HomeMy WebLinkAboutContract 58036-FP1FORT WORTH
-FP1
City Secretary
Contract No. 58036
Date Received 02/06/2024
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: Rhino Health
City Project No.: 103759
Improvement Type(s): Water ❑x Sewer ❑x
Original Contract Price: $467,250.00
Amount of Approved Change Order(s): $427,770.00
Revised Contract Amount: $39,480.00
Total Cost of Work Complete: $39,480.00
TOffN TOMB
JOHN TOMB (Jan 30, 202410:49 CST)
Contractor
Project Manager
Title
North Texas Contracting, Inc
Company Name
Ignac� Andrade (Jan 30, 202411:34 CST)
Project Inspector
Kha( Jaafari P.E. (Fet 6, 202415:27 CST)
Project Manager
*—'In-
(Feb 6. 202415:35 CSTI
CFA Manager
Lau re n P ri e u r ( Feb 6, 202415:37 CST)
TPW Director
6 �roai6onI-Sn
Asst. City Manager
Jan 30, 2024
Date
Jan 30, 2024
Date
Feb 6, 2024
Date
Feb 6, 2024
Date
Feb 6, 2024
Date
Feb 6, 2024
Date
OFFICIAL RECORD
CITY SECRETARY Page 1 of 2
FT. WORTH, TX
Notice of Project Completion
Project Name: Rhino Health
City Project No.: 103759
City's Attachments
Final Pay Estimate ❑x
Change Order(s): ❑x Yes ❑ N/A
Pipe Report: ❑x Yes ❑ N/A
Contractor's Attachments
Affidavit of Bills Paid
Consent of Surety
Statement of Contract Time
Contract Time: 90 WD Days Charged: 141
Work Start Date: 11/1/2022 Work Complete Date: 7/27/2023
Completed number of Soil Lab Test: 20
Completed number of Water Test: 6
Page 2of2
FoRTWORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name SOUTH RHINO HEALTH
Contract Limits
Project Type WATER IMPROVEMENTS
City Project Numbers 103759
DOE Number 3759
Estimate Number 1 Payment Number 1
City Secretary Contract Number
Contract Date 6/2/2022
Project Manager NA
Contractor NORTH TEXAS CONTRACTING, INC.
P.O. BOX 468
Inspectors
For Period Ending 7/27/2023
WD
Contract Time 9WD
Days Charged to Date 141
Contract is 100.00 Complete
KELLER , TX 76244
M. GLOVER / I. ANDRADE
Friday, December 1, 2023 Page 1 of 5
City Project Numbers 103759 DOE Number 3759
Contract Name SOUTH RHINO HEALTH Estimate Number 1
Contract Limits Payment Number 1
Project Type WATER IMPROVEMENTS For Period Ending 7/27/2023
Project Funding
UNIT I: WATER IMPROVEMENTS
Item
Description of Items
Estimated Unit
Unit Cost
Estimated
Completed
Completed
No.
Quanity
Total
Quanity
Total
1
REMOVE SIDEWALK
60 SF
$10.00
$600.00
60
$600.00
2
REMOVE CONC PVM
0 SY
$30.00
$1,500.00
50
$1,500.00
3
REMOVE CONC CURB & GUTTER
20 LF
$3.00
$60.00
20
$60.00
4
10" CONC PVM
0 SY
$80.00
$4,000.00
50
$4,000.00
5
4' CONC SIDEWALK
40 SF
$15.00
$600.00
40
$600.00
6
BARRIER FREE RAMP, TYPE P-2
1 EA
$1,500.00
$1,500.00
1
$1,500.00
7
6" CONC CURB & GUTTER
20 LF
$5.00
$100.00
20
$100.00
8
TRENCH SAFETY
70 LF
$1.00
$70.00
70
$70.00
9
DUCTILE IRON WATER FITTINGS W/
0.5 TO
$2,000.00
$1,000.00
0.5
$1,000.00
RESTRAINT
10
6" PVC WATER PIPE
70 LF
$65.00
$4,550.00
70
$4,550.00
11
CONNECTION TO EXISTING 4"-12" WATER
1 EA
$2,500.00
$2,500.00
1
$2,500.00
MAIN
12
3" WATER METER & VAULT
1 EA
$20,000.00
$20,000.00
1
$20,000.00
13
TRAFFIC CONTROL
1 MO
$2,500.00
$2,500.00
1
$2,500.00
14
12"X6" CUT -IN TREE
1 EA
$500.00
$500.00
1
$500.00
Sub -Total of Previous Unit $39,480.00 $39,480.00
- - - - - - - - - - - - - - - - - - -
UNIT II: SEWER IMPROVMENTS
Item
Description of Items
Estimated Unit
Unit Cost
Estimated
Completed Completed
No.
