HomeMy WebLinkAboutContract 57853-FP1City Secretary -FP1
Contract No. 57853
FORT WORTH
Date Received 3/26/2025
AT
NOTICE OF PROJECT COMPLETION
(Developer Projects)
The Transportation and Public Works Department upon the recommendation of the Project
Manager has accepted the following project as complete:
Project Name: Heritage Trace Parkway Logistics Park
City Project No.: 103620
Improvement Type(s): 0 Paving 0 Drainage N Street Lights ❑ Traffic Signals
Original Contract Price:
Amount of Approved Change Order(s)
Revised Contract Amount:
ITota I Cost of Work Complete
Kvle wSmt-fh
Kvle Vd Smith (Mar 24. 2025 09:32 CDT)
Contractor
Project Manager
Title
The Ridgemont Company
Company Name
Hector Montova arV4. 202515:33 CDT)
Project Inspector
Project Manager
Kandice Merrick 26, 2025 08:51 CDT)
CF��DA Manager
/%14....... %..war...
Lauren Prieur (Mar 26. 2025 08:53 CDT)
TPW Director
Asst. City Manager
$3,220,890.98
$214,237.68
$3,435,128.66
$3,435,128.66
M a r 24, 2025
Date
M a r 24, 2025
Date
M a r 26, 2025
Date
Mar 26, 2025
Date
Mar 26, 2025
Date
Mar 27, 2025
Date
OFFICIAL RECORD
CITY SECRETARY Page 1 of 2
FT. WORTH, TX
Notice of Project Completion
Project Name: Heritage Trace Parkway Logistics Park
City Project No.: 103620
City's Attachments
Final Pay Estimate x❑
Change Order(s): ❑x Yes ❑ N/A
Contractor's Attachments
Affidavit of Bills Paid
Consent of Surety
Statement of Contract Time
Contract Time 360 WD Days Charged: 427 WD
Work Start Date: 10/12/2022 Work Complete Date: 12/13/2024
Completed number of Soil Lab Test: 1,357
Completed number of Water Test: 18
Page 2of2
FoRTWORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name HERITAGE TRACE PARKWAY
Contract Limits
Project Type DRAINAGE, PAVING, LIGHTS
City Project Numbers 103620
DOE Number 3620
Estimate Number 1 Payment Number 1
City Secretary Contract Number
Contract Date 7/21/2022
For Period Ending 12/13/2024
WD
Contract Time 36WD
Days Charged to Date 427
Project Manager NA
Contractor RIDGEMONT COMPANY
1520 W. WALNUT HILL LANE
IRVING, TX 75038
Inspectors G.DEYON / H.MONTOYA
Contract is 100.00 Complete
Friday, March 21, 2025 Page 1 of 6
City Project Numbers 103620 DOE Number 3620
Contract Name HERITAGE TRACE PARKWAY Estimate Number I
Contract Limits Payment Number 1
Project Type DRAINAGE, PAVING, LIGHTS For Period Ending 12/13/2024
Project Funding
UNIT III: DRAINAGE IMPROVEMENTS
Item
Description of Items
Estimated Unit
Unit Cost
Estimated
Completed
Completed
No.
Quanity
Total
Quanity
Total
1
MEDIUM STONE RIPRAP, DRY
1178 SY
$65.00
$76,570.00
1178
$76,570.00
2
TRENCH SAFETY
1020 LF
$0.50
$510.00
1020
$510.00
3
CONCRETRE COLLAR
1 EA
$1,250.00
$1,250.00
1
$1,250.00
4
4' MANHOLE
7 EA
$5,200.00
$36,400.00
7
$36,400.00
5
4' EXTRA DEPTH MANHOLE
20 VF
$295.00
$5,900.00
20
$5,900.00
6
2 1 " RCP CLASS III
424 LF
$64.00
$27,136.00
424
$27,136.00
7
24" RCP CLASS lII
95 LF
$73.00
$6,935.00
95
$6,935.00
8
30" RCP CLASS lII
1960 LF
$89.00
$174,440.00
1960
$174,440.00
9
36" RCP CLASS lII
325 LF
$114.00
$37,050.00
325
$37,050.00
10
1OX6 BOX CULVERT
600 LF
$671.25
$402,750.00
600
$402,750.00
11
4' MANHOLE RISER
2 EA
$5,502.00
$11,004.00
2
$11,004.00
12
HEADWALL BOX CULVERT
260 CY
$800.00
$208,000.00
260
$208,000.00
13
24" PARALLEL HEADWALL 1 PIPE
2 EA
$2,789.00
$5,578.00
2
$5,578.00
14
10' CURB INLET
3 EA
$3,690.00
$11,070.00
3
$11,070.00
15
20' CURB INLET
2 EA
$8,294.00
$16,588.00
2
$16,588.00
Sub -Total of Previous Unit $1,021,181.00 $1,021,181.00
--------------------------
UNIT IV: PAVING IMPROVEMENTS
Item
Description of Items
Estimated Unit
Unit Cost
Estimated
Completed
Completed
No.
