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Home My WebLink AboutContract 58800-FP1FORTWORTH, TRANSPORTATION AND PUBLIC WORKS NOTICE OF PROJECT COMPLETION -FP1 City Secretary No. 58800 Date Received: 10/26/2023 City Project N!?: 103454 Regarding contract 58800 1 2022 Bridge Rehab Contract 1 for as required by the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by City Council on 12/13/2022 through M&C 22-1044 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 Patricia L. Wadsack (Oct 25, 202315:46 CDT) Recommended for Acceptance Asst. Director, TPW - Capital Delivery a Lauren Pri— (Oct 25, 2023 15:50 CDT) Accepted Director, TRANSPORTATION AND PUBLIC WORKS DEPARTMENT Wil liarp Inh--M YES )0)J 1555 fOT1 Asst. City Manager Comments: $ 969,857.20 $ Ns $ 960,136.77 Days @ $ 650 / Day $ $ 960,136.77 $ 912,129.93 $ 48,006.84 Oct 25, 2023 Date Oct 25, 2023 Date Oct 25, 2023 Date OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Contractor's Application for Payment To (Owner): City of Fort Worth Invoicing Period (From -To): 9/1/23 - 9r0/23 P. O. FW020-0000009244 From (Contractor): Number. MW PANEL TECH. LLC Project 103454 Contractor's CFW Vendor No.: 7000003501 City Secretary Contract 58800 Contract 2022 Bridge Rehab Contract 1 Number. Name: o Application For Payment Change Order Summary, Approved Change Orders Number Additions I 2 3 4 5 6 7 8 TOTALS NET CHANGE BY CHANGE ORDERS Invoice No. 22005-07 Invoice Date: 10/3/2023 Remit to ( IfNot Automatic Deposit ): MW Panel Tech 11. ORIGINAL CONTRACT PRICE ....................... _ ............................ ..- S Deletions 12. Net change by Change Orders ..... ...................... .... ......................... .... S 13. Current Contract Price (Line 1 t 2)...................... ............................ S 14. TOTAL COMPLETED AND STORED TO DATE (Progress Estimate, Construction Allowance and Change Orders).-- S 5. RETAINAGE: a. X S960,136.77 Work Completed.......... S b. X Not Used S c. Total Retainage (Line 5a + Line 5b)-._... _.... ...... -_._... S 16. AMOUNT ELIGIBLE TO DATE (Line 4 - Line 5c)-_._............. _....... S 17. LESS PREVIOUS PAYMENTS (Line 6 from prior Application)......... S S. AMOUNT DUE THIS APPLICATION .................... - ........ ................. . S 9. BALANCE TO FINISH, PLUS RET.AINAGE (Column G on Progress Estimate+ CA + Cos + Line 5 above)—......_._ S Contractor's Certification The Contractor certifies with the submittal of this document and associated Payment Request Submittal on the City of Fort Worth Buasaw 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 Lions, security interests and encumbrances (except such as arc 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 r 10. CONTRACT TIME: Consent of Surety Affidavit of Bills Paid a. Days Awarded b, Days Added by CO C. Total Days S969,857.20 S969,857.20 S960,136.77 S960,136.77 S9121129.93 S48,006.84 S9,720.43 150 150 d. Days Charged 150 e. Days Remaining C-620 Unit Price Progress Estimate Progress Estimate F°`ftan6nt0 2022 Bridge Rehab Contract 1 Applimtion Period: 9/1/23 - 9/30/23 A )tan Spodr-tion Bid Item No. Demriptien Satian No, 1 _ REMOBIUZATION _ 01 7000 2 REMOVING CONC(PAVI 1044i001 3 REMOVING CONC (SIDEWALKS) 104SDIS 4_._ - REMOVING CONC_(CURBI 104.6021 5 REMOVING CONC_(APPR SLAB) 104-6027 _6 EXCAVATION (ROADWAY)-------- 110.6001 _ 7 EMBANKMENT(FINALI(ORD COMP)(1Y_B) __ 132-6003 _8_ CONC PVMT(CONT REWF-CRCP)(7'1 _.