HomeMy WebLinkAboutContract 49693-R2FP1FORT WORTH,
WATER DEPARTMENT
NOTICE OF PROJECT COMPLETION
-FP1
City Secretary No: 49693-R2
Date Received:
12/20/2024
City Project Ns: 100909
Regarding contract 49693-R2 Sewer Main Replacement Contract 2017for as required by the WATER
DEPARTMENT as approved by City Council on 8/29/2017 through M&C c-28355 the director of the WATER
DEPARTMENT upon the recommendation of the Assistant Director of the Water Department has accepted the project
as complete.
Original Contract Prices:
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
77 S614D
Recommended for Acceptance
Asst. Director, WATER DEPARTMENT
Christopher Harper (Dec 16, 202412:07 CST)
Accepted
Director, WATER DEPARTMENT
Dana BUi'GIhd0AC
Dana Burghdoff (Dec 1 , 2021 09:19 CST)
Asst. City Manager
$ 1,000,000.00
$ 0.00 No
$ 918,655.08
Days @ $650.00/ Day
$ 918,655.08
$ 918,655.08
$ 0.00
Dec 16, 2024
Date
Dec 16, 2024
Date
Dec 18, 2024
Date
OFFICIAL RECORD
Comments:
CITY SECRETARY
FT. WORTH, TX
C-620 Signature Page
Contractor's Application for Payment
To (Owner) City of Fort Worth Invoicing Period (From - To):
11/30/23 to 10/22/2024
P. O. FW060-0000010205 From (Contractor):
Number: CIRCLE C CONSTRUCTION
Project: 100909
Contractor's CFW Vendor No.:
0000007744
City Secretary Contract
Number:
(Approved Change Orders
Number
1
2
3
4
5
6
7
8
TOTALS
NET CHANGE BY
CHANGE ORDERS
Contractor's Certification
Invoice No. 1 7 (Final)
Invoice Date:
10/22/2024
Remit to ( If Not Automatic Deposit):
49693-11Name: 2 Contract SEWER MAIN REPLACMENT CONTRACT 2017
N
Application For Payment
Change Order Summary.
1. ORIGINAL CONTRACT PRICE.......................................................... $
Additions Deletions 2. Net change by Change Orders................................................................. $
3. Current Contract Price (Line 1 f 2)......................................................., $
4. TOTAL COMPLETED AND STORED TO DATE
(Progress Estimate, Construction Allowance and Change Orders)..... $
5. RETAINAGE:
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.
7"eresw s&z4t
Teresa Skelly (Dec 13, 202 09:43 CST)
a. X $918,655.08 Work Completed.......... $
b. X Not Used $
c. Total Retainage (Line 5a + Line 5b).............................. $
6. AMOUNT ELIGIBLE TO DATE (Line 4 - Line 5c)............................. $
7. LESS PREVIOUS PAYMENTS (Line 6 from prior Application)........ $
8. AMOUNT DUE THIS APPLICATION ................................................. $
9. BALANCE TO FINISH, PLUS RETAINAGE
(Column G on Progress Estimate+ CA + Cos + Line 5 above) ............. $
10. CONTRACT TIME:
Affidavit of Bills Paid
Consent of Surety
a, Days Awarded
b, Days Added by CO
C. Total Days
it. Days Charged
e, Days Remaining
$1,000,000.00
$1,000,000.00
$918,655.08
$918,655.08
$918,655.08
$2,580,003.82
365
365
365
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AS-290 8awr8-11- LS 1.000OW 810,288.48 $10.286,48 100000000 $10,280.48 S10280.46 S10.2B0.48 1W.0%
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AS-297 Sh.M,H-d Dig 4-Se Lbe LS 1.000OW $62.000.00 S52.000.00 1.OW00DDO S62o00W $62.000.00 S62.WO.001 100-0%
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A3 Raparc Saser Some LS f000OD0 318,850.00 S18,850.00 1.000OOM S18.850.00 118,8W,OD $18,850.00 1W.O% II
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ADDITIONS
For(contrad)100909
SEWER MAIN REPLACMENT CONTRACT 2017
City Smeary
4%93•R2
Applicsttm Number 7(Final)
Conrad Num:
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Apphraliov Date 1012212024
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Progress Estimate Construction Allowance Usage
CONSTRUCTION ALLOWANCE ITEMS TO BE REDUCED
IFortconusc0: 100909 SEWER MAIN REPLACMENT CONTRACT 2017
Appliation Period: 11/10/23 to 10122/2024
A H C
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Progress Estimate
Change Order Number I 1
Contractor's Application
ADDITIONS
11-(—tm"): 100909
SEWER MAIN REPLACMENT CONTRACT 2017
City $—MU 49693-112
Apphnnon Nnmhm
7 (Final)
Cmtseet Num:
Application Penud:
11/30/23 to 10/2212024
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C-620 Charge order
Progress Estimate Change Order Number I I
DELETION$
IFn, lomtranh. 100909 SEWER MAIN REPLACMENT CONTRACT 2017
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Contractor's Application
7 (Final)
10/22J202a
F
NM Used NM Used NM Used
CA20 Change Order
Progress Estimate
Change Order Number 1 2
Contractor's Application
ADDITIONS
For (antrzct): 100909
SEWER MAIN REPLACMENT CONTRACT 2017
City seaaary
49693-112
Apphwtmn Number.
