HomeMy WebLinkAboutContract 61006-FP1-FP2
City Secretary 61006Contract No. ______ _
fORTWORTH® Date Received 212412025
03/11/2025
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: DD East Harmon
City Project No.: 104099
Improvement Type(s): Water�
Original Contract Price:
Sewer�
$118,079.00
Amount of Approved Change Order(s): -$105,325.00
Revised Contract Amount:
Total Cost of Work Complete:
Holden Turner (Feb 19, 202516:13 CST)
Contractor
Feb 19, 2025
Title
Schaffer Construction
Company Name
Sfeve Johnson
Steve Johnson (Feb 24, 2025 06:59 CST)
Project Inspector r
Project Manager
Kandice Merrick (Feb 24, 2025 16:11 CST)
CFA Man�er
Je__,%......_ Lauren Prieur (Feb 24, 202516:12 CST)
Asst. City Manager
$12,754.00
$12,754.00
Feb 19, 2025
Date
Feb 24, 2025
Date Feb 24, 2025
Date Feb 24, 2025
Date
Feb 24, 2025
Date Feb 24, 2025
Date
Page 1 of 2
Notice of Project Completion
Project Name: DD East Harmon
City Project No.: 104099
City's Attachments
Final Pay Estimate 0
Change Order(s): 0 Yes ❑ N/A
Pipe Report: 0 Yes ❑ N/A
Contractor's Attachments
Affidavit of Bills Paid �
Consent of Surety �
Statement of Contract Time
Contract Time: 365 WD Days Charged: 105 WD
Work Start Date: 6/24/2024 Work Complete Date: 1/23/2025
Completed number of Soil Lab Test: 13
Completed number of Water Test: 0
Page 2 of 2
FORTWORTH
CITY OF FORT WORTH
F1NAL PAYMENT REQUEST
Contract Name DD EAST HARMON
Contract Limits
Project Type WATER & SEWER
City Project Numbers 104099
DOE Number 4099
Estimate Number 1 Payment Number 1
City Secretary Contract Number
Contract Date
For Period Ending 1/23/202�
WD
Project Manager NA
Contractor SCHAFFER CONTRUCTION, LLC
2601 NETWORK BLVD., SUITE 413
FRISCOE , TX 75034
Inspectors D. WATSON / S. JOHNSON
Contract Time 36�JD
Days Charged to Date 105
Contract is 100.00 Complete
Tuesday, February 11, 2025 Page 1 of 4
City Project Numbers 104099
Contract Name DD EAST HARMON
Contract Limits
Project Type WATER & SEWER
Project F+unding
DOE Number 4099
Estimate Number 1
Payment Number 1
For Period Ending 1/23/202�
L?NTI' I:WATER IMPROVEMENTS
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
1 TRENCH SAFETY 10 LF $5.00 $50.00 10 $50.00
2 DUCTILE IRON WATER FITTINGS 1 TN $740.00 $740.00 1 $740.00
W/RESTRAINT
3 8" WATER PIPE 8 LF
4 CONNECTION TO EXISTING 4"-12 WATER 1 EA
MAIN
� 8" GATE VALVE 1 EA
6 4" WATER METER AND VAULT *(CO#2) 0 EA
Sub-Total of Previous Unit
$83.00 $664.00 8 $664.00
$9,800.00 $9,800.00 1 $9,800.00
$1,500.00 $1,500.00 1 $1,500.00
$53,000.00 $0.00 0 $0.00
$12,754.00 $12,754.00
L?NTI' II: SANTTARY SEWER IMPROVEMENTS
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
