HomeMy WebLinkAboutContract 56737-FP2Page 1 of 2
City Secretary
Contract No.__________________
Date Received ______________
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: East Bailey Boswell Road
City Project No.: 103320
Improvement Type(s): Paving Drainage Street Lights Traffic Signals
Developer Cost City Cost Total
Original Contract Price: Paving $ 1,743,779.50 $ 2,337,756.80 $ 4,081,536.30
Original Contract Price: Storm Drain $ 1,645,440.00 $ 784,825.00 $ 2,430,265.00
Original Contract Price: Street Lights $ 291,962.00 $ 201,004.00 $ 492,966.00
Original Contract Price: Traffic Signal $ - $ 346,414.00 $ 346,414.00
Amount of Approved Change Orders $87,136.04 $ - $ 87,136.04
Revised Contract Amount $ 3,768,317.54 $ 3,669,999.80 $ 7,438,317.34
Total Cost of Work Complete $ 3,768,317.54 $ 3,669,999.80 $ 7,438,317.34
Contractor Date
Title
Jackson Construction
Company Name
Project Inspector Date
Project Manager Date
CFA Manager Date
______________________________________ __________________________________
TPW Director Date
Asst. City Manager Date
Page 2 of 2
Notice of Project Completion
Project Name: East Bailey Boswell Road
City Project No.: 103320
City’s Attachments
Final Pay Estimate
Change Order(s): Yes N/A
Contractor’s Attachments
Affidavit of Bills Paid
Consent of Surety
Statement of Contract Time
Contract Time 3 0 WD
Work Start Date: 1/6/2022
Days Charged: 382
Work Complete Date: 12/20/2023
Completed number of Soil Lab Test: 1028
Completed number of Water Test: 102
CITY OF FORT WORTH
Contract Name EAST BAILEY BOSWELL ROAD
Contract Limits
Project Type STORM DRAIN & PAVING
DOE Number 3320
Estimate Number 1 Payment Number 1 For Period Ending 12/20/2023
FINAL PAYMENT REQUEST
City Secretary Contract Number
382
WD
Contract Date
JACKSON CONSTRUCTION LTD
NA
5112 SUN VALLEY DRIVE
FORT WORTH TX 76119
GLOVER
Contract Time
Days Charged to Date
CompleteContract is 100.00
Contractor
,
/Inspectors
Project Manager
City Project Numbers 103320
Wednesday, December 20, 2023 Page 1 of 8
Contract Name EAST BAILEY BOSWELL ROAD
Contract Limits
Project Type STORM DRAIN & PAVING
DOE Number 3320
Estimate Number 1
Payment Number 1
For Period Ending 12/20/2023
Project Funding
City Project Numbers 103320
STORM DRAIN
Item
No.Description of Items Estimated
Quanity Unit Unit Cost Estimated
Total
Completed
Quanity
Completed
Total
1 Remove Headwall/SET 8 EA $400.00 $3,200.00 8 $3,200.00
2 18" Storm Abandonment Plug 14 EA $80.00 $1,120.00 14 $1,120.00
3 21" Storm Abandonment Plug 1 EA $100.00 $100.00 1 $100.00
4 24" Storm Abandonment Plug 3 EA $110.00 $330.00 3 $330.00
5 36" Storm Abandonment Plug 3 EA $180.00 $540.00 3 $540.00
6 42" Storm Abandonment Plug 1 EA $200.00 $200.00 1 $200.00
7 SWPPP > 1 acre 1 LS $30,000.00 $30,000.00 1 $30,000.00
8 Trench Safety 8710 LF $2.00 $17,420.00 8710 $17,420.00
9 Utility Markers 1 LS $4,200.00 $4,200.00 1 $4,200.00
10 18" RCP 47 LF $63.00 $2,961.00 47 $2,961.00
11 21" RCP 1431 LF $67.00 $95,877.00 1431 $95,877.00
