HomeMy WebLinkAbout050202-FP2 - Construction-Related - Contract - San Saba Construction Services, Inc.FORTWORTHo
"Re-routed due to incorrect developer/city cost
breakdown on original greensheet.
-FP2
City Secretary No: 50202
Date Received: lz��z�zozs
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: Carroll Street Townhomes
City Project Number: 101025
Improvement Type(s): �Water �Sewer
Original Contract Price: Water
Original Contract Price: Sewer
Water & Sewer Original Contract Total
Amount of Approved Change Order(s)
Revised Contract Amount:
Total Cost of Work Complete
Developer Cost
$20,730.00
$54,036.00
$74,766.00
$5, 588.16
$80,354.16
$80,354.16
City Cost
$0.00
$31,007.00
$31,007.00
$2,606.84
$33,613.84
$33,613.84
Total Cost
$20,730.00
$85,043.00
$105,773.00
$8,195.00
$113,968.00
$113,968.00
�,�'°'_—
Contractor
San Saba Construction
Title
Vice President
Company Name
�haGcf Wat,to�r
Project Inspector
Ga�- ��-'
Project Manager
���
CFA Manager
�auven Pvieur
�,,� � �, �,� �- ����,��
TPW Director
12/12/2025
Date
i2/i2/2o2s
Date
i2/i2/Zo2s
Date
12/12/2025
Date
i2/i2/2o2s
Date
�FFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Page 1 of 2
Notice of Project Completion
Project Name: Carroll Street Townhomes
City Project Number: 101025
City's Attachments
Final Pay Estimate�
Change Order(s):❑✓ Yes ❑ N/A
Pipe Report:❑✓ 1(es ❑N/A
Contractor's Attachments
Affidavit of Bills Paid
Consent of Surety
��
�
Statement of Contract Time
125 CD
Contract Time:
workstart Date: 4�� 6�� 8
Completed number of Soil Lab Test(s): O
Completed number of Water Test(s): O
2392 CD
Days Charged:
work Complete Date: 1/� 7�25
Page 2 of 2
FORTWORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name CARROLL STREET TOWNHOMES
Contract Limits
Project Type WATER & SEWER
City Project Numbers 101025
DOE Number 1025
Estimate Number 1 Payment Number 1 For Period Ending 1/17/2025
CD
City Secretary Contract Number
Contract Date
Project Manager NA
Contractor SAN SABA CONSTRUCTION SERVICES, INC.
3100 INDEPENDENCE PKWY #311-314
PLANO, TX 75075
Inspectors DICKINSON / WATSON
Contract Time 12ED
Days Charged to Date 125
Contract is 100.00 Complete
Tuesday, January 28, 2025 Page 1 of 4
City Project Numbers 101025
Contract Name CARROLL STRI�,I:'I"L'OWNHOMI:S
Contract Limits
Project Type WATER & SEWER
Project Funding
WA"I F.R
DOE Number 1025
Estimate Number 1
Payment Number 1
For Period Ending 1/17/2025
Item Description of Items �stimated Unit Unit Cost Estimated
No. Quanity Total
1 SALVAGE 3/4" WATER METER 1 EA $850.00 $850.00
2 1" WATER SERVICE (CO#1) 9 EA $2,485.00 $22,365.00
Sub-Total of Previous Unit �23,2is.00
SEWER
Completed Completed
Quaniry Total
1 $850.00
9 $22,365.00
$23,215.00
Item Estimated Estimated Completed Completed
Description of Items Unit Unit Cost
No. Quanity Total Quanity Total
1 REMOVE4"SEWERLINE 40 LF $25.00 $1,000.00 40 $1,000.00
2 POST CCTV INSPECTION (CO#1), (CO#2) 342 LF $4.00 $1,368.00 342 $1,368.00
3 MANHOLE VACUUM TESTINHG (CO#2) 5 EA $825.00 $4,125.00 5 $4,125.00
4 BYPASS PUMPING 1 LS $12,000.00 $12,000.00 1 $12,000.00
5 TRENCH SAFETY (CO#1), (CO#2) 342 LF $3.00 $1,026.00 342 $1,026.00
6 16° CASING BY OPEN CUT 10 LF $115.00 $1,150.00 10 $1,150.00
7 4" SEWER SERVICE 8 EA $1,835.00 $14,680.00 8 $14,680.00
8 8" SEWER PIPE 257 LF $81.00 $20,817.00 257 $20,817.00
9 8" DIP SEWER PIPE (CO#1), (CO#2) 75 LF $150.00 $11,250.00 75 $11,250.00
10 8" DIP SEWER PIPE CSS BACKFILL 10 LF $240.00 $2,400.00 10 $2,400.00
11 4' MANHOLE (CO#2) 5 EA $4,100.00 $20,500.00 5 $20,500.00
12 4' EXTRA DEPTH MANHOLE 125 VF $350.00 $437.50 1.25 $437.50
Sub-Total of Previous Unit $90,753.50 $90,753.50
Tuesday, January 28, 2025 Page 2 of 4
City Project Numbers 101025
Contract Name CARROLL STRI�,I:'I"L'OWNHOMI:S
Contract Limits
Project Type WATER & SEWER
Project Funding
Contract Information Summary
Original Contract Amount
Chan�e Orders
Change Order Number 1
Change Order Number 1
Change Order Number 2
Change Order Number 2
Total Contract Price
DOE Number 1025
Estimate Number 1
Payment Number 1
For Period Ending 1/17/2025
$105,773.50
$2,485.00
$628.00
$2,475.16
$2,606.84
$113,968.50
Total Cost of Work Completed $113,968.50
Less % Retained $0.00
Net Earned $113,968.50
Earned This Period $113,968.50
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
$113,968.50
Tuesday, January 28, 2025 Page 3 of 4
City Project Numbers 101025
Contract Name CARROLL STRI�,I:'I"L'OWNHOMI:S
Contract Limits
Project Type WATER & SEWER
Project Funding
DOE Number 1025
Estimate Number 1
Payment Number 1
For Period Ending 1/17/2025
Project Manager NA City Secretary Contract Number
Inspectors DICKINSON / WATSON Contract Date
Contractor SAN SABA CONSTRUCTION SERVICES, INC. Contract Time 125 CD
3100 INDEPENDENCE PKWY #311-314 Days Charged to Date 125 CD
PLANO , TX 75075 Contract is 000000 Complete
CITY OF FORT WORTH
SUMMARY OF CHARGES
Line Fund Account Center Amount Gross Retainage Net
Funded
Total Cost of Work Completed
Less % Retained
Net Earned
Earned This Period $113,968.50
Retainage This Period $0.00
Less Liquidated Damages
� Days @ $0.00 / Day
LessPavement Deficiency
Less Penalty
Less Previous Payment
Plus Material on Hand Less 15%
Balance Due This Payment
$113,968.50
$0.00
$113,968.50
$0.00
$0.00
$0.00
$0.00
$0.00
$113,968.50
Tuesday, January 28, 2025 Page 4 of 4
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' „ D�VELOPER-A1NAR�ED-PROJECT CHANGE ORDER, ` . -
: . ��� (�(o: �Oao �
- � � �PROJECT NAME: � Carroll StreetTownhomes w "'
I . �
�CONTRACT: - INater. Sewer. Pavinq,�Storm Drain, Street Lights ` CHa,NGe ' "
' . I CFA # ' ORDER No: '
I ICITYPROJECT# 12017-175 I CI7YPARTICIPATION:I YES �� �
� 101025
� IDOE#' IN/A a . -' - .. ,.i
I�NATER PROJECT# q � "" i:
�56008-D600430-101025-001580
ISEWER PROJECT # � " �'�.-
�56008-0700430-101025-001380 •
I � FILE # ' - ' � W-2502, X-24437 � _ ' .
