HomeMy WebLinkAboutContract 59134-FP1-FP1
City Secretary59134
Contract No.
FORTWORTH.
Date Received 06/24/2024
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: ATCN Proposed Grocery Store
City Project No.: 104284
Improvement Type(s): Water 0 Sewer 0
Original Contract Price: $174,040.78
Amount of Approved Change 0rder(s): $54,180.04
Revised Contract Amount: $228,220.82
Total Cost of Work Complete: $228,220.82
Cody e(yJun18,25:21 CDT) Jun 18, 2024
Contractor Date
C&r% SlutGze-
Cody Shu ze (Jun 18, 2024 15:21 CDT)
Title
Jeremiah Rader EMJ Corp
Company Name
ffer'-hol Stanley Sutter field
Hershel Stanley Sutterfield(Jun l ,202415:41 CDT)
Jun 18, 2024
Inspector
PA`�
Date
Jun 23, 2024
Project Manager
Date
,n
Rebecca Owen (Jun 24,202408:20 CDT)
Jun 24, 2024
CFA Manager
Date
4&..,
Lauren Prieur (Jun 24, 202408:22 CDT)
Jun 24 2024
TPW Dire for
Date
Jun 25, 2024
Asst. City Manager
Date
OFFICIAL RECORD
Notice of Project Completion CITY SECRETARY
FT. WORTH, TX
Page 1 of 2
Project Name: ATCN Proposed Grocery Store
City Project No.: 104284
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: 280 WD Days Charged: 192
Work Start Date: 5/8/2023 Work Complete Date: 2/16/2024
Completed number of Soil Lab Test: 265
Completed number of Water Test: 8
Page 2 of 2
FORT WORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name PROPOSED GROCERY STORE (LOT 3, BLOCK 1 HERITAGE TRACE GR
Contract Limits
Project Type WATER IMPROVEMENTS
City Project Numbers 104284
DOE Number 4284
Estimate Number 1 Payment Number 1 For Period Ending 2/16/2024
City Secretary Contract Number Contract Time
Contract Date Days Charged to Date 192
Project Manager NA Contract is 100.00 Complete
Contractor EMJ CONSTRUCTION
5525 N. MACARTHUR BLVD., SUITE 400
IRVING, TX 75038
Inspectors W. MILLER / S. SUTTERFIE
Thursday, April 18, 2024 Page 1 of 5
City Project Numbers 104284 DOE Number 4284
Contract Name PROPOSED GROCERY STORE (LOT 3, BLOCK 1 HERITAGE TRACE G Estimate Number 1
Contract Limits Payment Number 1
Project Type WATER IMPROVEMENTS For Period Ending 2/16/2024
Project Funding
UNIT I: WATER IMPROVEMENTS
Item
Description of Items
Estimated Unit
Unit Cost
Estimated
Completed
Completed
No.
Quanity
Total
Quanity
Total
1
MOBILIZATION
1 LS
$6,197.13
$6,197.13
1
$6,197.13
2
CONSTRUCTION STAKING
1 LS
$586.96
$586.96
1
$586.96
3
TRENCH SAFETY
75 LF
$7.83
$587.25
75
$587.25
4
20" CASING BY OTHER THAN OPEN CUT
40 LF
$984.68
$39,387.20
40
$39,387.20
5
24" CASING BY OTHER THAN OPEN CUT
35 LF
$987.27
$34,554.45
35
$34,554.45
6
DUCTILE IRON WATER FITTINGS W/
1 TN
$7,716.18
$7,716.18
1
$7,716.18
RESTRAINT
7
8" DIP WATER
80 LF
$118.57
$9,485.60
80
$9,485.60
8
12" DIP WATER
80 LF
$140.87
$11,269.60
80
$11,269.60
9
1 1/2" WATER SERVICE (IRRIGATION)
1 EA
$6,200.65
$6,200.65
1
$6,200.65
10
2" WATER SERVICE
1 EA
$6,673.74
$6,673.74
1
$6,673.74
11
16"x8" TAPPING SLEEVE & VALVE
1 EA
$16,134.36
$16,134.36
1
$16,134.36
12
16"xl2" TAPPING SLEEVE & VALVE
I EA
$18,907.16
$18,907.16
1
$18,907.16
13
UTILITY SERVICE SURFACE RESTORATION
155 SY
$12.91
$2,001.05
155
$2,001.05
SODDING
14
8" GATE VALVE
1 EA
$3,811.72
$3,811.72
1
$3,811.72
15
12" GATE VALVE
1 EA
$6,207.69
$6,207.69
1
$6,207.69
16
6" FLEXIBLE BASE, TYPE A, GR-1 (CO#2)
17.3 SY
$53.50
$925.55
17.3
$925.55
17
4" ASPHALT BASE TYPE B (CO#2)
17.3 SY
$71.17
$1,231.24
17.3
$1,231.24
18
8" CONC PVMT (CO#2)
17.3 SY
$235.39
$4,072.25
17.3
$4,072.25
19
6" CONC CURB AND GUTTER (CO#2)
12 LF
$43.90
$526.80
12
$526.80
20
CONCRETE COLLAR FOR VALVE (CO#3)
1 EA
$1,750.00
$1,750.00
1
$1,750.00
21
8" CUT - IN GATE VALVE (CO#3)
1 EA
$8,125.00
$8,125.00
1
$8,125.00
Sub -Total of Previous Unit
$186,351.58
$186,351.58
UNIT
M SEWER IMPROVEMENTS
Item
Description of Items
Estimated Unit
Unit Cost
Estimated
Completed
Completed
No.
