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Contract 57462-FP1
FORTWORTH, TRANSPORTATION AND PUBLIC WORKS NOTICE OF PROJECT COMPLETION -FP1 City Secretary No. 57462 Date Received: 7/28/2023 City Project N!?: 100637-3 Regarding contract 57462 Lackland Road Sidewalk Improvements for as required by the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by City Council on3/29/2022 through M&C 22-0221 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 I - , — Prins it 11, 117 -- l T .R fn 11 Accepted Director, TRANSPORTATION AND PUBLIC WORKS DEPARTMENT III I I I_h1n»—Tl Asst. City Manager Comments: $ 787,959.50 $ 0.00 No 0 $ 787,959.50 $ 503,749.78 0 Days @ $ 650 / Day $ 0.00 $ 503,749.78 $ 478,562.29 $ 25,187.49 Jul 27, 2023 Date Ju127,2023 Date Jul 28, 2023 Date OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX C-620 Signature Page Contractor's Application for Payment To (Owner) City of Fort Worth Invoicing Period (From -To): 5/1/23 - 7/10/23 P.O. FW020-0000007737 From (Contractor): Number: Ti-Zack Concrete Inc. Project: City Secretary Contract Number: Approved Change Orders Number 1 2 3 4 5 6 7 8 TOTALS NET CHANGE BY CHANGE ORDERS Contractor's Certification 100637-3 57462 Application For Payment Change Order Summary Additions Invoice No. 7 - Final Invoice Date: 7/10/2023 Remit to ( If Not Automatic Deposit): Ti-Zack Concrete, Inc. Contractor's CFW Vendor No.: 39352 221st Avenue Le Center, MN 56057 Contract Name: Lackland Rd Sidwalk ImI1 I1 Improvements from Cam Bowie Blvd to Clamont Ave I1.ORIGINAL CONTRACT PRICE.......................................................... $ Deletions 12. Net change by Change Orders................................................................. $ 13. Current Contract Price (Line 1 t 2)........................................................ $ 14. TOTAL COMPLETED AND STORED TO DATE (Progress Estimate, Construction Allowance and Change Orders)....... $ 15. RETAINAGE: a. X $503,749.78 Work Completed.......... $ b. X Not Used $ c. Total Retainage (Line 5a + Line 5b) ............................... $ 16. AMOUNT ELIGIBLE TO DATE (Line 4 - Line 5c)............................. $ 17. LESS PREVIOUS PAYMENTS (Line 6 from prior Application)........ $ 8. AMOUNT DUE THIS APPLICATION ................................................. $ 9. BALANCE TO FINISH, PLUS RETAINAGE (Column G on Progress Estimate+ CA + COs + Line 5 above) .............. $ 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. Liquidated Damages $650.00 x day 10. CONTRACT TIME: a, Days Awarded b, Days Added by CO C. Total Days $787,959.50 $7879959.50 $5039749.78 $503,749.78 $478,562.29 $25,187.49 $284,209.72 180 180 d, Days Charged 180 e, Days Remaining Consent of Surety Affidavit of Bills Paid 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. C-620 Unit Price Pmgresa Eslimale Progress Estimate City secretary 57462 Cordmct Num Bowie Blvd to Clamont Ave Specrfrcanon Sectlon No 017123 024113 024113 024113 024113 024113 024115 024115 024115 311000 31 1000 31 1000 311000 311000 Unit of Measure LS Btd Quantity 100000d Unit Price $1o,wood $250 $50000 $200 $400 $1200 $2000 $2000 $1000 $1600 $500 00 $800 00 $1,65000 $2,50000 $6500 $40 00 $1,00000 $24000 $700 $700 $700 $2300 $9 50 $1000 $1,30000 $1,30000 $1,30000 $2300 B Bid Value $10,000 od $5,31250 $5,00000 $11,79000 $52000 $5,61600 $6,00000 $4,00000 $4,55000 $4,80000 $500 00 $800 00 $3,30000 $15,00000 $56,10000 $6,00000 $1,00000 $4,80000 $101,18500 $106,82000 $4,90000 $37,950 00 $70,585 00 $12,000 NO $1,300 NO $7,800 NO $2,60000 $1,95500 C Estimated Quantity Installed iwoo00d 280847000000 1200000000 718508000000 1600000000 1189000000 20675000000 73850000000 30000000000 100000000 100000000 102000000000 150 00000000 100000000 1842000000 961147000000 1686200000000 91000000000 142 87000000 5940 00000000 44600000000 100000000 600000000 200000000 8500000000 D Value $10,0000 $7,02118 $6,00000 $14,37016 $18000 $23780 $4,11500 $7,38500 $4,80000 $1,65000 $2,50000 $56,10000 $6,000 00 $1,00000 $4,42080 $66,58029 $118,03400 $6,37000 $3,286 01 $66,430 00 $4,46000 $1,30000 $7,80000 $2,60000 $1,96500 Previously Installed Value $10,000 Od $7,02118 $6,00000 $14,37016 $18000 $23780 $4,11500 $7,38500 $4,80000 $1,65000 $2,66 00 $56,10000 _ $6,00000 $1,00000 $4,42080 $66,58029 $118,03400 $6,37000 $3,286 01 $56,430 00 $4,46000 $1,30000 $7,80000 $2,60000 $1,95500 SF 2125.000000 EA 10.000000 SF 5895.000000 SF 130.000000 LF 468.000000 BY 300.000000 SY 200.000000 LF 455.000000 BY 300.000000 EA 1.000000 EA 1.000000 EA 2.000000 EA 6.000000 312316 CY 1020.000000 3125 00 CY 150.000000 312500 LS 1.000000 3212M TN 20.000000 321320 SF 14455.000000 321320 SF 15260.000000 323220 SF 700.000000 33 32 20 LF 1650.000000 32 1320 SF 7430.000000 331320 SF 1200.000000 321320 EA 1.000000 321320 EA 6.000000 331320 EA 2.000000 321723 LF 85.000000 33 16 13 LF 500.000000 $2300 $11,50000 86115000000 $19,80645 $19,80645 34 16 13 LF 125.000000 $3000 $3,75000 22725000000 600000000 $6,81750 $750 00 $6,81750 $750 00 $11,47344 $9,68500 $23,72220 $3,66 00 $2,25000 $9,00000 $2,60000 $5,20000 $1,30000 $2,60000 $2,80500 $3,39359 $1,82930 32 1725 EA 35.000000 $150 00 $5,250 00 323213 SF 700.000000 $3300 $23,10000 34768000000 $11,47344 21300000000 $9,58500 329119 329213 330514 344130 347113 321320 321320 321320 331320 33 12 10 330514 000000 02 41 14 & 33 4920 CY 1020.000000 $4500 $45,90000 SY 6720.000000 $500 $33,60000 474444000000 $23,72220 EA 14.000000 $60000 $8,40000 600000000 $3,60000 EA 13.000000 $15000 $1,95000 1600000000 $2,25000 600000000 $9,00000 200000000 $2,60000 400000000 $5,20000 100000000 $1,30000 200000000 $2,60000 1700000000 $2,80500 013574370 $3,39359 3326000000 $1,82930 Mo 6.000000 $1,50000 $9,00000 EA 1.000000 $1,30000 $1,30000 EA 4.000000 $1,30000 $5,20000 EA 1.000000 $1,30000 $1,30000 EA 1.000000 $1,30000 $1,30050 EA 14.000000 $16500 $2,31000 LS 1.000000 $25,00000 $25,00000 BY 50.000000 $5500 $2,75000 EA 1000000 $5.500.00 $5.500.00 $503,243.72 Contractor's Application Applresnou Number 7-Final Apphcaaon Dare 7/10/2023 E F G Total CompletN / Balarce to F-h Value This Period Materials PreseC)idland Stored to Date (P) (B-F) Stored(votm C) (D+E) B $10,wo od loom $7,02118 1322% $1,70868 $6,00000 1200% $1,00000 $14,37016 1219% $2,58016 $520 00 $18000 32% $5,43600 $23780 40% $5,76220 $4,11500 1029% $11500 $7,385 00 162 3% $2,835 00 $4,80000 100 0% $500 00 $800 00 $1,65000 500% $1,65000 $2,50000 167% $12,50000 $56,10000 100 0% $6,00000 100 0% $1,00000 100 0% $4,42080 92 1% $379 20 $66,58029 65 8% $34,604 71 $118,03400 1105% 411,21400 $6,37000 130 0% 41,470 00 $3,28601 87% $34,66399 $56,430 00 79 9% $14,155 00 $4,46000 37 2% $7,540 00 $1,300 00 100 0% $7,800 00 100 0% $2,60000 100 0% $1,95500 100 0% $19,80645 1722% $8,30645 $6,81750 1818% 43,06750 $750 00 14 3% $4,500 00 $11,47344 497% $11,62656 $9,585 00 20 9% $36,315 00 $23,72220 70 6% $9,877 80 $3,600 00 42 9% $4,80000 $2,25000 1154% $30000 $9,00000 100 0% $2,60000 2000% $1,30006 $5,20000 100 0% $1,30000 100 0% $2,60000 2000% $1,30000 $2,80500 121 4% $495 00 $3,39359 136% $21,60641 $1,82930 665% $92070 $5,500.00 $6,750.00 $800.00 100.0% $1,116.00 100.0% $100,000.00 $503,243.72 639% $284,715.78 This document has been modiBM from its origital form as an EJCDC document and the user did not highight We modifcanons. You are rncomaged to read de documem carefully and -It Legal Courrsel poor m its execumm C-620 Change Order Progress Estimate Construction Allowance Usage ADDITIONS Contractor's Application For (cmaracl) Lackland Rd Sidwalk Improvements 100637-3 from Camp Bowie Blvd to Clamont Ave City Seeretary 57aez Applicatmn Number 7 -Final ntra Contract Nnm Application Period 5/1/23 - 7/10/23 Apph°atmn Date 7/10/2023 A B C D E F Item Total Completed Specification Quantity to Add Unit Price Addition Value Estimated Quantity Valve Previously Value This Materials Presently and Stored to Dale (F) Item Number Descriptwn Unit