Quanity
Total
Quanity
Total
1
REMOVE CONC PVMT (CO #1)
0 SY
$30.00
$0.00
0
$0.00
2
REMOVE CONC CURB & GUTTER (CO #1)
0 LF
$3.00
$0.00
0
$0.00
3
REMOVE 8" SEWER LINE (CO #1)
0 LF
$15.00
$0.00
0
$0.00
4
REMOVE 4' SEWER MANHOLE(CO #1)
0 EA
$1,500.00
$0.00
0
$0.00
5
SWPPP> 1 ACRE(CO#1)
0 LS
$3,500.00
$0.00
0
$0.00
6
8" CONC PVMT(CO #1)
0 SY
$75.00
$0.00
0
$0.00
7
10" CONC PVMT(CO #1)
0 SY
$80.00
$0.00
0
$0.00
8
6" CONC CURB & GUTTER(CO #1)
0 LF
$5.00
$0.00
0
$0.00
9
POST -CCTV INSPECTION(CO #1)
0 LF
$1.00
$0.00
0
$0.00
10
BYPASS PUMPING(CO #1)
0 LS
$5,000.00
$0.00
0
$0.00
11
TRENCH WATER STOPS(CO #1)
0 EA
$150.00
$0.00
0
$0.00
Friday, December 1, 2023
Page 2 of 5
City Project Numbers 103759 DOE Number 3759
Contract Name SOUTH RHINO HEALTH Estimate Number 1
Contract Limits Payment Number 1
Project Type SEWER IMPROVEMENTS For Period Ending 7/27/2023
Project Funding
12 24" CASING BY OPEN CUT(CO #1)
0 LF
$350.00
$0.00
0
$0.00
13 8" SEWER SERVICE, RECONNECTION(CO #1)
0 EA
$500.00
$0.00
0
$0.00
14 12" SEWER PIPE(CO #1)
0 LF
$80.00
$0.00
0
$0.00
15 12" SEWER PIPE, CSS BACKFILL(CO #1)
0 LF
$85.00
$0.00
0
$0.00
16 12" SEWER PIPE, SELECT BACKFILL(CO #1)
0 LF
$83.00
$0.00
0
$0.00
17 EPDXY MANHOLE LINER(CO #1)
0 VF
$250.00
$0.00
0
$0.00
18 4' MANHOLE(CO #1)
0 EA
$3,500.00
$0.00
0
$0.00
19 T DROP MANHOLE(CO #1)
0 EA
$4,500.00
$0.00
0
$0.00
20 TRAFFIC CONTROL(CO #1)
0 MO
$2,000.00
$0.00
0
$0.00
Sub -Total of Previous Unit
$0.00
$0.00
Friday, December 1, 2023 Page 3 of 5
City Project Numbers 103759
Contract Name SOUTH RHINO HEALTH
Contract Limits
Project Type SEWER IMPROVEMENTS
Project Funding
Contract Information Summary
Original Contract Amount
Chanhe Orders
Change Order Number 1
Total Contract Price
DOE Number 3759
Estimate Number 1
Payment Number 1
For Period Ending 7/27/2023
$467,250.00
$427,770.00
$39,480.00
Total Cost of Work Completed $39,480.00
Less % Retained $0.00
Net Earned $39,480.00
Earned This Period $39,480.00
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
$39,480.00
Friday, December 1, 2023 Page 4 of 5
City Project Numbers 103759 DOE Number 3759
Contract Name SOUTH RHINO HEALTH Estimate Number 1
Contract Limits Payment Number 1
Project Type SEWER IMPROVEMENTS For Period Ending 7/27/2023
Project Funding
Project Manager NA City Secretary Contract Number
Inspectors M. GLOVER / I. ANDRADE Contract Date 6/2/2022