7(Final)
Convaa Nmn:
Apphcalim Penod
11/30/23 to 10/22/2024
Applie„'m' Vale
10rz22024
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modi8ratiovs. You an enmmaged to read the dooanent catefu3lyand consul) Legal Counsel pnor to its eaxution.
C- 20 Ch-go order
Progress Estimate Change Order Number 1 2
DELETIONS
Foe'mnhaml: 100909 SERER MAIN REPLACMENT CONTRACT 2017
Apprcehon Period 11/30/23 to 10/22/2024
A H C D
tem CO Quantity to Deletion Change
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modi0cations. You am encouraged to read the document carefully and consuh Legal Cnmsel pnor to its execution.
Contractor's Application
Application Number: 7 (Final)
Application Date: 10/2212024
E F
Not Used Not Used Not Used Not Used
"20 change Otder
Progress Estimate
Change Order Number 1 3
Contractor's Application
ADDITIONS
For(oontraa): 100909
SEWER MAIN REPLACMENT CONTRACT 2017
City smeary
491593-R2
AppliQlion Number:
7(Final)
C.- n Nuu:
Apphcabtm Penrrdr
11/30/23 to 10/2212024
Applinlioo Date,
10/222024
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(D FFI B
Total,
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modificatirms. You am encouraged to tend the ll o lramthIly-d—.11 Lpgal Counsel prior to its nsecvtitn.
C-e20 Change Order
Progress Estimate Change Order Number 1 3
Contractor's Application
DELETIONS
Frn(—.d): 100909 SEWER MAIN REPLACMENT CONTRACr 2017
I Applieatim Number:
7 (Final)
Apphcztim Period: — 11/30/23 to 10/22/2024
Apphatim Date:
10/22/2024
A
B C
D F
F
hem CO Quantity to
Change Chdcr hem Spcificatim Vill of
Del —
Unit Pritt Change Order Not Used
Not Used Not Used Not Used Not Us d
Not Used Not Used Not Used
smg
No. Dcroa Sedion Nn. Masme Delde
Value
T.I.I.
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modifications, You are enrnunged to read the dtxwnent oasefWty and —suit legal Counsel prior 10 its execution.
CA20 Change Order
Progress Estimate Change Order Number 4 1 Contractor's Application
ADDITIONS _
er: For (comnct): 100909 SEWER MAIN REPLACMENT CONTRACT 2017 City�ary 49693-R2 I Apphwnnn Nmnb7(FinaO
Contract None:
Applicalxm Now 11/30h3 to 10/22/2024 - — — — — Applaclion Date: 10122/2024
A .— — - I B C D E F
h— )
AnV0" TOUTcompkted %
Estimated pnamity Pmv—Iy Value This MatmialsPmentiy
Clump Order hem Specification Unit of Y ;;D Quamity to Add l lfiit l4ioe I CNnge fhdnr Value and SW I F.n Date IFI
No. DesasVtlno Section No. Measure Valce NaWlled Installed Value Period Stored loot in C) ID+F.1 B
'Ibis document has been modified "'- its original limn as an EICDC document and the user did not highlight the
modifications. Yon are enmomged to read the document..IW)yad cansull Legal Counsel prim to its —t-
Data— to Finish
(B-F)
C820 Change Ordar
Progress Estimate Change Order Number 1 4
DELETIONS
FoatcosraeU. 100" SEWER MAIN REPLACMENTCONTRACf 2017 Application Number
Apphahnn pmmd11/30/23 to 10/22/2024 Appli`atinn Date:
A B C D F.'