1 POST -CCTV INSPECTION (CO#1) 0 LF $3.00 $0.00 0 $0.00
2 MANHOLE VACUUM TESTING (CO#1) 0 EA $150.00 $0.00 0 $0.00
3 CONCRETE COLLAR (CO#1) 0 EA $500.00 $0.00 0 $0.00
4 TRENCH SAFETY (CO#1) 0 LF $1.00 $0.00 0 $0.00
5 8" SEWER PIPE (CO#1) 0 LF $74.00 $0.00 0 $0.00
6 4'MANHOLE (CO#1) 0 EA $5,600.00 $0.00 0 $0.00
7 4" EXTRA DEPTH MANHOLE (CO#1) 0 VF $265.00 $0.00 0 $0.00
8 8" SEWER PLUG (CO#1) 0 EA $250.00 $0.00 0 $0.00
9 CORE DRILL TO EX. MANHOLE (CO#1) 0 EA $2,100.00 $0.00 0 $0.00
Sub-Total of Previous Unit �o.00 �o.00
Tuesday, February 11, 2025 Page 2 of 4
City Project Numbers 104099
Contract Name DD EAST HARMON
Contract Limits
Project Type WATER & SEWER
Project F+unding
Contract Information Summary
Original Contract Amount
Change Orders
Change Order Number 1
Change Order Number 2
Change Order Number
Total Contract Price
DOE Number 4099
Estimate Number 1
Payment Number 1
For Period Ending 1/23/202�
$118,079.00
($52,325.00)
($53,000.00)
$12,754.00
Total Cost of Work Completed $12,754.00
Less % Retained $0.00
Net Earned $12,754.00
Earned This Period $12,754.00
Retainage This Period $0.00
Less Liquidated Damages
Days @ / Day
LessPavement Deficiency
Less Penalty
Less Previous Payment
Plus Material on Hand Less 15%
Balance Due This Payment
$0.00
$0.00
$0.00
$0.00
$0.00
$12,754.00
Tuesday, February 11, 2025 Page 3 of 4
City Project Numbers 104099
Contract Name DD EAST HARMON
Contract Limits
Project Type WATER & SEWER
Project F+unding
Project Manager NA
Inspectors D. WATSON / S. JOHNSON
Contractor SCHAFFER CONTRUCTION, LLC
2601 NETWORK BLVD., SUITE 413
FRISCOE , TX 75034
DOE Number 4099
Estimate Number 1
Payment Number 1
For Period Ending 1/23/202�
City Secretary Contract Number
Contract Date
Contract Time 365 WD
Days Charged to Date 105 WD
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
Less % Retained
Net Earned
Earned This Period $12,754.00
Retainage This Period $0.00
Less Liquidated Damages
� Days @ $0.00 / Day
LessPavement Deficiency
Less Penalty
Less Previous Payment
Plus Material on Hand Less 15%
Balance Due This Payment
$12,754.00
$0.00
$12,754.00
$0.00
$0.00
$0.00
$0.00
$0.00
$12,754.00
Tuesday, February 11, 2025 Page 4 of 4
DEVELOPER-AWARDED-PROJECT CHANGE ORDER
INSPECTOR: Dennis Rodgers Phone No: 817-471-4781
PROJECT MANAGER: Sandip Adhikari Phone No: 817-392-8424
CONTRACT UNIT
WATER SEWER PAVING DRAINAGE STREET LIGHTS CONTRACT
Developer Developer Developer Developer Developer DAYS
Cos[ City Cost Cost City Cost Cost City Cost Cost City Cost Cost City Cosl
ORIGINAL CONTRACT $65,754.00 $0.00 E52,325.00 $0.00 $128,653.04 E0.00 $16,073.00 $0.00 $0.00 E0.00 90
EXTRAS TO DATE $0.00