12 24" RCP 1388 LF $77.00 $106,876.00 1388 $106,876.00
13 30" RCP 422 LF $99.00 $41,778.00 422 $41,778.00
14 36" RCP 1373 LF $133.00 $182,609.00 1373 $182,609.00
15 42" RCP 280 LF $180.00 $50,400.00 280 $50,400.00
16 48" RCP 491 LF $213.00 $104,583.00 491 $104,583.00
17 54" RCP 453 LF $276.00 $125,028.00 453 $125,028.00
18 60" RCP 1745 LF $338.00 $589,810.00 1745 $589,810.00
19 6x6 Box Culvert 511 LF $512.00 $261,632.00 511 $261,632.00
20 7x6 Box Culvert 564 LF $609.00 $343,476.00 564 $343,476.00
21 4' Storm Junction Box 9 EA $6,300.00 $56,700.00 9 $56,700.00
22 5' Storm Junction Box 1 EA $13,000.00 $13,000.00 1 $13,000.00
23 6' Storm Junction Box 5 EA $14,000.00 $70,000.00 5 $70,000.00
24 4' Stacked Manhole 2 EA $2,000.00 $4,000.00 2 $4,000.00
25 Concrete Collar 8 EA $100.00 $800.00 8 $800.00
26 10' Recessed Inlet 25 EA $4,900.00 $122,500.00 25 $122,500.00
27 15' Recessed Inlet 6 EA $7,600.00 $45,600.00 6 $45,600.00
28 4' Drop Inlet 4 EA $4,600.00 $18,400.00 4 $18,400.00
29 6' Drop Inlet 1 EA $9,500.00 $9,500.00 1 $9,500.00
30 Large Stone Riprap, dry 515 SY $75.00 $38,625.00 515 $38,625.00
31 TxDOT PJB 2 EA $20,000.00 $40,000.00 2 $40,000.00
Wednesday, December 20, 2023 Page 2 of 8
Contract Name EAST BAILEY BOSWELL ROAD
Contract Limits
Project Type STORM DRAIN & PAVING
DOE Number 3320
Estimate Number 1
Payment Number 1
For Period Ending 12/20/2023
Project Funding
City Project Numbers 103320
32 TxDOT CH-PW-0 2 EA $15,000.00 $30,000.00 2 $30,000.00
33 TxDOT Wingwall PW-1, HW=7', (4:1)1 EA $19,000.00 $19,000.00 1 $19,000.00
$2,430,265.00 $2,430,265.00Sub-Total of Previous Unit
PAVING
Item
No.Description of Items Estimated
Quanity Unit Unit Cost Estimated
Total
Completed
Quanity
Completed
Total
1 Construction Staking 1 LS $80,000.00 $80,000.00 1 $80,000.00
2 As-Built Survey 1 LS $9,000.00 $9,000.00 1 $9,000.00
3 Remove Rip Rap 1420 SF $2.00 $2,840.00 1420 $2,840.00
4 Remove Conc Pvmt 1289 SY $17.00 $21,913.00 1289 $21,913.00
5 Remove Asphalt Pvmt 187 SY $16.00 $2,992.00 187 $2,992.00
6 Remove ADA Ramp 1 EA $400.00 $400.00 1 $400.00
7 Remove Sign Panel and Post 4 EA $150.00 $600.00 4 $600.00
8 Remove Headwall/SET 8 EA $600.00 $4,800.00 8 $4,800.00
9 Remove 21" Storm Line 90 LF $33.00 $2,970.00 90 $2,970.00
10 Remove 24" Storm Line 19 LF $37.00 $703.00 19 $703.00
11 Remove 30" Storm Line 12 LF $42.00 $504.00 12 $504.00
12 Remove 48" Storm Line 20 LF $45.00 $900.00 20 $900.00
13 6"-12" Tree Removal 2 EA $2,000.00 $4,000.00 2 $4,000.00
14 Unclassified Excavation by Plan 36054 CY $11.00 $396,594.00 36054 $396,594.00
15 Hydrated Lime (CO #5)1133 TN $200.00 $226,600.00 1133 $226,600.00
16 8" Lime Treatment (CO #5)34302 SY $5.50 $188,661.00 34302 $188,661.00
17 11" Conc Pvmt (CO #5) (CO #10)31607 SY $65.00 $2,054,455.00 31607 $2,054,455.00
18 11" Conc Pvmt HES 589 SY $128.00 $75,392.00 589 $75,392.00
19 8" Asphalt Base Type B 172 SY $140.00 $24,080.00 172 $24,080.00
