HomeMy WebLinkAboutContract 56809-FP2FORT WORTH.
City Secretary
Contract No. 56809 -FP2
Date Received 2/13/2023
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: Bar C Ranch Phase 10
City Project No.: 102444
Improvement Type(s): ❑x Paving
Original Contract Price:
Amount of Approved Change Order(s):
Revised Contract Amount:
Total Cost of Work Complete:
'6'z� %ze2,
Rob Tavlor (Feb 202315:37 CST)
Contractor
Accounts Receivable
Title
Gilco Contracting, Inc.
Company Name
c� U)
Project Inspector
Khal Jaafan P.E.(F b 10. 202316:36 CST)
Project Manager
Rebecca Diane Owen IFeb 12. 202308:57 CST)
CFA Manager
Lauren Pi eur (Feb 12. 2023 09:51 CST)
Interim TPW Director
william Johnson (Fe 13.202313:19 CSTI
Asst. City Manager
❑ Drainage ❑ Street Lights ❑ Traffic Signals
$1,030,672.35
-$31,661.05
$999,011.30
Feb 10, 2023
Date
Feb 10, 2023
Date
Feb 10, 2023
Date
Feb 12, 2023
Date
Feb 12, 2023
Date
Feb 13, 2023
Date
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Page 1 of 2
Notice of Project Completion
Project Name: Bar C Ranch Phase 10
City Project No.: 102444
City's Attachments
Final Pay Estimate ❑x
Change Order(s): ❑x Yes ❑ N/A
Contractor's Attachments
Affidavit of Bills Paid
Consent of Surety
Statement of Contract Time
Contract Time 255 WD Days Charged: 201
Work Start Date: 2/16/2022 Work Complete Date 02/20/2023
Completed number of Soil Lab Test: 502
Completed number of Water Test: 12
Page 2 of 2
FORT WORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name BAR C RANCH PHASE 10
Contract Limits
Project Type PAVING
City Project Numbers 102444
DOE Number 2444
Estimate Number 1 Payment Number 1 For Period Ending 2/10/2023
WD
City Secretary Contract Number Contract Time 5WD
Contract Date Days Charged to Date 160
Project Manager NA Contract is 100.00 Complete
Contractor GILCO CONTRACTING, INC.
6331 SOUTHWEST BLVD.
BENBROOK, TX 76132-1063
Inspectors GLOVER / WALKER
Friday, February 10, 2023 Page 1 of 4
City Project Numbers 102444 DOE Number 2444
Contract Name BAR C RANCH PHASE 10 Estimate Number 1
Contract Limits Payment Number 1
Project Type PAVING For Period Ending 2/10/2023
Project Funding
PAVING
Item
Description of Items
Estimated Unit
Unit Cost
Estimated
Completed
Completed
No.
Quanity
Total
Quanity
Total
1
HYDRATED LIME (CO A2)
349.8 TN
$170.00
$59,466.00
349.8
$59,466.00
2
6" LIME TREATMENT (CO A2)
21815 SY
$2.65
$57,809.75
21815
$57,809.75
3
6" CONC PVMT (CO A2)
20464 SY
$35.05
$717,263.20
20464
$717,263.20
4
4" SIDEWALK PVMT (CO A2)
10441 SF
$5.75
$60,035.75
10441
$60,035.75
5
BARRIER FREE RAMP
4 EA
$2,050.00
$8,200.00
4
$8,200.00
6
BARRIER FREE RAMP (CO A2)
20 EA
$1,750.00
$35,000.00
20
$35,000.00
7
FURNISH/INSTALL ALUM SIGN GROUND
13 EA
$250.00
$3,250.00
13
$3,250.00
MOUNT CITY STD
8