Contractor NORTH TEXAS CONTRACTING, INC. Contract Time 90 WD
P.O. BOX 468 Days Charged to Date 141 WD
KELLER , TX 76244 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 $39,480.00
Less % Retained $0.00
Net Earned $39,480.00
Earned This Period $39,480.00
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
$39,480.00
Friday, December 1, 2023 Page 5 of 5
DEVELOPER -AWARDED -PROJECT CHANGE ORDER
PPROJECT NAME: Water & Sanitary Sewer Improvements Fort Worth South Rhino Health (273 W Everman Pkwy) CHANGE
I CONTRACT: IPRC21-0133 ORDER No:
ICFA # CFA22-0025 I CITY PARTICIPATION:( NO
ICITYPROJECT# 103759
IDOE # INA
FID # 130114-0200431-103866-E07685
FILE # IX-27118
INSPECTOR: Ignacio Andrade
PROJECT MANAGER: KhaI Jaafari
WA1
veloper
Cost
(ORIGINAL CONTRACT
I $39,480.00
EXTRAS TO DATE
I S0.00
CREDITS TO DATE
I Si
CONTRACT TO DATE
$39,480.00
AMOUNT OF PROP. CHANGE ORDER
I 50.00
TOTAL REV(& COTNTRACT AMOUNT PER I $39,480.00
2 SEWER
City Cost LveloperCost
Phone No: 817.223.2261
Phone No: 817.392.7872
SO.00
1 $427.770.00
$0.00
$0.00
S0.00 I
$0.00
SO.00 I
$427.770.00
$0.00
S0.00
S0.00
UNIT $39A80.00
REVISED COST SHARE IDev. Cost:
TOTAL REVISED CONTRACT I
You are directed to make the following than )es i%ta c9�tecl documontg
CITY 81 ITEM
PAY ITEM 0
#
QUANTITY
1
0241.1000
1550
2
0241.1300
611)
3
02412013
1930
4
02412201
1
5
3125.0101 1
1 1
6
1 3213.01 D3 1
940 1
7
1 3213.0105 1
610 1
8
1 3216.0101 1
610 1
9
1 3301.0002 1
1930 1
10
I 3303.00D1 1
1
11
I 3305.0113 1
8
12
1 3305.1004 1
20
13
1 3331.3313 1
3
14
1 3331A208 1
740 1
15
1 3331.4209 1
20 1
16
1 3331.4210 1
1170 1
17
1 3339.0001 1
100 1
16
1 3339.1001 1
1 1
19
1 3339.1002
4 1
20
1 3471.0001 I
1 1
REASONS FOR CHANGE ORDER
CONTRACT UNIT
PAVING
DRAINAGE
STREETLIGHTS
Developer
Uovoloper
ueveloper
City Cost
Cost
City Cost
Cost
City Cost
Cost
City Cost
$0.00
S0.00
SO.00
I S0,00
SO.00
S4,00
SO.00
SO.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
SO.00
S0,00
SO.00
S0.00
SO.00
S0.00
SO.00
S0.00
$0.00
SO.00
S0.00
SO.00
S0.00
$0.00
$0.00
S0.00
50.00
$0.00
$0.00
S0.00
$0.00
S0.00
S0.00
S0.00
S0.00
I S0.00
S0.00
SO.00
$0.00 S0,00
$39,480.00 City Cost:
S39,480,00
$0.00 $0.00
$0.00
CONTRACT DAYS
90
0
0
90
0
90
UNIT
REM DESCRIPTION
UNIT PRICE
TOTAL
SY
REMOVE CONIC PVMT
$
(30.00) S
(46.500.00)
LF
REMOVE CONIC CURBBGUTTER
S
(3.00) $
(1.830.00)
LIFEA
