HomeMy WebLinkAboutContract 61302-FP1-FP1
FORT WORTH,
City Secretary 61302
Contract No.
Date Received 5/7/2025
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: Presbyterian Night Shelter
City Project No.: 105472
Improvement Type(s): Water ❑x Sewer ❑x
Original Contract Price:
Amount of Approved Change Order(s):
Revised Contract Amount:
Total Cost of Work Complete:
8�ef brx�Ce�
Bret Dour ler (Mav 5, 2025 11:50 CDT)
Contractor
Muckleroy and Falls
Title
Muckleroy Falls
Company Name
Richard Walden (May 5,202511:58 CDT)
Project Inspector
Project Manager
Kandice Merrick (Mav 7.2025 11:22 CDT)
CFA Manager
X.Z,.�
Lauren Prieur (May 7, 2025 11:25 CDT)
TPW Director
Asst. City Manager
$432,447.50
$432,447.50
05/05/2025
Date
05/05/2025
Date
05/07/2025
Date
05/07/2025
Date
05/07/2025
Date
05/07/2025
Date
OFFICIAL RECORD
CITY SECRETARY Page 1 of 2
FT. WORTH, TX
Notice of Project Completion
Project Name: Presbyterian Night Shelter
City Project No.: 105472
City's Attachments
Final Pay Estimate ❑x
Change Order(s): ❑ Yes ❑x N/A
Pipe Report: ❑x Yes ❑ N/A
Contractor's Attachments
Affidavit of Bills Paid
Consent of Surety
Statement of Contract Time
Contract Time: 80 WD Days Charged: 93 WD
Work Start Date: 9/24/2024 Work Complete Date: 3/27/2025
Completed number of Soil Lab Test: 77
Completed number of Water Test: 6
Page 2 of 2
FORT WORT 11
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name PRESBYTERIAN NIGHT SHELTER
Contract Limits
Project Type WATER & SEWER
City Project Numbers 105472
DOE Number 5472
Estimate Number 1 Payment Number 1 For Period Ending 3/27/2025
WD
City Secretary Contract Number
Contract Date
Project Manager NA
Contractor MUCKLEROY & FALLS
P.O. BOX 100206
FORT WORTH, TX 76185
Inspectors G.DEYON / R.WALDEN
Contract Time 8WD
Days Charged to Date 93
Contract is 100.00 Complete
Friday, April 18, 2025 Page 1 of 5
City Project Numbers 105472
Contract Name PRESBYTERIAN NIGHT SHELTER
Contract Limits
Project Type WATER & SEWER
Project Funding
UNIT I: WATER IMPROVEMENTS
DOE Number 5472
Estimate Number I
Payment Number 1
For Period Ending 3/27/2025
Item
Description of Items
Estimated Unit
Unit Cost
Estimated
Completed
Completed
No.
Quanity
Total
Quanity
Total
1
CONNECTION TO EXISTING 4"-12" WATER
2 EA
$4,050.00
$8,100.00
2
$8,100.00
MAIN
2
TEMPORARY WATER SERVICES
1 LS
$32,855.00
$32,855.00
1
$32,855.00
3
12" WATERLINE LOWERING
1 EA
$12,289.50
$12,289.50
1
$12,289.50
4
8" WATER CARRIER PIPE
121 LF
$53.00
$6,413.00
121
$6,413.00
5
20" CASING BY OTHER THAN OPEN CUT
121 LF
$530.00
$64,130.00
121
$64,130.00
6
12" GATE VALVE
2 EA
$5,400.00
$10,800.00
2
$10,800.00
7
8" GATE VALVE
5 EA
$2,800.00
$14,000.00
5
$14,000.00
8
6" GATE VALVE
2 EA
$1,900.00
$3,800.00
2
$3,800.00
9
FIRE HYDRANT
2 EA
$5,800.00
$11,600.00
2
$11,600.00
10
4" WATER PIPE
20 LF
$95.00
$1,900.00
20
$1,900.00
11
6" WATER PIPE
30 LF
$100.00
$3,000.00
30
$3,000.00
12
8" WATER PIPE
255 LF
$110.00
$28,050.00
255
$28,050.00
13
2" WATER SERVICE
1 EA
$5,000.00
$5,000.00
1
$5,000.00
14
3" WATER METER AND VAULT
1 EA
$31,220.00
$31,220.00
1
$31,220.00
15
REMOVE 12" WATERLINE
23 LF
$25.00
$575.00
23
$575.00
16
DUCTILE IRON WATER DITTINGS w/
2 TN
$14,300.00
$28,600.00
2
$28,600.00
RESTRAINT
17
TRENCH SAFETY
275 LF
$1.00
$275.00
275
$275.00
Sub -Total of Previous Unit
$262,607.50
$262,607.50
UNIT
II: SEWER IMPROVEMENTS
Item
Description of Items
Estimated Unit
Unit Cost
Estimated
Completed
Completed
No.
