HomeMy WebLinkAbout061796-FP1 - Construction-Related - Contract - Acadia ServicesFORTWORTHo
-FP1
City Secretary No: 61796
Date Received: 1/z�/zoz6
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: Laprelle Offsite Sewer & Meter Station
City Project Number: 104588
Improvement Type(s): �Water �Sewer
Original Contract Price: Offsite Sewer
Original Contract Price: Sewer Meter Station
Water & Sewer Original Contract Total
Amount of Approved Change Order(s)
Revised Contract Amount:
Total Cost of Work Complete
Developer Cost
$1, 338, 930. 75
$251,567.10
$1, 590,497.85
$7,140.12
$1, 597, 637.97
$1, 597, 637.97
City Cost
$2,231,551.25
$659,907.90
$2,891,459.15
$18, 729.88
$2,910,189.03
$2, 910,189.03
Total Cost
$3,570,482.00
$911,475.00
$4,481, 957.00
$25,870.00
$4,507,827.00
$4,507,827.00
WIII CoIIIhS
'�:N'� I I Col li ns (.1 � n 19, 2026 On:15'.34 CST I
Contractor
Sr. Project Manager
Title
Acadia Services, LLC
Company Name
�� ��
Project Inspector
�
Project Manager
_��
CFA Manager
/�a..�.,,. %�rt:...,,_
La u re n P ri e u r(J a n 27, 2026 0326:44 CST)
TPW Director
O1/19/2026
Date
O1/20/2026
Date
O1/26/2026
Date
O1/27/2026
Date
O1/27/2026
Date
OFFICIAL RECORD I page 1 of 2
CITY SECRETARY
FT. WORTH, TX
Notice of Project Completion
Project Name: Laprelle Offsite Sewer & Meter Station
City Project Number: 104588
City's Attachments
Final Pay Estimate�
Change Order(s):❑✓ Yes ❑ N/A
Pipe Report: ✓❑Yes ❑N/A
Contractor's Attachments
Affidavit of Bills Paid ��
Consent of Surety �
Statement of Contract Time
Contract Time: 22�
Days Charged: 1 92
work start Date: � �6�25
work Complete Date: 11 /17/25
Completed number of Soil Lab Test(s): 325
Completed number of Water Test(s): �
Page 2 of 2
F���r ���Tx
CITY OF FORT WORTH
F1NAL PAYMENT REQUEST
Contract Name LAPRELLE OFFSITE SEWER
Contract Limits
Project Type SEWER
City Project Numbers 104588
DOE Number 4588
Estimate Number 1 Payment Number 1
City Secretary Contract Number
Contract Date
For Period Ending ll/17/2025
WD
Project Manager NA
Contractor ACADIA SERVICES
1510 JELMAK ST
GRAND PRAIRIE � TX 75050
Inspectors T. GARDNER / S. ANGELES
Contract Time ���'�
Days Charged to Date 192
Contract is 100.00 Complete
Thursday, January 22, 2026 Page 1 of 5
City Project Numbers 104588
Contract Name LAPRELLE OFFSITE SEWER
Contract Limits
Project Type SEWER
Project Funding
UNIT IIA: SEWER IMPROVEMENTS (OFFICE STI'E SE
DOE Number 4588
Estimate Number 1
Payment Number 1
For Period Ending 11/17/2025
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
1 REMOVE FENCE 16 LF $125.00 $2,000.00 16 $2,000.00
2 10" SEWER ABANDONMENT PLUG 1 EA $2,000.00 $2,000.00 1 $2,000.00
3 SWPPP > 1 ACRE 1 LS $7,300.00 $7,300.00 1 $7,300.00
6 6' CHAIN LINK, STEEL 108 LF $200.00 $21,600.00 108 $21,600.00
7 BARBED WIRE FENCE, METAL POSTS 12 LF $105.00 $1,260.00 12 $1,260.00
8 12' DOUBLE SWING GATE, STEEL 1 EA $5,000.00 $5,000.00 1 $5,000.00
9 POST -CCTV INSPECTION 4968 LF $9.00 $44,712.00 4968 $44,712.00
10 MANHOLE VACUUM TESTING 15 EA $350.00 $5,250.00 15 $5,250.00
11 GROLTND WATER CONTROL 1 LS $25,000.00 $25,000.00 1 $25,000.00
