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Contract 56235-FP2
City Secretary 56235 -FP2 Contract No. FORTWORTH. Date Received Jul 13,2022 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: North Cowtown Crossing Horseman Road City Project No.: 103284 Improvement Type(s): Water ❑x Sewer ❑ Original Contract Price: $13,300.00 Amount of Approved Change Order(s): Revised Contract Amount: Total Cost of Work Complete: $13,300.00 Jul 11 , 2022 Carmen Estep(Jul 11,202214:08 Q T) Contractor Date Office Manager Title Jackson Construction, Ltd Company Name 2Z2 Jul 11 , 2022 Gary Oeyon(Jul 11,2022 15:33 CDT) Project Inspector Date Jul 11 , 2022 Project Manager Date s"4n�_mor`L-s- Jul 12 2022 Janie Scarlett Morales(Jul 12,2022 10:43 CDT) CFA Manager Date Oana doAc Jul 12 2022 Dana Burghdoff�ul 12,2022 10:47 CDT) Asst. City Manager Date OFFICIAL RECORD CITY SECRETARY Page 1 of 2 FT. WORTH, TX Notice of Project Completion Project Name: North Cowtown Crossing Horseman Road City Project No.: 103284 City's Attachments Final Pay Estimate ❑x Change Order(s): ❑ Yes ❑x N/A Pipe Report: ❑ Yes ❑x N/A Contractor's Attachments Affidavit of Bills Paid Consent of Surety Statement of Contract Time Contract Time: 50 WD Days Charged: 86 Work Start Date: 1/6/2022 Work Complete Date: 5/19/2022 Completed number of Soil Lab Test: 141 Completed number of Water Test: 0 Page 2 of 2 FORT WORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name NORTH COWTOWN CROSSING HORSEMAN ROAD Contract Limits Project Type WATER IMPROVEMENT City Project Numbers 103284 DOE Number 3284 Estimate Number 1 Payment Number 1 For Period Ending 6/30/2022 WD City Secretary Contract Number Contract Time 5WD Contract Date 9/10/2021 Days Charged to Date 86 Project Manager NA Contract is 100.00 Complete Contractor JACKSON CONSTRUCTION LTD 5112 SUN VALLEY DRIVE FORT WORTH, TX 76119 Inspectors CORDOVA,R / MCDONALD,B Wednesday,July 6,2022 Page 1 of 4 City Project Numbers 103284 DOE Number 3284 Contract Name NORTH COWTOWN CROSSING HORSEMAN ROAD Estimate Number I Contract Limits Payment Number I Project Type WATER IMPROVEMENT For Period Ending 6/30/2022 Project Funding UNIT L•WATER IMPROVEMENTS Item Estimated Estimated Completed Completed Description of Items Unit Unit Cost No. Quanity Total Quanity Total --------------------------------------- 1 CATHODIC PROTECTION TEST STATION 1 EA $2,800.00 $2,800.00 1 $2,800.00 ADJUSTMENT 2 MANHOLE ADJUSTMENT MAJOR W/COVER 1 EA $4,000.00 $4,000.00 1 $4,000.00 3 VENT PIPING AND VENT FOR EX AIR RELEASE 1 EA $6,500.00 $6,500.00 1 $6,500.00 --------------------------------------- Sub-Total of Previous Unit $13,300.00 $13,300.00 -------------------------------------- Wednesday,July 6,2022 Page 2 of 4 City Project Numbers 103284 DOE Number 3284 Contract Name NORTH COWTOWN CROSSING HORSEMAN ROAD Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER IMPROVEMENT For Period Ending 6/30/2022 Project Funding Contract Information Summary Original Contract Amount $13,300.00 Change Orders Total Contract Price $13,300.00 Total Cost of Work Completed $13,300.00 Less %Retained $0.00 Net Earned $13,300.00 Earned This Period $13,300.00 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 $13,300.00 Wednesday,July 6,2022 Page 3 of 4 City Project Numbers 103284 DOE Number 3284 Contract Name NORTH COWTOWN CROSSING HORSEMAN ROAD Estimate Number I Contract Limits Payment Number 1 Project Type WATER IMPROVEMENT For Period Ending 6/30/2022 Project Funding Project Manager NA City Secretary Contract Number Inspectors CORDOVA,R / MCDONALD,B Contract Date 9/10/2021 Contractor JACKSON CONSTRUCTION LTD Contract Time 50 WD 5112 SUN VALLEY DRIVE Days Charged to Date 86 WD FORT WORTH, TX 76119 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 $13,300.00 Less %Retained $0.00 Net Earned $13,300.00 Earned This Period $13,300.00 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 $13,300.00 Wednesday,July 6,2022 Page 4 of 4 FO RT WO RT H�,� TRANSPORTATION AND PUBLIC WORKS June 28, 2022 Jackson Construction 5112 Sun Valley Dr. Fort Worth,TX.76119 RE: Acceptance Letter Project Name: North Cowtown Crossing Horseman Rd. Project Type: Developer City Project No.: 103284 To Whom It May Concern: On May 20, 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 June 28, 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 June 28, 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 817- 392-2481. Sincerely, 7J¢�6ai�. U/ ri Debbie Willhelm, Project Manager Cc: Byron McDonald, Inspector Ron Cordova, Inspection Supervisor Edward Davila,Senior Inspector Victor Tornero, Program Manager Spiars Engineering&Surveying, Consultant Jackson Construction,Contractor Ojala Partners, LP, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev.8/20/19 8JACKSON CONSTRUCTION LTD. 51 12 SUN VALLEY DRIVE FORT WORTH,TX 