Quanity
Total
Quanity
Total
1
INSTALL CONCRETE CAP OVER EXISTING
4 CY
$1,080.01
$4,320.04
4
$4,320.04
SEWER LINE
2
MANHOLE ADJUSTMENT, MINOR (CO#1)
3 EA
$10,700.00
$32,100.00
3
$32,100.00
3
CONCRETE COLLAR (CO#1)
3 EA
$376.40
$1,129.20
3
$1,129.20
Thursday, April 18, 2024
Page 2
of 5
City Project Numbers 104284 DOE Number 4284
Contract Name PROPOSED GROCERY STORE (LOT 3, BLOCK 1 HERITAGE TRACE G Estimate Number 1
Contract Limits Payment Number 1
Project Type SEWER IMPROVEMENTS For Period Ending 2/16/2024
Project Funding
4 INSTALL CONCRETE CSP OVER EXISTING 4 CY $1,080.00 $4,320.00 4 $4,320.00
SEWER LINE (CO#1)
Sub -Total of Previous Unit $41,869.24 $41,869.24
Thursday, April 18, 2024 Page 3 of 5
City Project Numbers 104284 DOE Number 4284
Contract Name PROPOSED GROCERY STORE (LOT 3, BLOCK 1 HERITAGE TRACE G Estimate Number 1
Contract Limits Payment Number 1
Project Type SEWER IMPROVEMENTS For Period Ending 2/16/2024
Project Funding
Contract Information Summary
Original Contract Amount $174,040.78
Change Orders
Change Order Number 1 $37,549.20
Change Order Number 2 $6,755.84
Change Order Number 3 $9,875.00
Total Contract Price $228,220.82
Total Cost of Work Completed $228,220.82
Less % Retained $0.00
Net Earned $228,220.82
Earned This Period $228,220.82
Retainage This Period $0.00
Less Liquidated Damages
Days @ / 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
$228,220.82
Thursday, April 18, 2024 Page 4 of 5
City Project Numbers 104284 DOE Number 4284
Contract Name PROPOSED GROCERY STORE (LOT 3, BLOCK 1 HERITAGE TRACE G Estimate Number 1
Contract Limits Payment Number 1
Project Type SEWER IMPROVEMENTS For Period Ending 2/16/2024
Project Funding
Project Manager NA
Inspectors W. MILLER / S. SUTTERFIE
Contractor EMJ CONSTRUCTION
5525 N. MACARTHUR BLVD., SUITE 400
IRVING, TX 75038
City Secretary Contract Number
Contract Date
Contract Time
Days Charged to Date 192
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 $228,220.82
Less % Retained
$0.00
Net Earned
$228,220.82
Earned This Period $228,220.82
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
$228,220.82
Thursday, April 18, 2024 Page 5 of 5
DocuSign Envelope ID: BD171534-AF9F-41 F4-9D2C-7BC977C22398
REVIEWED
DEVELOPER -AWARDED -PROJECT CHANGE ORDER By Sandip Adhikari at 9:10 am, Jul 19, 2023
Water, Sanitary Sewer, Storm, Street Lighting & Paving Improvements to Serve Proposed
PROJECT NAME:
Grocery Store
CHANGE
CONTRACT:
Water, Sanitary Sewer, Storm, Street Lighting & Paving Improvements
ORDER No:
ICFA #
22-0187
I
CITY PARTICIPATION
ICITYPROJECT#
104284
IFILE #
W-2864
INSPECTOR:
Stan Sutterfield
Phone No:
PROJECT MANAGER
Sandie
Adhikan
Phone No:
CONTRACT UNIT
I
WATER
SEWER
PAVING
DRAINAGE
STREETLIGHTS I
CONTRACT
Developer
Developer
Developer
Developer
DAYS
Cost
Citycost
cost
ciTy cost
cost
ciTy coat
Developer Cost
ciTy coat
cost
City Coat
(ORIGINAL CONTRACT
$169,720.74
E0.00