. . I ,
� INSPECTOR: Donald L. Watson Jr. Phone No: 817-2p5-8911 �
PROJECTMANAGER: VicTomero PhoneNo: 817-392-7830 •
- � I � CONTR,4CT UN�T . � �
I� � ' I WATER I SEWER PAVING DRAINAGE � • ' ' .
I STREETLIGHTS- CONTRACT
Develo er i
� � . , I P Developer �� Developer Deveioper IDeveloper ' DAYS �
Cost CfryCost ICost CityCost Cost CityCost ICost CiryCost Cost CityCost � �
IIORIGINA�CONTRACT . � 520,730.00 � 554,036.50 537,007.00 �� 599,827.00 � 514,008.62 � $7,80U,00
EXfRASTODATE . I ' I � I . I . 125 � . ; � - `� '- '
ICREDITS TO DATE � �'. � I � ��.' I I I i I ,
ICO TRACT TO DATE _ ' � _
� I� �� 520,730.00� I 50.00 I�554,036.50 $31,007.00 I 599,827.00 I 50.00 � 514,008.62 I 50.00
AMOUNT OF PROP. CHANGE pRDER ' I SY,465,OD I � I� $628.00 I I ''� r i s+,aoo.00 � So.00 , 125 �' ,,: �
� � I
IREVISEDCONTRACTAMOUNT � 523,215.tlp I 50.00 I 554,664.50 � 53'I,007.00 I 599,827.00 I 50.00 � 514,008.62 � 50.00 I 51,800.00 I 50.00 125 + �
' TOTALREVISED CONTRACTAMOUNT � . •� „�` - �
' PERUNIT � � . - • � � '�
I 523,215,00 I 585,671,50 � I $99,827,00 . I �
I F
514.008.62 57,800.00
� � REVISEDCOSTSHARE IDev.�Cost � §193,515.1�2 � � ;
i City CosL• $31,007.00 '
i I � TOTAL REVISED CONTRACT I . � " . . . � ` I
. I . � $224,522.12 , . , .. . . . , , I .
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CITY SECREiAR�'
CONTRACT N0. ��0 � � ��
DEVELOPER-AWARDED-PROJECT CHANGE ORDER
PROJECT NAME: Carroll Street Townhomes
CONTRACT: Water, Sewer, Pavina. Storm Drain, Street Liahts
CFA # 2017-175 I CITY PARTICIPATION:I YES
CITY PROJECT # 101025
DOE # N!A
WATER PROJECT # 56008-0600430-t01025-001580
SEWER PROJECT # 56008-0700430-101025-001380
FILE # � W-2502, X-24437
INSPECTOR: Donald L. Watson Jr. Phone No: 817-205-8911
PROJECT MANAGER: Vic Tornero Phone No: 817-392-7830
I CONTRACT UNIT
IWATER SEWER PAVING �
�Deve{oper Developer Developer D
cosc �j�y �p� cost �jjv cost cost city cosc c
ORIGINAL CONTRACT I SZ0,730.00 f54,036.50 $31,007.00 599,827.00
EXTRAS TO DATE j2,485.00 =628.00 I
CREDITS TO DATE J
CONTRACT TO DATE SZ3,215.00 $D.00 f54,664.50 $31,007.00 E99,827.00 f�Q,Aj1.. � J
AMOUNT OF PROP CHANGE ORDER � =2,475.16 $2,606.84 EZ,S86.00 I
REVISED CONTRACT AMOUNT 523,215.00 $0.00 f57,179.66 $33,613.64 :6102,417A0 I E0.00 I
TOTAL REVISED CONTRACT AMOUNT I
PER UNIT SZ�.215.00 $90,7b3.50 ;102,413.00 I
REVISED COST SHARE Dev. CoSt: $198,576.28 City Cost:
TOTAL REVISED CONTRACT I E232,190.12
' `, �'^ �� � � .'1 �4�,.
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``�, .
Revised:10-12-2011
Csc No • 5oaoa
CHANGE
ORDER No:
2
DRAINAGE STREET LIGHTS
eveloper i�eveloper
ost �,jjy Co;j Cost C�j(y Cost
E14.008.62 E1,800.00
E14,008.62 $0.00 E1,800.00 $0.00
E14,008.62 50.00 51,800.00 $0.00
514�008.62 $1,800.00
$33,6i 3.84
5
i �
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R�CE�V��
NOV 2 5 2�19
CITY qF FORT UvORTH
CIIY SECR�TARy
CONTRACT
DAYS
125
125
125
' .... . ... _....._,- ,. ,
�� ° ��������; ���C�R�
� � �li� �E�����Rx �
j ��. ����'�r �R%�:
� �'age 1
bE
You are directed to make the followinq chanpes in the cP ntract docu ents.