Change Order hem 0—t,ima Specification Unit of - co lXIdcty se Unit Vries Change Urdm Not Used Not Used Not Used Not Used Not Used
No. Section No. Masmo Value
Totda
nis do —tail has been modified Goan its original form as an EICDC domament sad the case did nm higldight the
nmdifiations. Yon ate enoounged to mad the doemnent arcNlly and consult 1xppl Counsel faun to its emeelitm.
Contractor's Application
7 (Final)
1022/2024
F
NM Used Not Used Not Used
C-620 Change Wis.
Progress Estimate Change Order Number 1 5
Contractor's Application
ADDITIONS
Fi.Iwnlraa): 100909 SEWER MAIN REPLACMENT CONTRACT 2017
City Secretary
49693.R2
APPIIUtmn Number;
7 (Final)
Comaact Nwn:
Application Period` 11/30/23 to 10/22/2024
Appbution Date,
10/2212024
A
B
C
D F
F
Ilem
Balwce In Finish
('hxege OrM hem SPeuf lim Unit of CO Qmmiryto Add
Addilioo
Unit Price ('haw Order
Est, Quantity
Pre-A—ly Value'lltis Matcrials NeseollY
Valve
Total Completed %
and Slarod to Dale IF I
(B-F)
No. D—ipion Seetion M. Mess—
Value
tnslsllcd
Installed Value Period Storad(not in C)
(D+EI II
Torah
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ttwdifications. You are encunniged to read the dccwtent carehtlly and cansull Legal Counsel pnor 10 its execution.
C-620 Change Order
Progress Estimate Change Order Number 1 5
Contractor's Application
DELETIONS
IF° (CMIm")100909 SEWER MAIN REPLACMENT CONTRACT 2017
A°ph"tion Nn`nt—
7 (Final)
Awllalxm lkrltd: 11/30/23 to 10/22/2024
"""'I.""n m"
10/22/2024
A
B C
D B
F
Co Q"°e1ity to
Wilson
C'hatlge Order kmLem Slleeificadoo OMB nC
Descnphm Ddde
Unil Prig o"M Order Not Used
No Used Net Used Nnl tfsed NN Used
Nol the d NM lased Not U d
No. Salim No. M.—
Valee
Tatds
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mtdifitllions. Ym are manaaged to read the danmlent eamfully aad=suit legal Counsel poor In its cxenvlim,
C-620 Change Order
Progress Estimate
Change Order Number 1 6
Contractor's Application
ADDITIONS
100909
SEWER MAIN REPLACMENT CONTRACT 2017
City Secretary
49693-R2
Appliwi.N—l- 7(Fieel)
Contract N—:
IF,,,--,11:
Application Period:
11/30/23 to 10/22/2024
Appliution Date: 10122/2024
A
B
(7
D E F
hem -
r Balance to Finish
Change (hder hem
Specification I/ait of C'O Quantiryn Add
Addition
Unit Price ('hange Order
F.stimalM QuanlilY
Total Completed %
p—oualy Value This Materials Prese'Iy (B•F)
Value and Stored In Dale (F)
No.
Desrnpsion Seenon Na. M—
Value
Installed
NSIa11M Value Period Shed (vd mCl (D+F.) B
Taah
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modifimims, Ytm arc enoomaged to read the dne 1 —fully and consult Legal Counsel prim to its eatanion.
C-020 Chenpe Order
Progress Estimate
Change Order Number 1 6
DELETIONS
For( —tad). i00909
SEWER MAIN REPLAC.MENT CONTRACT 2017
Appheati-N—b-
Appliealim Perwd.
11/30/23 to 10/22/2024
Applintim Date`
A
B C
D E
hem CO Qnaliryto
'
Dektim
Change Order hem
Spadicatim Unitof
Descripim Delete
11ni1 P,= Change Order NM lhcd
NM Used NM Thad NM Used NM Used
No.
Seaim No. Mrasure
Valm
I Total,
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nodipattons. Ym am —zaged t0 read the deeament umfdlY and oonsdl Lepal Cowin prim to its ea i m.
