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Home My WebLink AboutContract 60966-FP3FORT WORTH. -FP3 City Secretary Contract No. 60966 Date Received 4/28/2025 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: Hampton Tract Phase 3 City Project No.: 104657 Improvement Type(s): Water 0 Sewer 0 (Original Contract Price: $758,447.20 Amount of Approved Change Order(s): $1,560.00 Revised Contract Amount: $760,007.20 Total Cost of Work Complete: $760,007.20 A(b,-� Amtt ►ems 04/24/2025 4Ibcrt Grantges (7�pr24, 20`2t 10:36 CDT) Contractor Date Vice President Title Burnsco Construction, Inc. Company Name Matt Cain 04/24/2025 Matt Cain (ADr 24, 2025 10:48 CDT) Project Inspector Date '�J 04/28/2025 Project Manager Date - 04/28/2025 e Merrick (Aar 28, 202514:22 CDT) CFA Manager Date �-� 04/28/2025 Lauren Prleur (Apr 28, 2025 14:24 CDT) TPW Director Date C�� 04/29/2025 Asst. City Manager Date OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Page 1 of 2 Notice of Project Completion Project Name: Hampton Tract Phase 3 City Project No.: 104657 City's Attachments Final Pay Estimate ❑x Change Order(s): ❑x Yes ❑ N/A Pipe Report: ❑x Yes ❑ N/A Contractor's Attachments Affidavit of Bills Paid Consent of Surety r Statement of Contract Time Contract Time: 110 WD Work Start Date: 5/22/2024 Completed number of Soil Lab Test: 215 Completed number of Water Test: 4 Days Charged: 176 WD Work Complete Date: 3/21/2025 Page 2 of 2 FORT WORT 11 CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name HAMPTON TRACT PHASE 3 Contract Limits Project Type WATER & SEWER City Project Numbers 104657 DOE Number 4657 Estimate Number 1 Payment Number 1 For Period Ending 3/21/2025 WD City Secretary Contract Number Contract Time l lWD Contract Date Days Charged to Date 176 Project Manager NA Contract is 100.00 Complete Contractor BURNSCO CONSTRUCTION, INC. 6331 SOUTHWEST BLVD FORT WORTH, TX 76132 Inspectors G.DEYON / M.CAIN Thursday, April 24, 2025 Page 1 of 5 City Project Numbers 104657 Contract Name HAMPTON TRACT PHASE 3 Contract Limits Project Type WATER & SEWER Project Funding UNIT I A: WATER IMPROVEMENTS (ONSITE) Item Description of Items No. 1 8" WATERLINE LOWRING 2 TRENCH SAFETY 3 20" CASING BY OTHER THAN OPEN CUT 4 DUCTILE IRON WATER FITTINGS W/ RESTRAINT DOE Number 4657 Estimate Number I Payment Number 1 For Period Ending 3/21/2025 Estimated Unit Unit Cost Estimated Completed Completed Quanity Total Quanity Total 3 EA $5,450.00 $16,350.00 3 $16,350.00 1616 LF $0.10 $161.60 1616 $161.60 20 LF $1,356.00 $27,120.00 20 $27,120.00 1 TN $6,000.00 $6,000.00 1 $6,000.00 5 8" PVC WATER PIPE 1616 LF $54.20 $87,587.20 1616 $87,587.20 6 FHtE HYDRANT w/ GATE VALVE 3 EA $8,120.00 $24,360.00 3 $24,360.00 7 1" WATER SERVICE (DOMESTIC) 43 EA $1,560.00 $67,080.00 43 $67,080.00 8 1" WATER SERVICE (IRRIGATION) (CO#1) 5 EA $1,560.00 $7,800.00 5 $7,800.00 9 8" GATE VALVE & BOX 2 EA $2,550.00 $5,100.00 2 $5,100.00 Sub -Total of Previous Unit $241,558.80 $241,558.80 UNIT I B: WATER IMPROVEMENTS (OFFSITE) Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total 1 8" WATERLINE LOWERING 1 EA $5,450.00 $5,450.00 1 $5,450.00 2 TRENCH SAFETY 904 LF $0.10 $90.40 904 $90.40 3 20" CASING BY OTHER THAN OPEN CUT 20 LF $1,356.00 $27,120.00 20 $27,120.00 4 DUCTILE IRON WATER