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Contract 59301-FP1
FORT WORTH, TRANSPORTATION AND PUBLIC WORKS NOTICE OF PROJECT COMPLETION -FP1 City Secretary No. 59301 Date Received:4/9/2025 City Project N!?: 102918 Regarding contract 59301 2022 Bond Year 1 Contract 1 for as required by the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by City Council on 4/25/2023 through M&C 23-0314 the director of the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT upon the recommendation of the Assistant Director of the Transportation & Public Works Department has accepted the project as complete. Original Contract Amount: 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: $ 8,894,386.00 Days 430 $ 0.00 JV2 1 Days Added by CO 71 $ 8,894,386.00 Total Days 501 $ 7,641,660.43 Days Charged 500 Days @ $ $ 7,641,660.43 $ 7,259,577.41 Final Payment Due $ 382,083.02 Tati'icia L. Wairack A r 7 2025 Patricia L. Wadsack (Apr7, 202516:50 CDT) P Recommended for Acceptance Date Asst. Director, TPW - Capital Delivery l:>' Apr 7, 2025 Accepted Date Director, TRANSPORTATION AND PUBLIC WORKS DEPARTMENT �v Apr 8, 2025 Asst. City Manager Date / Day Comments: OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX C-620 Signature Page Contractor's Application for Payment To (Owner) City of Fort Worth Invoicing Period (From - To): 2-24-25- to 3-14-25 P.O. FW020-0000009733 Number: Project: 102918 From (Contractor): McClendon Construction Company, Inc. Contractor's CFW Vendor No.: 0000007403 City Secretary Contract 59301 Contract Number: Name: Application For Payment Change Order Summary Approved Change Orders Number Additions 1 $71,618.00 2 3 4 5 6 7 8 TOTALS $71,618.00 NET CHANGE BY CHANGE ORDERS Contractor's Certification Invoice No.21-Final oice Date: 3/14/2025 to ( If Not Automatic Deposit): 2022 Bond Yr 1 - Contract 1 1. ORIGINAL CONTRACT PRICE.......................................................... $ $8,894,386.00 Deletions 2. Net change by Change Orders................................................................. $ $71,618.00 3. Current Contract Price (Line 1 + 2)........................................................ $ $8,894,386.00 4. TOTAL COMPLETED AND STORED TO DATE (Progress Estimate, Construction Allowance and Change Orders)....... $ $7,641,660.43 5. RETAINAGE: a. X $7,641,660.43 Work Completed.......... $ b. X Not Used $ c. Total Retainage (Line 5a + Line 5b) ............................... $ 6. AMOUNT ELIGIBLE TO DATE (Line 4 - Line 5c)............................. $ $7,641,660.43 $71,618.00 7. LESS PREVIOUS PAYMENTS (Line 6 from prior Application)........ $ $7,259,577.41 8. AMOUNT DUE THIS APPLICATION ................................................. $ $382,083.02 9. BALANCE TO FINISH, PLUS RETAINAGE (Column G on Progress Estimate+ CA + Cos + Line 5 above) .............. $ $1,252,725.58 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. Liquidated Damages $650.00 x day 10. CONTRACT TIME: a, Days Awarded 430 b, Days Added by CO 71 C. Total Days 501 d, Days Charged 500 e, Days Remaining I This document has been modified from its original form as an EJCDC document and the user did not highlight the modifications. 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I ff�j j o:Qy:�m�a�m .n�xe orm:en.. oa Qrbm os uon woo aw v.w 66 a I 0,�4�NIlG� ,.yaw,�eo��,eo e�,n num � 6� jysro I I u•m•m ,�1 s�oa� sldsw I 6, I I I I I I I I I I I I I I sass oo,66a�=au=�m�wma�rva���s;'� ss Tool. ;0000al too mod ,00000 a at s ss.eaaSe6 Contractor's Application .00u�e„onrv�m z�-ema� , clue v.m. Mo�ehwuaev.w• v.u.'xm. e.we sovmf c� • 'wa nmv �B e. �roFl wn mu � mein mid+6) Sx6.woao 6z6Aoo oal sz ,.�660 000� I S,s.woao S,s,so6 oal ssC waR ��oa� sz,�a ool Ee.ssoao lease wl szs.sas,o ue,ess,al ue.das,s s�sv: u,.a6a sol I s,00.a .00l I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I s�.6x.e,ons nsz6.e,o.w n.szs.naw es �� s4 xe�.nssel C-620 Change Order Progress Estimate Construction Allowance Usage ADDITIONS For (connw) 102918 2022 Bond Yr 1 - Contract 1 Apphcatiou Panod Item Item Number D—ption City Secretary 59301 Connect Nom: 2-24-25- to 3-14-25 A B Spedficafioo Una of Quantny to Add Una P.. Addition Value Section No Measure C D Estimated Quantity Value Installed Contractor's Application Application Number' 21-Final Application Date 3/14/2025 E F Previously ValueManuals Presently Total Complatad / Balance to Finish Nstalled Valae Period Stored (.ot m C) 8°d Stored to Date (P) (B - P) (D+B) B This docur.ant has bee. modified from as ongi,,l fuvn es au EJCDC dowme.t and the war did not highlight the modificafioos. You are encouraged to read the document carefully and consult Legal Counsel prior to its execution. C-620 Change Order Totals Tbis document has bee. mod,fiad Gom t, ongi,,l Ibm es en HICDC d-t and the war did urn highlight the modificafions. You are encouraged to read the document carefully and consult Legal Counsel pnor to its execution. C-620 Change Order Progress Estimate Construction Allowance Usage Contractor's Application CONSTRUCTION ALLOWANCE ITEMS TO BE REDUCED IFm (contracq 102918 2022 Bond Yr 1 -Contract 1 Application Number 21-Final Apphcstion Pend 2-24-25- to 3-14-25 Applicatwn Date' 3/14/2025 