E4,320.04
E0.00
$401,513.54
E0.00
$567,394.13
E0.00
E57,249.23
$0,00
I
EXTRAS TO DATE
I
(CREDITS TO DATE
ICONTRACT TO DATE
$169,720.74
$0.00
$4,320.04
$0.00
$401,513.54
$0.00
$567,394.13
$0.00
$57,249.23
120 I
(AMOUNT OF PROP. CHANGE ORDER
$ 37,549.20
$ 87,460.10
$ 1,750,216.94
120 I
I REVISED CONTRACT AMOUNT
$169,720.74
$0.00
$41,869.24
$0.00
$488,973.64
$0.00 _
$2,317,611.07
$0.00
$57,249.23
240
CONTRACT
TOTAAMO
NIED
T PER UNIT
$169,720.74
$41,869.24
$488,973.64
$2,317,611.07
$57,249.23
REVISED COST SHARE
Dev. Cost:
$3,076,423.92 City Cost:
TOTAL REVISED CONTRACT
$3,075,423.92
You are directed to make the following changes in t e contract do umentsCl
I
BID
I
I I
PAY ITEM#
ITEM
QUANTITY
UNIT
ITEM DESCRIPTION
UNITPRICE
TOTAL
(sewer Improvements
I
1 2*
1305.0108
3
EA
3305.0107 Manhole Adjustment, Minor
$ 10,700.00 $
32,100.001
I 3*
3305.0112
3
EA
3305.0 11 2 Concrete Collar
$ 376.40 $
1,129.20 I
1 4*
9999.9999
4
CY
9999.0001 Install concrete cap over existing sewer line
$ 1,080.00 $
4,320.00 I
I
Change Order Addition $
37,549.201
Drainage Improverpenta
I.i
0241.0800
4,320
CY
0241.0800 Remove Rip Rap
$ 4.93 $
21,297.601
I 8
3123.0101
4,000
CY
3123.0101 Unclassified Excavation by Plan (for storm drain improvements)
$ 27.00 $
108,000.001
1 9
3137,0102
-190
SY
3137.0102 Large Stone Riprap, dry
$ 143.22, $
(27,211.80)1
I 11
3305.0109
90
LF
3305.0109 Trench Safety
$ 1.17 $
105.301
1 20*
3305.0108
1
EA
3305.0108 Miscellaneous Structure Adjustment
$ 6,200.00 $
6,200.001
I 13
3341.0103
20
LF
3341.0205 24" RCP, Class III
$ 262.96 $
5,259.201
1 14
3341.0302
70
LF
3341.0302 48" RCP, Class III
$ 259.44 $
18,160.801
I 17
3349.9003
1
EA
3349.9003 4' Grate Inlet (Grate Rim Only)
$ 6,219.43 $
6,219.43 1
1 18
3349.4113
-1
EA
3349.4113 48" SET, 1 pipe
$ 9,552.19 $
(9,552.19)1
I 19
3292.0500
-1,260
SY
3292.0500 Seeding, Soil Retention Blanket
$ 7.04 $
(8,870.40)1
1 21*
3341.1502
410
LF
3341.1502 8x5 Box Culvert
$ 1,515.93 $
6 1,531.301
1 22*
3341.2001
540
LF
3341.2001 10x4 Box Culvert
$ 1,628.18 $
879,217.201
1 23*
3349.0104
1
EA
3349.0104 4' Stacked Manhole
$ 8,305.00 $
8,305.00 1
I 24*
3349.6002
1
EA
3349.6002 15' Recessed Inlet
$ 20,020.00 $
20,020.001
1 25
9999.9999
1
EA
60'X6' Junction Box
$ 101,535.50 $
101,535.501
1
Chang -Order Addition $
1,795,851.331
1
Change Order Deduction $
(45,634.39)1
1
Change Order Net Addition $
1,750,216.941
1
Paving Improvements
9
0241.0100
1,820
SF
0241.0100 Remove Sidewalk
$ 5.87 $
10,683.401
11 I
3213.0301 I
1,690
I SF
I 3213.0301 4" Cone Sidewalk
I $ 45.43 $
76,776.701
Change Ober Addition $
87,460.101
TOTAL
I
* New pay items added
Total Cost Addition $
1,920,860.63
Total Cost Subtraction $
(45,634.39)
Total Change order cast $
1,875,226.24
REASONS FOR CHANGE ORDER
Updates to construction
plans per approved
FSR-22-0003 to include the proposed fill within the existing floodplain
area and subsequent culvert extensions on site.