CREDITS T O UA I E $0.00
CONTRACTTODATE $65,754.00 $0.00 552,325.00 $0.00 $128,853.04 $0.00 $16,073.00 $0.00 $0.00 $0.00 90
AMOUNTOF PROP. CHANGEORDER �c-✓ ��,5 [�o,
REVISEDCONTRACTAMOUNT $65,754.00 $0.00 50.00 $0.00 $128,853.04 $0.00 $16,073.0� $0.00 $0.00 5�.00 90
TOTAL REVISED CONTRACT AMOUNT
PER UNIT $65,754.00 $0.00 $128,853.04 $16,073.00 $0.00
REVISED COST SHARE DeV. COSt: 5210,680.04 City COst: 50.00
TOTAL REVISED CONTRACT E21Q680.04
REVIEWED
By Sandip Adhikari at 9:51 pm, May 12, 2024
Revised: 10-�2-2011 Page 1
REVIEWED
By Sandip Adhikari at 9:51 pm, May 12, 2024
Revised:10-12-2011
Page 2
You are direc[ed to make the
PAY ITEM #
2
3
4
5
6
7
8
9
REASONS FOR CHANGE ORDER
9an es in the contract documenis :
CITY BI� ITEM
# QUANTITY UNIT
33 O1 31 -520 LF
33 01 30 -1 EA
33 05 17 -1 EA
33 05 10 -520 LF
33 31 20 -520 LF
33 39 20 -1 EA
33 39 20 -11 VF
72 41 74 -2 EA
]0 00 00 -i EA
ITEM DESCRIPTION
3301.0002 Post-CCTV Inspeclion
3301.0101 Manhole Vacuum Testinc
3305.0112 Cnncrete Collar
3305.0109 Trench Safety
3331.4115 8" Sewer Pipe
3339.1001 4' Manhole
3339.1003 4' Exira Depth Manhole
02472103 8" Sewer Plug
9999.0002 Core Drill �o Ex. Manhole
55,600
52.100
TOTAL
-� 1.5f 0.00
-� 150.00
-5500.00
-5520.00
-538.480.00
-$5,600.00
-$2,915.00
-5500.00
-$2,100.00
Rr.m�� n q -n�f.-,ry Sev e- ,+cop�� t�um pD Eost H;,�mon IPRC GFA to br; r.overe:� �.�ndF� IPRG�CFFl Ir.� /r�levrr JE i�rJepn;en! �IPI2C22-0756� GPN704347J.
NO CITY FUNDS INVOLVED IN THIS CONTRACT. DEVELOPER IS RESPONSIBIE FOR'100°/ OF THE CHANGE ORDER COSTAND NO
REIMBURSEMENT FROM THE CITY WILL 8E SOUGHT BY THE DEVELOPER.
RECOMMENDED: APPROVED: APPROVED:
iConsultinq Enpineer) (Develr;p���; (Connacto%I
�,
ey� _�> c t+.�� ; a ��d By ' ey
cn.vnoN S�ut4 6f ��� S��F cT+d � �.c-C.
Name: BENITO SOTO Name: -�� +viqs S�yqs�FEfL Name �Q
7i��e: PROJECT MANAGER 7i�le �p.NAC�E(L Title ��.6�JS(o �A�N1(��L
REVIEWED
By Sandip Adhikari at 9:51 pm, May 12, 2024
Revised: 10-12-20'I 1 Page 3
DEVELOPER-AWARDED-PROJECT CHANGE ORDER
PROJECT NAME: DD East Harmon CHANGE
CONTRACT: Water, Sewer, Pavin ,& Draina e ORDER No:
CFA # 22-0117 CITY PARTICIPATION: No
CITY PROJECT # 104099 Z
FID # 301140200431-104099-E07685
FILE # K-27345
INSPECTOR: Dennis Rodgers Phone No: 817-471-4781
PROJECT MANAGER: Sandip Adhikari Phone No: 517-392-8424
CONTRACT UNIT
WATER SEWER PAVING DRAINAGE STREETLIGHTS CONTRACT
Developer Developer Developer Developer Develaper DAYS
Cost City Cost Cost City Cost Cost City Cost Cost City Cost Cost City Cost
ORIGINAL CONTRACT $65,754.00 $0.00 $52,325.00 $0.00 $128,853.04 $0.00 $16,073.00 $0.00 $0.00 $0.00 90
EXTRAS TO DATE $0.00