Quanity
Total
Quanity
Total
1
4' MANHOLE
2 EA
$23,450.00
$46,900.00
2
$46,900.00
2
EPDXY MANHOLE LINER
13 VF
$450.00
$5,850.00
13
$5,850.00
3
4' EXTRA DEPTH MANHOLE
15 VF
$550.00
$8,250.00
15
$8,250.00
4
TRENCH WATER STOPS
1 EA
$1,500.00
$1,500.00
1
$1,500.00
5
8" 2-WAY
1 EA
$2,250.00
$2,250.00
1
$2,250.00
6
8" SEWER PIPE, SELECT BACKFILL
20 LF
$450.00
$9,000.00
20
$9,000.00
7
8" SEWER PIPE, CCS BACKFILL
30 LF
$650.00
$19,500.00
30
$19,500.00
8
8" SEWER PIPE
267 LF
$250.00
$66,750.00
267
$66,750.00
Friday, April 18, 2025 Page 2 of 5
City Project Numbers 105472
Contract Name PRESBYTERIAN NIGHT SHELTER
Contract Limits
Project Type WATER & SEWER
Project Funding
DOE Number 5472
Estimate Number I
Payment Number 1
For Period Ending 3/27/2025
9 TRENCH SAFETY 267 LF $20.00 $5,340.00 267 $5,340.00
10 MANHOLE VACUUM TESTING 2 EA $915.00 $1,830.00 2 $1,830.00
11 POST -CCTV INSPECTION 267 LF $10.00 $2,670.00 267 $2,670.00
Sub -Total of Previous Unit $169,840.00 $169,840.00
--------------------------------------
Friday, April 18, 2025 Page 3 of 5
City Project Numbers 105472
Contract Name PRESBYTERIAN NIGHT SHELTER
Contract Limits
Project Type WATER & SEWER
Project Funding
Contract Information Summary
Original Contract Amount
Change Orders
Total Contract Price
DOE Number 5472
Estimate Number I
Payment Number 1
For Period Ending 3/27/2025
$432,447.50
$432,447.50
Total Cost of Work Completed $432,447.50
Less % Retained $0.00
Net Earned $432,447.50
Earned This Period $432,447.50
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
$432,447.50
Friday, April 18, 2025 Page 4 of 5
City Project Numbers 105472
Contract Name PRESBYTERIAN NIGHT SHELTER
Contract Limits
Project Type WATER & SEWER
Project Funding
Project Manager NA
Inspectors G.DEYON / R.WALDEN
Contractor MUCKLEROY & FALLS
P.O. BOX 100206
FORT WORTH, TX 76185
DOE Number 5472
Estimate Number I
Payment Number 1
For Period Ending 3/27/2025
City Secretary Contract Number
Contract Date
Contract Time 80 WD
Days Charged to Date 93 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 $432,447.50
Less % Retained $0.00
Net Earned $432,447.50
Earned This Period $432,447.50
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
$432,447.50
Friday, April 18, 2025 Page 5 of 5
FORTWORTH
TRANSPORTATION AND PUBLIC WORKS
PIPE REPORT FOR:
PROJECT NAME: Presbytarian Night Shelter
CITY PROJECT NUMBER: 105472
WATER
PIPE LAID SIZE TYPE OF PIPE
C900 4" PVC
C900 8" PVC
C900
LF
20
30
FIRE HYDRANTS: 2 VALVES (16" OR LARGER)
PIPE ABANDONED SIZE TYPE OF PIPE LF
N/A N/A
N/A N/A
N/A N/A
N/A N/A