of Measure Installed Installed Value Period Stored (not iv C) B Sectiov No (D+E) I-50 344t.1502 Ground Box Tripe B W-APRON (CA-1) Paving Unit 1 EA 2.00000000 $253.03 $506.06 2.00000000 1 $506.06 $506.061 1 $506.06 100.0 This document has been modified from its original form as an EICDC document and the user did nor highlight the modifications. You are encouraged to read the document ca emlly and —silt Legal Counsel prior m its execution Balance to Finish (B -F) C-620 Change Order Totals $506.061 1 $506.061 $506.061 1 1 $506.061 100.0% 1 This document has been modified from its original form as an EICDC doeanam and the user did not highlight the modifications. You are eneomaged to read the doeoment —filly and —It Legal Counsel prior to its execution C-620 Change Order Progress Estimate Construction Allowance Usage CONSTRUCTION ALLOWANCE ITEMS TO BE REDUCED IFm (contiaa). 100637-3 Lackland Rd Sidwalk Improvements from Camp Bowie Blvd to Clarm nt Ave IApphcation Period. 5/1/23 - 7/10/23 A 6 C be Bid Item Number Description Specificzhon Unit of Measure Quantitym Delete Unit Price Reduction Value Not Used Section No I-41 Construchon Allowance Paving Unit I LS 0.00506060 $100,000.00 $506.06 ITotal. $506.04 Contractor's Application Application Number. 7 - Final Application Date. 7/10/2023 D E F Not Used Not Used Not Used Not Used Not Used Not Used Not Used This document has been modified from its original form as an EICDC 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 City of Fort Worth Summary of Charqes City Secretary Contract Num: 57462 1pn Lackland Rd Sidwalk improvements from Camp Bowie BO.vd FW020-0000007737to Clamont Ave Application Period: 5/1/23 - 7/10/23 Applic7 - Final Number: Funding Identification (FID) Total Completed Amt Remaining Gross Original Contract 34018-0200431-5740010-100637-003880-9999-18010201 $503,749.78 $284,209.72 0 0 0 0 0 0 0 0 0 0 Change Order 1 34018-0200431-5740010-100637-003880-9999-18010201 0 0 0 0 0 0 0 0 0 0 Change Order 2 34018-0200431-5740010-100637-003880-9999-18010201 0 0 0 0 0 0 0 0 0 0 Project Number: 100637-3 Application Date: 7/10/2023 Retainage Net City of Fort Worth Summary of Charges City Secretary Contract Num: 57462 In Lackland Rd Sidwalk improvements from Camp Bowie BO.vd FW020-0000007737to Clamont Ave Application Period: 5/1/23 - 7/10/23 Applic7 - Final Number: Funding Identification (FID) Change Order 3 34018-0200431-5740010-100637-003880-9999-18010201 0 0 0 0 0 0 0 0 0 0 Change Order 4 34018-0200431-5740010-100637-003880-9999-18010201 0 0 0 0 0 0 0 0 0 0 Change Order 5 34018-0200431-5740010-100637-003880-9999-18010201 0 0 0 0 0 0 0 0 0 0 Total Completed Amt Remaining Gross Project Number: 100637-3 Application Date: 7/10/2023 Retainage Net City of Fort Worth Summary of Charges City Secretary Contract Num: 57462 In Lackland Rd Sidwalk improvements from Camp Bowie BO.vd FW020-0000007737to Clamont Ave Application Period: 5/1/23 - 7/10/23 Applic7 - Final Number: Funding Identification (FID) Change Order 6 34018-0200431-5740010-100637-003880-9999-18010201 0 0 0 0 0 0 0 0 0 0 Change Order 7 34018-0200431-5740010-100637-003880-9999-18010201 0 0 0 0 0 0 0 0 0 0 Change Order 8 34018-0200431-5740010-100637-003880-9999-18010201 0 0 0 0 0 0 0 0 0 0 Total Completed Amt Remaining Gross Project Number: 100637-3 Application Date: 7/10/2023 Retainage Net City of Fort Worth Summary of Charges City Secretary Contract Num: I 57462 I Lackland Rd Sidwalk Improvements from Camp Bowie Blvd I P. C : FW020-0000007737 Project Number: 100637-3 to Clamont Ave I` Application Period: I 5/1/23 - 7/10/23 I Application I 7 - Final Application Date: 7/10/2023 Number: Funding Identification (FID) Total Completed Amt Remaining Gross Retainage Net Totals 1 34018-0200431-5740010-100637-003880-9999-18010201 10 10 10 10 10 10 10 10 10 10 Grand Total $503,749.78 $284,209.72 1 1 $503,749.78 1 1 $284,209.72 1 1 $0.00 1 1 ($25,187.49)1 1 $25,187.49 1 FORT WORTH Routing and Transmittal