FURNISH/INSTALL ALUM SIGN GROUND
13 EA
$190.00
$2,470.00
13
$2,470.00
MOUNT CITY STD
9
TRAFFIC CONTROL
1 LS
$1,500.00
$1,500.00
1
$1,500.00
10
REMOVE TYPE III BARRICADE (CO A2)
2 EA
$500.00
$1,000.00
2
$1,000.00
11
SWPPP MAINTENANCE
1 LS
$500.00
$500.00
1
$500.00
12
CONCRETE FLUMES (CO C1)
452 LF
$72.05
$32,566.60
452
$32,566.60
13
TOPSOIL
1165 CY
$5.00
$5,825.00
1165
$5,825.00
14
BLOCK SOD PLACEMENT
10485 SY
$1.00
$10,485.00
10485
$10,485.00
15
SAW CUT EXISITING CONCRETE PAVEMENT
91 LF
$40.00
$3,640.00
91
$3,640.00
(CO A2)
Sub -Total of Previous
Unit
$999,011.30
$999,011.30
Friday, February 10, 2023 Page 2 of 4
City Project Numbers 102444
Contract Name BAR C RANCH PHASE 10
Contract Limits
Project Type PAVING
Project Funding
Contract Information Summary
Original Contract Amount
Change Orders
Change Order Number A2
Change Order Number Al
Total Contract Price
DOE Number 2444
Estimate Number 1
Payment Number 1
For Period Ending 2/10/2023
$1,030,672.35
$15,027.35
($46,688.40)
$999,011.30
Total Cost of Work Completed $999,011.30
Less % Retained $0.00
Net Earned $999,011.30
Earned This Period $999,011.30
Retainage This Period $0.00
Less Liquidated Damages
Days @ / Day
LessPavement Deficiency
Less Penalty
Less Previous Payment
Plus Material on Hand Less 15%
Balance Due This Payment
$0.00
$0.00
$0.00
$0.00
$0.00
$999,011.30
Friday, February 10, 2023 Page 3 of 4
City Project Numbers 102444
Contract Name BAR C RANCH PHASE 10
Contract Limits
Project Type PAVING
Project Funding
Project Manager NA
Inspectors GLOVER / WALKER
Contractor GILCO CONTRACTING, INC.
6331 SOUTHWEST BLVD.
BENBROOK, TX 76132-1063
DOE Number 2444
Estimate Number 1
Payment Number 1
For Period Ending 2/10/2023
City Secretary Contract Number
Contract Date
Contract Time 50 WD
Days Charged to Date 160 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 $999,011.30
Less % Retained
$0.00
Net Earned
$999,011.30
Earned This Period $999,011.30
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
$999,011.30
Friday, February 10, 2023 Page 4 of 4
DocuSign Envelope ID: 7BE96E97-858C-43AB-9043-A8656BOF6484
DEVELOPER -AWARDED -PROJECT CHANGE ORDER
PROJECT NAME:
Bar C Ranch Phase 10
CONTRACT:
(A) Paving
CFA #
CFA21-0065 I
CITY PROJECT #
102444
DOE #
N/A
WATER PROJECT #
FID No. 30114-0200431-102444-EO7685
SEWER PROJECT#
IFID No. 30114-0200431-102444-EO7686
FILE # IW-2673
INSPECTOR: Eddie Walker
PROJECT MANAGER: KHALJAAFARI
CITY PARTICIPATION:I NO
Phone No: (469) 658-5100
Phone No: (817) 392-7872
CHANGE
ORDER No:
A2
RECEIVED
By Khal Jaafari at 2:48 pm, Feb 09, 2023
CONTRACT UNIT
UNIT I: WATER
UNIT IB: S COUNTY LINE RD
UNIT II: SANITARY SEWER
UNIT III: DRAINAGE
UNIT IV: PAVING
UNIT V: STREET LIGHTING
CONTRACT
WATER
-
DAYS
Developer
City Cost
Developer
City Cost