IqNBIDITEMI �
PAY ITEM # # QUANTIN UNIT I ITEM DESCRIPTION UNIT PRICE TOTAL
Unn {{: Samtary Sewer (Developer)
2 3301.0002 1 LF POST-CCN INSPECTION $2 40 $2.40
3 3301.0101 1 EA MANHOLE VACCUM TESTING $717 84 $717 84
5 I 33050109 1 LF TRENCH SAFETY - -
9 I 3331.4119 1 LF 8" DIP SEWER PIPE $68.58 $68.58
11 I 3339.1001 1 EA � _ 4' MANHOLE $1,686.34 $1,686.34
DEVELOPER TOTAL: "sz.475.16
Unit II Samtary Sewer (City) � T
2 � 3301 0002 1 LF T POST-CCN INSPECTION $1 60 $1 60
3 I 3301.0101 1 EA MANHOLE VACCUM TESTING $107 76 $707 16
5 3305 0109 1 LF TRENCH SAFETY $3 00 �$3 00
9 � 3331.4119 1 LF 8" DIP SEWER PIPE $81.42 $81 42
11 I 3339.1001 1 EA 4'MANHOLE $2,41366 $2,413.66
I � _ _ CITY TOTAL: 52.606.84
Umt IV: Paving (Developer) �
1 � 3213 0301 431 SF 4" CONC SIDEWALK 56.00 $2,586.00
I DEVELOPER TOTAL: 52,586.00
GRAND TOTAL $5,192.84
REASONS FOR CHANGE ORDER Realignmenf o/ Sanitary Sewer due to conilict with existing power pole Additionalty the sidewalk along Carroll street is to be widened to connect to the back o/
the curb (-1.5' width). Since this projec[ was not publicly bid, the City could only reimburse fhe developer based on the current CFA Unit pnces. The cost
breakdown presented above shows the City's maximum contribution for the change order and fhe developer will be required to pay the remaining portion. The
two unit costs combine match the overall unit cost in the contract documents bid proposal seciion/"�
RECOMMENDED: AP FZ ED� „./ _/ / APPROVED:
Kim Inc. Te s In L � r San Saba Cons o�
ey' ���E��7L., e By' '�
Name: l����d0� i�!�.7 ���*'1 Name: Name: �CXJf%H�/- �v����'v4
Title: Z' �� N tG� Titie: M Title: �/r�
..� . P.C`JAL ��COMM€`:C�C: APFnvJcD: APPROV�D AS TO FORM AND LEGALITY:
(CFW - Spon �ng D ment) (CF - ssrstant City Mana (CFW - Assisfant Ciry Atfomey )
By . . By: , � BY:
Name: ��`''r �'" "rl Name: � V ya h /� � Q � �� Name: �ZC�I�"� � • �^' �'�^
Title: ��^,g .. ���'c� ' /l,W�le: �� ��SS"� t';� � � � �lcq1�� �� - C''� �.e�e.c��
a �•� � �
RECOMMENDED:
(CFW -�onhact Compi� ce Man r) ' Contrect Compliance Manager (Project Manager):
BY �/� �// By signing I ackn�owledge that i am the person responsible
�� for the monitorin and administration of this contract, include
YIC� ,^ � � Ji� . ensuring all perfortnance and reporting requirements.
Name, w
n -� ��� �A ❑ There are NO City Funds associated with this Contract
Title: ��0� 7v L
- ❑' There are City Funds associated with this Contract
M&C Number: �I�
M8C Date Approved. /V /�
Revised 10-12-2011
Atteested
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City Secxetary
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DEVELOPER-AWARDED-PROJECT CHANGE ORDER
PROJECT NAME:
CONTRACT:
C FA #
CITY PROJECT #
DOE #
WATER PROJECT #
SEWER PROJECT #
FILE #
INSPECTOR:
PROJECT MANAGER:
CONTRACT UNIT
WATER SEWER PAVING DRAINAGE STREET LIGHTS
Developer Developer Developer Developer Developer
Cost City Cost Cost City Cost Cost City Cost Cost City Cost Cost City Cost
ORIGINAL CONTRACT $20,730.00 $54,036.50 $31,007.00 $99,827.00 $14,008.62 $1,800.00
EXTRAS TO DATE $2,485.00 � $3,103.16 $2,606.84 $2,586.00 � � �
CREDITS TO DATE
CONTRACT TO DATE $23,215.00 $0.00 $57,139.66 $33,613.84 $102,413.00 $0.00 $14,008.62 $0.00 $1,800.00 $0.00
AMOUNT OF PROP. CHANGE ORDER $0.00 $(5,850.00) $0.00 $0.00 $0.00
REVISED CONTRACT AMOUNT $23,215.00 $0.00 $57,139.66 $33,613.84 $96,563.00 $0.00 $14,008.62 $0.00 $1,800.00 $0.00
TOTAL REVISED CONTRACT AMOUNT
PER UNIT $23,215.00 $90,753.50 $96,563.00 $14,008.62 $1,800.00
REVISED COST SHARE Dev. Cost: $192,726.28 City Cost: $33,613.84 �
TOTAL REVISED CONTRACT $226,340.12
CSC No. 50202-0O3
CONTRACT
DAYS
125
125
0
125
Revised: 10-12-2011 Page 1
Carroll Street Townhomes
CS-50202
2017-175 �
101025
N/A
56008-0600430-101025-001580
56008-0700430-101025-001380
W-2502, X-24437
Donald L. Watson Jr
Debbie J. Willhelm
CITY PARTICIPATION:� YES
Phone No: 817-205-8911
Phone No: 817-392-2481
CHANGE
ORDER No:
3
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�g ��_� pre pVfc G�ty P
„rv� �l�� GFW , p.sslsla�i
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� T\t\e: ��.09«���
BY. �� ,..
m� ����dEE1'(112y k��haraF.��ntr.��ke�:*�Ty �� K
Na � na9er gy. M�Crac en
Psso��ate AppRO�E�' t GitiY a Ft�chard Pctorne
T�t\e: CFw . Pss�sta� � � Name: nt G��J
M�N �D, �� �� 2 3��o co� e� r P5s\sta
D ��, S �o
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eu�� a�age�1�
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G�w ,�jJ �ana 8 er �anagyr lP� e�person resp�t, ���\ude
��µ�' �.f NaK`e � Ass�stant G�t �ana * Co�t�a�t; amp`ov� a aa� � sKa °��n9 �e`aU�oernents�
�!„`� � 0Y s\0n�ng �to��n9 a�d and reP°� cpntta�t
BY� an, PE T\t�e� the R`O� orman�e th\s
nderm W\1h
1a �°r C'u fenSUr\n9 a\\ Pe� s assO��a�ed ct
Name: Ma�a e� �ES,�: ��1 F�nd Contra
�neer�ng A ���e(e are Np Gity d Wi1h th�s
� �, A F��ds asso��ate
T�t\e: En9
Ma��ge� aU p Zhere are G��y
_,..aMEN�E���mp��an�e 6 '� _..otie 5• `jp0d
�� ' -C�. ���,�"'
D`gg`� (/ /
ev�.
Name � � ss�ona� t�� �..
1�t\e'� Sen\or Pr0{e
NIA
M�`CNumbe( pIIP
M�c Da�e Pppro�ed.