- 36MOOl _ _ 9 CURB (TYPE ID _ _ 360-6027 -_ 10___CEMSTABILBKFL 400.6005 11 CL C CONC(WINGWALLS) 420-6057 12 CL C CONC (MISC) _ - 420-6074 13 APPROACH SLAB _ _ _ 422-6015 14 PENETRATING CONCRETE SURFACE TREATMENT 42&6001 15 CONC STR REPAIR NERTICALS OVERHEAD)__-... __-- 42M007 16 CONC STR REPAIR(STANDARD) 42A6009 17 REPAIR HANGER GROUT POCKET _ 429-60XX CLEANING AND SEALING EXISTING JOINTS 438.6001 19 REMOVSTR(WINGWALL) _ 49(15005 20 CONC SIDEWALKS f5) 53"002 21 _ MTL W-BEAM GO FEN MM POST1 __ -_ 5405001 22 _. MTL BEAM GO FEN TRANS (rHRIE.BEAM1_ _ _ _ _ _ _ _ 540.6006 _23_ DOWNSTREAM ANCHOR TERMINAL SECTION 5404i016 24 REMOVEMETALBEAM GUARDFENCE_ 54240o1 25 GUARDRAIL END TREATMENT(INSTALL) $44.6001 _ _26, REPLACE STEEL RAIL _ 776.6053 27 -ONO CRACK REAPIR (DISCRETE) (GRAVITY) _ _ 790-6001 _ 28 CNCCRACKREAPIR(DISCRETE)(INJECTI _ 790.6002 _ ._29_ _ REP STL BRIDGE MEMBER _MGHTEN_MEMBER)__ _ _ _ _ 7944033 30 9999.0096_PAVING CONSTRUCTION ALLOWANCE - _ Totals City seamy 58800 Contract Num: B C D Unit of Hid Quantity Unit Prim Bid Vdu< Eslimmed QuantityWWI°d Value Previomly Wmlld Voluc Value TNs Pend Mmsum EA 1.000000_.__=.Do $500.00 _ SY 346.700000 $45.00___.__515,601.50 _512.55000008_-523.964.75 _523.964.75 _ SY 5SIX000 $40.00 _ E224.OD 36,5100.0000 __ __E7.472.40 _$1.472.40 __ _-_.. ____- LF 15.OD0000 580.00 - _,51.200.00 - SY - -- 636.400000 E7200 $45,820.80 ___ 581,000OW00. S41,B3200 _E41,83200 CY 464,000000 _ $109.00 _ _ S50,576.W 620.00000000 _$67.580.00 ___-- $67,580.00 CY __- 39,800000 $126.00 $5.014.80 BY 415.000000 _ _ $171.00 370.965.00 _-_ -_ 53255000W0 591.0615.0S -__ 597,068.05 _ -LF 15.000000 _ $110.00 S7,650.00 CY 464.000000 -__ $154.00 $71.456.00 601.000000DD 592554.00 _- $82,554.00 _ CY _ 7,300000 $5,100.00 S37230.00 4.00000000 520.400.00 _ ._320,400.00 CY 7200000 E2153.00 $339.60 CY 204,400000 _ __- $858.00 $175.37520 278,13OD0DO0 $238.635.54 5238,63554 SY 459200DOW _ $45.00 E211.140.00 _ 46MO0000000 $211,140.00 E211,140A0 SF 15.200000 $422.00 _S6.414.40 _ SF S225.00 2110,27250.___ 3073DOWDOO E69,14250 . _. 369.142SD EA __49OAD0000 15.000000 S700.L07 $10,5DO.00 __ 18.00000000 $12.600.00 _ 512.600.OD LF 332.000000 $59.00 __-.._E19.688.00 - 108.00030000 _ _._ _$6.372.00 _$6,372.00 _ _ 4.D00D00 $2,650.00 -E10.600.00 1.D000D000 _ _ _ _E2.650.00 S2650.00 _ _EA_ SY 5=1300 S363,00 $203280 _ _.. _.._ 36.81000000 E13.36203__ ___.-E13,362.03 LF 125.000000 S122,00 $15.250.00 14250000000. $17.385.00 E17,385.00 _ EA_ 4.000000 $566,00 $2264.00 _ _____ --__ - EA_- __ 1.000ao0 $1 s6D.Do E1,SOD.Do _1,a000aoa0 _ $1soD.oO st.SCD.aD - LF 175.000000 $15.00 ___$2.625.00 _-. _ 14250WOODO __.-_E2.137.50 ____ $2,137.50 _ _ EA 3.000000 $565,00 E1.695.00 1.90000000 ___ $555.00 _ S_566.00 LF 189.300000 $122.00 $23.094.60 LF _- _ 1D.000000 $85.00 $850.00 _ 10.00000000 9850.00 SB50.00 LF 10.D00000 $115.00 $1_.150,00 EA_ 624.000000 $72.00 S44.928.00 __... 624.00000000 $44.928,00 _-E44.928.00 - LS _._ 1.00DOIX_ E30.000.W _ -_._E30.000.00 _. $969.857.20 5960.136.T7 $290.139.77 Contractor's Application Alli.fi. Number. 22005-07 Appllmtion Dore: 10/32023 E F G Toml Complctd I Balmm to FW A Matmiols P-fll °"d Stamd to D..(F) (B- F) Stored (not in C) (DIE) B $500.00 _ S23.964.75 153.6%_ S8.36325 $1,472.40 657.3% -- - - -$1248.40 - - - $1.200.00 - - $4.1.832.00 913%_ - _.. $3.988.80 - - -- $67.58MD0 133.6% -_ _ 417.004.00 _.