HomeMy WebLinkAboutContract 57401-FP3FORT WORTH
City Secretary 57401 -FP3
Contract No.
Date Received 3/7/2023
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: Northstar Parkway Section 4, Phase 3
City Project No.: 103495
Improvement Type(s): 0 Paving ❑ Drainage
Original Contract Price:
Amount of Approved Change Order(s):
Revised Contract Amount:
Total Cost of Work Complete:
❑ Street Lights ❑ Traffic Signals
Mar 6, 2023
I M nui— (Mara 2m'z1'n3rsr)
Contractor Date
Gilco Contracting, Inc.
Title
VP Operations
Company Name
ng#L—
Brandon Phillips (Mar 6, 202318:33 CST)
Project Inspector
k4-411t� Kdsu%urrti
Kira Konduru (Mar 7, 2023 08:55 CST)
Prrr�ojest Manager
Rebecca B Owen (M ar7, 202309:16 CST)
CFA Manager
Lauren Prieur (Mar 7. 2023 0930 CST)
TPW Director Date
�,J J
Will Johnson lM 7. 70731136 CST)
Asst. City Manager
Mar 6, 2023
Date
Mar 7, 2023
Date
Mar 7, 2023
Date
Mar 7, 2023
Mar 7, 2023
Date
$923,579.65
$923,579.65
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Page 1 of 2
Notice of Project Completion
Project Name: Northstar Parkway Section 4, Phase 3
City Project No.: 103495
City's Attachments
Final Pay Estimate ❑x
Change Order(s): ❑ Yes 0 N/A
Contractor's Attachments
Affidavit of Bills Paid Already Attached
Consent of Surety
Already Attached
Statement of Contract Time
Contract Time 195 CD Days Charged: 145
Work Start Date: 4/28/2022 Work Complete Date 2/8/2023
Completed number of Soil Lab Test: 411
Completed number of Water Test: 12
Page 2 of 2
FORT WORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name NORTHSTAR PARKWAY SECTION 4 PHASE 3
Contract Limits
Project Type PAVING IMPROVEMENTS
City Project Numbers 103495
DOE Number 3495
Estimate Number 1 Payment Number 1
City Secretary Contract Number
Contract Date 3/22/2022
For Period Ending 2/13/2023
WD
Contract Time 4WD
Days Charged to Date 145
Project Manager NA
Contractor GILCO CONTRACTING, INC.
6331 SOUTHWEST BLVD.
BENBROOK, TX 76132-1063
Inspectors Watson / Phillips
Contract is 100.00 Complete
Monday, March 6, 2023 Page 1 of 4
City Project Numbers 103495
Contract Name NORTHSTAR PARKWAY SECTION 4 PHASE 3
Contract Limits
Project Type PAVING IMPROVEMENTS
Project Funding
UNIT IV: PAVING IMPROVEMENTS
Item
Description of Items
Estimated Unit
No.
