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Home My WebLink AboutContract 59651-Fp1Page 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: Deer Creek Meadows Phase 1 City Project No.: 104026 Improvement Type(s): Water Sewer Original Contract Price: $2,909,347.70 Amount of Approved Change Order(s):$55,977.25 Revised Contract Amount:$2,965,324.95 Total Cost of Work Complete: $2,965,324.95 Contractor Date Title Burnsco Construction, Inc 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: Deer Creek Meadows Phase 1 City Project No.: 104026 City’s Attachments Final Pay Estimate Change Order(s):Yes N/A Pipe Report:Yes N/A Contractor’s Attachments Affidavit of Bills Paid Consent of Surety Statement of Contract Time Contract Time: 260 WD Work Start Date: 8/1/2023 Days Charged: 189 WD Work Complete Date: 7/26/2024 Completed number of Soil Lab Test: 1288 Completed number of Water Test: 21 CITY OF FORT WORTH Contract Name DEER CREEK MEADOWS PHASE 1 Contract Limits Project Type WATER DOE Number 4026 Estimate Number 1 Payment Number 1 For Period Ending 7/26/2024 FINAL PAYMENT REQUEST City Secretary Contract Number 189 WD Contract Date BURNSCO CONSTRUCTION, INC. NA 6331 SOUTHWEST BLVD FORT WORTH TX 76132 M. GLOVER I. INOCENCIO 115WDContract Time Days Charged to Date CompleteContract is 100.00 Contractor , /Inspectors Project Manager City Project Numbers 104026 Monday, July 29, 2024 Page 1 of 5 Contract Name DEER CREEK MEADOWS PHASE 1 Contract Limits Project Type WATER DOE Number 4026 Estimate Number 1 Payment Number 1 For Period Ending 7/26/2024 Project Funding City Project Numbers 104026 UNIT I: WATER FACILITIES Item No.Description of Items Estimated Quanity Unit Unit Cost Estimated Total Completed Quanity Completed Total 1 4"-12" PRESSURE PLUG 11 EA $210.00 $2,310.00 11 $2,310.00 2 TRENCH SAFETY 10717 LF $0.10 $1,071.70 10717 $1,071.70 3 DUCTILE IRON WATER FITTINGS W/ RESTRAINT 2.8 TN $27,000.00 $75,600.00 2.8 $75,600.00 4 4" PVC WATER PIPE 16 LF $48.00 $768.00 16 $768.00 5 6" PVC WATER PIPE 148 LF $45.00 $6,660.00 148 $6,660.00 6 8" PVC WATER PIPE 7381 LF $68.00 $501,908.00 7381 $501,908.00 7 8" PVC WATER PIPE, CSS BACKFILL 295 LF $78.00 $23,010.00 295 $23,010.00 8 12" PVC WATER PIPE 2728 LF $113.00 $308,264.00 2728 $308,264.00 9 12" PVC WATER PIPE, CSS BACKFILL 149 LF $130.00 $19,370.00 149 $19,370.00 10 STD. FIRE HYDRANT ASSEMBLY W/ 6" GATE VALVE & VALVE BOX 7 EA $7,620.00 $53,340.00 7 $53,340.00 11 1" WATEER SERVICES (CO#3)199 EA $1,410.00 $280,590.00 199 $280,590.00 12 1 1/2" WATER SERVICE (CO#3)8 EA $2,050.00 $16,400.00 8 $16,400.00 13 3" WATER METER & VAULT 2 EA $32,000.00 $64,000.00 2 $64,000.00 14 4" WATER METER AND VAULT 2 EA $36,000.00 $72,000.00 2 $72,000.00 15 6" GATE VALVE 8 EA $1,400.00 $11,200.00 8 $11,200.00 16 8" GATE VALVE & VALVE BOX 25 EA $2,500.00 $62,500.00 25 $62,500.00 17 12" GATE VALVE & VALVE BOX 11 EA $4,400.00 $48,400.00 11 $48,400.00 18 16" X 8" TAPPING SLEEVE & VALVE 1 EA $7,100.00 $7,100.00 1 $7,100.00 19 16" X 12" TAPPING SLEEVE & VALVE 2 EA $9,600.00 $19,200.00 2 $19,200.00 20 REMOVE & REPLACE 16" W.L.60 LF $650.00 $39,000.00 60 $39,000.00 21 3/4" WATER SERVICE (CO#2)0 EA $1,840.00 $0.00 0 $0.00 22 3" PRESSURE PLUG 2 EA $120.00 $240.00 2 $240.00 23 4" IRRIGATION SLEEVES (CO#3)520 LF $25.00 $13,000.00 520 $13,000.00 24 3" PVC WATER PIPE 52 LF $28.00 $1,456.00 52 $1,456.00 25 1" IRRIGATION SERVICE (CO#2)1 EA $1,840.00 $1,840.00 1 $1,840.00 26 8" WATER LINE LOWERING (CO#2)16 EA $900.00 $14,400.00 16 $14,400.00 27 12" WATER LINE LOWERING (CO#2)5 EA $1,000.00 $5,000.00 5 $5,000.00 $1,648,627.70 $1,648,627.70Sub-Total of Previous Unit Monday, July 29, 2024 Page 2 of 5 Contract Name DEER CREEK MEADOWS PHASE 1 Contract Limits Project Type SANITARY SEWAGE DOE Number 4026 Estimate Number 1 Payment Number 1 For Period Ending 7/26/2024 Project Funding City Project Numbers 104026 UNIT II: SANITARY SEWAGE FACILITIES Item No.Description of Items Estimated Quanity Unit Unit Cost Estimated Total Completed Quanity Completed Total 25 4"-12" PRESSUER PLUG (CO#1)4 EA $100.00 $400.00 4 $400.00 26 POST-CCTV INSPECTION (CO#1)10871 LF $3.00 $32,613.00 10871 $32,613.00 27 VACUUM TEST MANHOLES (CO#1)54 EA $140.00 $7,560.00 54 $7,560.00 28 TRENCH SAFETY (CO#1)9996 LF $1.00 $9,996.00 9996 $9,996.00 29 TRENCH WATER STOPS 17 EA $400.00 $6,800.00 17 $6,800.00 30 SDR-26 4" SEWER SERVICES 212 EA $1,380.00 $292,560.00 212 $292,560.00 31 6" SEWER PIPE (CO#1)41 LF $64.00 $2,624.00 41 $2,624.00 32 6" SEWER PIPE, CSS BACKFILL 19 LF $72.00 $1,368.00 19 $1,368.00 33 8" SDR-26 PVC SEWER PIPE (CO#1)8832 LF $61.00 $538,752.00 8832 $538,752.00 34 8" PVC SANITARY SEWER PIPE W/ CSS BACKFILL 607 LF $80.00 $48,560.00 607 $48,560.00 35 10" SEWER PIPE 1342 LF $71.00 $95,282.00 1342 $95,282.00 36 10" SEWER PIPE, SELECT BACKFILL 30 LF $100.00 $3,000.00 30 $3,000.00 37 4' STD DIA MANHOLE (CO#1)54 EA $4,400.00 $237,600.00 54 $237,600.00 38 4' EXTRA DEPTH MANHOLE (CO#1)152 VF $185.00 $28,120.00 152 $28,120.00 39 CONNECT TO EXISTING 4' S.S.M.H.2 EA $1,500.00 $3,000.00 2 $3,000.00 40 CONCRETE COLLAR FOR SEWER MANHOLE (CO#2) 12 EA $300.00 $3,600.00 12 $3,600.00 41 20" SPLIT STEEL CASING BY OPEN CUT (CO#4)15 LF $324.15 $4,862.25 15 $4,862.25 $1,316,697.25 $1,316,697.25Sub-Total of Previous Unit Monday, July 29, 2024 Page 3 of 5 Contract Name DEER CREEK MEADOWS PHASE 1 Contract Limits Project Type SANITARY SEWAGE DOE Number 4026 Estimate Number 1 Payment Number 1 For Period Ending 7/26/2024 Project Funding City Project Numbers 104026 Contract Information Summary Change Orders $2,909,347.70Original Contract Amount $2,965,324.95Total Contract Price $2,965,324.95 Less Total Cost of Work Completed % Retained $0.00 Net Earned $2,965,324.95 Plus Material on Hand Less 15%$0.00 Balance Due This Payment $2,965,324.95 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 $2,965,324.95 $0.00 2 $19,400.00Change Order Number 1 $18,185.00Change Order Number 2 $3,600.00Change Order Number 3 $9,930.00Change Order Number 4 $4,862.25Change Order Number Monday, July 29, 2024 Page 4 of 5 Contract Name DEER CREEK MEADOWS PHASE 1 Contract Limits Project Type SANITARY SEWAGE DOE Number 4026 