Slip Transportation & Public Works Department DOCUMENT TITLE: Lackland Sidewalk Improvements M&C CPN 100637-3 CSO # 57462 DOC# DATE: TO: INITIALS DATE OUT 1. Ilianisse Figueroa Aponte - review IF Nov 4, 2022 2 Jeremy Gibbs iclibbs(aOizack.com signature g Nov 4, 2022 3. Sergio Garcia - signature Nov 7, 2022 4. Donald Watson - review- Nov 4, 2022 5. Jose Orozco - signature ,Jo ° Nov 4, 2022 6. Mary Hanna - signature Nov 7, 2022 7. Martin Phillips - signature P Nov 10, 2022 8. Lauren Prieur - signature Nov 10, 2022 9. Doug Black - signature dwb Nov 11, 2022 10. William Johnson - signature '15- Nov 11, 2022 11. Jannette Goodall - signature isu JSG Nov 14, 2022 12. TPW Contracts DOCUMENTS FOR CITY MANAGER'S SIGNATURE: All documents received from any and all City Departments requesting City Manager's signature for approval MUST BE ROUTED TO THE APPROPRIATE ACM for approval first. Once the ACM has signed the routing slip, David will review and take the next steps. NEEDS TO BE NOTARIZED: ❑ Yes ❑ No RUSH: ❑ Yes ❑ No SAME DAY: ❑ Yes ❑ No NEXT DAY: ❑ Yes ❑ No ROUTING TO CSO: ❑ Yes ❑ No Action Reauired: ❑ As Requested ❑ For Your Information ❑x Signature/Routing and or Recording ❑ Comment ❑ File ❑ Attach Signature, Initial and Notary Tabs Return To: Please calITPW Contracts at ext. 7233 for pick up when completed. Thank you. CSC No. 57462-AR1 FORT WORTH. City of Fort Worth `11� Construction Allowance Request Project Name I Lackland Rd Sidewalk Improvements From Camp Bowie Blvd to Calmont Ave I CitySec # 157462 Client Project #(s) 1 100637-3 Project This is a Sidewalk improvements project along Lackland Rd from Camp Bowie W Blvd to Calmont Ave to provide concrete sidewalks and Description lbarrier free ramps. Contractor Ti-Zack Concrete, Inc. I CA #I 1 I Date I 10/20/2022 City Project Mgr. Jose A Orozco City Inspector I Sergio Garcia UNIT or DEPT Original Contract Amount Extras to Date Credits to Date Current contract Amount 'Amount oT t'roposea Allocation unglnal Allowance AvallaDle SO Allocation Allowance Funds Previously Allocated Revised Allowance Balance Paving UNIT 1 $fdf'vo9.ou $U.UU Sum I Totals $tdt'9s9.5u $161,9b9.bo $181,9b9.50 $bub.ub $U.UU $U.UU $1 UU,000.UU $U.UU $1 UU,000.UU $U.UU $99,493.94 $U.UU f $U.UU $U.UU $99,49J.94 JUSTIFICATION (REASONS) FOR CONSTRUCTION ALLOWANCE IN ACCORDANCE WITH THIS CONSTRUCTION ALLOWANCE REQUEST, THE CONTRACT SHALL: Furnish all labor and material as per attached proposed Construction Allowance Request. This Construction Allowance #1 will adjust the scope to include the necessary bid items to include the installation of 2 ground boxes not previously included during the design. Cost - City of Fort Worth has compared the unit prices which are being proposed by the contractor to the 2019 Unit price Ordinance. The City finds that the prices that are being proposed by the contractor are fair and reasonable. Time - Additional contract time has been reviewed and the no additional of days are being granted is deemed reasonable for the work scope when reviewed in relation to the critical path of the work activities. It is understood and agreed that the acceptance of this Construction Allowance Request 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 Construction Allowance Request. The Project/Program Manager signing below acknowledges that he/she is the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. Ti-Zack Concrete, Inc. I Jeremy Gibbs I I Nov 4, 2022 Inspector/Inspecti Date Project and Contract Compliance Manager Date y �M- Nov 7, 2022 Nov 4, 2022 Program Manager Date Senior Capital Project Officer Date Nov 7, 2022 Nov 7, 2022 - Assistant Director (Dept) Date Director, Contracting Department (Dept) Date Nov 10, 2022 f Nov 10, 2022 Assistant City Attorney Date Assistant City Manager Date Nov 11, 2022 I Nov 11, 2022 ATTEST: Jannette S. Goodall Jannette Goodall, City Secretary Construction Allowance SUMMARY Page 1 of 4 FOR_ _ T WORTH City of Fort Worth —�� Construction Allowance Additions Project Name I Lackland Rd Sidewalk Improvements From Camp Bowie Blvd to Calmont Ave I City Sec # 1 57462 1 Client Project # I 100637-3 1 Contractor JTi-Zack Concrete, Inc. PM 1 Jose A Orozco Inspector Sergio Garcia Construction Allowance Submittal # 0 Date 1 10/20/2022 I ADDITIONS ITEM DESCRIPTION DEPT Qty Unit Unit Cost Total 1-50 3441.1502 Ground Box Type B w/Apron Paving UNIT 1 2.00000000 EA $253.03 $506.06 Paving UNIT 1 $506.0 $0.0 $0.0 $0.0 Total Additions $506.0 Construction Allowance Additions Page 2 of 4 FORT WORTH City of Fort Worth �+ Construction Allowance Value Project Name I Lackland Rd Sidewalk Improvements From Camp Bowie Blvd to Calmont Ave I City Sec # 1 b(4b1 Client Project # I 100637-3 1 Contractor Ti-Zack Concrete, Inc. I PM 1 Jose A Orozco Inspector Sergio Garcia Construction Allowance Submittal # Date I 'iulzulzuzz I CONSTRUCTION ALLOWANCE VALUE BEING USED ITEM DESCRIPTION Qty Unit Unit Cost Total 1-49 Construction Allowance 0.0050606 LS $100,000.00 $506.06 Construction Allowance Value 3of4 MISBE for this Construction Allowance Request M/SBE Sub I Type of Service Amount for this CAR Total $0.00 Previous Construction Allowance Requests CAR # DATE I AMOUNT Total I $0.00 Construction Allowance MSBE Data Page 4 of 4 FORTWORTH. TRANSPORTATION AND PUBLIC WORKS July 13, 2023 Ti Zack Concrete Inc. 39352 221" Avenue Le Center, MN 56057 RE: Acceptance Letter Project Name: Lackland Road Sidewalk Improvements Project Type: Capital Improvement City Project No.: 100637-3 To Whom It May Concern: On May 30, 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 July 7, 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 July 7, 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- 329-6637. Sincerely, ?_ .A. O�� Jose Orozco, P.E., Project Manager Cc: Sergio Garcia, Inspector Donald Watson, Inspection Supervisor Oscar Aguillon, Senior Inspector Mary Hanna, P.E., CFM, PMP, Program Manager A.N.A. Consultants, L.L.C., Consultant Ti Zack Concrete Inc, Contractor N/A, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev. 8/20/19 Bond # 800129834 �21'1---AIA Document G707TM .1994 Consent of Surety to Final Payment PROJECT: (Name and address) ARCHITECT'S PROJECt NUMBER: OWNER ❑ City Project No. 100637-3 - Lackland Road Sidewalk Improvements from Camp Bowie Blvd. to CONTRACT FOR: ARCHITECT ❑ Calmont Avenue, Fort Worth, Texas CONTRACTOR ❑ TO OWNER: (Name and address) CONTRACT DATED: 3/29/2022 SURETY ❑ City of Fort Worth - Transportation and Public Works Department City Hall - 2nd Floor 200 Texas Street OTHER ❑ Fort Worth, TX 76102 In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the (Insert name and address of Surety.) Atlantic Specialty Insurance Company 605 Highway 169 North, Suite 800 Plymouth, MN 55441 ,'SURETY, on bond of (Insert name and address of Contractor.) Ti-Zack Concrete, Inc. 39352 - 221 st Ave Le Center, MN 56057 ,CONTRACTOR, hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve the Surety of any of its obligations to (Insert name and address of Owner.) City of Fort Worth - Transportation and Public Works Department City Hall - 2nd Floor 200 Texas Street Fort Worth, TX 76102 , OWNER, as set forth in said Surety's bond. IN WITNESS dvrir.t(1�ili1, the Surety has hereunto set its hand on this date: July 24, 2023 (Insert in writing the month followed by the numeric date ''and year.) Atlantic Specialty Insurance Company (Surety) (Signatui-of authorized representative) -; - - Troy Staples, Attorney -in -fact _-Artesf:- - (fle'W _ (Printed name and title) CAUMN: Yo a should sign an original AIA Contra ument, on which this text appears in RED. An original assures that changes viff:i not ti-- obscured. g{A [locum- G70aTM —1994. Copyright © 1970 and 1994 by The American Institute of Architects. All rights reserved. WARNA: This AIA Doyumerit is pratbcted by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA` Document, or any 'portion -of ittiriay result in severe civil and criminal penalties, and will be prosecuted to the -dovui-a extent possible under the law. Purchasers are not permitted to reproduce this document. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyright@aia.org. sr I-RAIA TM'Document G707 -1994 Instructions Consent of Surety to Final Payment GENERAL INFORMATION Purpose. AIA Document G707TM is intended for use as a companion to AIA Document G706TM, Contractor's Affidavit of Payment of Debts and Claims, on construction projects where the Contractor is required to furnish a bond. By obtaining the Surety's approval of final payment to the Contractor and its agreement that final payment will not relieve the Surety of any of its obligations, the Owner may preserve its rights under the bond. Related Documents. This document may be used with most of the AIA's Owner -Contractor agreements and general conditions, such as A201 and its related family of documents. As noted above, this is a companion document to AIA Document G706. Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify the most recent edition. Reproductions. This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G707, but only for use in connection with a particular project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement (EULA). To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyright@aia.org. CHANGES FROM THE PREVIOUS EDITION Changes in the location of various items of information were made, without revision to the substance of the document. COMPLETING G707-1994 General. The bond form is the usual source of required information such as the contract date and the names and addresses of the Surety, Owner, Contractor and Project. Architect's Project No. This information is typically supplied by the Architect and entered on the form by the Contractor. Contract For. This refers to the scope of the contract, such as "General Construction" or "Mechanical Work." EXECUTING THE DOCUMENT AIA Document G707 requires both the Surety's seal and the signature of the Surety's authorized representative. AIA Document G707T" —1994. Copyright ©1970 and 1994 by The American Institute of Architects. All rights reserved. WARMN Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this IG¢ Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under th"e10w.�Pur&fse`rs' are not permitted to reproduce this document. To report copyright violations of AIA Contract Documents, e-mail The American Institute of ArchItects'iegal counsel, copyright@aia.org. intact INSURANCE Power of Attorney KNOW ALL MEN BY THESE PRESENTS, that ATLANTIC SPECIALTY INSURANCE COMPANY, a New York corporation with its principal office in Plymouth, Minnesota, does hereby constitute and appoint: Jonathan Pate, Zachary Pate, Jennifer Boyles, Nicholas Hochban, Thomas Lahl, Thomas Kemp, Troy Staples, each individually if there be more than one named, its true and lawful Attorney -in -Fact, to make, execute, seal and deliver, for and on its behalf as surety, any and all bonds, recognizances, contracts of indemnity, and all other writings obligatory in the nature thereof, provided that no bond or undertaking executed under this authority shall exceed in amount the sum of: unlimited and the execution of such bonds, recognizances, contracts of indemnity, and all other writings obligatory in the nature thereof in pursuance of these presents, shall be as binding upon said Company as if they had been fully signed by an authorized officer of the Company and sealed with the Company seal. This Power of Attorney is made and executed by authority of the following resolutions adopted by the Board of Directors of ATLANTIC SPECIALTY INSURANCE COMPANY on the twenty-fifth day of September, 2012: Resolved: That the President, any Senior Vice President or Vice -President (each an "Authorized Officer") may execute for and in behalf of the Company any and all bonds, recognizances, contracts of indemnity, and all