CREDITS TO DATE $52,325.00
CONTRACT TO DATE $65,754.00 $0.00 $0.00 $0.00 $128,853.04 $0.00 $16,073.00 $0.00 $0.00 $0.00 90
AMOUNT OF PROP. CHANGE ORDER ($53,000.00)
REVISED CONTRACT AMOUNT $12,750.00 $0.00 $0.00 $0.00 5128,853.04 $0.00 $16,073.00 $0.00 $0.00 $0.00 90
TOTAL REVISED CONTRACT AMOUNT
PER UNIT $12,754.00 $0.00 $128,853.04 $16,073.00 $0.00
REVISED COST SHARE Dev. Cost: $157,680.04 City Cost: $0.00
TOTAL REVISED CONTRACT $157,680.04
REVI EWED
By Sandip Adhikari at 11:10 pm, Nov 21, 2024
Revised:l0-12-2011 Page 1
REVI EWED
By Sandip Adhikari at 11:10 pm, Nov 21, 2024
Revised:l0-12-2011 Page 2
REASONS FOR CHANGE ORDER
Removing Water Meter installation from scope of DD East Harmon IPRC/CFA to be covered under future permit
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: APPROVED: APPROVED:
(Consulting Engineer) (Developer) (Contractor)
By�. �.i.:.+.,.�G L�'� --�� By: By:
Name: BEIVI70 Sf}�f'O Name: � f�c �'G Name: ��� � IfF�F F��2—
Tfue. p�QJECiijAE1NAGE�i Title: ��}.��ro��1 Title: 1`�Vtip,x�C1h�7 N1E'i�1C��fL
REVI EWED
By Sandip Adhikari at 11:10 pm, Nov 21, 2024
Revised:l0-12-2011 Page 3
FflRTWORTH
TRANSPORTATION AND PUBLIC WORKS
PIPE REPORT FOR:
PROJECT NAME: DD East Harmon Rd
CITY PROJECT NUMBER: 104099
PIPE LAID SIZE
Open cut 8"
FIRE HYDRANTS: N/A
PIPE ABANDONED
DENSITIES:
NEW SERVICES:
SIZE
WATER
TYPE OF PIPE
G900
VALVES (16" OR LARGER)
TYPE OF PIPE
Taken Passed
LF
N/A
LF
8
SEWER
PIPE LAID SIZE TYPE OF PIPE LF
PIPE ABANDONED
DENSITIES:
NEW SERVICES:
SIZE TYPE OF PIPE
LF
TR�NSPORT:�TION 1�ND PUBLIC `��ORI�S
The City- of Fort ��'orth • 1000 Thxockmarton Stxeet • Fort ��'orth, T� 76012-6311
(817) 392 - 7941 • Fax: (817) 392 - 7845
��������x�
TRANSPORTATION AND PUBLIC WORKS
January 22, 2025
Schaffer Construction
4101 Dallas, TX. 75204
(214) 888-6923
RE: Acceptance Letter
Project Name: DD East Harmon
Project Type: Water, Sewer, Drainage, Paving
City Project No.: 104099
To Whom It May Concern:
On January 22, 2025 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 January 23, 2025. 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 January 23, 2025, 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 Adhikari , Project Manager
Cc: Steven Johnson, Inspector
Donald Watson, Inspection Supervisor
Aaron Ybarra, Senior Inspector
Adndrew Goodman , Program Manager
Burgess & Niple, Consultant
Schaffer Construcstion, Contractor
DD Harmon LLC, Developer
File
E-Mail: TPW_Acceptance@fortworthtexas.gov
Rev. 8/20/19
AFFIDAVIT
STATE OF
COUNTY OF
Before me, the undersigned authority, a notary public in the state
and county aforesaid, on this day personally appeared Thomas J.