Page 3
Rev\Sed 1p-12"2p11
DEVELOPER-AWARDED-PROJECT CHANGE ORDER
PROJECT NAME:
CONTRACT:
CFA #
CITY PROJECT #
CITY SECRETARY CONTRACT #
FID #
X#
FILE #
INSPECTOR:
PROJECT MANAGER:
Carroll Street Townhomes
Water, Sewer, Pavinq, and Street Liqhtinq
2017-175 I
101025
CS-50202
56008-0600430-101025-001580
56008-0700430-101025-001380
W-2502, X-24437
Donald L. Watson Jr
Debbie J. Wilhelm
WATER
Developer
Cost Ci
ORIGINAL CONTRACT $20,730.00
EXTRAS TO DATE $2,485.00
CREDITS TO DATE $0.00
CONTRACT TO DATE $23,27 5.00
AMOUNT OF PROP. CHANGE ORDER $0.00
REVISEDCONTRACTAMOUNT $23,275.00
TOTAL REVISED CONTRACT AMOUNT PER
UNIT $23,215.00
REVISED COST SHARE Dev. Cost:
TOTAL REVISED CONTRACT
CHANGE
ORDER No:
CITY PARTICIPATION
YES
�
Phone No:
Phone No:
817-205-8911
817-392-2481
CSC No. 50202-004
CONTRACT UNIT
SEWER DRAINAGE PAVING STREET LIGHTS CONTRACT
Developer Developer Developer Developer DAYS
Cost Cost Cit Cost Cost City Cost Cost Cit Cost Cost City Cost
$54,036.50 $31,007.00 $14,008.62 $0.00 $99,827.00 $0.00 I $1,800.00 $0.00 125
$3,103.16 $2,606.84 $0.00 $0.00 $2,586.00 $0.00 I $0.00 $0.00 0
$0.00 $0.00 $0.00 $0.00 $5,850.00 $0.00 I $0.00 $0.00 0
$57,139.66 $33,613.84 $74,008.62 $0.00 $96,563.00 $0.00 I $1,800.00 $0.00 125
$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 I $0.00 $0.00 0
$57,139.66 $33,613.84 $74,008.62 $0.00 $96,563.00 $0.00 I $1,800.00 $0.00 125
$90, 753.50 $14,OOS.62 $96,563.00 $1, 800.00
$192,726.28 City Cost: $33,613.84
$226,340.12
Revised: 12-17-2018 Page 1
You are directed to make the following changes in the contract documents:
PAY ITEM # CITY BI�D ITEM QUANTITY
8 3213.0301 (162.00)
9 3213.0301 (440.00)
NEW` 3441.4006 2
� � � �
Asterisk (*) indicates New Pay Item
U� IT IV: Pavina Imnrovements
UNIT ITEM DESCRIPTION CFPW enit UNIT PRICE DeCosPef City Cost TOTAL
SF 4" Conc Sidewalk I $0.00 $6.00 $ (972.00) $0.00 $ (972.00)
SF 6" Concrete Driveway $0.00 $10.00 $ (4.400.00) $0.00 $ (4,400.00)
EA Install Alum Sign Ground Mount $0.00 $2,686.00 $ 5,372.00 $0.00 $ 5,372.00
TOTAL UNIT IV: PAVING IMPROVEMENTS 0.00 0.00 $0.00
�
[SIGNATURES APPEAR ON THE FOLLOWING PAGE]
Revised: 12-17-2018 Page 2
REASONS FOR CHANGE ORDER Portions of the sidewalk and driveways were removed from contract and installed by Parkway Permit instead. Added two No Parking Signs.
There is no net change in this change order. Changes correspond to Plan Revision 3 as shown on Sheet C-12 of the construction Plans.
RECOMMENDED:
Kimley-Horn, Inc.
C?..e.�f'.,,
By � _ �5
Name: Jared Earnev
Title: Associate
APPROVAL RECOMMENDED:
CFW - Water Department
s�a� ��. ��—
By:
Name: Subv Varuqhese. PE
Title: Enqineering Manager
RECOMMENDED:
CFW- �Contract Compliance Manager
D=66�. � u/�E&4'
By:
Name: Debbie J. Wilhelm, PE
Title: Senior Professional Engineer
M&C Number: N/A
M&C Date Approved: N/A
APPROVED:
Texas InTown Homes, LLC.
�GtVlGi �00`
gy� -�. N a . ,�_�,
Name: David Foor
Title: Vice President
APPROVED:
CFW - Assistant City Manager
a�, s��,�
By:
Name: Dana Burghdoff
Title: Assistant City Manager
ATTEST: �
� � ��
Jannette S. Goodall
City Secretary
APPROVED:
San Saba Construction
BY �,��—
Name: Robert Beserra
Title: President
APPROVED AS TO FORM AND LEGALITY:
CFW - Assistant City Attorney
gy�_�� _�_��
Name: Richard McCracken
Title: Senior Assistant City Attorney
* Contract Compliance Manager (Project Manager):
By signing I acknowledge that I am the person responsible
for the monitoring and administration of this contract, include
ensuring all performance and reporting requirements.
�There are NO City Funds associated with this Contract
X �There are City Funds associated with this Contract
Revised: 12-17-2018 Page 3
i :, � .
� -. - , .
� -
. ,
� � . . . � � � - . ' . . . CI'fV SECRE'TAR1� �
, :- . . �� � ; �ONTR�4C�'N�. ��oaoa=C �
, �� . . � . �
. ,
' „ D�1/ELOPER-AWARCIFD-PROJECT CHANGE ORDER. J • -
: . C�C � I�fo: 50ao �
' � � �PROJECT NAME: � Carroli StreetTownhomes ~
i � .,-
�CONTRACT: - INater. Sewer. Pavinq, Storm Drain, Street Lights ' CHa,NGe ' �'
' . I CFA # � ' ORDER No: '
I ICITYPROJECT# 1010255 I CI7YPARTICIPATION:I YES �� '
� IDOE#' IN/A , -. '�s _' ` .. �.i
I�NATER PROJECT# • q s "" i:
�56008-0600430-101025-001580
" ISEWERPROJECT# � " �'�.-
�56008-0700430-101025-001380 • � �
�FILE# . • �W-2502,X-244371 _ '
. . i . I ' . . . � , .
� INSPECTOR: Donald L. Watson Jr. Phone No: 817-205-8911 �
i PROJECT MANAGER: Vic Tornero Phone No: 817-392-7830 •
� I � .. . � , COMR,4CT UN�T '
�� . � ' . .. ' i
I WATER I SEWER PAVING I DRAINAGE ' ' � �
Develo er STREETLIGHTS - CONTRACT
� � , I P Deveioper �� Developer Deveivper Developer ' DAYS � . I
Cost CIry Cost ICost I City Cost Cost Cit� Cost I Cost Ciry Cost Cost City Cost � �
IIORIGINALCONTRACT . � 520,730.00 � � 554,036.50 S31,007.00 �� 599,827.00 � 514,008.62 � 51,80U.0p
EXfRASTODATE � I ' I , I I ' I - 125 � � � � - `� '" ,
. ICREDITS TO DATE - -� I - � ��
. �' � � � ��.� � � �
ICO TRACT TO DATE � � ' �
'� IN , � 520,730.00 I 50.00 I 554,036.50 I$31,007.00 � 599,827.00 I 50.00 � 514,008.62 I 50.00 I 51,800.00 I So.00 125
AMOUNT OF PROP. CHANGE pRDER ' I 52,465,OD I � I� $628.�0 I I � I .� I ��
. f.