Estimate Number 1 Payment Number 1 For Period Ending 7/26/2024 Project Funding City Project Numbers 104026 Line Fund Account Center Amount Funded Gross Retainage Net CITY OF FORT WORTH SUMMARY OF CHARGES $2,965,324.95 Less Total Cost of Work Completed % Retained $0.00 Net Earned $2,965,324.95 Plus Material on Hand Less 15%$0.00 Balance Due This Payment $2,965,324.95 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 $2,965,324.95 $0.00 City Secretary Contract Number 189 WD Contract Date BURNSCO CONSTRUCTION, INC. NA 6331 SOUTHWEST BLVD FORT WORTH TX 76132 M. GLOVER I. INOCENCIO 115 WD Contract Time Days Charged to Date CompleteContract is 100.000000 Contractor , /Inspectors Project Manager Monday, July 29, 2024 Page 5 of 5 DocuSign EnvelopelD:BFC88A0D-6EE5-4405-AF25-700B4D4F5B57 DEVELOPER-AWARDED-PROJECT CHANGE ORDER REVIEWED By Sandip Adhikari at 1:51 pm, Sep 18, T023 CONTRACT UNIT WATER SEWER ❑RAINAGE PAVING STREETIJGHTS CONTRACT Developer oeveloper oeveloper �eveloper Oeveloper �AYS cost Grycost cost clrycost cost cirycost cwt cirycost cost cirycos� ORIGINAL COMRAGT 51,679,297.70 E�.00 57,290,050.00 50.00 E7,769,961.50 E0.00 SJ.1P],651.35 5�.40 5260,43].54 E0.00 2fi0 EXTRAS TO DATE CREOITS TO �ATE CONTRACTTODATE 57,fi19,197.70 E0.00 51.290,050.0a 50.00 51,769,9fiJ.50 F0.00 $3,11J,651.75 50.00 5260,4]7.52 SO,UO 260 AldOUNT OF PROP. CHANGE OR�ER 54.00 E18,185.aa Sa.ao 54aa So.00 0 REVISEDCONTRACTAP.IOUNT b1,679,297.70 50.00 E7,3�8,2]5.00 50.00 57.]fi9,963,50 50.00 E3,12],651.]5 50,00 SZ60,4]7.52 SOAO 260 TOTAL REVISEo CONTRACT AlAOUNT PERUNIT 51,619,]97.70 S1,J08,P]5.00 $1,769,96J.50 5�,12],651.J5 5260,4]7.52 RE�1SE0 COSTSHARE Dev. CosL 58,081,585.07 Clty Cost: 50.00 TOTAL RENSEO CONTRACT 50,081,585.07 REASONS FOR CHANGE OR�ER 1. Added Sandary Se�ver stub-out /or Cotfages north ol Ph.l NO CITY FUNDS INVOLVED IN THIS CONTRACT. DEVELOPER IS RESPONSIBLE FOR 100'6 OF THE CHANGE OR�ER COST AN� NO REIl.1BURSEPAENT FROlA THE CITY WILI BE SOUGHT BY THE OEVELOPER. RECOlAlAENDED: APPROVED: APPROVED: Gaodv,in and Marshall, Inc. Hh1H DeerCreek Land, LLC Bumsco Corf6Wc ion, Inc. //i +-. � /I 1 B ��i � 6 . �.,Y /��'._ B ' Y`"I y: i �_ y y. Name'. Malt Baacke, RE. Nam�Ob MCC� dl il Name�. Albert Granlges Title�. Project Engineer Tltle: Dl 1"2CLOP Of Devel op��t��ce Presidenl Revised: 10.12-2011 Page 1 INSPECTOR: Jason Inocencio Phone No: 817350-3321 PROJECT MANAGER: Sandip Adhikan, PE Phone No: 817-392-8424 DocuSign Envelope10:89424F92-A628-4CF8•B15E-8F49686F195B DEVELOPER-AWARDED-PROJECT CHANGE ORDER REVIEWED By Sandip Adhikari at 9:49 am, Dec 05, 2023 NO CITY FUNDS INVOLVEO IN THIS CONTRACT. DEVELOPER IS RESPON510LE FOR 100°6 OF THE CHANGE ORDER COST ANO NO REIM1IBURSEh1ENT fROhf THE CIN WILI BE SOUGHT BY THE DEVEIOPER. RECOAIMENDED: APPROVED: APPROVED: Goodvnn and Atarshall, Inc. HMHDeerCrvekLantl. LLC Bumsco ConstruUbn, Inc. gy i�' �j�� BY._(_:,�'yY" By__' I, .. Name�. IAattBaacke,P.E. Name: Rob IdCClain Name: AbGrantges Ti11e:ProJ2ctEngineer Trtiz� oirector Of oevelopment TN2:VIcePreSident Revised: 10.72-2011 Page i INSPECTOR: Jason