Schaffer, Manager of Harmon Squared SEI, LLC, known to me to be a
credible person, who being by me duly sworn, upon his oath deposed
and said;
That all persons, finns, associations, corporations, or other
organizations furnishing labor and�'or materials have been paid in full;
That the wage scale established by the City Council in the City of
Fort Worth has been paid in full;
That there are no claims pending for personal injury and/or
property damages;
On Contract described as;
CPN #104099
DD Harcnon East
BY PN � �-�t
--------------- --- ----�-----�-------------------------------
Na�ne or Title
Subscribed and sworn before me on this date Day of Month, Year.
� ��—
Notaiy Public
County, State
Col��-(�J ,"TK.
���1yp��i GINA GRE51K
��.10'R... ;�p ��i
=_:•' �: Notary Public, State of Texas
;"'�:���= Comm. Expires 01-17-2029
� •....� +:
'�,,,�. oF f�``.
.,,,,,,�� Notary ID 130966249
4912522
BOND #:
CONSENT OF SURETY OWNER ❑
TO FINAL PAYMENT ARCHITECT o
CONTRACTOR ❑
AIA Document G707 sURETT' 0
(instructions on reverse side) OTHER 0
TO OWNER: ARCHITECT'S PROJECT NO.:
� me ond uddr esa�)
Harmon Squared SEI LLC
PO Box 2431 CONTRACT FOR: Clt)I Of FOft WOlth
Frisco, TX 75034 CFA# CFA22-0117 at 1000 E. Harmon, Fort Worth, TX
PROJECT:
(Name and adAressJ
7-Eleven Harmon
1000 E. Harmon
Fort Worth, Texas
CONTRACT DATED: FBb�Ue�y 23, 2024
In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the
(insert name and address of Surety)
Great American Insurance Company
PO Box 2119
Cincinnati, OH 45202
on bond of
Qnsei 1 mm�r and addre.cs njCnnt�nc/or)
Schaffer Construction LLC
5700 Granite Parkway, Ste. 940
Plano, TX 75034
, SURETY,
,CONTRACTOR,
hereby approves of the final payment to the Contractor, and agrees that fna] payment to the Contractor shall not relieve the Surety of
any of its obligations to
(/n,rerl name and addre.rs af (hw�er)
Harmon Squared SEI LLC
PO Box 2431
Frisco, TX 75034
as set forth in said Surety's bond,
IN WITNESS WHEREOF, the Surety has hereunto set its hand on this date: February 4, 2025
(lnser� in wriling !he man�h Jbllowed by �he numeric da�e and yearJ
Great American Insurance Company
, OWNER,
j.tiurrry• LJ
� c (Signofureojaufhmizedrepresenfafive)
Attest:
(sea�): Colleen C. Coleman, Attorney-In-Fact
(Pri�ued nanie und li11eJ
CAUTION: You should sign an original AIA document that has this caution printed in red. An
� ■ original assures that changes will not be obscured as may occur when documents are reproduced.
See Instruction Sheet for Limited License for Reproduction of this document.
AIA DOCUMENT G707 - CONSENT OF SURF,TY TO FINAL PAYMENT- 1994 EDITfON - AfA Pagc I of 2
1994 - TIiF. AMF.RTCAN TNSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, NW, WASFt-
INGTON, D C 20006-5292 - WARNING: Unlicensed photucopying violates U.S. copy- G707-� 994
right laws and will suhject the vialator to legal prosecution.
aiafp
INSTRUCTION SHEET
FOR AIA DOCUMENT G707, CONSENT OF SURETY TO FINAL PAYMENT
A. GENERAL INFORMATION
7. Purpose
This document is intended for use as a companion to AIA Document G70b, Contractor's Affidavit of Payment of Debts and
Claims, on construction projccts whcrc thc Contractor is rcquired to fumish a bond. By obtaining the Surety's approval of final
payment to the Contractor and its agreement that final payment will not relieve the Surety of any of its obligations, the Owner
may preserve its rights under the bond.
