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Home My WebLink AboutContract 53754-FP1FORTWORTH, TRANSPORTATION AND PUBLIC WORKS NOTICE OF PROJECT COMPLETION City Secretary No: 53754 -FP1 Date Received:3/31/2023 City Project Ns: 101119 Regarding contract 53754 for 2018 Bond Street Reconstruction Contract 1 Part 1 as required by the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by City Council on 2/4/20 through M&C 20-0064 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: Amount of Approved Change Orders: Revised Contract Amount: Total Cost Work Completed: Less Deductions: Liquidated Damages: Pavement Deficiencies: Total Deduction Amount: Total Cost Work Completed: Less Previous Payments: Final Payment Due Recommended for Acceptance Asst. Director, TPW - Capital Delivery Lauren Prieur (Mar 31, 2023 12:47 CDT) Accepted Director, TRANSPORTATION AND PUBLIC WORKS DEPARTMENT Client Department William Johnson (Ma/31, 202313:46 CDT) Asst. City Manager $4,199,931.53 $0.00 Ne 2 $4,199,931.53 $3,945,001.78 0 Days @ $650.00/ Day $0.00 $3,945001.78 $3,747,751.69 $197,250.09 Mar31, 2023 Date Mar 31, 2023 Date Mar 31, 2023 Date Comm tits: OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX C-620 Signature Page Contractor's Application for Payment Invoice No. 19-FINAL To (Owner): City of Fort Worth Invoicing Period (From - To): Invoice Date: 611/22-1/31123 2/3/2023 P. °. FW020-0000003564 From (Contractor): Remit to ( If Not Automatic Deposit ): Number: FAIN GROUP INC Project: 101119 Contractor's CFW Vendor No.: 00000027241 City Secretary Contract 53754 Contract Bond Street Reconstruction Contract 1 Part 1 Number:2018 Name: Application For Payment ('.hanpe Order Snmmary Approved Change Orders Number Additions Deletions 1 $63,871.15 $63,871.15 2 $6,750.00 $6,750.00 3 4 5 6 7 8 TOTALS NET CHANGE BY CHANGE ORDERS $70,621.15 $70,621.15 $0.00 Contractor's Certification The Contractor certifies with the submittal of this document and associated Payment Request Submittal on the City of Fort Worth Buzzsaw system that to the best of their knowledge: (1) all previous progress 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 prior Applications for Payment; (2) title 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 of payment 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); and (3) all Work covered by this Application for Payment is in accordance with the Contract Documents and is not defective. Damages $650.00 x day 0426 Larfy F zier (Mr 31, 2023 08:26 CDT) L ORIGINAL CONTRACT PRICE............................................................. $ $4,199,931.53 LNet change by Change Orders.................................................................... $ $0.00 i. Current Contract Price (Line 1 f 2)........................................................... $ $4,199,931.53 1. TOTAL COMPLETED AND STORED TO DATE (Progress Estimate, Construction Allowance and Change Orders)....... $ $3,945,001.78 S. RETAINAGE: A. X $3,945,001.78 Work Completed.......... $ b. X Not Used $ c. Total Retainage (Line 5a + Line 5b)................................. $ i. AMOUNT ELIGIBLE TO DATE (Line 4 - Line 5c) ............................... $ $3,945,001.78 1. LESS PREVIOUS PAYMENTS (Line 6 from prior Application)......... $ $3,747,751.69 3. AMOUNT DUE THIS APPLICATION.................................................... $ $197,250.09 ). BALANCE TO FINISH, PLUS RETAINAGE (Column G on Progress Estimate+ CA + Cos + Line 5 above) ............... $ $254,929.74 10. CONTRACT TIME: a. Days Awarded 450 b, Days Added by CO 72 C. Total Days 522 d. Days Charged 496 e, Days Remaining 26 This document has been modified from its original form as an EJCDC document and the user did not highlight the modifications. You are encouraged to read the document carefully and consult Legal Counsel prior to its execution. 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SJ p1)00 51014' 5301E p0 1p00°5 25 321].101E Lore L-1 Arrox 121]23 EA BOW00_0 415561 St 15449 _ a_00000000 51.]5441 41.25449 51.25440 10p OX 25 121 ].1pGO Lane LegeM Bte J21]23 A 6000000 _ 449291 5J66J ]6 _ QOOOOOOW SJ E53]E SJ05J]6 $3.16376 1GO G35 2] 321]. 2104 REFL Razetl!Jaher TYIIGR4' 3J 1]21 EA 100000000 550E -2 D0 _ 100.o0000000 550200 S-G2 DO 4502 D0 100055 2B 1211 GIDO Tcp Scl 329119 615000- 52g.32 SI9.191 D0 _ 0]000000000 60n100000000 519I9101 D0 51 g.-GO 1000X 29 329E D100 Beck SOG P'acemaN 329213 ST E0]O OIMOpp 3545 439.15150 _ 539.t51 EO :19.]91 539.151.50 439.151.5a - _ 31.00200 1000SJ _ 6.00000000 JO 3)OS Ot 011111 xAgrtrrent I'll 33051J EA 11.000000 3316.4G $41. 40 51112 c0 S10B2 GO 455X 522$0<0 _ _ A1.199.2J 31 3J050111 Va`.e Oue Aa,vstlraN 3305Ii EA 1]OOpOW 518019 $J.199.2J 1].00000000 5J.15923 5J.1992J t000X J2 330501t41.°anno'xA0;n5rerj Nzarxl Ca��er (Ers[�ng SDJB) . 3305I4 EA 20p0000 552135 $1.251]0 .._.- .. 200000000 51 25470 51154 ]0 $1 ]54 70 1000% _ JJ 33GS.203 . A-- mfoM1M Ert RUReNRarV:; RS!.1�0nEy M10 Oy 0000p00 St6859 51348.]2 BODo00000 51349 ]2 51348 ]2 41349 ]2 100.0% 0% _ ISO D% J4 3441.150 un0 -Tyfe D, WApm -... 