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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: Cedarbrook Beltmill Phase 5
City Project No.: 104497
Improvement Type(s): Paving Drainage Street Lights Traffic Signals
Original Contract Price: $649,657.50
Amount of Approved Change Order(s):
Revised Contract Amount:
Total Cost of Work Complete:$649,657.50
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: Cedarbrook Beltmill Phase 5
City Project No.: 104497
City’s Attachments
Final Pay Estimate
Change Order(s): Yes N/A
Contractor’s Attachments
Affidavit of Bills Paid
Consent of Surety
Statement of Contract Time
Contract Time 207 WD
Work Start Date: 7/10/2023
Days Charged: 207 WD
Work Complete Date: 9/11/2024
Completed number of Soil Lab Test: 20
Completed number of Water Test: 0
CITY OF FORT WORTH
Contract Name CEDARBROOK-BELTMILL PHASE 5
Contract Limits
Project Type DRAINAGE
DOE Number 4497
Estimate Number 1 Payment Number 1 For Period Ending 9/11/2024
FINAL PAYMENT REQUEST
City Secretary Contract Number
207
WD
Contract Date
BURNSCO CONSTRUCTION, INC.
NA
6331 SOUTHWEST BLVD
FORT WORTH TX 76132
M.GLOVER E.WALKER
130WDContract Time
Days Charged to Date
CompleteContract is 100.00
Contractor
,
/Inspectors
Project Manager
City Project Numbers 104497
Thursday, September 26, 2024 Page 1 of 4
Contract Name CEDARBROOK-BELTMILL PHASE 5
Contract Limits
Project Type DRAINAGE
DOE Number 4497
Estimate Number 1
Payment Number 1
For Period Ending 9/11/2024
Project Funding
City Project Numbers 104497
UNIT III: STORM DRAIN IMPROVEMENTS
Item
No.Description of Items Estimated
Quanity Unit Unit Cost Estimated
Total
Completed
Quanity
Completed
Total
1 42" RCP, CLASS III 72 LF $212.00 $15,264.00 72 $15,264.00
2 36" RCP, CLASS III 197 LF $170.00 $33,490.00 197 $33,490.00
3 30" RCP, CLASS III 1099 LF $114.00 $125,286.00 1099 $125,286.00
4 24" RCP, CLASS III 1329 LF $92.00 $122,268.00 1329 $122,268.00
5 24" RCP, CLASS III 334 LF $80.00 $26,720.00 334 $26,720.00
6 10' CURB INLET 17 EA $5,600.00 $95,200.00 17 $95,200.00
7 15' CURB INLET 4 EA $7,500.00 $30,000.00 4 $30,000.00
8 20' CURB INLET 2 EA $10,700.00 $21,400.00 2 $21,400.00
9 4' STORM JUNCTION BOX 12 EA $5,600.00 $67,200.00 12 $67,200.00
10 5' STORM JUNCTION BOX 2 EA $6,500.00 $13,000.00 2 $13,000.00
11 MANHOLE STEPS 53 EA $50.00 $2,650.00 53 $2,650.00
12 4' DROP INLET 1 EA $5,600.00 $5,600.00 1 $5,600.00
13 6'x6' MODIFIED DROP INLET 1 EA $10,200.00 $10,200.00 1 $10,200.00
14 42" SLOPING HEADWALL 1 EA $3,500.00 $3,500.00 1 $3,500.00
15 36" SLOPING HEADWALL 1 EA $3,300.00 $3,300.00 1 $3,300.00
16 30" SLOPING HEADWALL 2 EA $2,700.00 $5,400.00 2 $5,400.00
17 24" SLOPING HEADWALL 4 EA $2,500.00 $10,000.00 4 $10,000.00
18 21" SLOPING HEADWALL 1 EA $2,400.00 $2,400.00 1 $2,400.00
19 4'x4' POND OUTLET STRUCTURE 1 EA $6,800.00 $6,800.00 1 $6,800.00
20 LARGE STONE RIPRAP, DRY 466 SY $104.00 $48,464.00 466 $48,464.00
21 TRENCH SAFETY 3031 LF $0.50 $1,515.50 3031 $1,515.50
$649,657.50 $649,657.50Sub-Total of Previous Unit
Thursday, September 26, 2024 Page 2 of 4
Contract Name CEDARBROOK-BELTMILL PHASE 5
Contract Limits
Project Type DRAINAGE
DOE Number 4497
Estimate Number 1
Payment Number 1
For Period Ending 9/11/2024
Project Funding
City Project Numbers 104497
Contract Information Summary
Change Orders
$649,657.50Original Contract Amount
$649,657.50Total Contract Price
$649,657.50
Less
Total Cost of Work Completed
% Retained $0.00
Net Earned $649,657.50
Plus Material on Hand Less 15%$0.00
Balance Due This Payment $649,657.50
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
$649,657.50
$0.00
Thursday, September 26, 2024 Page 3 of 4
Contract Name CEDARBROOK-BELTMILL PHASE 5
Contract Limits
Project Type DRAINAGE
DOE Number 4497
Estimate Number 1
Payment Number 1
For Period Ending 9/11/2024
Project Funding
City Project Numbers 104497
Line Fund Account Center
Amount
Funded Gross Retainage Net
CITY OF FORT WORTH
SUMMARY OF CHARGES
$649,657.50
Less
Total Cost of Work Completed
% Retained $0.00
Net Earned $649,657.50
Plus Material on Hand Less 15%$0.00
Balance Due This Payment $649,657.50
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
$649,657.50
$0.00
City Secretary Contract Number
207
WD
Contract Date
BURNSCO CONSTRUCTION, INC.