FITTINGS w/ 0.5 IN $6,000.00 $3,000.00 0.5 $3,000.00 RESTRAINT 5 8" PVC WATER PIPE 904 LF $105.00 $94,920.00 904 $94,920.00 6 CONNECTION TO EXISTING 4"-12" WATER 2 EA $1,900.00 $3,800.00 2 $3,800.00 MAIN 7 8" GATE VALVE & BOX 1 EA $2,540.00 $2,540.00 1 $2,540.00 8 TRAFFIC CONTROL 1 MO $4,800.00 $4,800.00 1 $4,800.00 9 REMOVE & REPLACE CONCRETE PAVEMENT 25 SY $200.00 $5,000.00 25 $5,000.00 - - Sub -Total of Previous Unit - - - - - - - - - - - - - - - - - $146,720.40 $146,720.40 UNIT H: SANITARY SEWER IMPROVEMENTS Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total 1 LARGE STONE RIPRAP, DRY 229 SY $96.00 $21,984.00 229 $21,984.00 Thursday, April 24, 2025 Page 2 of 5 City Project Numbers 104657 DOE Number 4657 Contract Name HAMPTON TRACT PHASE 3 Estimate Number I Contract Limits Payment Number 1 Project Type WATER & SEWER For Period Ending 3/21/2025 Project Funding 2 POST -CCTV INSPECTION 1697 LF $3.00 $5,091.00 1697 $5,091.00 3 MANHOLE VACUUM TESTING 8 EA $145.00 $1,160.00 8 $1,160.00 4 TRENCH SAFETY 1697 LF $1.00 $1,697.00 1697 $1,697.00 5 TRENCH WATER STOPS 4 EA $400.00 $1,600.00 4 $1,600.00 6 IMPORTED EMBEDMENT/BACKFILL, CSS 140 LF $54.00 $7,560.00 140 $7,560.00 7 20" STEEL CASING BY OPEN CUT 150 LF $200.00 $30,000.00 150 $30,000.00 8 20" CASING BY OTHER THAN OPEN CUT 35 LF $1,359.00 $47,565.00 35 $47,565.00 9 4" SEWER SERVICE 43 EA $1,520.00 $65,360.00 43 $65,360.00 10 8" SEWER MAIN 1319 LF $64.00 $84,416.00 1319 $84,416.00 11 8" DIP SEWER MAIN 378 LF $122.00 $46,116.00 378 $46,116.00 12 EPDXY MANHOLE LINER 29 VF $420.00 $12,180.00 29 $12,180.00 13 4' MANHOLE 8 EA $4,600.00 $36,800.00 8 $36,800.00 14 EXTRA DEPTH MANHOLE(>6.0') 47 VF $217.00 $10,199.00 47 $10,199.00 -------------------------------------- Sub -Total of Previous Unit $371,728.00 $371,728.00 Thursday, April 24, 2025 Page 3 of 5 City Project Numbers 104657 Contract Name HAMPTON TRACT PHASE 3 Contract Limits Project Type WATER & SEWER Project Funding Contract Information Summary Original Contract Amount Change Orders Change Order Number 1 Total Contract Price DOE Number 4657 Estimate Number 1 Payment Number 1 For Period Ending 3/21/2025 $758,447.20 $1,560.00 $760,007.20 Total Cost of Work Completed $760,007.20 Less % Retained $0.00 Net Earned $760,007.20 Earned This Period $760,007.20 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 $760,007.20 Thursday, April 24, 2025 Page 4 of 5 City Project Numbers 104657 Contract Name HAMPTON TRACT PHASE 3 Contract Limits Project Type WATER & SEWER Project Funding Project Manager NA Inspectors G.DEYON / M.CAIN Contractor BURNSCO CONSTRUCTION, INC. 6331 SOUTHWEST BLVD FORT WORTH, TX 76132 DOE Number 4657 Estimate Number I Payment Number 1 For Period Ending 3/21/2025 City Secretary Contract Number Contract Date Contract Time 110 WD Days Charged to Date 176 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 $760,007.20 Less % Retained $0.00 Net Earned $760,007.20 Earned This Period $760,007.20 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 $760,007.20 Thursday, April 24, 2025 Page 5 of 5 r � REVIEWED By George Marqeuez, P.E. at 11:51 am, Mar 31, 2025 DEVELOPER -AWARDED -PROJECT CHANGE ORDER PROJECT NAME. Hampton Tract Phase 3 CHANGE CONTRACT A -Water Improvements ORDER No: CFA # 23-0047 CITY PARTICIPATION