A B C D E F � Ilem Bid Item Number Desorption Specification Unit of Quantity to Delete Unit Pnce Reduction Value Not Used Na Used Not Used Not Used Na Used Na Used Not Used Not Used Section No Mae — Tot.], This document has bee. modified firm its orgi,,l form as au EJCDC docume.t and the war did urn highlight the modifications. You are encouraged to read the document carefully and consult Legal Counsel prior to its execution. C-620 Change Order Progress Estimate Change Order Number I 1 ADDITIONS Contractor's Application IF., (,mtmot) 102918 2022 Bond Yr 1 - Contract l City Secretary 59301 Application Number 21-Final Contract Nmic Application Period 2-24-25- to 3-14-25 Application Date 3/14/2025 A B C D E F lem' Addition Estimated Quantity Previously Value This Matenals Presently Total Completed Change Order Rem No. Desrn tion p SpedficaRon Unit of Section No. Mae —Value CO Quantity Add UnitPvce Change Val Order Installed Value Installed Value Period Stored (not inC) and Stored to Date (D+E) (F) B I 34 Reroute sewer sern a route for 4301 Vmson Street to Bradley Street IS 1.00000000 $14,850.00 $14,850.00 L00000000 $14,850.00 $14,850.00 $14,850.00 100M% 39 1-inch Water Se— EA 1.00000000 $2,000.00 $2,000.00 55 024L 17001 V Pavement Pulverimtion SY 688.00000000 $12.00 $8,256.00 56 3212.0303 Y Asphalt Pvml Type D SY 688.00000000 $24.00 $16,512.00 57 6" Can, Curb & Geller LF 200.00000000 $75.00 $15,000.00 I 62 I 6" Can, Curb & Gutter (shared cost with water) LF 200.00000000 $75.00 $15,000.00 ... Add 7 Days This doouruaut has bee. modified from its original formes a. EICDC document and the war did not highlight the modifiamom. You are encouraged to read the document carefully and consult Legal Couasel prior to its execution. Balance to Finish (B - F) $2,000.00 $8,256.00 $16,512.00 $15,000.00 $15,000.00 C-620 Change Order Totals I I I I I $7I,6IS.00I I $14,850.00I $14,850.00I I I $14,850.00I 20." I $$6,768.00I Tbis document has bee. mod,fiad Gom t, o,,gi,,l Ibm es en HICDC d-t and the war did urn highlight the modificafions. You are encouraged to read the document carefully and consult Legal Counsel pnor to its execution. C-620 Change Order Progress Estimate Change Order Number I 1 DELETIONS For (contmc0 102918 2022 Bond Yr 1 - Contract 1 Application Pend 2-24-25- to 3-14-25 A E C I Item Change Order Item P De non CO Qoanhty to Specificafion Una of Delete Unit Pnce Dakt Change Order Not Usad No. I 33 Constriction Allowance(se—) Shon No Measure ac LS 0.24750000 $60,000.08 Woe $14,850.04 I 38 Construction Allowance (stormwzter) LS 0.04000000 $50,000A $2,000.04 I 69 Constructim Allowance Water) IS 0.39768000 $100,000.04 $39,768.08 I 61 Construction All—inita(Pz ) LS 0.15000000 $100,000.04 $15,000.06 I I I I Totals $71,618.04 Applicator Number' Applicatwn Dale' D E Not Used Not Used Not Used Na Used This docor.ant has bee. modified firm its ongi,,l fovn it, it, EJCDC dowme.t and the war did urn highlight the modificafions. You are encouraged to read the document carefully and consult Legal Counsel prior to its execution. Contractor's Application 21-Final 3/14/2025 F Na Used Not Used Not Used C-620 Change Order Progress Estimate Change Order Number 1 2 I Contractor's Application ADDITIONS For (contract) 102918 2022 Bond Yr 1 - Contract 1 City Secretary $9301 Application Nambar 21-Final Contract Num Apphczfon Partod 2-24-25- to 3-14-25 Application Date 3/14/2025 A B C D E F Item Balance to Finish Addition Change Estimated Quantity Previoasly Valas This Materials Presently Total Completed % (B - F) Charge Order Item No. Speoification Umt of CO Quantity to Add Description Section No. Measure Unit Price Vat- L�stalled Value Lnstallad Valae Period Stored (not iu C) and Storod to Date (F) (1) (1) 1 E) B ... Add 64 Days This document has been modified from ns onginel form as an EJCDC document and the user did not highlight the modifications. You are enwmaged to read the document carefully and consult Legal Counsel poor to its execution. C-620 Change Order Totals This docume.t has bee. modtfted from ns onginel form as an HJCDC document and the user did no( highlight the modifications. You are enwuraged to read the document carefully and consult Legal Counsel pnor to its execution. C-620 Change Order Progress Estimate Change Order Number I 2 DELETIONS IF., (anntrsd) 102918 2022 Bond Yr 1- Contract 1 Applw tt- Numbar Apphcation Panod Applimt— Date 2-24-25-to 3-14-25 A 6 C D E Item CO Qaanhty to Dalahon Change Change Order Item Desenptiw Specification Umt of Delete Unit Price Order Value NM Used Not Used Na Used Not Used NM Used No. Sachon No Measure Totals This document has been modtfted from ns onginel form as an EJCDC document and the user did not highlight the modifications. You are enwuraged to read the document carefully and consult Legal Counsel pnor to its execution. Contractor's Application 21-Final 3/14/2025 F Not Usad Not Used Not Uscd C-620 Change Order Progress Estimate Change Order Number 1 3 ADDITIONS IF., (—tract) 102918 2022 Bond Yr 1 - Contract 1 City secretary 59301 Contract Nam: Appheation Parted 2-24-25- to 3-14-25 A Item Change Order Item Descnptiou No. B C D Addition Estimated Q—tay spscificstioa Umt of CO