HomeMy WebLinkAboutContract 59254-FP1-FP1
City Secretary
Contract No. 59254
FORT WORTH.
Date Received 12/20/2023
AT
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: Ventana SFR 7
City Project No.:104529
Improvement Type(s): Water x❑ Sewer x❑
Original Contract Price: $63,896.00
Amount of Approved Change Order(s):
Revised Contract Amount:
Total Cost of Work Complete: $63,896.00
" During the project, the contiad bid was updated to a higher amount than the initial estimate in the CFA. Asa result, the total oost of completed work is higherthan the CFA estimate. The City is providing
this explanation for audit purposes, as the CFA amountwas only an estimate
y-Dec 19, 2023
Ufa ,mod /n�. io �n'1't tF lIIIfGTI
Contractor Date
Manager
Title
Conatser Construction, TX LP
Company Name
CurtisHo(Dec 19, 202316:14 CST)
Project Inspector
cwr y A&Aft,V E
Sandi, Adhikari (Dec 20. 2023 14 39 CST)
Project Manager
�e 1`ouavr oil behaW o-
Dwavne Ho ars on behalf of: (Dec 20. 202314:41 CSTI
CFA Manager
A
Lau ren Prieur (Dec 20, 2023 15:02 CST)
TPW Director
William.Ihn�nn (D. �1 7f1�21R41 CSTI
Asst. City Manager
Dec 19, 2023
Date
Dec 20, 2023
Date
Dec 20, 2023
Date
Dec 20, 2023
Date
Dec 21, 2023
Date
OFFICIAL RECORD
CITY SECRETARY Page 1 of 2
FT. WORTH, TX
Notice of Project Completion
Project Name: Ventana SFR 7
City Project No.: 104529
City's Attachments
Final Pay Estimate ❑x
Change Order(s): ❑ Yes ❑x N/A
Pipe Report: ❑x Yes ❑ N/A
Contractor's Attachments
Affidavit of Bills Paid
Consent of Surety
Statement of Contract Time
Contract Time: 30 WD
Work Start Date: 8/21/2023
Completed number of Soil Lab Test: 15
Completed number of Water Test: 7
Days Charged: 51
Work Complete Date: 11/2/2023
Page 2 of 2
FORT WORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name VENTANA SFR PHASE 7
Contract Limits
Project Type WATER & SEWER
City Project Numbers 104529
DOE Number 4529
Estimate Number 1 Payment Number 1 For Period Ending 11/2/2023
WD
City Secretary Contract Number Contract Time 3VVD
Contract Date Days Charged to Date 51
Project Manager NA Contract is 100.00 Complete
Contractor CONATSER CONSTRUCTION TxLP
5327 WICHITA ST
FORT WORTH, TX 76119
Inspectors D. WATSON / HOLLINSWORTH
Friday, December 15, 2023 Page 1 of 4
City Project Numbers 104529
Contract Name VENTANA SFR PHASE 7
Contract Limits
Project Type WATER & SEWER
Project Funding
UNIT I: WATER IMPROVEMENT
Item Description of Items
No.
1 TRENCH SAFTEY
2 4" WATER METER AND VAULT
3 SWPPP> 1 ACRE
4 TEMPORARY WATER SERVICES
5 DUCTILE IRON WATER FITTINGS W/
RESTRAINT
6 6" WATER PIPE, SELECT BACKFILL
7 CONNECTION TO EXISTING 4"-12" water main
8 UTILITY SERVICE SURFACE RESTORATION
SODDING
DOE Number 4529
Estimate Number I
Payment Number I
For Period Ending 11/2/2023
Estimated Unit
Unit Cost
Estimated
Completed
Completed
Quanity
Total
Quanity
Total
50 LF
$2.00
$100.00
50
$100.00
2 EA
$16,000.00
$32,000.00
2
$32,000.00
1 LS
$1,500.00
$1,500.00
1
$1,500.00
1 LS
$2,500.00
$2,500.00
1
$2,500.00
0.114 TN
$8,771.93
$1,000.00
0.114
$1,000.00
50 LF
$75.00
$3,750.00
50
$3,750.00
2 EA
$2,500.00
$5,000.00
2
$5,000.00
66 SY
$8.00
$528.00
66
$528.00
--------------------------------------
-------------------
Sub-Total of Previous Unit
$46,378.00
$46,378.00
UNIT H: SANITARY IMPROVEMENT
Item
Description of Items
Estimated Unit
Unit Cost
Estimated
Completed
Completed
No.