IREVISEDS',ONTRACTAMOUNT � 523,215.�p I 50.00 � 554,664.50 I 53y,007.00 I 599,827.00 � 50.00 � 514,008.62 I 50.00 I 51,800.00 I 50.00 � �Zg + �
' TOTALREVISEDCONTRACTAMOUNT� .•� �.�` - '
' PERUWT � �� � - • ' � � �
.
, I 523,215,00 I 585,671.50 � I $99,827.00 I $14.008.62 I 57,800.00 ' � �
- � REVISEDCOSTSHARE IDev.'Cost � §193,515.1�2 � � i
� I City CosG $31,007.00
ii i ' . i
� TOTAL REVISED CONTRACT � . . � I
. I . � $224,522.12 , . . . . . , ' .
' I ' . . . . . . ' � _ ; ... . - '
� � " � . ' e _ . . . . . .� , , � .
� ' . . . � . � , ,
I� . . � . . . � , � � ' .. ,
I� ' � � . .. .. . . � . . .
Revised:10-�2-2011 -
I I`
� �
You are directed to make the followin9 changes in the contrect documents:
I I CITY BIO ITEM I
PAY ITEM # � pUANTl7Y UNIT
� � Unl[ I: Water i � i ITEM DESCRIpTION UNIT PRICE I TOTAL
� Z i 33'12,2003 I 1 � E,q � I
I 1" WATER SERVICE $2.485.00 I gz,485.00
i � � �
� Unit II: Sewer i � � I TOTAL I$2,485.00
� 2 3301.00D2 ; 4 I LF I � I
I 5 i 3305.0109 I 4 �F POST-CCN INSPECTION � $4.00 I $16.00
I g � I � TRENCH SAFETY I $3.00 I 512.00
I � 3331.41'19 I 4 LF i 8" DIP SEWER PIPE
I . � I � � � � $150.00 I $600.00
GRAND TOTAL TOTAL� I $628.00
� I $3,193.00
REASONS FOR CHANGE ORDER Exfens;on o! Sanrtary Sewer to cenler oI proposed easemenL Easement updefed lrom appmved p/ans to allow room lor franchise utility service. Ttis chan9e
orcler does nof eflect fhe City Cost Padiclpa0on slnce fhe developerls paying a 10046 tor fhis change orrler. Hence, there is no need to obtain City Signatures /or
this change o�de�.
f E�Ip.'d�qG"Jq�6^,r p�.F'I'•I:rJ'r'EG:
�iri�i, � „ , h� ,
t..
� �' — - -
..,rtu: .. . .. _ � .._ . ._ r.!amc- '
1"r:e ' �. � Tl;i� ��
_�.�_r �. ... �_
APPROVALRECOMMENDED:
(CFW - Sponsonng DepartmenU
By: N/A
Name:
Title:
RECOMMENDED:
(CFW - •C�ontracf Compli ce Mana r)
By: ,LT/6t
V1-C7lq'z 1% �
Name: � /G,�R�'6�.a �/K.
TiUe: �/�O�ii 'L� �jf�lZp^�
M&C Number: N/A
, M&C Date Approved: N/A
Revised:10-12-2011
� ApPRO'JF.A�
� i
�, " �� �:,�,;. : ��� r:'-F' %-r
, ,..,
C� '',�—_- j
. ___.__._ � G��� � '�'"'�
1
, ;:ai�<, f/�.,,G��� —,.' _�,l� ..
Tdlr. : �� � � �� ', ,•C -�
----._ - - ..:i T - L. G; � . . , �-
APPROVED: . APpROVED AS TO FORM AND LEGALITY:
(CFW - Assfstant ' anagerJ ���'%��,/ - (CFW - AssistanP C Attomey)
By: fYA �A
By: N
Name: ��N�L�`I�"' Name: � �C • M.�:�iT��y�
Title: I i..r� `�l r ,Title: ��� 7�7A� �`� �
" Contract Compliance Manager (Project Manager):
By signing I acknowledge that I am the person responsible
for the monitoring and administration of this contract, include
ensuring all perfortnance and reporting requirements.
❑There are NO City Funds associated with this Contract
OThere are City Funds associated with this Contrect
, l�t�tte bya
e
'�� �� ���--� ' ��� ---- -- o
r� �. ��'�5��.'- �}�� �Cret���
� .� , �.7 ''`'" J
�r'_ �`r..66'°xf';*'.
�,.-,�'. ... :��''�y
" �, P� � . v �4"..
.�`'�.,, � """'��.--�'" �? `.`✓
. ���� ;� � � � ,Y�
:l s�� ���� �
:,, ... . �e9� z
; ,���� ����;� Y��;.
1
CITY SECRE�ARi'
CONTRACT N0. �� � -� ��
DEVELOPER-AWARDED-PROJECT CHANGE ORDER
PROJECT NAME: Carroll Street Townhomes
CONTRACT: Water, Sewer, Pavina. Storm Drain, Street Liahts
CFA # 2017-175 I CITY PARTICIPATION:I YES
CITY PROJECT # 101025
DOE # N!A
WATER PROJECT # 56008-0600430-t01025-001580
SEWER PROJECT # 56008-0700430-101025-001380
FILE # � W-2502, X-24437
INSPECTOR: Donald L. Watson Jr. Phone No: 817-205-8911
PROJECT MANAGER: Vic Tornero Phone No: 817-392-7830
I CONTRACT UNIT
ORIGINALCONTRACT
EXTRAS TO DATE
CREDITS TO DATE
CONTRACTTO DATE
AMOUNT OF PROP. CHANGE ORDER
REVISED CONTRACT AMOUNT
TOTAL REVISED CONTRACT AMOUNT
PER UNIT
REVISED COST SHARE
TOTP.L REVISED CONTRACT
Csc No • 5oaoa
CHANGE
ORDER No:
2
IWATER � SEYdER PAVING � DRAINAGE STREET LIGHTS CONTRACT
�Devebper I � `Developer ` Developer �Developer ' Ceveloper DAYS
cosc I cay pq�Y I cost � ctry cost cost Gry cosr cost ���y �,�,5x _ cost � aGy cosc
I SZ0,730.00 � I$54,036.50 $31,007.00 599,827.00 514,008.62 f1,800.00 _ 125
j2,485.00 � 5628.00 .
_..� . —_ _____--
SZ3,215.00 $D q0 ;54,664.50 $11,007.00 � E99,827.00 $0.00 E14,008.62 $0.00 , $1,800.00 $0.00 125
$2,475.16 I $2.606 84 I EZ,S86.00 � �� _
523,215.00 $0.00 ;57,179.66 I $938 5.64. '. :i102,417A0 $OAU . '�;I 514,008.&2 $0.00 51,880.00 $0.00 125
SZ�.215.00 $90,7b3.50 ;102,413.00 „J $14,0�8.62 $1,800.b0
Dev. Cost: 5198,576.28 �yi � $33,613.84
f g, _
I 5232,190.12
�o�'� � ����:
� �` '
r , C���,.