((8.500.00)
REMOVE INMHOLE
S
(1.600.00) $
LS
SWPPP-1 ACRE
5
(3,500.00) $
(3.500.00)
SY
8" CONIC PVMT
Is
(75.00) S
(70.500.00)
SY I
10" CONC PVMT
I $
(80.00) S
(48.800.00)
LF I
6" CONC CURB AND GUTTER
is
(5.00) $
(3,050.00)
LF I
POST -CCTV INSPECTION
Is
(1.00) $
(1.930.00)
LS I
BYPASS PUMPING
IS
(5.000.00) S
(5.000.00)
EA I
TRENCH WATER STOPS
I $
(150.00) $
(1200.00)
LF I
24" CASING BY OPEN CUT
1 $
(350.00) S
(7.000.00)
EA 1
8" SEWER SERVICE. RECONNECTION
Is
(500.00)1 $
(1.500.00)
LF 1
12" SEWER PIPE
1 $
(80.00)I S
(59.200.00)
LF 1
12" SEWER PIPE. CSS BACKFILL
1 $
(85.00)1 $
(1.700.00)
LF
12" SEWER PIPE, SELECT BACKFILL
1 $
(83.00)1 S
(97,110.00)
VF I
EPDXY MANHOLE LINER
1 $
(250.00) l S
(25.000.00)
EA I
4' MANHOLE
I S
(3,500.00) $
(3.500.00)
EA I
4' DROP MANHOLE
1 5
(4,500.00)1 S
(18.000.00)
MO 1
TRAFFIC CONTROL
I S
(2.000.00)1 S
(2.000.00)
TOTAL
Is
(427,770.00)
REMOVAL OF SANITARY SEWER IMPROVEMENTS
Revised: 10.12-2011 Page 1
RECOMMENDED:
Kff.W w ML�m dA&Wdeft& Inc.
BY ' ^/4&—
Nome: 6ran6m M3QdiCM
iRla: Viapnzj erd
APPROVED:
NXM (�C.
floe: U, T '
APPROVED:
hbrfh 7a'oD/5)COr�K� dV
Nww Zach Fusilier
Tw, Vice President
Revse&. 1412—Xll 2
FORT WORTH
TRANSPORTATION AND PUBLIC WORKS
PIPE REPORT FOR:
PROJECT NAME: Rhino Health
CITY PROJECT NUMBER: 103759
1 WATER
PIPE LAID SIZE TYPE OF PIPE
WATER 6" PVC
FIRE HYDRANTS: VALVES (16" OR LARGER)
PIPE ABANDONED SIZE TYPE OF PIPE
DENSITIES:
NEW SERVICES:
I SEWER
PIPE LAID SIZE TYPE OF PIPE
PIPE ABANDONED SIZE TYPE OF PIPE
DENSITIES:
NEW SERVICES:
TRANSPORTATION AND PUBLIC WORKS
The City of Fort Worth • 1000 Throckmorton Street • Fort Worth, TX 76012-6311
(817) 392 - 7941 • Fax: (817) 392 - 7845
LF
LF
LF
LF
70
FORTWORTH.
TRANSPORTATION AND PUBLIC WORKS
August 7, 2023
North Texas Contracting INC.
4999 Keller Haslet Rd
Keller, Texas 76244
RE: Acceptance Letter
Project Name: Rhino Health
Project Type: Water & Sewer
City Project No.: 103759
To Whom It May Concern:
On August 4, 2023 a final inspection was made on the subject project. There were no punch list items
identified at that time. The final inspection indicates that the work meets the City of Fort Worth
specifications and is therefore accepted by the City. The warranty period will start on August 4, 2023,
which is the date of the final inspection 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,
KGcaG 9�� P. E.