12 TRENCH SAFETY 4968 LF $21.00 $104,328.00 4968 $104,328.00
13 UTILITY MARKERS 15 EA $200.00 $3,000.00 15 $3,000.00
14 CONCRETE COLLAR FOR MANHOLE 15 EA $1,500.00 $22,500.00 I S $22,500.00
15 TRENCH WATERS STOPS 6 EA $7,000.00 $42,000.00 6 $42,000.00
16 llV1PORTED EMBEDMENT/BACKFILL, CSS 30 CY $405.00 $12,150.00 30 $12,150.00
17 IMPORTED EMBEDMENT/BACKFILL, 50 CY $115.00 $5,750.00 50 $5,750.00
CRUSHED ROCK
18 15" DIP SEWER
19 15" SEWER PIPE
20 16" DIP SEWER
21 21" SEWER PIPE
22 24" SEWER PIPE
23 24" SEWER PIPE, CSS BACKFILL
24 EPDXY MANHOLE LINER
25 5' MANHOLE
26 24" PRESSUR
27 24" PRESSURE RATED PVC ASTM 2241
28 OUTDOOR CONTROL UNIT
20 LF
500 LF
974 LF
2515 LF
301 LF
50 LF
400 VF
15 EA
241.2 VF
659 LF
1 EA
$405.00 $8,100.00
$425.00 $212,500.00
$635.00 �618,490.00
$365.00 �917,975.00
$425.00 $127,925.00
$200.00 $10,000.00
$575.00 �230,000.00
$36,000.00 $540,000.00
$885.00 �213,462.00
$520.00 �342,680.00
$45,500.00 $45,500.00
20 $8,100.00
500 $212,500.00
974 $618,490.00
2515 $917,975.00
301 $127,925.00
50 $10,000.00
400 $230,000.00
15 $540,000.00
241.2 $213,462.00
659 $342,680.00
1 $45,500.00
Sub-Total of Previous Unit �3,570,482.00 $3,570,482.00
Thursday, January 22, 2026 Page 2 of 5
City Project Numbers 104588
Contract Name LAPRELLE OFFSITE SEWER
Contract Limits
Project Type SEWER
Project Funding
UNIT IIA: SEWER IMPROVEMENTS (METRO STATIO
DOE Number 4588
Estimate Number 1
Payment Number 1
For Period Ending 11/17/2025
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
4 6" FLEXIBLE BASE, TYPE A, GR-1 433 SY $55.00 $23,815.00 433 $23,815.00
5 6" CONC PVMT 260 SY $255.00 $66,300.00 260 $66,300.00
29 FLOW METER 1 LS $77,000.00 $77,000.00 1 $77,000.00
30 ELECTRICAL EQUIPMENT AND INSTALLATION 1 LS $583,000.00 $583,000.00 1$583,000.00
31 12' DOUBLE SWING GATE 1 EA $5,000.00 $5,000.00 1 $5,000.00
32 18" SINGLE- LEAF LIVESTOCK GATE WITH H- 1 EA $8,000.00 $8,000.00 1 $8,000.00
BRACING
33 18" CORRUGATED METAL PiPE WTTH TYPE ii 18 LF $520.00 $9,360.00 18 $9,360.00
SETS
34 7' METER STAlON MANHOLE 1 EA $139,000.00 $139,000.00 1$139,000.00
35 EMBANKMENT BY PLAN (CO#1) 520 cy $49.75 $25,870.00 520 $25,870.00
Sub-Total of Previous Unit �937,345.00 $937,345.00
Thursday, January 22, 2026 Page 3 of 5
City Project Numbers 104588
Contract Name LAPRELLE OFFSITE SEWER
Contract Limits
Project Type SEWER
Project Funding
Contract Information Summary
Original Contract Amount
Change Orders
Change Order Number 1
DOE Number 4588
Estimate Number 1
Payment Number 1
For Period Ending 11/17/2025
$4,481,957.00
�zs,a�o.00
Total Contract Price $4,507,827.00
Total Cost of Work Completed $4,507,827.00
Less % Retained $0.00
Net Earned $4,507,827.00
Earned This Period $4,507,827.00
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
$4,507,827.00
Thursday, January 22, 2026 Page 4 of 5
City Project Numbers 104588
Contract Name LAPRELLE OFFSITE SEWER
Contract Limits
Project Type SEWER
Project Funding
Project Manager NA
InspeCtors T. GARDNER / S. ANGELES
Contractor ACADIA SERVICES
1510 JELMAK ST
GRAND PRAIRIE, TX 75050