Quanity
Total
Quanity
Total
---------------------------------------
1
POST - CCTV INSPECTION
34 LF
$5.00
$170.00
34
$170.00
2
5' EXTRA DEPTH MANHOLE
4 VF
$245.00
$980.00
4
$980.00
3
8" SEWER PIPE
34 LF
$70.00
$2,380.00
34
$2,380.00
4
MANHOLE VACUUM TESTING
1 EA
$102.00
$102.00
1
$102.00
5
TRENCH SAFETY
34 LF
$2.00
$68.00
34
$68.00
6
SWPPP> 1 ACRE
1 LS
$1,500.00
$1,500.00
1
$1,500.00
7
EPDXY MANHOLE LINER
12 VF
$455.00
$5,460.00
12
$5,460.00
8
TRENCH WATER STOPS
1 EA
$250.00
$250.00
1
$250.00
9
UTILITY SERVICE SURFACE RESTORATION
51 SY
$8.00
$408.00
51
$408.00
SODDING
10
Y MANHOLE
1 EA
$6,200.00
$6,200.00
1
$6,200.00
Sub -Total of Previous Unit
$17,518.00
$17,518.00
Friday, December 15, 2023 Page 2 of 4
City Project Numbers 104529
Contract Name VENTANA SFR PHASE 7
Contract Limits
Project Type SANITARY
Project Funding
Contract Information Summary
Original Contract Amount
Change Orders
Total Contract Price
DOE Number 4529
Estimate Number I
Payment Number I
For Period Ending 1/1/2001
$63,896.00
$63,896.00
Total Cost of Work Completed $63,896.00
Less % Retained $0.00
Net Earned $63,896.00
Earned This Period $63,896.00
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
$63,896.00
Friday, December 15, 2023 Page 3 of 4
City Project Numbers 104529
Contract Name VENTANA SFR PHASE 7
Contract Limits
Project Type SANITARY
Project Funding
Project Manager NA
Inspectors D. WATSON J HOLLINSWORTH
Contractor CONATSER CONSTRUCTION TxLP
5327 WICHITA ST
FORT WORTH, TX 76119
DOE Number 4529
Estimate Number I
Payment Number 1
For Period Ending 1/1/2001
City Secretary Contract Number
Contract Date
Contract Time 30 WD
Days Charged to Date 51 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 $63,896.00
Less % Retained $0.00
Net Earned $63,896.00
Earned This Period $63,896.00
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
$63,896.00
Friday, December 15, 2023 Page 4 of 4
FORTWORTH
TRANSPORTATION AND PUBLIC WORKS
PIPE REPORT FOR:
PROJECT NAME: Ventana SFR 7
CITY PROJECT NUMBER: 104529
WATER
PIPE LAID SIZE TYPE OF PIPE
OPEN CUT 6" PVC
LF
50
FIRE HYDRANTS: 0 VALVES (16" OR LARGER) 0
PIPE ABANDONED SIZE TYPE OF PIPE LF
DENSITIES: PASSED
NEW SERVICES: 1" COPPER 6
I SEWER
PIPE LAID SIZE TYPE OF PIPE LF
OPEN CUT 8" PVC 34
PIPE ABANDONED SIZE TYPE OF PIPE LF
DENSITIES: PASSED
NEW SERVICES:
TRANSPORTATION AND PUBLIC WORKS
The City of Fort Worth • 1000 Throckmorton Street • Fort Worth, TX 76012-6311
FORTWORTH.
TRANSPORTATION AND PUBLIC WORKS
December 20, 2023
Conatser Construction TX
5347 Wichita St.
Fort Worth, TX 76119
RE: Acceptance Letter
Project Name: Ventana SFR 7
Project Type: Water and Sewer
City Project No.: 104529
To Whom It May Concern:
On November 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 November 16, 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 December 16,
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-
392-8424.
Sincerely,
Sm4 A&Am,? E
Sandi p Ad h i ka ri (D ec 20, 2023 14:39 CST)
Sandip Adhikari P.E., Project Manager
Cc: Curtis Hollingsworth, Inspector
Donald Watson, Inspection Supervisor
Aaron Ybarra, Senior Inspector
Victor Tornero P.E., Program Manager
BGE Inc., Consultant
Conatser Construction Tx, Contractor
PMB Capital, 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 Brock Huggins, President of Conatser Management Group, Inc.,
general partner of Conatser Construction TX. LP, 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, has
been paid in full; and
That there are no claims pending for personal injury and/or property damages;
On Contract described as:
VENTANA SFR PH. 7
WATER & SANITARY SEWER IMPROVEMENTS
CFA PRJ #: 23-0009
CITY PROJECT #: 104529
CITY OF FORT WORTH
STATE OF TEXAS
CONATSER CONSTRUCTION TX, LP
'4�1 0 *'
Brock Huggl'n-
Subscribed and sworn to before me this 1 OTH day of No
tuber, 2023.