NO CITY FUNDS INVOLVED IN THIS CONTRACT. DEVELOPER IS RESPONSIBLE FOR 100% OF THE CHANGE ORDER COST AND NO
REIMBURSEMENT FROM THE CITY WILL BE SOUGHT BY THE DEVELOPER.
RECOMMENDED
Baird, Hampton & Brown, Inc
By:
Name: Joe LaCroix, PE
Title: Civil Engineer
APPROVED:
H-E-B, LP
R.- Wang
By: 3a„amm.oasm
Name Rebecca Wang
Title: Senior Engineer
APPROVED:
EMJ Construction eeee
�,yJ
�2GGLWrit, Oa4enl
By'.
Name William Mosher
Title Executive Vice President
Revised 10-12-2011 Page 1
DocuSign Envelope ID: 34C9C6C2-6299-4E1C-882B-E69B0147EC50
DEVELOPER -AWARDED -PROJECT CHANGE ORDER
Water, Sanitary Sewer, Storm, Street Lighting & Paving Improvements to Serve Proposed
PROJECT NAME:
Grocery Store
CHANGE
CONTRACT:
Water, Sanitary Sewer, Storm, Street Lighting & Paving Improvements
ORDER No:
ICFA #
22-0187 CITY PARTICIPATION:(
ICITY PROJECT #
104284 2
FILE #
W-2864 I
INSPECTOR:
Stan Sutterfield Phone No:
PROJECT MANAGER:
Sandip Adhikari Phone No:
WATER I SEWER
CONTRACT UNIT I
PAVING DRAINAGE STREETLIGHTS CONTRACT
er IDeveloper DAYS
I 120
I 120
I
I 240
I 20
260
You are directed to make the following changes in the contract documents
I CITY BI#D ITEM(
I I
I
I
PAY ITEM #
QUANTITY UNIT
ITEM DESCRIPTION
UNIT PRICE
TOTAL
I Water Improvements
1
1 16*
3211.0112 17.3 SY
3211.0112 6" Flexible Base, Type A, GR-1
$ 53.50
J $
925.55 I
17*
32t2.0501 17.3 SY
3212.0501 4" Asphalt Base Type B
$ 71.1-
$
1,231.241
18*
3213.0103 17.3 SY
3213.0103 8" Conc Pvmt
$ 235.39
1 $
4,072.25 1
19*
3216.0101 12 LF
3216.0101 6" Conc Curb and Gutter
$ 43.90
$
526.80 1
1
* New pay items added
Total Change order cost
$
6,755.84
REASONS FOR CHANGE ORDER
Pavement repair withing N. Riverside Drive of concrete street panel to allow for connection of water lime 1 to existing 16" water line near station 17+35 as shown on
sheet 5 " Water Plan" of the approved IPRC plans.
NO CITY FUNDS INVOLVED IN THIS CONTRACT. DEVELOPER IS RESPONSIBLE FOR 100 % OF THE CHANGE ORDER COST AND NO
REIMBURSEMENT FROM THE CITY WILL BESOUGHT BY THE
DEVELOPER.
RECOMMENDED:
Baird, Hampton & Brown, Inc
By:
Name: Joe LaCroix, PE
Tine: Civil Engineer
APPROVED:
H-E-B, LP
ev Rebecca Wang"pz3�'z�,s ems°
Name Rebecca Wang
Title: Senior Engineer
APPROVED:
EMJ Construction
By: Wi-WtI-1.