3J 411O EA 6000001 $110l ll $1-2a . fi0pp000o0 59n322B 591122' 59G3120 _ 35 J411 <00 �... sb 8lns.a9ANnagn Gmurd NouN Ca[y 5t0 __- _ 3J41 )0 EA 10000000 $4] p4J 50 Gfi].]4 to p00p0000 50 <61 ]4 SJG5]]4 59452.]q 1pO 0% -.-. 36 J..1.GG0 nsta'IAMnugs Ex Pok Nount 3J4130 EA 4000000 52]593 51.1O196 4130000000 51.tO195 51.10396 51.1 3 of 1000% 31 ]4d1.4108 Remove Bqn ParclB PoY 3Ji139 EA 5000000 594 p3 54)045 5000p0000 $4] 045 14]O 45 54]045 1c00¢5 _ 3B 1441.411p Rxmmea Rinstalugn ParelB Post 3JJ139 _ Ep 9p00000 S31362 5202258 900000000 52 B225B 4282258 4262259 1c00% 39 34110/01 TI11I CoNml Ne 1- 347I13 SIO 10 DOOG00 /1013/12 1:,3 2ol 15DOOp0001 S3EO25 EO 111.2600 535U26EO 1500% -531 fi1560 G0 34I10002 PUM1at'e 1.'escege Sign 99330000 N.zc U'IV Re'out�onJAqustments 347113 99994E YM CO 000000 52149] SB599 EO 1500000000 5122455 SJ 22455 SJ22455 31.51 $53Id 25 41 42 53?30000 Flerb'a Bs�as aC OV ety D'K. 999999 LS 1.000000 20000p000 SJ000000 511.1E S]0 D00 DO 5S3.57623 1D0100000 2DO.00000000 SJOOe000 Ill 53/00000 515544 DO 530000 D0 5S3544D0 1000X 1050% q3 99?3 p000 Trex Prt'zctan for lntiv�tlusl l'-12'irae (In'vtlaz Nu]HVJr ---995949 99599J EA lA 190W000 S1BB.1] _ SJ5)52J 1900000000 $357523 535]523 53.5)52J 535152] 1000X _ 44 9999 pp00 Tree Prc!c<t1111111 : tlual l2'-24'Trea EA 100000GO 52.090 $2509.00 - � 100000000J 5250900 5250900 52509 D0 100015 45 S. pGGO Ttx Prc!ec[gn Nr lyd%-1 Tres 240larger 59939J FA 40D000O $31362 400000000 5111137 51154 45 5125448 103 055 a00000000 45 9933 DODO TreE Prc!ecton for Gus!xr of lAUYrTmn4 Cruxl.lrn'zs 935943 EA 300DOo0 $1254.40 $1.5053] 51505 J] 51505 ]] 51.:953] 100 pt5 41 9939 D000 Tree Pm- for Gus!er 1'-11'Trees .99. EA 40DooD0 S3 136E S1.25440 _- 400000000 112141 1121441 11.25446 100` 40 9993000095'CnncrF.e Pa.errrvnl HES 599399 11350o0Do0 58396 11121411 111523000000 595 J1091 595 J1]91 55531J 91 10p Ot5 -519 Jt 49 l 9399000095'Oencre!e Par .1 9989000G R-E-tq 101(AppmecA Saab)-TrDOTI!em 104 99990000 Ap,-61a0 T-T I!em 422 595999 9)9399 �9999 13690000000 1550l- 41.000000 501.95 511.04 51.121.0955E 52]652G 1364321000DOO 15500000000 rA 51,11 BD61 G5 $276520 51.110051.GO 52.]6520 S1, 1 IS G61.01 127652G 93.1°n 1000t5 5183444 51 52 53 99390000 C'aan--I G-II 1s-1-TItem All 99990000 Pa1'.ng lmfmremantz Ccnstrvcton A!bnance Y29999 WS999 OY LF LS 211 I.00 1-GO 55O].95 Si0 c4 I-lO GO 52G 02555 42 J11 S15G DDu 0G ]0009000 20, GOOO . 570.71420 _ S235943 520.;140. 52J5941 S207142G 52 JS3 C9 93535 10J 0:: II I1.71 $15OD000O Totals 541000]tS] $$ 10021.00 $3,8711.321.031 i S]8]8321.08 923°.5 S]2]810.15 This mrmt}u I-ma66ed-.aierul Siam n n JC d. Wr -Eit rea t,,,JOre ---m--m-,a brral Ore ds, -S,G, W-lRlCa 1I�m.-- C�M Change Order Progress Estimate Change Order Number I 1 Contractor's Application ADDITIONS Per(mnrad>: 101119 2018 Bond Stmel Recoml-thin Contract l Part l City St` Y 53754 C-Nnm App1""ii NvmM: 19-FINAL AMi.ian Period: 6/1122-1/31123 Appliestim Dae: 2/3/2023 A B C D E F Inm roQ"wi7'to Add Unit Prig Addition Cfuny On4r V+lua Estimated Quwdy Ikd \J1d PrcSioud)' LmallN Vahe l'alue7hi+ Period Afaerials Pa+ssdly Slored(m1in C) Tdal CpnPlAed B1d 5fDate D, E) (Dr E) .. (F) B Balanoeto Finish B-F) (B Change Orderhem Ra D .pig BPMf tim SMbn To. Udt ofAfeamse 40 41 12- DIP WATER LINE LDWERINO FLOWADIE FILL a- DIP SEWER PIPE(13N'EA&D) 4'MANHOLE ("948&4-SER\TCE TO\t-292C) DROP CONNECP10NTO EYISTING\t1I ON\I.292C ADDMONAI.BYPASSPU\IPING(8'"941&10'FRO\t\\ q'CLF.ANOIIT AT END OF B'SE\VER (LINE A&B) 4'PRIVATE 1111E.R SII1111E RILOCAT10N(MCLUDING CL ADDM.,"ALIIYPASSPU\IPINO(\IIITOCONNECFTOPRI\ ------------ -- -------- LF 32.00000ON _ _ $244.25 S7816.00 _ 32.00000000 $7,316.00 _ $7,116.00 _ _ _ $7,816,00 SL275.00 514,360.85 510,537.6E S1,72500 SM932.43 5925.00 S2,I0000 56,250.00 1000% 100.0% CY LF EA IS LS F.\ LF IS 30.00000000 9350000000 2.00000000 1.00000000 I00000000 100000000 12.00000000 100000000 S42.50 5169J5 $5,26931 $1,725.00 SI8.932.45 5935.00 S175.00 S6,25000 S1275.00 51Q10.01 30.00000000 _.._94.80000000 200000000 IMOOM00 100000000 1.00000000 12.000M00 1.00000000 SI,275.00 514760.88 SEm.00 514j60.81 S10,537.62 S1,7MM S18,93245 $925.00 52,100.00 $6,25000 3 6 IOOABi 100.0% 100,0% 100.0'. 1000°° M.W. 1U V. •S50.11 _ S10,537.62 S1,725M 518,932i5 592540 S2,100.00 S6,250.00 _ S10537.62 __$I Z25.00 S18,93245 5935.00 S2,100.00 S6,150.00 _ 45 46 47 48 49 Totai+ 561 71.16 165921.95 361 31.95 S6.1 21.95 100.1% 450.80 Thia damnsnd h. ban-dirW Oosn ine ig4.1 as as E)CDC dwvnsed and the a- did ms highlig&the madifi:atiam You are enwr+ged to read t dwvmed aMully and o-ft Legal Counsel pia to its e. vtim C6X Clwge Order Progress Estimate Change Order Number 1 1 j Contractor's Application 11101110YIiRIM F.1—). 101119 2018 Bond Slrcel Recowimelton Contract / Part I '\PPlic''tioo N,.bw. 19-FINAL Application Perim: 6/l/22-1/31/23 AMI"tim Date: 2/3/2023 A B C D E F Item MQu ilylo Oder Unit pnx Dekdoo CLv ONa V.I. Na Used NMU-1 Nm Us J Nd C'sm Not Uxd NN Uxd NaU Not Usm Ch,W Order It= Na Dar'Plion Spai",,dioo SMian N. U0,1724—o' 3 49 ti ;J IVDIP\\'AT..R WATER I\IPROt'E}IPNTS CON6TRLCTION ALLOWANCE 6-SEWERSERt'ICE SANfEARI'SF.