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Contract 58694-FP1
FORT WORTH, TRANSPORTATION AND PUBLIC WORKS NOTICE OF PROJECT COMPLETION -FP1 City Secretary No: 58694 Date Received: 01/09/2024 City Project N!?: 104182 Regarding contract 58694 2023 Concrete Restoration Contract 3 for as required by the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by City Council on 11/29/2022 through M&C 22-1002 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 Amount: 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 �ati'r`cia L. Pvo(sack Patricia L. Wadsack (Jan 9, 202414:01 CST) Recommended for Acceptance Asst. Director, TPW - Capital Delivery $1,627,186.00 Days 180 $ 0.00 )Vg Days Added by CO $ Total Days $ 1,276,966.14 Days Charged 115 Days @ $ $ 1,276,966.14 $ 1,273,325.09 $ 3,641.05 A,....., Lauren Prieur (Jan 9, 202414:05 CST) Accepted Director, TRANSPORTATION AND PUBLIC WORKS DEPARTMENT �, William Johnson (J n 9, 2024-.-14:17 CST) Asst. City Manager Jan 9, 2024 Date Jan 9, 2024 Date Jan 9, 2024 Date / Day Comments: OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX C-620 Signature Page To (Owner) P. O. Number: Project: Contractor's Application for Payment City of Fort Worth Invoicing Period (From '^To): FW020-0000009189 104182 City Secretary Contract 58694 Number: Application For Payment Change Order Summary (Approved Change Orders Number 1 2 3 4 5 6 7 8 TOTALS NET CHANGE BY CHANGE ORDERS Contractor's Certification Additions From (Contractor): URBAN INFRACONSTRUCTION, LLC Contractor's CFW Vendor No.: 0000039969 Contract Namme:: 2023 Concrete Res Contract 3 Invoice No. 8 Invoice Date: 11/14/2023 Remit to ( If Not Automatic Deposit): 1. ORIGINAL CONTRACT PRICE........................................................., $ $1,6279186.00 Deletions 2. Net change by Change Orders................................................................ $ 3. Current Contract Price (Line 1 f 2)....................................................... $ $196279186.00 4. TOTAL COMPLETED AND STORED TO DATE (Progress Estimate, Construction Allowance and Change Orders)......, $ $192769966.14 5. RETAINAGE: a. X $1,276,966.14 Work Completed........., $ b. X Not Used $ c. Total Retainage (Line 5a + Line 5b) ............................... $ 6. AMOUNT ELIGIBLE TO DATE (Line 4 - Line 5c)............................ $ $1,276,966.14 7. LESS PREVIOUS PAYMENTS (Line 6 from prior Application)........ $ $192739325.09 8. AMOUNT DUE THIS APPLICATION ................................................ $ $3,641.05 9. BALANCE TO FINISH, PLUS RETAINAGE (Column G on Progress Estimate+ CA + Cos + Line 5 above) .............. $ $350,219.86 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 nun Tim-Ax- Anup Ta rakar (Jan 2, 202413:58 CST) 10. CONTRACT TIME: a, Days Awarded 180 b. Days Added by CO C. Total Days 180 it. Days Charged 167 e. Days Remaining 13 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. Progress Estimate For (con -). 2023 Concrete Res Contract 3 (Application Period: 10/1/23-10/31/23 A Item Bud Item No Description Sp.Ww tam Unit of Sxtm. No. Win- 1 0135.0201 Remobilimtion 017000 FA 1 2 34710002 Portable Message Sign 347113 WK 1 3 9999 0000 Remove and Replace 6" Concrete Driveway 02 41 IN 32 13 SF 9999 0000 Remove Concrete and Replace with 7" Concrete Pavement 02 41 15/32 13 4 HES 13 BY 5 3123.0101 Unclassified Excavation 3123 16 CY 6 3211.0122 Flex Base. T A, GR-2 32 11 23 CY 1 7 jp 3213.0208 Concrete HES +extra depth) 32 13 13 CY 1 8 3292.0100 Block Sod Placement 3292 13 BY 1 9 3291.0100 TgFoil 329119 CY 1 10 3213.0700 Joint Sealant 321373 LF 1 11 33050108 Miscellaneous Ad,f.uatment f)1181i 11 3390514 LS 1 12 9999 0000 Geognd Tensar (TRIAX 140-475) or Approved equal 99 99 00 BY 1 13 3217 2001 Raised Marker TY W 32 17 23 FA 1 14 3217 2002 Raised Marker TY Y 32 17 23 FA 1 15 3217 2101 REFL Raised