William Mosher
Name:
Tine: Executive Vice President
REVIEWED 1
By Sandip Adhikari at 4:33 pm, Jul 28, 2023 J
ORIGINAL CONTRACT
EXTRAS TO DATE
CREDITS TO DATE
CONTRACT TO DATE
(AMOUNT OF PROP. CHANGE ORDER
IREVISED CONTRACT AMOUNT
TOTAL REVISED CONTRACT AMOUNT
PER UNIT
REVISED COST SHARE
TOTAL REVISED CONTRACT
Cost City Cost
$169,720.74 $0.00
$169,720.74 $0.00
$ 6,756.84
$176,476.58 i $0.00
$176,476.58
Dev. Cost:
Cost City Cost
$4,320.04 $0.00
$ 37,649.20
$41,869.24 $0.00
$41,869.24 $0.00
$41,369.24
$3,082,179.76
lCost City Cost Developer Cost City Cost
$401,513.54 $0.00 I $567,394.13 I $0.00
$ 87,460.10 I $ 1,750,216.941
I I
$483,973.64 $0.00 I $2,317,611.07 I $0.00
I
$483,973.64 $0.00 I $2,317,611.07 I $0.00
$488,973.64 $2,317,611.07
City Cost:
$3,082,179.76
Cost
City Cost
$67,249.23
$0.00
$57,249.23
$0.00
$57,249.23
$0.00 I
$57,249.23
Revised: 10-12-2011 Page 1
DocuSign Envelope ID: 45CEC1 E4-8E08-4161-85EB-9E3800BE6C42
DEVELOPER -AWARDED -PROJECT CHANGE ORDER
Water, Sanitary Sewer, Storm, Street Lighting & Paving Improvements to Serve Proposed
PROJECT NAME:
Grocery Store
CHANGE
CONTRACT:
Water, Sanitary Sewer, Storm, Street Lighting & Paving Improvements ORDER No:
ICFA #
22-0187 I CITY PARTICIPATION:( NO
CITY PROJECT #
104284 3
FILE #
W-2864
INSPECTOR: Stan Sutterfield Phone No: 817-240-4037
PROJECT MANAGER: Sandip Adhikari Phone No: 817-392-8424
CONTRACT UNIT
CONTRACT
DAYS
I 120
I 160
I
I 280
I
280
(ORIGINAL CONTRACT
(EXTRAS TO DATE
ICREDITS TO DATE
ICONTRACT TO DATE
(AMOUNT OF PROP. CHANGE ORDER
IREVISED CONTRACT AMOUNT
(TOTAL REVISED ER UNIT ACT AMOUNT
REVISED COST SHARE
TOTAL REVISED CONTRACT
WATER
Developer
Cost I City Cost
$169,720.74 I $0.00
$ 6,75&84I
I
$176,476.58 I
$ 9,87&001
$186,351.58 I $0.00
$186,351.53
Dev. Cost:
SEWER
Developer
Cost City Cost
$4,320.04
$ 37,549.20
$41,869.24 $0.00
$41,869.24 $0.00
$41,869.24
$3,092,054.76
PAVING
Developer
Cost City Cost
$401,513.54
$ 87,460.10
$488,973.64 $0.00
$488,973.64 $0.00
$488,973.64
City Cost:
$3,092,054.76
DRAINAGE
Developer Cost City Cost
I $567,394.13
I $ 1,750,216.94
I
I $2,317,611.07 $0.00
I
I $2,317,611.07 $0.00
$2,317,611.07
STREETLIGHTS
Developer
Cost
City Cost
$57,249.23
$57,249.23
$0.00
$57,249.23
$0.00 I
$57,249.23
You are directed to make the following changes in the contract documents
CITY #D ITEM(
I
I
I I
PAYITEM# QUANTITY UNIT
ITEM DESCRIPTION
UNITPRICE TOTAL
i Water Improvements
i
i 20*
3305.0117 EA
3305.0117 r for Valve
21* 133112.3033 I 1 I EA
I33112.3103 8" Cut -in Gate Valve
I $ 8,125.00 I $
8,125.00
* Indicates new item
Total Change order cost $
9,875.00
REASONS FOR CHANGE ORDER
Addition of 8" Cut In Gate Valve for Blow Off Valve at City's Request
NO CITY FUNDS INVOLVED IN THIS CONTRACT. DEVELOPER IS RESPONSIBLE FOR 100%
OF THE CHANGE
ORDER COST AND NO
REIMBURSEMENT FROM THE CITY WILL BESOUGHT BY THE DEVELOPER.