No CITY PROJECT # 104657 DOE # 1A WATER PROJECT # 30114.0200431.104657-EO7685 SEWER PROJECT# 30114.0200431.104657.EO7685 FILE # X•27756 INSPECTOR: Phone No: PROJECT MANAGER: George Marquez Phone No: 817 392 8826 I CONTRACT UNIT WATER aEWER I PAVING DRAINAGE STREETUGHTS I CONTRACT Devclopor j Developer Developer Develop., DAYS oeveloperCost C COat cost I City.CGft .. Cost Coll? Cost Ooet _ Coat G 'Cott ORIGINAL CONTRACT $386,719.20 SJ71,726.00 5869,Sb8.66 6187,J11.b0 $117.16d.12 EXTRAS TO DATE 1 CREDITSTODATE CONTRACT TO DATE 5356,7t9.20 60.00 S31L728AO 50100 $1149,658.1{6 5187, 311.60 ".0 $117.1(1 50.00 110 Afd}O�IINDT`O(F PROP. CHANGE ORDER RfOTAL A/2W..XA�� AMOUNT SJO71,27410 SO." S371,12E.00 70.00 $849,666.4 6107,311.60 p:00 S117.164.12 - 50.4 110 PER UNIT 5388,279.20 I..,. 5371.724,00 S8496668.46 614T.2t1.60 t117.1M.12 REVISED COST SHARE C.$1,914,041.47 TOTAL REVISED CONTRACT I $1,914,041A7 You are directed to make the followlnp changes in the controcl documents CITY a D STEM PAY ITEM 8 OUANTDY UNIT �rSCJt UNMPRICE TOTAL 8 331210 t E4 1" er rnca� q n1 $1.560.00 $1.560.00 TOTAL St.560 00 REASONS FOR CHANGE ORDER I7rlpellon service added for open space area NO CITY FUNDS INVOLVED IN IRIS CONTRACT. DEVELOPER IS RESPONSIBLE FOR 100%OF THE CHANGE OR DER COST AND NO REIMBURSEMENT FROM THE CITY WILL DE SOUGHT BY THE DEVELOPER. Revised: 10-12-2011 Pepe 1 RECOMMENDED: APPROVED APPROVED: near) (On�obpnr (Contractor) `(///y�Ifr1Y BY: IV411—- �By. Name: c.+4� �aP`> Name: =��-b —. By- Nae: AlbertPGr/an"tMgaLs I Tole: Prv,cal- /•IA.I(A r Vice President Tllle: �G,i/Dw.�b.�,�� We: APPROVAL RECOMMENDED: APPROVED: APPROVED AS TO FORM AND LEGALITY: CFW - Sponsoring Deparfmm;t CFW- Asstster4 CNy Manager CFW - AssistarN City Attorney By: N/A By: N/A BY: N/A Name: Name: Name. Title: We: Title RECOMMENDED: Cr-✓ 'CordractC Ran Manager ATTEST By:: Q 8 �J — � N/A Name//G Gorge Marau Z Jannelle S. Goodell nue:-CFW Project Manager Clly Secretary M&C Number: `NJ,Q MBC[)at,,Approved: N/A Contract Compliance Manager (Project Manages): By signlnp I acknowledge Anal A am the person responsible for the monlloring and adminlstratlon of this contract, Include enswing all performance and reporting requirements. ❑+ There are NO city Funds associated wllh this Contract El There are Cly Funds assoclated with Ants Contract i REVIEWED I" By George Marqeuez, P.E. at 11:51 am, Mar 31, 2025 Revlsed: 10-12.2011 Page 2 PROJECT NAME: CONTRACT: CFA # CITY PROJECT # FID # SEWER PROJECT # FILE # INSPECTOR: PROJECT MANAGER: ORIGINAL CONTRACT EXTRAS TO DATE CREDITS TO DATE CONTRACT TO DATE AMOUNT OF PROP. CHANGE ORDER REVISED CONTRACT AMOUNT TOTAL REVISED CONTRACT AMOUNT PER UNIT REVISED COST SHARE TOTAL REVISED CONTRACT DEVELOPER -AWARDED -PROJECT CHANGE ORDER Hampton Tract Phase 3 Street Light Revision 23-0047 104657 30114-0200431-104657-EO7685 X-27756 W-2928 George Marquez WATER Developer Cost $386,719.20 $1,560.00 $0.00 $388,279.20 $0.00 $388,279.20 CHANGE ORDER No: CITY PARTICIPATION:( NO Phone No: Phone No: 817-392-6826 CONTRACT UNIT X: OFFSITE STREETLIGHTS CLEBURNE CROWLEY ROAD SEWER DRAINAGE PAVING Developer Developer Developer City Cost Cost City Cost Cost City Cost Cost City Cost $0.00 $371,728.00 $0.00 $187,311.50 $0.00 $849,558.65 