Line Fund Account Center
DOE Number 4588
Estimate Number 1
Payment Number 1
For Period Ending 11/17/2025
City Secretary Contract Number
Contract Date
Contract Time 220 WD
Days Charged to Date 192 WD
Contract is .000000 Complete
CITY OF FORT WORTH
SUMMARY OF CHARGES
Amount Gross Retainage
Funded
Total Cost of Work Completed
Less % Retained
Net Earned
Earned This Period $4,507,827.00
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
Net
$4,507,827.00
$0.00
$4,507,827.00
$0.00
$0.00
$0.00
$0.00
$0.00
$4,507,827.00
Thursday, January 22, 2026 Page 5 of 5
CSC No. 61796-CO1
DEVELOPER-AWARDED-PROJECT CHANGE ORDER
PROJECT NAME:
CONTRACT:
CFA #
CITY PROJECT #
CITY SECRETARY CONTRACT #
FID #
X#
FILE #
INSPECTOR:
PROJECT MANAGER:
ORIGINAL CONTRACT
EXTRAS TO DATE
CREDITS TO DATE
CONTRACT TO DATE
AMOUNT OF PROP. CHANGE ORDER {
REVISEDCONTRACTAMOUNT �
TOTAL REVISED CONTRACT AMOUNT PER
UNIT
i REVISEDCOSTSHARE
i
TOTAL REVISED CONTRACT
Offsite Sewer Line And Meter Station To Serve LaPrelle
(B) Sewer Improvements
CFa2a-ooio I CITY PARTICIPATION: �
CPN 104586
6'1796
30114-0200431-104588-E07685
X-27630
N/A
CHANGE
ORDER No:
YES
1
Troy Gardner Phone No: 682-215-8720
Sandip Adhikari Phone No: 817-392-8424
CONTRACT UNIT
WATER SEWER (OFFSITE SEWER) SEWER (METER STATION) PAVING � STREET LIGHTS
Developer Developer Developer
Cost Ciry Cost Developer Cost City Cost Cost City Cost Cost City Cost Developer Cost � Ciry Cost
$0.00 $0.00 $�,338,930,75 $2,231,551.25 $251,567.�0 $659,907.90 $0.00 $0.00 $0.00 � $0.00
$0.00 $0.00 $0.00 $0.00 $O.OD $0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 I $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 , $1,338,930.75 $2,231,551.25 $251,567.1D $659,907.90 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00 $7,140.12 $18,729.86 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $'1,338,930.75 52,291,551.25 $258,707.22 $678,637.78 $0.00 $o.00 $0.00 $0.00
$0.00 $3,570,482.00 $937,345.00 $0.00 $0.00
Dev. Cost: $1,597,637.97 City Cost: $2,910,189.03
54,507,827.00
WORKING
DAYS
220
220
3
223
Revised: 12-17-2018 Page 1
You are directed to make the following changes in the contract documents
PAY ITEM #
35`
CITY BID ITEM
# QUANTITY UNIT
3124.0101 520.00 CY
� �
Asterisk (*) indicates New Pay Item
UNIT IIB: SEWER (METER STATION)
CFW Unit
ITEJJI DESCRIPTION Price
Embankment by Plan
TOTAL UNIT IIB: SEWER (METER STATION)
�
UNIT PRICE Deveioper Cost City Cost
$49.75 $7.140.12 $18,729.68
$o.00 so.00
$o.00 so.00
$a.00 $o.00
$o.00 so.00
so.00 �o.00
so.00 so.00
so.00 $o.00
$a.00 $o.00
so.00 $o.00
$o.00 $o.00
so.00 $o.00
$o.00 $o.00
so.00 so.00
so.00 $o.00
so.00 $o.00
$o.00 $o.00
$o.00 $o.00
so.00 $o.00
$o.00 $o.00
so.00 $o.00
$7.140.12 $18.729.88
� ��
TOTAL
$25,670.00
$o.00
$o.00
$o.00
$o.00
$o.00
so.00
so.00
$o.00
$o.00
$o.00
so.00
$o.00
so.00
$o.00
$o.00
so.00
$o.00
so.ao
$o.00
so.00
$25,870.00
Revised: 12-17-2018 Page 2
Docusign Envelope ID: 489C61A6-16B4-449C-8A5E-33FE3E3ECEF7
REASONS FOR CHANGE ORDER Site grading revised due to ponding issue. Additional fill matenal required to bnng site to final grades.