Quantity to Add Unit Pica Change Order Installed Value Section No Measure Value Contractor's Application hppaearton ramner: 21-Final Application Data: 3/14/2025 E F Balance to mash Total Completed Previously Value Thts Materials Presently (B - F) metalled Was Period Stored (net in c) and stared to Date (F) D+E) B This document has been modified from as onginal form as an EJCDC document and the user did not mghlight the modifications. You are enwuraged to read the document carefully and consult Legal Counsel poor to its execution. C-620 Change Order Totals This document has bee. modtfted from ns onginol form as an HJCDC document and the user did no( highlight the modifications. You are enwuraged to read the document carefully and consult Legal Counsel pnor to its execution. C-620 Change Order Progress Estimate Change Order Number I 3 DELETIONS IPor (contract) 102918 2022 Bond Yr 1- Contract 1 Apphcafio. Number: IApphcafio. Pertod 2-24-25- to 3-14-25 Apphcafio. Date: A E C D E Item CO Qoanhty to Dekt Change Order Item Descr ption Specification Umt of Delete Unit Price Change Order Not Used Na Used Not Used Na Used Not Used No. Secho. No Measure Value Totals This docume.t has bee. modtfted from ns onginel form as an EJCDC document and the user did not highlight the modifications. You are enwuraged to read the document carefully and consult Legal Counsel pnor to its execution. Contractor's Application 21-Final 3/14/2025 F Na Used Not Used Na Used C-620 Change Order Progress Estimate Change Order Number 1 4 ADDITIONS IF., (—trael) 102918 2022 Bond Yr 1 - Contract 1 Apphcatiov Pend Item —a- Item Description No... Contractor's Application City Secretary 59301 Apphcatiov Number. 21-Final Contract Nam: 2-24-25- to 3-14-25 Apphcation Data 3/14/2025 A B C D E F Balance to Ftmsh Addition Estimated Qaavhty Total Completed Previously Valae,d Materials Presently (B - F) Spacificatioa Umt of CO Quantity to Add Unit Prica Change Order Installed Val -and Star to Data Nstalled Was Period Stoted (not in C) (P) Section No. Measure Vat- (D +E) B This document has bee. modified from as onginal form as an EJCDC document and the user did not highlight the modifications. You are enwmaged to read the document carefully and consult Legal Coansel pnor to its execution. C-620 Change Order Totals This document has bee. modtfted from ns onginol form as an HJCDC document and the user did no( highlight the modifications. You are enwuraged to read the document carefully and consult Legal Counsel pnor to its execution. C-620 Change Order Progress Estimate Change Order Number I 4 DELETIONS IPor (contract) 102918 2022 Bond Yr 1- Contract 1 Apphcafio. Number: IApphcafio. Pertod 2-24-25- to 3-14-25 Apphcafio. Date: A E C D E Item CO Qoanhty to Dekt Change Order Item Descr ption Specification Umt of Delete Unit Price Change Order Not Used Na Used Not Used Na Used Not Used No. Secho. No Measure Value Totals This docume.t has bee. modtfted from ns onginel form as an EJCDC document and the user did not highlight the modifications. You are enwuraged to read the document carefully and consult Legal Counsel pnor to its execution. Contractor's Application 21-Final 3/14/2025 F Na Used Not Used Na Used C-620 Change Order Progress Estimate Change Order Number 1 5 ADDITIONS IF., (contract) 102918 2022 Bond Yr 1 - Contract 1 Apphcatiov Pend Item Change Ordu Item Dcscription No. Contractor's Application City Secretary 59301 Apphcatiov Number. 21-Final Contract Nam: 2-24-25- to 3-14-25 Apphcation Data 3/14/2025 A B C D E F Balance to mash Addition Specification Uman t of CO Quantity to Add Unit Prica Change Order Estimated Qaavhty Total Completed Previously Valuead Materials Presently Val -and Stored to Data (B -F) (P) Section No. Was— Value metalled metalled Was Period Stored(not in C) (D+E) B This document has bee. modified from as onginal form as an EJCDC document and the user did not highlight the modifications. You are enwmaged to read the document carefully and consult Legal Counsel pnor to its execution. C-620 Change Order Totals This document has bee. modtfted from ns onginol form as an HJCDC document and the user did no( highlight the modifications. You are enwuraged to read the document carefully and consult Legal Counsel pnor to its execution. C-620 Change Order Progress Estimate Change Order Number I 5 DELETIONS IPor (—tmal) 102918 2022 Bond Yr 1- Contract 1 Apphcefio. Number: IApphcafio. Partod 2-24-25- to 3-14-25 Apphcafio. Date: A B C D E Item CO Qaenhty to Delehoo Change Order Item Descnption Specification Umt of Delete Unit Pica Change Order Not Used Na Used Not Used Na Used Not Used No. Section No Measure Value Totals This docume.t has bee. modtfted from ns onginel form as an EJCDC document and the user did not highlight the modifications. You are enwureged to read the document carefully and consult Legs[ Counsel pnor to its execution. Contractor's Application 21-Final 3/14/2025 F N. Used Not Used Na Used C-620 Change Order Progress Estimate Change Order Number 1 6 I Contractor's Application ADDITIONS IF., (coutraot) 102918 2022 Bond Yr 1 - Contract 1 City Secretaryry 59301 Apph anon Number. 