Notary Public in Tarrant County, Texas
KAMRA HOERIG
Notary Public, State of Texas
Comm. Expires os-15-2027
Notary ID 13213162-8
�nm lk
CONSENT OF
SURETY COMPANY
TO FINAL PAYMENT
Conforms with the American Institute of
Architects, AIA Document G707
PROJECT:
(name, address)Ventana SFR Phase 7
Fort Worth, TX
TO (Owner)
OWNER
❑
ARCHITECT
❑
CONTRACTOR
❑
SURETY
❑
OTHER
Bond No 0254459
F— 7 ARCHITECT'S PROJECT NO: CFA23-0009
PMB VENTANA SFR LP AND CITY OF FORT WORTH CONTRACT FOR:
4001 Maple Avenue, Suite 600 Water & Sanitary Sewer Improvements for Ventana SFR Phase 7
Dallas TX 75219 --� CONTRACT DATE:
CONTRACTOR: CONATSER CONSTRUCTION TX, L.P.
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)
BERKLEY INSURANCE COMPANY
475 Steamboat Road
Greenwich CT 06830 , SURETY COMPANY
on bond of (here insert name and address of Contractor)
CONATSER CONSTRUCTION TX, L.P.
5327 Wichita St.
Fort Worth TX 76119-6035
,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)
PMB VENTANA SFR LP AND CITY OF FORT WORTH
4001 Maple Avenue, Suite 600
Dallas TX 75219 , 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): J,
9th day of November, 2023
BERKLEY INSURANCE COMPANY
Surety Company
��../. ♦ , : —, mil 0,-2 . ze,—
Signature of Authorized Representative
Robbi Morales
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
No. BI-7280k
POWER OF ATTORNEY
BERKLEY INSURANCE COMPANY
WILMINGTON, DELAWARE
NOTICE: The warning found elsewhere in this Power of Attorney affects the validity thereof. Please review carefully.
KNOW ALL MEN BY THESE PRESENTS, that BERKLEY INSURANCE COMPANY (the "Company"), a corporation duly
organized and existing under the laws of the State of Delaware, having its principal office in Greenwich, CT, has made; constituted
and appointed, and does by these presents make, constitute and appoint: Ricardo .I. Reyna; Don T Cornell; Sophinie Hunter,•
Robbi Morales; Kelly A. Westbrook; Tina McEioan; Joshua Saunders;. Tonie Petranek; or Mikaela Peppers of Aon Risk
Services Southwest, bic. of Dallas, TX its true and lawful Attorney -in -Fact, to sign its name as surety only as delineated below
and to execute, seal, acknowledge and deliver any and all bonds and undertakings, with the exception of Financial Guaranty
Insurance, providing that no single obligation shall. exceed Fifty Million and 00/100 U.S. Dollars (U.S.$50,000,000.00), to the.
same .extent as if such bonds had been duly executed and acknowledged by the regularly elected officers .of the Company at its
principal office in their own proper persons.
This Power of Attorney shall be construed and enforced in accordance with, and governed by, the laws of the State of Delaware,
without giving effect to the principles of conflicts of laws thereof. This Power of Attorney is granted pursuant to the following
resolutions which were duly and validly adopted at a meeting of the Board of Directors of the Company held on January.25, 2010:
RESOLVED, that, with respect to the Surety business written by Berkley Surety, the Chairman of the Board, Chief
.Executive Officer, President or any Vice President of the Company, in conjunction with the Secretary or any Assistant
Secretary are hereby authorized to execute powers of attorney authorizing and qualifying the attorney -in -fact named therein
to execute bonds, undertakings, recognizances, or other suretyship obligations on behalf of the Company, and to affix the
corporate seal of the Company to powers of attorney executed pursuant hereto; and said officers may remove any such
attorney -in -fact and revoke any power of attorney previously granted; and further
RESOLVED, that suchpower of attorney limits the acts of those named therein to the bonds, undertakings, recognizances,
or other suretyship obligations specifically named therein, and they have no authority to bind the Company except in the
manner and to the extent therein stated; and further
RESOLVED, that such power of attorney revokes all previous powers issued on behalf of the attorney -in -fact named; and
further
RESOLVED, that the signature of any authorized officer and the seal of the Company may be affixed by facsimile to any
power of attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or
other suretyship obligation of the Company; and such signature and seal when so used shalt have the.same force and effect as
though .manually affixed. The Company may continue to use for the purposes herein stated the facsimile signature of any
person or persons who shall have been such officer or officers of the Company, notwithstanding the fact that they may have
ceased to be such at the time when such instruments shall be issued.