RECOMMENDED:
(Consulting Engineer)
BY:�/�wv;f �in+Hl. c
`—EA130D]FBADt�12 v
Name: Garrett Scoggins
Title:Project Manager, BGE, Inc.
APPROVAL RECOMMENDED:
CFW - Water DepaRment
�.6 ✓e,.w�G... Pl"
By: �
Name: SubV Varuqhese
Title: DSWS Enqineerinp Manaqer
RECOMMENDED:
CFW- 'Cont2ct Compliance Manager
By: �f
Name: Sandip Adhikari
Title: Sr. Professional Engineer
M8C Number.
M&C Date Approved:
APPROVED:
(Developer)
°°`"g�°"'° °' 10/20/2025
Date:10/20/2025 g����� �� �� �(� Date:
DEEF]F]FEBIu1B0...
Name: Bruce French
Title: Vice President, Tri Pointe Homes
APPROVED:
CFW - Assistant City Manager
Date: 10/22/2025 gy. � � �'�-r J
Name: Jesica McEachern
Title: Assistant City Manager
APPROVED:
(Contrector)
�Doto51peady 10/20/2025
BY�� (Ali�� �n���i+c Date:
�ABO]5809BECAC]F...
Name: Will Collins
Title: Project Manager, Acadia Services, LLC
APPROVED AS TO FORM AND LEGALITY:
CFW - Assistant City Attomey
Date: 10/29/2025 gy; .� - �� � - � - Date: 10/27/2025
Name: Richard McCraCken
Title: Sr Assistant City Attorney
ATTEST
Date: 10/22/2025
B ��� � �� Date: 10/29/2025
Y
Name: Jannette S. Goodall
Title: City Secretary
N/A
N/A
' Contract Compliance Manager (Project Manager):
By signing I acknowledge that I am the person responsible
for the monitoring and administration of this contract,
and ensuring aIl pertormance and reporting requirements.
p There are NO City Funds associated with this Contract
� There are City Funds associated with this Contract
Revised: �2-17-2018 Page 3
FORT WORTH
TRANSPORTATION AND PUBLIC WORKS
PIPE REPORT FOR:
PROJECT NAME: Offsite Sewer Line and Meter Station to LaPelle
CITY PROJECT NUMBER: CPN 104588
� WATER
PIPE LAID SIZE TYPE OF PIPE
N/A
FIRE HYDRANTS: N/A
PIPE ABANDONED
N-A
DENSITIES:
NEW SERVICES:
�
PIPE LAID
Open Trench
Open Trench
Open Trench
Open Trench
Open Trench
PIPE ABANDONED
N-a
DENSITIES:
NEW SERVICES:
VALVES (16" OR LARGER)
SIZE TYPE OF PIPE
YES all Passed
SEWER
SIZE TYPE OF PIPE
15" DIP
16" DIP
21" PVC SDR - 26
24" PVC SDR -26
18" Comugated metal pipe
SIZE TYPE OF PIPE
N/A
YES All Passed
LF
LF
LF
LF
N/A
500
974
2515
351
18?