21-Final Contract Nam: Apphcation Pend 2-24-25- to 3-14-25 Apphcation Data 3/14/2025 A B C D E F Item Balance to Ftmsh Change Ord- Item 3pedficad.. Una of CO Quantity ro Add Addition Unit Price Change Order Quantity Previously Valued Materidla Pr -entry Value Total Completed %Psdmaled (B - F) and Stored (F) No. Dea-tptton 6ectiov No. Meaeme Value Installed Installed Value Period Stored (vot m C) )Date � � E) 6 This document has b-n modified fiom ns onginal form as an EJCDC document and the user did not highlight the modificafions. You are enwmaged to read the document carefully and consult Legal Counsel pnor to its execution. C-620 Change Order Totals This document has bee. modtfted from ns onginol form as an HJCDC document and the user did no( highlight the modifications. You are enwuraged to read the document carefully and consult Legal Counsel pnor to its execution. C-620 Change Order Progress Estimate Change Order Number I 6 DELETIONS IPor (contract) 102918 2022 Bond Yr 1- Contract 1 Apphcafio. Number: IApphcafio. Pertod 2-24-25- to 3-14-25 Apphcafio. Date: A E C D E Item CO Qoanhty to Dekt Change Order Item Descr ption Specification Umt of Delete Unit Price Change Order Not Used Na Used Not Used Na Used Not Used No. Secho. No Measure Value Totals This docume.t has bee. modtfted from ns onginel form as an EJCDC document and the user did not highlight the modifications. You are enwuraged to read the document carefully and consult Legal Counsel pnor to its execution. Contractor's Application 21-Final 3/14/2025 F Na Used Not Used Na Used C-620 Change Order Progress Estimate Change Order Number 1 7 I Contractor's Application ADDITIONS For (contract) 102918 2022 Bond Yr 1 - Contract 1 City Secretary 59301 Apphcetiov Number: 21-Final Contract Num: Apphcation Patted 2-24-25- to 3-14-25 Apphestio. Date: 3/14/2025 A B C D E F Item Balance to Ftmsh Change Order Item Specification Umt of CO Quantity to Add Addition Unit Price Change Order Estimated Quavhty Total Completed Previously Valued Materials Presently Value d Stored to Data (I) (B - F) an No. Description Seallo. Measure m- Value Installed Nstalled Value Period Stored(not in C) (D+E) B This document has bee. modified from ns onginnl form as an EJCDC document and the user did not highlight the modifications. You are enwmaged to read the document carefully and consult Legal Counsel pnor to its execution. C-620 Change Order Totals This docume.t has bee. modtfted from ns onginel form as an HJCDC document and the user did no( highlight the modifications. You are enwuraged to read the document carefully and consult Legal Counsel pnor to its execution. C-620 Change Order Progress Estimate Change Order Number I 7 DELETIONS IPor (contract) 102918 2022 Bond Yr 1- Contract 1 Apphcafio. Number: IApphcafio. Pertod 2-24-25- to 3-14-25 Apphcafio. Date: A E C D E Item CO Qoanhty to Dekt Change Order Item Descr ption Specification Umt of Delete Unit Price Change Order Not Used Na Used Not Used Na Used Not Used No. Secho. No Measure Value Totals This docume.t has bee. modtfted from ns onginel form as an EJCDC document and the user did not highlight the modifications. You are enwuraged to read the document carefully and consult Legal Counsel pnor to its execution. Contractor's Application 21-Final 3/14/2025 F Na Used Not Used Na Used C-620 Change Order Progress Estimate Change Order Number 1 8 ADDITIONS IF., (—trael) 102918 2022 Bond Yr 1 - Contract 1 Apphcatiov Pend Item —a- Item Description No... Contractor's Application City Secretary 59301 Apphcatiov Number. 21-Final Contract Nam: 2-24-25- to 3-14-25 Apphcation Data 3/14/2025 A B C D E F Balance to Ftmsh Addition Estimated Qaavhty Total Completed Previously Valae,d Materials Presently (B - F) Spacificatioa Umt of CO Quantity to Add Unit Prica Change Order Installed Val -and Star to Data Nstalled Was Period Stoted (not in C) (P) Section No. Measure Vat- (D +E) B This document has bee. modified from as onginal form as an EJCDC document and the user did not highlight the modifications. You are enwmaged to read the document carefully and consult Legal Coansel pnor to its execution. C-620 Change Order Totals This document has bee. modtfted from ns onginol form as an HJCDC document and the user did no( highlight the modifications. You are enwuraged to read the document carefully and consult Legal Counsel pnor to its execution. C-620 Change Order Progress Estimate Change Order Number I 8 DELETIONS IPor (contract) 102918 2022 Bond Yr 1- Contract 1 Apphcafio. Number: IApphcafio. Pertod 2-24-25- to 3-14-25 Apphcafio. Date: A E C D E Item CO Qoanhty to Dekt Change Order Item Descr ption Specification Umt of Delete Unit Price Change Order Not Used Na Used Not Used Na Used Not Used No. Secho. No Measure Value Totals This docume.t has bee. modtfted from ns onginel form as an EJCDC document and the user did not highlight the modifications. You are enwuraged to read the document carefully and consult Legal Counsel pnor to its execution. Contractor's Application 21-Final 3/14/2025 F Na Used Not Used Na Used City of Fort Worth Summary of Charges City secretary Contract Num: I 59301 I 2022 Bond Yr 1 - Contract 1 I P. Application Period: I 2-24-25- to 3-14-25 I Application Number: Funding Identification (FID) Total Completed Amt Remaining Original Contract 156002-0600430-5740010-102618-001780-9999 $3,218,851.77 $456,653.23 156002-0700430-5740010-102918-001780-9999 $798,195.00 $175,585.00 134027-0200431-5740010-102918-002480-9999-22010199 $2,992,079.01 $494,107.00 152002-0200431-5740010-102918-002880-9999 $617,684.65 $141,230.35 10 10 10 10 10 10 10 Change Order 1 1 56002-0600430-5740010-102918-001780-9999 156002-0700430-5740010-102918-001780-9999 $14,850.00 ($14,850.00) 134027-0200431-5740010-102918-002480-9999-22010199 152002-0200431-5740010-102918-002880-9999 10 10 10 10 10 10 10 Change Order 2 1 56002-0600430-5740010-10291 01780-9999 1 56002-0700430-5740010-102918-001780-9999 134027-0200431-5740010-102918-002480-9999-22010199 152002-0200431-5740010-102918-002880-9999 10 10 10 10 10 10 10 o : FW020-0000009733 21-Final Gross Project Number: 102918 Application Date: 3/14/2025 Retainage Net City Secretary Contract Num: 1 59301 Application Period: Funding Identification (FID) Change Order 3 1 56002-0600430-5740010-102918-001780-9999 1 56002-0700430-5740010-102918-001780-9999 134027-0200431-5740010-102918-002480-9999-22010199 152002-0200431-5740010-102918-002880-9999 10 10 10 10 10 10 10 Change Order 4 1 56002-0600430-5740010-102918-001780-9999 1 56002-0700430-5740010-102918-001780-9999 134027-0200431-5740010-102918-002480-9999-22010199 152002-0200431-5740010-102918-002880-9999 10 10 10 10 10 10 10 Change Order 5 1 56002-0600430-5740010-102918-001780-9999 1 56002-0700430-5740010-102918-001780-9999 134027-0200431-5740010-102918-002480-9999-22010199 152002-0200431-5740010-102918-002880-9999 10 10 10 10 10 10 10 City of Fort Worth Summary of Charges 2022 Bond Yr 1 - Contract 1 I P. 2-24-25- to 3-14-25 I Application Number: Total Completed Amt Remaining o : FW020-0000009733 21-Final Gross Project Number: 102918 Application Date: 3/14/2025 Retainage Net City Secretary Contract Num: 1 59301 Application Period: Funding Identification (FID) Change Order 6 1 56002-0600430-5740010-102918-001780-9999 1 56002-0700430-5740010-102918-001780-9999 134027-0200431-5740010-102918-002480-9999-22010199 152002-0200431-5740010-102918-002880-9999 10 10 10 10 10 10 10 Change Order 7 1 56002-0600430-5740010-102918-001780-9999 1 56002-0700430-5740010-102918-001780-9999 134027-0200431-5740010-102918-002480-9999-22010199 152002-0200431-5740010-102918-002880-9999 10 10 10 10 10 10 10 Change Order 8 1 56002-0600430-5740010-102918-001780-9999 1 56002-0700430-5740010-102918-001780-9999 134027-0200431-5740010-102918-002480-9999-22010199 152002-0200431-5740010-102918-002880-9999 10 10 10 10 10 10 10 City of Fort Worth Summary of Charges 2022 Bond Yr 1 - Contract 1 I P. 2-24-25- to 3-14-25 I Application Number: Total Completed Amt Remaining o : FW020-0000009733 21-Final Gross Project Number: 102918 Application Date: 3/14/2025 Retainage Net City of Fort Worth Summary of Charges City Secretary Contract Num: I 59301 I 2022 Bond Yr 1 - Contract 1 I P. 0. : FW020-0000009733 Project Number: 102918 Application Period: I 2-24-25- to 3-14-25 I Application I 21-Final Application Date: 3/14/2025 Number: Funding Identification (FID) Total Completed Amt Remaining I Gross Retainage Net Totals 1 56002-0600430-5740010-102918-001780-9999 1 56002-0700430-5740010-102918-001780-9999 134027-0200431-5740010-102918-002480-9999-22010199 152002-0200431-5740010-102918-002880-9999 10 10 10 10 10 10 10 I Grand Total $3,218,851.77 $813,045.00 $2,992,079.01 $617,684.65 $456,653.23 $160,735.00 $494,107.00 $141,230.35 1 1 $7,641,660.43 1 1 $1,252,725.58 1 1 $0.00 1 1 ($382,083.02)1 1 $382,083.02 CSC No. 59301-COI F_ Owr WO�H City of Fort Worth . # - Change Order Request Project Name: 1 2022 Bond Yr 1 - Contract 1 City Sec No.: 59301 Project No.(s):I 56002-0600430/0700430 and 34027/52002-0200431 M&C: I 23-0314 I City Proj. No.: I 102918 Project Description:) Combined Street Paving, Water, Sanitary Sewer and Storm Drain replacements for 2022 Bond year 1, Contract 1 Contractor: McClendon Construction Company, Inc. Change Order # 1 I Date: 1217/2023 City Project Mgr. l Dena Johnson City Inspector: Kevin Jackson Phone Number: 817-392-7866 I Phone Number:) 817-326-7623 Dept. Unit I Unit II Unit III Unit IV p Totals Contract Time Water Sewer Storm Water Paving (Calender days) Original Contract Amount $3,675,505.00 $973,780.00 $758,915.00 $3,486,186.00 $8,894,386.00 430 Extras to Date Credits to Date Pending Change Orders (in M&C Process) Contract Cost to Date $3,675,505.00 $973,780.00 $758,915.00 $3,486,186.00 $7,192,666.51 Amount of Proposed Change Order $0.00 $0.00 $0.00 $0.00 $0.00 7 r Revised Contract Amount $3,675,505.00 $973,780.00 $758,915.00 $3,486,186.00 $8,894,386.00 -437 Original Funds Available for Change Orders $183,775.00 $68,165.00 $37,945.00 $174,309.00 $464,194.00 Remaining Funds Available for this CO j $183,775.00 $68,165.00 $37,945.00 $174,309.00 $464,194.00 Additional Funding (if necessary) CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS % OF ORIGINAL CONTRACT 0.00% MAX ALLOWABLE CONTRACT AMOUNT (ORIGINAL CONTRACT COST + 25%) 1$11,117,982.50 JUSTIFICATION (REASONS) FOR CHANGE ORDER Change order No.1 will provide for the following: • Reroute of the sanitary