-$5.014.80 - E81,066.05 12&S%_ -. _- 4..0 $1 _31.6506W.00 $92554.00 129.5% _ 421.098.00 320.400.00 _54.8_% _$16.830.00 $339.60 $238.635.54 136.1% 463.260.34 $211.140.00 100.0% S6.414.4D $69.142.50 62.7% $41.130.00 $12.600.00 120.0% S2.100.00 S6.372.00 325% $13216.00 52.650.00 25% 57.950 $13,362.03 657.3% _ _ 577.3292323 $17.385.00 114.0% _ _. _ $Z135.00 S2264.00 S1.500.OD _100.0% _ _ 5213750 81.4% $487.50 5565DO 33.3% -- _ - - $1.130.DO 523,094.60 _ S850.00 100.0% _-._-- ._.. 31.150.00 $4 -- -- 4.928.00 100.D% - - _- - - $30.000.00 $960.136.77 99D% 59,720,13 T1,k douument hen bam mWilid f m it anginal form m m E)CDC document and the uw did not highlight the mdi0mtions You am mcoumgcd to read the document m fully and coroult Lqul Coumel primm its=,uuon. City Secretary Contract Num: 58800 Application Period: Funding Identification (FID) Original Contract 30100-0200431-5740010-103454-E02680-9999 0 0 0 0 0 0 0 0 0 City of Fort Worth Summary of Charges 2022 Bridge Rehab Contract 1 I P. 0.: FW020-0000009244 Project Number: 1103454 9/1/23 - 9/30/23 Application 22005-07 Application Date: I 10/3/2023 Number. Total Completed 1 Amt Remaining Gross ! Retaine Net i I $960,136.77 $9,720.43 C=' i I � _ I I - I ! I I -- '•'' I I -- I-- I -- I : I I Change Order 30100-0200431-5740010-103454-E02680-9999 0 I I - C I I o o 0 10 to to10 to-- 10 i � I Change Order 2 130100-0200431-5740010-103454-E02680-9999 to to 10 to to c, I I �'= t to I I �.� I I 6C.c,a I oc 10 to- 10 10 I I I I J,, I I ��J,- City of Fort Worth Summary of Charges City Secretary Contract Num: 58800 I 2022 Bridge Rehab Contract 1 P. 0.: FW020-0000009244 I Project Number: 103454 Application Period: I 9/1/23 - 9/30123 ApplicaNtion 22005-07 Application Date: 10/3/2023 Number:: Funding Identification (FIDI Total Completed I Amt Remaining I I Gross Retainage I Net I Change Order 3 30100-0200431-5740010-103454-E02680-9999 I 0 I ! o o o o I I I I I I I o o I I 1 I I I o I ! 1 1 I Change Order 4 30100-0200431-5740010-103454-E02680-9999 0 0 0 0 0 0 0 0 10 0 Change Orders 30100-0200431-5740010-103454-E02680-9999 0 0 0 0 0 0 0 0 0 0 City of Fort Worth Summary of Charges City Secretary Contract Num: 58800 2022 Bridge Rehab Contract 1 I P. p. : FW020-0000009244 Project Number: 1103454 Application Period: 9/1/23 - 9/30/23 Application 22005-07 Application Date: I 10/3/2023 Number: Funding Identification (FID) I Total Completed Amt Remaining 1 Gross Retainage I Net Change Order 7 I 30100-0200431-5740010-103454-E02680-9999 to to to t o-- 10 to- 10 o to I I I I to 30100-0200431-5740010-103454-E02680-9999 o o o I I —I I=I I e I I o o o o I I I ,s=l o o City of Fort Worth Summary of Charges City Secretary Contract Num: 58800 2022 Bridge Rehab Contract 1 p. 0.: FW020-0000009244 Project Number: 103454 Application Period: 9/1/23 - 9/30/23 Application 22005-07 Application Date: 10/3/2023 Number: Funding Identification (FID) Totals 30100-0200431-5740010-103454-E02680-9999 0 0 0 0 0 0 0 0 0 0 Grand Total Total Completed Amt Remaining Gros Retainaqe I $960,136.77I $9,720.43 1 1 $960,136.771 1 $9,720.431 1 'I I �I I i I $0.001 1 ($48,006.84)1 1 Net $48,006.84 FORT WORTH TRANSPORTATION AND PUBLIC WORKS October 2, 2023 MW Panel Tech 2735 Ludelle St Fort Worth, TX 76105-1212 RE: Acceptance Letter Project Name: 2022 Bridge Rehab Contract 1 Project Type: Paving Repair and Maintenance City Project No.: 103454 To Whom It May Concern: On August 25, 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 September 25, 