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $371,728.00 $0.00 $187,311.50 $0.00 $849,558.65 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $371,728.00 $0.00 $187,311.50 $0.00 $849,558.65 $0.00 STREET Developer Cost $117,164.12 $0.00 $0.00 $117,164.12 ($11,054.00) $106,110.12 $388,279.20 $371,728.00 $187,311.50 $849,558.65 1 Dev. Cost: $1,902,987.47 City Cost: 0000.00 $1,902,987.47 LIGHTS City Cost $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $106,110.12 (CONTRACT i DAYS 110 0 0 110 0 110 Revised: 12-17-2018 Page 1 Unit V - C: Streetlight Improvements (Offsite - Old Cleburne Crowley) You are directed to make the following changes in the con+ract documents CITY BID ITEM PAY ITEM # # QUANTITY UNIT ITEM DESCRIPTION UNIT PRICE TOTAL 1 2605.3015 (200.00) LF 2" CONDT PVC SCH 80(T) $ 21.52 (4,304.00) 2 3441.141 (400.00) LF NO 10 Insulated Elec Condr $ 6.03 (2,412.00) 3 3441.1646 (2.00 EA Furnish/Install Type 33B arm $ 398.00 (796.00) 4 3441.305 2.00 EA Furnish/Install LED Lighting Fixture (70W ATBO) $ 563.00 1,126.00 5 3441.3301 (2.00) EA Rdwy Illum Assmbly TY 18 $ 3,102.00 (6,204.00) 6 3441.3003 (2.00) EA Rdwy Illum assmbly TY 18, 18A, 19, AND D-40 $ 2,327.00 (4,654.00) 7* 3441.3302 3.00 EA Type 33B Arm Wood Pole Arm $ 1,200.00 3,600.00 8' 3441.1401 370.00 LF NO 6 Triplex OH Insulated Elec Condr $ 7.00 2,590.00 SUBTOTAL 11,054.00) TOTAL �11,054.00) Asterisk (") indicates New Pay Item REASONS FOR CHANGE ORDER Oncor overhead lines in conflict with light pole foundations on North side of Cleburne -Crowley Rd. Lights must be moved onto Oncor poles. 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. Revised: 12-17-2018 Page 2 RECOMMENDED: Shietdlbeering By: /I {'� Name: eftle6 ✓LfA^ Title: Proiec+ IVIC-O er- APPROVAL RECOMMENDED: CFW - Sponsoring Department By: N/A Name: Title: RECOMMENDED: CFW - *Contract Compliance Manager // Name: Andrew Goodman, PE Title: IPRC Engineering Manager M&C Number: N/A N/A M&C Date Approved: APPROVED: APPROVED: DR Norton Independen lity Construction By � � e- By: Narr��-r-' Name: Richard Wolfe Title: I/. le l �� _ Title: President APPROVED: CFW - Assistant City Manager N/A By: Name: Title: APPROVED AS TO FORM AND LEGALITY: CFW - Assistant City Attorney N By: /A Name: Title: ATTEST ' Contract Compliance Manager (Project Manager): By signing I acknowledge that I am the person responsible N/A for the monitoring and administration of this contract, include ensuring all performance and reporting requirements. Jannette S. Goodall City Secretary [] There are NO City Funds associated with this Contract ❑ There are City Funds associated with this Contract Revised: 12-17-2018 Page 3 FORT WORTH TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PROJECT NAME: Hampton Tract Ph.3 CITY PROJECT NUMBER: 104657 WATER PIPE LAID SIZE TYPE OF PIPE LF C900 8" PVC 1616 C900 (Offsite) 8" PVC 904 FIRE HYDRANTS 3 VALVES (16" OR LARGER; N/A PIPE ABANDONED SIZE TYPE OF PIPE LF N/A DENSITIES; Yes NEW SERVICES: 1" Copper (Irrigation) 5 1" Copper (Domestic) 43 SEWER PIPE LAID SIZE TYPE OF PIPE LF SDR26 8" PVC 1319 SDR26 8" DIP 378 PIPE ABANDONED SIZE TYPE OF PIPE LF N/A DENSITIES; Yes NEW SERVICES: 4" PVC 43 TRANSPORTATION AND PUBLIC WORKS The City of Fort Worth • 1000 Throckmorton Street • Fort Worth, TX 76012-6311 (817) 