DENSITIES: Performed & Passed
NEW SERVICES: 2" Copper 1
I SEWER
PIPE LAID SIZE TYPE OF PIPE LF
SDR-26 8" PVC 267
SDR-26 8" PVC
PIPE ABANDONED SIZE TYPE OF PIPE LF
DENSITIES: Performed & Passed
NEW SERVICES: N/A N/A N/A
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 9, 2025
Muckleroy & Falls
3200 Riverfront Dr Ste 200
Fort Worth, TX 76107
RE: Acceptance Letter
Project Name: Presbytarian Night Shelter
Project Type: Water, Sewer
City Project No.: 105472
To Whom It May Concern:
On April 8, 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 April 8, 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
andrew.goodman@fortworthtexas.gov.
Sincerely,
Andrew Goodman (Debbie Wellhelm), Project Manager
Cc: Richard Walden, Inspector
Gary Deyon, Inspection Supervisor
Edward D'avila, Senior Inspector
Andrew Goodman, Program Manager
Kimley-Horn, Consultant
Muckleroy & Falls, Contractor
Journey Home Housing LLC, Developer
File
E-Mail: TPW_Acceptance@fortworthtexas.gov
Rev. 08/20/19
AFFIDAVIT
STATE OF TEXAS
Before me, the undersigned authority, a notary public in the state
and county aforesaid, on this day personally appeared Jonathan Powell,
Controller Of Muckleroy & Falls, 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 105472 Presbyterian Night Shelter Water and Sewer
Subscribed and sworn before
on this date 5th of May, 2025.
&-Falls
". �. STEPHANIE GELMINI
My NWq ID # 133429039
Expires November 3, 2025
Notary Public m i l l 1 "'
Tarrant County, Texas
006213-1
PERFORMANCE BOND
Pagel of 2
1 SECTION 00 62 13
2 PERFORMANCE BOND
3 BOND # 2360903
4 THE STATE OF TEXAS §
5 § KNOW ALL BY THESE PRESENTS:
6 COUNTY OF TARRANT §
7 That we, HIM & MF, Ltd dba Mucklerov & Falls , known as
8 "Principal" herein and Swiss Re Corporate Solutions America Insurance Corporation , a corporate
9 surety(sureties, if more than one) duly authorized to do business in the State of Texas, known as
10 "Surety" herein (whether one or more), are held and firmly bound unto the Developer, Journey
11 Home Housing, LLC., authorized to do business in Texas ("Developer") and the City of Fort
12 Worth, a Texas municipal corporation ("City"), in the penal sum of,
13 Four Hundred Thirty -Two Thousand Four Hundred Forty -Seven & 501100 Dollars ($ 432,447.50 ),
14 lawful money of the United States, to be paid in Fort Worth, Tarrant County, Texas for the
15 payment of which sum well and truly to be made jointly unto the Developer and the City as dual
16 obligees, we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly
17 and severally, firmly by these presents.