IN WITNESS IMMREOF, the Company has caused these preseuts t_o-be signed and' attested by its appropriate officers hd its
corporate seal hereunto affixedthis Jrday of Mcu,
Attest Berkl Insurance Company
(Seal) Sy /I By U `✓
lt-eg_ dei an. Je fter
Executive Vice President & Secretary ` S i ice.. dent
WARNING TIUS POWER. INVALID I NOT PRRgTED ON BLUE-BERKLEY" SECURITY PAPER
STATE OF CONNECTICUT )
) ss:
COUNTY OF FNERFICLD )
Sworn to before me, a Notary Public in the State of Connecticut; this _L(t day of Mete ( a03�, by It. S. Lederman
and Jeffi-ey M. Hafter who are sworn to me to be the Executive Vice President Secretary, and Senior Vice- President,
respcativcly, ofBerkley insurance Company_ t1ARIF c P0
N(7TaRY N OM RI 1IC
CONNECTICUT
MY C0AIAVS5.;0N EXPIRES
At't L30,2625 otar;�.I�ublic;State v£Connecticut
CERTIFICATE:
I, the undersigned; Assistant Secretary of BERKLEY INSURANCE. COMPANY, DO HEREBY CERTIFY that the foregoing is a
true, correct and complete copy of the original Power of Attorney; that said Power of Attorney has 1901 been revoked or rescinded
and that the authority of the Attorney in -tact ;set forth therein, who executed the band ortuidert aking to which this :Power of
Attorney is attached; -is. in fall foree.and effect as of this d1te.
Give-n under my'hand and seal of the Company, this 9 t h day of N o V e? Iljb Z O
(Seal)
Vincent P. Fortey
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 Brock Huggins, President of Conatser Management Group, Inc.,
general partner of Conatser Construction TX. LP, 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, has
been paid in full; and
That there are no claims pending for personal injury and/or property damages;
On Contract described as:
VENTANA SFR PH. 7
WATER & SANITARY SEWER IMPROVEMENTS
CFA PRJ #: 23-0009
CITY PROJECT #: 104529
CITY OF FORT WORTH
STATE OF TEXAS
CONATSER CONSTRUCTION TX, LP
'4�1 0 *'
Brock Huggl'n-
Subscribed and sworn to before me this 1 OTH day of No
tuber, 2023.
Notary Public in Tarrant County, Texas
KAMRA HOERIG
Notary Public, State of Texas
Comm. Expires os-15-2027
Notary ID 13213162-8
�nm lk
CONSENT OF
SURETY COMPANY
TO FINAL PAYMENT
Conforms with the American Institute of
Architects, AIA Document G707
PROJECT:
(name, address)Ventana SFR Phase 7
Fort Worth, TX
TO (Owner)
OWNER
❑
ARCHITECT
❑
CONTRACTOR
❑
SURETY
❑
OTHER
Bond No 0254459
F— 7 ARCHITECT'S PROJECT NO: CFA23-0009
PMB VENTANA SFR LP AND CITY OF FORT WORTH CONTRACT FOR:
4001 Maple Avenue, Suite 600 Water & Sanitary Sewer Improvements for Ventana SFR Phase 7
Dallas TX 75219 --� CONTRACT DATE:
CONTRACTOR: CONATSER CONSTRUCTION TX, L.P.
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)
BERKLEY INSURANCE COMPANY
475 Steamboat Road
Greenwich CT 06830 , SURETY COMPANY
on bond of (here insert name and address of Contractor)
CONATSER CONSTRUCTION TX, L.P.
5327 Wichita St.
Fort Worth TX 76119-6035
,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)
PMB VENTANA SFR LP AND CITY OF FORT WORTH
4001 Maple Avenue, Suite 600
Dallas TX 75219 , 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): J,
9th day of November, 2023
BERKLEY INSURANCE COMPANY
Surety Company
��../. ♦ , : —, mil 0,-2 . ze,—
Signature of Authorized Representative
Robbi Morales
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
No. BI-7280k
POWER OF ATTORNEY
BERKLEY INSURANCE COMPANY
WILMINGTON, DELAWARE
NOTICE: The warning found elsewhere in this Power of Attorney affects the validity thereof. Please review carefully.