392 - 7941 • Fax: (817) 392 - 7845 FORTWORTH. M, TRANSPORTATION AND PUBLIC WORKS April 7, 2025 Burnsco Construction, Inc. 6331 Southwest Blvd. Benbrook, TX. 76132 RE: Acceptance Letter Project Name: Hampton Tract Ph.3 Project Type: water, sewer, paving, drainage, street lights City Project No.: 104657 To Whom It May Concern: On March 31, 2025 a final inspection was made on the subject project. There were no punch list items identified at that time. The final inspection indicates that the work meets the City of Fort Worth specifications and is therefore accepted by the City. The warranty period will start on March 31, 2025, which is the date of the final inspection and will extend of two (2) years in accordance with the Contract Documents. If you have any questions concerning this letter of acceptance, please feel free to contact me at (817)- 392-6826. Sincerely, George Marquez, Project Manager Cc: Matt Cain, Inspector Gary Deyon, Inspection Supervisor Edward D'Avila, Senior Inspector Andrew Goodman, Program Manager Shield Engineering Group, Consultant Burnsco Construction, Inc., Contractor D.R Horton, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev. 08/20/19 AFFIDAVIT STATE OF TEXAS COUNTY OFTARRANT Before me, the undersigned authority, a notary public in the state and county aforesaid, on this day personally appeared Ab Grantges, Contract Mgr, Of Burnsco 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; Hampton Tract Phase 3 - Water, Sanitary Sewer and Storm Drain BY 0 ) Ab Grantges�act Manager Subscribed and sworn before me on this date 24th of April, 2025. Notary Public Tarrant County, Texas z ►aY A�$� CESILIA CANALES Notary 10 #131652996 �a F My Commission Expires yTEpF t�} July 24, 2026 CONSENT OF SURETY COMPANY TO FINAL PAYMENT Conforms with the American Institute of Architects, AIA Document G707 OWNER ❑ ARCHITECT ❑ CONTRACTOR ❑ SURETY ❑ OTHER Bond No 022238142 PROJECT: (name, addresS)Hampton Tract Phase 3 -Water, Sanitary Sewer, Drainage Improvements Fort Worth TX TO (Owner) ID.R. HORTON -TEXAS, LTD AND CITY OF FORT ARCHITECT'S PROJECT N0: WORTH CONTRACT FOR: 6751 North Freeway Hampton Tract Phase 3 - Water, Sanitary Sewer, Drainage y Improvements Fort Worth TX 76131 �f CONTRACT DATE: CONTRACTOR: BURNSCO CONSTRUCTION, INC. In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the (here insert name and address of Surety Company) LIBERTY MUTUAL FIRE INSURANCE COMPANY 175 Berkeley Street Boston MA 02116 ,SURETY COMPANY on bond of (here insert name and address of Contractor) BURNSCO CONSTRUCTION, INC. 6331 Southwest Boulevard Benbrook TX 76132 ,CONTRACTOR, hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve the Surety Company of any of its obligations to there insert name and address of owner) D.R. HORTON - TEXAS, LTD AND CITY OF FORT WORTH 6751 North Freeway Fort Worth TX 76131 , OWNER, as set forth in the said Surety Company's bond, IN WITNESS, WHEREOF, the Surety Company has hereunto set its hand this 25th day of March, 2025 LIBERTY MUTUAL FIRE INSURANCE COMPANY Surety Company Attest: ,°J I,,,,a � r f1�.r TI (Seal): Signa e of Authorized Representative SnnhiniP Hunter 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 ONE PAGE This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. Liberty