Developer
City CostCity
Developer
Cost
Developer
City CostCity
Developer
Cost
Cost
Cost
Cost
Cost
Cost
Cost
ORIGINAL CONTRACT
$1,030,672.35
EXTRAS TO DATE
I
I
I
CREDITS TO DATE
I
I
I
I
I ($46,688.40)
I
ICONTRACT TO DATE
I $0.00
$0.00
I $0.00
$0.00 I
S0.00
S0.00 I S0.00
S0.00
I $983,983.95 $0.00
S0.00
$0.00
I 50
(AMOUNT OF PROP. CHANGE ORDER
I
I
I
I
I $15,027.35
I 0
IREVISED CONTRACTAMOUNT
I $0.00 I 50.00
S0.00 I
S0.00 I
$0.00 I
$0.00 I S0.00 I $0.00
I $999,011.30
$0.00
$0.00 I
50.00
50
TOTAL REVIS CONTRACT AMOUNT
PER UNIT
I $0.00
$0.00
$0.00
I S0.00
I $999,011.30
$0.00
REVISED COST SHARE
IDev. Cost:
$999,011.30
City Cost:
$0.00
TOTAL REVISED CONTRACT
I
$999,011.30
Revised: 1D-12-2011 Page 1
DocuSign Envelope ID: 7BE96E97-858C-43AB-9043-A8656BOF6484
You are directed to make the following changes in the contract documents
CITY BID ITEM
I
PAY ITEM #
I
QUANTITY
UNIT
(UNIT IV: Paving
1 1
3211.0400
2.8
TON
1 2
3211.0501
173
SY
3
3213.0101
148
SY
1 4
3213.0506
394
SF
1 6
3213.0506
2
EA
1 10
N/A
-1
EA
1 15
I
I
N/A
91
LF
ITEM DESCRIPTION
Hydrated Lime
6" Lime Treatment (32#/SY)
6" Conc. Pvmt.
4" Sidewalk Pvmt
Barrier Free Ramp, Type P-1
Remove T pe III Barricade
Sawcut ExistinSoncrete Pavement
RECEIVED
By Khal Jaafari at 2:49 pm, Feb 09, 2023
DEVELOPER
UNIT PRICE COST
$170.00 1 $476.00
$2.65 1 $458.45
$35.05 1 $5,187.40
$5.75 1 $2,265.50
$1,750.00 1 $3,500.00
$500.00 1-$500.00
$40.00 1 $3640.00
TOTALS $15,027.351
REASONS FOR CHANGE ORDER North intersection of Heritage Trace Parkway and Boulder Oak Boulevard not built with Phase B. Pavement and sidewalk addition required along with sawcut and BFRs.
RECOMMENDED:
DeeuSlgned by:
LJA E gine.e rig
a— Y
By:
wcossouea iaw...
Name: Lauren Gilstrap
Title: Sr. Protect Manager
APPROVED:
DocuSlgned by:
Fore rtart(USA) Real Estate Group, Inc.
t vuln, (,a�jaYt,S
By:
ucerAoucrai uaru...
Name: Kevin Lazares
Title: Vice President
APPROVED:
Gilco Contracting Inc.
By: Leta McoJ gie;l
Name: Leia McQuien
Title: Drina Emsirient Olaaratin—
CITY COST I TOTAL
$0.00 $476.001
$0.00 $458.451
$0.00 $5,187.401
$0.00 $2,265.501
$0.00 $3,500.001
$0.00-$500.001
mu.uu $3,64u.oy
$0.001 $15,027.351
Revised: 10-12-2011 Page 2
DocuSign Envelope ID: F9EE3C75-2226-49C4-9DF9-DAC7871900D3
DEVELOPER -AWARDED -PROJECT CHANGE ORDER
PROJECT NAME:
Bar C Ranch Phase 10
CHANGE
CONTRACT:
(A) Paving
ORDER No:
CFA #
CFA21-0065 I CITY PARTICIPATION:( NO
CITY PROJECT #
102444
I DOE #
I N/A
IWATER PROJECT#
IFID No. 30114-0200431-102444-EO7685
Al
ISEWER PROJECT#
IFID No. 30114-0200431-102444-EO7685
FILE #
I W-2673
RECEIVED
INSPECTOR:
Eddie Walker Phone No:
(469) 658-5100
PROJECT MANAGER:
Khal Jaafari Phone No:
(817) 392-7872
By Khal Jaafari
at 4:39 pm, Apr 29, 2022
'
CONTRACT UNIT
WATER
SEWER
PAVING
DRAINAGE