Quanity
Total
Quanity
Total
1
MOBILIZATION
1 LS
$10,000.00
$10,000.00
1
$10,000.00
2
CONSTRUCTION STAKING
1 LS
$5,000.00
$5,000.00
1
$5,000.00
3
REMOVE ASPHALT PVMT
32 SY
$15.00
$480.00
32
$480.00
4
REMOVE ASPHALT CURB & GUTTER
191 LF
$15.00
$2,865.00
191
$2,865.00
5
SITE CLEARING
1 LS
$5,794.13
$5,794.13
1
$5,794.13
6
UNCLASSIFIED EXCAVATION BY PLAN
20425 CY
$7.95
$162,378.75
20425
$162,378.75
7
SWPPP 1 ACRE
1 LS
$20,542.50
$20,542.50
1
$20,542.50
8
HYDRATED LIME (CO 1)
288 TN
$243.00
$69,984.00
288
$69,984.00
9
6" LIME TREATMENT (CO 3)
683 SY
$14.00
$9,562.00
683
$9,562.00
10
2" ASPHALT PVMT TYPE D (CO 1 & 4)
447 SY
$5.50
$2,458.50
447
$2,458.50
11
4" ASPHALT BASE TYPE B (CO 1 & 4)
447 SY
$7.50
$3,352.50
447
$3,352.50
Friday, March 21, 2025
Page 2
of 6
City Project Numbers 103620
Contract Name HERITAGE TRACE PARKWAY
Contract Limits
Project Type DRAINAGE, PAVING, LIGHTS
Project Funding
DOE Number 3620
Estimate Number 1
Payment Number 1
For Period Ending 12/13/2024
12 7" CONC PVMT (CO 3)
699 SY
$91.00
$63,609.00
699
$63,609.00
13 9" CONC PVMT (CO 1 & 3 & 4)
11770 SY
$95.00
118,150.00
11770
1,118,150.00
14 4" CONC SIDEWALK (CO 1 & 3 & 4)
22356 SF
$6.50
$145,314.00
22356
$145,314.00
15 BARRIER FREE RAMP, TYPE P-1 (CO 1 & 3 & 4)
12 EA
$2,817.00
$33,804.00
12
$33,804.00
16 6" CONC CURB AND GUTTER (CO 1 & 4)
245 LF
$1.75
$428.75
245
$428.75
17 4" SLD PVMT MARKING HAS (W) (CO 4)
575 LF
$2.00
$1,150.00
575
$1,150.00
18 4" SLD PVMT MARKING HAS (Y) (CO 3 & 4)
3950 LF
$2.00
$7,900.00
3950
$7,900.00
19 4" BRK PVMT MARKIN GHAS (W) (CO 4)
158 LF
$2.83
$447.14
158
$447.14
20 12" SLD PVMT MARKING HAE (W) (CO 4)
190 LF
$11.64
$2,211.60
190
$2,211.60
21 24" SLD PVMT MARKING HAE (W) (CO 4)
93 LF
$16.15
$1,501.95
93
$1,501.95
22 LANE LEGEND ARROW (CO 4)
2 EA
$295.00
$590.00
2
$590.00
23 LANE LEGEND ONLY (CO 4)
1 EA
$350.00
$350.00
1
$350.00
24 REFL RAISED MARKER TY H-A-A
196 EA
$5.00
$980.00
196
$980.00
25 TOPSOIL (CO 3)
1642 CY
$6.50
$10,673.00
1642
$10,673.00
26 BLOCK SOD PLACEMENT (CO 3 & 4)
9754 SY
$6.00
$58,524.00
9754
$58,524.00
27 SEEDING HYDROMULCH
1490 SY
$1.05
$1,564.50
1490
$1,564.50
28 SEEDING SOIL RETENTION BLANKET (CO 4)
1294 SY
$1.75
$2,264.50
1294
$2,264.50
29 INSTALL ALUM SIGN GROUND MOUNT
2 EA
$800.00
$1,600.00
2
$1,600.00
30 TRAFFIC CONTROL
12 MO
$12,000.00
$144,000.00
12
$144,000.00
31 8" CONC BASE MATERIAL
11009 SY
$19.59
$215,666.31
11009
$215,666.31
32 8" LIME TREATMENT (CO 1 & 3 & 4)
2149 SY
$19.59
$42,098.91
2149
$42,098.91
33 BARRIER FREE RAMP, TYPE M-1 (CO 1)
2 EA
$2,817.00
$5,634.00
2
$5,634.00
34 METAL BEAM GUARD FENCE (TL-3 MASH
69 LF
$61.00
$4,209.00
69
$4,209.00
COMPLIANT) (CO 2)
35 METAL BEAM GUARD FENCE LONG SPAN (TL-
100 LF
$61.00
$6,100.00
100
$6,100.00
3 MASH COMPLIANT) (CO 2)
36 PEDESTRIAN GUARDRAIL (TXDOT PRI1) (CO 2
230 LF
$192.00
$44,160.00
230
$44,160.00
& 4)
37 METAL BEAM FENCE DOWNSTREAM
1 EA
$2,975.00
$2,975.00
1
$2,975.00
ANCHOR TERMINAL (CO 2)
38 METAL BEAM GUARD FENCE TERMINAL
1 EA
$2,850.00
$2,850.00
1
$2,850.00
ANCHOR SECTION (CO 2)
39 4" BRK PVMT MARKING HAS (Y) (CO 4)
108 LF
$2.83
$305.64
108
$305.64
40 LANE LEGEND DBL ARROW (CO 4)
1 EA
$350.00
$350.00
1
$350.00
41 CONCRETE RETAINING WALL ADJACENT TO
280 SF
$13.00
$3,640.00
280
$3,640.00
SIDEWALK (CO 4)
Friday, March 21, 2025 Page 3 of 6
City Project Numbers 103620
Contract Name HERITAGE TRACE PARKWAY
Contract Limits
Project Type DRAINAGE, PAVING, LIGHTS
Project Funding
DOE Number 3620
Estimate Number 1
Payment Number 1
For Period Ending 12/13/2024
-------------
Sub -Total of Previous Unit
$2,215,468.68
$2,215,468.68
UNIT V: STREET LIGHTING IMPROVEMENTS
Item
Description of Items
Estimated Unit
Unit Cost
Estimated
Completed
Completed
No.