Marker TV I -A 32 17 23 FA 1 16 3217 2102 REFL Raised Marker TV I-C 32 1723 EA 1 17 3217 2103 REFL Raised Marker TV II -A -A 32 17 23 EA 1 18 3217 2104 REFL Raised Marker TY II-C-R 32 1723 EA 1 19 3217 1001 Lane Leclerc! RR 32 17 23 EA 1 20 321702 Lane Legentl Arrow 32 17 23 EA 1 21 32171004 Lane Leqend Only 321723 EA 1 22 3441.1301 Loop Detector Cable Sav-t 34 41 l0 LF 23 3441.1302 14 AWG Loop Detect Cable 344110 LF 24 3217.0001 4" Solid The-0 (HAS Lane Line 32 1723 LF 25 idic 321IT(ON1 6" Solid Thermo atic F AS Lane Line 321723 LF 26 3217.0301 8" SLD Pvmt Ma ino AE 32 1723 LF 27 3217.0401 18" SLD Pvmt Marking HAE 32 1723 LF Pvmt 29 3213.0501 Remove d ReA)`II cee P-1 0241 13/ 32 13 EA 07 �aaFrrier FFree �R�amp1Tvoe I3a tr Free Rmp, 3 32 13/ EA EA 33 32 3213.0501 Remove and Rer(lace I voe MAIM-2 9999.0000 Remove and Repplace 4" Sidewalk 02 41 32 13 024113/ 32 13 SF 33 3305.0106 Manhole Adiustment. Maior 33 05 14 FA 34 3217.5001 Curb Address Paintin 321725 FA 35 9999.0096 Paving Construction wance FA I Totals Qty Secretary Contract Num' Bud Quantity I Un t P- 1.OWW01 24.ODUUUdf $500.00 $575.00 22W.00000 $11.00 12118.000000 $102.00 GW.VVVVVU 12000000OU 160.Do 81.W 1 5().000UUU $323.OU 2000.UXXXXI $10.W 1W.000OOU $120.OU 2000.UOOOOU $3.OU 1.06wit; $5,000.011, fi000.cl000 U $5.01J 2W.oUM U $6.0U 2W.o0UUUU $6.OF 1W.00000U $6.0� 1 W.000UUU $6.0� 1 W.000UUU $6.00 l W.uuuuuu $6.00 z U uuuU $70006 2.000UUU $700:00 2.UV000U $700.0w SW.UVV000 $12.09 SW.000UUU $18.09 4W000VVU $2.00 ZVVV000 $2.0/ 4W.VVVVV $4.0- 44WW.uuuu27M $S.Oa WON 2.uuuu .VV000 $3,200.00 4.V000 $32000 $3,0aIVuuu.6 4W.000UUU $9.06 2.VV000U $2,400.06 1u.uuuuuU 100.06 1.uuuuud $5 '000.1 58694 B r.7r\F11R $500.00 $13.800.00 $24.200.00 $1,236,036.00 112,000.00 97,200.00 $48,450.00 $20,000.00 $12.000.00 $6.000.00 $5.000.00 $30.000.00 $1.200.00 $1.200.00 $600.00 $600.00 $600.00 $600.00 $1,400.00 $1:400.00 $1,400.00 $7,200.00 $10,800.00 $800.00 $800.00 $1,600.00 $3,200.00 $3,600.00 $6,400.00 $12,800.00 $6,400.00 $3,600.00 $4,800.00 11,000.00 50,000.00 C Esmnated Quantity Installed D Value 6 This document has been omhfued fom ns ooginal form as an EJCDC document and the user dud not highhght the moduficahons. You are encouraged to read the document carefu8y and consult Legal Counsel poor to its executmn. C-620 Unit Price Progress Estimate Contractor's Application Applucauon Number: 8 Application Date: 11/14/2023 E F Ma[enals Presently Total Completed 5 Previously Installed Value Value This Peood Stored (nor in C) and Stored to Date (I� (D+E) B $13,800.00 100.0% -$3,137.31 $13,265.34 54.8% -$61,897.27 $981,566.40 79.4% 9,930.5Q 82.8% $1 2,232.W 187.5% $9,690.Od 20.0% $6, 140.Od 30.7% S4,920.01/ 41.0% $2,475.Od 49.5% $30,181.75 100.6% $360.00 30A% $1,658.51 $90.00 15.0% $700.00 50.0% $1,400.00 100.0% $1,444.00 180.5% $164.00 20.5% $360.00 22.5% $96.00 3.0% $6,400.00 100.0% $9,150.12 254.2% $2,400.OU 50.0% $200.OU 20.0% $1,276,966.14 78.5% G Balance to Finish (B - F) $500.001 $10.934.661 $254,469.601 069.461 - 85,032.99 $38,760.00 $13,860.00 $7.080.00 $6.000.00 $2.525.00 -$181.75 $1.200.00 $840.00 $600.00 $600.00 $510.00 $600.00 $1,400.001 $700.001 1 $7,200.001 $10,800.001 -$644.001 $636.001 $1,240.001 $3,104.001 $3,600.001 $12,800.001 $6,400.001 -$5,550.121 $2,400.001 800.001 $5 ,000.001 $350,219.861 City of Fort Worth Summary of Charqes City Secretary Contract Num: 58694 I 2023 Concrete Res Contract 3 I p, 0.: F W020-0000009189 Application Period: 10/1/23-10/31/23 I Apphcahon 8 Number: Funding Identification (FID) Total Completed Amt Remaining ' Gross Original Contract 130100-0200431-5740010-104182-E03380-9999 $1,276,966.14 $350,219.86 ($63,376.06) 10 10 10 10 10 10 10 10 10 10 Change Order 1 130100-0200431-5740010-104182-E03380-9999 10 10 10 10 10 10 10 10 10 10 Change Order 2 130100-0200431-5740010-104182-E03380-9999 10 10 10 10 10 10 