18 WHEREAS, Developer and City have entered into an Agreement for the construction of
19 community facilities in the City of Fort Worth by and through a Community Facilities
20 Agreement, CFA Number CFA24-0033 ;and
21 WHEREAS, the Principal has entered into a certain written contract with the Developer awarded
22 the 7th day of August , 20 24 , which Contract is hereby referred to and made a
23 part hereof for all purposes as if fully set forth herein, to furnish all materials, equipment labor
24 and other accessories defined by law, in the prosecution of the Work, including any Change
25 Orders, as provided for in said Contract designated as WATER AND SANITARY SEWER,
26 IMPROVEMENTS TO SERVE PRESBYTERIAN NIGHT SHELTER.
27 NOW, THEREFORE, the condition of this obligation is such that if the said Principal
28 shall faithfully perform it obligations under the Contract and shall in all respects duly and
29 faithfully perform the Work, including Change Orders, under the Contract, according to the plans,
30 specifications, and contract documents therein referred to, and as well during any period of
31 extension of the Contract that may be granted on the part of the Developer and/or City, then this
32 obligation shall be and become null and void, otherwise to remain in full force and effect.
CITY OF FORT WORTH PRESBYTERIANNIGFITSHELTER
STANDARD CITY CONDITIONS —DEVELOPER AWARDED PROJECTS CITYPROJECTNO. 105472
Revised January 31, 2012
00 62 13 -2
PERFORMANCE BOND
Page 2 of 2
PROVIDED FURTHER, that if any legal action be filed on this Bond, venue shall lie in
2 Tarrant County, Texas or the United States District Court for the Northern District of Texas, Fort
3 Worth Division.
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This bond is made and executed in compliance with the provisions of Chapter 2253 of the
Texas Government Code, as amended, and all liabilities on this bond shall be determined in
accordance with the provisions of said statue.
IN WITNESS WHEREOF, the Principal and the Surety have SIGNED and SEALED
this instrument by duly authorized agents and officers on this the 8th day of
August , 20 24
PRINCIPAL:
HM & MF. Ltd dba Mucklerov & Falls
BY: A��
H &�r1 ii hx WDl ' 1�kEttl�7 ca t r�LLo, a texas
ATTEST: u.,� +vgrat and neralPartnerstructior
�O�-S G. 1�•t o�-1 CS — �! �A. O>�.rr..�ri �v�+S
(Principal) Secretary Name and Title
Witness as to Principal
Address: 3200 Riverfront Dr., Suite 200
Fort Worth, TX 76107
SURETY:
Swiss Re Corporate Solutions America
-Insurance Corporation
B
Signature
Debra Lee Moon, Attorney -in -Fact
Name and Title
Address: 1200 Main St. Suite 800
Kansas City, MO 64105
Witness Telephone Number: (816) 235-3700
*Note: If signed by an officer of the Surety Company, there must be on file a certified extract
from the by-laws showing that this person has authority to sign such obligation. If
Surety's physical address is different from its mailing address, both must be provided.
The date of the bond shall not be prior to the date the Contract is awarded.
CITY OF FORT WORTH PRESBYTERIANNIGHTSITELTER
STANDARD CITY CONDITIONS — DEVELOPER AWARDED PROJECTS CITYPROJECT NO. 105472
Revised January 31, 2012
0062 14 - 1
PAYMENT BOND
Pagel of 2
1 SECTION 00 6214
2 PAYMENT BOND
3 BOND # 2360903
4 THE STATE OF TEXAS §
5 § KNOW ALL BY THESE PRESENTS:
6 COUNTY OF TARRANT §
7 That we, HM & MF, Ltd dba Muckleroy & Falls , known as
8 "Principal" herein, and Swiss Re Corporate Solutions America Insurance Corporation , a
9 corporate surety ( or sureties if more than one), duly authorized to do business in the State of
10 Texas, known as "Surety" herein (whether one or more), are held and firmly bound unto the
11 Developer, Journey Home Housing, LLC, authorized to do business in Texas "(Developer"), and
12 the City of Fort Worth, a Texas municipal corporation ("City"), in the penal sum
13 of Four Hundred Thirty -Two Thousand Four Hundred Forty -Seven & 501100Dollars ($ 432,447.50 ),
14 lawful money of the United States, to be paid in Fort Worth, Tarrant County, Texas, for the
15 payment of which sum well and truly be made jointly unto the Developer and the City as dual
16 obligees, we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly
17 and severally, firmly by these presents:
18 WHEREAS, Developer and City have entered into an Agreement for the construction of
19 community facilities in the City of Fort Worth, by and through a Community Facilities
20 Agreement, CFA Number CFA24-0033 ;and
21 WHEREAS, Principal has entered into a certain written Contract with Developer,
22 awarded the 7th day of August , 20.24 , which Contract is hereby
23 referred to and made a part hereof for all purposes as if fully set forth herein, to furnish all
24 materials, equipment, labor and other accessories as defined by law, in the prosecution of the