Quanity
Total
Quanity
Total
1
GROUND BOX TYPE B
15 EA
$324.56
$4,868.40
15
$4,868.40
2
INSTALL TYPE 25A ARM
28 EA
$981.55
$27,483.40
28
$27,483.40
3
FURNISH/INSTALL 240-480 VOLT SINGLE
1 EA
$6,725.96
$6,725.96
1
$6,725.96
PHASE TRANSOCKET METERED PEDESTAL
4
RDWY ILLUMASSMBLY TY 18, 18A, 19 AND
14 EA
$2,500.00
$35,000.00
14
$35,000.00
D40
5
RDWY ILLUM FOUNDATION TY 3,5,6, AND 8
14 EA
$248.79
$3,483.06
14
$3,483.06
6
FURNISH/INSTALL CONDUIT -SCHEDULE 80
2664 LF
$25.14
$66,972.96
2664
$66,972.96
PVC 2 INCH OPEN CUT
7
LED LIGHTING FIXTURE
28 EA
$1,915.90
$53,645.20
28
$53,645.20
8
INSTALL ALUM SIGN GROUND MOUNT
3 EA
$100.00
$300.00
3
$300.00
Sub -Total of Previous Unit
$198,478.98
$198,478.98
Friday, March 21, 2025 Page 4 of 6
City Project Numbers 103620
Contract Name HERITAGE TRACE PARKWAY
Contract Limits
Project Type DRAINAGE, PAVING, LIGHTS
Project Funding
Contract Information Summary
Original Contract Amount
Chanhe Orders
Change Order Number 1
Change Order Number 2
Change Order Number 3
Change Order Number 4
DOE Number 3620
Estimate Number 1
Payment Number 1
For Period Ending 12/13/2024
$3,220,890.98
$21,853.89
$52,614.00
$83,461.42
$56,308.37
Total Contract Price $3,435,128.66
Total Cost of Work Completed $3,435,128.66
Less % Retained $0.00
Net Earned $3,435,128.66
Earned This Period $3,435,128.66
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
$3,435,128.66
Friday, March 21, 2025 Page 5 of 6
City Project Numbers 103620
Contract Name HERITAGE TRACE PARKWAY
Contract Limits
Project Type DRAINAGE, PAVING, LIGHTS
Project Funding
Project Manager NA
Inspectors G.DEYON / H.MONTOYA
Contractor RIDGEMONT COMPANY
1520 W. WALNUT HILL LANE
IRVING, TX 75038
DOE Number 3620
Estimate Number 1
Payment Number 1
For Period Ending 12/13/2024
City Secretary Contract Number
Contract Date
7/21/2022
Contract Time
360 WD
Days Charged to Date
427 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 $3,435,128.66
Less % Retained $0.00
Net Earned $3,435,128.66
Earned This Period $3,435,128.66
Retainage This Period $0.00
Less Liquidated Damages
0 Days @ $0.00 / Day
$0.00
LessPavement Deficiency
$0.00
Less Penalty
$0.00
Less Previous Payment
$0.00
Plus Material on Hand Less 15%
$0.00
Balance Due This Payment
$3,435,128.66
Friday, March 21, 2025 Page 6 of 6
DocuSign Envelope ID: DFF1414D-7A30-4CD2-80B3-AE9C5E73B7C1
REVIEWED
By Andrew Goodman at 1:54 pm, Oct 27, 2022
DEVELOPER -AWARDED -PROJECT CHANGE ORDER
PROJECT NAME:
Heritage Trace Parkway
CHANGE
CONTRACT:
(A) Water, (B) Sewer, (C) Paving, (D) Drainage, (E) Street Lighting
ORDER No:
CFA #
22-0015
CITY PARTICIPATION: I
No
CITY PROJECT #
103620
DOE #
1
WATER PROJECT #
X-27133
SEWER PROJECT #
X-27133
FILE #
K-2876
INSPECTOR:
James Ruiz
Phone No:
817-205-1256
PROJECT MANAGER:
Andrew Goodman
Phone No:
817-392-6251
CONTRACT UNIT
WATER
I SEWER
I PAVING
I DRAINAGE
STREET LIGHTS
Leveloper
I CONTRACT
Developer
beveloper
(Cost
DAYS
Cost
City Cost
City Cost
Developer Cost
City Cost
Developer Cost
City Cost
Cost
City Cost
ORIGINAL CONTRACT
$444,145.40
I $676,604.00
$2,001,231.00 I
I $1,021,181.00 I
I $197,478.98
360
EXTRAS TO DATE
I
I
I I
I
0
CREDITS TO DATE
I
I
I I
I
0
CONTRACT TO DATE
$444,145.40
$0.00
I $676,604.00
$0.00
$2,001,231.00 I $0.00
I $1,021,181.00 I
$0.00
I $198,478.98
$0.00
360
AMOUNT OF PROP. CHANGE ORDER
$0.00
I $0.00
$21,853.89 I
I $0.00 I
I $0.00
0
REVISED CONTRACT AMOUNT
$444,145.40
$0.00
I $676,604.00
$0.00
$2,023,084.89 I $0.00
I $1,021,181.00 I
$0.00
I $198,478.98
$0.00
360
TOTAL REVISED CONTRACT AMOUNT
PER UNIT
$444,145.40
$676,604.00
$2,023,084.89
$1,021,181.00
$198,478.98
REVISED COST SHARE
Dev. Cost:
$4,363,494.27
City Cost:
$0.00
TOTAL REVISED CONTRACT
$4,363,494.27
Revised: 10-12-2011 Page 1
DocuSign Envelope ID: DFF1414D-7A30-4CD2-80B3-AE9C5E73B7C1
REVIEWED
By Andrew Goodman at 1:54 pm, Oct 27, 2022
You are directed to make the following changes in the contract docurrents
CITY BID ITEM
PAY ITEM #
#
QUANTITY
8
3211.0400
272
10
3212.0302
-22
11
3212.0501
-22
13
3213.0104
-459
14
3213.0301
-1693
15
3213.0506
-2
16
3216.0101
-4782
32
3211.0502
971
33
3213.0503
2
REASONS FOR CHANGE ORDER
UNIT
ITEM DESCRIPTION
UNIT PRICE
TOTAL
TN
Hydrated Lime
$243.00
$66,096.00
SY
2" Asphalt Pavement Type D
$5.50
-$121.00
SY
4" Asphalt Base Type B
$7.50
-$165.00
SY
9" Concrete Pavement
$95.00
-$43,605.00
SF
4" Concrete Sidewalk
$6.50
-$11,004.50
EA
Barrier Free Ramp, Type P-1
$2,817.00
-$5,634.00
LF
6" Concrete Curb and Gutter
$1.75
-$8,368.50
SY
8" Lime Treatment (8" Thick Clay Subgrade with 6" Hydrated Lime)
$19.59
$19,021.89
EA
Barrier Free Ramp, Type M-1
$2,817.00
$5,634.00
TOTAL
$21,853.89
New configuration for connection to Blue Mound Rd, shifts in median locations, pavement marking and street signs.