20 4" Conc Sidewalk (CO #5) (CO #6)89974 SF $5.50 $494,857.00 89974 $494,857.00
21 Barrier Free Ramp Type M-2 3 EA $3,000.00 $9,000.00 3 $9,000.00
22 Barrier Free Ramp, Type C-2 3 EA $3,000.00 $9,000.00 3 $9,000.00
23 Barrier Free Ramp, Type P-1 (CO #5) (CO #8)29 EA $3,000.00 $87,000.00 29 $87,000.00
24 6" Conc Curb> and Gutter (CO #5)18745 LF $1.50 $28,117.50 18745 $28,117.50
25 6" SLD Pvmt Marking HAS (W) (CO #5)4767 LF $1.60 $7,627.20 4767 $7,627.20
26 6" SLD Pvmt Marking HAS (Y)2324 LF $1.60 $3,718.40 2324 $3,718.40
27 6" BRK Pvmt Marking HAS (W)2042 LF $1.60 $3,267.20 2042 $3,267.20
Wednesday, December 20, 2023 Page 3 of 8
Contract Name EAST BAILEY BOSWELL ROAD
Contract Limits
Project Type STORM DRAIN & PAVING
DOE Number 3320
Estimate Number 1
Payment Number 1
For Period Ending 12/20/2023
Project Funding
City Project Numbers 103320
28 6" DOT Pvmt Marking HAS (W)71 LF $1.60 $113.60 71 $113.60
29 SLD Pvmt Marking HAS (W)453 LF $1.80 $815.40 453 $815.40
30 18" SLD Pvmt Marking HAE (W)588 LF $4.00 $2,352.00 588 $2,352.00
31 24" SLD Pvmt Marking HAE (W) (CO #8)795 LF $13.00 $10,335.00 795 $10,335.00
32 Lane Legend Arrow (CO #5)27 EA $120.00 $3,240.00 27 $3,240.00
33 Lane Legend DBL Arrow 2 EA $180.00 $360.00 2 $360.00
34 Lane Legend Only 11 EA $130.00 $1,430.00 11 $1,430.00
35 REFL Raised Marker TY 11-C-R 227 EA $4.00 $908.00 227 $908.00
36 REFL Raised Marker TY II-A-A 27 EA $4.00 $108.00 27 $108.00
37 Remove 4" Pvmt Marking 1360 LF $1.00 $1,360.00 1360 $1,360.00
38 Remove 8" Pvmt Marking 275 LF $1.80 $495.00 275 $495.00
39 Remove Raised Marker 250 EA $1.00 $250.00 250 $250.00
40 TxDOT Sid Ret Wall - RW 1 (L) A 527 SF $48.00 $25,296.00 527 $25,296.00
41 Topsoil (CO #6)5914 CY $27.00 $159,678.00 5914 $159,678.00
42 Block Sod Placement (CO #5) (CO #6)18459 SY $5.00 $92,295.00 18459 $92,295.00
43 Seeding, Hydromulch 4411 SY $1.50 $6,616.50 4411 $6,616.50
44 Seeding, Soil Retention Blanket 12664 SY $2.00 $25,328.00 12664 $25,328.00
45 Salvage Street Light Pole 1 EA $2,000.00 $2,000.00 1 $2,000.00
46 Furnish/Install Alum Sign Ground Mount City Std,
(CO #5 & 7)
27 EA $460.00 $12,420.00 27 $12,420.00
47 Monolithic Concrete Median Nose (CO #5)46 SY $340.00 $15,640.00 46 $15,640.00
48 6" SLD Pvmt Marking HAE (Black)900 LF $4.00 $3,600.00 900 $3,600.00
49 12" DOT Pvmt Marking HAS (W)37 LF $4.00 $148.00 37 $148.00
50 18" SLD Pvmt Marking HAE (Y)25 LF $5.00 $125.00 25 $125.00
51 Yield Lines 14 LF $23.00 $322.00 14 $322.00
52 Flexible Delineator Post (Y)5 EA $200.00 $1,000.00 5 $1,000.00
53 Remove Gravel Driveway 9126 SF $0.50 $4,563.00 9126 $4,563.00
54 Remove Cattle Guard 1 LS $600.00 $600.00 1 $600.00
55 Remove Gate 1 LS $600.00 $600.00 1 $600.00
56 Remove and Dispose of Fence 508 LF $5.00 $2,540.00 508 $2,540.00
57 11" Conc Pvmt (CO #5) (CO #10)0 SY $128.00 $0.00 0 $0.00
58 REMOVE 24" PVMT MARKING (CO #7)12 LF $80.00 $960.00 12 $960.00
59 UNCLASSIFIED EXCAVATION BY PLAN (CO #9)1 LS $68,283.24 $68,283.24 1 $68,283.24
60 RETAINING WALL REMOVAL AND