25 Work as provided for in said Contract and designated as WATER AND SANITARY SEWER
26 IMPROVEMENTS TO SERVE PRESBYTERIAN NIGHT SHELTER.
27 NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION is such that if
28 Principal shall pay all monies owing to any (and all) payment bond beneficiary (as defined in
29 Chapter 2253 of the Texas Government Code, as amended) in the prosecution of the Work under
30 the Contract, then this obligation shall be and become null and void; otherwise to remain in full
31 force and effect.
CITY OF FORT WORTH PRESBYTERIANNIGFITSIYELTER
STANDARD CITY CONDITIONS —DEVELOPER AWARDED PROJECTS CITYPROJECTNO. 105472
Revised January 31, 2012
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006214-2
PAYMENT BOND
Page 2 of 2
This bond is made and executed in compliance with the provisions of Chapter 2253 of the
Texas Government Code, as amended, and all liabilities on this bond shall be determined in
accordance with the provisions of said statute.
IN WITNESS WHEREOF, the Principal and Surety have each SIGNED and SEALED
this instrument by duly authorized agents and officers on this the 8th day of
Auqust 2024
ATTEST:
(Principal) Secretary
i4f-1-171e-�
Witness as to Principal
ATTEST:
(Surety) Secretary
Witness as t ety .
PRINCIPAL:
HM & MF, Ltd dba Muckleroy & Falls
Y' fe AAt� a Texas
Sigma rtne ip by Muckteroy &Fails Constructior
r;n., a Tex.. groation and Cameral Partner
Name and Title
Address: 3200 Riverfront Dr., Suite 200
Fort Worth, TX 76107
SURETY:
Swiss Re Corporate Solutions America Insurance Corporation
Signature
Debra Lee Moon, Attorney -in -Fact
Name and Title
Address: 1200 Main St. Suite 800
Kansas City, MO 64105
Telephone Number: (816) 235-3700
Note: If signed by an officer of the Surety, there must be on file a certified extract from the
bylaws showing that this person has authority to sign such obligation. If Surety's physical
address is different from its mailing address, both must be provided.
The date of the bond shall not be prior to the date the Contract is awarded.
14 END OF SECTION
CITY OF FORT WORTH
STANDARD CITY CONDITIONS —DEVELOPER AWARDED PROJECTS
Revised January 31, 2012
PRESBYTERIAN NIGHT SHELTER
CITY PROJECT NO. 105472
006219-1
MAINTENANCE BOND
Page I of 3
I SECTION 00 62 19
2 MAINTENANCE BOND
3 BOND #2360903
4 THE STATE OF TEXAS §
5 § KNOW ALL BY THESE PRESENTS:
6 COUNTY OF TARRANT §
7 [Text in Blue is for information or guidance. Remove all blue text in the project final document.]
8 That we HM & MF, Ltd dba Muckleroy & Falls , known as
9 "Principal" herein and Swiss Re Corporate Solutions America Insurance Corporation , a corporate surety
10 (sureties, if more than one) duly authorized to do business in the State of Texas, known as
1 I "Surety" herein (whether one or more), are held and firmly bound unto the Developer, Journey
12 Home Housing, LLC authorized to do business in Texas ("Developer") and the City of Fort
13 Worth, a Texas municipal corporation ("City"), in the sum
14 of Four Hundred Thirty -Two Thousand Four Hundred Forty -Seven & 501100 Dollars ($ 432,447.50 )
15 lawful money of the United States, to be paid in Fort Worth, Tarrant County, Texas, for payment
16 of which sum well and truly be made jointly unto the Developer and the City as dual obligees and
17 their successors, we bind ourselves, our heirs, executors, administrators, successors and assigns,
18 jointly and severally, firmly by these presents.