.,
,, �
Revised:10-12-2011
.1234g6-�
�i �
R�C�I`JC!�
aov 2 � 2a�a
CITY OF FORT V+'ORTH
CITY SECR�TARY
y �
� � � � ` `�
��
��W����'�; �����R�
� �l1� 5����fi��� �
} ��. eG�'��'5�.�� �:�e�; ��age 1
� �.
You are directed to make the followinq chanpes in the c(57ntract docu ents.
I PAY ITEM # I qN BI�D ITEM I QUANTIN � UNIT I
ITEM DESCRIPTION UNIT PRICE TOTAL
� Unit {{: Sanitary Sewer (Developer)
I 2 3301.0002 1 LF POST-CCN INSPECTION $2 40 $2.40
I 3 3301.0101 1 EA MANHOLE VACCUM TESTING $717 84 $717.84
I 5 I 33050109 1 LF TRENCH SAFETY - -
I 9 I 3331.4119 1 LF 8" DIP SEWER PIPE $68.58 $68.58
I 11 3339.1001 1 EA 4' MANHOLE $1,686.34 $1,686.34
I DEVELOPER TOTAL: "sz.475.16
� Unit II: Samtary Sewer (City) � T
� 2 � 3301 0002 1 LF T POST-CCN INSPECTION $1 60 $1 60
I 3 3301.0101 1 EA MANHOLE VACCUM TESTING $107.76 $707.16
� 5 3305 0109 1 LF TRENCH SAFETY $3 00 �$3 00
� 9 � 3331.4119 1 LF 8" DIP SEWER PIPE $81.42 $81 42
I 11 I 3339.1001 1 EA 4'MANHOLE $2,41366 $2,413.66
I I � _ _ CITY TOTAL: $2,606.84
� Umt IV: Paving (Developer) �
� 1 � 3213 0301 431 SF 4" CONC SIDEWALK $6.00 $2,586.00
I I DEVELOPER TOTAL: 52,586.00
I GRAND TOTAL $5,192.84
REASONS FOR CHANGE ORDER Realignmenf o/ Sanifary Sewer due to conFlict with existing power pole. Additionaliy, the sidewalk along Carroll street is to be widened to connect fo the back o/
the curb (-t5' width). Since this project was not publicly bid, fhe City could oNy reimburse fhe developer based on the curre�t CFA Unit pnces. The cost
breakdown presented above shows the City's maximum contribution for fhe change ortler and fhe developer will be required to pay fhe remaining portion. The
two unit costs cambine match the overell unif cost in the coniracf documents bid proposat secfion/"�
RECOMMENDED: AP FZ ED� „ . / � _ / / APPROVED:
Kim Inc. � Te s In L � r San Saba Cons on
By: �'��� _ 8 BY'
Name: C����dO�h i•ecX,7 ��+f�'1 Name: Name: �C�JOH�T �v��� v�
Title: Z' �� H tG.� Title: r1 Title: ���/r�
..� . P.C`JAL ��COMM�`:C�C: APFnvJcD: APPROV�D AS TO FORM AND LEGALITY:
(CFW-Spon 'ngD ment) (CF - ssistantCityMana / (CFW-AssisfantGityAttorney)
By . �' By: /� O By: ��L _ _
Name: �t'''"'_ �`' "`d n Name: � V ya h /� � Q V� �J Name: ,�jr���3G�'V�ii' �• �'�
Title:C�^q .. '•r���� 'fs,YL�e: �� � is�s� �y�:�i.���ltq�(�.a !'�a�� C"`� 1��'��
� 8 �
RECOMMENDED:
(CFW -�ontract Compii ce Man r) ' Contrect Compliance Manager (Project Manager):
BY �/� �// By signing I ackn�owledge that i am the person responsible
�� for the monitorin and administration of this contract, include
YIC� ,^ � � Ji� . ensuring all perfortnance and reporting requirements.
Name, w
n -� ��� �A ❑ There are NO City Funds associated with this Contract
Title: ��0� 7v L
- ❑' There are City Funds associated with this Contract
M&C Number: �I�
M8C Date Approved. /V /�
Revised 10-12-2011
a . w��
0
�:" �.:��:��V'� k�,'` d"`�Gf�t�^'�.•c� .
,.; �^��K � �. �+''.-;� �.
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�;�: � � �° �'� Y",
� ±�� �-.�- �. �... �.�
��3, �R�., �� ikt,�
;59 ��'o ��d` � �
e� ..� ?� p`�,� `�
�`,°-^'^'* ^ - -
, ..
City Secretary
���I���� ���'� h a,.":'" ,
�ITYSE����"����'� ',
F'T.1N�R3' ��< ` � .
PBge 2
DEVELOPER-AWARDED-PROJECT CHANGE ORDER
PROJECT NAME:
CONTRACT:
C FA #
CITY PROJECT #
DOE #
WATER PROJECT #
SEWER PROJECT #
FILE #
INSPECTOR:
PROJECT MANAGER:
CONTRACT UNIT
WATER SEWER PAVING DRAINAGE STREET LIGHTS
Developer Developer Developer Developer Developer
Cost City Cost Cost City Cost Cost City Cost Cost City Cost Cost City Cost
ORIGINAL CONTRACT $20,730.00 $54,036.50 $31,007.00 $99,827.00 $14,008.62 $1,800.00
EXTRAS TO DATE $2,485.00 � $3,103.16 $2,606.84 $2,586.00 � � �
CREDITS TO DATE
CONTRACT TO DATE $23,215.00 $0.00 $57,139.66 $33,613.84 $102,413.00 $0.00 $14,008.62 $0.00 $1,800.00 $0.00
AMOUNT OF PROP. CHANGE ORDER $0.00 $(5,850.00) $0.00 $0.00 $0.00
REVISED CONTRACT AMOUNT $23,215.00 $0.00 $57,139.66 $33,613.84 $96,563.00 $0.00 $14,008.62 $0.00 $1,800.00 $0.00
TOTAL REVISED CONTRACT AMOUNT
PER UNIT $23,215.00 $90,753.50 $96,563.00 $14,008.62 $1,800.00
REVISED COST SHARE Dev. Cost: $192,726.28 City Cost: $33,613.84 �
TOTAL REVISED CONTRACT $226,340.12
CSC No. 50202-0O3
CONTRACT
DAYS
125
125
0
125
Revised: 10-12-2011 Page 1
Carroll Street Townhomes
CS-50202
2017-175 �
101025
N/A
56008-0600430-101025-001580
56008-0700430-101025-001380
W-2502, X-24437
Donald L. Watson Jr
Debbie J. Willhelm
CITY PARTICIPATION:� YES
Phone No: 817-205-8911
Phone No: 817-392-2481
CHANGE
ORDER No:
3
o S F�R GHPNGE �R�ER
REA
ct do�uments. e co5T pND
,S \n the �Ontra �N�T P�an G�,�p'(P�_ HpNGE QRpER
ppV1N
8�p �'(E� Qvp,Nj\jY EP
tin5 perm�t from PARD oN E� �p o �p'fH
# pR 0 /o
2g3'o1p4 ,9 GRAND 2ptp'L ted throu5h a tree P�an OpER�S RESP 5\8�
lan E�
Removin9 Street
trees from CFA Trees to be p ON��Gt. B�WNED �VE� pER o�NG ppGE1
�UNDS �N�o NE �� W�� BE Sa�GN RES PppEPR ON TNE ��``
'fHERE�gUR E EN,� FRON► Cg`GNp'(V
N�
Page 2
Rev\Sed 1p-12"2p11
ppr.-- Gpns��..-
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S� F 1G2309:75�� �
ROgERj gE`SEkRPtPP� Z_,
AppRO�Ep, n Nomes, �LC BY Robe� geserra
Texas �nT� N�'me� Pres�dent
�04r. , ac co�'..