RECONSTRUCTION (CO #9)
1 LS $11,652.30 $11,652.30 1 $11,652.30
Wednesday, December 20, 2023 Page 4 of 8
Contract Name EAST BAILEY BOSWELL ROAD
Contract Limits
Project Type STORM DRAIN & PAVING
DOE Number 3320
Estimate Number 1
Payment Number 1
For Period Ending 12/20/2023
Project Funding
City Project Numbers 103320
$4,195,425.34 $4,195,425.34Sub-Total of Previous Unit
ST LIGHT
Item
No.Description of Items Estimated
Quanity Unit Unit Cost Estimated
Total
Completed
Quanity
Completed
Total
1 Install Elec Serv Pedestal 1 EA $8,800.00 $8,800.00 1 $8,800.00
2 2" CONDT PVC SCH 80 (T) (CO #5)5025 LF $30.00 $150,750.00 5025 $150,750.00
3 Ground Box Type B, w/ Apron (CO #5)25 EA $1,100.00 $27,500.00 25 $27,500.00
4 Furnish/Install Type 33 A Arm (CO #5)43 EA $500.00 $21,500.00 43 $21,500.00
5 Rdwy Ilum Assmbly TY 18 26 EA $2,400.00 $62,400.00 26 $62,400.00
6 LED Lighting Fixture (CO #5)43 EA $700.00 $30,100.00 43 $30,100.00
7 Rdwy Ilum Foundalion TY 3 26 EA $1,900.00 $49,400.00 26 $49,400.00
8 No 2 Insulated Elec Conduit (CO #5)24411 LF $6.00 $146,466.00 24411 $146,466.00
$496,916.00 $496,916.00Sub-Total of Previous Unit
TRAFFIC SIGNAL
Item
No.Description of Items Estimated
Quanity Unit Unit Cost Estimated
Total
Completed
Quanity
Completed
Total
1 Furnish/Install Elec Serv Pedestal 1 EA $7,600.00 $7,600.00 1 $7,600.00
2 2" CONDT PVC SCH 80 (T)98 LF $30.00 $2,940.00 98 $2,940.00
3 2" CONDT PVC SCH 80 (B)50 LF $38.00 $1,900.00 50 $1,900.00
4 3" CONDT PVC SCH 80 (T)194 LF $38.00 $7,372.00 194 $7,372.00
5 4" CONDT PVC SCH 80 (B)407 LF $53.00 $21,571.00 407 $21,571.00
6 3-Sect Signal Head Assmbly 8 EA $1,300.00 $10,400.00 8 $10,400.00
7 4-Sect Signal Head Assmbly 5 EA $1,600.00 $8,000.00 5 $8,000.00
8 Ped Signal Head Assmbly 8 EA $900.00 $7,200.00 8 $7,200.00
9 Audible Pedestrian Pushbutton Station 8 EA $900.00 $7,200.00 8 $7,200.00
10 Furnish/Install BBU System EXT Mounted 1 EA $13,000.00 $13,000.00 1 $13,000.00
11 Furnish/Install Model 712 Preemption Detector 3 EA $1,100.00 $3,300.00 3 $3,300.00
12 Furnish/Install Radar Presence Detection Device (CO
#1)
0 EA $8,700.00 $0.00 0 $0.00
13 Furnish/Install Radar Advance Detection Device (CO
#1)
0 EA $8,700.00 $0.00 0 $0.00
14 Furnish/Install Radar Cable (CO #1)0 LF $3.00 $0.00 0 $0.00
15 5/C 14 AWG Multl-Conductor Cable 172 LF $2.00 $344.00 172 $344.00
Wednesday, December 20, 2023 Page 5 of 8
Contract Name EAST BAILEY BOSWELL ROAD
Contract Limits
Project Type STORM DRAIN & PAVING
DOE Number 3320
Estimate Number 1
Payment Number 1
For Period Ending 12/20/2023
Project Funding
City Project Numbers 103320
16 7/C 14 AWG Mulli-Conductor Cable 637 LF $3.00 $1,911.00 637 $1,911.00
17 20/C 14 AWG Multi-Conductor Cable 571 LF $5.00 $2,855.00 571 $2,855.00
18 3/C 14 AWG Multi-Conductor Cable 1155 LF $2.00 $2,310.00 1155 $2,310.00
19 NO 6 lnsulaled Elec Condr 8 LF $3.00 $24.00 8 $24.00
20 NO 8 Insulated Elec Condr 2000 LF $3.00 $6,000.00 2000 $6,000.00
21 NO 6 Bare Elec Condr SLD 4 LF $3.00 $12.00 4 $12.00