\t'F.R IAIPROt'E\IF.NTS CO\'STRUClION AIIO LF IS EA IS 32.00000000 0.09350640 ].00000000 0.6551JJ30 SI37.99 SS0,000.00 51,881.]2 S75,00000 Sl�415.63 54,6]SJ3 55,6;5.16 SJ9,IJi.99 Tat.ts 1 S6).8]1.16 This dwvnant Iu henmWirm ran in onp lfmm u an FICDC dwv v Newer did rc higNight We mmifi.at Y..rc ence Wd to rc,td Ne do, m a Nfly Wm oh UpI Cwnsel psis in eaennion C 620 Change Order Progress Estimate Change Order Number 1 2 Contractor's Application A nDITTONR F«(manes): 1o1119 2018 Bond Street Remmt—lion Contracl 1 Part 1 ChY �—y 53754 C000r . Tam: Appf ntimRamuer 19-FINAL APPlicafsm Period: 6/1122-1/31/23 APPuAfan Date: 213/2023 A D c D E F ImnI CO Quamdyto Add Ihat 1'ria Additim ChuV Osdc Value Fst-WQ—hy Imtalled \awe Pmi—ly ImtWValue ValveThis Period Mveriala Pxsemly Stored (not in C) Wdl,MWDA and Stered tEo Dan Ni ) F (B D.1—to FW A e- ChangeQderltem ro. Da.�ipim SPMf tian sMioaxo. Uadt of3feamre 12 <.inAs DIP N'aterSmitt I00.00000000 567.50 36J50.00 70.50000000 SA,758.75 S1758.75 54759.75 70.5% $1.991.25 ---- ------ . ........ ..... T..h 36750.00 S7758.75 54.7M.75i S4,758.75 70.5% SI 9i35 Thin duvmnahuhm modified f iaori&vlf— an FCDCdwimwaeandth—didMhigwielaN modif atiom. You are—gdtoaadt dw—.,Mlyatdmoon UVIComnelpiertoits—im C620 Change Order Progress Estimate Change Order Number 1 2 DELETIONS Contractor's Application F. acet 101119 2018 Bond Street Recomt—flon Confael I Part I Apolinti.SmnH`r. 19-FINAL .\vitiation PesiA 6/1/22-1/31/23 Ap,tiatim Date. 2/3/2023 A B C D E F Item CO QavLL�q to Detnim Clung Clung OM Item Sp 'fmlim D—pomCnit ofAleasure Delne U �tt Qder\'aloe �d Vsed fd Uud rd L•«d Td Used Nalhed Rdlhed �d lhed Tot tia.�i To. S 1im To. 49 \Vats Lnpros_rmmAs Co —dim Albxawro IS 0,13500000 S10,000.00 9,75000 Ar-fi Ymb sm gdt its oriyjsulf ssfFJCOC davns L pl themer di—highlipJn We smdifiatima You ers mwragd to and the dwvm�nt nrcPo113� and avuvH Isgl Cmmel pia la in ecevtim Citv of Fort Worth Summary of Charaes City Secretary Contract Num: 53754 2018 Bond Street Reconstruction Contract 1 Part 1 P. 0.: FW020-0000003564 Project Number: 101119 Application Period: 611/22-1/31/23 Application 19-FINAL Application Date: 2/3/2023 Number: Funding Identification (FID) Total Completed Amt Remainin Gross F- Retainage Net Ori inal Contract $2,133,043.13 $119805.72 $.7ID 410.n0 nn 34018-0200431-5740010-101119-002480-9999-18010199 56002-0600430-5740010-101119-001780-9999 $655,700.18 $97,800.43 b0.00 :b0 00 a0.00 56002-0700430-5740010-101119-001780-9999 $1,087,577.77 $106,004.30 1 $0 00 $D.00 0 no 0 :7VIO.00 :*0.00 30.00 "z0 00 0 $O.nO TROD $O.nn z0.n�i p '0 00 CO 0 SO.DO - I 50OD 0 ,h0.n0 $0OF) $,0.n0 `LO.nn OAO 0 $0.00 :y0.00 $0.00 'J 4.00 :;0 00 0 T0.00 $0.0t) $0.00 $0 up $0.00 i0o Change Order $,0 CID $O.DO 34018-0200431-5740010-1Oil 19-002480-9999-18010199 56002-0600430-5740010-101119-001780-9999 $9,091.00 $9,091.00 50.00 :10.00 00 56002-0700430-5740010-101119-001780-9999 $54,830.95 $54,830.96 $0.00 $0.00 00 0 30.00 yO 00 0.00 o aD oo $o.00 ?,o Dn no 0 - n to 00 0 1 1 0 :.n 30.00- 0 :�O OL) 1,0 00 0 :i;0. 00 3O.00 4,17 GC) 0 no 1. Lu pi;I r.0.n0 Change Order $200 $.0.00 a OD 34018-0200431-5740010-101119-002480-9999-18010199 56002-0600430-5740010-101119-001780-9999 $4,758.75 $4,758.75 10.00 $0 00 0 co 56002-0700430-5740010-101119-001780-9999 MOO jr, qr; gO UO 0 - OAO 200 0 $p,re n nn 0 0 $0 00 00 0 . � ;0 ! 0.00 .;. n.00 0 00 np $O.nO 0 C0 0 $0.00 200 �> (0 00 �) 00 o $D oo $D.00 Citv of Fort Worth Summary of Charaes City Secretary Contract Num: 53754 2018 Bond Street Reconstruction Contract 1 Part 1 p. O.: FW020-0000003564 I project Number: 101119 Application Period: 6/1/22-1/31/23 APNumber:umber: 19-FINAL Application Date: 2/3/2023 Funding Identification (FID) [ Total Completed Amt Remaining [ Gross Retaina a Net Change Order a Uci Cu 34018-0200431-5740010-101119-002480-9999-18010199 56002-0600430-5740010-101119-001780-9999 °; a rm - n GG 56002-0700430-5740010-101119-001780-9999 ffi.00 OJ Go 0 `t0.O0 - 3,O nn OD 0 $D.00 sQOO $O.DD $0 DD 0 *.OAO O,OG 0 p.00! 0 0 u0 0 ;O.00 i'o,w 0 :-OWL, : :SG.00 Change Order OC OG V)C0 b0.00 34018-0200431-5740010-101119-002480-9999-18010199 56002-0600430-5740010-101119-001780-9999 56002-0700430-5740010-101119-001780-9999 00 MOO 0 - -- iQ00 0 0 00 0 0.00 0 (O DO o o 00 o n0 $o DD o or) p $0 OD fiO.pP n ec Change Order 5 $O UO 00 34018-0200431-5740010-101119-002480-9999-18010199 56002-0600430-5740010-101119-001780-9999 $0DD 0ti0 56002-0700430-5740010-101119-001780-9999 io,00 $G.00 0 ,h0.00 O GO 0.uo Da aoo 0 $0.00 :;.u. r n 5,0.00 0 f0.00 :50.00 30 00 p a nn +O.OG [SQ OG p `u 0u 0.00 $D 00 :UO-00 o n nAG o DG $o 00 0 D-li0 ::GAO ;GAD $0.00 1 150.OG Citv of Fort Worth Summary of Charges City Secretary Contract Num: 53754 2018 Bond Street Reconstruction Contract 1 Part 1 P. 0.: FW020-0000003564 Project Number: 101119 Application Period: 6/1/22-1/31/23 Application 19-FINAL Application Date: 2/3/2023 Number: Funding Identification (FID) F—Total Completed —I F-Amt Remaining Gross Retainage I L Net 1 0 Uii 60 00 u.00 Change Order 6 34018-0200431-5740010-101119-002480-9999-18010199 56002-0600430-5740010-101119-001780-9999 :10 Un Won no or, ) CD 56002-0700430-5740010-101119-001780-9999 D 00 r0.00 ;0.00 $0 CO 0 0 01 4O.On 70.00 : 0.100 0 &0.00 :j 0.00 u 00 l0 00 0 5aa) sn o0 a Du � 0.00 +,ann 0 WOO In 00 1$0 00 K) 00 :p0 00 0 .Pi g0.np To An .