Contractor's Application
7 (Final)
10/22/2024
F
NM IJSW NM tj d NM heed
C420 Chanpe Order
C 02D Change Order
Progress Estimate Change Order Number 1 7
ADDITIONS
Fnr(eoolrao)100909 SEWER MAIN REPLACMENT CONTRACT 2017
"ppficat n Pend 11/30/23 to 10/22/2024
A
hem
Change OrdR he o lxscrigiot Specification thdt of CO Qaanlity In Add
No, Seaioa No. Measure
Contractor's Application
CitySecretary
49693-R2
Application Nnetb-
7 (Final)
Concoct Num:
Apphw- Dace
10/22/2024
B
C
D
F. F
B.Is— to Finish
Addition
Unit thine Change Drder
Estimaled Quantity
Value
Taal Completed
Previously Value Mus Matttials Presen0y
and Slued to Dale
M In -F)
Value
Installed
Installed Value Period Strnea Itto in C) ID+EI
B
TJJa I I I I I I I I I
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modifications. Yau are e—aged to read the dls I catefully and caesall legal Counsel prior to its ex=tlM
Progress Estimate Change Order Number 7
;
Contractor's Application
DELETIONS
ForlooetmcU: 100909 SEWER MAIN REPLACMENT CONTRACT 2017
AMiiuhon Nmuber:
7(Final)
Applirarion Perim: 11/30/23 to 10/22/2024
Applialion Date.
10122/2024
A
A C
D
E
F
hcm
Co Qusmitylo
'
11cMina
I
Change fhdcr Item Spxi ficalioa Unit of
No. DesatMiw Sxiw No. Measure Detae
Unit Pnce Change Order Not Used
Value
Not Used NM lfsed
Not Used NotUsed
Not Used Not Used Not U d
I Totals
This document has been modified fimn its original form as an HICDC document and the suer did not bighlight the
msdificalions. You are moo -aged to lead the document carefully and consult Legal Counsel Fodor to its eaeastion.
C-620 Change order
Progress Estimate
Change Order Number 1 8
I
Contractor's Application
ADDITIONS
For(oot".) 1009"
SEWER MAIN REPLACMENT CONTRACT 2017
CtbSccretary
49693-R2
Appl-1—Number 7(Final)
Cosdtan Num:
Applimnm Pmoa:
11/30/23 to 10/22/2024
Apphmtion Date
10f22/2024
A
B
C
D E F
Bent
Balance to Finish
Addition
Fslimmed Quantity
mpleted %
Total Comsently IB -F)
Previously Value This Materials I'
Staredlo Dale (Fl
Change Onlrr A-Desm�ion
Specifimtinn unit of Co Qumtity to Add
Unit Pecs Cha er
Installed
Vslm Installed Value Mind Slaedlvnliu C) and
B
No.
Sw—No. Messum
Vaim
L'alue
ID+EI
TMda
71tis document has been mndified fnm its niginal form as an FR DC document and the user did not highlight the
modifiaalitns. You are enunnaged to tad the document moclully and crosull Legal Comsel prior to its ea Ii(n.
"20 change ore«
C-020 Change Order
Progress Estimate Change Order Number 1 S
Contractor's Application
DELETIONS
For(amtranp 100909 SEWER MAIN REPLACMENTCONTRACT 2017
AppOcafi-Nmnben
7(Final)
ApMitatian Fer;td, 1 WO/23 to 10/22/2024
Application Dale:
l0l22f2024
A
B C
D E
F
CO Quaalhty to
Dehdipn
Change Order hem Spmficalion (tr¢I of
No. Dcacnptton Smion No. Measure Delete
thdl Frio, Change Order Not Iked
Value
Not Used Nat Ila,d Not Used Nd Used
Nd Used Not UsW Nn Used
Tolala
This dmunent has been modified *m its original fnsm as an EICIX. doa 1 and the user did net highlight the
modifications. You are --ged to read the d—.t carePtlly and —.11 Legal C-1 prior to its exewtinn.