19
20 WHEREAS, Developer and City have entered into an Agreement for the construction of
21 community facilities in the City of Fort Worth by and through a Community Facilities
22 Agreement, CFA Number CFA24-0033 ;and
23 WHEREAS, the Principal has entered into a certain written contract with the Developer
24 awarded the 7th day of Auqust , 20 24 , which Contract is
25 hereby referred to and a made part hereof for all purposes as if fully set forth herein, to furnish all
26 materials, equipment labor and other accessories as defined by law, in the prosecution of the
27 Work, including any Work resulting from a duly authorized Change Order (collectively herein,
28 the "Work") as provided for in said Contract and designated as WATER AND SANITARY SEWER
29 IMPROVEMENTS TO SERVE PRESBYTERIAN NIGHT SHELTER; and
30
31 WHEREAS, Principal binds itself to use such materials and to so construct the Work in
32 accordance with the plans, specifications and Contract Documents that the Work is and will
33 remain free from defects in materials or workmanship for and during the period of two (2) years
34 after the date of Final Acceptance of the Work by the City ("Maintenance Period"); and
CITY OF FORT WORTH PRESB YTERIAN NIGHT SHELTER
STANDARD CITY CONDITIONS —DEVELOPER AWARDED PROJECTS CITYPROJECTNO. 105472
Revised January 31, 2012
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006219-2
MAINTENANCE BOND
Page 2 of 3
WHEREAS, Principal binds itself to repair or reconstruct the Work in whole or in part
upon receiving notice from the Developer and/or City of the need thereof at any time within the
Maintenance Period.
NOW THEREFORE, the condition of this obligation is such that if Principal shall
remedy any defective Work, for which timely notice was provided by Developer or City, to a
completion satisfactory to the City, then this obligation shall become null and void; otherwise to
retrain in full force and effect.
PROVIDED, HOWEVER, if Principal shall fail so to repair or reconstruct any timely
noticed defective Work, it is agreed that the Developer or City may cause any and all such
defective Work to be repaired and/or reconstructed with all associated costs thereof being borne
by the Principal and the Surety under this Maintenance Bond; and
PROVIDED FURTHER, that if any legal action be filed on this Bond, venue shall lie in
Tarrant County, Texas or the United States District Court for the Northern District of Texas, Fort
Worth Division; and
PROVIDED FURTHER, that this obligation shall be continuous in nature and
successive recoveries may be had hereon for successive breaches.
CITY OF FORT WORTH
STANDARD CITY CONDITIONS — DEVELOPER AWARDED PROJECTS
Revised January 31, 2012
PRESBYTERIAN NIGHT SHELTER
CITY PROJECT NO. 105472
006219-3
MAINTENANCE BOND
Page 3 of 3
1 IN WITNESS WHEREOF, the Principal and the Surety have each SIGNED and SEALED this
2 instrument by duly authorized agents and officers on this the 8th day of
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Auoust .20 24
PRINCIPAL:
HM & MF, Ltd dba Mucklerov & Falls
BY:
ATTEST: f1m & R1rF t a UCKt ERCY & FALLt), a Texas
Limited Partnership y Muckleroy & Falls Constructio-
�� a Tnv?c r;nrnnr?tinn Ar?ri rPnoral Plrinn•
(Principal) Secretary Name and Title
Witness as to Principal
Address: 3200 Riverfront Dr., Suite 200
Fort Worth, TX 76107
SURETY:
Swiss Re Corporate Solutions America
Insurance Corporation
Signature
Debra Lee Moon, Attorney -in -Fact
ATTEST: Name and Title
Address: 1200 Main St. Suite 800
(Surety)
Secretary / Kansas City, MO 64105
Witn ss •e Telephone Number: (816) 235-3700
*Note: If signed by an officer of the Surety Company, there must be on file a certified extract
from the by-laws showing that this person has authority to sign such obligation. If
Surety's physical address is different from its mailing address, both must be provided.