KNOW ALL MEN BY THESE PRESENTS, that BERKLEY INSURANCE COMPANY (the "Company"), a corporation duly
organized and existing under the laws of the State of Delaware, having its principal office in Greenwich, CT, has made; constituted
and appointed, and does by these presents make, constitute and appoint: Ricardo .I. Reyna; Don T Cornell; Sophinie Hunter,•
Robbi Morales; Kelly A. Westbrook; Tina McEioan; Joshua Saunders;. Tonie Petranek; or Mikaela Peppers of Aon Risk
Services Southwest, bic. of Dallas, TX its true and lawful Attorney -in -Fact, to sign its name as surety only as delineated below
and to execute, seal, acknowledge and deliver any and all bonds and undertakings, with the exception of Financial Guaranty
Insurance, providing that no single obligation shall. exceed Fifty Million and 00/100 U.S. Dollars (U.S.$50,000,000.00), to the.
same .extent as if such bonds had been duly executed and acknowledged by the regularly elected officers .of the Company at its
principal office in their own proper persons.
This Power of Attorney shall be construed and enforced in accordance with, and governed by, the laws of the State of Delaware,
without giving effect to the principles of conflicts of laws thereof. This Power of Attorney is granted pursuant to the following
resolutions which were duly and validly adopted at a meeting of the Board of Directors of the Company held on January.25, 2010:
RESOLVED, that, with respect to the Surety business written by Berkley Surety, the Chairman of the Board, Chief
.Executive Officer, President or any Vice President of the Company, in conjunction with the Secretary or any Assistant
Secretary are hereby authorized to execute powers of attorney authorizing and qualifying the attorney -in -fact named therein
to execute bonds, undertakings, recognizances, or other suretyship obligations on behalf of the Company, and to affix the
corporate seal of the Company to powers of attorney executed pursuant hereto; and said officers may remove any such
attorney -in -fact and revoke any power of attorney previously granted; and further
RESOLVED, that suchpower of attorney limits the acts of those named therein to the bonds, undertakings, recognizances,
or other suretyship obligations specifically named therein, and they have no authority to bind the Company except in the
manner and to the extent therein stated; and further
RESOLVED, that such power of attorney revokes all previous powers issued on behalf of the attorney -in -fact named; and
further
RESOLVED, that the signature of any authorized officer and the seal of the Company may be affixed by facsimile to any
power of attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or
other suretyship obligation of the Company; and such signature and seal when so used shalt have the.same force and effect as
though .manually affixed. The Company may continue to use for the purposes herein stated the facsimile signature of any
person or persons who shall have been such officer or officers of the Company, notwithstanding the fact that they may have
ceased to be such at the time when such instruments shall be issued.
IN WITNESS IMMREOF, the Company has caused these preseuts t_o-be signed and' attested by its appropriate officers hd its
corporate seal hereunto affixedthis Jrday of Mcu,
Attest Berkl Insurance Company
(Seal) Sy /I By U `✓
lt-eg_ dei an. Je fter
Executive Vice President & Secretary ` S i ice.. dent
WARNING TIUS POWER. INVALID I NOT PRRgTED ON BLUE-BERKLEY" SECURITY PAPER
STATE OF CONNECTICUT )
) ss:
COUNTY OF FNERFICLD )
Sworn to before me, a Notary Public in the State of Connecticut; this _L(t day of Mete ( a03�, by It. S. Lederman
and Jeffi-ey M. Hafter who are sworn to me to be the Executive Vice President Secretary, and Senior Vice- President,
respcativcly, ofBerkley insurance Company_ t1ARIF c P0
N(7TaRY N OM RI 1IC
CONNECTICUT
MY C0AIAVS5.;0N EXPIRES
At't L30,2625 otar;�.I�ublic;State v£Connecticut
CERTIFICATE:
I, the undersigned; Assistant Secretary of BERKLEY INSURANCE. COMPANY, DO HEREBY CERTIFY that the foregoing is a
true, correct and complete copy of the original Power of Attorney; that said Power of Attorney has 1901 been revoked or rescinded
and that the authority of the Attorney in -tact ;set forth therein, who executed the band ortuidert aking to which this :Power of
Attorney is attached; -is. in fall foree.and effect as of this d1te.
Give-n under my'hand and seal of the Company, this 9 t h day of N o V e? Iljb Z O
(Seal)
Vincent P. Fortey