����0. �i , ,�,�
���� � o �F �r.��= T�t�e= q.l.
RE \e`1'N°r�, �n ' BY�- a�`d Foor PN `E�,AL�
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PROJECT NAME:
PROJECT NUMBER:
DOE NUMBER:
PIPE LAID
NA
NA
FIRE HYDRANTS:
PIPE ABANDONED
DENSITIES:
NEW SERVICES:
PIPE LAID
SEWER
SEWER
SEWER
PIPE ABANDONED
DENSITIES:
NEW SERVICES:
FORTWORTH
TRANSPORTATION AND PUBLIC WORKS
PIPE REPORT FOR:
Carroll Street Townhomes
101025
NA
WATER
SIZE TYPE OF PIPE
NA NA
NA NA
SIZE
SIZE
g��
16"
g��
SIZE
VALVES (16" OR LARGER)
TYPE OF PIPE
SEWER
TYPE OF PIPE
PVC
DIP
DIP
TYPE OF PIPE
LF
LF
LF
LF
NA
NA
257
10
75
� TRANSPORTATION AND PUBLIC WORKS
F�RT�ORTH�
`--�
TRANSPORTATION AND PUBLIC WORKS
January 21, 2025
San Saba Construction
2475 Glenda Ln,
Dallas,Tx 75229
RE: Acceptance Letter
Project Name: Carroll Street Townhomes
Project Type: Water,Sewer,Paving,Drainage,Street Lights
City Project No.: 101025
To Whom It May Concern:
On January 17, 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 January 21, 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-
392-2481.
Sincerely,
Ga►��- ���
Andrew Goodman, Project Manager
Cc: Donald Watson, Inspector
Mike Glover, Inspection Supervisor
Randy Horton, Senior Inspector
Andrew Goodman, Program Manager
Brandon D Middelton, Consultant
San Saba, Contractor
Kimley Horn, Developer
File
E-Mail: TPW_Acceptance@fortworthtexas.gov
Rev. 08/20/19
SILLS PAID AFFIDAVIT FOR CONTRACTOR
State of Texas §
County of Fort Worth §
BEFORE ME, the undersigned authority, on this day personally appeared Rvan Besena, known to me to
be a credible person and officer of San Saba Construction Services, Inc. and who, being duly sworn, upon
his oath declares and acknowledges as follows:
1. I am a duly authorized agent of San Saba Construction Services, Inc., which has authorized me to
make this affidavit, and all of the recitations herein are true and correct.
2. Pursuant to Private Development Contract No. CPM-101025 between Texas InTown Homes,
LLC and San Saba Construction Services, Inc. for Carroll Street Townhomes, San Saba
Construction Services. Inc. has supplied materials and performed labor in connection with the
construction of improvements on real property owned by Texas InTown Homes, LLC in the City
of Fort Worth ("the improvements").
3. San Saba Construction Services, Inc. has actual knowledge that all bills owed by Texas InTown
Homes, LLC to San Saba Construction Services, Inc. for materials supplied or labor performed in
connection with the improvements have been fiilly paid and satisfied.
4. San Saba Construction Services, Inc. has actual knowledge that all bills owed by San Saba
Construction Services. Inc. to others for materials supplied or labor performed in connection with
the improvements have been fully paid and satisfied.
5. San Saba Construction Setvices. Inc. has actual knowledge that thei•e are no claims or liens for
materials supplied or labor perfo�•med in connection with the Private Development Contract.
6. San Saba Construction Services. Inc. fiu-ther warrants that should any claim or lien be filed for
material supplied or labor performed in connection with the Private Development Contract, San
Saba Construction Services, Inc. will immediately furnish a bond pursuant to Texas Property
Code Sections 53.236 through 53.238 for release of each the claim or lien, obtain settlement of
any claiin or lien, and furnish the City of Fort Worth written full release. San Saba Construction
Services, Inc. agrees to fully indemnify and hold harmless the City of Fort Worth from any and
all costs that may occur by reason of such claims or liens.
EXECUTED this 18 day of March 2025.
STATE OF TEXAS
COUNTY OF DALLAS
San Saba Co �� - ion Servic c.
B-. � -- �
AME: yan Beserra
� TITLE: Vice President
This instrument was acknowledged before me on March 18, 2025 by
Rvan Beserra, Vice President of San Saba Construction a S corporation, on behalf of said corporation.
.o�.a��� =<= ._'.;,. ,;,
,��PY PGB STEVEN MICHAEL SHIELDS '
i �� Norary I� #132034680
My Commission Expires
'�'oF�' MaY3��2027 .
� � ��, ���o .,�, �
—l�C��S�`'�t�
NOTARY PUBLIC
CONSENT OF
SURETY COMPANY
TO FfNAI PAYMENT
Conforms whh the American Institute of
Architects, AIA Document G707
OWNER ❑
ARCHITECT ❑
CONTRACTOR ❑
SURETY ❑
OTHER
Bond No 4417036
PROJECT:
Iname, 8ddf 85S)Carroll St Townhomws - Water, Sanitary Sewer, Lighting and Paving Improvements
TO (Owner)
Fort Worth
TX
ITEXAS INTOWN HOMES, LLC AND CITY OF FORT � ARCHITECT'S PROJECT NO:
WORTH CONTRACT FOR:
1520 Oliver Street Carroll St Townhomws - Water, Sanitary Sewer, Lighting and Paving
Improvements
Houston Tx 7700� � CONTRACT DATE:
CONTRACTOR: SAN SABA CONSTRUCTION SERVICES, INC.