TRANSPORTATION AND PliBLIC WORKS
The CitS� of Fort Worth • 1000 Throckmorton Street • Fort Worth, TX 76012-6311
(817) 392 - 7941 • Fax: (81 � 392 - 7845
���� ������
TRANSPORTATION AND PUBLIC WORKS
November 20, 2025
Acadia Services, LLC
351 W. Southlake, LLC
Southlake,TX 76092
RE: Acceptance Letter
Project Name: Offsite Sewer Line and Neter Station LaPrelle
Project Type: Sewer
City Project No.: 104588
To Whom It May Concern:
On November 20, 2025 a final inspection was made on the subject project. There were punch list items
identified at that time. The punch list items were completed on December 16, 2025. The final
inspection and the corrected punch list items indicate that the work meets the City of Fort Worth
specifications and is therefore accepted by the City. The warranty period will start on December 16,
2025, which is the date of the punch list completion and will extend of two (2) years in accordance with
the Contract Documents.
If you have any questions concerning this letter of acceptance, please feel free to contact me at 817-
392-2373.
Sincerely, �, ,_^`
��
Sandip Adhikari, Project Manager
Andrew Goodman, Program Manager
Cc: John Rogers, Inspector
Troy Gardner, Inspection Supervisor
Charles Hayes, Senior Inspector
Andrew Goodman, Program Manager
BGE,INC, Consultant
Acadia Services,LLC., Contractor
TPHMI DFW 4047,LLC, Developer
File
E-Mail: TPW_Acceptance@fortworthtexas.gov
Rev. 8/20/19
AFFIDAVIT
STATE OF TX
COUNTY OF TARRANT
Before me, the undersigned authority, a notary public in the state
and county aforesaid, on this day personally appeared Brad Catlett,
President Of Acadia Services LLC, 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
ol•ganizations furnishing labor �nd/or materials have been paid in fiill;
That the wage scale established by the City Council in the City of
Fort Worth has been paid in fiill;
That there are no claims pending for personal injury and/or
property damages;
On Contcact described as;
LaPrelle Offsite Sewer & Meters Station CPN 104588
BY �
Brad Catlett - President
Subscribed and sworn before me on this date 18th of Novemeber, 2025.
�- .xe;,l,o :.:.�.,�at�.�.uru"'!c...S�..+c,�.'r.� �f.�a:a.a�.:ts�>. y
1`'
' .r,`"=""�� , Josie Sanchez
_ � �.,, �� My Commission Expires
*I\ 'I 5/31i2027
C"T�� r Notary ID134385976
_ �/(_� �i�(/1�.(.c�� �Faz/
Not y Public � � �� �
Tai ant, TX
coNSEN-r oF
SURETY COMPANY
TO FINAL PAYMENT
AIA DOCUME'NT G707
Bond No. 4�409092
PROJECT: Meter station 13-OHC (FW-Haslet Meter Station), City Project No. 104588
(name, address)
To (awner)
�TPHMI DFW 4047 LLC (TriPointe) �
6201 West Plano Parkway
Plano, TX 75093
ARCHITECT'S PROJECT f�iQ: N/f\
CONTRACT FOR: Meter Station
C�NTRACT DATE:
L�.. �
C�NTRACTOR: Acadia Services, LLC
351 W. Southlake Blvd. Southlake, TX 76092
In accordance with the provisions of the Contract between the Owner and fhe Contr�ictar as indicated above, the
(here insert name and address of Surely Company)
FCCI Insurance Company
6300 University Parkway , Sarasota, FL 34240
Ofl k70Rd Of (here Insert name and address ot Conlractor)
Acadia Services, LLC
351 W. Southlake Bivd. Southlake, TX 76092
, SURETY COMPANY,
,CONTRACTOR,
hereby appraves of the final payment to the Co�tractor, and agrees thai finaE payment to fhe Contractor shail not
relieve the Surety Company of any of its obligations to (nere ir,sert name and address o� owr��ry
TPHMI DFW 4047 LLC (TriPointe)
6201 West Plano Parkway Plano, TX 75093 , OWNERS,
as set forth in the said Surety Gompany's bond.