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: Please see attached signature page APPROVED:
By: Halff Associates
Name: Cody Hodge
Title: Land Development Team Leader
By: CRP/CHI Heritage Trace Owner, L.P
Name: John B. Cooper
Title: Vice President
By: Ridqemont Commercial
Name: Paul Camp
Title: Vice President of Operations/Principal
Revised: 10-12-2011 Page 2
DocuSign Envelope ID: DFF1414D-7A30-4CD2-80B3-AE9C5E73B7C1
REVIEWED
SIGNATURE PAGE TO CITY OF FORT WORTH By Andrew Goodman at 1:54 pm, Oct 27, 2022
COMMUNITY FACILITIES AGREEMENT
DEVELOPER AWARDED PROJECT CHANGE ORDER NO: 1
PROJECT NAME: HERITAGE TRACE PARKWAY
CIA #: 22-0015
CITY PROJECT #: 103620
CRP/CHI HERITAGE TRACE OWNER, L.P.,
a Delaware limited partnership
By: CRP/CHI HERITAGE TRACE GP, L.L.C.,
a Delaware limited liability company,
its general partner
By: CRP/CHI HERITAGE TRACE VENTURE, L.L.C.,
a Delaware limited liability company,
its sole member
By: CHI NORTH TEXAS 110 HERITAGE TRACE, L.P.,
a Delaware limited partnership,
its administrative member
By: CHI DEVELOPMENT GP, L.L.C.,
a Delaware limited liability company,
its general partner
By: ,66 6. (166f '
Name: John B. Cooper
Title: Vice President
Date: 1012 512022
REVIEWED
By Andrew Goodman at 8:49 —, Apr 19, 2023
DEVELOPER -AWARDED -PROJECT CHANGE ORDER
PROJECT NAME:
Heritage Trace Parkway
CHANGE
CONTRACT:
(A) Water, (B) Sewer, (C) Paving, (D) Drainage, (E) Street Lighting
ORDER No:
CFA #
22-0015
CITY PARTICIPATION: I
No
CITY PROJECT #
103620
DOE #
2
WATER PROJECT #
X-27133
SEWER PROJECT #
X-27133
FILE #
K-2876
INSPECTOR:
James Ruiz
Phone No:
817-205-1256
PROJECT MANAGER:
Andrew Goodman
Phone No:
817-392-6251
CONTRACT UNIT
WATER
I SEWER
I PAVING
I DRAINAGE
STREET LIGHTS
Leveloper
I CONTRACT
Developer
beveloper
(Cost
DAYS
Cost
City Cost
City Cost
Developer Cost
City Cost
Developer Cost
City Cost
Cost
City Cost
ORIGINAL CONTRACT
$444,145.40
I $676,604.00
$2,001,231.00 I
I $1,021,181.00 I
I $197,478.98
360
EXTRAS TO DATE
I
$21,853.89 I
I I
I
0
CREDITS TO DATE
I
I
I I
I
0
CONTRACT TO DATE
$444,145.40
$0.00
I $676,604.00
$0.00
$2,023,084.89 I $0.00
I $1,021,181.00 I
$0.00
I $198,478.98
$0.00
360
AMOUNT OF PROP. CHANGE ORDER
$0.00
I $0.00
$52,614.00 I
I $0.00 I
I $0.00
0
REVISED CONTRACT AMOUNT
$444,145.40
$0.00
I $676,604.00
$0.00
$2,075,698.89 I $0.00
I $1,021,181.00 I
$0.00
I $198,478.98
$0.00
360
TOTAL REVISED CONTRACT AMOUNT
PER UNIT
$444,145.40
$676,604.00
$2,075,698.89
$1,021,181.00
$198,478.98
REVISED COST SHARE
Dev. Cost:
$4,416,108.27
City Cost:
$0.00
TOTAL REVISED CONTRACT
$4,416,108.27
Revised: 10-12-2011 Page 1
REVIEWED
lBy Andrew Goodman at 8:49 am, Apr 19, 2023 J
You are directed to make the following changes in the contract documents
Unit 4 - Paving Improvements
CITY BID ITEM
PAY ITEM #
#
QUANTITY
UNIT
ITEM DESCRIPTION
UNIT PRICE
TOTAL
32
9999.0200
69
LF
Metal Beam Guard Fence (TL-3 Mash Compliant)
$61.00
$4,209.00
33
9999.0300
100
LF
Metal Beam Guard Fence Long Span (TL-3 Mash Compliant)
$61.00
$6,100.00
34
9999.0400
190
LF
Pedestrian Guradrail (TxDOT PR11)
$192.00
$36,480.00
35
9999.0500
1
EA
Metal Beam Guard Fence Downstream Anchor Terminal (TL-3 Mash Compliant)
$2,975.00
$2,975.00
36
9999.0600
1
EA
Metal Beam Guard Fence Terminal Anchor Section
$2,850.00
$2,850.00
TOTAL
$52,614.00
REASONS FOR CHANGE ORDER Change order required to reconcile revisions done to plans. These revisions consisted of pedestrian and vehicle guardrail additons at the proposed culvert crossing
near the intersection at Blue Mound Road.
NO CITY FUNDS INVOLVED IN THIS CONTRACT. DEVELOPER IS RESPONSIBLE FOR 100% OF THE CHANGE ORDER COST AND NO
REIMBURSEMENT FROM THE CITYWILLBE SOUGHT BY THE DEVELOPER.
