribed and sworn before me on this date 17 of FEB., 2022.
Notary Public
TARRANT, TX
ROMELIA AGU-€RRE-CRUZ
qP Ud
Notary Public, State of Texas
Comm. Expires 08-09-2022
Notary ID 729905744
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