Liberty Mutual Fire Insurance Company Mutu L Wausau, Wisconsin Certificate No; 8205468-022020 SURETY POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: Liberty Mutual Fire Insurance Company, being a Wisconsin Corporation having its principal office in the City of Wausau, State of Wisconsin does hereby make, constitute and appoint Don E. Cornell; Joshua Saunders; Kelly A. Westbrook; Mikaela Peppers; Ricardo J. Reyna; Robbi Morales; Sophinie Hunter; Tina McEwan; Tonie Petranek all of the city of Dallas state of TX each individually if there be more than one named, its true and lawful attorneys) -in -fact, with full power and authority hereby conferred in theirlits name, place and stead, to sign, execute, acknowledge and deliver in their/its behalf, and as their/its act and deed, without power of redelegation, as follows: Bonds, undertakings, recognizances, contracts of indemnity, and all other surety obligations, as required, unlimited as to Dollar amount and to bind the Company(ies) making this appointment thereby as fully and to the same extent as if such bond or undertaking was signed by the duly authorized officers of the Company(ies), and all the acts of said attorney(s), pursuant to the authority herein given, are hereby ratified and confirmed. AUTHORITY FOR MAKING APPOINTMENT OF ATTORNEYS -IN -FACT Appointment of Attorneys -in -Fact by Liberty Mutual Fire Insurance Company are made pursuant to Article V, Section 10 of Liberty Mutual Fire Insurance Company's By -Laws, as amended and by Unanimous Consent of the Board of Directors dated May 21st, 2013. Further, the President of Liberty Mutual Fire Insurance Company, executed a Delegation of I di (Authority and authorized the assistant secretary signing below to appoint attorneys -in -fact as may be necessary to act on behalf of Liberty Mutual Fire Insurance Company to make (D execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances, and other surety obligations. cc IN WITNESS WHEREOF, Liberty Mutual Fire Insurance Company has caused these presents to be signed by its authorized representatives, and its Corporate Seal to be hereto affixed, to this 23rd day of April 2021 Z3 V 0; 7 _ •U) o a) — L �o 0.2 c� N CCo al a5 State of PENNSYLVANIA County of MONTGOMERY Ni c E Liberty Mutual Fire Insurance Company m tr ,%RE 1NSG U 20 g 1908 Ca �_ rd COS a By: pCO d�y7 * d David M. Carey, Assistant Secretary 0-0 S � •is cE ' ,� I, n lr p p `a� Attest: �--�. o Heather B. Magee o 0 o N The foregoing instrument was acknowledged before me this 23rd day of April 2021 by David M. Carey "— L insurance Company. 13 T > a) Commonwealth of Pennsylvania Notary Seal ... i=�oww; ��, - Teresa Pastella, Notary Public Z U p,,r`t U@' Montgomery OF County My commission expires March 21, 2021 '1 °y0i PCs Commission number 1126044 Member, Pennsylvania Association of Notaries Ctry CERTIFICATE L 04 O N 3 °O O N rlM, an authorized representative of Liberty Mutual Fire Insurance o 0 c0' Ca a f6 U 9 0 dJ By: L10or /lLd LC.r<�ar> IL n O � Teresa Pastella, Notary Public 1, the undersigned, an Assistant Secretary of Liberty Mutual Fire Insurance Company, do hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy, is in full force and effect on the date of this certificate; and I do further certify