RECOMMENDED: ��. *� APPROVED: Please see attached siqnature page APPROVED:
By: Halff Associates
Name: Cody Hodqe
Title: Land Development Team Leader
By: CRP/CHI Heritaqe Trace Owner, L.P
Name: John B. Cooper
Title: Vice President
By: Ridqemont Commercial
Name: Paul Camp
Title: Vice President of Operations/Principal
Revised: 10-12-2011 Page 2
DocuSign Envelope ID: 42874960-C2D8-4E3B-A99C-OA03E26041A3
REVIEWED
By Aad—Goodman at 8:49 am, Apr 19, 2023 J
SIGNATURE PAGE TO CITY OF FORT WORTH
COMMUNITY FACILITIES AGREEMENT
DEVELOPER AWARDED PROJECT CHANGE ORDER NO: 2
PROJECT NAME: HERITAGE TRACE PARKWAY
CFA #: 22-0015
CITY PROJECT #: 103620
CRP/CHI HERITAGE TRACE OWNER, L.P.,
a Delaware limited partnership
By: CRP/CHI HERITAGE TRACE GP, L.L.C.,
a Delaware limited liability company,
its general partner
By: CRP/CHI HERITAGE TRACE VENTURE, L.L.C.,
a Delaware limited liability company,
its sole member
By: CHI NORTH TEXAS 110 HERITAGE TRACE, L.P.,
a Delaware limited partnership,
its administrative member
By: CHI DEVELOPMENT GP, L.L.C.,
a Delaware limited liability company,
its general partner
By: ,66 6. (166f '
Name: John B. Cooper
Title: Vice President
Date: 3/29/2023
DocuSign Envelope ID: FD735165-C352-4C97-9E3F-5BD58C62B98E
PROJECT NAME:
CONTRACT:
CFA #
CITY PROJECT #
DOE #
WATER PROJECT #
SEWER PROJECT #
FILE #
INSPECTOR:
PROJECT MANAGER:
DEVELOPER -AWARDED -PROJECT CHANGE ORDER
Heritage Trace Parkway
CHANGE
(A) Water, (B) Sewer, (C) Paving,
(D) Drainage, (E) Street Lighting ORDER No:
22-0015 I
CITY PARTICIPATION] No
103620
3
X-27133
X-27133
K-2876
James Ruiz
Phone No: 817-205-1256
Andrew Goodman
Phone No: 817-392-6251
WATER
Developer
Cost
City Cost
ORIGINAL CONTRACT
$444,145.40
EXTRAS TO DATE
CREDITS TO DATE
CONTRACT TO DATE
$444,145.40
$0.00
AMOUNT OF PROP. CHANGE ORDER
$0.00
REVISED CONTRACT AMOUNT
$444,145.40
$0.00
TOTAL REVISED CONTRACT AMOUNT
PER UNIT
$444,145.40
REVISED COST SHARE
Dev. Cost:
TOTAL REVISED CONTRACT
SEWER
Developer
Cost City Cost
$676,604.00
$676,604.00 $0.00
$0.00
$676,604.00 $0.00
$676,604.00
$4,499,569.69
CONTRACT UNIT
PAVING
Developer Cost City Cost
$2,001,231.00
$74,467.89
$2,075,698.89 $0.00
$83,461.42
$2,159,160.31 $0.00
$2,159,160.31
City Cost:
$4,499,569.69
REVIEWED
By Andrew Goodman at 1:48 pm, Oct 27, 2023
DRAINAGE
STREET LIGHTS
CONTRACT
Developer
DAYS
Developer Cost City Cost
Cost City Cost
$1,021,181.00
$197,478.98
360
0
0
$1,021,181.00 $0.00
$198,478.98 $0.00
360
$0.00
$0.00
0
$1,021,181.00 $0.00
$198,478.98 $0.00
360
$1,021,181.00
$198,478.98
$0.00
Revised: 10-12-2011 Page 1
DocuSign Envelope ID: FD735165-C352-4C97-9E3F-5BD58C62B98E
REVIEWED
By Andrew Goodman at 1:48 pm, Oct 27, 2023
You are directed to make the following changes in the contract documents:
Unit 4 - Paving Improvements
CITY BID ITEM
PAY ITEM #
#
QUANTITY
UNIT
ITEM DESCRIPTION
UNIT PRICE
TOTAL
I 9
3211.0501
-197.00
SY
6' Lime Treatment$14.00
I
8.00
I 12
3213.0102
-181.00
SY
7" Concrete Pavement
I $91 m
$16.4 00
I 13
3213.0104
897.00
SY
9" Concrete Pavement
$91.00
I b95.00
$85,2 5,
b85,215.00
I 14
3213.0301
-295
SF
4` Concrete Sidewalk
I b6.50
-b1,917.50
I 15
3213.0506
-2
EA
I
Barrier Free Ramp, Type P-1
1 b2,817bO
-b5,634.00
18
3217.0002
-34
LF
4' SLD Pvmt Marking HAS (Y)
$2.00
-b68.00
I 25
3291,0100
314
CY
Topsoil
I $6.50
$2,041.00
I 26
3292.0100
943
SY
Block Sod Placement
1 $6.00
$5,658.00
I 31
9999.0002
888
SY
8' Lime Treatment (8' Thick Clay Subgrade with 6" Hydrated Lime)
1 $19.59
$17,395.92
TOTAL
$83,461.42
REASONS FOR CHANGE ORDER
Change order required to reconcile revisions
done to plans. These revisions consisted of the addition of a cul-de-sac at the eastern end of Heritage
Trace
Parkway and the deletion of a driveway near
Station 21+50.