`60.n0 '30110 0 :$n 00 :b0,00 W.00 $o OO :U0.00 0 •o on uQ.oD $0 00 $0.0n Qo oD 0 a O 00 0.00 WOO $0.00 , n, 00 Change Order? 4 00 :1,0A0 pO 00 ?O.CO D uC 34018-02004315740010-101119-002480-9999-18010199 56002-0600430-5740010-101119-001780-9999 -- :}0 nD :•0 0n W.00 Coon 56002-0700430-5740010-101119-001780-9999 o ao 3[) 00 pi 'D OC 0 o n0 S0.00 $0.01) $000 0 :yO 00 :$0 00 :10.00 50 CO 0 g nn $0-00 1,0.00 sQ00 p OilhOAO 110-00 '0 00 0 +0 00 L0.0n V) On 0 �'G 30 00 bn 00 000 0`0.00 tO On �0.00 0 n_ n0 0.00 y:O p0 :in 00 Changa Order 8 ntT: O.OG CO 34018-0200431-5740010-101119-002480-9999-18010199 56002-0600430-5740010-101119-001780-9999 ^ nr 9Cn 56002-0700430-5740010-101119-001780-9999 0.00 p OO Do 0 00 p .! i.� _�i).rp� e n r�,- 0 Q i0.no n Q I I.00 0 u n nr; $o 00 o r0 0 iO. �'. b0 O0D.UQ 10.CC lCO Citv of Fort Worth Summary of Charaes City Secretary Contract Num: 53754 2018 Bond Street Reconstruction Contract 1 Part 1 P.O.: FW020-0000003564 Project Number: 101119 Application Period: 6/1/22-1/31/23 Application Number: 19-FINAL Application Date: 2/3/2023 Funding Identification (FID) Total Completed Amt Remaining Gross Retainage Net Totals $2133 043.13 $119,805.72 lU0 },O uO a uu 34018-02004315740010-101119-002480-9999-18010199 56002-0600430-5740010-101119-001780-9999 $669.549.93 $83950.68 s0.0!i y0.00 :OCu 56002-0700430-5740010-101119-001780-9999 $1 142,408.72 $51,173.35 a 0u j,0.00 u.CO 0 .h0.00o nn "0.00 rtQnn s0,n0 0 b0.00 00 O n0 O.OU 3400 0 ,0 00 W 00 s,a no n on $0 ou 0 WOO an.00 o 7-0.00 b0 00 sp nn 0 UO yu Go c • LO nU 0 $000 :�r. 0nn 0 _cl 0) 1 1 jii 00 Grand Total 1 1 $3,945,001.78 1 1 $264,929.74 1 $0.00 ($197,250.09) $197,250.09 CSC No. 53754-COI ]FOR-r WORTH Change Order Request Project Name 2018 Bond, Street Reconstruction Contract 1A - Great Southwest Parkway City Sec No. 153754 Project No.(s) 56002.060043010700430.001780&340i8.00043i.002480 City Pro. No. 101119 Project Combined Street Paving and Water and Sewer Main Replacements for 2018 Bond Reconstruction Contract 1, Part 1 Descdplion Contractorl The Fain Group,lnc. Change Order# 0 Date: 111312020 City Project Mgr.J Waller Norwood CityInspector I Tamara Vaughn Phone Number. 817-392-5026 Phone Number: 682-225.9106 Dept, Original Contract Amount Extras to Dale Credits to Date Pending Change Orders (in M&C Process) Contract Cost to Date (Amount of Proposed Channe Order Revised Contract Amount ' • Odg. Funds Available for Change Orders Remaining Funds Available for this CO Additional Funding (if necessary) UNIT 1 Water UNIT 2 Sewer UNIT g Drainage Unit 3b Paving Totals Uactlnme Co".darDays (Calendar Days) $753,500.61 $1,193,582.07 $61,044.62 $2,191,804.23 g, 4199,931.53 450 :`.$753150061;.::` 7$1;193,58207 $61;049.62 191,804.23 '$2 ;$4199,93153 450 : ;`,$0:00 $0.00 020 ;:- $753500..61.':.: $1;193;58207 '_;; $61;044.62 '.$211918Q423 11K199,93153 :.?;`470.' y3UMUAU I $47,743.00 1 $0.00 1 $112,642.00 $190;52.50Q CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS % OF ORIGINAL CONTRACT This change order will provide for the following; • Connection of a private sewer service at 2400 Great Southwest Parkway. • Additional bypass pumping to facilitate CIPP Installation and the connection of the private service. • Extend 8 inch diameter sewer main Line A and Line B to the south right of way line of Great Southwest Parkway for future connections. • Replace portions of L-6941 with ductile iron pipe (DIP) In lieu of polyvinyl chloride pipe (PVC) for pipe uniformity from manhole to manhole. • Additional manhole on L-6946 in Rondo Drive. • Adjustment of the 121nch diameter water line to avoid conflicts with existing franchise utility. Staff concurs with the contractor's request for 20 calendar days for this change order. 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. IS aGonlr�oto?so:.r� The Fain Group, Inc. Noel Sanchez ^� —�� /1 S. Nov 6, 2020 M&C Number NiA M&C Dale Approved [OFFICIALRECORD CITY SECRETARY FT. WORTH, TX L� C3+1,T WORTH City of Fort Worth Change Order Additions Project Name 2018 Bond, Street Reconstruction Contract 1A -Great Southwest Parkway City Sec No. 53754 Project No.