Quanity
-----------------------
4-1
6" CONC PVMT (29' B-B)
15247 SY
4-2
6" LIME TREATMENT
16238.054 SY
4-3
HYDRATE LIME
244 TN
4-4
BLOCK SOD PLACEMENT
100 SY
4-5
SEED HYROMULCH
10950 SY
4-6
4" CONCRETE SIDEWALK (5' WIDTH)
2547 SF
4-7
BARRIER FREE RAMP - TYPE R-1
12 EA
4-8
FURN / INSTALL ALUM SIGN AND DECORTIVE
9 EA
POST W/STOP R-1
4-9
STREET NAME PLATES FOR STREET
22 EA
INTERSECTIONS (D3-1)
DOE Number 3495
Estimate Number I
Payment Number I
For Period Ending 2/13/2023
Unit Cost Estimated Completed Completed
Total
Quanity
Total
----------------
$47.25
$720,420.75
15247
$720,420.75
$3.65
$59,268.90
16238.054
$59,268.90
$205.85
$50,227.40
244
$50,227.40
$10.00
$1,000.00
100
$1,000.00
$2.00
$21,900.00
10950
$21,900.00
$7.45
$18,975.15
2547
$18,975.15
$2,925.95
$35,111.40
12
$35,111.40
$1,205.85
$10,852.65
9
$10,852.65
$264.70 $5,823.40 22 $5,823.40
---------------------------
Sub-Total of Previous Unit $923,579.65 $923,579.65
Monday, March 6, 2023 Page 2 of 4
City Project Numbers 103495
Contract Name NORTHSTAR PARKWAY SECTION 4 PHASE 3
Contract Limits
Project Type PAVING IMPROVEMENTS
Project Funding
Contract Information Summary
Original Contract Amount
Change Orders
Total Contract Price
DOE Number 3495
Estimate Number 1
Payment Number 1
For Period Ending 2/13/2023
$923,579.65
$923,579.65
Total Cost of Work Completed $923,579.65
Less % Retained $0.00
Net Earned $923,579.65
Earned This Period $923,579.65
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
$923,579.65
Monday, March 6, 2023 Page 3 of 4
City Project Numbers 103495
Contract Name NORTHSTAR PARKWAY SECTION 4 PHASE 3
Contract Limits
Project Type PAVING IMPROVEMENTS
Project Funding
Project Manager NA
Inspectors Watson / Phillips
Contractor GILCO CONTRACTING, INC.
6331 SOUTHWEST BLVD.
BENBROOK, TX 76132-1063
DOE Number 3495
Estimate Number I
Payment Number I
For Period Ending 2/13/2023
City Secretary Contract Number
Contract Date
3/22/2022
Contract Time
45 WD
Days Charged to Date
145 WD
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 $923,579.65
Less % Retained $0.00
Net Earned $923,579.65
Earned This Period $923,579.65
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
$923,579.65
Monday, March 6, 2023 Page 4 of 4
FORT WORTH.
TRANSPORTATION AND PUBLIC WORKS
February 13, 2023
Gilco Contracting, Inc
6331 Southwest Blvd
Benbrook, TX 76132
RE: Acceptance Letter
Project Name: Northstar Parkway Section 4 Phase 3
Project Type: Developer
City Project No,: 103495
To Whom It May Concern:
On February 13, 2023 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 February 22, 2023. 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 February 22, 2023, 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-
715-7010.
Sincerely,
1<lraIV kowdul w
Kira n Ko n d u ru (M a r 7, 2023 08:55 CST)
Kiran Konduru, P.E, Project Manager
Cc: Brandon Phillips, Inspector
Don Watson, Inspection Supervisor
Aaron Ybarra, Senior Inspector
Victor Tornero, P.E, Program Manager
Welch Engineering, Inc, Consultant
Gilco Contracting, Inc, Contractor
170 Northstar Ranch Developer, Inc, Developer
File
E-Mail: TPW_Acceptance@fortworthtexas.gov
Rev. 8/20/19
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 Rob Taylor,
Accounts Receivable of Gilco 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, Texas has been paid in frill;
That there are no claims pending for personal injury and/or
property damages;
On Contract described as Paving Improvements to serve:
Northstar Section 4, Phase 3
Subscribed and sworn before me on this 1st of December , 2022.
lPRY SUB CESILIA CANALES
z Notary ID #131652996
P My Commission Expires
July 24, 2026
CIA
\� I�
Notary Public
Tarrant County, TX
CONSENT OF
SURETY COMPANY
TO FINAL PAYMENT
Conforms with the American Institute of
Architects, AIA Document G707
OWNER
❑
ARCHITECT
❑
CONTRACTOR
❑
SURETY
❑
OTHER
Bond No 022233309
PROJECT:
(name, address)Northstar- Section 4, Phase 3 - Paving Improvements
TO (Owner)
Fort Worth TX
1 00 NORTHSTAR RANCH DEVELOPER, INC. AND —] ARCHITECT'S PROJECT NO:
CITY OF FORT WORTH CONTRACT FOR:
3045 Lackland Road Northstar - Section 4, Phase 3 - Paving Improvements
Fort Worth TX 76116 --J CONTRACT DATE:
CONTRACTOR: GILCO CONTRACTING, INC.