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: Please see attached signature page APPROVED:
By: Halff Associates
Name: Cody Hodge
Title: Land Development Team Leader
By: CRPICHI Heritage Trace Owner, L.P
Name: John B. Cooper
Title: Vice President
By: Ridqemont Commercial
Name: Paul Camp
Title: Vice President of OnerationwPrincival
Revised. 10-12-2011 Page 2
DocuSign Envelope ID: FD735165-C352-4C97-9E3F-5BD58C62B98E
SIGNATURE PAGE TO CITY OF FORT WORTH REVIEWED
l By Andrew Goodman at 1:48 pm, Oct 27, 2023
COMMUNITY FACILITIES AGREEMENT
DEVELOPER AWARDED PROJECT CHANGE ORDER NO: 3
PROJECT NAME: HERITAGE TRACE PARKWAY
CFA #: 22-0015
CITY PROJECT #: 103620
CRP/CHI HERITAGE TRACE OWNER, L.P.,
a Delaware limited partnership
By: CRP/CHI HERITAGE TRACE GP, L.L.C.,
a Delaware limited liability company,
its general partner
By: CRP/CHI HERITAGE TRACE VENTURE, L.L.C.,
a Delaware limited liability company,
its sole member
By: CHI NORTH TEXAS 110 HERITAGE TRACE, L.P.,
a Delaware limited partnership,
its administrative member
By: CHI DEVELOPMENT GP, L.L.C.,
a Delaware limited liability company,
its general partner
By: �u.In. 6. t ob f V'
Name: John B. Cooper
Title: Vice President
Date: 10/16/2023
Docusign Envelope ID: 445C40D8-EAE6-4566-953E-lFDF3923E5CC
IPROJECT NAME:
I CONTRACT:
CFA #
CITY PROJECT #
IDOE #
I WATER PROJECT #
ISEWER PROJECT #
IFILE #
INSPECTOR:
PROJECT MANAGER:
DEVELOPER -AWARDED -PROJECT CHANGE ORDER
Heritaqe Trace Parkway
(A) Water, (B) Sewer, (C) Pavinq, (D) Drainage, (E) Street Lightin
22-0015 CITY PARTICIPATION: No
103620
X-27133
X-27133
K-2876
Hector Montoya Phone No: 817-392-8306
Andrew Goodman Phone No: 817-392-6251
WATER
Developer
Cost
City Cost
IORIGINAL CONTRACT
$444,145.40
EXTRAS TO DATE
(CREDITS TO DATE
(CONTRACT TO DATE
$444,145.40
$0.00
(AMOUNT OF PROP. CHANGE ORDER
$0.00
I REVISED CONTRACT AMOUNT
$444,145.40
$0.00
TOTAL REVISED CONTRACT AMOUNT
PER UNIT
$444,145.40
REVISED COST SHARE
Dev. Cost:
TOTAL REVISED CONTRACT
SEWER
Developer
Cost City Cost
$676,604.00
$676,604.00 $0.00
$0.00
$676,604.00 $0.00
$676,604.00
$4,555,878.06
CONTRACT UNIT
PAVING
Developer Cost City Cost
$2,001,231.00
$157,929.31
$2,159,160.31 $0.00
$56,308.37
$2,215,468.68 $0.00
$2,215,468.68
City Cost:
$4,555,878.06
REVIEWED
By Izeldeen Ahmed at 3:24 pm, Mar 17, 2025
CHANGE
ORDER No:
4
DRAINAGE
STREET LIGHTS
CONTRACT
Developer
DAYS
Developer Cost City Cost
Cost City Cost
$1,021,181.00
$197,478.98
360
0
0
$1,021,181.00 $0.00
$198,478.98 $0.00
360
$0.00
$0.00
570
$1,021,181.00 $0.00
$198,478.98 $0.00
930
$1,021,181.00
$198,478.98
$0.00
Revised: 10-12-2011 Page 1
Docusign Envelope ID: 445C40D8-EAE6-4566-953E-1FDF3923E5CC
You are directed to make the following
changes in the
contract dociments:
CITY BID ITEM
PAY ITEM #
#
QUANTITY
UNIT
10
3212.0302
2
SY
11
3212.0501
2
SY
13
3213.0104
323
SY
14
3213.0301
296
SF
15
3213.0506
2
EA
16
3216.0101
5
LF
17
3217.0001
170
LF
18
3217.0002
32
LF
19
3217.0003
52
LF
20
3217.0301
-42
LF
21
3217.0501
54
LF
22
3217.1002
-1
EA
23
3217.1004
-1
EA
26
3292.0100
17
SY
28
3292.0500
-10
SY
31
3211.0502
290
SY
34
9999.0400
40
LF
ITEM DESCRIPTION
2" Asphalt Pavement Type D
4" Asphalt Base Type B
9" Concrete Pavement
4" Concrete Sidewalk
Barrier Free Ramp, Type P-1
6" Concrete Curb and Gutter
4" SLID Pvmt Marking HAS (W)
4" SLID Pvmt Marking HAS (Y)
4" BRK Pvmt Marking HAS (W)
12" SLID Pvmt Marking HAE (W)
24" SLID Pvmt Marking HAE (W)
Lane Legend Arrow
Lane Legend Only
Block Sod Placement
Seeding, Soil Retention Blanket
8" Lime Treatment (8" Thick Clay Subgrade with 6" Hydrated Lime)
Pedestrian Guardrail (TxDOT PR11)
37 3217.0004 108 LF 4" BRK Pvmt Marking HAS (Y)
38 3217.1003 1 EA Lane Legend DBL Arrow
39 3232.0100 280 SF Concrete Retaining Wall Adjacent to Sidewalk
TOTAL
REASONS FOR CHANGE ORDER New configuration for connection to Blue Mound Rd, shifts in median locations, pavement marking and street signs.
REVIEWED 1
lBy Izeldeen Ahmed at 3:23 pm, Mar 17, 2025 J
UNIT PRICE
$5.50
$7.50
$95.00
$6.50
$2,817.00
$1.75
$2.00
$2.00
$2.83
$11.64
$16.15
$295.00
$350.00
$6.00
$1.75
$19.59
$192.00
$2.83
$350.00
$13.00
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.
dr
RECOMMENDED: I 4 N4 APPROVED: Please see attached signature page APPROVED:
By: Halff Associates
Name: Cody Hodge
Title: Land Development Team Leader
By: CRP/CHI Heritage Trace Owner, L.P
Name: John B. Cooper
Title: Vice President
By: Ridqemont Commercial
Name: Paul Camp
Title: Vice President of Operations/Principal
TOTAL
$11.00
$15.00
$30,685.00
$1, 924.00
$5,634.00
$8.75
$340.00
$64.00
$147.16
-$488.88
$872.10
-$295.00
-$350.00
$102.00
-$17.50
$5,681.10
$7,680.00
$305.64
$350.00
$3,640.00
$56,308.37
Revised: 10-12-2011 Page 2
Docusign Envelope ID:445C40D8-EAE6-4566-953E-1FDF3923E5CC
SIGNATURE PAGE TO CITY OF FORT WORTH
COMMUNITY FACILITIES AGREEMENT
DEVELOPER AWARDED PROJECT CHANGE ORDER NO: 4 (REVISED)
PROJECT NAME: HERITAGE TRACE PARKWAY
CIA #: 22-0015
CITY PROJECT #: 103620
CRP/CHI HERITAGE TRACE OWNER, L.P.,
a Delaware limited partnership
By: CRP/CHI HERITAGE TRACE GP, L.L.C.,
a Delaware limited liability company,
its general partner
By: CRP/CHI HERITAGE TRACE VENTURE, L.L.C.,
a Delaware limited liability company,
its sole member
By: CHI NORTH TEXAS 110 HERITAGE TRACE, L.P.,
a Delaware limited partnership,
its administrative member
By: CHI DEVELOPMENT GP, L.L.C.,
a Delaware limited liability company,
its general partner
By: �u,In, 6. (hb f V'
Name: John B. Cooper
Title: Vice President
Date: 3/6/202 5
FORTWORTH.