(s) 024E0 I DOE No.O City Pro. No. 101119 Project Description Combined Street Paving and Water and Sewer Main Replacements for 2018 Bond Reconstruction Contract 1, Part 1 Contractor The Fain Group,lnc. Cliange Order # = Date: F 111312020 City Project Mgr. Walter Norwood City Inspector I Tamara Vaughn AUUI I IONS l fEM DESCRIPTION DEPT Qty Unit Unit Cost Total 40 12" DIP Water Line Lowering Unit 1 Water 32.00 LF $244.25 $7,816.00 41 Flowable Fill Unit 1 Water 30.00 CY $42.50 $1,275.00 5 8" DIP Sewer Pipe (Line A & B) Unit 2 Sewer 84.50 LF $169.35 $14,310.08 6 4' Manhole (L-6946 & 4" Service to M-292C) Unit 2 Sewer 2.00 EA $5,268.81 $10,537.62 45 Drop Connection to Existing MH on M-292C Unit 2 Sewer 1.00 LS $1,725.00 $1,725.00 46 Additional Bypass Pumping (8" L-6941 & 10" from West) Unit 2 Sewer 1.00 LS $18,932.45 $18,932.45 47 4" Cleanout at end of 8" sewer (Line A & B) Unit 2 Sewer 1.00 EA $925.00 $925.00 48 4" Private Sewer Service Relocation (Including Cleanouls & Fittings) Unit 2 Sewer 12.00 LF $175.00 $2,100.00 49 Additional Bypass Pumping (MH to Connect Private Service) Unit 2 Sewer 1.00 LS $6,250.00 $6,250.00 UNIT 1 Water $9,091.00 UNIT 2 Sewer $54,780.15 UNIT 3a Drainage Unit 3b Paving Additions Sub Total $63,871.15 Page 1 of 1 FORT WORTH City of Fort Worth 5- 1"l Change Order Deletions Project Name 2018 Bond, Street Reconstruction Contract 1A -Great Southwest Parkway City Sec No. 53754 Project No.(s) I DOE No. [� City Pro. No. 101119 Project Description Combined Street Paving and Water and Sewer Main Replacements for 2018 Bond Reconstruction Contract 1, Part 1 Contractor The Fain Group,lnc. Change Order#= Date 111312020 City Project Mgr, Waller Norwood City Inspector FTamara Vaughn DELETIONS ITEM (DESCRIPTION DEPT Qty Unit Unit Cost Total 3 12" DIP Water Unit 1 Water 32.00 LF $137.99 $4,415.68 49 Water Improvements Construction Allowance Unit 1 Water 0.09 LS $50,000.00 $4,675.32 14 6" Sewer Service Unit 2 Sewer 3.00 EA $1,881.72 $5,645.16 43 Sanitary Sewer Improvements Construction Allowance Unit 2 Sewer 0.66 LS $75,000.00 $49,134.99 UNIT 1 Water $9,091.00 UNIT 2 Sewer $54,780.15 UNIT 3a Drainage Unit 3b Paving Deletions Sub Total $63,871,15 Page 1 of 1 Contract Compliance Manager By signing I acknowledge that I am the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. A - 2�W,, 'P Signature NvIlEV Alnoelo of) - Name of Employee Title 'O44UUR44� ap�� F°Rr�ao 0�`0 o8So �-�d ATTEST: o o * a i�� Pa �at vd r U ��~ ad r�EXASo4p �yROR4V Mary J. Kayser City Secretary OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX CSC No. 53754-0O2 (FORT WORTH Change Order Request Project Name 2018 Bond, Street Reconstruction Contract 1A - Great SouIhwesFPa-r-k—wa`y—J City Sec No. 153754 Project No.(s) 56002-0600430/0700430.001780&34018.000431-002480 City Pro. No.1 101119 Projecl Combined Street Paving and Water and Sewer Main Replacements for 2018 Bond Reconstruction Contract 1, Pan 1 Description Contractorl The Fain Group,lnc. Change Order# 0 Dale: 4/22/2021 City Project Mgr. Scott Taylor City Inspector I Tamara Vaughn Phone Number: 817-392-5026 Phone Number: 682-225.9106 Dept, Original Contract Amount Extras to Date Credits to Date Pending Change Orders (in M&C Process) Contract Cost to Dale (Amount of Proposed Change Order Revised Contract Amount Orig. Funds Available for Change Orders Remaining Funds Available for this CO Additional Funding (if necessary) UNIT 1 Water UNIT 2 Sewer UNIT 3a Drainage Unit 3b Paving Totals Conlract7he (CalandarDays) $753,500.61 $1,193,582.07 $61,044.62 $2,191,804.23 -$4;;199;931,i53 460 $0.00 $0.00 $0.00 $0.00 20 $753,500,61' $1193;582 07 $61044 62 `_$2,i191;80423 _ $4;19993153 =? .470 ' 40.00. >- $0.00 $0 00 _$0,00 , . $000 015 =$753,500 61 $1;193;582 07 $610-4 62 ,., $2;;191;804 23 $4;199;931.53 485 $30,140.00 $47,743.00 1 $0.00 1 $112,642.00 $19052$:00 jl CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS % OF ORIGINAL CONTRACT t� TI G110t� REA ®S rFOR C�j1�K RDf3_ 4 Change Order No. 2 will provide pay item quantity or 4-inch ductile iron pipe to allow for the replacement of a water service that is in close proximity to a storm drain box. Staff concurs with the contractor's request for 15 additional calendar days for this change order. 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. ��.Q� _ 4fs� • oin .;1Q�m � �o�n�ra.� orb a�e�-�-s ��#'�`G� Rtt e�ii'=4� � � �� a)_e�.. The Fain Group, Inc. Noel Sanchez Z7 W nnan�iirr�nnrrn�rsm" M&C Number N/A M&C Date Approved Apr 29, 2021 OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX City of Fort Worth Change Order Additions Project Name 1 2018 Bond, Street Reconstruction Contract 1A -Great Southwest Parkway City Sec No. 53754 Project No.(s) -2-+HhV1GO4300017w040134M43 MAN DOE No.[= City Pro. No. 101119 Project Description Combined Street Paving and Water and Sewer Main Replacements for 2018 Bond Reconstruction Contract 1, Part 1 Contractor The Fain Group,inc. Change Order# 0 Date: 4l22/2021 City Project Mgr. Scott Taylor City Inspector Tamara Vaughn ADDITIONS Page 2 of 4 Fo -r WO R-F m City of Fort Worth Change Order Deletions Project Name 2018 Bond, Street Reconstruction Contract 1A - Great Southwest Parkway City Sec No. 53754 Project No.