City of Fort Worth Summary of Charqes
City Secretary Contract Num: I 49693-R2 I SEWER MAIN REPLACMENT CONTRACT 2017 P. O.: FW060-0000010205 Project Number: 100909
I Application Period: I 11/30/23 to 10/22/2024 I Application I 7 (Final) Application Date: 10/22/2024
Number:
Funding Identification (FID) Total Completed Amt Remaining Gross Retainage Net
Original Contract
56002-0700430-5740010-100909-001780-9999 $918,655.08 $2,580,003.82
0
0
0
0
0
0
0
0
Change Order 1
56002-07004305740010-100909-001780-9999
0
0
0
0
0
0
0 _
0
0
0
Change Order 2
56002-0700430-5740010-100909-001780-9999
0
0 _
0
0
0
0
0
0
0
0
City Secretary Contract Num: I 49693-112
Application Period:
Funding Identification (FID)
Change Order 3
56002-0700430-5740010-100909-001780-9999
0
0 _
0
0
0 _
0
0
0
0
0
Change Order 4
56002-0700430-5740010-100909-001780-9999
0
0
0
0
0
0
0
0
0 _
0
Chan a Order 5
56002-0700430-5740010-100909-001780-9999
0 -
0 _
0
0
0
0
0
0
0
0
City of Fort Worth Summary of Charges
SEWER MAIN REPLACMENT CONTRACT 2017 (P. O.: FW060-0000010205 Project Number: 100909 1
11/30/23 to 10/22/2024 I Applicaaon I 7 (Final) Application Date: 10/22/2024
Number:
Total Completed Amt Remaining Gross Retainage Net
City Secretary Contract Num: I 49693-R2
Application Period:
Funding Identification (FID)
Change Order 6
56002-0700430-5740010-100909-001780-9999
0
0
0
0
0
0
0
0
0
0
Change Order 7
56002-0700430-5740010-100909-001780-9999
0
0
0-
0
0
0
0
0
0
0
Change Order 8
56002-0700430-5740010-100909-001780-9999
0
0
0
0
0
0
0
0
0
0
City of Fort Worth Summary of Charges
SEWER MAIN REPLACMENT CONTRACT 2017 [P. O.: FW060-0000010205 Project Number: 100909
11/30/23 to 10/22/2024 I Application I 7 (Final) Application Date: 10/22/2024
Number:
Total Completed Amt Remaining Gross Retainage Net
City of Fort Worth Summary of Charqes
City Secretary Contract Num:
I 49693-R2 I
SEWER MAIN REPLACMENT CONTRACT 2017 (p.o.: FW060-0000010205
Project Number:
100909
Application Period:
I 11/30/23 to 10/22/2024 I Application 7 (Final)
Number.
Application Date: 10/22/2024
Funding Identification (FID)
Total Completed Amt Remaining Gross
Retainage Net
Totals
56002-0700430-5740010-100909-001780-9999
$918,655.08 $2,580,003.82
0
—
0
--
-- ---
0
0
-
-
--
0
Grand Total
I $918,655.08 I I $2,580,003.82 I I $0.00 I I
$0.00 $0.00
FORT WORTH,
TRANSPORTATION AND PUBLIC WORKS
PIPE REPORT FOR:
PROJECT NAME: Sewer Main Replacement Contract 2017
CITY PROJECT NUMBER: 100909
WATER
PIPE LAID SIZE TYPE OF PIPE
LF
FIRE HYDRANTS: VALVES (16" OR LARGER)
PIPE ABANDONED SIZE TYPE OF PIPE LF
DENSITIES:
NEW SERVICES:
SEWER
PIPE LAID
SIZE
TYPE OF PIPE
LF
8" PVC sewer pipe
8"
PVC
1984.8
10" PVC sewer pipe
10"
PVC
29.5
12" PVC sewer pipe
12"
PVC
475
4" PVC sewer pipe
4"
PVC
72.3
6" PVC sewer pipe
6"
PVC
100.1
4" PVC DIP
4"
DIP
222
PIPE ABANDONED
DENSITIES:
NEW SERVICES:
SIZE TYPE OF PIPE
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
FORTWORTH.
M,
TRANSPORTATION AND PUBLIC WORKS
November 13, 2024
Circle C Construction
500 W Trammell
Fort Worth, Tx 76140
RE: Acceptance Letter
Project Name: Sewer Main Replacement Contract
Project Type: Sewer
City Project No.: 100909
To Whom It May Concern:
On October 30, 2024 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 October 30, 2024,
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
Lawrence Hamilton 817-392-2626.
Sincerely,
Lawl-elice 1 Gaw&011
Lawrence Hamilton (Dec 13, 202410:07 CST)
Lawrence Hamilton, Project Manager
Cc: Andre Taylor, Inspector
Gary Deyon, Inspection Supervisor
Lorrie Pitts, Senior Inspector
Lawrence Hamilton, Program Manager
Circle C Construction, Contractor
E-Mail: TPW_Acceptance@fortworthtexas.gov
Rev. 08/20/19
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 TERESA S SKELLY, PRESIDENT
of CIRCLE C CONSTRUCTION, known to me to be a credible person, who being by
me duly sworn, upon his oath deposed and said;
That all person, firms, associations, corporations or other organizations
furnishing labor and/or materials have been paid in full;
That there are no claims pending for personal injury and/or property damage;
On Contract described as;
2" d Renewal — Sewer Main Replacements Contract 2017
CPN 100909
BY
Subscribed and sworn before me on this 15 Day of D C,�P— 1'Y b-eK024.