TRANSPORTATION AND PUBLIC WORKS
February 12, 2025
THE RIDGEMONT COMPANY
1520 W. WALNUT HILL LANE
IRVING, TX 75038
RE: Acceptance Letter
Project Name: HERITAGE TRACE PARKWAY LOGISTICS PARK
Project Type: PAVING, DRAINAGE AND STREET LIGHTING IMPROVEMENTS
City Project No.: 103620
To Whom It May Concern:
On December 13, 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 February 7, 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 February 7, 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-
392-6251.
Sincerely,
Andrew Goodman, Project Manager
Cc: Hector Montoya, Inspector
Gary Deyon, Inspection Supervisor
Edward Davila, Senior Inspector
Andrew Goodman, Program Manager
HALFF Associates, Inc, Consultant
The Ridgemont Company; Wildstone Construction, LLC; Jackson Construction, Ltd., Contractor
Crow Holdings Industrial, Developer
File
E-Mail:
Douglas W. Wiersig, P.E., PhD., Director, TPW
Richard Martinez, Assistant Director, TPW
Marisa Conlin, Traffic Engineering
Allen Hall, Superintendent, TPW
John Robert Carman, P.E., Director, Water
Chris Harder, P.E., Assistant Director, Water
Wendy Chi-Babulal, P.E., Water
Tony Sholola, P.E., Water
Richard Zavala, Director, PARD
David Creek, Assistant Director, PARD
Rev. 9/15/16
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 Slade Turner,
Director Of Ridgemont Commercial Construction, known to me to be a
credible person, who being by me duly sworn, upon his oath deposed and
said;
That all persons, firms, associations, corporations, or other
organizations furnishing labor and/or materials have been paid in full;
That the wage scale established by the City Council in the City of
Fort Worth has been paid in full;
That there are no claims pending for personal injury and/or
property damages;
On Contract described as;
CPN 103620 Heritage Trace Parkway Water, Sewer, Drainage, Paving,
and Street Lighting
BY
Name or Title
Subscribed and sworn Yffore r►e on this date 20 of January, 2025.
11 IF l'
Notary Pub�c
County, Stag
�abl►�,.. , / e I-
""p MAUREEN MCDONNELL
1.01% Naiary Public
STATE OF TEXAS 9
rn�*4 f0#r 1287327&9
<, lmy Comm. Mar 3 a02s
CONSENT OF OWNER ❑
SURETY COMPANY ARCHITECT ❑
TO FINAL PAYMENT CONTRACTOR ❑
SURETY ❑
AIA DOCUMENT G707 OTHER
Bond No. PRF9396393
PROJECT: Heritage Trace Parkway. CFA Project #103620, Ft. Worth TX
(name, address)
TO (Owner) [ City of Fort Worth ] ARCHITECT'S PROJECT NO:
1000 Throckmorton Street
Fort Worth, TX 76102-6312 CONTRACT FOR:
[ ] CONTRACT DATE:
CONTRACTOR: The Ridgemont Company
1520 W. Walnut Hill Lane
Irving, TX 75038-3701
In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the
(here insert name and address of Surety Company)
Colonial American Casualty and Surety Company &
Fidelity and Deposit Company Of Maryland
1299 Zurich Way, 5th Floor , SURETY COMPANY,
Schaumburg, IL 60196-1056
on bond of (here insert name and address of Contractor)
The Ridgemont Company
1520 W. Walnut Hill Lane
Irving, TX 75038-3701 , CONTRACTOR,
hereby approves of the final payment to the Contractors, 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)
City of Fort Worth
1000 Throckmorton Street
Fort Worth, TX 76102-6312
as set forth in the said Surety Company's bond.
IN WITNESS WHEREOF,
the Surety Company has hereunto set its hand this 17th
Attest:
(Seal):
,OWNER,
day of December 2Q24
Colonial American Casualty and Surety Company &
Fidelity and Deposit Compav Of Mid
Surety Company
��1, � -)\(�) _
Signature of Authorized Representative
Faith Ann i-lilty, Attornev-In-Fact
Title
NOTE: This form is to be used as a companion document to AIA DOCUMENT G706,, COiNT.RACTO;.'S AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS,
Current Edition
AIA DOCUMENT 6707 • CONSENT OF SURETY COMPANY TO FINAL, PAYMENT • APRIL 1970 EDITION • AIAO ONE PAGE
O 1910 • THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 New York Ave.. NW, Wn SI 9INGTON, D.C. 20006
51111111lIf,
GyENEVIEVE M. MAISON
= ''•m UBLIC,
NOTARY PUBLIC
BALTIMORECOUWY,MG
%,l2ip�t> 'S,�
IdyComftsianExpirc,JANUARY27.2025
' nnn
EXTRACT FROM BY-LAWS OF THE COMPANIES
"Article V, Section 8, Attomevs-in-Fact. The Chief Executive Officer, the President, or any Executive Vice President or Vice President
may, by written instrument under the attested corporate sea], appoint attorneys -in -fact with authority to execute bonds, policies,
recognizances, stipulations, undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such
attorney -in -fact to affix the corporate seal thereto; and may with or without cause modify of revoke any such appointment or authority at any
time."
CERTIFICATE
I, the undersigned, Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN
CASUALTY AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the
foregoing Power of Attorney is still in full force and effect on the date of this certificate; and I do further certify that Article V, Section 8, of
the By -Laws of the Companies is still in force.
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998,
RESOLVED: "That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary
and the Seal of the Company may be affixed by facsimile on any Power of Attorney ... Any such Power or any certificate thereof bearing such
facsimile signature and seal shall be valid and binding on the Company."