NA
6331 SOUTHWEST BLVD
FORT WORTH TX 76132
M.GLOVER E.WALKER
130
WD
Contract Time
Days Charged to Date
CompleteContract is 100.000000
Contractor
,
/Inspectors
Project Manager
Thursday, September 26, 2024 Page 4 of 4
F�RTWfJRTH�
TRANSPORTATION AND PUBLIC WORI<S
September 11, 2024
BURNSCO CONSTRUCTION,INC.
6331 SOUTHWEST BLVD.
BENBROOK,TEXAS 76132
RE: Acceptance Letter
Project Name: CEDARBROOK-BELTMILL PHASE 5
Project Type: WATER,SEWER.STROM DRAIN
City Project No.: 104497
To Whom It May Concern:
On June 17, 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 September 11, 2024. The final
inspection and the corrected punch list items indicate that the worl< meets the City of Fort Worth
specifications and is therefore accepted by the City. The warranty period will start on September 11,
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-
392-2237.
Sincerely,
R� 7'ir�.��G
Ram Tlwan (Oct 1, 202409:01 CDT)
RAM TIWARI P.E., Project Manager
Cc: EDDIE WALI<ER, Inspector
MIKE GLOVER, Inspection Supervisor
DAIEL ROY, Senior Inspector
ANDREW GOODMAN, Program Manager
PELETON LAND SOUTIONS, Consultant
BURNSCO CONSTRUCTION,INC., Contractor
D R HORTON TX,LTD, Developer
File
E-Mail: TPW_Acceptance@fortworthtexas.gov
Rev. 8/20/19
aFFrDavIT
STATE OP T�XAS
COLTNTY OF TARRANT
Befio�e me, the undersig�led authority, a notaiy public in the state
and county aforesaid, oi� this day personally appeared Ab GraEltges,
Contract Mgr, Of Burr�sco Construction, l�iown ta me to be a credible
persan, wlao being by me duly swor�l, upon his oath deposed a��d said;
That all persons, firfns, associatians, corporations, or other
organizations furnishing labar and/or materials have been paid in full;
Tliat the wage scale established by the City Council in the City of
Fort tiVorth has been paid in full;
Tl�at there are no clai�ns pending for personal injury aild/or
praperty dannages;
On Contract described as;
Cedarbrook at Beltmill 5- Water, Sanitary Sewer and Stonn Drain
BY
Ab Grantges, tract Manager
Subscribed and sworn before ine on tllis date 30th ot' Septe�nber, 2024.
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Notary Public
Tarrant Couniy, Texas
7l}R��� CESILIA CANALES
Notary ID #131652996
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'r�cF t�+ July 24, 2026
CONSENT OF
SURETY COMPANY
TO FINAL PAYMENT
Conforms with the American Institute af
Architects, AIA Document G707
OWNER ❑
ARCHITECT ❑
CONTRACTOR ❑
SURETY ❑
OTHER
Bond No 022235993
PROJECT:
(name, 8dd1'ess)Cedarbrook-Beltmill Phase 5- Water, Sanitary Sewer, Storm Drain Improvements
Fort Worth TX
TO (Owner)
ID.R. HORTON - TEXAS, LTD AND CITY OF FORT � ARCHITECT'S PROJECT NO:
WORTH
CONTRACT FOR:
6751 North Freeway Cedarbrook-Beltmill Phase 5- Water, Sanitary Sewer, Storm Drain
Improvements
Fort Worth TX 76131
—I 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 i�sert name and address of Surety Company)
LIBERTY MUTUAL INSURANCE COMPANY
175 Berkeley Street
Boston MA 02116 , SURETY COMPANY
on bond of (here insert name 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)
D.R. HORTON - TEXAS, LTD AND CITY OF FORT WORTH
6751 North Freeway
Fort Worth TX 76131
, OWNER,
as set forth in the said Surety Company's bond.