AMANDA S JONKERS
Notmy Public
STATE OF TEXAS
b�y�4r f OF tw+.r' My Gww. E1p.#
S J6
Notary Public in Tarrant County, TX
CONSENT OF SURETY
TO FINAL PAYMENT
Bond No. TXC611158
TO OWNER:
City of Fort Worth
1000 Throckmorton Street
Fort Worth, TX
PROJECT:
(name, address)
2°d Renewal - Sewer Main Replacements Contract 2017
in the City of Fort Worth, TX
OWNER
ARCHITECT
CONTRACTOR
SURETY
OTHER
ARCHITECT'S PROJECT NO.:
City Project No. 100909
CONTRACT FOR: Utilities
CONTRACT DATED: August 29, 2017
In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the
(Insert name and address of Suret))
Merchants Bonding Company (Mutual)
6700 Westown Parkway
West Des Moines, IA 50266 , SURETY
on bond of
(Insert name and address of Contractor)
William J. Schultz, Inc., dba Circle C Construction Company
P. O. Box 40328
Fort Worth, TX 76140 , 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 to
(Insert name and address of Owner)
City of Fort Worth
1000 Throckmorton Street
Fort Worth, TX 76102 , OWNER,
as set forth in the said Surety's bond.
IN WITNESS WHEREOF, the Surety has hereunto set its hand this date: December 13, 2024
(Insert in writing the month followed by the numeric date and year.)
Merchants Bonding Company (Mutual)
(Surety)
(Signature of authorh9d representative)
Attest: ess as to Surety: Sheryl A. Klutts, Attorney -in -Fact
(Seal): (Printed name and title)
John A. Miller
MERCHANTS;
BONDING COMPANY,.
POWER OF ATTORNEY
Know All Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.,
both being corporations of the State of Iowa, d/b/a Merchants National Indemnity Company (in California only) (herein collectively called the
"Companies") do hereby make, constitute and appoint, individually,
John A Miller; Sheryl A Klutts
their true and lawful Attomey(s)-in-Fact, to sign its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings,
contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of
persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions
or proceedings allowed by law.
This Power-of-Attomey is granted and is signed and sealed by facsimile under and by authority of the following By -Laws adopted by the Board of
Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and April 27, 2024 and adopted by the Board of
Directors of Merchants National Bonding, Inc., on October 16, 2015 and amended on April 27, 2024.
"The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and
authority to appoint Attorneys -in -Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto,
bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof."
"The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney
or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the
Company, and such signature and seal when so used shall have the same force and effect as though manually fixed."
In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and aut hority hereby given to the
Attomey-in-Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction
contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department
of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of
its obligations under its bond.
In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given
to the Attorney -in -Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner -
Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation.
In Witness Whereof, the Companies have caused this instrument to be signed and sealed this 29th day of July 2024
.• ••. . • • "' • •. MERCHANTS BONDING COMPANY (MUTUAL)
••••Q.�1o..... •,. ••'*,a
Q�N�'.�QijjA.• MERCHANTS NATIONAL BONDING, INC.
y�pgPOR,,•�O'. �O,•ORPOp .9 d/b/a MERCHANTS NATIONAL INDEMNITY COMPANY
-o- G. .r -o-
2003 4) y: 1933 a'e: By
• '•d`�'' ;i,�`•�• ••��lji � President
STATE OF IOWA '•. ~^7 .•• •'• .••
COUNTY OF DALLAS ss. •••"""''•� • • • • •
On this 29th day of July 2024 before me appeared Larry Taylor, to me personally known, who being by me duly sworn
did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the
seals affixed to the foregoing instrument are the Corporate Seals of the Companies; and that the said instrument was signed and sealed in behalf
of the Companies by authority of their respective Boards of Directors.
�P s� Penni Miller
Z Commission Number 787952
• • My Commission Expires
rOWA January 20, 2027 Notary Public w�+�
(Expiration of notary's commission does not invalidate this instrument)
1, Elisabeth Sandersfeld, Secretary of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., do
hereby certify that the above and foregoing is a true and correct copy of the POWER -OF -ATTORNEY executed by said Companies,which is still
in full force and effect and has not been amended or revoked.
In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 13th day of December , 2024
• ...... 1'.0
•......••
pKPO/Q,q.�p;
;�O?ORP09q.gy�
�Y
_p_ 0,
-o- o:
's 2003 ?•�
:tea
% y 1933 ;'c; Secretary
: �d. ate:•