Khal Jaafari P.E. (Feb6, 202415:27 CST)
Khal Jaafari, Project Manager
Cc: Ignacio Andrade, Inspector
Mike Glover, Inspection Supervisor
Daniel Roy, Senior Inspector
Victor Tornero, Program Manager
Brandon Middleton, Consultant
John Tomb, Contractor
Jason Haas, Developer
File
E-Mail: TPW_Acceptance@fortworthtexas.gov
Rev. 08/20/19
AFFIDAVIT
STATE OF TX
COUNTY OF Tarrant
Before me, the undersigned authority, a notary public in the state
and county aforesaid, on this day personally appeared John Tomb, Project
Manager Of North Texas Contracting, 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;
Contract 58036. CFA22-0025.CPN 103759. Forth Worth South Rhino
Health Water and Sewer. j
B �f
- John Tomb
i
Subscribed and sworn before me n this date 30th of January, 2024.
Notary Public 1-11
Tarrant County, TX
Pue
4,
CARSON CLAY COLLIER
NOTARY PUBLIC
* *
STATE OF TEXAS
'oFPy
MY COMM. EXP 02-05-2024
NOTARY ID 13052756-2
CONSENT OF
SURETY COMPANY
TO FINAL PAYMENT
Conforms with the American Institute of
Architects, AIA Document G707
PROJECT:
(name, addreSS)Rhino Health
Fort Worth, TX
TO (Owner)
OWNER
❑
ARCHITECT
❑
CONTRACTOR
❑
SURETY
❑
OTHER
Band No SU1182166
EVERMAN FORT WORTH BUILDINGS 2&3 SPE. LLCARCHITECT'S PROJECT N0: CFA22-0025
AND THE CITY OF FORT WORTH CONTRACT FOR:
1800 Avenue of The Stars, Suite 320 Water and Sanitary Sewer Improvements to Serve Fort Worth South
Rhino Health, CP 103759
Los Angeles CA 90067 --J CONTRACT DATE:
CONTRACTOR: NORTH TEXAS CONTRACTING. INC.
In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the
there insert name and address of Surety Company)
ARCH INSURANCE COMPANY
Harborside 3, 210 Hudson Street, Suite 300
Jersey City NJ 07311-1107 , SURETY COMPANY
on bond of there insert name and address of Contractor)
NORTH TEXAS CONTRACTING, INC.
4999 Keller Haslet Rd.
Keller TX 76248 , 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 ;hare insert name and address of Owner)
EVERMAN FORT WORTH BUILDINGS 2&3 SPE, LLC AND THE CITY OF FORT WORTH
1800 Avenue of The Stars, Suite 320
Los Angeles CA 90067 , 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):
30th day of January, 2024
ARCH INSURANCE COMPANY
Surety Company
Signature of Authorized Representative
Robbi Morales
Title
Attorney -in -Fact
NOTE; Thio 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
00456
This Power of Attorney limits the acts of those named herein, and rhev have no authority to bind the Company except in the nranner rued to the extent herein scaled.
Not valid for Note. Loan, Letter of Credit, Currency Rate, Interest Rate or Residential Value Guarantees.
POWER OF ATTORNEY
Know All Persons By These Presents:
That the Arch Insurance Company, a corporation organized and existing under the laws of the State of Missouri, having its principal administrative office in Jersey City,
New Jersey (hereinafter referred to as the "Company") does hereby appoint:
Don F. Cornell, Joshua Saunders, Kelly A. Westbrook, Mikaela Peppers, Ricardo J. Reyna, Robbi Morales, Sophinle Hunter, Tina McEwan and Tonie
Petranek of Dallas, TX (EACH)
its true and lawful Attorney(s)in-Fact, to make, execute, sea], and deliver from the date of issuance of this power for and on its behalf as surety, and as its act and deed:
Any and all bonds, undertakings, recognizances and other surety obligations, in the penal sum not exceeding One Hundred Fiftv Million Dollars iS 150.000.000.00).
This authority does not permit the some obligation to be split into two or more bonds In order to bring each such bond within the dollar limit of authority as set forth
herein.