Inocencio Phone No: 8173503321 PROJECT MANAGER: Sandip Adhikari, PE Phone No: 817392-8424 REASONS FOR CHANGE ORDER 7. UpdatedlmgalionServiceloCilySfantlardSize 7. AddedWaterLfnaLov;enngBitlllems 3. Addrd Conazfz Collar on Off-site A4anholes DocuSign EnvetopelD:DFF4E4F9-F504-47D1-92F0-040992E4533A DEVELOPER-AWAROED-PROJECT CHANGE ORDER REVIEWED By Sandip Adhikari at 9:10 am, Dec O5, 2023 REASONS FOR CHANGE ORDER 1. Updaled imgation services fo meef landscape needs 2. Addadirr'gafionsleeves NO CITY FUNDS INVOLVED IN THIS CONTRACT. DEVELOPER IS RESPONSIBLE FOR 100% OF THE CHANGE ORDER COST AN� NO REIlABURSEh1ENT FROM THE CITY WILL BE SOUGHT BY THE DEVELOPER. RECOMlAENDED: APPROVED: APPROVED: Name; Gatt Baacke, P.E. Nama�. Title: Praject Engineer Tille' Di Pector of Deve Humeco Cansfmcfion, Inc. r l � i gY._.�; J� _ Namz: AbGrantpes Title' uce Presidem Goodvnn and IAarshall, Inc NMHOzer Creek LanU, LLC �A<<' a�.�w By /,- J - BY�G'�. �„e :C ' - Rob MCClain Revised: 10-12-2011 Page 1 INSPECTOR: Jason Inocendo Phone No: 8173503321 PROJECT MANAGER: Sandip Adhikari, PE Phone No: 817-392-8424 DEVELOPER-AWARDED-PROJECT CHANGE ORDER REASONS FOR CHANGE ORDER f. Atldedsplifsfeelcasingonsewe�line'S-2f' NO CITY FUNDS INVOLVED IN THIS CONTRACT. OEVELOPER IS RESPONSIBLE FOR 100 % OFTHE CHANGE ORDER COST AND NO REIMBURSEMENT FROM THE CITY WILL BE SOUGHT BY THE OEVEIOPER. RECOIAMENDED: APPROVEO: APpROVEO: Goodwin ana Marshall, Inc. . / ": i �i %� Neme: MaIlBaacke,P.E. Tille: Prqecl En9ineer HMH Oeer Creek Land, LLC �/� - � /�� BY F—�% � �(�� ( Name: �=Ci� 0.�,-� Title: �: eC L � Bumsco ConsWction, Inc. „ ... �. _ Name: Ab Grantges Title: Vlce Presieenl REVIEWED By Sandip Adhikari at 5:00 pm, May 23, 2024 Revised: 10-12-2011 Page 1 INSPECTOR: Jason Inocenc(o Phone No: 817350-3321 PROJECT MANAGER: Sandip Adhikari, PE Phone No: 817392-8424 FORTWORTH � . _ . _�.� � � .�� _ TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PROJECT NAM�: Deer Creek Meadows Phase 1 CITY PROJ�CT NUMB�R: 104026 WAT�R PIPE LAID SIZE TYP� OF PIPE LF C900 4" PVC 16 C900 6" PVC 148 C900 8" PVC 7381 C900 12" PVC 149 FIRE HYDRANTS: 7 PIPE ABANDONED DENSITIES: NEW SERVICES: SIZ� 1" 1 1 /2"" VALVES (16" OR LARGER) TYPE OF PIPE Yes Copper LF 199 8 SEWER PIPE LAID SIZE TYPE OF PIPE LF SDR-26 6" PVC 41 SDR-26 8" PVC 8832 SDR-26 10" PVC 1342 PIPE ABANDONED D�NSITI�S: N�W SERVIC�S: SIZE �� TYPE OF PIPE PVC Yes LF 212 TRANSPORTATION AND PUBLIC WORKS The Cit�� of Fort �`�/orth • 1000 Throckmorton Street • Fort \�/orth, "T1 76012-6311 F�RT�ORTH�� TRANSPORTATION AND PUBLIC WORI<S July 26, 2024 Burnsco Construction, Inc. 6331 Southwest Blvd. Benbrook, Texas 76132 RE: Acceptance Letter Project Name: Deer Creel< Meadows Phase 1 Project Type: Water and Sanitary Sewer City Project No.: 104026 To Whom It May Concern: On July 23, 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 July 26, 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 July 26, 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- 392-8424. Sincerely, � Sandip Adhil<ari, Project Manager Cc: Michael Perl<ins, Inspector Mike Glover, Inspection Supervisor Randy Horton, Senior Inspector Andrew Goodman, Program Manager Goodwin & Marshall, Consultant Burnsco Construction, Contractor History Mal<er Homes, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev.8/20/19 AFTIDAVIT STATF, �F TEXAS COLIN�I�Y DI� `I'1�f2RANT Befare ine, the iinclersi��ed auti��rity, � notary public in the state and cn�.