2. Related Documents
This documcnt may bc used with most of thc AIA's Owncr-Contractor agrccmcnts and gcncral conditions, such as A201 and its
related family of documents. As noted above, this is a companion document to AIA Document G706.
3. Use of Current Documents
Prior to using any AIA document, the user should consult the AIA, an AIA component chapter or a current AIA Documents List to
determine the current edition of each document.
4. Limited License for Reproduction
AIA Document G707 is a copyrighted work and may not be reproduced or excerpted from in substantial part without the express
written permission of the AIA. The G707 doctunent is intended to be used as a consumable-that is, the original document pur-
chased by the user is intended to be consumed in the course of being used. There is no implied permission to reproduce this
document, nor does membership in The American Institu[e of Architects confer any further rights to reproduce G707.
A cautionary notice is printed in red on the original of this document. This notice distinguishes an original AIA document from
copies and counterfeits. To ensure accuracy and uniformity of language, purchasers should use only an original AiA document or
one that has been reproduced from an original under a special limited license from the AIA.
A limited license is hereby granted to retail purchasers to reproduce a maximum of ten copies of a completed or executed G707, but
only for use in connection with a particular project. Further reproducfions aze prohibited without the express permission of the AIA.
B. CHANGES FROM THE PREVIOUS EDITION
Changes in thc location of various items of information werc made, without revision to the substance of thc documcnt.
C. COMPLETING THE G707 FORM
GENERAL: The bond form is the usual source of required information such as the contract date and the names and addresses of the
Surety, Owner, Contractor and Project.
ARCHITECT'S PRO]ECT NO.: this information is typicaily supplied by thc Architect and entered on [he forn� by the Contractor.
CONTRACT FOR: This refers to the scope of the contract, such as "General Construction" or "Mechanical Work".
D. EXECUTION OF THE DOCUMENT
The G707 form requires both the Surety's seal and the signature of the Surety's authorized representative.
4194
INSTRUCTION SHEET FOR AIA DOCUMENT G707 -CONSENT OF SURETY TO F[NAL PAYMENT � 1994 Pagc 2 of 2
EDiTIONCAIA�UGTHE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W.,
WASHINGTON, D.C. 20006-5292 aiafp G707-1994
GREAT AMERICAN INSURANCE COMPANY�
Administrative Office: 301 E 4TH STREET � GlNCINNATi, OHIO 45202 • 513-369-5000 • FAX 513-723-2740
The number of persons authorized by
this power of attomey is not more than Six
No.O 21864
POWER OR ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That the GREATAMERICAN INSURANCE COMPANY, a corporation organized and existing under
and by virtue of the laws of the State of Ohio, does hereby nominate, constitute and appoint [he person or persons named below, each individually if more than
one is named, its true and lawful attorney-in-fact, for it and in iis name, place and s[ead to execute on behalf of the said Company, as surety, any and all bonds,
undertakings and contracts of suretyship, or other written obligations in the nature thereof; provided that the liability of the said Company on any such bond,
undertaking or contract of suretyship executed under this authority shall not exceed the limit stated below.
Jim Beam
Colleen C. Coleman
Alyson Dominguez
Barbara Eden
Rhonda Hoopingamer
Chris Manroe
Name
Address
All of
Arlington, Texas
Limit of Power
All
$100,000,000
This Power ofAttomey revokes all previous powers issued on behalfofthe attomey(s)-in-fact named above.
1N WIT'NESS WHEREOF the GREAT AMERICAN INSURANCE COMPANY has caused these presents to be sigied and attested by its appropriate
officers and its corporate seal hereunto affixed this 14th day of July 2021
Attest fiiR1:ATAivl�ftlC'Ai�! IPlSU�A�'Cl: [:UMPAhiY
���,.�:�'� � _ � � , � �] � ,
'S:'E�'s�: � .. � �. � . � ��iafrG[�
, .�j''�-.—� �
Assislant Secrelary Divisional Senior �ce Pmsidenl
STATE OF OHIO, COUNTY OF HAMILTON - SS: MARK VICARIO (877-377-2405)
On this 14th day of July , 2021 , before me personally appeazed MARK VICARIO, to me known,
being duly swom, deposes and says that he resides in Cincinnati, Ohio, that he is a Divisional Senior Vice President of the Bond Division of Great American
Insurance Company, the Company described in and which execuied the above instrument; ffiat he knows the seal of Ihe said Company; that the seal affixed to the
said instrument is such corporate seal; that it was so affixed by authority of his office under the By-Laws of said Company, and that he signed his name thereto
by like authority.