STREET LIGHTS
CONTRACT
Developer
Developer
Developer
Developer
Developer
I
DAYS
I
Cost
City Cost
Cost
City Cost
Cost
City Cost
Cost
City Cost
Cost
City Cost
ORIGINAL CONTRACT
$1,030,672.35
EXTRAS TO DATE
(CREDITS TO DATE
(CONTRACT TO DATE
$0.00
$0.00 I $0.00
I $0.00
I $1,030,672.35I
$0.00 I
$0.00
$0.00
$0.00
$0.00 I 50
(AMOUNT OF PROP. CHANGE ORDER
I
I
I$ (46,688.40)I
I
I 0
(REVISED CONTRACT AMOUNT
I $0.00
I $0.00 I $0.00
I $0.00
I $983,983.95
I $0.00 I
$0.00
1 $0.00 I
$0.00
I $0.00 I 50
TOTAL REVIS CONTRACT AMOUNT
PER UNIT
I $0.00
$0.00
I $983,983.95
$0.00
$0.00
REVISED COST SHARE
Dev. Cost: $983,983.95
City Cost:
$0.00
TOTAL REVISED CONTRACT
$983,983.95
Revised: 10-12-2011 Page 1
DocuSign Envelope ID: F9EE3C75-2226-49C4-9DF9-DAC7871900D3
You are directed to make the followinc changes in the contract documents:
CITY BID ITEM
PAY ITEM # # QUANTITY UNIT
1 12 N/A -648 LF
I
I
I
REASONS FOR CHANGE ORDER
RECEIVED
By Khal Jaafari at 4:39 pm, Apr 29, 2022
ITEM DESCRIPTION UNIT PRICE TOTAL
Concrete Flume $ 72.05 $ (46,688.40)1
1
1
TOTAL $ (46,688.40)1
Pay Item 12 Shortened Concrete Flume at the northwest comer of the phase
NO CITY FUNDS INVOLVED IN THIS CONTRACT. DEVELOPER IS RESPONSIBLE FOR 100% OF THE CHANGE ORDER COST AND NO
REIMBURSEMENT FROM THE CITY WILL BE SOUGHT BY THE DEVELOPER.
RECOMMENDED:
Con°ouyfin yIN`AEenn�g^yXieeer )
��/ / VD
By:
—rcucoeyoq iaw...
Name: Lauren G1 strap
Title: Sr. Project Manager
APPROVED:
DocuSigned by:
(De eloe/r`)''1. .m
Kevin Lazares
Name:
Title: vice President
APPROVED:
(C
o Signed by:
tra//c o�'
�j�GLCt /•rGQwK.1L
By
boor444h.4M IAA,....
Name: Leia McQuien
Title: vice President, operations
Revised: 10-12-2011 Page 2
FORTWORTH.
TRANSPORTATION AND PUBLIC WORKS
February 10, 2023
Gilco Contracting Inc
6331 Southwest Boulevard
Benbrool< TX. 76132
RE: Acceptance Letter
Project Name: BAR C RANCH PHASE 10
Project Type: Paving
City Project No.: 102444
To Whom It May Concern:
On February 9, 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 10, 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 10, 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-
392-7872.
Sincerely,
KGu�G_9�� P. C-.
Khal Jaafari P.E.( eh 10, 202316:36 CST)
Khal Jaafari, Project Manager
Cc: Eddie Walker, Inspector
Mike Glover, Inspection Supervisor
Daniel Roy, Senior Inspector
VictorTornero, Program Manager
UA ENGINEERING, INC., Consultant
Gilco Contracting, Inc., Contractor
Forestar(USA) Real Estate Group,lnc., 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 full;
That there are no claims pending for personal injury and/or
property damages;
On Contract described as Paving Improvements to serve:
Bar C Ranch, Phase 10
�Y
BY: Rob Tay or
Subscribed and sworn before me on this 3rd of February , 2023.