��ty afc�resaid, �n tlzis day �3ersc�nally a��pcarcci Ah G�-ant�cs, Cnntract Mgr, Ol' E3�u•nsc« Constnictioai, knawn to me t� be a credihle person, who bcin� by ine d«ly sworn, �ipnn his oath dcp�scd azad said; "I'�lat �ill pe�-sc�ns, firms, associafions, catparation5, or nt�er �rganizations ftirnisl�ing ]ah�r �t�lor n�at�rials ha��e been paid ii7 full; That the wa�e scalc cstablisl�ed h_y ihe City Ct��incil in tlle City ��f F'nrt Wortl� l��s hee�� paid in f�ill; "I'hat there are nn �lai�ns pending foa' personal injuty andlclr prapez-ty cian�ages; C]n Cc3ntra�t de4crihcd as; Deer Creek Meado�vs - Water, Satlitary Scwcr and Stc�ri�i Draii� E3 Y Ab Grant , ,antract Managcz� Stihscribed and s�varn beFare me «n this dat� 24)th t�f .i�ily, ?024. �..__' �_ l' .� ��.--. �1ot�ry Puhlic � " T�r��a��t Ct�unty, Texas ,�'1s+`rP'' KA.55ANaR4 CANALCS � tiP.. U�i _ n.• �r: _ : +l,c _Nara�; PubliC. S1aleat iex��s � V'.r�' ` COmm Expiin�:41-23-20?1 '`��;�;��;: Nora�y ID 131f5�3873 CONSENT OF SURETY COMPANY TO FINAL PAYMENT Conforms with the American Institute of Architects, AIA Document G707 OWNER ❑ ARCHITECT ❑ CONTRACTOR ❑ SURETY ❑ OTHER Bond No 022235990 PROJECT; (name, add�esS)Deer Creek Meadows Phase 1- Water, Sanitary Sewer and Storm Drain Improvements TX TO (Owner) IHMH DEER CREEK LAND, LLC AND CITY OF FORT� ARCHITECT'S PROJECT N0: WORTH CONTRACT FOR: 1038 Texan Trail Deer Creek Meadows Phase 1- Water, Sariitary Sewer and Storm Drain Improvements Grapevine TX 76051 � CONTRACT DATE: CONTRACTOR: BURNSCO CONSTRUCTION, INC. In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the (here insert nama and eddress of Surety Company) LIBERTY MUTUAL INSURANCE COMPANY 175 Berkeley Street Boston MA 02116 , SURETY COMPANY on bond of (here insert neme and address of Contractor) BURNSCO CONSTRUCTION, INC. 6331 Southwest Boulevard Benbrook TX 76132 , CONTRACTOR, hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve the Surety Company of any of its obligations to (here insert name and address of Owner) HMH DEER CREEK LAND, LLC AND CITY OF FORT WORTH 1038 Texan Trail Grapevine TX 76051 , OWNER, as set forth in the said Surety Company's bond. IN WIT'NESS, WHEREOF, the Surety Company has hereunto set its hand this Attest: �"• � ��"y'� ��: n,s. i (Seal); "' �` — 17th day of July, 2024 LIBERTY MUTUAL INSURANCE COMPANY Surety Company �-` � � �-�� 1 Signatu e of Authorized Representative Sophinie Hunter Attorney-in-Fact Z'it18 NOTE: This form is to be used es a companion document to AIA DOCUMENT G706, CONTFAC70R'S AFFIDAVI7 OF PAYMENT OF DEBTS AND CLAIMS, Current Edition ONE PAGE r~ s ` ��.�i � � ��j� 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. Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company POWER OF ATTORNEY Certificate No: 8205467-022020 KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organizetl under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized untler the laws of the State of Massachusetts, and West American Insurance Company is a corporation tluly organized under the laws of the State of Indiana (herein collectively calletl the "Companies"), pursuant to and by authority herein set forth, tloes hereby name, constitute antl appoint, Don E. Cornell; Joshua Saunders; Kelly A. Westbrook; Mikaela Peppers; Ricardo .1. Reyna; Robbi Morales; Sophinie Hunter; Tina McEwan; Tonie Petranek all of the city of Dal las state of TX each individually if there be more than one named, its true and lawful attorney-in-fact to make, execute, seal, acknowletlge and deliver, for and on its behalf as surety and as its act and tleed, any and all untlertakings, bontls, recognizances antl other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies antl the corporate seals of the Companies have been a�xed thereto this 23rd day of April , 2021 . N � N c co c`o State of PENNSYLVANIA m County of MONTGOMERY Liberty Mutual Insurance Company P�, �NSURq P�SY INgV a�NSURq The Ohio Casualty Insurance Company ,�J 4pRP0/�T� y� yJ 40pPORq �'Qyy \VP 4�pPORqT 2� West American Insurance Company � 3 om vQ'3 o m p3 Focn 1912 � 0 1919 � � 1991 � � Y t y O Z � O Q O ,�/ /J '7r Yd J��/' * � 5 a a y°�,y N a M P s aa a3 �S�� ti o�A N P�a a� B G L- � L Q�� ,d�'�/�,. 1 * * M * � Y: .r^' David M. Carey, Assistant Secretary � U �� c .� — � � On this 23rd day of April , 2021 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance � a�i � Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes �� the�ein contained 6v sianinn nn hahalf nf fha enrnnrar�r,n� h�� h�m�oiv �� ,�� i„ �„�ti,..,-.,.,, ,.�,.,,, ... �� I� � � c •� c� o� _ ` N � O � C �p N � � (0 � �� O.� �� o c��a I cn � >� � o� ? U IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at King of Prussia, Pennsylvania, on the day and year frst above written. Q� � aO`' r ,,.�. � � Commonwealih of PennsyNania - Notary Seal = � � -�-;��``� = Teresa Pastella, Notary Public � �'— N m � �'� � � � Monigomery County � � e -` My commission expires March 28 2025 BY• �,j',Q.pC� ��(��j �� Commission number 1126044 E r r« � �. ,,a`� Memher, Pennsylvania Associa6on of Nolaries eresa Pastella, Notary Public Q p sr � s j>i�,�.< This Power of Attorney is made and executed pursuant toFand by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reatling as follows: ARTICLE IV— OFFICERS: Section 12. Power of Attorney. Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, antl subject to such limitation as the Chairman or the President may prescribe, shall appoint such attorneys-in-fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys-in-fact, subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney-in-fact under the provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. ARTICLE XIII — Execution of Contracts: Section 5. Surety Bonds and Undertakings. Any