sewer service for 4301 Vinson from its connection to a soon to be abandoned sewer main on Vinson Street to an existing sewer main on Bradley Street in order to maintain service to the residence. The sewer main to be abandoned is being relocated from the parkway to under pavement on Vinson Street. Conflicts with storm drain systems on Vinson Street necessitate the relocation of the identified sewer service to Bradley Street • The removal and replacement of a 1-inch water service in order to facilitate the construction of a storm drain line in Unit 3 of the project. • Pavement rehabilitation on Panola Avenue (Haynes Avenue to Perkins Street), to replace deteriorated pavement repair on the street subsequent to a previously completed Water Department Project that looped the water system between Haynes and Perkins. Staff concurs with the contractor's request for 7 additional calendar days for the change order. It is understood and agreed that the acceptance of this Change Order by the contractor constitutes an accord and satisfaction and represents payment in full (both time and money) for all costs arising out of, or incidental to, the above Change Order. Contractor's Company Name o itractor Name Contra for Signature Date McClendon Construction Company, Inc. Justin Blair I �I 12-19-23 Ins toc Director (Water Dept) Assistant City Attorney Date /2 / )'4 Date T.S.F ab 7, 2024 Date eh 7, 2024 /i Project Manger Const"Oop-Supervj r (TPW Dept) yr l �= Assista Manag s� Council Action (If Required) M&C Number N/A M&C Date Approved Date 2/5/24 Date Date -eb 7, 2024 FORT WORTH City of Fort Worth Change Order Additions Project Name 1 2022 Bond Yr 1 - Contract 1 City Sec No.: 59301 Project No.(s): 1 56002-0600430/0700430 and 34027/52002-0200431 DOE No.1 I City Proj. No.: 102918 Project Description Combined Street Paving, Water, Sanitary Sewer and Storm Drain replacements for 2022 Bond year 1, Contract 1 Contractor McClendon Construction Company, Inc. I Change Order: I 1 I Date: 1 121712023 City Project Mgr. Dena Johnson City Inspector I Kevin Jackson ADDITIONS I I tM UtSCKIP I ION DEPT Qty Unit Unit Cost Total 34 Reroute sewer service route for 4301 Vinson Street to Bradley Street Sewer 1.00 LS $14,850.00 $14,850.00 39 1-inch Water Service Storm Water 1.00 EA $2,000.00 $2,000.00 55 0241.1700 11" Pavement Pulverization Water 688.00 SY $12.00 $8,256.00 56 3212.0303 3" Asphalt Pvmt Type D Water 688.00 SY $24.00 $16,512.00 57 6" Conc Curb & Gutter Water 200.00 LF $75.00 $15,000.00 62 6" Conc Curb & Gutter (shared cost with water) Paving 200.00 LF $75.00 $15,000.00 (Water $39,768.00 (Sewer $14,850.00 (Storm Water $2,000.00 Paving $15,000.00 lAdditions Sub Total $71,618.00 Page 2 of 4 FORT WORTH City of Fort Worth —'� Change Order Deletions Project Name I 2022 Bond Yr 1 - Contract 1 City Sec No.: 59301 Project No.(s): I 56002-0600430/0700430 and 34027/52002-0200431 DOE No. I City Proj. No.: 1029`18 Project Description I Combined Street Paving, Water, Sanitary Sewer and Storm Drain replacements for 2022 Bond year 1, Contract 1 I Contractor I McClendon Construction Company, Inc. Change Order: F1 I Date 1217/2023 City Project Mgr, Dena Johnson City Inspector: I Kevin Jackson DELETIONS ITEM DESCRIPTION DEPT Qty Unit Unit Cost Total 33 Construction Allowance (Sewer) Sewer 0.2475 LS $60,000.00 $14,850.00 38 Construction Allowance (Storm Water) Storm Water 0.0400 LS $50,000.00 $2,000.00 69 Constructio Allowance (Water) Water 0.39768 LS $100,000.00 $39,768.00 61 Construction Allowance (Paving) Paving 0.1500 LS $100,000.00 $15,000.00 (Water $39,768.00 (Sewer $14,850.00 (Storm Water $2,000.00 (Paving $15,000.00 Deletions Sub Total $71,618.00 Page 3 of 4 MWWBE Breakdown for this Change Order MWBE Sub I Type of Service I Amount for this CO Total $0.00 Previous Change Orders co # I DATE AMOUNT Total $0.00 1 Page 4 of 4 Contract Compliance Manager By signing I acknowledge that I am the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. Signature Dena Johnson Name of Employee Project Manager Title ATTEST: Jannette Goodall City Secretary FORT WORTH. Routing and Transmittal Slip Transportation & Public Works Department DOCUMENT TITLE: 2022 Bond Year 1 Contract 1 Change Order 2 M&C: CPN: 102918 CSO: 59301 DOC#: Date: _ To: Name Department Initials Date Out 1. Filogonio Munoz TPW Jan 31, 2025 2 Justin Blair Vendor Feb 3, 2025 iblair(amcclendonconstrution.com 3. Kevin Jackson TPW ?