other writings obligatory in the nature thereof, and affix the seal of the Company thereto; and that the Authorized Officer may appoint and authorize an Attorney -in -Fact to execute on behalf of the Company any and all such instruments and to affix the Company seal thereto; and that the Authorized Officer may at any time remove any such Attorney -in -Fact and revoke all power and authority given to any such Attorney -in - Fact. Resolved: That the Attorney -in -Fact may be given full power and authority to execute for and in the name and on behalf of the Company any and all bonds, recognizances, contracts of indemnity, and all other writings obligatory in the nature thereof, and any such instrument executed by any such Attorney -in -Fact shall be as binding upon the Company as if signed and sealed by an Authorized Officer and, further, the Attorney -in -Fact is hereby authorized to verify any affidavit required to be attached to bonds, recognizances, contracts of indemnity, and all other writings obligatory in the nature thereof. This power of attorney is signed and sealed by facsimile under the authority of the following Resolution adopted by the Board of Directors of ATLANTIC SPECIALTY INSURANCE COMPANY on the twenty-fifth day of September, 2012: Resolved: That the signature of an Authorized Officer, the signature of the Secretary or the Assistant Secretary, and the Company seal may be affixed by facsimile to any power of attorney or to any certificate relating thereto appointing an Attomey-in-Fact for purposes only of executing and sealing any bond, undertaking, recognizance or other written obligation in the nature thereof, and any such signature and seal where so used, being hereby adopted by the Company as the original signature of such officer and the original seal of the Company, to be valid and binding upon the Company with the same force and effect as though manually affixed. IN WITNESS WHEREOF, ATLANTIC SPECIALTY INSURANCE COMPANY has caused these presents to be signed by an Authorized Officer and the seal of the Company to be affixed this first day of January, 2023. �V GpFPORgl�,9Zn'_ SEAL L r 1986 0_-' By STATE OF MINNESOTA ?e��Fw voP�aa HENNEPIN COUNTY Sarah A. Kolar, Vice President and General Counsel �b ,� Lao'' On this first day of January, 2023, before me personally came Sarah A. Kolar, Vice President and General Counsel of ATLANTIC SPECIALTY INSURANCE COMPANY, to me personally known to be the individual and officer described in and who executed the preceding instrument, and she acknowledged the execution of the same, and being by me duly sworn, that she is the said officer of the Company aforesaid, and that the seal affixed to the preceding instrument is the seal of said Company and that the said seal and the signature as such officer was duly affixed and subscribed to the said instrument by the authority and at the direction of the Company. ALISON DWAN NASH'TROUT NOTARY PUBLIC - MINNESOTA �' `" ""L r My Commission Expires 3 �January 31, 2025 Notary Public I, the undersigned, Secretary of ATLANTIC SPECIALTY INSURANCE COMPANY, a New York Corporation, do hereby certify that the foregoing power of attorney is in full force and has not been revoked, and the resolutions set forth above are now in force. Signed and sealed. Dated 24th day of This Power of Attorney expires January 31, 2025 July 2023 .