RECOMMENDED:
APPROVED:
APPROVED:
Baird, Hampton & Brown, Inc
H-E-B, LP
EMJ Construction
pflysi11 by Rebecca
Rebecca Wal z0z3.,z.m
'WlAa'w -MO�rz
By:
By: ��:wlbb 4706'00'
By:
'
William Mosher
Name: Joe LaCroix, PE
Name: Becca Wang, PE
Name.
Title: Civil Engineer
Title: Senior Engineer
Title:
11/30/2023
REVIEWED
By Sandip Adhikari at 9:40 am, Mar 18, 2024
Revised: 10-12-2011 Page 1
FORTWORTH
TRANSPORTATION AND PUBLIC WORKS
PIPE REPORT FOR:
PROJECT NAME: ATCN Proposed Grocery Store
CITY PROJECT NUMBER: 104284
WATER
PIPE LAID SIZE TYPE OF PIPE
DIP 8" slip joint
DIP 12" slip joint
FIRE HYDRANTS: N/A VALVES (16" OR LARGER)
PIPE ABANDONED SIZE TYPE OF PIPE
DENSITIES: yes
NEW SERVICES: 1.5 copper
2 copper
SEWER
PIPE LAID SIZE TYPE OF PIPE
PIPE ABANDONED SIZE TYPE OF PIPE
DENSITIES: yes
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
80
80
1 ea
1 ea
FORTWORTH.
TRANSPORTATION AND PUBLIC WORKS
April 10, 2024
EMJ Construction
5525 North McArthur Blvd. Suite 400
Irving. Tx 75038
RE: Acceptance Letter
Project Name: ATCN Proposed Grocery Store
Project Type: drainage,pav,street lights,water,sewer
City Project No.: 104284
To Whom It May Concern:
On March 27, 2024 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 April 15, 2024. 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 April 15, 2024, 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-
393-8424.
Sandip Adhikari, Project Manager
Cc: Hershel Stanley Sutterfield, Inspector
Troy Gardner, Inspection Supervisor
Cody Horton, Senior Inspector
Andrew Goodman, Program Manager
Baird, Hampton & Brown, Consultant
EMJ Construction, Contractor
H.E.B. Alliance Corp, Developer
File
E-Mail: TPW_Acceptance@fortworthtexas.gov
Rev. 8/20/19
DocuSign Envelope ID: 3CDEB248-6639-42BD-A6C7-A43B5688D3C2
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 Cody Shulze,
Project Manager of EMJ Construction, LLC., known to me to be a credible
person, who being by ne 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 Wroth has been paid in full;
That there are no claims pending for personal injury and/or
property damages;
On Contract described as;
ACTN Proposed Grocery Store CPN 104284
BY Cody shulze
Name or Title
Subscribed and sworn before me on this date 10"' of June, 2024
Notary Public Faith Cri ssman
County, State Tarrant Texas
FAITH CRISSMAN
.( �. Notary
130884493
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10/17/2024
CONSENT OF SURETY
TO FINAL PAYMENT
AM Document G707
Bond No. 30168461
TO OWNF -
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H-E-B, LP
646 South Flores
San Antonio, TX 78204
PROJECT:
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OWNER
ARCHITECT
CONTRACTOR
SURETY
OTHFA
ARCHITECT'S PROJECT NO.:
CO.NTRACP FOR:
CONTRACT DATED:
Water, Sanitary Sewer, Storm, Street Lighting & Paving Improvements to Serve Proposed Grocery Store (Heritage Trace Grocer Addition
Lt 3, Block 1)
In accordance with the provislons of the Contract between die Owner and the Contractor as indicaretl above, the
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Western Surety Company
151 N. Franklin St.
Chicago, IL 60606
, SURETY,
on bond of
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EMJ Corporation
5525 N. MacArthur Blvd., Suite 400
Irving, TX 75038
, 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 io
(hrwn name(4ndWdrw afOwner)
H-E-B, LP
646 South Flores
San Antonio, TX 78204
as set forth in said Surety's bond.