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)
LIBERTY MUTUAL INSURANCE COMPANY
175 Berkeley Street
Boston MA 02116 , SURETY COMPANY
on bond of (here insert name and address of Contractor)
GILCO CONTRACTING, 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 (here insert name and address of Owner)
170 NORTHSTAR RANCH DEVELOPER, INC. AND CITY OF FORT WORTH
3045 Lackland Road
Fort Worth TX 76116 , OWNER,
as set forth in the said Surety Company's bond.
IN WITNESS, WHEREOF,
the Surety Company has hereunto set its hand this
Attest: jLY�
(Seal):
2nd day of December, 2022
LIBERTY MUTUAL INSURANCE COMPANY
Surety Company
A -v,tn
Signature of Authorized Representative
Sophinie Hunter Attorney -in -Fact
Title
NOTE: This form is to be used as a companion document to AIA DOCUMENT 0706, CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS,
Current Edition
ONE PAGE
Liberty
Mutual.
SURETY
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 Mutual Insurance Company
The Ohio Casualty Insurance Company
West American Insurance Company
POWER OF ATTORNEY
Certificate No: 8205467-022020
KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the Slate 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 Hunter; 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, bonds, reoognizances 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 .
State of PENNSYLVANIA SS
County of MONTGOMERY
Liberty Mutual Insurance Company
P� 1NSIJy P011 INs&q%NSURq The Ohio Casualty Insurance Company
�J ooaPo�r 20 5J ooano�r p2 vP oµPo,�r West American Insurance Company
r;1912y q o " 1919 m
rd 9ss 3 y �� o° s 1991 0 75��
MAW' .aD
M * r� By:
David M. Carey, Assistant Secretary
o 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
m 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.
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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.
0
p Phg .
q�'S,�po111yF� Commonwealth of Pennsylvania - NotarySeal
p �[y �F T� ( Teresa Pastalla,tgomer Notary Public
OP Montgomery County
6
My commission expires March 28, 2025
C �V Commission number 1121 By.
QS.4 {I Member, PennsylvaniaAssai2ofNotaries eresa Pastella, Notary Public
IU
a This Power of Atomey is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual
.E Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows:
ARTICLE IV —OFFICERS: Section 12. Power of Attorney.
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
cPresident 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
m any and all undertakings, bonds, recognizances and other surety obligations. Such aftomeys-in-fact, subject to the limitations set forth in their respective powers of attorney, shall
o 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
Z L) 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
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.
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 altomeys-in-fact subject to the limitations set forth in their respective powers of attomey; 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 copy 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 2nd day of December 2022
P� 1NSU/q P 11( INSU 1NSUo
JJ3°oaPoksroti�,c^ P rooaPORgro�92c \4P=oaPOR,
r�yc+
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1912c/ o y1919� o a 1991 0
t�`119`PSACHUS" .da y0 'YAMP`S; L� Y �NOIANP �i� By:
* * *�d Renee C. Llewellyn, Assistant Secretary
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Liberty
Mutual.
SURETY
TEXAS
MPORTANT NOTICE
To obtain information or make a complaint:
You may call toll -free for information or to
make a complaint at
1-877-751-2640
You may also write to:
2200 Renaissance Blvd., Ste. 400
King of Prussia, PA 19406-2755
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
Consumer Protection (I I I -IA)
P. 0. Box 149091
Austin, TX 78714-9091
FAX: (512) 490-1007
Web: http://www.tdi.texas.gov
E-mail: Con sumerProtection@tdi.texas.gov
PREMIUM OR CLAIM DISPUTES:
Should you have a dispute concerning your
premium or about a claim you should first
contact the agent or call 1-800-843-6446.