The execution of such bonds, undertakings, recognizances and other surety obligations in pursuance of these presents shall be as binding upon the said Company as
fully and amply to all intents and purposes, as if the same had been duly executed and acknowledged by its regularly elected officers at its principal administrative
office in Jersey City. New Jersey,
This Power of Attorney is executed by authority of resolutions adopted by unanimous consent of the Board of Directors of the Company on August 31. 2022. true and
accurate copies of which are hereinafter set forth and are hereby certified to by the undersigned Secretary as being in full force and effect:
"VOTED, That the Chairman of the Board, the President, or the Executive Vice President, or any Senior Vice President, of the Surety Business Division, or their
appointees designated in writing and filed with the Secretary. or the Secretary shall have the power and authority to appoint agents and attorneys -in -tact, and to
authorize them subject to the limitations set forth in their respective powers of attorney, to execute on behalf of the Company, and attach the seal of the Company
thereto, bonds, undertakings, recognizanecs and other surety obligations obligatory in the nature thereof, and any such officers of the Company may appoint agents for
acceptance of process."
This Power of Attorney is signed, sealed and certified by facsimile under and by authority of the following resolution adopted by the unanimous consent of the Board of
Directors of the Company on August 31.2022;
VOTED, That the signature of the Chairman of the Board, the President, or the Executive Vice President, or any Senior Vice President, of the Surety Business
Division, or their appointees designated in writing and filed with the Secretary, and the signature of the Secretary, the seal of the Company. and certifications by the
Secretary, may be affixed by facsimile on any power of attorney or bond executed pursuant to the resolution adopted by the Board of Directors on August 31, 2022. and
any such power so executed, sealed and certified with respect to any bond or undertaking to which it is attached, shall continue to be valid and binding upon the
Company. In Testimony Whereof, the Company has caused this instrument to he signed and its corporate seal to be affixed by their authorized officers, this 23' day
of March, 2023.��
Attested and Ce
rtified Arch Insuu�ranceeCCo�mApa�ny
—%1 SEAt
t171
Regan61C. Shulman, Secretary Stephen C. Ruschak, Executive Vice President
STATE OF PENNSYLVANiA SS
COUNTY OF PHILADELPHIA SS k�SljaYl�
1. Michele Tripodi, a Notary Public, do hereby certify that Regan A. Shulman and Stephen C. Ruschak personally known to me to be the same persons whose names
are respectively as Secretary and Executive Vice President of the Arch Insurance Company, a Corporation organized and existing under the laws of the State of
Missouri, subscribed to the foregoing instrument. appeared before me this day in person and severally acknowledged that they beingthercurao duly authorized signed,
sealed with the corporate seal and delivered the said instrument as the free and voluntary act of said corporation and as their own free and VOILIntary acts for the uses and
purposes therein set forth. /} Cotrrax wealth of hnWA * . Mtny Sal
3MXHt1E TluPW, ebtary Pubtic 1
Ptawphia countyMich a podi, Notarf Public
My Cairnisslat Emovs MY 3 t, 2024
Conmisitim Mun6w t%un My commission expires 07'31i2025
CERTIFICATION
1. Regan A. Shulman, Secretary of the Arch Insurance Company, do hereby certify that the attached Power of Attorney dated March 23. 2023 on behalf of the
person(s) as listed above is a true and correct copy and that the saute has been in full farce and effect since the date thereof and is in full force and effect on the date of
this certificate: and 1 do further certify that the said Stephen C. Ruschak, who executed the Power of Attorney as Executive Vice President, was on the date of execution
of the attached Power of Attorney the duly elected Executive Vice President of the Arch Insurance Company.
iN TESTIMONY WHEREOF, l have hereunto subscribed my name and affixed the corporate seal of the Arch Insurance Company on this aan day of January
2024
Re A. Shulman, Sccrelary
This Power of Attorney limits the acts of those named therein to the bonds and undertakings specifically named therein and they have no authority to bind the Company
except in the manner and to the extent herein stated. 2knre
PLEASE SEND ALL CLAIM INQUIRIES RELATING TO THIS BOND TO THE FOLLOWING ADDRESS: Cg CQ
Arch insurance —Surety Division
3 Parkway, Suite 1500 Wl1VOMTE 4
Philadelphia, PA 19102 s
»rt
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To verify the authenticity of this Power of Attorney, please contact Arch Insurance Company at SuretyAuthentic archinsurance.com
Please refer to the above named Attorney -in -Fact and the details of the bond to which the power is attached.
AICPOAU40120 Printed in U.S.A.