22 Ground Box Type B, w/Apron 5 EA $1,100.00 $5,500.00 5 $5,500.00
23 Ground Box Type D, w/Apron 1 EA $1,500.00 $1,500.00 1 $1,500.00
24 Furnish lnstall 5' Pedestrian Push Button Pole 3 EA $800.00 $2,400.00 3 $2,400.00
25 Fumish/lnstall 10' -14 ' Ped Pole Assmbly 2 EA $1,100.00 $2,200.00 2 $2,200.00
26 Furnish/Install Type 41 Signal Pole 1 EA $10,000.00 $10,000.00 1 $10,000.00
27 Furnish/Install Type 42 Signal Pole 1 EA $9,000.00 $9,000.00 1 $9,000.00
28 Furnish/Install Type 45 Signal Pole 2 EA $15,000.00 $30,000.00 2 $30,000.00
29 Furnish/Install Mast Arm 16' -36'2 EA $4,600.00 $9,200.00 2 $9,200.00
30 Furnish/Install Mast Arm 52' - 60'2 EA $9,600.00 $19,200.00 2 $19,200.00
31 TY 1 Signal Foundation 5 EA $1,400.00 $7,000.00 5 $7,000.00
32 TY 3 Signal Foundation 2 EA $4,000.00 $8,000.00 2 $8,000.00
33 TY 5 Signal Foundation 2 EA $6,500.00 $13,000.00 2 $13,000.00
34 Signal Cabinet Foundation -352i & BBU 1 EA $6,000.00 $6,000.00 1 $6,000.00
35 Furnish/Install 352i Controller Cabinet Assembly 1 EA $20,000.00 $20,000.00 1 $20,000.00
36 Powder Coat Sig Pole and MA 16' -36 2 EA $3,000.00 $6,000.00 2 $6,000.00
37 Powder Coat Sig Pole and MA 52' - 60'2 EA $4,000.00 $8,000.00 2 $8,000.00
38 Powder Coat Ped Pole 2 EA $300.00 $600.00 2 $600.00
39 Powder Coat Ped Pushbutton Pole 3 EA $200.00 $600.00 3 $600.00
40 Furnish/Install LED Lighting Fixture (187 watt
ATB2 Cobra Head)
3 EA $750.00 $2,250.00 3 $2,250.00
41 Furnish/Install Alum Sign Mast Arm Mount 10 EA $900.00 $9,000.00 10 $9,000.00
42 Opticom Detector Cable 620 LF $3.00 $1,860.00 620 $1,860.00
43 PTZ Camera 1 EA $5,900.00 $5,900.00 1 $5,900.00
44 PTZ Camera Cable 95 LF $3.00 $285.00 95 $285.00
45 SMART MICRO VEHICLE DETECTOR (CO #1)4 EA $7,658.00 $30,632.00 4 $30,632.00
46 SMART MICRO VEHICLE DETECTION CABLE
(CO #1)
810 LF $4.50 $3,645.00 810 $3,645.00
$315,711.00 $315,711.00Sub-Total of Previous Unit
Wednesday, December 20, 2023 Page 6 of 8
Contract Name EAST BAILEY BOSWELL ROAD
Contract Limits
Project Type STORM DRAIN & PAVING
DOE Number 3320
Estimate Number 1
Payment Number 1
For Period Ending 12/20/2023
Project Funding
City Project Numbers 103320
Contract Information Summary
Change Orders
$7,351,181.30Original Contract Amount
$7,438,317.34Total Contract Price
$7,438,317.34
Less
Total Cost of Work Completed
% Retained $0.00
Net Earned $7,438,317.34
Plus Material on Hand Less 15%$0.00
Balance Due This Payment $7,438,317.34
Less Liquidated Damages
Days @ / Day
$0.00
Less Penalty
LessPavement Deficiency $0.00
$0.00
$0.00Less Previous Payment
Earned This Period
Retainage This Period
$7,438,317.34
$0.00
5 $62,260.00Change Order Number
1 ($30,703.00)Change Order Number
5 $3,950.00Change Order Number
6 $11,476.50Change Order Number
8 $8,496.00Change Order Number
9 $79,937.54Change Order Number
Wednesday, December 20, 2023 Page 7 of 8
Contract Name EAST BAILEY BOSWELL ROAD
Contract Limits
Project Type STORM DRAIN & PAVING
DOE Number 3320