If the dispute is not resolved, you may contact the
Texas Department of Insurance.
ATTACH THIS NOTICE TO YOUR
POLICY:
This notice is for information only and does not
become a part or condition of the attached
document.
NP70680901
LMS-15292 10/15
TEXAS
AVISO IMPORTANTE
Para obtener informacion o para someter una
queja:
Usted puede llamar al numero de telefono gratis
para informacion o para someter una queja al
1-877-751-2640
Usted tambien puede escribir a:
2200 Renaissance Blvd., Ste. 400
King of Prussia, PA 19406-2755
Puede comunicarse con el Departamento de
Seguros de Texas para obtener informacion
acerca de companias, coberturas, derechos o
quejas al
1-800-252-3439
Puede escribir al Departamento de Seguros
de Texas Consumer Protection (I I I-1A)
P. 0. Box 149091
Austin, TX 78714-9091
FAX # (512) 490-1007
Web: http://www.tdi.texas.gov
E-mail: ConsumerProtection@tdi.texas.gov
DISPUTAS SOBRE PRIMAS 0 RECLAMOS:
Si tiena una disputa conceiniente a su prima o a
un reclamo, debe comunicarse con el agente o
primero. Si no se resuelve la disputa, puede
entonces comunicarse con el departamento (TDI)
UNA ESTE AVISO A SU POLIZA:
Este aviso es solo para proposito de informacion
y no se convierte en parte o condicion del
documento adjunto.
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 Rob Taylor,
Accounts Receivable of Gilco 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, Texas has been paid in full;
That there are no claims pending for personal injury and/or
property damages;
On Contract described as Paving Improvements to serve:
Northstar Section 4, Phase 3
WA
Subscribed and sworn before me on this 1 st of December , 2022.
z�Par PUB CESILIA CANALES
Notary ID #131652996
P My Commission Expires
July 24, 2026
Notary Public
Tarrant County, TX
CONSENT OF
SURETY COMPANY
TO FINAL PAYMENT
Conforms with the American Institute of
Architects, AIA Document G707
OWNER
❑
ARCHITECT
❑
CONTRACTOR
❑
SURETY
❑
OTHER
Bond No 022233309
PROJECT:
(name, address) Northstar - Section 4, Phase 3 - Paving Improvements
TO (Owner)
Fort Worth TX
170 NORTHSTAR RANCH DEVELOPER, INC. AND 7 ARCHITECT'S PROJECT NO:
CITY OF FORT WORTH CONTRACT FOR:
3045 Lackland Road Northstar - Section 4, Phase 3 - Paving Improvements
Fort Worth TX 76116 —J CONTRACT DATE:
CONTRACTOR: GILCO CONTRACTING, INC.
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)
LIBERTY MUTUAL INSURANCE COMPANY
175 Berkeley Street
Boston MA 02116 , SURETY COMPANY
on bond of (here insert name and address of Contractor)
GILCO CONTRACTING, 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 (here insert name and address of Owner)
170 NORTHSTAR RANCH DEVELOPER, INC. AND CITY OF FORT WORTH
3045 Lackland Road
Fort Worth TX 76116 , OWNER,
as set forth in the said Surety Company's bond.
IN WITNESS, WHEREOF,
the Surety Company has hereunto set its hand this end day of December, 2022
LIBERTY MUTUAL INSURANCE COMPANY
Surety Company Attest: apo c uc -/&t )
,�'� �'1��z...+c� —
(Sea]): Signature of Authorized Representative
Soohinie Hunter Attorney -in -Fact
Title
NOTE: This form is to be used as a companion document to AIA DOCUMENT G706, CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS 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
Mutui.l.
SURETY
Liberty Mutual Insurance Company
The Ohio Casualty Insurance Company
West American Insurance Company
POWER OF ATTORNEY
Certificate No: 8205467-022020
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, Don E.