10 10 10 10 Change Order 3 130100-0200431-5740010-104182-E03380-9999 Project Number: 104182 Application Date: 11/14/2023 Retainage Net ($63,376.06) City Secretary Contract Num: 58694 Application Period: Funding Identification (FID) 10 10 10 10 10 10 10 10 10 10 Change Order 4 130100-0200431-5740010-104182-E03380-9999 10 10 10 10 10 10 10 10 10 10 Change Order 5 130100-0200431-5740010-104182-E03380-9999 10 10 10 10 10 10 10 10 10 10 Change Order 6 130100-0200431-5740010-104182-E03380-9999 10 10 City of Fort Worth Summary of Charqes 2023 Concrete Res Contract 3 I p, 0, : F W020-0000009189 Project Number: 104182 10/t/23-10/31/23 Apphcahon 8 Application Date: 11/14/2023 Number: Total Completed I Amt Remaining ' Gross I Retainage I Net City of Fort Worth Summary of Charqes City Secretary Contract Num: 58694 I 2023 Concrete Res Contract 3 I p, 0.: W020-0000009189 Project Number: 104182 Application Period: 10/t/23-10/31/23 Application 8 Application Date: 11/14/2023 Number: Funding Identification (FID) 10 10 10 10 10 10 10 10 Change Order 7 130100-0200431-5740010-104182-E03380-9999 10 10 10 10 10 10 10 10 10 10 Change Order 8 130100-0200431-5740010-104182-E03380-9999 10 10 10 10 10 10 10 10 10 10 Totals 130100-0200431-5740010-104182-E03380-9999 10 10 10 10 Total Completed I Amt Remaining $1,276,966.14 $350,219.86 Gross ($63,376.06) Retainage Net 10 10 10 10 10 10 City Secretary Contract Num: 58694 Application Period: Funding Identification (FID) Grand Total City of Fort Worth Summary of Charqes 2023 Concrete Res Contract 3 I p, 0.: F W020-0000009189 Project Number: 104182 10/t/23-10/31/23 Application 8 Application Date: 11/14/2023 Number: Total Completed I Amt Remaining I Gross I Retainage 1 1 $1,276,966.14 1 1 $350,219.86 1 1 ($63,376.06)1 1 ($3,641.05)1 1 Net ($59,735.01) 1 FORTWORTH. TRANSPORTATION AND PUBLIC WORKS December 6, 2023 Urban Infraconstruction, LLC 526 North Britain Rd Irving, TX 75061 RE: Acceptance Letter Project Name: 2023 Concrete Restoration Contract 3 Project Type: C.I.P (Paving) City Project No.: 104182 To Whom It May Concern: On September 13, 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 6, 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 6, 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, 1 Tariqul Islam (Jan 5, 202417:07 CST) Tariqul Islam, Project Manager Cc: Ignacio Andrade, Inspector Mike Glover, Inspection Supervisor Daniel Roy, Senior Inspector Omar Elbagalati, Program Manager N/A, Consultant Yajju S. Maharjan, Contractor TPW General Capital Projects Fund, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev. 8/20/19 CONSENT OF OWNER ❑ SURETY COMPANY ARCHITECT ❑ TO FINAL PAYMENT CONTRACTOR ❑ SURETY ❑ AIA DOCUMENT G707 OTHER Bond No. 2340218 PROJECT: 2023 Concrete Restoration Contract 3 Various Locations, City Project No. 104182, (name, address) Ft. Worth, TX TO (Owner) [ City of Fort Worth ] ARCHITECT'S PROJECT NO: 200 Texas Street Fort Worth, TX 76102 CONTRACT FOR: [ ] CONTRACT DATE: November 29, 2022 CONTRACTOR: Urban Infraconstruction, LLC 526 N. Britain Road Irving, TX 75061 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) Swiss Re Corporate Solutions America Insurance Corporation 1200 Main St., Suite 800 , SURETY COMPANY, on bond Of (here insert name and address of Contractor) Urban Infraconstruction, LLC 526 N. Britain Road Irving, TX 75061 , CONTRACTOR, hereby approves of the final payment to the Contractors, 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) City of Fort Worth 200 Texas Street Fort Worth, TX 76102 ,OWNER, as set forth in the said Surety Company's bond. IN WITNESS WHEREOF, the Surety Company has hereunto set its hand this 28th Attest: (Seal): day of December 2Q23 Swiss Re Corporate Solutions America Insurance Surety Company Signature of Authorized?eptrese�nt Sandra Lee Roney Title