� Feb 3, 2025 4. Jose Orozco TPW ,Ao9A0 Feb 3, 2025 5. Greg Robbins TPW GR Ge Feb 5, 2025 6. Mary Hanna TPW 7 Feb 5, 2025 7 Patricia Wadsack TPW PLW Feb 5, 2025 8 Lauren Prieur TPW I Feb 6, 2025 9 Doug Black Legal o-W Feb 7, 2025 10. Jesica McEachern CMO ,m` Feb 13, 2025 11. Jannette Goodall CSO JG 1G Feb 13, 2025 12. TPW Contracts TPW CC: Program Manager, Sr. CPO, TPW BSPAP Recon Team, TPW Records Room, TPW Contracts ALSO List: - Bus Sppt: Filogonio Munoz; Prg Mgr Greg Robbins; Sr CPO - Mary nanna DOCUMENTS FOR CITY MANAGER'S SIGNATURE: All documents received from any and all City Departments requesting City Manager's signature for approval MUST BE ROUTED TO THE APPROPRIATE ACM for approval first. Once the ACM has signed the routing slip, David will review and take the next steps. NEEDS TO BE NOTARIZED: [-]YES ®No RUSH: DYES ®No SAME DAY: DYES [-]No NEXT DAY: [-]YES [-]No ROUTING TO CSO: ®YES ❑No Action Required: ❑ Attach Signature, Initial and Notary Tabs ❑ As Requested ❑ For Your Information ® Signature/Routing and or Recording ❑ Comment ❑ File Return To: Please notify TPWContracts(&)fortworthtexas.gov for pickup when complete. Call ext. 7233 or ext. 8363 with questions. Thank you! CSC No. 59301-CO2 FOR_ _ TwORTH® City of Fort Worth Change Order Request Project Namel 2022 Bond Year 1 Contract 1 City Sec # 1 59301 Client Project #(s)1 102918 (56002-0600430/0700430 and 34027/52002-0200431) Project) Combined Street Paving, Water, Sanitary Sewer and Storm Drain replacements for 2022 Bond Yearl, Contract 1 Description Contractorl McClendon Construction Co., Inc Change Order#1 2 1 Datel 1/29/2025 City Project Mgr.l Jose Orozco City Inspectorl Kevin Jackson Dept. Unit I - Water Unit II - Sewer Unit III - Storm Unit IV - TPW Totals Contract Time (CD) Original Contract Amount $3,675,505.00 $973,780.00 $758,915.00 $3,486,186.00 $8,894,386.00 430 Extras to Date $0.00 $0.00 $0.00 $0.00 7 Credits to Date Pending Change Orders (in M&C Process) Contract Cost to Date $3,675,505.00 $973,780.00 $758,915.00 $3,486,186.00 $8,894,386.00 437 JGo to ADD & DEL Tabs to Enter CO Backup $0.00 $0.00 $0.00 $0.00 64 Revised Contract Amount $3,675,505.00 $973,780.00 $758,915.00 $3,486,186.00 $8,894,386.00 501 Original Funds Available for Change Orders $183,775.00 $68,165.00 $37,945.00 $174,309.00 $464,194.00 Remaining Funds Available for this CO $183,775.00 $79,293.00 $37,945.00 $174,309.00 1 $475,322.00 Additional Funding (if necessary) CHANGE ORDERS to DATE (INCLUDING THIS ONE) AS % OF ORIGINAL CONTRACT 0.00% MAX ALLOWABLE CONTRACT AMOUNT (ORIGINAL CONTRACT COST + 25%) $11,117,982.50 JUSTIFICATION (REASONS) FOR CHANGE ORDER IN ACCORDANCE WITH THIS CHANGE ORDER, THE CONTRACTOR SHALL: Furnish all labor and material as per the attached proposed Change Order. This change order provides the following: Change Order #2 provides additional time for delays related to franchise utility relocation. 64 calendar days were granted for delays caused by Atmos along Virginia and Edgewood Terrace to relocate shallow gas services to avoid conflicts with paving equipment and the proposed utility work (12/20/2023 — 02/21 /2024). Cost: No cost is associated with this change order It is understood and agreed that the acceptance of this Change Order by the contractor constitutes an accord and satisfaction and represents payment in full (both time and money) for all costs arising out of, or incidental to, the above Change Order. The Project/Program Manager signing below acknowledges that he/she is the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting reauirements. Contractors Com an Name Contractor Name Contract Si nature Date McClendon Construction Co., Inc. Justin Blair a Feb 3, 2025 'Inspector/Inspection Supervisor Date Project and Contract Compliance Manager Date k� Feb 3, 2025 Feb 3, 2025 Fro —gram Manager Date Senior Capital Project Officer Date Feb 5, 2025 �� -� Feb 5, 2025 ctor De t rf sl f _ Date Feb 5, 2025 Director, Contracting Department (Dept) JG. Z— Date 1 Feb 6, 2025 Assistant City Attorney Date Assistant Cit Manager Date Feb 7, 2025 M&C Number , op ired I I M&C Date Approved Feb 13, 2025 l ATTEST: � -.-A A;... Jannette Goodall, City Secretary City of Fort Worth Change Order Additions Project Name 2022 Bond Year 1 Contract 1 City Sec # 59301 j Client Project # 102918 (56002-0600430/0700430 and 34027/52002.0200431) 1 Conlractorl McClendon Construction Co., Inc PMI Jose Orozco I Inspectorl Kevin Jackson Change Order Submittal# � Date 1 1/29/2025 1 ADDITIONS I tM Ut6UKII1I IUN UtP I Uty Unit Unit host I otal Unit I -Water 0.00 Unit 11- Sewer 0.00 Unit III - Storm $0.00 UnitIV -TPW $0.00 Sub Total Additions $0.00 Change Order Additions Page 2 of 4 Foxe City of Fort Worth Change Order Deletions Project Name 1 2022 Bond Year 1 Contract 1 City Sec # 59301 Client Project # I 102918 (56002-0600430/0700430 and 34027/52002-0200431 I Contractorl McClendon Construction Co., Inc I PMJ Jose Orozco I Inspectorl Kevin Jackson l Change Order Submittal # F Date 1 1/29/2025 1 DELETIONS IItM ULSL;KIF'I IUN ULF'I Uty Unit Unit Cost total Unit I -Water $0.00 Unit II - Sewer C.00 Unit III - Storm $0.00 Unit IV - TPW $0.00 Sub Total Deletions $0.00 Change Order Deletions Page 3 of 4 M/SBE for this Change Order M/SBE Sub Type of Service Amount for this CO Total $0.00 Previous Change Orders CO # DATE I AMOUNT 12/7/2023 $0.00 Total I $0.00 1 FORTWORTH TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PROJECT NAME: 2022 Bond Year 1 Contract 1 CITY PROJECT NUMBER: 102918 WATER PIPE LAID SIZE TYPE OF PIPE LF C-900 16" PVC 859 LF DIP 16" DIP 160 LF C-900 8" PVC 6048 LF DIP 8" DIP 120 LF C-900 6" PVC 135 LF FIRE HYDRANTS: 11 VALVES (16" OR LARGER) 2 PIPE ABANDONED SIZE TYPE OF PIPE LF C.I 6" Cast Iron 1,164 LF C.I 16" Cast Iron 800 LF C.1 4" Cast Iron 250 LF DENSITIES: UPLOADED TO E-BUILDER NEW SERVICES: 2" COPPER 2 EA 1" COPPER 115 EA SEWER PIPE LAID SIZE TYPE OF PIPE LF SDR-26 8" PVC 2120 LF SDR-26 6" PVC 30 LF PIPE ABANDONED