offcer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe, shall appoint such attorneys-in-fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys-in-fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executetl such instruments shall be as binding as if signed by the presitlent antl attested by the secretary. Certificate of Designation — The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attorneys-in- fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bontls, recognizances and other surety obligations. Authorization — By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and bintling upon the Company with the same force and effect as though manually affxed. I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company tlo hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of A�torney executed by said Companies, is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 17th day of July , 2024 . � 1NS��, � J �GoaroRylQym F Y � 1912 y o ~d'�9SSacHuS� da� 9j� * �a LMS-12873 LMIC OCIC WAIC Multi Co 02/21 P��v INSUR � �NsuRq 5J G�RP��9T 9�Ji `GPp�RP�RqT 2� c�e r m° n, �' � F° cc` �� o Z 1919 � o Q 1991 0 �a/�„ y°�,yH.nnnPS �aa� YS��NoipNP�,aD� By� Renee C. Llewellyn, Assistant Secretary d ,t � M * 1- p O � � N � � M i� `oo o� n� (6 `o � � � � �� rR 4 � TEXAS IMPORTANT NOTICE To obtain information or make a complaint: You may call toll-free for information or to make a complaint at 1-877-751-2640 You may also write to: 2200 Renaissance Blvd., Ste. 400 King of Prussia, PA 19406-2755 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 Consumer Protection (1 l 1-lA) P. O. Box 149091 Austin, TX 78714-9091 FAX: (512) 490-1007 Web: http://www.tdi.texas. ov E-mail: ConsumerProtection(c�tdi texas ov PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should first contact the agent or call 1-800-843-6446. If the dispute is not resolved, you may contact the Texas Department of Insurance. ATTACH TH1S NOTICE TO YOUR POLICY: This notice is for information only and does not become a part or condition of the attached document. TEXAS AVISO IMPORTANTE Para obtener informacion o para someter una queja: Usted puede Ilamar al numero de telefono gratis para informacion o para someter una queja al 1-877-751-2640 Usted tambien puede escribir a: 2200 Renaissance Blvd., Ste. 400 King of Prussia, PA 19406-2755 Puede comunicarse con el Departamento de Seguros de Texas para obtener informacion acerca de companias, coberturas, derechos o quejas al 1-800-252-3439 Puede escribir al Departamento de Seguros de Texas Consumer Protection (1 l 1-lA) P. O. Box ] 49091 Austin, TX 78714-9091 FAX # (512) 490-1007 Web: http://www.tdi.texas.�ov E-mail: ConsumerProtection(a�tdi.texas �ov DISPUTAS SOBRE PRIMAS O RECLAMOS: Si tiena una disputa concerniente a su prima o a un reclamo, debe comunicarse con el agente o primero. Si no se resuelve la disputa, puede entonces comunicarse con el departamento (TDI) UNA ESTE AVISO A SU POLIZA: Este aviso es solo para proposito de informacion y no se convierte en parte o condicion del documento adjunto. NP 70 68 09 0] LMS-15292 10/15