Attornev-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 AIA DOCUMENT G707 • CONSENT OF SURETY COMPANY TO FINAL PAYMENT • APRIL 1970 EDITION • AIA® ONE PAGE © 1970 • THE AMERICAN INSTITUTE OF ARCHITECTS, I-135 Nmv York Ave., NW, WASHINGTON, D.C. 20006 SWISS RE CORPORATE SOLUTIONS SWISS RE CORPORATE SOLUTIONS AMERICA INSURANCE CORPORATION F/K/A NORTH AMERICAN SPECIALTY INSURANCE COMPANY ("SRCSAIC") SWISS RE CORPORATE SOLUTIONS PREMIER INSURANCE CORPORATION F/K/A WASHINGTON INTERNATIONAL INSURANCE COMPANY ("SRCSPIC") WESTPORT INSURANCE CORPORATION (" WIC!') GENERAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS, THAT SRCSAIC, a corporation duly organized and existing under laws of the State of Missouri, and having its principal office in the City of Kansas City, Missouri, and SRCSPIC, a corporation organized and existing under the laws of the State of Missouri and having its principal office in the City of Kansas City, Missouri, and WIC, organized under the laws of the State of Missouri, and having its principal office in the City of Kansas City, Missouri, each does hereby make, constitute and appoint: JOHN R. WARD, THOMAS DOUGLAS MOORE, EMILY ALLISON MIKESKA, ALLYSON W. DEAN, MONICA RUBY VEAZEY, JOHN WILLIAM NEWBY, TROY RUSSELL KEY, DEBRA LEE MOON, ANDREA ROSE CRAWFORD, SANDRA LEE RONEY, DANA ILENE MOORE AND COLIN E. CONLY JOINTLY or SEVERALLY Its true and lawful Attorney(s)-in-Fact, to make, execute, seal and deliver, for and on its behalf and as its act and deed, bonds or other writings obligatory in the nature of a bond on behalf of each of said Companies, as surety, on contracts of suretyship as are or may be required or permitted by law, regulation, contract or otherwise, provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the amount of TWO HUNDRED MILLION ($200,000,000.00) DOLLARS This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of both SRCSAIC and SRCSPIC at meetings duly called and held on the 18th of November 2021 and WIC by written consent of its Executive Committee dated July 18, 2011. "RESOLVED, that any two of the President, any Managing Director, any Senior Vice President, any Vice President, the Secretary or any Assistant Secretary be, and each or any of them hereby is, authorized to execute a Power of Attorney qualifying the attorney named in the given Power of Attorney to execute on behalf of the Corporation bonds, undertakings and all contracts of surety, and that each or any of them hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Corporation; and it is FURTHER RESOLVED, that the signature of such officers and the seal of the Corporation may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be binding upon the Corporation when so affixed and in the future with regard to any bond, undertaking or contract of surety to which it is attached." oiuTror",,,,,4, rr"'., �'.c _ �➢ °;=LO�Q 'TF; Brik Janssens, Senior Vice President of SRCSAIC& Senior Vice President da °•aaespL�b� SEAL of SRCSPIC & Senior Vice President of WIC ° o y_ =0 S E A L= - ,By ......��j��.•' Gerald Jagrowski, Vice President ofSRCSAIC&Vice President of SRCSPIC " & Vice President of WIC IN WITNESS WHEREOF, SRCSAIC, SRCSPIC, and WIC have caused their official seals to be hereunto affixed, and these presents to be signed by their authorized officers this 2nd day of AUGUST 2022 Swiss Re Corporate Solutions America Insurance Corporation State of Illinois Swiss Re Corporate Solutions Premier Insurance Corporation County of Cook ss Westport Insurance Corporation On this 2nd day of AUGUST , 20 22 , before me, a Notary Public personally appeared Erik Janssens , Senior Vice President of SRCSAIC and Senior Vice President of SRCSPIC and Senior Vice President of WIC and Gerald Jaerowski , Vice President of SRCSAIC and Vice President of SPCSPIC and Vice President of WIC, personally known to me, who being by me duly