(s) SlA20WO 3-1-3000 no ] ole-QANPED DOE No. E= City Pro. No. F 101119 Project Description Combined Street Paving and Water and Sewer Main Replacements for 2018 Bond Reconstruction Contract 1, Part 1 Contractor The Fain Group,lnc. Change Order Date 4/2212021 City Project Mgr. Scott Taylor City Inspector Tamara Vaughn DELETIONS Page 3 of 4 Contract Compliance Manager By signing I acknowledge that I am the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. Signature Name of Employee Title ATTEST: oaq FORr��a a '9�'L` OF000000 0o 0 ° o ��° °o�� d Vo o= Mary J. Kayser City Secretary 0o 000 0 - F �� 20000000O Nd OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX FORTWORTH TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PROJECT NAME: 218 Bond, Street Reconstruction, Contract IA, Southwest P CITY PROJECT NUMBER: 101119 WATER PIPE LAID SIZE TYPE OF PIPE LF 12" PVC (C900) 1962.08 12" DIP 150 8" PVC (DR14) 105.66 8" DIP 37 6" PVC (DR14) 121 FIRE HYDRANTS: 2 VALVES (16" OR LARGER) PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: NEW SERVICES: 2" (6) 1" (9) Copper Copper SEWER PIPE LAID SIZE TYPE OF PIPE LF 24" PVC 1362 24" CIPP 416 8" PVC 1045.39 8" DIP 224.48 PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: NEW SERVICES: 6"(7) PVC TRANSPORTATION AND PUBLIC WORKS The City of Fort Worth • 1000 Throckmorton Street • Fort Worth, TX 76012-6311 (817) 392 - 7941 • Fax: (817) 392 - 7845 Insituform Technologies, LLC is a subsidiary of Aegion Corporation lnsitufvnrm Techaalgies; LLC 580 Goddard Avenue Chesterfield, MO 63005 www.insituform.com WARRANTY Contractor warrants to Owner that the products and work provided by Contractor to Owner for the liner work installed on the line from 3+29 to 0+49 will be free from material defects in workmanship and materials for five (5) years, from the date of installation as represented below. In the event that a material defect in workmanship or materials supplied by Contractor for the installed liner is found during the five (5) year period following the date of installation, then such defect shall be repaired, replaced or adjusted by Contractor at no additional cost to Owner. Owner's exclusive remedy in the event of any warranty claim hereunder is limited to correction of such defect, adjustment, repair or replacement as the Contractor shall at its sole option elect. THE FOREGOING WARRANTY IS THE EXCLUSIVE WARRANTY PROVIDED BY CONTRACTOR FOR THE LINER AND IS GIVEN IN LIEU OF ALL OTHER WARRANTIES, WHETHER EXPRESS, IMPLIED OR STATUTORY, INCLUDING BUT NOT LIMITED TO, ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS OR SUITABILITY FOR A PARTICULAR PURPOSE OR USE; AND ALL OTHER WARRANTIES ARE HEREBY EXPRESSLY DISCLAIMED. In no event shall Contractor's liability for warranties hereunder exceed the purchase price paid by the Owner to the Contractor for the above installed liner. The warranty shall be void and of no effect in the event that (i) Contractor is not notified of claim of defect within the warranty period provided above; (ii) Contractor is not provided timely and unrestricted access to the site at which the claimed defect is located in order to investigate and/or repair, adjust or replace the work or materials claimed to be defective or Contractor is not provided suitable working conditions to perform such investigation, repair, adjustment or replacement; (iii) any materials and/or work are exposed to chemicals or substances other than those listed in the Specifications to the Contract for the work as accepted by Contractor; (iv) Owner's site conditions or pipe, pipeline, conduit or accessway conditions are not those disclosed to and accepted by Contractor; (v) the worksite, pipe, pipeline, conduit or accessways are cleaned or modified in a manner not disclosed in writing to and accepted in writing by Contractor in advance of commencement of Contractor's work or tampered with prior to, during or after completion of Contractor's work; or (vi) the work, the site at which the work is performed or the materials provided by Contractor are otherwise tampered with, abused or misused. PROJECT: Contract IA Great Southwest Parkway — Unit 2 OWNER: City of Fort Worth Texas CONTRACTOR: Insituform Technologies, LLC DATE OF INSTALLATION: 8 January 2021 BY: r3 ulWowl.L. Ursula . Youngblood,` ntrac ' gldnd A esting Officer Building Relationships Constructing Futures P.O. Box 164308 Fort Worth, TX 76161 8'7.927.4388 817-9274389 Fax www.faingp.com Project: CPN 101119-1 Great Southwest Parkway Owner: The City of Fort Worth General Contractor: The Fain Group, Inc The Fain Group agrees to solely provide an additional three (3) year warranty for the 9.5-inch concrete paving from station 16+79.38 to station 19+66.83 on the westbound lane, approximately 479.08 square yards of concrete paving on project CPN 101119-1 Great Southwest Parkway. This warranty will start immediately after the conclusion of CPN 101119-1 Great Southwest Parkway's standard 2-year maintenance bond period. Should any defect develop during the additional warranty period due to the use of unapproved concrete mix design or workmanship in that section, upon written notice by the Owner, Fain Group will repair or replace the concrete pavement at no expense to the Owner: The defects in the concrete panels due to any of the above -listed deficiencies will be determined by total cracking (quantity and size) and spalling compared to all other concrete paving panels that was installed by the project. TPW Field Operations and