Estimate Number 1
Payment Number 1
For Period Ending 12/20/2023
Project Funding
City Project Numbers 103320
Line Fund Account Center
Amount
Funded Gross Retainage Net
CITY OF FORT WORTH
SUMMARY OF CHARGES
$7,438,317.34
Less
Total Cost of Work Completed
% Retained $0.00
Net Earned $7,438,317.34
Plus Material on Hand Less 15%$0.00
Balance Due This Payment $7,438,317.34
Less Liquidated Damages
0 Days @ $0.00 / Day $0.00
Less Penalty
LessPavement Deficiency $0.00
$0.00
$0.00Less Previous Payment
Earned This Period
Retainage This Period
$7,438,317.34
$0.00
City Secretary Contract Number
382
WD
Contract Date
JACKSON CONSTRUCTION LTD
NA
5112 SUN VALLEY DRIVE
FORT WORTH TX 76119
GLOVER
3 0
WD
Contract Time
Days Charged to Date
CompleteContract is 100.000000
Contractor
,
/Inspectors
Project Manager
Wednesday, December 20, 2023 Page 8 of 8
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RECOMMENDED:APPROVED:APPROVED:By: Halff AssociatesBy: Transwestern Development CompanyBy: Jackson ConstructionName: Joseph Buchanan, P.E.Name: Denton WalkerName: Steve HaberstrohTitle:Project ManagerTitle: Regional PartnerTitle: CFW - Development ServicesCFW - Assistant City ManagerCFW - Assistant City AttorneyBy: By: By: Name: Tyson ThompsonName: Dana BurghdoffName: Richard McCrakenTitle:Development Services Asst. DirectorTitle:Asst. City ManagerTitle: Sr. Asst. Scet. ChiefRECOMMENDED:CFW - *Contract Compliance Manager* Contract Compliance Manager (Project Manager):By signing I acknowledge that I am the person responsibleBy: for the monitoring and administration of this contract, includeensuring all performance and reporting requirements.Name: George Marquez, P.E.There are NO City Funds associated with this ContractTitle:Senior Professional EngineerXThere are City Funds associated with this ContractM&C Number: N/AM&C Date Approved: N/ARevised: 10-12-2011 Page 2
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F�RTWORTH�
TRANSPORTATION AND PUBLIC WORI<S
December 20, 2023
Jacl<son Construction, Ltd.
5112 Sun Valley Dr.
Fort Worth, Texas 76119
RE: Acceptance Letter
Project Name: East Bailey Boswell Road
Project Type: Paving, Drainage, Street Lights, Traffic Signals
City Project No.: 103320
To Whom It May Concern:
On October 17, 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 December 20, 2023. The final
inspection and the corrected punch list items indicate that the worl< meets the City of Fort Worth
specifications and is therefore accepted by the City. The warranty period will start on December 20,
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-
392-6826.
Sincerely,
��� `����
George Marquez, Project Manager
Cc: Joseph Manry, Inspector
Mil<e Glover, Inspection Supervisor
Randy Horton, Senior Inspector
Andrew Goodman, Program Manager
Halff, Consultant
Jacl<son Construction, Ltd., Contractor
Transwestern Development, Developer
File
E-Mail: TPW_Acceptance@fortworthtexas.gov
Rev. 8/20/19
��C���3���
CONSTRUCTIOf� LTD.