sworn, acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the volunrary art anal deM nfAiejr respective companies. �:1 YY rb�F47r.eiil4 °YA� Yasmin A. Patel, Notary I, Jeffrey Goldberg, the duly elected Senior Vice President and Assistant Secretary of SRCSAIC and SRCSPIC and WIC, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney given by said SRCSAIC and SRCSPIC and WIC, which is still in full force and effect. IN WITNESS WHE? E017, I have set my hand and affixed the seals of the Companies this 28th day of December 202. Jeffrey Goldberg, Senior Vice President & Assistant Secretary of SRCSAIC and SRCSPIC and WIC IMPORTANT NOTICE In order to obtain information or make a complaint: You may contact Jeffrey Goldberg, Vice President - Claims, at 1-800-338-0753. You may call Swiss Re Corporate Solutions America Insurance Corporation or Swiss Re Corporate Solutions Premier Insurance Corporation's toll -free number for information or to make a complaint at: 1-800-338-0753 You may also write to Swiss Re Corporate Solutions America Insurance Corporation or Swiss Re Corporate Solutions Premier Insurance Corporation at the following address: 1450 American Lane, Suite 1100 Schaumburg, IL 60173 You may contact the Texas Department of Insurance to obtain information on companies, coverages, rights or complaints at: 1- 800-252-3439 You may write the Texas Department of Insurance: P.O. Box 149104 Austin, TX 78714-9104 Fax: (512) 475-1771 Web: httu://www.tdi.state.tx.us E-mail:Co ns ume rProtectionna,tdi.state.tx. us PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should first contact the Swiss Re Corporate Solutions America Insurance Corporation or Swiss Re Corporate Solutions Premier Insurance Corporation. If the dispute is not resolved, you may contact the Texas Department of Insurance. ATTACH THIS NOTICE TO YOUR POLICY: This notice is for information only and does not become a part or condition of the attached document. AVISO IMPORTANTE Para obtener information o para someter un queja: Puede comunicarse con Jeffrey Goldberg, Vice President - Claims, al 1-800-338-0753. Usted puede llamr al numero de telefono gratis de Swiss Re Corporate Solutions America Insurance Corporation o Swiss Re Corporate Solutions Premier Insurance Corporation's para information o para someter una queja al: 1-800-338-0753 Usted tambien puede escribir a Swiss Re Corporate Solutions America Insurance Corporation o Swiss Re Corporate Solutions Premier Insurance Corporation al: 1450 American Lane, Suite 1100 Schaumburg, IL 60173 Puede escribir al Departmento de Seguros de Texas para obtener information acerca de companias, coberturas, derechos o quejas al: 1- 800-252-3439 Puede escribir al Departmento de Seguros de Texas: P.O. Box 149104 Austin, TX 78714-9104 Fax: (512) 475-1771 Web: httD://www.tdi.state.tx.us E-mail:Cons u merProtection(atdi.state.tx.us DISPUTAS SOBRE PRIMAS O RECLAMOS: Si tiene una disputa concerniente a su prima o a un reclamo, debe comunicarse con el Swiss Re Corporate Solutions America Insurance Corporation o Swiss Re Corporate Solutions Premier Insurance Corporation primero. Si no se resuelve la disputa, puede entonces comunicarse con el Departmento de Seguros de Texas. UNA ESTE AVISO A SU POLIZA: Este aviso es solo para proposito de infromacion y no se converte en parte o condition del documento adjunto. AFFIDAVIT STATE OF COUNTY OF Before me, the undersigned authority, a notary public in the state and county aforesaid, on this day personally appeared Anup Tamrakar, CEO Of Urban Infraconstruction LLC, 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; 2023 Concrete Restoration Contract 3 V s Locatio s, CPN #104182 BY / 6 / amrakar, CEO Subscribed and sworn before me on this date 2nd of January, 2024. NIC1MA P®.�.�..�U.�EL �..., *` Ply Notary ID # 132586147 ,IL4y - -- LU14 Dallas County, TX