Warranty Inspections will review the deficient concrete section with this criteria and will give final direction as to the remediation method, if needed. If, at the end of the original 2-year maintenance bond, the above listed street section is replaced at the direction of the City of Fort Worth, The Fain Group will not be held to the additional 3-year warranty period as described. Nothing in the above shall be deemed to apply to work which has been abused, neglected or having experiences of acts of god. Date: Name Signs Title: Sworn to and subscribed before me this _� day of �"f,� , 20 14 KRISTI TREES Notary Public Notary ID #124427334 My Commission Expires: ®'171 P My Commission Expires -- "reo s� April 15, 2023 FORTWORTH. ''no, TRANSPORTATION AND PUBLIC WORKS February 6, 2023 Fain Group Inc. 2500 Great Southwest Pkwy Ft Worth, TX 76106 RE: Acceptance Letter Project Name: 2018 Bond, Street Reconstruction, Contract IA, Southwest ParkWAY Project Type: 01,02,03 & 04 City Project No.: 101119 To Whom It May Concern: On May 19, 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 February 2, 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 2, 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 817- 392-2333. Sincerely, Gregory Robbins, Project Manager Cc: Tamara Vauhgn, Inspector Wade Miller, Inspection Supervisor Ariel Duarte, Senior Inspector Mary Hanna, Program Manager Baird, Hampton & Brown, Consultant Fain Group Inc., Contractor N/A, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev. 8/20/19 AFFIDAVIT OF BILLS PAID AND RELEASE OF LIENS BY CONTRACTOR The Fain Group, Inc (Contractor), having furnished materials and/or performed labor in connection with the construction of the City of Fort Worth, Texas, Tarrant County, 2018 Bond Street Reconstruction Contract IA : Great Southwest Pkwy (Project) for and in consideration of the payment to the Contractor of the sum hereinafter specified does hereby acknowledge and release as follows: Upon the receipt of $197,250.09 for materials and/or labor performed by the Contractor for the Project (2018 Bond Street Reconstruction); Contractorwill waive and release any and all liens, rights and interests (whether Choate or inchoate, and including, without limitation, all mechanic's and materialmen's liens under the Constitution and the statutes of the "Property" state) which are or may be owed, claimed or held by Contractor in and to the Property and the improvements constructed thereon by reason of the Work or otherwise, and Contractor will thereby RELEASE AND FOREVER DISCHARGE any and all claims, debts, demands or causes of action the Contractor has or may have as a result of the same including, without limitation, any liens of Contract for the Work now or hereafter filed for record in said County. Contractor represents, warrants, and certifies that all bills owed by the Contractor for materials furnished and labor performed in connection with the Work have been or will be fully paid and satisfied. If for any reason a lien or liens are filed for materials or labor against the Property by virtue of the Contractor's participation in the Project by any person claiming by, through, or under the Contractor, then Contractor will immediately obtain a settlement of such lien or liens and obtain and furnish to the owners of the Property a release thereof. Contractor shall indemnify such owners and their respective heirs, successors and assigns from any such bill or liens and from all costs and expenses, including attorney's fees, incurred in discharging any such bills or removing such liens. Executed February 8 , 2023 Contract r me: The Fain Group, Inc. By: Ti le: Larry Frazier, President Subscribed and sworn to before me under my official seal of office this 8_ day of _February 2023 Notary Signature 2 P0.Y PLC,^ KRISTI TREES Notary ID #124427334 N My Commission Expires April 15, 2023 CONSENT OF SURETY COMPANY TO FINAL PAYMENT AIA DOCUMENT G707 OWNER xx❑ ARCHITECT ❑ CONTRACTOR ❑ SURETY ❑ OTHER ❑ Bond # 064818X PROJECT: Great Southwest Parkway Improvements, City Project No.101119 (name, address) TO (Owner)City of Fort Worth ARCHITECT'S PROJECT NO: 1000 Throckmorton CONTRACT FOR: FT. Worth, TX 76102 CONTRACT DATE: February 4, 2020 CONTRACTOR: The Fain Group, 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) Westfield Insurance Company P O Box 5001 Westfield Center, OH 44251-5001 on bond of (here insert name and address of Contractor) The Fain Group, Inc. P O Box 164308 Fort Worth, TX 76161 ,SURETY COMPANY, ,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 1000 Throckmorton FT. Worth, TX 76102 ,OWNER, as set forth in the said Surety Company's bond IN WITNESS WHEROF, The Surety Company has hereunto set its hand this 2nd day of February, 2023 Attest (seal): NOTE: This fonn is to be used as a companion document to AIA DOCUMENT G706, CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBT AND CLAIMS, Current Edition AIA DOCUMENT G707 * CONSENT OF SURETY COMPANY TO FINAL PAYMENT *APRIL 1970 EDITION *AIA 1970 