76119 TEL:817-572-3303 FAX:817-478-0443 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 Troy L. Jackson, President Of Jackson Construction, Ltd, 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; North Cowtown Crossing Horseman Road ,----7 BY Troy / Jackson, President Subscribed and sworn before me on this date 6th of July, 2022. Notary Public Tarrant, Texas CARMEN L. ESTEP Notary Public,State of Texas 6 '�� Comm.Expires 04 OF -0&2024 h`�. �p,m Notary ID 2910611 CONSENT OF OWNER Ci SURETY COMPANY ARCHITECT L_l CONTRACTOR TO FINAL PAYMENT SURETY f OTHER G AIA DOCUMENT G707 Bond No. 1086155 PROJECT: (name,address) TO(Owner) F ARCHITECT'S PROJECT NO: City of Fort Worth/Skyline Prairie Homes,LP(Developer) CONTRACT FOR:North Cowtown Crossing Horseman Road. City 200 Texas Street Project No. 103284; Water&Sewer Improvements. Fort Worth, TX 76102 I CONTRACT DATE:September 10, 2021 LJ CONTRACTOR: Jackson Construction, Ltd. 5112 Sun Valley Drive Fort Worth, TX 76119 In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the (here insert name and address of Surety Company) The Hanover Insurance Company 440 Lincoln Street,Worcester, MA 01653 SURETY COMPANY, On bond Of(here Insert name and address of Contractor) Jackson Construction, Ltd. 5112 Sun Valley Drive Fort Worth, TX 76119 ,CONTRACTOR, hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve the Surety Company of any of its obligations to(here insert name and address of owner) City of Fort Worth/Skyline Prairie Homes, LP (Developer) 200 Texas Street Fort Worth, TX 76102 OWNERS, as set forth in the said Surety Company's bond. IN WITNESS WHEREOF, the Surety Company has hereunto set its hand this 19th day of May, 2022 The Hanover Insurance Companyr ____ 5 ompany Sig Att ns ure of Authorized Representative t: ^ (Seal) Teuta Luri,Attorney-in-Fact Title NOTE: orm is to be used as a companion document to AIA DOCUMENT G706,CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS,Current Edition AIA DOCUMENT G707•CONSENT OF SURETY COMPANY TO FINAL PAYMENT•APRIL 1970 EDITION•AIA® ONE PAGE ©1970-THE AMERICAN INSTITUTE OF ARCHITECTS.1735 NEW YORK AVE.,NW,WASHINGTON,D.C.20006 THE HANOVER INSURANCE COMPANY MASSACHUSETTS BAY INSURANCE COMPANY CITIZENS INSURANCE COMPANY OF AMERICA POWER OF A MRNEY 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. KNOW ALL PERSONS BY THESE PRESENTS: That THE HANOVER INSURANCE COMPANY and MASSACHUSETTS BAY INSURANCE COMPANY,both being corporations organized and existing under the laws of the State of New Hampshire,and CITIZENS INSURANCE COMPANY OF AMERICA,a corporation organized and existing under the laws of the State of Michigan,(hereinafter individually and collectively the"Company")does hereby constitute and appoint, Steven R.Foster,Jack M.Crowley,Laurie Pflug,and Teuta Luri Of Willis Towers Watson Insurance Services West,Inc of Dallas,TX each individually,if there be more than one named,as its true and lawful attomey(s)-in- fact to sign,execute,seal,acknowledge and deliver for,and on its behalf,and as its act and deed any place within the United States,any and all surety bonds, recognizances,undertakings,or other surety obligations.The execution of such surety bonds,recognizances,undertakings or surety obligations,in pursuance of these presents,shall be as binding upon the Company as if they had been duly signed by the president and attested by the secretary of the Company,in their own proper persons.Provided however,that this power of attorney limits the acts of those named herein;and they have no authority to bind the Company except in the manner stated and to the extent of any limitation stated below: Any such obligations in the United States,not to exceed Thirty Five Million and Noll 00($35,000,000)in any single instance That this power is made and executed pursuant to the authority of the following Resolutions passed by the Board of Directors of said Company,and said Resolutions remain in full force and effect: RESOLVED: That the President or any Vice President,in conjuraction with any Vice President,be and they hereby are authorized and empowered to appoint Attorneys-in-fact of the Company,in its name and as it acts,to execute and acknowledge for and on its behalf as surety,any and all bonds, recognizances,contracts of indemnity,waivers of citation and all other writings obligatory in the nature thereof,with powerto attach thereto the seal ofthe Company.Any such writings so executed by such Attorneys-in-fact shall be binding upon the Company as if they had been duly executed and acknowledged by the regularly elected officers of the Company in their own proper persons. RESOLVED:That any and all Powers of Attorney and Certified Copies of such Powers of Attorney and certification in respect thereto,granted and executed by the President or Vice President in conjunction with any Vice President of the Company,shall be binding on the Companyto the same extent as if all signatures therein were manually affixed,even though one or more of any such signatures thereon may be facsimile.