IN WIT'NESS, WHEREOP,
the Surety Company has hereunto set its hand this
Attest:
(Seal): `.��u- �'y��:�y4,�,__-
24th day of May, 2024
LIBERTY MUTUAL INSURANCE COMPANY
Sure Company
i
- � � ���., ,
Signat re of Authorized Representative
Sonhinie Hunter Attorney-in-Fact
Title �� —
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
ONE PAGE
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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
Certifcate No: 8205467-022020
POWER OF ATTORNEY
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KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that
Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized
untler the laws of the State of Indiana (herein collectively called the "Companies°), pursuant to antl by authority herein set forth, does hereby name, constitute antl appoint, Don E.
Cornell; Joshua Saunders; Kelly A. Westbrook; Mikaela Peppers; Ricardo .I. Reyna; Robbi Morales; Sophinie Himter; Tina McEwan; Tonie Petranek
all of the city of Dallas state of TX each individually if there be more than one nametl, its true and lawful attorney-in-fact to make,
execute, seal, acknowledge and deliver, for antl on its behalf as surety and as its act and deed, any and all undertakings, bonds, 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 offcer or offcial of the Companies and the corporate seals of the Companies have been affixed
thereto this 23rd day of Aprii , 2021 .
Liberty Mutual Insurance Company
P� 1NSURq P��(V INSUR �\NSU�,q The Ohio Casualty Insurance Company
�J GoaPOR,, ti� yJ GpPP�Rq� v2 �,Q'�oaPORqr y� WestAmerican InsuranceCompany
J 3 Fo m Q' r Fo c� p r Fo m /�
��1912 0 o y1919� a Q 1991 � � ��
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o,� * ,,� �yl * tia �M * ti� By: �- �_ �o
David M. Carey, Assistant Secretary ��
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.� � 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 �
� �o Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorizetl so to do, execute the foregoing instrument for the purposes �
�� therein contained by signing on behalf of the corporations by himself as a duly authorized officer. >
� c`u State of PENNSYLVANIA ss
� � County of MONTGOMERY
IN WITNESS WHEREOF, I have hereunto subscribed my name and affxed my notarial seal at King of Prussia, Pennsylvania, on the tlay and year first above writlen.
� P'i;
' : Commonweal�h of Pennsylvania - Notary Seal
< ''-� Teresa Pastelia, No�ary Public � J//�
`¢ , Monigomery County ,, • 1 � /%
'`� i My commission expires March 28, 2025 By: ,�/�,1��✓ /L{�{/�..C.��
v . Cammissian number 1126044
ri�, ���� Member, Pennsylvania Association of Notaries eresa Pastella, Notary Public
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This Power of Attorney is made and executed pursuant to and by authority of the following By-laws antl Authorizations ot The Ohio Casualty Insurance Company, Liberty Mutual
Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows:
ARTICLE IV—OFFICERS: Section 12. PowerofAttorney.
Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and 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 revoketl at any time by the Board, the Chairman, the President or by the offcer or officers granting such power or authority.
ARTICLE XIII — Execution of Contracts: Section 5. Surety Bonds and Undertakings.
Any o�cer 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 executed such instruments shall be as binding as if
signed by the president and 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, acknowletlge and tleliver as surety any and all undertakings, bonds, recognizances and other surety
obligations.
Authorization — By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reprotluced signature of any assistant secretary of the
Company, wherever appearing upon a certifetl copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with
the same force and effect as though manually a�xed.
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 Attorney 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 24t1� day of May , 2024 .
P� 1NSUR4 P�,SY INSGR � 1NSUR�
�.J 4�FFOqq> 2f1 5J o°aP�Rqr 92 VP GDRP�R4T yCi
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d�9s`S'7CHU`'��.dD3 �y��NqMpS�''����0 �rs �Np�ANP aa3 By� Renee C. Llewellyn, Assistant Secretary
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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 (11 l -1 A)
P. O. Box 149091
Austin, TX 78714-9091
FAX: (512) 490-1007
Web: http://www.tdi.texas.gov
E-maiL• ConsumerProtection cr,tdi.texas.gov
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 THIS NOTICE TO YOUR
POLICY:
This notice is for information only and does not
become a pa►•t or condition of the attached
document.
TEXAS
AVISO IMPORTANTE
Para obtener informacion o para someter una
queja:
Usted puede llamar 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 Segur•os
de Texas Consumer Protection (1 11-1A)
P. O. Box 149091
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 concecniente 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 AV1S0 A SU POLIZA:
Este aviso es solo para proposito de infonnacion
y no se convierte en parte o condicion del
documento adjunto.
NP706809O1
LMS-15292 10/15