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 September 25, 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- 223-2261. Sincerely, Taric ul Islam (Oct 25, 202314:59 CDT) Tariq Islam, Project Manager Cc: Ignacio Andrade, Inspector Mike Glover, Inspection Supervisor Daniel Roy, Senior Inspector Omar Elbagalati, Program Manager Thomas G. Ashcraft, Consultant Johnathan White, Contractor TPW General Capital Projects Fund, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev. 8/20/19 CONSENT OF SURETY TO FINAL PAYMENT AIA Document G707 Bond No. 022235367 TO OWNER: (.vame and addnnq City of Fort Worth 200 Texas Street Fort Worth, TX 76102 PROJECT. (Name and aWrem) 2022 Bridge Rehabilitation Contract 1 City Project No. 103454 OWNER ARCHITECT CONTRACTOR I� SURM- � OTHER ❑ ARCHITECT'S PROJECT NO.: NIA CONTRACT FOR: 2022 Bridge Rehabilitation Contract 1 CONTRACT DATED: December 13, 2022 In accordance with the provisions of the Contract between the Owner and the Contractor as indic awd :lkove, t he (!Hoerr na+ne and udrtrewrr f.S+rrrn7 Liberty Mutual Insurance Company 175 Berkeley Street Boston, MA 02116 , SURFTY, on bond of (/leen name and a leiret+! f Cu)11 rV1C1v '1 MW Panel Tech LLC 5013 Martin Luther King Fwy Fort Worth, TX 76119 , CONTRACTOR, hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve the Surety of any of its obligations to (haex r1 none and ttdr(ree, of Owner) City of Fort Worth 200 Texas Street Fort Worth, TX 76102 , OWNER, as set forth in said Surety's bond. IN WITNESS WHEREOF, the Surety has hereunto set its hand on this date: October 20, 2023 (L:,erf In writ ft Ibe monlbJallouvil b), tbe,ur» fu de dare anr( Iran! Liberty Mutual lnsurarce Company /�� l.V';graErlurrnf fix "erl+rprrr..cu dirxl Attest: Kim Alta, Witness Bradv K. Cox, Attornev-in-Fact - lPrrnfcrl airnre and fitto CAUTION: You should sign an original AIA document that has this caution printed in rod. -Art i original assures that changes will not be obscured as may occur when documents are reproduced, See Instruction Sheet for Limited License for Reproduction of this document. ALA DWU14ENT 6707 • CONSFNT OF St: RF IY'IYJ FINAL PAYINIENT • 1994 Fni77ON • 'AIA 01994 • THE AMERICAN INSUn-M. OF ARCHITEM, 1735 NEVI' YORK AVF.Nt:E. NW. WA.5t1- INGInN. D.C. 200D6-5292 • WARNING: Unlicensed photocopying violates U.S. copy- G707-1994 tlgM taws and will subieat the violator to legal prosecution. This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. Liberty Liberty Mutual Insurance Company Mutual. The Ohio Casualty Insurance Company Certificate No. 8209206-022006 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, Blaine Allen; Brady K. Cox, Brent Baldwin; Brock Baldwin; Cynthia Alford; John A. Aboumrad; Kirsten Ortiz; Lorena Guticrrez: Michael B. Hill; Neira Hernandez; Russ Frenzel; Veronica Ramos; William D. Baldwin; Yamillec Ramos all of the city of Plano state of TX each individually if there be more than one named, its true and lawful attomey-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 4th day of January 2023 . P� yNSU� AJ 0�a, '=p 1912 � �tV INS& yJ �o�ORvr�y f° n " 1919 m I. � tNSU.11 GP g0 kAgr c, 4. FO ih a, 1991 n Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company ,1 CHUy�.�a ° �N41A4`',aa �s �HafANP .dL r _i." N O 'C U m David M. Carey, Assistant Secretary C w State of PENNSYLVANIA SS — :3 E p� County of MONTGOMERY o, 2 On this 4th day of January 2023 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance C m Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes •`;_-e therein contained by signing an behalf of the corporations by himself as a duly authorized officer. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seat at Plymouth Meeting, Pennsylvania, on the day and year first above written. 00 Sri` O 4rSp,gH y mvma Gomonitlt of Pennsylvania -Notary Seal h��(i Teresa Pastella, Notary Public a)Montgomery County O OF My commission expires Merch 28, 2M _prJ D 7 Commission number 1126044 y qj �, �� N Member. Pe,msyivana Aasoci Wn ofNotanes ZZa`P,,IelIa, Notary Public ¢ o N N ARY 4� O` N a? This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual eo O •S Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows: d ARTICLE IV— OFFICERS: Section 12. Power of Attorney. o 19 Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the President � o 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 any and all m CD_ Co a Co m undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact, subject to the [imitations set forth in their respective powers of attorney, shall have full 0 1 o t= 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 instruments shall � y Z U be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attomey4n-fact under the provisions of this `, m 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 attomeys-in- fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Authorization — By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with the same force and effect as though manually affixed. I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 20th day of October , 2023 Pv %NSU� 4`(l 1NSU a 1NSUR4 °fir s 1912 0 0 1919 o d 1991 rVHUs� da as°HAMvghpL rs vNDIAµP fly- Renee C. Llewellyn, Assistant Secretor y , y LMS-12973 LMIC OC]C WAIC Multi Co 02r21 Final Bills Paid Affidavit by Contractor BEFORE NIE, the undersigned authority, personally appeared MW Panel Tech (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: "vly name is Jonathan White and I am the Managing Director of MW Panel Tech hereafter sometimes referred to in this affidavit as "Contractor". Contractor's business address is 5013 MLR Fury, Fort Wor"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 bet%veen MN Panel Tech I Contractor. and City of Fort Word Owner/Administrator. Contractor furnished materials and labor for the construction. renovation, or repair of improvements located on or relating to project known as Bridge 2022 Contret 1 located at Various Locations , City of Fort Worth Tarrant County, Texas. All work provided for under said written construction contract, together with all changes and supplements thereto. has been full completed in accordance with the tenns and provisions thereof: Contractor has paid each of its subcontractors, laborers, suppliers and materiahnen 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. 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 2 EXECUTED Ibis© day of October . 2023 MW Panel TeQ. [Name of Contractor Company] By: Printed NameJonathan White Title: Managing Director 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 29 :day of October .20 23 (Sea]) Notary Pubhc. S �tnte Texas My commission expire _. 1-21 - i �qr�+r+rep Bfi{7CK MANGOS Sri r °�e =r : Notary Public, State of Texas f 4_ Comm- Expires 08-21.2024 +''�o;:'``:� Notary ID 132637814 'fern 1 s%'' - J Form 16 — Final Bills Paid Affidavit Page 2 of 2