e`1�„ r, SUSAN A KOHOfiST
_�.•�; NoWry PubNc
,,� $latE 010F1�0
�'��ti . �°' My Comm. Explres
May 18, 2025
S'� C1/l�-� L�' "L 'r`t �� �(,�}.{ �I"
This Power ofAttorney is granted by authority ofthe following resotutions adopted by the Board of Directors of Great American Insurance Company
by unanimous written consent dated June 9, 2008.
RESOLVED: That 1he Divisianal Pre,sident, !he several Divisionaf Senior �ce Presidents, Divisiona! Vice Presidents and DivisonalA.ssistant Vice
Pre.sidenl,s, or any one of them, be and hereby is aulhor•ized, from time to time, to appoinf one or more Aflorneys-in-Fact fo execule on behalf of the Company,
as s•urety, any and al! bonds, undertaking,s and conlracts ofsuretyshrp, or other wri�len obligalionr in Ihe nature ther•eof,• lo pr•escribe their respeclive dutie.s and
the re.speclive limils of their authority; and to revoke any such ap�oin[rnent at any time.
RESOLVED FURTNER: Thal 1he Company sea! and the signature of any of !he aforesaid officers and arry Secrelary or Assistant Secrelary of the
Company may be afJ�zxed by facsimile �o any pou�er of altarney or cert�cate of either given for fhe execurion of any boncl, uncfertaking, confracl of suretyship,
or other wrilten ob[igafion in the na�ure lhereof, such signature and seaf when so used being hereby adopted by Ihe Company as the original signalure of.such
affrcer and 1he original seal of �he Company, lo be valid and brnding upon the Contpany ivith 7he same force and effec� as �hough manually a�xed.
CERTIFICATION
I, STEPHEN C. BERAHA, Assistant Secretary of GreatAmerican Insurance Company, do hereby certify that the foregoing Power of Attomey and
the Resolutions of the Boazd of Directors of June 9, 2008 have not been revoked and are now in full force and effect.
Signed and sealed this 4th day of February, Z�ZrJ
��,ya... �
�
- r =�fi�
�ti�;� �
. ��. �- �. ��
Assislanf Secrelary
51029AH (03/20)
GREAT�l:RICAN.
INSURANCEGROUP
IMPORTANT NOTICE:
Great American Alliance Insurance Company
Great American Insurance Company
To obtain information or make a complaint:
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 at:
P.O. Box 149104
Austin, TX 78714-9091
FAX: 1-512-490-1007
Your notice of claim against the attached bond may be given to the surety company that
issued the bond by sending it by certified or registered mail to the following address:
Mailing Address:
Physical Address:
Great American Insurance Company
P.O. Box 2119
Cincinnati, Ohio 45202
Great American Insurance Company
301 E. Fourth Street
Cincinnati, Ohio 45202
You may also contact the Great American Insurance Company Claim office by:
Fax:
Telephone:
Email:
1-888-290-3706
1-513-369-5091
BondClaims@GAIG.COM
PREMIUM OR CLAIM DISPUTES:
If you have a dispute concerning a premium, you should contact the agent first. If you
have a dispute concerning a claim, you should contact the company first. If the dispute is
not resolved, you may contact the Texas Department of Insurance.
ATTACH THIS NOTICE TO YOUR BOND:
This notice is for information only and does not become a part or condition of the attached
document.
F.9667A (10/22)