Comell; Joshua Saunders; Kelly A. Westbrook; Mikaela Peppers; Ricardo J. Reyna; Robbi Morales; Sophinie Hunter; Tina McEwan; Tonic 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, bonds, reoognizances 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 .
(n
0)
N
ca
co State of PENNSYLVANIA
County of MONTGOMERY ss
Liberty Mutual Insurance Company
N. %NS P`w INS& � WsuR9 The Ohio Casualty Insurance Company
�J o°aPO'�4r�tip g`� ooaPORar� 9y �GPooO�ar tip West American Insurance Company
1912 °y1919�o s 1991 0
a�9sSACHUS.dD y°.NAMPS�`,dD� �!S uN°IANP ,aa -?
0/7 * 1 �y1 �� �'M >� By:
David M. Carey, Assistant Secretary
"J 4) 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
" m 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
a) > therein contained by signing on behalf of the corporations by himself as a duly authorized officer.
m m
= 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.
PAS
o
L `' pgyW < Commonwealth of Pennsylvania - Notary seal
do * Teresa Pastella, Notary Public Q
Montgomery County
C +�+ My commission expires March 28, 2025 B
`' Commission number 1126044 y
N flySPL$1' 8 Member, Pennsylvania Association of Notaries eresa Pastella, Notary Public
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
o •1 Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows:
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ARTICLE IV — OFFICERS: Section 12. Power of Attorney, 0 00
0
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
President may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety C°
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 attorney, shall -a L
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
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 -a-
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. O
LL-
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 'ecognizances 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, 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 2nd day of December , 2022
V 1NS(rR _ZY INSUA� iNSUR
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1912 ° 1919 1991
s W o Q °
da By Renee C. Llewellyn, Assistant Secretary
LMS-12873 LMIC OCIC WAIC Multi Co 02121
10,
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SURETY
TEXAS
IMPORTANT NOTICE
To obtain information or make a complaint:
You may call toll -free for information or to
make a complaint at
1-877-751-2640
You may also write to:
2200 Renaissance Blvd., Ste. 400
King of Prussia, PA 19406-2755
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
Consumer Protection (I I I-1A)
P. O. Box 149091
Austin, TX 78714-9091
FAX: (512) 490-1007
Web: http://www.tdi.texas�
E-mail: ConsumerProtection@tdi.texas
PREMIUM OR CLAIM DISPUTES:
Should you have a dispute concerning your
premium or about a claim you should first
contact the agent or call 1-800-843-6446.
If the dispute is not resolved, you may contact the
Texas Department of Insurance.
ATTACH THIS NOTICE TO YOUR
POLICY:
This notice is for information only and does not
become a part or condition of the attached
document.
TEXAS
AVISO IMPORTANTE
Para obtener informacion o para someter una
queja:
Usted puede llamar al numero de telefono gratis
para informacion o para someter una queja al
1-877-751-2640
Usted tambien puede escribir a:
2200 Renaissance Blvd., Ste. 400
King of Prussia, PA 19406-2755
Puede comunicarse con el Departamento de
Seguros de Texas para obtener informacion
acerca de companias, coberturas, derechos o
quejas al
1-800-252-3439
Puede escribir al Departamento de Seguros
de Texas Consumer Protection (I I I-1A)
P. O. Box 149091
Austin, TX 78714-9091
FAX # (512) 490-1007
Web: http://www.tdi.texas�ov//www.tdi.texas�ov
E-mail: ConsumerProtectionktdi.texas�
DISPUTAS SOBRE PRIMAS O RECLAMOS:
Si tiena una disputa concerniente a su prima o a
un reclamo, debe comunicarse con el agente o
primero. Si no se resuelve la disputa, puede
entonces comunicarse con el departamento (TDI)
UNA ESTE AVISO A SU POLIZA:
Este aviso es solo para proposito de informacion
y no se convierte en parte o condicion del
documento adjunto.
NP70680901
LMS-15292 10/15