SIZE TYPE OF PIPE LF SDR-26 6" PVC 100 LF DENSITIES: UPLOADED TO E-BUILDER NEW SERVICES: 4" PVC 54 EA TRANSPORTATION AND PUBLIC WORKS The City of Fort Worth • 1000 Throckmorton Street • Fort Worth, TX 76012-6311 FORTWORTH. TRANSPORTATION AND PUBLIC WORKS March 14, 2025 McClendon Construction Co., Inc. P.O. Box 999 Burleson, TX 76097 RE: Acceptance Letter Project Name: 2022 Bond Year 1 Contract 1 Project Type: Water,Sewer,Paving City Project No.: 102918 To Whom It May Concern: On October 24, 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 November 18, 2024. The final inspection and the corrected punch list items indicate that the work meets the City of Fort Worth specifications and is therefore accepted by the City. The warranty period will start on November 18, 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 .lose Orozco, P.E. Sr Project Manager Office: 817-392-8785 Jose. Orozco(@fortworthtexas.aov . Sincerely, A olg� Jose Orozco, Project Manager Cc: Kevin Jackson, Inspector Gary Deyon, Inspection Supervisor Lorrie Pitts, Senior Inspector Mary Hanna, Program Manager Pacheco Koch, Consultant McClendon Construction Co., Inc., Contractor City Of Fort Worth, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev. 8/20/19 CONSENT OF OWNER ❑ SURETY COMPANY ARCHITECT ❑ TO FINAL PAYMENT CONTRACTOR ❑ SURETY ❑ AIA DOCUMENT G707 OTHER Bond No. TXC616281 PROJECT: 2022 Bond Year 1 Contract 1 CPN 102918 (name, address) TO (Owner) [ City of Fort Worth ] ARCHITECT'S PROJECT NO: 200 Texas Street Fort Worth, TX 76102 CONTRACT FOR: 2022 Bond Year 1 FCP: $7,641,660.43 [ ] CONTRACT DATE: April 25, 2023 CONTRACTOR: McClendon Construction Company, Inc. 548 Memorial Plaza Burleson, TX 76024 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) Merchants Bonding Company (Mutual) P.O. Box 14498 Des Moines, IA 50306-3498 , SURETY COMPANY, On bond Of (here insert name and address of Contractor) McClendon Construction Company, Inc. 548 Memorial Plaza Burleson, TX 76024 , 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 200 Texas Street Fort Worth, TX 76102 ,OWNER, as set forth in the said Surety Company's bond. IN WITNESS WHEREOF, the Surety Company has hereunto set its hand this 12th day of March 2Q25 Merchants Bonding Company (Mutual) Attest: yl.M4 W t (�tC� S 1 (Seal): Connie Williamson, Witness Surety Com Signature of Auth ized Representative Emily Allison Mikeska Attornev-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 AIA DOCUMENT G707 • CONSENT OF SURETY COMPANY TO FINAL PAYMENT • APRIL 1970 EDITION • AIAOO ONE PAGE © 1970 • THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 New York Ave., NW, WASHINGTON, D C. 20006 MERCHANTS BONDING COMPANYT. 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, Allyson W Dean; Ana Owens; Andrea Rose Crawford; Andrew Gareth Addison; Bryan Kelly Moore; Colin E Conly; Cory Kiper; Debra Lee Moon; Elizabeth Ortiz; Emily Allison Mikeska; Faith Ann Hilty; John R Ward; Kimberly Rochelle Gonzalez; Michael Wiggins; Monica Ruby Veazey; Patrick Thomas Coyle; Sandra Lee Roney; Thomas Douglas Moore; Troy Russell Key their true and lawful Attorney(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 -Attorney 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 Attorney -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 13th day of January 2025 ,.••PI10Nq� ••,• ••O • •• •. �Nr�..��ij�A.• MERCHANTS BONDING COMPANY (MUTUAL) MERCHANTS NATIONAL BONDING, INC. q� Ot�PORy : : mom. �RPOgq.9y. d/b/a MERCHANTS NATIONAL INDEMNITY COMPANY v` 2003 1933 �'c: By ! �� :7 ,: •. lj/ �1 •• President STATE OFIOWA '•.,���•�S'�7••••.•• '•.•�•••.• COUNTY OF DALLAS ss. On this 13th day of January 2025 , 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. - �?�" 4 Penni Miller 0 Commission Number 787952 • • My Commission Expires \� / roWA January 20, 2027 ~ �,•%� Notary Public (Expiration of notary's commission does not invalidate this instrument) I, 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 12th day of March , 2025 •.....••• ,.••PZ10Nq. .•.O�itkG C04ic•• �. •aP0%p' B oq 9 ; •00 APO -Q:— -o O.:at�• •z'2 0 0'a000&b �. 2003 :�,7 y 1933 c; Secretary ''•���y ......... ..0#0: •.•.�w ��•: POA0018 (6/24) """'••••' • . • • . . . • • Affidavit of Compliance with City of Fort Worth Prevailing Wages 1, -�V ji�l1� �4,► T �rr-so G�l� (Name of person signing affidavit) (Title) do hereby certify that the wages paid to all employees of �GG��,,�0� kph $jvG�`rdr► �,�nC , (Company Name) for all hours worked on the �XX _,Ve-,l ZOv%L.J.2 �� k��9IX (Project name and location) project, during the period from G -12 - 23 to /® - Alt ® A ILI (Project Dates) are in compliance with the requirements of Chapter 2258, Texas Government Code related to paying established City of Fort Worth wage rates per the project bid documents. I further certify that no rebates or deductions have been or will be made, directly or indirectly, from any wages paid in connection with this project, other than those provided by law. (Signature of Officer or Agent) Sworn to and subscribed in my presence this day of 11,���'� 20� MISTY WEBB Notary PubEic, State of Texas Comm. Expires 01-09-2026 Notary ID 126638467 y Public) Revised 3/08/2024