51 12 SUN VALLEY DRIVE
FORT WORTH, TX 761 19
TEL' 8I 7-572-3303
FAX: 817-478-0443
AFFIDAVIT
STATE OF TEXAS
COUNTY OF TARR.ANT
Before me, the undersigned authority, a notary public in the state
and county aforesaid, on this day personally appeared Troy L. Jackson,
President Of Jackson Construction, Ltd, 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;
That there are no claims pending for personal injury and/or
property damages;
On Contract described as;
East Bailey Boswell Road_Paving Drainage Lights & Signal
BY �l�
Tro . Jackson, President
Subscribed and sworn before me on this date l lth of November, 2023.
��
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`"""' CARMEN L. ESTEP
��1�, V Pw�ir
_°;�;�,% Notary Public, State of Texas
;'�' 'r; Comm. Expires 04-06-2024
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',,,�� „�. Notary ID 2910611
ca�s�Nr a�
SU�ETY �C)�kt�PA�VY
T� FINA�. PAYIVIENT
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CONTRACTOR {�
SURETY [(
C?THER Q
AIA QQCUMEI�fT G70T
Bond No. 1086163
PRpJ�Ci; East Bailey Boswell Road. City Project No. 103320
{r�atr��, addr�Ss)
TO (�wner)
� �
City of Fort Worth / Cow Town Owner L.L.C. (Developer)
TX
GONrt�,cror�: ,lackson Construction, d.
ARCHIT6CT'S PFtOJEGT NQ:
CONTRACT FC3f�: Construction
C4NTRACT �JATE: September 2, 2021
5112 Sun Valley Drive Fort Worth, TX 76119
In aecordance with the provisinns of the Confract between the 4wner and the Contractor as indi�ated aboue, the
{here 4nsert name and adtlress oF Surely Company)
The Hanover Insurance Company
440 Lincoln Street , Worcester, MA 01653
on bot�d of there insert nar�te and address af Gontrastor}
Jackson Construction, Ltd.
5112 Sun Valley Drive Fort Worth, TX 76119
, SURETY COMPANY,
, CONI'F:AGi'OF�,
hergby aRproves of the �nai payment fo the Confractor, and agrees ihaE fina! payment io the Contractor shat! not
�elieve the Surety Gornpany of any of its c}btigatior�s ko 4nere �nsan name and address ot o+�ner}
City of Fort Worth / Cow Town Owner L.L.C. (Developer)
TX , OWNERS,
as set forth in the said Surety Cvmpany's bond.
IIV WITNESS WHEFtEdF,
the Surety Company has hereunta sef its hand this
Attest: (,v �� �
(Seaf�: � �
9th day of November, 2023
The a ver rance Com an
5u fy C4 n
Si akure af A horized ReprssEn ve
Laurie Pfluq, Attorne -in-Fact
Title
NOTE� This form is ta de us�d as a oampanion docnment ka A1A D�CUMENT G706, CQNTRRGTtJR'3 AFFIDAVIT OF PAYMENF OF pEB7$ AND
CL.AIMS, Current Editian
Alt�1 DqGUMkNT G7Q7 •�ONS�iVT flF SURETY COMRANY ii3 FINAI. RAYME�tT � APRIL 1970 �DiTiON • AiA�7 ONE PAGE
OO 3970 • TI-tE AhdERiCAN lNSTIFUI"E OF ARCHITEGTS. 973§ lyEW YQRfC AYE., N`N, WqSfi1NGTON, D.G_ 2�OD$
THE HANOVERINSURANCE COMPANY
MASSACHUSETT5 BAYINSURANCE COMPANY
CITIZENS INSURANCE COMPANY OF AMERICA
POWER OF AITORNEY
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.