(Adopted October 7,1981— The Hanover Insurance Company;Adopted April 14,1982—Massachusetts Bay Insurance Company;Adopted September 7,2001—Citizens Insurance Company of America and affirmed by each Company on March 24,2014) IN WITNESS WHEREOF,THE HANOVER INSURANCE COMPANY,MASSACHUSETTS BAY INSURANCE COMPANY and CITIZENS INSURANCE COMPANY OF AMERICA have caused these presents to be sealed with their respective corporate seals,duly attested by two Vice Presidents,this 101'day of January,2020. THE HANOVER INSUR6KE COMPANY THE HANOVER INSURANCE COMPANY MASSACHUSETTS ICY 14SURANCE COMPANY MASSACHUSETTS BAY INSURANCE COMPANY CITIZENS INSURA E C MPANY OF AMERICA CITIZENS INSURANCE COMPANY OF AMERICA f3rysn J Vice President J e H.Kaw4cki,Vice President THE COMMONWEALTH OF MASSACHUSETTS } COUNTY OF WORCESTER )ss. On this 101t' day of January,2020 before me came the above named Executive Vice President and Vice President of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America,to me personally known to be the individusisand offiMrs described herein, and acknowledged that the seals affixed to the preceding instrument are the corporate seals of The Hanover Insurance Company,Massachusetts Bay Insurance Company and Citizens Insurance Company of America,re spa clively,and that the said corporate seals and their signatures as officers were duly affixed and subscribed to said instrument by the authority and direction of said Corporations. ARLEEN V. SIMONS NALTH Public fff E M�TH s xpires,TS Areen V•Simons,Notary u Ic My Commission Fxpires ov June ts, zo23 My Commission Expires June 15,2023 -1 I,the undersigned Vice President of The Hanover Insurance Company,Massachusetts Bay Insurance Company and Citizens Insurance Company of America, hereby cerlify that the above and foregoing is a full,true and correctcopy ofthe Original Power of Attorney issued by said Companies,and do herebyfurther certify that the said Powers of Attorney are still in force and effect. GIVEN under my hand and the seals of said Companies,at Worcester,Massachusetts,this 19th day of May,2022 THE HANOVER INSURANCE COMPANY CERTIFIED COPY MA ACHUSETTS BAY INSURANCE COMPANY CI I NSIN3iJ C�COMPANYOFAMERICA L Carrick A.Blillgh, ident �1L' 4 Ha4 nauer The Hanover Insurance Company 1 440 Lincoln Street Worcester,MA 01653 Insurance Grau Citizens Insurance Company of America 1 645 West Grand River Avenue,Howell,MI 48843 Texas Complaint Notice IMPORTANT NOTICE AVISO IMPORTANTE To obtain information or make a complaint: Para obtener informacion o para someter una queja: You may call The Hanover Insurance Company/Citizens Usted puede Ilamar al numero de telefono gratis de The Insurance Company of America's toll-free telephone Hanover Insurance Company/Citizens Insurance Company number for information or to make a complaint at: of America's para informacion o para someter una queja al: 1-800-608-8141 1-800-608-8141 You may also write to The Hanover Insurance Company/ Usted tambien puede escribir a The Hanover Insurance Citizens Insurance Company of America at: Company/Citizens Insurance Company of America al: 440 Lincoln Street 440 Lincoln Street Worcester, MA 01615 Worcester, MA 01615 You may contact the Texas Department of Insurance to Puede comunicarse con el Departamento de Seguros de obtain information on companies, coverages, rights or Texas para obtener informacion acerca de companias, complaints at: coberturas, derechos o quejas al: 1-800-252-3439 1-800-252-3439 You may write the Texas Department of Insurance: Puede escribir al Departamento de Seguros de Texas: P. O. Box 149104 P. O. Box 149104 Austin, TX 78714-9104 Austin, TX 78714-9104 Fax: (512) 475-1771 Fax: (512) 475-1771 Web: http://www.tdi.texas.gov Web: http://www.tdi.texas.gov E-mail: ConsumerProtection@tdi.state.tx.us E-mail: ConsumerProtection@tdi.state.tx.us PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS O RECLAMOS: Should you have a dispute concerning your premium or Si tiene una disputa concerniente a su prima o a un rec- about a claim you should contact the agent or the com- lamo, debe comunicarse con el agente o la compania pany first. If the dispute is not resolved, you may contact primero. Si no se resuelve la disputa, puede entonces the Texas Department of Insurance. comunicarse con el departamento (fDI). ATTACH THIS NOTICE TO YOUR POLICY: This notice is UNA ESTE AVISO A SU POLIZA: Este aviso es solo para for information only and does not become a part or con- proposito de informacion y no se convierte en parte o dition of the attached document. condicion del documento adjunto. 161-1457(5112)