IN WITNESS WHEREOF,
the Surety Company has hereunto set its hand this
Att t
6th day of November, 2025
FCCI Insurance Comp�any
Surety Company
��
Signature of Aufhorized f2epresentative
r'.�`?J'_'�'Ag� •�°��'�
: Ci: GU R'��t' yt
' LL' SEA�., ': <'
��,�
,��P�o�.,.
es .
(Seal): � bram Sanchez, Surety Witness BaiLee Islas, Attorney�-in-Fact
Title
NOTE: This farm is to be used as a companfon dceument to A1A DQCUMENT G706, CONTRACiOR'S AFPID�4ViT OF PAYMENT OF DEBTS AND
CLAIMS, Current Edition
OWNER
ARCHITECT
CONTRACTOR
SURETY
OTHER
AIA DOCtJMENT G707 • CONSEN7 OF SURETY COMPANY TO FINAL PAYMENT • APRiL 1970 EDlTiON • ALA� ONE PAGE
� 1970 • TFEE AMERICAN INSTITUTE Of ARCHITECTS. 1735 NEW YORK AVE., NW, WASHINGTON, Q.C. 2[�006
,�-' ir.
FCC I c;Ro ��� �
GENERAL POWER OF ATTORNEY
Know all men by these presents: That the FCCI Insurance Company, a CorporaRion organized and existing under
the laws af the State of Florida (the "Corporation") does make, constitute and appaint:
BaiLee Islas
Each, its true and lawFul Attomey-In-Fact, to make, execute, seal and deliver, for and on its behalf as surety, and
as its act and deed in all bonds and undertakings provided that na bond or undertaking or contract of suretyship executed
under this authori#y shall exceed the sum of (nat to exceed $20,000,000.00}: $20,000,000.00
Surety Bond No.: 4409092
Prinapat: Acadia Services, LLC
Obligee: TPHMI DFW 4047 LLC (TriPointe)
This Power of Attorney is made and executed by authority of a Resolution adopte�i by the Board of Directors. That
resolution also authorized any further action by the officers of the Company necessary to e�ffect such transaction.
The signatures below and the seal of the Corporation may be affixed by facsimile, and any such facsimile
signatures or facsimile seal shall be binding upon the Corporation when so a�xed andl in the future with regard to any
bond, undertaking or cantract of surety to which it is attached.
In witness whereof, the FCCI Insurance Company has caused these presents to be: signed by its duly authorized
officers and its corporate Seal to be hereunto affixed, this 23rd day of J�uly , 2Q20 .
Attest: �-'h`��,��.� � LU�--�
Christina D. Welch, President
FCCI Insurance Company
State of Florida
County of 5arasota
:'b'`'•Jo Poraqr°'li,o:
-`U`;�G R':pZ'
:LL� SEAL ��;
��
� ���OR10P ,:.
��
Christopher Shoucair,
EVP, CFO, Treasurer, Secretary
FCCI Insurance Company
Befiore me #his day personally appeared Christina D. Welch, who is personally known to me and who executed
the foregoing document for the purposes expressed therein.
My commission expires: 2/27/2027 �!:':'•�t aeccrsHow
• * ranwNWontHil�S
�a ne�' � FebuerY 27.2Q27
C��s.a�-,�,,�
Notary Public
State of Florida
County of Sarasota
Before me this day personally appeared Christopher Shoucair, who is personally known to me and who executed
the foregoing document for the purposes expressed therein.
My commission expires: 2/27I2027 ;'�,��`�. �� ,�
l,��' �.. �z►.�
CERTIFICATE
<;�.��.,�
Notary Public
I, the undersigned Secretary of FCCI Insurance Company, a Florida Carporation, DO HEREBY CERTIFY that the
foregoing Power of Attorney remains in full force and has not been revoked; and furthermore that the February 27, 2020
Resolution of #he Board of Directors, referenced in said Power of Attorney, is now in force�.
.. 44rt
�'F'+� ` s
%�
Christopher Shoucair, E�lP, CFO, Treasurer, Secretary
FCCI Insurance Company
Dated this 6th day �f November , 2025
4`�
1-IONA-3582-NA-04, 7/2021