V P .,,, EMMA TURNER
O P"........8�
Notary Public, State of Texas
•g My Commission Expires
August 12, 2025
N01 APY 10 13326419
51winvi/`
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 022232639
PROJECT:
(name, address)Bar C Ranch Phase 10
TO (Owner)
Fort Worth
TX
FORESTAR (USA) REAL ESTATE GROUP, INC. AND ARCHITECT'S PROJECT NO:
CITY OF FORT WORTH CONTRACT FOR:
Building Two, Suite 500 Bar C Ranch Phase 10
Austin TX 78746 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)
FORESTAR (USA) REAL ESTATE GROUP, INC. AND CITY OF FORT WORTH
Building Two, Suite 500
Austin TX 78746 OWNER,
as set forth in the said Surety Company's bond.
IN WITNESS, WHEREOF,
the Surety Company has hereunto set its hand this
Attest:
(Seal):
3rd day of February, 2023
LIBERTY MUTUAL INSURANCE COMPANY
Surety
yCompany )
Signatufe of Authorized Representative
Soohinie Hunter
Title
Attorney -in -Fact
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
10� bind the Company except in the manner and to the extent herein stated.
Liberty Liberty Mutual Insurance Company
Mutua.L The Ohio Casualty Insurance Company Certificate No: 8205467-022020
SURETY West American Insurance Company
POWER OF ATTORNEY
KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation 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.
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, recognizances and other surety obligations, in pursuance
of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper
persons.
IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed
thereto this 23rd day of April 2021
Liberty Mutual Insurance Company
P� iNSUR4 PyI`f INS( iy \NSURThe Ohio Casualty Insurance Company
�J aoRPOR4TFyo �J aoReoaar 2 �6Pu.5L OR4qr 2� West American Insurance Company
o R� vQ 3 o m w g Fo to
ui Y�1912y0 o 1919 0 1991
�* ZOe) M * >`G.20
0j>
By:
m David M. Carey, Assistant Secretary 0-
to State of PENNSYLVANIA ss S
rn County of MONTGOMERY ;_
0
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 �
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
_(D _ therein contained by signing on behalf of the corporations by himself as a duly authorized officer. m tJ
N to
c
v 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.
O00
N
L �x^" iat�✓ ,vr Commonwealth of Pennsylvania -Notary Seal
Qj O
O 4?
C fu
Co
rn�
O
E�
oc}Lo
� U
Co c
>4)
o
Z 0
Teresa Paslelfa, Notary Public
Montgomery County
� s z " My commission expires March 28, 20?b
Commission number 1126044 By.
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
Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows:
>�
°o
O.Fu
E
O N
Q `o
00
Mutual
O N
ARTICLE IV —OFFICERS: Section 12. Power of Attorney, a w
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 0 o
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 -o c
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 a>
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 attorney -in -fact under the m
provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. g
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 attorneys -in -fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the
Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if
signed by the president and attested by the secretary.
Certificate of Designation — The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attorneys -in -
fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety
obligations.
Authorization — By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the
Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with
the same force and effect as though manually affixed.
1, 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 3rd day of February , 2023 .
P� 1NsVQq PVTY INS& %NSMI
2GonP0 fro ycc^ Q 3OoaaoRyroyyc, \V °oRaop'. y0
1912 0 1919 u 1991�
�V19s`SACHU`+��,aD yO 2t�NAMPS4 as '� �NDIANP a By �
Fla s�M * Renee C. Llewellyn, Assistant Secretary
LMS-12873 LMIC OCIC WAIC Multi Co 02/21
e i 4- Liberty-
TSURETY
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 (111-1A)
P. O. Box 149091
Austin, TX 78714-9091
FAX: (512) 490-1007
Web: htta://www.tdi.texas.gov
E-mail: ConsumerProtection c4.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.
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 -1 A)
P. O. Box 149091
Austin, TX 78714-9091
FAX # (512) 490-1007
Web: http://www.tdi.texas.aov
E-mail: ConsumerProtection(,tdi.texas.izov.
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