The date of the bond shall not be prior to the date the Contract is awarded.
CITY OF FORT WORTH PRESB YTERIAN NIGHTSIIELTER
STANDARD CITY CONDITIONS — DEVELOPER AWARDED PROJECTS CITYPROJECT NO. 105472
Revised January 31, 2012
SWISS RE CORPORATE SOLUTIONS
SWISS RE CORPORATE SOLUTIONS AMERICA INSURANCE CORPORATION ("SRCSAIC")
SWISS RE CORPORATE SOLUTIONS PREMIER INSURANCE CORPORATION ("SRCSPIC")
WESTPORT INSURANCE CORPORATION ("WIC')
GENERAL POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, THAT SRCSAIC, a corporation duly organized and existing under laws of the State of Missouri, and
having its principal office in the City of Kansas City, Missouri, and SRCSPIC, a corporation organized and existing under the laws of the State of
Missouri and having its principal office in the City of Kansas City, Missouri, and WIC, organized under the laws of the State of Missouri, and having its
principal office in the City of Kansas City, Missouri, each does hereby make, constitute and appoint:
JOHN R. WARD, THOMAS DOUGLAS MOORE, EMILY ALLISON MIKESKA, ALLYSON W. DEAN, MONICA RUBY VEAZEY, JOHN WILLIAM NEWBY,
TROY RUSSELL KEY, DEBRA LEE MOON, ANDREA ROSE CRAWFORD, SANDRA LEE RONEY, FAITH ANN HILTY, ANDREW GARETH ADDISON, PATRICK THOMAS COYLE,
MICHAEL DONALD HENDRICKSON, BRYAN KELLY MOORE, ELIZABETH ORTIZ, ANA OWENS, BETTY J REEII, AND ANDREW PATRICK CLARK JOINTLY OR SEVERALLY
Its true and lawful Attomey(s)-in-Fact, to make, execute, seal and deliver, for and on its behalf and as its act and deed, bonds or other writings
obligatory in the nature of a bond on behalf of each of said Companies, as surety, on contracts of suretyship as are or may be required or permitted by
law, regulation, contract or otherwise, provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the
amount of:
TWO HUNDRED MILLION ($200,000,000.00) DOLLARS
This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of
Directors of both SRCSAIC and SRCSPIC at meetings duly called and held on the 18th of November 2021 and WIC by written consent of its
Executive Committee dated July 18, 2011.
"RESOLVED, that any two of the President, any Managing Director, any Senior Vice President, any Vice President, the Secretary or any Assistant
Secretary be, and each or any of them hereby is, authorized to execute a Power of Attorney qualifying the attorney named in the given Power of
Attorney to execute on behalf of the Corporation bonds, undertakings and all contracts of surety, and that each or any of them hereby is authorized to
attest to the execution of any such Power of Attorney and to attach therein the seal of the Corporation; and it is
FURTHER RESOLVED, that the signature of such officers and the seal of the Corporation 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 signatures or facsimile seal shall be
binding uDon the Corporation when so affixed and in the future with reeard to anv bond, undertaking or contract of surety to which it is attached."
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OG�RP.-Rt?R--gr�LSG., ^`OC�QPo%igj.�G' By A.'e.�POAI:S'aL
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S E A L
Erik Janssens, Senior Vice President of SRCSAIC & Senior Vice President
of SRCSPIC &Senior Vice President of WIC
a E A L •.'M
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1973 .