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE. NW WASHINGTON, D.C. 2006 WARNING: Unlicensed photocopying violates U.S. copyright laws and is subject to legal prosecution. THIS POWER OF ATTORNEY SUPERCEDES ANY PREVIOUS POWER BEARING THIS SAME POWER # AND ISSUED PRIOR TO 05/25/22, FOR ANY PERSON OR PERSONS NAMED BELOW. General POWER NO. 4220012 14 Power Westfield Insurance Co. of Attorney Westfield National Insurance Co. CERTIFIED COPY Ohio Farmers Insurance Co. Westfield Center, Ohio Know All Men by These Presents, That WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, corporations, hereinafter referred to individually as a "Company" and collectively as "Companies," duly organized and existing under the laws of the State of Ohio, and having its principal office in Westfield Center, Medina County, Ohio, do by these presents make, constitute and appoint TONY FIERRO, JOHNNY MOSS, JAY JORDAN, MISTIE BECK, JEREMY BARNETT, JADE PORTER, ROBERT G. KANUTH, JARRETT WILLSON, JACK NOTTINGHAM, BRADY WILSON, BRENNAN WILLIAMSON, JOINTLY OR SEVERALLY of ROCKWALL and State of TX its true and lawful Attorney(s)-in-Fact, with full power and authority hereby conferred in its name, place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings, or other instruments or contracts of suretyship in any penal limit. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- LIMITATION: THIS POWER OF ATTORNEY CANNOT BE USED TO EXECUTE NOTE GUARANTEE, MORTGAGE DEFICIENCY, MORTGAGE GUARANTEE, OR BANK DEPOSITORY BONDS. and to bind any of the Companies thereby as fully and to the same extent as if such bonds were signed by the President, sealed with the corporate seal of the applicable Company and duly attested by its Secretary, hereby ratifying and confirming all that the said Attorney(s)-in-Fact may do in the premises. Said appointment is made under and by authority of the following resolution adopted by the Board of Directors of each of the WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY: "Be It Resolved, that the President, any Senior Executive, any Secretary or any Fidelity & Surety Operations Executive or other Executive shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-i n- Fact to represent and act for and on behalf of the Company subject to the following provisions: The Attorney -in -Fact. may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknowledge and deliver, any and all bonds, recognizances, contracts, agreements of indemnity and other conditional or obligatory undertakings and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney -in -Fact shall be as binding upon the Company as if signed by the President and sealed and attested by the Corporate Secretary." "Be it Further Resolved, that the signature of any such designated person and the seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signatures or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached." (Each adopted at a meeting held on February 8, 2000). In Witness Whereof, WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY have caused these presents to be signed by their National Surety Leader and Senior Executive and their corporate seals to be hereto affixed this 25th day of MAY A.D., 2022 . .ff1fN1 Corporate „ IIf1111 rp`asyy,t � ;.�.� oN�it�.�N. 111 WESTFIELD INSURANCE COMPANY Seals or,. fi..� �, SG•; �1° ...... � WESTFIELD NATIONAL INSURANCE COMPANY Affixed`�! �*�x=•'tip�3 r`;' 7' _ �.� 4 '•.cep' OHIO FARMERS INSURANCE COMPANY •r7C..Mxa SEAL •CNI►RTEIPE° :m: :o•._:.::...:....... ;'��,`•. „Y. ff� .y -o =�, 1848 .�a= �; •, M f , lr s , •pt' State of Ohio ""' By, County of Medina ss.: Gary W. �turnper, Nationa Surety Leader and Senior Executive On this 25th day of MAY A.D., 2022 , before me personally came Gary W. Stumper to me known, who, being by me duly sworn, did depose and say, that he resides in Medina, OH; that he is National Surety Leader and Senior Executive of WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, the companies described in and which executed the above instrument; that he knows the seals of said Companies; that the seals affixed to said instrument are such corporate seals; that they were so affixed by order of the Boards of Directors of said Companies; and that he signed his name thereto by like order. Notarial-f„ff•fffl.."4. Seal A L fNy,y Affixed State of Ohio :r +''40 David A. Kotnik, Attorney at Law, Notary Public County of Medina ss.: ` : y My Commission Does Not Expire (Sec. 147.03 Ohio Revised Code) Tf o F I, Frank A. Carrino, Secretary of WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said Companies, which is still in full force and effect; and furthermore, the resolutions of the Boards of Directors, set out in the Power of Attorney are in full force and effect. u In Witness Whereof, I have hereunto set my hand and affixed the seals of said Companies at Westfield Center, Ohio, thisday of A.D., +T• nwfa. oNAL �,v : '' Ire. '•.cF { : oaP ,...... �fVSG,, . .. f ' N SEAL •1141IfMN .„f.f NARTEIPEc��- I ' • Secretary 0. 1848 " • •�� Frank A. Carrino, Secretary BPOAC2 (combined) (03-22)