\POSY 'NSL9' " R TF i -U _1s66 9 Kara L.B. Barrow, Secretary Please direct bond verifications to suretv aOintactinsurance.com �. .Print Form _. Final Bills Paid Affidavit by Contractor BEFORE ME, the undersigned authority, personally appeared Jeremy Gibbs (hereinafter referred to as "Contractor"), known to me to be a credible person, and after being by me duly sworn, upon oath stated and affirmed that: "My name is Jeremy Gibbs and I am the Vice President of Ti-Zack Concrete, Inc. hereafter sometimes referred to in this affidavit as "Contractor". Contractor's business address is 39352 221st Avenue, Le Center, MN 56057 The undersigned Contractor has personal knowledge of the facts stated herein and has full authority to make the agreements in this affidavit on behalf of Contractor. Pursuant to and in accordance with a written construction contract between Ti-Zack Concrete, Inc, , Contractor, and Ft. Worth , Owner/Administrator, Contractor furnished materials and labor for the construction, renovation, or repair of improvements located on or relating to project known asCPN 100637-3 Lackland Sidewalk Improvements located at Lackland Road , City of Ft. Worth ) Tarrant County, Texas, legally described in Exhibit "A" attached hereto and made a part hereof for all purposes (the "Property"). All work provided for under said written construction contract, together with all changes and supplements thereto, has been fully completed in accordance with the terms and provisions thereof. Contractor has paid each of its subcontractors, laborers, suppliers and materialmen in full for all labor and materials provided to Contractor for or in connection with the construction, renovation, or repair of improvements on or relating to the subject Property, or any portion thereof, excepting only the amounts owed for the following specified bills to the persons identified below. Contractor warrants and represents that the following specified bills will be paid to Contractor by Owner/Administrator in reliance on this Final Bills Paid Affidavit: Name of Payee Address 'None Telephone No. Amount Owed Other than the above specified bills owed to the above referenced persons, Contractor is not aware of any unpaid bills, claims, demands, or causes of action by any of its subcontractors, laborers, suppliers, or materialmen for or in connection with the furnishing of labor or materials, or both, for the construction, renovation, or repair of improvements located on or related to the subject Property. In consideration of the funds paid to Contractor by Owner/Administrator and by Lender on behalf of Owner/Administrator in reliance on this affidavit, Contractor waives and releases all of Contractor's statutory and constitutional mechanic's lien rights connected with the construction of the Project, conditioned on the actual payment or collection if payment is made by check or draft. Contractor further understand that this Final Bills Paid Affidavit is being given pursuant to and in accordance with Sections 53.085 and 53.259 of the Texas Property Code and that the intentional, knowing, or reckless making of a false or misleading statement in this Affidavit constitutes an offense under said Section and is a Class A misdemeanor. Contractor hereby indemnifies and holds harmless Owner/Administrator from any and all claims, demands or causes of action, and any costs, expenses, and attorney's fees incurred in connection therewith, arising from or connected with, the statements and representations contained herein." Form 16 — Final Bills Paid Affidavit Page 1 of 3 May 1, 2009 EXECUTED this 24 day of July 120 23 Ti-Zack Concrete, Inc. [Name of Contractor CompE By: Printed Name:Jaremy Gibbs Title: Vice President Notary's Acknowledgement Before me, the undersigned authority, on this day personally appeared , who first being duly sworn by me to be the person whose name is subscribed to the foregoing Final Bills Paid Affidavit, acknowledged that he/she has the authority to make this Final Bills Paid Affidavit, and further acknowledged to me that he/ she executed the same for the purpose and consideration therein expressed. GIVEN UNDER MY HAND AND SEAL OF OFFICE on this the --1 day of -YuA , 20 33 (Seal) 1 S &-. Notary Public, State of+Ms r %144%-SoTA ,i+�jr, SUSAN LYNN SIMONETTE My commission expires t ! 31) 1 :`�' Notary Public Minnesota s<�J,a My Commission Expires :�., �.. Jan 31, 2027 � Form 16 — Final Bills Paid Affidavit Page 2 of 3 May 1, 2009 EXHIBIT "A" Form 16 — Final Bills Paid Affidavit Page 3 of 3 May 1, 2009