IN WITNESS VMREOF, the Surety Iles hereunto set its hand on this date; Tune 12, 2024
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Western Surety Company
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William M. Smith, Attorney -in -Fact
(Prri,hr! narrw arrd ikk)
, OWNER,
0707--1994
Western Surety Company
POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY -IN -FACT
Know All Men By These Presents, That WESTERN SURETY COMPANY, a South Dakota corporation, is a duly organized and existing corporation having its
principal office in the City of Sioux Falls, and State of South Dakota, and that it does by virtue of the signature and seal herein affixed hereby make, constitute and appoint
Mark W Edwards II, Jeffrey M Wilson, William M Smith, Robert R Freel, Aliss B Ferris, Anna Childress, Richard H Mitchell, Individually, of
Birmingham, AL R E Daniels, Individually, of Pensacola, FL
Robert M Verdin, Individually, of Covington, LA
Robert R Davis, Individually, of Atlanta, GA
its true and lawful Attomey(s)-in-Fact with full power and authority hereby conferred to sign, seal and execute for and on its behalf bonds, undertakings and other
obligatory instruments of similar nature
- In Unlimited Amounts -
and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said Attorney,
pursuant to the authority hereby given, are hereby ratified and confirmed.
This Power of Attorney is made and executed pursuant to and by authority of the Authorizing By -Laws and Resolutions printed at the bottom of this page, duly
adopted, as indicated, by the shareholders of the corporation.
In Witness Whereof, WESTERN SURETY COMPANY has caused these presents to be signed by its Vice President and its corporate seal to be hereto affixed on
this 9th day of November, 2023.
`o�r��`� WESTERN SURETY COMPANY
x
/ Lany Kasten, Vice President
State of South Dakota
ss
County of Minnehaha
On this 9th day of November, 2023, before me personally came Larry Kasten, to me known, who, being by me duly sworn, did depose and say: that he resides in
the City of Sioux Falls, State of South Dakota; that he is a Vice President of WESTERN SURETY COMPANY described in and which executed the above instrument;
that he knows the seal of said corporation; that the seal affixed to the said instrument is such corporate seal; that it was so affixed pursuant to authority given by the Board
of Directors of said corporation and that he signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said corporation.
My commission expires i M. BENT e
March 2, 2026 NOTARY PUBLIC(Mg.
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f�SOIITH OAKOTA
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M. Bent, Notary Public
CERTIFICATE
I, L. Nelson, Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in force, and further
certify that the By -Law and Resolutions of the corporation printed below this certificate are still in force. In testimony whereof I have hereunto subscribed my name and
affixed the seal of the said corporation this 12th day of June, 2024.
Srrc WESTERN SURETY COMPANY
QQgORq,6-�
,6 L. Nelson, Assistant Secretary
Authorizing By -Laws and Resolutions
ADOPTED BY THE SHAREHOLDERS OF WESTERN SURETY COMPANY
This Power of Attorney is made and executed pursuant to and by authority of the following By -Law duly adopted by the shareholders of the Company.
Section 7. All bonds, policies, undertakings, Powers of Attorney, or other obligations of the corporation shall be executed in the corporate name of the Company by
the President, Secretary, and Assistant Secretary, Treasurer, or any Vice President, or by such other officers as the Board of Directors may authorize. The President, any
Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys in Fact or agents who shall have authority to issue bonds, policies, or
undertakings in the name of the Company. The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other
obligations of the corporation. The signature of any such officer and the corporate seal may be printed by facsimile.
This Power of Attorney is signed by Larry Kasten, Vice President, who has been authorized pursuant to the above Bylaw to execute power of attorneys on behalf of
Western Surety Company.
This Power of Attorney may be signed by digital signature and sealed by a digital or otherwise electronic -formatted corporate seal under and by the authority of the
following Resolution adopted by the Board of Directors of the Company by unanimous written consent dated the 271 day of April, 2022:
"RESOLVED: That it is in the best interest of the Company to periodically ratify and confirm any corporate documents signed by digital signatures and to ratify and
confirm the use of a digital or otherwise electronic -formatted corporate seal, each to be considered the act and deed of the Company."
Go to www.cuosuretv.com > Owner / Obligee Services > Validate Bond Coverage, if you want to verify bond authenticity.
Form F4280-6-2023