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Gerald Jagrowski, Vice President of SRCSAIC & Vice President of SRCSPIC
& Vice President of WIC
IN WITNESS WHEREOF, SRCSAIC, SRCSPIC, and WIC have caused their official seals to be hereunto affixed, and these presents to be signed by their
authorized officers
this llth day of January 20 24
Swiss Re Corporate Solutions America Insurance Corporation
State of Illinois Swiss Re Corporate Solutions Premier Insurance Corporation
County of Cook ElWestport Insurance Corporation
On this 11 th day of January 20 24, before me, a Notary Public personally appeared Erik Janssens , Senior Vice President of SRCSAIC
and Senior Vice President of SRCSPIC and Senior Vice President of WIC and Gerald Jaerowski , Vice President of SRCSAIC and Vice President of
SPCSPIC and Vice President of WIC, personally known to me, who being by me duly sworn, acknowledged that they signed the above Power of Attorney
as officers of and acknowledged said instrument to be the voluntary act and deed of their respective companies.
OFREa SFJ1L
CHRISTlNA'MKNi^�CO
NQTII(iY PllB11C, BTAA?E OF Ll�KN6 . ny rn
Cainri+4mAirf B�t'1�"dr48. ffiI`- �;`�'n ��A�a �i�s�''d1.8
I, Jeffrev Goldberg, the duly elected Senior Vice President and Assistant Secretary of SRCSAIC and SRCSPIC and WIC, do hereby certify that the above and
foregoing is a true and correct copy of a Power of Attorney given by said SRCSAIC and SRCSPIC and WIC, which is still in full force and effect.
IN WITNESS WHEREOF, I have set my hand and affixed the seals of the Companies this 8th day of August .20 24
Jeffrey Goldberg, Senior Vice President &
Assistant Secretary of SRCSAIC and
SRCSPIC and WIC
IMPORTANT NOTICE
In order to obtain information or snake a complaint:
You may contact Jeffrey Goldberg, Vice President -
Claims, at 1-800-338-0753.
You may call Swiss Re Corporate Solutions
America Insurance Corporation or Swiss Re
Corporate Solutions Premier Insurance
Corporation's toll -free number for information or to
make a complaint at:
1-800-338-0753
You may also write to Swiss Re Corporate Solutions
America Insurance Corporation or Swiss Re
Corporate Solutions Premier Insurance
Corporation at the following address:
1450 American Lane, Suite 1100
Schaumburg, IL 60173
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) 475-1771
Web: http://www.tdi.state.tx.us
E-mail:ConsumerProtection(atdi.state.tx. us
PREMIUM OR CLAIM DISPUTES:
Should you have a dispute concerning your premium or
about a claim you should first contact the Swiss Re
Corporate Solutions America Insurance
Corporation or Swiss Re Corporate Solutions
Premier Insurance Corporation. 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.
AVISO IMPORTANTE
Para obtener informacion o para someter un queja:
Puede comunicarse con Jeffrey Goldberg, Vice
President - Claims, at 1-800-338-0753.
Usted puede llamr at numero de telefono gratis de
Swiss Re Corporate Solutions America Insurance
Corporation o Swiss Re Corporate Solutions
Premier Insurance Corporation's para informacion o
para someter una queja at:
1-800-338-0753
Usted tambien puede escribir a Swiss Re Corporate
Solutions America Insurance Corporation o Swiss
Re Corporate Solutions Premier Insurance
Corporation at:
1450 American Lane, Suite 1100
Schaumburg, IL 60173
Puede escribir at Departmento de Seguros de Texas
para obtener informacion acerca de companias,
coberturas, derechos o quejas at:
1- 800-252-3439
Puede escribir at Departmento de Seguros de Texas:
P.O. Box 149104
Austin, TX 78714-9104
Fax: (512) 475-1771
Web: http://www.tdi.state.tx.us
E-mail: Cons umerProtectionatdi. s tate.tx. us
DISPUTAS SOBRE PRIMAS O RECLAMOS:
Si tiene una disputa concerniente a su prima o a un
reclamo, debe comunicarse con el Swiss Re Corporate
Solutions America Insurance Corporation o Swiss
Re Corporate Solutions Premier Insurance
Corporation primero. Si no se resuelve la disputa,
puede entonces comunicarse con el Departmento de
Seguros de Texas.
UNA ESTE AVISO A SU POLIZA:
Este aviso es solo para proposito de infoomacion y no se
converte en parte o condicion del documento adjunto.