KNOW ALL PERSONS BY THESE PRESENTS:
ThatTHE HANOVER INSURANCE COMPANY and MASSACHUSETTS BAY INSURANCE COMPANY, both being corpora#ions organized and exis#ing underthe
laws of the State of New Hampshire, and CITIZENS INSURANCE COMPANY OF AMERICA, a corporation organized and existing underthe laws ofthe State of
Michigan, (hereinafter individually and collectively the "Company") does hereby constitute and appoint,
Jack M. Crowley, Laurie Pfiug , andlor Holly Clevenger
Of Wiliis Towers Watson Insurance Services West, Inc of Dallas, TX each individually, ifthere be more than one named, as its true and lawful attorney(s)-in-fact
to sign, execute, seal, acknowledge and deliver for, and on its behalf, and as its act and deed any place within the United States, any and all surety bonds,
recognizances, undertakings, or other surety obligations. The execution of such surety bonds, recognizances, undertakings or surety obiigations, in pursuance of
these presents, shali 6e as binding upon the Company as if they had been duly signed by the president and attested by the secretary of the Company, in their own
proper persons. Provided however, that this power of attorney limits the acts of those named herein; and they have no authority to bind fhe Company except in the
manner stated and to the extent of any limitation stated below:
Any such obligations in the United States, not to exceed Fifty Million and No/100 ($50,000,000) in any single instance
That this power is made and executed pursuant to the authority ofthe following Resolutions passed by the Board of Directors ofsaid Company, and said Resolutions
remain in full force and effect:
RESOLVED: That the President or any Vice President, in conjunction with any Vice President, be and they hereby are authorized and empowefed to
appoint Attorneys-in-fact of the Company, in its name and as it acts, to execute and acknowiedge for and on its behalf as surety any and all bonds,
�eCOgniZaltCeS, COnt�aCts of indemniiy, waivers of citation and all otherwritings obligatory in the nature thereof, with powerto attach thereto the seal ofthe
Company. Any suCh writings so executed by such Attorneys-in-fact shall be binding upon the Company as if they had been duly executed and
acknowiedged by the regularly elected officers of the Company in their own proper persons.
RESOLVED: That any and all Powers of Attorney and Certified Copies of suCh Powers of Attorney and certification in respect thereto, granted and
executed by the President or Vice President in conjunction with any Vice President ofthe Company, shall be binding on the Company to the same extent
as if all signatures therein were manually affixed, even though one or more of any such signatures thereon may be facsimile. (Adopted October 7,1981—
The Hanover Insurance Company; Adopted April 14,1982 — Massachusetts Bay Insurance Company; Adopted September 7, 2001— Citizens Insurance
Company of America and affirmed by each Company on March 24, 2014)
IN WITNESS WHEREOF, THE HANOVER INSURANCE COMPANY, MASSACHUSETTS BAY INSURANCE COMPANYand CITIZENS INSURANCE COMPANY
OF AMERICA have caused these presents to be sealed with their respective corporate seals, duly attested by two Vice Presidents, this 12th day of September,
2023
v�^k..,'!W� . i: � k�'4 �.`"`�f'�,`.�,q�
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ihe bFunouer tnsurinre 4uinp;iay
M+u�sachasctts 8ay tnfae�art Cnx�p�wy
CitiEens Ixasuranct Campaap�of Amrr;ca
J s H. 4Caxvieckf. Vka Prasitl�nt��
STATE OF CONNECTICUT )
COUNTY OF HARTFORD ) ss.
7)tc tiAno��cr ina�raHce Cw�paa}
4 chusetts Bqy 1esz�ranae Company
ee Fnsura�cc Coznp�n� of Americsr
tlan N. Mandaxs, Vica Prosident
On this 72th day of September, 2023 before me came the above named Executive Vice President and Vice President of The Hanover Insurance Company,
Massachusetts Bay Insurance Company and Citizens Insurance Company ofAmerica, to me personally known to be the individuals and officers described herein,
and acknowledged that the seals affixed to the preceding instrument are the corporate seals of The Hanover InsuranCe Company, Massachusetts Bay Insurance
Company and Citizens Insurance Company of America, respectively, and that the said corporate seals and their signatures es OffiCefs were duly affixed and
subscribed to said instrument by the authority and direction of said Corporations_
- - , i��'t1t��i �tC)tF!'#1@S- ---
��� Ncitar�r Pubiic, �taie a�t Gunn�jcut
� �41TY11155�Ot1 E7SpiFp5,Ili1 ��. �4i�$
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���� �.��C3i���l�r�, �A� �t ��C , _
�y carnm��s��p� r���`srea Ju�jr �1, �i��
l, the undersigned Vice President of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America,
hereby certify that the above and foregoing is a full, true and correct copy ofthe Original Power ofAttorney issued by said Companies, and do hereby further certify
that the said Powers of Attomey are still in force and effect.
GIVEN under my hand and the seals of said Companies, at Woroester, Massachusetts, this 9th day of NOVembef 2023.
CERTIFIED COPY
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