that the officer or official who executed the said power of attorney was one of the officers or officials specially authorized by the Board of Directors to appoint attorneys -in -fact as provided in the Unanimous Consent and Vote of the Board of Directors of Liberty Mutual Fire Insurance Company dated May 21, 2013. This certificate and the above power of attorney may be signed by facsimile or mechanically reproduced signatures under and by authority of the Board of Directors of Liberty Mutual Fire Insurance Company evidenced by the Unanimous Consent and Vote of the Board of Directors dated June 28, 2006 wherein it was VOTED that the signatures of such officers and the seal of the Company may be affixed to any such power of attorney or to any certificate relating thereto by facsimile, and any such power of attorney or certificate bearing such facsimile signature and facsimile seal shall be valid and binding upon the Company when so affixed and in the future with respect to any surety undertakings, bonds, recognizances and other surety obligations to which it is attached. IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed the corporate seal of the said company, affixed, this 25th day of March 2025 FARE INSG JQ�'400.PORgrRgy Fo m B 1908 n y' o Renee C. Llewellyn, Assistant Secretary ~d �scoNs`� a3 LMS-22023 03P21 TEXAS IMPORTANT NOTICE To obtain information or make a complaint: You may call toll -free for information or `to make a complaint at 1-877-751-2640 You may also write to: 2200 Renaissance Blvd., Ste. 400 King of Prussia, PA 19406-2755 You may contact the Texas Department of Insurance to obtain information on companies, coverages, rights or complaints at 1-800-252-3439 You may write the Texas Department of Insurance Consumer Protection (I I I-1A) P. O. Box 149091 Austin, TX 78714-9091 FAX: (512) 490-1007 Web: httn://www.tdi.texas.izov. E-mail: ConsumerProtectionntdi.texas.aov PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should first contact the agent or call 1-800-843-6446. If the dispute is not resolved, you may contact the Texas Department of Insurance. ATTACH THIS NOTICE TO YOUR POLICY: This notice is for information only and does not become a part or condition of the attached document. NP70680901 LMS-15292 10/15 TEXAS AVISO IMPORTANTE Para obtener informacion o para someter una queja: Usted puede llamar al numero de telefono gratis para informacion o para someter una queja al 1-877-751-2640 Usted tambien puede escribir a: 2200 Renaissance Blvd., Ste. 400 King of Prussia, PA 19406-2755 Puede comunicarse con el Departamento de Seguros de Texas para obtener informacion acerca de companias, coberturas, derechos o quejas al 1-800-252-3439 Puede escribir al Departamento de Seguros de Texas Consumer Protection (111-1A) P. O. Box 149091 Austin, TX 78714-9091 FAX # (512) 490-1007 Web: http://www.tdi.texas.gov. E-mail: ConsumerProtectionVtdi.texas.eov, DISPUTAS SOBRE PRIMAS O RECLAMOS: Si tiena una disputa concerniente a su prima o a un reclamo, debe comunicarse con el agente o primero. Si no se resuelve la disputa, puede entonces comunicarse con el departamento (TDI) UNA ESTE AVISO A SU POLIZA: Este aviso es solo para proposito de informacion y no se convierte en parte o condicion del documento adjunto.