In accardance with the provisions of the Contract between the Owner and the Contractor as indicated above, the
(here insert neme and address of Surety Company)
SURETEC INSURANCE COMPANY
1330 Post Oak Blvd.
Houston TX 77056 , SURETY COMPANY
on bond of Ihere insert name end eddress of Contractorl
SAN SABA CONSTRUCTION SERVICES, INC.
2475 Glenda Lane
Dallas TX 75229
, CONTRACTOR,
hereby approves of the fmal payrnent to the Contractor, and agrees that finai payment to the Contractor shall not relieve
the Surety Company of any of its obligations to (here insert name and address of Ownerl
TEXAS INTOWN HOMES, LLC AND CITY OF FORT WORTH
1520 Oliver Street
Houston TX 77007
as set forth in the said Surety Company's bond.
IN WITNESS, WHEREOF,
the Surety Company has hereunto set its hand this
Attest: �
(Seal): J�-^� �'1'1c�.c-
18th day of March, 2025
SURETEC INSURANCE COMPANY
Surety Company
� ��
Signa e of Authorized Representative
�phinie Huntar
Title
, OWNER,
Attornev-in-Fact
NOTE: This torm is to be used as a companion document to AIA DOCUMENT �706, CONTRACTOR'S AFfIDAVIT OF PAYMENT OF DEBTS AND CLAIMS,
CurreM Edition
ONE PAGE
POA# 4221097
JOINT LIMITED POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That SureTec Insurance Company, a Corporation duly organized and existing under the laws of the State of Texas and having its
principal office in the County of Harris, Texas and Markel Insurance Company (the "Company"�, a corporation duly organized and existing under the laws of the state
of Illinois, and having its principal administrative office in Gien Allen, Virginia, does by these presents make, constitute and appoint:
Don E. Cornell, Ricardo J. Reyna, Sophinie Hunter, Robbi Morales, Kelly A. Westbrook, Tina McEwan, Joshua Saunders,
Tonie Petranek, Mikaela Peppers
Their true and lawful agent(s) and attorney(s)-in-fact, each in their separate capacity if more than one is named above, to make, execute, seal and deliver for and on
their own behalf, individually as a surety orjointly, as co-sureties, and as their act and deed any and all bonds and other undertaking in suretyship provided, however,
that the penal sum of any one such instrument executed hereunder shall not exceed the sum of:
In Unlimited Amounts
This Power of Attorney is granted and is signed and sealed under and by the authority of the foilowing Resolutions adopted by the Board of Directors of SureTec
Insurance Company and Markel Insurance Company:
"RESOLVED, That tNe President, any Senior Vice President, Vice President, Assistant Vice President, Secretary, Assistant Secretary. Treasurer or Assistant Treasurer
and each of them hereby is authorized to execute powers of attorney, and such authority can 6e executed by use of facsimile signature, which may be attested or
acknowledged by any officer or attorney, of the company, qualifying the attorney or attorneys named in the given power of attorney, to execute in behalf of, and
acknowledge as the act and deed of the SureTec Insurance Company and Markel Insurence Company, as the case may be, all bond undertakings and contracts of
suretyship, and to affix the corporate seal thereto."
IN WITNESS WHEREOF, Markel Insurance Company and SureTec Insurance Company have caused their official seal to be hereunto affixed and these presents to be
signed by their duly authorized officers on the 21st day of august , zoza .
SureTec Insurance Company
BY: �\.
Michael C. Ke' g, President
State of Texas
County of Harris:
UaSURANC�C
�uf x 9 ��;
wt W :v
�7* 5 ;�
., .1 ... f �c
'�w„�.,*.
````��� ��� i����
;� a� �°'�;M�da
'�: SEAL :�`
�i�.••,��1� : 1",
'����4� e i iu�������.
Markel s rance Co any
By: % .
�.ir,�deyJennin , ice President
V
On this 21st day of August , zoza A. D., before me, a Notary Public of the State of Texas, in and for the County of Harris, duly commissioned and qualified,
came THE ABOVE OFFICERS OF THE COMPANIES, to me personally known to be the individuals and officers described in, who executed the preceding instrument, and
they acknowledged the execution of same, and being by me duly sworn, disposed and said thaY they are the officers of the said companies aforesaid, and that the
seals affixed to the proceeding instrument are the Corporate Seals of said Companies, and the said Corporate Seals and their signatures as officers were duly affixed
and subscribed to the said instrument by the authority and direction of the said companies, and that Resolutions adopted 6y the eoard of Directors of said Companies
referred to in the preceding instrument is now in force.
```����������ii��i
IN TESTIMONY WHEREOF, I have hereunto set my hand, and affixed my OffiEtiil���m��Rf�jarris, the day and year first above written.
[ �
. �`��' PAY P(�e •.' 1y '�:
' V : �� <i� ,. : ..
' 2 � �,i��rG�`� /,1'�l��►GHC/
N ' By' --b
=. Nj, ,�y.Q ; ! Chelsea Turner, Notary Public
� =�TF �F 't`�1►,%� � My commission expires 7/6/2028
•' •� � 1325�:2 � �' :
We, the undersigned Officers of SureTec Insurance Company and Markel InSTe�i�d ��� certify that the original POWER Of ATTORNEY of which the
foregoing is a fuli, true and correct copy is still in full force and effect and has ndlJ�er�� ,�+"�
'��/I/%id�p
IN WITNESS WHEREOF, we have hereunto set our hands, and affixed the Seals of said Companies, on the 'I Hth day of March . 2025 .
ureTec Insurance Company --'— Niarkel Insurance Company
� � .
/ f ���
By: // By: 7 l � �
M. BrentBeaty, Assistant Secretary �� ew N{arquis, Assistan cretary
Any Instrument Issued in excess of the penalty stated above is totally void and without any validity. 4221097
For verification of the authority of this Power you may call (713)812-0800 on any business day between 830 AM and 5:00 PM CST.
SureTec Insurance Company
IMPORTANT NOTICE
Statutory Complaint Notice/Filing of Claims
To obtain information or make a complaint: You may call the Surety's toll free telephone number for information or
to make a complaint or file a claim at: 1-866-732-0099. You may also write to the Surety at:
SureTec Insurance Company
9500 Arboretum Blvd., Suite
400
Austin, TX 78759
You may contact the Texas Department of Insurance to obtain information on companies, coverage, rights or
complaints at 1-800-252- 3439. You may write the Texas Department of Insurance at:
PO Box 149104
Austin, TX 78714-
9104
Fax#:512-490-1007
Web: httn://www.tdi.state.bc.us
Email: ConsumerProtection@tdi.texas.gov
PREMIUM OR CLAIMS DISPUTES: Should you have a dispute concerning your premium or about a claim, you
should contact the Surety first. If the dispute is not resolved, you may contact the Texas Department of
Insurance.
SIC TX Rider TDI Required Notices rev 07_2022 Page 1 of 1