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the 5th day or
May, 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a
meeting duly called and held on the 1 Olh day of May, 1990.
RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature
of any Vice -President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter, wherever appearing upon a
certified copy of any power of attorney issued by the Company, shall be valid and binding upon the Company with the same force and effect
as though manually affixed.
IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed the corporate seals of the said Companies,
this _ 17#h day of December 2024 .
5 515111l111lff 1155111111l1l I!! 1i+15111if!!lfff
......... �OJ', ;G�yy SNSU !C� ``�o`Qps51 COR7Aa�i
,gyp s, a, •,... Ryq,��f.� m•
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OR
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F!f �SEAL'io=�'o - Ex` SEALm` _ SEAL
ifE
�'''�fff!l1111I15151\5++``` +',,,'!!l�Ill1l 1115115x ``, fflfflll ll ll5l55+�+
i5,
�
Thomas 0. McClellan
Vice President
TO REPORT A CLAIM WITH REGARD TO A SURETY BOND, PLEASE SUBMIT A COMPLETE DESCRIPTION
OF THE CLAIM INCLUDING THE PRINCIPAL ON THE BOND, THE BOND NUMBER, AND YOUR CONTACT
INFORMATION TO:
Zurich Surety Claims
Authenticity of this bond can be confirmed at bondvalidator.zurichna.com or 410-559-8790
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That the ZURICH AMERICAN INSURANCE COMPANY, a corporation of the State of New
York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Illinois, and the FIDELITY
AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Illinois (herein collectively called the "Companies"), by Robert
D. Murray, Vice President, in pursuance of authority granted by Article V, Section 8, ofthe By -Laws of said Companies, which arc set forth
on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate, constitute, and
appoint to o John R.WARD, Monica Ruby VEAZEY, John William NEWBY, Thomas Douglas MOORE ,Sandra Lee RONEY,
Debra Lee MOON, Andrea Rose CRAWFORD, Troy Russell KEY, Emily Allison MIKESKA, Allyson W .DEAN, Colin E.
CONLY, Andrew Gareth ADDISON, Patrick Thomas COYLE, Michael Donald HENDERICKSON, Bryan Kelly MOORE,
Elizabeth ORTIZ Ana OWENS, Betty J. REEH, Andrew CLARK, Faith Ann HILTY of Addison, Texas, its true and lawful agent
and Attorney -in -Fact, to make, execute, seal and deliver, for, and on its behalf as surety, and as its act and deed: any and all bonds and
undertakings, and the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said Companies, as
fully and amply, to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the
ZURICH AMERICAN INSURANCE COMPANY at its office in New York, New York., the regularly elected officers of the COLONIAL
AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland., and the regularly elected officers of the
FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their own proper persons.
The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V, Section 8, of
the By -Laws of said Companies, and is now in force.
IN WITNESS WHEREOF, the said Vice -President has hereunto subscribed his/her names and affixed the Corporate Seals of the said
ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and
FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 31st day of January, A.D. 2024.
,,,,Ip 1131rh44,
,4t Ga5GaI1,Vd �� `,+aulnmrahgry,' ,nvumm�,,,
i'O ��J.:rn :`tra •'Q,P Oq,� "F!`s OO°C 4p9,q ;71-'�
USI ALrn' "�"{ O ri o _ � voQ P?•o a
3a c n=USEALntg` ,', SEALniaz'
......1!ll ll llt,tt+\+\`+` II I4t1, rr,l......rljjl�+`+` A•I••I Es,r.
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
By: Robert D. Murray
Vice President
By: Dawn E. Brown
Secretary
State of Maryland
County of Baltimore
On this 31st day of January, A.D. 2024, before the subscriber, a Notary Public of the Stale of Maryland, duly commissioned and qualified, Robert D.
Murray, Vice President and Dawn E. Brown, Secretary of the Companies, to me personally known to be the individuals and officers described in and who
executed the preceding instrument, and acknowledged the execution ofsame, and being by me duly sworn, deposeth and saith, that he/she is the said officer of
the Company aforesaid, and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies, and that the said Corporate Seals and
the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations.
IN TESTIMONY WI -IL -RE -OF, I have hereunto set my hand and affixed my Official Seal the day and year first above written.
Genevieve M. Maison
Authenticity of this bond can be confirmed at bondvalidator.zurichna.com or 410-559-8794
Texas Important Notice
IMPORTANT NOTICE
To obtain information or make a complaint:
You may call Zurich North America's toll -free telephone
number for information or to make a complaint at:
1-800-382-2150
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:
P.O. Box 149104
Austin, TX 78714-9104
Fax: (512) 490-1007
Web: www.tdi.texas,gov
E-mail: ConsumerProtection@tdi.texas.gov
PREMIUM OR CLAIM DISPUTES:
Should you have a dispute concerning your premium or
about 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 POLICY:
This notice is for information only and does not become
a part or condition of the attached document.
"ISO IMPORTANTE
Para obtener informaci6n o para presentar una queja:
Usted puede Ilamar al numero de tel6fono gratuito de
Zurich North America's para obtener informaci6n o para
presentar una queja al:
1-800-382-2150
Usted puede comunicarse con el Departamento de Se-
guros de Texas para obtener informaci6n sabre com-
pahlas, coberturas, derechos, o quejas al:
1-800-252-3439
Usted puede escribir al Departamento
de Seguros de Texas a:
P.O. Box 149104
Austin, TX 78714-9104
Fax: (512) 490-1007
Sitio web: www.tdi.texas.gov
E-mail: ConsumerProtection@tdi.texas.gov
DISPUTAS POR PRIMAS DE SEGUROS O
RECLAMACIONES:
Si tiene una disputa relacionada con su prima de seguro
o con una reclemaci6n, usted debe comunicarse con la
companla primero. Si la disputa no es resuelta, usted
puede comunicarse con el Departamento de Seguros de
Texas.
ADJUNTE ESTE AVISO A SU POLIZA: Este aviso es
solamente para propasitos informativos y no se con-
vierte en parte o en condicion del documento adjunto.
U-GU-296-E (06115)
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